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Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr.
Chapter 7 the evidence for evidence-based practice implementation.
Marita G. Titler .
Overview of evidence-based practice.
Evidence-based health care practices are available for a number of conditions such as asthma, heart failure, and diabetes. However, these practices are not always implemented in care delivery, and variation in practices abound. 1–4 Traditionally, patient safety research has focused on data analyses to identify patient safety issues and to demonstrate that a new practice will lead to improved quality and patient safety. 5 Much less research attention has been paid to how to implement practices. Yet, only by putting into practice what is learned from research will care be made safer. 5 Implementing evidence-based safety practices are difficult and need strategies that address the complexity of systems of care, individual practitioners, senior leadership, and—ultimately—changing health care cultures to be evidence-based safety practice environments. 5
Nursing has a rich history of using research in practice, pioneered by Florence Nightingale. 6–9 Although during the early and mid-1900s, few nurses contributed to this foundation initiated by Nightingale, 10 the nursing profession has more recently provided major leadership for improving care through application of research findings in practice. 11
Evidence-based practice (EBP) is the conscientious and judicious use of current best evidence in conjunction with clinical expertise and patient values to guide health care decisions. 12–15 Best evidence includes empirical evidence from randomized controlled trials; evidence from other scientific methods such as descriptive and qualitative research; as well as use of information from case reports, scientific principles, and expert opinion. When enough research evidence is available, the practice should be guided by research evidence in conjunction with clinical expertise and patient values. In some cases, however, a sufficient research base may not be available, and health care decision making is derived principally from nonresearch evidence sources such as expert opinion and scientific principles. 16 As more research is done in a specific area, the research evidence must be incorporated into the EBP. 15
Multiple models of EBP are available and have been used in a variety of clinical settings. 16–36 Although review of these models is beyond the scope of this chapter, common elements of these models are selecting a practice topic (e.g., discharge instructions for individuals with heart failure), critique and syntheses of evidence, implementation, evaluation of the impact on patient care and provider performance, and consideration of the context/setting in which the practice is implemented. 15 , 17 The learning that occurs during the process of translating research into practice is valuable information to capture and feed back into the process, so that others can adapt the evidence-based guideline and/or the implementation strategies.
A recent conceptual framework for maximizing and accelerating the transfer of research results from the Agency for Healthcare Research and Quality (AHRQ) patient safety research portfolio to health care delivery was developed by the dissemination subcommittee of the AHRQ Patient Safety Research Coordinating Committee. 37 This model is a synthesis of concepts from scientific information on knowledge transfer, social marketing, social and organizational innovation, and behavior change (see Figure 1 ). 37 Although the framework is portrayed as a series of stages, the authors of this framework do not believe that the knowledge transfer process is linear; rather, activities occur simultaneously or in different sequences, with implementation of EBPs being a multifaceted process with many actors and systems.
AHRQ Model of Knowledge Transfer Adapted from Nieva, V., Murphy, R., Ridley, N., et al. Used with permission. http://www.ahrq.gov/qual/advances/
Steps of promoting adoption of EBPs can be viewed from the perspective of those who conduct research or generate knowledge, 23 , 37 those who use the evidence-based information in practice, 16 , 31 and those who serve as boundary spanners to link knowledge generators with knowledge users. 19
Steps of knowledge transfer in the AHRQ model 37 represent three major stages: (1) knowledge creation and distillation, (2) diffusion and dissemination, and (3) organizational adoption and implementation. These stages of knowledge transfer are viewed through the lens of researchers/creators of new knowledge and begin with determining what findings from the patient safety portfolio or individual research projects ought to be disseminated.
Knowledge creation and distillation is conducting research (with expected variation in readiness for use in health care delivery systems) and then packaging relevant research findings into products that can be put into action—such as specific practice recommendations—thereby increasing the likelihood that research evidence will find its way into practice. 37 It is essential that the knowledge distillation process be informed and guided by end users for research findings to be implemented in care delivery. The criteria used in knowledge distillation should include perspectives of the end users (e.g., transportability to the real-world health care setting, feasibility, volume of evidence needed by health care organizations and clinicians), as well as traditional knowledge generation considerations (e.g., strength of the evidence, generalizability).
Diffusion and dissemination involves partnering with professional opinion leaders and health care organizations to disseminate knowledge that can form the basis of action (e.g., essential elements for discharge teaching for hospitalized patient with heart failure) to potential users. Dissemination partnerships link researchers with intermediaries that can function as knowledge brokers and connectors to the practitioners and health care delivery organizations. Intermediaries can be professional organizations such as the National Patient Safety Foundation or multidisciplinary knowledge transfer teams such as those that are effective in disseminating research-based cancer prevention programs. In this model, dissemination partnerships provide an authoritative seal of approval for new knowledge and help identify influential groups and communities that can create a demand for application of the evidence in practice. Both mass communication and targeted dissemination are used to reach audiences with the anticipation that early users will influence the latter adopters of the new usable, evidence-based research findings. Targeted dissemination efforts must use multifaceted dissemination strategies, with an emphasis on channels and media that are most effective for particular user segments (e.g., nurses, physicians, pharmacists).
End user adoption, implementation, and institutionalization is the final stage of the knowledge transfer process. 37 This stage focuses on getting organizations, teams, and individuals to adopt and consistently use evidence-based research findings and innovations in everyday practice. Implementing and sustaining EBPs in health care settings involves complex interrelationships among the EBP topic (e.g., reduction of medication errors), the organizational social system characteristics (such as operational structures and values, the external health care environment), and the individual clinicians. 35 , 37–39 A variety of strategies for implementation include using a change champion in the organization who can address potential implementation challenges, piloting/trying the change in a particular patient care area of the organization, and using multidisciplinary implementation teams to assist in the practical aspects of embedding innovations into ongoing organizational processes. 35 , 37 Changing practice takes considerable effort at both the individual and organizational level to apply evidence-based information and products in a particular context. 22 When improvements in care are demonstrated in the pilot studies and communicated to other relevant units in the organization, key personnel may then agree to fully adopt and sustain the change in practice. Once the EBP change is incorporated into the structure of the organization, the change is no longer considered an innovation but a standard of care. 22 , 37
In comparison, other models of EBP (e.g., Iowa Model of Evidence-based Practice to Promote Quality of Care 16 ) view the steps of the EBP process from the perspective of clinicians and/or organizational/clinical contexts of care delivery. When viewing steps of the EBP process through the lens of an end user, the process begins with selecting an area for improving care based on evidence (rather than asking what findings ought to be disseminated); determining the priority of the potential topic for the organization; formulating an EBP team composed of key stakeholders; finding, critiquing, and synthesizing the evidence; setting forth EBP recommendations, with the type and strength of evidence used to support each clearly documented; determining if the evidence findings are appropriate for use in practice; writing an EBP standard specific to the organization; piloting the change in practice; implementing changes in practice in other relevant practice areas (depending on the outcome of the pilot); evaluating the EBP changes; and transitioning ongoing quality improvement (QI) monitoring, staff education, and competency review of the EBP topic to appropriate organizational groups as defined by the organizational structure. 15 , 40 The work of EBP implementation from the perspective of the end user is greatly facilitated by efforts of AHRQ, professional nursing organizations (e.g., Oncology Nursing Society), and others that distill and package research findings into useful products and tools for use at the point of care delivery.
When the clinical questions of end users can be addressed through use of existing evidence that is packaged with end users in mind, steps of the EBP process take less time and more effort can be directed toward the implementation, evaluation, and sustainability components of the process. For example, finding, critiquing, and synthesizing the evidence; setting forth EBP recommendations with documentation of the type and strength of evidence for each recommendation; and determining appropriateness of the evidence for use in practice are accelerated when the knowledge-based information is readily available. Some distilled research findings also include quick reference guides that can be used at the point of care and/or integrated into health care information systems, which also helps with implementation. 41 , 42
Translation science is the investigation of methods, interventions, and variables that influence adoption by individuals and organizations of EBPs to improve clinical and operational decisionmaking in health care. 35 , 43–46 This includes testing the effect of interventions on promoting and sustaining adoption of EBPs. Examples of translation studies include describing facilitators and barriers to knowledge uptake and use, organizational predictors of adherence to EBP guidelines, attitudes toward EBPs, and defining the structure of the scientific field. 11 , 47–49
Translation science must be guided by a conceptual model that organizes the strategies being tested, elucidates the extraneous variables (e.g., behaviors and facilitators) that may influence adoption of EBPs (e.g., organizational size, characteristics of users), and builds a scientific knowledge base for this field of inquiry. 15 , 50 Conceptual models used in the translating-research-into-practice studies funded by AHRQ were adult learning, health education, social influence, marketing, and organizational and behavior theories. 51 Investigators have used Rogers’s Diffusion of Innovation model, 35 , 39 , 52–55 the Promoting Action on Research Implementation in Health Services (PARIHS) model, 29 the push/pull framework, 23 , 56 , 57 the decisionmaking framework, 58 and the Institute for Healthcare Improvement (IHI) model 59 in translation science.
Study findings regarding evidence-based practices in a diversity of health care settings are building an empirical foundation of translation science. 19 , 43 , 51 , 60–83 These investigations and others 18 , 84–86 provide initial scientific knowledge to guide us in how to best promote use of evidence in practice. To advance knowledge about promoting and sustaining adoption of EBPs in health care, translation science needs more studies that test translating research into practice (TRIP) interventions: studies that investigate what TRIP interventions work, for whom, in what circumstances, in what types of settings; and studies that explain the underlying mechanisms of effective TRIP interventions. 35 , 49 , 79 , 87 Partnership models, which encourage ongoing interaction between researchers and practitioners, may be the way forward to carry out such studies. 56 Challenges, issues, methods, and instruments used in translation research are described elsewhere. 11 , 19 , 49 , 78 , 88–97
Multifaceted implementation strategies are needed to promote use of research evidence in clinical and administrative health care decisionmaking. 15 , 22 , 37 , 45 , 64 , 72 , 77 , 79 , 98 , 99 Although Grimshaw and colleagues 65 suggest that multifaceted interventions are no more effective than single interventions, context (site of care delivery) was not incorporated in the synthesis methodology. As noted by others, the same TRIP intervention may meet with varying degrees of effectiveness when applied in different contexts. 35 , 49 , 79 , 80 , 87 , 100 , 101 Implementation strategies also need to address both the individual practitioner and organizational perspective. 15 , 22 , 37 , 64 , 72 , 77 , 79 , 98 When practitioners decide individually what evidence to use in practice, considerable variability in practice patterns result, 71 potentially resulting in adverse patient outcomes.
For example, an “individual” perspective of EBP would leave the decision about use of evidence-based endotracheal suctioning techniques to each nurse and respiratory therapist. Some individuals may be familiar with the research findings for endotracheal suctioning while others may not. This is likely to result in different and conflicting practices being used as people change shifts every 8 to 12 hours. From an organizational perspective, endotracheal suctioning policies and procedures based on research are written, the evidence-based information is integrated into the clinical information systems, and adoption of these practices by nurses and other practitioners is systematically promoted in the organization. This includes assuring that practitioners have the necessary knowledge, skills, and equipment to carry out the evidence-based endotracheal suctioning practice. The organizational governance supports use of these practices through various councils and committees such as the Practice Committee, Staff Education Committee, and interdisciplinary EBP work groups.
The Translation Research Model, 35 built on Rogers’s seminal work on diffusion of innovations, 39 provides a guiding framework for testing and selecting strategies to promote adoption of EBPs. According to the Translation Research Model, adoption of innovations such as EBPs are influenced by the nature of the innovation (e.g., the type and strength of evidence, the clinical topic) and the manner in which it is communicated (disseminated) to members (nurses) of a social system (organization, nursing profession). 35 Strategies for promoting adoption of EBPs must address these four areas (nature of the EBP topic; users of the evidence; communication; social system) within a context of participative change (see Figure 2 ). This model provided the framework for a multisite study that tested the effectiveness of a multifaceted TRIP intervention designed to promote adoption of evidence-based acute pain management practices for hospitalized older adults. The intervention improved the quality of acute pain management practices and reduced costs. 81 The model is currently being used to test the effectiveness of a multifaceted TRIP intervention to promote evidence-based cancer pain management of older adults in home hospice settings. * This guiding framework is used herein to overview what is known about implementation interventions to promote use of EBPs in health care systems (see Evidence Table ).
*Implementation Model Redrawn from Rogers EM. Diffusion of innovations. 5th ed. New York: The Free Press; 2003; Titler MG, Everett LQ. Translating research into practice: considerations for critical care investigators. Crit Care Nurs Clin North Am 2001a;13(4):587-604. (more...)
Evidence-Based Practice in Nursing
Characteristics of an innovation or EBP topic that affect adoption include the relative advantage of the EBP (e.g., effectiveness, relevance to the task, social prestige); the compatibility with values, norms, work, and perceived needs of users; and complexity of the EBP topic. 39 For example, EBP topics that are perceived by users as relatively simple (e.g., influenza vaccines for older adults) are more easily adopted in less time than those that are more complex (acute pain management for hospitalized older adults). Strategies to promote adoption of EBPs related to characteristics of the topic include practitioner review and “reinvention” of the EBP guideline to fit the local context, use of quick reference guides and decision aids, and use of clinical reminders. 53 , 59 , 60 , 65 , 74 , 82 , 102–107 An important principle to remember when planning implementation of an EBP is that the attributes of the EBP topic as perceived by users and stakeholders (e.g., ease of use, valued part of practice) are neither stable features nor sure determinants of their adoption. Rather it is the interaction among the characteristics of the EBP topic, the intended users, and a particular context of practice that determines the rate and extent of adoption. 22 , 35 , 39
Studies suggest that clinical systems, computerized decision support, and prompts that support practice (e.g., decisionmaking algorithms, paper reminders) have a positive effect on aligning practices with the evidence base. 15 , 51 , 65 , 74 , 80 , 82 , 102 , 104 , 107–110 Computerized knowledge management has consistently demonstrated significant improvements in provider performance and patient outcomes. 82 Feldman and colleagues, using a just-in-time e-mail reminder in home health care, have demonstrated (1) improvements in evidence-based care and outcomes for patients with heart failure, 64 , 77 and (2) reduced pain intensity for cancer patients. 75 Clinical information systems should deploy the evidence base to the point of care and incorporate computer decision-support software that integrates evidence for use in clinical decisionmaking about individual patients. 40 , 104 , 111–114 There is still much to learn about the “best” manner of deploying evidence-based information through electronic clinical information systems to support evidence-based care. 115
Interpersonal communication channels, methods of communication, and influence among social networks of users affect adoption of EBPs. 39 Use of mass media, opinion leaders, change champions, and consultation by experts along with education are among strategies tested to promote use of EBPs. Education is necessary but not sufficient to change practice, and didactic continuing education alone does little to change practice behavior. 61 , 116 There is little evidence that interprofessional education as compared to discipline-specific education improves EBP. 117 Interactive education, used in combination with other practice-reinforcing strategies, has more positive effects on improving EBP than didactic education alone. 66 , 68 , 71 , 74 , 118 , 119 There is evidence that mass media messages (e.g., television, radio, newspapers, leaflets, posters and pamphlets), targeted at the health care consumer population, have some effect on use of health services for the targeted behavior (e.g., colorectal cancer screening). However, little empirical evidence is available to guide framing of messages communicated through planned mass media campaigns to achieve the intended change. 120
Several studies have demonstrated that opinion leaders are effective in changing behaviors of health care practitioners, 22 , 68 , 79 , 100 , 116 , 121–123 especially in combination with educational outreach or performance feedback. Opinion leaders are from the local peer group, viewed as a respected source of influence, considered by associates as technically competent, and trusted to judge the fit between the innovation and the local situation. 39 , 116 , 121 , 124–127 With their wide sphere of influence across several microsystems/units, opinion leaders’ use of the innovation influences peers and alters group norms. 39 , 128 The key characteristic of an opinion leader is that he or she is trusted to evaluate new information in the context of group norms. Opinion leadership is multifaceted and complex, with role functions varying by the circumstances, but few successful projects to implement innovations in organizations have managed without the input of identifiable opinion leaders. 22 , 35 , 39 , 81 , 96 Social interactions such as “hallway chats,” one-on-one discussions, and addressing questions are important, yet often overlooked components of translation. 39 , 59 Thus, having local opinion leaders discuss the EBPs with members of their peer group is necessary to translate research into practice. If the EBP that is being implemented is interdisciplinary in nature, discipline-specific opinion leaders should be used to promote the change in practice. 39
Change champions are also helpful for implementing innovations. 39 , 49 , 81 , 129–131 They are practitioners within the local group setting (e.g., clinic, patient care unit) who are expert clinicians, passionate about the innovation, committed to improving quality of care, and have a positive working relationship with other health care professionals. 39 , 125 , 131 , 132 They circulate information, encourage peers to adopt the innovation, arrange demonstrations, and orient staff to the innovation. 49 , 130 The change champion believes in an idea; will not take “no” for an answer; is undaunted by insults and rebuffs; and, above all, persists. 133 Because nurses prefer interpersonal contact and communication with colleagues rather than Internet or traditional sources of practice knowledge, 134–137 it is imperative that one or two change champions be identified for each patient care unit or clinic where the change is being made for EBPs to be enacted by direct care providers. 81 , 138 Conferencing with opinion leaders and change champions periodically during implementation is helpful to address questions and provide guidance as needed. 35 , 66 , 81 , 106
Because nurses’ preferred information source is through peers and social interactions, 134–137 , 139 , 140 using a core group in conjunction with change champions is also helpful for implementing the practice change. 16 , 110 , 141 A core group is a select group of practitioners with the mutual goal of disseminating information regarding a practice change and facilitating the change by other staff in their unit/microsystem. 142 Core group members represent various shifts and days of the week and become knowledgeable about the scientific basis for the practice; the change champion educates and assists them in using practices that are aligned with the evidence. Each member of the core group, in turn, takes the responsibility for imparting evidence-based information and effecting practice change with two or three of their peers. Members assist the change champion and opinion leader with disseminating the EBP information to other staff, reinforce the practice change on a daily basis, and provide positive feedback to those who align their practice with the evidence base. 15 Using a core-group approach in conjunction with a change champion results in a critical mass of practitioners promoting adoption of the EBP. 39
Educational outreach, also known as academic detailing, promotes positive changes in practice behaviors of nurses and physicians. 22 , 64 , 66 , 71 , 74 , 75 , 77 , 81 , 119 , 143 Academic detailing is done by a topic expert, knowledgeable of the research base (e.g., cancer pain management), who may be external to the practice setting; he or she meets one-on-one with practitioners in their setting to provide information about the EBP topic. These individuals are able to explain the research base for the EBPs to others and are able to respond convincingly to challenges and debates. 22 This strategy may include providing feedback on provider or team performance with respect to selected EBP indicators (e.g., frequency of pain assessment). 66 , 81 , 119
Members of a social system (e.g., nurses, physicians, clerical staff) influence how quickly and widely EBPs are adopted. 39 Audit and feedback, performance gap assessment (PGA), and trying the EBP are strategies that have been tested. 15 , 22 , 65 , 66 , 70–72 , 81 , 98 , 124 , 144 PGA and audit and feedback have consistently shown a positive effect on changing practice behavior of providers. 65 , 66 , 70 , 72 , 81 , 98 , 124 , 144 , 145 PGA (baseline practice performance) informs members, at the beginning of change, about a practice performance and opportunities for improvement. Specific practice indicators selected for PGA are related to the practices that are the focus of evidence-based practice change, such as every-4-hour pain assessment for acute pain management. 15 , 66 , 81
Auditing and feedback are ongoing processes of using and assessing performance indicators (e.g., every-4-hour pain assessment), aggregating data into reports, and discussing the findings with practitioners during the practice change. 22 , 49 , 66 , 70 , 72 , 81 , 98 , 145 This strategy helps staff know and see how their efforts to improve care and patient outcomes are progressing throughout the implementation process. Although there is no clear empirical evidence for how to provide audit and feedback, 70 , 146 effects may be larger when clinicians are active participants in implementing change and discuss the data rather than being passive recipients of feedback reports. 67 , 70 Qualitative studies provide some insight into use of audit and feedback. 60 , 67 One study on use of data feedback for improving treatment of acute myocardial infarction found that (1) feedback data must be perceived by physicians as important and valid, (2) the data source and timeliness of data feedback are critical to perceived validity, (3) time is required to establish credibility of data within a hospital, (4) benchmarking improves the validity of the data feedback, and (5) physician leaders can enhance the effectiveness of data feedback. Data feedback that profiles an individual physician’s practices can be effective but may be perceived as punitive; data feedback must persist to sustain improved performance; and effectiveness of data feedback is intertwined with the organizational context, including physician leadership and organizational culture. 60 Hysong and colleagues 67 found that high-performing institutions provided timely, individualized, nonpunitive feedback to providers, whereas low performers were more variable in their timeliness and nonpunitiveness and relied more on standardized, facility-level reports. The concept of useful feedback emerged as the core concept around which timeliness, individualization, nonpunitiveness, and customizability are important.
Users of an innovation usually try it for a period of time before adopting it in their practice. 22 , 39 , 147 When “trying an EBP” (piloting the change) is incorporated as part of the implementation process, users have an opportunity to use it for a period of time, provide feedback to those in charge of implementation, and modify the practice if necessary. 148 Piloting the EBP as part of implementation has a positive influence on the extent of adoption of the new practice. 22 , 39 , 148
Characteristics of users such as educational preparation, practice specialty, and views on innovativeness may influence adoption of an EBP, although findings are equivocal. 27 , 39 , 130 , 149–153 Nurses’ disposition to critical thinking is, however, positively correlated with research use, 154 and those in clinical educator roles are more likely to use research than staff nurses or nurse managers. 155
Clearly, the social system or context of care delivery matters when implementing EBPs. 2 , 30 , 33 , 39 , 60 , 84 , 85 , 91 , 92 , 101 , 156–163 For example, investigators demonstrated the effectiveness of a prompted voiding intervention for urinary incontinence in nursing homes, but sustaining the intervention in day-to-day practice was limited when the responsibility of carrying out the intervention was shifted to nursing home staff (rather than the investigative team) and required staffing levels in excess of a majority of nursing home settings. 164 This illustrates the importance of embedding interventions into ongoing processes of care.
Several organizational factors affect adoption of EBPs. 22 , 39 , 79 , 134 , 165–167 Vaughn and colleagues 101 demonstrated that organizational resources, physician full-time employees (FTEs) per 1,000 patient visits, organizational size, and whether the facility was located in or near a city affected use of evidence in the health care system of the Department of Veterans Affairs (VA). Large, mature, functionally differentiated organizations (e.g., divided into semiautonomous departments and units) that are specialized, with a focus of professional knowledge, slack resources to channel into new projects, decentralized decisionmaking, and low levels of formalization will more readily adopt innovations such as new practices based on evidence. Larger organizations are generally more innovative because size increases the likelihood that other predictors of innovation adoption—such as slack financial and human resources and differentiation—will be present. However, these organizational determinants account for only about 15 percent of the variation in innovation adoption between comparable organizations. 22 Adler and colleagues 168 hypothesize that while more structurally complex organizations may be more innovative and hence adopt EBPs relatively early, less structurally complex organizations may be able to diffuse EBPs more effectively. Establishing semiautonomous teams is associated with successful implementation of EBPs, and thus should be considered in managing organizational units. 168–170
As part of the work of implementing EBPs, it is important that the social system—unit, service line, or clinic—ensures that policies, procedures, standards, clinical pathways, and documentation systems support the use of the EBPs. 49 , 68 , 72 , 73 , 103 , 140 , 171 Documentation forms or clinical information systems may need revision to support changes in practice; documentation systems that fail to readily support the new practice thwart change. 82
Absorptive capacity for new knowledge is another social system factor that affects adoption of EBPs. Absorptive capacity is the knowledge and skills to enact the EBPs; the strength of evidence alone will not promote adoption. An organization that is able to systematically identify, capture, interpret, share, reframe, and recodify new knowledge, and put it to appropriate use, will be better able to assimilate EBPs. 82 , 103 , 172 , 173 A learning organizational culture and proactive leadership that promotes knowledge sharing are important components of building absorptive capacity for new knowledge. 66 , 139 , 142 , 174 Components of a receptive context for EBP include strong leadership, clear strategic vision, good managerial relations, visionary staff in key positions, a climate conducive to experimentation and risk taking, and effective data capture systems. Leadership is critical in encouraging organizational members to break out of the convergent thinking and routines that are the norm in large, well-established organizations. 4 , 22 , 39 , 122 , 148 , 163 , 175
An organization may be generally amenable to innovations but not ready or willing to assimilate a particular EBP. Elements of system readiness include tension for change, EBP-system fit, assessment of implications, support and advocacy for the EBP, dedicated time and resources, and capacity to evaluate the impact of the EBP during and following implementation. If there is tension around specific work or clinical issues and staff perceive that the situation is intolerable, a potential EBP is likely to be assimilated if it can successfully address the issues, and thereby reduce the tension. 22 , 175
Assessing and structuring workflow to fit with a potential EBP is an important component of fostering adoption. If implications of the EBP are fully assessed, anticipated, and planned for, the practice is more likely to be adopted. 148 , 162 , 176 If supporters for a specific EBP outnumber and are more strategically placed within the organizational power base than opponents, the EBP is more likely to be adopted by the organization. 60 , 175 Organizations that have the capacity to evaluate the impact of the EBP change are more likely to assimilate it. Effective implementation needs both a receptive climate and a good fit between the EBP and intended adopters’ needs and values. 22 , 60 , 140 , 175 , 177
Leadership support is critical for promoting use of EBPs. 33 , 59 , 72 , 85 , 98 , 122 , 178–181 This support, which is expressed verbally, provides necessary resources, materials, and time to fulfill assigned responsibilities. 148 , 171 , 182 , 183 Senior leaders need to create an organizational mission, vision, and strategic plan that incorporate EBP; implement performance expectations for staff that include EBP work; integrate the work of EBP into the governance structure of the health care system; demonstrate the value of EBPs through administrative behaviors; and establish explicit expectations that nurse leaders will create microsystems that value and support clinical inquiry. 122 , 183 , 184
A recent review of organizational interventions to implement EBPs for improving patient care examined five major aspects of patient care. The review suggests that revision of professional roles (changing responsibilities and work of health professionals such as expanding roles of nurses and pharmacists) improved processes of care, but it was less clear about the effect on improvement of patient outcomes. Multidisciplinary teams (collaborative practice teams of physicians, nurses, and allied health professionals) treating mostly patients with prevalent chronic diseases resulted in improved patient outcomes. Integrated care services (e.g., disease management and case management) resulted in improved patient outcomes and cost savings. Interventions aimed at knowledge management (principally via use of technology to support patient care) resulted in improved adherence to EBPs and patient outcomes. The last aspect, quality management, had the fewest reviews available, with the results uncertain. A number of organizational interventions were not included in this review (e.g., leadership, process redesign, organizational learning), and the authors note that the lack of a widely accepted taxonomy of organizational interventions is a problem in examining effectiveness across studies. 82
An organizational intervention that is receiving increasing attention is tailored interventions to overcome barriers to change. 162 , 175 , 185 This type of intervention focuses on first assessing needs in terms of what is causing the gap between current practice and EBP for a specified topic, what behaviors and/or mechanism need to change, what organizational units and persons should be involved, and identification of ways to facilitate the changes. This information is then used in tailoring an intervention for the setting that will promote use of the specified EBP. Based on a recent systematic review, effectiveness of tailored implementation interventions remains uncertain. 185
In summary, making an evidence-based change in practice involves a series of action steps and a complex, nonlinear process. Implementing the change will take several weeks to months, depending on the nature of the practice change. Increasing staff knowledge about a specific EBP and passive dissemination strategies are not likely to work, particularly in complex health care settings. Strategies that seem to have a positive effect on promoting use of EBPs include audit and feedback, use of clinical reminders and practice prompts, opinion leaders, change champions, interactive education, mass media, educational outreach/academic detailing, and characteristics of the context of care delivery (e.g., leadership, learning, questioning). It is important that senior leadership and those leading EBP improvements are aware of change as a process and continue to encourage and teach peers about the change in practice. The new practice must be continually reinforced and sustained or the practice change will be intermittent and soon fade, allowing more traditional methods of care to return. 15
Several translation science principles are informative for implementing patient safety initiatives:
Translation science is young, and although there is a growing body of knowledge in this area, we have, to date, many unanswered questions. These include the type of audit and feedback (e.g., frequency, content, format) strategies that are most effective, the characteristics of opinion leaders that are critical for success, the role of specific context variables, and the combination of strategies that are most effective. We also know very little about use of tailored implementation interventions, or the key context attributes to assess and use in developing and testing tailored interventions. The types of clinical reminders that are most effective for making EBP knowledge available at the point of care require further empirical explanation. We also know very little about the intensity and intervention dose of single and multifaceted strategies that are effective for promoting and sustaining use of EBPs or how the effectiveness differs by type of topic (e.g., simple versus complex). Only recently has the context of care delivery been acknowledged as affecting use of evidence, and further empirical work is needed in this area to understand how complex adaptive systems of practice incorporate knowledge acquisition and use. Lastly, we do not know what strategies or combination of strategies work for whom, in what context, why they work in some settings or cases and not others, and what is the mechanism by which these strategies or combination of strategies work.
This is an exciting area of investigation that has a direct impact on implementing patient safety practices. In planning investigations, researchers must use a conceptual model to guide the research and add to the empirical and theoretical understanding of this field of inquiry. Additionally, funding is needed for implementation studies that focus on evidence-based patient safety practices as the topic of concern. To generalize empirical findings from patient safety implementation studies, we must have a better understanding of what implementation strategies work, with whom, and in what types of settings, and we must investigate the underlying mechanisms of these strategies. This is likely to require mixed methods, a better understanding of complexity science, and greater appreciation for nontraditional methods and realistic inquiry. 87
Although the science of translating research into practice is fairly new, there is some guiding evidence of what implementation interventions to use in promoting patient safety practices. However, there is no magic bullet for translating what is known from research into practice. To move evidence-based interventions into practice, several strategies may be needed. Additionally, what works in one context of care may or may not work in another setting, thereby suggesting that context variables matter in implementation. 80
Several electronic databases were searched (MEDLINE ® , CINAHL ® , PubMed ® ) using terms of evidence-based practice research, implementation research, and patient safety. (The terms “quality improvement” or “quality improvement intervention research” were not used.) The Cochrane Collaboration–Cochrane Reviews was also searched to look for systematic reviews of specific implementation strategies, and the Journal of Implementation Science was also reviewed. I also requested the final reports of the TRIP I and TRIP II studies funded by AHRQ. Classic articles known to the author were also included in this chapter (e.g.,Locock et al. 123 ).
*Principal Investigator: Keela Herr (R01 grant no. CA115363-01; National Cancer Institute (NCI))Background
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by Ashley Roberts
A question that comes up a great deal within our community is what is the difference between evidence-based and research-based programs? This is a fair question that deserves a proper answer. Alyssa Ciarlante defines them as:
" Evidence-Based Practices or Evidence-Based Programs refer to individual practices (for example, single lessons or in-class activities) or programs (for example, year-long curricula) that are considered effective based on scientific evidence. To deem a program or practice “evidence-based,” researchers will typically study the impact of the resource(s) in a controlled setting, for example, they may study differences in skill growth between students whose educators used the resources and students whose educators did not. If sufficient research suggests that the program or practice is effective, it may be deemed “evidence-based.”
Evidence-Informed, also known as Research-Based, Practices are practices which were developed based on the best research available in the field. This means that users can feel confident that the strategies and activities included in the program or practice have a strong scientific basis for their use. Unlike Evidence-Based Practices or Programs, Research-Based Practices have not been researched in a controlled setting.
Terms like “evidence-based” or “research-based” are useful indicators of the type of evidence that exists behind programs, practices, or assessments, however, they can only tell us so much about the specific research behind each tool. For situations where more information on a resource’s evidence base would be beneficial, it may be helpful to request research summaries or articles from the resource’s publisher for further review, but regardless, evidence-based is the preferred method, not researched-based."
That might be clear as mud so let' try this approach from the Child Welfare Information Gateway:
"Evidence-based practices are approaches to prevention or treatment that are validated by some form of documented scientific evidence. This includes findings established through controlled clinical studies , but other methods of establishing evidence are valid as well.
Evidence-based programs use a defined curriculum or set of services that, when implemented with fidelity as a whole, has been validated by some form of scientific evidence. Evidence-based practices and programs may be described as "supported" or "well-supported", depending on the strength of the research design.
Evidence-informed practices use the best available research and practice knowledge to guide program design and implementation. This informed practice allows for innovation while incorporating the lessons learned from the existing research literature. Ideally, evidence-based and evidence-informed programs and practices should be individualized."
And then let's put it through this lens:
Science-based - Parts or components of the program or method are based on Science.
Research-based - Parts or components of the program or method are based on practices demonstrated effective through Research.
Evidence-based - The entire program or method has been demonstrated through Research to be effective.
What this boils down to is that evidence-based is PREFERRED over research-based. Think of it this way, evidence-based means significant studies were performed, with control groups, meeting the criteria of scientific research, and that the results were repeatable numerous times with minimal variation. Research-based means someone stands on the shoulders of the giants who did the work for the evidence to create something based off of the evidence, but it isn't put through the same rigors. It can be though and that's a very clear distinction. Research-based programs can be studied until they become evidence-based, but not all are.
Now the challenge is, when being presented with remediation plans for your child, in differentiating between the two, and knowing which one is being used with your child. We at DI are keen advocates in knowing exactly what program(s) schools are using with your child, and while you should ask if it's evidence or research-based, it is also up to you to find that data yourself by calling the
publisher. The publisher should be willing to turn over the data, if not, let that be a sign that something is amiss.
Now, in Overcoming Dyslexia, Dr. Sally Shaywitz refers to the What Works Clearinghouse for referencing which programs are evidence v research based.
(https://ies.ed.gov/ncee/wwc/) "The What Works Clearinghouse is an investment of the Institute of Education Sciences (IES) within the U.S. Department of Education that was established in 2002. The work of the WWC is managed by a team of staff at IES and conducted under a set of contracts held by several leading firms with expertise in education, research methodology, and the dissemination of education research. Follow the links to find more information about the key staff from American Institutes for Research, Mathematica Policy Research, Abt Associates, and Development Services Group, Inc who contribute to the WWC investment."
The issue here is that too many question the validity of WWC. Programs like Fountas and Pinnell and other balanced literacy programs are given high marks, while some well known dyslexia programs are not, if they're even included at all.
So then what is a parent to do?
As stated, get the evidence or research, whichever is available, from the publisher and with an understanding of scientific principles and methodologies, review the evidence with a discerning eye. Ask questions like how many children were in the trials? If it's 5 then the findings can't be very legitimate. If enough children were used to make up a large enough statistical pool then the findings are more valid. This is just an example, but a key one within educational data that must always be at the forefront. Why? Too many papers exist calling programs / data "research-based" when in fact scientific principles and statistical modeling were not followed correctly therefore the data upon which the programs are based is in essence invalid. As you start to look at the data, you will start to see what to look for, i.e. what questions to ask.
But, this brings up an important point that we've had to repeat a few times lately, at DI we do not recommend or back any programs. We are parent advocates, not researchers and we do not possess the expertise we believe is necessary to do so. We defer to the list of approved programs that The International Dyslexia Association has already defined.
References :
“Evidence-Based” vs. “Research-Based”: Understanding the Differences, https://apertureed.com/evidence-based-vs-research-based-understanding-differences/
Child Welfare Information Gateway, https://www.childwelfare.gov/topics/management/practice-improvement/evidence/ebp/definitions/
Evidence Based Assessment, https://pubmed.ncbi.nlm.nih.gov/17716047/
ESSA, https://www2.ed.gov/policy/elsec/leg/essa/guidanceuseseinvestment.pdf
Science-based, Research-based, Evidence-based: What's the difference?, https://www.dynaread.com/science-based-research-based-evidence-based
A Response to Lucy's Rebranding Following Columbia University's Retreat From Her Curriculum
Lucy’s Misguided Desire For An Apology
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Curriculum and Instruction
As children learn to read, they learn how spoken and written language relate to each other. For this to happen, the components of the reading program, including the instructional materials selected for classroom use, must relate to one another and be orchestrated into sequences of instruction that engage all children and meet their needs. The following are twelve of the essential components of research-based programs.
Children’s comprehension of written language depends in large part upon their effective use and understanding of oral language . Language experiences are a central component of good reading instruction. Children learn a great deal about the world, about themselves, and about each other from spoken language. Kindergarten and first-grade language instruction that focuses on listening, speaking, and understanding includes the following:
Children’s appreciation and understanding of the purposes and functions of written language are essential to their motivation for learning to read. Children must become aware that printed language is all around them on signs, billboards, and labels, and in books, magazines, and newspapers and that print serves many different purposes. Reading and writing instruction that focuses on the use and appreciation of written language includes the following:
Listening to and talking about books on a regular basis provides children with demonstrations of the benefits and pleasures of reading. Story reading introduces children to new words, new sentences, new places, and new ideas. They also hear the kinds of vocabulary , sentences, and text structures they will find in their school books and be expected to read and understand. Reading aloud to children every day, and talking about books and stories, supports and extends oral language development and helps students connect oral to written language.
Children’s ability to think about individual words as a sequence of sounds ( phonemes ) is important to their learning how to read an alphabetic language. Toward that understanding, children learn that sentences are made up of groups of separate words, and that words are made up of separate sounds. Indeed, research has shown conclusively that children’s phonemic awareness , their understanding that spoken words can be divided into separate sounds, is one of the best predictors of their success in learning to read. Instruction that promotes children’s understanding and use of the building blocks of spoken language includes the following:
Children must also become expert users of the building blocks of written language. Knowledge of letters (graphonemes) leads to success with learning to read. This includes the use, purpose, and function of letters. Instruction that helps children learn about the essential building blocks of written language includes the following:
Increasing children’s awareness of the sounds of spoken language and their familiarity with the letters of written language prepares them to understand the alphabetic principle -that written words are composed of patterns of letters that represent the sounds of spoken words.
Effective instruction provides children with explicit and systematic teaching of sound-letter relationships in a sequence that permits the children to assimilate and apply what they are learning. Instruction that helps children understand the alphabetic principle and learn the most common relationships between sounds and letters includes the following:
Efficient decoding strategies permit readers to quickly and automatically translate the letters or spelling patterns of written words into speech sounds so that they can identify words and gain rapid access to their meanings. Children must learn to identify words quickly and effortlessly, so that they can focus on the meaning of what they are reading.
Research indicates that good readers rely primarily on print rather than on pictures or context to help them identify familiar words, and also to figure out words they have not seen before. For this reason, it is important that children learn effective sounding-out strategies that will allow them to decode words they have never seen in print.
Some strategies of decoding instruction focus primarily on the relationships between sounds and letters; others combine letter-sound practice with word families, with word parts (for example, onsets and rimes), and with blending activities. More advanced decoding strategies focus on structural analysis, the identification of root words , and prefixes and suffixes.
Instruction should introduce “irregular” words in a reasonable sequence and use these words in the program’s reading materials. It is important to realize, however, that essentially all words must become “ sight words ” - words children identify quickly, accurately, and effortlessly.
Effective decoding instruction is explicit and systematic and can include the following:
As children learn to read and write words, they become aware of how these words are spelled. Increasing children’s awareness of spelling patterns hastens their progress in both reading and writing. In the early grades, spelling instruction must be coordinated with the program of reading instruction. As children progress, well organized, systematic lessons in spelling will be beneficial. Activities for effective spelling instruction should include the following:
The words in decodable stories do emphasize the sound-letter relation ships the children are learning. While many predictable and patterned books provide children with engaging language and print experiences, these books may not be based on the sound-letter relationships the children are learning.
Decodable stories provide children with the opportunity to practice what they are learning about letters and sounds. As children learn to read words, sentences, and stories fluently, accurately, and automatically, they no longer have to struggle to identify words and are free to pay closer attention to the meaning.
Research asserts that most children benefit from direct instruction in decoding , complemented by practice with simply written decodable stories. Further, for some children this sort of systematic approach is critical. Stories should “fit” the child’s reading level. Beginning readers should be able to read easily 90 percent or more of the words in a story, and after practice should be able to do so quickly, accurately, and effortlessly.
As children develop effective decoding strategies and become fluent readers, they must read books and other texts that are less controlled in their vocabulary and sentence structure. They learn to use word order ( syntax ) and context to interpret words and understand their meanings. Soon, they become enthusiastic, independent readers of all kinds of written material including books, magazines, newspapers, computer screens, and more!
Providing children with a great many books, both narrative and informational, is of primary importance. Classroom and campus libraries must offer children a variety of reading materials, some that are easy to read and others that are more challenging and of increasing difficulty and complexity. Children need access to many books that travel home for reading with family members. Classrooms that ensure wide reading provide the following:
Written language places greater demands on children’s vocabulary knowledge than does their everyday spoken language.
In fact, many of the new words children learn in a year are learned from concrete and meaningful experiences from being read to and as they read on their own.
It is obvious that the number of new words children learn from reading depends upon how much they read and that the amount children read varies enormously. Therefore, it is important that teachers read aloud to children and encourage them to do a great deal of voluntary and independent reading. In addition, during reading instruction, children should be encouraged to attend to the meanings of new words. Activities that promote the acquisition of vocabulary include the following:
Written language is not just speech written down. Instead, written language offers new vocabulary , new language patterns, new thoughts, and new ways of thinking. Comprehension depends on the ability to identify familiar works quickly and automatically, which includes fluent reading, as well as the ability to figure out new words. But this is not enough.
Comprehension also depends upon the understanding of word meanings, on the development of meaningful ideas from groups of words (phrases, clauses, and sentences) and the drawing of inferences. It also depends upon the demands of the text (its concepts, its density), and the knowledge the reader brings to the text. The discussion of good books with their friends and classmates is one avenue for making these connections.
Such discussions will help children to appreciate and reflect on new aspects of written language and on the wide, wonderful world of print. For children to receive the greatest benefit and enjoyment from their reading, they must receive comprehension strategy instruction that builds on their knowledge of the world and of language. Comprehension strategy instruction can include the following:
As these components are translated into classroom experiences, children will have opportunities to talk, read, and write in the many ways they use language both inside and out of the classroom. Because the language arts (reading, writing, listening and speaking) are so interrelated, children must be given the opportunity to practice the strands of language arts in connected and purposeful ways.
Classroom experiences that offer children opportunities to write for real life reasons include having children write letters of invitation to parents and other community members to visit their classrooms, or writing letters of thanks to individuals and organizations that have contributed to their school. Children write to record newly acquired information, to reflect on what they are learning and to organize their ideas. They also work in groups to write reports on special topics.
Classroom experiences that offer children opportunities to read, listen and speak for real life purposes include the reading of “everyday” notes, news, messages, lists, labels, and the reading of compositions and reports written in the classroom. In such classrooms, reading, writing, listening, and speaking become important and meaningful to every child.
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Methodology
Published on June 7, 2021 by Shona McCombes . Revised on November 20, 2023 by Pritha Bhandari.
A research design is a strategy for answering your research question using empirical data. Creating a research design means making decisions about:
A well-planned research design helps ensure that your methods match your research objectives and that you use the right kind of analysis for your data.
Step 1: consider your aims and approach, step 2: choose a type of research design, step 3: identify your population and sampling method, step 4: choose your data collection methods, step 5: plan your data collection procedures, step 6: decide on your data analysis strategies, other interesting articles, frequently asked questions about research design.
Before you can start designing your research, you should already have a clear idea of the research question you want to investigate.
There are many different ways you could go about answering this question. Your research design choices should be driven by your aims and priorities—start by thinking carefully about what you want to achieve.
The first choice you need to make is whether you’ll take a qualitative or quantitative approach.
Qualitative approach | Quantitative approach |
---|---|
and describe frequencies, averages, and correlations about relationships between variables |
Qualitative research designs tend to be more flexible and inductive , allowing you to adjust your approach based on what you find throughout the research process.
Quantitative research designs tend to be more fixed and deductive , with variables and hypotheses clearly defined in advance of data collection.
It’s also possible to use a mixed-methods design that integrates aspects of both approaches. By combining qualitative and quantitative insights, you can gain a more complete picture of the problem you’re studying and strengthen the credibility of your conclusions.
As well as scientific considerations, you need to think practically when designing your research. If your research involves people or animals, you also need to consider research ethics .
At each stage of the research design process, make sure that your choices are practically feasible.
Discover proofreading & editing
Within both qualitative and quantitative approaches, there are several types of research design to choose from. Each type provides a framework for the overall shape of your research.
Quantitative designs can be split into four main types.
Type of design | Purpose and characteristics |
---|---|
Experimental | relationships effect on a |
Quasi-experimental | ) |
Correlational | |
Descriptive |
With descriptive and correlational designs, you can get a clear picture of characteristics, trends and relationships as they exist in the real world. However, you can’t draw conclusions about cause and effect (because correlation doesn’t imply causation ).
Experiments are the strongest way to test cause-and-effect relationships without the risk of other variables influencing the results. However, their controlled conditions may not always reflect how things work in the real world. They’re often also more difficult and expensive to implement.
Qualitative designs are less strictly defined. This approach is about gaining a rich, detailed understanding of a specific context or phenomenon, and you can often be more creative and flexible in designing your research.
The table below shows some common types of qualitative design. They often have similar approaches in terms of data collection, but focus on different aspects when analyzing the data.
Type of design | Purpose and characteristics |
---|---|
Grounded theory | |
Phenomenology |
Your research design should clearly define who or what your research will focus on, and how you’ll go about choosing your participants or subjects.
In research, a population is the entire group that you want to draw conclusions about, while a sample is the smaller group of individuals you’ll actually collect data from.
A population can be made up of anything you want to study—plants, animals, organizations, texts, countries, etc. In the social sciences, it most often refers to a group of people.
For example, will you focus on people from a specific demographic, region or background? Are you interested in people with a certain job or medical condition, or users of a particular product?
The more precisely you define your population, the easier it will be to gather a representative sample.
Even with a narrowly defined population, it’s rarely possible to collect data from every individual. Instead, you’ll collect data from a sample.
To select a sample, there are two main approaches: probability sampling and non-probability sampling . The sampling method you use affects how confidently you can generalize your results to the population as a whole.
Probability sampling | Non-probability sampling |
---|---|
Probability sampling is the most statistically valid option, but it’s often difficult to achieve unless you’re dealing with a very small and accessible population.
For practical reasons, many studies use non-probability sampling, but it’s important to be aware of the limitations and carefully consider potential biases. You should always make an effort to gather a sample that’s as representative as possible of the population.
In some types of qualitative designs, sampling may not be relevant.
For example, in an ethnography or a case study , your aim is to deeply understand a specific context, not to generalize to a population. Instead of sampling, you may simply aim to collect as much data as possible about the context you are studying.
In these types of design, you still have to carefully consider your choice of case or community. You should have a clear rationale for why this particular case is suitable for answering your research question .
For example, you might choose a case study that reveals an unusual or neglected aspect of your research problem, or you might choose several very similar or very different cases in order to compare them.
Data collection methods are ways of directly measuring variables and gathering information. They allow you to gain first-hand knowledge and original insights into your research problem.
You can choose just one data collection method, or use several methods in the same study.
Surveys allow you to collect data about opinions, behaviors, experiences, and characteristics by asking people directly. There are two main survey methods to choose from: questionnaires and interviews .
Questionnaires | Interviews |
---|---|
) |
Observational studies allow you to collect data unobtrusively, observing characteristics, behaviors or social interactions without relying on self-reporting.
Observations may be conducted in real time, taking notes as you observe, or you might make audiovisual recordings for later analysis. They can be qualitative or quantitative.
Quantitative observation | |
---|---|
There are many other ways you might collect data depending on your field and topic.
Field | Examples of data collection methods |
---|---|
Media & communication | Collecting a sample of texts (e.g., speeches, articles, or social media posts) for data on cultural norms and narratives |
Psychology | Using technologies like neuroimaging, eye-tracking, or computer-based tasks to collect data on things like attention, emotional response, or reaction time |
Education | Using tests or assignments to collect data on knowledge and skills |
Physical sciences | Using scientific instruments to collect data on things like weight, blood pressure, or chemical composition |
If you’re not sure which methods will work best for your research design, try reading some papers in your field to see what kinds of data collection methods they used.
If you don’t have the time or resources to collect data from the population you’re interested in, you can also choose to use secondary data that other researchers already collected—for example, datasets from government surveys or previous studies on your topic.
With this raw data, you can do your own analysis to answer new research questions that weren’t addressed by the original study.
Using secondary data can expand the scope of your research, as you may be able to access much larger and more varied samples than you could collect yourself.
However, it also means you don’t have any control over which variables to measure or how to measure them, so the conclusions you can draw may be limited.
As well as deciding on your methods, you need to plan exactly how you’ll use these methods to collect data that’s consistent, accurate, and unbiased.
Planning systematic procedures is especially important in quantitative research, where you need to precisely define your variables and ensure your measurements are high in reliability and validity.
Some variables, like height or age, are easily measured. But often you’ll be dealing with more abstract concepts, like satisfaction, anxiety, or competence. Operationalization means turning these fuzzy ideas into measurable indicators.
If you’re using observations , which events or actions will you count?
If you’re using surveys , which questions will you ask and what range of responses will be offered?
You may also choose to use or adapt existing materials designed to measure the concept you’re interested in—for example, questionnaires or inventories whose reliability and validity has already been established.
Reliability means your results can be consistently reproduced, while validity means that you’re actually measuring the concept you’re interested in.
Reliability | Validity |
---|---|
) ) |
For valid and reliable results, your measurement materials should be thoroughly researched and carefully designed. Plan your procedures to make sure you carry out the same steps in the same way for each participant.
If you’re developing a new questionnaire or other instrument to measure a specific concept, running a pilot study allows you to check its validity and reliability in advance.
As well as choosing an appropriate sampling method , you need a concrete plan for how you’ll actually contact and recruit your selected sample.
That means making decisions about things like:
If you’re using a probability sampling method , it’s important that everyone who is randomly selected actually participates in the study. How will you ensure a high response rate?
If you’re using a non-probability method , how will you avoid research bias and ensure a representative sample?
It’s also important to create a data management plan for organizing and storing your data.
Will you need to transcribe interviews or perform data entry for observations? You should anonymize and safeguard any sensitive data, and make sure it’s backed up regularly.
Keeping your data well-organized will save time when it comes to analyzing it. It can also help other researchers validate and add to your findings (high replicability ).
On its own, raw data can’t answer your research question. The last step of designing your research is planning how you’ll analyze the data.
In quantitative research, you’ll most likely use some form of statistical analysis . With statistics, you can summarize your sample data, make estimates, and test hypotheses.
Using descriptive statistics , you can summarize your sample data in terms of:
The specific calculations you can do depend on the level of measurement of your variables.
Using inferential statistics , you can:
Regression and correlation tests look for associations between two or more variables, while comparison tests (such as t tests and ANOVAs ) look for differences in the outcomes of different groups.
Your choice of statistical test depends on various aspects of your research design, including the types of variables you’re dealing with and the distribution of your data.
In qualitative research, your data will usually be very dense with information and ideas. Instead of summing it up in numbers, you’ll need to comb through the data in detail, interpret its meanings, identify patterns, and extract the parts that are most relevant to your research question.
Two of the most common approaches to doing this are thematic analysis and discourse analysis .
Approach | Characteristics |
---|---|
Thematic analysis | |
Discourse analysis |
There are many other ways of analyzing qualitative data depending on the aims of your research. To get a sense of potential approaches, try reading some qualitative research papers in your field.
If you want to know more about the research process , methodology , research bias , or statistics , make sure to check out some of our other articles with explanations and examples.
Statistics
Research bias
A research design is a strategy for answering your research question . It defines your overall approach and determines how you will collect and analyze data.
A well-planned research design helps ensure that your methods match your research aims, that you collect high-quality data, and that you use the right kind of analysis to answer your questions, utilizing credible sources . This allows you to draw valid , trustworthy conclusions.
Quantitative research designs can be divided into two main categories:
Qualitative research designs tend to be more flexible. Common types of qualitative design include case study , ethnography , and grounded theory designs.
The priorities of a research design can vary depending on the field, but you usually have to specify:
A sample is a subset of individuals from a larger population . Sampling means selecting the group that you will actually collect data from in your research. For example, if you are researching the opinions of students in your university, you could survey a sample of 100 students.
In statistics, sampling allows you to test a hypothesis about the characteristics of a population.
Operationalization means turning abstract conceptual ideas into measurable observations.
For example, the concept of social anxiety isn’t directly observable, but it can be operationally defined in terms of self-rating scores, behavioral avoidance of crowded places, or physical anxiety symptoms in social situations.
Before collecting data , it’s important to consider how you will operationalize the variables that you want to measure.
A research project is an academic, scientific, or professional undertaking to answer a research question . Research projects can take many forms, such as qualitative or quantitative , descriptive , longitudinal , experimental , or correlational . What kind of research approach you choose will depend on your topic.
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There’s a widespread understanding that managing corporate culture is key to business success. Yet few companies articulate their culture in such a way that the words become an organizational reality that molds employee behavior as intended.
All too often a culture is described as a set of anodyne norms, principles, or values, which do not offer decision-makers guidance on how to make difficult choices when faced with conflicting but equally defensible courses of action.
The trick to making a desired culture come alive is to debate and articulate it using dilemmas. If you identify the tough dilemmas your employees routinely face and clearly state how they should be resolved—“In this company, when we come across this dilemma, we turn left”—then your desired culture will take root and influence the behavior of the team.
To develop a culture that works, follow six rules: Ground your culture in the dilemmas you are likely to confront, dilemma-test your values, communicate your values in colorful terms, hire people who fit, let culture drive strategy, and know when to pull back from a value statement.
Start by thinking about the dilemmas your people will face.
The problem.
There’s a widespread understanding that managing corporate culture is key to business success. Yet few companies articulate their corporate culture in such a way that the words become an organizational reality that molds employee behavior as intended.
How to fix it.
Follow six rules: Ground your culture in the dilemmas you are likely to confront, dilemma-test your values, communicate your values in colorful terms, hire people who fit, let culture drive strategy, and know when to pull back from a value.
At the beginning of my career, I worked for the health-care-software specialist HBOC. One day, a woman from human resources came into the cafeteria with a roll of tape and began sticking posters on the walls. They proclaimed in royal blue the company’s values: “Transparency, Respect, Integrity, Honesty.” The next day we received wallet-sized plastic cards with the same words and were asked to memorize them so that we could incorporate them into our actions. The following year, when management was indicted on 17 counts of conspiracy and fraud, we learned what the company’s values really were.
By Julia Love and Mark Bergen
Over one week in mid-May, two companies announced artificial intelligence products built using one of Google’s seminal breakthroughs. On May 13, OpenAI Inc. introduced a new version of the model that underpins ChatGPT, its wildly popular chatbot that relies on a technology known as a transformer that Google first described in a research paper in 2017. The next day, Google announced AI Overviews, a product that offers responses to some searches with answers written by its own system based on the same technology.
The Overviews launch didn’t go well. The feature began offering embarrassing suggestions, such as advising people to ...
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Sngx: valuation change based on reverse split….
By David Bautz, PhD
NASDAQ:SNGX
READ THE FULL SNGX RESEARCH REPORT
Business Update
Reaches Agreement with European Medicines Agency on Second Confirmatory Trial for HyBryte™
On April 3, 2024, Soligenix, Inc. (NASDAQ:SNGX) announced it has reached agreement with the European Medicines Agency (EMA) on the key design elements for a confirmatory Phase 3 trial of HyBryte (synthetic hypericin) for the treatment of cutaneous T cell lymphoma (CTCL).
The proposed Phase 3 FLASH 2 trial will be a randomized, double blind, placebo controlled, multicenter study that will enroll approximately 80 subjects with CTCL. HyBryte will be applied topically to CTCL lesions twice weekly for 18 weeks, with each application followed 21 (± 3) hours later by the administration of visible light at a wavelength of 500 to 650 nm. The light will be administered starting at 6 J/cm 2 and will be increased upwards by 2 J/cm 2 until: 1) the patient experiences a Grade 1 erythema; 2) the patient reaches a maximum dose of 30 J/cm 2 , or 3) the patient cannot tolerate the treatment time, whichever comes first. All of the subjects lesions that are readily available to the visible light source will be treated and 3 to 5 index lesions will be prospectively identified and indexed for the modified composite assessment of index lesions severity (mCAILS) evaluation prior to randomization. The primary endpoint will be assessed by the percent of patients in each treatment group (HyBryte or placebo) achieving a Partial or Complete Response of the treated lesions defined as a ≥50% reduction in the total mCAILS score for the 3-5 index lesions following 18 weeks of treatment compared to the total mCAILS score at baseline. Following treatment, subjects will be followed every 4 weeks for a total of 12 weeks (through Week 30). One interim analysis is planned after 60% of the total subjects have completed the primary endpoint evaluation. A sample size recalculation may be performed after examining the assumptions or the trial can be halted for futility, safety concerns, or overwhelming efficacy. The figure below gives a comparison between the proposed FLASH2 trial and the previously completed FLASH trial. The similarities between the two increases our confidence in a successful outcome for the FLASH2 trial.
We anticipate that the trial will begin enrollment prior to the end of 2024 and topline results are expected in the second half of 2026. The company is continuing discussions with the U.S. Food and Drug Administration (FDA) on an appropriate study design as the agency has expressed a preference for a longer duration comparative study over a placebo-controlled trial.
Orphan Drug Designation for Marburg Marburgvirus Vaccine
On April 15, 2024, Soligenix announced that the U.S. FDA has granted orphan drug designation (ODD) to the active ingredient in MarVax™, the subunit protein vaccine of recombinantly expressed Marburg marburgvirus (MARV) glycoprotein, for “the prevention and post-exposure prophylaxis against MARV infection”.
ODD is designed to assist companies that are developing therapies for rare diseases and disorders, defined as those that affect 200,000 people or fewer in the U.S. Drugs granted ODD receive a seven year term of market exclusivity upon final FDA approval. In addition, financial and regulatory benefits are available including government grants to conduct clinical trials, waiver of FDA user fees, and certain tax credits.
MarVax addresses the potentially lethal Marburg Virus Disease caused by MARV. While vaccines exist for Zaire ebolavirus , they are ineffective against MARV. MarVax is based on the company’s novel vaccine platform that consists of a robust protein manufacturing process, a nano-emulsion adjuvant that induces a strong immune response, and thermostabilization of the adjuvant and antigen in a single vial that is stable at elevated temperatures for extended timeframes.
Patent Protection Extended for Filovirus Vaccine Platform
On April 25, 2024, Soligenix announced it received notice of intent to grant additional patents based on its patent application titled “Compositions and Methods of Manufacturing Trivalent Filovirus Vaccines” in the United Kingdom and South Africa, with other jurisdictions pending. Multiple patents have previously been issued in the U.S. within the same patent family. The described vaccine platform was previously used to successfully produce mono-, bi-, and tri-valent candidates for Zaire ebolavirus , Sudan ebolavirus , and Marburg marburgvirus .
Financial Update
On May 10, 2024, Soligenix announced financial results for the first quarter of 2024. The company reported revenues of $0.1 million for the first quarter of 2024, compared to $0.3 million for the first quarter of 2023. The revenues are derived from government contracts and grants to support the development of SGX943 for treatment of emerging and/or antibiotic resistant infectious diseases, development of CiVax™, and evaluation of HyBryte for expanded treatment in patients with early-stage CTCL. R&D expenses for the first quarter of 2024 were $1.1 million, compared to $0.9 million for the first quarter of 2023. The increase was primarily due to an increase in preliminary costs associated with the anticipated initiation of the Phase 2 study in Behcet’s Disease and the second confirmatory Phase 3 CTCL trial. G&A expenses for the first quarter of 2024 were $1.0 million, compared to $1.2 million for the first quarter of 2023. The decrease was primarily due to a decrease in legal and professional fees.
Soligenix exited the first quarter of 2024 with approximately $4.3 million in cash and cash equivalents. Subsequent to the end of the quarter, the company raised gross proceeds of $4.75 million through the (pre-split) sale of 11.875 million shares at $0.40 per share along with 11.875 million warrants with an exercise price of $0.40 per share and a five-year expiration date. Following the reverse split the company has approximately 987,490 shares outstanding and, when factoring in stock options, warrants, and the potential convertible debt the fully diluted share count is approximately 2.9 million.
We look forward to the initiation of the second confirmatory Phase 3 clinical trial of HyBryte and we’re confident that the FDA will come to an agreement with the company soon on its preferences for the trial. Following the recent reverse split our valuation is now $32.00 per share.
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Brain imaging, known as functional MRI, combined with machine learning can predict a treatment response based on one’s depression “biotype.”
June 17, 2024 - By Rachel Tompa
Researchers have identified six subtypes of depression, paving the way toward personalized treatment. Damerfie - stock.adobe.com
In the not-too-distant future, a screening assessment for depression could include a quick brain scan to identify the best treatment.
Brain imaging combined with machine learning can reveal subtypes of depression and anxiety, according to a new study led by researchers at Stanford Medicine. The study , published June 17 in the journal Nature Medicine , sorts depression into six biological subtypes, or “biotypes,” and identifies treatments that are more likely or less likely to work for three of these subtypes.
Better methods for matching patients with treatments are desperately needed, said the study’s senior author, Leanne Williams , PhD, the Vincent V.C. Woo Professor, a professor of psychiatry and behavioral sciences, and the director of Stanford Medicine’s Center for Precision Mental Health and Wellness . Williams, who lost her partner to depression in 2015, has focused her work on pioneering the field of precision psychiatry .
Around 30% of people with depression have what’s known as treatment-resistant depression , meaning multiple kinds of medication or therapy have failed to improve their symptoms. And for up to two-thirds of people with depression, treatment fails to fully reverse their symptoms to healthy levels.
That’s in part because there’s no good way to know which antidepressant or type of therapy could help a given patient. Medications are prescribed through a trial-and-error method, so it can take months or years to land on a drug that works — if it ever happens. And spending so long trying treatment after treatment, only to experience no relief, can worsen depression symptoms.
“The goal of our work is figuring out how we can get it right the first time,” Williams said. “It’s very frustrating to be in the field of depression and not have a better alternative to this one-size-fits-all approach.”
To better understand the biology underlying depression and anxiety, Williams and her colleagues assessed 801 study participants who were previously diagnosed with depression or anxiety using the imaging technology known as functional MRI, or fMRI, to measure brain activity. They scanned the volunteers’ brains at rest and when they were engaged in different tasks designed to test their cognitive and emotional functioning. The scientists narrowed in on regions of the brain, and the connections between them, that were already known to play a role in depression.
Using a machine learning approach known as cluster analysis to group the patients’ brain images, they identified six distinct patterns of activity in the brain regions they studied.
Leanne Williams
The scientists also randomly assigned 250 of the study participants to receive one of three commonly used antidepressants or behavioral talk therapy. Patients with one subtype, which is characterized by overactivity in cognitive regions of the brain, experienced the best response to the antidepressant venlafaxine (commonly known as Effexor) compared with those who have other biotypes. Those with another subtype, whose brains at rest had higher levels of activity among three regions associated with depression and problem-solving, had better alleviation of symptoms with behavioral talk therapy. And those with a third subtype, who had lower levels of activity at rest in the brain circuit that controls attention, were less likely to see improvement of their symptoms with talk therapy than those with other biotypes.
The biotypes and their response to behavioral therapy make sense based on what they know about these regions of the brain, said Jun Ma, MD, PhD, the Beth and George Vitoux Professor of Medicine at the University of Illinois Chicago and one of the authors of the study. The type of therapy used in their trial teaches patients skills to better address daily problems, so the high levels of activity in these brain regions may allow patients with that biotype to more readily adopt new skills. As for those with lower activity in the region associated with attention and engagement, Ma said it’s possible that pharmaceutical treatment to first address that lower activity could help those patients gain more from talk therapy.
“To our knowledge, this is the first time we’ve been able to demonstrate that depression can be explained by different disruptions to the functioning of the brain,” Williams said. “In essence, it’s a demonstration of a personalized medicine approach for mental health based on objective measures of brain function.”
In another recently published study , Williams and her team showed that using fMRI brain imaging improves their ability to identify individuals likely to respond to antidepressant treatment. In that study, the scientists focused on a subtype they call the cognitive biotype of depression, which affects more than a quarter of those with depression and is less likely to respond to standard antidepressants. By identifying those with the cognitive biotype using fMRI, the researchers accurately predicted the likelihood of remission in 63% of patients, compared with 36% accuracy without using brain imaging. That improved accuracy means that providers may be more likely to get the treatment right the first time. The scientists are now studying novel treatments for this biotype with the hope of finding more options for those who don’t respond to standard antidepressants.
The different biotypes also correlate with differences in symptoms and task performance among the trial participants. Those with overactive cognitive regions of the brain, for example, had higher levels of anhedonia (inability to feel pleasure) than those with other biotypes; they also performed worse on executive function tasks. Those with the subtype that responded best to talk therapy also made errors on executive function tasks but performed well on cognitive tasks.
One of the six biotypes uncovered in the study showed no noticeable brain activity differences in the imaged regions from the activity of people without depression. Williams believes they likely haven’t explored the full range of brain biology underlying this disorder — their study focused on regions known to be involved in depression and anxiety, but there could be other types of dysfunction in this biotype that their imaging didn’t capture.
Williams and her team are expanding the imaging study to include more participants. She also wants to test more kinds of treatments in all six biotypes, including medicines that haven’t traditionally been used for depression.
Her colleague Laura Hack , MD, PhD, an assistant professor of psychiatry and behavioral sciences, has begun using the imaging technique in her clinical practice at Stanford Medicine through an experimental protocol . The team also wants to establish easy-to-follow standards for the method so that other practicing psychiatrists can begin implementing it.
“To really move the field toward precision psychiatry, we need to identify treatments most likely to be effective for patients and get them on that treatment as soon as possible,” Ma said. “Having information on their brain function, in particular the validated signatures we evaluated in this study, would help inform more precise treatment and prescriptions for individuals.”
Researchers from Columbia University; Yale University School of Medicine; the University of California, Los Angeles; UC San Francisco; the University of Sydney; the University of Texas MD Anderson; and the University of Illinois Chicago also contributed to the study.
Datasets in the study were funded by the National Institutes of Health (grant numbers R01MH101496, UH2HL132368, U01MH109985 and U01MH136062) and by Brain Resource Ltd.
About Stanford Medicine
Stanford Medicine is an integrated academic health system comprising the Stanford School of Medicine and adult and pediatric health care delivery systems. Together, they harness the full potential of biomedicine through collaborative research, education and clinical care for patients. For more information, please visit med.stanford.edu .
Psychiatry’s new frontiers
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Horses revolutionized human history with fast mobility 1 . However, the timeline between their domestication and widespread integration as a means of transportation remains contentious 2–4 . Here we assemble a large collection of 475 ancient horse genomes to assess the period when these animals were first reshaped by human agency in Eurasia. We find that reproductive control of the modern domestic lineage emerged ~2,200 BCE (Before Common Era), through close kin mating and shortened generation times. Reproductive control emerged following a severe domestication bottleneck starting no earlier than ~2,700 BCE, and coincided with a sudden expansion across Eurasia that ultimately resulted in the replacement of nearly every local horse lineage. This expansion marked the rise of widespread horse-based mobility in human history, which refutes the commonly-held narrative of large horse herds accompanying the massive migration of steppe peoples across Europe ~3,000 BCE and earlier 3,5 . Finally, we detect significantly shortened generation times at Botai ~3,500 BCE, a settlement from Central Asia associated with corrals and a subsistence economy centered on horses 6,7 . This supports local horse husbandry before the rise of modern domestic bloodlines.
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Author information.
Pablo Librado
Present address: Institut de Biologia Evolutiva (CSIC – Universitat Pompeu Fabra), Barcelona, Spain
Antoine Fages
Present address: Zoological institute, Department of Environmental Sciences, University of Basel, Vesalgasse 1, Basel, Switzerland
Naveed Khan
Present address: Department of Biotechnology, Abdul Wali Khan University, Mardan, Pakistan
Mariya A. Kusliy
Present address: Department of the Diversity and Evolution of Genomes, Institute of Molecular and Cellular Biology SB RAS, 8/2 Academician Lavrentiev Avenue, Novosibirsk, Russia
Charleen Gaunitz
Present address: Lundbeck Foundation GeoGenetics Centre, Globe Institute, University of Copenhagen, Copenhagen, Denmark
Yvette Running Horse Collin
Present address: Taku Skan Skan Wasakliyapi: Global Institute for Traditional Sciences, 522 Seventh Street, Suite 202, Rapid City, South Dakota, USA
Gabriel Renaud
Present address: Department of Health Technology, Section for Bioinformatics, Technical University of Denmark (DTU), Copenhagen, Denmark
Katherine Kanne
Present address: School of Archaeology, University College Dublin, Dublin, Ireland
Centre d’Anthropobiologie et de Génomique de Toulouse, CNRS UMR 5288, Université Paul Sabatier, Faculté de Médecine Purpan, 37 Allées Jules Guesde, Toulouse, France
Pablo Librado, Gaetan Tressières, Lorelei Chauvey, Antoine Fages, Naveed Khan, Stéphanie Schiavinato, Laure Calvière-Tonasso, Mariya A. Kusliy, Charleen Gaunitz, Xuexue Liu, Stefanie Wagner, Clio Der Sarkissian, Andaine Seguin-Orlando, Yvette Running Horse Collin, Gabriel Renaud, Sylvie Duchesne, Éric Crubézy & Ludovic Orlando
Department of the Diversity and Evolution of Genomes, Institute of Molecular and Cellular Biology SB RAS, 8/2 Academician Lavrentiev Avenue, Novosibirsk, Russia
Alexander S. Graphodatsky
Lundbeck Foundation GeoGenetics Centre, Globe Institute, University of Copenhagen, Copenhagen, Denmark
Hugh McColl
INRAE Division Ecology and Biodiversity (ECODIV), Plant Genomic Resources Center (CNRGV), 24 Chemin de Borde Rouge – Auzeville, Castanet Tolosan Cedex, France
Stefanie Wagner
Genoscope, Institut de Biologie François Jacob, CEA, CNRS, Université d’Évry, Université Paris-Saclay, Évry, France
Aude Perdereau
Génomique Métabolique, Genoscope, Institut François Jacob, CEA, CNRS, Univ Évry, Université Paris-Saclay, Évry, France
Jean-Marc Aury & Patrick Wincker
Department of Earth System Science, University of California, Irvine, Irvine, CA, USA
John Southon
Department of Ecology and Evolutionary Biology, University of California Santa Cruz, Santa Cruz, CA, USA
Beth Shapiro
INRAE, GeT-PlaGe, Genotoul, Castanet-Tolosan, France
Olivier Bouchez & Cécile Donnadieu
The Royal Danish Academy, Institute of Conservation, Philip de Langes Allé 10, Copenhagen K, Denmark
Kristian M. Gregersen
National Museum of Denmark, Department for Prehistory, Middle Ages and Renaissance, Ny Vestergade 10, Copenhagen K, Denmark
Mads Dengsø Jessen
Museum Vestsjælland, Forten 10, Holbæk, Denmark
Kirsten Christensen & Lone Claudi-Hansen
UMR 5199 De la Préhistoire à l’Actuel: Culture, Environnement et Anthropologie (PACEA), CNRS, Université de Bordeaux, Pessac Cédex, France
Mélanie Pruvost
Museum of Natural History, Burgring 7, Vienna, Austria
Erich Pucher
Vinkovci Municipal Museum, Trg bana Josipa Šokčevića 16, Vinkovci, Croatia
Hrvoje Vulic & Anita Rapan Papeša
Centre for Applied Bioanthropology, Institute for Anthropological Research, Ljudevita Gaja 32, Zagreb, Croatia
Mario Novak
Ilok Town Museum, Šetalište o. Mladena Barbarića 5, Ilok, Croatia
Andrea Rimpf
Narodni muzej Slovenije, Prešernova 20, Ljubljana, Slovenia
Institute of Animal Breeding and Genetics, Department of Biomedical Sciences, University of Veterinary Medicine Vienna, Veterinärplatz 1, Vienna, Austria
Simone Reiter, Gottfried Brem & Barbara Wallner
Leibniz-Zentrum für Archäologie (LEIZA), Ludwig-Lindenschmit-Forum 1, Mainz, Germany
Christoph Schwall
Department of Prehistory & Western Asian/Northeast African Archaeology, Austrian Archaeological Institute (OeAI), Austrian Academy of Sciences (OeAW), Dominikanerbastei 16, Vienna, Austria
Université Paris-Saclay, AgroParisTech, INRAE, GABI UMR1313, Jouy-en-Josas, France
Éric Barrey & Céline Robert
Ecole Nationale Vétérinaire d’Alfort, 7 Av du Général De Gaulle, Maisons-Alfort, France
Céline Robert & Christophe Degueurce
National Natural History Collections, Edmond J. Safra Campus, Givat Ram, The Hebrew University, Jerusalem, Israel
Liora Kolska Horwitz
Museum Østjylland, Søndergade 1, Grenaa, Denmark
Lutz Klassen
Moesgaard Museum, Department of Archaeology, Moesgaard Allé 20, Højbjerg, Denmark
Uffe Rasmussen
Moesgaard Museum, Department of Archaeological Science and Conservation, Moesgaard Allé 15, Højbjerg, Denmark
Jacob Kveiborg
Department of Archaeology and Heritage Studies, Aarhus University, Højbjerg, Denmark
Niels Nørkjær Johannsen
Institute of Archaeology, Faculty of History, Nicolaus Copernicus University, Toruń, Poland
Daniel Makowiecki
Faculty of Archaeology, Adam Mickiewicz University, Poznań, Poland
Przemysław Makarowicz & Jan Romaniszyn
Institute of Archaeology, Maria Curie-Skłodowska University, Lublin, Poland
Marcin Szeliga
Kremenetsko-Pochaivskii Derzhavnyi Istoriko-arkhitekturnyi Zapovidnik, Kremenets, Kozubskogo 6, <City>, Ukraine
Vasyl Ilchyshyn
Institute of Archaeology, National Academy of Sciences of Ukraine, Volodymyr Ivasiuk Avenue 12, Kyiv, Ukraine
Vitalii Rud
Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
Victoria E. Mullin, Marta Verdugo & Daniel G. Bradley
ICArEHB, Campus de Gambelas, University of Algarve, Faro, Portugal
João L. Cardoso
Universidade Aberta, Lisbon, Portugal
Faculdade de Ciências Humanas e Sociais, Centro de Estudos de Arqueologia, Artes e Ciências do Património, Universidade do Algarve, Faro, Portugal
Maria J. Valente
Centre for Research on Science and Geological Engineering, Universidade Nova de Lisboa, Lisbon, Portugal
Miguel Telles Antunes
Department of Archaeology and History, University of Exeter, Exeter, UK
Carly Ameen, Katherine Kanne & Alan Outram
School of Archaeology and Ancient History, University of Leicester, University Road, Leicester, UK
Richard Thomas
Department of Evolutionary Genetics, Leibniz-Institute for Zoo and Wildlife Research, Berlin, Germany
Arne Ludwig
Albrecht Daniel Thaer-Institute, Faculty of Life Sciences, Humboldt University Berlin, Berlin, Germany
Università degli Studi di Milano, Dipartimento di Beni Culturali e Ambientali, Milan, Italy
Matilde Marzullo, Ornella Prato, Giovanna Bagnasco Gianni & Umberto Tecchiati
Basel University, Department of Environmental Sciences, Integrative Prehistory and Archaeological Science, Basel, Switzerland
José Granado, Angela Schlumbaum, Sabine Deschler-Erb & Monika Schernig Mráz
Institut de Paléontologie Humaine, Fondation Albert Ier, Paris/UMR 7194 HNHP, MNHN-CNRS-UPVD/EPCC Centre Européen de Recherche Préhistorique, Tautavel, France
Nicolas Boulbes
Centre National de Recherche Scientifique, Archéologie des Sociétés Méditeranéennes, Archimède IA-ANR-11-LABX-0032-01, Université Paul Valéry, Montpellier, France
Armelle Gardeisen
Federal Monuments Authority Austria, Department for Digitalization and Knowledge Transfer, Vienna, Austria
Christian Mayer
Landesamt für Denkmalpflege und Archäologie Sachsen-Anhalt – Landesmuseum für Vorgeschichte, Halle (Saale), Germany
Hans-Jürgen Döhle
National Institute of Archaeology, Hungarian National Museum, Budapest, Hungary
Magdolna Vicze
Paleoecology Laboratory, Institute of Plant and Animal Ecology, Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia
Pavel A. Kosintsev
Department of History of the Institute of Humanities, Ural Federal University, Ekaterinburg, Russia
Department of Natural Sciences and Archaeometry, Institute of Archaeology of the Czech Academy of Sciences, Letenská 4, Prague 1, Czechia
René Kyselý
Professional biological consultant, Moskevská 61, Prague 10, Czechia
Lubomír Peške
Department of Archaeology, University of York, c/o Kings Manor, York, UK
Terry O’Connor
Department of Archaeology, History Faculty, Vilnius University, Vilnius, Lithuania
Elina Ananyevskaya
Laboratory for Archaeological Research, Akhmet Baitursynuly Kostanay Regional University, Kostanay, Kazakhstan
Irina Shevnina & Andrey Logvin
Department of Archaeological Heritage Preservation, Institute of Archaeology of the Russian Academy of Sciences, Dm. Ulyanov Street, 19, Moscow, Russia
Alexey A. Kovalev
Department of Innovation and Technology, Ulaanbaatar Science and Technology Park, National University of Mongolia, Bayanzurkh district, Luvsantseveen street, 5th khoroo, Ulaanbaatar, Mongolia
Tumur-Ochir Iderkhangai
Zoological Institute, Russian Academy of Sciences, University Quay, 1, St Petersburg, Russia
Mikhail V. Sablin
Department of Russian Regional Studies, National and State-confessional Relations, Altai State University, Prospekt Lenina, 61, Barnaul, Russia
Petr K. Dashkovskiy
Toraighyrov University, Joint Research Center for Archeological Studies, Avenue Lomova 64, Pavlodar, Kazakhstan
Ilia Merts & Viktor Merts
Department of Archaeology, Ethnography and Museology, Altai State University, Prospekt Lenina, 61, Barnaul, Russia
Ilia Merts & Alexey A. Tishkin
Institute of the History of Material Culture, Russian Academy of Sciences, 18 Dvortsovaya Emb., St. Petersburg, Russian Federation
Aleksei K. Kasparov & Vladimir V. Pitulko
Peter the Great Museum of Anthropology and Ethnography (Kunstkamera), Russian Academy of Sciences, 3, Universitetskaya nab., St Petersburg, Russia
Vladimir V. Pitulko
Osteoarchaeology Practice and Research Center and Department of Anatomy, Faculty of Veterinary Medicine, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
Archaeology Department, Ankara University, Ankara, Türkiye
Aliye Öztan
Department of Anthropology, Alumni Building, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Benjamin S. Arbuckle
Kh. Ibragimov Complex Institute of the Russian Academy of Sciences (CI RAS), 21 a V. Alieva (Staropromyslovskoe highway), Grozny, Chechen Republic, Russia
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Institute of Archaeology, Russian Academy of Sciences, Dm. Uljanova, 19, Moscow, Russia
Sergey Demidenko & Dmitriy S. Korobov
State Historical Museum, Department of Archaeological Monuments, Moscow, Red Square 1, Moscow, Russian Federation
Anna Kadieva
Institute for Caucasus Archaeology, Ul. Katkhanova 30, Nalchik, Russian Federation
Biyaslan Atabiev
Östra Greda Research Group, Vialmvägen 5, Borgholm, Sweden
Marie Sundqvist
Department of Animal Breeding and Genetics, Swedish University of Agricultural Sciences, Uppsala, Sweden
Gabriella Lindgren
Center for Animal Breeding and Genetics, Department of Biosystems, KU Leuven, Leuven, Belgium
Institut d’Arqueologia de la Universitat de Barcelona (IAUB), Seminari d’Estudis i Recerques Prehistoriques (SERP-UB), Universitat de Barcelona (UB), Barcelona, Spain
F. Javier López-Cachero & Silvia Albizuri
Department of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova 55, Zagreb, Croatia
Tajana Trbojević Vukičević
Department of Archaeology, Faculty of Humanities and Social Sciences, University of Zagreb, I. Lučića 3, Zagreb, Croatia
Marcel Burić
Institute for Anthropological Research, Ljudevita Gaja 32, Zagreb, Croatia
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Faculty of Arts and Humanities (Archaeology), University of Southampton, Southampton, UK
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C/Major, 20, La Tallada d’Empordà, <City>, Spain
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Mosaïques Archéologie, Espace d’activités de la Barthe, Cournonterral, France
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IEC-Institut d’Estudis Catalans (Union Académique Internationale), Carrer Del Carme, 47, Barcelona, Spain
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Departament d’Història i Arqueologia, Facultat de Geografia i Història, Universitat de Barcelona, Carrer Montalegre 6-8, Barcelona, Spain
Joan Sanmartí
Ecole Tunisienne d’Histoire et d’Anthropologie, <City>, Tunisia
Nabil Kallala
University of Tunis, Institut National du Patrimoine, Tunis, Tunisia
Nabil Kallala & Bouthéina Maraoui-Telmini
Consell Insular d’Eivissa, Avenida de España 49, Eivissa, Illes Balears, Spain
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ICREA, Catalan Institution for Research and Advanced Studies, Passeig Lluís Companys 23, Barcelona, Spain
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ICAC (Catalan Institute of Classical Archaeology), Pl. del Rovellat, s/n., Tarragona, Spain
Archaeology of Social Dynamics (ASD, 2021SGR_00501), Institució Milà i Fontanals, Consejo Superior de Investigaciones Científicas (IMF-CSIC), C/Egipcíaques 15, Barcelona, Spain
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UNIARQ - Unidade de Arqueologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal
Centre National de Recherche Scientifique, Muséum national d’Histoire naturelle, Archéozoologie, Archéobotanique (AASPE), CP 56, Paris, France
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Max Planck Institute of Geoanthropology, Kahlaische Str. 10, Jena, Germany
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Institute of Archaeology, Mongolian Academy of Science, Ulaanbaatar, Mongolia
Department of Folk Studies and Anthropology, Western Kentucky University, Bowling Green, USA
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Archaeological Research Center and Department of Anthropology and Archaeology, National University of Mongolia, Ulaanbaatar, Mongolia
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University of Tehran, Central Laboratory, Bioarchaeology Laboratory, Archaeozoology section, Jalalieh street 6, Tehran, Iran
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Research Institute and Museum of Anthropology, Lomonosov Moscow State University, Moscow, Russia
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Nasledie Cultural Heritage Unit, Stavropol, Russia
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This Supplementary Information file contains the following sections: Section 1. Archaeological Contexts and Sample Information; Section 2. Radiocarbon Dating; Section 3. Genome Analyses; Section 4. Measuring temporal variations in the horse generation time; Supplementary References.
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Librado, P., Tressières, G., Chauvey, L. et al. Widespread horse-based mobility arose around 2,200 BCE in Eurasia. Nature (2024). https://doi.org/10.1038/s41586-024-07597-5
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Title: evaluating the retrieval component in llm-based question answering systems.
Abstract: Question answering systems (QA) utilizing Large Language Models (LLMs) heavily depend on the retrieval component to provide them with domain-specific information and reduce the risk of generating inaccurate responses or hallucinations. Although the evaluation of retrievers dates back to the early research in Information Retrieval, assessing their performance within LLM-based chatbots remains a challenge. This study proposes a straightforward baseline for evaluating retrievers in Retrieval-Augmented Generation (RAG)-based chatbots. Our findings demonstrate that this evaluation framework provides a better image of how the retriever performs and is more aligned with the overall performance of the QA system. Although conventional metrics such as precision, recall, and F1 score may not fully capture LLMs' capabilities - as they can yield accurate responses despite imperfect retrievers - our method considers LLMs' strengths to ignore irrelevant contexts, as well as potential errors and hallucinations in their responses.
Subjects: | Computation and Language (cs.CL); Information Retrieval (cs.IR) |
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One in five adults infected with COVID-19 may still be suffering its effects months after their diagnosis, according to new research out of the United States.
An investigation by more than two dozen researchers found while the average time of recovery was 20 days, an estimated 22.5 per cent failed to recover 90 days after infection.
The report, based out of the United States and published in the Journal of the American Medical Association, mirrored recent reporting by Australian researchers.
The peer-reviewed study used data from the Collaborative Cohort of Cohorts for COVID-19 Research (C4R), a long-term collaboration of 14 different studies across the US.
Some of the studies have been following its own participants for up to 50 years, meaning they can now compare their health pre- and post-COVID-19 diagnosis.
A total of 4,708 participants were asked whether they were "completely recovered from COVID-19".
Once they confirmed their recovery, they were asked how long it had taken.
"[We] found that one in five adults infected with SARS-CoV-2 did not fully recover by three months post-infection in a racially and ethnically diverse US population-based sample," the report said.
"Recovery by 90 days was less likely in women and participants with pre-pandemic clinical cardiovascular disease.
"Vaccination prior to infection and infection during the Omicron variant wave were associated with greater recovery … results were similar for reinfections."
The research team noted the results may have been limited by the self-reported recovery time and the "potential for measurement error, uncontrolled confounding and selection bias".
Dr Mulu Abraha Woldegiorgis, a researcher at the Australian National University (ANU), told the ABC it was "interesting" to see the findings classified by "before and after Omicron".
"The prevalence [of long COVID] during Omicron was the same as ours," she said.
"They use slightly different definitions and methodology, but even with that the prevalence was high. It shows us that long COVID is still a public health concern globally."
Four years after the beginning of the pandemic, much about "long COVID" remains a mystery for health officials.
Earlier this year Queensland's chief health officer called for the term "long COVID" to be scrapped despite stating the symptoms were "real".
"Using this term long COVID implies this virus has some unique, exceptional and sinister property that differentiates it form other viruses," Dr John Gerrard said.
"I want to make it clear that the symptoms that some patients describe after having COVID-19 are real. We believe they are real."
A study of more than 11,000 Australians who had tested positive for COVID-19 has had similar results — almost one in five were still experiencing symptoms three months after a 2022 diagnosis.
The joint ANU and Western Australia Department of Health study, released in March, found 90 per cent of participants with long COVID were suffering multiple symptoms.
Tiredness, fatigue, "brain fog", sleep problems, coughing, and changes in their menstrual cycle were frequently reported.
"Among respondents with long COVID who had worked or studied prior to their infection, 15.2 per cent had reduced their number of hours, and 2.7 per cent had not returned to work at all," the report said.
The researchers also noted long COVID was more prevalent in its sample than the levels reported by other studies in the United Kingdom and Canada.
Dr Woldegiorgis was the lead researcher on the ANU report. She said Australia presented a "unique" cohort of highly vaccinated people.
"You have multiple symptoms, it's not just cough, or tiredness, they have multiple symptoms and that affects them," she said.
"A longer term assessment is important. What we saw was by 90 days, so a long term follow-up may provide additional information on how people are going in a year or two.
"What's the recovery period? Are they recovering soon or is the term longer?"
The report also found those who had been vaccinated were less at risk of developing long COVID.
"I want to stress the importance of vaccination," Dr Woldegiorgis said.
"In Australia the vast majority were vaccinated ... at least one dose prevents long COVID compared to no vaccination."
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