Bipolar I Disorder ( Bd ) - 976 Words

This paper focuses on bipolar I disorder, previously known as manic-depressive illness. It includes the definition and characteristics, neurobiology and pathophysiology, psychological and environmental factors about the disorder. There is also a brief description about nursing interventions. Next, two evidence-based research papers will be presented. Additionally, there will be a summary on two audiovisual films that focused on bipolar I disorder. Lastly, there is a brief discussion about personal thoughts and feelings about bipolar I disorder. Introduction When people are asked what bipolar I disorder (BD) is, they often describe someone as being psychotic, having drastic mood changes, being depressed then super happy, and the list is endless. Often, individuals who suffer with BD are stigmatized and discriminated. The following piece is part of a poem called â€Å"You and Me† written by Debbie Sesula, â€Å"...If you get angry/ You’re considered upset/ If I get angry/ I’m considered dangerous. / If you over-react to something/ You’re sensitive/ If I over-react to something/ I’m out of control†¦Ã¢â‚¬  BD is not well understood by society and it is unfortunate that individuals who have this disorder often isolate themselves and feel ashamed. Definition and Characteristics â€Å"The essential feature of a manic episode is a distinct period during which there is an abnormally, persistently elevated, expansive irritable mood and persistently increased activity orShow MoreRelatedWhat Bipolar I Disorder ( Bd )1529 Words   |  7 Pagespeople are asked what bipolar I disorder (BD) is, responses often include, â€Å"Sometimes they’re really normal and then they get super mad,† â€Å"drastic mood swings,† â€Å"they’re psychotic,† â€Å"one can be very happy and excited but can also experience depression,† and the list is endless. Often, individuals who suffer with BD are stigmatized and discriminated. The following piece is part of a poem called â€Å"You and Me† written by Debbie Sesula, â€Å"...If you get angry /You’re considered upset/ If I get angry/ I’m consideredRead MoreBipolar And Related Disorders ( Bipolar )1289 Words   |  6 Pages Bipolar and related disorders Justin Rodriguez Professor Hanselman Social Psychological Counseling Cumberland County College April 21, 2015 April 21, 2015 Abstract Bipolar Disorder (BD), also known as manic depression, is a mood disorder that is thought to affect some 5.5 million Americans, or 2.6 percent of the population (Treatment Advocacy Center). This paper explores Bipolar I, Bipolar II, Cyclothymic disorder, their features, and treatments. Also discussed is the progression of BipolarRead MoreEssay about The Research on Bipolar Disorder1673 Words   |  7 Pagescity it strives for order and efficiency. However a patient with Bipolar Disorder has a very chaotic type of brain function; causing changes in mood and sometimes suicidal thoughts Bipolar Disorder is a common psychiatric mood disorder that is defined by recurrent episodes of abnormally elevated mood and depression, changes in energy and, the ability to carry out day to day tasks. (Joel, Jakosson and colleges) â€Å"Bipolar Disorder (BD) is a chronic disease with high risk of relapse. This disease alsoRead MoreFibromyalgia And Bipolar Disorder : Extent Of Comorbidity And Therapeutic Implications1109 Words   |  5 PagesFibromyalgia and Bipolar Disorder: extent of comorbidity and therapeutic implications ABSTRACT Fibromyalgia (FM) is a syndrome that affects muscles and soft tissues. Symptoms include chronic muscle pain, fatigue, sleep disturbances, and painful trigger points and and psychological symptoms such as depression and anxiety. In particular, there is strong evidence of comorbidity of FM and Bipolar Disorder (BD). Therefore, adequate psychiatricRead MoreBipolar Disorder ( Bipolar )1010 Words   |  5 PagesIntroduction/Overview of Condition Bipolar Disorder (BD) is a severe mental illness (SMI) characterized by dramatic mood â€Å"swings† between manic and depressed states. In their manic states, individuals experience an abnormally elevated mood characterized by extreme, grandiose gestures and ideas, inflated self-esteem, lack of sleep, constant talking, distractibility, poor judgement, and even aggression (Griggs). Individuals can be characterized as having either a hypomanic episode or a manic episodeRead MoreHow The Mind Works At A Young Age?1545 Words   |  7 PagesI first became interested in how the mind works at a young age. An introspective and deep thinker, I would take inventory of the people around me and the way they behaved. I assessed why a certain reaction may have occurred between two parties, whether the reaction was positive or negative. Replaying scenarios in my head, like Sherlock Holmes, became more prolific as the term â€Å"manic depression† came into my life. Manic depression, a lso known as bipolar disorder, became a topic of regular conversationRead MoreBipolar And Related Disorders : Symptoms And Treatment Of Bipolar Disorder1669 Words   |  7 PagesBipolar and related disorders are lifelong perplexing mental illnesses that are difficult to diagnose and treat. Bipolar illness is a chronic shifting of extreme euphoria (mania) and deep sadness or hopelessness (depressive) episodes, complicated by comorbidities and the potential for poor health outcomes. The occurrence of bipolar disorder (BD) throughout the adult population in the United States is reported to be approximately 5.7 million people each year, with a lifetime prevalence of 3.9 percentRead MoreBipolar Disorder And Its Effects861 Words   |  4 PagesBipolar disorder is caused, in part, by factors of nature. In short, bipolar disorder is caused by factors of genetics, heredity, factors that are inherent to who we are. Bipolar disorder (BD) is a â€Å"neuropsychiatric disorder†¦characteri zed by recurrent episodes of depression and mania or hypomania† (Bavamian et al., 2015. p. 573). The study conducted by Bavamian et. al., asserts that there are in fact microRNAs (miRNAs) which regulate gene expression. In individuals with BD, they expression of miR-34aRead MoreMajor Types Of Major Depressive Disorder ( Mdd ) Essay927 Words   |  4 PagesMajor Depressive Disorder (MDD) is a mental disorder characterized by behavioral, emotional, and cognitive symptoms that include but are not limited to the loss of pleasure or interest in activities (anhedonia), sleep disturbances, appetite changes, guilt or worthlessness, fatigue, lack of concentrating and/or indecisiveness including emotion dysregulation (mood swings) and views of the negative affect. People with MDD have five or more depressive symptoms, including sad mood or loss of pleasureRead MoreHow Does Gray Matter Effects Schizophrenia And Bipolar Disorder?1369 Words   |  6 Pagesclinical attention and research as it has been consistently involved in studies to better understand brain pathology, pathophysiology and neurobiology in schizophrenia and bipolar disorder. Many meta-analytical reviews in structural neuroimaging studies have persistently shown abnormalities in schizophrenia and bipolar disorder. Using anatomical likelihood estimation (ALE), a meta-analyses of forty- two studies demonstrated extensive gray matter deficits in frontal, temporal, cingulate and insular

Developing an Advertisement Design

Question: Discuss about theDeveloping an Advertisement Design. Answer: Introduction Johnson Johnson Company (J J) is one of the most famous Baby brand producing products (oil skin) that clean and clear spots. The company is well known across United Kingdom and United States of America. It rose to fame in the 1990s when it realized that its expertise in babies skin may offer credibility to other skin care products. The company therefore decided to come up with a number of sub brands under the same name (Johnson name) and targeted people at different stages (Belch Belch, 2015). This is where teenage girls came in and later the company started to bank on them as the sole costumers to its product. Purpose or Objectives of Johnson and Johnson Advertising Campaign in Measurable Terms The purpose or the objectives of the subject company in measurable terms was to become the first in ranking with respect to skin care brand. This it planned to achieve through increasing the product value and quality as well as producing a list of skin care brands for the teenage girls to clear spots (Booth Koberg, 2012). The other was to become one of the most popular brands that have got medicinal input among female teenagers. This was majorly because it is the medicinal substances that were going to clear the spots that may occur on the ladies skins. The final objective was to ensure an establishment of relationship between the company and the teenage girls. This was mainly aimed at establishing loyalty to Johnson Johnson for as long as they live. In order for the company to achieve the above objectives in measurable terms, it had the task of encouraging the subject girls to believe in them and convince them, that they understood the girls needs. Commenting on the Feasibility of the Subject Companies Objective with Regards to Budgets, Time and also Market Factors Feasibility in simple terms refers to the state or the degree of something to be done with ease. The feasibility on the subject in view of budget, time and market factor was possible only if a number of plans were developed. For example, market factor was dependant on the laid strategy that the company was going to use to outdo other companies with the similar product brand. In every market there has to be competitors and every competitor will always want to be at the peak. This is the basic reason why between 1992 to 1996, Johnson Johnson Company was still not able to take the top position due to poor promotional strategies. The feasibility of time and budget were achievable since there was enough time spans for the company to improve its dealings and rise to the top. That on budget was also possible since the company had laid strategies for improvements with an inclusion of the budget. Difference Between American Consumer Responses and British Responses American consumer responded positively and the Girls talking worked perfectly well with them and therefore, there was much sale made whereas the response of British consumers was negative since they never saw something good in the advertisements made. This therefore reduced sale among the British consumers (Brown, 2011). One Legal or Ethical Issue that would arose in the Course of the Campaign directed towards Teenage Girls One of the ethical concerns that would have arisen during the campaign would have been on the teenage girls were assisting in promotional activities ensuring that they operate within the legal policies and not violating any promotional laws. Summary on how J J Allocated Resources The first resource allocation by the subject company was on the buying of company name from Revlon in 1991, the other resource allocation was on achieving its strategies for achieving objectives. Much of which went to advertisements and also products promotion, this is the area where consumers in both America and Britain were also generalized since they were targeted through advertisements (Szetela Kerschbaum, 2010). Describing Campaign Length, Service Providers Chosen, Time Frames and Milestones chosen in this Particular Case Study The campaign length of J J Company in respect to its product was seven years. This is because the launch of the company name under clean and care that was bought from Revlon was in 1991. This is when it began its campaign till 1998 when it was able to achieve its objective of being the best in ranking. The service provider chosen by the subject company were mainly confident teenage girls who ensured that the company achieves it goal. This they did by engaging in promotional activities among other things of services to entice majority of teenage girls across Britain and U.S. to buy the brand (Anderson North Seattle Community College, 1975). The detailed response provided, goes hand in hand with time frame and answers the aspect of milestone as well. Answers or Responses to what should be included in the Marketing Plan Meeting Organizational and Marketing Objectives and Incorporating Marketing Approaches and Strategic Marketing Mix. The marketing plan of Johnson Johnson Company explores at a greater extent the number of objectives as well as its marketing approaches and not also excluding the marketing strategic mix. Some of its grand objectives includes; striving and raising to being one of the best dealing brand, consolidating a great number of consumer and finally establishing good rapport with consumers. Major marketing approach for this is on monopolizing the marketing field by the wide variety of brand product produced. Finally the strategic marketing mix as indicated in the diagram mainly provides a guideline on how the plan will be explored. Rationale for the Mentioned and Information that Supports the Choice of Strategies and Tactics The major rationale is to ensure that the performance of the company is at a better position and can maintain its pace of value addition. Presentation of the Plan in Time Frame and Particular Format The subject presentation is in the table of marketing plan below with the required time frame and the format that has been adopted from the Australian Marketing Plan Template. Showing How Adjustments have been made in Response to offering Feedback to Key Stakeholders for Implementation within the Required Time The adjustments made in line with the marketing plan in question are in reference with the time frame the company is to start operation and the time of implementation. It is after Implementation is done with when feedback will be provided. The details of the same are summarized in the template below. Marketing Plan of a Company of My Choice Johnson Johnson Company Management Plan Question Explanation More information Companys name Johnson Johnson Company Visit our Companys website (1) Companys objective To be the best in dealing brand Consolidate a great number of consumers in the market. Establish good rapport with consumers Visit our Business objective topic Companys strategy Using promotional services like the social media Coming up with discounts that will still leave the company having its profit to attract consumers Providing a wide variety of products related to the brand. Visit our Company strategy topic. Answer for number 1) Still, Marketing approaches as well as strategic marketing mix Monopolizing the marketing field by the wide variety of brand product produced Examine our performance in the stock exchange market Financial details for the plan An approximate of 3million dollars to be used in strategy application See our company financial books. It can be accessed through our major branches. Number 2) Rationale for business objectives The main rationale is to ensure that the performance of the company is at a better position and can maintain its pace of value addition Refer to our strategy reference within the marketing plan Answer for Number 4) Adjustments made in response to feedback from key stakeholders By the second and third year, there should be results seen (positive results) Fourth year of companies operation, financial analysis. An adjustment of two years is provided, then on the seventh year, response made to key stakeholders Visit of major offices Answer for Number 3) Time frame The first strategy to be executed between the first and second year, the second and third strategy should be realized by forth year. Implementation of the strategies should begin immediately the company begins operation but response to be made on the seventh year to key stakeholders You can go through the companys overview book Note; The table represents the format that has been adopted from the Australian Template thus answering question 3 that is also pegged to Time Frame. References Anderson, V. F., North Seattle Community College. (1975). Revival of Political Americana: An Analytical Review of the Organizationof Candidates' Fair '72. Belch, G. E., Belch, M. A. (2015). Advertising and promotion: An integrated marketing communications perspective. Booth, D., Koberg, C. (2012). Display advertising: An hour a day. Hoboken, N.J: John Wiley. Brown, B. C. (2011). How to use the Internet to advertise, promote and market your business or website-- with little or no money. Ogden, J. R., Rarick, S. (2010). The entrepreneur's guide to advertising. Santa Barbara, Calif: Praeger. Pride, W. M., Hughes, R. J., Kapoor, J. R. (2010). Business. Australia: South-Western/Cengage Learning. Szetela, D., Kerschbaum, J. (2010). Pay-per-click search engine marketing: An hour a day. Indianapolis, Ind: Wiley.

Cynthia I. Quintana Essays - Othello, Iago, Roderigo, Brabantio

Cynthia I. Quintana Racial Background Effect in Othello During the Elizabethan times it was uncommon for black people to act out roles in plays. Shakespeare introduces this to his audience in two plays, the first Titus Andromicus and the second Othello. The first black character, Aaron, is portrayed as a secondary villain. Othello on the other hand is of higher status than many of his peers in the play. This was different for Shakespeare to present a minority person with such authority as a main character. Even with such, many different racial slurs were used by supporters to degrade him. In Act I, Scene I, Iago, the villain in this play and at the same time the right hand man of Othello, is screaming to Desdemona's father from the outside of his house "even now, now, very now, an old black ram is tupping your white ewe" (Shakespeare 1051). The "thick-lips" (Shakespeare 1050) is mentioned in this play towards Othello but is not the first time Shakespeare uses it. He uses the phrase in Titus Andronicus to describe the biracial child of the Moor, Aaron. Moor is another term frequently used to identify those darker skinned people. (Shakespeare 1052). Brabantio goes as far as accusing Othello of witchcraft. He says that Othello must have used "drugs and minerals" to get Desdemona to marry his "sooty bosom". Iago instigates the characters in this play that do speak foul of Othello. It is quite obvious from the beginning of the story that Iago is betraying Othello. Iago mentions to Roderigo "I am not what I am". The choice of words he used towards Othello does not necessarily mean that he is a racist yet at the same time I do not feel that Othello's Quintana -2- background effects the events in this play. With or without Othello being a Moor the outcome of the play would have worked as well. Name-calling, which is how I describe what Iago was doing throughout the play, is a common way of trying to degrade someone even in today's society. You try to find something in your opponent that distinguishes him from yourself and the people who defend you and you use this to break down their esteem. Iago, out of jealousy, calls Othello names behind his back and still with all this. Iago is very clever in making Othello vulnerable to his word. Iago's manipulation to Othello is never specified to be race related although racial slurs are what he constantly repeats. He simply uses these remarks to mock Othello. This is evidence that leads me to believe that if Shakespeare would not have made Othello of the same race as the rest of the characters the plot of this story would have remained the same and it would have flowed just as well. Shakespeare would just have had to use other non-racial yet discriminating words against Othello. Love and jealousy are the central feelings portrayed in this story, not racism. All Iago wants is to take over the leadership power that Othello has. He enjoys creating chaos as all villains do and will stop at nothing to get what he wants. This demonstrates the evil he has within himself. Iago persuades Roderigo to sell all of his belongings so that there may be a chance between him and Desdemona. (Shakespeare 1065) Two-faced Iago also flourishes Desdemona with his praises. (Shakespeare 1068) is making himself out to be a loyal friend in her eyes everyone is easily influenced by Iago. He has his way with everyone. Neither Roderigo nor Desdemona are different in color Quintana -3- complexion for Iago to deceive them but he does anyway. They are all part of his betrayal. Iago is all for himself. He even goes to the extent of convincing his wife to steal a handkerchief from Desdemona and then made it part of his scheme. There were no limits for him. He took down whomever he had to. Even though Othello was black he was integrated into the Venetian society and was also the states military champion against the Turks, which made his status equal to that of Desdemona's father, Brabantio. Prior to Othello having eloped with Desdemona Brabantio had invited this Moor to his house and held this black man as one

Muscat Securities Market

Muscat Securities Market IntroductionAs emerging markets fund managers have scanned the world looking for new investment opportunities in recent years, the Gulf States have largely been unnoticed. Oman, however, has begun to open its door to overseas buyers. The Muscat Securities Market (MSM) was officially established in June 1988, with trading beginning in May of the following year. Since then, it has rapidly expanded with turnover increasing from $24.7 in 1989 to around $200 million per annum. It is anticipated that, as the size of the market grows and as foreign buyers commence to arrive, the liquidity of shares in the market should augment further.From a starting point of 75 listed companies in the exchangeÂÆ'‚‚s first year of operations, the number of quoted companies has now amplified to 95. These have a combined total value of over $1.7bn. The 10 largest companies, which are profiled below, account for two-fifths of the market, which has now managed to attract over 60,000 shareholders, a not inconsiderable number in a country of two million people.The Omani bourse consists of 3 main sections: The Regular Market - for the main corporations in Oman, who satisfy the strict listing criteria, the Parallel Market - for recently established companies and those which have ceased to satisfy the criteria for a full listing on the regular market, such as those which have incurred a loss in the last trading year, the Third Market - off-floor trading for business entities which are not joint stock companies or have a subscribed capital of less than RO 500,000.There are 9 brokerage firms operating in the MSM 2 of which act solely as underwriters, with the remaining seven trading on the floor on behalf of investors as well as on their own account.Since its inception, the main share index has...

Journal Assignment for documents and videos Essay

Journal Assignment for documents and videos - Essay Example At one vantage point, books are typical form of secondary source. Mostly scholars use primary sources material to make secondary sources for example letters and diaries to write books. It is also easy to determine whether a book functions as a primary source in case of published memoirs, autobiographies, and published documents. Also use of video in class, where the students to can see clearly charts, tables or concept maps are the most significant areas where students can find key ideas and relationship among ideas. In museum graphics organizer are there so that students can answer most historical questions, write connections, and relate to particular observation to larger concepts. Videos also help students to compare and contrast, a strategy that help analyze similarities and differences, this can be applied to in museum exhibitions and resources too. Forms film give the students a tangible feel of what people felt and how things were happening that time. Those videos show clarity to what may seem random happening. Examples of primary source include constitution, pamphlet, treaty, a law, and city council proceedings in political history. In cultural history, we have Novel, dance, music oral traditions, key religious work, and training manual for new converts, visual art, costume, and religious tract. Also in social history, we have Lyrics such as protest songs, laws, college catalogues for curriculum and types of students, letters, biographies, and news reports. According to economic history, primary sources are tax filing, will, and foreclosure records, patent applications Business ledger and contract placards. In military history it includes, map, soldier diary, weaponry, uniform and strategic and tactical plans. Court transcript, judicial ruling, parole officer report, police report in legal history and A law, constitution, pamphlet, treaty, city council proceedings finally in political science. Handling of selected primary documents. Identifying primary sources and using them requires a careful thought and some extra knowledge. Primary sources increase questions, may be among them: primary source is what? What is the level of history in these primary sources among others? They stand for range of concerns from vital studying skills to the nature and historical knowledge. There basic questions we must know their answers so that we can identify source of primary data: 1. Is the source is self-published? 2. What is the level of history does the source belong? 3. Is the source independent? 4. Where did the document originate? 5. The limitations present in the document. 6. Why is the document there? 7. How reliable the document is? All above will determine how we handle our primary document, which are useful in working definitions about historical sources and practical tips for reading primary documents. The theory of primary, secondary, and tertiary sources came from academic discipline of historiography. It gave historians away to indi cate how related was the piece of information to real events . It is vital that the concept is with actions of events but not ideas or theoretical aspects. A primary source has about same time of event, despite the source of contents. Therefore, when a dictionary is a tertiary source, an ancient one is the primary source because it has the meaning of words in ancient world. There is no quaternary source; the sources may be primary, secondar

Entrepreneurship Coursework Example | Topics and Well Written Essays - 1500 words

Entrepreneurship - Coursework Example In such a way, the following analysis will seek to engage the reader with some of the reasons for why networking is such an integral aspect and should be appreciated to a more definitive level and degree. Firstly, the most obvious reason for why networking is ultimately important has to do with the overall level of connections that an individual can build within the business community. These connections have a clear linkage to the way in which consumers and producers can be linked. One does not need to delve too deeply into existing literature to find the way in which value chain management and the relationship between producers and suppliers must be delineated in order to come to an appreciation for the fact that these connections are an invaluable compote of seeking to further the business profitability and continued survival of a given entrepreneur/business entity. Ultimately, the goal of these connections, brought about might networking, is to create a series of friendships and a t least acquaintance with stakeholders within a variety of different fields. It must not be understood that networking is done solely as a means of benefiting the bottom line. Oftentimes, networking has the tangential benefit of allowing the individual entrepreneur to come to a more full and well nuanced knowledge of existing best practices within a given field. Through such a knowledge of best practices, the entrepreneur can then apply these best practices, changing them as he/she feels fit, to more appropriately embodied the goals and visions of their respective business entity. Within such a way, the entrepreneur becomes less insular and can rely upon the best practices of different individuals in different fields as a means of benefiting their own business. All too often, producers and entrepreneurs are caught in the unenlightened frame of mind that they are in a game against the world. Within such an unenlightened standpoint, the entrepreneur does not wish to accept the best pr actices for business approach that many other individuals that they might network with have utilized to a great level of success. However, a brief and cursory analysis of the existing business environment notices that many of the most successful and multinational firms have sought to engage best practices in other tangentially related businesses as a means of benefiting their own bottom line and approach to the consumer. Moreover, one can see an example of the importance that networking can have with respect to the way in which network theory, a sociological construct, delineates the way in which this can and should occur within the realm of both business and interpersonal interaction. As such, network theory denotes that the greater the level of connections that can be made the greater the empathy and synergy that can be developed within each of these relationships/networks. As such, using the case of a large multinational firm such as Apple, one can readily denote the fact that ne twork theory is definitively in use and applied across the board with regard to the way in which business interactions and needs fulfillment takes place. Finally, seeking to forge these networks can result in lasting friendships and network relationships which encourage business to grow beyond the market constraints. For instance, if a given supplier has formed a

Myofascial Triggger Point Essay Example for Free

Myofascial Triggger Point Essay This chapter is the review of the available literature concerning the theoretic content that is necessary to understand the trapezius muscle and its role in the symptoms associated with upper back pain. Particularly the issues about the types of trigger points, including a discussion of myofascial trigger point therapy and acupuncture trigger point therapy. More importantly the awareness and understanding on how to improve the quality of life by learning about the alternative options, making changes and applying self-help strategies on myofascial trigger points. Given this points, a brief description of the topics are noted: It is painful to say that about 23 million persons, or 10 percent of the U. S. population, have one or more chronic disorders of the musculoskeletal system (Imamura, Fischer, Imamura, Teixeira, Tchia Kaziyama, (1997). The most common reason for the breakthrough of pain and rigidity in the head, neck and shoulder is the development of myofascial trigger points (MTrPs) activity in those areas. Factors responsible to set in motion trigger point in the muscles of the neck and shoulder region include postural disorders, drooping of the shoulder girdle, direct and indirect overloading of the neck muscles, acute trauma to the neck and anxiety (Baldry, 2002). For instance, the muscle most often affected by MTrPs is the trapezius muscle. Any position or task that requires the shoulders to carry out the weight of the upper extremities repeatedly or for prolonged periods of time overloads the upper trapezius muscle, and strongly boosts the development of MTrPs (Mense, 2001). Incidentally, MTrPs extremely common and became a painful part of nearly everyone’s life at one time or another. ), the upper trapezius active MTrPs are common in patients presenting neck pain (Simons Travell 1999). Surprising statistics suggested that neck pain has a lifetime incidence of 45%-54% in the general population (Fernandez-de-las-Penas, Alonso-Blanco Mangolarra, 2007). Trigger points are tender to direct pressure or squeezing, they are painful and they are palpable as hard nodules. Rachlin, 2005). In fact, Simons Travell (1999) has described pain due to TrPs is a cause of pain in all parts of the body and it has been reported as a source of pain in numerous medical conditions. Patients presenting mainly with upper body pain or headaches are more likely to MTrPs pain than patients presenting with pain located elsewhere (Rachlin, 2005). Indeed, therapy for MTrPs has been used by Bilkstad and Gemmell, (2008) with anecdotal success in patients with non-specific neck pa in. Gemmell and Allen’s (2008) study also proved that a session of trigger point therapy, has a clinical meaningful effects in the treatment of acute trigger points of the upper trapezius muscle. Certainly acupuncture for MTrPs is an effective and efficient technique for the treatment of myofascial pain and dysfunction. That is, an acupuncture needle is inserted through the skin and moved gently up and down through the MTrPs. The effect is to de-activate the trigger point and relax the muscle according to Travell and Simons (1999). Furthermore, studies of neck pain have proposed that manipulation is an effective therapy, especially when combined with exercise (Rubinstein, Leboeuf-Yde, Knol, de Koekkoek, Pfeifle van Tulder, 2008). Gatterman (2005) stated that chiropractic treatment of the spine has a relaxing effect on the spinal muscle and a loosening effect on spinal articulations, hence making a difference in a number of ailments drawn by cervical structure. Historical Background Review  Back to 1816, British physician Balfour, as cited by Stockman, described â€Å"nodular tumors and thickenings which were painful to the touch, and from which pains shot to neighboring parts† (Stockman, 1904 p. 107-116). In 1841, trigger points have been documented in western medicine research. In the European literature, regional musculoskeletal pain conditions have been documented since the 18th century (Reynolds, 1983). Dr. Janet Travell (1901-1997) is generally credited for bringing MTrPs to the attention of healthcare providers. MTrPs have been described and rediscovered for several centuries by various clinicians and researchers as far back as the 16th century, de Baillou (1538-1616), Ruhmann (1940) described what is now known as myofascial pain syndrome (MPS). Bron Dommerholt, ( 2012, p. 1) acknowledges, myofascial pain syndrome is defined as the â€Å"sensory, motor, and autonomic symptoms caused by Mypfascial Trigger Points†, and has become a recognized medical diagnosis among pain specialists. The first trigger point manual was published in 1931 in Germany nearly a decade before Dr.  Janet Travell became interested in MTrPs These early descriptions and other historic papers did illustrate the basic features of MTrPs quite accurately (Simons, 1975). In 1966, Dr. Travell founded the North American Academy of Manipulative Medicine, together with Dr. John Mennell, who also published several articles about MTrPs (Mennell, 1976-1989). In the early 1960s, Dr. David Simons was introduced to Dr. Travell and her work, which became the start of a fruitful collaboration eventually resulting in several publications, including the Trigger Point Manuals (Simons Travell 1999). The Trigger Point Manuals are the most comprehensive review of nearly 150 muscle referred-pain patterns based on Dr. Travell’s clinical observations, and they include an extensive review of the scientific basis of MTrPs. Both volumes have been translated into several foreign languages. These books are considered the definitive reference on myofascial pain and locating trigger points. Trapezius Muscle This diamond shape muscle is situated in the neck and upper part of the back and lies most superficially (Moore Dalley, 2006). It was given its name because the muscles of the two sides form a trapezium. The main action of the trapezius is to aid in head, neck and the clavicle movement. The trapezius commonly contains trigger points, and referred pain from these trigger points bring patients to the office more often than for any other problem. Figure 2. 1 shows the trapezius- a large kite-shaped muscle, covering much of the back and posterior neck. There are three main parts to the muscle: the Upper, middle, and lower part. Each part has its own actions and often different functions. Figure 2. 1 Trapezius Muscle Namely the upper portion of the trapezius muscle laterally flexes the head and the neck towards the same side, and assists in extreme rotation of the head so that the face turns to the opposite side. It can draw the clavicle backwards and raise it by rotating the clavicle. It usually helps to carry the weight of the upper limb during standing, or support a weight in the hand with the arm hanging. Acting bilaterally, the upper fibers extend the head and the neck . The upper trapezius can reflect headaches on the temples, dizziness, severe neck pain, intolerance to weight on your shoulders. While the middle trapezius reflects pain on the mid-back, headaches at the base of your skull and superficial burning pain close to the spine. On the other hand lower trapezius on the mid-back refers pain to the neck, and/or upper shoulder region (Simons Travell, 1999). Figure 2. 2 Trapezius Trigger Points Myofascial Trigger Points The word myofascial means muscle tissue (myo) and the connective tissue in and around it (fascia). According to the most commonly accepted theory, a myofascial trigger point ( Figure 2. ) is an area of hypersensitivity in a taut band, or contraction knot of skeletal muscle with respect to pain (Simons, et al. , 1999), as opposed to healthy muscle, which does not contain taut bands or trigger point (Shah, et al. 2005). The trigger point feels like a pea embedded within the muscle to the touch. A trigger point is always tender and becomes painful, like contracted knots that refers pain and tightness upon direct compression and is mediated by a local twitch response (Hong, 2006; Simons et al. , 1999; Simons, 2004). Auleciems (1995) furthermore researched the incidence of MPS, reported to be as high as 85% at certain American pain clinics. Figure 2. 3 Myofascia Trigger Point Taut Band Myofascial Trigger Point Development There are existing studies to account for the development of trigger points and subsequent pain patterns, but scientific evidence is lacking. Many researchers concur that an acute injury or repetitive small injuries may lead to the development of a trigger point which creates some degree of tissue damage (Rachlin, 2005). The damage to muscle and connective tissue can befall several ways. From lack of exercise, prolonged poor posture, vitamin deficiencies, sleep disturbances, and joint problems (Simons Travell, 1999). Examples of predisposing activities such as typing/moussing, handheld electronics, gardening, home improvement projects, work environments, holding a telephone receiver between the ear and shoulder to free arms; prolonged bending over a table; sitting in chairs with poor back support, improper height of arm rests or none at all (Simpson McCarthy, 2001); sustained loading as with heavy lifting, carrying babies, briefcases, boxes, wearing body armor or lifting bedridden patients. Injury from falling down stairs or whiplash injury in a motor vehicle accident (Lavelle, Lavelle, Susti, 2007). Myofascial Trigger Point Classification Trigger points are classified as being active or latent. The active, painful phase of the trigger point is the one which motivates people to seek relief. The active trigger point hurts when pressed with a finger and causes pain around it and in other areas. (Hong, 2006; Simons, 2004). The active trigger point referral symptom may feel like a dull ache, deep, pressing pain, burning, or a sensation of numbness and fatigue. If unaddressed or ineffectively treated, eventually other muscles around the dysfunctional one become stressed and develop secondary trigger points. It is not unusual for chronic pain patients to have multiple, overlapping referred pain patterns, making diagnosis and treatment more complex. Trigger points can also lie quietly in muscles, sometimes for years. This type of trigger point is called latent. Latent trigger points are very common. Probably one wont know they are there for the fact that they cause pain unless it is compressed. Latent trigger points cause restricted movement, distorted muscle movement patterns; stiffness and weakness of the affected muscle (Fricton, Kroening, Haley Siegert, 1985). When firm pressure is applied over the trigger point in a snapping often causes the muscle to â€Å"jump† or briskly contract a â€Å"local twitch response† (Simons et al. , 1999). The reaction of a twitch response during palpation of a trigger point, or during a trigger point release procedure, is a reliable confirmation that the trigger point has been accurately located. When a trigger point in one muscle can create pain in another area it is known as referred pain. This referred pain is felt not at the site of the trigger-point origin, but remote from it (Mense Schmit, 1977). For example (Figure. 2. 4), a primary trigger point in the upper trapezius muscle refers pain to the temple region of the head. All muscle tissue is potentially prone to developing trigger points. Fig. 2. 4 Referred Pain from Trapezius Trigger Points Treatment of Myofascial Trigger Points As a matter of fact treating each trigger point is relatively simple. Treating the whole myofascial pain syndrome so that pain fully goes away is a more complicated process. Pharmacologic treatment of patients with chronic muscle pain includes analgesics and medications to induce sleep and relax muscles. Antidepressants, anti-inflammatory drugs are often prescribed (Imamura et al. , 1997). The long-term clinical efficacy of various therapies is not clear, because data that incorporate pre- and post-treatment assessments with control groups are not available. No laboratory test or imaging technique has been established for diagnosing trigger points (Fricton et al. , 1985). However, the use of ultrasonography, electromyography, thermography, and muscle biopsy has been studied. A variety of hands-on skills, such as stretching, massage, manipulation, mobilization and strengthening (Simons, 2002), and a wide variety of modalities namely, diathermy, transcutaneous electrical nerve stimulation, ethyl chloride Spray and Stretch technique, dry needling, and trigger-point injections with local anesthetic, saline, or steroid heat, ice, ultrasound, electrical stimulation, mechanical pressure and light energy, are available to physicians and therapists for the treatment of trigger points (Edward Knowles, 2003). For instance trigger point therapies can help specifically a number of health issues such as: 1) Relieve migraine and headache 2) Alleviate low-back pain and improve range of motion Ease dependence over the counter or prescription medication 3) Release endorphins that work as the bodys natural painkiller 4) Enhance immunity by stimulating the bodys natural defense system. 5) Increase blood flow to bring oxygen (Dommerholt Huijbregts (2011, p. 18 ). The proposed principle of treatment of MPS is to inactivate the active MTrPs through the use of various therapeutic modalities (Hong, C. 2000). However, the various treatments are beyond the scope of this study, the main focus here is to determine the efficacy of acupuncture and myofascial trigger point therapy for upper back pain. Acupuncture Trigger point pain may result from old or new injuries, excessive work out, incorrect body mechanics and poor body posture. In this light, acupuncture treatments can help return the balance to muscles. It is one of the safest ways to address physical problems. Using FDA-approved grade of acupuncture needles, it stimulates the muscle fibers, generating involuntary twitching of muscles located on the suspect trigger point (Figure 2. 5). Usually leads to an immediate reduction of the tightness as well as a reduction or elimination of the related problems (Scholar Hong, 2000. Aside from relieving muscles from stress, acupuncture treatment releases endorphins, boosts the nervous system, enhances the immune system, and causes a number of other biochemical and hormonal changes (Napadow, Webb, Pearson, et al. , 2006). Acupuncture is a time proven and safe method to optimize health. In restoring balance to brain and nervous system functions, it helps regulate blood pressure, blood flow and body temperature, which is indirectly beneficial to managing and relieving body stressor (Birch, Hesselink, Jonkman, et al. , (2004).