Chronic Low Back Pain (CLBP) Literature Review on Treatment

Chronic Low Back Pain (CLBP) Literature Review on Treatment INTRODUCTION Chronic low back pain (CLBP) is a major health issue in the western world and is a significant burden on health care; Americans spend $37 billion annually with a further $19.8 billion lost in absenteeism [1]. There is 58% life time prevalence of back pain in the UK, a 22-65% 1-year prevalence and 6-7% of all adults have constant back problems [2]. Although CLBP is usually benign ( Modern (Verum) acupuncture originates in ancient Chinese philosophy which claims pain and disease manifest because of imbalances in bodies forces of Yin and Yang. It is believed these forces flow through specific courses (meridians) and can be manipulated using specific acupuncture points to regain the balance. Acupuncture has evolved from the traditional Chinese application and some styles incorporating adjuncts such as electrical stimulation of the acupuncture needle [4], A recent systematic review of articles published between 1966 and February 2003 [4] concluded that the efficacy of acupuncture on CLBP was inconclusive due to the low methodological quality of selected studies. They found acupuncture had some short-term improvements in pain and function compared to control or sham but due to low methodological quality they concluded a need for higher quality studies. This review updates that study [4] by including articles published after February 2003 or studies that were published prior but were of high relevance and methodological quality. The objective is to provide firm conclusions about the efficacy of acupuncture therapy for CLBP. METHODS Study Selection Criteria Only randomised controlled trials (RCTs) available in English and available free of charge were included. Search Strategy In October 2009 the MEDLINE database (period 1950 to date) was searched for RCTs published after February 2003 and matching the search string Chronic low back pain AND acupuncture OR dry needling OR Sham OR Placebo AND randomised controlled trial OR randomized controlled trial. Further searches using PEDro, Web of Science (using ISI Web of Knowledge) and Cinahl (period 1982 to date) (see appendix A). Each articles reference list was also used as a source of relevant publications. Participants For inclusion the studies participants needed to be =18-years old with non-specific CLBP. Non-specific CLBP was defined as pain between the 12th costal margin and the inferior gluteal folds =12-weeks. If radiating leg pain was present this must be secondary to the lumbosacral region pain. RCTs that included participants with specific pathologies as the root cause of their CLBP, such as malignancy, prolapse of =1 inter-vertebral disc or spinal fracture were excluded. Interventions Studies that investigated the effects of traditional (Verum) acupuncture, trigger-point acupuncture and dry needling were reviewed. RCTs were included regardless of hand of electro-stimulation. Studies investigating non-needle based acupuncture, such as laser acupuncture, were excluded. Control interventions included sham, usual care, Transcutaneous Electrical Nerve Stimulation (TENS) or conservative orthopaedic therapy. Outcome measures There are four outcome measures considered to be important when assessing CLBP Pain intensity (e.g. visual analogue scale (VAS-P), numerical rating scale (NRS-P)) A global measure (e.g. Overall improvement, proportional recovery of patients) A back specific functional status measure (e.g. Roland-Morris Disability Questionnaire (RMDQ)) Return to work (absenteeism, speed of return) RCTs must include =1 of the above. The primary outcomes were pain and function. Study selection A total of 544 studies were found through the searches with 17 potentially eligible RCTs identified. Of these 5 were excluded due to study duplication (n=1), sole inclusion of participants with specific CLBP (n=2) or use of non-needle based acupuncture (n=2). The remaining 12 articles were reviewed using the Critical Appraisal Skills Programme (CASP) to determine their methodological quality. CASP enables the systematic review of an RCT for validity, design, execution and reasoning. Assessment criteria included randomization and allocation of participants, blinding of participants and assessors, identification of potential observer bias, participant numbers at RCT start and conclusion, presentation and accuracy of results, and any identified limitations. Results were recorded and documented (Appendix B). RCT commonalities: Participants were excluded: if they exhibited contraindications to acupuncture, had received acupuncture for their CLBP previously, previous spinal surgery, infectious spondylopathy, malignancy, congenital spine deformity, compression fracture due to osteoporosis or spinal stenosis. No differences in demographic variables or baseline levels of pain and disability were detected between the groups at baseline (P >0.05). Randomization was computer-generated with random number tables. All participants gave informed consent. Each RCT received ethical approval Usual care is defined as a combination of drugs, physiotherapy and exercise. RESULTS [5] 298 participants with CLBP =6-months randomised to 12 sessions of acupuncture (n=146) or sham acupuncture (n=73) over 8-weeks, administering therapists had =140 hours training and 3-years experience, with a third delayed acupuncture group (n=79) who received no acupuncture for the initial 8-weeks followed by the acupuncture groups protocol. Outcome measures were VAS-P and back function using the validated German Funktionsfragebogen Hannover-RÃ ¼cken (FFbH-R) questionnaire. At 8-weeks VAS-P decreased from baseline in all groups; after 26 and 52-weeks the acupuncture groups results were better than sham however differences were not significant. Results from the delayed acupuncture group followed the acupuncture groups pattern. The trial had good methodological quality: outcome measures were assessed independently with participants completing questionnaires, attrition was reasonable (18%) but the acupuncture group was double the size of the others which may have influenced results. [6] 638 participants with CLBP =3-months randomised to standard acupuncture (n=185), individualised acupuncture (n=157), sham acupuncture (n=162) or usual care (161) groups. Acupuncture groups received 10 treatments over 7-weeks by acupuncturists with =3 training. The Primary outcome measure was RMDQ. Compared to baseline all groups showed improved function and pain at 8-weeks. Mean values for RMDQ were consistent up to 52-weeks with the usual care group having greater dysfunction than all acupuncture groups (P=.001). There was no significant difference between real and sham acupuncture groups (P>0.05). All forms of acupuncture had beneficial and persisting effects over usual care for CLBP treatment with clinically meaningful functional improvements. There were no significant differences between acupuncture groups. Outcome measures were gathered by blinded telephone interviewers and attrition was low (6%) resulting in good trial internal validity [7] 1162 participants with CLBP =6-months randomised to 5-weeks of twice-weekly acupuncture (n=387) or sham acupuncture (n=387), performed by acupuncturists with =140 hours training. A third group received usual care (n=387). Outcome measures were Von Korff Chronic Pain Grade Scale (GCPS) and Hanover Functional Ability Questionnaire (HFAQ). Results were presented as a percentage of improvement in function and pain at 6-month follow-up. At 6-months both acupuncture groups had significant improvements in pain and function compared to baseline and usual treatment. There was no difference between acupuncture groups (p=0.39). The trial was methodologically strong with good internal validity: the control group was an active multimodal conventional therapy, had high power with stated calculation, follow-ups at 1.5, 3 and 6-months, low attrition (4%) and balanced dynamic randomisation. This was a good, highly relevant, large, rigorous trial. [8] 35 participants, =65-years, with CLBP =6-months randomised to 1 of 3 groups receiving 2 3-week phases of 30-minute acupuncture sessions, with a 3-week interval between. Group A (n=12) received standard acupuncture, Group B (n=10) superficial trigger-point acupuncture and Group C (n=13) deep trigger-point acupuncture. Outcome measures were VAS-P and RMDQ score. Group C showed a statistically significant VAS-P and RMDQ reductions from baseline after phase 1 with VAS-P reduction persisting over 12-weeks. There was no significant reduction in VAS-P or RMDQ for either other groups. The RCTs methods are described well however small sample size, high dropout (27%), short-term follow-up and potential bias limited internal validity [9] 26 participants, =65-years, with CLBP =6-months randomised to 2 groups. Over 12-weeks each group received 1 phase of trigger-point acupuncture and 1 phase of sham acupuncture with a 3-week break between. Group A (n=13) received trigger-point phase first followed by sham, Group B (n=13) vice-versa. Acupuncturist had =4-years training and =7-years clinical experience. Outcome measures were VAS-P and RMDQ score. After phase 1 Group A had significantly lower VAS-P (P [10] 60 participants with CLBP =6-months randomised them to 6-weeks of 30-minute weekly sessions of either acupuncture (n=30) or placebo TENS (n=30). No details of administering therapists were given. The primary outcome measure was VAS-P. Although acupuncture showed highly significant differences in all the outcome measures between pre- and post-treatment, the differences between the 2 groups were not statistically significant. Generally the RCT was poor: therapists were not blinded, high noncompliance (23.3%), cointerventions might have influenced results, the dropout rate was not explained and there was no intention-to-treat analysis. [11] 131 participants 18-65 years old with CLBP =6-months were randomised to groups receiving 20 30-minute sessions of traditional and auricular acupuncture (n=40), physiotherapy (n=46) or sham acupuncture and physiotherapy (n=45), over 12-weeks. Outcome measures were VAS-P and pain disability index (PDI). After 12-weeks of treatment the acupuncture group showed significantly reduced pain and disability compared to the physiotherapy group but not compared to the sham group. At 9-months the acupuncture group was more effective than physiotherapy in reducing disability only and not different to sham. The trial was methodologically strong but short-term dropout was 24% and long-term 37%. The treatment scheduled was five-a-week for 2-weeks then weekly for 10-weeks which may not be clinically practical. [12] 55 participants =60 yrs, with CLBP =12-weeks were randomised to 2-weeks of twice-weekly acupuncture and electrical stimulation alongside usual care (n=31) or usual care alone (n=24). Primary outcome was RMDQ. At 6-weeks results indicate clinically and statistically significant improvements in the acupuncture group for pain and disability compared to control. Effects remained and only diminished slightly at 9-weeks follow-up. The trial was methodologically strong: balanced randomisation, clear methods, low attrition (14%). Participant inclusion criteria included prior imaging limiting generalisability. [13] 186 participants aged between 20 and 60 with CLBP =6-week were randomised to 4-weeks of usual care alone (n=60) or with either acupuncture (n=65) or sham acupuncture (n=61). Acupuncturists were experienced doctors trained in Beijing. Primary outcome measure was VAS-P. Immediately after treatment 65% of the acupuncture group reported a =50% reduction in VAS-P compared to 34% of the sham group and 43% of the usual care group. At 3-months 79% of the acupuncture group, 29% of the sham group and 14% of the usual care group reported a =50% VAS-P reduction. Methodological quality was high: balanced (stratified) randomisation and excellently described methods however there was 30% attrition at 3-month follow-up and data collection was from general practitioners leading to potential performance bias. [14] 241 participants, aged 18-65, with CLBP for 4 to 52-weeks were randomised to 10 sessions of acupuncture (n=160) or to usual care (n=81) over 3-months. Acupuncturists were training for =3-years and =12.8-years clinical practice. Outcome measures were SF-36 pain scores and Oswestry low back pain disability questionnaire (ODI) taken at baseline, 3, 12 and 24-months. A power calculation stated a required 100 participants per group to detect a 10-point difference on SF-36 (90% power and 5% significance level). A 5 point difference in SF-36 was deemed significant. The number of participants in the acupuncture group was increased to 160 to allow for between-acupuncturist effect, usual care group decreased to 80 participants without power loss. Results were presented as point differences between randomisation, 12 and 24-months. At 12-months a 5.6 point intervention effect difference in SF-36 pain was found and 8 point at 24-months. No treatment effect was found for any other dimension o f SF-36 or ODI. Participants were representative of UK population, randomisation was balanced, methods were thoroughly documented and acupuncture treatments were individualised resulting in high methodological quality and generalisability. However 25% of participants were unaccounted for at conclusion reducing internal validity. [15] 11630 participants with CLBP =6-months were allocated to three groups. Group A were received 15 individualised acupuncture sessions with usual care as needed (n=1549). Group B received delayed acupuncture with usual care as needed (n=1544). Group C declined to be randomised but received 15 individualised acupuncture sessions with usual care (n=8004). Treatment was over 3-months. Outcome measures were FFbH-R and SF-36 pain scores. At 6-months the acupuncture group showed significant improvements in FFbH-R and SF-36 pain compared to routine care alone. The large sample size and broad inclusion criteria meant results were generalisable however groups were different at baseline and findings identified a degree of randomisation selection. [16] 52 participants with CLBP =6-months were randomised to 4-weeks of physiotherapy with daily 1-hour electro-acupuncture sessions (n=26) or standard physiotherapy (n=26). Outcome measures were pain (NRS-P) and function using the Aberdeen-LBP. There was a significant reduction in NRS-P and Aberdeen-LBP scores in the acupuncture group immediately after treatment and at 1 and 3-months follow-up. Methodological quality was limited by possible breach of blinding integrity due to lack of patient blinding and subjective outcome measures. DISCUSSION Acupuncture vs. no treatment Two high quality studies (11928 people) [5] and [15] found acupuncture more effective in short-term pain reduction and functional improvements than no (delayed) treatment. However both studies were weakened by insufficient blinding and participants were recruited from newspaper adverts [5] or an insurance company [15] limiting generalisability; both of which reduce results confidence. Acupuncture vs. sham Studies comparing acupuncture and sham acupuncture (2460 people) ([5], [6], [7], [11] and [13]) found both effective at reducing pain and increasing function compared to baseline measures; however no study found a clinically significant difference between groups With five methodologically sound trials all reporting similar results clinicians can have confidence in the effectiveness of acupuncture or sham-acupuncture in pain and functional improvements. However with no clinically significant difference between groups, placebo effect seems to be a substantial contributing factor. Acupuncture vs. usual care Five RCTs comparing acupuncture and usual care (12164 people) ([12], [13], [14], [15] and [16]) concluded that acupuncture was more effective at reducing pain. Increased function in the acupuncture group compared to control was reported in 1 RCT [12] at 6- and 9-weeks, [15] at 6-month and another [16] investigated effect immediately after treatment and 1- and 3-months follow-up; however 1 RCT [14] found no significant improvement in function in their longer-term study at 12 or 24-month. Unlike other papers reviewed, Thomas and colleagues used UK based participants who received treatments in private or GP clinics adding confidence to their conclusions when applied to the general UK population. From study findings clinicians can have confidence that the addition of acupuncture to their treatment of CLBP will be more effective than usual care alone. Acupuncture vs. deep and superficial trigger-point acupuncture One study ([8] 35 people) found greatest improvements in pain and function using deep trigger-point-acupuncture. However this study, while being methodologically thorough and having patient and assessor blinding, was limited by small size, high dropout (23%), short-term follow-up and possible centre bias leading to reduced clinical confidence. Acupuncture vs. TENS One RCT ([10] 60 people) found significant improvements using both TENS and acupuncture but no significant intergroup difference over 6-months. However, confidence in results are limited because participants also received usual care and exercise so may have improved regardless; furthermore the study had no therapists blinding, high noncompliance (23.3%), unexplained dropouts and no intention-to-treat analysis. Trigger-point acupuncture vs. sham In 1 cross-over trial ([9] 26 people) trigger-point acupuncture was found to be more effective than sham however small sample size, high attrition (23%), restricted to short-term follow-up and possible bias due to centre location (Department of Orthopaedic Surgery, Meiji University of Oriental Medicine) limit confidence in findings. LIMITATIONS Studies were commonly limited by being unrepresentative: of the 12 studies 2 were UK based ([10], [14]), six restricted participants by age ([8], [9], [11] [12], [13], [14]), 2 used participant recruitment methods which may have introduced expectation bias (newspaper adverts, [5], insurance company [15]) and five had underpowered sample sizes or non-stated power calculations ([8], [9], [11], [12], [13]). Without representative sample groups the outcome measures cannot be applied to the general population with any reliability. Discrepancies were noted in treatment frequency with control group participants receiving less attention than intervention participants [16]. Blinding was inconsistent across studies: 1 study ([5]) blinded participants in the acupuncture groups but not the delayed group, 1 study ([6]) blinded participants only, four ([7], [8], [9], [13]) blinded assessors and participant, 1 ([10]) blinded assessors only, 1 ([11]) blinded assessors and participants but not acupuncturists, three ([12], [14], [15]) had no blinding and 1 ([16]) blinded assessors but not participants. CONCLUSIONS There is some evidence for the efficacy of acupuncture for CLBP; compared to no treatment there was short-term ([5] 8-week and [15] 3-month) pain reduction and functional improvements. Compared to sham therapy both showed similar improvements in pain and function at short-term ([5] 8-week, [6] 8-week, [11] 12-week and [13] 3-month) and mid-term ([5] 6-month and 1-year, [7] 6-month, [11] 9-month) follow-up but no significant difference was detected between groups. Compared to usual care acupuncture showed significant improvements in primary outcome measures at treatment, short- ([12]6- and 9-week, [13]3-month, [16]1- and 3-month) and long-term ([15]6-month, [14]1- and 2-year) follow-up. Compared to superficial and deep trigger-point all treatments showed improvements but none were significantly different from each other. Both acupuncture and TENS were found to produce long-term ([10] 6-month) improvements but no significant difference was found between interventions. Comparing trigger -point therapy to sham, trigger-point was found to be more effective although benefits were not sustained. There is evidence that acupuncture alongside other treatments relieves pain and increases function better than individual therapies alone. Further research needs to be conducted to determine treatment frequencies and sustainability of treatment effects. Effective sham treatments need to be developed to establish placebo effect compared to acupuncture and other therapy types. Additional Resources Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R. (2003). Lost productive time and cost due to common pain conditions in the US workforce. JAMA;290(18):2443-2454. Maniadakis, N. and Gray, A. (2000) The economic burden of back pain in the UK. Pain, 84, 95-103. Koes BW, van Tulder MW and Thomas S (2006). Diagnosis and treatment of low back pain. BMJ; 332, p1430-1434 Furlan AD, van Tulder M, Cherkin D, Tsukayama H, Lao L, Koes B, Berman B. (2005). Acupuncture and Dry-Needling for Low Back Pain: An Updated Systematic Review Within the Framework of the Cochrane Collaboration. Spine 2005;30:944-963 Reviewed Journals Brinkhaus B, Witt CM, Jena S, Linde K, Streng A, Wagenpfeil S, Irnich D, Walther HU, Melchart D, Willich SN. (2006) Acupuncture in patients with chronic low back pain: a randomized controlled trial. Archives of internal medicine. 166: 450-457. Cherkin et al (2009) A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Haake M, Muller H, Schade-Brittinger C, Basler HD, Schafer H, Maier C, Endres HG, Trampisch HJ, Molsberger A. (2007). German Acupuncture Trials (GERAC) for chronic low back pain- randomized, multicenter, blinded, parallel-group trial with 3 groups. Arch Intern Med. 167(17):1892-1898. Itoh E, Katsumi Y, Hirota S, Kitakoji H. (2006). Effects of trigger point acupuncture on chronic low back pain in elderly patients a sham-controlled randomised trial. Acupuncture in Medicine. 24(1):5-12 ItohK. Katsumi Y. Kitakoji H. Acupuncture in Medicine. (2004) Trigger point acupuncture treatment of chronic low back pain in elderly patients: a blinded RCT. 22(4):170-7, Kerr DP, Walsh DM, Baxter D. (2003) Acupuncture in the management of chronic low back pain: a blinded randomized controlled trial. The clinical journal of pain. 19: 364-370 Leibing E, Leonhardt U, Koster G, Goerlitz A, Rosenfeldt JA, Hilgers R, Ramadori G. (2001). Acupuncture treatment of chronic low-back pain a randomized, blinded, placebo-controlled trial with 9-month follow-up. Pain 96 (2002) 189-196 Meng CF, Wang D, Ngeow J, Lao L, Peterson M, Paget S. (2003). Acupuncture for chronic lower back pain in older patients: a randomized, controlled trial. Rheumatology. 42:1508-1517 Molsberger AF, Mau J, Pawelec DB, Winkler J (2002). Does acupuncture improve the orthopedic management of chronic low back pain a randomized, blinded, controlled trial with3 months follow up. Pain 99 (2002) 579-587 Thomas KJ, MacPherson H, Thorpe L, Brazier J, Fitter M, Campbell M J , Roman M, Walters S J, Nicholl J. (2006). Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain. British Medical Journal.doi:10.1136/bmj.38878.907361.7C Witt CM, Jena S, Selim D, Brinkhaus B, Reinhold T, Wruck K, Liecker B, Linde K, Wegscheider K, Willich SN. (2006). Pragmatic Randomized Trial Evaluating the Clinical and Economic Effectiveness of Acupuncture for Chronic Low Back Pain. American Journal of Epidemiology 2006;164:487-496 Yeung CKN, Leung MCP, Chow DHK. (2003). The Use of Electro-Acupuncture in Conjunction with Exercise for the Treatment of Chronic Low-Back Pain. The Journal Of Alternative And Complementary Medicine..2003:9:4:479-490

The History and Impact of the Printing Press Essay -- Technology

Everyday people read newspapers and books, but where did printing begin? The movable type printing press by Johannes Gutenberg made this all possible. Johannes first conceived of this idea of the printing press in the 15th century in order to speed up the slow process of producing books (Bantwal). The movable type printing press, the first real technology of its kind, helped to solve problems, but in turn also caused problems. This technology did influence many areas of life in its lifespan. This includes challenging the church and poisoning people with the increased toxins from mass products of materials. Depending on one’s point of view, this invention could be the best or worst thing to happen during the 15th century. Regardless of that, the printing press’s influence was widespread and therefore, was a great invention for the machine’s time. Despite the negative repercussions of Gutenberg’s movable printing press, the machine is a positive technology. Johannes Gutenberg created the printing press in the year 1452. Four other technologies that were more or less common to different parts of the world, made the printing press possible. The first technology was a wine/olive in the screw-press, which areas of Asia and Europe used to obtain oils and create wines. The second invention was block-print technology that Marco Polo originally brought to Europe. A third technology is oil-based ink that was invented in the eleven hundreds. Since this ink smears on vellum, printing did not use this ink. Vellum was costly, but durable so books that took awhile to make utilized this material. Finally, the fourth material was paper, which many process make different forms of all over the globe (Bantwal). Gutenberg used these old technologies ... ...to thank. Everyone should know the origins of many of the technologies in the world and many of those do lead straight back to the printing press. Without this invention, the world would have stayed in the dark ages for generations. People, as a species would not be anywhere close to what we have achieved. Works Cited Bantwal, Natasha. "History of the Printing Pres." Buzzle.com: Intelligent Life on the Web. Buzzle.com. Web. 19 Apr. 2012. Beach, Justin. "Pros of the Printing Press." EHow. Demand Media, 08 Apr. 2011. Web. 19 Apr. 2012. Jensen, Carolyn. "Jensen Review." Rev. of The Printing Revolution in Early Modern Europe. Lore. San Diego State University. Web. 24 Apr. 2012. "Printing Press." ThinkQuest. Oracle Foundation. Web. 22 Apr. 2012. Ross, Tiffany. "Negative Effects of the Printing Press." EHow. Demand Media, 28 Mar. 2011. Web. 19 Apr. 2012.

Blocking rehearsal time with an interference task Essay

The theories of memory and how much, or how long we can remember things, and why, is a greatly studied area of Psychology as a science. Psychologists have created and recreated numerous tests and research methods in order to prove that their particular theory is correct. There are two main theories of memory: Levels of Processing (L.O.P.) and the Multi-store Model.  The L.O.P. approach was pioneered by two psychologist Craik and Lockhart (1972), who believed that the mind will remember things better if the information is processed on a deeper level, ie. thought about more, taking into account the amount of ‘work’ that is put into processing the information received. From research they discovered that the deeper the processing required the longer and more durable the memory is likely to be. They also identified what they believed to be three levels of processing: Structural – What something looks like.  Phonetic – What something sounds like.  Semantic – What something means.  From experiments and tests carried out, they found that the deepest level was semantic, and their reason for this, they argued, was because in order to extract the meaning from a word, and to consider it’s relevance in a sentence of words, requires a lot of processing. They decided that hearing a word and then trying to visualize it also requires some extensive cognitive processing, but not as much as semantic processing, and the least amount of mental work was required for structural processing, ie. what the letters look like. A test carried out by Craik and Tulving (1975), ‘Depth of processing and retention of words in episodic memory’ supported their theory. Another model which is highly regarded as one of the most influential theories of memory is the Multi-store model, in particular the two-process model, designed and tested by Atkinson and Shiffrin (1968, 1971). Their theory was that information received by the senses is primarily stored in the sensory store for a very short period of time before it is transferred to the short term memory. Atkinson and Shiffrin believed that when the information is in the short term memory (STM), it could either be rehearsed for a certain amount of time and then stored in the long term memory (LTM), or alternatively lost. Figure 1.1 illustrates the theory in an easier to understand way. Perhaps this is also an example of how the L.O.P. theory is flawed as although the diagram is seen to be structural information, it will probably provoke strong visual imagery. Atkinson and Shiffrin believed that ‘chunks’ of information received by the sensory store could be held in the STM for around 20 seconds, but only 5 to 9 (on average) chunks of info can be remembered without rehearsal. However, if rehearsed the chunks of information can be transferred into the long term memory and more items can be remembered. The theory of the rehearsal loop interests me, so I decided to look further into it and found that psychologists: Brown (1958) and Peterson and Peterson (1959) independently discovered a method for testing the existence of the rehearsal loop called the Brown-Peterson technique. This basically involves a list of trigrams (three letter words made up of consonants with no immediate meaning ie. BKD, as apposed to WHY) shown to subjects for 20 seconds, rehearsed for 25 seconds and then recorded in order by the subject as well as possible. The same list is then shown to another subject for the same amount of time, however this time the 25 seconds rehearsal time will be interrupted with an interference task ie. counting backwards in threes from the number 58. This is the technique I will use as a basis of my mini-cognitive research project. AIM:  To test the existence of the rehearsal loop by preventing it from its task with an interference task during the rehearsal time.  RATIONALE:  I will be re-creating the Brown-Peterson technique for testing the existence of the rehearsal loop, although my study will use slightly different trigrams, and obviously a different set of people. I’m interested to check whether the results of my study will support the results found by Brown-Peterson or not. I will use a set word list for both groups of people studied and I’m expecting the results of my study to support the results of previous tests, thus supporting the theory of existence of the rehearsal loop. HYPOTHESIS:  When asked to recall the list of trigrams in order after a period of 25 seconds rehearsal time, the subject will remember significantly more trigrams if the rehearsal time is not interrupted by an interference task.  NULL HYPOTHESIS:  Subjects taking part in the experiment will not recall a significantly greater number of words whether their rehearsal time is interrupted with an interference task or not. Any difference found is purely down to chance. METHOD:  The method I chose to use in order to obtain the clearest and most reliable data was the laboratory experiment. The reason for using this method is to reduce the amount of extraneous and possibly confounding variables which could interfere with the results; also it becomes very easy to repeat the same test over and over without change. I will use the independent groups design to ensure that different participants are used for each test in order to avoid the chances that the participants will skew the results through rehearsal. The first set of participants will be shown a list of 15 trigrams for 20 seconds, after which time they will be asked to rehearse these for a period of 25 seconds. After that time they will then be asked to write out as many as possible in the correct order (if the trigram is BHD then the participant must write BHD, no mark will be given for BDH). The results will then be recorded.  The same set of trigrams will then be shown to a different set of participants for the same amount of time. This time however during the 25 seconds rehearsal time, the participants will be asked to perform an interference task, which will be counting backwards in sets of 4 from the number 295. After the 25 seconds, they too will be asked to recall the trigram list and their results will also be recorded.

Christopher Columbus Discovery Of The America - 1124 Words

Nowadays, the world is not difficult to see that human rights are the words. I think the human right suggests that the size of the Board. Christopher Columbus’ discovery of the America is frequently considered one of the most important incidents that propelled the West to the front stage of history until today. It is because since the late 15th century the West began sailing across the oceans and founded colonies wherever they landed. All the places the European conquistadors took over, however, none incurred more horrifying damage and suffering than the indigenous peoples in the Americas. There were laws that protected some of their rights. But their life was not an easy one, and the punishments meted out to people who wronged were harsher than those for non-servants. An indentured servant s contract could be extended as punishment for breaking a law, such as running away, or in the case of female servants, becoming pregnant. For those that survived the work and received their freedom package, many historians argue that they were better off than those new immigrants who came freely to the country. Their contract may have included at least 25 acres of land, a year s worth of corn, arms, a cow and new clothes. Some servants did rise to become part of the colonial elite, but for the majority of indentured servants that survived the treacherous journey by sea and the harsh conditions of life in the New World, satisfaction was a modest life as a freeman in a burgeoningShow MoreRelatedChristopher Columbus And The Discovery Of The Americas1303 Words   |  6 PagesAt the be ginning of the book Christopher Columbus and the Discovery of the Americas, the author Tim McNeese is telling us a general explanation of why Christopher Columbus is so recognized. 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Columbus’s deeds are soured by false motives, violence against theRead MoreChristopher Columbus Discovery Of The Americas919 Words   |  4 PagesChristopher Columbus’ discovery of the Americas set the precedent for the European conquest of it. In fact, his tactics of taking land, wealth, and labor from the indigenous populations were carried out by many of the Europeans who later came to the Americas. King Ferdinand and Queen Isabella of Spain, whose country eventually benefited from this endeavor, financially supported Columbus. However, not all people included benefited from Columbus’ ‘discovery’ of the Americas. It also led to the decimationRead MoreChristopher Columbus s Discovery Of The America1132 Words   |  5 PagesChristopher Columbus’s discovery of the America’s was monumental. His exploration of the New World impacted the culture, and development of America. One of these effects was the expansion of goods and products in the decades after Columbus’s first contact with Americans. Other effects included how these goods and products affected Amerindians and Europeans which also influenced the Columbian Exchange. Christopher Columbus’s influence on the Americas and Europe is the main reason why he is stillRead MoreChristopher Columbus: Not a Hero1057 Words   |  5 PagesHave you ever wondered why America has had an annual holiday known as Columbus Day ever since the early 1900s? While enjoying the day off has the question of why an Italian explorer has a day dedicated to him in America ever occurred to you? Probably not, but every American with at least an elementary education has the general knowledge that Christopher Columbus is the hero credited with discovering America. It wouldn’t be an overstatement to even say that he is a national icon. In actuality, he’sRead MoreThe Discovery Of The New World903 Words   |  4 P agesAfter the discovery of the New World in 1492 many issues and uproars took place. Particularly, Christopher Columbus viewed America as an opportunity for mankind to begin again. While Bartolomeo de las Cases considered the New World a place of abuse for the Native Americans and took the initiative to save the Native people. In general, the Europeans felt that the America had benefits and major setbacks of coming to the new lands. The following documents â€Å"The Meaning of America†, â€Å"Utilizing the NativeRead MoreChristopher Columbus and His Legacy: Positive vs. Negative Essay1435 Words   |  6 Pagesgrade, it is likely that children in America will have learned about the famous maritime explorer and navigator, Christopher Columbus. Born in 1451, Columbus was a Genoese captain commissioned by the king and queen of Spain to find a route to the Indies. However, he sailed the opposite direction of his intended goal by crossing the Atlantic and landing in the Americas , resulting in the discovery of the New World for Spain. Like all major figures in history, Columbus has left behind a legacy that peopleRead MoreChristopher Columbus and His Discoveries702 Words   |  3 Pagesâ€Å"In 1492, Columbus sailed the ocean blue.† Have you ever heard of this famous quote? This quote is about Christopher Columbus and his discovery of the Americas. On the first Monday in October, we celebrate Columbus Day, based on the belief that he discovered the Americas. One might conclude that Christopher Columbus did not discover the Americas because the Native Americans, Vikings, and Phoenicians had already set foot there. First of all, when Christopher Columbus set foot in the Americas, he encounteredRead MorePositive Impact Of Christopher Columbus Discoveries1249 Words   |  5 PagesPositive Impact of Christopher Columbus’ Discoveries The world is a better place because of Christopher Columbus’ important discoveries in the New World. His explorations resulted in the vast expansion of property for Europe, the exchange of goods and cultures between countries and a change in the worldview of geography. Columbus’s explorations were the catalyst for unprecedented trade known as the Columbian Exchange, which started the exchange of goods and ideas that would last for centuriesRead MorePositive Impact Of Christopher Columbus s Discoveries1247 Words   |  5 Pages Positive Impact of Christopher Columbus’s Discoveries The world is a better place because of Christopher Columbus’ important discoveries in the New World. His explorations resulted in the vast expansion of property for Europe, the exchange of goods and cultures between countries and a change in the worldview of geography. Columbus’s explorations were the catalyst for unprecedented trade known as the Columbian Exchange, which started the exchange of goods and ideas that would last for centuries