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Reasons for carrying out research on impact of student intern engagement on the operations of an organization
The research question is the impact of student intern engagement on the operations of an organization. The reason why I choose to research on it is the fact that most supervisors complain that they do not feel the impact of engaging interns in their organizations. After theoretical studies, students get attached to an organization to take have practical experience before taking on real jobs. However, interns influence a firm’s productivity differently thus the research was intended to find out how part-time, temporary, and paid interns affect the production of an organization so that managers can provide terms and conditions that will motivate the interns to be highly productive.
What I did to carry out the research
First of all, I reviewed works done by other researches on the particular topic in order to find a gap and improve their studies. Since little research has been carried out on intern engagement, I decided to find a solution to the research question by engaging managers and interns through one on one interview and questionnaires. Apart from the managers, the other respondents had prior intern experience which they used to answer the questions. The questions explored the different aspects of intern engagement and the respondents had either been part-time, temporal, paid, or a combination. The responses formed the basis of concluding the research question.
Result of the research
After a thorough literature review and data collection through interviews and questionnaires, I found out that the different levels of intern engagement influence the productivity of the interns in organizations. One of the findings is that paid interns tend to be more productive than the unpaid interns. When there is monetary compensation, interns are motivated to work hard and also have peace of mind since they can take care of their personal financial needs.
Monetary compensation and peace of mind motivates them to give their best to the organization and thus end up increasing the productivity of the organization. On the other hand, unpaid interns are not motivated and only try to finish up the assigned tasks so that they can be given a positive recommendation letter.
Additionally, I found out that part-time interns are more productive compared to the temporal interns since the part-time interns have few hours to work at the organization thus do their best so that their work can sell them to the managers and be retained after the internship. The temporal interns tend to feel comfortable at the place of work since they mingle with the other employees and only work on given tasks instead and do not put extra effort. Overall, paid and part-time interns are the most productive in an organization. If organizations paid their interns and utilized more of the part-time interns, they would have an increase in productivity.
How the research changed my thinking on the topic
Prior to doing the research, I thought that intern’s productivity in organizations is the same and they normally work hard so that they can be retained irrespective of working conditions. However, while carrying out the interviews I realized that majority of people consider the conditions given by a firm for engagement and organizations that offer monetary compensation are the most sought after. The common belief that interns only need a positive recommendation and do not mind about the working conditions is not the case anymore but working conditions and motivation play a key role in the engagement process.
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How the research changed me as a researcher
I have gained confidence after interactions with different stakeholders during the research process. As a researcher, I realized that people have different views and perceptions about a certain topic or situation thus it’s important to involve many data samples in order to get a complete analysis of the research question.
Originality of my thesis and what I did before doing the dissertation
My thesis is original since I used real life situations and samples to conduct the research instead of relying on the already published works. I identified a problem as far as intern engagement is concerned and that formed the basis of my thesis. Before writing the dissertation, I read books and articles concerning internship engagement, I then wrote a draft of literature review as a guide on the questions I would ask during interviews and in the questionnaires to avoid duplication of previous research, I identified the methods to use to collect data, then carried out the research. It was after successful research that I wrote the dissertation since I then had all the needed information.
Practical and theoretical implications of my research
The findings of the research can be utilized by managers that take up interns in their organizations. Firms that want interns to contribute productively to their operations should consider monetary compensation so that the interns are more motivated. Also, more supervision and encouragement should be given to the temporal interns while part-time interns should be given the most productive sections of the firms operations since they normally give their best. Theoretically, the research forms a foundation for future research where it can be based on specific industrial sectors instead of generalizing it.
Reasons for not answering vocally during the first VIVA interview
Though I have improved my confidence after the research, I find presenting my ideas in writing simpler than oral communication. It’s easier to write than communicate amiably in English but I am in the process of engaging myself with people and situations that will enable me improve on my oral communication.
Carrying out the research helped me to view internship engagement in a different perspective and I realized that motivation is essential in ensuring there is productivity of interns in the organizations. Future research should be carried out in different industrial sectors since my research was general and assumed all sectors offer the same internship environment.
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Feminism: Simone Beauvoir
Question one
According to Simone Beauvoir, feminism has already been tainted to an extent that there seems no hope of talking about the subject. Though a lot has been said about feminism, little improvement has been seen in women and they are still subject to men. A woman no longer exists as a fellow man, but lives in the shadow of a man. Though a woman is just a fellow human being like a man, society has made her less significant such that there are no definite characteristics relating to a woman as it is for a man (Simone, 1949). The author wondered whether women still existed, if they are supposed to exist, and if they existed, what place would the society place them.
In her introduction, Simone Beauvoir develops her thesis by claiming that women are a lost course and tries to give different characteristics given to a man to show that there is no definite place for a woman in the society. Though women make half of the human population, they are normally encouraged to be and behave like women, and men are often viewed as superior human beings. It is often said that a woman cannot exist without a man though a man can exist on his own.
The author gives definitions of a woman depending on how the society perceives her. One of the definitions is that a woman is characterized by a womb. However, some scholars oppose the definition by claiming that although some women have a womb, they cannot be referred to as women. The very parts that make a woman are the same parts that happen to imprison her. Ovaries, uterus, and glands make women seem weak to a man to an extent that Aristotle claimed that a woman is a human being that has certain physical defects. Men view themselves as having an original connection with the world and rule over it albeit the fact that they also have glands and other physical features as a woman. Although both men and women are categorized as human beings, a woman is treated as inferior.
The author admits that women also fail to recognize their importance by making men superior such that they exist under the shadow of a man. A wife is named after her husband and the society always considers a woman to be autonomous to a man. A woman cannot live or think without a man, but a man can exist and think without a woman (Simone, 1949). It is not possible to hear of a man who is named after a woman, but a woman is referenced with a man. To a man, a woman is just a sexual being and nothing else. Therefore, man is the superior and absolute human being while a woman is just the another human being.
In addition, the author continues to describe a woman as just another human being by saying that relationship of two sexes is not like electrical poles. Electrical poles are in an equal measure and size, but in the case of a relationship between a man and a woman, the two are separate and unique individuals. A man is the overall designator of a human being and represents both the positive and neutral sides. On the other hand, a woman is only defined by the negative side as she is deemed to lack some components as compared to a man. Whenever there is a discussion, women are viewed as weak by men and if a woman takes a certain side, it is said she did so just because she is a woman. A man is the only one supposed to be right and if he sides with a woman, it is not because she is right but because she is just a woman. It is right to be a man, but it is considered wrong to be a woman. A man is the only rightful human being, but a woman exists as an incomplete individual.
For consciousness to exist, the self must be present. Therefore, the other is as original as the one who in this case is the man. The implication of otherness is just a human thought that is not defined by ancient things and situations. Having a self and the other, is not supposed to divide human beings to different sexes but it’s something that has been formulated by society. For this reason, it implies that a man and a woman are a dual that depend on each other for survival and existence. A man is born off a woman and he cannot exist without the former. Although a woman is defined as the other, she is in the likeness of a man and shares same privileges as a man.
The author also noted that for a group to set itself as the one, it has to be against the other. If one group considers itself privileged, it is because it views the other group as inferior. Consequently, the reason why a woman is defined as the other is because a man has set himself against her for he does not want to be equal to a woman.
Question two
Kimberley Crenshaw used inter-sectionality theory to show how gender and racial discrimination was experienced by black women. Intersectionality is a theory that studies overlapping discrimination. In her study, the author noted that black women faced gender and race-based discrimination, especially in the work place. If black women had a lawsuit resulting from race discrimination, they were not favored since it would be ruled that other blacks were not discriminated. In addition, gender discrimination would be ruled out since not all women were discriminated. Thus, the American Black women faced discrimination due to their gender and race. Facing both types of discrimination is what Kimberley Crenshaw coined as intersectionality notion.
Legal concepts could not defend Black women since it was either race discrimination or gender discrimination, but not both. Also, feminist activists only explored discrimination experienced by only the white privileged women who co-existed with powerful men; thus, it was not possible to know the issues faced by other women. The women activists preferred having privileges given to them by white men at the expense of the needs of women of color; hence, making discrimination to the latter intersectional as described by Kimberle (1989).
Bell Hooks is another writer that talked about intersectionality discrimination. According to the writer, privileged white women were selfish in their activism as they only sought to advocate for their needs since they wanted to enjoy the same privileges as men. For instance, the white women advocated for abortion but did not advocate against involuntary sterilization of women of color, a vice that was becoming wide spread. The women considered as essential to be in male dominated roles as opposed to taking their roles as wives and daughters and fighting for the rights of women and feminism for all women.
Also, discrimination is faced by women of color on the basis that they are overworked in workplaces while the white women fail to advocate for their rights, but instead try to outdo men in the workplace. Since white women were busy during the day and had chores to take care of after work, they instead took in the women of color and made them their domestic workers. Eventually, women of color faced discrimination due to their race and gender. Having no right over reproduction as well as the lack of advancement in the workplace is a form of discrimination faced by women of color since it is based on the fact that they are black and female (Bell, 2000).
Audre Lorde noted that having social privileges is one of the reasons why feminists and activists join the oppressors into oppressing the underprivileged. The feminists are assured by the antagonists that they will share power, and instead of helping the minority, they end up being used to deprive them of their rights. The author suggested that feminists should take it upon themselves to understand unrelated connections that women have due to oppression so that they can liberate all the oppressed. According to the writer, it is not possible to liberate one group and leave another; hence, intersectionality can help to reveal the unrelated experiences that women of color have as a result of oppression.
Combahee River Collective talked about how black women were not included in liberation movements due to their color and gender. The movements did not address all the issues faced by black women, but just highlighted a few. A black woman’s identity was in terms of her color, race, and sex and not who she was. Intersectionality came to exist in the States when black women tried to take up social and political positions. Also, the concept came to being when they were excluded from liberation movements. Women had to fight for their identity since they were treated based on their race and color instead of integrating all the identities that characterized an individual (Jayme, 2015). Combahee River Collective was formed to help liberate black women so that they can be respected similar to fellow human beings.
Adrianne Rich noted that white women who were in a position to liberate and advocate for women of color did not do so as they were busy struggling to fit in the shoes of their male counterparts. Lesbians, white women, and women of color started liberation movements on behalf of women, but the white women were deceptive as witnessed in the US and Canada (Ana, 2008). Instead of the three groups working together, the white upper-class women still liaised with men and neglected their duties as wives so as to belong in powerful positions. The upper-class white women chose their careers and powerful positions at the expense of their fellow white women, lesbians, and women of color; thus, the voices of the minority were not heard and they continued to be discriminated against.
Simone, Adrianne, Combahee River, Bell, and Crenshaw wrote about women and are some of the popular feminists that advocated for the rights of women. All of these women claim that a woman is as powerful as a man and should be given equal rights and privileges. As per the intersectionality theory, black women and other women belonging to minority groups such as lesbians are often victims of overlapping discrimination and there seems to be no law that protects them from it. Therefore, the writers advocated for the rights of women so that they would not be discriminated against with regards to race, sexual orientation, or gender.
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Transportation Facilities
Increasing demand for effective travel has prompted transportation projects focused on the improvement of transportation facilities (Cooper, 2012). The response of the federal government to this demand has been through an enhancement of an ambitious transport program (Bell, 2013). This is because transport usually involves the movement of people and goods from one location to the other, using a variety of modes including road, air, water, rail, air, and pipeline (Alstadt, 2010).
The transportation theory according to its articulation by Cooley (1894) provides an explaination of the contribution of traffic to geographical and mechanical concepts, the relationship between land and/or waterways and physical situations, as well as the general observations that links transportation to natural conditions. Transportation contribution is also focused on political organization, society organization, economic organization, military organization, the location of cities and town, as well as markets (Tilahun & Levinson, 2010).
The industry of transportation consists of the modes of transportation, physical infrastructure and operations, and plays a crucial role in the facilitation of economic development, particularly through intertrade promotion between regions and persons (Levinson & Huang, 2012).
Transportation infrastructure improvement enhances socio-economic outcomes, especially by increasing earnings arising from opened up consumer goods’ markets and labor markets (Tilahun & Levinson, 2010). Improved transportation infrastructure is associated to socio-economic benefits including increased accessibility of spatial locations and mobility among residents (McDermott, 2010). As a result, transportation is attributed to enhanced quality of life, which ensures there is a link between individuals to occupation, teaching, healthiness, refreshment among other socio-economic activities (Bell, 2013).
Transportation presents market accessibility by connecting manufactures and consumers to enable transactions. Without any elaboration, as mentioned in the theory of transportation by Cooley (1894), economic expansion cannot progress in the absence of transport facilities. In addition, the socio-economic effects are differentially experienced according to demographic parameters such as income level, job level, marital status, and level of education (Gomben et al., 2012).
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Specifically, with regards to the state of California, the transportation program that exists is not adequate to equate with the predicted economic expansion (Kernohan & Rognlien, 2011; Saunders & Dalziel, 2014). This is because in the State of California the rate of economic expansion has not matched that of transport expansion, necessitating an evaluation of the specific status of the situation which has been affecting commuters (Cooper, 2012).
As such, the literature indicates the need for a more ambitious approach that would involve a far-reaching strategy to develop and improve transport facilities for enhancement of the socio-economic status of California residents (Kernohan & Rognlien, 2011; Levinson & Huang, 2012; Saunders & Dalziel, 2014). The findings of studies by Gonzalez-Guillen (2012) and Bell (2013) showed that transportation influences socio-economic status of a population in various ways including increased connectivity, which enables residents to easily commute from one point to another.
Purpose of the Study
The purpose of this quantitative, correlational study is to examine the relationship between transportation investment and socio-economic well-being of residents in the State of California. The target population for this study is the members of the communities of California and the sample will be archival data on transportation investment measures retrieved from the California State Transportation Agency website and survey data on measures of the population’s socio-economic status satisfaction.
According to Cohen (1992) and Faul et al. (2009) G*Power is the most appropriate method to determine the sample size for a study. The sample size will include 150 participants randomly drawn within the communities in California with an assumption of a response rate of about 70 per cent (Babbie, 2010). The sample size was determined using 0.95 as the power of test and 0.05 as the alpha, while the study was one-sided. Considering that California is the place of study, the primary data will be gathered using rating scale analysis survey questionnaires as data collection instrument administered on the randomly selected sample size (Wright & Masters, 1982).
The survey questionnaires will rate responses of research participants in a five-point Likert scale that range from strongly disagree (1) to strongly agree (5). On basis on the above analysis, it is undoubtedly evident that the field of service quality has be extensively researched (Parasuraman, et. al., 1985, 1988, 1991), and this has led to the development of SERVQUAL, used as a measurement of service, which states that the assessment of service quality in overall by customers is determined by the direction and degree of the gap between their perceptions and expectations of actual performance levels.
As a result, they identified five key variables that are associated to service quality including reliability, tangibles, responsiveness, empathy and assurance. They proposed that the service quality perception could be approximated through calculation of the difference between perceptions and expectations of actual performance of service. Hence, this research instrument can be used to examine the relationship between transport investments and socio-economic status perceptions in California.
The sample will be randomly picked from the target population, particularly within communities across California to ensure each of them is appropriately covered in the data collection and analysis process (Coleman 2010; Williamson, Philbin & Sanderson, 2012). The collected primary data will be cleaned subsequent to processing and coding followed by data analysis using SPSS to enable the hypothesis testing. The analytic plan will include regression and correlation analysis for the determination of the direction and strength of variables’ relationships using Pearson r correlation, Kendall rank correlation and Spearman rank correlation statistics.
In this study, specific quantitative research questions will be asked to gather primary information essential for hypotheses testing. The questions must be in tandem with research variables/constructs as far as transport infrastructure investment is concerned and how it relates to on socio-economic status of residents. The research questions will ensure the problem statement is addressed to establish whether there is significant relationship between public transportation investment and socio-economic status satisfaction levels among the residents California State.
References
Litman, T. (2014). Land use impacts on transport. Considering the impacts, benefits and costs of different land use development patterns. Retrieved from Victoria Transport Policy Institute, Canada, website: http://www.vtpi.org/landuse.pdf
MacKinnon, D., Pine, G. & Gather, M. (2008). Transport and Economic Development. In R. Knowles, J. Shaw and I. Docherty (eds.) Transport Geographies: Mobilities, Flows and Spaces. Oxford: Blackwell, pp. 10-28.
In the stages of change model, there are a series of cycles that include, precontemplation, contemplation, preparation, action and maintenance. Within each and every function, there are tasks and responsibilities (Ernecoff, Keane, & Albert, 2016).These functions are considered as interrelated and continuous. The healthcare manager therefore needs to consider individuals may change their behaviors and actions in the shorted time may be challenging. This requires an allowance for individuals to work through the various stages.
In this case, the healthcare administrators may use the Stages of Change model in the development of procedures that support the patients and subordinates in behavioral modification (Gantiva, et al., 2015). This helps in initiating motivators that gives the patient’s ability to pass through recovery stages while modifying their behaviors. Healthcare administrators may therefore effectively use this theory in developing interventions that may impact the behaviors of individuals.
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Lessons
This approach aids in understanding the aspects of customary counseling that may not be effective in meeting the needs of these individuals (Koyun, & Eroğlu, 2016). Understanding the stages of behavior change, aids in the development of interventions that help employees to change their behaviors. Employers can use this approach to help employees identify and modify their actions that may negatively impact their productivity in employment.
Employers can also understand and enable the employees undergo the processes and stages of change. With this knowledge, the employers can encourage positive actions and practices that would maintain the behaviors of their employees. The Stages of Change model is a tool that can be incorporated by Human Resource managers in reinforcing positive behavior among unruly staff members within an organization.
Gantiva, C., Ballén, Y., Casas, M., Camacho, K., Guerra, P., & Vila, J. (2015). Influence of motivation to quit smoking on the startle reflex: differences between smokers in different stages of change. Motivation & Emotion, 39(2), 293-298. doi:10.1007/s11031-014-9449-7. Retrived From: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=101471616&site=ehost-live
Koyun, A., & Eroğlu, K. (2016). The effect of transtheoretical model-based individual counseling, training, and a 6-month follow-up on smoking cessation in adult women: a randomized controlled trial. Turkish Journal of Medical Sciences, 46(1), 105-111. doi:10.3906/sag-1407-100. Retrieved From; http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=112148167&site=ehost-live
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Healthcare Quality Management
Mcleod Medical Centre is an acute centre hospital located in Florida. The hospital is ranked higher among the others which provide acute care. The hospital provides emergency treatment, receives its tests electronically, can track the patient’s progress electronically and provides both outpatient and inpatient services (“Medicare Hospital Comparison”, 2016). As shown above, the hospital has invested in both resources and professionals. The ratio of nurses to patients is high meaning that more patients can receive more attention.
Additionally, the hospital has an internal quality control system the monitors the quality levels of different practices. Examples of some of the practices monitored include the wait time and response level of the medical practitioners (“Medicare Hospital Comparison”, 2016). The second hospital should introduce a quality management section that will introduce standards for different practices. Additionally, it should invest more in resources and medical professionals to reduce the nurse to patient ratio.
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The value of services in the different hospitals can be increased by focusing on both medical and non-medical aspects of quality (Hibbard & Greene, 2013). Access to medical care and physicians should be increased in the different hospitals. Additionally, the waiting time should be reduced to minimal levels. Responses should be collected from different patients on the effects of waiting times.
Additionally, the hospital should invest in providing patients with enough information regarding different conditions (Taylor et al., 2014). Well, trained counsellors will be used to create a link between the hospital and the patients. Check-in and check-out procedures should also be friendly to patients (Aiken et al., 2013). The hospital should also provide ancillary services to all patients (Dixon-Woods, McNicol & Martin, 2012). Medical aspects include having trained professionals, use of modern equipment and new technologies as well as proper medications and instruments.
References
Aiken, L. H., Sermeus, W., Van den Heede, K., Sloane, D. M., Busse, R., McKee, M., … & Tishelman, C. (2012). Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ, 344, e1717.
Dixon-Woods, M., McNicol, S., & Martin, G. (2012). Ten challenges in improving quality in healthcare: lessons from the Health Foundation’s programme evaluations and relevant literature. BMJ quality & safety, bmjqs-2011.
Hibbard, J. H., & Greene, J. (2013). What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health Affairs, 32(2), 207 214.
Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan–do–study–act method to improve quality inhealthcare. BMJ quality & safety, 23(4), 290-298.
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Cholera Outbreak
Introduction
Cholera is a diarrheic condition that is caused by bacteria known as Vibrio cholerae. The bacterium is an enterotoxin that affects the ileum. Patients with this disease present with a sudden onset of rapid watery stool that is painless (Sekar, 2012). Early stages of cholera are manifested by rapid vomiting and nausea. When cholera is not treated, it can results into hypoglycemia in children, circulatory collapse, dehydration, renal failure and acidosis.
The infection is transmitted by asymptomatic carriers. Cholera is mostly asymptomatic or occasionally causes moderate diarrhea particularly with EI T micro-organisms or biotype. Death occurs within a few hours in severely dehydrated cases where by the rate of case-fatality may go beyond the 50% mark. However, timely and effective rehydration reduces the death rate to 1%.
Background
A cholera outbreak was first detected in The Central African Republic (CAR) in the early months of 1997 and hit the country for the second time in 1999.
The affected regions within the country included the sub-prefecture of Ngaoundaye. This is located along river Oubangui which is located near the border with Chad(Dworkin, 2010). Sékia moté village had the very first few reported cases and within a short period, the outbreak had spread to the prefecture of Lobaye and its environs and to the city of Bangui. Ombella Mpoko district and seven other villages where the Oubangui River passed later became part of the tragedy.
The outbreak was primarily discovered after the chief’s son of Sékia mote village became sick and passed away after showing signs of profuse diarrhea, abdominal pains and fever. The chief of Sékia mote village reported the case to the district’s governor on the very same day it occurred, who then alerted the Ministry of Health immediately later that day.
Both private and public health facilities in the Central African Republic (CAR) recorded extraordinary cases of watery diarrhea from Sékia moté village and several other villages to the Ministry of Health (Kamradt, 2015).
On the 25th of September 2011, a stool sample was obtained from a patient that had been transferred and got admitted at the community clinic in Bangui by two of the laboratory technicians from the Central African Field Epidemiology and Laboratory training Program (CAFELTP)(Nair, 2014).
After three days of thorough testing, the National Laboratory in Bangui (NLB) isolated Vibrio cholera sero group 131 from the earlier submitted specimen of stool with the help of a laboratory expert, from the NCIRD/GID.
This fostered the drive of Global Immunization Division, Immunization Systems, and Centers for Disease Control and prevention (CDC) since they were certainly convinced that the disease was cholera. On September 30th, cholera outbreak was declared officially in CAR. Rapid response team was put in place by the Minister of Health (MOH). The team comprised of CAFELTP residents, WHO, MSF staff, UNICEF, MOH staff, and others. The team established a series of control and preventative guidelines that would curb the spread of the outbreak.
The first measure entailed enhancing treatment capacity and cholera surveillance at the already existing health facilities. Secondly, the city of Bangui and affected villages had to have cholera treatment facilities. Thirdly, endorsing practices such as improved sanitation, proper food preparation, proper funerals and burial. The fourth measure was on affected people were to be advised on usage of oral rehydration solution and encouraged to seek medical attention at the onset of watery diarrhea. Finally, there were to be provision of chlorine for treatment of drinking water.
The rapid response team had a report of the case as by October 23rd. The record indicated that there were a total of 172 individuals who were suffering from acute watery diarrhea and also recorded 16 cholera deaths. This study was carried out with the goal of identifying risk factors associated with cholera outbreak. Moreover it also focused on assessing how prepared the affected districts were in controlling the outbreak.
Cholera Investigation
Environmental investigation
Many households were constructed along river Oubangui. The distance between the river and these households was approximately 20 meters. Generally, there was poor hygiene in the village characterized by mud and stagnant water (Kurjak, 2015). The children in the village were playing and walking bare feet in the mud and at times not fully dressed. Villagers were commonly using pit latrines whose maintenance was poor. Oubangui river was has many uses which include a source of drinking water, fishing, swimming and defecation.
Epidemiological investigation
The Ministry of Health requested CAFELTP resident advisors to assist in investigation and control of cholera outbreak in Central Africa Republic. The CAFELTP officials formed a rapid response team that worked in the affected areas. The team members were assigned different duties. For instance, one of the epidemiological officials was charged with the responsibility of reporting and collecting data on cholera outbreak where as two other lab technicians had the responsibility of collecting and analyzing samples.
Moreover, the advisors of these officials arrived in Bangui after two weeks. Upon arrival, they were taken through the events in Bangui by the CAFELTP staff and the officials from the MOH on the matter at hand and evolution of cholera. A data collection instruments and a protocol were developed by the residents and RAs. The main risk factors were highlighted as follows, lack of infrastructure for sanitation, drinking untreated water, and attending a cholera case funeral. Cholera Treatment Facility in Mbobo and Bangui district held arena for questionnaires pre-testing. In-country procedures such as mission orders, submission of terms of reference were followed before going to the field.
Coincidentally, during the outbreak investigation several campaigns on cholera awareness were underway in different areas of the country. The awareness involved sessions of community education and use of mobile Information Education Communication (IEC) resources presented on posters, TV, radio, cars, and mobile phones prevention messages.
Confirmation of the outbreak
The term outbreak is simply defined as a sudden increase or start of disease of fighting. It can also be defined as a sudden increase in numbers of a harmful organisms particularly the insects within a specific area. A disease outbreak is the occurrence of diseases in excess beyond the normal expectations in a specific geographical area, season or community.
An outbreak may emerge in a restricted geographical area or even spread to several countries. Its duration may be a few days, weeks or several years(Sekar, 2012). Definition of an outbreak enables those responsible for managing an outbreak occurrence to report the condition in its early stages to the responsible authorities.
The director of disease control conducted training sessions on cholera management in the hospitals as well as the community. The training was done to the health personnel in the affected districts. Weekly review notification records under joint custodian of the (WHO) and MOH, found 172 individuals diagnosed with suspected cholera. In the CAR from September 20th to October 26th, national case fatality rate was 9.3%.
Data on the number of individuals infected with cholera was sourced from the WHO Bangui office, cholera treatment centers and health centers in the affected areas. Medecins Sans Frontiers (MSF) were responsible for collection of the data on infected individuals. These information was used by the investigators in performing a comprehensive analysis of cholera outbreak.
Assessment on the level of epidemic readiness and response was carried out in each district using a checklist. General hygiene in the affected areas termed environmental investigation was also assessed. Stool and water samples were taken to the lab to be examined for Vibrio cholerae.
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Epidemic preparedness and response (surveillance)
None of the visited districts had either an epidemic readiness plan or a committee in place prior to the outbreak. There was provision of IV fluids and protective materials after the event of the outbreak. Some of the health centers such as Kamba had a radio system that was functional for communication, the health centers in Ngazi and Mogo had no means of communication. Unfortunately they had to travel for about 35 Km by bicycle or foot to the health facility (Shah, 2016).
Epidemic management funds were not available in the country before the occurrence of the outbreak. However, there were disinfectants in the entire health district that was visited. Chlorine used for water treatment was distributed by ministry of health to the two villages. Centers for chlorine treatment were planted at Bangui hospital, Ngazi and Mbombo health facilities. At the time of visit, these centers were functional although each had at least one cholera patient.
One personnel in Ngazi and Mongo village managed the public health surveillance system. The system was exempted prior to the occurrence of the epidemic.
Case definition
Case definition entails a standard criterion that categorizes an individual as a case. It includes criteria for person, time, clinical features and place. The criteria should be specific to the outbreak under investigation (Madoraba, 2010).
Place
Most houses were constructed along the Oubangui River. The distance between the river and the houses was less than 20 meters. There was generally poor hygiene in the village (Dale 2013). Mud and stagnant water were everywhere. Children played and walked in the mud bare feet and at times not fully dressed. There was common use of pit latrines; however, the latrines were poorly maintained. The Oubangui River served as a source of drinking water and swimming, fishing and defecation.
Person
Diarrhea: Diarrhea as a result of cholera usually has a milky, pale appearance that resembles water that has been used to rinse rice, hence the name rice-water stool.
Dehydration: dehydration develops within hours after the commencement of the symptoms of cholera. The ranges of dehydration vary from mild to severe depending on the amount of fluid lost. Severe dehydration is characterized by a loss of 10% or more of total body weight.
Nausea and vomiting: occurs during the early phase of cholera. Sometime vomiting may occur for hours.
Other signs and symptoms of cholera include lethargy, irritability, dry mouth, and sunken eyes, dry skin that bounces back slowly after it has been pinched into a fold, extreme thirst, little urine output, irregular heartbeat (arrhythmia) and low blood pressure
The people of Bangui expressed symptoms that are consistent with the case definition of cholera outbreak. The environment in Bangui also had conditions that are likely to predispose people to developing cholera
Cases
Cases are categorized into three types; confirmed, possible and probable cases. Confirmed cases are the laboratory confirmed cases such as the cholera victims who had their stool tested for Vibrio cholerae. However probable cases have characteristics clinical features of the disease but they lack laboratory confirmations (Ramamurthy, 2011). For example, there were residents of Mbaika district who had bloody diarrhea but without laboratory testing. Finally, possible cases are those with some clinical features such as abdominal cramps and diarrhea such as three stools in a 24-hour period.
Cholera is a point source epidemic. It arises due to common sources such as contaminated food or an infected food handler. The period for incubation ranges from a few hours to 5 days after infection. Suspected cholera case was defined as any individual of any age that presented with acute watery diarrhea. The most affected individuals were the women living in villages along Bangui River.
Hypothesis
The cholera outbreak in Mbaika district, Central Africa Republic where 170 patients and 16 cholera deaths reported, were related with risk factors that were food borne. There is a substantive association between cholera and eating cold cassava leaves. Epidemiological studies from Zambia indicated that the major transmission vehicle of cholera outbreak is contaminated food.
Vibrio cholerae could be inoculated into cooked food during preparation by an asymptomatic but infected person (Howard, 2011). However, the cause of contamination of cassava leaves may vary and the study did not determine its course. This hypothesis is true because earlier studies indicate that soiled kitchen ware can contaminate food and the Vibrio cholerae live for up to 2 days.
Discussion
Cholera outbreak caused many deaths in the region. The death rate rose up to 24.2% in Matuu which is higher than the countrywide rate of 9%. MOH in collaboration with various partners assisted in the management of cholera. The investigation produced important results. The outbreak of cholera in Kamba district, Central African Republic where by more than 170 cases and 16 deaths reported, was as a result of risk factors that were food borne.
The case control investigation associated cholera with consumption cold leaves of cassava. Epidemiological study from Zambia indicated that during an outbreak, the major transmission vehicle of cholera is contaminated food. When food is prepared, Vibrio cholerae could be inoculated by asymptomatic but affected person. The source of contamination varies in cassava leaves. The study did not determine its course. According to previous studies, soiled kitchen ware can contaminate food where the Vibrio cholerae persists for 1-2 days.
There was lack of association between the outbreak and water-related risk factors. Cholera transmission through direct waterborne ways was not very evident in these areas. Other previous investigations have reported that drinking water sold in the streets was responsible for the outbreak of cholera in Latin America.
The study ruled out the link between cholera and drinking contaminated water, poor sanitation and attending burials that are cholera related in the district. Households in the two villages are built along the river which makes the area vulnerable especially during floods. Consumption of untreated water from Oubangui River was not proven risky but it should be avoided.
Delay in the analysis of stool samples should be discouraged. It leads to delayed confirmation of an outbreak as well as delayed implementation measures. According to this case, the delay occurred because the outbreak emanated outside Bangui. On the other hand, Bangui National Laboratory (NLB) did not have a means of transport for collecting stool samples from outside Bangui. It is very vital to have all the appropriate resources during an outbreak. Availability of epidemic readiness plan and a committee present in a district results in effective and timely management of the outbreak. Public health surveillance system management by only one individual in the entire district may not be effective in handling all the threats in public health.
Conclusion
The outbreaks of cholera in Central Africa are still ongoing but in a slow rate compared to the past three week. Considerable association between cholera and eating cold cassava leaves was identified. First and seventh regions were the only ones affected by the outbreak (Lewenson, 2013). Women and children living along the Oubangui River were the most affected by the outbreak. Lack of transport of samples to the National Laboratory delayed outbreak confirmation. Effective measures in cholera treatment there were to be implemented include; establishment of cholera treatment center, treatment of drinking water, health education on good food and general hygiene.
Lessons learnt
The study provided epidemiological information that leads to cholera. They include consuming untreated water, poor sanitation and attending cholera areas.
The major transmission vehicle of cholera is contaminated food.
Consumption of water sold in the street can also result into cholera outbreak.
Lack of laboratory materials transport and communication causes delay in analysis of an outbreak
There is need for a stand by epidemic readiness plan and committee in the district that ensures well-timed management of the outbreak.
Recommendations
Health education and social sensitization on habits of eating, community hygiene and personal, sanitation and burial practice.
System for public health surveillance should be strengthened by the administration.
Encouragement of eating food when still hot.
Each region should be supported in development of a functional epidemic readiness plan and response committee and a definite epidemic readiness control plan as soon as possible.
Ministry of health in conjunction with that of water should ensure that the communities have access to clean water.
Laboratories should have basic resources to avoid delaying in laboratory confirmations.
The surveillance system should be able to identify outbreaks and report in time.
Bibliography
SEKAR, R., & MYTHREYEE, M. (2012). Microbiological Investigation of Diarrheal Outbreak in South India Cholera Outbreak – Microbiological Investigation. Saarbrücken, LAP LAMBERT Academic Publishing. http://nbn-resolving.de/urn:nbn:de:101:1-20121026248.
DWORKIN, M. S. (2010). Outbreak investigations around the world: case studies in infectious disease field epidemiology. Sudbury, Mass, Jones and Bartlett Publishers.
TRUGLIO-LONDRIGAN, M., & LEWENSON, S. (2013). Public health nursing: practicing population-based care. Burlington, Mass, Jones & Bartlett Learning.
KURJAK, ASIM. (2015). Textbook of Perinatal Medicine. Jaypee Brothers Medical Pub.
CARNEIRO, I., & HOWARD, N. (2011). Introduction to epidemiology. Maidenhead, Berkshire, Open University Press. http://public.eblib.com/choice/publicfullrecord.aspx?p=863803.
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Strategic Human Resource Management
Introduction
Strategic human resource management is a very broad area of study. It has also evolved over time, making it difficult to summarize the concept in a few words. As such, there is not one single definition that can fully encompass what the concept is about. However, there are certain key aspects which help to put the definition of this concept into context.
Strategic human resource management (SHRM) revolves around systematically connecting and integrating human resource concepts to match and meet corporate needs. Every organization has laid out structures intended to assist in the achievement of set goals and aspirations.
In order for these goals to be realized, there has to be a systematic and practical manner through the strategies of human resource management are merged with the needs of the organization. SHRM concerns itself with overseeing a smooth integration of the two. Since its emergence, human resource management has evolved. As organizations keep up with the dynamism in their respective fields, HRM has had to keep up. There is a lot of materials that have been written in regard to this topic, including the constant evolution. The focus of this discussion is literature review on this topic and what various authors thing about SHRM.
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Background Information
Human resource strategies play a crucial role as they address all fundamental issues arising from management of various issues on human resource. There is need to ensure that there is alignment between the needs of an organization and the strategies of human resource. The human resource department is in charge of the personnel who form the human resource of an organization.
As such, it is pertinent to ensure that there is a blend between the two. On one hand, human resource practices are more concerned about the welfare of the personnel in the organization. On the other hand, every organization has set goals which must be achieved. Sometimes, there is a clash between the two and hence the need to have middle point where the needs of both can be harmonized.
Literature Review
Why is it so important to have integration between business or organizational strategies and human resource management? Authors on this topic have provided a myriad of reasons as to why the integration is essential. Mello (2014) notes that integration of human resource management with business strategies contribute significantly to improvement of performance within the organization.
Further, Storey notes that with proper integration of the two aspects, the competitive advantage o the organization is increased. The competitive advantage is increased since the human resource management is customized to meet the specific needs of an organization. Due to the unique system of HRM it is not easy for other organizations to imitate, giving the organization in context a niche.
Crucial Aspects of SHRM
Strategic human resource management is supported by two main tenets. The first tenet is the integration of human resource with specific business needs and the second is the devolution of human resource management to the managers. Millimore (2010) notes that integration of the two is considered successful when all matters pertaining to human resource are considered to be crucial in business strategy.
In the past, business strategies have been formulated devoid and in total failure to consider the impacts on human resource management. The impact thereof is that in most cases, the human resource strategies and business strategies clash leading to a deadlock. Armstrong (2011) therefore recognizes the importance of such an integration thereby avoiding a deadlock.
Resource- Based View
There are a number of theories that have been developed all of which seek to explain the relationship that exist between performance of an organization and human resource management. The resource-based view is one of the theories whose arguments have been used by researchers to assert this position.
According to this theory, organizations gain what is seen as competitive advantage or a niche for themselves when the resources within the organization are well taken care of. Blau & Schoenherr (2011) is of the view that the most valuable asset and resource for any organization is its human resource. The integration of human resource management will hence have a direct impact on the performance of the organization.
The resource based theory is certainly a departure from previously held views where business strategy would focus more on the external environment. Prior to the evolution of human resource management, business organizations put more focus on the external environment including the market while completely ignoring the human resource.
It is not until the recent past that the perception changed. Human resources are now considered an integral part of business strategy and this has evidently seen a shift in performance by organizations. The integration of the two aspects has seen an alignment of goals for both concept which together work for the betterment of organizations.
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Findings
From the above discussion, there are a number of findings. The first finding is that there is indeed a relationship between human resource management and performance of an organization. The second finding is that when the two aspects are integrated systematically, then there is evidence of improved performance for organizations.
There is need for more studies to be conducted with an aim of proving that the relationship between SHRM and organizational performance is causal. This means that strategic human resource management has direct impact on the performance of an organization. This means that failure to properly integrate the two will have ripple effect on the performance of a business firm.
Conclusion
Human resource management sits at the center of good performance of every organization. Unfortunately, until very recently, human resource management has always been set aside during business strategizing. The role of HRM was not appreciated as more focus would be on the external environment of the business. However, with multiple researches conducted on the topic, the role of human resource management is now recognized and appreciated. Further, the need to integrate human resource management with business strategies has seen improved performance of organizations.
As the name suggests, the integration must be strategic meaning that it must be done in a certain manner. The most important factor of consideration during integration of human resource management and business strategy is alignment of goals of each department. Recognition that human resources is one of the most valuable asset for each organization is a step in the right direction for organizations.
Management of human resources has grown in leaps and bounds to become the centerpiece of organizations. More organizations are now investing in this area as they seek to create a niche for themselves by increasing their competitive advantage.
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SOAP Note for a Patient with; Ectopic Pregnancy
Subjective
A 30-year-old female, gravid 1, para1+0.The patient complained of abdominal pain in the right adnexal area which was generalized. She complained of dizziness, light headedness, and syncope. She experienced abnormal uterine bleeding for three days. She had not undergone and gynecological operation and had been on folic and iron supplements. Her menarche was at the age of 14years. Her menses were regular and used to last for 5days and occurred every 28days.The patient had used hormonal implant for three years and had been removed three months ago. She had not received her menses for two months. She was sexually active and had post-coital bleeding. She used to take alcohol on a regular basis.
Objective
The patient was sick looking and was groaning in pain.On palpation, there was generalised abdominal tenderness, and unilateral adnexal mass was present on the right hypochondria. Her vital signs were; Temperature -36.7degrees Celsius, blood pressure-98/56 mm/Hg, pulse-50beats/min. On bimanual examination, there was cervical motion tenderness. Her Serum HCG levels were 4500 IU/l; a trans-vaginal Ultrasound revealed a tubal mass in absence of intrauterine gestational sac.
Assessment
Ectopic pregnancy which leads to acute abdominal pain and bleeding (Marion & Meeks, 2012).
Ovarian torsion resulting in localized lower abdominal pain radiating to the back or thigh and nausea and vomiting
A Urinary tract infection leading to lower abdominal pain and dysuria and increased micturition
Appendicitis presenting with guarding abdominal pain and nausea and vomiting. Diagnosis of ectopic pregnancy was made due to the acute abdominal pain, associated bleeding, and increased βhCG levels
Plan
The overall goal of management was to preserve the life of the mother, and this was managed through termination of pregnancy and reconstruction of the implantation site. The patient was given a bed rest ensure that she had reduced activity (Marion & Meeks, 2012). The patient was cannulated and started on intravenous fluids to restore the fluid volume deficit. Blood samples for the laboratory were obtained. Relaxation techniques were used to relieve pain.
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Medical management
The patient was put on intramuscular methotrexate. Methotrexate is a folic acid antagonist which deters cell division. The products of conception degenerates and detaches from the uterus leading to death (Epee-Bekima & Overton, 2013). Viability of the cytotrobhoblast is prevented together with β-hCG secretion (Wright, Busbridge & Gard, 2013).
Surgical management
Laparoscopic salpingectomy was considered to be the primary treatment of the ectopic pregnancy. Salpingectomy was conducted so as to repair the ruptured fallopian tube (Marion & Meeks, 2012).
Alternative management
Expectant management, the ectopic pregnancy could be waited to resolve on its own. However, this would be followed by β-hCG measurement and trans-vaginal ultrasound to confirm whether the disorder has resolved (Epee-Bekima & Overton, 2013).
Follow-up
The patient was advised to visit the clinic after 3-4 weeks for b-hCG measurement and ultrasonography. The patient was also advised on early pregnancy clinic visits.
Reflection notes
Patient involvement: I would carefully advise my patient of the advantage associated with any of the treatment approaches and ensure she fully participates in the selection of the mode of therapy. The use of laparoscopy could be used so as to come up with the diagnosis so as to minimize use of Surgery is the primary form of treatment. In addition to that, a less surgical procedure such as laparoscopic approach would have been used since it is associated with minimal intra-operative blood loss and hospital stay.
Marion, L. L., & Meeks, G. R. (2012). Ectopic pregnancy: history, incidence, epidemiology, and risk factors. Clinical obstetrics and gynecology, 55(2), 376-386.
Mergenthal, M. C., Senapati, S., Zee, J., Allen-Taylor, L., Whittaker, P. G., Takacs, P., … & Barnhart, K. T. (2016). Medical management of ectopic pregnancy with single-dose and 2-dose methotrexate protocols human chorionic gonadotropin trends and patient outcomes. American Journal of Obstetrics and Gynecology.
Practice Committee of the American Society for Reproductive Medicine. (2013). Medical treatment of ectopic pregnancy: a committee opinion. Fertility and Sterility, 100(3), 638-644.
Wright, S. D., Busbridge, R. C., & Gard, G. B. (2013). A conservative and fertility-preserving treatment for interstitial ectopic pregnancy. Australian and New Zealand Journal of Obstetrics and Gynaecology, 53(2), 211-213.
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Assessing How the Market affects Economic Decisions about Retirement Plans
A number of aspects have emerged in the last ten years regarding the behaviors of employee in making retirement decisions. This dissertation investigates various insights from previous studies about how employees make investment, saving and manage their retirement plans. The purpose of this study understands the behavior adopted by the individuals while making economic decisions and the reaction of the market towards these decisions.
This study aims at assessing behavior adopted by the individuals while making economic decisions and the reaction of the market towards these decisions. Quantitative analysis was used to assess the correlation between dependent as well as independent variables (Christensen, Diebold and Rudebusch, 2011). Understanding behavior adopted by the individuals while making economic decisions is vital when it comes to addressing the research questions of this study.
This study uses empirical approach to report on the findings of different simulation tests performed on the Model Plan in the Model Economy (Diebold, Rudebusch & Aruoba 2006). The Model economy and Model plan are considerably streamlined; nevertheless, they demonstrate the actual behavior adopted by the individuals while making economic decisions. To assess behavior adopted by the individuals while making economic decisions simple model of pension plans is created (Diebold, Rudebusch & Aruoba, 2006).
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The purpose of this study is to assess individual behaviors while making economic decisions and the reaction of the market towards these decisions. The study also highlights on the how workers make decisions to save, manage the retirement investments and how they address their assets in retirement. The study used quantitative technique to assess the gathered information (Perlin, 2007).
Different behavior adopted by the individuals while making economic decisions can be estimated by data. Information associated with behavior adopted by the individuals while making economic decisions can provide a detailed understanding regarding how DC plans are implemented by various nations; decisions workers make about their retirement plans; and if employees are well placed and informed about the plans offered by the employers or the governments
Much as plan-level information is an effective technique to assess the behavior adopted by the individuals while making economic decisions, a number of them are ineffective when it comes to analyzing the effect of how the workers make decisions to save, manage the retirement investments and how they address their assets in retirement (Gai and Vause, 2004). As such, survey data can address these challenges, such that it involves defined contribution plans with or without investment decisions.
This study embraces first wave from HRS, which is a household survey that was initiated in 1992. Moreover, detailed demographic information of the participants, supplementary issues, the spouse’s pension eligibility and benefits from present or previous employer or other sources of pension integrated in the questionnaire. Owing to the fact that survey technique is of elderly population, the sample does not represent pen-age group, particularly, the sample of elderly group and hence assessing this data cannot adequately depict behavior adopted by the individuals while making economic decisions.
Data values with handful plan features will be suitable for empirical research in terms of contribution rates. Again, the study presents econometric effects of investment decisions, however it fails to assess the way in which decision feature will be integrated in the employee budget. Optimization model containing budget set design will be appropriate to investigate the impacts of pension to the next level.
In short the central debate in the paper was the behavior adopted by the individuals while making economic decisions and the reaction of the market towards these decisions, were divergent extensions would emerge. Individuals with DC plans cannot adequately control the exact amount of contribution from their salaries. Lastly, the study offers econometric impact of investment decision, however, it does not examine the decision variable will be a constraint on the budget of the individuals.
References
Ito, Takatoshi, 2002. Is Foreign Exchange Intervention Effective?: The Japanese Experiences in the 1990s. NBER Working Paper No. w8914. Available at SSRN: http://ssrn.com/abstract=309603
Jefferson, R. 2011. Rethinking the Risk of Defined Contribution Plans.
Kaminsky, L. R. 1997.”Leading Indicators of Currency Crises,” IMF Working Papers 97/79, International Monetary Fund.
