Wednesday, May 6, 2020
Indus River Dolphin free essay sample
HIndus river dolphin, bhulan, blind river dolphin, Indus dolphin, side swimming dolphin, Plataniste de lIndus (Fr), Delfin del Indo (Sp) Scientific name: Plantanista minor What are Indus river dolphins? The Indus River dolphin (Platanista minor) is one of the worlds rarest mammals and the second most endangered freshwater river dolphin. The species is characterized by a long beak, rounded belly, stocky body, very small dorsal fin and large flippers. It relies on echolocation (sound sensors) to find fish, shrimp, and other prey in the bottom mud. The Indus River dolphin swims on its side, at times enabling it to move in water as shallow as 30 cm. When it needs to breath, it swims to the surface, rotates upright to take in the air, and then rotates 90 degrees again as it swims back to the bottom. This unique side swimming behaviour is not consistently seen in any other dolphin, except the Ganges River dolphin. We will write a custom essay sample on Indus River Dolphin or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page The Indus River dolphin weighs 70-110 kg (155-245 lbs). The maximum size is 2. 5m (8. 2 ft), with males smaller than females. Habitat Biogeographic realm Indo-Malayan Range States Pakistan Ecological Region Indus river Delta Rann of Kutch Endemism Indus river system of Pakistan [pic] The current situation. Approximately 1,100 specimens of this species exist today in a small fraction of their former range, the lower reaches of the Indus River in Pakistan. Why becoming endangered? The population of this species has gradually declined because of various factors, including water pollution, poaching, fragmentation of habitat due to barrages, and dolphin strandings in the irrigation canals. What being done for protection? In addition to efforts to conserve their habitat, including addressing problems such as river pollution, WWF staff have also been involved in rescue missions when individual dolphins become trapped in canals. WWF also coordinated the largest survey of the species ever in 2001 in collaboration with partners. WWF-Pakistan assists in a number of education initiatives and has arranged training courses for various institutions. An aerial survey of the species range was conducted in 2003. WWFs objective for freshwater cetaceans is to ensure that habitat degradation, strandings and fisheries bycatch do not threaten freshwater cetaceans.
Thursday, April 30, 2020
The Articles of Confederation Essay Example
The Articles of Confederation Essay The years 1776 to 1787 are often considered to be the most important and fateful when compared to all other epochs of American History: the now self-proclaimed Americans, having rebelled against royal authority, needed to develop a new system of government in order to survive. To accomplish such a feat, they needed a basis on which to establish this new authority. Established in autumn of 1777 and fully ratified in 1781, the Articles of Confederation was Just this. These documents, at best a primitive constitution, were formed to be the basis of the federal government. While erectly serving as such, the Articles of Confederation subjected the united States to a series of problems In both domestic and foreign respects. Increasing In adversity with each aching year, these documents only brought about one good effect: they showed the Americans that a weak and disorganized government like the one during the Articles reign could never work. Regarding structure, the Articles of Confederation, or simply Articles, were relatively bare-bones when compared to the complex constitutions and declarations of government other countries had. It laid out simple and ultimately primitive government: the power of the government was to Ill solely In Congress, a group of delegates from all states. It was to be Congress and only Congress to create laws and run most of the government. This concept did not work well in practice: Congress, the only branch of the government, was weak and unable to bring about policy change for the country. First, all amendments to the Articles required a unanimous vote of all thirteen states something that was quite rare and even the simplest of national laws required a two-thirds majority to be established. We will write a custom essay sample on The Articles of Confederation specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on The Articles of Confederation specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on The Articles of Confederation specifically for you FOR ONLY $16.38 $13.9/page Hire Writer This became a major issue. As a new country, a lot of issues were going to come forth to Congress, and due to the bureaucratic rules that were In place, It was difficult for a treaty or policy to be approved. Furthermore, the Articles did not allow for a national judicial system or an executive branch of government to be established. These policies, reflecting the lack of trust and respect for the British courts and monarchs from American politicians, allowed for perpetual and incessant bickering to persist, and also did not give the nation a single, strong leader to trust in. It made the united States a weaker and less Just nation, something that was very much needed In Its Infancy. For these reasons, the Articles, while In effect, made It very difficult for Congress to make any laws or utilize even the slightest of powers. During the eight year period in which the articles dictated American government, many injustices, misdeeds, and problems came to face them on their home land. The Articles damaged the frail union of states, created economic depression, and establish a period of instability for the infant united States. The major problem with he Articles In this respect Is that It gave far too much power to the Individual states. Again reflecting a mistrust of central government the British Empire the states were given special abilities and powers that allowed them to control the face of politics. Eventually, this devolved into state of corruption, wherein the states disrespected the federal government and pursued their own, sole interests. Instead acting as one body of peoples and ideals, they chose to act as if they were still colonies, something that the Articles allowed for. A major issue this brought about deader tax, states such as Rhode Island, as seen in this letter to Congress, decried, it would be unequal in its operation, bearing hardest on the most commercial states. (Document A). Rhode Island, like many other states, believed that that by granting to Congress a power to collect moneys from the commerce of these states, indefinitely as to time and quantity, and for the expenditure of which they are not to be accountable to the states, they would become independent of their constituents; and so the proposed impost is repugnant to the liberty of the United States. Document A). Essentially, it was believed that by establishing a tax to be utilized by the Continental Congress, they would be acting too much like the British, and by doing this they surrender the liberty they had fought so valiantly to grasp. The issue in this is that the states did not have to submit this tax, and in a nod of disrespect to the government, they chose not to; Congress c ould only acquire funds by asking the states for it. By doing this, the states condemned Congress to criticism and debt, thus causing further chaos for the blossoming country. This lack of funds is indicated in a letter to George Washington, sent from a delegate from Virginia: Every class of public creditors must know the inability of Congress to pay their demands, unless furnished with the means by the several States, and the exertions of that body have not been lacking heretofore to obtain the means. (Document C). This not only shows the negative and weak connotation many Americans had for Congress, but also how much power the states truly had. Essentially, the federal government was not to be trusted unless a state was supporting its ambitions financially. As also shown in the letter sent from Joseph Jones to George Washington, another major problem was resulting from the lack of funding: One ground of discontent in the army, and on which they found the opinion that Justice is not intended to be done to them is the delay in complying with their requests for bonuses and back pay (Document C). The soldiers were becoming restless at Congress inability to compensate them for their valorous deeds. This discontent eventually sprouted into something far worse: a complete lack to properly maintain a standing army and navy. In a time where military strength means life or death, this policy was incredibly dangerous. They were only months out of a bloody war with military behemoth Britain, they had perpetual land disputes with mighty Spain, and were under constant threat of attack and annihilation from anyone and from anywhere. And yet, the states did not bother much with this lack of Army, again showing their disregard for the federal government. In fact, they set up and maintained their own militias, which they often utilized for their own self-interests and protection. Adding insult to injury, the Articles gave Congress no authority to interfere with these misdeeds, conflicts which they helped catalyst. Another major issue with the Articles of Confederation was that it did not allow for national intervention in commerce and economy. Being the young and capitalist nation that it was, the United States had issues keeping its trade in order; States would often fight for control of small trades, often going to extremes for a quick buck. Since Congress had no power over national trade, they could not stop this. Thus, trade, the primary source of income of all states, as stifled by these conflicts. States began to draft and establish their own trade policies, placing tariffs and restrictions at their own will. Gradually, commerce began fight tooth and nail for trade, shattering the sense of unwavering union the country had Just months before the Articles of Confederation were ratified. Inflation spread as part of this economic decay, since the value of state printed money, something that was legal under the Articles, decreased, and the federal note was not in use. In 1779, none other than aristocrat George Washington wrote to acting Congressional President John Jay stating that, that a wagon load of money will scarcely purchase a wagon load of provisions. (Wisped). Since Congress essentially had no power to tax, Mr.. Jay and Congress responded to these crises by begging nearly fifty million dollars in funds from the States. In this response, Mr.. Jay appealed that the funds were the price of liberty, the peace, and the safety of yourselves and posterity. (Wisped). The ineffectiveness of the Articles of Confederation become blatantly apparent upon examining domestic American history during its use. It proved to be both harmful and restricting to the Americans who desperately craved wealth, comfort of living, security, and land. The total lack of unity in addition to the weakness of the Army and Navy kept the American government under the Confederation from achieving much in respect to foreign policy. If anything, the United States was set back in attempts to attain respect and instill fear in other countries eyes. It became apparent to Congress soon after the revolution that the Government needed to conduct proper, effective, and authoritative foreign policy. As Thomas Jefferson puts it, There never will be money in the treasury till the Confederacy shows its teeth. The states must see the rod. (Wisped). However, even under this spirit of change and expansion, few positive changes in foreign relations occurred. The issue of most importance in foreign policy was the control of the Mississippi River and relations with colonial rivals Spain and Britain, who posed the biggest threat to American expansion and prosperity in the Midwest and beyond. However, the Articles of Confederation stifled these aspirations. A poorly supplied and practically non-existent Army and Navy, brought about by another weakness of the Articles, made it impossible to flaunt or use power as a means of forcing treaties or making others surrender. The lack of a properly unified country, also caused by other weaknesses of the Articles, made it hard for Americans to act together for one goal. Foreigners would have no reasons to respect them, and thus their wishes. For example, in 1785, the US Minister to the British Empire was ordered by John Jay to, insist that the United States be put, thou further delay, into possession of all the posts and territories within their limits, which are now held by British Garrisons. (Document D). However, the British had no incentive to bow down to theirs wishes: the Americans could not behave them militarily from the frontier posts on US soil, since they had neither the troops nor the funds to do so. John Jay understood this, and further instructed the Minister, Mimi will represent in strong terms the losses which many of our and also of their merchants will sustain if the former be unseasonably and immoderately pressed for he payment of debts contracted before the war. (Document D). Even still, the British did not leave the land they occupied. They did not respect American ideals and boundaries and also realized that Congress really has no way to make them leave whatsoever. Another major defeat in American foreign relations occurred in 1786 that access to the Mississippi River for Americans be denied, and that they should also give up some of its western territories. The Mississippi River was crucial as both a supply route of goods, money, and people to the Western Territories, but also a humbly of American progress, accomplishment, and hope. Although the treaty was never ratified due to its immense unpopularity, its introduction represented something more significant. It showed, as did the incident with the British forts, that the young nation that its carries with its name no respect, and that it needs to improve itself in order to be more effective as a nation in the colonial world it resides in. As time progressed and the weaknesses of the Articles became increasingly apparent, many American citizens were beginning to develop animosity for the infamous documents and rules that dictated how their Government was run. These ideas eventually morphed into actions, and citizens started to actively rebel against their government leaders and protest the misdeeds they believed their rulers were committing. In one particular case, populist and veteran of the Revolutionary War Daniel Shays led a powerful rebellion against the Massachusetts government, which he believed has highly unreasonable tax policies, reasons that ironically parallel those of the American Revolution. His rebellion, while largely effective at conveying is anger, was eventually suppressed, but only by a militia force of three-thousand men. However, it wasnt Just the poorer citizens who were distraught by the Articles of Confederation: John Jay, the Congressional President himself, was unhappy with the Articles. He expressed these emotions to his friend and colleague George Washington, where he revealed, I am uneasy and apprehensive; more so than during the war Yet I did firmly believe we should succeed, because I was convinced that Justice was with us. The case is now altered; we are going and doing wrong, and Hereford I look forward to evils and calamities.. What I fear most is, that the better kind of people.. Ill be lead by the insecurity of property, the loss of confidence in their rulers, and the want of public faith and rectitude, to consider the charms of liberty as imaginary and delusive. A state of fluctuation and uncertainty must disgust and alarm such men, and prepare their minds for almost any change they may promise them quiet and security (Document G). Suggesting its ineffectiveness, many Americans grew to protest and despise the Articles of Confederation, the sole item hat was holding them back as a nation. While the Articles were only in use for a short period of time, its effects were felt for years thereafter. It, while in effect, destroyed the loose union that Americans held, ravished the economy and the military, brought about protests which could have caused another revolution, and generally caused the US to lose respect in the eyes of the world. It was not only entirely ineffective, it was counter-intuitive. The founding fathers based the new country on principles of liberty, prosperity, and security, and yet, they created and deified a document that did Just the opposite of that; the Articles of Confederation provided Americans with a weak and ineffective government, the lack of both an army and a navy, and economic troubles as well. In essence, the Articles proved to be the exact opposite of the kind of government the people of the Revolution dreamed of. However, it was not until the 1787 at the Constitutional Convention, ten years after attempts were made to learn from the mistakes of the past, in turn rectifying them and starting the country over, anew and free from its troubled past.
Saturday, March 21, 2020
Solutions (in bold font) to Homework Assignment 3 Essays
Solutions (in bold font) to Homework Assignment 3 Essays Solutions (in bold font) to Homework Assignment 3OPIM 3104: Operations Management Problem 2-1: Backwoods American, Inc., produces expensive water-repellent, down-lined parkas. The company implemented a total quality-management program in 2005. Following are quality-related accounting data that have been accumulated for the five-year period after the programs start. Note: Numbers in the table are in thousands of dollars (e.g. quality cost of 3.2 is $3,200). a)Compute the companys total failure costs as a percentage of total quality costs for each of the five years. Does there appear to be a trend to this result? If so, speculate on what might have caused the trend. The failure costs decrease as a percentage of total quality costs. This may be attributed to an increase in product monitoring and inspection. Fewer defective products are reaching the consumer, as evidenced by the sharp decline in external failure costs. b)Compute prevention costs and appraisal costs, each as a percentage of total quality costs, during each of the five years. Speculate on what the companys quality strategy appears to be. The increase in prevention costs as a percentage of total quality costs indicates that Backwoods American is placing more emphasis on prevention of defects rather than correction of them. Perhaps they are spending more in the areas of quality planning, product design, process, training, and information. This is contributing to a decline in the need for inspection and testing, equipment testing, and operators to test quality; thus appraisal costs decline, both absolutely and as a percentage of total costs. Prevention also contributes to the decline in external and internal failures, because fewer defective products are produced to begin with. Increases in prevention expenditures will result in a decrease in all other quality costs. c)Compare quality-sales indices and quality-cost indices for each of the five years. Is it possible to assess the effectiveness of the companys quality management program from these index values? These index values do not provide much information regarding the effectiveness of the quality assurance program. They are, however, useful in making comparisons from one period to the next and in showing trends in product quality over time d)List several examples of each quality-related cost that is, prevention, appraisal, and internal and external failure that might result from the production of parkas. Prevention: Market research, that is, producing what consumers want; purchasing only high-quality down and other materials, designing an efficient and effective manufacturing process; training employees in making quality products. Appraisal: Inspection of raw materials, work-in-process, and finished product; equipment testing (pattern cutter, sewing machines, etc.), inspection. Internal failure: Wasted materials and labor, defective products discovered during inspection, use of inefficient processes, equipment downtime, poorly trained employees. External failure: Defective products, customer complaints, warranty costs, lost sales, loss of good will. Problem 2-2: The Backwoods American company in Problem 2-1 produces approximately 20,000 parkas annually. The quality management program the company implemented was able to improve the average percentage of good parkas produce by 2% each year, beginning with 83% good quality parkas in 2006. Only about 20% of poor-quality parkas can be reworked. a)Compute the product yield for each of the five years. b)Using a rework cost of $12 per parka, determine the manufacturing cost per good parka for each of the five years. What do these results imply about the companys quality management program? Problem 2-9: The total processing cost for producing the X-Pacer running shoe is $18. The Omega Shoe Company starts production of 650 pairs of the shoes weekly, and the average weekly yield is 90%, with 10% defective shoes. One quarter of the defective shoes can be reworked at a cost of $3.75 per shoe. a)Compute the quality-productivity ratio (QPR) b)Compute QPR if production rate is increased to 800 pairs of shoes per week c)Compute QPR if processing cost is reduced to $16.50 and remark cost is reduced to $3.20 d)Compute QPR if the product yield is increased to 93% good quality.
Thursday, March 5, 2020
Mistrust vs. Distrust
Mistrust vs. Distrust Mistrust vs. Distrust Mistrust vs. Distrust By Maeve Maddox A reader wants to know if there is a difference between the words mistrust and distrust. The short answer is, ââ¬Å"No.â⬠As verbs, both distrust and mistrust mean, ââ¬Å"to be without confidence.â⬠As nouns, both distrust and mistrust mean, ââ¬Å"lack of trust or confidence.â⬠The Google Ngram Viewer graph shows distrust as the more common of the two words since 1800. When I entered various phrases, the ones that began with distrust were more common than the ones with mistrustââ¬âwith one curious exception: ââ¬Å"mistrust my wifeâ⬠was more common than ââ¬Å"distrust my wife.â⬠And neither ââ¬Å"mistrust my husbandâ⬠nor ââ¬Å"distrust my husbandâ⬠brought up any results at all. I predict that mistrust will eventually drop out of general use. I base my prediction on the fact that a red squiggly line appears under mistrust when I type a phrase with it into the Google search box. Another clue is that the search results come up prefaced with the question, ââ¬Å"Do you mean distrust?â⬠The only possible distinction I can discern between mistrust and distrust is that mistrust is a slightly ââ¬Å"softerâ⬠word that may imply some doubt that the lack of trust is justified. Here are some examples of current usage of these synonyms: Marilyns insecurity madeà her mistrustà everyone. Gen Halvorson cant resist reaching out to the little boy, despite his fathers obvious mistrust of her talents and her motives.à Politics has become static in America, and Americansà have always distrusted politicians.à à Ià distrust thoseà people who know so well what God wants them to do, because I notice it always coincides with their own desires. ââ¬âSusan B. Anthonyà Research has found weà distrust those whoà are mean with their money. Cynicismà is anà attitudeà or state of mind characterized by a general distrust of others motives believing that humans are selfish by nature. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Misused Words category, check our popular posts, or choose a related post below:Direct and Indirect Objects60 Synonyms for ââ¬Å"Tripâ⬠Empathic or Empathetic?
Monday, February 17, 2020
The Broader Impact Of DSP (Digital signal processing) In A Global Research Paper
The Broader Impact Of DSP (Digital signal processing) In A Global Economi And Social Context - Research Paper Example Each of these areas has involved substantial involvement of the digital signal processing technology with its own unique algorithms, mathematics and specialized techniques. As a result, digital signal processing has significant impact on the social, economic and in global lives in our society today. Digital signal processing convert analogue signals to digital signal. By doing this, there is extraction of signals, which later get modifications to meaningful and relevant information through the digital signal. In the pioneer ages digital signal processing was only in computers and by the application of technology limited in some key areas, for instance radar and sonar where national security appeared to be at risk. This is because of the international threats that were happening because of international tension. Another area is oil expiration and in this area, there are large amounts of revenue for example mad, oil sector industry is a very profitable industry that is capable of raisi ng the economic level of a nation. Space exploration is another sector that digital signal processing adopted because of the importance of data received. The collected data are of an irreplaceable nature. The final area of involvement in digital signal processing was medical imaging, where it could play a vital role in the treatment and saving of lives. Impact in an economic context Digital signal processing has had great impact in our lives especially economically. The recent technological advances have commanded entrepreneurs and investors to spend a lot of money in technology. Innovations in technology have led to many firms competing with each other to develop the most sophisticated technological devices that outsmart its competitors and gain the largest market share in the industry. Advances in computing, data storage and data transmit ion have enabled firms to reduce costs, create new market, expand existing market and create employment in the nation (44). Maintaining the inte grity of the specifications Companies and organizations have moved quickly to grab these newly found opportunities and as a result, firms are spending billions on their enterprise system. Firms are developing sophisticated software and hardware packages that integrate ordering, procurement, inventory, finance and human resources in their companies. Consumers get a wide range of goods and services for communication entertainment, shopping, education and other activities that relate to the firm and firms on the other hand get the opportunity to widen their consumer targets. With the embracing of technology, firms are able to reduce cost, maximize their profits and increase shareholders wealth. Consumers also benefit from these technological advancements where by prices of commodities are reduced due to the decrease of costs. This is also by being able to access wide ranges of products that are available (32). Telecommunication has also been a beneficiary of these technological advance s. Drastic improvements in computing power, accompanied by healthy competition in the industry have led to dramatic reduction rates among the consumers in communication. The telecommunication industry has been able to expand massively to tap the new opportunities; these firms now enjoy substantial customers in their networks. The introductions of wireless and broadband services have made communication much easier and faster (22). This
Monday, February 3, 2020
Political Humor Essay Example | Topics and Well Written Essays - 1500 words
Political Humor - Essay Example While satire and humor are usually meant to be funny, their greater goal is to offer constructive criticisms through performing arts, graphic, and satirical writing and speech among other ways. This paper will analyze the article from the US-based satirical news website ââ¬Å"The Onionâ⬠, titled ââ¬Å"Mexico Killed in Drug Deal.â⬠It will analyze the piece using four different approaches to studying humor: superiority theory, incongruity theory, relief theory, and benign violation theory. It will then discuss the best approach that explain the different jokes in the article, and finally comment on whether the article is funny and if it is effective as political humor. Contemporary philosophers have developed main theories of humor. The first one is the Superiority Theory which holds that the humor that we find in life and comedy is majorly based on ridicule, where the object of amusement is regarded as inferior and we regard ourselves as superior. This theory explains tha t the object of laughter is ridiculous and that the ridiculous is othersââ¬â¢ self-ignorance when they have a belief that they have wisdom (Morreall 36). This is reflected in the article where Mexicans are regarded as inferior as they are all killed during a shoot-out between rival drug cartels. The U.S Drug Enforcement Administration is perceived as being superior as they are the one in control following the ââ¬Å"death of Mexicoâ⬠(The Onion). Humor, according to this theory, is as a result of feeling of pleasure at seeing others suffer a misfortune after being deluded by their own wisdom (Bardon 2). In this article, humor arises from the misfortune suffered in Mexico where all people who were present in Mexico at the time of the shoot-out died (The Onion). Superiority theory regarding philosophy of humor further argue that laughter arises from seeing those who hold power in society being ruled by emotion and desire and therefore are tempted to abuse power and make bad de cisions (Bardon 2). This aspect is well depicted in the article where Felipe Calderon, the Mexican President is gunned down by passing drug dealers as he declares the state of emergency at the podium. This theory also holds that a passion of humor arises from sudden glory as a result of sudden eminency conception of certain persons; in other words, humor is basically found in that which seems inferior to people, and that which makes them to have the assurance of relative superiority (Bardon 3). The U.S. drug dealers have a sudden conception of eminence as demonstrated at press time where they assure the American public that they would ensure that the vast supplies of marijuana that Mexican cartels left behind reach the intended consumers (The Onion). The critics of Superiority Theory argue that there are many experiences that might make people feel superior but are not amusing. Therefore, some philosophers have developed a different and radical account of the comic, which states tha t humor is primarily found in an intellectual recognition of a ridiculous incongruity between experiences and ideas that are conflicting (Cohen 44). This account of humor falls under the incongruity theory which states that the cause of humor is the bringing together of contrary ideas, images and some resemblance in the grand idea (Bardon 7). In the article, this is demonstrated by the death of all the Mexican citizens within a very short period of time (The
Sunday, January 26, 2020
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 patientââ¬â¢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 patientââ¬â¢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 crowââ¬â¢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.
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