Public precurement and (ppt) + (ppp) Essay Example | Topics and Well Written Essays - 1750 words

Public precurement and (ppt) + (ppp) - Essay Example The public department just makes monthly repayments for capital utilized and bears the on-going service costs. The major objective of PFI is to increase efficient delivery of public services and transfer risk to the private enterprises. But currently, it has come under lot of controversy for excessive payments, bribery, corruption and poor value for money. The paper would analyse PFI for managerial effectiveness, operational efficiency and cost effectiveness for public service delivery and asses its viability for best value for money. Analysis Public sector is showing significant shift in its operational areas towards privatization regarding public procurements of works, goods and services with emphasis on cost saving and increasing efficiency. The concept had originated in the developed nations which were getting concerned with large amounts of spending from the public funds for public utility services. It had led to frequent cases of irregularities related to public funding includi ng lack of commitment, transparency and efficiency issues (OECD, 2007). The reforms therefore had become necessary. An effective public procurement through PFI was a good option especially when relationship is forged through fair and competitive auction –bidding (Audit commission, 2001). ... PFI is improved form of public procurement system because of its unique framework as public private partnership. Moreover, private finance is sought within the realms of a public environment, processed by a series of state defined legal, administrative, political, and management networks. Like private sector, it ensures that the procurement of goods, services and works is optimally efficient and effective, and results in best value for money (Deloitte, 2009). But it differs from the private sector in the sense that it is not profit oriented. Indeed, these emerge as vital issues that require constant monitoring, regulation, and audit to keep the process corruption free. In the traditional procurement system, the spending department or body finalizes the project and budget and thereafter sends proposal to the treasury for loan (Whitfield, 2001). After approval the department gets the long term loan at very low interest rates as they are perceived to be low risk borrowers with governmen t not expecting to fail or default in its repayments (Grout, 1997). The loan sanction for the project is a long drawn process that each public department has to follow for any proposed work in the public area. Apart from the highly fractious procedures of finance, the operation, management and risks are hugely critical elements that become difficult to manage in the long run with the same efficiency and quality (Hood et al., 2006). Indeed, the changing socio-economic and political environment makes the various projects quite risky. Most importantly, getting the state treasuries to fund the various public projects would a massive burden on it and which could

Central Locking System Essay Example for Free

Central Locking System Essay Power door locks (also known as electric door locks or central locking) allow the driver or front passenger to simultaneously lock or unlock all the doors of an automobile or truck, by pressing a button or flipping a switch. Power door locks were introduced on the luxury Scripps-Booth in 1914, but were not common on luxury cars until Packard reintroduced them in 1956. Nearly every car model today offers this feature as at least optional equipment. Early systems locked and unlocked only the car doors. Many cars today also feature systems which can unlock such things as the luggage compartment or fuel filler cap door. It is also common on modern cars for the locks to activate automatically when the car is put into gear or reaches a certain speed. Remote and handsfree In 1980, Ford Motor Company introduced an external keypad-type keyless entry system, wherein the driver entered a numeric combination —either pre-programmed at the factory or one programmed by the owner— to unlock the car without the key. Early- to mid-1980s Nissan Maximas could also be installed with a keypad, which would also retract the windows and moonroof once the car was successfully unlocked by pushing a specific button on the keypad. During the 1990s the Subaru Legacy could also be opened by pulling the drivers external door handle a specific number of times to enter a passcode number that would unlock the drivers door only. Today, many cars with power door locks also have a radio frequency remote keyless system, which allows a person to press a button on a remote control key fob, the first being available on the French made Renault Fuego in 1982. [1] Currently, many luxury makers also allow the windows to be opened or closed by pressing and holding a button on the remote control key fob, or by inserting the ignition key and holding it in the lock or unlock osition in the external drivers door lock. The remote locking system confirms successful locking and unlocking through either a light or a horn signal, and usually offers an option to switch easily between these two variants. Both provide almost the same functionality, though light signals are more discreet while horn signals might create a nuisance in residential neighborhoods and other busy parking areas (e. g. short-term parking lots). Some manufacturers offer the ability to adjust the horn signal volume. Other cars have a proximity system that is triggered if a keylike transducer (Advanced Key or handsfree) is within a certain distance of the car. How Stuff Works Between the keypads, keyless entry systems and conventional locks, some cars today have four or five different ways to unlock the doors. How do cars keep track of all those different methods, and what exactly happens when the doors unlock? The mechanism that unlocks your car doors is actually quite interesting. It has to be very reliable because it is going to unlock your doors tens of thousands of times over the life of your car. In this edition of HowStuffWorks, well learn just whats inside your door that makes it unlock. Well take apart the actuator that does the work, and then well learn how the lock can be forced open. But first, lets see how the car keeps all its signals straight. Locking and Unlocking Here are some of the ways that you can unlock cardoors: †¢ With a key †¢ By pressing the unlock button inside the car †¢ By using the combination lock on the outside of the door †¢ By pulling up the knob on the inside of the door †¢ With a keyless-entry remote control †¢ By a signal from a control center In some cars that have power door locks, the lock/unlock switch actually sends power to the actuators that unlock the door. But in more complicated systems that have several ways to lock and unlock the doors, the body controller decides when to do the unlocking. The body controller is a computer in your car. It takes care of a lot of the little things that make your car friendlier for instance, it makes sure the interior lights stay on until you start the car, and it beeps at you if you leave your headlights on or leave the keys in the ignition. In the case of power door locks, the body controller monitors all of the possible sources of an unlock or lock signal. It monitors a door-mounted touchpad and unlocks the doors when the correct code is entered. It monitors a radio frequency and unlocks the doors when it receives the correct digital code from the radio transmitter in your key fob, and also monitors the switches inside the car. When it receives a signal from any of these sources, it provides power to the actuator that unlocks or locks the doors. Now, lets take a look inside an actual car door and see how everything is hooked up. Inside a Car Door In this car, the power-door-lock actuator is positioned below the latch. A rod connects the actuator to the latch, and another rod connects the latch to the knob that sticks up out of the top of the door. When the actuator moves the latch up, it connects the outside door handle to the opening mechanism. When the latch is down, the outside door handle is disconnected from the mechanism so that it cannot be opened. To unlock the door, the body controller supplies power to the door-lock actuator for a timed interval. Lets take a look inside the actuator. Inside the Actuator The power-door-lock actuator is a pretty straightforward device. [pic] Inside the power-door-lock actuator This system is quite simple. A smallelectric motor turns a series of spur gears that serve as a gear reduction. The last gear drives a rack-and-pinion gearset that is connected to the actuator rod. The rack converts therotational motion of the motor into the linear motion needed to move the lock. One interesting thing about this mechanism is that while the motor can turn the gears and move the latch, if you move the latch it will not turn the motor. This is accomplished by a neatcentrifugal clutch that is connected to the gear and engaged by the motor. [pic] Centrifugal clutch on the drive gear When the motor spins the gear, the clutch swings out and locks the small metal gear to the larger plastic gear, allowing the motor to drive the door latch. If you move the door latch yourself, all of the gears will turn except for the plastic gear with the clutch on it. Forcing the Lock If you have ever locked yourself out of your car and called the police or AAA to help you get back in, you know that the tool used is a thin metal strip with a flat hook on it. From this article you can now see how this strip works. A simple vertical motion from either the knob on the door or the power-lock actuator is all thats needed to turn the lock and open the door. What the officer is doing with the metal strip is fishing around until he or she hooks onto the point that the knob and actuator connect to. A quick pull on this point and the door is unlocked! For more information on power door locks and related topics, see the links on the next page.

Did Japan Benefit Economically as a result of the World Cup 2002? :: Economics

Has Japan really benefitted economically as a result of the World Cup 2002? Introduction ============ From the 31st of May until June 30th, Japan & Korea hosted the World Cup in which 32 teams competed to be crowned football champions of the world. Many thousands of people watched the matches live and hundreds of millions worldwide watched on T.V. The World Cup has been the most popular sporting event ever since the 1930s when Uruguay hosted and won the first ever World Cup. Since then the World Cup has been hosted every four year in different countries apart from during World War 2 and there have been 17 World Cups. Since the 30s football has became the world's most popular sport and with the introduction of commercial air flight, motorcars and the global T.V network it has become an important source of revenue. In 1994 the World Cup was hosted in the USA and a record 3,587,530 people watched it live. Since the 1986 World Cup held in Mexico the total attendance had begun to rise to over 2 million live viewers a World Cup. This would result in host countries gaining massive revenue from ticket sales and money received from the T.V companies broadcasting the match. The rights for broadcasting the 2002 World Cup were bought for  £622 million by Kirchmedia showing just how valuable World Cup football is. Also a study by HSBC securities in 1998 showed that countries which hosted the World Cup after 1966 saw their respective stock markets do better on average by 9%, 6 months prior to the tournament. However the study also showed that 6 months after the tournament most markets under performed by an average of 6%. In 1998 Japan was chosen to joint host the World Cup with South Korea and began a vigorous development project to upgrade and build good quality stadiums, improve public transport, build more hotels and create an excellent security force for the games. Stadiums such as the Shizuoka stadium, Sapporo dome, the Oita stadium and Niigata stadium were built just for the games and are considered some of the most modern stadiums in the world. Japan's aim from the 2002 World Cup was to attract many tourists, have a smoothly run games, encourage Japanese citizens into football and to improve its international reputation as an excellent place to host international sports events. From joint hosting the World Cup Japan achieved many economic benefits and in this essay I will explain how and why this improved Japan's economy. The Japanese economy improved because of the following effects of the World Cup during and before the event. Economic Concepts ================= Economic growth is caused by improvements in the quantity and quality

American Tragedy: Self-Destruction in a Self-Indulgent Society Essay ex

American Tragedy: Self-Destruction in a Self-Indulgent Society  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     "The boy moved restlessly from one foot to the other, keeping his eyes down . . . . [and he] appeared indeed to resent and even to suffer from the position in which he found himself" (p.9). Clyde Griffiths always wanted to be somebody---anyone but who he was. Growing up in a poor home of evangelizing, exhorting missionaries, he was not drawn to God but pushed away from Him and his family. Clyde was looking for a way to escape from his haunting reality to both a place and position in life that were more attractive. He was ashamed of his looks, his attire, his social position and his poor education. American Tragedy (1925) by Theodore Dreiser is the tragic story of a man whose fate is sealed and ambitions are shaped by society's values. Clyde, in trying to fit in with the norms of society, gets into more trouble than he could ever imagine. His trouble begins in Kansas City, where he works at a hotel and runs with some boys who are not all bad, yet are not good either. When these rowdy boys "borrow" a car and pick up their girls for some fun, they hit and kill a little girl. Rather than remain at the scene, they all run. When Clyde finds himself with nowhere to go, he roams until he runs into an old friend from Kansas City. He gets a job at another hotel where he meets his rich uncle. Uncle Samuel tells Clyde that he can come up and get a job in his factory. While working in that factory, he meets Roberta and falls very much in love. However, their love affair must be a secret because he is not, as a department head, supposed to date an employee. As time goes on their relationship becomes physical. In the midst of this physical relationship, Clyde accid... ...ams of getting on and up, was in danger of death. . ." (p.623)! His mother has always known that he is driven to become more like the Griffiths of Lycurgus, but still never imagined that he would become a murderer with this drive. Clyde's desire and ambitions to be something great with the help of society's twisted thinking is what brought about Clyde's demise. The selfish, self-centered thinking of this "high society," and their teaching Clyde these thoughts makes him feel like he has no choice if he wants to obtain his goals. Being corrupted by values which he accepts in order to be successful does nothing more than seal his fate and send him to the electric chair. An American Tragedy is Clyde's story about vice and greed, and the resulting catastrophe.    Bibliography Dreiser, Theodore, An American Tragedy, N.Y., The World Publishing Company, 1953. American Tragedy: Self-Destruction in a Self-Indulgent Society Essay ex American Tragedy: Self-Destruction in a Self-Indulgent Society  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     "The boy moved restlessly from one foot to the other, keeping his eyes down . . . . [and he] appeared indeed to resent and even to suffer from the position in which he found himself" (p.9). Clyde Griffiths always wanted to be somebody---anyone but who he was. Growing up in a poor home of evangelizing, exhorting missionaries, he was not drawn to God but pushed away from Him and his family. Clyde was looking for a way to escape from his haunting reality to both a place and position in life that were more attractive. He was ashamed of his looks, his attire, his social position and his poor education. American Tragedy (1925) by Theodore Dreiser is the tragic story of a man whose fate is sealed and ambitions are shaped by society's values. Clyde, in trying to fit in with the norms of society, gets into more trouble than he could ever imagine. His trouble begins in Kansas City, where he works at a hotel and runs with some boys who are not all bad, yet are not good either. When these rowdy boys "borrow" a car and pick up their girls for some fun, they hit and kill a little girl. Rather than remain at the scene, they all run. When Clyde finds himself with nowhere to go, he roams until he runs into an old friend from Kansas City. He gets a job at another hotel where he meets his rich uncle. Uncle Samuel tells Clyde that he can come up and get a job in his factory. While working in that factory, he meets Roberta and falls very much in love. However, their love affair must be a secret because he is not, as a department head, supposed to date an employee. As time goes on their relationship becomes physical. In the midst of this physical relationship, Clyde accid... ...ams of getting on and up, was in danger of death. . ." (p.623)! His mother has always known that he is driven to become more like the Griffiths of Lycurgus, but still never imagined that he would become a murderer with this drive. Clyde's desire and ambitions to be something great with the help of society's twisted thinking is what brought about Clyde's demise. The selfish, self-centered thinking of this "high society," and their teaching Clyde these thoughts makes him feel like he has no choice if he wants to obtain his goals. Being corrupted by values which he accepts in order to be successful does nothing more than seal his fate and send him to the electric chair. An American Tragedy is Clyde's story about vice and greed, and the resulting catastrophe.    Bibliography Dreiser, Theodore, An American Tragedy, N.Y., The World Publishing Company, 1953.

Characters in “Saving Sourdi” Essay

In Saving Sourdi, the little sister, Nea attempts numerous times to save her sister. First Nea attempts to save Sourdi from an unruly customer. At which she gets berated not only from her mother but also Sourdi. The second time is from Sourdi’s boyfriend Buck. The third time is from an older man, her Uncle’s friend, with which Soursi marries. The fourth time she involves Buck when she attempts to save her from her husband. The setting is simply contemporary America, South Dakota and Iowa. If the author hadn’t mentioned the rapper Snoop-Dog and given a reference to the candy bar Payday and the store 7-11, I could have dated this work to be in the 20’s trough to the 50’s because of the stereotypical way the daughter gets married off to an older man. The author characterizes Nea with what I call â€Å"little man† syndrome, she is in constant readiness to fight for her sister, however she doesn’t go about it with common sense. Nobody seems to understand Nea, least of all her sister Sourdi. All she attempts to do is save Sourdi, however Nea is not looking at the big picture. There is nothing or no one from which to save Sourdi. The characterization of Sourdi is the stereotypical Chinese/American in which she does exactly what her family expects of her, even if it is something that she is against. The author characterizes their Ma as someone who cares only for the restaurant and the family’s reputation, however that it not fair to their mother. She may fear if they lose the restaurant they could lose the right to stay in the states. We are never told. Buck is characterized as a person whom to protect Sourdi from at first and then a champion whom will fight for Sourdi, who is in the middle of an abusive relationship. When in fact we are never told why Sourdi was crying to her Ma, it could have been the fact that she is pregnant and doesn’t know how to deal with her baby and pregnancy at the same time. Nea never learns that the most important thing to her sister and mother is family. McCarty 2 I would have preferred the writing to be in first person than third person. It may have changed the way I felt about the way the family treated Nea. Works Cited Chai, May-lee, Saving Sourdi (2001)

tHOMAS jEFFERSON essays

tHOMAS jEFFERSON essays "Thomas Jefferson and the American Ideal" Thomas Jefferson was the third president of the United States. He was from Virginia and was one of the youngest men in Congress. He had only recently become involved in politics. John Adams, the delegate from Massachusetts, had years of experience. Jefferson thought it was only logical that the task of writing this important document should fall to the older, more experienced statesman. Adam's wanted Jefferson to write the Declaration of Independence, but Jefferson did not want to do it because he thought it would be too hard and it would take a lot of thinking. Jefferson was a writer, inventor, a statesman, and an architect. He explored the new ideas about science and government that were taking shape all around him. When he was told that he had to write the Declaration of Independence, he started right away which is contradictory to what we would think, because he didn't want to do it. It took him 2 weeks to write the Declaration. With this document, the colonies were declaring themselves independent. Americans would govern themselves. Thomas Jefferson had first learned the principle of individual freedom as a student in Williamsburg. He had learned that there were certain rights by which all people had to live to be able to make their own choices, and to be free to do as they wished as long as it didn't hurt others. Today we take these ideas for granted, but they were fairly new in the 1770's. The Americans were not allowed to govern themselves, to set taxes for themselves, or to defend themselves. Thomas' first home was the family plantation of Shadwell on the Rivana River. When Thomas was nine years old, his family moved from the Randolph's place back to their own plantation, Shadwell. On a bright September morning in 1752, a wagon drove up the path to Shadwell. The driver gave a shout and the family hurried outside. Everyone help...

Extended Project Dissertation Regenerative Medicine Essays

Extended Project Dissertation Regenerative Medicine Essays Extended Project Dissertation Regenerative Medicine Essay Extended Project Dissertation Regenerative Medicine Essay Essay Topic: Extended With the continued research going on into this new, potential way of curing many diseases that 20 years go we would never have thought could have been cured, can it do the same for the neurological condition, multiple sclerosis? And how effective is it in doing so? Many reports have come out of stem cells being effective in mice to cure the disease but with the many controversial points that come with the use of stem cells would alternative, existing methods be a better way of treating it? Are the instrumentation drugs of today more effective in treating the condition and are they a more realistic thing to be using? Also is it actually a good thing if we are finding new cures to all of these diseases? With he worlds population rapidly rising and resources running out to feed everybody and supply them all with energy, would it be better if we continued as we are and stopped playing God? These are the issues that will be discussing in this essay. Introduction and Research What is multiple sclerosis? An abnormal condition of a part, organ, or system of an organism resulting FRR mom various causes, such as infection, inflammation,environmental factors, or genetic defect, and characterized by an identifiable group of signs, symptoms, or both. Is the definition of a disease in an online free dictionary[l] and they effect peoples lives in in many ways, nearly all of them being bad and detrimental to both society, families and the world. They can be passed on by direct transf er of bacteria, viruses and other germs. However they can be passed on by sex, either in the form of sexually transmitted diseases or by genetically passing down to offspring during fertilization. A disease that is linked to being both hereditary and environmental is the unrepresentative disease, Multiple Sclerosis. Multiple Sclerosis is a disease that affects the nervous system of the body, specifically in the brain and spinal cord Every river cell in the body is surrounded by a protective layer known as the myelin sheath which enables electrical impulses that travel around the body to reach their destination hundreds of times quicker than it would without one. If a person has Multiple Scleroses, MS, then this myelin is broken down partly and therefore messages are not sent to the brain or spinal cord as efficiently. This results in a sufferer or MS to experience potential symptoms such as: loss of vision, in one eye usually, uncontrollable muscle spasms and muscle stiffness, difficulties in balance and co-ordination and people find they often suffer room tiredness and fatigue. There are two main types of Multiple sclerosis that sufferers get. The first, relapsing remitting MS, occurs in approximately eight out of ten people that are diagnosed with MS are diagnosed with this form. Somebody with relapsing remitting multiple sclerosis will have periods without suffering any of the symptoms usually associated with the disease, then they will suffer periods where the symptoms are severe and the patient may become partially blind or be unable to move. However, this period will pass and the sufferer will go back to almost normal again without showing any signs or having the disease. This period may last weeks, months or even years and this is why diagnosing this type of MS is so hard to do because of how irregular it is it can be mistaken for a number of temporary conditions and people dont report when they experience symptoms because they have had them before and was k. After 15 years of so, about half of people that have got relapsing remitting MS will go on to develop secondary progressive multiple sclerosis. This is much like the first form and people may still experience relapses but the symptoms will worsen over time and they may not fully recover from their relapse. Primary progressive MS is the least common type of sclerosis. This is where there are no periods of remission and symptoms just worsen over time with no break periods. Treatments for multiple sclerosis: Currently there is no cure for Multiple sclerosis but there are a number of treatments that can help Relapsing remitting multiple sclerosis can be treated with drugs called disease modifying drugs, these are not a cure for the disease but instead can reduce the severity of the symptoms in a sufferer and can reduce the number of relapses they have. However they are not suitable for all sufferers of Multiple Sclerosis. There are currently 10 licensed Dams (disease modifying drugs) [3] these are: Bugaboo (trinitrotoluene) oral tablet taken once a day. Available if patient has had at least two relapses in the past two years. Avenue (interferon beta-I a) -? Injection available if patient has had two relapses in the past two years. Beefeater (interferon beta-I b) available if patient has had two relapses in the past years, it is injected. Capstone (glitterati acetate) -? another injection available after two relapses in the same period of time. Octavia (beta interferon-I b) injection if patient has has 2 relapses in 2 years. Galilean (fondling) -? available if patient is still experiences despite treatment with one of the beta interferon. It is an oral tablet taken once a day. Elementary (lumberman) available for treating the active relapsing remitting form of multiple sclerosis. It is given to patient via a drip once a year. Pleurisy (vociferation beta la) injection for people living in Scotland for sufferers that have had 2 relapses in 2 years. Rebuff (beta interferon- 1 a) another injection available for patients suffering 2 relapses in the past 2 years. Deciders (timidity fumigate) used to treat active elapsing remitting MS. Approved by the NASH and became available in autumn 2014. It is a oral tablet that should be taken twice a day. Disability (nutritional) available if you have had 2 relapses in one year or if severity of relapses has increased once another DIM has been taken, given by drip monthly. There are also a wide range of other treatments available to treat multiple sclerosis. Physiotherapy can be used to make day to day living with MS more bearable and steroids can be given to patients to speed up recovery times from relapses. Causes of Multiple Sclerosis: Multiple sclerosis is an autoimmune condition. This means that the bodys defense against harmful diseases (the immune system) is affected in some way and that causes the immune system to change from attacking foreign viruses to attacking healthy body tissue- in multiple sclerosis this is the healthy Myelin that surrounds nerve cells in the body. The myelin is broken down by the bodys own immune system, nervous impulses are less efficient in traveling to the bodys Central Nervous System. As a result of this, in the places where the myelin on the myelin sheath has been thinned or destroyed, a hard region or scar is left in its place, often referred to as a sclerosis. Where there is multiple Of these hardened scars on different places On the brain or spinal cord is where the autoimmune disease gets its name from- Multiple Sclerosis. The causes of Multiple sclerosis are currently unknown; however scientists believe the main causes of the disease are a combination of genetic and environmental factors and are putting the pieces of this complicated puzzle together [4]. Genetic factors- genes are pieces of genetic information that code for the production of proteins, molecules that are essential for many of the bodies vital functions. Occasionally come genes may be faulty ND produce defective proteins. This is the cause of many of the diseases we see today however this isnt what is believed to occur in multiple sclerosis. It is thought that individuals that are affected by MS have slight variations, called polymorphism, which are healthy genes that fit badly when combined together in DNA and thus cause healthy cells around it to be altered, especially cells involved in the bodys immune system. This bad combination of genes is then passed down through the generations by normal mechanism of inheritance and therefore there is a strong link of multiple sclerosis being hared within families. There are a few genes that have been identified to make people more likely to get MS, in particular the HAL (also known as major historiographys complex, as containing the most MS susceptible gene. These proteins are found on the surface of all body cells. They act as a messenger to the immune system telling the body whether a cell is foreign or part of the body and whether it should be attacked or not. These proteins are usually healthy and therefore there must be another reason for them being altered to become defective. Scientists believe this is down to environmental actors. One theory is that a virus that is usually lying dormant in the body may disturb the immune system and therefore cause the disease to develop. There is probably on one MS virus but actually a combination of a common virus such as measles that acts as a trigger for MS. This trigger activates white blood cells (lymphocytes) in the bloodstream, which enter the brain by making the brains defense mechanisms (I. . The blood/brain barrier) vulnerable. Once inside the brain, these cells activate other elements of the immune system in such a way that they attack and destroy myelin. It is also Hough that vitamin D, the vitamin we get from sunlight, is linked to the disease. There has been a correlation between people that receive low levels of vitamin D have a higher chance of developing MS. A number of studies have i ndicated that smoking is also linked to the development of Multiple Sclerosis. It is not clear why this happens however it has been theorized that chemicals in cigarettes may have some sort of effect on the immune system and may alter it. Smoking effect on the progression of multiple sclerosis is also being investigated as it could be the fact that smoking leads to the regression of the disease being quicker and it may cause relapses to be more often and more severe. It is estimated that around 100,000 people in the UK are suffering with Multiple sclerosis at this present time, with 2. Million Cases Of MS in the world. Every week in the United States there are 200 people diagnosed with MS so this is a disease that has worldwide influence and is a major problem worldwide however it is incurable, this needs to change. Although the disease is not fatal in itself, some complications that can arise from severe MS, such as pneumonia, can be. This means that in order to reduce the numbers of people and families offering with this terrible disease we as a race need to find a new way of treating it. This might be achieved through regenerative medicine. Regenerative medicine: Regenerative medicine is the process by which scientists are able to restore normal bodily functions by repairing or replacing damaged or malfunctioning cells and tissues in cells[5] and although it is in its early stages of development, it is bringing huge advances in the field of medicine as it could provide the cure for many different diseases such as Multiple sclerosis, dementia, strokes, heart disease and many types of cancer. For example, the guardian reported a recent trial on 18 people suffering with two different types of muscular degeneration, the leading causes of blindness in adults and children in the world, Stardusts muscular dystrophy and dry atrophic age- related muscular degeneration[6]. The patients had embryonic stem cell therapy on their eyes and were cured of sight loss without any side effects. Whatever sources of potential bias the guardian may have, being a politically left leaning newspaper, the point still remains, stem cell therapy and regenerative medicine has and will continue to provide a big source of hope n the fight against many different deadly diseases. Regenerative medicine mainly comes in the form Of stem cell treatment, allowing scientists to use undifferentiated cells and turn them into any cell in the body to serve any function. This is a huge breakthrough in science and medicine as it enables anything to be made, it solves the problem of organ storage or a lack of organ donors, as hearts and lungs can just be grown in a lab and transplanted into the patient that requires them. Stem cell Research: In the early 1 sass, European researchers discovered that various types of load cells all came from a particular stem cells, however it was not until 1 963 that the particular type of self-renewing cells was first described in mice bone marrow cells by Canadian researchers Ernest A McCullough and James E Till [7]. Since that time there has been continued efforts to grow and differentiate adult animal and human stem cells in a lab. This was made a lot easier in the 1 sass and sass where there was an introduction of techniques for targeting and altering genetic material and methods for growing human cells in the laboratory. These advances really opened the doors for human tem cell research. The breakthrough came in 1998 when James Thompson, from the university of Wisconsin in Madison, successfully removed embryonic cells from a fertility clinic and cultivated them in a lab, this launched stem cell research into the limelight. Since then there has been plenty of further research that suggests that these embryonic stem cells can specialist into any cell in the human body which, if mastered, could open up a whole new world of new medicine that could change millions of peoples lives. As stem cells were only brought into the public attention in 1 998, the technology is still elatedly new and still in its youth. There have been no clinical trials of stem cell treatments as of yet however; adult stem cells are already being used in treatments for over one hundred conditions including leukemia, Hunters syndrome and heart disease. So stem cells are the answer to all of humanities works yes? Unfortunately that is not that case as this new technology does not come with many controversial parts with many people opposing to this potentially lifesaving new technology, the main point of controversy is the use Of embryonic stem cells and the ethical considerations behind that. In this document I will be discussing the main treatments of multiple sclerosis and relating it back to the question of is Regenerative Medicine the most effective way of treating Multiple Sclerosis? O I will evaluating whether other methods of treating multiple sclerosis is more effective than stem cell research then I will be coming to a conclusion at the end of the essay. Discussion Effectiveness of Stem Cell Treatment: The first issue to talk about is whether stem cells are an effective method of treating any disease and then to focus down on the specific disease we are looking at. There is no doubt that the discovery of these undifferentia ted, unspecified cells is a hugely promising unearthing, however are they a truly effective way of treatment? Do they actually do all the things that scientists promise they can do? And are they sustainable? Firstly, lets look at the plus sides of stem cells, what they can do that is beneficial to the body and what they can do to aid the recovery of a disease or illness. Diseases such as cancer or conditions such as birth defects are thought to occur because of problems in the differentiation process, an understanding of the development that appends in normal cells and stem cells will help scientists treat the developmental errors that can occur. This will help in two fields because we will know more about the development of cancers and birth defects as well as discovering more about how stem cells differentiate (to make or become different in the process of growth or development), and this will help us be able to use stem cells more effectively in turn at treating these problems, working in a positive feedback model. The next advantage of stem cells, according to website explore stem cells is that there is another potential application of cell based therapies [8]. This is when stem cells are used to grow specific cells and then are bound together using a mould to create a completely new organ or tissue. This is a huge advantage to stem cells as currently when a patient needs to new organ they get one transplanted from an organ donor. At this current time there is nowhere near the required amount of organ donors to supply the needs of people needing an organ transplant and with this new regenerative technique instead of waiting for a new organ to be donated, a new organ can be grown from scratch to fit into your body. This will dramatically reduce the amount of people dying whilst being on the waiting lists for an organ transplant. Stem cells can benefit those suffering from Parkinson disease, type 1 diabetes, arthritis, burn victims and people with cardiovascular diseases (the biggest killing disease in the UK- BBC) using this method of treatment. Stem cells also have the potential to reverse the effects of diseases. Stem cells are directed into differentiating into specific cell types, they can be fed into the body, providing a renewable resource of replacement cells for the patient. For example, people with heart ease can have stem cells differentiated into heart muscle cells to replace cells damaged by the disease, in Parkinson disease damaged brain cells can be reversed by replacing them with new healthy brain cells, reversing the effect of the disease. An even more exciting prospect is to address genetic defects that are present from birth by restoring function and health with the introduction of normal healthy cells that do not have these defects. Burn victims will, instead of suffering large amounts of pain from their injuries and instead of having to wait for donor tissues, they can have new healthy skin ells implanted onto the patient. Scientists are hoping to do this by growing skin cells in a lab from a very small piece of skin by triggering stem cells to differentiate outside the body so that large burn areas can be covered by a relatively small amount of initial skin cells. The final major benefit to stem cells research is that is provides a huge role in the pharmaceutical industry and is involved heavily in drug development. Any new drugs that are being tested for human consumption can be tested on human stem cells before they are released for their safety. This could be the case with a new anti- amour drug for example, and if the conditions that the drugs are tested in are in the correct conditions then the results could end up being very accurate and the drugs could be shown to be safe for human use and will help to treat people with life threatening diseases. The advantages of stem cells are well documented and for people with serious conditions could be a source Of major hope that one day they could be the cure for them. O it would seem as though stem cells are completely fine, effective and the answer to all of our prayers. This is not the case however, stem cell therapy is till a very controversial topic, and this is nearly all down the disadvantages that come about with stem cells. Firstly it is where stem cells are collected from. Many stem cells are collected from embryos to form embryonic stem cells; these are a very good type of stem cell to use as embryos are full of unspecified cells as eventually these will turn into a new baby human being. However, if embryonic stem cells are used then effectively there is no chance that the embryo will develop into a new-born and an abortion will take place. For many people this raises the argument of at what point does an embryo come a human and therefore has the same rights as every other person? If that point comes about at fertilization or during the embryonic stage then what occurs to extract stem cells out of these early life forms is effectively murder and therefore should not happen. Embryos are not the only place stem cells can be extracted from however, umbilical cords that are disposed of and bone marrow can be a plentiful source also however according to one source found[9], religious groups Religious groups claim that because embryonic stem cell research requires the subsequent destruction of the embryos used, it is a form of abortion. They sustain that creating embryos for the sole purpose of commercial use, followed by their disposal is morally unacceptable, and strongly oppose the area of study while adult and cord stem cells are readily available instead. Perhaps the biggest risk with this new area of research is the unknown. The introduction of stem cells into the body is permanent and this means there may be some long term side effects that we do not know about at the moment that might become clearer later along in the process. These are bad because we would not be able to reverse the effects of these side effects, A French study ten years ago found that spiniest of genetically altered bone marrow transplants developed leukemia years after their allegedly successful transplants had cured their severe combined immunodeficiency. Some research on rats in California found a way of successfully curing paralysis, however some small cysts appeared in the area near where the stem cells were injected. However harmless these were to rats, the effect of this to humans is still questionable. Other side effects that could be because of stem cell research include growth of strange objects such as teeth bones and hair on unusual areas, if this was done using embryonic stem cells these continue to grow wrought the patients life. Around 20% of rats injected with embryonic stem cells later die of some kind of cancerous tumor. This could be completely by chance but this high statistic is enough for large groups of people to doubt whether regenerative medicine is the right way to go in medicine. Another major cause for concern in stem cells is that in some cases it is known for differentiated stem cells to be rejected by the host body. A report published in nature in 2011 showed that when a specific type Of stem cell, induced plenteous stem cells (epics), used to treat diseases, found hat epics could face rejection by the immune system, even when injected into the same person who donated the cells. This immune response could destroy the transplants, rendering them ineffective as treatments. Although a different report published in 201 3 by Nature seemed to show that these epics were effective in being transferred in genetically identical mice and not triggering a strong immune response. This contrasting information shows just how unpredictable stem cell research is and that it may not be the best way to treat diseases. In conclusion then think that on balance using generative methods in treating diseases in general are a very effective way Of doing things however it is not a completely safe and iris free process as in my opinion still think that for it to be the best method stem cell therapy can be it still needs more research on the long term effects of the process, but from early indications it is looking promising barring a few studies. However what about in our specific disease? How does a using stem cell therapy affect the multiple sclerosis disease? Is it as effective at treating it as the other conditions already mentioned? At present there are no treatments that pacifically target the abnormal immune responses in MS. Current approaches, such as interferon, capstone, or immune suppressants all act in a non-specific manner blocking immune responses against the myelin sheath. While these approaches are useful for reducing the severity of disease, they do not repair the damage to nervous system tissue that has already occurred and therefore they cannot cure multiple sclerosis. However stem cells provide a different way Of treating the disease. Instead Of protecting the myelin sheath they allow it to be destroyed however it is replaced by stem cells that re externally differentiated in a lab before injected into the spinal cord or in the blood stream ready to be transferred to the brain. It is either this repair method used or, according to the MS society website, the nerve cell can be prevented from being damaged. This is called imperfection and is an active area of research involving adult stem cells from the bone marrow called mechanical stem cells. These stem cells are taken from human umbilical cords [1 1] that are donated after normal healthy births so this avoids the debate over the controversial topic of where the stem cells are oaken from. These stem cells are then screened for infectious diseases, with only about 1 in 10 umbilical cords passing screening tests. The advantages of this treatment are that anybody can be treated using these stem cells as they do not need to be matched with their genome, the stem cells are easily extracted and there is a large supply of them, and these HI-?CIT mechanical stem cells are a lot more robust then other types leading to a higher success rate. So that type of stem cell treatment by the stem cell institute seems relatively effective in terms of protecting the myelin sheath from the autoimmune response brought about by MS. However this is not the only study I found that seems to show that Multiple sclerosis can be cured by regenerative medicine. Scientists at The Scripps Research Institute (TSR) have identified a set of compounds that may be used to treat multiple sclerosis (MS) in a new way. Unlike existing MS therapies that suppress the immune system, the compounds boost a population of progenitor cells that can in turn repair MS-damaged nerve fibers. [1 2]. In this report, it is shown that a previous drug penetration, that was used to treat Parkinson disease, as been shown to increase numbers of electioneered (cells that make the myelin sheath and wrap it around the nerve fiber) in the nerve sharply, and thus increasing the amount of myelin produced. To do this scientists screen over 1 0,000 diverse compounds to see if any could potentially cause OPS cells to differentiate, and the already tested drug penetration seemed to do that already. However, not all studies show this trend however, a journal on PLOPS one[1 3] shows that a new type of stem cell, neural stem cells (NCSC), does not have a major influence on the clinical course of room-induced EYE. Improving the efficiency at which NCSC home to inflammatory sites may enhance their therapeutic potential in this model of CONS autoimmunity Meaning that the new type of stem cell does not have any effect on the number of electioneered cells being produced to repair the myelin sheath, and thus showing that regenerative medicine isnt always effective.

Dr. MLK Jr. essays

Dr. MLK Jr. essays Martin Luther King Jr.s Letter from Birmingham Jail, was very persuasive to a wide variety of audiences. Not only did he directly address the writers of the newspaper article, but included fellow African Americans with their struggle to gain acceptance. What makes this letter persuasive, is the amount of examples and situations described by Martin Luther King Jr. King also gains credibility by citing these sources without a history book, using only his own intellect that shows that he is not just your average man. Martin Luther King Jr. directed his letter to the white clergymen of Birmingham, in a response to their newspaper article criticizing him for his actions. At the beginning Martin Luther King Jr. states that he is in Birmingham for three reasons. I along with several members of my staff, am here because I was invited here. I am here because I have organizational ties here. But more basically, I am in Birmingham because injustice is here.(King, Pg.2) King has gone to where injustice is, and he is carrying the word of freedom with him, Just as the prophets of the eighth century BC left their villages and carried their thus saith the lord far beyond the boundaries of their home towns.(King, Pg.2) With that statement he is reaching to the religious part of the clergymen, stating that he is just like the ancient prophets, building his ethos with his audience. Martin Luther King uses historical examples to prove his point, using logos which most intellectuals can understand, and then uses examples for any African American can understand. In paragraph 16, King talks about St. Thomas Aquinas and his definition of an unjust law. Any law that degrades human personality is unjust.(King, Pg.3) In Paragraph 21, In the refusal of Shadrach, Meshach, and Abednego to obey the laws of Nebuchadnezzar, on the grou ...

International Law Essay Example | Topics and Well Written Essays - 750 words

International Law - Essay Example As to ancient Rome, it was an empire that absorbed many of the western independent nations. When the empire fell, however, many of the rules and laws it imposed in commerce and in other areas also faded away. Nevertheless, many of the rules and principles of international law took root in the ancient Greco-Roman systems although such rules and principles were often employed as rules of religion and laws for international relations of one state with foreign states forming part of its municipal law. A. Ancient Greece Although the Greeks did not foster close relations with its neighbors, it had to deal with its components, the city-states, which are independent from each other. Each of the city-states (or polis) comprising Greece had their respective economic and political systems. Each was considered a religious community and the rules and laws that characterized their relationships were called religious obligations and not laws (Bederman 2001:33) Some of these were: the avoidance of w ar; if unavoidable, should be commenced only through a declaration; heralds or messengers not to be harmed; fallen soldiers in battles entitled to burial; in the event of a city’s capture, refugees in temples to be spared; prisoners of war cannot be killed, but only ransomed, enslaved or exchanged; priests and seers also to be spared (Kaczorowska 2010:8). Moreover, it was Greece that first developed a highly sophisticated system of arbitration and proxeny (state hospitality), which is the basis of diplomatic immunity (Kaczorowska 2010:2). Associations and federations were also periodically formed among city-states for the purpose of establishing non-interference agreements, full citizenship grants, offensive and defensive alliances or for religious reasons. With respect to other states, however, ancient Greece was in a perpetual state of war due to its experience in the Persian Wars in 500-479 BCE, when Persia invaded and captured its colonies (Bederman 36-37). B. Ancient Rom e Rome, which is considered the most influential of all ancient civilizations, entered into treaties with neighboring Latin states, but once it started to expand its empire it employed the principles of jus fetiale and jus gentium in conducting relations with foreign states. Jus fetiale are religious laws that governed wars. Wars must be underpinned by a reason, otherwise they are unjust. Jus gentium or the law of tribe, on the other hand, governed Rome’s conduct with non-Romans and the conduct of Roman citizens with non-Roman citizens. This body of laws was made up of norms and concepts that were believed to be common and acceptable to both Romans and non-Romans. It primarily regulated the relations between private individuals and was first crafted by the praetor peregrinus or special magistrate. Jus gentium has greatly influenced the European legal systems and public international law (Kaczorowska 2010:3). In addition, the doctrine of natural law, believed to have anteceded human rights, was first created by the Stoic philosophers of ancient Greece and was subsequently adopted by the Romans. This doctrine is underpinned by the existence of right reason as something inherent in man and nature and therefore, capable of being discovered (Kaczorowska 2010:9). C. Conclusion: Greco-Roman Influence on the UN Charter The avoidance of war as well as the principle of just war, which first appeared in ancient Greece as religious obligations and in ancient

Proposal for Market Research for the Australia University Paper

Proposal for Market for the Australia University - Research Paper Example Information regarding the positioning of THE UNIVERSITY in comparison to the other institutions can help in devising a branding to improve the rating so as to attract students from other areas apart from the traditional population group of THE UNIVERSITY. RO 2: What are the expectations of the target group from the present offerings/facilities of THE UNIVERSITY? Are there any additional facilities expected? Are other similar universities or educational institutions offering more? 4. Using the Repertory Grid on the RO 3 (ranking of THE UNIVERSITY among other universities/institutions of higher learning) will give valuable information regarding the attributes on which students rank institutions. We can have a list of elements (other universities and institutions along with THE UNIVERSITY) and the attributes like admission process, popularity of the institution among peers, history of the institution, choice of courses, size of the institution, accreditation of the institution, tie-ups of the institution with other institutions and reception of the institute’s students in the industry after graduation. This will give us an insight into the core necessities of the target group and further help in tailoring THE UNIVERSITY’s brand positioning and communication strategy towards the target group. 5. Content Analysis for RO 4 (sources of information regarding universities, educational institutions and courses of study). Universities are chosen by students depending upon the information available to them. Knowing their methods of information search and the places where they search for the information will further help in focusing our communication strategy. Based on the data collected like websites, magazines, publications, agency ratings which the target group uses to obtain information, communication can be improved to increase the reach and perception of THE UNIVERSITY.

International business Essay Example | Topics and Well Written Essays - 750 words - 1

International business - Essay Example China fits the needs of my criteria because it presents great opportunities and great challenges: China has something for everybody, but it is not always an easy place to do business and it is getting harder as a result of China’s harmonization of trade rules and tightening of loopholes. (Inch, 2008) The best location to have new branch outside of Qatar is China because it is an industrial country and encourages investment and businesses. It competes with well-developed country such as USA. Notably, China also offers a cheap labor at all times. Another encouragement for me is to learn and serve the entirely different cultural manifestations, thoughts, and natural geography. Collectivistic cultures have a great emphasize on groups and think more in terms of ‘we’. On the collectivist side, we find societies in which people from birth onwards are integrated into strong, cohesive in-groups. China indicates that a society is a representation of collectivism rather than individuality. Collectivism was certainly present throughout the country – strangers are to be treated like friends, and although emotions of individuals are important, the group is also very important in decision-making. Most Importantly, Social relations are often expressed by the exchange of gifts. An important concept within Chinese social relations is the concept of face and many other Oriental cultures. Hence, people are perceived as being "near" or "far" rather than "in" or "out". (Oneness, 2010). Ascription involves elderly influence, relationships and his/her position in the community. Chinese do not focus on the achievements; however, the primary focus is on the elderly, having relationships or prestige in the community. So, there will be a little bewilderment to find the employees due to an ascription culture. Hence, the rules of recruiting should follow the same rules that the people of the country follow. They relate status to

Modern methods of teaching English Language Essay

Modern methods of teaching English Language - Essay Example Moreover, English is one of the most widespread languages of the planet serving as the means of politics, business, and economics communication for world leaders. With the help of the technological innovation and Internet English vocabulary enriches with new words every day. However, there are also degrading process in the language, some grammar rules get redundant and there appear new on their place. Therefore, teaching English demands close attention to all the changes. Every teacher knows that despite general requirements he/she must elaborate personal approach to the teaching and choose among the numerous methods. It is possible to base the choice on the experience received at school or University, or follow already existing methods. There exist numerous techniques of teaching English Language. Some of them become outdated with the development of new technologies, and some get substituted with more efficient. It is hardly possible to choose one method that could be applied for ev ery situation as each technique has its own purpose. It is necessary to know advantages and disadvantages of each method and be able to utilize them according to the situation. There are numerous innovations in English language teaching which appeared in the past century. Many schools, teachers, and applied linguists strived to find the optimal and the most efficient methods of language teaching basing on their understanding of the learning mechanisms. Traditional methods were mostly concentrated on teacher`s explanation of the material, practicing of lexical and grammatical material, and skills development. Modern methods of English language teaching are more student-oriented comparing to the old methods, they encourage students to learn rather than make them learning. A student becomes involved in a half-natural process of interaction with a techer.

Regulation of Advertising and Promotion Essay Example | Topics and Well Written Essays - 500 words

Regulation of Advertising and Promotion - Essay Example NAD examines that whether not all the claims being made in the advertisement are true. It also makes sure that the product being promoted on any platform should not mislead the audience as it can be a threat to consumers (National Advertising Division, 2013). NAD may also play an effective role during the promotion of alcohol in school. It makes sure that the sponsors are not misleading the consumers by making them think that they must start the consumption of alcohol before their legal age. NAD would also examine that the whether the claims being made by the companies regarding their alcoholic products are accurate or they are again misleading the consumers. As there are children in school the alcohol companies must keep in mind the guidelines of Children Advertising Review Unit (CARU). FTC or Federal Trade Competition makes fair competition possible between the rivals. FTC also deals with deceptive advertisement. It fosters free trade and restrains the growth of economy within any prescribed area. It oversees all the deceptive issues and then deals with it according to the Federal law. It promotes competition, restrains unfair method of competition and ensures the honest labeling of every product. This regulatory agency is also responsible for creating awareness among the companies about their rights (Protecting Americas Consumer, 2013). Federal regulation imposed during the promotion by alcohol companies can also be quite effective as it will foster healthy competition, not letting any company to practice monopoly. It will let the audience present decide the brand of their choice based on the effectiveness of promotion. No company would be allowed to promote their product unless their product features are same as they have claimed. The significance of both the regulation differs from one another. Self-regulation is imposed for the purpose of the letting the customers know that the product is

Modern methods of teaching English Language Essay

Modern methods of teaching English Language - Essay Example Moreover, English is one of the most widespread languages of the planet serving as the means of politics, business, and economics communication for world leaders. With the help of the technological innovation and Internet English vocabulary enriches with new words every day. However, there are also degrading process in the language, some grammar rules get redundant and there appear new on their place. Therefore, teaching English demands close attention to all the changes. Every teacher knows that despite general requirements he/she must elaborate personal approach to the teaching and choose among the numerous methods. It is possible to base the choice on the experience received at school or University, or follow already existing methods. There exist numerous techniques of teaching English Language. Some of them become outdated with the development of new technologies, and some get substituted with more efficient. It is hardly possible to choose one method that could be applied for ev ery situation as each technique has its own purpose. It is necessary to know advantages and disadvantages of each method and be able to utilize them according to the situation. There are numerous innovations in English language teaching which appeared in the past century. Many schools, teachers, and applied linguists strived to find the optimal and the most efficient methods of language teaching basing on their understanding of the learning mechanisms. Traditional methods were mostly concentrated on teacher`s explanation of the material, practicing of lexical and grammatical material, and skills development. Modern methods of English language teaching are more student-oriented comparing to the old methods, they encourage students to learn rather than make them learning. A student becomes involved in a half-natural process of interaction with a techer.

Hormones and Nerve Questions Essay Example | Topics and Well Written Essays - 3250 words

Hormones and Nerve Questions - Essay Example But it was proved that epinephrine alone could not cause this transformation to occur. It had to call on the help of a secondary messenger, cyclic AMP, for assistance. Cell membranes consist of lipid chains which makes them hydrophobic or water repelling in nature. Whereas hormones are proteins made of hydrophilic or water loving peptide chains, and they cannot readily pass through the cell membranes. This is where secondary messengers come in. they serve as a messenger between the hormones and the target cell. Secondary messengers are mostly small molecules causing a higher rate of diffusion through the cytoplasm of the cell and a faster rate of information transmission. Secondary messengers also help intensify the strength of a particular signal. Hormones in very small amounts can cause the release of thousands of secondary messengers. This means that the body can save up a lot of energy. It does not need to utilize all its nutritive resources such as proteins in the formation of h ormones, because only tiny quantities of these hormones are needed to get a response from the target cells. Therefore minimum amounts of energy are used by the body to communicate with various cells. Secondary messengers are present in the cytoplasm of cells, thereby controlling the rate of hormones and enzymes utilized by the cells. They could either cause an increase or decrease in the metabolic reactions of the cells. This means that tiny doses of hormones could cause immediate responses as the effects are amplified by the secondary messengers. Secondary messengers are also responsible for signal transduction torrents. Words: 310 NERVE QUESTION Write approximately 800 words on why it is important to understand the structure of nerve cells in order to appreciate their function. Please make sure you cover the generation of an action potential and the transmission of a nerve impulse. It is important to understand the structure of nerve cells, because it is because of their specific structure that they can carry out their important functions. A nerve is a bundle of neurons and a neuron is an individual nerve cell. There are three types of neurons: Sensory neurons Relay neurons Motor neurons These three neurons function together to transmit nerve impulses and each of them have a separate structure which facilitates the entire process. Sensory neuron endings are more concentrated in our sense organs like the retina of the eye, cochlea of the ear, etc. sensory neuron endings receive stimulus from the sense organs and then they pass the nerve impulse immediately to the dendrite which then passes them to the Dendron, which is a single fiber, and then these impulses are brought to the cell body which consists of a nucleus and cytoplasm. Finally these impulses pass through the axon and arrive at the synaptic knob which has several branches. These impulses are somewhat similar to electrical impulses. Sensory neurons are elongated cells consisting of sensory nerve endin gs at one end and synaptic knobs at the other. They are coated with a fatty layer known as the myelin sheath which acts as an electrical insulator so as not to get disturbed with other passing impulses. Gaps in the myelin sheath are known as the nodes of Ranvier, which help speed up the passage of nerve impulses. Relay neurons are smaller cells which act as a link

Change Insight Analysis Paper Essay Example for Free

Change Insight Analysis Paper Essay Managing change is an ideal process in organizational management and greatly helps in realization of organizational goals and objectives. In business, change insight management is analyzed by different theoretical models that are essential in business process. As a result, this paper analyzes the three basic change models theories. These are discussed as follows: The Kotter’s 8-Step Change Model, The Marvin Weisbord’s Six Model and the Linda Ackerman Anderson’s 9 Phase. The three theoretical models on change management discuss the various strategies of managing and coping with organizational change. In particular, the strengths and weakness of each model are analyzed. Further the application of each theoretical model on change management in an organizational setting is discussed. Kotters 8-Step Change Model See more: analytical writing In business change is the only constant. John Kotter, a change expert and a professor of Harvard business school and a renowned leadership and management guru. In his book, leading change, Kotter discussed the 8-Step Model to change management as follows: The first step is creation of urgency. In order for change to happen, the whole organization must be in dire need of the organizational change. Thus, the leadership and management must develop the need for change among the members of the team. In administering change in an organization, the management is expected to identify the potential threats to develop scenarios that indicate the possible projections on what can happen in future. The other step in management of change involves the formation of a powerful coalition. This is attained by convincing people that change is necessary and important. This must take strong leadership efforts and activities to implement. To achieve this, the leadership and management team must ask for emotional commitment, work with the team building in change coalition as well as evaluating the team for weak areas to enhance a good mix for of different people from different departments. The third step in the Kotter’s Model of change management involves creation of vision for change. At this point, the leadership management must determine the values that are essential for change, create a short summary and have a strategy that is applicable in attainment of the expected changes. Communication for buy in is the next  step in achieving organizational change, others step include and not limited to the following: Empowering action, creation of short term wins, do not let up and make the change stick. The Applicability of the Kotter’s 8-Step Change Model The Kotter’s change model is applied in all top-down change processes. For instance, for the projects that have been identified and decided, at the top level of the organizational management. Indeed, the United States Army used the model to prepare their soldiers at the war. The Strengths of the Kotter’s 8-Step Change Model This theoretical model on change management is characterized by the following strengths: First, it is easy to understand, it can well fit into the culture of classical hierarchies, it is well successful when all the steps are applied and exercised. Further, the model focuses on the employee buy in as it focuses on success. The Weaknesses of the Kotter’s 8-Step Change Model To start with, the model is too linear to an extent of leading to wrong assumptions. Second, it is difficult to change the directions of the model when action has already started. Third, the model can result to frustration among the employees when the initial stages of grief and the needs of individuals are not taken care of. The Marvin Weisbord’s Six-Box Model The six-box model of managing organizational change is a leadership and management framework that was developed by an American business analyst Marvin Weisbord with the main aim of assessing the organizational functioning. Its key generic framework in management of organizational change is intended for use and application in a variety of different organization. The Model has its key basis on the assumptions and techniques of the field organizational change and development. The Six-box Model constitute of the following boxes: Purpose that includes a clear definition of the business that an organizations in, structure that explains on the dimension of dividing work among employees, relationships that encompass the techniques of managing all the possible changes in relationships, rewards that constitutes of the definition on incentives and what needs to be done,  leaderships that involves selection of change managers who will help in keeping the five boxes in balance as well as the he lpful mechanisms that are applicable in coordination of the technologies that are necessary in management and leadership. The Application of Marvin Weisbord’s Six-Box Model This model is applicable in organizations where there is a need to look or consider the organizational structures and designs in a specified way. Indeed, the model is applicable in areas of change management that needs planning, rewards, incentives, and the role of support functions that include international organizations, partnerships and standards of remunerations. In addition, the model is particularly useful at times when consultation have little time that is desirable for diagnosis or when a relatively less complicated organizational map is required for quick service. The Strengths of the Marvin Weisbord’s Six-Box Model The first strength of the model is attributed to the fact that the model is the most suitable in helping the change leadership development manager to effectively visualize the organization as a whole system without using key and strange change terminologies. The other strength that is associated with the model is in its easy application. Indeed, the model is easily understandable and can be well applied by any change manager who can actively engage in change development. The Weaknesses of the Marvin Weisbord’s Six-Box Model The Marvin Weisbord’s Six-Box model has the following weaknesses. First, the model is only applicable in organizations that are constituted by the six boxes. This mean that organizations that are not characterized by the above discussed components can not effective apply the model in management of change leadership. Moreover, the model is weak because it cannot be conveniently applied to manage organizational change in organizations with complex organizational structures. Linda Ackerman Anderson and Dean Anderson 9 Phase Model on Change Leadership Roadmap Methodology This is a model of managing organizational change that is mainly rooted in the change in leadership road map. The theoretical model is sidelined in the designation  and the implementation of the major organizational transformations. The main question analyzed by the model is on the availability of a roadmap that is needed by an organization in realizing change. The first phase of the model is preparation to lead the change. Here, the organizational leadership selects the leaders that are needed to change the organization in order to attain the organizational success. This is the most important phase because it addresses the key process of the decision making in the efforts of change administration. The main purpose of this phase is to prepare the leaders to lead the change in accomplishment of six main activities. The two basic activities out of the six main activities are outlined as follows: Staffing and starting up the change efforts with the use of change expertise in leadership, determination of the case for change and the exact scope of the change and the expected outcomes. The other phases of this model include creation of commitment, organizational vision and capability, assessment of situation in determination of design requirements, plan and design the implementation of the change activities, implement the required organizational change, celebrate and integrate the new state on change management as well as learning and course correcting the change. The Application of Ackerman Anderson 9 Phase Model This model is applicable in offering the specialized change leadership development as well as transformational leadership in organizations that are consulting on change. Indeed, the founders of the model are the owners of Being First, Inc., a company that has adopted the model to guide and advice Fortune 1000 companies, non-profit organizations, government agencies, and international change consultancies that are in need of assistance in change leadership management and transformational leadership. The Strengths of the Ackerman Anderson 9 Phase Model There are several strengths that are associated with the Ackerman Anderson 9 phase model. First, the model is useful in attaining favorable tangible results that a firm is after in administration of change. This is achieved faster will little or no costs in the business or people. In addition, the model helps in building an organization change skills and capabilities. This greatly helps to consistently realize the maximum benefits realized from a  successful change. Moreover, the model is helpful in transforming the organizational culture and the people in an organization. This is essential in attainment of the desired organizational change. Furthermore, the model is evidenced by its strengths in the development of the mangers and leaders to become competent in transforming the organization to realize the needed organizational change. Most important, the model is applied in the development of internal consultants to become an expert change consultants’. Notably, the Ackerman Anderson 9 phase model of change management in ensuring all the possible change strategy development and process planning. This is because change strategy development and the process of planning are essential for complex change transformation. The Weaknesses of Ackerman Anderson 9 Phase Model Irrespective of the numerous strengths of the model, its key weaknesses cannot be underestimated. These are described as follows: First, skipping a phase in the change leadership roadmap or a key decision leads to numerous impacts that can dismantle all the established changes. Moreover, failure to customize the change process can result to discouragement on the identity of the customers in respect to the best change practices. Conclusion Change insight analysis is essential in managing organizational change. This is because of the available theoretical models that play an essential role in leadership and transformational development. The essential three models include and not limited to the following: Ackerman Anderson 9 phase model, Marvin Weisbord’s Six-Box model and the Kotter’s 8 Step Change model. All the three models are applicable in different ways and each consists of its strengths and weaknesses.

Communication for Health Promotion

Communication for Health Promotion The purpose of this assignment is to strongly critique an interaction between a health professional and a service user in a video clip titled â€Å"Sexual Health Advice Role-play† (Nice (National Institute for Health and Care Excellence) Media, 2012). In the video clip, an adolescent male is seen using the C card scheme to obtain free condom from a pharmacy. The health professional in the pharmacy takes this as an opportunity to offer the adolescent service user a free chlamydia test. The type of health promotion and communication seen in the video clip will be discussed including the health promotion models observed in the clip and the strategies that could have been used to enhance the opportunity will be highlighted. In order to promote health, heath professionals must understand the definition of health. Health is commonly defined by two definitions; one of which is a negative definition and the other positive. The negative definition of health defines health as the absence of disease or illness (Naidoo and Wills, 2009), whereas the positive definition looks at holistic health and defines health as not just the absence of disease and infirmity but as a state of complete physical mental and social well-being (World Health Organisation (WHO), 1946). Health is holistic and consists of different dimensions which all need to be considered (Naidoo and Wills, 2009). Health promotion is a practice of empowering people to improve control over their health, and to also better it. It encourages people to improve their mental, physical and social well-being and to do so individuals and groups should have the knowledge of interventions that are in place in order to help people satisfy their needs, and change or cope with the environment (WHO), 1986). Nutbeam (1998) suggested that a comprehensive social and political process is represented by Health Promotion. It does not just look at strategies used to strengthen people’s skills and capabilities but it also looks at the strategies used to change social, environmental and economic conditions in order to improve their impact on individuals and public health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions (WHO) 1986). There is a variety of health promotion approaches which all have different objectives. These approaches are medical, behaviour change, educational, empowerment and social change (Naidoo and Wills 2009). The medical approach concentrates on strategies used to decrease morbidity and premature mortality. The approach is also concerned with disease prevention among high-risk groups. This approach is usually linked with the three levels of health promotion, which are primary, secondary and tertiary (Leddy, 2006). Primary health promotion consists of strategies that prevent ill health before it occurs. Strategies may include immunisation or encouraging people to live healthier lifestyles (Hubley et al, 2013). The C card is a form of Primary health promotion because it aims to help young people protect themselves from sexually transmitted diseases by issuing free condoms.[g1] Condoms are an effective way of preventing sexually transmitted diseases (National Health Service (NHS) choices, 201 3) therefore the C Card scheme is a good example of primary health promotion because it prevents disease before it occurs. Secondary health promotion consists of actions taken to identify and prevent the progression of disease at an early stage (Scriven,2005). Secondary health promotion strategies may include health screening programmes. Secondary health promotion is seen in the video clip when the health professional encourages the service user to get screened for chlamydia. Every young person under the age of 25 is entitled to a free and confidential chlamydia test through the National Chlamydia Screening Programme (NCSP). The NCSP is an NHS sexual health programme which was put into place by the Department of Health (DOH) in 2003 (NCSP 2003). In 2012 206,912 people in England tested positive for chlamydia and 64% of these were under 25 (NHS Choice, 2013). The NCSP targets young people under 25 because they are a high risk group where chlamydia is concerned. The programme’s aims are to make sure that young people under the age of 25 who are sexually active are aware of the effects of chlamydia and have access to free and confidential chlamydia screening (NCSP, 2013). According to Public Health England (PHE) (2013), since the NCSP was introduced there has been a 40% increase of chlamydia diagnoses in young people. This shows that more young people are being tested and getting treatment for chlamydia. The last level of health promotion is tertiary health promotion which looks at improving the health of individuals who are already affected by a disease. It consists of actions to avoid deterioration and aims to reduce complications (Fertman and Allensworth, 2010). An example of tertiary health promotion is when an HIV infected person takes antiretroviral drugs to help slow down the spread of virus in the body (NHS choice, 2012). The educational approach aims to enable individuals to make informed choices about their health behaviours by educating and assi sting them in developing skills (Trapani 2007). The educational approach is applied in the interaction when the health professional firstly provides the service user with information about chlamydia before performing the chlamydia test. The behaviour change approach aims to change individual’s unhealthy behaviours, by encouraging them to adopt healthy behaviours (Dixey, 2013). An element of the behaviour change approach is seen in the video clip; by providing free condoms to young people, the C card scheme is trying to change their behaviours by encouraging them to stop engaging in unprotected sex. The C-Card scheme is a service for young people which provides free condoms, advice and information. [g2]The service is free and confidential. The aims of the scheme are to help young people have more access to condoms, support them, educate them on sexual heath and how to correctly use condoms (Burtney, 2008). The initial reason why the service user went to the pharmacy was to obtain free condoms but the health professional takes this as an opportunity to promote health. The promotion of health and wellbeing is a fundamental part of being a health professional (Scriven, 2005). All health care professionals are encouraged to make every contact count. They are encouraged to use every interaction with an individual as an opportunity to promote health, whatever their profession or the reason of the interaction (Department of Health, 2012). Good communication skills are essential when health professional are attempting to promote good sexual health to young people. Effective communication enables health professionals to maximise the success of the interaction and this enhances the associated health promotion throughout the consultation (Barnes, 2009). The communication process begins at point of greeting and introduction (French, 2006). Williams and Davies (2005) suggest that communication with adolescents should begin with the development of trust. They further on elaborate that rapport with the adolescent should be built by health professionals and they are also are advised to be non judgemental and straight forward. Throughout the interaction, the health professional did not introduce herself to the service user. The health professional could have presented the idea of a chlamydia screening more effectively by firstly introducing herself. According to NICE (2012) health and social care professionals must always make it a priority to introduce themselves to service users and clearly explain their role and responsibilities. If the health professional had introduced herself to the service user, the service user would have felt more comfortable and would have had more trust in the health professional. Introducing herself could have helped her build rapport between herself and the service user. Establishing rapport and building a relationship between a service user and health professional are considered as foundations to good communication (Mitchell and Welling, 1998). Building a relationship is fundamental when working with young people because if a young person does not trust you, they may not disclose personal information (Royal College of Nursing (RCN), 2013). Throughout the consultation the health professional maintained excellent professionalism. The language used by the health professional was that of a professional manor and not over technical. The service user used clinical language that could be understood by the service user, she did not speak in way that could have been patronising to the service user. When interacting with adolescents, some health professionals resort to using patronising language because they believe an adolescent would not be capable of understanding professional language (Berry, 2006) The health professional maintained good eye contact throughout the interaction. When interacting with a service user, health professionals are advised to maintain eye contact if it is culturally acceptable for the service user because it shows honest, confidence and helps build a more therapeutic relationship (Eisenberge, 2012). According to Bateman (2000), a health professional’s advice may not be absorbed if there is a la ck of eye contact. Appropriate body language was used by the health professional throughout the interaction. The body language used by the service user was also that of a professional manor. Allen (2013) suggests that body language can be used as a foundation of building rapport between service user and health professional. She also goes on to say that trust can be established through mirroring and matching the body movements of a person. The health professional is seen mirroring the service user’s body movement throughout the interaction. Maintained good communication skill, eye contact, body language Good environment no noise, privacy, no interruptions When service user asked if it could be transmitted through kissing professional asked as if she didn’t know. No information. Did not ask for consent She did not give him a chance to ask questions Gave information before test References Burtney, E (2008) Guidelines for Setting Up a C-Card Condom Distribution Scheme For Young People. Available at: http://www.phru.net/shin/Condom%20Distribution%20Review/Brook%20guidelines%20FINAL%2029%20Oct.doc (Accessed: 23 April 2014) Department of Health (2012) The NHSs role in the publics health: a report from the NHS Future Forum. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216423/dh_132114.pdf (Accessed: 23 April 2014) Public Health England (2013) Chlamydia screening intervention proves infectious in general practice. Available at: https://www.gov.uk/government/news/chlamydia-screening-intervention-proves-infectious-in-general-practice (Accessed: 24 April 2014) Fertman, C. and Allensworth, D. (ed.) (2010) Health Promotion Programs: From Theory to Practice. London: Jossey-Bass Hubley, H., Copeman, J. and Woodall, J. (2013) Practical Health Promotion. 2nd edn. Cambridge: Polity Press Leddy, S. (2006) Integrative Health Promotion: Conceptual Bases for Nursing Practice. 2nd edn. London: Jones and Bartlett Naidoo, J. and Wills, J. (2009) Foundations For Health Promotion. 3rd edn. London: Elsevier NCSP (2013) What is the NCSP?. Available at: http://www.chlamydiascreening.nhs.uk/ys/about.html (Accessed: 23 April 2014) NHS Choices (2012) HIV and AIDS – Treatment. Available at: http://www.nhs.uk/Conditions/HIV/Pages/Treatmentpg.aspx (Accessed: 23 April 2014) NHS Choices (2013) Chlamydia. Available at: ttp://www.nhs.uk/Conditions/Chlamydia/Pages/Introduction.aspx (Accessed: 24 April 2014) http://www.nice.org.uk/guidance/qualitystandards/patientexperience/PatientAwarenessOfHealthcareProfessionals.jsp Nutbeam, D. (1998) ‘Evaluating Health Promotion – progress, problems and solutions’, Health Promotion international ; 13, pp. 27-44 Scriven, A. (2005) Health Promoting Practice: The contribution of nurses and allied health professional. 1st edn. Hampshire: Palgrave Macmillan World Health organisation (1986) The Ottawa Charter for Health Promotion. Available at: http://www.who.int/healthpromotion/Milestones_Health_Promotion_05022010.pdf?ua=1 (Accessed: 23 April 2014) World Health Organisation (1946) Constitution. World Health Organisation, Geneva http://books.google.co.uk/books?id=TjI1QMi3cnoCdq=medical+approach+in+health+promotionsource=gbs_navlinks_s http://books.google.co.uk/books?id=xwOd0PcEdtoCsource=gbs_navlinks_s http://www.nursingtimes.net/nursing-practice/clinical-zones/sexual-health/health-promotion-in-sexual-health-2-nurses-role-in-engaging-with-clients/5001424.article http://books.google.co.uk/books?id=yUTP2ioasf8Csource=gbs_navlinks_s http://books.google.co.uk/books?id=bkDjTmriEiYCdq=why+is+eye+contact+important+in+health+and+social+caresource=gbs_navlinks_s http://books.google.co.uk/books?id=AK_Mg2J5EhUCdq=language+used+by+health+professionalssource=gbs_navlinks_s http://www.naturalhealthcourses.com/Reading_Room/Body_Language.htm [g1]Reference [g2]Reference

Vote No For Quebec To Be Separate From Canada :: essays research papers

Vote No For Quebec To Be Separate From Canada   Ã‚  Ã‚  Ã‚  Ã‚  I urge you as a fellow Canadian to vote NO! to the upcoming referendum question. Canada as a whole has many unique qualities. Our most valued characteristic is our cultural diversity. Our combination of Anglophone and Francophone regions throughout our country and their ability to work together sets us apart from the rest of the world. Canada cannot function without Quebec just as Quebec cannot function without Canada.   Ã‚  Ã‚  Ã‚  Ã‚  It has been said by many, that those who live in Quebec to want to separate because of their need and desire to have their own distinct culture and heritage. This is not a valid point because Canada's culture and heritage is largely defined by that of Quebec. Quebec separating from Canada would mean that Canada as a whole would lose that part of its history. Quebec does not need to separate from Canada to maintain its culture since Canada has always greatly encouraged it.   Ã‚  Ã‚  Ã‚  Ã‚  Voting YES to the referendum will cause problems in many relationships between peolpe who live in Quebec and those in the rest of Canada. Some of these problems are unemployment and jobs. The residents of Quebec will no longer be able to work in Canada just as Canadians will no longer be allowed to work in Quebec. This will cause a rise in unemployment because many people will be forced to quit thier jobs. The border between Canada and Quebec will impose even more obstacels. Travel will become stessfull because passports will be needed and duty taxes will be imposed. International trade will also be a problem since Canada and Quebec will be two separate countries. It would be unlikely for the two countries to do business with each other primarily due to feelings of resentment and hostility. Another problem that will arise is the fact that some Quebecers are not willing to separate. There will never be a time when everyone living in Quebec will want to separate. It therefor causes a problem for those who want to stay because they would be compelled to leave.

Comparing the Hero in Fall of the House of Usher, Rip Van Winkle, and M

The Romantic Hero in Fall of the House of Usher, Rip Van Winkle, and May-Pole of Merry Mount Hero n. a man of distinguished courage or ability, admired for his brave deeds and noble qualities. Though this is the definition of hero according to Random House Webster’s Dictionary, the Romantic interpretation of hero is quite different. A Romantic hero is usually somewhat innocent and carefree, separate from the masses, and is almost always on some type of journey. This hero is idealistic, non-conforming, and rarely lives in the â€Å"here and now,† but, on the contrary, is well rounded, skilled in some fashion, and able to communicate with all walks of life. Romantic heroes are found in the works of Nathaniel Hawthorne, Edgar Allen Poe, and Washington Irving. Edith and Edgar are the hero and heroine of â€Å"The May-Pole of Merry Mount† by Nathaniel Hawthorne. Though the people of Merry Mount are themselves romantic, these two characters typify authentic Romantic qualities. In this short story, May is a time for renewal, merriment, and celebration. This season is full of color, laughter, and animal-like costumes. â€Å"Within the ring of the monsters, appeared the two airiest forms†¦Ã¢â‚¬  (624). Edith and Edgar, the focus of the festivities, are getting married and are adorned with vibrant garments; therefore, are the most beautiful and admired of the Merry Mount group. They are both young and innocent, which is also an attribute of Romantic heroes. While waiting for the ceremony to begin, Edgar glances at Edith and is surprised by her disposition. He questions her â€Å"pensive† look and explains to her â€Å"that nothing of futurity will be brighter than the mere remembrance of what is now passingâ⠂¬ (625). Edith then acknow... ... In conclusion, not all definitions of hero can be found in the dictionary. Washington Irving, Nathaniel Hawthorne, and Edgar Allen Poe offer three contrasting portraits of a Romantic hero. Rip, Edith and Edgar, and Roderick may not fill Webster’s shoes of criteria, but their wardrobe is truly Romantic.    Works Cited Hawthorne, Nathaniel. â€Å"The May-Pole of Merry Mount.† The Norton Anthology of American Literature. Ed. Nina Bayn. New York: Norton & Company, 1999. 623-630. Irving, Washington. â€Å"Rip Van Winkle.† The Norton Anthology of American Literature. Ed. Nina Bayn. New York: Norton & Company, 1999. 429-439. Poe, Edgar Allen. â€Å"The Fall of the House of Usher.† The Norton Anthology of American Literature. Ed. Nina Bayn. New York: Norton & Company, 1999. 717-730.

Analgesic and Facilitator Pain Assessment

Individual Research Article Critique Presentation Resource: The research study that you selected in Week Two Develop a 10- to 15-minute presentation in which you address the following points (7 pts): †¢Strengths and weaknesses of the study †¢Theoretical and methodological limitations †¢Evidence of researcher bias †¢Ethical and legal considerations related to the protection of human subjects †¢Relationship between theory, practice, and research †¢Nurse’s role in implementing and disseminating research †¢How the study provides evidence for evidence-based practice †¢Identify the following for the research study selected (choose 1 or 2 NOT BOTH): 8 pts. †¢ 1. Quantitative Research Article Critique (Follow the example pp. 433–442 of the text): †¢ a. Phase 1: Comprehension b. Phase 2: Comparison c. Phase 3: Analysis d. Phase 4: Evaluation †¢ 2. Qualitative Research Article Critique (Follow the example pp. 455–461 o f the text): †¢ a. 1. Problem (problem statement; purpose; research questions; literature review; frame of reference; research tradition) b. 2. Methodology (sampling & sample; data collection; protection of human subjects c. 3. Data (management; analysis . 4. Results (findings; discussion; logic; evaluation summary †¢ Format the presentation as one of the following (5 pts): †¢Poster presentation in class †¢Microsoft ® PowerPoint ® presentation including detailed speaker’s notes †¢Video of yourself giving the presentation uploaded to an Internet video sharing site such as www. youtube. com –Submit the link to your facilitator, include a written reference page in APA format †¢Another format approved by your facilitator Pain Assessment in Persons with Dementia: Relationship Between Self-Report and Behavioral Observation Ann L.Horgas, RN, PhD,A Amanda F. Elliott, ARNP, PhD,w and Michael Marsiske, PhDz OBJECTIVES: To investigate the relatio nship between self-report and behavioral indicators of pain in cognitively impaired and intact older adults. DESIGN: Quasi-experimental, correlational study of older adults. SETTING: Data were collected from residents of nursing homes, assisted living, and retirement apartments in northcentral Florida. PARTICIPANTS: One hundred twenty-six adults, mean age 83; 64 cognitively intact, 62 cognitively impaired.MEASUREMENTS: Pain interviews (pain presence, intensity, locations, duration), pain behavior measure, Mini-Mental State Examination, analgesic medications, and demographic characteristics. Participants completed an activitybased protocol to induce pain. RESULTS: Eighty-six percent self-reported regular pain. Controlling for analgesics, cognitively impaired participants reported less pain than cognitively intact participants after movement but not at rest. Behavioral pain indicators did not differ between cognitively intact and impaired participants. Total number of pain behaviors w as signi? antly related to self-reported pain intensity (b 5 0. 40, P 5. 000) in cognitively intact elderly people. CONCLUSION: Cognitively impaired elderly people selfreport less pain than cognitively intact elderly people, independent of analgesics, but only when assessed after movement. Behavioral pain indicators do not differ between the groups. The relationship between self-report and pain behaviors supports the validity of behavioral assessments in this population. These ? ndings support the use of multidimensional pain assessment in persons with dementia.J Am Geriatr Soc 57:126–132, 2009. Key words: pain; dementia; measurement From the ADepartment of Adult and Elderly Nursing, University of Florida, College of Nursing, Gainesville, Florida; wDepartment of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and zDepartment of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, G ainesville, Florida. Address correspondence to Ann Horgas, College of Nursing, University of Florida, PO Box 100197-HSC, 101 S.Newell Drive, Room 2201, Gainesville, FL 32610. E-mail: [email  protected]?. edu DOI: 10. 1111/j. 1532-5415. 2008. 02071. x ain, a persistent daily problem for many elderly adults, is associated with physical and social disability, depression, and poor quality of life. 1 Between 50% and 86% of older adults experience pain; 32% to 53% of those with dementia experience it daily. 2 The high prevalence is associated with proliferation of pain-related health conditions in late life, such as osteoarthritis, hip fractures, peripheral vascular disease, and cancer. Dementia complicates pain assessment, because it impairs memory, judgment, and verbal communication. Dementia is associated with central nervous system changes that alter pain tolerance4 but not pain thresholds (e. g. , minimum level at which a painful stimulus is recognized as pain). 5 No empirical evid ence indicates that persons with dementia physiologically experience less pain; rather, they appear less able to recognize and verbally communicate the presence of pain. Findings that cognitively impaired older adults underreport pain relative to nonimpaired elderly people7 and are less likely to be treated for pain than their cognitively intact peers8,9 re? ect dif? culty assessing pain in this population. Self-report is considered the criterion standard of pain assessment. Despite recent studies supporting the reliability and validity of self-report in persons with dementia,7,10 healthcare providers and pain experts recognize that selfreport alone is insuf? cient for this population and that observational pain assessment strategies are needed.In 2002, the American Geriatrics Society established comprehensive guidelines for assessing behavioral indicators of pain. 1 More recently, the American Society for Pain Management Nursing Task Force on Pain Assessment in the Nonverbal Patien t (including persons with dementia) recommended a comprehensive, hierarchical approach that integrates selfreport and observations of pain behaviors. 11 Recently, tools to measure pain in persons with dementia have proliferated. In 2006, a comprehensive stateof-the-science review of 14 observational pain measures was completed.The authors concluded that existing tools are still in the early stages of development and testing and that more psychometric work is needed before tools are recommended for broad adoption in clinical practice. 12 Others, including an interdisciplinary expert consensus P JAGS 57:126–132, 2009 r 2008, Copyright the Authors Journal compilation r 2008, The American Geriatrics Society 0002-8614/09/$15. 00 JAGS JANUARY 2009–VOL. 57, NO. 1 PAIN ASSESSMENT IN PERSONS WITH DEMENTIA 127 panel on pain assessment in older persons,13 have corroborated these conclusions. 4 In particular, these authors highlight the need for more evaluation of observational pa in measures, including validation against the criterion standard of self-report in intact and impaired populations. Almost all research on measuring pain in persons with dementia has focused exclusively on persons with moderate to severe disease. There has been only one published study that compared pain behaviors and self-reported pain in persons with and without cognitive impairment, but it focused on postoperative patients undergoing rehabilitation and acute pain associated with physical therapy. 5 Thus, the purpose of this study was to investigate the relationship between self-report and behavioral indicators of pain in cognitively intact and impaired older adults with persistent pain. Speci? cally, this study evaluated whether cognitive status (intact or impaired) differentially in? uenced verbal and nonverbal expression of pain. It was hypothesized that self-reported pain would be lower in cognitively impaired elderly people than in those who were cognitively intact but that p ain behaviors, because they are more re? exive and less reliant on verbal communication, would be equivalent in both groups.The relationship between pain behaviors and self-reported pain was also evaluated in cognitively intact elderly people to validate whether behaviors measured are indicators of pain. The following research questions were asked. Does cognitive status in? uence self-reported pain? Does cognitive status in? uence observed pain behaviors? Are self-reported pain and observed pain behaviors related, and is the relationship different in cognitively intact and impaired elderly people? One hundred forty participants were enrolled and completed the baseline interview; 126 (90%) completed the protocol. Attrition analyses revealed no signi? ant differences between completers and noncompleters on demographic, residential status, health, or pain variables. The ? nal sample was predominantly female (81%), Caucasian (97%), and widowed (60%), with a mean age of 83 (range 5 65â⠂¬â€œ98). Thirty-nine percent resided in nursing homes, 39% resided in assisted living, and 22% lived independently in retirement apartments. Participants’ average Mini-Mental State Examination (MMSE) raw score was 24 (range 5 7–30, median 5 27, mode 5 29). Based on 10th percentile education-adjusted MMSE norms as the cutoff,16,17 64 (50. 8%) were cognitively intact, and 62 (49. %) were impaired. See Table 1 for a description of the total sample and of cognitively intact and impaired subsamples. Groups differed only in residential status (cognitively Table 1. Sample Characteristics, Overall (N 5 126) and According to Cognitive Status Total Sample Cognitive StatusA Intact Impaired (n 5 64) (n 5 62) PValue Characteristic METHODS The University of Florida institutional review board approved this study. Informed consent was obtained from cognitively intact participants and from impaired elderly people’s legally authorized representatives, with assent from persons wi th dementia.Design A quasi-experimental, correlational design was used to investigate pain in older adults with mild to moderate dementia, because dementia status cannot be experimentally manipulated. Cognitively intact elderly people functioned as a comparison group to examine behavioral indicators and self-reported pain in the two groups. If self-report and behaviors were related in cognitively intact persons, there would be some basis to infer that the same behaviors indicated pain in cognitively impaired elderly people. Participants One hundred ? ty-eight older adults were screened for enrollment from 17 assisted living facilities, nursing homes, and retirement communities in north central Florida. Inclusion criteria were aged 65 and older, English-speaking, able to stand up from a chair and walk in place, diagnosed osteoarthritis in the lower body, and adequate vision and hearing to complete the interview. Sex, n (%) Male 24 (19. 0) 12 (18. 8) 12 (19. 4) Female 102 (81. 0) 52 ( 81. 3) 50 (80. 6) Race, n (%) White 123 (97. 6) 63 (98. 4) 60 (96. 8) Black 1 (0. 8) 0 (0) 1 (1. 6) Other 2 (1. 6) 1 (1. 6) 1 (1. 6) Marital status, n (%) Married 37 (29. ) 21 (32. 8) 16 (25. 8) Unmarriedw 89 (70. 6) 43 (67. 2) 46 (74. 2) Education, n (%) ohigh school 11 (8. 7) 5 (7. 8) 6 (9. 7) graduate High school graduate 38 (30. 2) 17 (26. 6) 21 (33. 9) Some college or 31 (24. 6) 18 (28. 1) 13 (21. 0) equivalent College graduate or 34 (27. 0) 18 (28. 1) 16 (25. 8) more Residence Assisted living 49 (38. 9) 28 (43. 8) 21 (33. 9) Nursing home 47 (37. 3) 14 (21. 9) 33 (53. 2) Retirement apartment 30 (23. 8) 22 (34. 4) 8 (12. 9) Analgesics taken 579 ? 1,320 313 ? 699 853 ? 1,708 (in acetaminophen equivalents), mean ? SD Age, mean ? SD 82. 2 ? 7. 3 81. 9 ? 7. 83. 1 ? 7. 6 Number of medical 6. 7 ? 3. 1 6. 6 ? 2. 9 6. 9 ? 3. 4 diagnoses, mean ? SD .93 .59 .39 .84 .001z .02 § .55 . 63 A Cognitive status was computed using the following education-adjusted Mini-Mental State Examination s cores as cutoffs: o8th grade education, 20; 9 to 11 years, 24; high school graduate or equivalent, 25; some college, 27; and college degree or higher 5 27. 16,17 w Unmarried 5 never married, widowed, separated, or divorced. z Chi-square 5 15. 2, degrees of freedom 5 2, P 5. 001.  § t (124) 5 2. 22. SD 5 standard deviation. 128 HORGAS ET AL. JANUARY 2009–VOL. 57, NO. 1 JAGS mpaired elderly people were signi? cantly more likely to reside in assisted living or nursing home facilities). to use in elderly adults than the traditional visual analogue scale. 21 Procedures Participants completed a brief screening interview to con? rm study eligibility and to ascertain cognitive status. Those eligible were interviewed about their pain and completed an activity-based protocol designed to evoke pain behaviors in persons with persistent pain (described in more detail below). Activity Protocol Participants were asked to sit, stand, lie on a bed, walk in place, and transfer between activi ties.Based on previous work, the activity protocol had several strengths for use with this population. First, it simulates performance of basic activities of daily living, thereby enhancing ecological validity of the tasks. Second, it was tested in other studies, and activities were shown to induce pain in persons with osteoarthritis and chronic low back pain, thus providing a naturalistic pain induction method. Third, use of these realworld tasks avoids undue health or safety risks for elderly adults and eliminates potential bias associated with arti? cially induced (e. g. , laboratory-based) pain induction techniques. 8,19 The protocol was simpli? ed by using only 1-minute activity intervals (to reduce complexity of directions and physical demands for frail or cognitively impaired participants) and substituted walking in place for walking across the room and back (to accommodate physical space limitations in residential care facilities where data were collected). Activities were c onducted in random order to minimize order effects, and the entire 10-minute protocol was videotaped. Measures Self-Reported Pain The principal investigator (ALH) or a trained research assistant interviewed each participant in a private session about their pain experience.Pain presence, intensity, locations, and duration were assessed. Pain Presence. Questions from the Structured Pain Interview (SPI)20 were used to assess presence of self-reported pain. During the pain screening interview, participants were asked ‘‘Do you have some pain every day or almost every day (daily pain)? ’’ Pain was also assessed immediately before the start of the activity protocol (‘‘Are you having any pain right now? ’’ (pre-activity)) and immediately after it (‘‘Did you experience any pain during these activities? ’’ (postactivity)).Response choices to all three questions were yes (1) or no (0). Pain Intensity If participants responded ‘‘yes’’ to experiencing pain (daily, pre-activity, or postactivity), they were asked to rate the intensity using a numerical rating scale (NRS). The NRS was presented as a horizontal line with 0 5 no pain and 10 5 worst pain as anchors and equally spaced dashes representing pain intensity rating of numbers 1 through 9. The scale was printed in large, bold font on an 8. 5†³ A 11†³ paper to facilitate use with older adults who may have vision dif? culties. The NRS is considered valid, reliable and easierPain Duration Participants were asked to indicate how long (in months and years) they had experienced daily or almost daily pain. Responses were coded as less than 1 year, 1 to 5 years, 6 to 10 years, 11 to 15 years, or more than 15 years. Pain Locations The pain map from the McGill Pain Questionnaire22 was used to assess pain locations. Participants indicated areas on the body drawing in which they were currently experiencing pain. Total n umber of painful locations was summed. This widely used measure has been validated in several epidemiological studies and has high interrater reliability (average kappa 5 0. 2). 23 Observed Pain Behaviors Pain Behaviors A modi? ed version of the Pain Behavior Measure18 was used to measure behavioral indicators of pain. Based on standardized behavioral de? nitions, occurrence of the following speci? c pain behaviors was evaluated: rigidity, guarding, bracing, stopping the activity, rubbing, shifting, grimacing, sighing or nonverbal vocalization, and verbal complaint. Standardized de? nitions were adapted from previous work,18,19 modi? ed for use in this older, moreimpaired population, and pilot tested in a sample of nursing home residents with dementia. 4 This measure has adequate reliability and validity. 13 Pain Behavior Coding Independent raters, all registered nurses blind to participants’ cognitive status, scored the videotaped activity protocols. Coders completed extensi ve training in coding procedures until intrarater and interrater agreement (with the master coder (PI) and another rater) reached a kappa coef? cient of 0. 80 or greater, indicating good to very good reliability. 25 After coding reliability was attained, reliability checks were conducted on 10% of all videotapes to minimize rater drift.Noldus Observer software was used to analyze digitized videotapes and code pain behaviors (Noldus Information Technology, Wageningen, the Netherlands). The following summary variables were created and used in the analyses: total number of pain behaviors observed, number of times each behavior (rigidity, guarding, bracing, stopping, rubbing, shifting, grimacing, sighing or nonverbal vocalization, and verbal complaint) was observed, and total numbers of pain behaviors observed during each activity state (e. g. , number of behaviors while walking, reclining, sitting, standing, and transferring).Cognitive Status Cognitive status was assessed using the MMS E,26 an 11-item screening instrument widely used to assess general cognitive status in elderly adults. The following MMSE scores served as the cutoffs to classify participants as intact or impaired: less than 8th grade education, 20; 9 to 11 years, 24; high school graduate or equivalent, 25; some college, 27; and college degree or higher, 27. 16,17 JAGS JANUARY 2009–VOL. 57, NO. 1 PAIN ASSESSMENT IN PERSONS WITH DEMENTIA 129 Analgesic Medications Drug data for each participant were coded according to the American Hospital Formulary Service system.All pain medications were identi? ed and converted to acetaminophen equivalents. 8,27 This standardized drugs and dosages to a common metric and facilitated comparison of analgesic dosing. To ensure that only analgesics actually taken would be controlled for, equianalgesic dosages were considered in these analyses only if they were taken within the standard therapeutic dosing window for each drug (e. g. , acetaminophen, every 4â€⠀œ6 hours) before the activity protocol. Data Analysis SPSS, version 15. 0 (SPSS Corp. , Chicago, IL) was used for data analysis.Descriptive statistics, Pearson chi-square (w2) tests, and t-tests were used to describe sample characteristics and examine group differences. Analysis of covariance (ANCOVA) was used to test relationships between cognitive status, pain intensity, and pain behaviors. Logistic regression was used to predict pain presence. Multiple regression was used to predict pain intensity and number of pain behaviors, with a centered cognitive status–by–pain intensity interaction term to identify group differences; standardized regression coef? cients (b) are reported in the results.RESULTS Self-Reported Pain The majority of participants (86. 5%) reported experiencing pain every day or almost every day. More than 65% reported experiencing pain for more than 1 year ( $ 40% indicated duration of 45 years). On average, participants reported pain in four body locations (range 5 1–25); usual pain intensity was 4. 3 (moderate) on a scale from 0 to 10. Immediately before the activity protocol, 45 (35. 7%) participants reported experiencing pain. Mean pain intensity was rated as 1. 7 (range 5 0–9). After the protocol, 79 (62. 7%) reported experiencing pain during the activities; mean pain intensity was 3. (range 5 0–9). Relationship Between Cognitive Status and Self-Reported Pain Chi-square analyses were conducted to examine the relationship between cognitive status (impaired vs intact) and presence of self-rated daily pain and pain duration at baseline. The baseline pain interview was not always conducted on the same day as the activity protocol, and analgesic use before the interview was not assessed. Thus, initial analyses are descriptive only and do not control for analgesic use. At baseline, 77. 4% of impaired and 95. 3% of intact participants reported experiencing pain every day (w2(1) 5 8. 6, P 5. 003).Cognitively impaired elderly people also recalled shorter pain duration (w2(3) 5 16. 0, P 5. 001) than intact participants, but no signi? cant differences were reported in the number of pain locations. Logistic regression, controlling for acetaminophen equivalents, indicated that cognitive status was not signi? cantly predictive of pre-activity pain presence. Regression analyses, with pre-activity pain intensity as the dependent variable and cognitive status and analgesics as predictors, revealed no signi? cant difference between the two groups (Figure 1). Intact Impaired 16 14 12 Mean values 10 8 6 4 2 0 In te a * t ns y SR 😛 a re- cti v in Pa ng cing ing rbal aint sity pi b l n e ra uar ig Sh op rima Rub onv mp Inte B G R St G N al co ain P rb Ve activ tos 😛 SR b Pain indicators cin g n di g i id ty in ift g a tt Si g g g g g in din kin yin rrin l e n L sf a Wa St an Tr c Activity states Figure 1. Relationship between self-report and observed pain behaviors in cognitively int act and cognitively impaired elderly people (N 5 126). aMean self-reported (SR) pain intensity, controlling for acetaminophen equivalents taken. bMean number of behaviors observed for each pain indicator, controlling for acetaminophen equivalents taken. Mean number of behaviors observed during each activity state, controlling for acetaminophen equivalents taken. 130 HORGAS ET AL. JANUARY 2009–VOL. 57, NO. 1 JAGS At the end of the activity protocol, cognitive status was signi? cantly associated with the reported presence of pain, controlling for analgesics (b 5 1. 2, P 5. 002); cognitively impaired elderly people were less likely to report pain. Impaired participants also reported signi? cantly lessintense pain than intact participants after the activity protocol (3. 8 vs 2. 6; F (1) 5 A 5. 0, P 5. 03).Paired t-tests indicated that pain intensity increased signi? cantly from start to end of the protocol for both groups (Figure 1). Table 2. Relationship Between Self-Reported Pa in Intensity and Observed Pain Behaviors (N 5 126) Total Number of Behaviors Observed Model bA P-Value 1 Pre-activity pain intensity Analgesics taken Pain intensity A cognitive status R2 F 2 Postactivity pain intensity Analgesics taken Pain intensity A cognitive status R2 F Standardized regression coef? cient. R2 5 coef? cient of determination. A Relationship Between Cognitive Status and Observed Pain Behaviors On average, 21. pain behaviors per person (range 5 3–50, median 5 21, mode 5 16) were observed during the activity protocol. ANCOVA models, controlling for analgesics, revealed no signi? cant differences in mean number of pain behaviors observed between cognitively intact and impaired participants (covariate-adjusted means 5 21. 8 and 21. 3, respectively; F (1) 5 0. 08, P 5. 77). The number of occurrences of each of the eight behavioral indicators observed was summed. ANCOVA models, controlling for analgesics and using Bonferroni correction for multiple comparisons (P 5. 005), revealed no signi? ant differences between cognitively intact and impaired elderly people for any behavioral pain indicators investigated (Figure 1). Of the activity states observed during the protocol, transferring elicited the most frequent pain behaviors (mean 5 13. 4; range 5 2–43). No signi? cant differences were noted between cognitively intact and impaired participants in number of behaviors observed during any of the ? ve observed activity states. Relationship Between Self-Reported Pain and Observed Pain Behaviors Regression analyses were conducted to examine the relationship between elf-reported pain intensity and total number of pain behaviors observed, controlling for analgesics. Before the activity protocol, pain intensity was signi? cantly predictive of the pain behaviors sum score (b 5 0. 27, P 5. 002), but the relationship did not differ between cognitively intact and impaired participants. After the activity protocol, self-reported pain intensity was signi? cantly (and more strongly) related to number of pain behaviors observed (b 5 0. 40, P 5. 000), and the painby-cognitive status interaction was signi? cant (b 5 0. 22, P 5. 008). Thus, postactivity pain intensity and summed behavioral indicators were signi? antly related in intact but not impaired participants (Table 2). DISCUSSION It was found that cognitive impairment diminishes selfreported pain assessed at rest but only when analgesics are not controlled. At baseline, cognitively impaired elderly people were signi? cantly less likely than cognitively intact elderly people to report pain, consistent with reports in the literature,7 but when analgesics were controlled for, these differences disappeared. This ? nding highlights the need to control for analgesics taken when making group comparisons, which to the best of the authors’ knowledge, has not been previously done.The few studies reporting medication use include drugs prescribed or number of doses taken 0. 27 0. 01 0. 09 0. 08 2. 9 0. 40 A 0. 03 . 22 . 18 6. 70 .003 . 99 . 30 . 02 . 00 . 75 . 01 . 000 (regardless of medication class), whereas the current study identi? ed analgesics in the subject’s body during the pain assessment protocol. After the activity-based protocol was completed, selfreported pain intensity increased for both groups, but cognitively impaired elderly people reported less-intense pain than their intact peers. This ? ding supports the usefulness of the protocol to exacerbate pain in those with painful conditions and highlights the importance of mobility-based pain assessments. 12,14 This ? nding held even when the amount of analgesics taken by participants was controlled for in the statistical analysis. Behavioral indicators of pain observed during activities were equivalent across both groups. This ? nding contradicts previous work15 and may re? ect that medication use was controlled for and that the focus of the current study was on persistent pain, as oppose d to more-acute, postoperative pain. This research con? ms that reliance on selfreport alone is insuf? cient to assess pain in older adults with dementia, because the pain experience may be underestimated,11 and supports growing recognition that behavioral observation is a necessary and useful pain measure, particularly in subjects with cognitive impairment. Cognitively impaired elderly people took signi? cantly more pain medication than their intact peers. The difference was approximately 500 acetaminophen equivalents, approximately the dose of one extra-strength acetaminophen tablet. This ? nding, which contradicts previous work,8,9 warrants further investigation.Post hoc analyses indicated that this difference was not attributable to residential status, number of medical conditions, or demographic characteristics. Thus, it may re? ect recent changes in prescriptive practice as a result of heightened focus on pain in older adults with dementia. Another important ? nding is the sig ni? cant relationship between self-reported pain intensity and observed pain behaviors in cognitively intact persons. This ? nding provided support for the validity of behavioral pain JAGS JANUARY 2009–VOL. 57, NO. 1 PAIN ASSESSMENT IN PERSONS WITH DEMENTIA 31 indicators against the criterion standard of self-report, as least in cognitively intact elderly people, and is consistent with other researchers’ ? ndings. 28 Because there is no evidence that cognitively impaired elderly people experience less pain, it is reasonable to infer that pain behaviors are a valid indicator of pain in persons with dementia, although this assumption cannot be directly tested unless biological tests are developed. 12,24 Pain is subjective, and pain behaviors can be dif? cult to interpret, be subject to bias, and lack speci? city. 14,29 It has been uggested that some behaviors may indicate anxiety or generalized distress, not pain, in those with advanced dementia. 29,30 Thus, pain behavio r measurements should be used in conjunction with selfreport, not as a replacement, and in the context of a comprehensive pain assessment. 14,30 Study strengths are that cognitively intact and impaired elderly people participated, thereby facilitating comparison of assessment strategies in persons of differing cognitive abilities, that a careful analysis of analgesics used during the pain assessment was conducted, and that persistent pain was focused on.Most related prior research has included only persons with advanced dementia and postoperative pain. The sample was limited, however, by being primarily Caucasian and by being restricted to individuals with mild to moderate dementia. This was likely because of inclusion criteria requiring that participants be able to rise, stand, and walk. Individuals with severe dementia are typically more immobilized and unable to follow directions, factors that would impair ability to complete the activity-based protocol in this study. Thus, gener alizations are limited, and further study is needed.This study contributes several important ? ndings to the discourse on pain assessment in persons with dementia. First, it was con? rmed that self-reported pain, although still attainable, may be less reliable in those with mild to moderate dementia than in cognitively intact elderly people, depending on when it is assessed. Second, assessment of pain during movement is supported. Cognitively intact and impaired elderly people both showed greater self-reported pain intensity after movement, indicating that static assessment may underestimate pain.Third, results support the validity of behavioral pain assessment against the criterion standard of self-report and provide evidence of an association between summed pain behaviors and self-reported pain intensity. More work is needed to establish scale properties of pain behaviors in relation to pain severity before this approach can be translated to clinical practice. Fourth, ? ndings hig hlight the importance of carefully evaluating analgesics taken when measuring pain, since results indicate that cognitively intact and impaired elderly people with persistent pain are often medicated differently.This ? nding may re? ect a change in prescriptive practice that warrants further investigation. (Dr. Horgas) and a John A. 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