Medical ethics Essay Example | Topics and Well Written Essays - 250 words

Medical ethics - Essay Example To some degree I would classify myself as a secular humanist and believe that ethical decisions should be based on firm logic and ethical theory, instead of religious doctrine. One of the major issues of in medical ethics has been the question of whether individuals in severe and life-ending pain should be able to commit euthanasia. Currently, individuals such as Dr. Jack Kevorkian have been imprisoned for practicing euthanasia. I believe this should not occur. I object entirely to the notion that individuals in such situations should not have the option of terminating their life. I believe that if an individual is clearly in a strong level of pain and their life will be hindered beyond enjoyment and wellness, then the individual should be given the option of ending their existence. Furthermore, allowing religious doctrine to dictate medical ethics is a dangerous slope, wherein progress and outstanding care may be compromised because of outdated

Types of Essay Writing Essay Example for Free

Types of Essay Writing Essay Essays are major part of academic education. In US almost all college and university admission can be done by writing essay. The admission officers with better insight about your essay and how you differ from the other applicants essays. In crucial stages the essays are used to make a decision whether an applicant will be selected. In academic education students regularly have essay writing activities based on their course content. The initial steps are usually deciding what topic to discuss. The next choice that essay writers tackle is what type of essay to write. There are various types of essays such as critical essays, reflective essay, admission essays, narrative essays analytical essays and many others. In addition there is variety of essay types, most of them are related to academic coursework written to study an exact topic and reflect the outlook of the writer. However, the students should focus on specific topic and what types of essays will be wrote. Admission essay The main point of an admission essay is conducted by admission board that you are worth entering the college. Nowadays almost all college and university admission can be done by using admission essay. You should write your best and demonstrate your superior writing skills. The admission essays are the best chance to show your commitment to a career in business by demonstrating those experiences, people, and events that influenced your decision to enter the field. Argumentative essay In Argumentative essay writing we try to convincing others to agree with our facts, share our values. When writing argumentative essay you should state or position regarding of a subject for the main point of opinion. While writing you can add statistics report, well expert view and well support advice about a state or debate. The well argumentative essay should be clear, exact, and highly focused. Cause effect essay In Cause effect essay writing you have to talking about a troubled with why things occur (causes) and what happens as a consequence (effects). The cause and effect essay is the best technique of organizing and talking about ideas. At university and college cause and effects essays are most general papers in a composition course. Classification essay Classification essay writing is not only writing about other essay types, but also the ability to organize the ideas and things into sort. Most of students are well experts in writing classification essays. Since years the students studying in the field that have need of them to sort out ideas. Hence, the students can be written his classification essay without difficulty. Critical essay When critical essay writings you have to state agree with the fully subject. The word critical is telling about the attitude when you have read editorial or part of the book. The critical essays start with a psychoanalysis or explanation of the article or part of a book. Definition essay The definition essay writing you can talk an understanding about certain idea or things. Such things as bird, water are very exact and well concentrate. The way of writing your definition essays you have to give your readers with a new way of looking at things your way. Five paragraph essay The five paragraph essay is the classic format of composition. Its only the format of writing essays; its the types of essays which help for college and university students to develop your composition skills. The name represents like this essays should have five paragraphs. The introduction should include with thesis statement and following paragraphs must be talking about the core your essay topic or subject. The conclusion should be concluding the topics or idea of your topic given.

The Abominable Pig by Marvin Harris Essay -- Abominable Pig Marvin Har

The Abominable Pig by Marvin Harris Is it possible that the almighty God is wrong? The bible explicitly states, in no questionable terms that whatever is of the hoof and is cloven footed and chews the cud among animals, you may eat. Obviously, the pig has fallen short of the statement’s requirements, hence the reason why, Marvin Harris author of the article â€Å"The Abominable Pig,† has opted to explore the reasons why this is the case as his central argument. Harris does not seek to completely refute this theory; in fact, even though he pinpoints certain flaws in the biblical proclamation, he scrutinizes the reasons why God has chosen to isolate this particular animal, for it is no more a carrier of disease than any other. Harris contends that if the statement is reworded to state, â€Å"Flesh of swine thou shalt not eat until the pink has been cooked from,† and then that would have sufficed as opposed to eradicating its use completely. Firstly, Harris looks at the Old Testament’s characterization of the pig and then compares it to a trichinosis perspective (which is a di...

Impact of Cosmetic Advertisements on Women Essay -- Advertising Market

The Shape of America As marketing strategies have evolved, they have enhanced the ability of advertisers to communicate to the "masses" more effectively than ever before. This ability has allowed advertisers to not only reach more markets, but to be more influential in the decision making process of the audience. American society, especially young women, is being influenced by advertisers more now than in previous generations. It is not by accident that teenagers and young adults are targeted by advertisers, especially since their purchasing power as a group exceeds that of any other consumer group. Not only have advertisers learned to identify specific products that appeal to men and women, but they have also found that the "want" of the consumer can be turned into a "need" for the advertised product. Many of the beauty product companies advertise their products as a "need" which ultimately appeals to a vast majority of women. Estee Lauder’s beauty product is one such advertiser. In an August 2004 issue of Vogue magazine, enclosed was a two-page ad campaign intended to sell Estee Lauder’s â€Å"Future Perfect Anti-Wrinkle Radiance Moisturizers SPF.† This advertisment is appealing to the consumer because it stresses the importance of remaining young by the use of this product. This advertisement then goes further to stress that, â€Å"The past is forgiven, the present is improved, and the future will be perfect.† This advertisement includes three alluring models, all of which are of different ethnicity but essentially have the same physical attributes. This image is used to appeal to all sorts of American women. The models all have famished bodies; this includes their angular, somewhat gaunt faces and protruding collarbones. Located right below this image is the company’s slogan which reads, â€Å"ESTEE LAUDER. Defining Beauty.† The attempt is made with this adverti sement to define beauty with images of starved and malnourished models which Estee Lauder claims to be the standard for beauty. Estee Lauder is presenting its view of beauty to the consumer as the defining truth. The issue with the advertisment is the acceptance by the consumer that the Estee Lauder definition of beauty is truthful and factual. The targeted audience for this advertisement is women of all ages. Beauty is something extremely important to women and is constantly being reinforced in the socie... .... Of course these women are not "real" women, but far to often do women take drastic measures look like these fashion models; this eventually will lead to eating disorders or severe depression. According to Natural Health magazine, 44% of women who are average or underweight think that they are overweight. The average woman's dress size is 12 and the average mannequin/model's dress size is 4 (NBC.com); this makes women feel as if they will never be good enough. According to Melissa Raftery, "When we open a magazine, we never see some 400-pound woman on the first page. Instead we see a woman who is 23% skinnier that the average American woman" (What Is Beauty?). Unfortunately, Estee Lauder is not the only beauty product company that puts forth this â€Å"definition of Beauty† and beauty product companies are not the only companies â€Å"defining beauty.† As long as the targeted market continues to buy into the advertisers â€Å"perfection line,† the advertiser s will continue to deceive the public. For those who are gullible enough to believe this line of advertising, Estee Lauder ensures confidence and beauty all in one product. After all, their slogan does read, â€Å"ESTEE LAUDER. Defining Beauty!†

DM Bicycle Company

As the HR director of DMBC I have witnessed first hand the change in Mr. Duncan’s responsibilities to the company. He has become deeply afflicted by the diagnosis of Batten disease to his nine year old daughter Nicole. Wanting to begin a new CSR program aimed at combating Batten disease Mr. Duncan has gone out on his own accord to use the windfall created by the FY11 projections to help fund this endeavor of his. Though I’m empathetic and personally feel for what he and his family are going through, Mr. Duncan still has a responsibility to the employees and shareholders of DMBC. By combining his role as CEO with his role as a father it is clear he has gotten off track and has overstepped his responsibility as the face of the company. My concerns with what is happening at DMBC has to do not just with the proposed CSR program for Mr. Duncan and it’s effects towards the company, but also with the duties of the senior leadership and the current culture amongst them. If he goes through with funding a new CSR program in order to help his daughter Nicole, Mr. Duncan will be doing more than just taking away bonuses from our well deserved employees. He will be changing the core principles and key practices of DMBC. When I approached Jim Miniter in order to get some resolution about the situation he told me several things that created a feeling of unease. As we talked in his office he said â€Å"We’re going to have to present this change (new CSR program for Batten disease) in the annual report and at the shareholder meeting—but I guess Gino can finesse those things,† and when I asked him if he would talk to Mr. Duncan he responded with â€Å"I can’t. It would be like betraying a brother. This rationalization by Mr. Miniter and his loyalty to Mr. Duncan has skewed his primary duty as the CFO of DMBC. I believe as the CEO, Mr. Duncan is an agent to the individuals who own the corporation and its employees not the other way around. By letting him fund this project without debate, he has created an environment where employees are afraid to speak up about his direction. He wants to change the current CSR program of Ride for Life towards a cause that personally benefits his interests which is ethically unsound. Senior leadership has been passive in letting Mr. Duncan force his future CSR program for fear of disloyalty and reprisal. While talking to other employees they’re also afraid. They’re afraid of possible effects on promotions and evaluations if they do not follow suit or participate in helping Mr. Duncan use the projected windfall for his daughters fight against Batten disease. I make these following recommendations in order to thwart off any negative effects Mr. Duncan’s professional choices could have against DMBC. Create an indoctrination program for all new employees and a refresher training course for all current employees to establish the company’s code of ethics and values. By doing this, we’ll have employees who are responsible into ensuring that leaders are consistent in their commitment to proper ethical behavior. Rather than put the Ride for Life program on hold we need to expand on it by creating a program that raises the issue of Batten disease. Raising awareness for Batten disease doesn’t have to be just monetary. The Ride for Life program has been so successful—both in raising employee morale and in creating positive public relations that Dottie Thompson had been working for nearly a year to take the program national. Though Mr. Duncan is the CEO, he should lead the Ride for Life/Fight Batten Disease CSR program so it allows him to focus on his cause and spend more time with his family. By having him focus directly on what has been side-tracking him from his professional duties for the last several months he will have a greater impact with everyone who is connected to DMBC. It also allows him to expand awareness of DMBC CSR programs from Greensboro to Rochester, New York that will benefit the company. Lastly, employees should be allowed to dictate where their bonuses and participation goes without fear of retaliation from corporate. I can assure you by allowing them to decide where their bonuses and volunteer work go they will end up supporting Mr. Duncan and his cause even more than despising him. I understand my position as the HR Director at DMBC, but it is also my duty regardless of title to uphold my values, integrity, and my overall responsibility to the employees and shareholders.

Interrogations Of Chinese Immigrants At Angel Island Essays

Interrogations Of Chinese Immigrants At Angel Island Essays Interrogations of Chinese Immigrants at Angel Island Chinese immigration, after being shut down for many years by governmental legislation and an anti- Chinese climate resumed quickly after 1906. The major earthquake and fire that occurred in San Francisco lent the Chinese immigrants a window of opportunity to regain entrance to America. Immigrants could now claim, without proof, that they were indeed the son or daughter of a citizen or a partner in a legitimate business. These paper sons and paper merchants increased the number of Chinese immigrants by an unbelievable rate. It was this supposed population explosion that would lead the United States to investigate all incoming Chinese immigrants. Being wary of the impossibility of so many legitimate children of U.S. citizens of Chinese descent, the department of immigration and naturalization sought out to verify that these people were indeed the true sons and daughters or the actual businessmen that they claimed to be. Therefore it was against this historical background and unde! r these particular auspices that the interrogations at Angel Island were carried out from 1910 to 1940. These interrogations were by no means fair, nor were they based on any other legal or practical precedent. While unreasonable detentions were already the norm, the act of interrogating immigrants to the extent that the Chinese were interrogated was unheard of in history. These interrogations were intricate and detailed, and designed to ensnare unwitting Chinese immigrants seeking entrance into the United States. The interrogations not only presented a hurdle for incoming immigrants by prolonging their detention at Angel Island and increasing the bureaucracy required to process Chinese immigrants, but would deeply scar the Chinese landing in the United States. Moreover, the traumatic experiences at Angel Island coupled with other practices following the detentions such as raids of Chinatown during the Red Scare of the 1950's led to a persistent fear of deportation by landed C! hinese. The interrogations were more than just simple interview questions about one's village or parents, rather they were, taken as a whole, another method to exclude the Chinese from America. The entire interrogation was loosely structured but by no means were they were regular or fair. After being held at Angel Island on a writ of habeas corpus, Chinese immigrants were interrogated by a Board of Special Inquiry which was composed of two inspectors, one of which was the Chairman of the Board, a stenographer, and finally an interpreter. This board was not held to technical rules of procedure or evidence as used in other federal courts but rather was allowed to use any means it deemed fit under the exclusion acts and immigration laws to ascertain the applicant's legitimacy to enter the United States (Lai 20). Nevertheless the lines of questioning were generally the same for all immigrants. The questions usually started with personal information then proceeded onto family information, village information, and then finally information on the home. Within these groupings there were multiple side questions concerning details of the family or village. Immigrants were aske! d extremely detailed and far ranging questions within these side questions. They were asked questions similar to the questions Jow Yick faced in 1909 in case #1424, "Is she (your mother) a small footed woman?" or "Is any body of water near or within sight of your house?" Other questions concerning the village became increasingly detailed. In the case of Ung Shee, case #16778/2-12, the husband had to testify on the entire village and all the particulars of the inhabitants of each home. In one instance the inspector asked the husband of Ung Shee whether or not the woman in the third house and fourth row of the village had bound feet. In Ung Shee's case, detailed questioning about every family in every house was continued up until the seventh row of the village. Her husband also endured questions such as, "Do you cross a stream going to the market?" and "How large is the bridge over that stream?" as well as other questions such as, "Did your brother have a picture of yourself in ! his house?" (Box 1211 National Archives). This however, was not far from the norm for most immigrants. To give a general idea of the structure of the interrogation,

Tips for Applying to Clinical Psychology PhD Programs

Tips for Applying to Clinical Psychology PhD Programs Clinical psychology is the most popular and competitive area of study in psychology, and arguably the most competitive of graduate programs in all social and hard sciences. Counseling psychology is a close second. If you hope to study either of these fields you must be on your game. Even the best applicants dont get into all of their top choices and some dont get into any. How do you improve your odds of gaining admission to a graduate program in clinical or counseling psychology? Obtain Excellent GRE Scores This one is a no-brainer. Your scores on the Graduate Record Exam will make or break your doctoral application in competitive fields like clinical and counseling psychology. High GRE scores are important because many clinical and counseling doctoral programs receive hundreds of applications. When a graduate program receives more than 500 applications, the admissions committee looks for ways to weed out applicants. GRE scores are a common way of narrowing the applicant pool. Excellent GRE scores not only gain you admittance to graduate school, but they may also get you funding. For example, applicants with high GRE quantitative scores might be offered teaching assistantships in statistics or a research assistantship with a faculty member. Get Research Experience Applicants to graduate school in clinical and counseling psychology need research experience. Many students believe that applied experience working with people will help their application. They look for internships, practica, and volunteer experiences. Unfortunately applied experience is useful only in small doses. Instead doctoral programs, specifically Ph.D. programs, look for research experience and research experience trumps all other extracurricular activities. Research experience is out of class experience conducting research under the supervision of a faculty member. It usually begins with working on a professors research. Volunteer to help in any way needed. This might include administering surveys, entering data, and looking up research articles. It often also includes tasks like copying and collating papers. Competitive applicants design and carry out independent studies under the supervision of a faculty member. Ideally, some of your research will be presented at undergraduate and regional conferences, and perhaps even published in an undergraduate journal. Understand the Value of Research Experience Research experience shows that you can think like a scientist, problem solve, and understand how to ask and answer scientific questions. Faculty look for students who show a good fit to their research interests, can contribute to their lab, and is competent. Research experience suggests a baseline skill level and is an indicator of your ability to succeed in the program and complete a dissertation. Some applicants gain research experience by earning a masters degree in a research-oriented field such as experimental psychology. This option often appeals to students with little preparation or low-grade point averages as supervised experience with a faculty member highlights your potential to become a researcher. Know the Field Not all clinical and counseling doctoral programs are the same. There are three classes of clinical and counseling doctoral programs: ScientistScientist-practitionerPractitioner-scholar They differ in the relative weight given to training in research and practice. Students in scientist programs earn PhDs and are trained exclusively as scientists; no training is offered in practice. Scientist-practitioner programs train students in both science and practice. Most students earn PhDs and are trained as scientists as well as practitioners and learn to apply scientific approaches and techniques to practice. Practitioner-scholar programs train students to be practitioners rather than researchers. Students earn a PsyD and receive extensive training in therapeutic techniques. Match the Program Know the difference between a Ph.D. and PsyD. Choose the type of program that youd like to attend, whether it emphasizes research, practice, or both. Do your homework. Know each graduate programs training emphases. Admissions committees look for applicants whose interests match their training emphases. Apply to a scientist program and explain that your professional goals lie in private practice and youll receive a rejection letter instantly. Ultimately you cannot control the admission committees decision, but you can choose a program that fits you well, and you present yourself in the best light possible.

Free Essays on Review Of Narrative Of The Life Of Frederick Douglass

. At this point in his lesson Mr. Auld encountered what his wife was doing for Frederick and forbid her to continue. He believed that "if you give a nigger an inch, he will take an ell" and continuing with "learning would spoil the best nigger in the world". The masters felt that an ignorant slave formed a choice slave and any beneficial learning would damage the slave and therefore be futile to his master. His next step on the road to success was during his seven years living with Master Hugh’s family. Frederick would make friends with as many white boys as he possibly could on the street. His new friends would be transformed into teachers. When he could, Frederick carried bread on him as a means of trade to the famished kids for knowledge. He would also carry a book anytime he had an errand to run. The errand would be completed quickly, allowing extra study time. When Frederick was working in Durgin and Bailey’s ship-yard he would notice timber marked with various letters... Free Essays on Review Of Narrative Of The Life Of Frederick Douglass Free Essays on Review Of Narrative Of The Life Of Frederick Douglass Review of Narrative of the Life of Frederick Douglass Frederick Douglass was born in Tuckahoe, Maryland, near Hillsborough. He doesn’t know for sure of his age, he has seen no proof and his master will not inform him. Most masters prefer for their slaves to stay ignorant. He believes that he was around twenty-seven and twenty-eight when he began writing his narrative - he overheard his master say he was about seventeen years of age during 1835. His mother, Harriet Bailey, was separated from him when he was an infant and she died when he was seven years old. Frederick’s father was a white man who could have been his master but he never found out. Education was of utmost importance in his life. He received his first lesson while living with Mr. and Mrs. Auld. Sophia Auld, Frederick’s "mistress", was very humane to him and spent time teaching him the A, B, C’s. After he mastered this, she assisted him in spelling three and four letter words. At this point in his lesson Mr. Auld encountered what his wife was doing for Frederick and forbid her to continue. He believed that "if you give a nigger an inch, he will take an ell" and continuing with "learning would spoil the best nigger in the world". The masters felt that an ignorant slave formed a choice slave and any beneficial learning would damage the slave and therefore be futile to his master. His next step on the road to success was during his seven years living with Master Hugh’s family. Frederick would make friends with as many white boys as he possibly could on the street. His new friends would be transformed into teachers. When he could, Frederick carried bread on him as a means of trade to the famished kids for knowledge. He would also carry a book anytime he had an errand to run. The errand would be completed quickly, allowing extra study time. When Frederick was working in Durgin and Bailey’s ship-yard he would notice timber marked with various letters...

Of Mice And Men by John SteinbeckYou will need to develop an Research Paper

Of Mice And Men by John SteinbeckYou will need to develop an argumentative thesis statement based on the idea of The American - Research Paper Example Crooks, also desiring not to be left alone on the ranch, wants to join their dream of independence. Curly’s wife, before she dies, confesses her dream to be a movie star. In fact, the only characters that do not admit to such a dream are those who stand atop the social and economic hierarchy. Curly, for instance, enjoys his place of power and represents a repressive force in the story insofar as he suppresses and controls the dreams of others. These are dreams of independence that reflect the concept of the American dream generally; however, at least from Of Mice and Men, the reader comes to realize that such dreams are economic, and spiritual, impossibilities. The impossibility of the stereotypical American dream is only strengthened by the overarching economic climate in which the men live. As Crooks tells George, â€Å"Nobody never gets to heaven, and nobody gets no land† (Steinbeck 74). What Crooks says here is particular interesting because it indicates that men ar e both economically and spiritually deprived of what they truly need. While George and Lennie are seeking the seemingly simple goal of acquiring their own land and independence, Crooks’ observation is that such land would provide more than substance and bodily satisfaction.

Vehicle Pay-As-You-Go Insurance Essay Example | Topics and Well Written Essays - 8250 words

Vehicle Pay-As-You-Go Insurance - Essay Example These may include efficiency, equity, safety and environmental protection. This essay describes and appraises the Pay As You Go system. I wish to deliver an excellent and understanding piece of report. After the completion of my Businesses Information Technology degree I wish to do future studies in Software Engineering. This would allow me to focus on software development and go beyond programming to include such things as eliciting customers' requirements, and designing and testing software. I would learn how to assess customer needs and develop usable software that meets those needs. I am keen on how companies market their product which could help me when I have to do this at work. I will put in all the knowledge and skills that I have learnt throughout the course of my studies to my project. I would also like to learn more about marketing and how this chosen system works. By the end of the project I am hoping to gain a good level of understanding of how the systems work and the reasons for such system. In order to write this report I researched into different materials, which included books, journals articles, various publications and web resources. I widely used the internet which was essential as the time was limited and plenty of information can be extracted from various websites. Certain web resources are not reliable but I managed to avoid them by choosing only those which were official or had references given with the data. This allowed for enough accuracy in order to write this article. Some books and journal articles were also available on the internet and they were looked into. The books and journals usually provide with accurate information and data that is helpful in writing an essay. Apart from these, there were case studies and research findings also that I read up and reviewed. Such resources are very reliable thus I made use of them. Background Car insurance premiums can take a bite out of your household budget. There are many tips available to reduce your car insurance costs but the fact remains you are required by law to carry a minimum amount of coverage if you own and drive a car. While most people are aware that car insurance providers offer discounts for people who travel fewer miles than their high mileage partners many people are not aware that some insurance provide

Impacts on Liquidity - ECO316 Essay Example | Topics and Well Written Essays - 500 words

Impacts on Liquidity - ECO316 - Essay Example This consequently led to the financial crisis and eventually a shortage of liquidity due to wrong policies. Excessive savings were required to fight the crisis and ensure that no financial institution faced liquidity issues. United States first followed the expansionary policy where it experienced an increase in the monetary base. To avoid excessive liquidity in the market, US implemented contractionary policy to control the rate at which the monetary base was increasing. The financial markets yet had liquidity and were not insolvent. Adding the role of government, the budget deficits have been soaking up the savings. Consequently, this has hindered the growth of the market and economy. The government budget deficits have created solvency issues not only for the government but also for the whole nation. The impact of government spending is less productive as compared to the measures undertaken by the central bank, Fed. Government budget deficits do lead to difficulties in getting investments, and it does cause solvency issues, but that can be fought with a right monetary policy by the central bank, Fed. Falling government budget deficits do support and strengthen the fact that there was too much liquidity in the financial markets. However, it does not mean the government’s declining budget deficits had stronger influence on increasing liquidity. Federal Reserve (Fed) has the strongest ability to influence the monetary base which consequently determines the level of liquidity available in the financial markets. By 2006, Federal Reserve (Fed) had been able to increase liquidity in the financial markets. In fact, there was too much liquidity, and to control the liquidity level, by the fall of 2006, Federal Reserve (Fed) introduced contractionary monetary policy. This is when US budget deficits started declining. The rapidly increasing monetary base and levels of liquidity were consequences of the monetary policy and measures taken by the

Femininity, Feminism, & The Beauty Myth Essay Example | Topics and Well Written Essays - 2000 words

Femininity, Feminism, & The Beauty Myth - Essay Example 96). This essay discusses this statement with regard to the concepts of femininity, feminism, and ‘the beauty myth’ by Naomi Wolf. Most apparently, Bennett is trying to argue that fashion is a type of nonverbal communication. It is easy to see that even when articles of clothing are coated with words, like catchphrases, logotypes, or trademark name for instance, there remains a degree of nonverbal communication that goes beyond the exact messages of those catchphrases or trademark names (Barnard 2002, 29). There are several scholars who take into consideration numerous instances of terms or phrases being used on fashion, tracing their connections to calligraphy, foreign languages, punk, and graffiti, for instance. Fashion makes use of these expressions to offer willing consumers more ways to visually communicate themselves (Barnard 2002, 29). The issue then comes up as to whether, since they are types of nonverbal expression, fashion could be viewed as being somehow similar to written or verbal communication. For instance, when Umberto Eco declares to be communicating through his attires he perhaps implies that he is following fashion to perform the same kinds of tasks as he makes use of verbal expression to perform in other circumstances Essentially, the symbolism of Eco appears to indicate that fashion is created into something similar to a language (Barnard 2002, 29). Alison Lurie, in The Language of Clothes, seems to think that there is an open similarity. She argues that there are numerous distinct expressions of fashion, each espousing its own language. In view of this, fashion is the counterpart of word and could be assembled into ‘expressions’ (p. 29-30). For instance, as explained by Barnard (2002), Lurie proposes that an individual having hardly any clothes, will have little opportunity to build more

Chipotle Case Analysis Essay Example | Topics and Well Written Essays - 2250 words

Chipotle Case Analysis - Essay Example ii. Ensured usage of raw materials of the highest quality and application of classic methods of cooking. This was to ensure that the restaurant produces dishes that are reasonably priced and ready to serve to customers in a short while. iii. Creation of operationally efficient restaurant having a pleasing aesthetic distinctive setting in its interior. iv. Friendly customer care services. v. Increased awareness and respect for the environment. This would have entailed the use of freshly grown organic produce and meat that is humanely raised and having no hormones or antibiotics. At the point of establishing these chains of restaurants, the main idea that was in the mind of the entrepreneur Steve was that, as a place of fast foods, the restaurant needed not to be quite expensive but, more accessible and affordable to most of the consumers. As such, when Steve commissioned the opening of the first of such restaurants in Denver in the year 1993, it became a great hit in the marketplace, and the majority of consumers were pleased with the services offered. According to the report, Chipotle grew in operations from a 1-unit restaurant to a 1,230-unit chain of restaurants that served in various parts of the country (41 states), and which managed to serve a daily customer base of about 800,000 people. The reasons for this great increase in sales turnover and high profitability index was due to a combination of various factors among them, provision of better quality fast foods compared to other restaurants, up scaling of the restaurant and the ability to deliver faster services to the customers. It is as a result of this extensive expansion and tremendous increase in sales turnover of the restaurant that Steve sought to expand the base into other neighboring states. Such expansions were to areas such as the District of Columbia, the United Kingdom and Canada. For instance, according to the financial reports of the year 2011, Chipotle managed to record revenues worth $2.3 billion and a $214.9 million in net income. The diluted earnings per share (EPS) for the same year were about $6.76 million. These are clear indications to a company with a positive growth profile hence, prospectively looking forward to increased business opportunities in the near future. A SWOT analysis for Chipotle Mexican Grill will be based on the past relations for continued existence of the company. For instance, the continued increase in the stock prices for a company is a likely indication of strength in the restaurant. There are a number of reasons as to why a SWOT analysis for a company is essential, especially to stakeholders and prospective investors to the company. This is because the analysis will help in making informed decisions about investing in the company or even buy shares and stocks from the shares of the company traded in the stocks market (Paiz, Dave, Ryan, Brian, Kristina, Frank & Mark 165). Chipotle Mexican Grill is recorded to have publicly started tradin g in its shares in the year 2006, and since then, it has had impressive stock prices recordings in the market. For instance, according to this report, the stock price of Chipotle Mexican Grill in the year 2012 climbed to record high of about $380 to $385 per every traded stock as compared to the previous year; thus, a representative 80% increase. Strengths 1. The availability of a well developed marketing strategy. A critical study into the report

Femininity, Feminism, & The Beauty Myth Essay Example | Topics and Well Written Essays - 2000 words

Femininity, Feminism, & The Beauty Myth - Essay Example 96). This essay discusses this statement with regard to the concepts of femininity, feminism, and ‘the beauty myth’ by Naomi Wolf. Most apparently, Bennett is trying to argue that fashion is a type of nonverbal communication. It is easy to see that even when articles of clothing are coated with words, like catchphrases, logotypes, or trademark name for instance, there remains a degree of nonverbal communication that goes beyond the exact messages of those catchphrases or trademark names (Barnard 2002, 29). There are several scholars who take into consideration numerous instances of terms or phrases being used on fashion, tracing their connections to calligraphy, foreign languages, punk, and graffiti, for instance. Fashion makes use of these expressions to offer willing consumers more ways to visually communicate themselves (Barnard 2002, 29). The issue then comes up as to whether, since they are types of nonverbal expression, fashion could be viewed as being somehow similar to written or verbal communication. For instance, when Umberto Eco declares to be communicating through his attires he perhaps implies that he is following fashion to perform the same kinds of tasks as he makes use of verbal expression to perform in other circumstances Essentially, the symbolism of Eco appears to indicate that fashion is created into something similar to a language (Barnard 2002, 29). Alison Lurie, in The Language of Clothes, seems to think that there is an open similarity. She argues that there are numerous distinct expressions of fashion, each espousing its own language. In view of this, fashion is the counterpart of word and could be assembled into ‘expressions’ (p. 29-30). For instance, as explained by Barnard (2002), Lurie proposes that an individual having hardly any clothes, will have little opportunity to build more

Interview Essay Example | Topics and Well Written Essays - 750 words - 6

Interview - Essay Example To begin with, her school, being all female offered all kinds of sports activities. These included but were not limited to swimming, basketball, volleyball, badminton, tennis, track and field, and Karate. Needless to say, almost all of the students participated in the school sanctioned sports activities. However, while some of them did it just for want of an activity to do after classes, there were those who took the sports seriously. These were the women who were considered â€Å"jocks† on campus and who sometimes found their sexuality called into question due to their diligence and dedication to their training programs. During her era, most of the women would go to the nearby soda shops and restaurants for a snack with their friends in order to unwind after a long day of classes. This is where the rest of the plans for their day were usually created. More often than not, this get together would continue either at a classmates house or at a nearby shopping area where they would look at entertainment magazines or see a movie. During her era, my interviewees favorite activity was going to the movies. She had always been a fan of Hollywood films and seeing those films helped her learn about the country and culture of the country that, unknown to her at the time, she would one day call her home. The 70s was the era of consciousness for the people in her country. For women of her age, sexual encounters were done but not spoken about openly for fear of social repercussion. There was a double standard of morality existing at that time for women. While men could openly discuss having sex with various women, women who engaged in sex needed to do it secretly and always with just one partner or else she would be deemed a woman of tremendously loose morals if word ever got out. Since my interviewees favorite activity when she was younger was going to the movies, she has been able to continue that activity of hers to this very day. Although

“The Death and the Maiden” D. 810 by Franz Schubert Essay Example for Free

â€Å"The Death and the Maiden† D. 810 by Franz Schubert Essay Franz Peter Schubert was born on the 31st of January 1797 in Lichtental, Austria which is near Vienna. He has fifteen brothers and sisters, but only five of them live to see their first birthday. The father, Franz Teodor is the Principal in a local school. The mother, Elizabeth Viets was a cook in a Viennese family. When Franz Schubert was just five-year-old he started playing the violin and his teacher was his own father. Three years later, Michael Holzer, who was the parish priest in the town, started to teach the eight-year-old composer how to play the organ. Franz Schubert composed his first piece at the age of just ten. In 1808, he started singing in the courtier choir. Not only he was a soloist in the choir but did he play in the section of second violins in the orchestra. This way, he came to know the music of Joseph Haydn and Wolfgang Amadeus Mozart. At this time, Shubert was taught by Antonio Salieri. After graduating from a teaching seminary in 1814, Schubert worked as a teacher alongside his father until 1818. The three year period between 1818 and 1821 is probably the toughest test in the composer’s life. Shubert was trying to earn enough giving private lessons but the money was really insufficient. He was not able to find a full-time job either, so he had to live with some of his friends – other composers and poets. In 1818 and 1820 as a musical teacher of count Esterhazy’s daughters, the young composer had the chance to visit Hungary. Schubert learnt a lot about the Hungarian national music and the Gypsy music during these visits. Suddenly and unexpectedly, his songs become very popular in Hungary and Austria after 1821 when he managed to publish some of his works with his friends’ help. Franz Schubert is the composer of some of the greatest classical master pieces ever written such as â€Å"The Unfinished Symphony† No. 8 D 759, the piano quintet â€Å"The Trout† D. 667, the string quartet â€Å"The Death and the Maiden† D 810 and of course his more than 600 songs. Schubert is also the pioneer of the song cycle genre, composing pieces such as Die Winterreise D.911, and Die Schone Mullerin D. 795. The composer died on November the 19th 1928 in Vienna. This essay has been prepared to examine several different aspects of Franz Schubert’s chamber music by mainly giving examples from the string quartet â€Å"Death and the Maiden† D. 810 and the song â€Å"Der Tod und Das Madchen† D. 531. Analyses and connection between the poem â€Å"Der Tod und Das Madchen† by Matthias Claudius, the song and the string quartet â€Å"The Death and the Maiden† by Franz Schubert will also be included. Also, the extent to which Schubert has taken the vocal melody and made it idiomatic for the string instruments will be explored. Most of the Schubert’s songs are really connected with poetry. He used to work with poets such as Goethe and Schiller, who had a huge impact onto the composer’s works. Christoph Wolff suggests that the things which Shubert mostly liked in the Matthias Claudius’ poems were the purity and simplicity of the poetic language. (Bandura-Skoda, Branscombe, 1982, 144). The song â€Å"The Death and The Maiden† D. 531, which was composed by Franz Schubert in 1815 is based on the poem â€Å"Der Tod und Das Madchen† by Matthias Claudius which was written in 1775. The poem consists of two stanzas as example one shows. Das MadchenDer Tod: Voruber! Ach, voruber!Gib deine Hand, du schon und zart Gebild! Geh, wilder Knochenmann!Bin Freund, und komme nicht, zu strafen. Ich bin noch jung! Geh lieber,Sei gutes Muts! Ich bin nicht wild, Und ruhre mich nicht an.Sollst sanft in meinen Armen schalfen! The Maiden: Death: Pass me by! Oh, pass me by! Give me your hand, you beautiful and tender form! Go, fierce man of bones! I am a friend, and come no to punish. I am still young! Go, rather, Be of good cheer! I am not fierce, And do not touch me. Softly shall you sleep in my arms! Example 1 – The poem â€Å"Der Tod und Das Madchen†. It is clear to see that the poem is in a form of a dialog between â€Å"The Maiden† and â€Å"The Death†. A key feature in the first stanza is the short sentences, ending with an exclamation mark. This shows that the girl is frightened and afraid of â€Å"The Death†. On the other hand, â€Å"The Death† in the second stanza is meant to be scary and dangerous, but instead of that it sounds harmless and even makes a compliment in the opening words: â€Å"Give me your hand, you beautiful and tender form†. Anyhow, there is an interesting fact about the title of the poem â€Å"Der Tod und Das Madchen†, therefore the names of the song and the string quartet by Schubert â€Å"The Death and The Maiden†, which is the reverse order of the two stanzas compare with the title which shows the serious presence of Death even before the opening words. The song â€Å"The Death and The Maiden† D. 531 by Schubert is logically as contrasting as the poem which it is based on. The opening eight bars of the song are just an introduction to the following piece. From bar nine onwards, Schubert uses very smart resources to establish the scary and anxiety atmosphere such as chromatism and quicker metric rhythm, as it can be seen on example two. Example 2 – the song â€Å"The Death and The Maiden† D. 531 It can be said that the Maiden is giving up resisting the Death between bars sixteen and twenty-one and there are few evidence supporting this idea. Firstly, the vocal line is going downwards which is a sign of humility. Secondly, the metric rhythm in these six bars is calm and uninterested, exactly as it was in the very opening of the song. Lastly, the fermata in bar twenty-one could be the final clue that the Maiden is already given up fighting. After this really dramatic moment for the listener, Schubert introduces the second character in the piece – â€Å"The Death†. (Bandura-Skoda, Branscombe, 1982, 152) The composer sets the tempo of the introduction as a tempo for the second part of the song. There is a little dynamic detail, however really important. The dynamic in the first part of the song (the part of â€Å"The Maiden†) is p while in the second part (the part of â€Å"The Death†) is pp. By using this technique, Shubert makes the lyrics of â€Å"the Death† sound even more shocking. The opening words in the second stanza are so important that the composer keeps the vocal line on the tonic of D minor for nearly six whole bars. The words: â€Å"Gieb deine Hand, du schon und zart Gebuild!†, which translates as follows: â€Å"Give me your hand, you beautiful and tender form!† are accompanied by quite a simple harmony pattern. Schubert uses the tonic of the D minor in the first bar of the second part of the song and then the sub-dominant is used in the second bar which develops into its first inversion in the following bar. The composer goes back to the tonic in the fourth bar, but just to set a much more interesting harmonic pattern for the second verse of the stanza: â€Å"Bin Freud, und komme ni cht, zu strafen†, which means: â€Å"I am a friend, and come not to punish†. In the fifth bar of the second part of the song the chord being used is the first inversion of the supertonic seventh which changes to the second inversion of the same chord in the first part of the following bar. However, the chord used in the second part of the bar in question, which is bar six of the second part of the song, is the seventh of the sub-dominant. The composer uses bar seven for a transition to the new key of F major, which is established in the eighth bar. The harmony is being changed from sub-dominant to the tonic of F major and back to the first inversion of the sub-dominant in the frames of the next bar. During the next two bars – ten and eleven, the tonic – sub-dominant movement in F major continues. â€Å"The Death† ends with the words: â€Å"Sollst Sanft in Meinen Armen Schafen† which translates as: â€Å"Softly shall you sleep in my arms†. Schubert goes back to D minor in this last passage; also, the composer uses the â€Å"French† augmented 6th for the word â€Å"Schlafen†. This chord seems to be the perfect one to finish the idea of â€Å"the Death† with, as it sounds unsure, uncomfortable and probably harmless. Immediately after that, in the last seven bars, Schubert unexpectedly uses D major, as if to show the public that â€Å"the Death† has no bad intentions. These harmonic patterns and the lack of melody movement in the second stanza can only characterize â€Å"the Death† voice as supernatural and really contrasting to the active voice part in the first stanza. (Bandura-Skoda, Branscombe, 1982, 153) As already said above, the song is based on the poem, which is the reason for some absolutely striking similarities between the two of them. For example, Schubert clearly differentiates the two stanzas and the two dialogue partners by various terms such as the dynamics and declamatory gestures. The piano dynamic, crescendo and diminuendo in the first part of the song correspond to the short and disjunct phrases in â€Å"the Maiden† part of the poem. Likewise, the pianissimo dynamic in the second part of the song is in harmony with the long and conjunct phrases in â€Å"the Death† part of the poem (Bandura-Skoda, Branscombe, 1982, 150). However, an interesting fact is that Schubert does not use two different voices for the two stanzas. This perhaps was his way of making the dramatic dialogue between â€Å"the Maiden† and â€Å"the Death† even more effective. In fact, Schubert uses a material which was previously written by him quite often. For example, the famous piano quintet in A major D. 667 is based on the song â€Å"the Trout† D. 550. Similarly, â€Å"the Wanderer† D. 493 supplies with material the C major fantasy D. 760. As it was already mentioned above, the String Quartet D. 810 â€Å"The Death and the Maiden† is based on the song D. 531. More precisely, the second movement of the string quartet, which consists of one main theme and five variations, is completely based on that song. The main theme can be divided into three parts: A, B and C. Example 3 – Comparison of the first eight bars of the second movement of the string quartet (above) and the song (below) The A section, which is shown on example three above, is almost directly taken from the song. Afterwards, between bars nine and sixteen, which is section B, the music is getting livelier and vivid, just to correspond perfectly to â€Å"the Maiden’s† feelings. The C section of the main theme, between bars seventeen and twenty-four, is again calm exactly as â€Å"the Death† in the Claudius’s poem is. The first twenty-four bars are probably the most beautiful and angelic, yet incredibly simple, in the Romantic era. However, the simplicity of the whole passage is what makes it so genuine. For example, the note G is repeated thirteen times between bars seventeen and twenty-four in the part of the first violin, while the note B is repeated fourteen times in the viola part. Anyhow, the feature which makes these bars sound so perfect is t he harmony pattern which is shown on example four. Example 4 – Harmonic analysis of bars seventeen to twenty four of the second movement of the string quartet The first variation starts in bar twenty-five. Basically, the harmony pattern is the same to the one in the original theme. This time, however, the second violin and the viola provide the harmony which was previously played by the whole quartet. The inner-voices sustain the key feature in this variation in triplets throughout. The cello is providing the foundation of the whole passage by playing strong quaver pizzicato notes. The first violin part is really interesting in this variation, because it has very much a supporting role, something unusual, especially at the beginning of a piece. The notes played are part of the chord played by the rest of the group. This first of five variations is somehow more tensed and emotional compare to the original theme in the movement. This is probably to underline â€Å"the Maiden† fright when she tries to escape â€Å"the Death† at the beginning of the poem. In the second variation, there is a lead singing part – the cello. It is interesting to see how this melody corresponds to the original theme, which can be seen on example five. Example 5 – Comparison between the cello part in the 2nd variation (above) and the original theme (underneath) The second violin provides a second voice, which supports the main tune. It is a unique accompaniment because of its multitasking. The dotted quavers form the supporting voice which was mentioned above, while the semi-quavers complete the first violin and the viola accompaniment roles, as it can be seen on example six. Example 6 – The unique, multitasking second violin part in the second variation. The role of the viola throughout this variation is to provide a strong base part. Schubert achieved that with very simple but incredibly effective rhythm – quaver, quaver rest and two quavers. This pattern repeats for twenty-four bars. The first violin part has an ornamental function again, likewise in the first variation. It can be said, that the harmonic patterns remains similar to these at the beginning of the piece, however, there are simply more notes played in this variation which is the reason for the more tensed and excited feelings. The third variation is an absolute shock for the listener. It is a kind of culmination of the feelings which have been building up so far in the movement. This variation is unlike any of the rest in terms of role playing of the four instruments. The key feature in the third variation is the rhythm which is presented mainly by the second violin and the viola, while still reminiscing about the main theme with all the quavers, as example seven shows. Example 7 – Strong rhythmic second violin and viola parts, which still reminisce about the main theme. The first violin and the cello have a similar job of playing big three-part chords later on, which create additional tension in the music. There is an interesting fact that the original theme and the previous two variations finished in the key of G major. In the third one, however, all four instruments resolve to a single G note. The composer surprises the listener again with the fourth variation. Having listened to the previous really tensed and exciting variation, Schubert introduces very light and beautiful music in G major. A similarity to the main theme has been found in this variation, as shown on example eight. Example 8 – Similar material in the fourth variation and the main theme. The first violin is playing an accompanying role again in this variation, but this time, so lyrical and smooth, that it can be described as a counter-melody. The last part of this variation is in C major, which is the first significant change of tonality so far in the movement. By going back to the more relaxed music in this variation, the composer hides the return to the home key of G minor perfectly, as he prepares the listener for the end of the movement. In this final fifth variation, the second violin and the viola play a version of the main theme which has been played in the first variation, but this time much more lyrically. Schubert uses some voice exchange between the two of them as well. This time the cello part has the job of providing the base. It is a very simple ostinato movement, but again, incredibly effective for the listener as example nine shows below. Example 9 – The ostinato movement of the cello in the last variation The first violin has a very limited part. Starts off with a very long G note, just to continue with a passage, which strongly emphasizes the G minor chord as shown on example ten. Example 10 – The first violin line at the beginning of the fifth variation Of particular interest is the note of the cello in bar one-hundred and thirty which is shown on example eleven. There, the cello reaches the lowest note of the whole piece. This note is greatly emotional for the listener, because this is the point where all the tension and excitement, which has been building up throughout the movement, finally resolves. Example 11 – Bar 130, where the cello reaches the lowest note in the piece The coda of this movement starts in bar one-hundred and forty-four. Schubert uses the material from sections B and C of the original theme. This can be seen in the parts of the second violin, viola and cello while the first violin part is more variative and ornamental then any of the other instruments. It is an interesting fact, that Schubert finishes this movement the same way he finishes the song, with a restatement of the introduction but this time in a major key. Having written more than six-hundred songs, Franz Schubert has a huge contribution to the developing of this genre. His creativeness as a song composer, of course pervade some of his instrumental music as well. It is very difficult to reproduce in great detail what the composer had in mind about his vocal and instrumental works, in order to the fact that the singing techniques and the instruments some two-hundred years ago were so different to what they are nowadays. An interesting fact is the use of slurs in Schubert’s instrumental music. He is the composer who has rarely written a slur which is longer than a string player could manage. The slurs in a string player part correspond to the breaths a singer would take. This proves that even when composing pieces for a string quartet or even a symphony, Schubert uses his vocal techniques all the time. (Montgomery, 2003, 11) Unlike the classical string quartets, the Schubert’s works can be described as â€Å"genuine† according to the violinist Louis Spohr. This means that there is no one leading part, as it used to be during the Classical era, but all four parts are equally important. Therefore, the first violin should not aim to distinguish himself above the other three players by style of delivery or strength of tone. (Montgomery, 2003, pp.12-13) In conclusion, the String Quartet in D minor, D. 810 is one of the greatest chamber music pieces in the classical repertoire nowadays. After listening to such music, the genius of Franz Schubert cannot be questioned in any way. There is a striking fact that, this piece was not published while the composer was still alive. Anyhow, this essay analysed the poem â€Å"Der Tod und das Madchen† by Mathias Claudius, the song â€Å"The Death and The Maiden† D. 531 and the second movement of the string quartet D. 810 by Franz Schubert, by exploring mainly harmony patterns and instrumental voice leading. The strong link between the song and each of the variations from the second movement of the string quartet with the poem by Mathias Claudius has been explained. Schubert himself, in an often-cited letter, refers to the String Quartet in A minor, D. 804 and the D. 810 in D minor as well as the Octet D. 803, in a specific context: â€Å"†¦ I intend to pave my way towards grand symphony in that manner †¦Ã¢â‚¬  (Bandura-Skoda, 1982, 171). There can be no doubt that the D minor Quartet is really experimental and adventurous, which can easily be in the dimensions of the symphonic format in terms of cyclical form and expressive content. Bibliography: 1. Bandura-Skoda, E. Branscombe P. (eds.) (1982) ‘Schubert Studies: Problems of style and chronology’. Cambridge: University Press. pp. 1-25, 143-173, 327-347. 2. Brown, C. (2010) ‘Performing 19th- century chamber music: the yawning chasm between contemporary practice and historical evidence’. Oxford: Oxford University Press. 3. Montgomery, D. (2003) ‘Franz Schubert’s Music in Performance. Compositional Ideals, Notational Intent, Historical Realities, Pedagogical Foundations’. New York: Pedagogical Press. pp. 65-173. 4. Somervell, A. (1927) ‘Schubert: Quartet in D minor and Octet’. London: Humphrey Milford: Oxford University Press. pp. 5-30. 5. Rink, J. (ed.) (2002) ‘Musical Performance’, A Guide to Understanding. Cambridge: Cambridge University Press. Discography: 1. Schubert, F. String Quartets Nos. 13 and 14, â€Å"Death and the Maiden† (Alban Berg Quartet) EMI Classics, Compact disc, 0077774733359. 2. Schubert, F. String Quartet Nos. 10 and 14, â€Å"Death and the Maiden† (Britten Quartet) EMI Classics, Compact disc, 0724357327350. Music Scores: 1. Schubert, F., 1981, String Quartet in d minor: ‘Death and the Maiden’ D. 810, Eulenberg Edition, Leipzig. Music Score. 2. Schubert, F., 1989, String Quartet: ‘Death and the Maiden’ D. 810, Barrenreiter Edition, Kessel. Music Score. Web-sites: 1. Claudius, Matthias. Der Tod und das Mà ¤dchen / Death and the Maiden. Trans. Emily Ezust. The Lied and Art Song Texts Pages: Texts and Translations to Lieder (2007): http://www.recmusic.org/lieder.

Knowledge Management Processes

Knowledge Management Processes Introduction The Introduction section is reserved for the client to use to describe the background and purpose for this process. Overview A Process is a set of linked activities that transform specified inputs into specified outputs, aimed at accomplishing an agreed-upon goal in a measurable manner. The process definition laid out in this document further breaks down these Activities into Tasks, each of which have a complete set of attributes defined such as workflow, data and tool specifications and the role(s) responsible for executing the tasks. The document also includes process goal and objectives, metrics, role definitions, policies and other process related attributes. A Visio file can be found in the Appendix of this document and in the eProcess tool under Attachments Links. It contains Cross-Functional Flow Diagrams (CFFDs) for each of the activities of the process. Process Description This process strawmodel is compliant with the concepts depicted in the ITIL ® V3 framework. The Knowledge Management process provides the ability to deliver quality by providing the ability to store/capture, share, and re-use data and information; consistently and accurately. It provides a means of storing head knowledge for everyone to use. However, while Knowledge Management provides the information and data that drives the management of knowledge, details related to asset and configuration management are excluded from this process. Goal The process goal describes a specific purpose or achievement toward which the efforts of the process are directed. Each ITSM process has a specific focus and when combined with the other ITSM processes, forms a comprehensive framework for delivering and managing services. * Process Goal The goal of the process is to manage data and information; ensuring that it is available, reliable, and secure. This will aid in improving management decision making. Objectives Process objectives describe material outcomes that are produced or achieved by the process. The following is a list of objectives for this process: Portal To provide a portal or channel for accessing the knowledge repository. Manage Knowledge To manage the knowledge based on information and data. Continuous Improvement To regularly review the goals and objectives of the process; compared to business requirements. Timeliness To provide knowledge (data and information) in a timely fashion, leading to improved efficiency. Accuracy To ensure the accuracy of the knowledge repository. Improved Service Quality To improve the quality of service by enabling service provider efficiency. Increase Satisfaction To increase satisfaction by improving the quality of service provision. Inputs Process inputs are used as triggers to initiate the process. They are also used by the process to produce the desired outputs. Inputs are provided by users, stakeholders or other processes. Inputs are measurable in terms of quantity and quality. Outputs Each process produces tangible outputs. These outputs can take the form of products or data and can be delivered to a user or stakeholder, or, they can be used as inputs to other processes. Outputs are measurable in terms of quantity and quality. Controls Process controls represent the policies and guiding principles on how the process will operate. Controls provide direction over the operation of processes and define constraints or boundaries within which the process must operate. States States are indicators of points of progress of an instance through a process. These are highly dependent on the Service Management tool employed, and as such, are best identified once the process design has been completed and the ITSM supporting tool has been selected. The following states are samples that can be used as a starter set of states for this process: Metrics Metrics are used for the quantitative and periodic assessment of a process. They should be associated with targets which are set based on specific business objectives. Metrics provide information related to the goals and objectives of a process and are used to take corrective action when desired results are not being achieved and can be used to drive continual improvement of process effectiveness and efficiency. Roles Each process defines at least one role. Each role is assigned to perform specific tasks within the process. The responsibilities of a role are confined to the specific process. They do not imply any functional standing within the hierarchy of an organization. For example, the process manager role does not imply the role is associated with or fulfilled by someone with functional management responsibilities within the organization. Within a specific process, there can be more than one individual associated with a specific role. Additionally, a single individual can assume more than one role within the process although typically not at the same time. Policies Policies outline a set of plans or courses of action that are intended to influence and determine decisions or actions of a process. Policies provide an element of governance over the process that provides alignment to business vision, mission and goals. Governance Process governance defines the authority and oversight that is required to assure that the process is fulfilling its goals and objectives. Governance consists of the set of guidelines and resources that an organization uses to facilitate collaboration, communication and conformance. Process governance covers process ownership and management, process communication, process tool development and feedback (reporting) mechanisms. Governance ensures that everyone is complying with the policies and procedures of the process. Process Responsibilities (RACI): The RACI-method is based on the principle that people act in one of four ways when executing a task. It accounts for the fact that more than one role may be active in performing a specific task while clearly defining specific responsibilities for that role. While many roles may be involved in a task only one is Accountable for the results. The actions are: R Responsible for the action (may do the task) A Accountable for the action (including approval) C Required to be Consulted on the action I Required to be Informed of the action If a task does not have an ‘Accountable role indicated then the ‘Responsible role is assumed to be accountable for the task. General Tool Requirements This section describes the general requirements that the supporting tools must meet in order to fully support the needs of the process. To achieve optimum benefits, a process must be â€Å"imbedded† into the tool. This linkage between process and tool is the most effective way of ensuring process conformance and efficiency. Activities Code Name <

Civil war :: essays research papers fc

THE CAUSE Americans have always been independent group of people. We just don’t like being told what to do. This is true now as it was in the past, or will be in the future. It all started in the early colonial era (1700) when we really felt ourselves as â€Å"Americans†. Before that in the 1600’s we were just settlers in the new America. In the 1700’s we fought with the British to stop the union of France and Spain. We started our own newspaper, the Pennsylvania Gazett published by Benjamin Franklin. We opened the first American public library, the first hospital. We started the postal service with Benjamin Franklin as Postmaster General. All was not perfect in the colonies. The English Parliament started raising the taxes on imported items such as sugar, coffee, textiles and wines. We started raising the issue of taxation without representation. The English Parliament went as far as to introduce the Quartering Act, requiring colonists to house British troops and supply them with food. On April 19, 1775 an unordered shot begins the American Revolution. If the question at hand is what were the events that lead to the secession of South Carolina? Why did I spend two paragraphs on the American Revolution? Because I feel it is important to remind us of what kind of people we Americans are. How we will stand up for ourselves. I will not say we will fight for what is right, one cannot say slavery was right, or every fight we got ourselves into was right, but South Carolina and most of the south felt it was their right to own slaves. After all they had slaves in early colonial America when in 1619 a Dutch ship brought twenty Africans for sale as indentured servants thus marking the beginning of slavery in America. In 1793 Eli Whitney invented the cotton gin and more slave labor was needed to keep up with the vast amount of cotton that could now be produced. Less than forty years latter a growing anti-slavery movement was gaining recognition in the north. Harriet Beecher Stowe’s novel â€Å"Uncle Tom’s Cabin† helped spread the anti-slavery message. Everyday Americans who probably wouldn’t have given the anti-slavery movement much thought were now motivated by this book. The south had growing concerns that the anti-slavery movement was growing and could abolish slavery. After all this was a way of life for the south.

Gods Grandeur :: essays research papers

Relationships between humans and the Divine have been the subject of many authors writings, in fact the very first text ever published was the Bible; the most comprehensive link between the Divine and humans. History is full of examples of people trying to define their relationship with the Divine or lack there of, “Have mercy on me, O God, according to your unfailing love...'; (Psalm 51:1). In the poems, “God’s Grandeur'; by Gerard Manley Hopkins and “Leda and the Swan'; by William Butler Yeats, humans relationships with the Divine is explored. In these poems we see an attempt to capture the obscurity, beauty and knowledge that are ever present in human beings relationships with the Divine. Hopkins and Yeats use a variety of method to express these views and in many ways differ in their attempts to capture this special relationship, but essentially they are trying to explain the same thing: the interconnection between the Divine and humans.   Ã‚  Ã‚  Ã‚  Ã‚  In many aspect human and Divine relationships are very obscure, since it is often difficult to remain faithful when God does not appear to be apparent in every day life. Hopkins realizes this, but compels the reader to take a closer look at the splendor of God which surrounds us every day, “The world is charged with the grandeur of God'; (Hopkins). Everything around is full of God’s glory, but one needs to realize that, “God’s glory is hidden except to the inquiring eye or on special occasions'; (MacKenzie, 1981, p. 63). This is represented by the comparison of God’s glory to the shaking of gold foil. Gold foil when viewed from only one angle appears to be dull, but when shaken gives of radiant light, much like lightning. If we limit ourselves to looking for God only on the surface we may actually miss His true radiance because we are unwilling to explore other venues to discover Him. Much like lightning, God’s display of glory can be dangerous and powerful: “The electrical images convey danger as well as power, but their display is rare'; (MacKenzie, 1981, p. 63). The glory of God is present but at the same time is obscure and irregular, we must therefore, strive to see it in our everyday life. Yeats also uses these images of power to portray the obscure nature of the Divine: “A sudden blow: the great wings beating still'; (Yeats).

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.