Overview of Tourette Syndrome

Contribution of Digital Projections for Approaching Mise En Scene in Contemporary Theatre Performance Essay Example for Free

Commitment of Digital Projections for Approaching Mise En Scene in Contemporary Theater Performance Essay In this exploration paper I’m going to depict about theater creation innovation which it is utilizing computerized creation and how it is soak to the mise en scene. Artistic auditorium is term of utilizing advanced projection in contemporary theater. That can be quickly portrayed as a combination of live execution and the enchantment of the big screen. By using the best emotional gadgets that every work of art needs to flock a story and engage a crowd of people; the conceivable outcomes to make intriguing stories and stage elements through the collaboration of stage and realistic plan is energizing. Artistic performance center is a contemporary style of dramatization that rotates around utilizing pre-altered and live vision successions to be anticipated onto screens and surfaces. These groupings are then coordinated with the live presentation to make emotional implying that connects with the sensational activity in front of an audience. The incorporated utilization of projection during scenes and scene changes permits the stage activity to get ceaseless, along these lines making an acceptance of difficult ideas mistrust that draws in the crowd. In the consistently expanding innovative condition, increasingly more data and narrating is being brought to us through visual pictures and screens; contemporary crowds can peruse layered visual writings. In building up an innovative reason for the usage of true to life arrangements in live execution you need to think about different components; how to utilize the anticipated vision without overpowering the stage execution, making a showy and visual structure that upgrades the sensational importance and the story decision among screen and stage activity. To direct the creation and creation of new work we have built up a portrayal of the components of realistic mix for live execution. To go with the Cinematic Theater style they have contrived an exhaustive inventive method of reasoning that we instruct to instructors and understudies utilizing the shows and components that we use to create visual execution work. Essential Conventions: The fundamental guideline of Cinematic Theater is to make a consistent encounter by utilizing visual groupings anticipated onto screens or surfaces, related to set structure and lives execution to make diverse sensational spaces. The true to life configuration should be dynamic all through the presentation, to accomplish this there are two essential shows that are utilized to incorporate the phase with the Visual plan: Cinematic Backdrop is the live visual condition that cooperates with live scenes in front of an audience to make a unique visual structure to improve the sensational activity. There number of approaches to use the live background: Cinematic Transitions are the visual arrangements between the live stage scenes that permit the exhibition to keep during scene changes keeping the crowd locked in. These advances work very well with music and the utilization of famous tunes to go with these artistic arrangements to include significance and activity, particularly if the music picked is illustrative of the story. Visual Conventions: In delivering a Cinematic Theater creation there are number visual shows that can be used to make a really coordinated exhibition. Style Elements: When conceptualizing the visual segment of an artistic theater execution it is imperative to address the general style regarding the content/story/setting. In beneath depict innovations, which is utilizing for the true to life theater. Screens and Surfaces: Traditionally projection has been utilized on one screen straightforwardly behind the stage activity, much like a film screen. With increasingly portable projectors and screens it is conceivable to consider better approaches to place and venture pictures. Various screens can be utilized to make various impacts, in What Simon Said? there back anticipated screens were utilized to make the dividers of the character’s room as the true to life foundation. We imagine having the option to make enormous scope vivid conditions to make far off skylines, urban design or various pictures. Stage configuration permitting the use of anticipated pictures on surfaces can make a powerful canvas on which to apply vision. The applications are just restricted by your creative mind and capacity to situate the projector. A few models include: a window space to see outside, a mirror to show emblematic portrayals of character, floor space to make a pool of water, smoke, draperies and so forth. Lighting structure: It is significant while joining video into live execution that you consider the impact of lights on the screen surface. One trouble in setting lights is that they can essentially debase the brilliance and shade of the screen pictures if there is light either straightforwardly hitting or ricocheting from the floor onto the screen. One arrangement is to set the screen up from the floor and putting a few squares/organizing in front to obstruct a portion of the bobbing light. When considering shading gels it is basic to consider hues utilized in the screen pictures and attempt to coordinate them as well as could be expected to give a mixed impact. Mise-en-scã ¨ne Mise-en-scã ¨ne is a French expression and starts in the theater. That is to say, truly, put in the scene. For film, it has a more extensive significance, and alludes to nearly everything that goes into the organization of the shot, including the structure itself: confining, development of the camera and characters, lighting, set plan and gen baron visual condition, even stable as it expounds the sythesis. Mise-en-scã ¨ne can be characterized as the verbalization of artistic space, and it is correctly space that it is about. Cutting is about time; the shot is about what happens in a characterized region of room, flanked by the edge of the film screen and controlled by what the camera has been made to record. That space, the mise-en-scã ¨ne, can be one of a kind, shut off by the edge, or open, giving the fantasy of more space around it. Four parts of mise-en-scene, which cover the physical specialty of the theater, are setting, ensemble, lighting and development of figures. Control of these components gives the executive a chance to arrange occasions. Utilizing these components, the movie executive stages the occasion for the camera to give his crowd distinctive, sharp recollections. Chiefs and movie researchers the same perceive mise-en-scene as a basic piece of the director’s innovative craftsmanship. End In this exploration I’m attempting to clarify ‘contribution of advanced projections for drawing closer mise en scene in contemporary theater performance.’ In the initial segment I quickly clarify what is ‘Digital projections’, ‘mise en scene’ and ‘contemporary theater performance’. Mise en scene is French term and it for the most part use for film thankfulness or film analysis. Be that as it may, beforehand this term use for pundit theater creations. Genuine importance of mise en sence is ‘put in the Frame’. Casing is fundamentally clarified in both film and theater. So I think utilizing term of mise en sence is conceivable in theater creations. For making theater sets, props and space for the most part utilizing hard materials. Be that as it may, in this work of art those things make by advanced projections. This is significant improvement of the contemporary theater creations. Further more I’m clarifying favorable circumstances and inconveniences of utilization advanced projection in this work of art. At long last I’m discussing choreographers who utilize this artistic expression effectively and indicating scarcely any recordings. Fundamentally this is new fine art. It is difficult to contrast and other theater execution, which isn't utilizing advanced projections. Choreographers step by step make new craftsmanship pieces utilizing projections. So I think this is significant event of advanced media use in the public eye.

Great Topic Ideas for Problem Solution Essay Writing

Great Topic Ideas for Problem Solution Essay Writing Problem solution essay are often assigned to students as a basic academic writing requirement. In essence, it should describe a specific issue and offer its effective solution. Completing this academic assignment requires your detailed research before getting started. That’s because you need to gather enough information to adequately analyze a given situation, determine why it requires your attention, offer an effective solution, and evaluate its impact. Your basic target is to advocate for specific solutions or strong cases. This type of writing also involves solid arguments to convince the targeted audience to take action. Look for excellent and fresh problem solving essay topic ideas to succeed. Intro Writing a problem solution paper is a common requirement for all students. It’s an essay that defines a specific problem and discusses its effective solutions. The main thrust is to argue for your chosen solution to a given problem and convince other people to address it as soon as they can. Which problem to describe? Which solution to include? In this type of writing, you should discuss all issues based on the chosen topic and suggest viable solutions. To decide on a specific problem, you need to analyze possible options, expressions to introduce them, relevant results, and how to illustrate them in your paper. If you find it hard to choose the best solution, decide how it can be implemented and choose the most effective ways to make useful suggestions. Consider interesting problem-solution paper topic ideas to make these choices accordingly. Reference on how to write problem solution essay Completing this academic assignment starts with an introductory paragraph that identifies your chosen problem. Paint its clear image to make it more compelling for other to read your paper. Include a hook to grab their attention and appeals to their emotions by stating the consequences of your problem. The next part is elaborating and it requires you to present a given issue from a broad perspective. Write about its historical and other backgrounds and make the factual claims supported by reliable sources through endnotes or footnotes. Use correct citations to maintain a trustworthy style. After presenting your problem, you need to state a concrete solution. The main point of writing your problem solution essay is to convince readers that it’s the best option. To achieve this goal, your offered solution must be feasible, logical, and supported by strong evidence. This piece of writing should end with a logical conclusion that restates your problem and sums up all arguments into the most effective solution to address it. This paragraph should include a certain call to action to encourage the targeted audience to participate in your suggested solution or search for alternatives. Include potential consequences to create a sense of urgency. Essay samples for inspiration To find excellent problem solution essay topic ideas and take other steps necessary to end up with a perfect piece of writing, look for credible samples. Use them as your comprehensive guides at any stage of the writing process. Tips for writing There are some basic steps that should be taken to write a great problem solution paper. First, make a strong thesis statement to explain a particular problem. Create a connection with your readers because you need to convince them that it can be solved. You also need to clarify an efficient solution scheme and add more details to prove that it really works. Be sure to choose the best topics for problem solution essay writing. A list of topics for problem solution essay It’s often hard for students to choose good essay topics for problem solution essays because of available options. Check the following useful suggestions grouped based on their general themes. Social problems Check these helpful topics for problem solution essay on social issues: Address the need for helping homeless people in the community; How to wipe out racism totally; The most effective way to stop teen pregnancy; How to stop everyone from drunk driving; How divorces can be prevented; How to raise the awareness of teenagers to force them to be more cautions on roads; How to help the victims of family violence; How to improve the modern welfare system to destroy a cycle of poverty; Stopping gun violence effectively; How to handle illegal immigration; How to prevent human trafficking; Reducing the negativity that children face through video games, online activities, and movies; Finding the best balance between avoiding abusing and free speech; Convincing people to live without bad eating habits and smoking; How available employment opportunities can be improved? Relationship problems Interesting problem solution essay topics about relationships include these fresh ideas: How to take further steps when you’re just friends; Freeing yourself from unhealthy relationship; Saving your friends from bad relationship choices in life; Effective ways to deal with cheating partners; Should girls take the first step in relationships? How to define real relationships in the modern world; Face-to-face communication and texting; Group barriers that should be broken. Sports and entertainment problems These easy problem solution essay topics can help you write the best paper on sports and entertainment issues: How steroid use can be limited in sports; Do children train too hard at young ages? Should all college athletes be paid? How coaches can encourage athletes to succeed; What is the most effective way for young athletes to learn sports? How to limit the negative influences of reality shows? Should kids play video games less often? How to increase attendance at sporting events? How players can prepare themselves for future losses; How sports injuries can be effectively prevented. Family problems How parents can address social media issues of their children; How to stop parents to push kids too hard in academics and other areas; Helping families cope with children with mental conditions; How parents can improve honesty in their kids; How to improve children’s discipline and make them be more effective; How to promote finding the best parents and adoption rates; How parents can teach their kids to manage money wisely; Teaching faith to children. Politics Solving gun violence politically; Businesses that influence important political decisions through donations; How to solve the problem of illegal immigration; Effective programs for minority integration; Fairer political representations. Health How to relieve social anxiety by spending more time with your friends; Short exercise sessions during breaks to relieve back pain; Using special fitness apps if you lack regular exercises; How to ban food products with GMOs; Going offline on weekends and in the evening; How to get rid of aggressive behaviors; Melatonin for insomnia; Making all tobacco products illegal to reduce high lung cancer rates. Educational problems How to improve education for struggling students; Effective ways for schools to address different behavioral issues; Addressing special education needs of high-school students; Effective ways to make students more active; Special programs for talented and gifted students; How to prepare home-schoolers for their college; Allocating enough resources and funds for extra programs, including sports and fine arts; How to stop bullying, teasing, and violence at school; How to improve education for failing students; Should digital textbooks be used instead of the traditional ones? How to attract educated and talented teachers to public schools; Should physical education be mandatory in all schools? Should students use their laptops at school? How schools can improve a chance on building a healthier society? How to choose a right topic? If you don’t know where and how to find the best topic for your next problem solution paper, there are some easy guidelines that can help you make the right choice. Look for interesting and original problem solution essay topic ideas online, in local libraries, and other sources. Remember that choosing personal issues is not a clever idea because this academic paper should be focused on real-world matters. However, your topic shouldn’t center on such large-scale issues as world piece or national threats because their scope is too vast to cover in your essay. Pay attention to different ground-level problems that have an impact on people’s lives and you’ll find a number of suggestions. Look for something that really interests you to make the entire writing process easier and more enjoyable. Take your targeted readers into consideration when making a final topic choice. Conclusion Writing an impressive problem solution paper may seem quite a challenging academic task at first. However, if you use all the guidelines and tips mentioned above, you’ll make it much easier. Before submitting a final draft, check it for all possible mistakes and ensure that it follows the necessary formatting rules. It’s also necessary to reference your problem solution essay correctly. If you still have any hardship when completing this academic assignment, it’s time to use custom writing services online. Our skilled and talented professionals are always there to help you, so that you shouldn’t hesitate to entrust your problem solution paper to them. Their reliable and efficient services are designed to help you with any academic writing hardship or difficulty.

Biography of Sam Houston, Founding Father of Texas

Sam Houston (March 2, 1793–July 26, 1863) was an American frontiersman, soldier, and politician. As commander of the forces fighting for Texas’ independence, he routed the Mexican troops at the Battle of San Jacinto, which essentially won the struggle. Over his long career, he was a successful and effective statesman, serving as congressman and governor of Tennessee and the first and third president of the Republic of Texas, before becoming a U.S. senator and governor for the state of Texas. Fast Facts: Sam Houston Known For: After winning the Battle of San Jacinto, which effectively won the Texas War of Independence, Houston was the founding statesman of Texas, serving as the first president of the Republic of Texas, then a U.S. senator and governor for the state of Texas.Born: March 2, 1793 in Rockbridge County, VirginiaParents: Samuel Houston and Elizabeth (Paxton) HoustonDied: July 26, 1863 in Huntsville, TexasEducation: Minimal formal education, self-taught, founded Cherokee school, read law in Nashville under Judge James TrimblePositions and Offices: Attorney general for Nashville Tennessee, U.S. congressman for Tennessee, governor of Tennessee, major general of the Texas Army, first and third president of the Republic of Texas, U.S. senator for Texas, governor of TexasSpouse(s): Eliza Allen, Diana Rogers Gentry, Margaret Moffette LeaChildren: With Margaret Moffette Lea: Sam Houston, Jr., Nancy Elizabeth, Margaret, Mary William, Antoinette Power, Andrew Jackson Houston, William Rogers, Te mple Lea HoustonNotable Quote: Texas has yet to learn submission to any oppression, come from what source it may. Early Life Houston was born in Virginia in 1793 to a middle-class family of farmers. They went West early, settling in Tennessee—which was, at that time, part of the western frontier. While still a teenager, he ran off and lived among the Cherokee for a few years, learning their language and their ways. He took a Cherokee name for himself: Colonneh, which means Raven. Houston enlisted in the American army for the War of 1812, serving in the west under Andrew Jackson. He distinguished himself for heroism at the Battle of Horseshoe Bend against the Red Sticks, Creek followers of Tecumseh. Early Political Rise and Fall Houston soon established himself as a rising political star. He had allied himself closely to Andrew Jackson, who in turn came to see Houston as a protà ©gà ©. Houston ran first for Congress and then for governor of Tennessee. As a close Jackson ally, he won easily. His own charisma, charm, and presence also had a great deal to do with his success. It all came crashing down in 1829, however, when his new marriage fell apart. Devastated, Houston resigned as governor and headed west. Sam Houston Goes to Texas Houston made his way to Arkansas, where he lost himself in alcoholism. He lived among the Cherokee and established a trading post. He returned to Washington on behalf of the Cherokee in 1830 and again in 1832. On the 1832 trip,  he challenged anti-Jackson Congressman William Stanberry to a duel. When Stanberry refused to accept the challenge, Houston attacked him with a walking stick. He was eventually censured by Congress for this action. After the Stanberry affair, Houston was ready for a new adventure, so he went to Texas, where he had purchased some land on speculation. He was also charged with reporting to Jackson about the political climate and events in Texas. War Breaks out in Texas On October 2, 1835, hotheaded Texan rebels in the town of Gonzales fired on Mexican troops who had been sent to retrieve a cannon from the town. These were the first shots of the Texas Revolution. Houston was delighted: by then, he was convinced that Texas separation from Mexico was inevitable and that the fate of Texas lay in independence or statehood in the United States. He was elected head of the Nacogdoches militia and would eventually be appointed major general of all Texan forces. It was a frustrating post, as there was little money for paid soldiers and the volunteers were hard to manage. The Battle of the Alamo and the Goliad Massacre Sam Houston felt that the city of San Antonio and the Alamo fortress were not worth defending. There were too few troops to do so, and the city was too far from the rebels east Texas base. He ordered Jim Bowie to destroy the Alamo and evacuate the city. Instead, Bowie fortified the Alamo and set up defenses. Houston received dispatches from Alamo commander William Travis, begging for reinforcements, but he could not send them as his army was in disarray. On March 6, 1835, the Alamo fell. All 200 or so defenders fell with it. More bad news was on the way, however: on March 27, 350 rebel Texan prisoners were executed at Goliad. The Battle of San Jacinto The Alamo and Goliad cost the rebels dearly in terms of numbers of soldiers and morale. Houstons army was finally ready to take the field, but he still had only about 900 soldiers, far too few to take on General Santa Annas  Mexican army. He dodged Santa Anna for weeks, drawing the ire of the rebel politicians, who called him a coward. In mid-April 1836, Santa Anna unwisely divided his army. Houston caught up with him near the San Jacinto River. Houston surprised everyone by ordering an attack on the afternoon of April 21. The surprise was complete and the battle was a total rout  with 700 Mexican soldiers killed,  about half of the total. The other Mexican soldiers were captured, including General Santa Anna. Although most of the Texans wanted to execute Santa Anna, Houston did not permit it. Santa Anna soon signed a treaty recognizing Texas independence which effectively ended the war. President of Texas Although Mexico would subsequently make several half-hearted attempts to re-take Texas, independence was essentially sealed. Houston was elected the first president of the Republic of Texas in 1836. He became president again in 1841. He was a very good president, attempting to make peace with Mexico and the Native Americans who inhabited Texas. Mexico invaded twice in 1842 and Houston always worked for a peaceful solution; only his unquestioned status as a war hero kept more bellicose Texans from open conflict with Mexico. Later Political Career Texas was admitted to the United States in 1845. Houston became a senator from Texas, serving until 1859, at which time he became governor of Texas. The nation was wrestling with the slavery issue at the time and Houston was an active participant in the debate, opposing secession. He proved a wise statesman, working always toward peace and compromise. He stepped down as governor in 1861 after the Texas legislature voted to secede from the Union and join the Confederacy. It was a difficult decision, but he made it because he believed that the South would lose the war and that the violence and cost would be for naught. Death Sam Houston rented the Steamboat House in Huntsville, Texas in 1862. His health took a downturn in 1862 with a cough that turned into pneumonia. He died on July 26, 1863, and is buried in Huntsville. The Legacy of Sam Houston The life story of Sam Houston is a gripping tale of rapid rise, fall, and redemption. His second, greatest ascent was remarkable. When Houston came west he was a broken man, but he still had just enough prior fame to immediately take an important role in Texas. A one-time war hero, he prevailed again at the Battle of San Jacinto. His wisdom in sparing the life of the defeated Santa Anna is considered to have been crucial to sealing Texas independence. Through this second rapid rise, Houston was able to put his more recent troubles behind him and become the great man that had seemed to be his fate as a young man. Later, Houston governed Texas with great wisdom. In his career as a senator from Texas, he made many prescient observations about the Civil War that he feared was on the nations horizon. Today, many Texans consider him among the greatest heroes of their independence movement. The city of Houston is named after him, as are countless streets, parks, and schools. Sources Brands, H.W. Lone Star Nation: The Epic Story of the Battle for Texas Independence. Anchor Books, 2004.Henderson, Timothy J. A Glorious Defeat: Mexico and its War with the United States. Hill and Wang, 2007.Kreneck, Thomas H. â€Å"Houston, Samuel.†Ã‚  The Handbook of Texas Online| Texas State Historical Association (TSHA), 15 June 2010.Sam Houston Memorial Museum.

The Persian Royal Road Improve Governing And Communism Essay

Essential Questions Chapter 4 - Christopher Hallinan Why would the Persian Royal Road improve governing and communism in the Persian Empire? The Persian Royal Road was very beneficial for governing and communication because it allowed people to go throughout the empire efficiently. According to the Behistun inscription, how does Darius the first justify his assumption to power and why is his relationship to Ahuramazda significant? He says that he has power because Ahuramazda gave him control of the kingdom. Because he was chosen by the god, nobody would ever think to question his authority due to respect for their religion. According to the Behistun inscription, what role does divinity play in human affairs? Divinity plays a major role in human affairs because the gods let Darius rule Persia. According to the document of Xerxes from Persepolis, did Alexander the Great possess the desired qualities of a ruler? According to the document, Alexander the Great did possess the desired qualities of a ruler because he was friendly with his people, respected their culture, and was a great leader for war. Which Persian leader would be the equivalent of George Washington; Cyrus, Darius, and Xerxes? Explain your answer. I would pick Xerxes to be most equivalent to George Washington because he firmly believed in religion and was respected by his people. How did the Persian treatment of conquered people compare to the Assyrians treatment of conquered people. As we learned fromShow MoreRelatedInternational Management67196 Words   |  269 Pagesarticles have been published in the Academy of Management Journal, Journal of International Business Studies, Journal of World Business, and European Management Journal. Since the very beginning of the transition to a market economy after the fall of communism in Eastern Europe, he has been actively involved in management education programs sponsored by the U.S. Agency for International Development in Albania and Macedonia, and in U.S. Information Agency programs involving the Central Asian countries ofRead MoreOne Significant Change That Has Occurred in the World Between 1900 and 2005. Explain the Impact This Change Has Made on Our Lives and Why It Is an Important Change.163893 Words   |  656 Pagesan overview of the gendering of political and social transformations over the course of the twentieth century. Attentive to differences across cultures and regions and under varying political regimes, Smith chronicles the struggles of women to improve their situation within the domestic sphere and the conditions under which they labored to expand the career opportunities available to them at different times and in diverse settings. She places special emphasis on the important but often overlooked

Learning from Mistake, Agree or Disagree Free Essays

I don’t like to make mistake. Everything to me has to be perfect because I felt that if one person made a mistake the first time, how they would be able to do anything. That is why learning from mistake is impossible to me. We will write a custom essay sample on Learning from Mistake, Agree or Disagree or any similar topic only for you Order Now When you make mistake and try to learn something from your mistake, you will waste lots of things, ruin the way that people look about you. In addition, learning from mistakes will make you regret much. First of all, learning from our mistakes will waste you lots of things. You will waste your time because you have to do again everything that you did in the wrong way. It seems too hard to start something again which is done one time already. By doing again, you will feel bored and tired. Not only doing it over, but also, you have to find where you did it wrong and give yourself a lesson in order to prevent from making that mistake once more. Studying in this school is an example. If you failed, you had to spend 16 weeks in fall or spring semester and 8 weeks in summer semester. You have to study again. In addition, learning from your mistake will waste your money. Failing in this school is an instance. You have to spend lots of money on the subject that you failed to study again. Spending 75 US dollar for each subject in ELS program and 150 US dollar for each subject in AAS program is the result. In learning, you always have many chances to fix your mistake but how about in working, will you have any opportunity? In reality, the real world, you will not have second chance. Especially, in the business world, where everything is a competition, you do not have the time to learn from mistakes. So, you are forced to do everything completely. Even though you can learn from your mistakes, you do not have chance to fix them. It means that you will be going to end up your career. That is the reason why I don’t like to learn from my mistakes. Secondly, in daily life, learning from mistakes will ruin the way that your friends and family look or feel about you. Everyone will look at you with a strange way if you learn from your mistakes. In addition, they will laugh at you as a silly person. Even though you learn from mistakes, they will make you feel uncomfortable. My cousin is as an illustration. She failed high school exam. She said to me that her old friends looked at her with their curious eyes; her neighbor and her relative always annoyed her with their questions. She seemly lost her hope though she had a lesson from her mistakes and knew how to overcome this hard situation. In life, learning from your mistakes will affect your job and your ability to success. When you work in a company and you always say that I have lots of experience from my mistakes. Then, you continue making mistakes. What will your boss and you co-worker think about your ability? Of course, they will suspect your capability. In addition, does the company want to hire employees that always make mistake and say that they learn a lot from their mistakes? In my point of view, people do not care about if you learn from your mistakes or not. They just look at your mistake because caring about your learning from mistakes dose not bring any benefits to them. In a company, the boss just wants to have perfect employees- hard working and aâ‚ ¬? no-mistakeaâ‚ ¬? employees. More over, your boss may think that if he allows employees to make mistakes, how will they ever learn? They will just keep on making even more mistakes. Further more, when you learn from your mistakes, people who do not like you will know where you are weak. It will be easy for them to let you down. They can seize your status in your company. Everything that you have will not belong to you any more. It belongs to people who want to harm you. So, learning from your mistakes will deteriorate yourself and bring disadvantages to your life. Thirdly, learning from mistakes will make you regret much. You may think that you do not willing to do any things that you face. You have not enough experience to overcome your challenges. Further more, you will be diffident when you face some hard situations. So, you do not concern much about what you are doing. Students who learn from their mistakes will be discouraged because they used to not to pay more attention to their study. They do not prepare any things for their future. In addition, felling ashamed and giving up their goal is the affect of learning from mistakes. The more complicated mistakes they learn, the more shameful they feel. To me, if I do something, you I will do it for a reason and I will not regret. I find that regretting is a bad way. If you know results that will not good for you, why donaâ‚ ¬Ã¢â€ž ¢t you try to prevent that? To me, I before doing something will always attempt to think about what Iaâ‚ ¬Ã¢â€ž ¢m going to do first. In addition, I usually consider about the result of doing something. I ask myself that if doing some things will bring benefit to me or not. So, I may choose the way that will not make me regret. Right now, we are living in an achievement and success oriented world. So, a popular rule is whenever you do anything, try to do it right. That is why, to me, learning from mistakes is something unacceptable. In conclusion, I do not like learning from mistakes. Everybody can reduce as much mistake as possible. By preparing yourself and hard working, I believe that you can overcome everything in your life. In addition, do not think about learning from your mistakes because it just brings disadvantages to your life. It not only makes you spend lots of things, but also lays down the way that your relative look at you and makes you regret much. Hopefully, you will be strong and confident to overcome every hard situation. How to cite Learning from Mistake, Agree or Disagree, Essays

Personal Identity free essay sample

In life there will be many of challenges, you just have to be the stronger person and fight it through. There will be many people trying to get in your way of success; first thing you have to do is find yourself. If you know yourself can’t no one tell you what your not capable of. It took me awhile to actually find out the person I was. There were many of challenges I came across and didn’t succeed. Everything takes time, you have to tell yourself that you can and will be anything you want to be. We will write a custom essay sample on Personal Identity or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Growing up I didn’t know what I wanted to be in the future, I changed my mind over a million times. When you’re a kid you have the biggest dreams and you see yourself with the biggest future, not knowing what you have to do in order to get to the place you want to be. I am the youngest of the 4 of my mothers kids, being that im the youngest I have the most guidance because it was passed down to me from the older kids. I respect everybody because that’s what I would want in return. You have to find yourself before you can work on anything, you have to know how far you can go. Life itself is about finding yourself, putting yourself in the position to succeed. As a child life for myself was great, I wouldn’t say I was silvered spooned or nothing. Growing up my mother was a single mother but she was a great one. She provided everything for me, we we’re pretty wealthy. When I was a child I knew my place. Everything I know I was taught by pretty much everyone. When something wasn’t right I always had to get a second opinion from some I had a billion teachers; I would walk up to a complete stranger and ask them something that I didn’t know the answer to just to hear the opinion from someone else. In life things don’t come easy; you have to work for everything you want in order to succeed. As you may have figured out, yes I am the baby of my family. My mom has 2 sons and 2 daughters. I look up to each and every one of them. My older brother is 29 he’s a successful probation officer, my 22 year old brother has joined the navy, and my 30 year old sister is a registered nurse. My mom is a construction worker at one of the biggest refineries in the state of Texas. Being the baby has its highs and its lows, I like that I am the baby because  when I need to know certain answers to things I can just ask one of my siblings and I know they will give me some of the best answers. Being that I am the baby I’m super spoiled, I pretty much get whatever I want. Elementary to me was the best stages of school, because it starts you off. I was new to everything and learned faster than the other students. Elementary students love to color, but I didn’t I loved reading and writing. People would call me weird because of that, but that’s just what I enjoyed to do. Things didn’t start getting rough until middle school; this is where everyone grew up and want to experience new things. I stayed on the right track and it was very had to influence me to do something that wasn’t right, that’s just what made me so different from everyone. My teachers in middle school did everything they could to prepare me for high school. They said they knew I would make it to become successful so they taught me everything they could. Dancing literally is my life; I’ve been dancing since I was 2. Ballet, Jazz, Hip-Hop, and modern dance were my specialty. High school is when everything literally mattered to me, I was involved in everything. Track, the dance team captain, I ran track, I even played softball. I pretty much got involved with anything that would keep me out of trouble and on the right track. In high school everyone gets excited, because you are actually getting ready to follow your goals. You wait all this time to do what you actually want to do in your career field. 9th grade was pretty difficult because everything is new, you experience everything new. I remember staying up all night writing long essay, because my English teacher was one of the hardest teachers. I took all advance placement classes, these classes get you prepared for college great. In the 11th grade I was already use to the feeling of having to more work than others, because of my placement. By 12th grade I was ranked number 5 in my entire class, that was a wonderful feeling knowing all my hard work paid off. Just being able to see my family so proud of me was the best feeling in the world. Everything felt right my dream finally came true I was really getting ready to graduate and go off to college. I didn’t attend college soon as I graduated from high school, I wait a semester and worked at the public library. To get feeling of the college life, I didn’t want to get there and be completely lost. I thank everyone who believed in me today and actually helped me make it to the person I am today. I have people looking up to me and it would hurt me if I let them down, I will be successful.

Operation Linebacker in the Vietnam War

Operation Linebacker in the Vietnam War Operation Linebacker took place from May 9 to October 23, 1972 during the Vietnam War (1955-1975). In March 1972, with the United States working to transfer responsibility for fighting on the ground to the South Vietnamese, the North Vietnamese launched a major offensive. With South Vietnamese forces under pressure and giving ground, Operation Linebacker was launched with the goal of slowing the enemy advance by striking transportation and logistical targets. These air attacks proved effective and by June, North Vietnamese units were reporting that only 30% of supplies were reaching the front. An effective campaign, Operation Linebacker helped halt the Easter Offensive and aided in restarting peace talks. Fast Facts: Operation Linebacker Conflict: Vietnam War (1955-1975)Dates: May 9 to October 23, 1972Force Commander:United StatesGeneral John W. Vogt, Jr.Seventh Air ForceTask Force 77Casualties:United States: 134 aircraft lost to all causes Background As Vietnamization progressed, American forces began handing off responsibility for fighting the North Vietnamese to the Army of the Republic of Vietnam (ARVN). In the wake of ARVN failures in 1971, the North Vietnamese government elected to move forward with conventional offensives the following year. Beginning in March 1972, the Easter Offensive saw the Peoples Army of Vietnam (PAVN) attack across the Demilitarized Zone (DMZ) as well as east from Laos and south from Cambodia. In each case, PAVN forces made gains driving back the opposition. Debating the American Response Concerned about the situation, President Richard Nixon initially desired to order three days of B-52 Stratofortress strikes against Hanoi and Haiphong. In an effort to preserve the Strategic Arms Limitation Talks, National Security Advisor Dr. Henry Kissinger dissuaded Nixon from this approach as he believed it would escalate the situation and alienate the Soviet Union. Instead, Nixon moved forward with authorizing more limited strikes and directed that additional aircraft be dispatched to the region. As PAVN forces continued to make gains, Nixon elected to push forward with a large escalation of air attacks. This was due to both the deteriorating situation on the ground and the need to preserve American prestige prior to a summit meeting with Soviet Premier Leonid Brezhnev. To support the campaign, the US Seventh Air Force continued to receive additional aircraft, including large numbers of F-4 Phantom IIs and F-105 Thunderchiefs, while the US Navys Task Force 77 was increased to four carriers. On April 5, American aircraft began striking targets north of the 20th Parallel as part of Operation Freedom Train. A US Air Force F-4 Phantom II during the Vietnam War. Photograph Courtesy of the US Navy Freedom Train Pocket Money On April 10, the first large B-52 raid struck North Vietnam and hit targets around Vinh. Two days later, Nixon began allowing strikes against Hanoi and Haiphong. American air attacks largely focused on transportation and logistics targets, though Nixon, unlike his predecessor, delegated operational planning to his commanders in the field. On April 20, Kissinger met with Brezhnev in Moscow and convinced the Soviet leader to reduce military aid to North Vietnam. Unwilling to risk an improving relationship with Washington, Brezhnev also pressured Hanoi to negotiate with the Americans. This led to a meeting in Paris on May 2 between Kissinger and Hanois chief negotiator Le Duc Tho. Sensing victory, the North Vietnamese envoy was unwilling to deal and effectively insulted Kissinger. Angered by this meeting and the loss of Quang Tri City, Nixon further upped the ante and directed that the North Vietnamese coast by mined. Moving forward on May 8, US Navy aircraft penetrated Haiphong harbor as part of Operation Pocket Money. Laying mines, they withdrew and additional aircraft conducted similar missions over the next three days. F-105D Thunderchief. Photograph Courtesy of the US Air Force Striking at the North Though both the Soviets and Chinese frowned on the mining, they did not take active steps to protest it. With the North Vietnamese coast effectively closed to maritime traffic, Nixon ordered a new air interdiction campaign, dubbed Operation Linebacker, to commence. This was to focus on suppressing North Vietnamese air defenses as well as destroying marshaling yards, storage facilities, transshipment points, bridges, and rolling stock. Commencing on May 10, Linebacker saw Seventh Air Force and Task Force 77 conduct 414 sorties against enemy targets. In the wars single heaviest day of aerial combat, four MiG-21s and seven MiG-17s were downed in exchange for two F-4s. During the early days of the operation, the US Navys Lieutenant Randy Duke Cunningham and his radar intercept officer, Lieutenant (j.g.) William P. Driscoll, became the first American aces of the conflict when they downed a MiG-17 (their third kill of the day). Striking targets across North Vietnam, Operation Linebacker saw the first widespread use of precision-guided munitions. MiG-17. US Air Force This advance in technology aided American aircraft in dropping seventeen major bridges between the Chinese border and Haiphong in May. Switching to supply depots and petroleum storage facilities, the Linebacker attacks began to have a telling effect on the battlefield as PAVN forces saw a 70% drop in supplies through the end of June. The air attacks, coupled with increasing ARVN resolve saw the Easter Offensive slow and finally stop. Unhampered by the targeting restrictions that had plagued the earlier Operation Rolling Thunder, Linebacker saw American aircraft pound enemy targets into August. Aftermath With imports into North Vietnam down 35-50% and with PAVN forces stalled, Hanoi became willing to resume talks and make concessions. As a result, Nixon ordered bombing above the 20th Parallel to cease on October 23, effectively ending Operation Linebacker. In the course of the campaign, American forces lost 134 aircraft to all causes while downing 63 enemy fighters. Considered a success, Operation Linebacker was critical to halting the Easter Offensive and damaging PAVN forces. An effective interdiction campaign, it began a new era of aerial warfare with the mass introduction of precision-guided munitions. Despite Kissingers proclamation that Peace is at hand, American aircraft were compelled to return to North Vietnam in December. Flying Operation Linebacker II, they again struck targets in an attempt to force North Vietnamese to resume talks.

3 Tips for Staying Focused at Work During the Holidays

3 Tips for Staying Focused at Work During the Holidays Don’t let your holiday shopping, budgeting, travel-planning- or the weather!- get the better of you this season. Stay focused on wrapping up your year and gearing up for 2017. 1. Deflect the interruptionsThe holidays are always extra distracting. Prepare yourself for the inevitable onslaught and don’t let yourself give in. Instead, use the interruptions to structure your day. Online shopping session? Office cookie break? Set these as deadlines for you to work toward and remain diligent  until its time for your break.2. Look for the right projectsEveryone’s schedules are erratic during the holidays. If you’re stuck working when everyone else is out of office, use the peace and quiet to get work done on your pet projects and big picture tasks. And don’t forget that holiday parties and lingering team lunches can be a great networking opportunity, rather than a waste of time.3. Don’t take it homeStaying focused at the desk means you don’ t have to stay late to get ahead or be on your email 24/7. Make sure to save your off-work hours for all of those distractions you’ve been fending off so successfully. Save time for your shopping and traveling and package-mailing and savor it. Guard it, even. And if you’re worried about getting those things done, schedule them as though they were after-hours meetings.Being mindful about distractions and staying focused will make you more relaxed throughout the holiday season. You’ll probably find you’re way ahead of the game once the fun is over and everybody’s back at work.

Analysis Of GE, Clean Energy Group and Yingli Solar Energy Company Essay

Analysis Of GE, Clean Energy Group and Yingli Solar Energy Company Profiles - Essay Example A number of studies have been taken up to assess the actual achievability and practicability of the renewable resources of energy. Issues have been raised about the concerns on sustainability of the alternative energy resources. One of them is the requirement of a detailed analysis of the suitability of the diverse technologies and expertise in the sector and efficient utilization of the by-products, and managing of natural resources. This also consists of nature conservation issues, pollution control, demand supply of energy and the social acceptance by the society. The use and viability of this technology cannot be evaluated until it has been put to use on a large and long-term scale and assess the results in the social and environmental contexts. Moreover, the complex social systems may lead to uncertainty in the minds of the project planners which might be enhanced by the lack of flexibility of the technology system to meet the demands of the social, economic systems of the socie ty. However, all these concerns related to the development of the clean energy sector will not possibly hamper the continuing growth and production in the sector and the increasing importance of maintaining sustainability in the business sector. The renewable energy sector has continued to grow along with the climate change and control issues, high rise in the prices of oil, increasing international community support and encouraging energy regulation laws. Studying the various, environmental social technological and economic benefits arising from the sector, there are a number of them which can be counted upon. Sustainable clean energy business contributes to the environment with reduced carbon emissions, deceleration in the climate, reduced flood rate, improved air quality and landfilling prospects, (Scott, 2010). Among the economic benefits, the chances of job creation, manufacturing and research – development expertise, increased supply as compared to the existing levels, higher investment in the sector are some of them. Among the social issues that may be benefitted due to a long-term sustainable clean energy business are direct employment, retention of population in remote cities, increase in the skill and expertise of the remote population that gets employed and higher quality of life. Challenges to the Clean Energy Sector In this section, the challenges to the clean energy sector shall be studied. In spite of the fast growth of the renewable energy resources, there exist many challenges. Some of them are discussed below – Reliability?†¢ The most popular renewable sources of clean energy – wind and solar are variable in nature and cannot be a reliable round the clock resources.

The Cost Accounting System of Bagalot PLC Coursework

The Cost Accounting System of Bagalot PLC - Coursework Example On the overall analysis, it can be stated that the cost system in Bagalot PLC is not appropriate and it requires certain changes. To justify this, light can be thrown on the findings of the internal team, which is appointed to study the overhead costs in both the plants. The findings can be summarised and demonstrated as follows: The above outcomes signify the importance of the production and post-production related activities. If the overhead cost of a product is calculated based on the production-run direct labor, then the other activities will be surely ignored. It implies that the adopted mechanism for the cost calculation is not effective as it takes into account only the partial costs. Based on the above explanation, it can be recommended to the Bagalot management to bring certain transformation in the host system or to change the method of the cost estimation. In this note, the management can be proposed to adopt ‘Activity-Based Costing’ (ABC). In this case, one question can crop up that whether both the plants should adopt the technique or not. It is true that variations in the activities are less in the Bath plant, but the mechanism of estimating overhead expenses is similar. Therefore, it will be better if ABC method can be applied to both the plants. There are several activities in Bristol plant and few activities in Bath plant. The activities are ‘receiving and production control’, ‘packaging and shipping’, ‘plant management and facilities’ and most importantly ‘set up labor’. By implementing ABC method, the organization will be able to monitor each activity that has a contribution in direct overhead. It will result in effective cost structure as well as transparent mechanism. In the last part, cost of each product of Bagalot has been calculated according to the activity-based costing method. In this portion of the paper, the profitability of the Briefcases based on the new approach (ABC method) will be computed. A comparative analysis of the old and new methods can be presented in a tabular format to figure out the best approach.

Shakespeares Star Crossed Lovers :: essays research papers

In Shakespeare’s play Romeo and Juliet, set in Verona, Italy, Juliet’s own happiness is put on hold due to her parents authority and the lack of control children had in the sixteenth century. John W. Draper’s excerpt â€Å"Shakespeare’s Star-Crossed Lovers† also supports my outlook on how Juliet’s life is being controlled by her parents. Juliet is a thirteen year old Capulet who’s family is in a lifelong feud with her love interest’s family, Romeo, a Montague.   Ã‚  Ã‚  Ã‚  Ã‚  In Act three, Scene five, Juliet is forced with a dilemma. Her parents have arranged for her to partake in the marriage of Country Paris. They told Juliet that she shall be wed on Thursday. â€Å"I will not marry yet; and when I do, I swear it shall be Romeo, whom you know I hate, rather than Paris† said Juliet to Lady Capulet (her mother). What her parents didn’t know was that she was secretly married to Romeo already. In her bedroom they argue about marriage. The Capulet’s don’t let her live her own life the way she wants. It’s like they are living through her or for her. Her opinion and happiness doesn’t seem to mean anything to her family. They are forcing her into a marriage with a man she has no affection towards whatsoever. She claims to love Romeo. Weather it’s real or not, we will never know, but if it’s what she wants and it will make her happy, I think they should back off of their daughter and let her live her life. If she makes a mistake it would be considered her mistake and misfortune. NOT her parents.   Ã‚  Ã‚  Ã‚  Ã‚  Draper explains how Juliet feels about her and Romeo’s fate of being together. â€Å"Nevertheless, over the play hangs a tragic fate....her ‘all-diving soul’ sees Romeo ‘As one dead in the bottom of a tomb.’ She described her case as ‘past hope, past cure, past help’ says Draper. He further explains in greater detail how Juliet feels about being put into this situation. He thoroughly explains how Juliet feels she has no control over her own life In this sixteenth century way of life. Although in Juliet’s decision since it is in fact her life, but considering the circumstances she was stuck with the awful fate her parents were controlling. Just think if Juliet’s parents only listened and didn’t push her, maybe Romeo and Juliet’s lives could have been spared.

Analgesic and Facilitator Pain Assessment

Individual Research Article Critique Presentation Resource: The research study that you selected in Week Two Develop a 10- to 15-minute presentation in which you address the following points (7 pts): †¢Strengths and weaknesses of the study †¢Theoretical and methodological limitations †¢Evidence of researcher bias †¢Ethical and legal considerations related to the protection of human subjects †¢Relationship between theory, practice, and research †¢Nurse’s role in implementing and disseminating research †¢How the study provides evidence for evidence-based practice †¢Identify the following for the research study selected (choose 1 or 2 NOT BOTH): 8 pts. †¢ 1. Quantitative Research Article Critique (Follow the example pp. 433–442 of the text): †¢ a. Phase 1: Comprehension b. Phase 2: Comparison c. Phase 3: Analysis d. Phase 4: Evaluation †¢ 2. Qualitative Research Article Critique (Follow the example pp. 455–461 o f the text): †¢ a. 1. Problem (problem statement; purpose; research questions; literature review; frame of reference; research tradition) b. 2. Methodology (sampling & sample; data collection; protection of human subjects c. 3. Data (management; analysis . 4. Results (findings; discussion; logic; evaluation summary †¢ Format the presentation as one of the following (5 pts): †¢Poster presentation in class †¢Microsoft ® PowerPoint ® presentation including detailed speaker’s notes †¢Video of yourself giving the presentation uploaded to an Internet video sharing site such as www. youtube. com –Submit the link to your facilitator, include a written reference page in APA format †¢Another format approved by your facilitator Pain Assessment in Persons with Dementia: Relationship Between Self-Report and Behavioral Observation Ann L.Horgas, RN, PhD,A Amanda F. Elliott, ARNP, PhD,w and Michael Marsiske, PhDz OBJECTIVES: To investigate the relatio nship between self-report and behavioral indicators of pain in cognitively impaired and intact older adults. DESIGN: Quasi-experimental, correlational study of older adults. SETTING: Data were collected from residents of nursing homes, assisted living, and retirement apartments in northcentral Florida. PARTICIPANTS: One hundred twenty-six adults, mean age 83; 64 cognitively intact, 62 cognitively impaired.MEASUREMENTS: Pain interviews (pain presence, intensity, locations, duration), pain behavior measure, Mini-Mental State Examination, analgesic medications, and demographic characteristics. Participants completed an activitybased protocol to induce pain. RESULTS: Eighty-six percent self-reported regular pain. Controlling for analgesics, cognitively impaired participants reported less pain than cognitively intact participants after movement but not at rest. Behavioral pain indicators did not differ between cognitively intact and impaired participants. Total number of pain behaviors w as signi? antly related to self-reported pain intensity (b 5 0. 40, P 5. 000) in cognitively intact elderly people. CONCLUSION: Cognitively impaired elderly people selfreport less pain than cognitively intact elderly people, independent of analgesics, but only when assessed after movement. Behavioral pain indicators do not differ between the groups. The relationship between self-report and pain behaviors supports the validity of behavioral assessments in this population. These ? ndings support the use of multidimensional pain assessment in persons with dementia.J Am Geriatr Soc 57:126–132, 2009. Key words: pain; dementia; measurement From the ADepartment of Adult and Elderly Nursing, University of Florida, College of Nursing, Gainesville, Florida; wDepartment of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and zDepartment of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, G ainesville, Florida. Address correspondence to Ann Horgas, College of Nursing, University of Florida, PO Box 100197-HSC, 101 S.Newell Drive, Room 2201, Gainesville, FL 32610. E-mail: [email  protected]?. edu DOI: 10. 1111/j. 1532-5415. 2008. 02071. x ain, a persistent daily problem for many elderly adults, is associated with physical and social disability, depression, and poor quality of life. 1 Between 50% and 86% of older adults experience pain; 32% to 53% of those with dementia experience it daily. 2 The high prevalence is associated with proliferation of pain-related health conditions in late life, such as osteoarthritis, hip fractures, peripheral vascular disease, and cancer. Dementia complicates pain assessment, because it impairs memory, judgment, and verbal communication. Dementia is associated with central nervous system changes that alter pain tolerance4 but not pain thresholds (e. g. , minimum level at which a painful stimulus is recognized as pain). 5 No empirical evid ence indicates that persons with dementia physiologically experience less pain; rather, they appear less able to recognize and verbally communicate the presence of pain. Findings that cognitively impaired older adults underreport pain relative to nonimpaired elderly people7 and are less likely to be treated for pain than their cognitively intact peers8,9 re? ect dif? culty assessing pain in this population. Self-report is considered the criterion standard of pain assessment. Despite recent studies supporting the reliability and validity of self-report in persons with dementia,7,10 healthcare providers and pain experts recognize that selfreport alone is insuf? cient for this population and that observational pain assessment strategies are needed.In 2002, the American Geriatrics Society established comprehensive guidelines for assessing behavioral indicators of pain. 1 More recently, the American Society for Pain Management Nursing Task Force on Pain Assessment in the Nonverbal Patien t (including persons with dementia) recommended a comprehensive, hierarchical approach that integrates selfreport and observations of pain behaviors. 11 Recently, tools to measure pain in persons with dementia have proliferated. In 2006, a comprehensive stateof-the-science review of 14 observational pain measures was completed.The authors concluded that existing tools are still in the early stages of development and testing and that more psychometric work is needed before tools are recommended for broad adoption in clinical practice. 12 Others, including an interdisciplinary expert consensus P JAGS 57:126–132, 2009 r 2008, Copyright the Authors Journal compilation r 2008, The American Geriatrics Society 0002-8614/09/$15. 00 JAGS JANUARY 2009–VOL. 57, NO. 1 PAIN ASSESSMENT IN PERSONS WITH DEMENTIA 127 panel on pain assessment in older persons,13 have corroborated these conclusions. 4 In particular, these authors highlight the need for more evaluation of observational pa in measures, including validation against the criterion standard of self-report in intact and impaired populations. Almost all research on measuring pain in persons with dementia has focused exclusively on persons with moderate to severe disease. There has been only one published study that compared pain behaviors and self-reported pain in persons with and without cognitive impairment, but it focused on postoperative patients undergoing rehabilitation and acute pain associated with physical therapy. 5 Thus, the purpose of this study was to investigate the relationship between self-report and behavioral indicators of pain in cognitively intact and impaired older adults with persistent pain. Speci? cally, this study evaluated whether cognitive status (intact or impaired) differentially in? uenced verbal and nonverbal expression of pain. It was hypothesized that self-reported pain would be lower in cognitively impaired elderly people than in those who were cognitively intact but that p ain behaviors, because they are more re? exive and less reliant on verbal communication, would be equivalent in both groups.The relationship between pain behaviors and self-reported pain was also evaluated in cognitively intact elderly people to validate whether behaviors measured are indicators of pain. The following research questions were asked. Does cognitive status in? uence self-reported pain? Does cognitive status in? uence observed pain behaviors? Are self-reported pain and observed pain behaviors related, and is the relationship different in cognitively intact and impaired elderly people? One hundred forty participants were enrolled and completed the baseline interview; 126 (90%) completed the protocol. Attrition analyses revealed no signi? ant differences between completers and noncompleters on demographic, residential status, health, or pain variables. The ? nal sample was predominantly female (81%), Caucasian (97%), and widowed (60%), with a mean age of 83 (range 5 65â⠂¬â€œ98). Thirty-nine percent resided in nursing homes, 39% resided in assisted living, and 22% lived independently in retirement apartments. Participants’ average Mini-Mental State Examination (MMSE) raw score was 24 (range 5 7–30, median 5 27, mode 5 29). Based on 10th percentile education-adjusted MMSE norms as the cutoff,16,17 64 (50. 8%) were cognitively intact, and 62 (49. %) were impaired. See Table 1 for a description of the total sample and of cognitively intact and impaired subsamples. Groups differed only in residential status (cognitively Table 1. Sample Characteristics, Overall (N 5 126) and According to Cognitive Status Total Sample Cognitive StatusA Intact Impaired (n 5 64) (n 5 62) PValue Characteristic METHODS The University of Florida institutional review board approved this study. Informed consent was obtained from cognitively intact participants and from impaired elderly people’s legally authorized representatives, with assent from persons wi th dementia.Design A quasi-experimental, correlational design was used to investigate pain in older adults with mild to moderate dementia, because dementia status cannot be experimentally manipulated. Cognitively intact elderly people functioned as a comparison group to examine behavioral indicators and self-reported pain in the two groups. If self-report and behaviors were related in cognitively intact persons, there would be some basis to infer that the same behaviors indicated pain in cognitively impaired elderly people. Participants One hundred ? ty-eight older adults were screened for enrollment from 17 assisted living facilities, nursing homes, and retirement communities in north central Florida. Inclusion criteria were aged 65 and older, English-speaking, able to stand up from a chair and walk in place, diagnosed osteoarthritis in the lower body, and adequate vision and hearing to complete the interview. Sex, n (%) Male 24 (19. 0) 12 (18. 8) 12 (19. 4) Female 102 (81. 0) 52 ( 81. 3) 50 (80. 6) Race, n (%) White 123 (97. 6) 63 (98. 4) 60 (96. 8) Black 1 (0. 8) 0 (0) 1 (1. 6) Other 2 (1. 6) 1 (1. 6) 1 (1. 6) Marital status, n (%) Married 37 (29. ) 21 (32. 8) 16 (25. 8) Unmarriedw 89 (70. 6) 43 (67. 2) 46 (74. 2) Education, n (%) ohigh school 11 (8. 7) 5 (7. 8) 6 (9. 7) graduate High school graduate 38 (30. 2) 17 (26. 6) 21 (33. 9) Some college or 31 (24. 6) 18 (28. 1) 13 (21. 0) equivalent College graduate or 34 (27. 0) 18 (28. 1) 16 (25. 8) more Residence Assisted living 49 (38. 9) 28 (43. 8) 21 (33. 9) Nursing home 47 (37. 3) 14 (21. 9) 33 (53. 2) Retirement apartment 30 (23. 8) 22 (34. 4) 8 (12. 9) Analgesics taken 579 ? 1,320 313 ? 699 853 ? 1,708 (in acetaminophen equivalents), mean ? SD Age, mean ? SD 82. 2 ? 7. 3 81. 9 ? 7. 83. 1 ? 7. 6 Number of medical 6. 7 ? 3. 1 6. 6 ? 2. 9 6. 9 ? 3. 4 diagnoses, mean ? SD .93 .59 .39 .84 .001z .02 § .55 . 63 A Cognitive status was computed using the following education-adjusted Mini-Mental State Examination s cores as cutoffs: o8th grade education, 20; 9 to 11 years, 24; high school graduate or equivalent, 25; some college, 27; and college degree or higher 5 27. 16,17 w Unmarried 5 never married, widowed, separated, or divorced. z Chi-square 5 15. 2, degrees of freedom 5 2, P 5. 001.  § t (124) 5 2. 22. SD 5 standard deviation. 128 HORGAS ET AL. JANUARY 2009–VOL. 57, NO. 1 JAGS mpaired elderly people were signi? cantly more likely to reside in assisted living or nursing home facilities). to use in elderly adults than the traditional visual analogue scale. 21 Procedures Participants completed a brief screening interview to con? rm study eligibility and to ascertain cognitive status. Those eligible were interviewed about their pain and completed an activity-based protocol designed to evoke pain behaviors in persons with persistent pain (described in more detail below). Activity Protocol Participants were asked to sit, stand, lie on a bed, walk in place, and transfer between activi ties.Based on previous work, the activity protocol had several strengths for use with this population. First, it simulates performance of basic activities of daily living, thereby enhancing ecological validity of the tasks. Second, it was tested in other studies, and activities were shown to induce pain in persons with osteoarthritis and chronic low back pain, thus providing a naturalistic pain induction method. Third, use of these realworld tasks avoids undue health or safety risks for elderly adults and eliminates potential bias associated with arti? cially induced (e. g. , laboratory-based) pain induction techniques. 8,19 The protocol was simpli? ed by using only 1-minute activity intervals (to reduce complexity of directions and physical demands for frail or cognitively impaired participants) and substituted walking in place for walking across the room and back (to accommodate physical space limitations in residential care facilities where data were collected). Activities were c onducted in random order to minimize order effects, and the entire 10-minute protocol was videotaped. Measures Self-Reported Pain The principal investigator (ALH) or a trained research assistant interviewed each participant in a private session about their pain experience.Pain presence, intensity, locations, and duration were assessed. Pain Presence. Questions from the Structured Pain Interview (SPI)20 were used to assess presence of self-reported pain. During the pain screening interview, participants were asked ‘‘Do you have some pain every day or almost every day (daily pain)? ’’ Pain was also assessed immediately before the start of the activity protocol (‘‘Are you having any pain right now? ’’ (pre-activity)) and immediately after it (‘‘Did you experience any pain during these activities? ’’ (postactivity)).Response choices to all three questions were yes (1) or no (0). Pain Intensity If participants responded ‘‘yes’’ to experiencing pain (daily, pre-activity, or postactivity), they were asked to rate the intensity using a numerical rating scale (NRS). The NRS was presented as a horizontal line with 0 5 no pain and 10 5 worst pain as anchors and equally spaced dashes representing pain intensity rating of numbers 1 through 9. The scale was printed in large, bold font on an 8. 5†³ A 11†³ paper to facilitate use with older adults who may have vision dif? culties. The NRS is considered valid, reliable and easierPain Duration Participants were asked to indicate how long (in months and years) they had experienced daily or almost daily pain. Responses were coded as less than 1 year, 1 to 5 years, 6 to 10 years, 11 to 15 years, or more than 15 years. Pain Locations The pain map from the McGill Pain Questionnaire22 was used to assess pain locations. Participants indicated areas on the body drawing in which they were currently experiencing pain. Total n umber of painful locations was summed. This widely used measure has been validated in several epidemiological studies and has high interrater reliability (average kappa 5 0. 2). 23 Observed Pain Behaviors Pain Behaviors A modi? ed version of the Pain Behavior Measure18 was used to measure behavioral indicators of pain. Based on standardized behavioral de? nitions, occurrence of the following speci? c pain behaviors was evaluated: rigidity, guarding, bracing, stopping the activity, rubbing, shifting, grimacing, sighing or nonverbal vocalization, and verbal complaint. Standardized de? nitions were adapted from previous work,18,19 modi? ed for use in this older, moreimpaired population, and pilot tested in a sample of nursing home residents with dementia. 4 This measure has adequate reliability and validity. 13 Pain Behavior Coding Independent raters, all registered nurses blind to participants’ cognitive status, scored the videotaped activity protocols. Coders completed extensi ve training in coding procedures until intrarater and interrater agreement (with the master coder (PI) and another rater) reached a kappa coef? cient of 0. 80 or greater, indicating good to very good reliability. 25 After coding reliability was attained, reliability checks were conducted on 10% of all videotapes to minimize rater drift.Noldus Observer software was used to analyze digitized videotapes and code pain behaviors (Noldus Information Technology, Wageningen, the Netherlands). The following summary variables were created and used in the analyses: total number of pain behaviors observed, number of times each behavior (rigidity, guarding, bracing, stopping, rubbing, shifting, grimacing, sighing or nonverbal vocalization, and verbal complaint) was observed, and total numbers of pain behaviors observed during each activity state (e. g. , number of behaviors while walking, reclining, sitting, standing, and transferring).Cognitive Status Cognitive status was assessed using the MMS E,26 an 11-item screening instrument widely used to assess general cognitive status in elderly adults. The following MMSE scores served as the cutoffs to classify participants as intact or impaired: less than 8th grade education, 20; 9 to 11 years, 24; high school graduate or equivalent, 25; some college, 27; and college degree or higher, 27. 16,17 JAGS JANUARY 2009–VOL. 57, NO. 1 PAIN ASSESSMENT IN PERSONS WITH DEMENTIA 129 Analgesic Medications Drug data for each participant were coded according to the American Hospital Formulary Service system.All pain medications were identi? ed and converted to acetaminophen equivalents. 8,27 This standardized drugs and dosages to a common metric and facilitated comparison of analgesic dosing. To ensure that only analgesics actually taken would be controlled for, equianalgesic dosages were considered in these analyses only if they were taken within the standard therapeutic dosing window for each drug (e. g. , acetaminophen, every 4â€⠀œ6 hours) before the activity protocol. Data Analysis SPSS, version 15. 0 (SPSS Corp. , Chicago, IL) was used for data analysis.Descriptive statistics, Pearson chi-square (w2) tests, and t-tests were used to describe sample characteristics and examine group differences. Analysis of covariance (ANCOVA) was used to test relationships between cognitive status, pain intensity, and pain behaviors. Logistic regression was used to predict pain presence. Multiple regression was used to predict pain intensity and number of pain behaviors, with a centered cognitive status–by–pain intensity interaction term to identify group differences; standardized regression coef? cients (b) are reported in the results.RESULTS Self-Reported Pain The majority of participants (86. 5%) reported experiencing pain every day or almost every day. More than 65% reported experiencing pain for more than 1 year ( $ 40% indicated duration of 45 years). On average, participants reported pain in four body locations (range 5 1–25); usual pain intensity was 4. 3 (moderate) on a scale from 0 to 10. Immediately before the activity protocol, 45 (35. 7%) participants reported experiencing pain. Mean pain intensity was rated as 1. 7 (range 5 0–9). After the protocol, 79 (62. 7%) reported experiencing pain during the activities; mean pain intensity was 3. (range 5 0–9). Relationship Between Cognitive Status and Self-Reported Pain Chi-square analyses were conducted to examine the relationship between cognitive status (impaired vs intact) and presence of self-rated daily pain and pain duration at baseline. The baseline pain interview was not always conducted on the same day as the activity protocol, and analgesic use before the interview was not assessed. Thus, initial analyses are descriptive only and do not control for analgesic use. At baseline, 77. 4% of impaired and 95. 3% of intact participants reported experiencing pain every day (w2(1) 5 8. 6, P 5. 003).Cognitively impaired elderly people also recalled shorter pain duration (w2(3) 5 16. 0, P 5. 001) than intact participants, but no signi? cant differences were reported in the number of pain locations. Logistic regression, controlling for acetaminophen equivalents, indicated that cognitive status was not signi? cantly predictive of pre-activity pain presence. Regression analyses, with pre-activity pain intensity as the dependent variable and cognitive status and analgesics as predictors, revealed no signi? cant difference between the two groups (Figure 1). Intact Impaired 16 14 12 Mean values 10 8 6 4 2 0 In te a * t ns y SR 😛 a re- cti v in Pa ng cing ing rbal aint sity pi b l n e ra uar ig Sh op rima Rub onv mp Inte B G R St G N al co ain P rb Ve activ tos 😛 SR b Pain indicators cin g n di g i id ty in ift g a tt Si g g g g g in din kin yin rrin l e n L sf a Wa St an Tr c Activity states Figure 1. Relationship between self-report and observed pain behaviors in cognitively int act and cognitively impaired elderly people (N 5 126). aMean self-reported (SR) pain intensity, controlling for acetaminophen equivalents taken. bMean number of behaviors observed for each pain indicator, controlling for acetaminophen equivalents taken. Mean number of behaviors observed during each activity state, controlling for acetaminophen equivalents taken. 130 HORGAS ET AL. JANUARY 2009–VOL. 57, NO. 1 JAGS At the end of the activity protocol, cognitive status was signi? cantly associated with the reported presence of pain, controlling for analgesics (b 5 1. 2, P 5. 002); cognitively impaired elderly people were less likely to report pain. Impaired participants also reported signi? cantly lessintense pain than intact participants after the activity protocol (3. 8 vs 2. 6; F (1) 5 A 5. 0, P 5. 03).Paired t-tests indicated that pain intensity increased signi? cantly from start to end of the protocol for both groups (Figure 1). Table 2. Relationship Between Self-Reported Pa in Intensity and Observed Pain Behaviors (N 5 126) Total Number of Behaviors Observed Model bA P-Value 1 Pre-activity pain intensity Analgesics taken Pain intensity A cognitive status R2 F 2 Postactivity pain intensity Analgesics taken Pain intensity A cognitive status R2 F Standardized regression coef? cient. R2 5 coef? cient of determination. A Relationship Between Cognitive Status and Observed Pain Behaviors On average, 21. pain behaviors per person (range 5 3–50, median 5 21, mode 5 16) were observed during the activity protocol. ANCOVA models, controlling for analgesics, revealed no signi? cant differences in mean number of pain behaviors observed between cognitively intact and impaired participants (covariate-adjusted means 5 21. 8 and 21. 3, respectively; F (1) 5 0. 08, P 5. 77). The number of occurrences of each of the eight behavioral indicators observed was summed. ANCOVA models, controlling for analgesics and using Bonferroni correction for multiple comparisons (P 5. 005), revealed no signi? ant differences between cognitively intact and impaired elderly people for any behavioral pain indicators investigated (Figure 1). Of the activity states observed during the protocol, transferring elicited the most frequent pain behaviors (mean 5 13. 4; range 5 2–43). No signi? cant differences were noted between cognitively intact and impaired participants in number of behaviors observed during any of the ? ve observed activity states. Relationship Between Self-Reported Pain and Observed Pain Behaviors Regression analyses were conducted to examine the relationship between elf-reported pain intensity and total number of pain behaviors observed, controlling for analgesics. Before the activity protocol, pain intensity was signi? cantly predictive of the pain behaviors sum score (b 5 0. 27, P 5. 002), but the relationship did not differ between cognitively intact and impaired participants. After the activity protocol, self-reported pain intensity was signi? cantly (and more strongly) related to number of pain behaviors observed (b 5 0. 40, P 5. 000), and the painby-cognitive status interaction was signi? cant (b 5 0. 22, P 5. 008). Thus, postactivity pain intensity and summed behavioral indicators were signi? antly related in intact but not impaired participants (Table 2). DISCUSSION It was found that cognitive impairment diminishes selfreported pain assessed at rest but only when analgesics are not controlled. At baseline, cognitively impaired elderly people were signi? cantly less likely than cognitively intact elderly people to report pain, consistent with reports in the literature,7 but when analgesics were controlled for, these differences disappeared. This ? nding highlights the need to control for analgesics taken when making group comparisons, which to the best of the authors’ knowledge, has not been previously done.The few studies reporting medication use include drugs prescribed or number of doses taken 0. 27 0. 01 0. 09 0. 08 2. 9 0. 40 A 0. 03 . 22 . 18 6. 70 .003 . 99 . 30 . 02 . 00 . 75 . 01 . 000 (regardless of medication class), whereas the current study identi? ed analgesics in the subject’s body during the pain assessment protocol. After the activity-based protocol was completed, selfreported pain intensity increased for both groups, but cognitively impaired elderly people reported less-intense pain than their intact peers. This ? ding supports the usefulness of the protocol to exacerbate pain in those with painful conditions and highlights the importance of mobility-based pain assessments. 12,14 This ? nding held even when the amount of analgesics taken by participants was controlled for in the statistical analysis. Behavioral indicators of pain observed during activities were equivalent across both groups. This ? nding contradicts previous work15 and may re? ect that medication use was controlled for and that the focus of the current study was on persistent pain, as oppose d to more-acute, postoperative pain. This research con? ms that reliance on selfreport alone is insuf? cient to assess pain in older adults with dementia, because the pain experience may be underestimated,11 and supports growing recognition that behavioral observation is a necessary and useful pain measure, particularly in subjects with cognitive impairment. Cognitively impaired elderly people took signi? cantly more pain medication than their intact peers. The difference was approximately 500 acetaminophen equivalents, approximately the dose of one extra-strength acetaminophen tablet. This ? nding, which contradicts previous work,8,9 warrants further investigation.Post hoc analyses indicated that this difference was not attributable to residential status, number of medical conditions, or demographic characteristics. Thus, it may re? ect recent changes in prescriptive practice as a result of heightened focus on pain in older adults with dementia. Another important ? nding is the sig ni? cant relationship between self-reported pain intensity and observed pain behaviors in cognitively intact persons. This ? nding provided support for the validity of behavioral pain JAGS JANUARY 2009–VOL. 57, NO. 1 PAIN ASSESSMENT IN PERSONS WITH DEMENTIA 31 indicators against the criterion standard of self-report, as least in cognitively intact elderly people, and is consistent with other researchers’ ? ndings. 28 Because there is no evidence that cognitively impaired elderly people experience less pain, it is reasonable to infer that pain behaviors are a valid indicator of pain in persons with dementia, although this assumption cannot be directly tested unless biological tests are developed. 12,24 Pain is subjective, and pain behaviors can be dif? cult to interpret, be subject to bias, and lack speci? city. 14,29 It has been uggested that some behaviors may indicate anxiety or generalized distress, not pain, in those with advanced dementia. 29,30 Thus, pain behavio r measurements should be used in conjunction with selfreport, not as a replacement, and in the context of a comprehensive pain assessment. 14,30 Study strengths are that cognitively intact and impaired elderly people participated, thereby facilitating comparison of assessment strategies in persons of differing cognitive abilities, that a careful analysis of analgesics used during the pain assessment was conducted, and that persistent pain was focused on.Most related prior research has included only persons with advanced dementia and postoperative pain. The sample was limited, however, by being primarily Caucasian and by being restricted to individuals with mild to moderate dementia. This was likely because of inclusion criteria requiring that participants be able to rise, stand, and walk. Individuals with severe dementia are typically more immobilized and unable to follow directions, factors that would impair ability to complete the activity-based protocol in this study. Thus, gener alizations are limited, and further study is needed.This study contributes several important ? ndings to the discourse on pain assessment in persons with dementia. First, it was con? rmed that self-reported pain, although still attainable, may be less reliable in those with mild to moderate dementia than in cognitively intact elderly people, depending on when it is assessed. Second, assessment of pain during movement is supported. Cognitively intact and impaired elderly people both showed greater self-reported pain intensity after movement, indicating that static assessment may underestimate pain.Third, results support the validity of behavioral pain assessment against the criterion standard of self-report and provide evidence of an association between summed pain behaviors and self-reported pain intensity. More work is needed to establish scale properties of pain behaviors in relation to pain severity before this approach can be translated to clinical practice. Fourth, ? ndings hig hlight the importance of carefully evaluating analgesics taken when measuring pain, since results indicate that cognitively intact and impaired elderly people with persistent pain are often medicated differently.This ? nding may re? ect a change in prescriptive practice that warrants further investigation. (Dr. Horgas) and a John A. Hartford Foundation Building Academic Geriatric Nursing Capacity Pre-doctoral Scholarship (Dr. Elliott). Author’s Contributions: Dr. Horgas was responsible for scienti? c oversight of all aspects of the study reported in this manuscript, including study design, data collection, data management, data analyses, and manuscript preparation. Dr. Elliott provided critical review of the manuscript and contributed to the design and study methods, data collection, and data coding.Dr. Marsiske provided critical review of the manuscript and contributed to the design and study methods, data management, and statistical analyses. All authors have approved the ? nal version of this manuscript that was submitted for publication. Sponsor’s Role: The National Institute of Nursing Research sponsored this study but had no role in the design, methods, subject recruitment, data collections, data analyses, or manuscript preparation. REFERENCES 1. American Geriatrics Society. Clinical practice guidelines: The management of persistent pain in older persons.J Am Geriatr Soc 2002;50:S205–S224. 2. Shega JW, Hougham GW, Stocking CB et al. Pain in community-dwelling persons with dementia: Frequency, intensity, and congruence between patient and caregiver report. J Pain Symptom Manage 2004;28:585–592. 3. Helme RD, Gibson SJ. The epidemiology of pain in elderly people. Clin Geriatr Med 2001;17:417–431. 4. Benedetti F, Vighetti S, Ricco C et al. Pain threshold and tolerance in Alzheimer’s disease. Pain 1999;80:377–382. 5. Huffman JC, Kunick ME. Assessment and understanding of pain in patients with dementia. Gerontol ogist 2000;40:574–581. . Bachino C, Snow AL, Kumik M et al. Principles of pain assessment and treatment in non-communicative demented patients. Clin Gerontol 2001;23: 97–115. 7. Fisher SE, Burgio LD, Thorne BE et al. Pain assessment and management in cognitively impaired nursing home residents: Association of certi? ed nursing assistant pain report, Minimum Data Set pain report, and analgesic medication use. J Am Geriatr Soc 2002;50:152–156. 8. Horgas AL, Tsai PF. Analgesic drug prescription and use in cognitively impaired nursing home residents. Nurs Res 1998;47:235–242. 9.Won A, Lapane K, Gambassi G et al. Correlates and management of nonmalignant pain in the nursing home. J Am Geriatr Soc 1999;47:936–942. 10. Pautex S, Michon A, Guedira M et al. Pain in severe dementia: Self-assessment or observational scales. J Am Geriatr Soc 2006;54:1040–1045. 11. Herr K, Coyne PJ, Key T et al. Pain assessment in the nonverbal patient: Position statemen t with clinical practice recommendations. Pain Manage Nurs 2006;7:44–52. 12. Herr K, Bjoro K, Decker S. Tools for assessment of pain in nonverbal older adults with dementia: A state-of-the-science review.J Pain Symptom Manage 2006;31:170–192. 13. Hadjistavropoulos T, Herr K, Turk D et al. An interdisciplinary expert consensus statement on assessment of pain in older persons. Clin J Pain 2007;23(Suppl):S1–S43. 14. Stolee P, Hillier LM, Esbaugh J et al. Instruments for the assessment of pain in older adults with cognitive impairment. J Am Geriatr Soc 2005;53: 319–326. 15. Hadjistavropoulos T, LaChapelle DL, MacLeod FK et al. Measuring movementexacerbated pain in cognitively impaired frail elders. Clin J Pain 2000;16:54–63. 16.Crum RM, Anthony JC, Bassett SS et al. Population-based norms for the MiniMental State Examination by age and education level. JAMA 1993;269: 2386–2391. 17. Cullen B, Fahy S, Cunningham CJ et al. Screening for dementia in an Irish community sample using MMSE: A comparison of norm-adjusted versus ? xed cut-points. Int J Geriatr Psychiatry 2005;20:371–376. 18. Keefe FJ, Block AR. Development of an observation method for assessing pain behavior in chronic low back pain patients. Behav Ther 1982;13: 363–375. 19. Weiner D, Pieper C, McConnell E et al.Pain measurement in elders with chronic low back pain: Traditional and alternative approaches. Pain 1996;67: 461–467. ACKNOWLEDGMENTS Con? ict of Interest: The editor in chief has reviewed the con? ict of interest checklist provided by the authors and has determined that the authors have no ? nancial or any other kind of personal con? icts with this manuscript. This study was supported by Grant R01 NR05069 from the National Institutes of Health, National Institute of Nursing Research 132 HORGAS ET AL. JANUARY 2009–VOL. 57, NO. 1 JAGS 20. Weiner D, Peterson B, Keefe F.Chronic pain-associated behaviors in the nursing home: Resident versus caregiver perceptions. Pain 1999;80:577–588. 21. Gagliese L, Melzack R. Age-related differences in the qualities but not the intensity of chronic pain. Pain 2003;104:597–608. 22. Melzack R. The McGill Pain Questionnaire: Major properties and scoring methods. Pain 1975;1:277–299. 23. Lichtenstein MJ, Dhanda R. , Cornell JE et al. Disaggregating pain and its effect on physical functional limitations. J Gerontol A Biol Sci Med Sci 1998; 53A:M361–M371. 24. Horgas AL, Nichols AL, Schapson CA et al.Assessing pain in persons with dementia: Relationships between the NOPPAIN, self-report, and behavioral observations. Pain Manage Nurs 2007;8:77–85. 25. Gibson SJ, Helme RD. Cognitive factors and the experience of pain and suffering in older persons. Pain 2000;85:375–383. 26. Folstein MF, Folstein SE, McHugh PR. ‘‘Mini-mental state’’: A practical method for grading the cognitive state of patients for the clinician. J Psy chiatr Res 1975;12:189–198. 27. Allen RS, Thorn BE, Fisher SE et al. Prescription and dosage of analgesic medication in relation to resident behaviors in the nursing home.J Am Geriatr Soc 2003;51:534–538. 28. Labus JS, Keefe FJ, Jensen MP. Self-reports of pain intensity and direct observations of pain behavior: When are they correlated? 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Punctuation Marks Part 1

The German word for dot, point or period,  der Punkt, and the English word  punctuation  both have the same Latin source:  punctum  (point). Among many other things that German and English have in common are the punctuation marks they use. And the reason most punctuation marks look and sound the same is that many of the signs and some of the terms, such as  der Apostroph,  das Kommaand  das Kolon  (and English  period, hyphen), are of common Greek origin. The period or full stop (der Punkt) dates back to antiquity. It was used in Roman inscriptions to separate words or phrases. The term question mark (das Fragezeichen) is only about 150 years old, but the ? symbol is much older and was earlier known as the mark of interrogation. The question mark is a descendant of the  punctus interrogativus  used in 10th-century religious manuscripts. It was originally used to indicate voice inflection. (Greek used and still uses a colon/semicolon to indicate a question.) The Greek terms  kà ³mma  and  kà ³lon  originally referred to parts of lines of verse (Greek  strophe, German  die Strophe) and only later came to mean the punctuation marks that demarcated such segments in prose. The most recent punctuation marks to appear were quotation marks (Anfà ¼hrungszeichen)—in the eighteenth century. Fortunately for English-speakers, German generally uses the same punctuation marks in the same way that English does. However, there are some minor and a few major differences in the way the two languages use common punctuation marks. „ Der Bandwurmsatz ist die Nationalkrankheitunseres Prosastils.†Ã‚  - Ludwig Reiners Before we look at the details of punctuation in German, let’s define some our terms. Here are some of the more common punctuation marks in German and English. Since America and Britain are â€Å"two countries separated by a common language† (G.B. Shaw), I have indicated the American (AE) and British (BE) terms for items that differ. SatzzeichenGerman Punctuation Marks Deutsch English Zeichen die Anfà ¼hrungszeichen 1„Gà ¤nsefà ¼ÃƒÅ¸chen† (â€Å"geese feet†) quotation marks 1speech marks (BE) „ â€Å" die Anfà ¼hrungszeichen 2â€Å"chevron,† „franzà ¶sischeâ€Å" (French) quotation marks 2French â€Å"guillemets†  «  » die Auslassungspunkte ellipses dots​​, ommission marks ... das Ausrufezeichen exclamation mark ! der Apostroph apostrophe ’ der Bindestrich hyphen - der Doppelpunktdas Kolon colon : der Ergà ¤nzungsstrich dash - das Fragezeichen question mark ? der Gedankenstrich long dash — runde Klammern parentheses (AE)round brackets (BE) ( ) eckige Klammern brackets [ ] das Komma comma , der Punkt period (AE)full stop (BE) . das Semikolon semicolon ; Note:  In German books, periodicals, and other printed materials you will see both kinds of quotation marks (type 1 or 2). While newspapers generally use type 1, many modern books use type 2 (French) marks.    Part 2: Differences German versus English Punctuation In most cases, German and English punctuation are similar or identical. But here are a few key differences: 1. Anfà ¼hrungszeichen  (Quotation Marks) A. German uses two types of quotation marks in printing. â€Å"Chevron† style marks (French â€Å"guillemets†) are often used in modern books: Er sagte:  «Wir gehen am Dienstag. »orEr sagte:  »Wir gehen am Dienstag. « In writing, in newspapers, and in many printed documents German also uses quotation marks that are similar to English except that the opening quotation mark is below rather than above: Er sagte: „Wir gehen am Dienstag.† (Note that unlike English, German introduces a direct quotation with a colon rather than a comma.) In email, on the Web, and in hand-written correspondence, German-speakers today often use normal international quotation marks (â€Å" †) or even single quote marks (‘ ’). B. When ending a quotation with â€Å"he said† or â€Å"she asked,† German follows British-English style punctuation, placing the comma outside of the quotation mark rather than inside, as in American English: „Das war damals in Berlin†, sagte Paul. „Kommst du mit?†, fragte Luisa. C. German uses quotation marks in some instances where English would use  italics  (Kursiv). Quotation marks are used in English for the titles of poems, articles, short stories, songs and TV shows. German expands this to the titles of books, novels, films, dramatic works and the names of newspapers or magazines, which would be italicized (or underlined in writing) in English:„Fiesta† („The Sun Also Rises†) ist ein Roman von Ernest Hemingway. — Ich las den Artikel „Die Arbeitslosigkeit in Deutschland† in der „Berliner Morgenpost†. D. German uses single quotation marks (halbe Anfà ¼hrungszeichen) for a quotation within a quotation in the same way English does:„Das ist eine Zeile aus Goethes ,Erlkà ¶nig’†, sagte er. Also see item 4B below for more about quotations in German. 2. Apostroph  (Apostrophe) A. German generally does not use an apostrophe to show genitive possession (Karls Haus, Marias Buch), but there is an exception to this rule when a name or noun ends in an s-sound (spelled  -s, ss, -ß, -tz, -z, -x, -ce). In such cases, instead of adding an s, the possessive form ends with an apostrophe:  Felix’ Auto, Aristoteles’ Werke, Alice’ Haus.  - Note: There is a disturbing trend among less well-educated German-speakers not only to use apostrophes as in English, but even in situations in which they would not be used in English, such as anglicized plurals (die Callgirl’s). B. Like English, German also uses the apostrophe to indicate missing letters in contractions, slang, dialect, idiomatic expressions or poetic phrases:  der Ku’damm (Kurfà ¼rstendamm), ich hab’ (habe), in wen’gen Minuten (wenigen), wie geht’s? (geht es), Bitte, nehmen S’ (Sie) Platz!  But German does not use an apostrophe in some common contractions with definite articles:  ins (in das), zum (zu dem). 3. Komma  (Comma) A. German often uses commas in the same way as English. However, German may use a comma to link two independent clauses without a conjunction (and, but, or), where English would require either a semicolon or a period:  In dem alten Haus war es ganz still, ich stand angstvoll vor der Tà ¼r.But in German you also have the option of using a semicolon or a period in these situations. B. While a comma is optional in English at the end of a series ending with and/or, it is never used in German:  Hans, Julia und Frank kommen mit. C. Under the reformed spelling rules (Rechtschreibreform), German uses far fewer commas than with the old rules. In many cases where a comma was formerly required, it is now optional. For instance, infinitive phrases that were previously always set off by a comma can now go without one:  Er ging(,) ohne ein Wort zu sagen.  In many other cases where English would use a comma, German does not. D. In numerical expressions German uses a comma where English uses a decimal point:  Ã¢â€š ¬19,95 (19.95 euros)  In large numbers, German uses either a space or a decimal point to divide thousands:  8 540 000 or 8.540.000 8,540,000  (For more on prices, see item 4C below.) 4. Gedankenstrich  (Dash, Long Dash) A. German uses the dash or long dash in much the same way as English to indicate a pause, a delayed continuation or to indicate a contrast:  Plà ¶tzlich — eine unheimliche Stille. B. German uses a dash to indicate a change in the speaker when there are no quotation marks:Karl, komm bitte doch her! - Ja, ich komme sofort. C. German uses a dash or long dash in prices where English uses double zero/naught: â‚ ¬5,— (5.00 euros)