Client Response Research Articles

Communicating Scope of Practice: An Outpatient Group Art Therapy Documentation Initiative (Communiquer le champ de pratique : une initiative de documentation sur l’art-thérapie ambulatoire de groupe)

In medical settings, art therapists face challenges of communicating their therapeutic practices to clinicians who are unfamiliar with the vernacular of art therapy. Despite growing evidence, the field of art therapy lacks a common language “scope of practice” that easily translates across fields. In this study, we piloted a novel documentation tool, The Progress Note for Group Art Therapy (PN-GAT), which aggregated frequencies of assessments and interventions within the Addiction Institute at Mount Sinai Beth Israel Hospital in New York, while identifying common practices of outpatient art therapy groups that may contribute to the development of a more communicable “scope of practice.” Our interdisciplinary documentation initiative was implemented during 18 adult outpatient art therapy groups conducted by one art therapist from August 2018 through February 2019. Analysis showed that insight-development (38.6%) and social-relational (35.9%) interventions were recorded more frequently than art-making (25.5%) interventions. The most frequently logged art therapy assessments included assessments of client response (88.9% of sessions) and mental status examinations (72.2%). The growth of art therapy within medical practices necessitates a rethinking of treatment collaboration. Our findings identified frequently used components of art therapy based in a medical setting, as well as the need for future medical education initiatives. While improving standards of collaborative care, the development of a well-defined “scope of practice” may serve to enhance interdisciplinary communication.

The Use of a Brief Treatment Package to Increase Session Note Completion in an ABA Agency

ABSTRACT The number of Board Certified Behavior Analysts® (BCBAs) has grown exponentially over the last two decades, with the majority of practitioners providing services to individuals with autism spectrum disorder (ASD) and their families. Although there are different funding mechanisms for services provided by a BCBA®, third-party payers and insurance companies are increasingly providing coverage for these services. Clinical documentation, such as session notes on client progress, are typically required by funders of such services. Additionally, complete session notes can lead to effective coordination of care and recording client response to treatment. In this study, a treatment package consisting of a sample note, self-monitoring, and feedback was utilized to improve the completion of session notes of six technicians in an ABA agency serving individuals with ASD. Results indicate that the procedure was rapidly effective in increasing the number of items completed on the notes for all technicians, and this improvement was maintained at 1 and 2-week follow-up probes.

Current Innovation Sources Driving The Spanish Electric Power Sector

Renewable energy is not simply the cornerstone of a transition, but an entire electric power revolution. However, which are the technologies with which power companies are going to redesign the electricity industry? Interviews were conducted with innovation managers of the biggest power companies in Spain to shed some light on the innovation sources upon which the electric power system of the future is based. The results revealed that renewable electricity represents a complete paradigm shift. Until now, the system’s net electricity balance has been achieved by adjusting power generation to its demand. However, in a renewable system, electricity generation is limited by and depends on environmental resources, so it cannot be sufficiently controlled to meet the demand at all times. Therefore, it is the electricity consumption that must be adjusted to generation. It was concluded that there are currently nine innovation sources that are redesigning the industry: renewable energy, energy storage systems, electric vehicles, Industry 4.0, smart grids, blockchain, distributed and selfconsumption generation, smart client, and demand side response. Moreover, it was found that system regulations established by governments, business sustainability plans, and open innovation by startups play key roles in the development of innovation.

From the Ivory Tower to the Treatment Trenches: Bridging the Gap between Research and Practice.

The evidence-based practice (EBP) movement in social work has challenged the traditionally insular relationship between research and practice, demonstrating a critical need for more reciprocity. Despite a proclaimed commitment to EBP in social work, an implementation gap persists (Bellamy, Bledsoe, & Traube, 2006). This commentary identifies factors that have contributed to the gap between research and practice and proposes solutions to bridge this divide. EBP originated in the field of medicine and emphasizes the systematic use of research in the decision-making process of patient care (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996). EBP tasks researchers with conducting and synthesizing treatment research to develop best practices and clinicians with identifying and implementing appropriate EBPs and evaluating client response in a systematic manner. Clinicians can implement the EBP approach in a four-step process: (1) formulating a question, (2) appraising relevant literature, (3) applying data to the clinical context, and (4) evaluating outcome-based measures of the novel intervention (Edmond, Megivern, Williams, Rochman, & Howard, 2006).

Diagnosing the start of a slow HTTP DDoS attack based on two-parameter traffic correlation analysis

The article investigates the problem of detecting slow DDoS attacks based on network traffic analysis. Detecting a slow HTTP attack is a significant challenge because the attacker's behavior can mimic that of a legitimate user with slow resources. The authors proposed a four-zone attack detection architecture based on the analysis of two parameters: the number of connections to the server and the average client response delay time. A technique for detecting slow DDOS attacks based on correlation analysis and parameter forecasting is proposed. The author's approach uses an original two-parameter correlation analysis model based on the number of connections and the average real delay in the network. An algorithm for detecting a slow DDoS attack based on the prediction of two parameters has been developed. These parameters are used both for analysis and for short-term prediction of traffic behavior. The forecasting algorithm uses the method of calculating the posterior trajectory of the time series depending on a priori statistical observations. Prediction of user behavior parameters allows early detection of slow DDoS attacks based on an algorithm for searching for unknown future values for a time series of parameters. Using the relative values of NC and ARNL as prediction parameters makes it possible to build a flexible recognition system adapted to the specifics of a particular system. Simulation of the two-parameter algorithm for detecting slow DDOS attacks based on prediction was carried out and its effectiveness was evaluated. The proposed method is a combination of artificial intelligence and statistical analysis and uses a self-learning algorithm with sufficient attack statistics. Experimental results show that the method is suitable for early detection of attacks such as Slow HTTP Headers, Slow HTTP Body, Slow HTTP Read. Simulation of traffic parameters confirms the method's ability to detect slow attacks at different time intervals, since the accuracy of the forecast depends on the timeliness of the observations. With sufficient statistics of observations, the deviation of the forecast curve can be less than 5%.

Sounds Good to Me: How Communication Mode and Priming Affect Auditor Performance

SUMMARYAudit associates routinely interact with clients to request explanations and evidence regarding financial statement account balances. Client explanations may be vague or incomplete. We examine whether auditors' assessments of the quality of client explanations and their decision to follow-up with the client are influenced by (1) communication modes that vary in media richness, and (2) a prime that is intended to stimulate skeptical behavior. Media richness refers to the amount of data inherent in the communication mode. We predict that richer communication modes, such as video, can be more distracting than less rich communication modes, such as email. More distracted auditors will assess the quality of the client's response as higher and are less likely to follow-up with the client—potentially impairing audit quality and increasing audit risk. We predict and find that a prime that focuses auditors on the verifiability of the client's response will mitigate this behavior.

Quantifying Experiences with Telepractice for Aphasia Therapy: A Text Mining Analysis of Client Response Data.

Measures of satisfaction following treatment for aphasia have been limited. The challenge associated with reduced verbal output among many persons with aphasia (PWA) has reportedly been a key reason measures of treatment satisfaction have been limited. A novel approach to measure treatment satisfaction is the use of content analysis (CA), which uses the presence of certain words, themes, or concepts to explore outcomes such as treatment satisfaction particularly among individuals who generate limited output. CA utilizes responses and response patterns to assign meaning to client responses. The aim of this study was to use CA to measure posttreatment satisfaction with a telepractice approach for aphasia treatment. Seventeen PWA received 12 treatment sessions over a 6-week period. At the conclusion of the treatment, CA was utilized to explore patient satisfaction with this treatment approach. The participants reported an overall positive sentiment for the telepractice approach. Two primary topics emerged which were healthcare provider and healthcare delivery, where text analysis revealed discussion of these topics to be centered around being "helpful" and "being effective." This study demonstrated that CA can be an effective approach for determining satisfaction with aphasia treatment particularly among PWA with limited verbal abilities.

Coaching approaches for a lost sense of self – hunt it down or let it be?

This article uses Stevens’s (2002) five lenses (biological, experimentalist, social constructivist, psychodynamic and experiential) and Bachkirova’s (2011) three stories of the self (self as an operator, an evolved self and no self) to describe different manifestations and interpretations of a lost sense of self. Using a developmental coaching approach, the article then explores three key considerations when coaching a lost sense of self. Firstly, the origin of the loss – how the loss was first sensed by the client. Secondly, the importance of understanding client self-concept is explored in two parts. Initially, understanding of their self-construction (unitary stable self, dynamic self, multiple selves and no self) and next their ego development stage (unformed, formed and reformed). Self-concept is likely to inform client response to their lost sense of self but also inform the type of coaching techniques that might be most appropriate. Finally, the coach perspective is considered. Coaches are encouraged to be aware of their own self-concept and how it might impact their approach. This article concludes that a blend of all these factors will determine whether a lost sense of self is hunted down or simply let be.

Verbal aversive control in clinical interaction

Aversive control techniques involve aversive stimuli to generate behavioral change. The purpose of this work is to analyze the use of verbal aversive control by psychologists during the clinical interaction, combining respondent and operant explanations. Observational methodology is used to analyze 26 session recordings of three different cases of anxiety disorder, relationship problem and low mood problem (27h 32') carried out by two psychologists of the Therapeutic Institute of Madrid. The variables considered were psychologists' aversive and non-aversive verbalizations and clients' antitherapeutic verbalizations. There is a strong relationship between clients' antitherapeutic verbalizations and psychologists' aversive verbalizations, both potential punishments (aversive verbalizations contingent on the client's response) and aversive pairings. Additionally, the possible psychologists' aversive verbalizations are accompanied by other verbalizations aimed to induce clients' non-problematic behaviors. This work opens a new way to an explanation of therapeutic change using learning processes (both respondent and operant conditioning) that take place through verbal interaction in clinical context.

Who benefits from cognitive intervention in older age? The role of executive function

Objective: In the context of the positive impact of cognitive interventions for age-related memory concerns, clinicians are seeking information about variables that predict optimum client response. In this study of older adults, the aim was to investigate baseline predictors of gain in memory performance, i.e. prospective memory, following a memory intervention.Methods: One hundred and one healthy older adults (H0A) and 73 older people with amnestic mild cognitive impairment (aMCI) were evaluated at 6-months after participating in a 6-week memory group intervention (LaTCH). The outcome measure was a clinic-based prospective memory task. Baseline predictors included demographic variables (age, gender, education), baseline prospective memory, and cognitive resources (retrospective memory, executive function).Results: Thirty percent of the HOA and 16% of the aMCI cohorts demonstrated reliable training effects on prospective memory test performance at 6-month assessment. Through hierarchical regressions in the HOA cohort, executive function (working memory, attention set shifting) rather than retrospective memory was the best predictor of change in prospective memory. Moderated regression did not demonstrate any interactions between retrospective memory and executive function. For the memory impaired cohort (aMCI), better baseline retrospective memory predicted greater gain in prospective memory but only when executive function was also high.Conclusions: Memory groups can improve performance on clinic-based prospective memory tests in older people with concerns about memory performance, suggesting the value of further translation studies to demonstrate functional real-world gains and quality of life improvement after training. These interventions may be especially effective for those older people with better executive function (working memory, attention set shifting).

How Much Justice Can You Afford

It is one of the oldest lawyer jokes in the book, and its punchline is about to change. Remember the New Yorker cartoon, in which a lawyer and the client sit at a table, and the lawyer assesses the client's legal problem? You have a pretty good case, the lawyer informs him. How much justice can you afford? the client's response is unvoiced in the cartoon, but moving beyond the punchline, one can imagine the client's heart sinking, realizing that he may not be able to afford all the justice he needs, or any justice at all. This reflects the day-to-day reality of most people in the United States and around the world: the justice they can afford is not the justice they need. That, too, is about to change as Online Dispute Resolution offers an affordable justice option for litigants who have been denied access to justice because they could not afford the cost of lawyers. In this article, we discuss ODR, its goals and implementation in the court system, and the ways in which it shakes up some of the conventional economics and practices of the legal services market.

Sentiment Analysis using Optimized Feature Sets in Different Twitter Dataset Domains

in the last years, the relevance of sentiment analysis is broad and dominant. The capability to take out insights from social data is a tradition that is being extensively accepted by all over globe. Sentiment Analysis has turn out to be a hot-trend issue of technical and marketplace research in the area of Natural Language Processing (NLP) and Machine Learning. Sentiment analysis is enormously useful in social media supervising as it permits us to expand an impression of the wider open estimation behind definite topics. Investigation of social media streams is typically limited to just essential sentiment analysis and count based metrics. This is of the same kind to just scratching the outside and missing out on those elevated value insight that is ahead of you to be discovered. There’s a lot of effort to be done, but perfections are being prepared every day. It is a way to appraise on paper or verbal language to settle on if the expression is favorable, unfavorable, or unbiased, and to what level. Today’s algorithm-based sentiment analysis tools can touch vast amount of client response constantly and precisely. Balancing with text analytics, sentiment analysis exposes the customer’s estimation concerning topics ranging from your goods and services to your position, your advertisements, or even your challengers. These efforts scrutinize the crisis of studying texts, like posts and reviews, uploaded by user on Twitter. The Support Vector Machine (SVM), k-nearest neighbors algorithm (KNN) and proposed optimized feature sets model is offered to progression the tweet features and to recognize the out of sight sentiments from these tweets. These essential concepts when used in combinations become a very significant tool for analyzing millions of variety conversations with human echelon accurateness. The projected optimized feature sets model Sentiment Analysis exercise the assessment metrics of Precision, Recall, F-score, and Accuracy. Also, average measures weighted F1-scores are constructive for categorization of Positive, Negative and Neutral multi-class problems. The running time of the technique is evaluates by accomplishing diverse methods in the same investigational setup consisting a cluster of 8 nodes. Planned optimized feature sets model Sentiment Analysis reachs 82 % accuracy as compare with SVM 78.6 % and KNN 75 %. Further, while analyzing sentiments of tweets we have measured only tweets in English acknowledged by Twitter streaming API.

ASUHAN KEPERAWATAN KANKER NASOFARING DENGAN FOKUS STUDI PENATALAKSANAAN NYERI DI RSUD TIDAR KOTA MAGELANG

Cancer / nasopharyngeal carcinoma (NPC) is a malignant cancer in the head and neck. This cancer is located in the nasopharynx, behind the nose. NPC including five large malignant tumors. Ebstein Barr is one of the triggers of this carcinoma. Most NPC patients come to the clinic for treatment at an advanced stage. The purpose of writing is to discuss and examine the application of nursing care with a focus on pain studies on clients with nasopharyngeal cancer. The method used by the writer is descriptive by managing one client who has nasopharyngeal cancer. The results of the study were obtained as long as 2x24 hours of nursing care was provided, the pain problem was resolved in accordance with the established criteria with the results of the implementation carried out in accordance with the client's developmental response. During the evaluation of nursing care that has been given for 2 consecutive days there is a nursing problem that pain can be resolved. Keywords: Nasopharyngeal Cancer, Pain, Nursing Care

How the Role of Risk Tolerance on Manage Satisfaction Level

Many major firms within the world, particularly in Indonesia, they contend to every different to allow best services as the way to achieve the goal of their main business. They need launched several programmes to enhance and commit for higher quality management by approach of listening their customers. In an exceedingly service surroundings, info on client response toward services is one in all the simplest key component of feedback that indicates whether good or not, the services meet into perception or even below expectation. Someday what we would like is simply assembling info from client and re-evaluation to actual system of performance report. Supported analysis and assesment, we would like change some parameters to satisfy into the client expectation that become their satisfaction. Since client satisfaction can bring United States into trust and commitment, that loyalty are going to be the the last word goal and bussiness can continue once more and once more, coincidental. To adjust some parameters appears straightforward however really all tough. To measure Perception and Expectation become Service Quality is tough, want observation from time to time to induce the best values, particularly to face risk factors like internal and external setting factors, Risk Management capability, IT capability, and IT-related business capability become Risk Response. To achieve the goal to produce Service Quality between Risk Factors and Risk Response, we have got to regulate Risk Tolerance to induce ideal worth and at an equivalent time manage service quality.

HUBUNGAN MOTIVASI KERJA PERAWAT DENGAN PENDOKUMENTASIAN ASUHAN KEPERAWATAN RAWAT INAP DI RUMAH SAKIT SENTRA MEDIKA CISALAK

Introduction nurses must have motivation in work, especially in documentation. Documentation of the nursing process includes assessment, problem identification, planning, nurse actions, then observing and evaluating the client's response to the action given and informing the information to other health workers. The results of data obtained in documenting inpatient nursing care there are completeness targets that have not been achieved. The purpose of the study was to determine the relationship between nurses' work motivation and documenting inpatient nursing care at the sentra medika cisalak hospital. Research method is descriptive correlative with cross-sectional approach. The total population is 50 respondents in the adult inpatient room. Results based on the results of the study there were 52.0% of respondents had high work motivation and 62.0% of nursing care documentation that had been done. With the value of Chi Square = 0.002 <0.05, the HA hypothesis is accepted. The conclusion is that there is a relationship between nurses' inpatient work motivation in the hospital center medica cisalak (0.6138) which means “strong”. Suggestions for nurse who have implemented nursing care documentation provided rewards / awards from superiors and audits are carried out continuously.

Efficient Monitoring of Treatment Response during Youth Psychotherapy: The Behavior and Feelings Survey

An emerging trend in youth psychotherapy is measurement-based care (MBC): treatment guided by frequent measurement of client response, with ongoing feedback to the treating clinician. MBC is especially needed for treatment that addresses internalizing and externalizing problems, which are common among treatment-seeking youths. A very brief measure is needed, for frequent administration, generating both youth- and caregiver-reports, meeting psychometric standards, and available at no cost. We developed such a measure to monitor youth response during psychotherapy for internalizing and externalizing problems. Across 4 studies, we used ethnically diverse, clinically relevant samples of caregivers and youths ages 7–15 to develop and test the Behavior and Feelings Survey (BFS). In Study 1, candidate items identified by outpatient youths and their caregivers were examined via an MTurk survey, with item response theory methods used to eliminate misfitting items. Studies 2–4 used separate clinical samples of youths and their caregivers to finalize the 12-item BFS (6 internalizing and 6 externalizing items), examine its psychometric properties, and assess its performance in monitoring progress during psychotherapy. The BFS showed robust factor structure, internal consistency, test–retest reliability, convergent and discriminant validity in relation to three well-established symptom measures, and slopes of change indicating efficacy in monitoring treatment progress during therapy. The BFS is a brief, free youth- and caregiver-report measure of internalizing and externalizing problems, with psychometric evidence supporting its use for MBC in clinical and research contexts.

Culture and therapist self-disclosure

AbstractCognitive behaviour therapy (CBT) as a treatment for schizophrenia and psychotic-related disorders has been shown to have significantly greater drop-out rates in clients of black and minority ethnic (BME) groups. This has resulted in poor outcomes in treatments. Our recent qualitative study thus aimed to develop culturally sensitive CBT for BME clients. The study consisted of individual in-depth 1:1 interviews with patients with a diagnosis of schizophrenia, schizo-affective, delusional disorders or psychosis (n = 15) and focus groups with lay members (n = 52), CBT therapists (n = 22) and mental health practitioners (n = 25) on a data set of 114 participants. Several themes emerged relating to therapist awareness on culturally derived behaviours, beliefs and attitudes that can influence client response and participation in therapy. The current paper aims to explore one of these themes in greater detail, i.e. client-initiated therapist self-disclosure (TSD). Using thematic analysis, the paper highlights key elements of TSD and how this could impact on therapist’s reactions towards TSD, the therapeutic alliance and ultimately, the outcomes of therapy. The findings appear to show that TSD has significant relevance in psychological practice today. Some BME client groups appear to test therapists through initiating TSD. It is not the content of TSD they are testing per se, but how the therapist responds. Consequently, this requires therapists’ cognisance and sensitive responses in a manner that will nurture trust and promote rapport. Further investigation in this area is suggested with a recommendation for guidelines to be created for clinicians and training.Key learning aims(1)To develop a dialogue and practice with confidence when addressing issues of self-disclosure with diverse populations.(2)To appreciate the impact therapist self-disclosure has in early stages of engagement, in particular when working with patients from BME communities.(3)To understand the impact and role of self-disclosure as initiated by patients.(4)To increase therapist awareness on cultural differences in self-disclosure and develop ways to address this in therapy.(5)To challenge therapists to adapt psychological therapies to diverse cultures and be cognisant that ‘one size does not fit all’.

A Lightweight Service Placement Approach for Community Network Micro-Clouds

Community networks (CNs) have gained momentum in the last few years with the increasing number of spontaneously deployed WiFi hotspots and home networks. These networks, owned and managed by volunteers, offer various services to their members and to the public. While Internet access is the most popular service, the provision of services of local interest within the network is enabled by the emerging technology of CN micro-clouds. By putting services closer to users, micro-clouds pursue not only a better service performance, but also a low entry barrier for the deployment of mainstream Internet services within the CN. Unfortunately, the provisioning of these services is not so simple. Due to the large and irregular topology, high software and hardware diversity of CNs, a “careful” placement of micro-clouds services over the network is required to optimize service performance. This paper proposes to leverage state information about the network to inform service placement decisions, and to do so through a fast heuristic algorithm, which is critical to quickly react to changing conditions. To evaluate its performance, we compare our heuristic with one based on random placement in Guifi.net, the biggest CN worldwide. Our experimental results show that our heuristic consistently outperforms random placement by 2x in bandwidth gain. We quantify the benefits of our heuristic on a real live video-streaming service, and demonstrate that video chunk losses decrease significantly, attaining a 37% decrease in the packet loss rate. Further, using a popular Web 2.0 service, we demonstrate that the client response times decrease up to an order of magnitude when using our heuristic. Since these improvements translate in the QoE (Quality of Experience) perceived by the user, our results are relevant for contributing to higher QoE, a crucial parameter for using services from volunteer-based systems and adapting CN micro-clouds as an eco-system for service deployment.

A lightweight service placement approach for community network micro-clouds

Community networks (CNs) have gained momentum in the last few years with the increasing number of spontaneously deployed WiFi hotspots and home networks. These networks, owned and managed by volunteers, offer various services to their members and to the public. While Internet access is the most popular service, the provision of services of local interest within the network is enabled by the emerging technology of CN micro-clouds. By putting services closer to users, micro-clouds pursue not only a better service performance, but also a low entry barrier for the deployment of mainstream Internet services within the CN. Unfortunately, the provisioning of these services is not so simple. Due to the large and irregular topology, high software and hardware diversity of CNs, a “careful” placement of micro-clouds services over the network is required to optimize service performance. This paper proposes to leverage state information about the network to inform service placement decisions, and to do so through a fast heuristic algorithm, which is critical to quickly react to changing conditions. To evaluate its performance, we compare our heuristic with one based on random placement in Guifi.net, the biggest CN worldwide. Our experimental results show that our heuristic consistently outperforms random placement by 2x in bandwidth gain. We quantify the benefits of our heuristic on a real live video-streaming service, and demonstrate that video chunk losses decrease significantly, attaining a 37% decrease in the packet loss rate. Further, using a popular Web 2.0 service, we demonstrate that the client response times decrease up to an order of magnitude when using our heuristic. Since these improvements translate in the QoE (Quality of Experience) perceived by the user, our results are relevant for contributing to higher QoE, a crucial parameter for using services from volunteer-based systems and adapting CN micro-clouds as an eco-system for service deployment.

Estimating Nonorganic Hearing Thresholds Using Binaural Auditory Stimuli.

Minimum contralateral interference levels (MCILs) are used to estimate true hearing thresholds in individuals with unilateral nonorganic hearing loss. In this study, we determined MCILs and examined the correspondence of MCILs to true hearing thresholds to quantify the accuracy of this procedure. Sixteen adults with normal hearing participated. Subjects were asked to feign a unilateral hearing loss at 1.0, 2.0, and 4.0 kHz. MCILs were determined. Subjects also made lateralization judgments for simultaneously presented tones with varying interaural intensity differences. The 90% confidence intervals, calculated for the distributions, indicate that the MCIL in 90% of cases would be expected to be very close to threshold to approximately 17-19 dB poorer than the true hearing threshold. How close the MCIL is to true threshold appears to be based on the individual's response criterion. Response bias influences the MCIL and how close an MCIL is to true hearing threshold. The clinician can never know a client's response bias and therefore should use a 90% confidence interval to predict the range for the expected true threshold. On the basis of this approach, a clinician may assume that true threshold is at or as much as 19 dB better than MCIL.