SSCP reality - Systems Security Certified Practioner Updated: 2023
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Exam Code: SSCP Systems Security Certified Practioner reality November 2023 by Killexams.com team|
SSCP Systems Security Certified Practioner
Exam Title :
ISC2 Systems Security Certified Practitioner (SSCP)
Exam ID :
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Real Questions :
ISC2 SSCP Real Questions
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ISC2 SSCP Certification VCE Practice Test
Access Controls 16%
Implement and maintain authentication methods
- Single/multifactor authentication
- Single sign-on
- Device authentication
- Federated access
Support internetwork trust architectures
- Trust relationships (e.g., 1-way, 2-way, transitive)
- Third party connections
Participate in the identity management lifecycle
- Identity and Access Management (IAM) systems
Implement access controls
Security Operations and Administration 15%
Comply with codes of ethics
- (ISC)² Code of Ethics
- Organizational code of ethics
Understand security concepts
- Least privilege
- Separation of duties
Document, implement, and maintain functional security controls
- Deterrent controls
- Preventative controls
- Detective controls
- Corrective controls
- Compensating controls
Participate in asset management
- Lifecycle (hardware, software, and data)
- Hardware inventory
- Software inventory and licensing
- Data storage
Implement security controls and assess compliance
- Technical controls (e.g., session timeout, password aging)
- Physical controls (e.g., mantrap, cameras, locks)
- Administrative controls (e.g., security policies and standards, procedures, baselines)
- Periodic audit and review
Participate in change management
- Execute change management process
- Identify security impact
- Testing /implementing patches, fixes, and updates (e.g., operating system, applications, SDLC)
Participate in security awareness and training
Participate in physical security operations (e.g., data center assessment, badging)
Risk Identification, Monitoring, and Analysis 15%
Understand the risk management process
- Risk visibility and reporting (e.g., risk register, sharing threat intelligence, Common Vulnerability Scoring System (CVSS))
- Risk management concepts (e.g., impact assessments, threat modelling, Business Impact Analysis (BIA))
- Risk management frameworks (e.g., ISO, NIST)
- Risk treatment (e.g., accept, transfer, mitigate, avoid, recast)
Perform security assessment activities
- Participate in security testing
- Interpretation and reporting of scanning and testing results
- Remediation validation
- Audit finding remediation
Operate and maintain monitoring systems (e.g., continuous monitoring)
- Events of interest (e.g., anomalies, intrusions, unauthorized changes, compliance monitoring)
- Source systems
- Legal and regulatory concerns (e.g., jurisdiction, limitations, privacy)
Analyze monitoring results
- Security baselines and anomalies
- Visualizations, metrics, and trends (e.g., dashboards, timelines)
- Event data analysis
- Document and communicate findings (e.g., escalation)
Incident Response and Recovery 13%
Support incident lifecycle
- Detection, analysis, and escalation
- Lessons learned/implementation of new countermeasure
Understand and support forensic investigations
- Legal and ethical principles
- Evidence handling (e.g., first responder, triage, chain of custody, preservation of scene)
Understand and support Business Continuity Plan (BCP) and Disaster Recovery Plan (DRP) activities
- Emergency response plans and procedures (e.g., information system contingency plan)
- Interim or alternate processing strategies
- Restoration planning
- Backup and redundancy implementation
- Testing and drills
Understand fundamental concepts of cryptography
- Symmetric/asymmetric encryption/Elliptic Curve Cryptography (ECC)
- Non-repudiation (e.g., digital signatures/certificates, HMAC, audit trail)
- Encryption algorithms (e.g., AES, RSA)
- Key strength (e.g., 256, 512, 1024, 2048 bit keys)
- Cryptographic attacks, cryptanalysis, and counter measures
Understand reasons and requirements for cryptography
- Integrity and authenticity
- Data sensitivity (e.g., PII, intellectual property, PHI)
Understand and support secure protocols
- Services and protocols (e.g., IPSec, TLS, S/MIME, DKIM)
- Common use cases
- Limitations and vulnerabilities
Understand Public Key Infrastructure (PKI) systems
Fundamental key management concepts (e.g., key rotation, key composition, key creation, exchange, revocation, escrow)
- Web of Trust (WOT) (e.g., PGP, GPG)
Network and Communications Security 16%
Understand and apply fundamental concepts of networking
- OSI and TCP/IP models
- Network topographies (e.g., ring, star, bus, mesh, tree)
- Network relationships (e.g., peer to peer, client server)
- Transmission media types (e.g., fiber, wired, wireless)
- Commonly used ports and protocols
Understand network attacks and countermeasures (e.g., DDoS, man-in-the-middle, DNS poisoning)
Manage network access controls
- Network access control and monitoring (e.g., remediation, quarantine, admission)
- Network access control standards and protocols (e.g., IEEE 802.1X, Radius, TACACS)
- Remote access operation and configuration (e.g., thin client, SSL VPN, IPSec VPN, telework)
Manage network security
- Logical and physical placement of network devices (e.g., inline, passive)
- Segmentation (e.g., physical/logical, data/control plane, VLAN, ACLs)
- Secure device management
Operate and configure network-based security devices
- Firewalls and proxies (e.g., filtering methods)
- Network intrusion detection/prevention systems
- Routers and switches
- Traffic-shaping devices (e.g., WAN optimization, load balancing)
Operate and configure wireless technologies (e.g., bluetooth, NFC, WiFi)
- Transmission security
- Wireless security devices (e.g.,WIPS, WIDS)
Systems and Application Security 15%
Identify and analyze malicious code and activity
- Malware (e.g., rootkits, spyware, scareware, ransomware, trojans, virus, worms, trapdoors, backdoors, and remote access trojans)
- Malicious code countermeasures (e.g., scanners, anti-malware, code signing, sandboxing)
- Malicious activity (e.g., insider threat, data theft, DDoS, botnet)
- Malicious activity countermeasures (e.g., user awareness, system hardening, patching, sandboxing, isolation)
Implement and operate endpoint device security
- Host-based firewalls
- Application white listing
- Endpoint encryption
- Trusted Platform Module (TPM)
- Mobile Device Management (MDM) (e.g., COPE, BYOD)
- Secure browsing (e.g., sandbox)
Operate and configure cloud security
- Deployment models (e.g., public, private, hybrid, community)
- Service models (e.g., IaaS, PaaS and SaaS)
- Virtualization (e.g., hypervisor)
- Legal and regulatory concerns (e.g., privacy, surveillance, data ownership, jurisdiction, eDiscovery)
- Data storage and transmission (e.g., archiving, recovery, resilience)
- Third party/outsourcing requirements (e.g., SLA, data portability, data destruction, auditing)
- Shared responsibility model
Operate and secure virtual environments
- Software-defined networking
- Virtual appliances
- Continuity and resilience
- Attacks and countermeasures
- Shared storage
|Systems Security Certified Practioner|
ISC2 Practioner reality
Other ISC2 examsCISSP Certified Information Systems Security Professional - 2023
CSSLP Certified Secure Software Lifecycle Professional
ISSAP Information Systems Security Architecture Professional (ISSAP)
ISSEP Information Systems Security Engineering Professional
ISSMP Information Systems Security Management Professional
SSCP Systems Security Certified Practioner
CCSP Certified Cloud Security Professional (CCSP)
HCISPP HealthCare Information Security and Privacy Practitioner
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Systems Security Certified Practioner
A Black Hat is someone who uses his skills for offensive purpose. They do not seek
authorization before they attempt to comprise the security mechanisms in place.
"Grey Hats" are people who sometimes work as a White hat and other times they will
work as a "Black Hat", they have not made up their mind yet as to which side they
prefer to be.
The following are incorrect answers:
All the other choices could be possible reasons but the best one today is really for
References used for this Question:
What best describes a scenario when an employee has been shaving off pennies from
multiple accounts and depositing the funds into his own bank account?
A. Data fiddling
B. Data diddling
C. Salami techniques
D. Trojan horses
Source: HARRIS, Shon, All-In-One CISSP Certification test Guide, McGraw
Hill/Osborne, 2001, Page 644.
Java is not:
C. Architecture Specific.
JAVA was developed so that the same program could be executed on multiple
hardware and operating system platforms, it is not Architecture Specific.
The following answers are incorrect:
Object-oriented. Is not correct because JAVA is object-oriented. It should use the
object- oriented programming methodology.
Distributed. Is incorrect because JAVA was developed to be able to be distrubuted,
run on multiple computer systems over a network.
Multithreaded. Is incorrect because JAVA is multi-threaded that is calls to
subroutines as is the case with object-oriented programming.
A virus is a program that can replicate itself on a system but not necessarily spread
itself by network connections.
What is malware that can spread itself over open network connections?
D. Logic Bomb
Computer worms are also known as Network Mobile Code, or a virus-like bit of code
that can replicate itself over a network, infecting adjacent computers.
A computer worm is a standalone malware computer program that replicates itself in
order to spread to other computers. Often, it uses a computer network to spread itself,
relying on security failures on the target computer to access it. Unlike a computer
virus, it does not need to attach itself to an existing program. Worms almost always
cause at least some harm to the network, even if only by consuming bandwidth,
whereas viruses almost always corrupt or modify files on a targeted computer.
A notable example is the SQL Slammer computer worm that spread globally in ten
minutes on January 25, 2003. I myself came to work that day as a software tester and
found all my SQL servers infected and actively trying to infect other computers on
the test network.
A patch had been released a year prior by Microsoft and if systems were not patched
and exposed to a 376 byte UDP packet from an infected host then system would
Ordinarily, infected computers are not to be trusted and must be rebuilt from scratch
but the vulnerability could be mitigated by replacing a single vulnerable dll called
Replacing that with the patched version completely disabled the worm which really
illustrates to us the importance of actively patching our systems against such network
The following answers are incorrect:
- Rootkit: Sorry, this isn't correct because a rootkit isn't ordinarily classified as
network mobile code like a worm is. This isn't to say that a rootkit couldn't be
included in a worm, just that a rootkit isn't usually classified like a worm. A rootkit is
a stealthy type of software, typically malicious, designed to hide the existence of
certain processes or programs from normal methods of detection and enable
continued privileged access to a computer. The term rootkit is a concatenation of
"root" (the traditional name of the privileged account on Unix operating systems) and
the word "kit" (which refers to the software components that implement the tool). The
term "rootkit" has negative connotations through its association with malware.
- Adware: Incorrect answer. Sorry but adware isn't usually classified as a worm.
Adware, or advertising-supported software, is any software package which
automatically renders advertisements in order to generate revenue for its author. The
advertisements may be in the user interface of the software or on a screen presented
to the user during the installation process. The functions may be designed to analyze
which Internet sites the user visits and to present advertising pertinent to the types of
goods or services featured there. The term is sometimes used to refer to software that
displays unwanted advertisements.
- Logic Bomb: Logic bombs like adware or rootkits could be spread by worms if they
exploit the right service and gain root or admin access on a computer.
The following reference(s) was used to create this Question:
The CCCure CompTIA Holistic Security+ Tutorial and CBT and
Which of the following technologies is a target of XSS or CSS (Cross-Site Scripting)
A. Web Applications
B. Intrusion Detection Systems
D. DNS Servers
XSS or Cross-Site Scripting is a threat to web applications where malicious
code is placed on a website that attacks the use using their existing authenticated
session status. Cross-Site Scripting attacks are a type of injection problem, in which
malicious scripts are injected into the otherwise benign and trusted web sites. Cross-
site scripting (XSS) attacks occur when an attacker uses a web application to send
malicious code, generally in the form of a browser side script, to a different end user.
Flaws that allow these attacks to succeed are quite widespread and occur anywhere a
web application uses input from a user in the output it generates without validating or
An attacker can use XSS to send a malicious script to an unsuspecting user. The end
user’s browser has no way to know that the script should not be trusted, and will
execute the script. Because it thinks the script came from a trusted source, the
malicious script can access any cookies, session tokens, or other sensitive information
retained by your browser and used with that site. These scripts can even rewrite the
content of the HTML page.
Configure your IPS - Intrusion Prevention System to detect and suppress this traffic.
Input Validation on the web application to normalize inputted data.
Set web apps to bind session cookies to the IP Address of the legitimate user and only
permit that IP Address to use that cookie.
See the XSS (Cross Site Scripting) Prevention Cheat Sheet See the Abridged XSS
Prevention Cheat Sheet
See the DOM based XSS Prevention Cheat Sheet
See the OWASP Development Guide article on Phishing.
See the OWASP Development Guide article on Data Validation. The following
answers are incorrect:
Intrusion Detection Systems: Sorry. IDS Systems aren't usually the target of XSS
attacks but a properly-configured IDS/IPS can "detect and report on malicious string
and suppress the TCP connection in an attempt to mitigate the threat.
Firewalls: Sorry. Firewalls aren't usually the target of XSS attacks.
DNS Servers: Same as above, DNS Servers aren't usually targeted in XSS attacks but
they play a key role in the domain name resolution in the XSS attack process.
The following reference(s) was used to create this Question:
CCCure Holistic Security+ CBT and Curriculum and
https://www.owasp.org/index.php/Cross-site Scripting %28XSS%29
Which of the following should be performed by an operator?
A. Changing profiles
B. Approving changes
C. Adding and removal of users
D. Installing system software
Of the listed tasks, installing system software is the only task that should normally be
performed by an operator in a properly segregated environment.
Source: MOSHER, Richard & ROTHKE, Ben, CISSP CBK Review presentation on
At which of the basic phases of the System Development Life Cycle are security
B. System Design Specifications
C. Development and Implementation
D. Functional Requirements Definition
During the Functional Requirements Definition the project management and systems
development teams will conduct a comprehensive analysis of current and possible
future functional requirements to ensure that the new system will meet end-user
needs. The teams also review the documents from the project initiation phase and
make any revisions or updates as needed. For smaller projects, this phase is often
subsumed in the project initiation phase. At this point security requirements should be
The Development Life Cycle is a project management tool that can be used to plan,
execute, and control a software development project usually called the Systems
Development Life Cycle (SDLC).
The SDLC is a process that includes systems analysts, software engineers,
programmers, and end users in the project design and development. Because there is
no industry-wide SDLC, an organization can use any one, or a combination of SDLC
The SDLC simply provides a framework for the phases of a software development
project from defining the functional requirements to implementation. Regardless of
the method used, the SDLC outlines the essential phases, which can be shown
together or as separate elements. The model chosen should be based on the project.
For example, some models work better with long-term, complex projects, while
others are more suited for short-term projects. The key element is that a formalized
SDLC is utilized.
The number of phases can range from three basic phases (concept, design, and
implement) on up.
The basic phases of SDLC are:
Project initiation and planning Functional requirements definition System design
specifications Development and implementation
Documentation and common program controls
Testing and evaluation control, (certification and accreditation) Transition to
The system life cycle (SLC) extends beyond the SDLC to include two additional
phases: Operations and maintenance support (post-installation)
Revisions and system replacement
System Design Specifications
This phase includes all activities related to designing the system and software. In this
phase, the system architecture, system outputs, and system interfaces are designed.
Data input, data flow, and output requirements are established and security features
are designed, generally based on the overall security architecture for the company.
Development and Implementation
During this phase, the source code is generated, test scenarios and test cases are
developed, unit and integration testing is conducted, and the program and system are
documented for maintenance and for turnover to acceptance testing and production.
As well as general care for software quality, reliability, and consistency of operation,
particular care should be taken to ensure that the code is analyzed to eliminate
common vulnerabilities that might lead to security exploits and other risks.
Documentation and Common Program Controls
These are controls used when editing the data within the program, the types of
logging the program should be doing, and how the program versions should be stored.
A large number of such controls may be needed, see the reference below for a full list
In the acceptance phase, preferably an independent group develops test data and tests
the code to ensure that it will function within the organization’s environment and that
it meets all the functional and security requirements. It is essential that an
independent group test the code during all applicable stages of development to
prevent a separation of duties issue. The goal of security testing is to ensure that the
application meets its security requirements and specifications. The security testing
should uncover all design and implementation flaws that would allow a user to violate
the software security policy and requirements. To ensure test validity, the application
should be tested in an environment that simulates the production environment. This
should include a security certification package and any user documentation.
Certification and Accreditation (Security Authorization)
Certification is the process of evaluating the security stance of the software or system
against a predetermined set of security standards or policies. Certification also
examines how well the system performs its intended functional requirements. The
certification or evaluation document should contain an analysis of the technical and
nontechnical security features and countermeasures and the extent to which the
software or system meets the security requirements for its mission and operational
Transition to Production (Implementation)
During this phase, the new system is transitioned from the acceptance phase into the
live production environment. Activities during this phase include obtaining security
accreditation; training the new users according to the implementation and training
schedules; implementing the system, including installation and data conversions; and,
if necessary, conducting any parallel operations.
Revisions and System Replacement
As systems are in production mode, the hardware and software baselines should be
subject to periodic evaluations and audits. In some instances, problems with the
application may not be defects or flaws, but rather additional functions not currently
developed in the application. Any changes to the application must follow the same
SDLC and be recorded in a change management system. Revision reviews should
include security planning and procedures to avoid future problems. Periodic
application audits should be conducted and include documenting security incidents
when problems occur. Documenting system failures is a valuable resource for
justifying future system enhancements.
Below you have the phases used by NIST in it's 800-63 Revision 2 document
As noted above, the phases will vary from one document to another one. For the
purpose of the test use the list provided in the official ISC2 Study book which is
presented in short form above. Refer to the book for a more detailed description of
activities at each of the phases of the SDLC.
However, all references have very similar steps being used. As mentioned in the
official book, it could be as simple as three phases in it's most basic version (concept,
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Your mind is very powerful. Yet, if you're like most people, you probably spend very little time reflecting on the way you think. After all, who thinks about thinking?
But, the way you think about yourself turns into your reality.
The Link Between Thoughts, Feelings And Behavior
Your thoughts are aÂ catalyst for self-perpetuating cycles. What you think directly influences how you feel and how you behave. So if you think youâ€™re a failure, youâ€™ll feel like a failure. Then, youâ€™ll act like a failure, which reinforces your belief that you must be a failure.
I see this happen all the time in my therapy office. Someone will come in saying, â€śIâ€™m just not good enough to advance in my career.â€ť That assumption leads her to feel discouraged and causes her to put in less effort. That lack of effort prevents her from getting a promotion.
Or, someone will say, â€śIâ€™m really socially awkward.â€ť So when that individual goes to a social gathering, he stays to in the corner by himself. When no one speaks to him, it reinforces his belief that he must be socially awkward.
Your Beliefs Get Reinforced
Once you draw a conclusion about yourself, youâ€™re likely to do two things; look for evidence that reinforces your belief and discount anything that runs contrary to your belief.
Someone who develops the belief that heâ€™s a failure, for example, will view each mistake as proof that heâ€™s not good enough. When he does succeed at something, heâ€™ll chalk it up to luck.
Consider for a minute that it might not be your lack of talent or lack of skills that are holding you back. Instead, it might be your beliefs that keep you from performing at your peak.
Creating a more positive outlook can lead to better outcomes. Thatâ€™s not to say positive thoughts have magical powers. But optimistic thoughts Â lead to productive behavior, which increases your chances of a successful outcome.
Challenge Your Conclusions
Take a look at the labels youâ€™ve placed on yourself. Maybe youâ€™ve declared yourself incompetent. Or perhaps youâ€™ve decided youâ€™re a bad leader.
Remind yourself that you donâ€™t have to allow those beliefs to restrict your potential. Just because you think something, doesnâ€™t make it true.
The good news is, you can change how you think. You can alter your perception and change your life. Here are two ways to challenge your beliefs:
â€˘ Look for evidence to the contrary. Take note of any times when your beliefs werenâ€™t reinforced. Acknowledging exceptions to the rule will remind you that your belief isnâ€™t always true.
â€˘ Challenge your beliefs.Â Perform behavioral experiments that test how true your beliefs really are. If you think youâ€™re not good enough, do something that helps you to feel worthy. If youâ€™ve labeled yourself too wimpy to step outside of your comfort zone, force yourself to do something that feels a little uncomfortable.
With practice, you can train your brain to think differently. When you give up those self-limiting beliefs, youâ€™ll be better equipped to reach your greatest potential.
[Devin Coldewey] shared his experiences with some of the more unusual VR concepts on display at SIGGRAPH 2023. Some of these ideas are pretty interesting in their own right, and even if they arenâ€™t going to actually become commercial products they give some insight into the kinds of problems that are being worked on. Read on to see if anything sparks ideas of your own.
In the area of haptics and physical feedback, Sony shared research prototypes that look like short batons in which are hidden movable weights. These weights can shift up or down on demand, altering their center of gravity. [Devin] states that these units had a mild effect on their own, but when combined with VR visuals the result was impressive. Thereâ€™s a video demonstration of how they work. Continue memorizing â€śSee Some Of The Stranger VR Ideas From SIGGRAPHâ€ť
Paying extra for exotic vitamins in skin creams that promise to erase fine lines and prevent wrinkles will get you little more than an empty wallet, according to dermatologists. Although many face creams contain vitamins known as antioxidants, very few are actually effective in preventing or reversing skin damage.
"Despite advertising claims, almost all available topical formulations contain very low concentrations of antioxidants that are not well absorbed by the skin," said Karen E. Burke, MD, in a presentation to the American Academy of Dermatology's annual meeting this week in New Orleans. "There are three antioxidants that have been proven to decrease the effect of the sun on the skin and actually prevent further damage: selenium, vitamin E, and vitamin C."
Antioxidants are known to prevent agents called free radicals from damaging cells in the body and the skin. Free radicals are a result of normal body processes, but they can also be created by exposure to various environmental factors such as smoking or ultraviolet (UV) radiation from the sun and can speed up the aging process.
Burke says the problem with applying antioxidants to the skin to fight aging is that they aren't very well absorbed or only have short-term effects. But new research presented at the dermatology conference suggests more effective formulations to deliver two of these antioxidants directly to the skin that needs it may soon be available.
The mineral selenium helps protect the body from cancers, including skin cancer caused by sun exposure. It also preserves tissue elasticity and slows down the aging and hardening of tissues associated with oxidation. Dietary sources of the mineral include whole grain cereals, seafood, garlic, and eggs.
Recent animal studies have found that when selenium is taken orally or through the skin in the form of L-selenomethionine, it provided protection against both everyday and excessive UV damage. A study also showed selenium also delayed the development of skin cancer in the animals.
Burke says those results are promising, but studies are still needed in humans.
Experts consider vitamin E to be the most important antioxidant because it protects cell membranes and prevents damages to enzymes associated with them. Natural sources of vitamin E include vegetable oils such as sunflower oil, grains, oats, nuts, and dairy products.
New laboratory studies suggest vitamin E helps inactivate free radicals, making them less likely to cause damage. Several other studies have shown applying vitamin E to the skin can reduce damage caused by sun exposure and limit the production of cancer-causing cells.
"For additional sun protection, individuals may consider taking vitamin E supplements," said Burke, in a release. "Supplementation with vitamin E in 400 milligrams a day has been noted to reduce photodamage, wrinkles and Improve skin texture."
Vitamin C is the most common antioxidant found in the skin. It's also found in vegetables and citrus fruits. Like vitamin E, vitamin C is considered important in repairing free radicals and preventing them from becoming cancerous or accelerating the aging process.
Since vitamin C is most prevalent in the skin, the skin is the organ that suffers most from environmental stressors. Smoking, sun exposure, and pollution rob the nutrient from our bodies, says Burke.
"Even minimal UV exposure can decrease the vitamin C levels in the skin by 30 percent, while exposure from the ozone of city pollution can decrease the level by 55 percent," said Burke in a release.
Creating a skin cream that carries a useful dose of vitamin C is difficult because it reacts immediately when exposed to oxygen. Several clinical trials examining more stable, effective formulations are currently under way.
Few diagnoses in psychiatry have stirred up as much controversy as Attention-Deficit Hyperactivity Disorder (ADHD). For some critics, the label "ADHD" is merely an excuse for frustrated parents and overzealous doctors to "medicate away" a child's annoying behaviors. Other critics concede that ADHD exists, but believe it is vastly overdiagnosed. While there's sometimes a grain of truth to these claims, there are now convincing clinical and research studies showing that ADHD is a real disorder with a strong biological basis -- and that, if anything, ADHD is often underdiagnosed.
While ADHD is not inherited like blond hair or blue eyes, the odds that both members of an identical twin pair will have ADHD are much higher than the odds for fraternal twins. This suggests that the more closely one twin's genes match the other's, the more likely they are to share the disorder. Furthermore, studies of brain activity have shown that in ADHD children, the frontal regions of the brain are actually underactive. This may seem puzzling, given that "hyperactivity" is usually linked with ADHD. But since the frontal regions of the brain exert a calming influence on more primitive regions, frontal-lobe underactivity may mean that these regions are not "keeping the lid on" disruptive behaviors.
Contrary to a popular notion, there is no convincing evidence that ADHD is caused by too much sugar in the diet. Furthermore, the last 20 years have made it clear that kids with ADHD do not always "outgrow" the disorder. Between 4 percent and 30 percent of ADHD children will show symptoms in adulthood, depending on whether we count only the full-blown disorder or even a few ADHD symptoms.
What does ADHD look like in children? Consider Shawn, an 11-year-old who was a "problem kid" for more than five years. Beginning at the age of 5, Shawn had trouble sitting still in class. Teachers would complain that Shawn would fidget, squirm in his seat, or even leave his seat after only a half-hour of class. Sometimes he would run around the classroom, despite the teacher's firm instructions to sit down. Shawn had great difficulty paying attention to the teacher, and seemed to be "off in a cloud" during class. He almost never followed through on homework assignments, chores or duties, either in school or at home. Any task that required more than a few minutes of sustained attention was beyond Shawn's ability. He was easily distracted by the slightest noise, and had trouble remembering even simple instructions. At times Shawn would blurt out answers before the question had been completed, and he had difficulty waiting his turn in line. Sometimes Shawn would disrupt the play of other children, demanding to be let in to their activities.
While this picture is fairly typical of boys with ADHD, this disorder may declare itself in other ways. While many studies suggest that ADHD is more common in boys than in girls, this may reflect the fact that girls tend to be less disruptive than boys, and thus prompt fewer complaints from parents and teachers. Thus, severe attentional problems in girls may be due to ADHD, even though outward behavior seems normal. Of course, many other problems can cause poor attention in children, ranging from boredom to poor teaching to depression. That's why the diagnosis of childhood ADHD must be made after a careful evaluation by a mental-health professional and/or pediatrician. In adults, untreated ADHD may appear in the guise of "personality disorder," alcohol abuse, irritability or antisocial behaviors.
The mainstay of treatment for ADHD is stimulant medication, such as methylphenidate (Ritalin). Numerous short-term studies have shown that these agents are safe and effective, although long-term data are scarce. While adolescents without ADHD have been known to abuse stimulants, this is very rare among ADHD sufferers. Stimulants do not make the individual with ADHD feel "high" -- just normal. For most children with ADHD, a working alliance of parents, clinicians and teachers is essential, since these children require both a structured educational environment and a behavioral modification program that can assist them in learning how to deal with their disruptive or aggressive acts. Finally, adults with ADHD may also benefit from a combination of medication and counseling.
Updated Oct. 25, 2023 11:38 am ET
TOKYOâ€”Toyota Motor Chairman Akio Toyoda, when asked about electric-vehicle challenges including a exact lull in U.S. demand, said the industry was coming to recognize that there isnâ€™t a single answer to reducing carbon emissions.
â€śPeople are finally seeing reality,â€ť Toyoda said Wednesday, speaking in his capacity as the head of the Japan Automobile Manufacturers Association.Â
Copyright Â©2023 Dow Jones & Company, Inc. All Rights Reserved. 87990cbe856818d5eddac44c7b1cdeb8
Defining and Assessing Productivity
Productivity has been defined as a measure of output per unit of input. Within the discipline of nursing, productivity is described as proof or evidence of how efficient the NP is in his/her labor, job setting, or how efficiently she/he handles resources and equipment (Martin, 2005). It is a measure of how well the health care provider meets the needs of the community she/he serves (Blumenthal, 1999; Martin, 2005). Frequently productivity is expressed in terms of numbers of patients seen per day or amount of reimbursement a provider brings to the practice. But productivity is really much more than that. Martin (2005) reminds providers that all successful practices build on the three A's: availability, affability, and ability.
How available the health care provider is to patients is crucial for productivity. Obviously the more available a health care provider is to the community served, the greater the client base. Martin (2005) states that being available to patients is essential: "you can't get 'em in if you're not there..." Availability speaks to both physical presence and the ability to move smoothly from one patient to the next. Providers who cannot move from patient to patient because of ancillary demands on their time are not "available."
Beyond the basic availability question of how many patients can the NP see in one day, is the issue regarding how much support the practice provides for seeing the number of patients expected. For example, does the practice provide the practitioner with adequate space and support staff to see patients efficiently; are support staff available to perform diagnostic and treatment regimes ordered by the practitioner (for example, blood work, immunizations, allergy injections, spirometry, dexascans, EKG, and diabetic education)? If this support is not available, the practitioner may find that a portion of his/her productivity includes functioning as the clinic nurse. Under these circumstances, traditional methods of collecting provider productivity will not capture the full value of the practitioner's efforts. Practitioners who function as both the clinic nurse and a clinic provider will clearly lower productivity as a provider. In the analysis of "how available is the practitioner," ancillary duties not performed by other providers will reduce provider revenue, but may be offset by the value of the ancillary duties to the clinic. If this is the case, simply reviewing billables will not provide an adequate picture of the productivity of the practitioner. On the other hand, if the clinic is focused on the income generation potential of the provider, all providers should be given similar supports.
Affability addresses the health care experience from the patient's point of view. It requires health care providers to examine how pleasant, open, responsive, and approachable they are. Because the discipline of nursing is grounded in caring, most NPs do well on this measure. Nevertheless, we must review how patients view their interactions with us. On the whole, do patients feel comfortable with the provider? Does the provider listen to the patient, taking his/her concerns seriously? Additionally, the patient experience within the clinic should be reviewed. For example, how difficult it is for patients to contact the provider? Is the staff in the clinic responsive to patient needs? Do patients complain about the service or that the staff is rude? This is an important aspect of productivity as providers who spend a portion of every visit apologizing for rude or dismissive staff cannot function as smoothly as those who can dedicate the entire visit to the patient's health issues. Measurement of these key issues can be done through patient satisfaction surveys.
Ability is also important, not only of the health care provider but of the office staff as well. Is diagnostic data readily compiled for the health care provider to review? Incomplete and confusing medical records reduce the efficacy of the most capable practitioner and set the stage for missing key components of adequate followup. If practice records and scheduling are in disarray, and the practitioner must serve as the manager to alleviate these problems, the practitioner's revenue figures will be reduced. Support staff who cannot keep records, materials, and bookings up to date will negatively affect the patient's experience and, over time, will directly reflect on the patient's evaluation of the practitioner's competency. This directly impacts the productivity of the office, costing the practice patients and revenue (Martin, 2005).
Although Martin's (2005) three A's are one method for reviewing productivity, there are additional models to consider. Ability or NP competency must be held against a specific standard, and availability can be measured indirectly by the number of patients seen each day.
Shelley Yerger Huffstutler, DSN, APRN-BC, FNP, GNP, Nurse Practitioner; Associate Professor & Director, FNP Programs, University of Alabama at Birmingham
Gayle Varnell, PhD, MSN, BSN, CPNP, Associate Professor and Associate Dean for Advanced Practice, University of Texas at Tyler College of Nursing & Health Sciences, Tyler, Texas
Disclosure: Shelley Yerger Huffstutler, DSN, APRN-BC, FNP, GNP, has disclosed no relevant financial relationships.
Disclosure: Gayle Varnell, PhD, MSN, BSN, CPNP, has disclosed no relevant financial relationships.
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