Monday, September 30, 2019
Articles of Confederation Essay
When the Revolutionary War was over and the Americans had won their independence, the revolutionists and republicans leading the new country were quite convinced that their government should differ from that of Britain and have a limited amount of power. Clearly, these men took these ideals more seriously than they should have. They created a constitution for the 13 states known as the Articles of Confederation, which put the majority of power in the hands of these individual states. They were adopted in 1777 after the war and enacted in 1781. The Articles of Confederation were quite a success pertaining to western lands, but proved unbeneficial for the economy of our new country. Once the war was over, many Americans hoped to expand in the west, and they could successfully do so under the Articles of Confederation through the Northwest Ordinances and the Treaty of Paris, which tripled the size of the new country. For example, the Ordinance of 1784 divided the Western territory into self-governing districts that could each make a constitution and petition Congress for statehood after certain requirements were completed. The Ordinance of 1785 that followed created a system that allowed the land to be surveyed and sold to the public. The greatest accomplishment pertaining to western lands and the Articles of Confederation was the Northwest Ordinance of 1787, as it created one Northwest Territory and solved the problem caused by the ordinance of 1785, land speculation. This ordinance also brought stability and organization to the process of western settlement and built the framework for settlement in the Northwest Territory. These enactments also proved beneficial to the ideal citizen of the time, the yeomen farmer. In the area of western lands and settlement, the Articles of Confederation were quite successful. When politicians gathered to create the Articles, it is quite evident how afraid both they and the American people were of the government having too much power like that which they suffered under Great Britain. So, they made sure this wouldnââ¬â¢t happen by giving the government very little power over the citizens, also giving the states the power to create their own constitutions, have their own forms of executive and legislature, and coinà their own money. This proved terrible for the economy of the new country, for it was already in an enormous post-war debt. Congress could not enforce laws, regulate interstate trade (resulting in various tariffs between the states), or tax people directly, and the only way to change any of these rules was if all states approved of such a change. Each state had its own currency, causing havoc for trade in a country that was already forced to borrow money from others. Some states such as Massachusetts issued very high taxes, trying to collect specie even from the war veterans and farmers who could not be paid due to Congressââ¬â¢s inability to tax people directly, ending up in tragedy such as Shaysââ¬â¢ Rebellion. This led to fears of anarchy and a ââ¬Å"mobocracy.â⬠The state governments and Congress were forced to print a huge amount of paper money, leading to the worst inflation in U.S. history between 1778 and 1783. Americaââ¬â¢s trade deficit was also astoundingly high during this period of time. It is very evident that the U.S. economy suffered under the Articles of Confederation. It is also safe to say that the Articles had both their successes and failures in each of their aspects. For example, the Ordinance of 1785 resulted in the problem known as land speculation, which occurred when the land of people such as yeomen farmers was foreclosed, benefitting merchants and the rest of the gentry as they bought the land to make their own profits. Although this problem was eliminated through the Northwest Ordinance of 1787, this newer enactment caused a big problem with the Native Americans living in the Western lands, even though the law specified that their land would not be taken from them and they would be treated with ââ¬Å"the upmost, good faith.â⬠And, throughout all of this the British were still residing in the Ohio River Valley, causing more havoc. Although there were no shorthand benefits in the economic status of the country under the Articles of Confederation, the only benefit overall was the tragedy itself! The repeated economic failures under the Articles heavily impacted the Constitutional Convention of 1787 and the need for a new Constitution. Though the Articles of Confederation can be called a failure, they were very commendable. The Americans were a new people who fought for their freedom and created a new government from scratch with both its successes andà failures, just like any other country. Throughout their creation of the Articles and even the later modified version, the U.S. Constitution, the Americans stuck with their belief that the majority of power belonged to the people even though they learned that the government needs power as well in order to regulate and ensure the success of America. The Articles led to what would be the Northwest part of the nation, and can be forgiven for their failure on the economic conditions as they enticed people such as James Madison to gather and improve the constitution.
Sunday, September 29, 2019
How the internet works Essay
Although the details of routing and software are complex, the operation of the internet from the usersââ¬â¢ perspective is fairly straight forward. As an example of what happens when the Internet is used, consider that you type the URL www. helpmegetoutofthis. com into the Netscape browser. The browser contacts a DNS server to get the IP address. A DNS server would start its search for an IP address. If it finds the IP address for the site, then it returns the IP address to the browser, which then contacts the server for www.helpmegetoutofthis. com, which then transmits the web page to your computer and browser so you can view it. The user is not aware that of the operation of an infrastructure of routers and transmission lines behind this action of retrieving a web page and transmitting the data from one computer to another. The infrastructure of the internet can be seen as a massive array of data relay nodes (routers) interconnected by data transmission lines, where each node can service multiple transmission lines. In the general case where information must be sent across several nodes before being received, there will be many possible pathways over which this transmission might occur. The routers serve to find a path for the data transmission to occur. The routing of a file or data packets of a file is either be done by the technique of source routing or the technique of destination routing. In source routing, the path the data transmission will follow id specified at the source of the transmission, while destination routing is controlled by the routers along the path. In the modern internet, almost all routing is done by destination routing because of security issues associated with source routing. Thus, the routers must be programmed with protocols that allow a reasonable, perhaps optimum, path choice for each data packet. For the routers to choose an optimum path also requires that the interconnected routers communicate information concerning local transmission line metrics. Router communication is thus itself a massive information transfer process, given that there is more than 100,000 networks and millions of hosts on the Internet. When viewing the enormity of the problem, it is perhaps easier to understand why engineers have accepted a sub-optimal solution to the problem of efficiency in data transfer on the Internet. When initially confronting a problem, the practical engineering approach is to simplify the problem to the point where a working solution can be obtained and then refine that solution once the system is functional. Some of the simplifying assumptions used by engineers for the current internet data transmission system include. 1) A transmission line is never over capacity and is always available as a path choice. 2) The performance of the router and transmission line does not depend on the amount of traffic. These two assumptions do simplify the problem of path choice considerably because now all the transmission lines and nodes may be considered equal in capacity and performance completely independent of traffic. As such, it is a much simpler optimization problem consisting of finding the route with the shortest path length. To simplify the problem even further, another assumption is made: 3) Consider that an ââ¬Å"Autonomous Systemâ⬠(AS), is a small internet inside the Internet. An AS is generally considered to be a sub-network of an Internet with a common administrative authority and is regulated by a specific set of administrative guidelines. It is assumed that every AS is the same and provides the same performance. The problem of Internet routing can now be broken down into the simpler problem of selecting optimum paths inside the AS and then considering the optimum paths between the AS. Since there are ââ¬Ëonlyââ¬â¢ around 15,000 active ASââ¬â¢s on the Internet, the overall problem is reduced to finding the best route over 15,000 AS nodes, and then the much simpler problem of finding the best route through each AS. There is an important (to this thesis) set of protocols which control the exchange of routing information between the ASââ¬â¢s. The sort of routers in an AS which communicates with the rest of the internet and other ASââ¬â¢s are called border routers. Border routers are controlled by a set of programming instructions known as Border Gateway Protocol, BGP. A more detailed discussion of computer networking principals and the Internet facts can be found in e. g. [7]. An Introduction to Router Protocols. Routers are computers connected to multiple networks and programmed to control the data transmission between the networks. Usually, there are multiple paths that are possible for transmission of data between two points on the Internet. The routers involved in the transmission between two points can be programmed to choose the ââ¬Ëbest pathââ¬â¢ based on some metric. The ââ¬Ëprotocolsââ¬â¢ used to determine the path for data transmission are routing algorithms. Typical metrics used by routing algorithms include path length, bandwidth, load, reliability, delay (or latency) and communication cost. Path length. Path length is a geometric measure of how long the transmission lines are. The routers can be programmed to assign weights to each transmission line proportional to the length of the line or each network node. The path length is then the sum of the weights of the nodes, lines or lines plus nodes along the possible transmission path. Bandwidth. Bandwidth is used to describe the available transmission rate (bps) of a given section the possible transmission path. An open 64 kbps line would not generally be chosen as the pathway for data transmission if an open 10 Mbps Ethernet link is also open, assuming everything else is equal. However, sometimes the higher bandwidth path is very busy and the time required for transmission on a busy, high bandwidth line is actually longer than on a path with a lower bandwidth. Load. This data packet transmission per unit time or the percent of CPU utilization of a router on a given path is referred to as the load on this path. Reliability. The reliability of a data transmission path can be quantitatively described as the bit error rate and results in the assignment of numeric reliability metrics for the possible data transmission pathways. Delay. The delay in data transmission along a certain path is due to a combination of the metrics that have already been discussed, including geometric length of the transmission lines, bandwidth, and data traffic congestion. Because of the hybrid nature of the communications delay metric, it is commonly used in routing algorithms.
Saturday, September 28, 2019
Significance of ingot
To look into the significance of metal bar during the Bronze Age within the Mediterranean trade industry.Chapter I: IntroductionThe significance of the metal bars in the Bronze Age has long been recognized in the development of metallurgical engineering, societal organisation and the primary focal point of this research, the Mediterranean trade industry. The metal metal bars, peculiarly those made from Cu and Sn became an of import facet in the Bronze Age trade, as they were the majority of the ship ââ¬Ës lading. Furthermore the location of these metal ores occur in geographically localized countries, which would hold limited entree of prehistoric communities to metals, which hence encouraged long distance trade between them. ( Jones, 2007, 1 ) Copper was particularly an of import natural stuff as it was used for doing tools, arms and status-enhancing luxury goods. Furthermore, Cu was the chief constituent within the sea trade. Evidence found on Mesopotamia and Dilmun, Egypt, Levant, the Aegean and subsequently the cardinal Mediterranean suggests ladings were much easier to transport by sea than by overland. The shipwrecks at Uluburun ( c.1300B.C ) and Cape Gelidonya ( c.1200B.C ) provide direct grounds for the conveyance of Cu metal bars by sea. This has hence influenced Mediterranean civilizations to increase nautical trade and established interregional contacts for Cu and Sn entree. This besides applies for metals such as gold, Ag and led which besides played a function in long-distance trade, thought non in the same measures as Cu. There have been many arguments for the exact nature of this trade. Muhly references that the metal metal bars would supply us ââ¬Å" a proper apprehension of the nature and the range of this trade. â⬠( 1977, 73 ) However, we can non establish our hypothesis on understanding Bronze Age trade on the metal metal bars entirely as ââ¬Å" The metals trade would hold differed considerable in volume and organisation in different parts, depending on locally available resources, geographics, established trade paths, local metallurgical engineering, and assorted societal and political factors. â⬠( Jones, 2007, 3 ) The most direct grounds for an analysis of early trade comes from Tell el Amarna. The three-hundred-eighty-two clay tabular arraies found within the metropolis, where records of elusive communicating with foreign powers. These clay tablets provide grounds that the function of the metal metal bars in the development of long-distance trade in metals varied over clip. Howev er they provide no grounds for the beginnings of Sn and Cu which suggest that they must hold been imported from states such as Cyprus. Cyprus is by and large known for its laterality within the Cu production. ââ¬Å" This historical state of affairs is well-known among Cypriot and Mediterranean archeologists, and the Cu ingots represent the terminal merchandise of a complex procedure affecting the excavation, smelting and casting of Cu. ââ¬Å" ( Knapp, Kassianidou, Donnelly, 2001, 204 ) However this ââ¬Ëhistorical state of affairs ââ¬Ë was really complex and ill understood. Nevertheless the grounds shows that the Cypriots played a dominant function within the Cu industry. Sites, such as the Troodos Mountains in western and cardinal Cyprus, contained the largest measure of Cu ore in the Mediterranean ; therefore becomes an of import beginning within the Cu metallurgy in the Late Cypriot societies. Other sites in Cyprus were besides important in understanding the Cu metallurgy. By the Late Cypriot period ( c.1400-1100B.C. ) many sites became affluent regional Centres ; sites such as Enkomi, Hala Sultan Tekke, Kition and several other colonies. These metropoliss were of import in understanding trade, due to their part in Cu production and export. These metropoliss nevertheless, did non bring forth any paperss affecting trade like the castles ; a few Bronze Age letterings found called ââ¬ËCypro-Minoan ââ¬Ë . These were undeciphered syllabic books which have been suggested to incorporate economic texts, votive letterings, or for case the clay balls from Enkomi and Kition contained short fables. However a figure of archeologists believe that the map of these books is yet to be known. Nonetheless epigraphers suggested that these texts show marks from a Cypro-Minoan alphabet, which may be identified on trade points such as the Cypriot and Mycenaean clayware and a assortment of oxhide metal bars. This connexion between the books and the goods has late been well-established. Equally of import as Cyprus was within the Cu production, archaeologists struggled to bring out grounds for Bronze Age smelting activities. Virtually all the scoria sedimentations discovered on the excavation countries dated to periods after the Bronze Age. ââ¬Å" While more grounds for Middle and Late Cypriot Cu excavation and metallurgical production is available today, unluckily this grounds is by and large fragmental and hard to construe. â⬠( Jones, 2007, 6 ) However, the led isotope analysis proved to be really successful and accurate, as it measured the stable isotopes of lead utilizing a mass spectrometer in order to qualify peculiar samples. This method severally measured the samples ââ¬Ë radioactive concentration harmonizing to the geological age of the lead ores. This analysis would supply archeologists with near-conclusive grounds that Cypriot Cu was exported on a important graduated table. The chemical and metallographic analysis show high measures of pre Cu within the oxhide metal bars. This analysis suggests a high demand and production for Cu in the Bronze Age. Another of import facet of Bronze Age trade were the shipwreck finds, particularly those found at Uluburun and Cape Gelidonya. Each of these shipwrecks provide of import information for the nature and organisation of the Cu trade within the period of 1300-1200B.C. The Uluburun and Cape Gelidonya ladings contained the largest measures of Cu metal bars, particularly Uluburun which about contained over 10 dozenss of Cu and one ton of Sn metal bars. The three-hundred and 54 metal bars found within this lading exceed old ladings found on land and on submerged sites. Other important goods found within the Uluburun lading include a big figure of glass metal bars, about one ton of terebinth rosin in Canaanite jars, Cypriot clayware in several pithoi, and a broad assortment of luxury goods plus other points such as the personal ownerships of the crew and riders which bordered the ship. These goods were besides notable as they are an indicant for directional trade ; points such as the Nefertit i Scarabaeus sacer. On the other manus the Cape Gelidonya ship is significantly different. This complete digging contained in its vessel 34 complete Cu oxhide ingots every bit good as other ingot types. The Cape Gelidonya ship seems to hold a lower position that the Uluburun ship as it was a great trade smaller in size that the Uluburun ship and the goods it contained and transported have a lower value. These shipwrecks raise a figure of theories which are of import in understanding Bronze Age trade. How important was the position of the goods found within the ladings? Are the smaller ladings, for case the one found at Cape Gelidonya, more typical that the larger 1s? How common was the transit of the Cu and Sn metal bars? How does this alter our position on the Bronze Age trade? This inquiry besides applies to land-based transit. The most appropriate would be that the production and circulation of metals occurred in several different ways to one another. However this response is really by and large used, as there are a figure of possibilities to differences between Cu and Sn metal bars. However the most dominant accounts are the fluctuations of trade mechanisms, the geological and geographical factors, the societal organisation of societies involved and the utilizations to which the metals were employed. These are a few of the accounts used to assist us associate Cu and Sn metal bar s to Bronze Age trade and let us to understand the differences between each metal bar. Furthermore we could now do the theory that by analyzing these metal bars in deepness would let us to acknowledge the trade paths within the Mediterranean. There are a scope of grounds which describe the trade and production of Cu, Sn and other metals in the Bronze Age. The most common are the textual grounds of Tell el Amarna, Mesopotamia, Aegean, Syria-Palestine and Anatolia. However the iconographic grounds is besides of equal importance as several civilizations such as the Egyptians, Cypriots and Mycenaean ââ¬Ës represented their oxhide metal bars in pictural signifiers. These ââ¬Å" Representations of oxhide metal bars demonstrate a cultural group ââ¬Ës acquaintance with Cu metal bars in this signifier and therefore their entree to interregional trade paths connected with the beginning or beginnings of Cu used to do oxhide metal bars. â⬠( Jones, 2007, 9 ) Iconographic grounds such as the pictures and reliefs found at Sahure ââ¬Ës burial temple represent the ships ââ¬Ë crews. This provides information on the ship ââ¬Ës beginning and information on the different foreign groups involved within the Mediterranean t rade.
Friday, September 27, 2019
A Study of Health & Safety Management on Construction Sites, for Dissertation
A Study of Health & Safety Management on Construction Sites, for construction companies within Riyadh city in Saudi Arabia - Dissertation Example While this may stand true for more developed nations, however, nations such as Saudi Arabia are still trying to tackle with a high construction rate coupled with a low safety assessment and enforcement methodology. Overall, there is no single governmentally sponsored safety assessment and enforcement system within Saudi Arabia for the moment. (Fullman, 1984) Though there has been a move forward by the creation of the ââ¬Å"Saudi Building Code National Committeeâ⬠but as yet work within the safety and health portfolios remains scant and as yet experimental. (Mena Report, 2006) The lack of coherent safety assessment and enforcement schemes implies that there is still much ground that needs to be covered as per the Saudi safety standards in general and construction safety standards in particular are concerned. Hence, the need for research into current safety practices arises based on the concerns noted above so as to have a baseline available before policy making on safety begins. The proposed research aims at plugging some gaps in the current research base so as to expand horizons. The other question now, is the methodology that ought to be applied in order to conduct meaningful research.
Thursday, September 26, 2019
Marketing and Distribution Management Essay Example | Topics and Well Written Essays - 2000 words
Marketing and Distribution Management - Essay Example Statistics for the company as per the year 2011 showed that the company has 221,726 employees and its assets total USD 135.131 billion. The companyââ¬â¢s main areas of products are mobile phones, televisions, semiconductors along with LED and LCD panels. 1 b. Marketing and Selling Concept Marketing is a collective process through which Individuals and groups attain what they require and want by creating, offering and exchanging products and services which considered as valuable with others. The major concepts hold in this perspective is: Selling Concept This Inside-out perspective assumes that people must be sold whatever good or service the firm wants to offer. First it is decided what should be produced and then is selected a strategy to persuade people to buy the decided product. This approach implies that great deals of promotional or selling activities are needed to make the product move through the market to the consumers. The Selling Concept could be summarized as 1) Start with deciding what the firm wants to make; 2) Persuade the customers to buy the given product; and 3) It is aimed at ââ¬Ëgetting rid of what consumers haveââ¬â¢. Marketing concept According to this concept, the achievement of organizational goals depends greatly on knowledge of needs and wants of the target markets. Also, these needs and wants have to be satisfied more efficiently than done by the competitors. The Marketing Concept could be summarized as 1) Start with the needs of the customers; 2) Develop the Four Pââ¬â¢s of marketing in light of the customer needs; 3) It is about ââ¬Å"Having what consumers can get rid ofâ⬠In practice, Samsung followed the marketing concept after analyzing the needs of consumers who require smartphones at affordable costs with all advanced features. The changes in life styles of consumers are closely monitored and suitable applications are designed to match these needs in every new model. That is why the sales volume of smart phone s reached about 40% of sales volume of the company mobile phones category in 2012. 1 b. Market Segmentation and Targeting The segmentation done at Samsung is mainly on the basis of demographics and psychographics. Youth and middle age cosmopolitan consumers of both genders are targeted who belong to middle and high income groups. Novelty seekers, fun loving, extroverts are major personality traits of company consumers segments. The target strategy applied by Samsung is the 'shotgun' strategy according to which a wide range of market segments are covered through creation of many models. In contrast, Apple, which itself is a competitor, offers only a small number of models which are high-profile. In the pursuit of market share, both the companies have managed to mark their geographical presence as well expand it. However, the two companies can possibly come in to conflict inevitably as both get in to the run of trying to generate additional gains. 1 c. Brand Positioning The main posit ioning strategy of Samsung is to stop consumers just thinking about the product instead start feeling it as part of their personality. Normally when brand is transitioned from the left side of the brain to the right side, its position becomes powerful. i) Samsung has a position of best alternative to Apple iPhone category at economical price. Recent court cases of both companies supported this position as Samsung trying to achieve the leading edge in smartphones market.
How To Build Your Own Computer Term Paper Example | Topics and Well Written Essays - 1500 words
How To Build Your Own Computer - Term Paper Example For basic operation, minimum hardware configuration is required but for some special purposes hardware must be selected accordingly. This paper contains the procedure of building your computer according to oneââ¬â¢s own requirement. How to Build Your Own Computer A personal computer is not only utilized to surf the internet or check email but it is vastly used for other purposes like creating different software, run various programs and for maintain office documents and collecting information. Software is incomplete without hardware and in computers processor is the brain and heart of the system. Some people use a personal computer to play various games. A personal computer contains many parts that help run the processor and perform other functions. Processor and some other hardware components are mounted on a motherboard. All the hardware components are interfaced but utilizing a motherboard. A simple computer has a central processing unit (CPU) also known as processor, a random access memory (RAM), hard disk drive (HDD), compact disk drives (CD ROM) and DVD ROMs. Keyboard, mouse, scanners, camera and microphone are the inputs whereas monitor, printer and speaker are the output devices of a computer (Kitchen Table Computer ,2004). Designing your own computer, or even simply choosing the parts you want included in a custom build from a manufacturer, can prove to be quite difficult, or even impossible for an inexperienced computer user. I will attempt to demystify this process and provide guidance for an average, non-tech savvy person to define the intended purpose for their new computer and then select individual hardware components for purchase. We will start by deciding on the new computerââ¬â¢s intended use and then get right into the heart of the computer: the processor unit, memory (how much is right), hard disk drive (size and access speed), and other hardware components you can include in the computer proper. We will look at basic operating softwar e and then turn our attention to external devices, which can include items such as display devices, input devices (mouse/keyboard), printers, scanners, and external storage devices. Iââ¬â¢ll briefly touch on some easy to understand web sites for making your purchase, and finally, take a look at redundancy, or back-up options, you should consider in order to protect all of your precious data created or stored on your new computer. To begin with, let us consider some of the more common uses of computers today. There is a definite need for general-purpose home computers for activities as simple as using email, surfing the internet and storing and viewing pictures. Many people like to have a computer for simple office automation functions while others enjoy developing and hosting web sites for pleasure or small business opportunities. Another quite popular use is gaming, and in some niche communities, extreme gaming, for which expensive processors, graphics cards, maximum memory amou nts, and even special cooling systems are employed. And yet another use is for home entertainment, which may include streaming video directly to a display unit, downloading and storing media for later use, or even producing personal audio and video files for private use or sharing with friends and family. Some may classify the later into graphical arts studio work, but I personally reserve this category for people who use computers
Wednesday, September 25, 2019
Similarities and Differences between Baboon and Human Being Term Paper
Similarities and Differences between Baboon and Human Being - Term Paper Example Based on social behavior studies, psychological and physical stress levels remain exceptionally higher amongst individuals within the lower hierarchy. The social behaviors results include high blood pressure, suppressed immune system and increased stress hormones. It is imperative to note that due to the social behaviors baboons can differentiate real menace and neutral factor in a similar manner as behaviors of neurotic persons. In addition, both human beings and baboons believe that violence control implicates less stress and good health. Mostly, the highly sociable baboons normally have a healthier lifestyle and with minimal stress in a similar manner to human beings. Minimize social stress directly relates to reduces mental and physical torture with consequent comfort in health. The social build up is indispensable in a realization of least social stress, and it begins at birth amongst both baboons and human beings. Besides health-related stress similarities, baboons also have a strong tendency towards competition and aggression just like human beings. In a similar way as human beings, baboons develop inherent competitive urge when relating to each other. In addition to competitiveness aggression, baboons also directly get involved in decision-making processes in a similar way as human beings. Typically, baboons develop thinking and take sides during discussions both emotionally and rationally just like human beings. However, human beings slightly differ with baboons mainly because their decisions may surpass the immediate situation and environment. Furthermore, both the baboons and humans manifest wickedness and envy friendship in all their social associations. Another important social behavior relates to the unique personality developed by an individual and baboons.Ã
Tuesday, September 24, 2019
Research project Essay Example | Topics and Well Written Essays - 3750 words
Research project - Essay Example The literature review of the proposal was mainly designed to shed light on the existing scenario of the employee management aspects in the corporate industry. However, this segment will focus on the overall factors that are closely connected with employee turnover and employee retention process in the fast food firms. The observations presented by Alan, Radzi and Hemdi (2009) show that business growth and development process is supported by the contributions of their employee base however the changes in their workforce are not being considered by the business houses which creates a mystery in the corporate concepts. Moncarz, Zhao and Kay (2009) further added that although business houses are aware of the changes in the situation of the job market and the extensive search for talent in the business, the employee retention process of the first food industry is mainly done by the tangible rewards such as tips received from customers or the incentives paid by the employer. However, the nature of work may be a demoralising factor for long term service in the sector. Rankin (2008) stated that the skills required for working in fast food industry are primarily based on fast and quality service which also serves as a foothold for the employees to curve their passage towards the hospitality industry and b ig brands in the sector. Chang and Chang (2008) also confirmed to the fact that biog hotels and restaurants are searching for talent in the fast food sector considering their service providing abilities and also the ability to handle pressure during peak seasons. These are some factors which influence the employee turnover rate of the fast food segment. Focusing on the existing employee retention policies being implemented in the fast food segment, it can be stated that their strategies are not significant enough to reduce the overall employee turnover. Ferres, Connell and Traraglione (2004) noticed that the financial standard of the fast food firms in comparison to biog
Monday, September 23, 2019
Societal Changes Assignment Example | Topics and Well Written Essays - 1000 words
Societal Changes - Assignment Example We just know we do not want any part of it. Introduction The issue of stereotyping, which also leads to a form of racism, can be seen in both the population and within the police force and the type of interactions that occur. When looking for someone to blame for why certain crimes happen, it is easy to think automatically that if someone thinks, looks and acts within a narrow visual framework, then it is easy to blame that person and that group of people (Bradshaw & Roseborough, 2005). The issue of Muslims has a tender spot in the minds of many Americans who see all Muslims as perpetrators of bombings and terrorism in the country. Whenever something happens in the country, people automatically assume it was done by a Middle Eastern Muslim terrorist. As we have also seen, the bomber can also be a Western Muslim terrorist, such as in the case of the Shoe Bomber in 2001 (Elliot, 2002). 1.With the recent bombing of the Boston Marathon, and the near-beheading and death of a British soldi er on a London street, tensions have been running high with the public, particularly in England. There have been numerous protests, and police, both in England and in the United States, have been told to look for groups of people, who might commit crimes against Muslims directly, or on or around property owned by Muslims. It is very hard for people to understand that when one, or a few, members of a group have committed a crime against others, it does not mean that all people of that group will be doing that same sort of crime (Gabbidon & Greene, 2013). When people look for the enemy, the only thing they have to go on is what the enemy would typically look like. In a war, one side knows that a certain uniform represents the enemy, and that there may be other physical identifications, such as an Asian appearance, for wars conducted in World War II and Vietnam. In a more modern day, and in modern warfare conducted today, appearances are far more deceiving and it is hard to know who th e enemy is. Some have dressed up in Western army uniforms and then turned guns on unsuspecting Western soldiers. Even seeing women with burkas and, especially with full face veils, promotes the concept of hiding something that makes identification possible (Moore, 2010). Therefore, those who hide behind veils, or ski masks, are potentially considered an enemy. It would be easy to suspect that some other person may be under that burka and veil besides a normal Muslim woman. While in Muslim countries, veils are rarely given a second thought, in Western countries, it is important for Muslim people to respect parts of the society they are now living in, and to let women remove the veil so it is not so threatening. Integration with their new society is essential to their success. Living as if they were still in their own land and observing their own rules without regard to the new country, is not acceptable (Moore, 2010). 2. There are several solutions to the issue of racial profiling. A ) In the first case, Muslims can take matters into their own hands by meeting law enforcement members of their community and getting to know the neighborhood police who conduct regular beats in the area (Bradshaw & Roseborough, 2005). Making friends, or at least, acquaintances, allows the police: to 1) know who they are individually; 2) establish
Sunday, September 22, 2019
Determining the Formula of an Unknown Hydrate Essay Example for Free
Determining the Formula of an Unknown Hydrate Essay The final equations that was concluded after the experiment and the calculations are CuSO4 à ¯Ã ¿Ã ½ 5H2O and MgSO4 à ¯Ã ¿Ã ½ 5H2O. There are 5 water molecules per Copper (II) Sulphate and 7 water molecules per Magnesium Sulphate. The compounds are all hydrates which is a substance that contains water. This occurs when crystals form from the evaporation of an aqueous solution of a salt and water molecules become included into the crystal. The hydrates were heated and lost its water of hydration and made it possible to calculate how much water was in the hydrate and the water to salt ratio. The percentage error for the Copper (II) Sulfate was 4.61%. It is a large error but the coefficient was correctly rounded to the accepted value of 5. The percentage error for Epsom salts was 5.51% which is also very large but can also be rounded to the accepted value of 7. Errors and Limitations Error Explanation Suggested Improvements No lid Without a lid on the evaporating dish, the powder popped out the dish when heated therefore causing the mass of the remaining substance to be lower Using a lid Imprecise measurements of mass Causing the mass of the evaporating dish, H2O and the remaining hydrate to be lowered or raised and therefore makes the final formula incorrect Making sure the surface of the scale is clean and waiting until the weight displayed has completely stopped No depth in experiment More experiments can be done for comparison and further our knowledge of hydrates Another Sulfate hydrate to compare the hydrates and see if there is a pattern of the different hydrate and the number of water molecules due to factors of periodicity. Also we could have also just used sulfate hydrate to observe how adding another element affect the water and salt ratio. Overheating of the substances The hydrates were heated under the Bunsen burner and were left under the heat for too long. This could alter the result by lowering the mass, which would increase the water to salt ratio. Mixing the powder to evenly distribute the heat to prevent overheating the salt. Not letting the substance cool before weighing it This would raise the mass of the anhydrate because the water molecules would not be entirely evaporated making the substance left heavier. Having more patience and letting the salt completely cool before weighing Oval chunks of CuSO4 remain after burning Not all of the water of hydration has been removed which will throw off the result by decreasing the mole of water and the increase the final water to salt ratio. Break up the chunks before heating or while heating.
Saturday, September 21, 2019
Chronic Low Back Pain (CLBP) Literature Review on Treatment
Chronic Low Back Pain (CLBP) Literature Review on Treatment INTRODUCTION Chronic low back pain (CLBP) is a major health issue in the western world and is a significant burden on health care; Americans spend $37 billion annually with a further $19.8 billion lost in absenteeism [1]. There is 58% life time prevalence of back pain in the UK, a 22-65% 1-year prevalence and 6-7% of all adults have constant back problems [2]. Although CLBP is usually benign ( Modern (Verum) acupuncture originates in ancient Chinese philosophy which claims pain and disease manifest because of imbalances in bodies forces of Yin and Yang. It is believed these forces flow through specific courses (meridians) and can be manipulated using specific acupuncture points to regain the balance. Acupuncture has evolved from the traditional Chinese application and some styles incorporating adjuncts such as electrical stimulation of the acupuncture needle [4], A recent systematic review of articles published between 1966 and February 2003 [4] concluded that the efficacy of acupuncture on CLBP was inconclusive due to the low methodological quality of selected studies. They found acupuncture had some short-term improvements in pain and function compared to control or sham but due to low methodological quality they concluded a need for higher quality studies. This review updates that study [4] by including articles published after February 2003 or studies that were published prior but were of high relevance and methodological quality. The objective is to provide firm conclusions about the efficacy of acupuncture therapy for CLBP. METHODS Study Selection Criteria Only randomised controlled trials (RCTs) available in English and available free of charge were included. Search Strategy In October 2009 the MEDLINE database (period 1950 to date) was searched for RCTs published after February 2003 and matching the search string Chronic low back pain AND acupuncture OR dry needling OR Sham OR Placebo AND randomised controlled trial OR randomized controlled trial. Further searches using PEDro, Web of Science (using ISI Web of Knowledge) and Cinahl (period 1982 to date) (see appendix A). Each articles reference list was also used as a source of relevant publications. Participants For inclusion the studies participants needed to be =18-years old with non-specific CLBP. Non-specific CLBP was defined as pain between the 12th costal margin and the inferior gluteal folds =12-weeks. If radiating leg pain was present this must be secondary to the lumbosacral region pain. RCTs that included participants with specific pathologies as the root cause of their CLBP, such as malignancy, prolapse of =1 inter-vertebral disc or spinal fracture were excluded. Interventions Studies that investigated the effects of traditional (Verum) acupuncture, trigger-point acupuncture and dry needling were reviewed. RCTs were included regardless of hand of electro-stimulation. Studies investigating non-needle based acupuncture, such as laser acupuncture, were excluded. Control interventions included sham, usual care, Transcutaneous Electrical Nerve Stimulation (TENS) or conservative orthopaedic therapy. Outcome measures There are four outcome measures considered to be important when assessing CLBP Pain intensity (e.g. visual analogue scale (VAS-P), numerical rating scale (NRS-P)) A global measure (e.g. Overall improvement, proportional recovery of patients) A back specific functional status measure (e.g. Roland-Morris Disability Questionnaire (RMDQ)) Return to work (absenteeism, speed of return) RCTs must include =1 of the above. The primary outcomes were pain and function. Study selection A total of 544 studies were found through the searches with 17 potentially eligible RCTs identified. Of these 5 were excluded due to study duplication (n=1), sole inclusion of participants with specific CLBP (n=2) or use of non-needle based acupuncture (n=2). The remaining 12 articles were reviewed using the Critical Appraisal Skills Programme (CASP) to determine their methodological quality. CASP enables the systematic review of an RCT for validity, design, execution and reasoning. Assessment criteria included randomization and allocation of participants, blinding of participants and assessors, identification of potential observer bias, participant numbers at RCT start and conclusion, presentation and accuracy of results, and any identified limitations. Results were recorded and documented (Appendix B). RCT commonalities: Participants were excluded: if they exhibited contraindications to acupuncture, had received acupuncture for their CLBP previously, previous spinal surgery, infectious spondylopathy, malignancy, congenital spine deformity, compression fracture due to osteoporosis or spinal stenosis. No differences in demographic variables or baseline levels of pain and disability were detected between the groups at baseline (P >0.05). Randomization was computer-generated with random number tables. All participants gave informed consent. Each RCT received ethical approval Usual care is defined as a combination of drugs, physiotherapy and exercise. RESULTS [5] 298 participants with CLBP =6-months randomised to 12 sessions of acupuncture (n=146) or sham acupuncture (n=73) over 8-weeks, administering therapists had =140 hours training and 3-years experience, with a third delayed acupuncture group (n=79) who received no acupuncture for the initial 8-weeks followed by the acupuncture groups protocol. Outcome measures were VAS-P and back function using the validated German Funktionsfragebogen Hannover-RÃ ¼cken (FFbH-R) questionnaire. At 8-weeks VAS-P decreased from baseline in all groups; after 26 and 52-weeks the acupuncture groups results were better than sham however differences were not significant. Results from the delayed acupuncture group followed the acupuncture groups pattern. The trial had good methodological quality: outcome measures were assessed independently with participants completing questionnaires, attrition was reasonable (18%) but the acupuncture group was double the size of the others which may have influenced results. [6] 638 participants with CLBP =3-months randomised to standard acupuncture (n=185), individualised acupuncture (n=157), sham acupuncture (n=162) or usual care (161) groups. Acupuncture groups received 10 treatments over 7-weeks by acupuncturists with =3 training. The Primary outcome measure was RMDQ. Compared to baseline all groups showed improved function and pain at 8-weeks. Mean values for RMDQ were consistent up to 52-weeks with the usual care group having greater dysfunction than all acupuncture groups (P=.001). There was no significant difference between real and sham acupuncture groups (P>0.05). All forms of acupuncture had beneficial and persisting effects over usual care for CLBP treatment with clinically meaningful functional improvements. There were no significant differences between acupuncture groups. Outcome measures were gathered by blinded telephone interviewers and attrition was low (6%) resulting in good trial internal validity [7] 1162 participants with CLBP =6-months randomised to 5-weeks of twice-weekly acupuncture (n=387) or sham acupuncture (n=387), performed by acupuncturists with =140 hours training. A third group received usual care (n=387). Outcome measures were Von Korff Chronic Pain Grade Scale (GCPS) and Hanover Functional Ability Questionnaire (HFAQ). Results were presented as a percentage of improvement in function and pain at 6-month follow-up. At 6-months both acupuncture groups had significant improvements in pain and function compared to baseline and usual treatment. There was no difference between acupuncture groups (p=0.39). The trial was methodologically strong with good internal validity: the control group was an active multimodal conventional therapy, had high power with stated calculation, follow-ups at 1.5, 3 and 6-months, low attrition (4%) and balanced dynamic randomisation. This was a good, highly relevant, large, rigorous trial. [8] 35 participants, =65-years, with CLBP =6-months randomised to 1 of 3 groups receiving 2 3-week phases of 30-minute acupuncture sessions, with a 3-week interval between. Group A (n=12) received standard acupuncture, Group B (n=10) superficial trigger-point acupuncture and Group C (n=13) deep trigger-point acupuncture. Outcome measures were VAS-P and RMDQ score. Group C showed a statistically significant VAS-P and RMDQ reductions from baseline after phase 1 with VAS-P reduction persisting over 12-weeks. There was no significant reduction in VAS-P or RMDQ for either other groups. The RCTs methods are described well however small sample size, high dropout (27%), short-term follow-up and potential bias limited internal validity [9] 26 participants, =65-years, with CLBP =6-months randomised to 2 groups. Over 12-weeks each group received 1 phase of trigger-point acupuncture and 1 phase of sham acupuncture with a 3-week break between. Group A (n=13) received trigger-point phase first followed by sham, Group B (n=13) vice-versa. Acupuncturist had =4-years training and =7-years clinical experience. Outcome measures were VAS-P and RMDQ score. After phase 1 Group A had significantly lower VAS-P (P [10] 60 participants with CLBP =6-months randomised them to 6-weeks of 30-minute weekly sessions of either acupuncture (n=30) or placebo TENS (n=30). No details of administering therapists were given. The primary outcome measure was VAS-P. Although acupuncture showed highly significant differences in all the outcome measures between pre- and post-treatment, the differences between the 2 groups were not statistically significant. Generally the RCT was poor: therapists were not blinded, high noncompliance (23.3%), cointerventions might have influenced results, the dropout rate was not explained and there was no intention-to-treat analysis. [11] 131 participants 18-65 years old with CLBP =6-months were randomised to groups receiving 20 30-minute sessions of traditional and auricular acupuncture (n=40), physiotherapy (n=46) or sham acupuncture and physiotherapy (n=45), over 12-weeks. Outcome measures were VAS-P and pain disability index (PDI). After 12-weeks of treatment the acupuncture group showed significantly reduced pain and disability compared to the physiotherapy group but not compared to the sham group. At 9-months the acupuncture group was more effective than physiotherapy in reducing disability only and not different to sham. The trial was methodologically strong but short-term dropout was 24% and long-term 37%. The treatment scheduled was five-a-week for 2-weeks then weekly for 10-weeks which may not be clinically practical. [12] 55 participants =60 yrs, with CLBP =12-weeks were randomised to 2-weeks of twice-weekly acupuncture and electrical stimulation alongside usual care (n=31) or usual care alone (n=24). Primary outcome was RMDQ. At 6-weeks results indicate clinically and statistically significant improvements in the acupuncture group for pain and disability compared to control. Effects remained and only diminished slightly at 9-weeks follow-up. The trial was methodologically strong: balanced randomisation, clear methods, low attrition (14%). Participant inclusion criteria included prior imaging limiting generalisability. [13] 186 participants aged between 20 and 60 with CLBP =6-week were randomised to 4-weeks of usual care alone (n=60) or with either acupuncture (n=65) or sham acupuncture (n=61). Acupuncturists were experienced doctors trained in Beijing. Primary outcome measure was VAS-P. Immediately after treatment 65% of the acupuncture group reported a =50% reduction in VAS-P compared to 34% of the sham group and 43% of the usual care group. At 3-months 79% of the acupuncture group, 29% of the sham group and 14% of the usual care group reported a =50% VAS-P reduction. Methodological quality was high: balanced (stratified) randomisation and excellently described methods however there was 30% attrition at 3-month follow-up and data collection was from general practitioners leading to potential performance bias. [14] 241 participants, aged 18-65, with CLBP for 4 to 52-weeks were randomised to 10 sessions of acupuncture (n=160) or to usual care (n=81) over 3-months. Acupuncturists were training for =3-years and =12.8-years clinical practice. Outcome measures were SF-36 pain scores and Oswestry low back pain disability questionnaire (ODI) taken at baseline, 3, 12 and 24-months. A power calculation stated a required 100 participants per group to detect a 10-point difference on SF-36 (90% power and 5% significance level). A 5 point difference in SF-36 was deemed significant. The number of participants in the acupuncture group was increased to 160 to allow for between-acupuncturist effect, usual care group decreased to 80 participants without power loss. Results were presented as point differences between randomisation, 12 and 24-months. At 12-months a 5.6 point intervention effect difference in SF-36 pain was found and 8 point at 24-months. No treatment effect was found for any other dimension o f SF-36 or ODI. Participants were representative of UK population, randomisation was balanced, methods were thoroughly documented and acupuncture treatments were individualised resulting in high methodological quality and generalisability. However 25% of participants were unaccounted for at conclusion reducing internal validity. [15] 11630 participants with CLBP =6-months were allocated to three groups. Group A were received 15 individualised acupuncture sessions with usual care as needed (n=1549). Group B received delayed acupuncture with usual care as needed (n=1544). Group C declined to be randomised but received 15 individualised acupuncture sessions with usual care (n=8004). Treatment was over 3-months. Outcome measures were FFbH-R and SF-36 pain scores. At 6-months the acupuncture group showed significant improvements in FFbH-R and SF-36 pain compared to routine care alone. The large sample size and broad inclusion criteria meant results were generalisable however groups were different at baseline and findings identified a degree of randomisation selection. [16] 52 participants with CLBP =6-months were randomised to 4-weeks of physiotherapy with daily 1-hour electro-acupuncture sessions (n=26) or standard physiotherapy (n=26). Outcome measures were pain (NRS-P) and function using the Aberdeen-LBP. There was a significant reduction in NRS-P and Aberdeen-LBP scores in the acupuncture group immediately after treatment and at 1 and 3-months follow-up. Methodological quality was limited by possible breach of blinding integrity due to lack of patient blinding and subjective outcome measures. DISCUSSION Acupuncture vs. no treatment Two high quality studies (11928 people) [5] and [15] found acupuncture more effective in short-term pain reduction and functional improvements than no (delayed) treatment. However both studies were weakened by insufficient blinding and participants were recruited from newspaper adverts [5] or an insurance company [15] limiting generalisability; both of which reduce results confidence. Acupuncture vs. sham Studies comparing acupuncture and sham acupuncture (2460 people) ([5], [6], [7], [11] and [13]) found both effective at reducing pain and increasing function compared to baseline measures; however no study found a clinically significant difference between groups With five methodologically sound trials all reporting similar results clinicians can have confidence in the effectiveness of acupuncture or sham-acupuncture in pain and functional improvements. However with no clinically significant difference between groups, placebo effect seems to be a substantial contributing factor. Acupuncture vs. usual care Five RCTs comparing acupuncture and usual care (12164 people) ([12], [13], [14], [15] and [16]) concluded that acupuncture was more effective at reducing pain. Increased function in the acupuncture group compared to control was reported in 1 RCT [12] at 6- and 9-weeks, [15] at 6-month and another [16] investigated effect immediately after treatment and 1- and 3-months follow-up; however 1 RCT [14] found no significant improvement in function in their longer-term study at 12 or 24-month. Unlike other papers reviewed, Thomas and colleagues used UK based participants who received treatments in private or GP clinics adding confidence to their conclusions when applied to the general UK population. From study findings clinicians can have confidence that the addition of acupuncture to their treatment of CLBP will be more effective than usual care alone. Acupuncture vs. deep and superficial trigger-point acupuncture One study ([8] 35 people) found greatest improvements in pain and function using deep trigger-point-acupuncture. However this study, while being methodologically thorough and having patient and assessor blinding, was limited by small size, high dropout (23%), short-term follow-up and possible centre bias leading to reduced clinical confidence. Acupuncture vs. TENS One RCT ([10] 60 people) found significant improvements using both TENS and acupuncture but no significant intergroup difference over 6-months. However, confidence in results are limited because participants also received usual care and exercise so may have improved regardless; furthermore the study had no therapists blinding, high noncompliance (23.3%), unexplained dropouts and no intention-to-treat analysis. Trigger-point acupuncture vs. sham In 1 cross-over trial ([9] 26 people) trigger-point acupuncture was found to be more effective than sham however small sample size, high attrition (23%), restricted to short-term follow-up and possible bias due to centre location (Department of Orthopaedic Surgery, Meiji University of Oriental Medicine) limit confidence in findings. LIMITATIONS Studies were commonly limited by being unrepresentative: of the 12 studies 2 were UK based ([10], [14]), six restricted participants by age ([8], [9], [11] [12], [13], [14]), 2 used participant recruitment methods which may have introduced expectation bias (newspaper adverts, [5], insurance company [15]) and five had underpowered sample sizes or non-stated power calculations ([8], [9], [11], [12], [13]). Without representative sample groups the outcome measures cannot be applied to the general population with any reliability. Discrepancies were noted in treatment frequency with control group participants receiving less attention than intervention participants [16]. Blinding was inconsistent across studies: 1 study ([5]) blinded participants in the acupuncture groups but not the delayed group, 1 study ([6]) blinded participants only, four ([7], [8], [9], [13]) blinded assessors and participant, 1 ([10]) blinded assessors only, 1 ([11]) blinded assessors and participants but not acupuncturists, three ([12], [14], [15]) had no blinding and 1 ([16]) blinded assessors but not participants. CONCLUSIONS There is some evidence for the efficacy of acupuncture for CLBP; compared to no treatment there was short-term ([5] 8-week and [15] 3-month) pain reduction and functional improvements. Compared to sham therapy both showed similar improvements in pain and function at short-term ([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) follow-up but no significant difference was detected between groups. Compared to usual care acupuncture showed significant improvements in primary outcome measures at treatment, short- ([12]6- and 9-week, [13]3-month, [16]1- and 3-month) and long-term ([15]6-month, [14]1- and 2-year) follow-up. Compared to superficial and deep trigger-point all treatments showed improvements but none were significantly different from each other. Both acupuncture and TENS were found to produce long-term ([10] 6-month) improvements but no significant difference was found between interventions. Comparing trigger -point therapy to sham, trigger-point was found to be more effective although benefits were not sustained. There is evidence that acupuncture alongside other treatments relieves pain and increases function better than individual therapies alone. Further research needs to be conducted to determine treatment frequencies and sustainability of treatment effects. Effective sham treatments need to be developed to establish placebo effect compared to acupuncture and other therapy types. Additional Resources Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R. (2003). Lost productive time and cost due to common pain conditions in the US workforce. JAMA;290(18):2443-2454. Maniadakis, N. and Gray, A. (2000) The economic burden of back pain in the UK. Pain, 84, 95-103. Koes BW, van Tulder MW and Thomas S (2006). Diagnosis and treatment of low back pain. BMJ; 332, p1430-1434 Furlan AD, van 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 Journals 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 pain: a randomized controlled trial. Archives of internal medicine. 166: 450-457. Cherkin et al (2009) A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. 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 trial with 3 groups. Arch Intern Med. 167(17):1892-1898. Itoh E, Katsumi Y, Hirota S, Kitakoji H. (2006). Effects of trigger point acupuncture on chronic low back pain in elderly patients a sham-controlled randomised trial. Acupuncture in Medicine. 24(1):5-12 ItohK. Katsumi Y. Kitakoji H. Acupuncture in Medicine. (2004) Trigger point acupuncture treatment of chronic low back pain in elderly patients: a blinded RCT. 22(4):170-7, Kerr DP, Walsh DM, Baxter D. (2003) Acupuncture in the management of chronic low back pain: a blinded randomized controlled trial. The clinical journal of pain. 19: 364-370 Leibing E, Leonhardt U, Koster G, Goerlitz A, Rosenfeldt JA, Hilgers R, Ramadori G. (2001). Acupuncture treatment of chronic low-back pain a randomized, blinded, placebo-controlled trial with 9-month follow-up. Pain 96 (2002) 189-196 Meng CF, Wang D, Ngeow J, Lao L, Peterson M, Paget S. (2003). Acupuncture for chronic lower back pain in older patients: a randomized, controlled trial. Rheumatology. 42:1508-1517 Molsberger AF, Mau J, Pawelec DB, Winkler J (2002). Does acupuncture improve the orthopedic management of chronic low back pain a randomized, blinded, controlled trial with3 months follow up. Pain 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 trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain. 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). Pragmatic Randomized Trial Evaluating 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
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