Effects of Sleep Deprivation among Emergency Medical Services Workers Essay

Effects of Sleep Deprivation among Emergency Medical Services Workers - Essay Example Emergency medical service is one such field which requires utmost attention, even in the middle of the night. At times the workers are required to remain attentive continuously for more than 24 hrs, because it's a question of urgent medical requirements for someone. Studies have highlighted that if the workers are subjected to sleep deprivation regularly on many occasions; their body starts responding adversely, which in turn impacts their efficiency and accuracy at the workplace. If the worker is subjected to continuous sleep deprivation, the resultant fatigue could lead to effects like poor decisions, fatal accidents. It has been pointed out that continuous exposure to sleep disorders results in impairment of carbohydrate metabolism, weight gains and type-2 diabetes1. This in turn results in development of sleep apnea, which in turn reduces the quality of sleep, thus further resulting in deterioration of the carbohydrate metabolism and it gives rise to a brutal cycle of disorder. T herefore, experts are of the opinion that proper attention be paid towards this issue. This study is an effort to find out some such reasons and the resultant disorders. Today we live in a fast paced society, where competition is a rule rather than an exception, where all aspects of life are being viewed from the angle of sales and marketing. Be it a manufacturing unit or the healthcare sector, the competition is all pervasive. Healthcare services are a very crucial and integral part of the society. Health care becomes an issue, because while taking care of the competition we tend to ignore what we are supposed to do to lead a healthy life. Emergency medical services (EMS) are supposed to play a vital role in taking care of the emergency and trauma care system. The workers in these services provide emergency medical response to the sick and injured citizens. Though, the workers are placed in shift duties, but quite often it so happens that due to more number of emergency cases, they cannot leave the workplace even during extended working hours. Different levels of medical responses are included in the EMS. In general, the EMS includes, call handlers , emergency medical dispatchers, workers in the emergency telephone call centers, first responders like fire or police units, basic life support (BLS) ambulances, advanced life support (ALS) ambulances (USHS, 2007). The workers in these units are trained according to the requirements. Based on the reasons, the sleep deprivation is broadly divided into four categories; i. Based on lifestyle ii. Due to certain health complications iii. The medication side effects iv. Clinical disorders For an EMS worker the lifestyle becomes so irregular that it leads to other types of complications as well. Literature Review According to a study conducted by World Health Organization (WHO)2, the number of people with diabetes is sharply on the rise in recent years. This study found out that in the year 2000 the number of people affected with the disease was about 171 million worldwide. But more alarming is the projection for the year 2030, if we continue to adopt the existing lifestyle. It has been projected that by 2030 this figure might reach a whopping 366 million. Demanding working conditions often take its toll on the individuals' health as well as the actual output of the work. Emergency

James Cook's Voyage to Australia and The Subsequent British Research Paper

James Cook's Voyage to Australia and The Subsequent British Colonization - Research Paper Example James Cook, an inhabitant of England, was born in the year 1728. He was one of the most popular explorers of the 17th century. He also made a mark in the history of the world for his navigation and cartographic skills. Cook was promoted as a captain in the Royal Navy. Cook navigated to different parts of the world and was popular for his three distinct voyages in the Pacific Ocean. He was also the first to observe a European connection with Australia along the eastern coastline. He also gained distinction in becoming the first person to circumnavigate the coast of New Zealand. The legacy of knowledge which James Cook had was very influential among his successors. His role in the political history of the world is also a matter of huge importance as he took a major role in opening up areas along the Pacific which led to the colonization. In the three voyages undertaken by James Cook he travelled thousands of miles and helped in the mapping of various lands starting from New Zealand and continuing till Hawaii. In his expeditions he was reputed for surveying and naming certain features which was not done before. He was instrumental in marking islands in the maps of Europe which was one of his significant contributions. James Cook’s talent in surveying came into the forefront when he successfully mapped the coast of Newfoundland in 1760. He was the one who produced the large scale accurate maps of the island. His success in the very first voyage promoted him to the rank of a commander and was given the charge of identifying Terra Australis which was believed to exist in a place further from Australia. He was persuaded by Alexander Dalrymple who was a dignitary person belonging to the Royal society. During his second voyage he navigated along very high latitudes in the southern part and became the first person to cross the Antarctic Circle. In his expedition he took the possession over South Georgia and also surveyed and mapped the area. In his second voyage, Cook was also successful in the employment of the chronometer which helped him to study the accurate longitudinal positions. The chart of the Southern Pacific Ocean was made by the help of the chronometer and it gained so much accuracy level that those charts are still being used in the 21st century. He returned from the second voyage as a captain of the Royal Navy and he was felicitated with many awards and recognition programs. He was also declared to be the first navigator belonging from Europe in the House of Lords. Captain James Cook volunteered the third voyage in finding out the Northwest Passage. He set on for the voyage in the year 1776. During his last voyage James Cook became the first among the Europeans to visit the Hawaiian Islands. He also explored the western coast of the Northern part of America and he covered the Strait

Treatment for Renal Transitional Cell Carcinoma (TCC)

Treatment for Renal Transitional Cell Carcinoma (TCC) Dear All, Thank you for the new images Roz – it is interesting to follow this case as it unfolds. After reviewing the new CT images I would agree with Susie that they could indicate an alternative diagnosis of a transitional cell carcinoma (TCC) of the left kidney and ureter. I would like to investigate a couple of the many treatment options available for TCC and aim to answer the question put forward by Susie – ‘What treatment options are available to the patient?’ Renal transitional cell carcinoma (TCC) is a malignant tumour that stems from theepithelial cells lining the urinary tract. Upper urinary tract TCCs (UUTUC) – in this patient’s case involving the left kidney and ureter are uncommon. They account for only 5-10% of urothelial carcinomas (Siegel et al, 2012) although evidence indicates an increase in these malignancies (Jemal et al, 2009). The predisposition UUTUCs have for recurrence, metastases and their multi focal nature mandates aggressive clinical intervention (Cai et al, 2011). Treatment is strongly influenced by tumour stage, which correlates closely with prognosis. Surgical intervention is usually the preferred method of treatment for localised disease. Radical nephroureterectomy Radical nephroureterectomy (RNU) with excision of the bladder cuff is the gold standard treatment for UTUC (Margulis et al, 2009). The aim of surgery is to prevent tumour seeding via bypass of the urinary tract during tumour resection. Since the risk of tumour recurrence is considerable, resection of the distal ureter and its orifice is also performed. Recent research by Lughezzani et al, (2010) concluded that this method – removing the distal ureter and bladder cuff significantly improves survival rates. The traditional open surgical approach to RNUs is being challenged by less invasive approaches, e.g. laparoscopic. Simone et al, (2009), a prospective randomised study of 80 patients with non-metastatic UUUC demonstrated no superior effectiveness of laparoscopic surgery over open RNU, whilst the majority of recent research concludes superior outcomes for a laparoscopic versus open surgical approach (Ariane et al, 2012) and (Ni et al, 2012). Endoscopic Treatment Endoscopic ablation is sometimes indicated in patients with a solitary kidney, in bilateral kidney disease and where major surgery is contraindicated. Although now slightly dated, research by Keeley et al, (1997) is commonly cited in recent literature. Their study looked at the ureteroscopic management of 38 patients (41 kidneys) with upper tract urothelial tumours graded 1 3. After endoscopic treatment, 16 of the 21 (76%) with grade 1 disease were tumour free 4 had recurrences at a mean follow-up of 40.3 months. 9 of the 14 (64%) of grade 2 disease were tumour free 4 had recurrent disease at a mean follow-up of 27.6 months. Finally, 2 of the 5 (40%) grade 3 tumours were tumor free at a mean follow-up of 21 months – no recurrence rates were reported for this group. They concluded that ureteroscopic treatment of the upper urinary tract TCC minimises morbidity and provides excellent success rates in patients with solitary, low-grade tumours. Despite these findings, the tract recurrence risk is hard to calculate because relatively few endoscopic ablation treatments have been performed. Additionally, there is a reported risk of understating and under grading the disease with endoscopic management alone. In order to determine the optimal treatment pathway for a patient with TCC – renal function, tumour grade, stage and location must first be evaluated. I have only examined two of the treatment options available for TCC – would anybody else like to expand upon Susies question by examiningothers? I will not add any further questions as there are a few already outstanding. Kind Regards, Alana Show parent See this post in context RDM032_PRD1_A_2014-15 -> On-Line Case Discussions -> Case 12 -> Re: Case 12 by Alana McInally Wednesday, 19 November 2014, 11:51 PM Dear All, Thank you for posting this interesting case and uploaded images Susie. It appears that Noorayen and I have been working on the same topic over the last few days so although this post is likely to overlap in places, I hope to add insight and an alternative slant. I would like to examine the images and a possible diagnosis. In the right lobe of the liver, there appears to be large 67 x 49 mm, well-defined, heterogeneous mass predominantly hyperechoic in nature. Appearances are in keeping with a solid, rather than cystic, lesion. In the second ultrasound image, the liver lesion looks more isoechoic in echotexture with some internal and peripheral vascularity demonstrated when colour Doppler is applied. The sagittal section of the unenhanced CT abdo-pelvis image also highlights this area of low attenuation in the right lobe. These are unusual findings given the patient’s symptoms acute LIF pain. It would be interesting to know whether the patient has had any other tests carried out, for example any blood work prior to the scans? I agree with Noorayen that ultrasound appearances such as these could represent a Focal nodular hyperplasia (FNH). An FNH is a benign hyperplastic process which results in the normal constituents of the liver being arranged in an abnormally organised pattern – this is caused bya response to a congenital arteriovenous malformation'(Khan et al, 2013). An FNH is considered the second most common tumour of the liver following hepatic hemangiomas (Kang et al, 2010). In the majority of situations (80-95%), FNH arises as a solitary lesion, however, multiple lesions have been known to present themselves (Khan et al, 2013). Ultrasound characteristics of these lesions can vary, making diagnosis using one modality challenging. Lesions can range from hypoechoic, isoechoic to hyperechoic when compared to that of the surrounding liver tissue (Bates, 2011). Venturi et al, (2007) as well as other recent research – state that typical lesions usually demonstrate a large, well circumscribed mass, with a central feeding artery and a radiating spoke-wheel pattern of blood flow (Bates, 2011). It could be suggested that the second ultrasound image shows central blood flow within the lesion, in keeping with the typical appearances described. Although FNHs are normally asymptomatic, which is not in keeping with the patient’s LIF pain, it may indicate that the LIF pain and the liver lesion (located in the RUQ) are unrelated that the liver lesion is instead an incidental finding; this is consistent with the typical diagnosis of an FNH. Most diagnoses occur when patients undergo cross-sectional imaging or surgery for other problems and / or routine medicals (Palladino et al, 2014). Although the use of contraceptive agents is not proven to cause FNH, they may have a role in the development of these lesions. Additionally, they can also act as an irritant causing haemorrhage or infarctions to occur – resulting in symptomatic patients. Malignant transformation of FNH has not been reported (Chung and DeGirolamo, 2011) and FNHs rarely bleed or grow. As a result, the diagnosis of an FNH rarely impacts the patient’s medical management other than the accurate diagnosis of the lesion to prevent unnecessary biopsies, surgery, and further imaging of the lesion. Despite advances in medical imaging, it is difficult to discern an FNH from other focal hepatic lesions. As a relatively recent imaging modality, the use of Contrast-Enhanced Ultrasound (CEUS) to identify focal liver lesions is becoming increasingly common (Bartolotta et al, 2009). I will reiterate one of the three outstanding questions does anyone have any further differential diagnoses? Kind regards, Alana Show parent See this post in context RDM032_PRD1_A_2014-15 -> On-Line Case Discussions -> Case 3 -> Re: Case 3 by Alana McInally Tuesday, 18 November 2014, 9:38 PM Dear All, Lucy’s post on the function of the spleen in particular, the implications when it is removed was interesting to read, especially as the spleen’s function and morphology have, in the past, remained unstudied (Lahey and Norcross, 1948). Although they havebecomeless common, as the spleensimportance as an organ isrecognised, splenectomies are still performed and I would like to address Lucy’s question ‘What are the indications for a splenectomy?’. A splenectomy consists of the total or partial surgical removal of the spleen. Literature sources provide a wide spectrum of clinical scenarios for when a splenectomy may be indicated. A general consensus exists for a handful of diagnoses which require a splenectomy. These include: primary cancers of the spleen (very rare), splenic trauma and hematologic diseases. One blood disorder – Hereditary spherocytosis (HS) – often requires treatment via a splenectomy. It involves the loss of specific proteins in the red blood cell membrane, resulting in fragile cells which are further damaged when they pass through the spleen (Encyclopedia of Surgery). This damage ceases once the spleen is removed. Another hematologic disease primary immune thrombocytopenia (ITP) shows the highest cure rate (60-70%) after a splenectomy versus other treatments (Ghanima et al, 2012). Trauma to the spleen can result from damage or rupture from both blunt and penetrating injuries to the abdomen. Studies suggest 25% of trauma injuries are originally caused by medical intervention to the abdomen (Rull, 2012). Laparoscopic splenectomies are often indicated in splenic trauma to prevent internal hemorrhaging and potentially death (NHS Choices, 2014). There are also numerous other conditions where a splenectomy may be indicated / recommended these include: Splenic artery aneurysms surgical resection is often indicated in the presence of large splenic artery aneurysms (over 2 cm in diameter), because the risk of hemorrhage and rupture can be fatal if not treated (Bates, 2011). Multiple splenic abscesses relatively uncommon but have an associated high mortality rate (Provenzale et al, 2012). Some view percutaneous drainage combined with antibiotic therapy as the best management for solitary abscesses (Bates, 2011) whereas other research proposes a splenectomy is the best treatment for multiple abscesses. Splenomegaly – an enlarged spleen (more than 12 cm) (Bates, 2011) as an isolated indicator for a splenectomy is often unjustified. Best practice is to now investigate the underlying cause. Surgery is only indicated if the enlarged spleen is causing serious complications and/or if the underlying cause cannot be identified (NHS Choices, 2014). As Lucy mentioned, there are benefits and risks of a splenectomy. Most research recognises the associated life-long risk of bacterial infection following a splenectomy (Schilling, 2009), combined with the risks of invasive surgery. The general consensus shifts towards a conservative approach – attempting to preserve the spleen as opposed to invasive treatment (Akinkuolie et al, 2010). In our trust I found it hard to locate hospital guidelines and protocols for when splenectomies were considered appropriate. However, I came across one case where a patient had a partial laparoscopic splenectomy using wedge resection to treat splenic trauma. This allowed him to retain some splenic function and additionally he was fortunate enough to have an accessory spleen (present in 30% of the population) – which has the ability to grow and function when a large portion has been removed (Arra et al, 2013). Consequently his splenic function was comparable to that prior to surgery. This technique supports the recent advance towards a conservative outlook on splenectomies. It would be interesting if anyone else is aware of the guidelines in their local hospital for when a splenectomy is indicated? Kind regards, Alana

The Speech of Marcus Antonius in Julius Caesar -- William Shakespeare

The speech made by Marcus Antonius, called Antony, in Act Three, Scene Two of Julius Caesar shows that despite being considered a sportsman above all else, he is highly skilled with the art of oratory as well. In the play by William Shakespeare, this speech is made at the funeral of Caesar after he is killed by Brutus and the other conspirators. Brutus claimed earlier, in his own funeral speech, that the killing of Caesar was justified. He felt that Caesar was a threat, and too ambitious to be allowed as ruler. Much of this sentiment, however, was developed by the treacherous Cassius. Antony, on the other hand, felt that the conspirators were traitors to Rome and should be dealt with. This speech used a variety of methods to gradually bring the crowd to his side, yet maintain his side of the deal with Brutus. This deal was that he, â€Å"shall not in your funeral speech blame us...† (3.1.245) for the death of Caesar. Antony holds his end of the deal for the majority of the speech, yet by doing so convinces the crowd of Brutus' and the others' disloyalty. In many ways, this speech can be seen as the ultimate rhetoric, and it includes all three of Aristotle's methods of persuasion. This are the appeal to credibility, called ethos, the appeal to emotions, called pathos, and the appeal to logic, called logos. All three of these devices are used to great effect during the speech of Marcus Antonius. Antony begins with the now famous words, â€Å"Friends, Romans, countrymen, lend me your ears.†(3.2.62) In referring to the commoners as equals, they feel a sense of empathy even at the first line. This can be seen as a sort of ethos. He goes on to say that Brutus has said that Caesar was ambitious, and that this, if true, is a serious... ...2.248) Antony, though he kept to his bargain, brought the audience to his side in a variety of ways. He used all three methods of persuasion to his advantage. He claimed the killers of Caesar to be honorable and noble, and in the very act of doing so turned Brutus' followers against him. This shows the true ability of Marcus Antonius, and that he is a far greater threat than the conspirators recognized. This power of words is well known, and Aristotle's three methods of persuasion live on in modern speechwriters. Ethos, logos, and pathos are just as effective in our time as in that of Shakespeare, the Roman Empire, and wherever there are people to speak and people to listen. Thus even today, this speech of Shakespeare through Antony shows the sheer impact that mere words can have. Works Cited Shakespeare, William. Julius Caesar. New York: Simon, 1975.

Effects of Behavioral Interventions on Disruptive Behavior and Affect in Demented Nursing Home Residents Essay

Behavioral interventions might ameliorate them and have a positive effect on residents’ mood (affect). Objectives: This study tested two interventions—an activities of daily living and a psychosocial activity intervention—and a combination of the two to determine their efficacy in reducing disruptive behaviors and improving affect in nursing home residents with dementia. Methods: The study had three treatment groups (activities of daily living, psychosocial activity, and a combination) and two control groups (placebo and no intervention). Nursing assistants hired specifically for this study enacted the interventions under the direction of a master’s prepared gerontological clinical nurse specialist. Nursing assistants employed at the nursing homes recorded the occurrence of disruptive behaviors. Raters analyzed videotapes filmed during the study to determine the interventions’ influence on affect. Results: Findings indicated significantly more positive affect but not reduced disruptive behaviors in treatment groups compared to control groups. Conclusions: The treatments did not specifically address the factors that may have been triggering disruptive behaviors. Interventions much more precisely designed than those employed in this study require development to quell disruptive behaviors. Nontargeted interventions might increase positive affect. Treatments that produce even a brief improvement in affect indicate improved quality of mental health as mandated by federal law. Key Words: affect †¢ Alzheimer’s disease †¢ behavior therapy †¢ dementia †¢ nursing homes Nursing Research July/August 2002 Vol 51, No 4 proximately 1. 3 million older Americans live in nursing homes today (Magaziner et al. , 2000). By 2030, with the aging of the population, the estimated demand for long-term care is expected to more than double (Feder, Komisar, & Niefeld, 2000). Thus, nursing home expenditures could grow from $69 billion in 2000 to $330 billion in 2030 (Shactman & Altman, 2000). About half of new nursing home r esidents have dementia (Magaziner et al. , 2000). The disease has an impact on four major categories of functioning in persons with dementia. These are disruptive behavior (DB), affect, functional status, and cognition (Cohen-Mansfield, 2000). This article will focus on the first two categories. Disruptive behavior has received much more attention than affect has (Lawton, 1997), perhaps for three reasons. First, more than half (53. 7%) of nursing home residents display DB with aggression (34. 3%) occurring the most often (Jackson, Spector, & Rabins, 1997). Second, DB threatens the wellbeing of the resident and others in the environment. Consequences include: (a) stress experienced by other resiCornelia K. Beck, PhD, RN, is Professor, Colleges of Medicine and Nursing, University of Arkansas for Medical Sciences. Theresa S. Vogelpohl, MNSc, RN, is President, ElderCare Decisions. Joyce H. Rasin, PhD, RN, is Associate Professor, School of Nursing, University of North Carolina. Johannah Topps Uriri, PhD(c), RN, is Clinical Assistant Professor, College of Nursing, University of Arkansas for Medical Sciences. Patricia O’Sullivan, EdD, is Associate Professor, Office of Educational Development, University of Arkansas for Medical Sciences. Robert Walls, PhD, is Professor Emeritus, University of Arkansas for Medical Sciences. Regina Phillips, PhD(c), RN, is Assistant Professor, Nursing Villa Julie College. Beverly Baldwin, PhD, RN, deceased, was Sonya Ziporkin Gershowitz Professor of Gerontological Nursing, University of Maryland. A Note to Readers: This article employs a number of acronyms. Refer to Table 1 to facilitate reading. 219 220 Effects of Behavioral Interventions Nursing Research July/August 2002 Vol 51, No 4 TABLE 1. Acronyms Term Activities of daily living Analysis of variance Apparent affect rating scale Arkansas Combined Disruptive behavior(s) Disruptive behavior scale Licensed practical nurse(s) Maryland Mini mental status exam Negative visual analogue scale Nursing home nursing assistant(s) Observable displays of affect scale Positive visual analogue scale Project nursing assistant(s) Psychosocial activity Research assistant(s) Acronym ADL ANOVA AARS AR CB DB DBS LPN MD MMSE NVAS NHNA ODAS PVAS PNA PSA RA decreases in targeted behaviors (Gerdner, 2000; Matteson, Linton, Cleary, Barnes, & Lichtenstein, 1997). However, others reported nonsignificant reductions (Teri et al. , 2000), no change (Churchill, Safaoui, McCabe, & Baun, 1999), or increased behavioral symptoms (Mather, Nemecek, & Oliver, 1997). These studies used nursing home staffs to collect data, had sample sizes below 100, and measured an array of DB with different assessments. Only in the last decade have researchers investigated affect. Compared to studies to reduce DB, far fewer studies have measured interventions using affect as an outcome measure. Studies reported positive outcomes on affect from such interventions as simulated presence therapy (Camberg et al. , 1999), Montessori-based activities (Orsulic-Jeras, Judge, & Camp, 2000), advanced practice nursing (Ryden et al. , 2000), music (Ragneskog, Brane, Karlsson, & Kihlgren, 1996), rocking chair therapy (Watson, Wells, & Cox, 1998), and pet therapy (Churchill et al. , 1999). The studies on affect used global measures that relied on observer interpretation, which could have compromised objectivity. Theoretical Bases A number of conceptual frameworks have guided intervention research on persons with cognitive impairment (Garand et al. , 2000). The theoretical basis for this study was that individuals have basic psychosocial needs, which, when met, reduce DB (Algase et al. , 1996) (Table 2). The interventions, one focusing on activities of daily living (ADL) and the other focusing on psychosocial activity (PSA), and a combination (CB) of the two, were developed to meet most of the basic psychosocial needs that Boettcher (1983) identified. These included territoriality, privacy and freedom from unwanted physical intrusion; communication, opportunity to talk openly with others; self-esteem, respect from others and freedom from insult or shaming; safety and security, protection from harm; autonomy, control over one’s life; personal identity, access to personal items and identifying material, and cognitive understanding, awareness of surroundings and mental clarity. The section on study groups specifies which interventions were designed to meet which needs. Positive affect usually accompanies interventions that meet basic psychosocial needs (Lawton, Van Haitsma, & Klapper, 1996). Several researchers and clinicians have suggested that displays of affect may offer a window for revealing demented residents’ needs, preferences, aversions (Lawton, 1994), and responses to daily events (Hurley, Volicer, Mahoney, & Volicer, 1993). The study reported here dents and staff; (b) increased falls and injury; (c) economic costs, such as property damage and staff burn-out, absenteeism, and turnover; (d) emotional deprivation such as social isolation of the resident; and (e) use of physical or pharmacologic restraints (Beck, Heithoff, et al. 1997). Third, before the Nursing Home Reform Act (Omnibus Budget Reconciliation Act, 1987), nursing homes routinely applied physical and chemical restraints to control DB with only moderate results (Garand, Buckwalter, & Hall, 2000). However, the Act mandated that residents have the right to be free from restraints imposed for discipline or convenience and not required to treat the residents’ medical symptoms. Thus, research ers have tested a wide range of behavioral interventions to reduce DB and replace restraints. The Act (1987) also stipulated that all residents are entitled to an environment that improves or maintains the quality of mental health. Interventions that promote positive mood or affect fulfill this entitlement. Therefore, this article will report the effects of an intervention to increase functional status in activities of daily living (Beck, Heacock, et al. , 1997), a psychosocial intervention, and a combination of both on reducing DB and improving affect of nursing home residents with dementia. TABLE 2. Basic Psychosocial Needs Relevant Literature Literature suggests that behavioral interventions offer promise in managing DB. A wide range of modalities and approaches have been tested: (a) sensory stimulation (e. g. , music); (b) physical environment changes (e. g. , walled garden); (c) psychosocial measures (e. g. , pet therapy); and (d) multimodal strategies. Many studies found significant Territoriality Communication Self-esteem Safety and security Autonomy Personal identity Cognitive understanding Nursing Research July/August 2002 Vol 51, No 4 Effects of Behavioral Interventions 221 adopted the inference by Lawton et al. (1996) that frequent displays of positive affect when basic psychosocial needs are met might indicate improved emotional wellbeing. is leg continually and without apparent reason needs redirection. This intervention lasted 45–60 minutes a day during various ADL. PSA Intervention. A PNA also conducted the PSA intervention, which involved 25 standardized modules designed to meet the psychosocial needs for communication, selfesteem, safety and security, personal identity, and cogni tive understanding through engagement in meaningful activity while respecting the individual’s unique cognitive and physical abilities (Baldwin, Magsamen, Griggs, & Kent, 1992). The intervention was chosen because it: (a) provided a systematic plan for the PNA to address some of the participant’s basic psychosocial needs; and (b) represented clinical interventions that many long-term care facilities routinely used, but had not been formalized into a research protocol or systematically tested. Each module contained five psychosocial areas of content (expression of feelings, expression of thoughts, memory/recall, recreation, and education) and stimulated five sensory modalities (verbal, visual, auditory, tactile, and gustatory/olfactory). For instance, Activity Module I involved life review, communicating ideas visually (identifying and making drawings), clapping to different rhythms, massaging one’s face, and eating a snack. Initially, many participants tolerated less than 15 minutes of the activity but eventually habituated and participated 30 minutes. CB Intervention. This treatment consisted of both the ADL and PSA interventions and lasted 90 minutes daily. Placebo Control. This involved a one-to-one interaction between the participant and PNA. It controlled for the effect of the personal attention that the PNA provided to the three treatment groups. The PNA asked the participant to choose the activity, such as holding a conversation or manicuring nails. It lasted 30 minutes a day. No Intervention Control. This condition consisted of routine care from a NHNA with no scheduled contact between participants and the PNA. Instruments: Disruptive Behavior Scale. The 45-item disruptive behavior scale (DBS), designed to construct scores based on the occurrence and severity of behaviors, assessed the effect of the interventions on DB (Beck, Heithoff et al. 1997). Gerontological experts (n 29) established content validity, and interrater reliability tests yielded an interclass correlation coefficient of . 80 (p . 001). Geropsychiatricnursing experts weighted the behaviors using a Q-sort to improve the scale’s capacity to predict perceived patient disruptiveness. Factor analysis identified four factors (Beck et al. , 1998). Two corresponded to two—physically aggressive and physically nonaggressive—of the three categories from the factor analysis of the Cohen-Mansfield Agitation Inventory (Cohen-Mansfield, Marx, & Rosenthal, 1989). The third category of the Inventory was verbally agitated; in contrast, the factor analysis of the DBS produced a third and fourth category—vocally agitated and vocally aggressive. To obtain a score for the DBS, a trained individual completed a DBS form for every hour of a shift by check- Methods The primary aim was to conduct a randomized trial of the ADL and PSA interventions individually and in combination (CB) for their effect on DB and affect on a large sample of nursing home residents. The experimental design consisted of three treatment groups (ADL, PSA, and Combined) and two control groups (placebo and no intervention). Individual residents were assigned to one of the five groups at each of seven sites in Arkansas and Maryland, which controlled for site differences. To demonstrate the practicability of the interventions and assure adherence to the treatment protocols, certified nursing assistants were hired and trained as project nursing assistants (PNA). They implemented the interventions Monday–Friday for 12 weeks. Afterward, one-month and two-month follow-up periods occurred. Nursing assistants employed by the nursing homes (NHNA) recorded DB. To measure affect, raters were hired for the study to analyze videotapes filmed during intervention. Research Subjects: The sample initially consisted of 179 participants. The study design allowed for the detection of an improvement in DB scores on the Disruptive Behavior Scale (DBS) (Beck, Heithoff et al. , 1997) across time of at least 1. 6 units with a power of 80%. This power calculation assumed that the repeated measures would be correlated with one another at 0. 60. Inclusion criteria were age 65; a dementia diagnosis; a Mini Mental Status Exam (MMSE) (Folstein, Folstein, & McHugh, 1975) score of 20; and a report of DB in the previous two weeks. To form a more homogeneous group for generalizing findings, exclusion criteria were a physical disability that severely limited ADL; a psychiatric diagnosis; and a progressive or recurring medical, metabolic, or neurological condition that might interfere with cognition or behavior. Study Groups: ADL Intervention. A PNA used the ADL intervention during bathing, grooming, dressing, and the noon meal based on successful protocols that improved functional status in dressing (Beck, Heacock et al. , 1997). It attempted to meet residents’ psychosocial needs for territoriality, communication, autonomy, and self-esteem to promote their sense of safety and security. The intervention also tried to respect participants’ cognitive and physical abilities by prescribing three types of strategies specific to the individual participant. First, strategies to complete an ADL address specific cognitive deficits. For example, the person with ideomotor apraxia needs touch or physical guidance to start movements. Second, standard strategies are behaviors and communication techniques that work for almost everyone with dementia. For example, the caregiver gives a series of one-step commands to guide the resident to put on her shoe. Third, problem-oriented strategies address particular disabilities such as fine motor impairment, physical limitations, or perseveration. For example, a subject who rubs his hand back and forth on 222 Effects of Behavioral Interventions ing the behaviors that occurred. The score for a behavior was the frequency (0–8) times the weight. The item scores were summed to obtain each of the four subscale scores. Mini Mental Status Exam. The Mini Mental Status Exam (MMSE) (Folstein et al. 1975) provided a global evaluation of participants’ cognitive statuses for screening subjects for the study. Test-retest reliability of the MMSE is . 82 or better (Folstein et al. ). Cognition is assessed in seven areas, and scores lower than 24 out of 30 indicate dementia. Nursing Research July/August 2002 Vol 51, No 4 Observable Displays of Affect Scale. The Observable Displays of Affect Scale (ODAS) (Vogelpohl & Beck, 1997), designed to rate videotaped data, contains 41 behaviors categorized into six subscales of positive and negative facial displays, vocalizations, and body movement/posture. Raters indicate presence/absence of each behavior during five 2-minute intervals from a 10minute videotape. Scores range from 0–5 for each item. The range of scores for each scale is: facial positive (0–20), Aggression during bathing facial negative (0–20), vocal positive (0–45), vocal negative (0–50), body could stem from physical positive (0–30), and body negative discomfort or rough (0–40). Interrater reliabilities (Kappa handling coefficients) for the ODAS range from . 68–1. 00, and intrarater reliability is . 97–1. 00. Ten gerontological nursing experts established content validity (Vogelpohl & Beck). Apparent Affect Rating Scale. The Apparent Affect Rating Scale (AARS) (Lawton et al. , 1996) is designed for direct observation of persons with dementia and contains six affective states: pleasure, anger, anxiety/fear, sadness, interest, and contentment. (In later work, Lawton, Van Haitsma, Perkinson, & Ruckdeschel [1999] deleted contentment). Each item has a noninclusive list of behaviors that might signal the presence of the affect from which observers infer the affect. The observer assigns a score of 1 to 5 to measure the duration of the behavior. Visual Analogue Scales. The Positive Visual Analogue Scale (PVAS) and Negative Visual Analogue Scale (NVAS) (Lee & Kieckhefer, 1989; Wewers & Lowe, 1990) are two 10centimeter lines on separate pages for rating positive and negative affect. The PVAS has end anchors of â€Å"no positive affect† and â€Å"a great deal of positive affect. † The NVAS has end anchors of â€Å"no negative affect† and â€Å"a great deal of negative affect. † Scores range from 0 to 100. Procedure: The study consisted of six phases: (a) preliminary activities, (b) a three-week normalization/desensitization period, (c) a 12-week intervention period, (d) a onemonth follow-up period, (e) a two-month follow-up period, and f) a videotape analysis. Preliminary Activities. The institutional review boards at the University of Arkansas for Medical Sciences and the Univer- sity of Maryland approved the research. Each nursing home identified residents with dementia and sent letters informing persons responsible for the residents that researchers would be contacting them. Responsible persons could return a signed form if they did not want to participate. Willing responsible persons received a telephone call explaining the study followed by a mailed written description along with two consent forms. Those willing kept one consent form for their records and signed and mailed back the other. Screening involved a review of the residents’ charts, recording their diagnoses, and interviews with the staff to find evidence of DB during the previous two weeks. Each resident took the MMSE to meet inclusion criteria. Within each home, female residents who passed these screens were randomized to one of the five groups by a drawing, but males were assigned to the five groups to ensure even distribution of their small number. Simultaneously, research staff members were hired and trained. Normalization/Desensitization. For the next three weeks, each PNA accompanied a NHNA to learn the routines of the facility but did not help care for potential study participants. A videotape technician placed a camera that was not running in the dining and shower rooms to desensitize residents and staff to its presence. In addition, nursing home staffs participated in two-hour training sessions on the DBS. Throughout the study, a gerontological clinical nurse specialist trained any new NHNA and retrained if behaviors reported on the DBS differed from those she observed during randomized checks. Intervention. During the 12-week intervention period, the first three weeks were considered baseline and the last two weeks postintervention. The PNA administered the treatment/s or placebo five days a week. Every day, they asked participants to give their assent and espected any dissents. During weeks 11–12 (postintervention), the PNA prepared the participants for their departure by telling them that they were leaving soon. To facilitate data collection, a separate form of the DBS for each of the three eight-hour daily shifts was developed. Eight one-hour blocks accompanied each item of the scale. The NHNA placed a check mark in the block that corresponded to the hour when the NHNA observed the behavi or. The NHNA completed the DBS on all participants during or at the end of a shift. In addition, a technician videotaped participants in the treatment and placebo groups every other week during an interaction with the PNA and no intervention group monthly during an ADL. The technician monitored positioning and operation of the camera from outside the room or behind a curtain to respect the participants’ privacy. One-Month and Two-Month Follow-up. One month and two months after the research team left the nursing home, Nursing Research July/August 2002 Vol 51, No 4 Effects of Behavioral Interventions 223 esearch assistants (RA) retrained nursing home staffs on the DBS. The NHNA then collected DB data on their shifts Monday–Friday for one week. tervention, week 16 as one-month follow-up, and week 20 as two-month follow-up. Participants with fewer than six observations at any time period were omitted. For each period, a total DBS score represented an averVideotape Analysis. The videotapes ranged in length from age of the participant’s data for the t hree shifts of each day less than five minutes to 40 minutes, depending on the across the five days of the observation week. Therefore, activity and the participant’s willingness to cooperate with total DBS scores were obtained for baseline (M of weeks the treatment (baseline and control participants’ tapes 1–3), intervention (M of weeks 4–10), postintervention (M tended to be shorter). To standardize the opportunity for of weeks 11–12), first follow-up (M of week 16), and secbehaviors to occur, an editor took 10-minute segments ond follow-up (M of week 20). The same procedure from the middle of baseline and final treatment eek tapes yielded subscale scores for physically aggressive, physically and randomized them onto videotapes for rating. Because nonaggressive, vocally aggressive, and vocally agitated videotaping occurred to ensure appropriate implementabehaviors for each of the five time periods. tion of interventions, the treatment groups had more A repeated measures analysis of variance (ANOVA) usable videotapes than the control groups did. consisted of two between- subjects and one within-subjects A master’s prepared gerontological factors. The between-subjects factors nurse specialist intensively trained six were intervention group and state (AR raters on the Observer III Software or MD) to account for regional differSystem (Noldus Information Technolences in scoring DB, and the withinogy, 1993) for direct data entry and subjects factor represented DBS scores the affect rating scales. The raters for the five different time periods. Each reached . 80 agreement with the speanalysis allowed for testing by intervencialist on practice tapes before they tion group, time period, and state. The Screaming may started rating the study videotapes. nalysis of the interaction effect of She monitored reliability for each tape intervention group by time period express pain or monthly, retrained as needed, and rantested the hypothesis that the intervenself-stimulation domized the sequence of rating the tions would decrease DB across time in scales. The raters entered the ODAS treatment conditions as compared to and AARS data directly into a comcontrol conditions. The analysis was puter using the Observer. The system repeated five times, once for each suballowed raters to watch videos repeatscale of the DBS and once for the total edly in actual time and slow action to score. Level of significance was set at document behaviors objectively and 0. 05. The researchers believed that the precisely. The raters indicated their small group sizes justified the liberal perception of the participants’ positive and negative level of significance. For the videotape analysis, analyses of affect by placing a vertical mark at some point between covariance occurred for the 14 variables observed from the the two end anchors of the PVAS and NVAS. They videotapes during intervention. The baseline score served marked neutral affect as negative. s a covariate for the final score. While a multivariate analysis would have been desirable, it would have had Intervention Integrity: The PNA and video camera techniinsufficient power with this number of variables and subcian underwent two weeks of intensive training on general jects. The 14 univariate analyses do inflate the Type I error aging topics, stress management, information on dementia, rate. and confidentiality/privacy issues. Training also involved instruction on the study interventions, DBS, and research Results protocols. Of the 179 initial participants, 36 did not finish; the greatA gerontological clinical nurse specialist viewed treatest attrition occurred in the no intervention control group. ment and placebo videotapes biweekly in a private office to Attrition resulted from death (39%), withdrawal of fammonitor PNA compliance with research protocols, provide ily’s consent or at nursing home staff’s request (26%), discorrective feedback to PNA, and help PNA recognize and charge (18%), and change in health status/medications meet participants’ needs as they changed during treatment. hat did not meet inclusion criteria (17%). This left 143 The possibility for contamination appeared to be low participants: 29 in the ADL, 30 in PSA, 30 in CB, 30 in the because NHNA were unlikely to change their care practices placebo, and 24 in the no intervention, but 16 with incomand had little opportunity to observe PNA. Further, NHNA plete data were dropped. Table 3 gives the demographic were b linded to the hypothesis of the study, the nature of the statistics for the 127 participants with complete data. No interventions, and the participants’ group assignments, statistically significant demographic differences emerged although they probably could identify the no intervention among the five groups. In short, this sample primarily conparticipants. sisted of elderly, white females with severe cognitive impairment. Analysis: Reviewers checked for completeness of all data. For the videotape analysis, the final number was 84 The researchers designated intervention weeks 1–3 as baseparticipants with 168 videotape segments. Most were line, weeks 4–10 as intervention, weeks 11–12 as postin- 224 Effects of Behavioral Interventions Nursing Research July/August 2002 Vol 51, No 4 TABLE 3. Description of the Sample by Intervention Group No Intervention 19 89. 5 78. 9 84. 2 86. 47 (6. 37) 11. 47 (6. 43) ADL Number in group Percent female Percent white Percent widowed Mean age (SD) M MMSE (SD) 28 78. 6 82. 1 64. 3 82. 29 (8. 40) 11. 44 (7. 69) PSA 29 82. 1 85. 7 66. 7 82. 18 (7. 64) 10. 65 (6. 76) CB 22 81. 8 77. 3 77. 3 82. 82 (9. 81) 7. 91 (5. 41) Placebo 29 75. 9 86. 2 75. 9 86. 45 (6. 92) 11. 11 (6. 39) Total 127 81. 0 82. 5 72. 8 83. 64 (7. 97) 10. 55 (6. 64) Note. ADL = activities of daily living; PSA = psychosocial activity; CB = combination. emale (79%) and widowed (69%) with a mean age of 83 (SD 7. 44). Participants had a mean score of 10 (SD 6. 34) on the MMSE, indicating moderate to severe cognitive impairment. Table 4 displays the means and standard deviations for the DBS overall and the four subscales across the five time periods for the five groups. No significant differences emerged for the interventi on-by-time interaction for any of the dependent variables. Thus, the results failed to support the hypothesis that the interventions would decrease DB across time in treatment groups as compared to control groups (statistical analysis tables on Website at: http://sonweb. nc. edu/nursing-research-editor). However, the main effect of state was significant in three analyses. Arkansas recorded significantly more behaviors than Maryland did for the dependent variables of physically nonaggressive (p . 001), vocally agitated (p . 001), and overall DBS (p . 002). Further, the main effect of time was significant for overall DBS (p . 002) and the four subscales of physically aggressive (p . 001), physically nonaggressive (p . 027), vocally aggressive (p . 021), and vocally agitated behaviors (p . 008). The significance resulted from increased DB after the PNA had left the home (generally from intervention or postintervention to first follow-up). For the videotape analysis, the hypothesis stated that treatment groups, compared with control groups, would display more indicators of positive affect and fewer indicators of negative affect following behavioral interventions. In general, neither the positive nor the negative affect scores were particularly high, indicating that this sample had relatively flat affect. Results from the analysis of covariance tests supported increased positive affect but not decreased negative affect. Compared to the control groups, the treatment groups had significantly more positive facial expressions (p . 001) and positive body posture/movements (p . 001), but not more positive verbal displays on the ODAS. The treatment groups displayed significantly more contentment (p . 037) and interest (p . 028) than the control groups did on the AARS. For the negative affects on the AARS, the treatment groups had a shorter duration of sad behaviors (p . 007) than the control groups did. Comparison of VAS scales likewise showed that the treatment groups displayed more positive affect (p . 012). Discussion In contrast to other studies (e. . , Hoeffer et al. , 1997; Kim & Buschmann. , 1999; Whall et al. , 1997), this study found no treatment effect on DB. The interventions were a synthesis of approaches believed to globally address â€Å"triggers† of DB and meet psychosocial needs (Boettcher, 1983). They did not address the specific factors that might have been triggering the particula r behavior (Algase et al. , 1996). Such triggers include under/over stimulation, unfamiliar or impersonal caregivers, and particular individual unmet psychosocial needs. For example, aggression during bathing could stem from physical discomfort or rough handling (Whall et al. 1997). Interventions much more individually designed require development. Increasing DB across all groups was reflected in the DBS scores at 1-month follow-up. Two factors may explain this increase. First, the PNA had warned participants that they would be leaving. Second, the ADL and CB participants no longer received care from the familiar PNA, and PSA, CB, and placebo participants no longer had a daily activity or visit. The increased stress and time constraints for NHNA as they resumed caregiving of the ADL and CB participants may explain the heightened DB in the control groups. Such changes may trigger increased behavioral symptoms in persons with dementia (Hall, Gerdner, Zwygart-Stauffacher, & Buckwalter, 1995). Two measurement issues may have affected outcomes. First, observers view behaviors differently (Whall et al. , 1997) and come to expect particular behaviors from certain residents (Hillman, Skoloda, Zander, & Stricker, 1999). If the NHNA were accustomed to a participant’s DB pattern, such as persistent screaming, they may have overlooked decreases in that behavior. Initial training and retraining of raters occurred as needed; however, some Nursing Research July/August 2002 Vol 51, No 4 Effects of Behavioral Interventions 225 TABLE 4. Weighted Scores for Disruptive Behavior by Intervention Group and Time Period No Intervention (n = 19) Mean (SD) 408. 71 (427. 24) 303. 69 (408. 44) 281. 97 (410. 85) 418. 31 (630. 58) 292. 85 (405. 15) 114. 66 (202. 89) 90. 85 (182. 70) 77. 98 (173. 15) 130. 92 (257. 12) 128. 20 (195. 67) 191. 97 (157. 75) 117. 11 (112. 30) 118. 23 (137. 08) 154. 46 (225. 05) 100. 45 (153. 30) 55. 16 (74. 70) 42. 89 (54. 54) 33. 26 (47. 06) 64. 72 (77. 89) 28. 09 (37. 02) (continues) DB Category Time Period DBS total Baseline ADL (n = 28) Mean (SD) 172. 51 (191. 47) 182. 45 (181. 3) 164. 56 (154. 95) 207. 22 (205. 58) 190. 70 (291. 06) 20. 67 (30. 52) 32. 59 (51. 29) 15. 02 (26. 10) 44. 18 (100. 62) 21. 45 (36. 47) 95. 50 (105. 28) 87. 58 (87. 58) 85. 04 (89. 60) 88. 81 (85. 69) 148. 75 (187. 28) 22. 85 (32. 10) 28. 37 (32. 50) 21. 15 (26. 54) 30. 72 (48. 95) 18. 28 (24. 55) PSA (n = 29) Mean (SD) 348. 02 (467. 50) 306. 81 (393. 03) 303. 24 (367. 54) 373. 17 (533. 05) 300. 20 (366. 42) 85. 87 (199. 01) 83. 94 (167. 53) 82. 82 (166. 93) 113. 49 (235. 71) 81. 30 (151. 85) 162. 41 (206. 65) 130. 82 (142. 72) 133. 92 (145. 97) 141. 47 (188. 99) 164. 92 (223. 63) 49. 64 (93. 15) 43. 80 (64. 6) 37. 90 (53. 43) 54. 47 (90. 33) 40. 26 (45. 26) CB (n = 22) Mean (SD) 287. 66 (373. 73) 300. 84 (379. 33) 286. 21 (365. 78) 374. 10 (510. 10) 312. 83 (433. 18) 68. 84 (126. 18) 67. 14 (137. 79) 61. 04 (127. 78) 92. 68 (205. 52) 60. 40 (131. 54) 136. 67 (189. 03) 124. 64 (164. 49) 125. 99 (157. 78) 159. 97 (202. 75) 146. 53 (201. 83) 34. 49 (55. 91) 40. 73 (52. 60) 31. 18 (33. 85) 36. 95 (42. 70) 32. 82 (51. 32) Placebo (n = 29) Mean (SD) 325. 96 (337. 14) 337. 60 (328. 94) 336. 80 (366. 55) 389. 92 (434. 43) 319. 15 (384. 59) 49. 26 (90. 24) 62. 10 (112. 71) 59. 67 (106. 37) 76. 79 (165. 45) 48. 25 (101. 4) 167. 01 (177. 80) 164. 62 (161. 48) 175. 36 (189. 80) 201. 68 (212. 06) 87. 67 (127. 38) 47. 20 (79. 70) 39. 55 (57. 74) 32. 69 (55. 77) 29 . 30 (47. 60) 30. 18 (52. 85) Intervention Postintervention 1 month follow-up 2 month follow-up Physically aggressive Baseline Intervention Postintervention 1 month follow-up 2 month follow-up Physically nonaggressive Baseline Intervention Postintervention 1 month follow-up 2 month follow-up Vocally aggressive Baseline Intervention Postintervention 1 month follow-up 2 month follow-up 226 Effects of Behavioral Interventions Nursing Research July/August 2002 Vol 51, No 4 TABLE 4. Weighted Scores for Disruptive Behavior by Intervention Group and Time Period (Continued) NoIntervention (n = 19) Mean (SD) 47. 65 (97. 22) 68. 32 (103. 13) 68. 01 (116. 62) 84. 50 (112. 48) 73. 07 (117. 12) DB Category Time Period Vocally agitated Baseline ADL (n = 28) Mean (SD) 33. 49 (84. 39) 33. 91 (62. 52) 43. 17 (72. 10) 43. 48 (64. 39) 50. 53 (117. 95) PSA (n = 29) Mean (SD) 46. 92 (98. 70) 52. 84 (96. 03) 52. 50 (90. 78) 68. 22 (98. 89) 48. 89 (92. 33) CB (n = 22) Mean (SD) 62. 49 (98. 97) 70. 43 (110. 85) 69. 08 (107. 29) 82. 14 (118. 97) 75. 80 (129. 67) Placebo (n = 29) Mean (SD) 50. 0 (92. 05) 48. 25 (81. 63) 48. 59 (72. 20) 63. 74 (95. 30) 54. 11 (80. 61) Intervention Postintervention 1 month follow-up 2 month follow-up Note. Scores were created by assigning each behavior with a severity weight prior to summing and then averaging across day and then week(s). DBS = disruptive behaviors; ADL = activities of daily living intervention; PSA = psychocial activity inte rvention; CB = combination of the two interventions. NHNA appeared to continue to consider participants’ behaviors, such as repetitive questioning, to be personality characteristics or attention-seeking efforts rather than DB. Thus, they may have under-reported behaviors. Further, staff may prefer withdrawn behaviors, such as isolating self and muteness (Camberg et al. , 1999), and view them as nonproblematic. Second, categorizing a behavior as disruptive without understanding its meaning to the person with dementia may be conceptually flawed. For example, screaming may express pain or self-stimulation. Two design features may explain differences between the findings of this study and others. First, this study had both placebo and no intervention control conditions. Just a few other studies randomized subjects to treatment or control groups or included two control groups (e. g. , Camberg et al. , 1999). In most studies, control conditions preceded or followed treatment conditions (e. g. , Clark, Lipe, & Bilbrey, 1998). In both designs, subjects served as their own controls, which limits examination of simultaneous intra- and extra-personal events that might affect DB frequency. Second, many control groups came from separate units or different nursing homes (e. g. , Matteson et al. , 1997), which makes it difficult to control for differences in environment, staff relationships, and personalities. This study occurred at seven sites in two different geographical areas, but at each site, the randomization of female participants distributed the groups across all nursing units to control for environmental and staff characteristics. Acknowledged limitations include the following. First, in spite of the large overall sample, the group sizes were small (range 19–30) with the greatest loss in the no inter- vention group. Larger groups might have provided more definitive findings on the relationship between behavioral interventions and DB frequency as Rovner et al. (1996) did (treatment group 42; control group 39). Second, NHNA served as data collectors because using independent observers would have been cost-prohibitive. These results suggest that future intervention research should consider the individual characteristics of the person with dementia (Maslow, 1996) and the triggers of the behavior (Algase et al. , 1996). Studies that have individualized interventions have demonstrated decreased DB (Gerdner, 2000; Hoeffer et al. , 1997). Researchers need to continue to refine methods for identifying what works for whom (Forbes, 1998) to minimize the prevalent trial-anderror approach to DB management.

Puppy Mills

Tiffany Baldeo MWF 8:00-8:50am ENC1101 Informative Essay Puppy Mills, Be gone! Bulldogs on sale! Yorkie puppies available here! Have you ever wondered where all these cheap puppies for sale in pet stores come from? The answer is that they are produced in factory-like environments known as â€Å"puppy mills†. Puppy mills are large-scale dog breeding operations where profit is given priority over the well-being of the dogs. Puppy mills treat dogs like products, not living beings, and usually house them in overcrowded and unsanitary conditions without adequate veterinary care, socialization, or even food and water.The cute puppies for sale at your local mall were probably bred from dogs that don’t play outside or get groomed. Puppy mill dogs are typically kept in cages with wire flooring that injures their paws and legs and cages can be stacked up in a column, which means waste falls on the dogs housed below them. Compromised health and conditions like matting, sores, mang e, severe dental disease and abscesses are often widespread. Many puppy mill puppies are born with or develop overt physical problems that make them unsalable to pet stores, which mean they end up abandoned or just left to die.Many sick puppies do manage to end up at pet stores, though, where the new puppy owner unknowingly purchases the sick dog. Breeding dogs at the mills sometimes spend their entire lives outdoors, exposed to the elements, or crammed inside filthy structures. When a parent at a puppy mill is no longer able to produce, the dog may be given to the nearest shelter, abandoned, or even destroyed. Also, because the puppies produced in puppy mills do not have safe and healthy homes selected for them ahead of time, if they are not purchased by the time they hit a certain age, they may suffer the same fate.Female dogs usually have little to no recovery time between bearing litters. When, after a few years, the females can no longer reproduce or when their breed goes out o f style, the dogs are often abandoned, shot, or starved until they eventually die. Many pet stores with cute puppies for sale will tell you that they don't get their puppies from puppy mills. They'll say their puppies are all from â€Å"USDA licensed breeders. † If you dig a little deeper into what that actually means, you'll find that it's not worth much. The standards of care required by the USDA are woefully inadequate and not what most of us would consider humane.They leave a lot of room for dogs to be severely mistreated. Even if they were adequate, they're not enforced. Take a look at a scathing report done by the Inspector General on USDA's lax enforcement of the law regulating breeders and judge for yourself whether USDA licensing of puppy mills is enough to make you shop at stores that sell puppies. In fact, you only have to be licensed by USDA as a commercial breeder if you are selling puppies to pet stores or brokers. So USDA licensure is actually a pretty good ind icator that the breeders are, in fact, puppy mills.Small hobby breeders, who sell their dogs directly to the public, including those who only sell their puppies online, do not have to be licensed or inspected by USDA. Don’t support the industry. Most pet shop puppies come from puppy mills, and so do most dogs sold over the Internet. Pet shop puppies are separated from their mother at as young as six weeks of age. The health of the puppies is not always guaranteed. Purchasing a puppy for sale at a pet store or online often supports the horrible puppy mill industry. Buying anything in pet stores that sell puppies supports the industry, too.Buy all your pet supplies, toys, pet food, and kitty litter, from stores that do not sell puppies, or buy your pet supplies online from websites that do not sell puppies. Breeders or owners of large kennels are supposed to adhere to regulations and follow protocol when it comes to their business and the wellbeing of the animals that are in th eir facilities. The puppy mills project states that of the 3,000 USDA licensed breeding facilities, a large number of them have violations that go unpunished and led to the maltreatment of the animals behind the walls.The United States government should be making more strides to help the animals that must endure these horrific living conditions. The Animal Bill of Rights is being used by the Animal legal defense Club to show that there is a large amount of support that is going towards the promotion of more strict animal rights. They also need to help congress come up with harsher punishments for the people that feel that they are above the law and do not need to follow the laws when it comes to animals and abuse.The Fund also states in their website that in the United States about 45 states including the District of Columbia have a type of felony level animal cruelty provision which may be in forced in cases of animal fighting or death of an animal. States need to take a closer loo k at the puppy mill facilities or â€Å"breeding kennels† and take more drastic measures against people who violate regulations. It is not fair to the animals that they have to live in such conditions that can make them sick and feel unloved.

Blowing The Gaff

Blowing The Gaff Blowing The Gaff Blowing The Gaff By Sharon I recently mentioned a book called Mind The Gaffe, which is all about errors in English. It got me to thinking about the word gaffe and other related expressions. I set out to do some digging in my trusty dictionary and came up with a few surprises. The word gaffe means a social blunder and originates from French in the 19th century. It should not be confused with the word gaff, which has a variety of interesting meanings. If you fish, then you probably use a sturdy pole with a strong hook to capture the biggest catch of your life. Thats called a gaff, and youll need it if you want to avoid tales about the one that got away. If you actually manage to land that fish, then gaff becomes a verb that shows how you hook it. Sailors know a gaff as a special boom to which a gaffsail is attached. Cockfighting is a favored pastime in some parts of the world, and in that context, gaff describes the spur thats attached to a gamecocks leg. Gaff is also a popular slang word with several meanings. It can mean nonsense talk, cheat or hoax. If youre British and you blow the gaff, then you reveal a secret, while Americans and Canadians who stand the gaff are able to take a bit of ribbing. Gaff was also an old British term for someones home, as well as a cheap theater or music hall in Victorian times. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Expressions category, check our popular posts, or choose a related post below:Arrive To vs. Arrive At8 Proofreading Tips And TechniquesInspiring vs. Inspirational

5 Illegal Interview Questions and How to Deal with Them

5 Illegal Interview Questions and How to Deal with Them When it comes to job interviews, honesty (okay, maybe enhanced honesty in some cases) is the way to go. But what if the interviewer is asking you questions they have no right to ask? Out of ignorance or slyness, an interviewer might try to get information out of you that the company is not allowed to factor into their hiring decisions. However, you’re not obligated to answer them- and in fact you shouldn’t. Your battle plan should be to figure out why they’re asking (whether it has direct consequences for the job itself), and to decide whether you should answer. In most cases, the answer is â€Å"no,† but there are ways to redirect the conversation and/or call attention to the inappropriateness of the question without alienating the interviewer. After all, it may just be someone talking off the cuff without realizing it’s actually illegal to talk about certain personal issues. Some of the hardest interview questions you’ll encounter might be illegal.Here are some examples of illegal interview question areas, and how to get around them.1. Religion/Race/Sexual OrientationDo you volunteer with your church? That’s an interesting last name, what’s your background? These questions all sound pretty harmless†¦just making small talk, right? Yet each one gives away information known as â€Å"protected class.† Employers are prohibited by federal and state law from hiring (or not hiring) based on categories like race or ethnicity, religion, or sexual orientation. Talking about topics like your church (or lack thereof), your spouse, or your family’s ethnic background can give information that could tip the interviewer against you if there’s a bias involved. Even if it happens in a pre-interview chat, before you get down to the brass tacks of the job itself, you’ve given information that the interviewer had no real right to ask.The way to handle this is to redirect the question. If you r efuse to answer, even though you’re in the right, it could set you up as â€Å"combative† or disagreeable in the eyes of the interviewer. It’s okay to be vague and try to channel the conversation elsewhere. On church activity: I do volunteer at my local soup kitchen- I like to give back to the community when I can. On family background: Gotta love the American melting pot, right? 2. AgeYou have a pretty long and distinguished resume, do you see yourself retiring soon? Age (particularly 40 and up) is another protected class. If an interviewer tries to get information about how old you are, he or she might be trying to suss out whether you’re likely to be a long-time employee at the company†¦or whether this job is a pit stop on your way to the golf course.You should never feel obligated to give your age. Instead, take the chance to re-emphasize your commitment to the job for which you’re interviewing: On the contrary, I’m looking forward to talking about a long and productive relationship with this company, and bringing the fruits of that experience to my work for a long time to come.3. Family StatusIf you’re pregnant, have children, or may want children some day†¦doesn’t matter. An interviewer is not allowed to use your family status as part of the hiring decision. Even if you’re eight months pregnant in your interview suit, he or she can’t ask when you’re due, or about your childcare plan afterward.In a case like this, the best tactic is to try to push it back on the asker. Without being overly antagonistic, it’s okay to ask, Can you help me understand why that matters? I just want to make sure I better understand what this job entails.4. Whether You’ve Been ArrestedConvictions are fair game for interviewers and job applications, but arrests (without convictions) are not. Even that’s starting to change in some places: New York is looking at phasing out e mployers’ ability to ask about particular kinds of convictions. For now, however, convictions are askable, but arrests are not.If you’re asked, have a simple response ready to go (taking too long can trigger the kind of reaction you’re trying to avoid): I have never been convicted of anything, no. And if you do have a conviction, it’s essential to remember not to lie about that, because a background check would likely uncover that information.5. Your Military ServiceI see from your resume that you’re in the National Guard. Does that take up much of your time? Employers are not allowed to use active military service as criteria in hiring. Basically, the interviewer can’t factor in your military service at all. If you choose to answer this one, emphasize that you’ve never had a problem balancing your service with your career.6. Disability StatusIf you don’t mind my asking, how did you get in that wheelchair? Will you be on crutch es long-term? I see you have glasses- is that a pretty strong prescription? The Americans with Disabilities Act (ADA) is pretty clear- employers are not allowed to discriminate against employees that may need physical accommodations. Instead, they are allowed to ask if you would need any specific accommodations to do the job.If it seems like the interviewer is fishing for information about a disability, deflect it. Are you asking whether I would need special accommodations? Or, I’m not sure I see how this relates to my ability to analyze sales reports- can you clarify and help me understand?The most important thing to remember is that if you feel uncomfortable, you don’t have to answer- but you also don’t have to disqualify yourself by putting up a defensive wall or walking out of the interview. It’s fine to call attention to the reasons behind asking (in as non-confrontational a way as you can manage), then try to segue back to the interview and job desc ription as quickly as possible.If you have concerns about any of the areas outlined here, definitely check with the Equal Employment Opportunity Commission (EEOC), and know your rights as an applicant.

0610 BIOLOGY Essays (1277 words) - Secondary Education In England

UNIVERSITY OF CAMBRIDGE INTERNATIONAL EXAMINATIONS International General Certificate of Secondary Education MARK SCHEME for the May/June 2007 question paper 0610 BIOLOGY 0610/02 Paper 2 (Core Theory), maximum raw mark 80 This mark scheme is published as an aid to teachers and candidates, to indicate the requirements of the examination. It shows the basis on which Examiners were instructed to award marks. It does not indicate the details of the discussions that took place at an Examiners meeting before marking began. All Examiners are instructed that alternative correct answers and unexpected approaches in candidates scripts must be given marks that fairly reflect the relevant knowledge and skills demonstrated. Mark schemes must be read in conjunction with the question papers and the report on the examination. CIE will not enter into discussions or correspondence in connection with these mark schemes. CIE is publishing the mark schemes for the May/June 2007 question papers for most IGCSE, GCE Advanced Level and Advanced Subsidiary Level syllabuses and some Ordinary Level syllabuses. Page 2 Mark Scheme Syllabus Paper IGCSE May/June 2007 0610 02 UCLES 2007 1 (a) (i) leaf B has parallel veins/veins not branched; [1] (ii) organism D has body divided into segments/rings/OWTTE; [1] (iii) organism E has four pairs of/eight legs/limbs ; I - ref to cephalothorax (erroneous) [1] (iv) organism G has more than 4 pairs of legs/limbs/non-identical/varied legs/limbs/2 regions to body/cephalothorax and abdomen; I refs to exoskeleton [1] N.B. No letter given no mark (b) show division of 50/5; (magnification) x10/times 10; R 10mm If no working then 2 marks for correct magnification If wrong working can gain 1 mark for correct magnification I ratios [2] [Total: 6] 2 (a) A = sepal/calyx; B = anther/stamen; Accept androecium [2] (b) to receive/trap pollen/OWTTE; Accept ref to male gamete [1] (c) 1 no nectary (in wind pollinated flower); 2 smaller/less obvious petals (in wind pollinated flower); 3 stamens outside of petals/flowers (in wind pollinated flower); 4 stigma/style outside of petals/flowers (in wind pollinated flower); 5 feathery stigma (in wind pollinated flower); any two 1 mark each [2] (d) process flowering plant human fertilisation germination implantation pollination sexual intercourse Each vertical column correct 1 mark each [2] I crosses in other boxes Page 3 Mark Scheme Syllabus Paper IGCSE May/June 2007 0610 02 UCLES 2007 (e) (i) 1 dispersed by animals/mammals/birds/named examples; R insects 2 red outer coat attracts them; 3 flesh encourages them to eat fruit; 4 seeds hard coats allow it to avoid digestion/discourage swallowing; 5 dispersal in faeces/dropped while removing flesh; any three 1 mark each [3] (ii) 1 moisture/water/OWTTE; 2 with minerals/named mineral; 3 warm conditions/suitable/optimum temperature; 4 in light/not shaded area; any three 1 mark each [3] [Total: 13] 3 (a) continuous (variation); [1] (b) (i) plotted as four bars, all clearly identified (beneath or on bar); accurate plotting (+/ half a square); [2] (ii) genes/alleles/genotype/DNA/OWTTE; [1] (c) (i) a change/alteration in a gene/allele/DNA/chromosome/chromosome number; [1] (ii) chemical/named example/cigarette tar; (gamma/beta/alpha/ionising) radiation; X rays; UV light; any two 1 mark each [2] [Total: 7] Page 4 Mark Scheme Syllabus Paper IGCSE May/June 2007 0610 02 UCLES 2007 4 (a) (i) F; [1] (ii) E; [1] (iii) no tropical forest left/all destroyed; [1] (iv) D; [1] (b) (i) bacteria/fungi; [1] (ii) carbon dioxide; minerals/named mineral salt/ion; I nutrients R nitrogen (gas) [2] (c) 1 crops take/use mineral salts from soil; 2 crop removed from land; 3 soil becomes infertile/low in mineral salts; 4 crop yield drops to worthless levels; 5 no fresh/replacement of humus/no recycling of materials; 6 crumb structure lost; any three 1 mark each [3] [Total: 10] 5 (a) (i) carbon compounds in animals; [1] (ii) C; D; E; any two 1 mark each [2] (iii) B; [1] (iv) A; [1] (b) (i) arrow labelled P parallel to C but in opposite direction/ linking boxes from air to plants around outside of diagram; [1] (ii) carbon dioxide + water; = glucose/(simple) sugar/starch + oxygen; [2] I ref to water on product side A correct formula as substitute for word no need for equation to be balanced [Total: 8] Page 5 Mark Scheme Syllabus Paper IGCSE May/June 2007 0610 02 UCLES 2007 6 (a) A; D; E; [3] I named parts (b) root hair cell 1 long extension/description to cell; 2 increase surface area (for absorption); 3 no chloroplasts/chlorophyll; 4 underground/hidden from light; [4] I - ref to photosynthesis

Essay applying theories of political economy to music

Applying theories of political economy to music - Essay Example The newer pop and rock music that is being included in each genre, as well as from the Big 6 music corporations, are specifically leading many to have a commercialized expression that will always sell within the genre. The music is becoming a superstructure of what sells, as opposed to providing genuine music. When looking at the different aspects of the top 20, it can be seen that commercialization has taken over the different genres, as opposed to independent artists and variety. The top 20 on itunes included mostly pop and hip hop music, with only one country song and one alternative rock song. The genres continued with the Big 6 having several smaller branches that were sponsoring the artists, as opposed to a larger corporation. However, none of the artists were independent and all were signed to a contact with the Big 6. The same trend was seen at the Last FM site. Most of the artists were in the genre of dance and pop music. The majority of the artists were also signed over to the Big 6 or a branch of the larger corporations. In the Last FM component, there were more rock and alternative sounds with two to three Indie musicians that were mixed in with the others of this genre. However, Last FM also had several of the same artists playing with different songs for a similar affect. Fr om the two areas of Top 20 that were analyzed, several assumptions could be made. The first is that specific genres, such as pop and hip – hop, are the most popular in society on a global level. The second is that the Big 6 are continuing to create a mass response to what individuals are demanding in society. It can also be assumed, from this analysis, that specific musicians are more popular than others and are instantly hitting the Top 20 on a global level, which shows a mass response to cultural icons and artists that are being promoted by

Performance Management Essay Example | Topics and Well Written Essays - 2750 words

Performance Management - Essay Example Firstly I will be basing my argument on the fact that apart from financial measures ‘Non-financial indicators is likely to be used for identifying best practices within cooperative relationships’ (Patelli and Dossi, 2012). Next the team’s activities will be further related with job satisfaction and motivation as a consequence of 360 degree feedback, supervisor skills and work itself. (Shah et al, 2012) A positive relationship can be found between Job Satisfaction and motivation and Reward and Recognition, Supervision and Work itself. The fact that a healthy supervision was maintained through relative feedback and unbiased opinion through rotation of team leaders will be discussed later in the subsequent paragraphs.(Shah et al, 2012). In our 6 weeks of reading and team activities we have been taken through various stages. Every week was characterised by a unique and essential quality of team work, individual performance, relative moderation all of which sum up to g ive a first-hand experience of the following experiences: relationship between professional work and supervision( through weekly activities), supervisory skills (Through weekly rotation of the role of a leader) and balance between nature of work, reward and recognition and intrinsic motivation towards one’s job ... Performance Management in context of group activities Performance Management is not a one-dimensional activity as seen from the weekly group activities, involving not only supervision, but also assessment, emotional understanding, intellectual brainstorming seen in week 2 and 3 activities of questionnaire on a summary and the debate. In the same way Performance Management relies not just on absolute parameters and outcomes but relative analysis. As shared by one of the subsidiaries, ‘In our company, we pay much attention to information-sharing, and relative performance evaluation is one way to learn from each other’ ( Dossi and Patelli, 2012). Reflective analysis of weekly activities The diverse tasks in the first activity like: reading out a summary, comprehending the same and testing the assimilation and understanding through a rapid fire round of question, followed by subsequent critique by the leader and an open discussion gives an all-round practical exposure to Per formance and Talent Management. My group is composed of 6 participants, all of them being female. Participant A is an Australian local, participant B is another Australian local who already has a job and some work experience. Participant C is an international citizen thirty five year of age and having two children. Participants C, D and E are Chinese full time student. I am participant E. As can be observed form the above assimilation of participants. They have a balanced mix of students and professionals, young and middle aged participants, locals and foreign nationals, college graduates, undergraduates and working professionals. Various stages of Forming Storming, Norming, Confirming and

Engineering Practice Assignment Example | Topics and Well Written Essays - 2000 words

Engineering Practice - Assignment Example This essay stresses that ethics is a normative science which differs in some way with the positive science. The science which is studied in laboratories of the universities is described as the positive science. Positive science is depicted as what we observe through our eyes or through other sensory organs. There is another science which does not directly deals with the observation rather it is based on the standard of rules and norms by which certain objects are judged, this science is known as normative science. Normative science is also responsible for testing the validity of the set standard of rules. This paper declares that a person gets his ethical principles and values form the moral education at home, lessons taught at school or in some special religious training. Some people also acquire the principles and values from the messages of society via radio, television, newspaper, books and magazines. Some of the individuals also acquire values and principles through real life experiences. Engineering and management are both relevant areas of study. Now Engineering can be defined as a profession where there is knowledge of mathematics and natural science gained through theoretical, practical studies and experience, is applied to develop different forces of nature for the welfare of people. Management can be defined as a process of planning, designing and controlling the environment in which persons, working together in group, successfully accomplishes their desired goals. (Weihrich & Koontz, 2006, p.5-6). Control plays an effective role in the management of an enterprise. An organ isation comprises of different types of employees on the basis of their needs, want and interest, in that area management control creates coordination and give directions (Flamholtz, 1996, p.4-6). Ethical Issues Ethics in workplace is the set of values and beliefs which guides an employee.

Elements of Religious Traditions Research Paper Example | Topics and Well Written Essays - 750 words

Elements of Religious Traditions - Research Paper Example The paper would discuss its relationship with various elements of social interaction. Identifying critical issues God is a supreme being in different religions vis-a-vis Christianity, Islam, Hinduism, Judaism, Buddhaism etc. The varying traditions and their interpretations therefore become critical issues to define human behavior and actions, especially with regard to various socio economic and political paradigms which have catalytic effect on all people cutting across nationality, race, culture and color. The racial prejudices, gender inequality, capitalistic structure of society and even national boundaries are seen as going against the basic posit of religions’ core beliefs. This also raises the need to examine religion in various perspectives to gauge its responses amongst the people who practice it in different format and expressions. Relationship with divine God’s supremacy is recognized within all religious scriptures and exemplifies its relationship with the Di vine in terms of behavior that is morally and ethically correct. The Bible teaches to be God fearing and stresses the need to repent by the sinners. It believes that God has endowed man with free will so he can follow his course of actions that would lead him towards the God. The sinful acts would lead him to purgatory and therefore repentance becomes intrinsic part of Christianity. Hinduism also reveres God as Creator and inculcates God fearing tendencies for fear of going to hell rather than heaven. Thus, in all religions, good actions are encouraged because they bring men closer to God. Relationship with sacred time Religious traditions and scriptures are abound with the notion of eternity and the scientific theory of evolution of man which has faced tremendous pressure from the Church and other religions. The theory of creation and orthodox Jews beliefs that ‘our history had been preceded by untold cosmic cycles of millions and billions of years’ (N.d, 2010, reading 1). The Hinduism’s concept of rebirth delineates the concept of time to surreal realities which are but the imagery of our physical self. In religious traditions, sins and purgatory would invite wrath of God, resulting in ultimate destruction of the world. The sacred time, therefore is important aspect where events occur in cyclic order irrespective of the fact whether it is desired or not. Thus, prayers become important part of religious traditions. Relationship with sacred space or natural world World is created by God and Human beings are called to work as God's stewards. The created order is entrusted to humanity, not as individuals, but as a community. The private property right is therefore embedded in an inclusive concept of common property of all people and is never allowed to become an absolute right that excludes others completely (Graafland, 2008, reading 3) Religious conceptualization of space and natural world delimits the manmade boundaries of nations. Everythin g belongs to God and respect and healthy regard for all elements of the earth become intrinsic to religious philosophy. Merleau-Ponty (reading2, 1965) says that there are two world, one external that needs space or territory and the internal one or ‘agora’ that resides within oneself. Agora continuously provokes people to move and thereby ‘

EMAAR Essay Example | Topics and Well Written Essays - 1500 words

EMAAR - Essay Example EMAAR has its headquarters in Dubai (United Arabs Emirates). Despite the above growth, EMAAR has still been in the verge of discussing new prospects of growth which entails geographical expansion to new and virgin lands most so the far east and North Africa (Group, 2008). The other strategy is that of product segmentation. It deals in variety of products ranging from the housing industry, hospitality and tourism industry. The company has also invested much in the Education Sector and the Health sector where it has built schools and hospitals as well as investing in the best facilities for the buildings (Group, 2008). The company as well deals in the financial instruments in the financial markets of Dubai, where last year (2010/2011) alone it traded in a turnover of over 29 billion AED in stocks (Group, 2008). The company’s total sale of apartments in the year 2010/2011 has been estimated to be Dh 583; this has been stated as a decline of about 86% of the previous year’s sales (Group, 2008). This may be because of the economic hard time, which even caused a crush in the western economies. The revenue from such sales was estimated to be about $ 1.52 billion last year, which is still a drop of about 10%, the previous year’s revenues. The drop in revenue is attributed to and depicts a slash in prices due to stiff competition in the industry. Two major products that the company deals in are the apartments and the villas. The apartments are the largest income-generating unit with a revenue of Dh 183 in the last quarter of last year. Villas on the other hand made good sales, the sales was about Dh126.4, this was a drop though of some few percentages (Group, 2008). EMAAR does not operate as a monopoly in its business. Just as I have mention previously it operates in a highly competitive environment where there are several

Engineering Practice Assignment Example | Topics and Well Written Essays - 2000 words

Engineering Practice - Assignment Example This essay stresses that ethics is a normative science which differs in some way with the positive science. The science which is studied in laboratories of the universities is described as the positive science. Positive science is depicted as what we observe through our eyes or through other sensory organs. There is another science which does not directly deals with the observation rather it is based on the standard of rules and norms by which certain objects are judged, this science is known as normative science. Normative science is also responsible for testing the validity of the set standard of rules. This paper declares that a person gets his ethical principles and values form the moral education at home, lessons taught at school or in some special religious training. Some people also acquire the principles and values from the messages of society via radio, television, newspaper, books and magazines. Some of the individuals also acquire values and principles through real life experiences. Engineering and management are both relevant areas of study. Now Engineering can be defined as a profession where there is knowledge of mathematics and natural science gained through theoretical, practical studies and experience, is applied to develop different forces of nature for the welfare of people. Management can be defined as a process of planning, designing and controlling the environment in which persons, working together in group, successfully accomplishes their desired goals. (Weihrich & Koontz, 2006, p.5-6). Control plays an effective role in the management of an enterprise. An organ isation comprises of different types of employees on the basis of their needs, want and interest, in that area management control creates coordination and give directions (Flamholtz, 1996, p.4-6). Ethical Issues Ethics in workplace is the set of values and beliefs which guides an employee.

EMAAR Essay Example | Topics and Well Written Essays - 1500 words

EMAAR - Essay Example EMAAR has its headquarters in Dubai (United Arabs Emirates). Despite the above growth, EMAAR has still been in the verge of discussing new prospects of growth which entails geographical expansion to new and virgin lands most so the far east and North Africa (Group, 2008). The other strategy is that of product segmentation. It deals in variety of products ranging from the housing industry, hospitality and tourism industry. The company has also invested much in the Education Sector and the Health sector where it has built schools and hospitals as well as investing in the best facilities for the buildings (Group, 2008). The company as well deals in the financial instruments in the financial markets of Dubai, where last year (2010/2011) alone it traded in a turnover of over 29 billion AED in stocks (Group, 2008). The company’s total sale of apartments in the year 2010/2011 has been estimated to be Dh 583; this has been stated as a decline of about 86% of the previous year’s sales (Group, 2008). This may be because of the economic hard time, which even caused a crush in the western economies. The revenue from such sales was estimated to be about $ 1.52 billion last year, which is still a drop of about 10%, the previous year’s revenues. The drop in revenue is attributed to and depicts a slash in prices due to stiff competition in the industry. Two major products that the company deals in are the apartments and the villas. The apartments are the largest income-generating unit with a revenue of Dh 183 in the last quarter of last year. Villas on the other hand made good sales, the sales was about Dh126.4, this was a drop though of some few percentages (Group, 2008). EMAAR does not operate as a monopoly in its business. Just as I have mention previously it operates in a highly competitive environment where there are several

Explore the representation Essay Example for Free

Explore the representation Essay The stereotypical view of evil is shown through dark colours and beings such as the devil, these contrasts with murders and killings as shown in Jekyll and Hyde. In Dr. Jekyll and Mr Hyde the views on good and evil are shown through characters appearances, their behaviour, the modern standard of living and suppression; there are communicated by gothic horror. Throughout the story, there are references to light and dark which metaphorically relates to good vs. evil, not only between characters, but in the conflicting sides of the same character. At the setting of the play (Victorian era) Science had just been introduced into the Victorian era and was treated as unexplainable circumstances as little was known behind the theory of experiments. This caused for mystery in the Victorian era, thus making Jekyll and Hyde a more horrific and frightening novel. Stevenson had an obsession with the darker side of life and he relates to the character of Hyde by being a respectable man during the day but losing to his obsessions at night. Stevenson, can relate to his novel as he lived in Edinburgh, though in the more affluent area. The setting of Dr. Jekyll and Mr. Hyde is London but it was based on Edinburgh with the contrast of two sides of poor and rich. In this essay, I will explore how evil is represented in Dr Jekyll and Mr Hyde in the Victorian era. At this time, crime was extremely high in the poorer areas which lead people, in desperation to make a living, to involve themselves in crimes (murder, rape, prostitution ). The Victorian era was host to many notorious murders such as Jack the Ripper, who, as seen stereotypically was never identified. The murder knew his way around the human body showing a sign of education thus having as he appeared to have a great anatomical knowledge, hence making him a respectable man by day and a butcher by night. This may have greatly influenced Stevenson, with the magnificent degree of mystery surrounding the case, it may have given rise to thoughts on how to a great, mysterious villain may operate, fuelling Stevensons imagination. Dr. Jekyll was an intelligent man with scientific knowledge, but his reflection; Mr. Hyde was a violent crook. Smog was extremely thick London due to the highly populated industrial farms, causing for the environment to be covered. This made for it be close to impossible to see in distances, so villains could use this as an aid for means of escape. These city conditions were the perfect environment for elaborating deaths, murder and mystery to show pure evil. At the beginning we see Mr. Enfield witness the incident of the little girl, and he describes the magnitude of the smog. There was an incredibly strict code of conduct in the Victorian times, with many natural desires being repressed. The seven deadly sins are a perfect example of some of the things that were repressed. These are lust, gluttony, greed, pride, sloth, wrath and envy. The repression of lust was so great that table legs would have been covered at all time. Middle-class men would have been expected to conceal their secret desires, and if they wanted to express them, they would have to do so in darker parts of the city. This can explain Dr.Jekylls desire to transform himself into Hyde, as it would give him a way to release some of his desires and not be discovered doing it. When Stevenson was young, he developed a medical condition that would live with him for the rest of his life. Stevenson was raised by his nurse who extravagantly showed him the divide between good and evil. This troubled him as a young child, giving him terrifying nightmares and tormenting memories through out his life. It is suggestible that the idea of Dr. Jekyll and Mr. Hyde came from one of these night mares. With all these troubled thoughts on the topic of good and evil, Stevenson may have developed many different superstitious views of what good and evil were, and therefore written about them in Dr. Jekyll and Mr. Hyde. The Victorian era was a revolutionary time; religion was on the decline and scientific and medical discoveries were growing like never before. This influenced writers such as Mary Shelley. She was the author of Frankenstein; a science fiction horror about a revolutionary experiment that goes wrong. This concept mad scientists getting in deeper than they could handle is one of the main themes in the book. As very few people knew what was possible with this new found phenomenon it would appear as though anything was possible. This was important because the key to a good horror is truth and as no one knew anything about it, no one was in the position to question its reality. It is obvious that the appearances of Dr. Jekyll and Mr. Hyde are intended to make a distinction between how each character behaves. The smart image of Jekyll is easily contrastable to the primeval image of Hyde. The audience would expect Hyde to dress fairly scruffy when compared to Dr. Jekyll, however we can see him always dressed smart and in a suit, playing of the social context where we would expect eh evil Mr. Hyde to be in shabby tattered clothing Mr. Hyde is described as a short stocky man, leading us to assume him to have deformities of some sort. Mr. Utterson, Dr. Lanyon and Mr. Enfield all describe witnessing something horrifically evil in Mr.Hydes face. It is as though he emits a sense of foreboding to everyone he meets. He is often described as having the characteristics of an animal, suggesting that he has not evolved entirely into a human being. He is infamous for his horrific actions such as trampling over a little girl and for the murder of Sir Danvers Carew, despite this he still appears to hold a civilised manor whilst talking to his associates; however, he still appears to be blunt, rash and eager to avoid convocation.

Contributions that can be made by emotional literacy for social and emotional wellbeing of childrens

Contributions that can be made by emotional literacy for social and emotional wellbeing of childrens How can parents and carers, schools and communities aid the social and emotional wellbeing of children? Discuss what contribution can be made by emotional literacy. For many years, the emphasis on childhood as evolved on the cognitive and physical aspects of child development. Recently, more attention has been given on the emotional and social welfare of childrens development. Childrens emotional maturity and immaturity on their personal happiness, performance and behaviour has finally been recognised, as a consequence, this is currently being recognised by schemes such as, The Healthy Schools Initiative. The Healthy Schools Initiative contributes significantly to emotional health and well-being. All children deserve the opportunity to achieve their full potential. This is set this out in the five Every Child Matters (ECM) outcomes that are key to children and young peoples well-being: The five outcomes are: * Stay safe * Be healthy * Enjoy and achieve * Make a positive contribution * Achieve economic well-being To achieve ECM, The HM document states children need to feel loved and valued, and be supported by a network of reliable and affectionate relationships. If they are denied the opportunity and support they need to achieve these outcomes, children are at increased risk not only of an impoverished childhood, but also of disadvantage and social exclusion in adulthood (HM Government, 2006, pg 32). In a nutshell, the promotion of positive emotional health and well-being helps young people and children to build their confidences and express their feelings. It embeds the understanding and their capacity to learn effectively. Emotional literacy is the ability to understand ourselves and others and to be aware of, understand and to use information about the emotional states of others with competence. It includes the ability to understand, express and manage our own emotions, and respond to the emotions of others, in ways that are helpful to ourselves and others. Developing the Emotionally Literate School (Weare, 2004) Emotional Intelligence is linked to The Nuturing Programme. The programme origniated in the United States as a result of research undertaken by Dr Strephen J. Bavolek who pioneered in the prevention of child abuse and neglect and the development of family life. The progamme aims to enable children to become emotionally literate by exploring ideas which can contribute to learning to mange our emotions. Learning these skills can improve our motivation, help us feel good about ourselves and explores ideas for managing our emotions. Learning these skills can contribute to building self-esteem, which is crucial to provide positive attitude towards living. This is important as it controls how you think, the way you act and more importantly, how you relate to other people. Consequently, emotional literacy leads to emotional health; this health can have a huge impact on your potential to be successful in every aspect of life. All ingredients for emotional literacy are reflected in the Nurturing programme. The programme offers an effective way of encouraging co-operative behaviour, which empowers both parent/carer and children. It is also an emotional literacy programme. It is therefore crucial to state, that as a facilitator we need to reflect upon our own level of emotional literacy, as we cannot help others to become more emotionally literate unless we are emotional literate ourselves. We are all born with emotional intelligence and naturally, wired to our brains. However, how this emotional literacy develops depends on the kind of relationships they have and the adults caring for them. There are five elements of emotional literacy reflect the key principles of the Nurturing Programme. These are required in order to develop and become emotionally literate. Family Links quotes these key principles as:  · Knowing our emotions Self-awareness recognising a feeling as it happens is the first stage. We can eventually learn to stay aware, simply noticing the emotion rather than being overwhelmed by it, however turbulent we may be feeling at the time. This takes a lot of practice!  · Managing our emotions Handling our feelings builds on our awareness of them. Its helpful if we have ways of reassuring ourselves when were feeling anxious, calming down when were angry, soothing ourselves when we are upset, and so on. Every feeling has its value and significance theyre signposts to whats going on in our lives. The ratio of comfortable to painful feelings determines our emotional well-being.  · Motivating ourselves Harnessing our emotions to help us identify our goals and reach them helps us to achieve our aims. If we are kindly in charge of our emotions, rather than being overwhelmed by them, we can also take charge of our actions. We can guide our behaviour positively, and also resist the lure of instant gratification in other words, we develop self-discipline.  · Recognising emotions in others Empathy, the ability to be sensitively aware of what another person is feeling, is the most important people skill of all, and essential for satisfying relationships. Children who are treated with empathy and respect will grow up to be empathic and respectful towards others. * Handling relationships Building on empathy, the art of relationships is based on skill in coping with emotions in others while also managing and expressing our own effectively having good communication skills. Emotionally skilled people are great to be with because we enjoy their rapport. People who have these skills are easy to trust with our feelings, and learning these skills ourselves enhances all our relationships. (Family Links, 2004) Contained in the Nurture programme are four constructs, which fundamentally become the programmes building blocks. All the approaches, strategies and ideas in the Nurturing Programme are based on these four key concepts as outlined by Family Links:  · Self-awareness and self-esteem The art of self-awareness is to know ourselves well what we do and dont like, what our needs are, how we feel. If we are sensitive towards ourselves, its easier to look after our needs. Nurturing ourselves by meeting our own needs helps to boost our self-esteem, making it easier for us to nurture others and particularly to help children develop their self-awareness and a healthy, positive self-esteem.  · Appropriate expectations Children grow up in different ways: physically, intellectually, socially and emotionally. We need to match our expectations to what they can actually do. They learn all the thousands of skills at different rates. What one child finds easy another child of the same age might find hard. If we expect too much or too little of them, children tend to become rebellious, frustrated and angry, or to give up in despair. It is helpful to them if we recognise each small step in their learning.  · Positive discipline All children need discipline to learn what behaviour is OK and what is not. Positive discipline focuses on praise, rewarding their efforts, giving choices, negotiating and awarding responsibility. There are also fair penalties for poor behaviour. It makes life more enjoyable for adults and children, and helps to build self-esteem. Negative discipline, on the other hand, uses punishment and fear; it is stressful for everyone. There is convincing evidence to suggest that developing the social and emotional competence of children and young people leads to improved well-being, self-esteem, pro-social behaviour and higher achievement.  · Empathy This is the cornerstone of the Nurturing Programme. Empathy is the ability to sense how someone else is feeling, to tune in to their emotional point of view. We dont have to agree with what the other person thinks just to be sensitive to the way they feel, and to accept it. An empathic response to a childs inner world, to their excitement, frustrations and fears, fosters a close, trusting relationship, and helps them learn to respond sensitively towards others (Family Links, 2004) The author works with children weekly within the school environment. The work centres on supporting the development of childrens personal, social, emotional and behavioural growth. The aim is to: * Raise childrens self awareness * Develop healthy self esteem and confidence * Help children to manage their emotions and behaviour/social difficulties * Improve motivation and improve learning opportunities in and out of school The children work on individual targets, and sessions help them practice the skills they require to meet these targets both within class and all areas of their lives. A balance of role models promote group dynamics and peer support. A wide range of techniques are used within the session which includes: * Art focused work * Structured play * Drama * Counselling approaches * Relaxation, visualisation and reflection exercises * Circle time discussions * Reflection exercises Parent/carers play a huge role in their childs social and emotional well-being. It is important in its own right, simply because it can affect their physical health for both the child and parent/carer and can have a detrimental effect on how well the child does at school. Therefore, good social, emotional and psychological health protects children from emotional and behavioral problems, misuse of drugs and alcohol, for example. Therefore, it is equally important to pay attention to the social and emotional skills that children develop in their earliest years, as it will enable them to succeed through the transition from primary to secondary school and into adulthood. In a nutshell, responsibility for school readiness lies not with the child, but with the parent/carers who care for them and the educational systems in place to support them. Critically, intervention may not be successful with all children and families, especially those with Special Educational Needs (SEN), English as an Additional Language (EAL) and a withdrawn and shy child. One must take into account the dynamics of the group and these must be taken into account when actively planning intervention. Therefore, group work may not be the appropriate solution, therefore one to one teaching may be a useful strategy in order to provide intervention. This work complements existing national initiatives to promote social and emotional well-being. It should be considered in the context of the Social and Emotional Aspects of Learning (SEAL) programme and related community-based initiatives. These initiatives stress the importance of such programmes to enable children to participate fully in the development to ensure their views are heard. To conclude, we are now beginning to understand that by providing these enriched environments children and young people are more able to develop emotional intelleigence and maturity far more effectively than they used too. Many schools, like mine, is putting so much empahisis into the development, simply because it leads to so many benefits. Therefore, schools are finding ways to explicitly place emotional literacy at the heart of the curriculum with their approach to learning, teaching, delivery, behavoiur and well-being. Staff are being specificially training and coaching enable them to put the theory into practice. It is important to stress, virtually all the interventions described, only work if they are embedded in the whole community. Those efforts can promote resilience and build the strengths that already exist in the family and the community. References DCSF, (2008) Every Child Matters Resources-and-Practice, Nottingham: DfES Publications, (online), extracted from http://www.everychildmatters.gov.uk/deliveringservices/caf/ (Accessed 8th Feb 2010) Family Links The Nurturing Programme Handbook for Parent Group Leaders, 2004 Weare, K, Developing the Emotionally Literate School, London: Paul Chapman Publishing, 2004 Knowledge and understanding of: * 1.2 the emotional, physical, intellectual, social and moral lives of children aged 0-12 as they develop and experience transitions in their lives. Cognitive skills: * 2.4 identify and re ¬Ã¢â‚¬Å¡ect on own values and positions and those of others, and assess their relationships to policy and practice. Practical and professional skills: * 4.3 develop communication and engagement skills that could be applied to work with children * 4.4 understand the importance of sharing information and developing critical analytical practice that will contribute to a) listening to children b) promoting childrens wellbeing and c) multi-agency working with children and families. After many years of emphasis on the cognitive and physical aspects of childhood development, recently more attention has been focused on the social and emotional developmental cycles of children. The impact of a childs relative emotional maturity or immaturity on their behaviour, performance and personal happiness is finally being recognised. Furthermore, the issue of mental (emotional) health has been acknowledged as part of schemes such as The Healthy Schools Initiative. Against a background of increasing social exclusion, a worrying trend in diminishing self-esteem in teenage boys, and increasing numbers of children being recognised as having additional learning needs or presenting challenging behaviour, there is a growing pressure to find solutions. A childs capacity to learn and grow depends to a very significant extent on their ability to manage personal and social tasks. Without the ability to be aware of their emotional states and self-management skills to contain and handle these, their work will suffer. Without the ability to be aware of others, what they are feeling and to practise relationship management skills, their friendships and social support will vanish. There has also been a steady rise in recognition of the importance of sound self-esteem for children. This recognition has emerged through psychological studies into the aetiology of behaviour disorders, learning difficulties and other disturbances to the steady development and maturation of children. This has coincided with research into human Emotional Intelligence and the development of emotional literacy training programmes. Emotional Intelligence is now known to play a very significant part in achieving goals set, as well as being the foundation for personal satisfaction. Many gifted educators and child-care workers have already developed excellent emotional literacy programmes to support and develop children at every level of need. These enable children to learn the skills and abilities to give them greater emotional awareness, more emotional control and strong relationship building skills. This in turn leads to higher emotional intelligence, and usually, sound self-esteem.http://www.schoolofemotional-literacy.com/content.asp?ArticleCode=147 We now understand that by providing these environments, together with specific training and coaching in personal and social skills, we can enable children and young people to develop emotional maturity far more effectively than we could before. Many schools believe that emotional intelligence can and must be developed because it leads to so many benefits. They are therefore finding ways to explicitly place emotional literacy at the heart of their approach to learning, teaching, achieving, behaviour change and well-being. The environments that encourage emotional and social competence are: * an enriched physical environment * an enriched emotional environment. Aspects of emotional literacy The various aspects of emotional literacy as described by Katherine Weare in her book Developing the Emotionally Literate School are outlined here. Self-understanding: * having an accurate and positive view of ourselves * having a sense of optimism about the world and ourselves * having a coherent and continuous life story. Understanding and managing emotions: * experiencing the whole range of emotions * understanding the causes of our emotions * expressing our emotions appropriately * managing our responses to our emotions effectively: for example, managing our anger, controlling our impulses * knowing how to feel good more often and for longer * using information about emotions to plan and solve problems * resilience: processing, and bouncing back from, difficult experiences. Understanding social situations and making relationships: * forming attachments to other people * experiencing empathy for others * communicating with others and responding effectively * managing our relationships effectively * being autonomous, independent and self-reliant. Every parent, every politician, and every teacher want young children to enter kindergarten ready to succeed. Often the focus is on cognitive skills, early literacy, or early math, and indeed there are exciting new developments in early education. But it is equally important to pay attention to the social and emotional skills that young children develop in their earliest years. These skills-how children manage their feelings, follow directions, concentrate, relate to other children and to teachers, and approach learning-will enable them to succeed as they transition to kindergarten and first grade. . Importantly, virtually all the interventions described here work best if they are embedded in a larger community effort to promote resilience and build on the strengths that exist in families and communities. Four core assumptions shaped the guide: * The family plays the most important role in a young childs life. * Responsibility for school readiness lies not with children, but with the adults who care for them and the systems that support them. * The first 5 years of life are a critical developmental period. * Child development occurs across equally important and interrelated domains-physical and motor, social and emotional, language, and cognitive. The guide is intended to be especially useful for: * Child care providers, preschool and kindergarten teachers, and others who work directly with young children and their families. * Families and school readiness coordinators and administrators involved in organizing early childhood school readiness and early literacy campaigns. * Family support advocates and others who provide support to parents and other caregivers (e.g., grandparents and foster parents) of young children. * Community leaders and coalitions who understand the importance of reaching out to young children and families to ensure early school success. * Mental health and other professionals who want to do more to ensure that young children and families get help when they need it. Section I answers frequently asked questions about why it is important to pay attention to social and emotional development as part of school readiness. Section II provides examples of the resources that are available to help programs and community planners as they seek, intentionally, to promote social and emotional school readiness. It is organized in three parts: * Resources to Help Parents describes resources and strategies that can help parents, particularly low-income parents and others raising young children, promote healthy emotional development in young children. * Resources to Help Child Care Providers and Teachers describes resources and strategies that can help child care providers and teachers promote healthy social and emotional development and school readiness. * Resources to Help Young Children and Families Facing Special Stresses describes resources and strategies that can promote resilience in the most stressed young children and families so that these children, too, can enter school ready to succeed. Each part provides examples of specific resources that can be embedded into and adapted to particular program and community circumstances. Section II of this guide highlights several informal and community-based approaches that bring families and community leaders together to develop preventive strategies, connect existing resources better, and take action around high-priority challenges to promote early school success for all young children in the community. The guide concludes in Section III with a set of questions to guide community action and 10 principles to guide action. This guide complements Spending Smarter: A Funding Guide for Policymakers and Advocates to Promote Social and Emotional Health and School Readiness, as well as a series of issue briefs that the National Center for Children in Poverty (NCCP) has developed over the past several years. (For more information, see Appendix B or www.nccp.org.) Both documents recognize that for every young child to enter school ready to succeed, focusing solely on supporting the early physical, emotional, and cognitive development of young children is not enough. There must also be powerful and sustained attention to ensuring that families can earn enough to support their children, to improving the overall quality of child care and early learning experiences, and es- pecially to ensuring that when young children enter schools, the schools are ready for them. However, the guide also recognizes that for some young children and families, without intentional strategies that are focused on social and emotional well-being, even ready schools and ready communities may not be enough. http://www.nccp.org/publications/pub_648.html