Causes of Chronic Migraines

Causes of Chronic Migraines Headache is pain in any part of the head that can occur suddenly or gradually and produce a varying amount of pain; in fact, it is the most common form of pain in the United States (U.S. Department of Health and Human Services, 2014). Headache is often divided into two categories, primary and secondary (U.S. Department of Health and Human Services, 2014). A primary headache is one that is due to the headache itself, it is not caused by another problem (U.S. Department of Health and Human Services, 2014). The three types of primary headache include tension headaches, cluster headaches, and migraine headaches (U.S. Department of Health and Human Services, 2014). Secondary headaches, on the other hand, are headaches that are caused by something else (U.S. Department of Health and Human Services, 2014). Examples of secondary headaches include headaches from an illness, headaches from a medication, sinus headaches, cervicogenic headaches (which are headaches related to an underlying neck condition, like degenerative disc disease), and headache due to a brain tumor or aneurysm (U.S. Department of Health and Human Services, 2014). Migraine headaches are one of the most common forms of headache (Davanzo, Bua, Paloni, Facchina, 2014). Migraines are considered a neurological condition (Schwedt, 2014; Silberstein, 2014). They often manifest as recurrent attacks of throbbing, frequently unilateral headaches with associated features, including: nausea, vomiting, photophobia, and phonophobia (Pietrobon Moskowitz, 2012; Schwedt, 2014). Migraines can be further subdivided into episodic or chronic (Schwedt, 2014). Episodic migraine sufferers have less than 15 headache days a month, whereas chronic sufferers have at least 15 headache days a month for at least three months, and at least eight headaches that have symptoms consistent with a full-blown migraine attack (Ferrari, 2013; Schwedt, 2014). Chronic migraine is a common disorder; it impacts people during their most productive years of life, has tremendous costs to the individual and society, and is associated with a variety of comorbid disorders (Schwedt, 2014). Chronic migraine typically develop through a process called migraine transformation, which is a slow increase in the frequency of headaches, usually over a period of months to years (Schwedt, 2014). Chronic migraine is diagnosed based on the patient’s symptoms by excluding other causes of headache (Schwedt, 2014). A general physical and neurological exam should be performed on each patient and attention should be paid to the patient’s neck, shoulders, temporal artery pulses, and tempromandibular joint; if any abnormalities are found on the neurological exam, a secondary headache should be suspected and the patient should undergo further evaluation (Schwedt, 2014). Many risk factors are associated with a higher likelihood of transformation from episo dic to chronic migraine and include obesity, excessive caffeine intake, low socioeconomic status, and major life changes like marriage or divorce, to name a few (Schwedt, 2014). Common conditions comorbid with chronic migraine include other neurological disorders, gastrointestinal problems, and cerebrovascular disease (Pietrobon Moskowitz, 2012; Schwedt, 2014). Compared to people with episodic migraines, patients with chronic migraine are twice as likely to have certain psychiatric disorders, including anxiety, depression, and bipolar disorder (Schwedt, 2014). The pathophysiology of chronic migraine is complicated and not fully understood (Schwedt, 2014). It was once believed that migraines were simply a swelling of the blood vessels in the brain (Pietrobon Moskowitz, 2012). More recent experiments have shown that swelling of the meninges and/or extracranial arteries is neither necessary nor sufficient to cause migraine pain (Pietrobon Moskowitz, 2012). While such swelling is certainly often found during migraines, migraines are no longer assumed to be exclusively a disorder of blood vessels; rather, there are data to suggest that chronic migraine is associated with progressive brain changes, both in brain structure and brain function (Ferrari, 2013; Pietrobon Moskowitz, 2012). Atypical modulation of pain is suspected to play a role in the transformation from episodic to chronic migraine by reducing the inhibition of pain in the regions of the descending pain modulatory pathway in the brain (Schwedt, 2014). Neuroimaging studies of patie nts with chronic migraine have shown both atypical structures of pain processing and atypical pain processing in the brain (Schwedt, 2014). Regions of the brain that participate in sensory discrimination, affect, and the cognitive appraisal of pain are also atypical in migraine sufferers (Schwedt, 2014; Silberstein, 2014). Many studies have found correlations among the extent of these abnormalities and the frequency and severity of migraine headaches, suggesting that these abnormalities could be precursor to the transformation from episodic to chronic migraine (Schwedt, 2014), but more research is necessary to determine the exact role and mechanism of these abnormalities. The trigemininovasular system is currently considered one of the major players in the role of chornic migraine (Pietrobon Moskowitz, 2012; Schwedt, 2014). The trigeminal nerve is the fifth cranial nerve in the body and is the main sensory nerve in the head (Fix Brueckner, 2009). Some researchers believe that the musculature around the trigeminal nerve branches become irritated, which leads to the swelling and pain caused by migraine headaches (Kurlander, Punjabi, Liu, Sattar, Guyuon, 2013). Presently it is speculated that a sensitization of the trigeminal system that innervates cranial tissues, specifically the meninges (which often swell during migraine attacks) leads to a lower threshold for activation (Pietrobon Moskowitz, 2012; Schwedt, 2014). A lower threshold for activation means the system becomes activated more easily, which leads to more migraine attacks, and more migraine attacks therefore increase the likelihood of a chronic migraine diagnosis (Pietrobon Moskowitz, 20 12; Schwedt, 2014). Another line of research that is currently being investigated is cortical hyperexcitability (Schwedt, 2014). The human nervous system is composed of billions of synapses and neurons functioning as part of a large, highly specializes system (Fix Brueckner, 2009). All aspects of behavior are informed by the nervous system, and it can rudimentarily be broken down into excitatory and inhibitory components that facilitate the communication among different neurotransmitters in the brain to determine the level of inhibition of excitation of each response (Fix Brueckner, 2009). Excitation in the brain is mainly associated with the neurotransmitter glutamate (Fix Brueckner, 2009). Recent transcranial magnetic stimulation studies on patients with chronic migraine have shown cortical hyperexcitability, particularly in the occipital cortex of the brain. The occipital cortex is associated with vision, and this makes sense to researchers as visual auras are often associated with migraine attack s (Fix Brueckner, 2009; Schwedt, 2014). A neurotransmitter of interest, particularly with the beginning phase of a migraine attack, is dopamine (Charles, 2012). Some research has shown that dopamine receptor agonists administered to patients produce some of the same symptoms that are experienced by migraine sufferers at the beginning of an attack (Charles, 2012). Conversely, dopamine receptor antagonists administered to patients can reverse those symptoms and have even been suggested to have the ability to prevent the onset of additional migraine attacks (Charles, 2012). While the exact role of dopamine in chronic migraine is unknown, it is certainly an interesting line of future study. Treatments for chronic migraine range from trigger identification and avoidance to risk-factor modification, and include both pharmacological and nonpharmacological components (Schwedt, 2014). A discussion of each type of treatment and the variety of treatments within is beyond the scope of this review, however, some of the most common pharmacological treatments will be highlighted. Pharmacological treatment for migraines can be divided into two categories: abortive drugs, which stop a headache after onset, and prophylactic drugs, which are taken on a regular basis to prevent the onset of a migraine (Davanzo et al., 2014). Those who suffer from chronic migraine are often on a prophylactic regimen, due to the intensity and severity of the headaches (Davanzo et al., 2014). While many drugs are used for chronic migraine prophylaxis, it is important to note that many are prescribed off label; in fact, the only drug approved by the Food and Drug Administration for the treatment of chronic migraine is onabotulinumtoxinA (Schwedt, 2014). OnabotulinumtoxinA, more commonly known as Botox, has been popularized as a series of small injections in the face that reduce the appearance of crow’s feet and frown lines (Oliver, MacDonald, Rajwani, 2006). However, the injections are also used to treat chronic migraine (Schwedt, 2014). Botox is part of a class of medications called neurotoxins (Fix Brueckner, 2009). It has no direct effect on the central nervous system because it cannot penetrate the blood brain barrier, however, it can have some important indirect effects on the central nervous system (Fix Brueckner, 2009; Oliver, MacDonald, Rajwani, 2006). When used to treat chronic migraine, Botox is injected into different muscles in the face to block the nerve signals to those muscles (Fix Brueckner, 2009; Oliver, MacDonald, Rajwani, 2006). Specifically, Botox has been shown to inhibit sensitizations of central trigeminal nerves, which was previously discussed regarding the pathophysiology of chronic migraine (Ol iver, MacDonald, Rajwani, 2006). Triptans are another common class of drugs used for chronic migraine prophylaxis (Davanzo et al., 2014). Triptans are serotonin receptor agonists, meaning they bind to serotonin and increase the response of serotonin at the site of action (Davanzo et al., 2014; Fix Brueckner, 2009). Triptans have a vasoconstriction action on blood vessels, meaning they shrink the size of blood vessels, which is helpful in reducing the pain of migraines some of which can be attributed to swollen blood vessels in the brain (Davanzo et al., 2014). However, the desired effect of vasoconstriction is not limited to just the brain and also constricts other blood vessels, including those in the heart (Davanzo et al., 2014). As a result, patients with any coronary disease should use care when taking triptans (Davanzo et al., 2014). The most commonly prescribed triptan medication is Sumatriptan and is available in multiple forms including pills, injections, and intranasal spray (Davanzo et al., 2014). The inj ections and intranasal spray reach the brain more quickly and are therefore faster acting than the pill which must first get absorbed into the blood stream to take effect (Davanzo et al., 2014). Beta blockers, originally used for the treatment of hypertension and angina, are also often used for migraine prophylaxis (Davanzo et al., 2014). The beta part of beta blockers refers to receptors on blood vessels that are called beta receptors (Fix Brueckner, 2009). Therefore, beta blockers prevent the interaction of certain chemicals with this receptor (Fix Brueckner, 2009). The most commonly prescribed beta blocker for chronic migraine is Propranolol (Davanzo et al., 2014). Propranolol is likely successful in preventing migraine headaches by blocking beta adrenergic receptors, which inhibits swelling of arteries. Additionally, Propranolol may also exhibit its effect by preventing the platelets (the sticky elements of the blood) from sticking together and releasing substances that caused the blood vessels to constrict and dilate. A concern with pharmacological treatment of chronic migraine is the development of medication overuse headaches. These occur when a migraine sufferer uses migraine drugs too frequently, and develops a secondary headache as a result of the medication use (Schwedt, 2014). The treatment includes a drug withdrawal phase, during which time the patient would have to stop taking medication for his migraine or take a medication with different mechanism of action to allow the overused drug to leave his system (Schwedt, 2014). This response is paradoxical because sufferers of chronic migraine often rely on pharmacological treatments to alleviate their pain, but if they take too much they will actually end up exacerbating their pain. About half of chronic migraine sufferers are treated for medication overuse headaches at some point (Schwedt, 2014). A brief overview of the criteria for diagnosis, hypothesized pathophysiology, and pharmacology for the treatment of chronic migraine has been discussed. While there is still much to learn about the pathophysiology of chronic migraine, recent research has increased the understanding and opened up new areas of research to bring scientists closer to a more comprehensive understanding. While many data indicate that chronic migraine is a debilitating condition with great intensity and duration of headaches, and often lead to lost productivity and high costs on society (Schwedt, 2014), there are prophylactic and abortive drugs that can greatly ameliorate the problems caused by migraines. With attention to and modification of risk factors, often in addition to appropriate adherence to these medications, migraine sufferers can live normal, productive lives.

World History-High Middle Ages

WORLD HISTORY – UNIT 3: THE MEDIEVAL WORLD HIGH MIDDLE AGES: MONARCHIES AND THE CHURCH In the midst of this setting, medieval countries began to emerge. England and France began to develop strong monarchal systems of government. Spain and Portugal emerged as monarchies near the end of the Middle Ages. Germany and Italy never developed strong monarchies. Here are your goals for this lesson:  ·Identify key political leaders, especially of France and England, during the High Middle Ages.  ·Identify key personalities of the Christian church during the High Middle Ages. interdict[->0]|In a religious sense, to cut off church functions or privileges. | [->1][->2] [->3][->4] France. As the Carolingian Empire declined and the rulers weakened, a split occurred in the region of France between two factions. One faction supported Charles the Simple; the other supported the Count of Paris. This second faction eventually won out and a new family of Capetian kings ruled the kingdom of Fra nce. The Capetian kings ruled France for over three hundred years from 987[->5] to 1328[->6]. Hugh Capet, the Count of Paris, was elected king by the French nobles in 987[->7].Capet formed alliances with other nobles and began extending his territory through warfare. His strength was in his feudal alliances and in the support given him by the church. He insured Capet succession by crowning his eldest son associate king. The early Capetian kings ruled as lord among other lords rather than a sovereign. The anointing of each king by the church set them apart from the others. The first strong Capetian king was Louis VI (Louis the Fat). Louis VI ruled from 1108[->8]-1137[->9] and established the strong leadership needed to lay the foundation of royal power in France.He gained complete control over the lle de France, the area around Paris, and established it as the center of royal law. Philip II (Philip Augustus) grandson of Louis VI, ruled from 1180[->10]-1223[->11] and began expanding t he kingdom. He captured Normandy, Anjou, and some of the other English territories in France. Philip Augustus also founded the University of Paris, and in 1200[->12] began construction of the Louvre, the palace of the French Kings. The Capetian kings proved themselves stronger than the feudal lords. They encouraged the development of towns so that king and townspeople could be allies against the feudal nobility.Another Capetian king, Louis IX (St. Louis), ruled from 1226[->13] to 1270[->14] and was considered the ideal king of his age. He is famous for enacting judicial reforms that allowed both rich and poor to receive equal justice. He also led the Seventh and Eighth Crusades. He was considered a saint during his lifetime and was canonized by the Roman Church in 1297[->15], less than thirty years after his death. In 1328[->16], the Capetian dynasty ended because the king left no male heir. The house of Valois claimed the throne because Philip VI , of the house of Valois, was the n ephew of Philip the Fair.Ap World History Units 1-3 Study GuideHowever, Edward III of England, also claimed the throne because he was the grandson of Philip the Fair. Edward III paying homage to Philip VI This double claim to the throne led to The Hundred Years' War, which lasted from 1338[-;17]-1453[-;18]. Many long and bitter battles were fought between England and France, all on French soil. The English dominated the war until 1429[-;19], gaining large territories in France. In 1429[-;20], however, a young girl, Joan of Arc, led an army to break the English siege at Orleans and insured the coronation of Charles VII. Joan was captured by pro-English Frenchmen, led by the Duke of Burgundy.She was then turned over to the English, who returned her to the French for a trial. She was burned at the stake in 1431[-;21]. During a second trial in 1456[-;22], she was re-tried and declared innocent. The events of 1429[-;23] were the turning point of the Hundred Years' War for France. From th is point France regained territory and won the war in 1453[->24]. France had gained a true national spirit by this time. The monarchy was firmly established. Louis XI, who ruled from 1461[->25] to 1483[->26], finally achieved a united France in 1477[->27] when he defeated Charles the Bald of Burgundy.England. King Alfred's successors ruled England until 1016[-;28]. In 1013[-;29] and 1014[-;30] England was overrun by the Danes once more when the king, Ethelred the Unready, fled to Normandy. The English Witan accepted the Dane Canute (Cnut) as king of England in 1016[-;31]. Canute ruled a united Danish kingdom that included Norway, Denmark, and England. During his reign, 1016[-;32]-1035[-;33], England was peaceful. When Canute died, however, his two sons were incompetent and tyrannical. When the last son died in 1042[-;34], the English Witan chose Edward, the son of Ethelred the Unready, as King.Edward, the Confessor, ruled from 1042[-;35] to 1066[-;36]. The power, however, rested lar gely with the strongest earl, Godwin, Earl of Wessex, and later with his son, Harold Godwinson. When Edward died leaving no heir, Harold became king. Shrine of Edward, the Confessor Harold was not the only claimant to the English throne. Both William, Duke of Normandy, and King Hardrada of Norway planned to invade England. William was a distant relative of Edward, and was officially approved by the pope. William raised an army, invaded England, and defeated Harold at the battle of Hastings in 1066[-;37].William ruled from 1066[-;38] to 1087[-;39]. He brought the feudal system to England from Normandy, but he modified it so that all vassals were subject directly to him. He granted smaller parcels of land to prevent consolidation of power. William used much of the Anglo-Saxon legal and military systems. Two main factions, the Normans and the Saxons, split England for several years. After William and his successors, England was ruled by a new line of kings, the Plantagenets. Henry II w as first in the line of Plantagenet kings. The Plantagenets ruled England from 1154[-;40] to 1399[-;41].Henry II has been called one of England's greatest kings because of his extensive judicial reforms. Henry hoped that he could unify England by making the royal law the law of the land. This royal law was the foundation of English common law. English common law became the basis for most of the United States law, and legal procedures. Henry also initiated a circuit court system and developed the jury system that led gradually to the jury trial system. Henry II had difficulty with the church because he attempted to put clergy under common law and because his legal reforms interfered with the church court system.The culmination of Henry's problem with the church was his argument with his friend and advisor Thomas a' Becket over these church-state concerns. The murder of Becket by some of Henry's knights brought public anger and hurt Henry's attempt to unify England. Henry's son, Richa rd the Lionhearted, spent so many years fighting in the Crusades that he had little affect on England as king. His cruel brother, John, plotted often to overthrow Richard between 1189[-;42] and 1199[-;43], but did not succeed. John finally took the throne when Richard died. His reign from 1199[-;44] to 1216[-;45] is often called the worst in English history.His cruelty led to defeat on all fronts. His wars with Philip Augustus lost most of the English holdings in France by 1214[-;46]. His disputes with the pope, led the pope to place England under interdict in 1208[-;47] and to excommunicate John in 1209[-;48]. His ruthless ways at home caused the English nobles to revolt in 1215[-;49]. At Runnymede in the year 1215[-;50], John was forced by his nobles to sign the Magna Carta (the Great Charter). The Magna Carta was a document which protected feudal rights and limited the power of the king by stating that even the king was under the rule of law.Before this time, the king was not bou nd by any law; he was the law. John did not honor the Magna Carta for long. The principles in the Magna Carta, however, influenced later developments such as fair trials, representative government, and taxation only by consent of the people. John's refusal to abide by the Magna Carta led to further unrest. When John died in 1216[->51], he left a country torn by civil wars. The Plantagenet kings following John were largely responsible for the formation of English Parliament. Edward I, who reigned from 1272[->52] to 1307[->53], was the first to use Parliament effectively.He called together an assembly of people's representatives made up of knights, nobles, clergy, and burgesses. Initially this group was called together to make monetary decisions, especially concerning taxes. In the beginning the representatives met as separate groups, knights meeting with nobles, clergy and burgesses meeting by themselves. In later years the clergy no longer joined the group. The knights and burgesses met together forming the basis for the House of Commons, and the nobles met together in what became known as the House of Lords. Edward I tried to conquer both Wales and Scotland.He succeeded in conquering Wales in 1284[-;54], but he could not conquer Scotland. The high cost of these wars forced him to collect money through taxes. This need for tax revenue led to the calling of Parliament. Edward II (1307[-;55]-1327[-;56]), Edward III (1327[-;57]-1337[-;58]), and Richard II (1377[-;59]-1399[-;60]), were the last Plantagenet rulers. Edward II and Edward III further developed Parliament making it an integral part of English government by the end of the fourteenth century. The Hundred Years' War had taken its toll and continued beyond the Plantagenet reign.Richard II was only ten years of age when he took the throne. His uncle, John of Gaunt, Duke of Lancaster, held the real power until Richard was of age. The costs of war, the unrest among the peasants that led to the Peasants Revolt of 1381[->61], and the seizure of John of Gaunt's lands after his death made Richard unpopular. In 1399[-;62], Richard II was forced to abdicate when John of Gaunt's son Henry of Bolingbroke led a revolt of nobles against the king. Henry of Bolingbroke became Henry IV, the first king of the House of Lancaster. His son, Henry V, was a strong king who reigned between 1413[->63] and 1422[->64].Henry V fought bravely in the Hundred Years' War and won the famous Battle of Agincourt in 1415[-;65]. After Henry V's death, England again was torn by civil wars. When Henry died, his son was only nine months old, and was named Henry Vl. Before Henry VI came of age in 1437[->66], England had suffered severe losses in the Hundred Years' War, and the country was dominated by rival factions, primarily by the Houses of Lancaster and York. Henry VI's weak and disastrous reign led England into a second war that began just two years after England's loss of the Hundred Years' War.This new war lasted th irty years (1455[->67]-1485[->68]), and was called the Wars of the Roses because the red rose was the symbol of the House of Lancaster, and the white rose was the symbol of the House of York. The Wars of the Roses finally ended in 1485[->69] when Henry Tudor of the House of Lancaster defeated King Richard III in the battle of Bosworth Field. Henry Tudor became Henry VII and began the reign of the Tudor kings, a reign that lasted until 1603[->70]. Holy Roman Empire. In the kingdoms of Germany and Italy, strong monarchies did not develop as they did in England and France.Germany had the opportunity to establish a strong government but the choice to seek power and conquest prevented them from doing it. After the last Carolingian king of east Frankland died, the kingdom of Germany was split into four duchies. In 919[->71], a Saxon noble, Henry the Fowler became King Henry I. Henry I established a strong government and began to increase the territory of the kingdom of Germany. His son Ot to, called Otto the Great, became one of the strongest kings in Europe. During his reign from 936[->72] to 973[->73], Otto created a united Germany by dominating the nobles.He stopped the Magyar and Slav invasions, and united German church leaders under his power. Once he had united Germany, Otto turned to Italy. On an expedition to Italy (961[->74]-964[->75]), Otto saved the pope, deposed the Italian king, and added north and central Italy to the German kingdom. In 962[->76], the pope crowned him Roman Emperor of the West, and Otto became the first emperor of what was called the Holy Roman Empire. This title gave Otto power not only over Italy and Germany, but also over the papacy.Otto and the German emperors who followed him became ambitious and desired to live as the Roman emperors had lived before them. While they wasted their efforts trying to hold the Italian states and to live as emperors, the German nobles regained power and established their own feudal states. Some of the s trongest German kings could have reunited Germany, but the lure of Italian power kept them divided. One of the most famous kings, Frederick Barbarossa (Redbeard), first of the Hohenstaufen dynasty, extended the empire to Burgundy, Bohemia, Hungary, and Poland.His reign from 1152[->77] to 1190[->78] was successful, but he spent twenty-five years trying to reconquer Italian lands. Frederick died in Asia Minor on the Third Crusade. Spain and Portugal. After 711[->79] when the Muslims invaded Spain, civil wars split the Muslim factions. The Umayyad Kingdom of Cordoba became the center of culture and power in Spain from the eighth to the eleventh century. Tenth century Cordoba was the great intellectual center of Europe. Small groups of Christians had scattered during the Muslim invasions.After 711[->80] Christians fought both Muslims and other Christians and established small kingdoms. By the tenth and eleventh centuries independent Christian kingdoms were well established. Muslim power had begun to disintegrate. The Christian reconquest, or Reconquista, as it was called, began in the eleventh century and continued for nearly four hundred years. Rodrigo Diaz of Vivar, known as El Cid, was the great hero of the early Reconquista movement. He conquered the Muslims in Valencia in 1094[->81] and became its ruler until his death in 1099[->82].In 1139[->83] Alphonso I of Portugal defeated the Muslims. Portugal was declared a free kingdom in 1143[->84]. In 1212[->85] the Spanish Christians defeated the Muslims in the battle of Las Navas de Tolosa. All that remained under Muslim control was Granada. The Reconquista finally ended in 1492[->86] when Ferdinand and Isabella captured Granada. THE CHURCH The Roman Catholic Church of the High Middle Ages was one of the only unifying factors in Europe. Europe was often called Christendom because the church was so much a part of life.The church controlled many legal and political functions and during this period promised protectio n as well as salvation. People depended on the church first of all for salvation. Roman Catholics believed in certain basic doctrines, the most important of which were the seven sacraments: baptism confirmation penance the Holy Eucharist (Lord's Supper) matrimony (marriage) holy orders extreme unction The sacraments covered every aspect of Roman Catholic life from birth with baptism to preparation for death with extreme unction. The sacraments were considered essential to salvation and could only be administered by clergy.The church structure was similar to earlier church structures. In the High Middle Ages, however, bishops were often upper class, equal to the nobles in wealth and power. Parish priests, especially in the villages, were often poorly educated, but were concerned with the salvation of their people. The church began to develop a more highly structured ritual, or liturgy. The liturgy was not the same all over Europe, but the essential Eucharistic ritual was central to i t. Church fathers and later poets composed elaborate hymns for church services. Observance of religious festivals and special seasons increased.The church regulated certain aspects of warfare. Knights who killed innocent people or who pillaged churches or monasteries were banned from the sacraments in accordance with a document known as the Peace of God (990[-;87]). Another document, the Truce of God, prohibited fighting during certain religious seasons and on specified days of the week. The church courts tried those who ignored these rules as well as members of the clergy who were guilty of offenses. Heretics were also tried by church courts. A fear of heresy led to the creation of a court to search out and to try heretics.This court became known as the Inquisition. The church could impose severe penalties, such as interdiction and excommunication. The Church could also depose unfit rulers. Religious orders. The medieval church was not without controversies. The increased wealth of some church leaders and of some monasteries led to reforms from the tenth to the thirteenth centuries. The primary reforms were monastic. Many monasteries had become part of the feudal system, accepting lands in return for protection. The land brought further involvement with the world, along with wealth.Many monks, vowed to poverty, found this acquisition of land unacceptable and set out to find new, reformed orders with stricter rules. The monastery of Cluny, founded in 910[-;88], was such a reformed monastery. The monks of Cluny refused land grants that tied them to lay leaders. The movement spread, and Cluny eventually had 300 monasteries under the abbot at Cluny. These monks were responsible directly to the pope. Two other reform groups were the Carthusians, who lived as hermits, and the Cistercians, who were a stricter branch of the Benedictines and who were led in the early twelfth century by St.Bernard of Clairvaux (1091[-;89]-1153[-;90]). In the twelfth and thirteenth cent uries new orders, known as mendicant orders, began to appear. The members of these monastic orders took vows of poverty and were forbidden to own property. They were supported by alms (begging). Two of these orders were begun by Francis of Assisi (1182[-;91]-1216[-;92]) and Dominic (1170[-;93]-1221[-;94]). These two men organized groups of friars, or brothers, who did not live in monasteries, but went out as missionaries, earning or begging for their food and shelter as they went.These orders, the Franciscans and the Dominicans, were founded to fight the spread of heresies. In addition to a vow of poverty, the friars' rule forbade them to marry. Papacy. As papal powers and secular powers became more closely linked, problems arose between church and state in all matters. Both church and state claimed sovereign powers in cases that did not concern them, especially in legal matters. The outcome was usually determined by the stronger leader, either pope or king. From 962[->95] to 1149[- >96], Otto the Great and the other emperors of the Holy Roman Empire, had declared themselves above the pope.They deposed and named popes at will. The Clunaic Reforms under Pope Leo IX (1049[->97]-1054[->98]) gave the papacy independence. Gregory III, who was pope from 1037[->99] to 1085[->100], tried to establish church authority over state authority by standing against the German emperors. Although he was driven from Rome, he established a precedent of opposition to the Germans which spurred future popes to similar action. Pope Innocent III had greater success over secular rulers during his papacy from 1198[->101]-1216[->102].He was victorious over both Philip Augustus of France in 1198[->103], and King John of England in 1213[->104]. In the latter case, he forced John to pay tribute to the papacy and to acknowledge that England was a fief of the papacy. In the thirteenth century, Pope Gregory IX was unable to defeat Frederick II of Germany, but he created considerable opposition that led eventually to the downfall of the Hohenstaufens. In 1302[->105] Pope Boniface VIII (1294[->106]-1303[->107]) declared that all states were subject to the pope.This action resulted in controversy, especially with Philip the Fair in France, and led to the Avignon Captivity, a group of French popes who reigned in the city of Avignon from 1305[->108] to 1376[->109]. From 1378[->110] to 1417[->111], the Great Schism, an era when the church was ruled by two rival popes, dealt a severe blow to papal supremacy and severely split the church. The schism ended in 1417[->112] when the Council of Constance deposed both popes and elected a new pope, Martin V. Philosophy. One of the major intellectual developments to rise out of the church at this time was a serious study of philosophy.Medieval philosophy began to examine the relationship between faith and reason. The introduction of many of Aristotle's works into medieval Europe combined with knowledge of church teachings led to the deve lopment of a religious philosophy known as Scholasticism. Scholasticism attempted to apply Aristotle's logic to church teachings. The greatest scholastic philosopher was St. Thomas Aquinas, a Dominican who lived from about 1224[->113] to 1274[->114]. His twenty-one volume Summa Theologica carefully studies the relationship between faith and reason. Thomas spoke of reason and faith as gifts of God.He concluded that reason could understand certain truths and that faith perceived the truths of Christians, which could not be understood by reason. Scholasticism was not immediately accepted, but eventually Thomas' works were adopted officially by the church. The Crusades. In the period from 1096[-;115] to 1291[-;116], eight Catholic Crusades were launched to drive the Muslim â€Å"infidels† from the Holy Land. The Crusades were military failures. They did, however, stimulate the growth of trade in Europe, which, in turn, led to the growth of cities, trade centers, and monetary syst ems.They also led to advances in armor and weaponry. The Crusades were very costly and many nobles were forced to sell their lands to finance military campaigns. This led eventually to a decline in the feudal system because the sale of the lands lessened the power of the lords, and it released the serfs who then moved into the towns. Major Crusades:| The First Crusade (1096[-;117]-1099[-;118]) called by Pope Urban II at request of the Byzantine emperor;| The Second Crusade (1147[-;119]-1149[-;120]) called by St.Bernard of Clairvaux at the request of Pope Eugenius II;| The Third Crusade (1189[-;121]-1192[-;122]) called by European leaders after the fall of Jerusalem;| The Fourth Crusade (1202[-;123]-1204[-;124]) called by Pope Innocent III;| The Fifth Crusade (1218[-;125]-1221[-;126]) called by Pope Innocent III;| The Sixth Crusade (1228[-;127]-1229[-;128]) led by Frederick II of the Holy Roman Empire;| The Seventh Crusade (1248[-;129]-1254[-;130]) called by Louis IX of France;| The Eighth Crusade (1270[-;131]-1272[-;132]) called by Louis IX of France. |The Crusades diminished the power of the church somewhat because they failed to defeat the â€Å"infidels. † The Crusades were responsible, however, for the growth of chivalric and monastic orders of knights, such as the Knights Templars, the Teutonic Knights, and the Knights Hospitalers. Three other Crusades are often mentioned. The first is the People's Crusade of 1096[->133] composed of about fifty thousand peasants and their families who set out for Asia Minor. They pillaged their way through Europe and killed many Jews. Led by a man called Peter the Hermit, about twelve thousand reached their goal, only to be slaughtered by Turks.The second was the Children's Crusade of 1212[-;134]. This Crusade led to disaster and was a tragic memory for families across the continent. Most of the idealistic children either died or were captured and sold as slaves. The third crusade was officially called by Pope Greg ory in 1274[-;135] and would have been the Ninth Crusade, but it never began. Pope Gregory died in 1276[-;136] and preparation for the Crusade ceased. 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Unusual Article Uncovers the Deceptive Practices of Essay Writing Topics for School Children

Unusual Article Uncovers the Deceptive Practices of Essay Writing Topics for School Children Afterwards, you have to explain the factors for which you support that side. If you can select the problem by yourself, it's possible to think of the issue of interest! Very often it becomes hard to choose a single topic either due to the many ideas in the student's head, or due to their complete absence. The major aim is to describe various organizational patterns. The Unexposed Secret of Essay Writing Topics for School Children In reality, lots of argumentative essays are in reality persuasive papers. Categories, essay topics could be divided into. Argumentative essay topics are so important since they are debatableand it's essential to at all times be critically considering the world around us. Argumentative writings is a particular kind of a paper. You don't need to acquire super technical with legal argumentative essays, but make sure you do your homework on what the present laws about your favorite topic actually say. On our site you'll find a whole lot more useful exceptional information that is certain to be handy for junior and higher school kids from, like common home task essay about Hamlet, along with, for instance, application essays for college for future students. In high school, you're supposed to decide on the type of topic you are going to be in a position to dig into that is, you've got to make sure to can come across enough info on the discipline. Even a student can begin a business online. Essay Writing Topics for School Children at a Glance MLA would be the simplest style to get started with, and it's great for every one of the ideas listed above. Such topics are simply deductions in a free but decent style. Skateboard helmets ought to be mandatory. Many students think that it is a waste of time. Who Else Wants to Learn About Essay Writing Topics for School Children? Every family needs to have a all-natural disaster survival program. Though some say completely free public transportation would assist the environment and decrease traffic, others think completely free public transportation is too pricey, and the government can't afford to cover it. Each topic is broken up into subtopics that you should prepare. A minumum of one parent should work at home. The Debate Over Essay Writing Topics for School Children Spiritual science is an area of science that might attract you. Once you choose a topic, you should reply to the query and after that substantiate your response with three or more motivations as to why you think like that. Therefore, the topic needs to be debatable! Special attention needs to be paid to the inception of a strong argument. To choose which subject you're likely to discuss, it's essential to see the complete collection of good persuasive speech topics from the specific area of study. It's needless to say that you should choose a subject that you regard as interesting. When you've chosen one subject from the scope of expository essay topics, it's time to begin writing. So, the best method to compose a wonderful persuasive essay is to locate a theme you're acquainted with and wish to share your experience with the reader. Our writers use their abilities and abilities to meet the wants and necessities of our clientele. When you're picking your topic, bear in mind that it's much simpler to write about something which you currently have interest ineven in case you don't know a good deal about it. Our crew of professional writers with the crucial experience and writing skills is always prepared to fulfill your demands and exceed y our expectations. What is Truly Going on with Essay Writing Topics for School Children How can you get children to want to. Students ought to be permitted to pray in school. Children should have to read more. Kids and adolescents are. Allow the professional academic writers help to your informative paper! Many students know it is not simple to effectively develop an argumentative topic. Put simply, the essay should say how you intend to get ready for class. Though the essay questions change, the topic of the essays often stays the same. SATs ought to be eliminated. Writing practice should not be boring! School tests aren't effective.

Admission Essay on What Confuses Me Most

Questions That Are Hard to Answer Socrates once said that the more one tries to understand life, the more confused and lost one feels. This idea is definitely true for me. Although I love my life and thank God every day for this precious gift, there are a lot of things which I find strange, puzzling or irritating. But what I find the most confusing is the phenomenon of people who ask you questions the answer to which is either obvious or so personal that you simply could not reply honestly. Whenever I am asked such a question, I get extremely embarrassed and lose my ability to speak completely. My neighbor is at the door. A nice kindhearted single woman in her late fifties: â€Å"Hey, darling! Tired today again? A sleepless night because youve split up with your boyfriend?† Yes. Right, I did split up with my boyfriend yesterday. Yes, she knows it one hundred percent, as only a totally deaf person would not have heard the way we shouted at each other. And she is anything but deaf. I mumble something in reply and try to escape as fast as possible. A car park on a rainy day. I am trying to get into the car being wet to my bones. A middle-aged man with a kind smile comments: â€Å"Left your umbrella at home, havent you?† â€Å"No, no, I just enjoy getting absolutely wet! Such an extraordinary feeling†. But my sarcasm is only in my thoughts. In reality I do not say anything at all. Why do people ask such strange questions? What answer do they expect to get? Is it a peculiar form of expressing your compassion? The motives of some peoples actions seem so ambiguous. However, I believe that even these feelings are good because they prove that we live in the most unusual world.

Equal Pay Act 1970 Equality And Diversity - 963 Words

Equality To me this means treating everyone with respect and fairness whilst recognising their individual needs. Diversity Recognising, valuing and acknowledging difference and similarity. Inclusion Providing opportunities to everyone, in its simplest term it is the ‘state of being included’. The Equality act 2010 replaced nine primary legislations and over 100 bits of secondary legislation to make it simpler to understand and ensure that everyone is treated fairly and brings together a number of previous legislations including the: †¢ Equal Pay Act 1970 †¢ Sex Discrimination Act 1975 †¢ Race Relations Act 1976 †¢ Disability Discrimination Act 1995 †¢ Employment Equality (Religion or Belief) Regulations 2003 †¢ Employment Equality (Sexual†¦show more content†¦From another perspective, it is only in recent years that I have been honest with potential employers during the recruitment process as I had experienced discrimination upon disclosure in previous applications. Even today I am still cautious as to the point of should I or when I disclose my disability especially as I am also in the older workers category which on its own is prone to discrimination. Vedas recruitment training are a ‘disability confident’ employer which means we positively engage with persons who may normally feel excluded from applying for our vacancies by using a range of application techniques and advertising in a wide range of places not normally used. The workforce is naturally diverse and closely represent the social makeup of the community therefore doesn’t need positive discrimination. Within Vedas Recruitment Training the policies relating to equality, diversity and inclusion are not specifically measured in terms of performance of employees. One incidents of unfair treatment occurred within Vedas Recruitment Training which came about when one individual was promised a promotion should a bid be successful. This caused resentment in others who felt theyShow MoreRelatedManaging Diversity Within An Organization1674 Words   |  7 PagesManaging Diversity is often defined as a â€Å"management philosophy of recognising and valuing heterogeneity in organisations with a view to improve organisational performance† (Ozbilgin and Tatli, 2011). Hence recognising the wide variety of qualities possessed by people within an organisation and creating an environment that understands, values and utilises the differences within people. 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Diversity means although people differ from each other it is accepting this difference and its value that brings richness and variety to society. Equality? Equality is about each person being equal and entitled to their rights and being treated the same regardless of their age, gender or religion Inclusion? The aim of inclusion is to embrace all people irrespective of age, race, gender, and disability, medical or other need. It is about giving equal access andRead MoreDiversity in the Workplace1452 Words   |  6 PagesIntroduction As a general statement diversity refers to the prevention of discrimination in conjunction with the improvement of equality. It’s about valuing differences and inclusion; this is the act of spanning such areas as ethnicity, age, race, culture, sexual orientation, physical disability and religious beliefs. 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Objectives and Measurement Free Essays

The main goals that hard core will be aimed at achieving for a period of one year are:- 1. To improve the health statues of people by serving a minimum of 50customers per day.   The main objective of hard core is to improve the health status of the people. We will write a custom essay sample on Objectives and Measurement or any similar topic only for you Order Now    For the start a minimum of 50 customers will be served within one day.   People will be advices on the diets to take so that their health status improves.   Teachings on maintaining the required weight shall also be offered. Our customers shall be taught on the kind of lifestyle to lead in order to keep their bodies strong and free from preventable diseases.   Also our customers shall be educated on the kind of exercised to carry out regularly so as to maintain their bodies and remain strong.   Also educate our customer about nutrition values of various foods.   We shall ensure that a minimum of 50 customers have been served per day. 2. To ensure 99% efficiency in offering quality services.   We shall ensure that any service offered by hard core is within the best standards.   Health issues are very crucial and sensitive to somebody’s life.   A small mistake can lead to the death or deterioration of the health of a customer.   Therefore we look forward to offering the best services to our customers. 3. To buy 30 equipments by the end of the year for the start hardcore shall be having the basic equipments for weight measurements, skin treatment, and body massage to ensure a smooth running during the start.   But as time will go by hardcore targets at buying 30 equipments for offering our trainings. 4.To reduce the cost of services by 10% compared to our competitors for hardcore to expand and have more customers it will be charging lower prices to all the services it will be offering our prices will be lower by 10% compared to those charged by our competitors. 5. To build one big recreational hall for practicing by the year 2009.   Hardcore has got many professionals like nutritionist, dietitians, naturopathic doctors, dermatologist, the rapist, personal trainers, fitness instructors, physical therapist and psychiatrist.   Each and everyone of this professional require his own room. This room should be enough and spacious to accommodate at least four people and some equipments.   So for hardcore to be efficient in offering all its services a recreational hall should be build by the year 2009. 6. To buy at least five televisions sets for our customers to be watching while waiting to be served by the end of year 2008.   Hardcore should buy at least five televisions that will be installed at the halls to keep customers busy as they wait to be served.   These television sets should also be used to offer basic teaching to customers to issues like diets, nutrition, prevention of diseases, the importance of maintaining health bodies.   Therefore these televisions will assist offering some basic teachings to our customers. 7. To increase our monthly sales by 10% by the year 2009/ hardcore will have its own retail shop.   This shop will be selling equipments for homes, clothing, other supplements and nutritional valued light foods and drinks to compliment the services it offers.   Hardcore will target at increasing its monthly sales by 10% as from the year 2009. 8. To own our own  ½ acre piece of land by the year 2009. For hardcore to offer its services efficiently it need to won  ½ on acre piece of land by 2009. 10. To have a well trained team of 90 professionals within the first 6 months of starting.   Hardcore should have at least 90 well trained professionals like nutritionists, dietitians, naturopathic doctors, dermatologist, therapist and many more others.   These professionals are the once to ensure that hard core is fulfilling its main mission of improving the health status of its customers. Performance Measurement Performance measurement is vital in all organizations because the organizations need to verify the validity of the selection methods; they also need to do performance measurement in order to improve productivity of the organization. As much as this may seem an important and key aspect of management, still it has a lot more difficulties associated with it. Some of the main factors that may make performance measurement to be more challenging are the measurement problems that make it impossible the supervisors (those in charge of the performance measurement) to tell the juniors or subordinates that they are below the average standards. How should the organization deal with such situations? In order for organizations to do performance measurement well, then they should carefully study the job, systematically and scientifically, in order to determine the nature and characteristics of the job, knowledge, skills and experience required for the successful performance of the job. They should collect all the vital information related to the job. They should then look at the specific individual tasks that comprise the job and qualifications necessary to do the job. This is called job analysis that involves determining the content of the job in terms of what the worker is expected to do, methods and techniques used, and lastly, the conditions and skills required for the job. For proper job measurement, the management must adopt the following process and the methods of job measurements that follow: Management should identify and isolate the component tasks of the job. They should examine when, why and the tasks are done. Find out the duties and responsibilities involved in the job. Identify the working conditions involved in the job. Determine the demands which the job has on the job holder. Know the job relationships. After gathering all these, management can now use the methods of job measurement to know whether the job is being done s it is supposed to be done. The various methods of job measurement include: Performance rating Critical incident MBO Performance Rating Under performance rating values such as creativity, initiative, dependability, knowledge etc assigned to the job and the rating is presented on a scale like this and questions are asked. To what extent does this person demonstrate creativity and then the scores given for the question give the rating of the employee. This method has a number of problems like: a) Managers may be inclined to give everyone a high rating and hence failure to differentiate them. b) Managers may tend to be influenced by most recent performance rather than general performance. Critical Incident Good and bad performance incidents are recorded at the end of the period. The more the good performance incidents the better the employee. The major problem is that this type of job measurement is comparative and qualitative and cannot determine the actual performance on the job. MBO Here the performance of the job is rated as per the objectives set at the begging of the period i.e. sales targets set as 15% and then the sale representative gets 15%, he will get a positive sales performance order and vice versa. For this method of appraisal to be effective there must be a clear understanding between the employer and the employee at the point of setting the objectives. The authority and recourses necessary to achieve the objectives must be delegated to the managers. References Lnick F. John and WillinLee Ziegler, sales promotion and modern Merchandising, McGraw Hill. How to cite Objectives and Measurement, Essay examples

Management of a Team for Flavored Milk - myassignmenthelp.com

Question: Discuss about theManagement of a Team for Flavored Milk. Answer: Introduction The firm taken into consideration produces dairy products. The plant where the production of the dairy products takes place has been upgraded recently to support the growing demands. A wide range of dairy products are produced such as cream, yoghurt, butter, types of milk as skim, powdered, evaporated or flavored milk. A team has been formed and the members of this team have been assigned respective roles for the production program goes on without any problem. The following team members are the manager, the team leader, the production head and the operational manager. There is interdependence within the team. The team leaders perform their respective tasks by guiding the employees. The business manager reflects upon the stimulation round and comments on the decisions that the team has made. Discussion The team members have specific tasks according to the roles they have been assigned. According to their role, the team members have responsibilities to perform so that there is enough production to meet the growing demands of the products. The four-team members have certain responsibilities, which have been discussed below: The Manager The manager is the most important member of this team. The project manager is the person who has the responsibility for the successful initiation of this project. The manager plans, designs, executes, monitors, controls the project (Kerzner, 2013). The manager of this company looks into the production of the diary products by the plant that has undergone changes to support the growing demands. The manger recognises the risks that may have an impact on the production and distribution of the products. These risks arise from uncertainty and focus on it is the primary concern of the manager. The manager makes decisions, which are both large and small. The manager should communicate with the other members of the team and the employees so that there is smooth production at the plant (Kim, Kumar Kumar, 2012). The manager organises his task through project management. He produces reports and charts and guides the other team members. The manager should have the ability of monitoring and repo rting about the progress at the plant regarding the production and distribution of the diary products. The manager has to have a strategic planning to allocate the resources and use control mechanisms to guide the implementation of strategy at the production plant (Bryson, 2012). The market segmentation of the diary products is among the wholesaler, families, distributors, dairy VAP and the health centres. The manager decides this market segmentation of the dairy products. The Team Leader The Team leader is the second most important member of the team. The team leader is the person who leads the team and guides it about how to progress (Schoemaker, Krupp Howland, 2013). The team leader just like the manger develops a strategy for the team to reach the goal that has been set by the manager. He provides training and full understanding to the team members providing them with clear instructions. The team leader is aware about the production capacity, the target group and the research and development of the products (Northouse, 2015). He monitors the team members participation to ensure they work accordingly. He also manages the flow of day-to-day operations. The team leader creates reports about the progress of the team and keeps the manager updated. The reports are to be distributed by the team leader to the team members so that they have an idea about the production. The Production Head The production manager is responsible for technical management, supervision and is in control of the production processes. He plans and organizes the schedule for quarterly production of the milk products and the desserts range .The production head may build a cost leader strategy. The cost leadership strategy is used to enable the lowest cost of operation in the industry. There has to be a substantial reduction in the cost of the products so that the products have a high market value in the market than its competitors (Martinelli Milosevic, 2016). The production head oversees the production process at the plant. He is in charge of the selection, ordering and purchasing of the materials required for production. The production head should have communication with each of the team members and keep the manager and the team leader informed about the production report. He is also in charge of the marketing and sales. The Operational Manager The operational manager has a broad role to perform. He monitors and analyses the present system of the production and works out a strategy to improve it if it is necessary. The operational manager plays a vital role in the company (Dozier, Grunig Grunig, 2013). He plans and controls the changes and makes research and development regarding the dairy products (Hill Hill, 2012). The operational manager also looks after the promotion of the products. The promotion of the dairy products is by advertising mainly. It is either through small advertising campaigns, moderate advertising campaigns or major advertising campaigns. The operational manager also looks after the production capacity of the plant 1, lite milk and chocolate flavor milk. The advertising is mainly for the family, infant, health, organic, dairy, wholesalers and distributors. He oversees the inventory, the distribution of the goods and the layout facilities. Conclusion Thereby, the following report discusses and explains the role and the responsibilities of the team members. Each of the team members perform their responsibilities and the tasks assigned to them. The production and the operational managers look after the production by plant 1 of full cream milk, lite milk, chocolate flavor milk and the desserts range. The cost of the products is kept in mind by the production head so that the value of the products is at par with the products of the competitors in the target market. The manager keeps overall information of the other team members duties and success of the project. References Bryson, J. M. (2012). Strategic Planning and.The SAGE Handbook of Public Administration, 50. Dozier, D. M., Grunig, L. A., Grunig, J. E. (2013).Manager's guide to excellence in public relations and communication management. Routledge. Hill, A., Hill, T. (2012).Operations management. Palgrave Macmillan. Kerzner, H. (2013).Project management: a systems approach to planning, scheduling, and controlling. John Wiley Sons. Kim, D. Y., Kumar, V., Kumar, U. (2012). 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