The Touchstone Process An Ongoing Critical Evaluation of Reiki in the Scientific Literature

Abstract

Reiki is used by a growing number of people but little is known about the scientific basis for its use.
The Touchstone Process was developed as an ongoing process to systematically analyze published, peer-reviewed studies of Reiki, the results being made accessible to the public online.
Thirteen scientifically qualified experts in the field of Reiki were assembled into 3 teams to retrieve, evaluate, and summarize articles using standardized, piloted evaluation forms.
Summaries of 26 Reiki articles, including strengths and weaknesses, were posted on a newly developed Web site (www.centerforreikiresearch.org), together with an overall summary of the status of Reiki research and guidelines for future research: The Touchstone Process determined that only 12 articles were based on a robust experimental design and utilized well-established outcome parameters. Of these articles, 2 provided no support, 5 provided some support, and 5 demonstrated strong evidence for the use of Reiki as a healing modality.
There is a need for further high-quality studies in this area.

Full text

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An Ongoing Critical Evaluation of Reiki
in the Scientific Literature
■Ann L. Baldwin, PhD ■Anne Vitale, PhD, APN, AHN-BC ■Elise Brownell, PhD
■Jan Scicinski, PhD ■Mary Kearns, PhD ■William Rand
23,451*+/67 Reiki is used by a growing number of people but little is known about the scientific basis for its use.
0+18*-)7 The Touchstone Process was developed as an ongoing process to systematically analyze published,
peer-reviewed studies of Reiki, the results being made accessible to the public online. 9).(*67 Thirteen
scientifically qualified experts in the field of Reiki were assembled into 3 teams to retrieve, evaluate, and summarize
articles using standardized, piloted evaluation forms. &)-+:.-7 Summaries of 26 Reiki articles, including strengths
and weaknesses, were posted on a newly developed Web site (www.centerforreikiresearch.org), together with an
overall summary of the status of Reiki research and guidelines for future research:The Touchstone Process
determined that only 12 articles were based on a robust experimental design and utilized well-established outcome
parameters. Of these articles, 2 provided no support, 5 provided some support, and 5 demonstrated strong
evidence for the use of Reiki as a healing modality. ;*/,:+-<*/7 There is a need for further high-quality studies in
this area. ="> ?@&A'7 evidence-based practice,Reiki,Reiki research Holist Nurs Pract !"#"$!%&'()!*"+!,*
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The Touchstone Process !*I
$#2F" DE Defined Numerical Score Ranges for
Word Evaluations
G+3:<.3.<H) G+3/.<.3.<H)
I@+. *J DKL I@+. *J MNL
Weak 0-8 0-20
Satisfactory 9-11 21-25
Very good 12-13 26-29
Excellent 14-15 30-34
0; jCN90>Dk 36>D.1; .; E?.>? D?6 =67.6E6= F=.6K
3D0D63 E?6D?6= D?6 3D45K .3 >1;3.3D6;D E.D? 9=67.P
143 ;5.;G3B >=60D63 ;6E 90=05.GN3B 1= 5.39=1763
9=67.143 ;5.;G3A C; 055.D.1;B 60>? =67.6E6= =0D63
D?6 0=D.>86 Q1= jg76=088 CN9=633.1;k &6^>6886;DB
76=K G115B 30D.3Q0>D1=KB 1= E60/(A M1 6;34=6 >1;P
3.3D6;>K F6DE66; 0 =67.6E6=f3 3>1=6 0;5 g76=088
CN9=633.1;B 6^0>D ;4N6=.>08 =0;G63 E6=6 56;65
Q1= 60>? g76=088 CN9=633.1; >0D6G1=K &M0F86 #(A
M?636 =0;G63 E6=6 1FD0.;65 Q=1N D?6 3>1=6 5.3D=.P
F4D.1;3 Q1= 60>? >0D6G1=K .; D?6 9.81D 3D45KA CQ D?6
! =67.6E6=3 Q1= 0 G.76; 0=D.>86 5.QQ6= .; D?6.= g76=P
088 CN9=633.1;3 FK # >0D6G1=KB D?0D .3B 1;6 G.763
j_0D.3Q0>D1=Kk 0;5 D?6 1D?6= j\6=K `115Bk D?6 0=P
D.>86 .3 >8033.65 03 30D.3Q0>D1=Ki76=K G115A M?6
O408.D0D.76 0;5 O40;D.D0D.76 Q1=N3B 567681965 FK
D?6 M14>?3D1;6 D60N 0;5 3?1E; .; D?6 U996;5.^B
>1;D0.; 0 D1D08 1Q #! 0;5 !# .D6N3B =6396>D.768KB
31N6 1Q E?.>? 0=6 >1NN1; F6DE66; D?6 ! >0D6P
G1=.63A C; >0363 1Q 3.G;.>0;D8K 5.76=G6;D 3>1=.;G
&g76=088 CN9=633.1;3 5.QQ6=.;G FK N1=6 D?0; # >0DP
6G1=K(B 0 D?.=5 =67.6E .3 96=Q1=N65 0;5 D?6 I 3>1=63
076=0G65A M?6 :67.6E M60N N0.;D0.;3 =6>1=53 1Q
088 966=P=67.6E65 0=D.>863 03 E688 03 3676=08 >036
3D45.63 Q1= Q4D4=6 670840D.1;A T1N986D65 =67.6E3
0=6 36;D D1 D?6 _4NN0=.V0D.1; D60NA M?6 =67.6E
Q1=N3 E6=6 .;.D.088K 9.81D65 D1 6;34=6 D?6.= 34.DP
0F.8.DK D1 D?6 9=1c6>D G1083 0;5 D1 D63D 0;5 ;6P
D4;6 D?6 670840D.1; 9=1>633 .D368QA M?6 =3D % :6./.
=6360=>? 0=D.>863 =6D=.6765 E6=6 4365 Q1= D?6 9.81D
3D45KB 0881E.;G D.N6 D1 >08.F=0D6 3>1=.;G 90DD6=;3
0;5 D1 670840D6 14= 176=088 9=1>633A
IA The Summarization Team) T1;3.3D3 1Q , D60N
N6NF6=3 E?1 jD=0;380D6k D?6 =67.6E3 .;D1 90=65P
51E; 34NN0=.63 D?0D >1;76K D?6 .N91=D0;D .;Q1=P
N0D.1; .; 60>? 0=D.>86 &94=9136 1Q 3D45KB 1Fc6>P
D.763B ?K91D?63.3B N6D?153B 0;5 =6348D3(B D1G6D?6=
E.D? .D3 3D=6;GD?3 0;5 E60/;63363B .; 0; 603.8K 4;P
56=3D0;50F86 E0KA H60/;63363 &.Q 0;K( .; D?6 436
1Q :6./. 9=0>D.D.1;6=3 0;5 .; 176=088 >80=.DK 1Q E=.DP
.;G 0=6 .;>84565 .; D?.3 36>D.1; 0;5 80D6= 670840D65
.; 055.D.1; D1 D?6 9=.N0=K 3>1=65 =67.6EA U 3D0;P
50=5.V65 9.81D65 34NN0=K Q1=N .3 4365 D1 N0.;P
D0.; 4;.Q1=N.DK .; 80;G40G6 0;5 176=088 >1;D6;D
D?=14G?14D D?6 G=149 1Q 34NN0=.63A g;>6 >1NP
986D65B D?6 34NN0=K G163 D1 D?6 65.D1=P.;P>?.6QB
E?1 56D6=N.;63 D?0D 60>? 34NN0=K D=48K =66>D3
D?6 =67.6E6=3f 3>1=63 0;5 >=.D.>.3N3B 0;5 65.D3 0>P
>1=5.;G8K 9=.1= D1 980>6N6;D 1; D?6 H6F 3.D6A
E7680:878=: ;179: 24 01: )2/=19028: .32=:99
M?6 M14>?3D1;6 S=1>633 .3 =.G1=143 0;5 3.N.80= D1 D?6
63D0F8.3?65 =67.6E 9=1>654=63 4365 FK 65.D1=.08 F10=53
1Q ?.G?8K =0;/.;G 3>.6;D.> c14=;083 D1 3686>D 0=D.>863
E1=D?K 1Q 94F8.>0D.1;A -48D.986 =67.6E6=3 0;5
3D0;50=5.V65 670840D.1; >=.D6=.0 0=6 4D.8.V65 .; F1D?
O40;D.D0D.76 0;5 O408.D0D.76 =67.6E3 1Q :6./. =6360=>?A
M?6 =6348D3 1Q 14= 670840D.1; D1 50D6 &; =!* 0=D.>863(
0=6 D0F480D65 .; 0 80D6= 36>D.1; 1Q D?.3 0=D.>86 &M0F86 !(A
M?636 0=D.>863 &N0=/65 E.D? 03D6=.3/3( 0=6 >.D65 .; D?6
j:6Q6=6;>63k 36>D.1; 1Q D?.3 0=D.>86A M?6 >1N986D.1; 1Q
966= =67.6E3 1; 088 6^.3D.;G :6./. =6360=>? 0=D.>863
D?=14G? <4;6 !""@ N0=/3 D?6 F6G.;;.;G 1Q D?6
-0.;D6;0;>6 S?036 1Q D?6 9=1c6>DA M60N 86056=3
>1;D.;46 D1 N66D N1;D?8K D1 >1;D.;41438K 4950D6 D?6
50D0F036 E.D? ;6E8K 94F8.3?65 :6./. =6360=>?
14D>1N63A X0>? 94F8.3?65 3D45K .3 >=.D.O465 43.;G D?6
3D0;50=5.V65 9=1>654=63 1Q D?6 M14>?3D1;6 S=1>633B
6;34=.;G 0>>4=0D6B 49PD1P50D6 0>>633 D1 D?6 3D0D43 1Q
:6./. =6360=>?A UD 0;K G.76; D.N6B 1;6 >0; 033633 G093
.; /;1E865G6 0;5 563.G; Q4D4=6 3D45.63B 0>>1=5.;G8KA
M?6 M14>?3D1;6 S=1>633 0;5 D?6 T6;D6= Q1= :6./.
:6360=>? E6=6 567681965 D1 F6 0 >6;D=08 >860=.;G?1436
1Q :6./. =6360=>? .;Q1=N0D.1; Q1= 9=0>D.D.1;6=3 0;5
=6360=>?6=3 08./6A M?6 T6;D6= Q1= :6./. :6360=>? ?03
567681965 0 H6F 3.D6 &EEEA>6;D6=Q1==6./.
=6360=>?A1=G( D1 N0/6 D?6 ;5.;G3 1Q D?6 M14>?3D1;6
S=1>633 070.80F86 D1 D?6 94F8.>A M?6 3.D6 8.3D3 088 1Q D?6
966=P=67.6E65 :6./. 3D45.63 .; D?6 9=1c6>D E.D?
34NN0=.63A
!",GH),
*B:3755 03:8<9 78< 90706906=9 432> 01: ;36>73I
3:B6:J ;32=:99
M?6 M14>?3D1;6 S=1>633 .56;D.65 !* 966=P=67.6E65
:6./. 0=D.>863 .; D?6 >4==6;D 3>.6;D.>
8.D6=0D4=6B,,I#,I!,I%PIJ ,%"P', , 1Q E?.>? E6=6 qualitative
0;5 #@ E6=6 quantitativeA U 34=9=.3.;G ;5.;G E03
Copyright © 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

!*% LgYC_MCT Z2:_CZ` S:UTMCTX •_XSMX-WX:igTMgWX: !"#"
$#2F" OE Major Primary and Additional
Weaknesses Specific to Each Article
P?)34Q #1.<,:)-
Ring46 A, B, C, E, H J, K, M, O
Raingruber and Robinson45 A, E, G, H J, K, M
Engebretson lWardell7A, B, C, E J
Wetzel53 A, B, C, D L
Sharma et al48 C, D, F K, L
Wardell and Engbretson52 A, C, D, E J
Wirth et al55 B, D, F, I
Olson et al43 A, B, C J
Brathovde37 B, D, E L
Potter44 AJ, K
Rubik et al47 M, N
P9<6R&3/5)Q #1.<,:)-
Shiflett et al49 A, B, C, D, F
Crawford et al40 A, B, C, D J, O
Tsang et al51 A, B, C J, K
Gillespie et al57 C, F L
Mackay et al42 B, D, F
Dressin and Singg41 A, C, F
Wirth et al54 B, I
P$*8R&3/5)Q #1.<,:)-
Vitale and O’Conner38 A, B J
Shore50 FN
Whelan and Wishnia32 B, H
Vitale31 B
Witte and Dundes56 D
Baldwin and Schwartz35 B
Baldwin et al36 B
Assefi et al34 B
A. Lack of blinding of participants to treatment group
B. Small sample size
C. Lack of blinding of data collectors
D. Convenience sample of participants
E. Lack of controls
F. Lack of information about participants (gender/age/race)
G. Lack of standardization of qualitative outputs
H. Lack of independent decision-audit trail
I. Using multiple treatment modalities simultaneously
J. Lack of sham Reiki treatment (if possible)
K. Lack of standardization of Reiki treatments within study
L. Lack of information about training level of Reiki practitioners
M. Lack of clarity of writing
N. Using Reiki practitioners of different levels in same study
O. Using Reiki practitioners as subjects receiving Reiki
D?0D 1;8K '"h 1Q D?6 0=D.>863 =67.6E65 9=17.565 Q488
.;Q1=N0D.1; 0F14D D?6 G6;56=B 0G6B 0;5 6D?;.>.DK 1Q D?6
6^96=.N6;D08 90=D.>.90;D3A CD .3 9133.F86 D?0D D?6
6QQ6>D.76;633 1Q :6./. N0K F6 .;46;>65 FK # 1= N1=6
1Q D?636 90=0N6D6=3A U>>1=5.;G D1 D?6 9=.N0=K
670840D.1; >=.D6=.0B 0F14D ?08Q &% 1Q ,$ ',h( 1Q D?6
O408.D0D.76 3D45.63 E6=6 >0D6G1=.V65 03 jE60/k 0;5 D?6
=63D &I 1Q ,$ %Ih( E6=6 3>1=65 03 j76=K G115k D1
j6^>6886;DAk U 3.N.80= 90DD6=; E03 366; Q1= D?6
O40;D.D0D.76 3D45.63 &, 1Q #@B mI,hn E6=6 jE60/k 0;5
% 1Q #@ m!#hn E6=6 j76=K G115k D1 j6^>6886;Dk(A Z1;6
1Q D?6 O408.D0D.76 0=D.>863 0;5 , &I,h( 1Q D?6 #@
O40;D.D0D.76 0=D.>863 E6=6 >8033.65 03 N.5=0;G6A C;
D1D08B ## &%!h( 1Q D?6 !* 3D45.63 E6=6 >0D6G1=.V65 03
jE60/k 0;5 , &!,h( 03 j76=K G115k D1 j6^>6886;Dk
&M0F86 !(A M?6 176=088 0;08K3.3 3?1E65 D?0D Q1=
O40;D.D0D.76 3D45.63 D?6=6 .3 0 Q0= 81;G6= ?.3D1=K 1Q
94F8.>0D.1; .; 966=P=67.6E65 c14=;083 D?0; Q1=
O408.D0D.76 3D45.63 &[.G4=63 !0 0;5 !FB =6396>D.768K(A
M?6 =3D 966=P=67.6E65 O40;D.D0D.76 0=D.>86 09960=65 .;
#@J@B E?6=603 D?6 =3D 966=P=67.6E65 O408.D0D.76
0=D.>86 5.5 ;1D 09960= 4;D.8 !""#A C; 055.D.1;B D?6
076=0G6 ;4NF6= 1Q 94F8.3?65 O40;D.D0D.76 3D45.63
.;>=60365 0QD6= !""IA ME1 1Q D?6 % O40;D.D0D.76 3D45.63
>8033.65 03 j6^>6886;Dk E6=6 94F8.3?65 .; !""JA
U;1D?6= ! 1Q D?6 % j6^>6886;Dk 3D45.63 &94F8.3?65 .;
!""* 0;5 !""J( .;718765 6^96=.N6;D3 1; 0;.N083
=0D?6= D?0; 1; ?4N0;3A U;.N083 0=6 90=D.>480=8K
=68670;D D1 :6./. 3D45.63 F6>0436 6^96=.N6;D3 E.D?
0;.N083 0=6 ;1D >1;Q14;565 FK D?6 5.QQ6=6;>63 .;
F68.6Q3 1= 8.Q63DK863B 03 1QD6; 1>>4=3 E.D? ?4N0;3B 0;5
D?43 D?6 436 1Q 0;.N083 86053 D1 N1=6 603.8K
.;D6=9=6D0F86 6^96=.N6;DA gQ D?6 J 3D45.63 >8033.65 03
j76=K G115k D1 j6^>6886;DBk 088 E6=6 94F8.3?65
F6DE66; !""# 0;5 !""@B 34GG63D.;G D?0D D?6 O408.DK 1Q
D?6 3D45.63 09960=3 D1 F6 .N9=17.;G E.D? D.N6A
M?6 N0.; 56>.6;>.63 1Q D?6 3D45.63B 03 03363365
43.;G D?6 9=.N0=K 670840D.1; >=.D6=.0B 0=6 8.3D65 .;
M0F86 IB D1G6D?6= E.D? D?6 ;4NF6=3 1Q 0=D.>863
>8033.65 03 jE60/Bk jN.5P=0;G6k &30D.3Q0>D1=K 1=
30D.3Q0>D1=Ki76=K G115(B 1= jD19 =0;G6k &76=K G115 D1
6^>6886;D( D?0D 3?1E65 60>? 90=D.>480= 56>.6;>KA M?6
N0.; 56>.6;>.63 0331>.0D65 E.D? 60>? 90=D.>480=
0=D.>86 0=6 3?1E; .; M0F86 !A [4=D?6= 56D0.83 >1;>6=;.;G
D?6 N6D?15181G.63 1Q D?6 =0;51N.V65 >1;D=18865 D=.083
.;>84565 .; D?6 M14>?3D1;6 S=1>633IJ,%"P%% ,%@P'# >0; F6
Q14;5 .; 0 9=67.143 94F8.>0D.1;A'J -13D 1Q D?6
56>.6;>.63 E6=6 =680D65 D1 0 E.56 =0;G6 1Q .;D6=;08
0;5 6^D6=;08 708.5.DK .33463 E.D? 6^96=.N6;D08 563.G;A
T1N90=65 D1 D?6 0=D.>863 >8033.65 03 jE60/Bk Q6E6= 1Q
D?136 >8033.65 03 jN.5 =0;G6Bk 0;5 Q0= Q6E6= 1Q D?6
jD19P=0;G6k 0=D.>863B 3?1E65 N0c1= 56>.6;>.63 6^>69D
D?0D 08N13D 088 D?6 0=D.>863 E6=6 >=.D.>.V65 Q1= D?6 3N088
30N986 3.V6A M?.3 90=D.>480= 56>.6;>K E03 D?6 1;8K
1;6 D?0D 390;;65 088 >0D6G1=.63 1Q N6=.DA U88 J 0=D.>863
D?0D E6=6 >8033.65 03 jD19 =0;G6k 56N1;3D=0D65
E688P563.G;65 N6D?15181GK 0;5 4D.8.V65 3D0;50=5.V65
D=60DN6;D 9=1D1>183 0;5 14D>1N6 90=0N6D6=3 D?0D ?05
F66; 9=67.1438K 708.50D65A
M0F86 % 8.3D3 055.D.1;08 E60/;63363 =6G0=5.;G
9=1F86N3 E.D? D?6 436 1Q :6./. 9=0>D.D.1;6=3 0;5 80>/
Copyright © 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

The Touchstone Process !*'
!BC%&" OE Graphs to show number and quality of peer-reviewed original Reiki research articles as a function of year of
publication for (a) qualitative and (b) quantitative articles.
1Q 176=088 >80=.DK 1Q E=.D.;GB 03 03363365 Q=1N D?6
_4NN0=K 3D0D6N6;D3A C;>84565 .; D?6 D0F86 .3
.;Q1=N0D.1; 3?1E.;G D?0D D?6 ;4NF6= 1Q 055.D.1;08
E60/;63363 96= 0=D.>86 E03 >1;3.3D6;D E.D? 60>?
9096=f3 g76=088 CN9=633.1; .; D?6 9=.N0=K 670840D.1;A
M?6 055.D.1;08 E60/;63363 0331>.0D65 E.D? 60>?
90=D.>480= 0=D.>86 0=6 3?1E; .; M0F86 !A
g76=088B D?6 =6348D3 Q=1N D?6 M14>?3D1;6 S=1>633
0;08K3.3 1Q D?6 !* 966=P=67.6E65 :6./. =6360=>?
0=D.>863 56N1;3D=0D65 D?0D 1;8K #! 1Q D?6
3D45.63I#BI!,I%PI* ,IJ,%",%#,%@,'",'%,'* E6=6 F0365 1; =1F43D
=6360=>? 563.G;3 0;5 E688P63D0F8.3?65 14D>1N6
90=0N6D6=3A M?636 0=D.>863 E6=6 033.G;65 E1=5
670840D.1;3 1Q j\6=K `115k 1= jX^>6886;Dk FK 0D 8603D
Copyright © 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

!** LgYC_MCT Z2:_CZ` S:UTMCTX •_XSMX-WX:igTMgWX: !"#"
$#2F" ME Numbers of Articles of a Given Quality Demonstrating Each Particular Major Primary Weakness
S+TU)1 *J #1.<,:)-
?)34 9<6 $*8 &3/5)
A Lack of blinding of participants to treatment group 7 4 1
B Small sample size 6 5 6
C Lack of blinding of data collectors 6 5 0
D Convenience sample of participants 5 3 1
E Lack of controls 5 0 0
F Lack of information about participants (gender/age/race) 2 5 0
G Lack of standardization of qualitative outputs020 0
H Lack of independent decision-audit trail020 1
I Using multiple treatment modalities simultaneously 1 1 0
0For qualitative studies only.
# =67.6E6= 0;5 E6=6 ;1D >1;3.56=65 jE60/k FK 0;K
=67.6E6=A CD 3?1485 F6 ;1D65 D?0D N13D 1Q D?636 3D45.63
0=6 =6>6;DB .;5.>0D.;G D?0D D?6 3>.6;D.> 3D0;50=5 1Q
94F8.3?65 :6./. =6360=>?B 03 670840D65 FK D?6
M14>?3D1;6 S=1>633B .3 .N9=17.;GA
&2 01: ;/D5691:< ;::3C3:B6:J:< 90/<6:9 ;32B6<:
9/;;230 423 !:6@6K
M?6 #! 0=D.>863 D?0D E6=6 >8033.65 03 j\6=K `115k 1=
jX^>6886;Dk FK 0D 8603D # =67.6E6= E6=6 6^0N.;65 D1
56D6=N.;6 D1 E?0D 56G=66 D?6K 9=17.56 34991=D Q1= D?6
436 1Q :6./. 03 0 ?608.;G N1508.DKA M?6 =6348D3 E6=6
N.^65A g; D?6 ;6G0D.76 3.56B 1;6 3D45K 3?1E65 318.5
67.56;>6 1Q ;1 6QQ6>D 1Q :6./. 1= D14>? 1; =654>.;G
90.; =6348D.;G Q=1N F=1NK08G.0AI% M?.3 90=D.>480=
3D45K E03 76=K E688 563.G;65 0;5 .;>84565 3?0N :6./.
G=1493A L1E676=B D?6 6^96=.N6;D E03 ;1D 91E6=65 D1
56D6>D 34FD86 >?0;G63 .; 90.; 96=>69D.1;B 0;5
05?6=6;>6 D1 3D0;50=5.V65 :6./. ?0;5 913.D.1;3 N0K
$#2F" NE Numbers of Articles of a Given Category of Quality Demonstrating Each Particular Additional
Weakness Assessed from Summaries
S+TU)1 *J #1.<,:)-
?)34 9<6 $*8 &3/5)
J Lack of sham Reiki treatment0(if possible) 6 2 1
K Lack of standardization of Reiki treatments within study 4 1 0
L Lack of information about training level of Reiki practitioners 3 1 0
M Lack of clarity of writing 3 0 0
N Using Reiki practitioners of different levels in same study 1 1 0
O Using Reiki practitioners as subjects receiving Reiki 1 1 0
0An example of a sham Reiki treatment would be when a person, untrained in energy healing, assumes the hand positions of a Reiki practitioner as if
delivering Reiki to a participant.
?076 ;6G86>D65 .;5.7.5408 90=D.>.90;D ;6653A U;1D?6=
3D45K E03 34GG63D.76 1Q ;1 6QQ6>D 1Q :6./. .;
913D3D=1/6 =6?0F.8.D0D.1; 0;5 =6>176=KA%@ M?.3 3D45K
4365 1;8K 0 3N088 30N986 3.V6B 0;5 D?6 Q4;>D.1;08
.;5696;56;>6 N6034=6 4365 Q1= 670840D.;G =6>176=K
N0K ;1D ?076 F66; 34Q>.6;D8K 36;3.D.76 F6>0436 .D 5.5
;1D .;>8456 0 >1G;.D.76 >1N91;6;DA U 3?0N >1;D=18
G=149 E03 .;>84565 .; D?6 3D45KA
[.76 0=D.>863 3?1E65 N.^65 1= >1;5.D.1;08 =6348D3A
H.=D? 6D 08'% 56N1;3D=0D65 3.G;.>0;D =654>D.1; .;
913D196=0D.76 90.; 0QD6= D11D? 6^D=0>D.1; .; 90D.6;D3
E?1 =6>6.765 0 >1NF.;0D.1; 1Q :6./. 0;5 Y0_?0;
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F66; 5.30991.;D65 D?0D D?6K E6=6 ;1D 3686>D65 Q1= :6./.
Copyright © 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

The Touchstone Process !*,
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Copyright © 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

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Copyright © 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

The Touchstone Process !*@
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Copyright © 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

The Touchstone Process !,I
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Copyright © 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

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Copyright © 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

The Touchstone Process !,'
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Copyright © 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

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