Philosophy of Nursing Coursework Example | Topics and Well Written Essays - 2000 words

Philosophy of Nursing - Coursework Example During those ages when women were confined within their homes and family life, nursing had become a household art. Progress of nursing has been influenced by the duties of women and their economic independence. In earliest times, nursing was associated with motherly care of infants and was termed as wet nurse. By the 16th century the meaning of nursing meant to attend and care for the sick (Donahue, 2010, pp.4,6). In early times it was believed that nurses required no formal education or training. They were unlicensed doctors, abortionists, midwives and counselors in the western history. For centuries, the nurses passed on their experiences to their neighbors or daughters. They were termed as â€Å"wise women† by the people. One early myth was that women were so trapped by their menstruation and reproduction cycles that they were not independent outside their homes. Another myth was that male professionals had superior technology. These myths were false since women were inherently healers for the poor. It was also found that male professionals depended more on ritualistic practices while women represented more humane approach to healing (Ehrenreich & English, pp.25,27). According to Jean Watson, professor of Nursing, â€Å"The nurse has a human responsibility to move beyond the patient’s immediate specific needs and help the patient reach his or her highest level of growth, mat urity and health† (Clarke, 2011, p.406). Professor Margaret Newman has stated all contrasting experiences are equal like pain and pleasure, failure and success etc. Although, spiritually this makes sense, this is not practical when practicing nursing especially in cases where patients seek recovery from illness (Clarke, 2011, p.406). The concept of nursing is often considered as informal care of patients and therefore most practicing nurses do not accept nursing models

Designing and Implementing Effective HRD Programs Essay

Designing and Implementing Effective HRD Programs - Essay Example Hence, selection of appropriate methods that fulfill the purpose of training has an incremental effect on employees’ skill set and motivation, and relevance to management’s objectives needs to be selected (Carr, 1999). Â  In the light of my past experiences, it was observed that where HR department managed to select appropriate training topics for the workforce, training sessions intended to develop soft skills i.e. presentation skills etc, were considered as a leisure activity due to ineffective evaluation processes with intangible outcomes. A thorough analysis of the research method helped in developing an understanding that evaluation processes need to be amalgamated into the lesson plans and overall activity planning. Furthermore, peer evaluations and knowledge of industry’s best practices on the subject matter along with a concrete understanding of intended outcomes helps in developing relevant and effective evaluation processes. Â  Rockwell Collins faces a major issue of lack of accessibility of training resources to the employees as it has an extensive workforce scattered at different stations. Since the HR department is centralized and does not have a physical presence outside headquarters, it is important to identify how the training can be made available to the employees outside the physical proximity of HR department. First and foremost, support of organizational leadership needs to be acquired in order to extend delivery of training in secondary workstations. Secondly, close observation of employee performance and work schedule needs to be performed. Where HR department is aware of employees schedule outside headquarters, sending company’s trainers at a particular destination and arranging training may do the needful.

In a climate of austerity is it right for government to support small Essay

In a climate of austerity is it right for government to support small business - Essay Example There are also people who advocate that government should not intervene at all and should let the forces of market prevail. So there are many differing opinions about areas where government should or should not spend money of tax payers. In this essay we will argue why governments should support small businesses even in a climate of austerity. It is not only economically but socially also desirable for any economy if small and medium enterprises are encouraged. These small businesses can provide employment and at the same time can boost economy by increasing consumer spending. The arguments against government support to small and medium enterprises will also be studied in order to understand both sides of the debate. There is no doubt that these are tough times for the economy but it is not logical to curb spending in areas that will reap positive cash flows in future. Support for small businesses should be seen as an investment. This is the reason why governments should support smal l businesses even in a time of economic austerity. Why Government Should Support Small Businesses? This portion of the text will be devoted to the understanding of the reasons for government support of small businesses. There are many reasons why government should support small and medium enterprises. The effect of support to small businesses is seen directly in a country’s economy. ... With the support of government small businesses can help an economy increase its GDP. Economists argue that growth of GDP can solve many problems of a country. If economy is growing at a good pace then it is an indicator that the country is going in the right direction. These are tough times for the whole world and countries are still trying to recover from the crisis of 2008. In these times focus of the governments should be on increasing Gross Domestic Product of the country. More GDP means growth and growth in an economy can fight every crisis. It is actually a stimulus for the economy as whole. Small business can help governments do that and the money that is needed for small business support is very small as compared to the other methods of increasing growth. It can be safely concluded that governments should spend money in order to support small business even in a climate of austerity because it will help the economy recover from the very crisis it is going through. The role of government in this regard can be substantial and development and growth of small businesses are dependent upon government policies regarding small and medium enterprises (Li & Matlay, 2006). The best way through which small businesses can help solve problems of any economy is by creating jobs. Unemployment is a very awful thing for an economy because as a result government revenues decrease and more and more people become dependent on the state instead of earning for themselves. The problem of unemployment can be reduced, if not resolved, by supporting small and medium enterprises. These small businesses will provide the people with the job opportunities that they desperately need.

Bloodstream Infections Research Paper Example | Topics and Well Written Essays - 1750 words

Bloodstream Infections - Research Paper Example In USA, it has been reported that increased risk of developing blood stream infections (BSI) is associated with the increased use of central venous catheters (CVSs) in ICU patients especially when the skin catheter site is colonized by bacteria and fungi. This is a major risk factor for CVC infection. Other predisposing factors to infection includes; exposure to mechanical ventilations (Jerome, 2000). Patients receiving TPN are also at risk as they are associated with growth of other microorganisms such as Candida spp and coagulase negative Staphylococcus. ... an be compromised, there is more exposure to different infectious agents, the hospital is forced to put more stuff for surveillance, prevention and control and this means extra cost. The nurses will also have a lot of work loads if there is under stuffing and more injuries such as needle stick (Stone, 2004). Nursing interventions that impact percentages of blood stream infection. Line management It may consist of daily inspection of catheters insertion sites, taking care of the site by changing the dressing if wet or soiled, time to time documentation of ongoing catheter, ensuring of proper application of CHG impregnated sponge on the insertion site, hand hygiene, using chlordexine during dressing of the site, appropriate flushing procedures, tubing replacement and increasing time allocated for CVC management. Other intervention that impact on the percentages of blood stream infections includes, educating of the stuff so as to make the nurses aware of evidence based infection control guidelines for inserting and also for maintaining of CVCs. This will help in prevention of nosocomial infections and empower them to stop catheter insertion if guidelines have not been followed. Putting in place a checklist will be important in ensuring that the nurses adhere to evidence based guidelines of preventing infections. Creation of a catheter insertion carts will be critical in ensuring that nurses obtain all the materials needed to follow the CDC guidelines for sterile CVV insertions (Guerin, 2010). Aseptic techniques. Aseptic techniques should be used during insertion and caring of intravascular catheters. Clean gloves are recommended for peripheral catheters while sterile gloves are good for arterial and central catheters. Aseptic techniques includes the use of mask, sterile

Importance of English Essay Example for Free

Importance of English Essay Good morning, teacher and fellow students.Today I would like to talk to you about â€Å"the Importance of English.† First, English is the language for communication more than 1.5 billion people speaks this language everyday. It is indeed one of the most widely spoken languages in this world. Second, English is the language for Science and Technology many books are written in English. Many research papers are presented in English. If you are good in English, you were be able to give up with it latest development. Third, English is the language for travel if you ever travel oversea, you will understand it is importance .For example, you go to the airport-you read signs and directions in English .You checked into a hotel-you speak English with the receptionists .You go shopping-you bargain in English .You go to a restaurant-you order you food in English. Imagine just how difficult things can be if you can’t speak English well. Finale, English is the language for international business and trade. If you want to do business internationally, you were have to commence with your business associates in English, the better your English is the more business opportunities you were have. My conclusion is that everybody must learn this importance languages .You want be successful, MASTER ENGLISH! ! ! You want to have good career, MASTER ENGLISH! ! ! You want to make friend with people from all over the world, MASTER ENGLISH! ! ! If you successfully master English, You were have many more opportunities in life so make up you mind, pick up your book, open your mouth and start learning English today.

Jean Piaget: The Four Stages Of Cognitive Theory

Jean Piaget: The Four Stages Of Cognitive Theory Cognitive theory of Jean Piaget includes four stages of development that children move through during which the explanatory behaviors of infants transform into the abstract, logical intelligence of adulthood. There are three important specific characteristics of Piagets theory of which the first one is being a general theory, that is, cognitions all aspects undergo a similar course of change. Another characteristic is that children move through the stages in an invariant sequence. Piaget believed that there is a same order that children follow. Third, the stages are universal. Stages in cognitive theory assume the theory to include all children everywhere (Berk, 2003). Biological concepts are used in a limited way in Piagets theory. However, he stated the importance of genetic and environmental factors on the way that children move through the stages (Crain, 2005). He emphasized that the speed of children while passing those stages is affected by differences in genetic and environmen tal factors. Jean Piaget used the term scheme while explaining human beings organized way of making sense of experience (Mark, 1969). Traill (2008) explains that the term scheme used by Piaget is different from peoples everyday usage of scheme. The term can be any pattern for exploring and learning from the environment and it has three different intellectual structures. Piaget calls first intellectual structures to emerge as behavioral schemes, ones that appear after 2 years as symbolic schemes, and structures that appear after 7 years as operational schemes (Piaget, 1972, as cited in Traill 2008). For instance, dropping scheme of an 8 month old baby and a 25 months of will not be the same, as sooner it will become more deliberate and creative. Toddlers, different from infants, begin to think before acting and Piaget identifies that transition from sensorimotor to cognitive approach to the world which depends on mental representations. (Piaget, 1926, as cited in Berk 2003) Images and concepts are the two powerful mental representations. Especially, the shift from sensorimotor to cognitive approach is accounted for two processes; adaptation, consisting assimilation and accommodation, and organization. Interpretation of new structures into already existing schemes is called as assimilation and modification of existing schemes into adaptation of new experiences is called as accommodation. Cognitive adaptation aims to adjust to the environment and is a result of the equilibrium between assimilation and accommodation (Block, 1982). While trying to grasp an object, a baby is experiencing the assimilation process, while removing an obstacle and grasping an object, a baby now accommodates the scheme (Crain, 2005). During the organization process more complex intellectual structures are combined with existing schemes by children. For instance, after the baby experienced and covered dropping movement, then he/she will relate it with throwing movement as well as understanding the concepts of near and far (Berk, 2003). The Sensorimotor Stage (Birth to 2 Years) Jean Piaget observed his children during their developmental period and constructs the stages based on his observations. His books mostly involve many examples from his dialogues and interactions with his children. The sensorimotor stage consists of six substages. (Santrock, 2004) That stage starts with the use of reflexes from birth to 1 month. Newborn reflexes take important place in sensorimotor stage. According to Piaget inborn reflexes are consisted from first schemes. He states that as children use inborn reflexes and experience assimilation, they desire to put them to active use (Crain, 2005). After one month, children begin to repeat their chance behaviors and primary circular reactions period (one to four months) starts. A baby experiences the thumb sucking by bringing her hand to her mouth by a chance, when the hand falls she wants to get it back and experiences many failures until she gets it back (Crain, 2005). At that example the child organizes the hand movement and sucking which is a kind of circular reaction. Piaget also states that children at that period indicate the first efforts at imitation (Berk, 2003). The next substage is secondary circular reactions and is observed between fourth and eighth months. Infants start to experience motor achievements that encourage them to play attention to their environment. Infants begin to get enjoyment from the response of the environment to their attempts and they repeat their movements that get reaction from their surrounding (Santrock, 2004). Coordination of secondary schemes substage takes place during eight to twelve months. At this stage infants begin to coordinate tow or more actions to achieve simple objectives. In addition with an intentional purpose, babies try to imitate behaviors after watching a person. One may be able to observe a baby at this stage trying to stir with a spoon. In addition, a baby may begin to cry when she sees her mother wearing her coat in order to stop her mother leaving (Berk, 2003). In substage 5, tertiary circular reactions (twelve to eighteen months), children are interested with different outcomes. Piaget had observed one of his children hitting on a table at different rates in order to listen different sounds that he creates (Crain, 2005). It should be noted that all experiences are results of childrens intrinsic curiosity about the environment around them that Piaget emphasizes within his cognitive development theory. The last substage of the sensorimotor period is named as beginnings of thought or internalization of schemes lasting from eighteen to twenty months. During that substage children have the capacity to remember the behaviors that are not present (deferred imitation). Their efforts on imitation also indicate progress and they experiment with actions inside their heads. Besides, children can be observed to engage in make-believe play during that period (Santrock, 2004). Object Permanence: Piaget and many researchers concluded that infants appreciate concepts of permanence objects. Up to four months, children do not make any attempt to an object leaving in front of their eyes. During secondary circular reactions stage children are more able to explore their surrounding and they have a better sense of permanence of objects. At stage four children have the ability to find the hidden objects. If an adult takes a toy behind a box, the baby will look at the behind of the box and find the toy. During the stages five and six children are able to follow displacements and follow invisible shifts (Crain, 2005). Beginnings of Categorization: Before the capability of mental representation children are not able to categorize objects. During the first year of their life, children experience perceptual categorization. For example they can categorize the legs of an animal. Conceptual categorization begins with the end of first year; they are now able to categorize similar characteristics and behaviors. Active categorization period starts with the beginning of the second year. It is stated that sorting objects into two classes can be observed in eighteen months babies. In the second year babies can group two different kinds of objects without grasping them (Berk, 2003). When the observed milestones of research and the description of substages of Piaget are compared from birth to two years, both similarities and differences are seen. There are points that seem to occur earlier than Piaget accepted such as categorization, deferred imitation, and analogical problem solving. Those differences are explained differently from many researchers. Some of the surveys indicate that some children born with different intellectual capacities and some of them with a set off limits which causes those differences. The latter argue the theory of Piaget in terms of biological considerations. The Preoperational Stage (2 to 7 Years) Preoperational stage is lasting from two to seven ages in which the child is more capable while dealing with the environment. Although the reasoning of child is still unsystematic and illogical, that is the period that children begin to use symbols and rapidly develop representation. One of the important symbols that indicate increase during that period is language (Santrock, 2004). Piaget believed that experience of internal images occurs before labeling words and he did not take language as an important tool in cognitive development of children. Berk (2003) argues that Piaget had misadjusted the role of language in early intellectual development. She proposes that conceptual abilities of children are highly affected from the dialogues of children with adults. Moreover, there are many psychologists that believe as children develop their language ability, they begin to think more logically. Children experience transductive reasoning during that stage which means shifting from one particular to another. Children place two unrelated situations into the same case as if they have a relationship. One of Piagets children had concluded that she hadnt had her nap yet so it wasnt afternoon (Piaget, 1924). Piaget (1924) explains that statement as an example of transductive reasoning, because the child did not catch the understanding that afternoons include many different events and having nap is only one of them. An important milestone of the increase in mental representation is make-believe play during preoperational stage. The differences in make-believe play between sensorimotor and preoperational stage can be clearly observed. By the middle of preoperational stage make-believe play of children indicate real life conditions. In addition, by preoperational stage children begin to engage in sociodramatic play, they coordinate variety of roles and story lines during their play. One of the criticized points of cognitive theory of Piaget is based on the belief of Piaget that play reflects childrens cognitive and social skills, however there are many recent studies indicating the contribution of play on those skills. Especially during sociodramatic play, children interact with their peers longer and they are more cooperative. Many psychologists believed the role of strengthening of make believe play on a wide range of mental abilities and logical reasoning (Berk, 2003). Egocentrism: Piaget stated that children look at their surrounding from their own viewpoint and they ignore perspectives of others. Three-mountains study is one of the famous observations of Piaget explaining egocentric behavior of children at preoperational stage. He had used a model of three mountains and taken a child for a walk around the model in order to give opportunity for the child to look at the model from different view. Piaget had placed the child from one point of the model and placed a toy to another place. The child had been asked what he/she saw while looking at the model and what the toy would be seen while looking at it. All the children could correctly explain what they were seeing, however children at preoperational stage gave the same answer with their own view (Crain, 2005). Studies emphasize on the relation between egocentrism and social communication. Children at preoperational stage, according to Piaget, fail to recognize the needs of their peers during verbal interaction (Rubin, 1973). As they look only from their own view, they are able to understand view of the person interacting with them. They think that they can be seen from everywhere, everybody see and hear them. An adult may observe a child at this period telling that nobody could see him/her while closing his/her eyes with hands. Animism: Piaget (1951) proposes that the child recognizes no limits between himself and the external world and it is expected that the child would see many nonliving and non acting things as living and conscious and he explains this phenomenon as animism. In his book The Childs Conception of World, 1951, he identifies the reason for him to use the term animisim. He accepts that animism was term used for primitive human beings and responds the criticisms by telling that he had used that term as a generic term and emphasizing on the different types of animism in psychological origins (Piaget, 1951). Children at preoperational stage have a belief that objects are alive because they move and grow. For example, a child may tell that there are not any cars on the road, because they are sleeping. Piaget described animism inside four stages. Initially children accepted useful things as living. At this first stage broken or damaged objects were not alive for them. At the second stage, moving objects, whether are moved by an external factor or by themselves, were considered as alive. In stage three, to be categorized as living, things should move by themselves. Lastly, at the fourth stage, adults know that plants and animals are living things only (Moriarty, 2005). Irreversibility: Going through a series of steps and after changing direction is difficult for children at preoperational stage. Another well known experiment of Piaget indicates that problem in a way that there are children shown 16 boxes, 6 of which are yellow and 10 of which are red. When children are asked whether red boxes are more or boxes, children at this stage responds as red boxes and fails to be aware of that both yellow and red boxes are boxes. In his book The Childs Conception of World, 1951, Piaget gives examples about irreversibility. There are dialogues indicating their inability such as, asking a child about her sister, the child responds that she has a sister named A, then Piaget asks the child whether A has a sister or not, the child responds that A has not a sister. (Piaget, 1951) Inability to Conserve: Piaget propounds preoperational childs lack of conservation by applying experiments of liquids and number. He shows two same size glasses to the children and fulls the glasses with water. He asks children which of the water was more. All the children respond that they were equal in amount. Then he puts the water in one of the glasses into a different size glass (wider or taller) and repeats his question. Children at preoperational stage tell that they are now different. They have not the capability to perceive that certain physical features of objects remain same, even their physical appearance changes (Santrock, 2004) Based on experiments of Piaget, at the beginning of seven children begin to give the correct answer to the conservation tests. Before that age children indicates at conservation but not totally achieve it. They give answers like one is more because it is taller and then change their answers the other one is more because it is wider. Besides, irreversibility of the child can be concluded based on the conservation of liquid experiment. The child cannot understand the end result as a reverse of the original one. Jean Piaget also had thought about the failures of children from the linguistic point. Terms such as taller, more, wider takes time to be understood. He suggests ways to overcome that problem and tells adults to apply experiments by using different sentences and establishing questions by using different words within a particular case (Berk, 2003). Piaget experimented conservation of children also with using number. A row of egg cups and a bunch of eggs are given to children and they are asked to take enough eggs to fill the cups. At the first half of preoperational stage children ignored the number of eggs in the cups and they made an equal length with the rows. Children at the second half of preoperational stage made one-to-one correspondence. However, those children failed in the second question. Piaget then brought together the eggs and asked which of them was more and they could not respond that they are still same. Most of them thought that the longer was more in number. Piaget explains that phenomenon as been influenced by their sudden perceptions than by logic (Crain, 2005). Categorization: In coordinating and extending knowledge in cognitive development theory of Piaget, categorization takes an important place. Researchers state that children begin to make similar categorizations and form some categories with the age of two such as animals, plants, and vehicles (Scholnick, Nelson, Gelman, Miller, 2008). Things or objects in all of those categories have differences in perceptual characteristics, so a conflict emerges with the main idea of Piaget that childrens reasoning is governed by the way they see and objects appear. By the age of three children become able to make distinctions between basic and general categories such as furniture versus tables. However, children at preoperational stage are not able to organize objects into classes and subclasses based on their basic similarities and differences (Meadows, 1986). It is argued that Piaget was partly right and partly wrong with his conclusions of preoperational stage. Researchers give simplified tasks for children and preschoolers indicate the beginnings of logical operations, however there are important differences between their reasoning and children at school age. Difficulties were observed in conservation tests, three mountains tests and appearance-reality tests. As opposed to perceptual approaches to solve problems, children rely on increasing effective mental. In order to give an example, research indicate that children who have not the capability to use counting while comparing two groups of objects, do not also conserve number. They begin to find effective solution ways for proms with more objects when they become capable of counting. Piaget states that, as many other psychologists accept, children move through variety of stages of understating, although they do not totally handle conservation up to school years. The Concrete Operational Stage (7 to 11 years) The beginning of concrete operational stage is furnished by logical reasoning. That period is accepted as a major turning point in cognitive development. The time that a child begins to mentally resemble an adult starts with attaining concrete operational stage. A school-aged childs cognitive performance is more evident in terms of concrete operations. For example an eight year of childs response to conservation of liquid test is that the amount has not changed and they are still same. This explanation of the child also indicates the reversibility of the reasoning that the child has now the capability to understand that the reverse is the same with the original. Their ability to achieve conservation tasks indicate their logical thinking (Richardson, 2003). Between ages seven and ten, children take attention on relations between a general and two specific categories within the same case. Their awareness of classification is getting developed. In middle childhood period many children are interested in collections such as coins, rocks, and stamps which show their level of classification. Children in the concrete operational stage are fairly good at the use of inductive reasoning which involves going from a specific experience to a general principle, whereas children at this age have difficulty with using deductive reasoning. Deductive reasoning involves using a general principle to determine the outcome of a specific event. Seriation: Seriation refers to the capability to arrange objects along a quantitative dimension. Ordering sticks from different lengths is one of Piagets tests. Children at five and six years could create series but they made many errors. However, children at concrete operation stage, by starting the shortest and putting the next, indicate a perfect arrangement with an orderly plan. Children between ages seven to eleven have an ability called transitive inference which refers to mentally arrangement of items. Piaget had showed children three stick with different colors. Children had observed that first stick is longer than second stick and second stick is longer than third stick and they had made the inference that first stick is longer than third stick. Children at concrete operation stage mentally integrate three relations at once. On the other hand, preoperational stage children can achieve analogical reasoning by encouragement of an adult (Meadows, 1989). Spatial Reasoning: The ability of understanding space is more developed in concrete operational children. School age children begin to give directions as they gain more advanced space understanding. Children at five or six years indicate difference while representing an object on a persons, in front of them, left or right. Starting from seven age children achieve mental rotations, that is, they can recognize their own frame and of a person in a different direction (Santrock, 2004). While drawing large scale areas their performance indicate important changes representing their development of cognitive skills. In the middle period of concrete operational stage children achieve to place notes showing the location of objects in their classroom. Their capability to use a rotated map is improving and also their map drawing become more accurate. Research indicate that concrete operational thinking has a limitation that while children are reasoning in a logical manner, they are always dealing with concrete knowledge. With abstract information, they cannot catch the achievement (Crain, 2005). When they are given ideas that do not appear in the real world they are not able to indicate the same responds with concrete ones. That can be easily observed from transitional inference that when children are shown the sticks they give the correct responds whether which one is smaller or taller than the others. However, when the questions turned to a more concrete version such as As hair is longer than B, B2 hair is longer than C. Who has the longest hair?, up to eleven years children cannot give the right answer (Richardson, 2003). Jean Piaget believed the importance of rich and appropriate environment for the speed of concrete operational cognitive skills of children. Many research done in small towns or villages represent the lack of rich environment and its consequences on children. Even the easiest conservation tasks are not easily achieved until the age of eleven. On the contrary, many children living in big cities, especially Western nations, have many opportunities in terms of environment and from very young periods of childhood they meet with rich and varied materials. Hence, they easily understand the conservation tasks. The same comparison had done between children receiving a professional early childhood education and the ones that spend their early period at home or street. The conclusions indicate better results of the children continuing a preschool program (Berk, 2003). A survey had been made between Brazilian street vendors and Brazilian economically advantaged children on informal version and Piagetian version of class inclusion test of Piaget. In the informal one, the researcher asks children for the price of two chewing gums which are different. In the Piagetian one, four units of one type (mint) chewing gum and two units of the other (strawberry) one is set aside and the researcher asks In which one do you get more money, whether you sell me the chewing gum with mint or all the chewing gum? The success of two groups children indicates difference that on the informal version of the conservation task street vendors performed better and on the other version economically advantaged children performed well (Ceci Roazzi 1994, as cited in Berk 2003). The Formal Operational Stage (11 Years and Older) The child in sensorimotor period can do things and play with objects, the child in sensorimotor period and concrete operational period can think and make reasoning about those objects. Thinking about propositions and relations different from objects and events is another period. Now human beings are bale to make coordinations of coordinations, in other words, they can combine two different groupings of concrete operations within reversibility by reciprocity (Richardson, 2003). In formal operational stage adolescents do not require concrete things as objects of thought. Adolescents at this stage are capable of deductive reasoning. In order to overcome a problem, they start more generally and think evaluate all possible factors and then proceed to more specific predictions. Piaget used pendulum problem in that stage in which he had showed many strings with different lengths, objects differing in weight, and in order to hang the strings a bar to children. He asked the factors that will affect the speed with which a pendulum swings. Children in concrete operational level made an unsystematic experimentation. The influences of each variable could not be distinguished by them. Adolescents of formal operational stage separate the factors that have the possibility to affect the speed into four groups; strings length, objects weight, the level of force when pushing the object, and how high the object is raised before it is released. At the end they come up to a right conclusion that the length of the string affects the speed (Berk, 2003). They work systematically in terms of all possibilities as a scientist. Cognitive development theory of Piaget is mostly depending on mathematical and scientific reasoning; however he has some speculations on social life of formal operational stage adolescents. Piaget thinks that children between seven and ten live in here and now, whereas at the formal operational stage they start to think about long-term periods. They handle abstract ideas such as justice and love and they start to construct theories for better living world (Inhelder Piaget, 1955, as cited in Crain 2005). Piaget identifies egocentrism again and believes that a new kind of egocentrism is carried by utopian during that period. Piaget takes into account and repeat the forms of egocentrism from beginning to later periods: At the beginning, sensorimotor period, infants have no idea bout the environment around them and they are egocentric, still the objects that they cannot see have no existence on their own. At the next level, preoperational thought, children enter a representative world in terms of language and symbols. They indicate difficulty more than their own view. After a time they become aware of other perspectives and they start to think about concrete objects. Finally, adolescents, formal operational period, meet with a world full of problems and possibilities. Adolescents feel unlimited power in themselves for their thoughts and egocentrism reappears and they are now not able to distinguish self and others abstract views.(Crain, 2005). Teenagers feel that they are at the centre of their environment and they assume that everyone is looking at them. They spend many hours in front of a mirror feeling anxiety for the peoples criticism about them. This is called as imaginary audience. Then with having a thought that everyone is observing them, they start to feel themselves special and unique and this is named as personal fable. Propositional Thought: Adolescents do not need to refer real-life conditions and they are capable of evaluating the logic of propositions. Previously, they were evaluating statements when they were concrete in the real world. Piaget did not give an important role for language in childhood period, but he thought that it was more significant during adolescence. So, verbal reasoning about abstract situations and events is one of the important concepts in formal operational thought. Adolescents thoughts and opinions about abstract conditions and their capacity while expressing those views are demonstration of their propositional thought. Theory and research of Piaget have greatly changed the view at infant action and thought and provided a new way of looking at children (Fischer Heneke, 1996). Evaluation of Piagets Theory Jean Piaget has contributed to the field of child development than many other theorists, as many things he expressed were the first for his time. He was the first to tell that children were different from adults and they are curious and active learners (Berk, 2003). Piaget is the founder of discipline of cognitive development. He was interested in reasoning of children and that ensured the idea of that field would be developmental and should be different from the study of adult thinking. Piagets considerations through the idea about active roles of children on their development can be seen as obvious recently, but it was innovative for his time (Shaffer Kipp, 2001). Piaget tried to explain the process development and from that part he was one of the firsts who not only described the theory. Piagets explanations had a major impact about social and emotional developmental theories. By asking many questions about intellectual development of children and creating thousands of resource for that field, he had important contributions for the educators and researchers (Shaffer Kipp, 2001). Many studies criticize Piaget for underestimating mental capabilities of children due to his concern with defining the underlying cognitive structure which considered performance of children on a conservation task. Piaget is criticized as assuming that child making mistake in one problem will lack the underlying concepts he was testing. Validity of this assumption is refuted by stating that performance of a child may be influenced by many other factors instead of lack in cognitive skills (Scholnick et all, 2008). Researchers have challenged stage theory of Piaget by asking if intellectual development is at all stagelike. It is proposed that transitions in mental gradually occur and the consistency of a performance of a child in a test would be very little. For instance, problems of concrete operations and problems of formal operations may be achieved in different orders by many children with different abilities. Many theorists believe that cognitive functions are so complex that would be evaluated within a stage manner. For instance, a nine years old child may do well on verbal reasoning tests if he likes to deal with word puzzles and play verbal games, however he may not do well in mathematical reasoning (Shaffer Kipp, 2001). Besides, Piaget ignores cultural differences while claiming that his stages move on the same sequence in all cultures. Children from different cultures are educated differently and a s environment has a direct interaction with cognitive development, cultural differences should be taken into account to get a valid conclusion. Implications for Education Piaget did influence much from Montessori and Rousseau and emphasized on the importance of active learning of children. He believed that learning is a process of active discovery and should be related with the level of the child. The role of educator at giving the child appropriate and rich environment based on childs interests and modes of learning takes significant place in terms of encouraging innate curiosity of children. An environment with rich, variety, and interesting materials will encourage children to discover and become active learners (Crain, 2005). According to Piaget educators should not teach children in a direct way, children should be allowed to construct their own knowledge through experience. Children should be given the opportunities to make mistakes and learn through those mistakes, and look for solution ways. Piaget helps educators to be aware of that, meaningful interactions of children with environment and real activities will enable children to learn. All of those factors are the roots of constructivism which is a Apoptosis: Techniques for Measuring and Observing Apoptosis: Techniques for Measuring and Observing INTRODUCTION   The number of cells within an organism is tightly regulated- not simply by controlling the rate of cell division, but also by controlling the rate of cell death. If cells are no longer needed, they commit suicide by activating an intracellular death program. (Liao, 2008) Apoptosis, is defined by distinct morphological and biochemical changes mediated by a family of cysteine aspartic acid-specific proteases (caspases), which are expressed as inactive precursors or zymogens (pro-caspases) and are proteolytically processed to an active state following an apoptotic stimulus. (Liao, 2008) The aim of this paper is to discuss the techniques for measuring and observing apoptosis, whilst commenting on any limitations reported to date. DISCUSSION The intracellular machinery responsible for apoptosis Kerr, Wylie and Currie (1972) observed controlled cell death that was distinct from uncontrolled necrotic death. They noticed a characteristic, identical sequence of events in many different types of cells and published their observations in 1972 and used the term apoptosis. (Alberts, 2007; Cancer, 1972) In apoptosis, cell shrinkage and membrane ruffling (blebbing) occur, and the cell disintegrates into small membrane-bound apoptopic bodies. Inside the cell chromatin condensation and nuclear fragmentation occur, which are accompanied by breakdown of the DNA into regular size fragments. On the surface of the cell lipids are rearranged in the bilayer of the plasma membrane with the lipid phosphatidylserine becoming exposed to the outside. (Hancock, 2005) Measuring and observing apoptosis Apoptosis is essentially a morphological state arrived at by a whole variety of different biochemical pathways. Some routes may result in the expression or loss of an antigen but there is no assurance that the same biochemical alterations occur in every cell. The identification of protein markers permits ready detection by conventional immunohistochemistry, which facilitates rapid and confident assessment of apoptosis. (Harrison, 1996) The in situ end labelling and in situ nick translation techniques rely on the presence of DNA strand breaks characteristic of the nuclear implosion and fragmentation seen in apoptosis. Thus, labelling with biotinylated nucleotides and subsequent immunodetection can be used to identity sensitively cells with strand breakage. (Harrison, 1996) Activation of the caspase-3 pathway is a hallmark of apoptosis and can be used in cellular assays to quantify activators and inhibitors of the death cascade by molecular identification. The response is both time and concentration dependent suggesting that multiple pathways play a role in triggering the caspase-3 activation. (Bio Medicine, 2008) TUNEL assay is a technique used for observing activation of the caspase-3 pathway by biochemical verification. The enzyme TdT is able to add nucleotides to the ends of DNA fragments; most commonly, biotin-labelled nucleotides (usually dUTP) are added. The biotinylated DNA can be detected by using streptavidin, which binds to biotin, coupled to enzymes that convert a colourless substrate into a coloured insoluble product. Cells stained in this way can be detected by light microscopy. (Janeway, 2001) The cells with unsuccessful DNA repair may undergo apoptosis; in some cases, false positive labelling may result. TUNEL staining has been reported to give false positive staining in the kidneys of nude and BALB/c mice. In situ localization of activated or cleaved caspase-3 is starting to replace TUNEL as the molecular verification of the apoptotic process. (Hughes, 2007) Extrinsic and Intrinsic signal activation The extrinsic pathway is initiated by ligation of transmembrane death receptors (DR) with their respective to activate membrane-proximal caspases, which in turn cleave and activate effector caspases. A killer lymphocyte carrying the Fas ligand binds and activates Fas proteins on the surface of the target cell. Adaptor proteins bind to the intracellular region of aggregated Fas proteins, causing the aggregation of procaspase-8 molecules. These then cleave one another to initiate the caspase cascade. This pathway can be regulated by c-FLIP, which inhibits upstream initiator caspases, and inhibitor of apoptosis proteins (IAPs), which affect both initiator and effector caspases. (Alberts, 2007; Liao, 2008) The intrinsic pathway requires disruption of the mitochondrial membrane and the release of mitochondrial proteins, such as cytochrome c. Cytochrome c, which binds to and causes the aggregation of the adaptor protein Apaf-1. Apaf-1 binds and aggregates procaspase-9 molecules, which leads to the cleavage of these molecules and the triggering of a caspase cascade. (Alberts, 2007, Liao, 2008) The primary regulatory step for mitochondrial-mediated caspase activation might be at the level of cytochrome c release. The known regulators of cytochrome c release are Bcl-2 family proteins. Members of this family are divided into two main groups, the anti-apoptotic proteins with Bcl-2 and Bcl-Xl as archetypes and the pro-apoptotic proteins such as Bax. The ratio between these different proteins determines the sensitivity of the cell to apoptosis; antiapoptotic proteins inhibit apoptosis by counteracting Bax and Bak, and BH3-only proteins either trigger apoptosis through direct interaction with Bax or sensitize cells to death by inactivating Bcl-2 or Bcl-Xl. (Cartron, 2003; Liao, 2008) RT-PCR primer sets that are specific for genes involved in inducing and regulating the apoptotic response. These primers are specific for genes encoding proteins from the Fas and Fas ligand, Bcl-2 and ICE protein families. The RT-PCR primer sets for studying the apoptotic response are designed to meet several criteria. The primers sets, based on known genomic sequences, amplify a region that spans at least one intron. To distinguish the amplification products from genomic sequences, which are longer than the cDNA products, the primer sets amplify PCR products that are 400 bp to 650 bp in length. The primers are synthesized as 18- to 27-mer oligonucleotides. Each set of primers amplifies only a specific target. (Biomedicine, 2008) Direct measurement using fluorescence resonance energy transfer has shown the interaction between Bax and Bcl-2. (Cartron, 2003) Light microscopy and electron microscopy, including staining, are frequently used to observe the morphological changes of the cells undergoing apoptosis. There are many staining protocols used for identification of apoptotic cells, and the choice varies subject to the laboratory and the tissue being studied. (Wang, 2008) The advantages of Near-Field Scanning Optical Microscope (NSOM) are observing in normal environment, observing in nanometre scale resolution, and observing in non-contact mode. (Wang, 2008) CONCLUSION Using morphology, biochemical or molecular methods to identify, localize and quantify apoptosis gives strength to many research studies. The measurement of the level of apoptosis within tissue sections represents only a à ¢Ã¢â€š ¬Ã‹Å"snapshotà ¢Ã¢â€š ¬Ã¢â€ž ¢ of one time point during a developmental, physiological or pathological process. Given the rapid nature of apoptosis and its cryptic nature in tissue sections, these measurements may often be underestimates of the actual extent of apoptosis. The ability to measure the levels of apoptosis within living organisms, including humans, non-invasively at repeated intervals over time would facilitate the analysis of apoptosis in many organs as well as tumours. (Hughes, 2007) These investigative techniques have broadened the understanding of disease development and will undoubtedly present real opportunities for novel therapeutic intervention. For example, the gene-driven nature of apoptosis and its modulation by various controlling molecules have provided a basis to develop therapies for selectively protecting or deleting cell populations. (Hughes, 2007)

An Investigation Into The Causes Of Migraine Headache Nursing Essay

An Investigation Into The Causes Of Migraine Headache Nursing Essay Migraine is a neurological disorder which affects almost 10% of the worlds population (Woeber et al., 2007). In 2003, the World Health Organization (WHO) estimated the number of migraineurs worldwide at 303 million people. A similar study in 2004 found that approximately 20 million migraine attacks occur every day (Forshaw, 2003). Individuals who suffer from migraine headaches carry the burden of pain and suffering that can lead to an impaired quality of life. At a community level, migraine headaches can also be problematic because of absences from work or decreased productivity from migraine sufferers (NINDS Migraine Information Page). As a result of the problems associated with migraine headaches, there is significant interest in discovering the triggers for migraines. A migraine is a specific type of headache characterized by altered bodily perceptions, pulsing pain in the cranial region, and nausea (Forshaw, 2003). Most migraines are unilateral, meaning they affect only one side of the head, and the pain is usually localized to a very specific area (Forshaw, 2003). A typical migraine can last anywhere from 4 to 72 hours. The most frequent symptoms of a migraine include nausea, vomiting, and increased sensitivity to sensory input (Gallagher et al., 2002). Most commonly, individuals affected by migraine headaches have increased sensitivity to light (photophobia) and sound (phonophobia) (Gallagher et al., 2002). A smaller percentage of migraine sufferers report an aura which accompanies their migraine. An aura usually consists of unusual visual, olfactory, or other sensory experiences that give the individual some forewarning that a migraine will soon occur (Gallagher et al., 2002). The diagnosis of migraine can be difficult, especially because this specific type of headache mimics several other types. Migraines are also habitually written off by those who experience them infrequently as a result of the cold or flu (Gallagher et al., 2002). Because of these difficulties, migraines are often underdiagnosed or misdiagnosed (Lyons, 2007). The International Headache Society (IHS) has laid the foundation for the diagnosis and classification of migraine headaches. According to the IHS, there are seven different classes of migraines (Headache Classification Subcommittee, 2004). These include migraine without aura, or common migraine, migraine with aura, hemiplegic migraine, childhood periodic syndromes which are precursors of migraine, retinal migraine, complications of migraine, and probably migraine. Although there are many classifications of migraine headaches, there are really only two methods of diagnosis, which correlate with the two main types of migraine: migraine without aura and migraine with aura. Migraine without aura can be diagnosed using the 5, 4, 3, 2, 1 criteria: 5 or more attacks, 4 hours to 3 days in duration, 2 or more of unilateral location, pulsating quality, moderate to severe pain, aggravation by or avoidance of routine physical activity, and 1 or more accompanying symptoms which could include nausea and/or vomiting, photophobia, or phonophobia (Headache Classification Subcommittee, 2004). In the method of diagnosing migraine with aura, only two attacks are necessary to make the diagnosis. Although migraine headaches are experienced by individuals from many different lifestyles and backgrounds, there are some demographics in which migraine is more commonly seen. Although migraine headaches are equally prevalent in male and female prepubescent patients, 75% of adult patients are women (Lay et al., 2009). Migraines become more common with age, though 98% of patients experience their first migraine before the age of 50 (Forshaw, 2003). Migraines are also thought to be genetically linked, as 70% of migraine patients have some other, first-degree relative (e.g. brother) who has experienced migraine headaches (Forshaw, 2003). Perhaps the most intriguing question pertaining to migraines is that no one knows what causes them. To date, research has not been able to definitively discern which of the suspected triggers of migraine may actually cause the headaches, nor has anyone determined which of the suspected triggers might play the largest role in producing migraines (Woeber et al., 2007). The list of suspected triggers for migraines is extensive, including, but not limited to: weather, missing a meal, stress, alcohol, various types of food and changes in sleeping patterns (Forshaw, 2003). Women have also reported menses as a trigger, and studies of both men and women have also shown that environmental factors and even certain activities, such as using a computer for too long, can bring on a migraine (Woeber et al., 2007). Because it would be impossible to investigate each and every one of these suspected triggers, the comparison of this studied has been narrowed to include sleep-related, hormonal and food triggers. Sleep Disorders (Amelia Van Handel) The role of sleep in migraine has not been fully explained (Kelman, 2005). Studies have determined that disturbed sleep patterns may trigger a migraine attack, and it is also widely accepted that sleep can alleviate and even terminate a migraine (Blau, 1982). Although the exact relationship between changes in sleep patterns and migraine is unclear, many researchers believe there is a correlation (Woeber et al., 2007; Kelman, 2005). Much of the argument for the relationship between migraine and sleep disorders stems from the preponderance of migraine in the morning hours (Fox, 1998). Patients with sleep disorders are far more prone to have morning headaches, and chronic migraine sufferers often experience morning migraines after interruptions in their sleep cycle. This has led researchers to speculate that the circadian clock plays a role in migraine pathophysiology, though no one has yet determined why changes in sleep pattern are a trigger for migraine headache (Cohen, 2005). Several sleep disorders are speculated to be triggers for migraine. Insomnia, which involves difficulty getting to sleep or staying asleep, is one of the most researched causes for sleep-related migraine (Pallesen, 2001). Excessive daytime sleepiness (EDS) is also commonly associated with migraine. EDS is defined as difficulty maintaining a desired level of wakefulness, and patients diagnosed with the disorder often experience migraine headaches after dosing off during the day (Young, 2004). EDS is relatively prevalent in the general population, ranging from 10% to 20% and increasing in the very young and very old (Hasler, 2005). EDS is usually caused by poor sleep quality at night, which can sometimes be associated with insomnia (Carskadon, 1993). To a lesser extent, narcolepsy (symptoms similar to EDS) and sleep apnea (pauses in breathing during sleep which cause an individual to wake up sporadically) have been studied to determine whether or not they might be associated with migra ine (Bixler, 2005). For more than 100 years, medical personnel and researchers alike have noticed an association between sleep problems and headaches (Sahota, 1990). One of the main causes of confusion, however, is whether the headaches are the cause or the result of disrupted sleep. While interruptions in sleep patterns can cause migraine headaches to become more prevalent, migraines can have the same affect on the sleeping disorders themselves (Paiva, 1997). The determination of which comes first, the sleep disruption or the migraine, is the subject of much current research (Woeber, 2007; Lee, 2009). Hormones (Kelly Pritzl) Previous research indicates that headaches are three times more common in adult females than adult males. (Evans et al, 2000) The reason for this staggering statistic could be due in part to differences in male and female hormones and levels of hormones. (Evans et al, 2000) The major male and female hormones are estrogens and androgens. Men produce significantly more testosterone, a type of androgen, per day than women (7 mg vs. .5 mg), while women produce more estrogen per day than men. A woman experiences more fluctuations in hormone levels during her life than a male does. During these times of fluctuation, many women will have an increased incidence of migraine, suggesting that fluctuations in hormone levels play a role in the onset of migraine. (Lee, 2009) Some of the hormones that may be involved in the onset of migraine are estrogen, progestin, androgens, testosterone, and serotonin. (Glass, 2009) The mechanisms by which these hormones are involved are not clear, but there is strong evidence for the role of hormones in precipitating migraine attack. (Glass, 2009) There is particular evidence for the role of hormones in causing migraine attacks in women. Before puberty, males and females tend to experience migraines at the same rate, there is a sharp increase in the number of girls over boys who experience migraine at the mean age that girls begin menstruating. (Dzoljic et al, 2002) Pregnancy also seems to have an effect on the occurrence of migraines. During pregnancy, there is an increased level of estrogen in the body. Many women either experience an absense of headache when they otherwise suffered from migraine on a regular basis, or they experienced an increase in frequency of headache when they typically did not have migraines. (Robbins, 2002) Another instance of the role of hormone involvement in migraine attack in women is the increase in incidence of migraine as women near menopause, a time of decreased estrogen production. (Robbins, 2002) While there are many different hormones that may have an effect on incidence of migraine, the main focus of this research will primarily be on the mechanisms by which estrogen may induce migraine, with respect to different times in a womans life estrogen levels fluctuate, such as during menstruation, pregnancy, and menopause. Estrogen is a type of steroid hormone and is considered the primary female sex hormone responsible for regulating the normal sexual and reproductive development in women. (Robbins, 2002) Organ systems such as the musculoskeletal system, the cardiovascular system, and the brain are affected by estrogen. (Robbins, 2002) There are two approaches to the current understanding of the role of estrogen in migraines. One type is estrogen withdrawal headache. This happens after a severe drop in estrogen levels in the body, such as during menstruation, during menopause, or post-partum. The second type is exogenous hormone induced headache. This occurs during or after the u se of oral contraceptives or hormone replacement therapy. (Kibler et al, 2005) A comparison of studies that examines the correlation between levels of estrogen during certain periods of a womans life and the incidence of migraine will allow better understanding of the function of this hormone as a cause of migraine. Very little is known about the way in which estrogen actually precipitates migraine, but with an enhanced understanding of the current research that has been done, future research will be promoted on a topic that affects such a considerable proportion of migraineurs. Food (Brandon Pellerin) Various foods have been suspected of triggering migraines for decades (Grant, 1979; Peatfield, 1984). In susceptible people, certain foods and particular compounds contained in these foods are believed to induce trigeminovascular (warning system to protect the brain from tissue injury and toxins) neurons to release neurotransmitters such as calcitonin, gene-related peptide and substance P. The release of these neurotransmitters leads to vasodilation (widening of blood vessels), mast cell degranulation (release of molecules from secretory vesicles called granules), increased vascular permeability (capacity of a blood vessel wall to allow the flow of small molecules), and meningeal edema (accumulation of fluid within the meninges) resulting in neurogenic inflammation (release of inflammatory mediators from neurons) (Sun-Edelstein, 2009). Many common foods such as wheat, eggs, beef, and corn are documented migraine triggers (Grant, 1979). However, the most prevalent food precipitants of migraine are alcohol, chocolate, coffee, fatty foods and artificial sweeteners (Peatfield, 1984). Various compounds present in common foods are suspected to play important roles in the triggering of migraines. Certain amines such as tyramine and phenylethylamine are thought to be precipitators of migraines and are present in alcohol and chocolate (Sun-Edelstein, 2009, Marcus, 1997). Caffeine, also present in chocolate, is believed to be the culprit of coffees capacity of being a trigger (Sun-Edelstein, 2009). Artificial sweeteners themselves such as aspartame and more recently sucralose, have been subjects of research as to their ability to precipitate migraines (Sun-Edelstein, 2009; Bigal, 2006). However, not all migraineurs exhibit sensitivity to food and those that do are not equally affected by each trigger. The food that affects one person may not be the same food that triggers migraine in another, while at the same time a third person may be affected by both. The inconsistency of results keeps food as a continued subject of debate and study in migraine precipitation. The purpose of this research was to determine the role, if any, that sleep disorders, hormones, and food play in the triggering of migraine headaches. The goal of this study was to determine if there is any validity to the conjectures that these are triggers for migraine and if so, which trigger plays the largest role in determining whether or not migraine will occur. To answer these questions, data was gathered from primary sources by searching PubMed and Biological Abstracts. From these studies, each researcher conducted his or her own analysis of the data found within a particular subtopic to determine what correlation that specific cause might have with migraine headache. The information collected in this portion of the research was then combined to determine the relative relationship between the triggers and migraine, using correlation data and p-values to determine which was the overriding cause of migraine headaches. METHODS Sleep Disorders (Amelia Van Handel) In order to find articles relating sleep disorders to migraine, the database Biological Abstracts was used. This database was chosen because Biological Abstracts includes articles from all science-based subject areas and includes many reviews and other literature forms, which proved helpful for background or supplemental information. This database was also chosen because it was a good resource for primary research sources relating to the specific subject matter. Having chosen this database, the search was initiated using keywords relating to the topic. Initially, the subtopic for this section of the research was sensory stimuli, so the search began with the keywords migraine headache* and light. The word headache was truncated so as to provide a larger base of results. This returned 31 articles, but after looking through them, it was determined that most of them were reviews. The lack of primary research led to a search other types of stimuli, common food triggers, and even specific symptoms of migraine associated with the senses. When none of these provided the intended results, it was determined that this subtopic should be changed. Leaving the idea of sensory stimuli behind completely, a search was performed using the words migraine and sleep, which yielded 38 articles. The number of articles and the quality of the source material fit the needs of the research, and thus the search was completed. With a manageable number of articles, those which were most pertinent to the subtopic of sleep disorders were chosen for further analysis. The initial 38 were narrowed by removing those articles which were not primary research. Although the reviews and other literature forms would be helpful for background information, they would not be useful in making comparisons and finding correlation. The article selection was further narrowed by looking for those articles which contained the metrics the research would focus on. With these parameters in place, only 12 articles remained, a number which was determined to be appropriate for drawing conclusions about the correlation between certain triggers and migraine. The metrics of focus chosen for this research pertained to the quality of patients sleep and the correlation this had to the number of migraines they experienced. Epworth Sleepiness Scale scores and Pittsburgh Sleep Quality Index made it possible to measure the quality of patients sleep. The association between migraine and sleep disorders was reported in the chosen articles, which aided in the determination of the relationship between sleep quality and the number of migraines experienced. Hormones (Kelly Pritzl) All of the primary research articles relating to hormones as a cause of migraines were found online through the search engines Biological Abstracts and PubMed. The same process for finding citations was used with both engines. The search strategy consisted of first examining the results when migraines was entered into the search box. This yielded far too many results; the goal was to restrict the number of articles relevant to hormones as precursors of migraines to 40 or less. In order to refine the search, the entities migraines AND hormones were entered into the search box. To further refine the search, migraines AND estrogen was entered in and results were limited to only clinical trials and articles in English only. After gathering 40 relevant research articles, five articles within these were found containing specific criteria in order to properly conduct the meta-analysis within the topic of hormones and across the three topics of sleep-induced migraines, nutrition and migraines, and hormones and migraines. The criteria for selecting the five best articles included: relevant and useful primary data, p-values, similar subjects and number of subjects, similar methods of data collection, and recentness of publication. Food (Brandon Pellerin) To find relevant articles on the subject of food triggered migraines, the electronic databases Biological Abstracts and PubMed were used. Biological Abstracts was used using a title search for the word migraine* with a secondary title search of food* or diet*. This search turned up 30 records. The asterisk is used to search for any result which contains the root word. More specific searches were done by a title search of migraine* with topic searches of chocolate*, alcohol*, caffeine*, aspartame*, or sucralose*. Similar methods were used using the PubMed database with the exception of the use of the asterisk and the differentiating of topic searches and title searches. General searches were done using migraine and diet and migraine and food. More specific searches were done using the same keywords used in biological abstracts, joined by the and limiter. The articles searched for were published in relevant scientific journals and pertained to the topic of food and its potential to precipitate migraines. Articles that were chosen contained two types of data. One set of data included the results of general surveys that were done to ascertain details of migraineurs attacks, such as various triggers. The second type of data obtained were results from studies of specific foods documented as triggers for migraine. When an article seemed to contain useful information and was able to be accessed online, it was saved as a PDF file for future reference. The data collected from the general surveys consisted of questionnaires asking for details of subjects migraines. A vast amount of information was collected in these surveys such as the type of migraine (with or without aura), associated symptoms of migraine (photophobia, nausea, etc.), frequency, duration, and so on. The information important to this study was that concerning precipitants of migraines. Each survey documented the reported triggers of each subject if a trigger existed. This information is used to ascertain the prevalence of foods as triggers within the population that suffer from migraines. The second data set used results from studies that sought to test whether suspected foods did indeed trigger migraines. The studies relied on correlating migraine occurrences with the consumption of particular foods. The studies analyzed diet and migraine diaries kept by the subjects. The diet records often required subjects to record all food consumption and the time at which it was consumed. Likewise, the migraine diaries required subjects to document the occurrence of migraines and details regarding them such as severity, duration, type, associated symptoms, etc. The studies analyzed the results by comparing the onset of migraine with the consumption of a particular food. If there was a significant increase in the amount of migraines after consumption of a particular food, it was reasonable to conclude it played a role in the triggering of the migraine. RESULTS Sleep Disorders (Amelia Van Handel) As preliminary research, the results of five studies were analyzed. These studies were interested in finding the correlation, if one existed, between sleep disorders and migraine. Four of the five articles documented research conducted by asking patients to record the quality of their sleep and the number of migraine headaches they experienced, either in diary format or by answering questions in a comprehensive questionnaire (Woeber et al., 2007; Alstadhaug et al., 2007; Barbanti et al., 2007; Peres et al., 2005). The fifth article focused on removing the stimulus i.e. sleep problems by providing targeted behavioral sleep invention (Calhoun et al., 2007). The researchers then analyzed whether or not there was an improvement in headache frequency to determine if sleeping disorders were correlated with migraine. In order to conduct research on the relationship between sleeping disorders and migraine, only patients who suffered from both conditions could be included in the studies. To determine the level of sleep disruption, two studies measured excessive daytime sleepiness (EDS) as a function of a score on the Epworth Sleepiness Scale (Barbanti et al., 2007; Peres et al., 2005). A score of 10 or higher on the Epworth Sleepiness Scale indicated EDS. The first study (Barbanti et al., 2007) found that EDS was more common in migraineurs than in controls (14% vs. 5%), and the second study (Peres et al., 2005) found EDS occurred in 85% of chronic migraine sufferers. In the same study, dozing off was a headache trigger in 30% of all patients and 70% of patients with EDS. In both studies, patients who presented with EDS had more frequent migraines (Barbanti et al., 2007; Peres et al., 2005). In the same two studies, the quality of sleep was measured using the Pittsburgh Sleep Quality Index (Barbanti et al., 2007; Peres et al., 2005). An overall score of greater than 5 separated poor sleepers from good sleepers on this scale. In both studies, about 90 percent of patients diagnosed with EDS were also categorized as poor sleepers using the Pittsburgh Sleep Quality Index (Barbanti et al., 2007; Peres et al., 2005). This provided further evidence that poor or inadequate sleep and migraine headaches often occurred in the same patients. On the subject of correlation, all of the articles chosen for analysis found a correlation between sleep disorders and migraine, though most were hesitant to state definitively that the sleeping disorders were the direct cause of the migraine. Two studies found that patients with excessive daytime sleepiness and/or insomnia experienced more migraines after a night of restless or inadequate sleep (Alstadhaug et al., 2007; Barbanti et al., 2007). These migraines were more likely to occur during the morning hours (Alstadhaug et al., 2007). Conversely, another study which focused on EDS noticed a correlation between fatigue and migraine, but they did not believe the results to be conclusive enough to state whether migraines lead to EDS or if EDS is the primary condition leading to migraine (Peres et al., 2005). One study was tracking several different sleep disorders, but found their results to be inconclusive in determining which sleep disorder was most correlated with migraine (Woeber et al., 2007). The researchers did, however, come to the conclusion that tiredness increased the risk of headache and migraine (headache ratio increased from 0.689 to 1.184 in cases where patients were tired) (Woeber et al., 2007). The final study, which attempted to remove the sleep disruptions by using behavioral sleep intervention, found a significant decrease in headache frequency and intensity after successful sleep modification (Calhoun et al., 2007). They were also able to revert chronic migraineurs to episodic migraineurs after improving the quality of sleep in their patients. By the final visit, 48.5% of those who had received behavioral sleep modification instructions had reverted to episodic migraine (Calhoun et al., 2007). Hormones (Kelly Pritzl) The purpose of the individual meta-analysis was to determine when hormones were most involved in the precipitation of migraine. Two of the studies used only females as subjects. (Dezoljic, 2002 and Kibler, 2005) The subjects in two other studies consisted of males and females with medically diagnosed cases of migraine. (Kelman, 2007 and Rasmussen, 1993) The subjects in the remaining study were self-reported male and female migraineurs (Russel, 1996) All of the studies were researching adults. The mean age of subjects for all the studies was the mid-thirties. (Dezoljic, 2002; Kelman, 2007; Kibler, 2005; Rasmussen, 1993; Russell, 1996) The methods used in all of the articles were very similar. Four of the studies conducted a clinical examination to confirm a diagnosis of migraine and were followed by a questionnaire or an interview to collect data on lifestyle of the subjects and possible causes of their migraines. One of the studies involved self report of migraine status and if the subject indicated positively, they were issued a questionnaire. (Russell, 1996) In all of the studies, incidence of migraine caused by fluctuations in hormones was overwhelmingly more prevalent in females than by males. This indicates that female sex hormones, such as estrogen, play a significant role in the onset of migraine. Food (Brandon Pellerin) Four articles were used that studied triggers of migraine in various populations (Kelman, 2007; Spierings, 2001; Takeshima, 2004; Chabriat, 1999). The studies used surveys to gather information about a population. The individuals chosen for the surveys were either random people or known migraine sufferers. In the case of the random surveying, individuals that reported having migraines were instructed to complete a detailed migraine questionnaire. Three of these studies (Kelman, 2007; Spierings, 2001; Chabriat, 1999) show evidence of food as a precipitant for migraine. Of these three studies, at least 26% of individuals documented food as being a trigger. The fourth study (Takeshima, 2004) shows little evidence of this as it reports less then 1% of surveyors listing food as a trigger. Of these four studies, two (Kelman, 2007; Spierings, 2001) listed alcohol as a separate category and reported about 40% of individuals claiming alcohol as a trigger for migraine. Alcohol, chocolate, caffeine, and artificial sweeteners are among the most often cited food triggers for migraine (Sun-Edelstein, 2009; Peatfield, 1984). The high frequency of these claims makes these subjects of particular interest. Articles were obtained that studied these particular triggers in order to ascertain whether they did indeed trigger migraine. Two case studies were found that documented the artificial sweetener sucralose as a probable precipitant of migraine (Bigal, 2006; Rajendrakumar, 2006). In the two studies, migraine attacks were documented at least 90% of the time after the individuals consumed a beverage containing the sweetener. In one study this was ascertained through correlating a food diary with the occurrences of migraine (Bigal, 2006). The other study (Rajendrakumar, 2006) relied on administering different sodas that contained and did not contain sucralose. It was found that only the sodas containing the sweetener triggered migraines.