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Side effects of using corticosteroid to treat Addison’s disease
Patients diagnosed with Addison’s disease needs to take up their medication daily in order to replace the inadequate hormones. This normally helps the patients to live a normal life. Treatment mainly involves use of corticosteroids (steroid therapy) to replace hormones lost and those not produced by the aldosterone. Although these medications are effective, corticosteroids are associated with short term and long term side effects (Bentley, 2011)
The short-term side effects includes stomach upset, increased irritability, weight gain due to water retention, increased fat on the face, unusual hair growth , high blood pressure, and risk of other infections. The long-term side effects include muscle weakness, brittle bones, and stunted growth among the children. To minimize such side effects, people taking the drugs should be watched carefully and of necessary, their doses reduced as low doses can be effective and have minimal side effects (In Arieti, 2014).
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Factors that make it problematic for management Addison’s disease in adolescents
The process of diagnosing Adrenal insufficiency is usually a challenge. This is because most of clinical manifestation are nonspecific, and tend to vary according to the underlying causative agent and extent of disease progress. It is important to make early diagnosis as the disease can be life threatening if not diagnosed early enough. The signs and symptoms and management of the diseases are the main challenges faced by the adolescents diagnosed with Addison’s disease. These include issues such as fatigue, malaise, and general muscle weakness. This negatively impacts on quality of life and their daily activities (Helms, 2015).
Importance of inter-professional team for treatment of Addison disease
Team-work in management of Addison disease is important as it aids in improving patient quality of life, reduce mortality, improve communication, reduce errors, and increase patient satisfaction. In this case study, healthcare staff from the following disciplines should work together when delivering care to Addison’s patients. These include physicians, nurses, nutritionists, pharmacists, and physiotherapists. This will help in developing a detailed case related information, which facilitates the decision making processes (Bar, 2013).
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Database Characteristics and the Language of Health Information
Introduction
Electronic information systems are a strategic idea that any organization can adopt. Information systems help organizations to store information in an organized format that can be easily retrieved. Using information systems in hospitals will guarantee the safety of information for both the patient and the provider by making it easy to store and access health care information.
This is a shift from the manual hard copy store of data to the digital store of information (Beaumont, 2000). This will enable the storage, retrieval and processing of health data easily. This data is stored on a database that keeps all the information according to the format that the administrator has assigned it. This overview is guided by the outlined questions that are highlighted.
The hospital is faced with the storage of records on paper copies and files. The patient records have to be searched through the numerous files within the hospital and its respective centres in order to access a record. Furthermore the hospital needs to have information from its centres linked to the main hospital for it to be easily accessed.
The aim of this project is to develop an electronic health information system that will capture all the information of the hospital and its centres n one database that is easy to access and reliable. This presentation gives an overview of the relevance of adopting a health management system. It highlights the relevance of shifting from the manual paper work to a digital model of record keeping.
Fundamentals of database characteristics and structure
A database is a collection of data that is related that can be produced to information that is relevant to the user. A database is large since it has to store a lot of information ranging from figure to word. Beaumont (2000) argues that data represents facts that are recorded and can be processed to produce information that is based on the facts that are stored in the database.
These data is maintained as a collection of files that are stored in a database management system. A database management system has several programs that enable the users to enter data into the system and processing it into information that is relevant to the end user.
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In changing the hospital system to an EHR a database will be developed where data is entered into the database for access by several users on different platforms. The database is self describing; it insulates programs and data, supports viewing of data from multiple sources and enables the sharing of data across several users.
The database will be easy t use since it has definition of its components like, storage format, individual files structure, and the data constrains that may exist. The database will have different users that are differentiated from the way they use the database. They can be programmers, sophisticated users, specialized users or native users.
All these users can access the database but their use is limited according to the administrator privileges that exist in the database (Versel, 2011). The administrator coordinates the whole database system and understands the needs of each user and the privileges that should be assigned to the user.
Types of medical data and information records relevant to this project
According to Szolovits (2003), Hospitals keep different types of data that is relevant to both the government and the healthcare facility. The information is used in government planning for specific cases of illness and also in determining the patient disease patterns. The database will contain patient records and health records
Patient medical records contain the identification of the patient like, name, sex, age, residence blood type, chronic diseases, family health history and previous prescriptions ever administered to the patient. This data is entered in a database that can be shared across hospitals in a digital format through a network connecting all hospitals.
This aids in ensuring that the medication given to the patient is consistent unlike the manual system where the patient may have to narrate the prescriptions given to them (Szolovits, 2003). Individual files for each patient are supposed to be kept that help in making diagnosis for future cases of illness. The records help the patient and the doctor to make a diagnosis that best fits the situation of the patient.
On the other hand health records give a summary of the healthcare services and patterns that have been registered in the facility. These records are classified using different indicators for example they can be according to the disease that has been diagnosed or can be based on the type of drugs that have been administered to patients. These records are used by planners and policy makers to make decisions that affect the healthcare system (Versel, 2011). The type of health information stored will depend on state requirements that have been set.
The records will be linked to the main server that is located in the main facility. Each facility will have a login ID that will be used to record the cases in that facility. This will ensure that the cases can be differentiated easily as having been registered in one centre or the other.
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The importance of uniform terminology, coding, and standardization of the data
Use of uniform terminology entails harmonising the health information systems that exist to use terms that are similar across. Since the health standards are equal and have been set by the WHO then it means the terminologies used should apply across the globe. The use of uniform terminologies enables the exchange of health information and data among systems in a uniform manner. Therefore the medical terms have to be understood universally (Ramez & Shamkant, 2003).
Coding enables the practitioners and the health information system to easily interpret the data using the health information that has been built in the system. Coding is computer assisted increases the efficiency of the codes so that the codes are not human generated universally (Ramez & Shamkant, 2003).
Coding is further used in clinical health surveillance and decisions support within the healthcare. Coding makes the interpretation of data easy thus increasing health surveillance and the application of health information universally (Ramez & Shamkant, 2003)..
On the other hand Ramez & Shamkant (2003) argue that universally standardization of data ensures a uniform platform that all practitioners work on. This improves quality and efficiency during health care. Standards are defined by several organizations like ISO that determine that ensure all practitioners use a standard platform in healthcare.
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Information standards and organizations that may be applicable, and possibly required, for this project
In the current world where quality is a prerequisite, there are standards that are required for every organization or application that is used. ISO TC 215 sets standards that are required for electronic health records. It provides international specifications that are required which are described in ISO 18308 (Szolovits, 2003).
However there are 55 countries that have subscribed to the global authority in health care information health seven international. Below are various standards that guide the use of electronic health records.
HL7- a texting protocol between the physician and record systems and practice management systems.
ASC X12(12), a protocol for transmitting data of patients, this is commonly used in the US.
Claims attachment standard; it guides the submissions and making of claims in a health care System.
Personal health records standard that ensures uniformity of patient health records across countries.
The healthcare information systems vendor that offers electronic medical record products
Acummedic health: it’s a practice management and EHR application that is customised to capture the health care flow from the contact with the patient to discharge. The advantage with this system is it gives the opportunity for the user to add modules that are relevant to their agency. It supports the HL7 standard and offers several packages like substance abuse, behavioural health, community service and many others. It has been in use since 1977 and offers better platforms for EHR (Versel, 2011).
Acumen Physician Solutions is designed for nephrologists; it offers physician guideline and ambulatory services and is wholly owned by Fresenius Medical Care North America. Therefore the services it offers are linked to Fresenius Medical Care North America (Versel, 2011).
BML MedRecords Alert LLC was designed to provide solutions that are more efficient and a better healthcare system. It provides physicians with a digital platform to interact and gather information from patients. It allows the patients to easily access their medical information from anywhere and can be effective during emergency. Further it has medical alerts that patients can use and an online library for referral. This leads to both quality and efficiency in achieving healthcare (McBride, 2012).
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From the three EHR vendors, it is noted that they vary in their application but offer interaction between the patient and the healthcare provider. However Acumen Physician Solutions offers ambulatory services apart from the services that all others offer, while BML MedRecords Alert LLC offers a patient profile that the patient can search through the website and get information that can be relevant for emergency.
The patient is able to easily access the health records and can interact directly with the physician without physical contact. While Acummedic health is an open platform that enables the user to change and add the modules that are relevant, this shows why it has been in use since 1977. Therefore all the EHR vendors are good and will depend on the user preferences and requirements. The cost of installing the system will range from a minimum of $3000 US dollars.
Conclusion
Electronic Health records system helps to coordinate and make healthcare provision easy and fast to patients. According to Grooves et al (2013), health facilities use the system to increase performance and efficiency of the healthcare system. It assists the health care providers to exchange and coordinate information from one source to another. The Electronic Health records system provider immediate access to health records and literature by practitioners that helps in diagnosing medical cases.
The sharing of information between the patient, the practitioner and other health facilities has improved the quality of care. This is the invention that has brought health care to the door step of the patient and further reduced the distance between the patient and the hospital.
Grooves P, Kayyali B, Knott D & Kuiken S (Jan 2013) The big data revolution in healthcare, accelerating value and innovation. Centre for US Health System Reform. McKinney & Company.
Michael McBride (July, 2012) Understanding the true costs of an EHR implementation plan. Medical Economics.
Ramez Elmasri & Shamkant Avathe (2003) Fundamentals ofdatabase systems. Fourth ed. Pearson. New York
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Strategic Change at the American Red Cross
American Red Cross is a non-profit humanitarian organization which provides emergency assistance or services and disaster relief to Americans. In addition, the organization educates people inside the United States on how to avert risks in the society. It is beyond doubt that the American Red Cross performs functions significant to the lives of Americans.
Founded in May 21, 1881, the organization has alleviated human suffering in various ways. It has save a number of lives especially those affected by natural disasters and victims and survivors of war or terror attacks. The lives of the police or army policies are in the hands of the American Red Cross, a role which further highlights its significance (McGovern, 2011).
The organization has been applauded by most Americans for its effective service delivery. However, the organization has been plagued with a number of problems in the recent past and this has subjected the lives of many Americans to danger. The organization continues to face other challenges have impacted its growth and development. With the significance of this organization in mind, it is critical for the entity to pursue strategic change as a way of realizing stability and growth which it enjoyed in the 20th century.
The nature of disasters has changed significantly hence becoming hard to save the lives of Americans using the traditional methods employed in the 20th century. The causes of death around the world have become complex hence demand more complex solutions. Therefore, strategic change should be assumed in order to turn around things in the country and to restore confidence that Americans had in it.
Additionally, the activities of the organization have expanded. While it was meant to help those affected by natural disasters, soldiers and victims of war, American Red Cross is expected to offer community education and outreach. Generally speaking, strategic change is necessary at American Red Cross in order to change its design of response to disasters hence effectively alleviating human sufferings (The American Red Cross, 2014).
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SWOT Analysis of the American Red Cross
Strengths
Strong brand quality
The success of the American Red Cross is largely influenced by its brand strengths. It has strong brand quality which is attributed to its contributions to humanitarian history. The entity has gained popularity and respect from the Americans owing to the previous contributions to saving humanity. For an entity to have a strong foundation, it must have depth.
The American Red Cross is supported by more than 700 locally chapters throughout the United States, which perform more than 200,000 blood drives every year. This explains why this organization is the largest blood supplier in the country (The New York Times, 2015).
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Strong resource base
It is not easy for an entity to achieve strong quality brands if there are no sufficient resources. The American Red Cross has a wide network of both human and financial resources, and this explains why it has been able to deliver the services as expected by the public.
Advanced volunteers network
The strengths of the American Red Cross lie in the advanced volunteers’ network. There is a high number of youth who have volunteered to support the functions of the organization. The entity has youth marketing program which has about 169,000 volunteers, and all of them work towards ensuring realization of the organization’s objectives and mission (The American Red Cross, 2014).
A high trust from the public
The American Red Cross is trusted by majority of the Americans, some of them have volunteered to supports its functions. Majority of the Americans are of the view that the organization is effectively delivering its mandate. There has been no case of corruption or mismanagement of funds, and this is the main reason why majority of the Americans have donated their money to support organization’s programs (The New York Times, 2015).
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Youth Marketing Strategy
The presence of the youth marketing strategy puts the American Red Cross ahead of other humanitarian organization in the United States. With this strategy, the company has been able to use interactive mediums to conduct marketing activities.
Better Coordination
Proper coordination of activities is one of the aspects which have contributed to the success of the American Red Cross. This means that the company is functioning effectively and efficiently (McGovern, 2011).
The strengths discussed above are critical for the success of the strategic change process. The American Red Cross should capitalize on this strength in order to succeed in this pursuit.
Weaknesses
Poor Handling of the Resources
Management of resources is critical for success of any organization. Hurricane Katrina wrought a widespread devastation which compelled Americans to rethink of the responses adopted by the government as well as the humanitarian organizations. The American Red Cross, which is the de factor human side of the Federal Emergency Management Agency, was on the spotlight.
The issues which unfolded after this unforgettable event raised eyebrows about mismanagement of the resources by the entity. The entity later admitted that it had miscalculated the number of personnel to engage in evacuation of the victims in hotels and motels.
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Assumption that it is a government project
There is a widespread believe that the American Red Cross is the project of the government hence should be supported and funded fully by the government. Consequently, the number of supporters continues to decline every year (Weerawardena & Mort, 2012).
Low Transparency Level
The American Red Cross has been accused of providing misleading information and data about how it has been spending Donor’s Dollars. How the company used Hurricane Sandy funds remains a secret up to now, something which would definitely inflict a competitive harm (The American Red Cross, 2014).
In the pursuit of the strategic change, the American Red Cross must identify these weaknesses and establish the right approaches to handle them as it would negatively affect the whole process.
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Opportunities
Wide network which enables the company reach global community
The American Red Cross has established its presence in majority of the parts in the United States. However, it has the opportunity to capitalize on its ability to establish more presence in all regions both locally and internationally and this would enhance its efficiency in delivering the services.
New Media Channels Exploding
The modern generation is innovative and technology savvy. This provides a golden opportunity for the American Red Cross to embrace new technologies to market its operation. Additionally, the entity can use celebrities to influence the actions of the modern youth (Dolnicar & Lazarevski, 2009).
New Ways of Connecting to the Public
Other than social media platforms, which have emerged in the recent past, the American Red Cross can use blood drive activities to connect to the public.
Threats
Huge Competition
There are numerous humanitarian organizations which offer services similar to those of the American Red Cross. Some of its rivals offer to pay those who donate blood (The American Red Cross, 2014).
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Regulatory Compliance
The government of the United States established policies which governs operations of every non-profit organization. For the American Red Cross to perform its operations, it must meet specific requirements. In some cases, meeting all the requirements is costly to the company. In the event that the organization is not able to meet the regulatory compliance, then the strategic change process will not be undertaken.
Busier Target
The American Red Cross depends on the contributions of the young professionals, majority of whom are always busy. As such, the entity risk delays of its operations in some situations. Therefore, strategic change process is likely to be negatively affected.
Appreciative Inquiry 4-D cycle
Discovery
While the organization faces some challenges and shortcomings, it is also important to highlight that it has good history marked with great successes. The organization uses the success story of the past as a tool for developing better outcome for the future (Whitney & Cooperrider, 2011). Notably, the fundamental goal of this strategy is to capitalize past success to create an image of excellence for its customers and shareholders. This strategy will paint the organization as effective and excellent thus making customers and shareholders ignore any shortfall associated with it.
Dream
In regard to design, the organization projects poor strategies. Specifically, it has poor strategy in regard to sustainability as it depends mainly on donors as one of their sources of finances. With great scrutiny and many conditions that come with this source, sustainability is not secured (Whitney & Cooperrider, 2011).
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Design
Evident in its strategies, American Red Cross has successfully crafted a good and ideal organization using the positive successes from the past. This will inform a clear image of the future and this will be felt both at individual and organization levels, making the organization to achieve future possibilities.
Destiny
In regard to this strategy, the organization posts positive results. For instance, there is a great sense of belonging and purpose within the organization, and employees as well as shareholders taking part in major decisions. This will create a shared vision that will also be executed through shared values (The American Red Cross, 2014).
Comparison of the Organizational Outcomes using the Two Analysis Methodologies
From SWOT analysis, it is clear that the American Red Cross has the right resources and capabilities necessary for successful strategic change. The organization can capitalize on its strength to succeed in this pursuit. Strong quality brand is vital in this endeavor. The company is trusted highly by the public and this is important towards realization of the intended objectives of strategic change.
Notably, the weaknesses discussed are likely to pose challenges in this process. The company has the responsibility to identify these weaknesses and convert them to be strengths if predetermined objectives are to be achieved. Appreciative Inquiry analysis points out some of the strengths that are similar to those identified by SWOT analysis.
AI identifies good long history as one of the aspects which will enable the company succeeds with regard to this strategic change. The strategic change is closely linked to the mission of the company, which is to offer quality services, something which is also identified in SWOT analysis.
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Conclusion
The American Red Cross has gained popularity for its strong quality brand and the nature of services it offers to Americans within and outside the United States. While it is easy to conclude that the organization is doing perfectly well, critical analysis shows otherwise. The nonprofit organization has faced myriad of challenges in the recent past, which has negatively service delivery.
This demands the management to undertake strategic change so as to restore the pride of the company. To achieve the intended results, it is important for the management to employ SWOT analysis and Appreciate Inquiry 4-D analysis to understand some of the aspects that will influence the process.
References
Dolnicar, S. & Lazarevski, K. (2009). Marketing in Non-Profit Organizations: An International Perspective. International Marketing Review, 26(3), 275-291.
Whitney, D. & Cooperrider, D. (2011). Appreciative Inquiry: A Positive Revolution in Change. New York: ReadHowYouWant.com.
Weerawardena, J. & Mort, G. S. (2012). Competitive Strategy in Socially Entrepreneurial Nonprofit Organizations: Innovation and Differentiation. Journal of Public Policy & Marketing, 31(1), 91-101.
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Contemporary metaphors for the kingdom of God
God’s Kingdom is described metaphorically in most parts of the New Testament. As Tame (2005) pointed out, the metaphors used in the New Testament actually do not relate to the contemporary society. This essay is focused on contemporary metaphors for the Kingdom of God. One particular metaphor or parable is used in describing the Kingdom of God.
The essay discusses how the selected metaphor or parable would have made sense to Jesus’ audience during the first century. The impact and meaning of this message to the original audience of Christ is described exhaustively. Lastly, this essay describes the way in which that same message and impact may actually be communicated in the modern context.
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One particular metaphor that has been utilized in describing the Kingdom of God is the Parable of the Mustard Seed. This parable was taught by Jesus Christ in rhetorical hyperbole. Here, Christ makes use of a tree or shrub growing up from a seed to represent the growth of God’s Kingdom (Daniel 4: 11-21; Ezekiel 17: 23; John 12: 24). The growth of the seed attracts the presence of evil – portrayed as birds (Revelation 18: 2; Matthew 13: 4, 19) – to dilute the church whilst exploiting its benefits.
According to Christ, the heavenly kingdom is analogous to a mustard seed that a person takes and sows. Although the mustard seed is in fact the tiniest of all seeds, when this seed grows, it becomes the biggest of plants in the garden and tree where birds come and rest on in its many branches (Morrison, 2011).
Therefore, the picture that Jesus Christ paints in this parable is that of the lowly initial stages of the church undergoing an explosive growth rate. The church grows very big and later on it becomes a source of shelter, rest, and food not just for believers, but also for false professing persons who want to take advantage of or consume its benefits whilst mixing or residing amongst what the seed produced (Galatians 1: 7; Corinthians 11:13; and 1st Corinthians 6,7; 5:1).
Put simply, Christ was predicting that despite the fact that the church would grow to become very large from merely a small beginning, it would not remain unadulterated. Even though this is not a disapproval of the big size of modern Christianity, it actually shows the audience the biggest burden which comes with it. This parable serves not just as a prediction, but also as a warning (Morrison, 2011).
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Given that the metaphors used to describe the Kingdom of God in the Bible are out of date, it is not easy for people in today’s society to comprehend what Christ is saying. Nowadays, Bible readers struggle to find the meaning of God’s Kingdom (Tame, 2005). The same meaning and impact of the Parable of the Mustard Seed may be communicated in the contemporary context by using the metaphor of financial investments; that is buying growth stocks.
A growth stock is essentially a share in an organization whose earnings grow at a rate that is above average in relation to the market. Growth stocks generate sustainable and considerable positive cash flow and whose earnings and revenues are projected to increase much quicker in relation to the average company in the same industry (Fuscaldo, 2014).
An investor who invests in growth stocks may start off by purchasing a very small amount of stocks in a growth company and as the company continues to grow over time, so does the investor’s assets in that company. Growth stocks are generally attractive to a lot of investors since they are growing (Fuscaldo, 2014). The revenues and earnings of the investor in growth stocks would increase much quicker than investments in other companies in that industry.
Therefore, after a period of time such as 10 years, the earnings of the investor who initially invested $2,000 would be about $150,000 (Fuscaldo, 2014). However, there are challenges for instance the company’s stock price may decline later on and the investor’s earnings reduce. These challenges or risks are comparable to how the church would not remain pure.
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The changed metaphor from the Parable of the Mustard Seed to the metaphor of investing in growth stocks is faithful to the teaching of Christ on God’s Kingdom whilst changing the metaphor for the audience in that my contemporary audience members will easily understand how the Kingdom of God grows. It starts small like a little financial investment in growth stocks of a company that grows slowly but steadily and after some years, the investment will increase into a substantial amount of money for the investor.
Put simply, just like financial investments in growth stocks, God’s kingdom has small beginnings; however, its growth is gradual but certain. This updated metaphor is especially suited to today’s audience members since many people nowadays tend to buy stocks in companies as a better way of investing their money rather than just saving them in banks and earning annual interest on their savings.
The metaphor conveys to my audience members the traits of the Messianic Kingdom of God as modelled and taught by Christ since it illustrates how God’s kingdom is comparable to buying growth stocks; has humble beginnings but eventually grows into a big thing.
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Conclusion
To sum up, Christ using the mustard seed parable to his audiences was describing the kingdom not simply as a seed, but as the tiniest seed. He was not explaining to the audience members a kingdom which comes in a conflagration of glory – Jesus basically described a kingdom which starts really small. This is not what was expected by the Jewish people at the time, but it was the kingdom of God which Christ stated was forthcoming.
On the whole, the kingdom of God is a narrative regarding slow growth. The meaning and impact of the mustard seed parable could be conveyed in contemporary context using the metaphor of investing in growth stocks; humble start but steady increase. Companies with growth stocks grow at a comparatively faster rate than other companies.
References
Fuscaldo, D. (2014). 5 characteristics of good growth stocks. Chartered Institute of Management Accountants.
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Sexually Transmitted Infections (STIs)
Sexually transmitted disease among the youths is a global concern to public health. The rates of sexually transmitted infections (STIs) such as syphilis, simplex virus, chlamydia, and gonorrhoea have dramatically increased among the heterosexual youths, especially among women of childbearing age. Research indicates that two-thirds of the estimated 12 million new incidences of STIs in the USA are women.
Women are twice likely to acquire infections after a single exposure to pathogens causing Hepatitis B, Chlamydia infection, Chancroid, and gonorrhoea as compared to men. These STIs are the leading causes of reproductive morbidity among the women of childbearing age (Mittal, Senn, & Carey, 2011).
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This highlights that STIs are of particular distress among women due to their potential acute complications which can be life threatening especially during pregnancy. These include complications such as fetal death secondary, pneumonia, sepsis and premature delivery. My main inspiration for this topic is derived from the many cultural and religion expectations of women on mutual monogamy during and after their marriage.
This expectation contradicts most STI teachings resulting into the dramatic increase in STIs prevalence rates among this group. I feel obliged to conduct this research as women need to understand their STI risks, and learn the most effective preventive measures, chiefly because we live in a generation that lacks any assurance of mutual monogamy (Mittal, Senn, & Carey, 2011).
Without any interventions, a dramatic increase of the incidences is anticipated. This is has earned my interest as there is limited research on knowledge and perceived risk among women in the childbearing age. Due to the rising incidences of the STIs among the youths, evidence-based research indicates that behavioural interventions should aim at empowering women to increase their knowledge and perceptions of risk factors (Mittal, Senn, & Carey, 2011). Well, it is said that when a woman is educated (empowered) the whole nation is educated.
References
Mittal, M., Senn, T., & Carey, M. (2011). Mediators of the Relation between Partner Violence and Sexual Risk Behavior among Women Attending a Sexually Transmitted Disease Clinic. Sexually Transmitted Diseases, 1. http://dx.doi.org/10.1097/olq.0b013e318207f59b
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Impacts of FDI on Employment in China
Introduction
Foreign Direct Investment (FDI) has been defined by different scholars, with the common definition referring to an investment where a firm gets acquisition and control over another foreign firm or such a firm set up its subsidiary in another foreign country. Taking many different forms, such investments could include mergers and acquisitions, intercompany loaning facilities, reinvestment of profits in foreign countries and development of new facilities overseas.
A clear distinction is drawn between FDI and portfolio investment, which involves the investments in the security of another country, either equity or debt securities (Sornarajah, 2011).
Due to the rapid changes resulting from globalization, better opportunities arise in the FDI arena. Foreign investments have flowed to different countries and had great impact on these countries’ economy. Developing countries, for instance, have endeavored to set policies that are competent and able to attract foreign investors. China, in its developing stages, managed to conceptualize the Reform and Opening Policy as early as 1978, a move that started revolutionary policy guidance for Foreign Direct Investment in China (Hale & Long, 2011, p. 16).
Since its beginning, FDI in China has undergone rapid developments. Within 1979 and 1986, a total amount of about $8.304 Billion was transacted as a result of FDI with the main players being Taiwan, Hong Kong and Macao (Chen, 2011, p. 93). This good trend was distorted from 1987 through 1991, when China’s legal system was unsound and incapable of attracting foreign investments
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Mainly referred to as the Rapid Development Stage, happened between 1992 and 1997 after China embarked on their socialist market economic system, hence improving tremendously the opportunities for investments. During this time, China’s FDI hit the highest at $196.7 Billion.
Though the following years witnessed a dwindling trend in FDI, this changed in 2001 to the present, due to China’s involvement in the World Trade Organization and its conducive environment that attracts investments internationally. Mostly, the main sectors which China concentrated on to stabilize their FDI included technology and telecommunications, banking, retail and wholesale growth.
Other than this, China promulgated new government policies that were business friendly. By the year 2011, the country had invested in over 400,000 enterprises that were internationally funded (Deng, 2013, p. 213). Apart from the inflow on FDI, there was massive effect of such investment to the indigenous firms in China. Such effects are referred to as spillover effects, which are usually divided into monetary and demonstration effects.
Due to their technological advancements, multi-national firms are competent compared to the local companies hence giving excessive competition grounds. As a result, local companies seek better managerial skills, technological equipment and production efficiency to meet the standards of the multinational companies (Zhang, et. al., 2016, p. 180). Despite being advantageous, this kind of competition between firms can be detrimental on the local firms, where multinational companies using technological advancements and productivity snatch market shares from local firms.
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There are various forms of FDI in China, including; equity joint ventures, wholly foreign-owned enterprise, joint exploration, FDI shareholding and contractual joint ventures. As its name may suggest, equity joint ventures are owned jointly by foreign and Chinese companies, individuals or other governmental organizations. Both companies manage the company together, hence sharing profits and risks together on determined scales as per capital contributions.
Contractual joint ventures, on the other hand, are somewhat similar to the equity joint venture, only that obligations and duties arising on the parties are laid off in a contract. Wholly foreign owned refer to foreign companies, individual and enterprise investments who establish themselves in China. In this scenario, all capital derives from such foreign firms. FDI shareholding involves the purchase of equity by foreign investors, hence leading to foreign invested enterprise.
Joint explorations, on the other hand, refer to various economic cooperation on the international arena, usually divided into exploration, exploitation then production. In many instances, joint explorations venture into exploitation of natural resources (OECD, 2013, p. 53).
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As earlier mentioned, FDI has a spillover effect. Particularly, FDI ensures creation of jobs, explained through the greenfield and brownfield analogies. Greenfield analogy can be explained as an investment that creates new production lines in host countries, through starting of a new company. Brownfield investment, in contrast, involves overseas mergers and acquisition. Due to its nature, brownfield investments cannot be certainly denoted as job openers, considering no new companies are created.
Another effect of FDI experienced in China is the crowding-effect, considering many multinationals are investing in the country. Local firms are overly pressurized to exhibit good performance, or risk winding up. This leads to severe pressure on employees. The inter-dependency between FDI and employment is usually affected by diverse variables, including population, exports and growth of domestic economy (Michael, 2013, p. 24).
Literature review
In the recent years, China has been trying to support the foreign direct investment to enhance its purchasing power via wages and to create job opportunities. Through understanding factors that impacts on employment, particularly those associated with FDI, China can realize its potential expansion of its productive sector and the required production innovation techniques to improve its economy.
It is because FDI can create jobs through the direct hiring of individuals for the new industries. Moreover, the enhanced aggregate domestic employment via various types of jobs created, income distribution, wages levels, and skills transfer will result in indirect effects. The increased FDI inflow to China has led to the creation of many job opportunities, and as a result, many people have been employed (Hu, 2011).
Therefore, FDI has positively impacted on employment in the long-term since individuals who could have been unemployed, now can have jobs. However, since FDI bring new business culture and technology, its influence relies on the interaction between the growth of the productivity, labor specialization, and output growth.
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FDI has led to the improvement of technology, skills, and trade in the long-term in China. Moreover, it has facilitated adverse effects on jobs and wages as realized in China in the short-term. The findings in China in both secondary and tertiary firms for the period 1985-2008 indicated that FDI growth led to the creation of employment, enhanced skills and technology, and trade for the period.
FDI needed high-skilled personnel to work in their organizations that had sophisticated technologies, hence, necessitated an individual to acquire skills that matched FDI requirements, making one to have improved skills in the end. However, in situations where there was a bidirectional linkage between employment and FDI, in the short-term, FDI led to the loss of jobs because of displacements of workers, according to Liu (2012).
Furthermore, on one hand, new technology made industries more competitive that allowed them to employ more employees and to grow. On the other hand, new technology led to decrease in demand because of substitution of many low-skilled workers by fewer high skilled employees. Therefore, new technology had both merits and demerits attributed to job creation and employment.
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Recent empirical evidence studies show that China should not expect to have any job opportunities despite the benefits she gets from FDI (Zia & Rizvi,2011). It is because elasticity growth associated with employment in China is extremely low, which makes employment enhancing policies be priorities. Initially, when foreign investors and their companies came, many people were employed, but over time the rate of absorption became low. T
he new companies were able to attain the required number of employees in their organizations with time, meaning new people could not be employed leading to low elasticity growth associated jobs.
When China is studied using the two-sector dual economy model to show the influence of foreign investment on domestic capital accumulation and underemployment, it shows that foreign investment lower manufacturing sectors in the long-term. The manufacturing sector decline because some of the local companies were not able to compete adequately with foreign organizations associated with FDI as they had a lower level of technology and skills.
FDI also had a large effect in the high-wage manufacturing firms than on a one-for-one basis and crowds out domestic capital. The study of FDI effect using analysis of panel information to find labor demands roles for white and blue collar employees showed that FDI had significantly positive outcomes. However, the positive effect, especially with the blue-collar jobs, declined with the rise of the skilled intensity of manufacturing companies (Liu, 2012).
According to Duan (2011), labor market, market size and market potential, clustering and cluster, macroeconomic policies, openness, and scientific research level account for the reason of determining the FDI location. Labor productivity and labor costs also influence FDI location, which indicates that improved workforce skills level attracts FDI. Thus, FDI favors high-skill workers because they are the ones mostly likely to get employed in the new job markets, and makes low-skill workers liable to lose their employments due to replacement.
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Ownership that is so crucial in the creation of the jobs affects employment in China. Research indicates that the major reason for inadequate employment creation is because the state own enterprises absorb employees quickly than the private sector. The low absorption rate is attributed to the fact that both joint ventures and foreign-owned multinationals that are supposed to employ many people belong to the private sector.
Thus, it means that the private sector has a higher capacity of creating more employment opportunities when compared to the state-owned enterprises (Sjoholm, 2011). In a similar analysis of employment, Hale & Long (2012) found out that FDI indirectly and directly impacts jobs. According to them, FDI can directly increase jobs and indirectly lower jobs by improving productivity levels indirectly and supplanting domestic investment. However, when the effects of the two are combined, FDI has significant positive influence in China.
Liu (2012) analyzed the effect FDI has on employment creation in China as far as manufacturing companies are concerned. Liu relied on the industry-level data in the Chinese manufacturing industry for the period 2000-2009. Also, Liu presented an analysis of direct and indirect job impacts. The findings indicated that both the private domestic industries and FDI have higher employment growth than the non-private domestic companies in China.
Furthermore, firms with other types of ownerships had less advantageous features than the FDI, in particular, their access to the export market, when the cross-ownership comparison is done. The conclusion was that FDI had led to employment creation in the Chinese manufacturing sector.
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The impact of FDI on employment may not be beneficial to China. Hu (2011) illustrates that when crowding-out is taken into consideration, the crowding-out only becomes significant when foreign multinational enterprises focus on the recipient nation’ market. It is because the FDI influx may bring in more pressure on domestic firms. Moreover, the external investment requires higher efficiency and better technology, which implies that it will only need fewer employees than before, making the crowding-out effect of FDI lead to more workers being laid off as a result of more of the domestic companies going bankrupt.
Zia & Rizvi (2011) indicate that FDI has more favorable when China faces economic crises. It is because FDI has an advantage over other investments programs such as loans or portfolio as it often prove to be more resilient in times of economic crisis. The other types of investment are subject to large reversal when there is a financial crisis. Thus, economic crisis presents a major challenge to employees and employment.
Workers who are employed in other types of investment are more likely to be laid off because their organizations may go bankrupt, which is unlikely of FDI that is more resilient and stable in an economic crisis. In this scenario, FDI positively impacts on employment in China because workers are not likely to lose their jobs due to the economic crisis.
FDI has also led to the loss of employment among people in China, according to Zia & Rizvi (2011). The increased competition associated with FDI’s international corporations has pushed out some of the more productive local business enterprises as they are not able to compete. It is because the local business enterprises have lower technology and skills in most cases than the FDI’s companies making them less favorable to compete in the market.
Therefore, the increased competition brought in FDI has led to the loss of jobs, rather than creating. Moreover, it illustrates that FDI does not contribute to local economy development because the increased competition associated with FDI leads to people being laid off in local business ventures.
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The amount of FDI in China increased by 225.20 USD HML between December and February 2016. This is according to data the ministry of commerce of the people’s republic of china. The country averaged 416.01 USD HML between 1997 and 2016 hitting an ultimate high of 1262.7 HML in December 2015.
Labor is affected by a variety of factor in an economy both from either side of the border of the economic space of a country or an economy. Empirical research has given much more attention to the effects of trade on labor markets than to the impacts of FDI on employments. Analysis on the effect of FDI on employment is thus more complicated.
A large number of studies have been conducted that try to establish whether OFDI substitutes or complements domestic jobs and this is split into two. In the home employment effect of foreign direct investment: from empirical results, China’s OFDI contribution to the employment of the country is a noticeable difference in the studies conducted over time. It was found that FDI can stimulate exports thus, in turn, achieving more employment.
These multinationals, in the process of processing trade of foreign investments, source most of their materials from the domestic markets. This are raw materials, spare parts and other half finished products. This increases the demand for these goods in the domestic market hence raising the employment in the different industries producing them and those related to them.
However, with the surplus of china’s labor being serious and FDI still being at a start stage, many investments belong to the defensive industry. These investments cause an increase in the demand of domestic capital and goods thus edging out domestic investments from the market.
Research also shows that china’s FDI does not influence employment in the primary industries but gives a significant effect in secondary and tertiary industries. With the composition of capital in the tertiary industries being comparatively small, labor is higher compared to other industries at similar investment levels thus FDI achieving more influence in tertiary sectors.
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Research done on the effect of FDI on the home country have elicited mixed results. Research dealing in detail with the employment effect of FDI found a substitution effect between a foreign subsidiary’s activity and its parent’s employment. These studies have majorly concluded that change mainly occurs between countries with comparable endowments. This thus implies that low-wage countries make better substitute among themselves than.
Studies indicate that American multinationals are employing vertical FDI seem to be reducing employment back home compared to production by transferring labor intensive stages of their production processes to their affiliates in developing countries. Other studies have concluded that labor substitution is more likely to take place when factor proportions are different in various locations and vertical FDI prevails. The second group of research has found that the complementary effect prevails, this noted a positive effect on employment due to an affiliate activity in the host country.
The main reason behind this is that the opportunity to invest in a low-cost host country could increase the firm’s competitiveness, promote its use of economies of scale, and reduce its costs, which may lead to an increase in home-country employment.
This brings the picture of a scale effect dominating over a substitution effect for the parent country’s firms and the parent country’s employment. In the North American car industry, studies have found that jobs in Japan were growing as a consequence of investing abroad. This is explained as the result of allocating labor intensive production to developing countries thus increasing supervisory and ancillary employment to mainly service foreign operations.
According to Hu (2011), the two factors affecting employment are economic development and capital stock, with capital stock encompassing both domestic and foreign FDI.
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The third group of studies shows that outward investments can increase the demand and wages for skilled labor in both the parent and host countries. This is attributed to the differences in labor demand in both countries
Nunnenkamp, Bremont and Waldrich (2011) posed the question on whether foreign direct Investment contributed to employment creation in Mexico. An analysis of FDI and employment data covering manufacturing firms in Mexico were used. From this, they estimated the dynamic labor demand functions for blue and white collar workers, including both FDI and its interaction with major industry characteristics.
Using the GMM estimator proposed by Nunnenkamp, Bremont and Waldrich (2011) they accounted for the relatively short time dimension of the panel data (1994-2006). It showed that FDI had a positive though the quantitatively modest impact on manufacturing employment in Mexico. This was in contrast to a widely held view applying to both white collar and blue collar jobs.
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Hu (2011) found that it is very difficult to assess the outcome of FDI on employment in European nations mainly due to the different stages of economic development in the countries. According to him, the first stage of FDI is characterized by elimination unproductive jobs giving way to new productive jobs.
This is mainly due to the restructuring of jobs by extensive mechanization and automation leading to loss employment while the organisations became better and more profitable. From these, the multinationals create a better and more productive labor force. This process of creatively destroying labor ends up creating a more positive effect on employment. Finally, it is found that the research shows that FDI is not a golden wand to the creation of jobs.
Liu (2012) using data collected between 1986-2010, concludes that that the effect of FDI on employment was positive before 1996, but the effect was not noticeable after 1996.
According to established theory, the activities of affiliates can be related to the motives of FDI, namely efficiency seeking, market seeking and strategic-asset-seeking flows. The impact of these types of FDI on trade patterns are explained by distinguishing four kinds of trade linkages between the parent firm and her affiliates:
The substitution of former exports through FDI
Growing (re-)imports of goods and services produced abroad
FDI associated exports of goods and services
FDI induced exports of other product lines neither generated by the foreign affiliates nor exported earlier by the parent
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The overall impact of FDI on domestic employment is the sum of negative (export substitution, re-imports) and positive effects (associated and induced exports) and can be tested only empirically. Any distinction between direct and indirect FDI is justified only if their trade linkages differ. In a broad view, the literature reviewed shows that MNE (Multinational Enterprises) employment can promote growth and poverty reduction in host countries in four ways.
(i) Multinational Enterprises job has a direct and indirect impact on domestic employment: this is through direct employment and indirect employment through forward and backward linkages in the local firms.
(ii) Multinational Enterprises employment boosts wages in host countries:
A number of studies have shown that Multinational Enterprises pay higher wages than local firms even after controlling for firm and worker characteristics. The presence of multinationals will also at times cause wages to be higher in industries and in provinces that have a higher foreign direct investment
Through labor turnover, technology gets diffuse into the host countries as domestic employees move from foreign firms to local companies.
(iv) Multinational enterprises employment enhances labor force productivity in host country:
Several studies have shown that workers in foreign-owned enterprises are more productive than workers in domestically owned enterprises.
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Methods
Time series and AUTOREG process in SAS were used to access historical association between the inflows of FDI and employment in China. Since, dependent and independent variables are time series data, model error has a significant probability of not being independent based on time The AUTOREG procedure measures and predicts linear regression for time series in the event that errors are Autocorrelated.
Dependent and independent Variables
As indicated early, FDI has led to crowding-out influence on employment, as such an essential indicator of job opportunities. Besides FDI, various variables may impact employment including GDP, interest rates and wages. Some of the components of GDP include government expenditure, consumption, value of net exports and investment (Mankiw, 2012). The thesis uses China’s Statistical Yearbook that has FDI as an investment element.
For that reason, the assessment was performed using GDP values from this Statistical yearbook and provided values of GDP subtracted with FDI. The results were then utilized in testing the association between GDP and employment. For easier understanding, model outcomes of GDP are obtained from Statistical Yearbook of China. The estimates of the model are similar, with same independent variables under the requirements of alternative model. The model outcome of GDP with no adjusted FDI is demonstrated in analysis section.
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Moreover, since China’s FDI information from World Bank beginning in 2005 demonstrate considerably amounts in comparison to Statistical Yearbook, however, employment and GDP are similar in these sources, models were evaluated using FDI and other variables from World Bank and Statistical Yearbook respectively. The results are demonstrated in table 1.
Table 1: Chinese National Economy Data
Year
Emplo yment (100mi llion)
FDI
FDI ˄World Bank˅
GDP
GDP- FDI
total wage
intere st rate for depos its
intere st rate for loans
Exchan ge rate
1985
4.9873
19.56
16.59
2943.0 7
2923.5 1
430.9 1
8.28
7.92
3.2095
1986
5.1282
22.44
18.75
2816.2 3
2793.7 9
444.7 9
9.36
7.92
3.7314
1987
5.2783
23.14
23.14
3290.2 9
3267.1 5
504.1 3
9.36
7.92
3.7314
1988
5.4334
31.94
31.94
4124.0 9
4092.1 5
620.7 3
10.80
13.32
3.7314
1989
5.5329
33.92
33.93
4113.1 1
4079.1 9
622.1 5
14.94
19.26
4.2088
1990
6.4749
34.87
34.87
3695.7 1
3660.8 4
563.7 0
11.52
11.16
5.2352
1991
6.5491
43.66
43.66
4162.9 6
4119.3
612.8 8
9.00
9.72
5.4234
1992
6.6152
110.0 8
111.56
4739.0 5
4628.9 7
677.2 3
9.00
9.72
5.8166
1993
6.6808
275.1 5
275.15
6345.6 6
6070.5 1
844.5 6
12.06
12.24
5.8210
1994
6.7455
337.6 7
337.87
5906.2 7
5568.6
782.8 8
13.86
14.04
8.5024
1995
6.8065
375.2 1
358.492
7584.4 2
7209.2 1
966.4 9
13.86
14.04
8.3351
1996
6.8950
417.2 6
401.8
8904.2 7
8487.0 1
1076. 29
12.06
15.12
8.3290
1997
6.9820
452.5 7
442.37
9874.0 6
9421.4 9
1161. 11
6.66
10.53
8.2700
1998
7.0637
454.6 3
437.51
10463. 32
10008. 69
1228. 04
6.66
8.01
8.2700
1999
7.1394
403.1 9
387.53
11018. 74
10615. 55
1324. 66
2.88
6.21
8.2700
2000
7.2085
407.1 5
383.993
11940. 63
11533. 48
1324. 63
2.88
6.21
8.2700
2001
7.3025
468.7 8
442.41
13183. 56
12714. 78
1475. 86
2.88
6.21
8.2700
2002
7.3740
527.4 3
493.079 766
14567. 79
14040. 36
1649. 11
2.79
5.76
8.2700
2003
7.4432
535.0 5
494.568 471
16519. 16
15984. 11
1853. 64
2.79
5.76
8.2700
2004
7.5220
606.3 0
621.080 43
19462. 7
18856. 4
2129. 99
3.60
6.12
8.2700
2005
7.5825
603.2 5
1041.08 694
23208. 33
22605. 08
2554. 22
3.60
6.12
8.0757
2006
7.4978
630.2 1
1240.82 036
28471. 13
27840. 92
3101. 64
4.14
6.39
7.8224
2007
7.5321
747.6 8
1562.49 335
36166. 7
35419. 02
3998. 09
4.41
6.39
7.3714
2008
7.5564
923.9 5
1715.34 65
46083. 95
45160
5147. 09
5.58
7.47
6.8565
2009
7.5828
900.3 3
1310.57 053
51082. 38
50182. 05
5900. 70
5.58
7.47
6.8227
2010
7.6105
1057. 35
2437.03 435
60602. 15
59544. 8
7111. 57
4.20
6.14
6.6469
2011
7.6420
1160. 11
2800.72 219
73453. 39
72293. 28
9455. 83
5.00
6.60
6.3405
Table 2 Chinese National Economy GDP Disaggregated Data
Unit (100 million US$)
Year
Gross Domestic Product
household expenditure
government expenditure
Gross capital formation
Net export
1985
1460.48
404.70
1077.27
0.62
1986
1420.94
407.27
1056.41
-68.39
1987
1641.77
449.83
1195.80
2.89
1988
2108.62
528.33
1527.63
-40.49
1989
2093.85
558.73
1504.63
-44.10
1990
1805.26
504.20
1288.78
97.47
1991
1978.57
619.78
1450.75
113.86
1992
2235.00
722.62
1734.05
47.38
1993
2819.46
942.76
2700.17
-116.73
1994
2569.18
870.11
2392.40
74.58
1995
3403.64
1005.21
3055.76
119.81
1996
4076.83
1196.25
3455.99
175.20
1997
4464.51
1356.60
3623.70
429.25
1998
4743.57
1494.43
3786.48
438.84
1999
5068.97
1658.59
3984.46
306.72
2000
5544.69
1893.76
4213.16
289.02
2001
5977.74
2115.84
4808.88
281.10
2002
6415.55
2268.43
5509.67
374.14
2003
6970.96
2422.70
6766.99
358.51
2004
7886.15
2700.62
8363.77
512.16
2005
9034.35
3268.92
9640.88
1264.18
2006
10556.29
3902.69
11883.06
2129.09
2007
13068.41
4870.23
15050.50
3177.56
2008
16286.79
6089.42
20174.33
3533.41
2009
18100.47
6691.89
24087.65
2202.37
2010
21176.58
8027.25
29126.95
2271.37
2011
26014.54
10033.29
35487.21
1918.35
Data Source: China statistical yearbook.
Table 3 Chinese Economy Primary Sector Source Data
Unit (100 million US$)
Year
Employment (100 million)
FDI
GDP
GDP-FDI
Total Wage
1997
3.484
6.2763
1746.3
1740.02
31.78
1998
3.5177
6.2375
1791.73
1785.49
30.22
1999
3.5768
7.1015
1786
1778.9
30.58
2000
3.6043
6.7594
1807.1
1800.34
31.45
2001
3.6513
8.9873
1908.26
1899.27
32.43
2002
3.687
10.2764
1999.64
1989.36
33.63
2003
3.6546
10.0084
2101.78
2091.77
40.6
2004
3.5269
11.1434
2589.21
2578.07
42.46
2005
3.397
7.1826
2776.23
2769.05
45.65
2006
3.1941
5.9945
3073.23
3067.24
51.56
2007
3.0731
9.2407
3883.52
3874.28
63.03
2008
2.9923
11.9102
4915.34
4903.43
75.32
2009
2.889
14.2873
5159.28
5144.99
78.71
2010
2.7931
19.1195
6098.12
6079
94.34
2011
2.6594
20.0888
7489.35
7469.26
110.03
Data Source: China statistical yearbook.
Table 4 Chinese Economy Secondary Sector Data
Unit (100
million US$)
Year
Employment (100 million)
FDI
GDP
GDP-FDI
Total Wage
1997
1.6547
325.6989
4539.66
4213.96
556.41
1998
1.66
313.2749
4716.35
4403.08
514.97
1999
1.6421
277.8432
4961.74
4683.9
521.02
2000
1.6219
295.798
5508.57
5212.77
546.18
2001
1.6284
348.0844
5986.98
5638.9
575.7
2002
1.578
394.7185
6517.14
6122.42
627.26
2003
1.6077
391.9696
7549.94
7157.97
719.88
2004
1.692
454.6306
8936.43
8481.8
831.48
2005
1.8084
446.9243
10847.12
10400.2
1009.74
2006
1.8894
425.066
13259.3
12834.2
1248.39
2007
2.0186
428.6105
17070.21
16641.6
1587.29
2008
2.0553
532.5624
21731.71
21199.1
2018.55
2009
2.108
500.7582
23088.12
22587.4
2272.02
2010
2.1842
538.6037
28191.07
27652.5
2789.19
2011
2.2544
557.487
34762.69
34205.2
4030.86
Data Source: China statistical yearbook.
Table 5 Chinese Economy Tertiary Industry Data
Year
Employment (100 million)
FDI
GDP
GDP-FDI
Total Wage
1997
1.8432
120.5952
3263.38
3142.78
549.09
1998
1.886
135.1151
3697.76
3562.64
578.94
1999
1.9205
118.2424
4095.94
3977.7
642.53
2000
1.9823
104.5907
4681.25
4576.66
710.91
2001
2.0228
111.7042
5361.16
5249.46
822.43
2002
2.109
122.4337
6033.72
5911.29
930.53
2003
2.1809
133.0687
6772.03
6638.96
1093.16
2004
2.3011
140.5258
7806.69
7666.16
1256.05
2005
2.3771
149.14
9277.12
9127.98
1498.82
2006
2.4143
199.0819
11320.68
11121.6
1801.7
2007
2.4404
309.8277
15105.94
14796.1
2347.77
2008
2.5087
379.4812
19155.54
18776.1
3053
2009
2.5857
385.2817
21681.98
21296.7
3549.97
2010
2.6332
499.6292
26116.83
25617.2
4228.04
2011
2.7282
582.5342
32329.08
31746.5
5314.93
Data Source: China statistical yearbook.
Unit (100 million US$)
Model outcome of industry with respect to GDP without FDI are indicated in table 6
Table 6: Chinese National Economy Normal Least Squares Results
The AUTOREG Procedure
SSE
2.74028586
DFE
18
MSE
0.15224
Root MSE
0.39018
SBC
44.5152978
AIC
32.852766
MAE
0.22047964
AICC
43.4410013
MAPE
3.56510991
HQC
36.3206481
Durbin-Watson
0.7275
Regress R-Square
0.8492
Total R-Square
0.8492
Variable
DF
Estimate
Standard Error
t Value
ApproxPr > |t|
Intercept
1
5.4839
0.8842
6.20
<.0001
FDI
1
0.003170
0.001355
2.34
0.0310
household
1
-0.000139
0.000722
-0.19
0.8497
government
1
0.001427
0.001350
1.06
0.3044
GCF
1
-0.000182
0.000230
-0.79
0.4394
export
1
-0.000146
0.000220
-0.67
0.5144
wage
1
-0.000588
0.000951
-0.62
0.5443
deposit
1
0.006644
0.1214
0.05
0.9569
loan
1
0.0137
0.0893
0.15
0.8795
Additionally, wages influence employment. A number of studies have assessed the connection between wages and employment. Wages cannot affect employment, in other words, reducing real wages in not useful to increase job opportunities. On the contrary increased job opportunities do not affect wages. When job opportunities increase, it implies that increased demand while reducing real wages. Interest rates also affect employment.
For instance, a decrease in interest rate on deposit means that individuals will deposit less hence promote consumption in households while promoting production and recruitment as the market will require additional employees. In contrast, when there is a reduction of interest rate on loans, producers will borrow from banks at reduced costs thus assist in expanding production and a nation will need extra employees.
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Sources of data
In this study, to assess the connection between FDI and employment in China, eight independent variables were used including wages, FDI, government expenditure, consumption, net exports, investment, interest rates for loans and deposit from 1985 to 2011.
In china, the Reform and Opening Policy was introduced in 1978, a period when FDI started to flow. Nonetheless, as a result of inadequate information on FDI, interest rate for deposit and loans, wages while ensuring that independent variable , data was collected from similar source as well as period- 1985to 2011.When it comes to statistical analysis, three major industries in the economy of China, information on four elements of GDP and interest rates for loans and deposit was not available.
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Additionally, in the analysis of three major sectors; GDP, FDI and wages were used as independent variables. Information on industry analysis was available for 1997 to 201. And for national economy and industry analysis dependent variable was similar – number of employed individuals, which was represented as 100 million employment opportunities.
Consequently, original Chinese information source FDI units, household spending, net exports, wages, government spending and gross capital are represented by 100 million US dollars. On the other hand, household spending, net exports, wages, government spending and gross capital are represented based on Chinese currency RMB. To ensure that there is uniformity in the information, exchange rate for RMB to USD from 1985 to 2011 was employed to convert RMB to 100 million USD. The interest rates units are expressed as a percentage.
Owing to the fact that each industry has various units/sectors, the primary, secondary and tertiary data values are the totals of every sector in each industry. The primary sector comprises of forestry, agriculture, fishing and animal husbandry while the secondary industry involves manufacturing, mining, supply of water, gas, and waters. Addition, tertiary industry represents other sectors not in the primary and secondary industries.
Some of these sectors are storage, transport, information dissemination, hotels and catering; realtor, scientific research and so forth (China Statistical Yearbook).For that reason, the useful data for primary, secondary and tertiary sectors, and FDI information and wages were estimated. GDP information is collected from China’s yearbook. Information for the China’s economy is illustrated in Table 1 and Table 2. Table 3 presents primary sector data and Table 4 and Table 5 represents secondary and tertiary sectors for the economy of china respectively.
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Results
Data analysis was performed using AUTOREG procedure to demonstrate the connection between independent and dependent variables of employment. The modeling approach changes due to inadequate interdependence of data values as well as estimation error through modeling errors as lag-one autoregressive, or AR(1), framework. According to the model errors in the analysis, it demonstrates cases of moderate level of skewedness for particular model while approximating normality in certain cases.
Much as heteroskedasticity of errors is not directly tackled, AUTOREG process id developed to deal with such issues; based on the fact that there is insufficient volatility in the information to assess the models.
Findings for the national economy of China
Based on the findings from the overall economy of China, it is evident that independent variables including household spending, FDI, gross capital, government spending wages, net capital and interest rates of loans and deposits have a significant relationship with employment- the dependent variable. According to estimations from Ordinary Least Squares, 84.95 percent of changes in employment can be forecasted by independent variables (table 6).
In addition, from Maximum Likelihood that involves adjusted Autocorrelated errors, there were about 95.89 percent changes in employment, which can be estimated by eight predictor variables (Table 7). The association between every independent as well as dependent variable is illustrated in Tables 6 and 7. Since the information is focused on 27 year while standard errors are huge compared to large datasets, estimations demonstrate that particular p-values are more than 5%.
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Using, Ordinary Least Squares, it is clear that there is a strong correlation between FDI and employment- with a p-value of 0.031. There is no evident association between dependent variable and household spending, FDI, gross capital, government spending wages, net capital and interest rates of loans and deposits (Table 6 With respect to Maximum Likelihood that comprises of the impacts of autoregressive lag-1 framework there is a negative correlation between employment and interest rates loans, because the p-value is more than 5% at 0.0616.
While this is not a strong relationship, it indicates and provides areas fro further studies in future. Again, there is no correlation between employment and other independent variables (Table 7). First-order autoregressive or AR (1) model is utilized to address trends of high serial reliance within data. It is estimated at -0.9779 with a Pearson value of less than 0.0001. This suggests that independent errors associated with data for one time though closely associated. in other words, every year independent error is closer to the previous year’s error.
Based on Maximum Likelihood and Ordinary Least Squares, the association between independent and dependent variables are not similar. In the Ordinary Least Squares, there is a strong correlation between dependent and independent variables (Table 6), this is because the p-value is at 0.031 while estimate for parameter at 0.00317. On the other hand, for Maximum Likelihood, there is no significant correlation between employment and FDI; however, there is a negative association between employment and interest rates for loans (Table 7), since the Pearson value and parameter estimates at 0.0653 and -0.0653 respectively.
This variation is due to Maximum Likelihood put into account First-order autoregressive procedure and also the impact of independent variables that significantly affects parameter estimations of every predictor variable. This result indicates that putting into account autoregressive framework, the impact of FDI weakens while interest rates for loan demonstrate a significant influence on employment. Residual analysis is shown in Figure 6.
Residual analysis is important when it comes to measuring the variation between estimated and observed values for every year employment level. For employment- the individuals employed in China, every year’s residual is at -1 and 1 apart from 1988 to 1990. In other words, the observed and estimated values are closely, other than in 1988 t0 1990.
According to lag framework, the probability of white noise reduces as the lag time increases, when the lag period increase, it becomes challenging to forecast employment level. The autocorrelation function is a trend of autocorrelation in a given time series at several lags while the partial autocorrelation function is the trend of incomplete autocorrelation in any given time series at different lags
Findings for primary, secondary and tertiary sectors of the economy of China
In the primary sector it is evident that 3 independent variables including FDI, wages and GDP have a significant correlation with employment. With Ordinary Least Squares estimation, 97.36% of difference in the employment is described by these variables as demonstrated in Table 8while Maximum Likelihood represents 97.39 percent of difference in employment (Table 9).
Since the data used is fifteen year data, it is intricate to achieve a small Pearson value, which demonstrates a positive statistical association. With regards to Ordinary Least Squares, there is a strong connection between employment and FDI as the p-value is at 0.001. In addition, the Maximum Likelihood, there is a strong relationship between employment and FDI because the Pearson value is at 0.005.
When it comes to secondary industry, 3 independent variable such as GDP, FDI and wages have a strong correlation with employment. The Ordinary Least Squares, 96.63 percent and Maximum Likelihood estimations indicate that 97.91percent changes in employment level can be forecasted by wages, FDI and GDP (Table 4.5 and 4.6). Much as the Ordinary Least Squares value indicate that there is a strong connection between employment and FDI since the Pearson value is 0.0007, there is a strong negative association between employment and wages with a p-value of 00187 and -0.000276 parameter estimates.
Again, Maximum Likelihood demonstrates a strong positive association between FDI and employment since the p-value is less than 0.05 at 0.027 and parameter estimates at 0.0000461. While the there is no statistical significance between employment and wages, Maximum Likelihood is similar to Ordinary Least Squares Figure 8).
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In the tertiary industry, there is a strong correlation between 3 independent variables- wages, FDI and GDP. Ordinary Least Squares results shows 95.16 percent of difference in the employment level, which is due to these variables while Maximum Likelihood demonstrates a 98.27 percent of change in employment level, which can be described by wages, FDI and GDP.
In Ordinary Least Squares values, there is a negative association between FDI and employment, because the Pearson value is greater than 0.05 at 0.0251 and parameter value at -0.002095. There is a strong negative connection between wages and employment with Pvalue and parameter estimation at 0.0264 and -0.001326 respectively. However, there is a significant correlation between employment and GDP since Pearson value is at 0.0046 and parameter estimate at 0.00312.
Based on Maximum Likelihood outcome, the parameter estimations demonstrates a negative correlation between employment and FDI because the p value is more than 0.05 at 0.0251 and strong association between GDP and employment with a p value at 0.0604. The strong negative association between employment and wages in the Ordinary Least Squares results is not significant in Maximum Likelihood results (Figure 9).
To guarantee that these correlations are precise, further estimations were performed by subtracting FDI from GDP, rather than using GDP information from Chinese Statistical Yearbook to establish the reported association between employment and independent variables of primary, secondary and tertiary industries of China’s economy.
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These results are similar to the above results. Nonetheless, the new outcomes will assist in verifying the validity of previous relationships. Furthermore, FDI information collected from Chinese Statistical Yearbook were evaluated against those from World Bank to guarantee that past outcomes are in line with other sources of information. The results of primary industry demonstrate that with careful consideration of autoregressive system, the strong correlation between employment and FDI is still strong.
This confirms that without doubt FDI has a positive influence on employment in the primary industry. In the secondary industry, Ordinary Least Squares and Maximum Likelihood estimates demonstrate a similar correlation between independent and dependent variables, therefore, GDP as well as wages affect level of employment, where GDP has a strong relationship while wages has a negative correlation.
In the tertiary industry, the negative association between wages and level of employment is not statistically significant in Maximum Likelihood; GDP has a strong correlation on the employment in Ordinary Least squares; and GDP is closely a strong independent variable of employment in Maximum Likelihood. Apparently, FDI has a negative impact on employment in the tertiary industry. For the general economy of China, there is no strong correlation between FDI and employment; and there exists a strong negative association between interest rates on loan and employment.
Chen, C. 2011. Foreign Direct Investment in China: Location Determinant, Investor behavior and Economic Impact. Amazon: Edward Elgar Publishing.
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Duan, J. 2011. Location on Determination of FDI in China (1986-2009).
Hale, C., & Long, C. 2012. Foreign direct investment in China: Winners and losers.Singapore: World Scientific Publishing.
Hale, C., and Long, C. 2012. Foreign direct investment in China: Winners and losers. Singapore World Scientific Publishing.
Hannon, P., & Reddy, S. 2012. China edges out U.S. as top foreign-investment
Hu, B. 2011. An empirical research on impacts of FDI upon employment in China. Economy and Management, (9), 12-16.
Liu, B. (2012). Effect of FDI on employment in China. Modern Business Trade Industry, (17), 10-11.
Liu, L. 2012. FDI and Employment by Industry: A Co-Integration Study, Modern Economy, Vol. 3 No. 1, pp. 16-22.
Michael, H. (2013). Foreign Direct Investment in China: Theories and Practices. New Jersey State: Routledge Publishers.
OECD, (2013). Southeast Asian Economic Outlook 2013 With Perspectives on China and India. New Jersey: OECD Publishing.
Sjöholm, F. 2011. The Effect of FDI on Employment and Technology in China. Research Institute of Industrial Economics and Örebro University
Sornarajah, M. (2011). The International Law on Foreign Investment. United Kingdom: Cambridge University Press.
Zhang, L., LeGates, R. & Zhao, M. (2016). Understanding China’s Urbanization: The Great Demographic, Spatial Economic and Social Transformation. New York: Edward Elgar Publishing.
Zia, S., and Rizvi, A. 2011. The Impact of Foreign Direct Investment on Employment Opportunities: Panel Data Analysis. Institute of Business Management.
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Porter’s Five Forces Model
Introduction
Starting a business or developing an existing business, it is necessary to consider the porter’s five forces to answer questions that may arise from competition. The five porters model help to determine whether a business will be profitable or not when comparing with other businesses within the same field of operation. Magretta (2013) the importance of comprehending the competitive forces and their fundamental reasons, will disclose the base of the market’s present productivity and will provide the procedure for forecasting and inducing competition overtime.
Purpose of porter’s five forces model.
The porter’s five forces study helps a company to comprehend the issues affecting productivity in a given market, help to update judgments connecting to: whether to entre a given market, whether to maximize volume in a given market and developing the competitive strategies, (Magretta, pg. 87, 2013). For example, threat of new entry to a given market is a strong force to the existing marketers in that market.
This is because a market which is productive will attract new entrants and this will eventually corrodes profitability. In order to maintain profitability, the given market will be protected by solid and long-lasting barriers to entry such as economies of scale, patents, government policies or capital requirement. Unless this barriers are implemented, the market will experience a competitive decline rate of profitability.
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Also, the buyer power is a weak force to determine the profitability and competition in a given market. This is because, it is easy for the buyers in a given market to drive the prices down. To do so, several factors such as importance of each buyer in the market, the cost of buyer switching from one supplier to another or number of buyers in the market, (E. Dobbs, pg. 43, 2014). If in a given specific market has few and influential customers, they are in a position to command their own terms.
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Pavilion Architectural Design
Pavilion in United Arab Emirates for Dubai Expo 2020
The complexity involved in contemporary architectural designs or structures and their respective demands usually drive designers and architects to experiment other possibilities that are suitable for development of exhibition pavilions. As a result, according to Alves and Nojimoto (2011) designers and architects endeavor to explore these possibilities in a manner only simulated using the available project development technologies in search for design processes that have compatibility aspect with contemporaneity phenomena.
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Main Requirements and Theories for Designing the Pavilion
Pavilions are an essential form of prototypical apparatus or stepping stone for ideas and solutions which have the potential for expansion upon in buildings later (Alves and Nojimoto, 2011). This means that a pavilion can be considered as an aggregation since it enables accumulation of various architectural ingredients or elements which are in proximal interaction and influencing each other, but have not yet been proven as options for perfect synthesis for application in more complex and larger building projects (Alves and Nojimoto, 2011).
In the planning of the pavilion design, it is imperative to note that, pavilions usually have more than one exhibition which is an essential aspect of consideration. The general requirements involved in designing pavilions include:
inclusion of an entrance lobby to prevent direct entry into a corridor;
the changing and muddy and wet areas need to be separated from any indoor sports or social accommodation;
flexibility need to be planned for to easier response to varied levels of female/male users; the circulation routes need to be planned simple and straightforward; access for disabled users need to be provided;
a flexible catering and social layout; plan for satisfactory viewing of major playing areas and convenient access to pitches;
security and protection of the pavilion when not occupied must be considered through installation of security systems such as CCTV;
and also the pavilion must have adequate external lighting to minimize power usage during the day.
Furthermore, the pavilion will generally be required to have adequate facilities to cater for all the users even when at full capacity. These facilities include: toilets; changing rooms; information area; showers and dry off areas; toilets; officials’ changing rooms; kitchen; club room; souvenir shop; cafeteria and snack bar; cleaner’s store; lobby; disabled toilets; as well as equipment storage rooms (each for sporting and social purposes).
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In this context, the Pavilion in United Arab Emirates for Dubai Expo 2020 will be designed based on a design process which embraces parametric applications, shared creation, digital fabrication as well as interactivity (Mitchell, 2009). Through this approach, the designer or architect will be provided with an opportunity to put into practice theoretical concepts of the Second Order Cybernetics and Complex Systems theory (Alves and Nojimoto, 2011).
In the design process, the concepts of this theory will be used mainly as design criteria guiding the decision-making process throughout the project. These theoretical concepts are very crucial because they ensure that the designer remains attentive and receptive to the surrounding and to its changes, in a manner that allows appropriate reorganization to be timely made in order to ensure the balance of the system is maintained.
The theory is based on systems observation from the perspective of communication, regulation, and control using feedback and loops circularity in order to balance the system and explore a set of possibilities to achieve anticipated goals. Fundamental theoretical concepts such as feedback, loop and responsivity from the theory will be applied in the project design process (Alves and Nojimoto, 2011).
Spaces Programming Chart
The spaces programming chart the functional areas and/or facilities in the pavilion architectural design include: entrance/reception/information area; waiting or lobby area; showers and changing rooms; toilets (females, males and disabled); officials’ changing rooms; souvenir shop; cafeteria and snack bar; cleaner’s store; common rooms/clubhouse; sitting terraces; as well as sports storage room (for both sporting and social purposes).
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Functional Zoning Bubble Diagrams
Functional Matrix and Spaces Priorities
Spaces Requirements’ Tables
This provides an overview of how different elements of the pavilion will occupy space, with an emphasis on the space taken up by each element and whenever an element exists in duplicates the occupied space has to be specified. For instance, the different elements specified in the general requirements to be considered before designing the pavilion such as the basic facilities.
However, it is also important to note that the spacing of tables and chairs is determined by a consideration of the area of all spaces with sitting capacities and evaluating the space available against the tentative number of needed chairs and tables. It is also important here to note that some facilities such as the changing rooms, toilets, and showers have to be differentiated according to gender, and also those for the disabled users should also be separated from those of other users in order to ensure that they can easily access them. The measurements are provided:
Spaces
Area
Quantity
Net Area
Users
Pavilion of United Arab Emirates in Dubai Expo 2020
Typical
Reception
50 m2
1
50 m2
Staff & Clients
Lobby Area
100 m2
1
100 m2
Souvenir Shop
40 m2
1
40 m2
Cafeteria & Snacks
50 m2
1
50 m2
Common Rooms
100 m2
2
200 m2
Toilets
Staff
5 m2
2
10 m2
Staff
Males
5 m2
4
20 m2
Male Clients
Females
5 m2
6
30 m2
Female Clients
Disabled
10 m2
2
20 m2
Disabled Clients
Urinals
10 m2
2
20 m2
Male Clients
Offices
Manager’s office
40 m2
1
40 m2
Manager
Administrative offices
30 m2
2
60 m2
Staff
Ticketing office
30 m2
1
30 m2
Staff
Special
Soccer Pitch
7,000 m2
1
7,000 m2
Players
Lockers
Males
1 m2
50
50 m2
Male Players
Females
1 m2
50
50 m2
Female Players
Shower & Changing Rooms
Female
5 m2
9
45 m2
Female Players
Male
5 m2
9
45 m2
Male Players
Officials
5 m2
2
10 m2
Teams Officials
Communal
20 m2
5
100 m2
Clients
Sitting Terraces
Adults
1200 m2
1
1200 m2
Clients
Children
200 m2
1
200 m2
Disabled
90 m2
1
90 m2
Physiotherapy & First Aid Room
20 m2
1
20 m2
Staff, Clients & Players
Cleaner’s Cupboard or store
20 m2
1
20 m2
Cleaners
Sports Store
100 m2
1
100 m2
Staff & Players
Corridors & Walkways
Corridors
20 m2
10
200 m2
Staff & Users
Walkways
40 m2
5
200 m2
Staff & Users
Total
10,000 m2
Table 1: Space Requirements Table
Design Considerations
The design requirements to be involved in designing the pavilion include:
There will be inclusion of an entrance lobby to prevent direct entry into a corridor;
The changing and muddy and wet areas need to be separated from any indoor sports or social accommodation;
Flexibility need to be planned for to easier response to varied levels of female/male users, and this will be achieved through wide circulation routes that are to be planned simple and straightforward, as well as providing a flexible catering and social layout.
Routes for ease access of the pavilion by disabled users will also be provided;
The pavilion will be planned to ensure that there is satisfactory viewing of principle or major playing areas and convenient access to pitches;
Security and protection of the pavilion when not occupied will also be considered in the pavilion design through installation of security systems such as CCTV; and
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Heating and ventilation requirements are the other important design consideration because good heating and ventilation design is crucial, not only for comfort but also to ensure unwanted health implications to users from outside the Arab world from temperatures that are sometimes extremely high to bear.
Therefore, there will be no need of insulation and heating will not be necessarily needed during the day but at nights and only for some people. However, a lot of ventilation will be required in the pavilion to ensure that there is free flow of air. This means that there will be need to provide for cross-ventilation that is efficient in the entire pavilion by fitting grills, air bricks externally on walls as well as large windows.
When the pavilion is locked, ventilation will also be enhanced by fitting robust transfer grills or undercut internal doors. In addition, kitchens, toilets in the changing area and shower areas will be fitted with mechanical extracts. Moreover, ceiling and wall mounted fans which are fitted with over-ran and humidstats switches will be used to enhance ventilation.
Lighting fittings will be directly attached to the ceiling or walls to provide a minimum of between 100 and 150 lux throughout the changing block, and the switching should be located in a secure and centralized location.
In to provide power, an electrical intake together with a cupboard, and guarded power sockets will be fitted for cleaning equipment in the changing areas. In addition, the main power switch should be located in a corridor and the circuit fitted with a current circuit breaker for residential areas.
Heating and ventilation
For sustainability purposes, external lighting will be considered with a link to sensors and time clock in order to minimize power usage during the day. An option for solar panels will also be considered in order to ensure solar power potential which is extremely high in the region is tapped (Alves and Nojimoto, 2011; Mitchell, 2009).
References
Alves, G. M. and Nojimoto, C. (2011). Strings Pavilion: design process, V!RUS, [online] n. 6.
Mitchell, M. (2009). Complexity: A guided tour. New York: Oxford University Press.
Le Corbusier, Creation is a patient search (New York: Praeger, 2010) 90.
F.R.S. Yorke and Frederick Gibberd, The Modern Flat (London: Architectural Press, 1997) 150.
Christian Sumi, “The Immeuble Clarte” in In the footsteps of Le Corbusier, edited by Carlo Palazzolo and Riccardo Vio, 177-178 (New York: Rizzoli, 1991).
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Acute Tonsilitis
Subjective Data:
Name: J.W. Date: 2/27/2016 Time: Case ID #: 8008-20164545-015 Age: 35 years old Sex: Female SUBJECTIVE
CC: Patient feels sick, with multiple symptoms including skin rash, fever, headache, pain in swallowing, sore throat, abdominal pain, nausea and vomiting.
HPI:
The patient is a 35 year old female who presented to the clinic on Saturday, complaining that she has been feeling sharp pain in her abdomen and severe headache. She also notes that she has been experiencing the following symptoms sore throat, pain when swallowing food and nausea plus vomiting.
Patient is accompanied by her 15 year old daughter and 42 year old husband, who bring her to the clinic. J.W. further notes that she has fever and the symptoms began about three days ago, with the sore throat setting in suddenly. This is the first incident that the patient reports to the clinic. The patient notes that she took acetaminophen to relieve the fever and headache, but she decided to consult further treatment once she developed a skin rash.
Medications Currently in Use: Acetaminophen
Past Medical History
Allergies: Allergic to sulfa containing compounds. Had complications after using sulfonamides
Medication Intolerances: Intolerant to sulfonamides and generally sulfa containing drugs
Chronic Illnesses/Major traumas: no major illness/traumas Hospitalizations/Surgeries: No surgical history recorded; hospitalized once due to pneumonia infection Family History: No family history recorded on major illnesses; patient’s mum in good health
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Social History
Patient is a casual laborer living with her daughter and husband, plus her 54 year old mum. She takes her lunch from a local cafeteria, but cooks breakfast and supper at her home when she arrives from job in the evening. Her mum helps her cook food, but rarely when she is not present, ill or too tired to cook.
The patient states that she started to suspect food from the cafeteria after a change in management about a month ago. However, she continued to take lunch at the same place, but notes quality had significantly dropped. Also, she had heard a complaint from a regular customer, John, that the food was making him bloat his stomach two weeks ago though the condition disappeared without him attending to hospital.
Review of Systems General
Positive for fever: No Cardiovascular symptoms. This time she was using acetaminophen Denies chest pain, palpitations, PND, orthopnea, edema
Has a history of hx pneumonia but negative at the time of admission
Only reports for pain in her abdomen
Skin Denies bruising, delayed healing, bleeding or skin discolorations. Has no lesion changes or moles but presents with a skin rash
Respiratory Patient denies cough, breathing regular and symmetrical.
Eyes Denies eye discharge, no blurred vision, sees clearly without any aid
Gastrointestinal Reports pain in the abdomen
Ears Denies pain in ears has no ear discharge, hearing loss, or ringing in ears.
Genitourinary
Denies concerns
Nose/Mouth/Throat Positive for sore throat
Musculoskeletal Denies concerns
Breast Negative history
Neurological Denies syncope, seizures, transient paralysis, weakness, paresthesia, black out spells
Psychological: Denies depression, suicidal thoughts, irritability, sleep disturbances, and anxiety
Heme/Lymph/Endo HIV status, bruising, blood transfusion hx, night sweats, swollen glands, increase thirst, increase hunger, cold or heat intolerance Psychiatric Denies concerns
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Objective Data
Physical exam is done in the clinic, after which the patient is sent for a lab test out of the clinic. Case is suspected to be upper respiratory bacterial infection particularly streptococcal infection. The following data is recorded from the physical exam;
General Appearance Constitutional marked as unremarkable: well developed: well nourished; no acute distress. Vital signs also noted as within acceptable limits. Patient dehydrated. General impression: A&Ox3, nicely dressed, appear appropriate, restless but cooperative, complains of chronic pain in the abdomen and headache
Skin Skin is black, warm, dry, clean and intact. No lesions noted upon examination. Scarlatiniform rashes noted HEENT Head is normocephalic, atraumatic and without lesions; hair evenly distributed.
Eyes: PERRLA. EOMs intact. No conjunctival or scleral injection.
Nose: Nasal mucosa pink; normal turbinates. No septal deviation.
Neck: Supple. Full ROM.
Pharynx redness or exudates over the tonsils noted plus erythema. Beefy red swollen uvula: Anterior cervical Adenitis and Soft Palate Petechiae noted. Teeth and gums are however unremarkable
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Cardiovascular S1, S2 with regular rate and rhythm. Heart location and apex is normal. No murmurs; no rubs, gallops, or click; femoral pulses normal.
Respiratory Respiratory unremarkable; respiratory rate and pattern normal; lungs clear to auscultation bilaterally.
Gastrointestinal Abdomen is soft, non tender and non-distended. No palpable masses. Liver and spleen normal; no hernias; normal bowel sounds, no bloating, only pain in the abdomen noted
Breast Chest/breast unremarkable, no masses palpitated, no redness
Genitourinary Bladder is non-distended, no UTI present
Musculoskeletal Full ROM seen in all 4 extremities as patient moved about the exam room.
Neurological Speech is clear, Good tone plus Posture erect. Balance is stable; gait normal.
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Assessment
Diagnostics & Lab Tests
Throat smear culture and blood specimen used
Incubation of the culture done for 48 hours before test
The suspected case is streptococcal infection by S. pyogenes or GAS
Positive rapid streptococcal test
Positive results for Antistreptolysin O test
Special Tests
Latex agglutination immunoassay test positive
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Assessment Findings and Plan
Diagnosis:
Patient confirmed to be having Group A Beta hemolytic Streptococcal infection, related acute pharyngitis and acute tonsilitis
Medication:
Penicillin V 500 mg tid for daily 10 days or Amoxicillin 500 mg tid for 10 days
Continue with Acetaminophen till fever completely subsidizes
Amoxicillin is a substitute in the event the patient reports to be allergic to Penicillin
Drugs to be taken orally and in full dosage given by a pharmacist
There are no generic substitutes available
Education
Advice patient to take the following measures:
Use OTC acetaminophen only for fever if relapsing occurs
Wash hands well with soap and water after using bathroom or before eating
Rinse food well and cook properly before eating
Drink water that has been purified or filtered only
Not to smoke or drink alcohol before medication is over and tests negative for GAS
If possible carry packed lunch or change the place she takes lunch from
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Further Notes:
The likely cause of the GAS infection is food from the cafeteria that the patient takes lunch. This, she should refrain from consuming food from the place to avoid a recurrence of the infection. High hygiene standards must be maintained to ensure zero infections to the members of her household, who include her daughter, husband and mum. Also, if convenient to her report the matter concerning the low quality food being sold at the cafeteria to public health offices, for further investigation.
Follow up Schedule
The patient is advised to report to the clinic after a week, for assessment of dosage coverage and progression of the illness. This is to ensure she completes the dosages of all medications in order to eliminate all GAS in her system and avoid development of antibiotic resistance to the Penicillin V given, which results from an incomplete dosage. In this regard, the patient should be advised strongly on the importance of completing her medications, with two follow up meetings being scheduled after a week each.
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Evaluation and Revisions:
The subjective and objective data was collected accordingly but the diagnostics did not cover all possible infections. Since the above are confirmatory of GAS infection, as the cause of the acute pharyngitis and acute tonsillitis, there was deemed no need to conduct tests for other upper respiratory bacteria on the cultures.
This is not only to eliminate the chances of it being a multiple infection case, but also to dictate the medicine given. This revision is necessary alongside a confirmation from the patient concerning her status in connection penicillin allergy, which should dictate the type of antibiotic given. This should be handled accordingly by the pharmacist addressing the prescription.
Metronidazole, Trimethoprim, Tetracyclines and flouroquinolones should not be used for the following reasons. Metronidazole is not effective against S. pyogenes while the patient is allergic to sulfa compounds hence Trimethoprim is contraindicated.
On the other hand, Tetracyclines pose a very high susceptibility to resistance by the bacterial species, that is GAS. Finally, Flouroquinolones are very expensive and have an unnecessary broad spectrum of activity, hence a more specific antibiotic is necessary including the above named plus Azithromycin, Clarithromycin, Clindamycin and various Cephalosporins.
Camara, M., Dieng, A., & Boye, C. S. B. (2013). Antibiotic susceptibility of streptococcus pyogenes isolated from respiratory tract infections in dakar, senegal. Microbiology insights, 6, 71.
