Simplest alkylphenols isomeric mixtures Essay Example

Simplest alkylphenols isomeric mixtures Essay Introduction Cresols Cresols merely are isomeric mixtures of the simplest alkylphenols. Its molecular expression is C7H8O, and it occurs in three chief isomers: A corporate term used for the mixture of the three isomer is tricresol. As pure substances, o- and p- methyl phenol are crystalline ; m-cresol is a syrupy oil at room temperature. { 2 } Cresols are colorless and have a phenol-like smell. They are extremely flammable, reasonably soluble in H2O and soluble in ethyl alcohol, ether, propanone, or alkali hydrated oxides. Cresols and cresol derived functions ( quintessences and esters ) are by and large distributed in nature. They are formed as metabolites of assorted micro-organisms and are found in the piss of mammals. Humans eliminate, on norm, 87 milligram of p-cresol per twenty-four hours in the urine [ 3 ] . Assorted signifiers of methyl phenols can besides be detected in the infusions and H2O vapour distillations of some workss. Minute sum of methyl phenols can besides be found in certain nutrient and drinks e.g tomatoes, mushrooms and black tea We will write a custom essay sample on Simplest alkylphenols isomeric mixtures specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Simplest alkylphenols isomeric mixtures specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Simplest alkylphenols isomeric mixtures specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Considerable sums of methyl phenol may be formed and enter surface Waterss if woods are pyrolyzed by pyroclastic flow from break outing vents, as happened after the eruption of Mount St. Helens in 1980 [ 3 ] . Coal pitch was originally the exclusive beginning of methyl phenol production until universe war 2, after which they were besides obtained exhausted refinery caustics. Since the mid-1960s, they have been produced synthetically on an progressively big graduated table. Approximately 60 % of the planetary production of methyl phenol is now met by man-made paths Properties: Chemical Properties: Sourness Cresols are weak acids and that dissolve in aqueous base to organize H2O stable salts known as cresolates. They can hence be extracted into Na hydroxide solution from dissolver that are non mixable with H2O. There sourness is so low ( pKa 10.1 10.3 ) to the extent that it can be liberated from cresolates by H sulphide and C dioxide. Chemical reactions Cresols can undergo etherification with alkyl halides, dialkyl sulphates, dialkyl carbonates and toluenesulfonic acid esters. They besides undergo esterification with acyl anhydrides or acyl chlorides to organize the corresponding tolyl esters. Chemical reaction with sulfur oxytetrafluoride at 150 C will give flourotoluene, whilst reactions with diphenylphosphine trichloride at 220 C and phosphorus tribromide at 280 C will give chlorotoluene and bromotoluene severally Hydrogenation can happen in vapour stage at 300-400 C and at force per unit area of up to 8MPa in the presence of accelerators that contains passage metals and aluminium oxides to give methylbenzene. Oxidation reactions of methyl phenols depend on the oxidizing agent, reaction conditions and the place of the methyl group. This reaction occurs by free extremist mechanisms and the green goods assorted compounds such as hydroquinones, quinols, quinines, furans and tolyl quintessences Cresols readily undergo electrophilic permutation. The substituent enters the karyon chiefly in the o- and p- places relative to the hydroxyl group. If o- or p methyl phenols is heated with friedel-crafts catatlyst, isomeriztion to m-cresol, which is thermodynamically the most stable, occurs. When heated with CO2 under force per unit area dry base metal cresolates produces hydroxyl ( methyl ) benzoic acid. When methanal is added to cresols in the presence of base and at room temperature hydroxyl ( methyl ) benzyl intoxicants are form, but in the presence of an acid and at higher temperature the intoxicant condenses to organize high molecular rosins. At high temperature unalloyed steel is attacked by methyl phenols to a noticeable extent, the badness of the onslaught depends on the H2O content. Chromium steels are somewhat more immune to assail by methyl phenols than unalloyed steel. Tantalum is considered to be wholly immune to cresols. The caustic behaviour of methyl phenols can alter significantly with the presence of other compounds. The physical belongingss of methyl phenols shown in the tabular array below: Separation of methyl phenols O-cresols can easy be separated from the mixture of the three isomers through distillment. This is non the instance for m-cresol and p-cresol due to the minute difference in their boiling points. Below is the list of some the procedures employed in the separation of m-/p- methyl phenol mixtures: Crystallization: Although m and P methyl phenols have near boiling points, there is an appreciable difference in there runing point which indicates that crystallisation can be used in for separation. Adsorption: Alkali metal-modified or alkalic earth metal-modified zeolites, and besides Ti dioxide, adsorb p-cresol more strongly than m-cresol { 4 } . Therefore a mixture of P and m methyl phenols can be separated in an surface assimilation column and dissolved once more with a suited desorbing liquid such as an aliphatic intoxicant, e.g. , a mixture of 1-hexanol and 2-heptanol, or a ketone Separation via Ester or salt formation: The female parent spirits enriched with p-cresol ( e.g. , to a m/p ratio of 35: 65 ) from the precipitation with sodium ethanoate can respond with oxalic acid to give the semiester or diester, which is precipitated on chilling to 20 A °C. The ester is separated and so hydrolyzed by heating with H2O at 85 % in the presence of the several nonionic dissolver. The oxalic acid may be precipitated on chilling and recycled. The p-cresol dissolves in the organic dissolver, from which it is isolated by distillment. The jumping usage of both procedures separates m- and p-cresol about wholly { 4 } Alkylation with Isobutylene: Alkylation of m-/p- cresol mixture gives a mixture of butylated m-cresol and p-cresols. Dealkylation of either or both of these merchandises makes it possible to acquire pure m-cresol and p-cresol. Uses O-cresol O-cresol can be chlorinated to 4-chloro-o-cresol and can be used as a get downing stuff for the production of chlorophenoxyalkanoic acids, 4-chloro-2-methylphenoxyacetic acid and 2- ( 4-chloro-2-methylphenoxy ) -propionic acid ; these acids are of import as selective weedkillers. A smaller proportion of o-cresol can besides be nitrated to 4,6-dinitro-o-cresol, which can be used in the production and distillment of cinnamene as a polymerisation inhibitor. O-cresol of high pureness is now being processed to epoxy-o-cresol novolak rosins which are utile as sealing stuffs for incorporate circuits ( french friess ) . Normal choice o-cresol is besides employed in the alteration of traditional phenol-formaldehyde rosins. O-cresol is besides of import as a precursor of assorted dye intermediates, of which the most of import in footings of measure is o-cresotinic acid ( o-hydroxymethylbenzoic acid ) produced by the kolbes synthesis. { 5 } This acid can besides be used in the pharmaceutical industry. O-cresols can be used as a dissolver, straight or after it has been hydrogenated to 2-methylcyclohexanol or 2-methylcyclohexanone. O-cresol in the signifier of its carbonated ester is used as a get downing stuff in the synthesis of coumarin. Alkylation of o-cresol with propene green goodss carvacrol, which is used in aromas and as an antiseptic. Alkylated with isobutene, little sums of o-cresols can be used as get downing stuffs in the production of antioxidants and in the production of constituents used for thermic recording stuffs. M- and p- methyl phenols A mixture of these two isomers can organize a starting stuff for contact insect powders like O, O-dimethyl-O- ( 3-methyl-4-nitrophenyl ) thionophosphoric acid and O, O-dimethyl-O- ( 3-methyl-4-methylthiopheny ) thionophosphoric acid. Although pure m-cresol can besides function this intent. M-cresol is used in the synthesis of phenyl m-tolyl quintessence ( m-phenoxytoluene ) , which can so be oxidized to m-phenoxybenzaldehyde, which can served as a edifice block in the production of insect powders of the pyrethroid type. An of import get downing stuff for the synthesis of vitamin E is 2,3,6-trimethyphenol, this can be produced by the selective methylation of pure m-cresol with methyl alcohol. Alkylation of m-cresol with isobutene green goodss 6-tert-butyl-m-cresol which can be condensed with sulfur bichloride to give 4,4A?-thiobis ( 6-tert-butyl-m-cresol ) , an of import antioxidant for polythene and polypropene. More antioxidants are produced from 6-tert-butyl-m-cresol by condensation with butyraldehyde or crotonaldehyde. In Japan, amination of m-cresol is used to bring forth m-toludine 4-chloro-m-cresol which is used as a germicide and preservative can be produced by selective chorination of either pure m-cresol or a mixture of m-/p-cresols. An of import field of application for proficient methyl phenol mixtures is the production of modified phenoplast rosins by condensation with methanal. The suitableness and monetary value of methyl phenol mixtures for this purpose depends on their content of m-cresol, the most reactive of the three isomers. Cresol mixtures are extremely of import as dissolvers for man-made rosin coatings ( wire enamels ) . { 5 } Impersonal phosphorous acid esters which are used as fire immune hydraulic fluids, additives in lubricators, air filter oils and flameproof plasticisers for PVC and other plastics can be produced from mixtures of m-/p-cresols that do non incorporate the o isomer. Due to its bactericidal and fungicidal belongingss, methyl phenols can be used as germicides in soap. Condensation of methanal with cresolsulfonic acid and Sulfonation of novaks obtained from methyl phenols are used to bring forth man-made tanning agent. Cresols are besides used as wood preservatives. Cresols are used in Ore floatation, fiber intervention, as metal degreaser, as pull outing dissolvers, and as agents for taking carbonisation sedimentations from internal burning engines. Hydrogenation of methyl phenols green goodss methylcyclohexanol and methylcyclohexanone which are used in the pigment and fabric industries. Xylenols Xylenol or dimethylphenol is an arene compound with two methyl groups and a hydroxyl group. The name xylenol comes from xylol and phenol Xylenol occurs in six isomeric signifiers: Commercially, 2-6 xylenol is considered to be the most utile out of the six isomers. Properties The Physical belongingss are shown in the affiliated tabular array: Xylenols are colourless crystallising compounds that are soluble in intoxicant, propanone, and in many other organic dissolvers. They are less soluble in H2O than the methyl phenols { 5 } . There sourness is by and large lower than that of methyl phenol, except for 3,5-xylenol. They are normally soluble in aqueous Na hydrated oxide but the extent of solubility depends on the isomer. The chemical belongingss are similar to that of the methyl phenols Separation: Crude xylenols can be separated into its different isomers by fractional distillment. The different isomers at the matching boiling point are highlighted below. 2,4-xylenol and 2,5-xylenol are contained in the fraction boiling point at 208-212 A °C at 101.3 kPa. Crystallization method is used to divide these isomers since the difference in their boiling point at 101.3 kPa is 0.2 C 2,3-Xylenol is isolated from a fraction boiling at 215-218 A °C by selective dephenolation with dilute aqueous Na hydrated oxide, debut of the free phenols into milk of calcium hydroxide, and depriving with steam ; it can so be purified by recrystallization from benzine { 5 } 3,5-xylenols is crystallized by chilling the fractions with boiling points scope of 218-221 C, 3,4-xylenols is besides obtained this manner but with a fraction of boiling points of 223-225 C Separation of 2,6 xylenols: In the azeotropic distillment of the m-/p-cresol fraction with steam, 2,6-xylenol crystallizes from the condensate. 2,6-Xylenol can be distilled from cresolate caustics because of its lower sourness, after which it is obtained from the condensate by extraction with benzene.. In fractions rich with 2,6-xylenol like the one obtained from synthesis by the methylation of phenol, the 2,6-xylenol can be separated from m- and p-cresol and other phenols by countercurrent extraction with aqueous Na hydroxide-hydrocarbon mixtures. Uses Xylenol mixtures can be used as dissolver for wire enamels, germicides, fabric aides and in ore floatation. Xylenol-formaldehyde rosins can be manufactured from mixtures rich in 3,5-xylenols and xylenols with two H atoms in the o- and p-positions Nontoxic plasticiziers and trixylenyl phosphates which are used as fire-retardant hydraulic fluids can be produced from Xylenols that are without an o-methyl group. 2,4-/2,5-Xylenol mixtures constitute natural stuffs for antioxidants, particularly those intended for gasolene ( e.g. , 6-tert-butyl-2,4-dimethylphenol ) and rubber [ e.g. , 2-methyl-1,1-bis ( 2-hydroxy-3,5-dimethylphenyl ) propane ] . { 5 } Pure 2,5-xylenol is besides used in the pharmaceutical industry for the production of lipid reducing agents. 2,6-xylenols is primary used to bring forth poly ( phenylene oxide ) resins. Oxidation of 2,6-xylenol gives 2,6-xylenol dimer, a forte monomer to bring forth epoxy rosins for encapsulating advanced semiconducting materials. { 6 } Condensation of 2,6-xylenol with acetone green goodss 2,2-Bis ( 4-hydroxy-3,5-dimethylphenyl ) propane ( tetramethylbisphenol A ) which is used as an intermediate for polycarbonates whose belongingss are similar to that of poly ( phenylene oxide ) resins. Treated with ammonium hydroxide, 2,6-Xylenol outputs 2,6-dimethylaniline, which is used in the industry of pesticides and besides in the production of pharmaceuticals. Xylenols are besides used in little sums in the synthesis of dyes and in the production of aromas. Feedstock: There are several paths to bring forth methyl phenols and xylenols runing form natural paths to man-made paths, some of which are listed below: Sythentic paths from methylbenzene Splitting of cymene hydroperoxide Methylation of phenol Production from coal pitch Production from naptha checking The feedstock required mostly depends on the production path and the specific isomers required. The procedure paths are extensively covered in subdivision 4 Safety Cresols and xylenols burn the tegument and mucose membranes through debasement of proteins, likewise to phenols. Initially white and later chocolate-brown black necroses appear on the tegument. { 5 } Certain persons may demo hypersensitivity symptoms in add-on to the caustic consequence. Absorption occurs even more quickly when the compounds are in the liquid province. Severe harm to the wellness can happen even if the open portion of the tegument is comparatively little. Inhalation of the compounds besides leads to severe poisoning whose symptoms includes concern, giddiness, sickness, purging, muscular vellication and depending on the badness, loss of consciousness. As these compounds are quickly absorbed through the tegument, a causal intervention of the toxic condition is non yet in being, although a good first assistance step would be to rinse it off the tegument every bit shortly as possible. A mixture of polythene ethanediol and ethyl alcohol in the ratio of 2:1 has been proven to be the most suited for this intent and it is extremely recommended that it is readily available in countries where methyl phenols and xylenols are being handled. It is besides recommended that when working with these two compounds, it should be done in closed setup if possible. Suites should be good ventilated and safeguards such as air locks and gas compensation technique should be in topographic point to avoid the inspiration of cresol/xylenol vapor. With brassy point of the different isomers of both compounds runing from 80-87 C, the storage and transit are handled with extreme attention. Cresols and xylenols are normally stored in well-sealed containers in a cool and good ventilated country. During transit, well-sealed and protective containers are besides used ; the high flammability and the caustic nature of the substances are besides indicated on the label. Further information sing the safety and handling of methyl phenols and xylenols can be found in the MSDS included in the appendices and subdivision 4 Environmental Consideration Cresols and xylenols are readily biodegradable, although cresol degrades faster than xylenol. Waste H2O incorporating 900mg/l of methyl phenols can be treated utilizing biological works with appropriately adapted bacteriums. In the environment, methyl phenols are degraded at low concentrations, particularly by bacteriums that are widely distributed in the dirt and H2O ( peculiarly Pseudomonas species ) . Degradation by other beings, including barms, Fungis, algae, and higher workss, every bit good as by photolysis, is besides known. { 6 } Because of these grounds methyl phenols and xylenol do non prevail in the environment. Due to its toxicity in H2O, there are rigorous Torahs regulating their release into the aquatic environment. Liquid methyl phenols and xylenols can be absorbed with absorbents like sawdust, peat or diatomaceous earth and so later fire off in particular incineration workss. â€Å"Solidified merchandises should non be dissolved, but removed automatically. Concluding residues can be neutralized with 2 3 % aqueous Na hydrated oxide and flushed with plentifulness of H2O into suited drains taking to a biological effluent intervention plant† Cresols and xylenols nowadays in waste gas watercourses can be removed by scouring the watercourse with sodium hydrated oxide or by firing. Adsorption on activated C is another method that can be used ; this method can roll up up to 0.5kg of cresols/kg. The adsorbate is recovered when the activated C is regenerated. Market and Resources Size The entire production of methyl phenol was estimated to be 175,000 t/a, of which 105 000t was produced via man-made path and 70 000t via natural paths. Approximately 42,000t are produced in the United States, 50,000t in Europe, 58000t in Japan and 25000 T in South Africa. The natural methyl phenol comes from the gasification of coal, from coaking of coal and exhausted refinery caustics in a ratio of 50:35:15. { 7 } The entire end product of methyl phenols have been worsening in the past decennary, this fact can be attributed to a figure of grounds which includes worsening markets, the entryway of 2,6-xylenol manufacturers into the o-cresol market, the outgrowth of South Africa in the market for purified methyl phenols, the worsening handiness of coal pitchs from coking procedures and of exhausted refinery caustics, and the increasing environmental costs. Approximately 165,000t of xylenols are produced yearly, chiefly from United States, Western Europe, and Japan. Xylenol mixtures histories for 30 000 40 000 T, 2,6-xylenol for 125 000 T, and the staying single isomers ( particularly 2,4- , 2,5- and 3,5-xylenol ) , obtained by synthesis or isolated from mixtures, for 10 000 T. Xylenol mixtures are chiefly obtained from exhausted refinery caustics and coal pitchs in the United States, South Africa and Europe As mentioned earlier, there are several procedure paths to methyl phenols and xylenol, nevertheless the most utilised 1s are: Production from coal pitch Production from naptha checking Methylation of phenol Synthesis paths from methylbenzene. The inside informations for each of the named procedure paths will be covered in the ulterior facet of this study, below is merely an lineation of the procedure paths and states where it is being utilized. Production FROM COAL TAR Historically, Cresylic acids ; a corporate name for the mixture of methyl phenols phenol and xylenol have been produced from coal pitch isolated during the gasification or carbonisation of coal. The chief feedstock for this procedure is coal pitch and the merchandise is normally a mixture of methyl phenol, phenol and xylenols. Countries and makers that employ the usage of coal pitch in the production of Cresylic acid are outline as follows: Cresylic acids have been traditionally produced from low-temperature coal pitchs in the United Kingdom, with the most outstanding manufacturer being Coalite chemicals. Cresylic acids and 3,5-xylenols are produced in Germany by RuA? tgers VFT AG utilizing coal pitch chemical science â€Å"CdF Chimie in France and Nippon Steel Chemical Co. of Japan have besides been bring forthing some coal pitch based cresols† { 1 } SASOL of South Africa is a major manufacturer of Cresylic acid, and it has been reported methyl phenols of 99 % pureness can be supplied for selected clients. Production FROM NAPTHA CRACKING In the USA, methyl phenols and xylenols have been produced from the naphtha fractions from catalytic thermic snap. The merchandises normally contain up to 1 % C6-C8 phenols. Sulphur Compounds such as alkyl and aryl thiols are treated with concentrated alkalic solutions in a procedure known as sweetener and methyl phenols and xylenols are recovered from exhausted acerb washes, bring forthing Na cresolates/xylenolates. The composing of the exhausted acerb cresolates scopes from 20-25 % of C6-C8 phenols and 10-15 % sulfur compounds. The acerb washes are so collected by companies that produce methyl phenols of which Merichem of Houston, Texas is the most outstanding. This method is largely confine to the USA because of the deficiency of cresolates feedstocks in other states. METHYLATION OF PHENOL This procedure is mostly used for the production of o-cresols and 2,6 xylenols, the procedure consists of merely one reaction measure based on phenol, which is comparatively expensive. Separating the merchandises can besides be dearly-won because of the similarity in boiling points. This procedure can either be carried out in the vapor stage or the liquid stage, with the most common path being the vapour stage path. Methylation in the vapour stage is utilized by: General Electric Co. in the United States ( capacity 5000 t/a of o-cresol and 70 000 t/a of 2,6-xylenol ) Inspec Fine Chemicals ( once Man-made Chemicals, now a portion of Laporte ) in the United Kingdom ( capacity 10 000 t/a of o-cresol and 2,6-xylenol, but the works is besides used for the production of 2,4-xylenol by methylation of p-cresol and for 2,5-xylenol and 2,3,6-trimethyphenol by methylation of m-cresol ) Chemopetrol in the Czech Republic ( capacity 10 000 t/a of o-cresol, m/p-cresol, 2,6-xylenol and other xylenols ) Nippon Crenol ( joint venture of Asahi Chemical Industry and Nippon Steel Chemical Company ; capacity 8000 t/a of o-cresol and 15 000 of t/a 2,6-xylenol ) , GEM Polymers ( joint venture of General Electric Company, Mitsui Chemicals Co. , and Mitsui Toatsu Chemicals ; ( capacity 2500 t/a of o-cresol and 11 500 t/a of 2,6-xylenol ) , Mitsubishi Gas Chemical Company ( capacity 5000 t/a of 2,6-xylenol ) and Honshu Chemical Industry Co. ( capacity 5000 of t/a 2,5-xylenol and chiefly 2,3,6-trimehyphenol by methylation of m-cresol ) all of which are in Japan Synthesis paths from methylbenzene There are three possible man-made paths from methylbenzene Sulfonation of methylbenzene Alkylation of methylbenzene with propene Chlorination of methylbenzene Sulfonation of methylbenzene: Sulfonation of methylbenzene is normally used in the production of p-cresol and o-cresol. Companies that makes usage of this procedure includes Inspec Fine Chemicals in United Kingdom ( 15000 -16000t/a ) Konan Chemicals, Japan ( 4000t/a ) Atul limited in India ( 5500t/a ) Commercial workss that employ the usage of Alkylation of methylbenzene with propene includes Mitsui Petrochemical Industries Limited and Sumitomo Chemical Co. Ltd which are both in Japan. The capacity of the workss are about 20,000t/a The lone commercial works in the universe that uses chlorination of methylbenzene is operated by BAYER AG in Germany. Easy handiness of Cl at a low monetary value might hold made Bayer s works still attractive. { 7 } Market Although used in aromas and nutrient additives, the chief markets for methyl phenol and xylenol are in the pharmaceutical and agrochemical industries. Pharmaceutical industry Cresol and xylenol derived functions, particularly p-cresol derived functions have been used as an of import intermediate in the pharmaceutical industry. Compounds derived from p-derivative include dilitiazem hydrochloride and trimethoprin. P-cresol derived functions such as Para-anisic aldehyde and p-anisic intoxicant have been used as feedstock for production of of import majority drugs. P-anisic aldehyde is used as a critical natural stuff in production of Dilitiazem. Dilitiazem hydrochloride is a calcium antagonist high blood pressure drug. It produces its antihypertensive consequence chiefly by relaxation of vascular smooth musculus and the attendant lessening in perepheral vascular opposition. The magnitude of blood force per unit area decrease is related to the grade of high blood pressure { 7 } . Introduced in the 1970s dilitiazem is presently being produced in Japan, India, Israel and Holland with the planetary production estimated at 1000t/a. it has been reported that there is expected growing of about 7-8 % in production of Dilitiazem during the following few old ages. It is besides of import to observe that India is presently the largest maker of p-anisic aldehyde. P-cresol have besides replaced Gallic acid as the get downing stuff for the production of 3,4,5-trimethoxy benzaldehyde which is later used in the synthesis of trimethoprim. States that make usage of the engineering for the for the synthesis of trimethoprin from 3,4,5-trimethoxy benzaldehyde includes USA, Canada, UK, Germany, France, Switzerland, Spain, Denmark and India. The planetary demand for trimethoprim is estimated to be around 500t/a with about 300t/a produced in India. These are merely two named illustrations of how methyl phenols and xylenols can be utilized in the pharmecutical industry. They serve as edifice blocks to legion other drugs which includes vitamin E. Going into the elaborate production of each drug produced is beyond the range of this study. However because of their huge application, the pharmaceutical industry is a moneymaking market for methyl phenol and xylenol and their derived functions. Agrochemicals The germicide, bactericidal and antifungal belongingss of Cresylic acids have been known for the last 60 old ages. Cresols were used in domestic application as bactericidal and para-chloro-meta-cresol is besides used as wood preservatives. However, it is non merely the first coevals derived functions of single methyl phenols but secondary and even third derived functions that have proved to be really of import works growing regulators or agrochemicals apart from their utilizations as family insect and pest repellants { 7 } As mentioned with the pharmaceutical industry, methyl phenol and xylenol are of import intermediate used in the production of agrochemicals, traveling into inside informations of the different agrochemical produced would be diversing from the chief intent of these study.

The Rise of Technology in the Two Decades

The Rise of Technology in the Two Decades Free Online Research Papers The contexts of teaching have changed since the last century. The classroom has evolved from the humble one room schoolhouse to a virtual classroom. With this enormous change come changes in the role of the teacher. What we have seen is the phenomenal rise of technology in the two decades; it has taken place against a complex backdrop of cultural and social change, advances in technology and shifts in educational theory and practice. We see new tensions, new requirements, new pressures and changes in the environment socially, economical and technological, this has led to modified teaching jobs. In my experiences students have become more difficult, less motivated, more requiring, more inclined to defend their rights than to fulfill their duty. The administration or the educational authorities are making more pressure for greater accountability. Bodies such as the Adult Learning Inspectorate (FE) and the Quality Assurance Agency (HE) oversee standards and assessments, and incorporate both inclusive learning and teaching strategies, and effective use of information and learning technologies (ILT), within their remit. There it seems less and less social recognition of the teaching job†¦ The question is are teachers prepared for these changes and pressures? The traditional picture I have of the teacher as the â€Å"Master of the knowledge† with an institutional power is disappearing. What we see now is a new style of teachers: leadership style seems more appropriate to respond to those challenges. This implies new competencies: the emotional competencies. Those ch anges remind us that the teaching act is not only a cognitive action but also and first a social and affective action where emotions interfere in the class and work atmosphere. Education, along with all public services in the UK, also faces calls for greater accountability, Accountability that in essence is a positive and productive step but in the larger frame of things damages the profession as ones actions stereotype the whole profession and not to mention taint it. Different educational disciplines enjoy various learning styles, delivery techniques, Resources and Support. Flexible Learning requires support but no teaching, Distance learning requires Resources and support but not 100% teaching, Practical Professions like medicine and accountancy require Teaching as well practical learning opportunities. What the article is stressing time and time again is that there is no denying that the future and existence of HE and teaching is intertwined and that there is no substitute to the teacher in such learning environments all other supporting profession and resources and technologies are important and have their place but the human presence in HE shows no sign of diminishing no matter how strong, professional, research proven, quality focused the proposal may be. On the contrary there is a greater need for experienced and Un-experienced practitioners to be trained on a standardized platform which may be beneficial to them and to the institution as sometimes a change process may be required to benefit institutional needs and enhance sustainability. Another issue which forces Education establishments to focus on is the volume of service it has to provide and commit to as each year the no of applications in HE are increasing. This leads to the subject of cost to be discussed, to counter this the role of a teacher is carried out by supporting professionals through personalized teaching. The cost of specialist teachers personalized delivery compared to a supporting professionals cost is tremendously higher hence more and more supporting teachers roles are being created to counter and keep under control the ballooning cost. Another theory for all parties involved is that the word â€Å"Teacher† is over emphasised, the important thing is that â€Å"is effective learning being accomplished† because that is the main issue here and Priority. As described from different points of view but the statement remains the same that Education, teaching, delivery, core competencies, Resources and practice are evolving, with the introduction and expansion of the e-learning components and supporting teacher roles in all professions the road to the future is a very uncertain one. Conclusion The changes which have taken place in recent years and which continue to shape the educational landscape of the UK Higher Education sector pose many new challenges for teaching staff. Nonetheless, perhaps because of rather than in spite of these challenges, it is evident that there are unique opportunities for the enhancement of teaching and learning in the higher education sector. The current emphasis on student-centred teaching, on promoting inclusion, and developing criticality all contribute towards improving the student experience and towards maximising learning potential. It is anticipated that the present trend towards collaborative learning which emphasizes key skills (such as ICT, communication and numeracy) will hopefully address a concern expressed by employers for many years by ensuring that graduates are better-prepared for the workplace. In conclusion I would state that various changes would occur when a fundamental shift in education is required and hence the future we need to be careful of how we implement strategies and policies when in HE as it importance to any nation is Paramount. Research Papers on The Rise of Technology in the Two DecadesStandardized TestingThree Concepts of PsychodynamicOpen Architechture a white paperThe Project Managment Office SystemComparison: Letter from Birmingham and CritoBionic Assembly System: A New Concept of SelfRelationship between Media Coverage and Social andPETSTEL analysis of IndiaAnalysis of Ebay Expanding into AsiaInfluences of Socio-Economic Status of Married Males

Applications of Information Technology

Driving force in educational reform Students have many opportunities to learn the basic computer skills to facilitate their learning. Multimedia learning centre (MMLC) in secondary school Classroom with a projector 1. 1 Applications of Information Technology in Our Daily Life ? IT at Home ? Smart home technology ?Allows people to control household and other domestic appliances over the Internet ? Personal computer ?Has become a necessity for many households 1. 1 Applications of Information Technology in Our Daily Life ? IT at Home ? Personal computer Uses of personal computer 1. 1 Applications of Information Technology in Our Daily Life ? IT at Home ? Home office ?Refers to a small computerized office setup at home ?Self-employed persons can work at home and communicate with others through the Internet. Clients Self-employed person Colleagues 1. 1 Applications of Information Technology in Our Daily Life ? IT in Public Places ? Information kiosk ?Provides information on nearby facilities in public places ? Electronic Money ?Can be used for petty cash payments ?Example: Octopus Octopus Kiosks 1. 1 Applications of Information Technology in Our Daily Life ? IT in Public Places Internet access service ?It is provided in various public places. ?The public can obtain information from the Internet more conveniently. Internet access service in public area 1. 1 Applications of Information Technology in Our Daily Life ? IT in Business ? Office automation ?Office automation helps office workers improve working efficiency productivity, data security and communications with others An automated office 1. 1 Applications of Information Technology in Our Daily Life ? IT in Business ? Intranet ?A private and small-scale Internet of an organization ?Helps improve workflow and enables efficient collaboration and  communication. Applications of Information Technology in Our Daily Life ? IT in Business ? E-commerce ?Refers to commercial activities carried out in an electronic network ?The Internet is now the most popular way to conduct e-commerce. e-bay, a popular online auction site 1. 1 Applications of Information Technology in Our Daily Life ? IT in Business ? E-commerce We can also purchase groceries online (http://www. wellcome. com. hk) We can book tickets online (http://www. cityline. com. hk) Applications of Information Technology in Our Daily Life ? IT in Government ? Information technology has become an  important means of providing government services. ? Under the ‘2004 Digital 21 Strategy’, the Hong Kong SAR government has committed to developing e-government. 1. 1 Applications of Information Technology in Our Daily Life ? IT in Government ? Electronic Service Delivery ?A web site that provides a wide range of government information and services ?The services include, application for government job vacancies payment of government bills purchasing books making appointments for The use of public services 1. 1 Applications of Information Technology in Our Daily Life ? IT in Government ? Employers concerned about exposing of company confidentials More difficult for employers to monitor work progress 1. 2 Information Technology and the Information Age ? Digital Divide ? Describes the growing gap between those people who can access and make effective use of IT and those who cannot ? Separate people into two groups ?Internet users ?Non-Internet users.

Edward Snowdens NSA Leaks Assignment Example | Topics and Well Written Essays - 500 words

Edward Snowdens NSA Leaks - Assignment Example The revelation was a show of gross violation of civil liberties. When Snowden resigned from CIA, he started working as a contractor at the NSA facility in the United States Military base in Japan. Snowden had excellent computer skills and was given top secret clearance. At the time, there were a lot of opportunities for contractors as the United States security outsourced intelligence tasks to outside private companies. Snowden found out the all-consuming NSA surveillance activities. He was also keen to notice that the mechanisms that were built into the United States system to keep NSA in check were not working. While working for one of the 13 hubs that spied on Chinese interests, he made anonymous contacts with journalists and leaked top-secret information to them. When he took a new job with the Booz Allen Hamilton, he got access to the list of machines that had been hacked by NSA from across the globe. He was among those who were allowed to look at the system. Other people with t op secret clearance did not have the permission to view all the classified files. Snowden was able to open files without leaving any electronic trace. He was a ghost user. As an administrator, he managed to persuade others to give him their login details. Snowden used his authority as a sysadmin to download documents to thumb drives. He was able to reach the NSA servers remotely from Hawaii. After completion of four weeks in his new job, he claimed to be unwell and requested for unpaid leave from his bosses at Booz. Then, he disappeared. There are a number of measures that should have been ensured to prevent Snowden’s leaks. Firstly, the top secret clearance should have been given to people with clear motives who have passed integrity tests. Secondly, there should have been a strong security policy barring any staff from disclosing his/her login details to prevent unauthorized access to files.  

The Lyrics About Artist's Difficulty in the Song Case Study

The Lyrics About Artist's Difficulty in the Song - Case Study Example According to the song, the artist explained his involvement in a gang that was into the illegal drug trade. As part of the song’s second stanza says, he became part of the gang while he was looking for a father that has gone. Besides this, he was in need of money, considering that peddling illegal drugs is the only way he can overcome his poverty. To show his gratitude and love for his mother, he sends money often. It is obvious in the song that the artist disliked how his mother took other men whose characters were only as bad as that of their irresponsible father. Despite this, the artist still managed to show his appreciation for the maternal love and concern he received even if he was beginning to be a major problem for his mother. The lines that said how he felt when his mother gave him a hug from a jail cell aptly depict this. It is not clear in the song if the artist’s father left the family before he died. However, whether he was actually present the whole time until he died, the artist considered him a stranger. This means that he was actually an entity whose existence was not appreciated at all by his kids. Because of this, the kids were more attached to their mother, the only person whom they saw carrying out the role of a parent to them. However, even at the end of the song, the lyrics about his difficulty in showing his appreciation to his mother are repeated. Despite the fact that he has already been sending money to her, he still thinks that this was not enough.

Historian’s Wizard of Oz Review Essay Example for Free

Historian’s Wizard of Oz Review Essay the movie `wizard of oz`, the strengths and weaknesses of each document, the major differences between the documents, and feedback on any links to present day political and economic issues. Investigate the authors background. Introduction The Historian’s Wizard Of Oz, first published in 1900, made ripples in the literary world and its writer L. Frank Baum shoot to eminence, and the result was so many of the sequels. When MGM, in 1939, decided to convert this hit into movie version, many of the adaptations of Wizard of Oz had been appeared on stage. Although the film did not cause swell at the box office sales in the beginning, but made waves, as people become conscious to its hidden meaning, years following its initial release. â€Å"Its status as an American classic owes more to television, as The Wizard of Oz became an annual television event in the 1950s and 1960s. The universal quality of the story and the warmth of the film made it appealing to people of all ages. Who wouldve thought that The Wizard of Oz contained hidden meanings†?1 Critics and observers has been interpreted this mega hit in different ways for more than a century now. And it is Henry Littlefield, a high school teacher; presented the most illustrious interpretation of The Wizard of Oz. it is a fact that Baum had been very much involved in active politics in the last decades of 1800s.But, Baum never made claim at any stage that that the story, in its contents, was an allegory for politics. â€Å"Baums story corresponded to the issues and figures in American politics at the end of the 19th century. Littlefield found that he could use The Wizard of Oz to teach history to his students, as the story functioned well as an allegory to the Populist movement and the 1896 presidential election†. 2 Populism, the Key Issues of 1896 and Impact on Culture More than 50 translations has been made in various languages of East and West of The Wizard of Oz so far. Even, due to its popularity, different countries adapted in a way to match the corrosponding conditions of the local culture. For instance, â€Å"in some countries where the Hindu religion is practiced, abridged versions of the book were published in which, for religious reasons, the Tin Woodsman was replaced with a snake†. 1 When Henry Littlefield article was published in American Quarterly then people began to realize that The Wizard of Oz was a parable on Populism, a prototype of a rural political awakening in the last decades of 1800. The Populist Party of late 19th century mobilized the Farmers Alliances to its advantage. â€Å"Farmers faced considerable economic hardship and they believed that monetary policy was determined by eastern bankers and industrial interests. The Farmers Alliances wanted greater government regulation of railroads, tax reform and the free coinage of silver to increase the money supply†. 3 Wizard of the Oz made great impression on American, Russian, and other European countries. â€Å"A mere sampling of the breadth in which it is referenced might include Futurama (which parodied it in an episode), The Cinnamon Bear (a 1938 radio serial), RahXephon (a 2002 Japanese animated television show), Zardoz (a 1974 Sean Connery movie), Wizard and Glass (a 1997 Stephen King fantasy/Western novel), and the science fiction literature of Robert Heinlein†. 4 The Wizard of Oz: the movie: the Ups and Downs Although Baum produced the Oz film series in 1908 and 1914 but the most famous adaptation is the 1939 film, The Wizard of Oz, featuring Judy Garland as Dorothy. Francis MacDonell argues that the movie is an allegory of New Deal, Franklin D. Roosevelts program of social welfare to combat the widespread hardship of the Great Depression in the 1930s. The man primarily responsible for injecting this political message into the film was lyricist E.Y. Yip Harburg, who was a socialist and supporter of Roosevelts policies. Harburg had written the lyrics to Brother Can You Spare a Dime? which served as an apt anthem for the Great Depression. 5 The movie is magical and creative, its pluses is as MacDonnell described, The Wizard of Oz, †¦is a brightly-colored, visually bold, rapidly paced extravaganza, full of gaudy sets, outlandish costumes, and way-over-the-top acting.6 But, some of the scenes were insipid (the ridiculous conclusion of the poppy field sequence) or misplaced (the Cowardly Lions song, which occurs at perhaps the least appropriate moment). 5 A look into Frank Baum’s Life and His Political Ambitions L Frank Baum was born on 15 May 1856 in Chittennnango, New York. His earlier interest in the newspapers and magazines but when he entered in his 20s he started taking interest in theaters and operas. His mother was one of the leading champions of the Women’s Rights Movements. He shoot to eminence when he teamed up with Maxfield Parrish, the illustrator, and wrote his first book Mother Goose in Prose, afterwards he together with illustrator William Wallace he published Father Goose, His Book. Both books had drawn huge attention from the children. Nobody can say with surety that Frank Baum really preplanned to produce a work that was so much critical of the monetary aspects of the 1896 election. â€Å"Yet it is not too much of a stretch to interpret the imagery of the story in this light. Of all the fantasy characters Baum could have created to accompany Dorothy on her journey, he chose characters that evoked so strongly the occupations of ordinary people in the late-19th century—farmers and industrial workers. Lawrence Swaim suggests that Baum may not have been conscious of [the political significance of the Oz imagery], which would explain why the political references in Baums books pop up in such a surrealistic way.1 It is surprising none of the Baum biographers identified that if Baum had any political intention to write The Wonderful Wizard of Oz. â€Å"If Baum had been a Populist supporter, the imagery in The Wonderful Wizard of Oz suggests that Baum had lost his zeal for the Populist movement.† 1 Endnotes 1. Ranjit S. Dighe, The Historians Wizard of Oz: Reading L. Frank Baums Classic as a Political and Monetary Allegory (Westport, CT: Praeger, 2002) 2. Richard Jensen, The Winning of the Midwest: Social and Political Conflict, 1885-1896 (Chicago: University of Chicago Press, 1971) 3. Martin Gardner and Russell B. Nye, eds., The Wizard of Oz and Who He Was (East Lansing: Michigan State University Press, 1994) 4. William Leach, Land of Desire: Merchants, Power, and the Rise of a New American Culture, (New York: Vintage Books, 1993) 5. Lynette Carpenter, Theres No Place Like Home: The Wizard of Oz and American Isolationism, Film and History 15 (May, 1985), pp. 37-45 6. Francis MacDonnell, The Emerald City Was the New Deal: E.Y. Harburg and The Wonderful Wizard of Oz, Journal of American Culture (13 (Winter 1990), pp. 71-75.

America Needs The Patient Protection Affordable Care Act Essay

The Patient Protection Affordable Care Act (PPACA) is a federal statute that was signed into law by President Barak Obama on March 23, 2010. The PPACA which is commonly referred to as â€Å"Obamacare† was endorsed by lawmakers based on the objective of shifting healthcare cost from the employer to the government. The enactment of the PPACA has been viewed as unprecedented by many based on the constitutionality concerns related to healthcare reform. In order to address some of the concerns related to healthcare reform it is important to go back and view the nation’s history. Prior to the nation experiencing globalization and free trade, businesses were designed as employee based models, freely offering health care coverage to their employees as a perk to promote loyalty among other incentives within their companies. As a result of globalization, employers have become less capable of offering the same healthcare coverage based on competition with other countries. In order for companies to stay competitive with the current free trade agreements, companies are finding it necessary to cut their overhead expenses, hence cutting healthcare coverage for employers. In other words, in a global economy the healthcare status quo is unsustainable; wages and incomes have progressively flat lined over the years due to the increase in healthcare coverage costs, these costs makes it impossible for employers to give raises to their employees and stay competitive within a global market. These issues endanger the survival our nation’s small businesses as well as large corporations, basically disrupting our nation’s commerce, which entitles the government to intercede with healthcare reform based on the commerce clause enumerated power listed ... ..., R. (2011). Compliance Matters. Matters of Integrity: Examining anti-fraud measures in the health care reform law. PT in Motion, 3(4), 37-40. Retrieved from EBSCOhost. Filson, C., Hollingsworth, J., Skolarus, T., Quentin Clemens, J. J., & Hollenbeck, B. (2011). Health care reform in 2010: transforming the delivery system to improve quality of care. World Journal of Urology, 29(1), 85-90 Pickert, K. (2011). Obamacare Goes Under The Knife. Time, 177(2), 48-51. Retrieved from EBSCOhost. Healthcare Reform: Retrieved from Public Broadcasting Services: August 16, 2011: PBS.org Stengel, R., & Ford, A. (2011). One Document, Under Siege. (Cover story). Time, 178(1), 30-45. Retrieved from EBSCOhost. Wilson, C. B. (2010). A Prescription for America's Health Care System. Vital Speeches of the Day, 76(9), 421-424. Retrieved from EBSCOhost. (Healthcare Reform, 2011)

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

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

To Vaccinate or Not to Vaccinate

A lot of parents stress over the choice of deciding wither or not to vaccinate their children. The reason why deciding to vaccinate children is so difficult is due to the wide range of myths and side effects that are connected with vaccinations. Examples of myths spread to parents all over the United States is that the diseases don’t even exist anymore, rumors of vaccinations weakening a child’s immune system, and the risk of a child becoming autistic due to thimerisol in vaccinations causing autism. Side effects also scare parents out of getting their children vaccinated like brain damage, seizures, or allergic reactions. But then parents are pulled back to the thought of the possibility of their child or children catching a very serious life threatening disease. Any of these terrible things occurring in a child’s life makes it very easy for a parent to steer clear of the whole situation, and in ending result, not get their child vaccinated. When children aren’t vaccinated, they are left defenseless against diseases like hepatitis B, measles, mumps, chicken pox, polio, pertussis (whooping cough),   rubella, and more. All these diseases have the ability to easily kill a child within days, and if it weren’t for the vaccines protection over many children in the United States, the spread of these diseases would travel rapidly. There are a lot of people that do not recommend or get vaccinations for children because they think it is unnecessary to vaccinate for a disease that is no longer around. But let’s look at the big picture. If everyone stopped getting the vaccinations what would happen? Todd Neale from Medpage today inquires in San Diego 2008, â€Å"  Although the rate of two-dose immunization against measles was 95% in the area, a single case of measles from a 7-year-old child returning from overseas sparked an outbreak that exposed 839 people and sickened 11 other children†. If those 839 people weren’t protected with strong immune systems or vaccinations, there would have been a drastic dilemma. This is a perfect example of how fast a disease can get out of control. When parents think that its o. k. not to vaccinate because the diseases aren’t around anymore, they are really relying on other children who are vaccinated to keep their own children healthy, which is a gamble. In other words, According to the Children’s hospital of Philadelphia, if the immunizations rates drop only a little bit, outbreaks of diseases would sweep across the country rapidly. Another reason parents don’t want to vaccinate is because of the rumor of he vaccinations weakening children’s immune system. According to the Children’s hospital of Philadelphia â€Å"If 11 vaccines were given to infants at one time (which they aren’t), then about 0. 1 percent of the immune system would be used up, but because B cells and other lymphocytes are constantly replenished, a vaccine never really uses up a fraction of the immune system. For example, the immune system has th e ability to replenish about 2 billion lymphocytes each day. Also a study in Germany revealed that 496 vaccinated and unvaccinated children who received immunizations within the first three months of life had fewer infections with vaccine-related and unrelated pathogens than the non-vaccinated group. So here is the proof that vaccinations will not affect a child’s immune system. Then there is the big scare of vaccines containing the ingredient thimerisol causing autism in children. According to FDA, thimerosal is a mercury containing preservative found in vaccines that prevents bacterial and fungal growth which might occur with repeated puncture of multi dose vials. A lot of controversy has been held between doctors and parents because of prediction of autism being linked to thimerosal. According to the Centers for Disease Control and Prevention Vaccine Safety Datalink, â€Å"Preliminary results from the VSD Thimerosal Screening Study published in 2003 did not find an association between thimerosal exposure and autism risk and recent ecological studies has not found a correlation between thimerosal content of vaccines and autism rates†. Numerous studies by many scientists have been done and prove that Thimerosal and autism are not related. Examples: Vaccine Education Center at The Children’s Hospital of Philadelphia, â€Å"Multiple studies have shown that thimerosal in vaccines does not cause autism†. Another reason people do not get their children vaccinated is because of risks associated with getting the vaccinations. Scary examples of some of the side effects associated with vaccinations include: seizures, brain damage, high fevers and even death. Let’s take the vaccine for hepatitis B as a good example. The Children’s Hospital  of Philadelphia states, â€Å"About one of every 600,000 doses of hepatitis B vaccine is complicated by a severe allergic reaction called anaphylaxis. The symptoms of anaphylaxis are hives, difficulty breathing and a drop in blood pressure. On the other hand, every year about 5,000 people die soon after being infected with hepatitis B virus. According to Car Accident Statistics from Edgar Snyder and Associates,† Each year, lmost 250,000 children are injured in car crashes, meaning nearly 700 kids are harmed every day. But this doesn’t stop people from putting their children in cars. The chicken pox vaccine is another example that side effects are very rare. According to Medic 8, â€Å"A macular or accine rash usually consisting of a few lesions at the injection site is reported in 3% of children and 1% of adolescents. Cases of allergic reactions to children are very low a nd should hold any parent back from getting children vaccinated. So in conclusion, the diseases that vaccines are made to treat are still around, and it is very easy for a disease to spread. Vaccines do not weaken a child’s immune system because of B cells and lymphocytes being constantly replenished by immune system. Numerous studies have been conducted proving that thimerisol does not cause autism. And The risk of a child having a adverse reaction to a vaccine is so low that its safer than driving down the street in a car. Protect your children from deadly diseases, get them vaccinated.

Embryonic Stem Cells for Research Applications essays

Embryonic Stem Cells for Research Applications essays Embryonic stem cells are undifferentiated cells that can divide indefinitely and develop into more mature, specialized cells. In the course of development, they ultimately become skin cells, neurons, muscle, blood cells and every other of the 220 cell types that make up the tissues and organs in the body. Through years of research, scientists have found that stem cells show an ability to divide indefinitely in their undifferentiated state in the laboratory. Although stems cells also exist in adult humans, embryonic stem cells are the most researched and debated. Currently, the U.S. has had limited federal funding of embryonic stem cells to the 60 stem cell lines that already exist. This is very unfortunate since it limit's the potential benefits that new stem cell lines might offer. The embryos from which human embryonic stem cells are derived are typically from four or five-day-old blastocysts. The blastocyst includes three structures: the trophoblast, which is the layer of cells that surrounds the blastocyst; the blastocoel, which is the hollow cavity inside the blastocyst; and the inner cell mass, which is a group of approximately 30 cells at one end of the blastocoel. Human embryonic stem cells are isolated by transferring the inner cell mass into a petri dish containing a culture medium. The inner surface of the culture dish is typically coated with a feeder layer, consisting of mouse embryonic skin cells that have been treated so they will not divide. The feeder cells release nutrients into the culture medium and act as a sticky surface allowing the inner cell to attach. Recently, scientists have begun to devise ways of growing embryonic stem cells without the mouse feeder cells. This is a significant scientific advancement because of the risk that virus es or other macromolecules in the mouse cells may be transmitted to the human cells. For several days, the cells of the inner cell mass proliferate, and when this occurs, the...

Negligence in medical malpractice based in medical law Research Paper

Negligence in medical malpractice based in medical law - Research Paper Example In the worst instance, a hospital error causes death of a patient, bringing about grief and financial strain on the deceased’s relatives (Andrew Grubb 445). A wrongful-death lawsuit can be filed to demand damages for lost wages and suffering or pain. Examples of hospital errors that could result in medical malpractice include: - Birth injuries: Improper labor services resulting injury to a baby, at times leading to complications such as Erb’s palsy or cerebral palsy. - Prescription errors: This may be over or under medication, or administration of the wrong drug. - Improper diagnoses: A patient may be treated for an illness he or she is not suffering from or a disease remains untreated because of the doctor’s failure to recognize a intimidating condition. - Surgical errors: Negligence may lead to infections or surgery on the incorrect body part or even the wrong patient. Medical malpractice law lies under personal injury law subset and its practice frequently overlaps with litigation law. This area of practice deals with legal claims on medical care specialists when the care they offer or the lack thereof, cause injury, damage, harm and/or death of the patient. The laws guiding medical malpractice varies from one state to another. These highly regulated procedures explain many aspects of the practice process, including the following: - If notice of the malpractice assertion have to be given to the medical professional before filing; - If the claim must be handed to a malpractice review board before being filed in court; How speedily a medical malpractice claim should be filed; Determining the essential qualifications for a professional medical witness, for the reasons of testifying; and Establishing statutory caps on compensations that may be awarded to the plaintiff. Although medical negligence is normally attributed to the medical professionals responsible for patients’ diagnosis, medical care / medical treatment, medical corporations, managed care organizations, clinics and hospitals may as well be sued for their employees’ actions (Stauch 66). As with every personal injury claim, proof of negligence is vital. The tort of negligence comprises of 4 elements which must be all proven to attain this verdict. The 4 elements include: (i) There was a duty of medical care owed; (ii) The medical care professional desecrated the standard of care obliged, which demonstrated negligence; (iii) This negligenc e by the medical professional caused the injury /harm; and (iv) There were compensable damages directly resulted from the injury/harm suffered . Since there is a patient - doctor relationship, the first element is usually already established in these kinds of claims. For the 2nd element, if there is no an obvious and glaring blunder, expert witness testimony is commonly implemented to prove the negligent behavior or actions. The complainants are the party passing the action and they bear the burden of attesting these elements in their claims against the medical care giver, the defendant (Smith). Medical malpractice claims are the subject of extreme controversy. Healthcare professionals and medical care businesses have encouraged legal reforms meant to eradicate big money awards for health damages, claiming that defending a case against the various lawsuits and the exorbitant compensations have resulted in a costly healthcare costs. In some states, this aggressive advocacy for these measures has resulted to