Adult PTSD Essay Example For Students

Grown-up PTSD Essay Word Count: 825 NU832.90 Feb 8, 2000 PTSD/ADULTS The study of disease transmission At any rate half all things considered and kids are presented to a mentally awful mishap, (for example, a dangerous attack or mishap, humanmade or cataclysmic event, or war). The same number of as 67% of injury survivors experience enduring psychosocial impedance, including post-horrible pressure issue (PTSD); alarm, phobic, or summed up tension issue; sorrow; or substance abuse.(Van der Kolk, et al, 1994) Symptoms of PTSD incorporate determined automatic re-encountering of horrendous pain, enthusiastic desensitizing and separation from others, and hyperarousal (touchiness, sleep deprivation, frightfulness, apprehensive fomentation). PTSD is connected to basic neurochemical changes in the focal sensory system which may have a direct natural impact on wellbeing, for example, defenselessness to hypertension and atherosclerotic coronary illness; variations from the norm in thyroid and other hormone capacities; expanded helplessness to diseases and immunologic issue; and issues with torm ent recognition, torment resistance, and incessant agony. (Fesler, 1991) PTSD is related with noteworthy conduct wellbeing dangers, including smoking, helpless sustenance, strife or brutality in personal connections, and outrage or antagonistic vibe. Veteran PTSD Etiology American Veterans experienced war-related injury in Vietnam.(Friedman, 1998) The war injuries included being on visit or drawn out battle missions in hostile area, experiencing ambushes and firefights, being assaulted by sappers, expert riflemen, mounted guns or rockets. They saw demise and horrendous damage to their own and others bodies while being enduring an onslaught on helicopters, payload and observation airplane, and watch pontoons. They regularly were alloted exceptionally dangerous obligation, for example, strolling point, radio administrator, doctor, scout, burrow rodent, guard or entryway heavy armament specialist. Different peoplespouses, youngsters, relatives, companions, or coworkersoften are more mindful of the veterans passionate trouble than he is himself. (Scurfeild, 1993) Numerous veterans can't desert the injury of Vietnam and mentally get back. They battle with an assortment of very extreme issues that neither they nor their families, companions, or networks realized how to comprehend or then again adapt to. A significant number of the accompanying indications are found in grown-up victims of PTSD whether veterans of war or different types of PTSD survivors. v Fears, (for example, of shut spaces, swarms, new places, or unexpected assault) v Anxiety, (for example, fretfulness, over the top concerns, urgent ceremonies) v Panic, (for example, a fear of losing control, choking, or going insane) v Depression, (for example, misery, loss everything being equal, or self-destructive driving forces) v Rage, as either serious fierce feelings and rough activities v Irritability, (for example, feeling continually irritated, nervous, and basic) v Shame, (for example, feeling humiliated, uncovered, disregarded, or like a nonconformist) v Guilt, (for example, feeling others ought to have lived and he ought to have passed on, or feeling that he fizzled or committed errors that had horrendous results) v Isolation, (for example, being truly present however genuinely missing, or going off alone for significant stretches of time, or declining to discuss family matters) v Emotional vacancy, (for example, gazing vacantly at nothing in particular vacantly or declining to show any sentiments when every other person is enthusiastic) v Alienation, (for example, feeling that nobody comprehends or that everybody makes as well much object about irrelevant things and too minimal about enormous issues) v Over controlling, (for example, being incredibly requesting or expecting to settle on all choices regardless of whether theyre truly somebody elses obligation) v Unable to unwind, (for example, continually being in a hurry, always unable to have a fabulous time, or making everything into genuine work or an emergency) v Addiction, (for example, urgent abuse of liquor, medications, or betting) The indications of PTSD include: v Unwanted troubling recollections or a sentiment of remembering (flashbacks) horrible encounters v Nightmares and trouble falling or staying unconscious peacefully v Bodily pressure and strain, particularly when helped to remember horrible encounters v Loss of enthusiasm for exercises and trouble in focusing on exercises or tasks v Detachment or withdrawal from enthusiastic inclusion seeing someone v Difficulty feeling or communicating feelings other than fractiousness or disappointment v Feeling like there is no future or their lives will be stopped by an inopportune demise v Feeling jittery, nervous, and handily frightened v Feeling continually perilous and unfit to let down their watchman (hyper-cautious) .u5b54ed3f3220fa65fdc65f39dee4b068 , .u5b54ed3f3220fa65fdc65f39dee4b068 .postImageUrl , .u5b54ed3f3220fa65fdc65f39dee4b068 .focused content region { min-stature: 80px; 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position: relative; vertical-adjust: center; width: 100%; } .u5b54ed3f3220fa65fdc65f39dee4b068:after { content: ; show: square; clear: both; } READ: Television Is A Pervasive And Complex Part Of Childrens Lives, There EssayThis is a short review of emotions, indications and etiology. As you probably are aware numerous , numerous encounters can cause PTSD in the grown-up. I have attempted to go over what is comprehensively experienced by PTSD casualties as opposed to focusing on the bunch of causes. Class: Psychology .

Malachi Stacks in the Matchmaker Essay Example for Free

Malachi Stacks in the Matchmaker Essay In the realm of business there are consistently those people who are not perceived for the commitments they make to specific items, activities, or works despite the fact that without them the outcome could never exist. Regardless, these individuals go on with their day by day lives buckling down, realizing that all their commitment is going to profit others and not them. However, they can’t censure the enormous organizations for not being perceived, in light of the fact that these people do this readily. They are completely mindful that their activities fill a need to the more prominent as opposed to an individual one, and for them that is sufficient. Such individuals needn't bother with the acknowledgment of others since they themselves know the significance of their activities. One case of such an individual is depicted in Thornton Wilder’s The Matchmaker. His name is Malachi Stacks, and however he just appears in front of an audience a few times, he is the person who gives the whole creation meaning. Malachi is the individual who sets into movement a progression of occasions that totally change the characters, yet in addition their lives. With this character, Thornton Wilder takes what used to be only a standard joke satire and gives it meaning which has a significant effect, Malachi Stacks has a significant effect. Thornton deliberately created the job of Stacks so that made him particular from the remainder of the characters. Indeed, even with being in his fifties, bitterness and wretchedness are totally missing from his life. Each line verbally expressed by him has an euphoric inclination to, and nearly puts a grin on the reader’s face. Indeed, even now and again when he is being put somewhere near Mr. Vandergelder, euphoria is felt in his words. More out of control causes Malachi to appear to be somewhat youthful, who has not yet been presented to the real world, and still thinks the world is great. In any case, this is only a picture that Malachi builds up for his own motivations. He causes individuals to accept he can be trusted by claiming to be deferential and following requests. Malachi makes a connection among himself and the others, particularly Mr. Vandergelder, which causes him to appear to be artless and simple to control when in actuality it is he who controls them. This kind of move is depicted very well in his first scene with Mr. Vandergelder, in which he says â€Å"You’ll never think twice about it, Mr. Vandergelder. You’ll never lament it.† It is such a basic line, but there is such a great amount there. Malachi causes it to appear as though he is simply one more man who is upbeat about finding a new line of work, when in all actuality he is covering his actual goals behind these guiltless words. The genuine explanation Malachi is glad to have landed the position, is on the grounds that he currently can fix the imbalance which exists among Vandergelder and the others. Believe it or not, Malachi is really the main person who see this blemish among the characters, and he realizes it ought not be there. Along these lines, by detailing this kind of blameless character, Malachi Stacks gives himself the ideal chance to at long last carry balance into the lives of the characters. Everything occurs in Act III when Mr. Vandelgelder is having his jacket taken off as his tote loaded up with cash tumbles to the ground. Malachi, realizing that the essential purpose behind such imbalance among the characters is their money related circumstances, takes his risk to adjust the scale. Be that as it may, he doesn't overemphasize it. Malachi essentially takes the tote, inquires as to whether it’s his, and since the reaction is no he offers it to Cornelius. It’s speedy, inconspicuous, and appears the best activity. However, despite the fact that what he did was so basic, it was sufficient to bring correspondence into their lives and he realized that. By asking Vandergelder whether the tote was his, Malachi tried him to check in the event that he merits the cash. For in his short little monolog that he has directly in the wake of getting the handbag, Mr. Stacks says â€Å"The law is there to ensure property, yet sure the law doesn’t care whether a land owner merits his property or not, and the law must be corrected†. Hence when he asked Vandelgelder â€Å"Did you drop something† the genuine inquiry was â€Å"Are you deserving of this cash you have†. Vandelgelder reacting immediately said no, and that was sufficient for Malachi to realize that the cash had the right to be in the possession of another person, Cornelius. It is likewise now that imbalance starts to gradually vanish between the characters. To start with, Cornelius and Barnaby can pay for their costly supper and genuinely intrigue Mrs. Malloy alongside Minnie. At that point Mrs. Levi at long last tells Mr. Vandergelder what she considers him when he can't take care of the tab, and that is the point at which he at long last acknowledges what sort of man he is. Gradually through scenes like these, the harmony between the characters starts to try and out and by the end, everybody is upbeat, blissful, and above all else the disparity among them totally disappears all gratitude to Malachi Stacks. Despite the fact that Thornton picked Malachi to be the device for harmony among the characters by having him â€Å"redistribute the superfluities†, the part likewise is significant with regards to the lesson of the story. Obviously, in the wake of perusing The Matchmaker it safe to express that there are different exercises to be gained from this play, yet one of the fundamental ones appears in Malachi’s monolog. Directly in the wake of examining the whole matter of redistributing property, Thornton has the character talk about how one man ought not have more than one bad habit. Indeed, he closes his line with the words â€Å"One bad habit at a time†. Presently this whole idea may appear to be unique, in light of the fact that after all even in today’s world indecencies are looked downward on. In any case, Thornton shows what two indecencies can never really man by having Malachi use Vandergelder’s wrongs against him. His first evident feebleness is that in quite a while own reality Mr. Vandergelder sees himself a lord, where nobody can stop him since he has such a lot of cash. The second is his obsession for cash. Truth be told, his first bad habit originates from this one, in light of the fact that to him an individual who has more cash has greater power. So rather than just having Vandergelder wreck himself through his indecencies, Thornton utilizes Malachi to show how having more than one bad habit is formula for demolition. To start with, he utilizes Vandergelder’s disposition towards himself to pick up his trust, by claiming to be faithful to him. Next, once Vandergelder thinks he has him under his influence, Malachi utilizes the second delicacy against him taking what is generally valuable, his cash, and parting with it. By utilizing both of these imperfections in his master’s character, Mr. Stacks brings Vandergelder into a condition of despondency where he has lost everythin g that made him, a King as far as he could tell. One man. Three Scenes. However without him, The Matchmaker could never be the equivalent. Thornton Wilder settled on a keen choice in imgaging such a character, since he is created so that his significance to the entire play isn't understood until the end. For with only a basic activity of giving off a handbag to Cornelius, Malachi made a far reaching influence which changed the course of the whole creation and had a significant effect. Malachi Stacks had a significant effect.

Is your Bible Holy or full of Holes Essay Example For Students

Is your Bible Holy or loaded with Holes Essay IS YOUR BIBLE HOLY OR JUST FULL OF HOLES?Answer the accompanying inquiries utilizing a NIV BibleMatthew 6:13How does the masters supplication end?Matthew 8:29Who was the evil spirits terrified of who might torment them?Matthew 17:21What two things did Jesus say are expected to thrown out a demon?Matthew 18:11Why did Jesus come to earth?Mark 7:16What is expected to hear?Mark 15:28Who was Jesus numbered with?Luke 22:14How numerous Apostles were with Jesus at the Last Supper? Luke 23:38The give up the cross, THIS IS THE KING OF THE JEWS was written in what languages?John 5:4Who disturbed the water?John 7:50What time of day did Nicodemus come to Jesus ?Acts 8:37What should an individual do before they are sanctified through water ?Acts 9:6When Paul got spared what inquiry did he pose to Jesus? Romans 16:24What did Paul petition God for every one of us to have? (It is his mark shutting in every one of his books.)1 Timothy 3:16Who was made show in the flesh?1 John 5:7According to this refr ain, who are the three people of the Trinity?Revelation 1:11What does Jesus consider himself that suggests that he is GOD?Now do a similar utilizing the KJV variant. God has not just uncovered His assertion (Heb. 1:1,2 ) and enlivened His word(II Tim. 3:16,17), however He additionally vowed to save and keep His Word unadulterated and flawless down through every age until the cows come home. This is known as the Doctrine of Divine Bible Preservation. (Romans 4:20,21; Titus 1:2; Hebrews 10:23)1. Hymns 12:6,76. Songs 119:1522. Songs 78:1-87. Hymns 119:1603. Hymns 105:88. Adages 22:20,215. Hymns 119:11110. Matthew 5:17,1812. Luke 22:44 (Jesus put his blessing on the Old Testament)13. Matthew 24:35 (Jesus puts his blessing on the New Testament)a. Safeguarding of the GospelsJohn 14:26b. Conservation of the Acts..John 15:26,27c. Protection of the Epistles(letters of the Apostles).John 16:12-13d. Protection of Revelation..John 16:13b*******************************************Why do they consider it the Received Text or Majority Text ? Since out of the 5,255 complete original copies of the Greek New Testament, 5,210 or (99%) of them concur. Just two genui nely complete original copies from the second century and 43 halfway parts of sacred text can't help contradicting the Received Text. Gotten TextWestcott Hort of the N.T. Has 140,521 Greek words in the N.T.Changes 5,604 Passages. Has 217 Greek words for each page. An aggregate of 9,970 words have been Has 647 pages of text.left out, included or changed ( Thats 7After 2,000 years it still hasof the N.T.- equivalent to the size of the book of674 unaltered pagesRomans). Had 26 new versions in 81 years100% of the Greek words (allthats one new release each 3.1 years!140,521) have been safeguarded by GOD!WHICH DO YOU CARRY, A SWORD OR A BUTTERKNIFE?Bibliography:

Disseminating Evidence free essay sample

The term scattering implies a lot of composed activities intended to advance and engage fuse and utilization of approved procedures (Maibach et al. , 2006). Spread is the way toward making the results and expectations of a task accessible to the partners and to the more extensive crowd (EAHC, n. d. ). The spread of the outcomes is significant in keeping up the training and the result for fitting DC rehearses in NICU. The aftereffects of the venture result will be scattered to the key partners. The motivation behind dispersing the consequences of venture to key partners is to educate venture improvement, to get input and to guarantee that the training and the result will be kept up after the usage of the task. The partners for this undertaking are, the CEO of the clinic, Director of Nursing for Maternal and Child Health, Director of Pediatrics, Nurse Educators, NICU Nurse Manager, NICU staff, Director of research division, Director of non-intrusive treatment and EBP board of trustees. We will compose a custom article test on Dispersing Evidence or on the other hand any comparative theme explicitly for you Don't WasteYour Time Recruit WRITER Just 13.90/page The undertaking and its outcomes will be introduced through news announcements, messages just as workforce gatherings. Organizing gatherings or workshops, on the venture can guarantee that the task has a prominent, that the members gain from its accomplishments, and that the yields are installed and taken up (EAHC, n. d. ). Meetings or workshops likewise offer the bit of leeway that correspondence can go in the two bearings: individuals from the NICU people group can be welcome to contribute thoughts and conceptualize about approaches to utilize the venture results (EAHC, n. d. ). Welcoming different NIUs in the network to take an interest in the orchestrated meeting will permit spreading hugeness of task results to more noteworthy nursing network. End Dissemination is fundamental for inspire, and elevate is basic for the triumph of the task and for the tirelessness of the result for an all-encompassing period (EAHC, n. d. ). The reports can be conveyed to the partners and to a more extensive network by various strategies.

My Three Weeks in the Dominican Republic Essay Example For Students

My Three Weeks in the Dominican Republic Essay Starting today at about 2:44 p.m, I will land at one of the most excellent islands on the planet, Punta Cana, Dominican Republic. Ideally this outing will be a decent escape for me to unwind and make sense of what I truly need to achieve in my life, this â€Å"I need to get great grades† has gotten me somewhat out of track and somewhat befuddled too yet ideally this excursion is sufficient. I need jump on the plane to Punta Cana at 7:40 a.m. The ticket to get there and back cost me $442.20 not terrible really, bringing my aggregate of $5000 down to $4,557.8. The excursion has one stop in the Philadelphia air terminal where I should hold up an hour and 45 minutes, at that point take the following trip to Punta Cana at 9:50 a.m. I get to the Punta Cana air terminal at 2:44 p.m but since of security purposes and certain strategies a traveler needs to tail I will leave the air terminal at around 3 or something like that, where a cab driver is standing by to take me to the Four Poi nt lodging in the Punta Cana resort town. Upon appearance I pay the man in $50 US dollars and book a space for 5 evenings costing me $107 per night for an aggregate of $535 cutting down my aggregate to $4,022.8. Insane how cash goes huh? I have spent over a thousand dollars in a single day, the main day. I really have a quite decent impact on my decision of lodging however. I choose to stroll up the steps as opposed to taking the lift to make sure I can get acquainted with the inn thus far so great, I am not lamenting anything. Everything is by all accounts great and clean. Simply the manner in which I like it. Day 2 Day 2, today is the official day. Ideally today I will wander some cool undertakings. It is 8:30 in the first part of the day, not all that terrible of a morning, it’s beautiful chill outside. I head down to the retreats buffet for breakfast, fortunately for me I dont need to stress over paying for a plate of food since all suppers come packaged with the room. The steaks were quite acceptable really, I mean it is a Spanish nation right? Truly from peruser to essayist, one of the fundamental reasons why I came here, was a direct result of the food and due to that reality that I realized I can got get the very required tan. It is actually 12:00 p.m exactly when the sun is hitting the center sky. Ideal time for tanning. I return to my room and get my towel and some tanning oil. Around 4 hours have passed by and gosh I would already be able to see a distinction, well ideally the lines an under my biking mean something to be thankful for. It is about 4:30 and I simply recollect tha t I need to visit the vehicle endeavor so I can lease vehicle appears paying a taxi ordinary will presumably lead me to my only remaining dollar note. Day 3 I am really considering going to visit my family, pause, guess what? that is a piece of my arrangement now. It is day 3, 6 in the first part of the day to be careful. I sort of need to go to the exercise center yet sick rather go for breakfast and give my family a shock. Goodness man I cannot recollect when was the last time I saw them, ideally they recall my face, I will in general hear a ton that Ive changed over the previous years. Ideally I look better at this point. It is around 15 of 12 I head to the opposite side of Punta Cana where the greater part of my family is at. Cant lie, I am really energized yet anxious at the equivalent. I am as of now envisioning what their responses will be on the off chance that they really recollect me. Day 4 You dont see how astonishing this spot is, there may really be a chance of settling an actual existence here, after school obviously, however consider the possibility that I go to a school here in Punta Cana. I unquestionably would wouldn't fret. All things considered, it is day 4, 7:30 in the first part of the day, and todays plans are, to make arrangements, since I dont have any yet. I am considering visiting many spots. I have no clue what places I need to visit yet i’ll discover, ideally with the assistance of the web and a few local people that I will abnormally be moving toward today. In any case, first thing is first and that is my stomach. I am right now at one of the neighborhood â€Å"Cafe† café in the retreat. The espresso certainly tastes extraordinary however it sure tastes magnificent. I head down to the â€Å"mini library†, I mean my room is greater than this â€Å"library†. The examination is going acceptable up until now, a great deal of stunning various destinations and lands and verifiable places and stops and sea shores and lakes. God I love this spot. Day 5 Day 5, a day ago at the hotel. Huge amounts of pressing to do, well not so much. In the event that the pressing goes well ideally by 12:00 pm Ill be free. I caught wind of samba classes that is held by a calling moving group that the retreat has an organization with to make sure they can have an assortment of exercises for us to do and well, you know, I am unquestionably in there! It is 12:30 sharp, 30 minutes past my unique arrangement however it’s alright. I head down to the move studio about a street or two away from my room. I am unquestionably prepared for this. One thing I think about Dominican Republic. They love moving. I wish I wouldve got some answers concerning this classes prior however, not the most recent day ugh. Day 6 Day 6, I am presently on my route West of Punta Cana, to the city of La Romana. From that point I trade a portion of my USD to the nations cash, pesos. I took $1000 USD and changed over it to pesos, each USD is around 43 pesos so I was left with around 43,000 Dominican Pesos. Since I was at that point in the city I chose to check in the Hotel Frano that was around the territory since time was slipping away. I pay 2161 for the evening, not terrible, I mean it is not, at this point a 4 point inn any longer yet I mean, it doesnt matter on the grounds that starting tomorrow I will visit huge amounts of spots, ideally. Imposing business model or is it simply fake EssayDay 14 I get together the provisions and bring an individual taxi down to the air terminal of Puerto Plata to get the vehicle I held. The taxi ride was extremely long and took most of the day. At the point when we at last showed up I gave the cab driver $150 USD leaving me with $1,509.8 USD left. I lease the vehicle for six days costing me an aggregate of $476 USD charge included. This leaves my aggregate to $1,033.8 USD. Im running exceptionally low on cash so I choose to remain in a modest lodging called Celuisma Cabarete for three evenings which costs $34 every night. This leaves me with $931.8. It is late around evening time so I leave the vehicle and head to my space to rest. Day 15 I was at that point in the Puerto Plata zone so I chose to look at a swimming spot called the 27 Waterfalls of Damajagua which is a free tidal pond type thing where anybody can go swim by the cascade or bounce from it on the off chance that they need. The spot is completely occupied by local people who go every day for a free daily schedule of hopping from cascade, the lake, and back. I eat what the neighborhood shippers sell me, squandering around 200 pesos in addition to the food I despite everything have from the night on the sea shore. By the day's end I drive back up to the lodging, Day 16 Today I left the vehicle in the inn and was gotten promptly in the first part of the day for a Dominican Outback Safari visit which cost me $80. The truck took us along earth streets to the lesser occupied regions of Puerto Plata. The visit was exceptionally instructive and fun. It endured around 7 hours roughly and I got the opportunity to get familiar with the nations history and its rich culture. After the visit the visit truck made a stop to a neighborhood café where the feast cost me a sum of $80 (short the $80 for the visit today I burned through $160 USD). I calculated the costs are so high since this is an enormous vacation spot in the city. Today I was left with $771.8 USD. I currently need to figure out how to extend that sum for the following five days. Day 17 Today I went through the day around the lodging seeing what it brought to the table. After breakfast I went down to the pool region and chose to evaluate yoga with one of the individual teachers. Later today I loaded up on provisions and went to an individual climbing trip in Pico Isabel de Torres. The path was 5 miles in length and required moderate exertion to finish. It didnt cost me anything since it was a characteristic path for anybody to utilize. By the day's end I book the inn for one more night ($737.8 USD left) and plan for rest. Day 18 From Puerto Plata I drive down to the City of Santiago, seemingly one of the more modernized urban areas of the nation. Its an hour outing and I spend about $30 on gas ($707.8 USD left). After arriving at the city I rapidly look into the Hodelpa Hotel which costs $100 USD a night and I book two evenings. After the free lunch I go to a baseball field and play some baseball with an amicable gathering of young ladies. I go through the entire night playing and subsequent to losing I head to the shopping center to do some young lady shopping. Today has been an extremely long however pleasant day, I head back to my lodging to rest. Day 19 Today there is an uncommon occasion occurring in the city called Las Patronales which is a festival of the nations freedom and culture that traversed various pieces of the nation lasting through the year. I spend the whole day in the inn and leave around evening time for the occasion. Ordinarily there is an extraordinary visitor star appearance in the celebration and in the Patronales in Santiago it happens to be Romeo Santos. Everybody is making some acceptable memories drinking, moving, going on the rides, and singing that I forget about the time and head back to the inn at first light. Day 20 Today I settled up with the lodging and gradually passed through urban areas, wide open spaces, and army installations advancing back to the Punta Cana zone. Dominican Republic all in all is assorted in its landscape. I inquire in the Hotel I previously showed up to. I pay the standard $107 ($400.8 left) and I turn the vehicle back in around the air terminal. Showing up back to the lodging, around evening time I go to the pool region and bar where I drink some piã ±a colada before heading once more into my room. It has unquestionably been a mind-blowing excursion yet I am insane for a bed at this moment. Day 21 The complimentary lodging transport returns me to the air terminal gratis. I jump on my 1:33 p.m flight and sick be arriving in Philadelphia air terminal once more, i’ll then hold up 2 hours and 33 minutes. Ideally by 8:31 i’ll be arriving in Boston. Since I have cash to save

Can a Payday Loan Company Take You to Court

Can a Payday Loan Company Take You to Court Can a Payday Loan Company Take You to Court? Can a Payday Loan Company Take You to Court?You know a payday loan can hurt your credit. But can failing to pay one back actually put you in front of a judge?Court shows can be fun to watch on television. Whether it’s Law and Order or Judge Judy or classic Lionel Hutz episodes of  The  Simpsons,  we all apparently like watching people in court.But no one actually wants to be in a courtroom in real life. Heck, even most  lawyers prefer settling cases out of court. Thats why its important to know when something poses the risk of landing you in front a judgeâ€"one who may or may not be looking to throw a book and/or book-like object in your general direction.And when it comes to taking out a predatory payday loan, you could certainly end up in court if you have troubling paying it back. Its not common, but it does happen.Whats a payday loan, again?Before we get into whether a payday loan company can take you to court, let’s make sure we all know what a payday loan is.It’s not nece ssarily a scientific term, but generally, payday loans are a type of bad credit loan with very short payment terms and very high annual percentage rates (APRs). They are aimed at people who have poor credit, and the lender doesnt check a persons credit during the lending process. Payday loans are available as both storefront loans and online loans, and they are sometimes also called no credit check loans or cash advance loans.APR is a measurement that captures the total cost of a loan over one year, with all fees and interest included, allowing you to make an apples-to-apples comparison between different loans. So the lower the APR on a loan, the better. And the APRs on payday loans are nearly as high as they can go, with rates between 300 and 400 percentâ€"and sometimes much higher.And while having a shorter payment term for a loan with a high interest rate might seem like a great idea, it often backfires. Unlike, a traditional installment loan, which is paid off a little bit at a time, the short payment terms for payday loans mean that they have to be paid off all at once, often just two weeks after the loan was issued. As it turns out, many people have trouble paying back their payday loan on time. So instead, they have to reborrow the loan or pay an extra fee to roll it over and extend the due date.So why does anyone get a payday loan? Usually, its because they have some sort of financial emergency and a poor credit score so they can’t get a traditional personal loan. Still, it’s a risky proposition, because if you can’t pay back that loan in time, you may end up rolling it over and over again, landing you in a dangerous cycle of debt. To learn more about the dangers of payday lending, check out these five alarming payday loan statistics.Payday loan companies do take people to court, but they dont do it very often.Now, depending on how that cycle of debt unfoldsâ€"and whether or not you stop making paymentsâ€"you might end up in court with the payday loan company seeking a judgment against you. However, we spoke to the experts and they seemed to share a consensus:While you might end up in court for not paying off your payday loan, if that’s all you’ve done, you’re unlikely to find yourself in front of a judge.“I am a Florida consumer protection attorney who has 29 years experience,” consumer rights expert Donald E. Peterson explained. “I have probably consulted with a couple thousand people about their debts including potential bankruptcy clients who were defendants in collection lawsuits and consumers who were seeking a lawyer to represent them because they were being sued by a creditor or debt collector. NONE of them were ever sued by a payday lender. Not one.”But Peterson went beyond just his own personal experience: “Around 2006, I searched clerks online dockets to determine whether a large brick mortar payday lender ever sued anyone. I searched the records for several counties in central Florida and found approximately five lawsuits during a period of five to seven years. It made me wonder what was unique about those five borrowers that motivated the payday lender to file suit. I have read that there are payday lenders in Ohio who actually sue sometimes. I am not observing this in Florida nor have I ever heard that its a national problem.”If a payday lender takes you to court, theyre hoping you wont show up.Damon Duncan, an attorney with Duncan Law, gave us a similar sense of the risks while also explaining how the litigation process might play out:“Absolutely you can end up in court for failure to pay a payday loan. Im a board certified consumer bankruptcy attorney and will periodically see folks being sued for failure to pay these payday loans. It is, however, uncommon.“After late payment(s) the payday loan company would likely sue the debtor in an area where the debtor has real property and, if they dont have real property, a location convenient for the creditor. Most debtor s will fail to respond to a lawsuit so a default judgment would be entered against them.Once the creditor has a judgment they can attach liens to property like houses, cars, bank accounts, etc. Liens in North Carolina (where I live) last for 10 years and can then be renewed for an additional 10 year period. Other states are very similar.”Its safe to assume a payday loan company will sueâ€"sometimes for much more than you owe.If you have stopped making payments on your payday loan and are hoping the problem will just go away, then guess again.“You should study your loan agreement to see the terms on defaulting and late/missed payments,” advised Shaolaine Loving, a Las Vegas attorney. “Generally speaking, the lender can start assessing late fees and other penalties. Depending on how late you are, they or a collection company will probably start calling to collect on the debt. They can report delinquencies on your credit. Eventually, they can sue you. Even if it’s a small amo unt, dont presume the company wont sue.As Living mentioned, its not just the payday loan company itself that you have to worry about. Most of the time, a debt collector or a law firm will also be involved.Payday loan companies routinely sell their accounts to debt collectors or use attorneys to handle their debt in bulk. Thus, no amount is too small to sue you over, particularly when they can seek late fees, collection costs, court costs, and late fees. The final sum against you can greatly surpass the original amount owed.The only way to prevent a court judgment against you is if you have some legitimate legal defense, like fraud or illegal practices on their part. Otherwise, once they get a judgment against you, they can garnish your wages/assets or lien your property.”Dont ignore a debt collectors calls. Instead, try to negotiate. If it goes to court, show up.Katie Ross, Education and Development Manager at  American Consumer Credit Counseling, or ACCC, gave us her advice on ma naging the threat of a lawsuit:“When you miss a payment, the lender will try to contact you via the contact information you provided (address, phone, email). If you ignore the lender and don’t make any payments, they will turn to a third-party collections agency to try to get the debt back. This can happen even after thirty days of a missed payment.Their tactics may be aggressive, including threatening to notify the credit bureaus. Each city/state has its own laws regarding payday loans, so make sure you know your rights under the Fair Debt Collections Practices Act.“If the collections agency fails to collect your debt, they may sue you even over a small amount. Make sure you show up to court. If a judge rules against you, the collection agency can levy your bank account, garnish your wages, or put liens on your property, depending on the state’s laws.Prevent ending up in court by trying to negotiate your repayment terms with your creditor or entering into a settlement plan. If you do receive a court summons, go to court and ask that the collector show proof that you owe money. If they don’t show proof, your case may get dismissed or at least postponed until they do.”To learn more about your debtors rights, check out our blog post:  What Debt Collectors Can and Can’t Do.If a payday loan company or a debt collector has misstepped, you can take them to court too.Don’t forget that the ability to take someone to court can go both ways. Obviously, a payday lender will likely have more resources than you, but you should still know your options, even if you’re just going to use them as a negotiating tactic.“Usually, consumers end up with grounds to sue the payday lender,” Peterson told us. “Many payday lenders, especially online payday lenders, are not licensed to extend loans to customers in many of the states where their borrowers reside.Under most (if not all) states laws, the payday loan is void and can not be enforced if the lender was no t licensed to make the loan. Debt collectors who attempt to collect a void loan may be liable under the Fair Debt Collection Practices Act (FDCPA) and possibly under similar state laws.“Debt collectors who attempt to collect payday loans often (if not almost always) violate the FDCPA by threatening to press criminal charges or have the borrower arrested for writing a ‘bad check.’ Payday lenders obtain postdated checks from the borrowers. Postdated checks which are eventually dishonored because of insufficient funds are not ‘bad checks’ under the criminal codes.“Debt collectors often burn consumers phones by calling excessively including calls to cell phones even after the consumer instructs the caller to ‘stop calling me.’ If the debt collector is calling a cell phone after the consumer told them ‘stop calling,’ the caller may be liable to the consumer in an amount between $500 to $1,500 per call.”Peterson wrote a guide to what you should do if you’re getting those kinds of calls.While the risk of being taken to court over a payday loan may not be that high, its not like payday loans are worth it in the first place. To learn more about improving your credit scoreâ€"so that you can leave predatory payday loans and title loans in the dustâ€"check out these related posts and articles from OppLoans:How to Fix Your Bad Credit in 2018An Apple a Day Keeps the Bad Credit AwayWhy You Should NOT Close That Old Credit CardHas a payday loan ever landed you in court?  We want to hear from you!  You can  email us  or you can find us on  Facebook  and  Twitter.ContributorsDamon Duncan  (@Damon_Duncan) (@DuncanLaw)  is an attorney on the North Carolina Bar Association and Foundation’s Board of Governors, a member of the Elon University School of Law’s Alumni Council, the Secretary of the North Carolina Bar Association’s Bankruptcy Section and adjunct professor at Elon University School of Law and Guilford Technical Community College.Shaolaine Lov ing (@LovingLawyer) is an attorney who has been practicing law in Las Vegas for over a decade. She established her own firm, Loving Law Ltd., in 2015 and provides services in family law, estate planning, consumer law, contracts, and other legal areas.Donald Petersen is an Orlando, Florida trial lawyer who represents consumers against companies who violate their rights under the Telephone Consumer Protection Act, Fair Debt Collection Practices Act,  Fair Credit Reporting Act and other consumer protection laws.Katie Ross, joined the  American Consumer Credit Counseling, or ACCC, management team in 2002 and is currently responsible for organizing and implementing high-performance development initiatives designed to increase consumer financial awareness. Ms. Ross’s main focus is to conceptualize the creative strategic programming for ACCC’s client base and national base to ensure a maximum level of educational programs that support and cultivate ACCC’s organization.

Team Related and Job Related Risk Factors - 2750 Words

Organizational, Team Related and Job Related Risk Factors for Bullying (Article Critique Sample) Content: Summary of articlesNameInstitutionCourseInstructorDateOrganizational, Team Related and Job Related Risk Factors for Bullying, Violence and Sexual Harassment in the Workplace: A Qualitative StudyOrganizations need to have good environments that allow social interactions to foster the well-being of employees and subsequently, the organization itself. Negative acts such as sexual harassment, bullying, and violence at workplaces often cause dissatisfaction with employee's work, reduced motivation at work, lowered organizational commitment, and additional organizational costs. These negative acts are a common result from poor interpersonal relationships at workplaces. The greatest number of research works conducted in the area of risk factors emanating from work-related negative acts including violence, sexual harassment, and bullying are all based on the real experiences of actual victims who have been directly involved in such acts. Many researchers have associated negat ive acts to characteristics of any given job. Such job characteristics include low autonomy, role conflict, job insecurity, noisy work environments, crowdedness, high workload, and absence of feedback.This article, based on qualitative research, employs a divergent methodology whereby members of an organization who have experienced some of these work-related negative acts are interviewed. The study concentrated on identifying team, organizational, and work related risk factors that may be the reason for the perpetration and/or victimization of such negative acts. Moreover, the study focuses on appreciating the role of perpetration and/or victimization of the risk factors in the negative acts process. Past studies in this topic had identified several risk factors. The findings of this study benefited from interviewing 126 participants in a semi-structured interview.The findings revealed that among the factors that result in negatives acts were: work content, work relations, work cond itions, and the environment where the participants worked seemed all at the job level. Regarding both organizational and team level factors, absence of balance with respect to social atmosphere, worker's well-being versus organizational goals, and organizational chain of command seemed to result in negative acts. Conversely, the presence of balance in respect of these aspects appeared to avert over and above terminating the negative acts.The study revealed that four processes promote the negative acts within a work environment. The first process involves organizational, job, and team factors that may provoke personal stress or obstructions and may possibly restrain the ability of employees in trying to deal with with such situations. The second process involves a team, job, and organizational factors that may possibly promote emergence of conflicts, which in turn may perhaps affect the worker's style of managing work-related conflicts. The third process this research revealed is tha t a team's characteristics and those of the organization such as gossiping culture might be responsible for directly promoting or even enabling the negative acts. The last process involves negative acts including team, change job, organizational factors, and influence. This process has the potential of encouraging stresses, more bullying, violence within working environments, sexual harassment, and new frustrations.The findings further show that interpersonal conflicts are the recipe for violent acts while inadequate capacity to manage conflicts lead to higher chances of violent acts. Stress and job related frustrations do not significantly influence acts that lead to sexual harassment except when such behaviors lead to interpersonal conflict. However, bullying seems to be the global act that fits well with work related negative acts.Sexual Harassment in the Workplace: A PrimerSexual harassment within a working or job environment is not a contemporary problem. However, the legal lia bility for it is recent. In spite of proliferating publicity of the threats associated with sexual harassment, surveys conducted in the past have continually shown that numerous businesses with their operations in the United States of America have not yet deal with this problem. In fact, the most current news reports show that this vice has reached its peak levels in terms of management. This is because even though businesses are aware of the problem's existence, they are not certain of how to deal with it. Consequently, the employer keeps on bearing liability for such acts at workplaces.The dangers of not adopting an appropriate preemptive and forceful standpoint in an attempt to address this problem can potentially result in many problems. Some of the resulting problems or risks include significant reduction in the morale of workers, expensive litigations, reduced performance of employees and the business as well, and the marring of a company's reputation within public circles. Pe rhaps the clearest demonstration of failure in trying to arrest this issue in good time is evidenced in the inability of businesses to take firm positions in respect of this issue.Unfortunately, the costs associated with risks from sexual harassment have significantly escalated in the contemporary period. For this reason, the Congress made changes to Title VII in the year 1991 to allow sexual harassment victims obtain recovery of damages as covered under the federal law. An example of such damages allowed for recovery was punitive damages. In addition, the U.S. Supreme Court, in 1993, made it easier for victims of sexual violence to reach this law when it made it far much easier for them to prove any injury caused them. Consequently, the negative act of sexual harassment within the context of work environment is one such present-day threat to the thriving of an enterprise. If companies fail to respond to the outcry and stipulations of the law, they will have to face heightened risk of liability for its non-observance.Therefore, for the businesses to be wise, they must comprehend sexual harassment in its entirety. They must not only try understanding the scary statistics around sexual harassment at workplaces that often cover the problem itself, but also consider the available victims' legal platforms, present legislative trends, and the manner in which businesses can safeguard their interests. This article serves as a primer for attorneys especially in times of giving advice to their clients on matters pertaining to the issue of workplace related sexual harassment.This paper describes not only the scope of sexual harassment but also the severity of this problem. Further, the study assesses the newly firmed up federal law that administers justice as applied to the area of sexual harassment within a workplace. This is a strong legal in response to the problems of the past where victims of sexual harassment did not find refuge in the federal law as they frequentl y found themselves in a legal dilemma. Lastly, the paper recommends the creation of clear company policies and procedures with the purpose of instituting and instigating a sexual harassment policy. However, the full application of the policy requires a substantial investment of human resources and time applied aggressively, consistently, and quickly. The benefits of companies observing federal law in regards to sexual harassment include improved employee productivity, a higher public reputation, reduced healthcare expenses, and lower legal fees.Interpersonal Mistreatment in the Workplace: The Interface and Impact of General Incivility and Sexual HarassmentCortina Lim (2005) discuss about of behaviors conceptualized as general and sexual kinds of harassments in attempt to find out how they are associated and their consequences at the workplace. This paper attempts to summarize the findings of the discussion. Interpersonal mistreatments have been appreciated to constitute various for ms of harassments that are of increasing concerns at the workplace with sexual abuses on the lead. Theoretical concepts have been applied to examine these forms of behaviors in the context of sexual harassment. General harassment, sexual coercion and unwanted sexual attention are the three forms of mistreatments that have been seen to quantify sexual harassment. The study further examines how these three forms of sexual harassment relate to their domains adjacent in the context of incivility. That is, where the normal workplace norms have been violated by behaviors directed to cause harm.Physical aggression is also noted to refer to abnormal expectations of causing harm to another a term which counteracts incivility. That is, a form of abnormality that lacks intentionality. Theoretical concepts have been employed to examine the relationship between sexual harassment and incivility. The desire to dominate occasions sexual aggressors to harass their victims and they also mistreat non- sexually. Gender harassment that involves one being hostile is said to form the link between sexual harassment and incivility. Another relationship is said to be inform of the norm established as a result of the frequency these mistreatments occur to the same employees.Here, the research study involved examining these relationships at the court workplace. Mathematical equations are employed to test the relationship of the described models of harassments. Further, multivariate analysis of covariance is also adopted to determine the frequency and kind of outcomes of employees. Functions of discrimination are also employed to further examine and analyze the differences on the various types and combinations of interpersonal mistreatments. This study is said to involve a much smaller sample not as big as case study 1 and used the same techniques of conducting research as in case study 1.Both resul...

Essay about Drug Testing For Missouri Welfare Recipients

On 30 January 2011, the Missouri House of Representatives passed a bill and sent it to the senate that would require drug testing for those receiving state Temporary Assistance for Needy Family (TANF) funds. Funding from food stamps, medicare, and public housing would not be affected by this bill (Keller – House). According to Columbia Tribune reporter Rudi Keller, the bill is very similar to the Arizona law which is the only other state that tests welfare recipients. Missouri and Arizona would use a questionare and interview which would determine which applicants to test. The two states are also similar in their caseload of 45,017 people on assistance in Arizona and 42,885 in Missouri. The state would not be obligated to provide treatment†¦show more content†¦According to Keller’s article, the law would protect children. It would discourage parents from using drugs which would create a better home environment. It would also ensure that state money would be use d for supporting families, not recreational drugs (Keller). Rep. John McCaherty said â€Å"The bill will show the state expects TANF recipients to be responsible with public money.† (Qtd. in Keller). The idea behind those that support this legislation is that the state is responsible for ensureing that taxpayer’s money doesn’t ultimately end up buying illegal substances and drug testing is an effective means to ensure this. As with all political issues, there are those on the other side of the fence. People oppose this legistlation for various reasons: from constitutionality to cost. According to a study done by the American Civil Liberties Union (ACLU), welfare recipients are no more likely to use drugs. Furthermore, placing a requirement to be tested may place a stigma upon those receiving welfare which would be counterproductive to their relief (Drug Testing). An editorial by Henry Waters in the Columbia Daily Tribune, the bill is the government attempting t o punish a class of people who are presumed worthless (Waters). Another reason people oppose this legislation is the cost. The ACLU study reports the average cost of a drug test at $42 per person. There are less invasive and cheaper methods toShow MoreRelatedDrug Testing : A Controversial Issue Right Now1439 Words   |  6 PagesRUNNING HEAD: Mandatorily Drug Testing Welfare Recipients Does More Harm Than Good Mandatorily Drug Testing Welfare Recipients Does More Harm Than Good Clare M. Pitlik Marist High School Author Note First paragraph: Introduction to history of drug testing welfare recipients Second paragraph: Explains why drug testing welfare recipients is unconstitutional Third paragraph: Explains why drug testing welfare recipients is costly Fourth paragraph: Rebuttals Fifth paragraph:Read MoreDrug Testing For Welfare Recipients1347 Words   |  6 PagesIntroduction Since the reformation of welfare in 1996, nearly all states have attempted to pass legislation to require the use of drug testing among welfare recipients. Thirteen states have passed legislation and there are currently seven states testing applicants for drugs. The results have been somewhat anticlimactic, as the number of positive drug test results is lower than the national average. There are many concerns surrounding the issue of drug testing welfare recipients, including the cost, constitutionalityRead MoreThe Welfare System Is A Broken System1590 Words   |  7 Pagesor other benefits directly to poor families† (Tanner). Welfare is a broken system that needs to be fixed because it is teaching the current generation the wrong way to live, encourages people to not work for what they need or want, and lacks accountability for how or where the money is being spent. The welfare system was originally created to help people who were temporarily out of work or in need of assistance, but â€Å"total welfare spending has nearly doubled since 1996† (Donovan and Rector)Read MoreDrug Testing the Less Fortunate 1023 Words   |  4 PagesShould drug testing be a necessity for all state and federal aid programs? Drug testing welfare recipients have been a major issue across the United States for a few years now. Many indicate that if working class people are subject to a test prior to hire or randomly during the duration of employment, why should those that don’t have to work for money not have the same treatment? The government estimated that random annual drug testing for welfare recipients would cost each taxpayer an additionalRead MoreThe Issue Of Drug Testing Welfare Recipients And Applicants1231 Words   |  5 Pagesissue of drug testing welfare recipients and applicants. The journals and articles used to determine whether d rug testing is necessary or a hindrance to public assistance applicants, recipients and the government vary in their argument on the effects of those who receive assistance. The study, completed by Anderson, Shannon, Schyb and Goldstein (2002) determined that, due to the change in Welfare reform in 1996, the disruption of benefits increased the risk homelessness and usage of drugs and alcoholRead MoreWelfare Reform : Social Welfare Policy1257 Words   |  6 Pages Social Welfare Policy Social Welfare Policy Analysis Eric Dean University of Arkansas Introduction Several states have recently begun to enact legislation that requires welfare recipients to submit to drug tests before they are eligible to receive any public assistance. The purpose of mandatory drug testing is to prevent the potential abuse of taxpayer money, help individuals with drug problems, and ensure that public money is not subsidizing drug habits (Wincup, 2014). WhileRead MoreShould Drug Testing Welfare Recipients?1679 Words   |  7 Pageswho test positive for drugs should be able to receive welfare. It was an argument that flooded social media, arguments filling comments with opinions. It is a subject that continues to be discussed within our peer groups, our communities, and our states. This paper will discuss the opinions of individual’s within the country, the beneficial factors of drug testing welfare recipients as well as the unbeneficial factors, as well as who decides if drug testing welfare recipients goes into effect or notRead MoreWelfare Reform For D rug Test Recipients Essay1719 Words   |  7 Pagesexactly how many taxpayers feel about welfare recipients that refuse to take drug test prior to receiving their welfare checks. Since 1996 there has been a call for welfare reform to drug test recipients prior to admission, but any attempts have been unsuccessful because they are viewed as a violation of the fourth amendment, more harmful for children, and an unnecessary expense. These common fallacies have been the main arguments leading the anti-drug testing campaign, but in the past few years manyRead MoreDrug Testing For The United States Essay1589 Words   |  7 Pages The state spent $493,000 on drug testing for this fiscal year. It received 32,511 welfare applications and referred 636 for drug testing. Only twenty came back positive, although nearly two hundred people refused to comply. But even if all 200 were drug users, that still comes to more than $2,200 per positive result, which is more expensive than the median bene fit in the state. (Benen 1) Many people do not think it is worth the money to stop just a mere few individuals. Even though two hundred wereRead MoreDrug Testing and Public Assistance1299 Words   |  5 PagesDrug Testing Public Assistance Public or federal assistance is considered to be a federal program and service, provided to the needy by the federal government. These federal programs are meant to assist government, organizations, and individuals in all areas such as health, public safety, education, and public welfare. These various programs can typically reach over $400 billion annually; and are provided through many federal agencies. Perhaps the most controversial these days is drug testing

3d Animation in Film Industry - 785 Words

1.0 Abstract Evidence of artistic interest in depicting figures in motion can be seen as early as the still drawings of Paleolithic cave paintings, where animals are depicted with multiple sets of legs in superimposed positions, clearly attempting to convey the perception of motion.[1] Other examples include a 5,200-year old earthen bowl found in Iran in Shahr-e Sukhteh and an ancient Egyptian mural. The Persian bowl has five images painted along the sides, showing phases of a goat leaping up to nip at a tree.[2][3] The Egyptian mural, found in the thomb of Khnumhotep and Niankhkhnum, at the Beni Hassan cemetery. The paintings are approximately 4000 years old and show scenes of young soldiers being trained in wrestling and combat.[4]†¦show more content†¦The technology kept getting better and better until 1995, when the film company Pixar raised the bar on 3D technology with their box office hit â€Å"Toy Story†. â€Å"Toy Story† was the first feature film created entirely with 3-dimensional animations. Since then Pixar and other film production houses have jumped on board and began producing similar films because they were guaranteed to be hits, but Pixar remains the top studio. The process The main reason the technology used in 3-dimensional animations took off dealt with the amount of work it took to create a motion graphic in a digital setting creating depth to the images. The process begins with developing a primitive outline of a character or object. 3-dimensional animation differs from 2-dimensional animation because it is done entirely through a computer program rather than paper. After the initial model is created the animator begins texturing it to give the character more depth and adding realistic details. During this step the animator adds features such as hair and clothing. The last step of creating an animated character is the actual animation and adding in the last of the physical details. The animation of a character can be done in various ways such as moving the characters frame by frame or using a built in physics engine to help the characters move naturally. Once this is completed, the character is finished, but the characters that need to beShow MoreR elatedPixar Animation Changed The World1537 Words   |  7 Pages Pixar Animation changed the game of animation, but how? Is it the beautiful quality, the picturesque feel, or the new change that brought the animation industry to a new focus? Animation is so much more than what we think or know about it. It is an art that challenges the way we look at the world. It brings a new level of realism and imagination to our bleak, everyday lives. Animation changed not only from Disney but also from the 3D beauty that lead the world to an understanding of whatRead MoreEssay on My Dream of Being a 3D Animator575 Words   |  3 Pagesbind imagination and reality into one, when applied to animation the boundaries of visual imagery are endless. An individual possesses the ability to create at the minds will with the possibility of one day being able to affect millions globally. The film and gaming industries, now utilise the power of animation to its full effect, this is where I ai m to belong, fulfilling my dream of being a 3D animator within either industries. Animation has always had a profound impact on my perception of theRead MoreLightwave Essay992 Words   |  4 Pagesthe use of rendering 3D images. These can be animated and static renders of images and it includes a rendering engine within it to support reflections that look realistic, refraction, radiosity and caustics. It supports both polygon modelling and subdivision surfaces. It is developed by NewTek Inc. and it can be used on the AmigaOS, Windows and MacOS, it uses animations, visual effects, product design, architectural visualisations etc and can be used with everything that a 3D software can do. It alsoRead MoreHayao Miyazaki: Auteur Essay1138 Words   |  5 Pagescreative aspects of a film. They develop the vision for a film and carry the vision out, deciding how the film should look. The director may also be heavily involved in the writing and editing of the film, as well as managing the script into a sequence of shots, coordinating the actors in the film and supervising musical aspects. The Auteur Theory suggests that films contain certain characteristics or ‘signatures’ that reflect the director’s individual style and give a film  its personal and uniqueRead More3D Artist Essay1356 Words   |  6 Pagesproduced at steady rates. However, many of the artists behind the new animated cartoons and movies do not have such steady rates. 3D artists’ salaries are dropping and some artists are losing their jobs; as they are a big part of the entertainment industry, the public should have more care about these artists keeping their jobs and being compensated with what they deserve. 3D artists and animators are being pushed too hard for not enough reward. The Occupational Outlook Handbook is a website which listsRead MoreIs Academy Voters Are Ignorant About Animation?1592 Words   |  7 PagesFor it appears that the Academy has a differing opinion on these animated films. Amid Amidi, brings attention to how some judges’ feel for their nominations, in his article, â€Å"Definitive Proof That Academy Voters Are Ignorant About Animation†. One such judge stated how, â€Å"I have seen none of them. I have no interest whatsoever. That ended when I was 6. My son dragged me to a few when he was 6; I would seat him and go outside and make phone calls.† This academy judge apparently didn’t even waste theirRead MoreThe Ever Changing Field Of Film Essay1223 Words   |  5 Pages The Ever-Changing Field of Film The world of film has changed dramatically over the years and will likely continue to change along with technological and professional developments. Like many modern innovations, film has changed substantially over a rather short period of time, from black and white movies to modernized color films. Still, it is impressive to think how far film has come, and looking back into the near past affords an appreciation of the technology that no longer exists. Thus my viewingRead MoreThe Importance of Technology in the Production of 3d Animation Films Among the Animators in Malaysia.2220 Words   |  9 PagesOF TECHNOLOGY IN THE PRODUCTION OF 3D ANIMATION FILMS AMONG THE ANIMATORS IN MALAYSIA. DINIZAR BIN DANIAL 2010273278 AD2214B LECTURER : EN MD SABRI MOHAMAD ASSIGNMENT 3 The importance of technology in the production of 3D animation films among the animators in Malaysia. Issue - 3D animation films Problem - importance of technology in the production Sample - animators Location - Malaysia Direction - the importance INTRODUCTION Animation generally refers to the process of settingRead MoreRecognizing the Advancements in Animation615 Words   |  3 PagesGCC’s animation department consists of about nine classes each term, which are taught by experienced animators. Technology keeps advancing, and 3D is being widely used in the film industry. Yina Chang is one of the talented professors in the animation department. She teaches Art 233 (Character set-up) and Art 235 (character animation). In her class, before they animate on the computer, they sketch it out on a story board to get their ideas flowing. Then, they begin their animation process. Read MorePixar1465 Words   |  6 PagesPixar’s resources and capabilities have set a standard that is extremely difficult to imitate. Through its highly talented employee pool, culture of creativity and collaboration, and proprietary 3D computer animation software, Pixar has created a competitive advantage in the animation film industry that yielded average total box office sales of $538 million with just six movies. Pixar shareholders should be wary of the potential breakdown of these resources and capabilities, which in essence

The Death Penalty Is Inevitable - 1629 Words

Punishment is inevitable in a world that judges one’s every move. Common decisions turn into tendencies and tendencies turn into life choices that construed a life forever. For centuries people have faced execution for crimes which were considered to be horrendous. A system that has remained in our judicial system since the first execution in 1606 (deathpenalty.org). As of 2015 execution is only recognized as a form of correction in 31 states throughout the U.S. To ensure justice crimes are punished in a form or fashion equal to the severity of the crime committed. According to the US Federal Government list there are 41 capital offenses punishable by death. Included in this list are crimes such as first-degree murder, treason, and genocide. The death penalty is a largely debatably topic that is constantly criticized for its faults. Many argue that the death penalty violates an individual’s eighth amendment which prohibits the federal government from imposing excessive bail, excessive fines, or cruel and unusual punishment. This is provided to every American under the United States Bill of Rights. The justice system provides many methods of deterrence in hopes of decreasing crime rates. One that is prevalent is the power of publicity. Research shows that in comparison to other deterrent methods, publicity has a significant Impact on future crime rates. A Study done by a man named Robert Dann questioned the effectiveness of deterrence using the media. For his sample heShow MoreRelatedDeath Penalty Is The End Of Life906 Words   |  4 PagesAccording to the Webster’s Dictionary, death means the end of life (Dictionary, 80) and penalty means punishment for any crime or offense (Dictionary, 223). Therefore, by definition the death penalty means the end of a life due to punishment for a crime or offense. The death penalty is started with the Code of King Hammurabi’s in the eighteenth century B.C. This code consisted of 282 laws that stressed justice as clearly stated in the opening of the code, An eye for an eye, and a tooth for a toothRead MoreAbolishing The Death Penalty Is Justified910 Words   |  4 PagesEliminating the Death Penalty According to the Webster’s Dictionary, death means the end of life (Dictionary, 80) and penalty means punishment for any crime or offense (Dictionary, 223). Therefore, by definition the death penalty means the end of a life due to punishment for a crime or offense. The death penalty is started with the Code of King Hammurabi’s in the eighteenth century B.C. This code consisted of 282 laws that stressed justice as clearly stated in the opening of the code, An eye forRead MoreAnother Fact Is That The Death Penalty Is Not A Deterrent.Reports908 Words   |  4 PagesAnother fact is that the death penalty is not a deterrent. 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John Anthony Burgess s A Clockwork Orange - 1706 Words

A relatively unknown author at the beginning of his writing career, John Anthony Burgess Wilson, better known under his pen name by just Anthony Burgess, would become a prominent author towards the end of his life. Burgess has allowed many to scrutinize his novels, ranging from his three colonial novels at the beginning of his writing career, Time for a Tiger, The Enemy in the Blanket, and Beds in the East to his most well known novel, A Clockwork Orange (The International Anthony Burgess Foundation). Burgess’s dystopian classic continues to provoke deeper thinking, yet also startle those today. Many believe that Burgess is a remarkable author due to his stunning portrayal of extreme youth violence in his novel A Clockwork Orange. From a†¦show more content†¦A couple of years after his father remarried, Burgess would begin writing his earliest published poems and short stories. Similar to many children today, Burgess despised his stepmother, declaring how â€Å"she s ubscribed to all the current bigotries.† The relationship between father and son was not the ideal relationship either, his father, to an extent, still blamed him for his mother s death. Burgess did not only lose his mother, but he would lose his father as well, gaining â€Å"a mostly absent drunk who called himself a father† (Burgess). Before Burgess could even speak, he lost his mother, and the affection of his father. Burgess was schooled at St. Edmund s Elementary School before moving to Bishop Bilsborrow Memorial Elementary school, both Catholic schools in Moss Side. As a child, he be largely isolated from others his age, due to being either persecuted because of his wealthier appearance, or ignored by all (Burgess). As a result of Burgess’s impressive grades, he would be given a place in Xaverian College. This would be where he would stay to complete his School Certificate examinations. Burgess’s first published poems would appear in the school magazine, named The Manchester Xaverian, under the name John Burgess Wilson. Although uninterested in music as a child, Burgess would find his passion after listening to a flute solo in which he described as â€Å"sinuous, exotic, and erotic.† Music was not taught atShow MoreRelatedAnthony Burgess and A Clockwork Orange987 Words   |  4 Pagesnothing you can do about it. Anthony Burgess created this world through his novel, A Clock work Orange. Anthony Burgess was born in 1917 and died in 1963. A lot of social changes occurred during this period of time, such as: the roaring twenties, prohibition, the Great Depression, World War II, the fall of the Berlin Wall, and many more. Burgess not only lived through those changes, but also helped influences some social changes in literature and music. 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Analgesic and Facilitator Pain Assessment Free Essays

string(102) " on postoperative patients undergoing rehabilitation and acute pain associated with physical therapy\." 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. We will write a custom essay sample on Analgesic and Facilitator Pain Assessment or any similar topic only for you Order Now 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 of 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 relationship 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 was 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 su pports 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, Gainesville, 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: ahorgas@u?. 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 evidence indicates that persons with dementia physiologically experience less pain; rather, they appear less able to recognize and verbally com municate 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 Patient (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 pain 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-repor ted pain in persons with and without cognitive impairment, but it focused on postoperative patients undergoing rehabilitation and acute pain associated with physical therapy. You read "Analgesic and Facilitator Pain Assessment" in category "Essay examples" 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 pain 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 65–98). Thirty-nine percent resided in nursing homes, 39% resided in assisted living, and 22% lived independently in retire ment 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 with 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 scores as cuto ffs: 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 activities. 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 conduct ed 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 easier Pain 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 number 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 extensive 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 MMSE,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 4–6 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, a nd 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 cogni tively intact 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 Pain 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 oc currences 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, whic h 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 medicatio n use was controlled for and that the focus of the current study was on persistent pain, as opposed 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 signi? 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 te sted 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 behavior 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, generalizations 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 highlight 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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