Paper on Chronic Low Back Hurting Essay Example

Paper on Chronic Low Back Hurting Essay Example Paper on Chronic Low Back Hurting Essay Paper on Chronic Low Back Hurting Essay Introduction Chronic low back hurting ( CLBP ) is a major wellness issue in the western universe and is a important load on wellness attention ; Americans spend $ 37 billion yearly with a farther $ 19.8 billion lost in absenteeism [ 1 ] . There is 58 % life clip prevalence of back hurting in the UK, a 22-65 % 1-year prevalence and 6-7 % of all grownups have changeless back jobs [ 2 ] . Although CLBP is normally benign ( lt ; 1 % serious pathology [ 3 ] ) yet there are many curative attacks. Acupuncture has become a popular intervention but its effectivity has non been sufficiently demonstrated. Modern ( Verum ) stylostixis originates in ancient Chinese doctrine which claims hurting and disease manifest because of instabilities in organic structures forces of Yin and Yang. It is believed these forces flow through specific classs ( acmes ) and can be manipulated utilizing specific stylostixis points to recover the balance. Acupuncture has evolved from the traditional Chinese application and some manners integrating adjuncts such as electrical stimulation of the stylostixis needle [ 4 ] , A recent systematic reappraisal of articles published between 1966 and February 2003 [ 4 ] concluded that the efficaciousness of stylostixis on CLBP was inconclusive due to the low methodological quality of selected surveies. They found stylostixis had some short-run betterments in hurting and map compared to command or simulate but due to low methodological quality they concluded a demand for higher quality surveies. This reappraisal updates that survey [ 4 ] by including articles published after February 2003 or surveies that were published prior but were of high relevancy and methodological quality. The aim is to supply steadfast decisions about the efficaciousness of stylostixis therapy for CLBP. Method Study Selection Criteria Merely randomised controlled tests ( RCTs ) available in English and available free of charge were included. Search Scheme In October 2009 the MEDLINE database ( period 1950 to day of the month ) was searched for RCTs published after February 2003 and fiting the hunt threading Chronic low back hurting AND stylostixis OR dry needling OR Sham OR Placebo AND randomised controlled test OR randomized controlled test . Further searches utilizing PEDro, Web of Science ( utilizing ISI Web of Knowledge ) and Cinahl ( period 1982 to day of the month ) ( see appendix A ) . Each articles reference list was besides used as a beginning of relevant publications. Participants For inclusion the surveies participants needed to be =18-years old with non-specific CLBP. Non-specific CLBP was defined as hurting between the 12th costal border and the inferior gluteal creases =12-weeks. If radiating leg hurting was present this must be secondary to the lumbosacral part hurting. RCTs that included participants with specific pathologies as the root cause of their CLBP, such as malignance, prolapsus of =1 inter-vertebral phonograph record or spinal break were excluded. Interventions Surveies that investigated the effects of traditional ( Verum ) stylostixis, trigger-point stylostixis and dry needling were reviewed. RCTs were included regardless of manus of electro-stimulation. Studies look intoing non-needle based stylostixis, such as optical maser stylostixis, were excluded. Control intercessions included fake, usual attention, Transcutaneous Electrical Nerve Stimulation ( TENS ) or conservative orthopedic therapy. Result steps There are four result steps considered to be of import when measuring CLBP Pain strength ( e.g. ocular parallel graduated table ( VAS-P ) , numerical evaluation graduated table ( NRS-P ) ) A planetary step ( e.g. Overall betterment, relative recovery of patients ) A back specific functional position step ( e.g. Roland-Morris Disability Questionnaire ( RMDQ ) ) Tax return to work ( absenteeism, velocity of return ) RCTs must include =1 of the above. The primary results were hurting and map. Study choice A sum of 544 surveies were found through the hunts with 17 potentially eligible RCTs identified. Of these 5 were excluded due to analyze duplicate ( n=1 ) , exclusive inclusion of participants with specific CLBP ( n=2 ) or usage of non-needle based stylostixis ( n=2 ) . The staying 12 articles were reviewed utilizing the Critical Appraisal Skills Programme ( CASP ) to find their methodological quality. CASP enables the systematic reappraisal of an RCT for cogency, design, executing and logical thinking. Assessment standards included randomisation and allotment of participants, blinding of participants and assessors, designation of possible perceiver prejudice, participant Numberss at RCT start and decision, presentation and truth of consequences, and any identified restrictions. Consequences were recorded and documented ( Appendix B ) . RCT commonalties: Participants were excluded: if they exhibited contraindications to acupuncture, had received stylostixis for their CLBP antecedently, old spinal surgery, infective spondylopathy, malignance, inborn spinal column malformation, compaction break due to osteoporosis or spinal stricture. No differences in demographic variables or baseline degrees of hurting and disablement were detected between the groups at baseline ( P gt ; 0.05 ) . Randomization was computer-generated with random figure tabular arraies. All participants gave informed consent. Each RCT received ethical blessing Usual attention is defined as a combination of drugs, physical therapy and exercising. Consequence [ 5 ] 298 participants with CLBP =6-months randomised to 12 Sessionss of stylostixis ( n=146 ) or assumed stylostixis ( n=73 ) over 8-weeks, administrating healers had =140 hours developing and 3-years experience, with a 3rd delayed stylostixis group ( n=79 ) who received no stylostixis for the initial 8-weeks followed by the stylostixis groups protocol. Outcome steps were VAS-P and back map utilizing the validated German Funktionsfragebogen Hannover-R A ; uuml ; cken ( FFbH-R ) questionnaire. At 8-weeks VAS-P decreased from baseline in all groups ; after 26 and 52-weeks the stylostixis group s consequences were better than assumed nevertheless differences were non important. Consequences from the delayed stylostixis group followed the stylostixis groups form. The test had good methodological quality: result steps were assessed independently with participants finishing questionnaires, abrasion was sensible ( 18 % ) but the stylostixis group was double the size of the others which m ay hold influenced consequences. [ 6 ] 638 participants with CLBP =3-months randomised to standard stylostixis ( n=185 ) , individualized stylostixis ( n=157 ) , assumed stylostixis ( n=162 ) or usual attention ( 161 ) groups. Acupuncture groups received 10 interventions over 7-weeks by acupuncturists with =3 preparation. The Primary result step was RMDQ. Compared to baseline all groups showed improved map and hurting at 8-weeks. Average values for RMDQ were consistent up to 52-weeks with the usual attention group holding greater disfunction than all stylostixis groups ( P=.001 ) . There was no important difference between existent and assumed stylostixis groups ( P gt ; 0.05 ) . All signifiers of stylostixis had good and dogging effects over usual attention for CLBP intervention with clinically meaningful functional betterments. There were no important differences between stylostixis groups. Outcome steps were gathered by blinded telephone interviewers and abrasion was low ( 6 % ) resulting in good test internal c ogency [ 7 ] 1162 participants with CLBP =6-months randomised to 5-weeks of twice-weekly stylostixis ( n=387 ) or assumed stylostixis ( n=387 ) , performed by acupuncturists with =140 hours developing. A 3rd group received usual attention ( n=387 ) . Outcome steps were Von Korff Chronic Pain Grade Scale ( GCPS ) and Hanover Functional Ability Questionnaire ( HFAQ ) . Consequences were presented as a per centum of betterment in map and hurting at 6-month followup. At 6-months both stylostixis groups had important betterments in hurting and map compared to baseline and usual intervention. There was no difference between stylostixis groups ( p=0.39 ) . The test was methodologically strong with good internal cogency: the control group was an active multimodal conventional therapy, had high power with declared computation, followups at 1.5, 3 and 6-months, low abrasion ( 4 % ) and balanced dynamic randomization. This was a good, extremely relevant, big, strict test. [ 8 ] 35 participants, =65-years, with CLBP =6-months randomised to 1 of 3 groups having 2 3-week stages of 30-minute stylostixis Sessionss, with a 3-week interval between. Group A ( n=12 ) received standard stylostixis, Group B ( n=10 ) superficial trigger-point stylostixis and Group C ( n=13 ) deep trigger-point stylostixis. Outcome steps were VAS-P and RMDQ mark. Group C showed a statistically important VAS-P and RMDQ decreases from baseline after stage 1 with VAS-P decrease prevailing over 12-weeks. There was no important decrease in VAS-P or RMDQ for either other groups. The RCTs methods are described good nevertheless little sample size, high dropout ( 27 % ) , short-run followup and possible prejudice limited internal cogency [ 9 ] 26 participants, =65-years, with CLBP =6-months randomised to 2 groups. Over 12-weeks each group received 1 stage of trigger-point stylostixis and 1 stage of assumed stylostixis with a 3-week interruption between. Group A ( n=13 ) received trigger-point stage foremost followed by fake, Group B ( n=13 ) vice-versa. Acupuncturist had =4-years preparation and =7-years clinical experience. Outcome steps were VAS-P and RMDQ mark. After stage 1 Group A had significantly lower VAS-P ( P lt ; 0.001 ) and RMDQ tonss ( P lt ; 0.001 ) than group B. Both groups showed important within-group lessenings in VAS-P ( P lt ; 0.001 ) and RMDQ tonss after trigger-point stylostixis but non during fake. At 12-weeks effects were non sustained. This test was described good but suffers from the same defects as the 2004 RCT by the same writers. [ 10 ] 60 participants with CLBP =6-months randomised them to 6-weeks of 30-minute hebdomadal Sessionss of either stylostixis ( n=30 ) or placebo TENS ( n=30 ) . No inside informations of administrating healers were given. The primary result step was VAS-P. Although stylostixis showed extremely important differences in all the result steps between pre- and post-treatment, the differences between the 2 groups were non statistically important. By and large the RCT was hapless: healers were non blinded, high disobedience ( 23.3 % ) , cointerventions might hold influenced consequences, the dropout rate was non explained and there was no intention-to-treat analysis. [ 11 ] 131 participants 18-65 old ages old with CLBP =6-months were randomised to groups having 20 30-minute Sessionss of traditional and otic stylostixis ( n=40 ) , physical therapy ( n=46 ) or assumed stylostixis and physical therapy ( n=45 ) , over 12-weeks. Outcome steps were VAS-P and pain disablement index ( PDI ) . After 12-weeks of intervention the stylostixis group showed significantly reduced hurting and disablement compared to the physical therapy group but non compared to the fake group. At 9-months the stylostixis group was more effectual than physical therapy in cut downing disablement merely and non different to simulate. The test was methodologically strong but short-run dropout was 24 % and long-run 37 % . The intervention scheduled was five-a-week for 2-weeks so hebdomadal for 10-weeks which may non be clinically practical. [ 12 ] 55 participants =60 years, with CLBP =12-weeks were randomised to 2-weeks of twice-weekly stylostixis and electrical stimulation aboard usual attention ( n=31 ) or usual attention entirely ( n=24 ) . Primary result was RMDQ. At 6-weeks consequences indicate clinically and statistically important betterments in the stylostixis group for hurting and disablement compared to command. Effectss remained and merely diminished somewhat at 9-weeks followup. The test was methodologically strong: balanced randomization, clear methods, low abrasion ( 14 % ) . Participant inclusion standards included prior imaging restricting generalisability. [ 13 ] 186 participants aged between 20 and 60 with CLBP =6-week were randomised to 4-weeks of usual attention entirely ( n=60 ) or with either stylostixis ( n=65 ) or assumed stylostixis ( n=61 ) . Acupuncturists were experient physicians trained in Beijing. Primary outcome step was VAS-P. Immediately after intervention 65 % of the stylostixis group reported a =50 % decrease in VAS-P compared to 34 % of the fake group and 43 % of the usual attention group. At 3-months 79 % of the stylostixis group, 29 % of the fake group and 14 % of the usual attention group reported a =50 % VAS-P decrease. Methodological quality was high: balanced ( stratified ) randomization and magnificently described methods nevertheless there was 30 % abrasion at 3-month follow-up and informations aggregation was from general practicians taking to possible public presentation prejudice. [ 14 ] 241 participants, aged 18-65, with CLBP for 4 to 52-weeks were randomised to 10 Sessionss of stylostixis ( n=160 ) or to usual attention ( n=81 ) over 3-months. Acupuncturists were developing for =3-years and =12.8-years clinical pattern. Outcome steps were SF-36 hurting tonss and Oswestry low back hurting disablement questionnaire ( ODI ) taken at baseline, 3, 12 and 24-months. A power computation stated a needed 100 participants per group to observe a 10-point difference on SF-36 ( 90 % power and 5 % significance degree ) . A 5 point difference in SF-36 was deemed important. The figure of participants in the stylostixis group was increased to 160 to let for between-acupuncturist consequence, usual attention group decreased to 80 participants without power loss. Consequences were presented as point differences between randomization, 12 and 24-months. At 12-months a 5.6 point intercession consequence difference in SF-36 hurting was found and 8 point at 24-months. No interventi on consequence was found for any other dimension of SF-36 or ODI. Participants were representative of UK population, randomization was balanced, methods were exhaustively documented and acupuncture interventions were individualized ensuing in high methodological quality and generalisability. However 25 % of participants were unaccounted for at decision cut downing internal cogency. [ 15 ] 11630 participants with CLBP =6-months were allocated to three groups. Group A were received 15 individualized stylostixis Sessionss with usual attention as needed ( n=1549 ) . Group B received delayed stylostixis with usual attention as needed ( n=1544 ) . Group C declined to be randomised but received 15 individualized stylostixis Sessionss with usual attention ( n=8004 ) . Treatment was over 3-months. Outcome steps were FFbH-R and SF-36 hurting tonss. At 6-months the stylostixis group showed important betterments in FFbH-R and SF-36 hurting compared to routine attention entirely. The big sample size and wide inclusion standards meant consequences were generalisable nevertheless groups were different at baseline and findings identified a grade of randomization choice. [ 16 ] 52 participants with CLBP =6-months were randomised to 4-weeks of physical therapy with day-to-day 1-hour electro-acupuncture Sessionss ( n=26 ) or standard physical therapy ( n=26 ) . Outcome steps were hurting ( NRS-P ) and map utilizing the Aberdeen-LBP. There was a important decrease in NRS-P and Aberdeen-LBP tonss in the stylostixis group instantly after intervention and at 1 and 3-months followup. Methodological quality was limited by possible breach of blinding unity due to miss of patient blinding and subjective result steps. Discussion Acupuncture vs. no intervention Two high quality surveies ( 11928 people ) [ 5 ] and [ 15 ] found acupuncture more effectual in short-run hurting decrease and functional betterments than no ( delayed ) intervention. However both surveies were weakened by deficient blinding and participants were recruited from newspaper adverts [ 5 ] or an insurance company [ 15 ] restricting generalisability ; both of which cut down consequences assurance. Acupuncture vs. fake Surveies comparing stylostixis and assumed stylostixis ( 2460 people ) ( [ 5 ] , [ 6 ] , [ 7 ] , [ 11 ] and [ 13 ] ) found both effectual at cut downing hurting and increasing map compared to baseline steps ; nevertheless no survey found a clinically important difference between groups With five methodologically sound tests all describing similar consequences clinicians can hold assurance in the effectivity of stylostixis or sham-acupuncture in hurting and functional betterments. However with no clinically important difference between groups, placebo consequence seems to be a significant contributing factor. Acupuncture vs. usual attention Five RCTs comparison stylostixis and usual attention ( 12164 people ) ( [ 12 ] , [ 13 ] , [ 14 ] , [ 15 ] and [ 16 ] ) concluded that stylostixis was more effectual at cut downing hurting. Increased map in the stylostixis group compared to command was reported in 1 RCT [ 12 ] at 6- and 9-weeks, [ 15 ] at 6-month and another [ 16 ] investigated consequence instantly after intervention and 1- and 3-months followup ; nevertheless 1 RCT [ 14 ] found no important betterment in map in their longer-term survey at 12 or 24-month. Unlike other documents reviewed, Thomas and co-workers used UK based participants who received interventions in private or GP clinics adding assurance to their decisions when applied to the general UK population. From survey findings clinicians can hold assurance that the add-on of stylostixis to their intervention of CLBP will be more effectual than usual attention entirely. Acupuncture vs. deep and superficial trigger-point stylostixis One survey ( [ 8 ] 35 people ) found greatest betterments in hurting and map utilizing deep trigger-point-acupuncture. However this survey, while being methodologically thorough and holding patient and assessor blinding, was limited by little size, high dropout ( 23 % ) , short-run followup and possible Centre prejudice taking to cut down clinical assurance. Acupuncture vs. TENS One RCT ( [ 10 ] 60 people ) found important betterments utilizing both TENS and stylostixis but no important intergroup difference over 6-months. However, assurance in consequences are limited because participants besides received usual attention and exercising so may hold improved irrespective ; furthermore the survey had no healers blinding, high disobedience ( 23.3 % ) , unexplained dropouts and no intention-to-treat analysis. Trigger-point stylostixis vs. fake In 1 cross-over test ( [ 9 ] 26 people ) trigger-point stylostixis was found to be more effectual than sham nevertheless little sample size, high abrasion ( 23 % ) , restricted to short-run follow-up and possible prejudice due to center location ( Department of Orthopaedic Surgery, Meiji University of Oriental Medicine ) bound assurance in findings. Restriction Surveies were normally limited by being unrepresentative: of the 12 surveies 2 were UK based ( [ 10 ] , [ 14 ] ) , six restricted participants by age ( [ 8 ] , [ 9 ] , [ 11 ] [ 12 ] , [ 13 ] , [ 14 ] ) , 2 used participant enlisting methods which may hold introduced outlook prejudice ( newspaper adverts, [ 5 ] , insurance company [ 15 ] ) and five had underpowered sample sizes or non-stated power computations ( [ 8 ] , [ 9 ] , [ 11 ] , [ 12 ] , [ 13 ] ) . Without representative sample groups the result steps can non be applied to the general population with any dependability. Discrepancies were noted in intervention frequence with control group participants having less attending than intercession participants [ 16 ] . Blinding was inconsistent across surveies: 1 survey ( [ 5 ] ) blinded participants in the stylostixis groups but non the delayed group, 1 survey ( [ 6 ] ) blinded participants merely, four ( [ 7 ] , [ 8 ] , [ 9 ] , [ 13 ] ) blinded assessors and participant, 1 ( [ 10 ] ) blinded assessors merely, 1 ( [ 11 ] ) blinded assessors and participants but non acupuncturists, three ( [ 12 ] , [ 14 ] , [ 15 ] ) had no blinding and 1 ( [ 16 ] ) blinded assessors but non participants. Decision There is some grounds for the efficaciousness of stylostixis for CLBP ; compared to no intervention at that place was short-run ( [ 5 ] 8-week and [ 15 ] 3-month ) hurting decrease and functional betterments. Compared to simulate therapy both showed similar betterments in hurting and map at short-run ( [ 5 ] 8-week, [ 6 ] 8-week, [ 11 ] 12-week and [ 13 ] 3-month ) and mid-term ( [ 5 ] 6-month and 1-year, [ 7 ] 6-month, [ 11 ] 9-month ) followup but no important difference was detected between groups. Compared to usual attention stylostixis showed important betterments in primary result steps at intervention, short- ( [ 12 ] 6- and 9-week, [ 13 ] 3-month, [ 16 ] 1- and 3-month ) and long-run ( [ 15 ] 6-month, [ 14 ] 1- and 2-year ) followup. Compared to superficial and deep trigger-point all interventions showed betterments but none were significantly different from each other. Both stylostixis and TENS were found to bring forth long-run ( [ 10 ] 6-month ) betterments but no importan t difference was found between intercessions. Comparing trigger-point therapy to simulate, trigger-point was found to be more effectual although benefits were non sustained. There is grounds that stylostixis alongside other interventions relieves hurting and increases map better than single therapies entirely. Further research needs to be conducted to find intervention frequences and sustainability of intervention effects. Effective fake interventions need to be developed to set up placebo consequence compared to acupuncture and other therapy types. Extra Resources Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R. ( 2003 ) . Lost productive clip and cost due to common hurting conditions in the US work force. JAMA ; 290 ( 18 ) :2443-2454. Maniadakis, N. and Gray, A. ( 2000 ) The economic load of back hurting in the UK. Pain, 84, 95-103. Koes BW, new wave Tulder MW and Thomas S ( 2006 ) . Diagnosis and intervention of low back hurting. BMJ ; 332, p1430-1434 Furlan AD, new wave Tulder M, Cherkin D, Tsukayama H, Lao L, Koes B, Berman B. ( 2005 ) . Acupuncture and Dry-Needling for Low Back Pain: An Updated Systematic Review Within the Framework of the Cochrane Collaboration. Spine 2005 ; 30:944-963 Reviewed Diaries Brinkhaus B, Witt CM, Jena S, Linde K, Streng A, Wagenpfeil S, Irnich D, Walther HU, Melchart D, Willich SN. ( 2006 ) Acupuncture in patients with chronic low back hurting: a randomized controlled test. Archivess of internal medical specialty. 166: 450-457. Cherkin et Al ( 2009 ) A randomised test comparison stylostixis, fake stylostixis, and usual attention for chronic low back hurting. Haake M, Muller H, Schade-Brittinger C, Basler HD, Schafer H, Maier C, Endres HG, Trampisch HJ, Molsberger A. ( 2007 ) . German Acupuncture Trials ( GERAC ) for chronic low back pain- randomized, multicenter, blinded, parallel-group test with 3 groups. Arch Intern Med. 167 ( 17 ) :1892-1898. Itoh E, Katsumi Y, Hirota S, Kitakoji H. ( 2006 ) . Effectss of trigger point stylostixis on chronic low back hurting in aged patients a sham-controlled randomized test. Acupuncture in Medicine. 24 ( 1 ) :5-12 ItohK. Katsumi Y. Kitakoji H. Acupuncture in Medicine. ( 2004 ) Trigger point stylostixis intervention of chronic low back hurting in aged patients: a blinded RCT. 22 ( 4 ) :170-7, Kerr DP, Walsh DM, Baxter D. ( 2003 ) Acupuncture in the direction of chronic low back hurting: a blinded randomized controlled test. The clinical diary of hurting. 19: 364-370 Leibing E, Leonhardt U, Koster G, Goerlitz A, Rosenfeldt JA, Hilgers R, Ramadori G. ( 2001 ) . Acupuncture intervention of chronic low-back hurting a randomised, blinded, placebo-controlled test with 9-month followup. Trouble 96 ( 2002 ) 189-196 Meng CF, Wang D, Ngeow J, Lao L, Peterson M, Paget S. ( 2003 ) . Acupuncture for chronic lower back hurting in older patients: a randomized, controlled test. Rheumatology. 42:1508-1517 Molsberger AF, Mau J, Pawelec DB, Winkler J ( 2002 ) . Does acupuncture better the orthopaedic direction of chronic low back pain a randomised, blinded, controlled test with3 months follow up. Trouble 99 ( 2002 ) 579-587 Thomas KJ, MacPherson H, Thorpe L, Brazier J, Fitter M, Campbell M J, Roman M, Walters S J, Nicholl J. ( 2006 ) . Randomised controlled test of a short class of traditional stylostixis compared with usual attention for relentless non-specific low back hurting. British Medical Journal.doi:10.1136/bmj.38878.907361.7C Witt CM, Jena S, Selim D, Brinkhaus B, Reinhold T, Wruck K, Liecker B, Linde K, Wegscheider K, Willich SN. ( 2006 ) . Matter-of-fact Randomized Trial Measuring the Clinical and Economic Effectiveness of Acupuncture for Chronic Low Back Pain. American Journal of Epidemiology 2006 ; 164:487-496 Yeung CKN, Leung MCP, Chow DHK. ( 2003 ) . The Use of Electro-Acupuncture in Conjunction with Exercise for the Treatment of Chronic Low-Back Pain. The Journal Of Alternative And Complementary Medicine..2003:9:4:479-490

Struthiomimus - Facts and Figures

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Kinds of accounting Essay Example | Topics and Well Written Essays - 500 words

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Textual analysis - Essay Example Although I agree with Talbot that the new generation needs a boost to accomplish more, I do not believe that neuroehancers is what our generation needs to get ahead in the white collar competition. Although there are many people out there who are using these drugs to try and get ahead of the competition, not all people are really making any progress in that direction. In fact, the people who are using these drugs are mostly already ahead of the competition that we wonder if these drugs actually even helped these people achieve their goals. Throughout the report of Talbot, we can clearly see that the people who used neuroenhancing drugs did not feel smarter or more creative. First, let us take a look at Alex the guy who recently graduated from Harvard. Alex is a classic example of a student who wants to achieve almost everything at once. He led a very hectic schedule so he needed an energy booster to keep him awake, alert and focused. Since Alex was admitted to Harvard and he ran a student organization, presumably, this guy is already smart and is ahead in terms of academic achievements. During his interview with Talbot, Alex clearly stated that the drug Adderall helped him focus his mind on the tasks at hand but it did not make him feel smarter. According to Alex, â€Å"The drug, along with a steady stream of caffeine, helped him to concentrate during classes and meetings, but he noticed some odd effects; at a morning tutorial he†¦ alternated between speaking too quickly and thoroughly on some subjects and feeling awkwardly quiet during other points of the discussion.† Lunch was a blur: â€Å"It’s always hard to eat much when on Adderall.† Based on the statement of Alex, we can clearly see that the effects of nueroehancers are not always good. The sudden bursts of mental activities followed by silence are not a good sign. If our generation wants stay competitive, we need more than just drugs that boost out mental

Marketing management Essay Example | Topics and Well Written Essays - 3000 words

Marketing management - Essay Example Effective segmenting, targeting and positioning are the key to successfully gaining customers by forming a good perception of the product in the mind of the customer. This report aims to develop appropriate segmentation and targeting strategies for â€Å"Natura† range of herbal beauty care products being launched by Janelle Inc., a US based company operating in the cosmetics and beauty care product industry. The report will also outline the positioning objective of the new product line and design a positioning strategy, which will aid the achievement of the set objectives. Lastly, the different marketing mix strategies which needs to be deployed as the product progress in the product life cycle will also be discussed along with an outline of key competitive strategies which the product will be using in competing in the long run. Janelle Inc. is a medium scale business operation incorporated in 1992, to cater to the US beauty care market. The company markets under two main brands – Janelle and Cleo, which is aimed at two different market segments. Janelle products are targeting the younger consumer base aged 18- 35 and mainly consisting of cosmetic items and few skin care products while the Cleo which is a more exclusive and upmarket product offered at the 35 + market segment, includes an extensive skin and hair care range along with cosmetics. In a recent market survey, the company realised that there is a substantial market interest in natural beauty care products, mainly in the 30+ age category. Based on this information, Janelle has decided to launch a new Herbal Beauty care product line. The company has formed an alliance with a reputed and well-established Herbal beauty care manufacturer in India, which manufactures for an exclusive cosmetic brand in the UK market. The new product line will be branded â€Å"Natura†

Context Based Approaches in Teaching of Primary Science

Context Based Approaches in Teaching of Primary Science This chapter provides a theoretical rationale for creating technology-rich, constructivist learning environments that use context-based teaching strategies in classrooms and engage students in student-centered, personally meaningful, authentic, and collaborative learning. It also provides examples of schools that have experimented context-based teaching in science in classrooms, and a curricular example that teachers can modify to increase student understanding of any curricular area. Finally, it provides online resources and a podcast that provide teachers with additional ideas for making their lessons more interesting and engaging, empowering, and enlightening classrooms. There have been many studies that indicate context-based approach is essential in order for student learning to take place. Research reveals that teaching Strategies are necessary in schools for teachers to effectively increase student achievement. The focus of this research study is to examine effects of context-based approaches in teaching science in Classroom. The review of literature will look at several factors related to teaching strategies. Those factors include the Traditional view of teaching science, problematic questions that arise in this research, importance of context-based teaching, in classroom. The review of literature will also include a discussion about how teachers can encourage character and social development of students, and the current brain-based research, which suggests and encourages context-based teaching, which promotes success of students, teachers, and improves communication standard among them. Context-based approaches to teaching science in primary school have become widely used over the past two decades. They aspire to foster more positive attitudes to science while, at the same time, provide a sound basis of scientific understanding for further study. One of the most distinct trends of the last two decades in science curriculum development across a number of countries has been to use contexts and applications of science as a means of developing scientific understanding. Teaching in this way is often described as adopting a context-based approach. The trend toward the use of context-based approaches is apparent across the whole age spectrum from primary through to university level, but is most noticeable in materials developed for use in the secondary age range. Traditional Teaching Style of Science Over the last two decades reports have traced students increasingly negative attitudes to Science in Australia over the primary years of schooling, and the associated decrease in student participation in post-compulsory science (Goodrum, Hackling, Rennie, 2001; Tytler, 2007). This decline in interest in Science in the early years of primary education is of particular concern, since it is in these years that attitudes to the pursuit of science subjects and careers are formed (Speering Rennie, 1996). A number of studies have explicitly linked this decline in student interest with the nature of the traditional science curriculum and its inability to make science meaningful and interesting to students (Fensham, 2004; Lyons, 2006). By making Science more relevant to a broader audience we can prepare prospective science degree students and professionals, as well as contribute to improved scientific literacy for all students. Context-Based Approach Context-based approaches are approaches adopted in science teaching where contexts and applications of science are used as the starting point for the development of scientific ideas. This contrasts with more traditional approaches that cover scientific ideas first, before looking at applications. But literature has a different meaning for context-based teaching. Whitelegg and Perry (1999) say that context-based learning can have several meanings, at its broadest, it means the social and cultural environment in which the student, teacher and institution are situatedà ¢Ã¢â€š ¬Ã‚ ¦a narrow view of context might focus on an application of a physics theory for the purposes of illumination and reinforcement. (p. 68) In the classroom, the use of context-based approaches might mean, for example, that students study medical diagnostic techniques in order to develop their understanding of electromagnetic radiation and atomic structure, or look at a range of different fabrics and their uses to introduce ideas about materials and their properties. A further feature of context-based approach is that, due to the nature of the material being studied, they tend to employ wider range of teaching strategies (e.g. small-group discussions, role-play, student presentations) than is normally associated with conventional science courses. How do you and your friend get to school this morning? You probably used various forms of transport between you Speed is the rate of change of distance moved with time. (Judith Bennett, 2003) These two pieces came from the opening lines of chapters on forces and motion in two different books of secondary level course, one written in 1970s and the other in 1990s. They provide good enough example to illustrate a major turn over in approaches to teaching science in that period. This turn over sheds light on the use of context-based teaching and applications as the beginning for developing scientific knowledge, understanding and comprehending it. The question arises that where this concept of context-based writing does came into being? The term context-based appeared to have been applied to some of the scientific activities in classroom for around fifteen years ago when such activities were described as an attempt to make science relevant and understandable to the young ones. They were used for young students to links between science and their daily life. So this is how context-based approaches in teaching science were originated, to make students understand, create relevance with their everyday life, and comprehend the meaning more easily. So the origin of context-based approaches was desired by teachers to make the lessons they were teaching interesting and easily understood by their students. But the research reveals that the strongest factor was the active engagement they desired from their children. Context-based approaches have also emerged in response to the concern of many countries over the teaching of physical scien ce subject. One of the characteristics of curriculum development in recent years has been an increased emphasis on using contexts and applications as a means of developing scientific understanding. Nationally and internationally, context-based programs have been implemented in an attempt to engage students in science through connecting the canonical science with the real world. The study found that by providing students with the opportunity to write, fluid transitions between concepts and context were an outcome of context-based learning. Many schools using context-based approach report positive effect on students. The context-based approach in teaching science is gaining popularity day by day. Holman and Pilling concludes that such a method seems to be successful in enhancing students interest in science, and understanding of science though they expressed some doubts over how successful it is in developing students abilities in problem-solving (Holman and Pilling, 2004). Examples of Context-Based Teaching New approaches to the teaching of Science have been tried in the last ten years and research has been undertaken to look at ways of improving the way in which we teach school Science (Millar, Leach, Osborne, 2000; Roth, 1995; Tobin McRobbie, 1995). Examples of Context-based teaching can be found everywhere now. In particular, chemistry teaching is one area that has undergone significant reform in an attempt to make Science more relevant for all students (Barber, 2000; Beasley Butler, 2002; De Vos, Bulte Pilot, 2002; Gabel Bunce, 1994; Gutwill-Wise, 2001; Ramsden, 1992, 1997; Tobin McRobbie, 1995). Context-based Science has been implemented in international Science programmes (e.g. Chemistry in Context in the USA, Salters in the UK, Industrial Science in Israel, Chemie im Kontext in Germany and Chemistry in Practice in The Netherlands) throughout the last decade and has been trialed more recently in Victorian and Queensland classrooms in Australia. This new context-based approac h to teaching science was designed to address issues such as students lack of engagement in science and decreasing participation rates. In Queensland, the new Chemistry syllabus using the context-based approach has been on trial in schools since 2002, and the trial-pilot syllabuses in chemistry and physics were published in September 2004 by the Queensland Board of Senior primary School Studies. Despite recent changes, with the current syllabus mandating the inclusion of only one context (or one Extended Experimental Investigation (EEI)) in the Queensland chemistry syllabus, teachers may choose to continue to teach all science units in context. Context-based approaches represent a significant change in the teaching of chemistry. Problem Questions Many people involved in curriculum development and teaching believe that there are considerable benefits associated with context-based approaches. However, it raises a number of interesting questions: Does teaching science through the use of everyday contexts help school students understand science any better? Does teaching science in context improve school students attitudes to science? Are there differences in the effects on girls and boys, or on students of different ability? This chapter examines in detail the research evidence on the effects of context-based approaches to the teaching of science. In particular, it looks at the effects on students understanding of science and on their attitudes to science. Positive and Negative Effects of Context-Based Teaching Primary Science teaching around the world has been undergoing radical changes over the past decade. As most states move towards a context-based secondary syllabus, there is a danger that tertiary science teaching will be left behind. Although there are drawbacks to contextual teaching in the tertiary environment (such as lack of preparation time, the breadth of physics concepts covered, and stretching the boundaries of ones own understanding as a teacher), the benefits for students interest and motivation, as well as their learning outcomes are significant. Over the last decade, the syllabi for primary school science around Australia have been evolving from an approach based around set conceptual content to one in which the concepts are taught using a contextual approach. The advantages of contextual teaching are that students can link science to their lives in the real world, and are usually more motivated. In the US, school students taking a context-based course outperformed those students studying more traditional courses. This success was attributed, at least in part, to higher levels of interest and motivation amongst the students, together with their perception of the relevance of the topics (Sutman and Bruce, 1992; Gutwill-Wise, 2001). However, there can be an apparent mismatch between the teaching styles that school students experience (and their prior knowledge) with expectations of tutors in universities, and this has been identified as a possible cause of students difficulties in understanding thermodynamics (Carson and Watso n, 1999). Whitelegg and Parry (1999) discuss the advantages of teaching physics in context, both by applying previous knowledge to real life situations, and by initially learning physics through analyzing these situations. Although the latter option has obvious advantages for student perceptions of the relevance of a course, it is pointed out that there is an inherent danger that students will be unable to generalize their knowledge outside the context in which it was initially learned. Conclusion Teachers can create technology-rich, constructivist learning environments that engage students in student-centered, personally meaningful, authentic, and collaborative learning that is inquiry-based, requires informed decision-making, views mistakes as opportunities for growth, and values information exchange among all learners. One plausible way to achieve this goal is to use context-based teaching in classrooms. This article provided a theoretical rationale for such an approach. It also provided specific examples of context-based approaches being used in different schools these days, specific steps a teacher should take to create similar curricular lessons, as well as examples a student could use in understanding of any curricular area. Finally, it provided numerous positive and negative effects it has on pupils and teachers as well and online resources that provide teachers with additional ideas for making context-based teaching studies usable in their engaging, empowering and enl ightening classrooms. It is also claimed that the approach can enhance or, at least, not adversely affect students understanding of science ideas. Work Cited Abell, S. K., Bryan, L. A. (1999). Development of professional knowledge in learning to teach elementary science. Journal of Research in Science Teaching, 36(2), 121- 139 Angus, M., Olney, H. Ainley, J. (2007). In the balance: The future of Australias primary schools. Canberra: Australian Primary Principals Association. Biggs, J. (1999) What the student does: teaching for enhanced learning. Higher Education Research and Development 18(1), 57-75. Carson Watson, (1999). Chemical education: Towards Research-Based Practice. Accessed: April 16, 2010. From: http://books.google.com.pk/books?id=- 23VbCeM17QCpg=PA350lpg=PA350dq=Carson+and+Watson,+1999source=bl ots=Bd051tQtOrsig=JWZeYuupeInjdaIze5aUysoHRYIhl=enei=2o_IS92lMpWjO LjI7LgNsa=Xoi=book_resultct=resultresnum=10ved=0CCQQ6AEwCQ#v=one pageq=Carson%20and%20Watson%2C%201999f=false Fensham, 2004; Lyons, (2006). Context-based chemistry: creating opportunities for fluid transitions between concepts and context. Accessed: April 16, 2010.From: http://findarticles.com/p/articles/mi_6957/is_4_55/ai_n45557673/ Gutwill-Wise J.P., (2001), The impact of active and context-based learning in introductory chemistry courses: an early evaluation of the modular approach, Journal of Chemical Education, 78, 684- 690 Goodrum, D Rennie, L 2007, Australian School Science Education: National Action Plan 2008-2012, Volume 1, The National Action Plan, Department of Education, Training and Youth Affairs, Canberra. Goodrum, D, Hackling, M Rennie, L 2001, The status and quality of teaching and learning of science in Australian schools: A research report, Department of Education, Training and Youth Affairs, Canberra. Accessed: April 15, 2010. From: http://cmslive.curriculum.edu.au/leader/default.asp?id=25011issueID=11579 Holman J. and Pilling G., (2004), Thermodynamics in context: a case study of contextualised teaching for undergraduates, J. Chem. Educ., 81, 373-375. Hackling, M. W. (2006a). Research Report 1: Case study teachers experience of Primary Connections. Canberra: Australian Academy of Science. Judith Bennett. Teaching and Learning Science. Context-based Approaches to the Teaching of Science. Accessed: April 17, 2010. From: http://books.google.com.pk/books?id=CiaFobS- Cn0Cpg=PA99lpg=PA99dq=context- based+approaches+in+teaching+primary+sciencesource=blots=eZSJG0iC7csig=z3 Ml8P_Hdvo4_fg4s1KdotSE518hl=enei=aqnIS- 75HoevOKqWgNcMsa=Xoi=book_resultct=resultresnum=4ved=0CBoQ6AEw Aw#v=onepageq=context- based%20approaches%20in%20teaching%20primary%20sciencef=false Lubben F, Campbell B, Dlamini B (1997) Achievement of Swazi students learning science through everyday technology. Journal of the Southern African Association for Research in Mathematics and Science Education 1: 26-40. Ramsden JM (1997) How does a contextbased approach influence understanding of key chemical ideas at 16+? International Journal of Science Education 19: 697-710. Speering Rennie, (1996). Deakin Research Online. Primary students perceptions of mathematics and science. Charles University Education Faculty. Prague, Czech Republic. Accessed: April 15, 2010. From: http://www.deakin.edu.au/dro/view/DU:30008215 Whitelegg, E., and Parry, M. (1999) Real-life contexts for learning physics: meanings, issues and practice. Physics Education 34(2), 68-72.

Oedipus, Antogone, And Media :: essays research papers

ANALYTICAL ACCOUNT OF A RUNNING THEME   Ã‚  Ã‚  Ã‚  Ã‚  Ã¢â‚¬Å"All those who were meant to die have died: those who believed one thing, those who believed the contrary thing, and even those who believed nothing at all, yet were caught up in the web without knowing why.† This particular quote by Jean Anouilh, author of Antigone, helped me choose fate, one of the more interesting underlining themes in all three plays: Oedipus the King, Antigone, and Medea, as the topic for my paper. No matter how hard the protagonists or antagonists in each play tried to change the fate of the protagonists, they failed and fate took over the chain of events. When humans try to change that which is beyond their control, they often fail and make the matters even worse than before as expressed by the authors of the three plays.   Ã‚  Ã‚  Ã‚  Ã‚  When Oedipus was born to Laius and Jocasta, their happiness was interrupted by a horrible prophecy: Oedipus will kill Laius and marry Jocasta when he grows up. The mood in Thebes changed from joyous to somber for the king chose to have his own son killed so that he could remain alive. Considering the situation from Laius’ point of view, it is not difficult to understand his actions but the mere fact that he tried to challenge fate causes his actions to seem ironic and cynical. By tinkering with fate, Laius caused the death of Jocasta, and Oedipus’ blindness and banishment in addition to the events caused by fate. In Antigone, Anouilh portrayed Creon in a similar way as Sophocles portrayed Laius. They both contributed more damage than benefit to the protagonists and their families with their â€Å"noble intentions.†   Ã‚  Ã‚  Ã‚  Ã‚  When Antigone violated the law created by Creon and tried to bury the body of her brother, Creon should have ordered her to be killed right away. Since he tried to persuade Antigone to forget about the body of her brother and marry his son, which was against her fate, his plan did not work out. One might think Antigone, being of noble blood and having a chance to marry a prince, was out of her mind to jeopardize her life while worrying about a dead body but Antigone’s fate was to die fighting for respect of her family. By delaying her death, Creon inadvertently caused the death of his wife and son. Jason tried to interfere with Medea’s fate and lost his life as well as the life of his loved ones.