Archive for December, 2012

Marijuana Use among Teenagers: Effects and Possible Solutions

December 19, 2012

Introduction

Marijuana is a greenish-gray mixture of the dried, shredded leaves, stems, seeds, and flowers of Cannabis sativa. Marijuana is used as a drug. Most marijuana users smoke it in hand-rolled cigarettes called joints, while some smokers use pipes, or water pipes called bongs. Marijuana cigars or blunts are also made available by marijuana vendors/peddlers (NIDA 1). According to the NIDA (2012) report, marijuana is the most commonly used illicit drugs in the United States of America (2).

In many countries, marijuana is illegal. However, its use tends to counteract its illegal status with a rising trend of usage among teenagers. According to Nora D. Volkow, the Director of NIDA, by the time they graduate from school, about 46 percent of the teenagers will have tried marijuana. According to her, the use of drugs among teenagers has dropped significantly in the past decade to a prevalence of about 15 percent in 2011. However, this decline has stalled over the past several years. Nora acknowledges that the use of marijuana can produce adverse physical, mental, emotional and behavioral effects and that it can impair short-term memory and judgment, and distort perception. The director also acknowledges that marijuana affects the brain system that are still maturing through young-adulthood and its use by teenagers, in particular, may have detrimental effect on their development (NIDA para. 1- 2).

This paper analyzes five peer-reviewed academic articles, from reputable sources, with the view of finding out the facts about marijuana and how these facts can be utilized in finding an amicable solution to the bhang-smoking problem. These articles are: “Prevalence of Marijuana Use Disorders in the United States – 1991-1992 and 2001-2002,” by Compton, Wilson et al., “Psychosocial Correlates of Marijuana Use and Problem Drinking in a National Sample of Adolescents” by Jesser Richard et al., “Association Between Marijuana Exposure and Pulmonary Function Over 20 Years” by Pletcher, Mark J. et al., “Comparison of Extended Versus Brief Treatments for Marijuana Use,” by Stephens, Robert S. and “Dose-related Neurocognitive Effects of Marijuana Use” by Bolla, KI.

The Scope of Marijuana Use in the U.S.A.

Compton et al.’s “Prevalence of Marijuana Use Disorders in the United States – 1991-1992 and 2001-2002” examines the changes in how often marijuana is used and abused in two national surveys: the 1991-1992 National Longitudinal Alcohol Epidemiologic Survey and the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (2114). According to their research, marijuana dependency among adults in the United States of America stands at four percent. Marijuana use disorders among those who are dependent on it have increased substantially in the intervening year. This is strongly attributed to the potential strengthening and increased potency of the THC (tetrahydrocannabinol) or the active ingredient in marijuana (2121).

According to Compton et al., the factors contributing to the addiction potential are operating to produce the increase in prevalence in marijuana abuse or dependency (2121). In essence, as the years have progressed there has been a substantial addictive nature of marijuana; a higher level of THC in the current marijuana product is making the product more likely to cause addiction. With this dependence comes a great number of marijuana use disorders, such as “increased tolerance, compulsive use, impaired control, and continued use despite physical and psychological problems caused or exacerbated by use” (2115). Demographic comparisons of marijuana users are also changing in very fundamental ways; “the rates of marijuana use disorders did not increase among white young adults (ages 18-29 years), but did increase among young adult black men and women and among young adult Hispanic men” (2120).

The youthfulness of this article (as it was published in 2004) makes its relevance more tenable hence its information is crucial in pinpointing the key target areas with respect to dealing with the menace of marijuana abuse in the U.S.

The Effects of Marijuana on Pulmonary Function

“Association between Marijuana Exposure and Pulmonary Function over 20 Years” by Pletcher et al. explores the possibility that marijuana smoke has the same kinds of adverse effects on pulmonary function. Since tobacco smoke has been found to cause lung damage with severe clinical consequences (like lung cancer, chronic obstructive pulmonary disease, and more), the researchers attempted to determine whether or not marijuana smoke has the same effect, as it “contains many of the same constituents as tobacco smoke” (173). The researchers performed a longitudinal study on over 5000 men and women in major cities who smoke marijuana, testing their pulmonary function based on their level of exposure to marijuana as compared to tobacco. According to the results, marijuana use was not linearly linked to adverse pulmonary function, meaning there was little to no correlation between smoking marijuana and acquiring lung cancer or diminished pulmonary health.

This study provides a concrete, well-studied and comprehensive examination at one of the primary sticking points for marijuana use. Does it cause harm in the same way that cigarette smoking does? In exploring this notion, the researchers support the prevailing literature on the subject, noting that “analyses of pulmonary function and lung disease have failed to detect clear adverse effects of marijuana use on pulmonary function” (174). By making their study span 20 years, they hope to circumvent the normal problem in these examinations, which is that short-term effects might mask cumulative lung damage that might occur from marijuana smoking. The nonlinear relationship that was found between pulmonary function and marijuana use supports the notion that it does not cause the same type of pulmonary effects that tobacco does. While the researchers did not determine whether or not heavy marijuana use would lead to adverse pulmonary function, “our findings do suggest an accelerated decline in pulmonary function with heavy use and a resulting need for caution and moderation when marijuana use is considered” (181). At the same time, this heavy amount of use was so rare as to be insignificant, as the vast majority of the sample used marijuana on only a low to moderate basis.

The Relationship between Marijuana Use and Psychosocial Factors

In “Psychosocial Correlates of Marijuana Use and Problem Drinking in a National Sample of Adolescents,” Jessor et al. examine the personality, social and behavioral factors that lead adolescents to engage in illicit drug use, particularly problem drinking and marijuana use. A national sample study was used on more than 10,000 high school students to determine what demographics and scenarios are conducive to higher rates of marijuana use. According to the results, adolescents are more likely to try marijuana when they place a greater value on independence than their school work, when they have lower expectations for academic achievement, and a lower prevalence for religious faith (604).

While this is an older study (1980), it also demonstrates the substantial shift in behaviors that are correlated with marijuana use exploring the psychosocial elements of adolescents who engage in these activities can help us understand their motivations for trying it. According to Jessor et al., primary prevention, intervention, or health promotion approaches directed at adolescents need to consider the relation between these behaviors – their possible syndrome character – rather than trying to deal with them as if they were isolated, or unique, or separate kinds of action (612).

Treatment Options and the Hurdle Ahead

In “Comparison of Extended Versus Brief Treatments for Marijuana Use” Stephens, Roffman and Curtin evaluate the effectiveness of marijuana treatment strategies for those who wish to lower their dependency on marijuana use. In their study, long term cognitive-behavioral group treatments and other types of therapy were used on both a brief and an extended basis for those attempting to recover from marijuana addiction. The short term and long term methods of treatment (the group therapy and a two-session motivational interview) were found to have comparable levels of treatment for marijuana use, while the third option (a four month delayed treatment control program) had substantially less effectiveness. Either way, these types of programs were shown to have significant positive effects on symptoms of marijuana dependence, and lessened withdrawals at an increasing rate during each follow-up (898).

Roffman and Curtin discuss the proper way to treat those who are addicted to marijuana. According to these two “researchers have identified impairments in the attentional and executive functioning of heavy marijuana users that do not show up in more global estimates of intelligence…chronic, heavy marijuana users report impairments of memory, concentration, motivation, self-esteem, interpersonal relationships, health, employment, or finances related to their marijuana use” (899). To that end, interventions must be made that could effectively help individuals who wish to lessen their dependency on marijuana accomplish those goals; the researchers argue that both long and short term interventions seem to be properly effective. However, delayed control treatments are seen to not be as effective, because “assignment to the DTC condition also may have been perceived as permission to continue using marijuana” and as such their commitment to lessening dependency was less than those in the other treatment types (905). Up to this juncture, is marijuana’s usage effect on the individual marijuana smoker really curable? What is the real extent of marijuana as manifested even after one quits smoking?

A research in “Dose-related Neurocognitive Effects of Marijuana Use” by Bolla et al. (a 2002 publication) examines the science behind what goes on in your brain when you use marijuana. Neurocognitive tests were administered to heavy marijuana abusers who were asked to go without the drug for 28 days, to measure what actually happens in their nervous systems depending on how heavy their marijuana use was. After being abstinent for nearly a month, the participants were evaluated in terms of their neurocognitive abilities and mental acuity. According to the results, heavy marijuana use can be closely correlated to significant deficits in neurocognitive performance, as even after 28 days of abstinence, users were left wanting in terms of their mental acuity. These deficits included slower reaction times, slower executive cognitive functioning, and more, indicating that heavy marijuana use does have a significantly negative effect on the brain even after quitting. Bolla et al. are still unsure as to whether these effects would increase or decrease given continued abstinence.

According to Bolla et al., the actual effects of marijuana on the human mind are outlined. “The neurocognitive functions most negatively affected were memory, executive function, and manual dexterity” which are all closely related to the prefrontal cortex, cerebellum and hippocampus, are all parts of the brain that are adversely affected through heavy marijuana use (1341). Bolla et al.also demonstrate that for marijuana smokers even after quitting, the effects of marijuana on the brain do not evaporate overnight. This however does not negate the significance of quitting marijuana smoking. According to Bolla et al., scientists have found that a marijuana smoker consuming 10 joints a day for 10 years would probably show greater neurocognitive effects than marijuana user smoking one joint per day for 10 years (1340).

Conclusion

The marijuana smoking phenomenon in the country is worrying, especially among teenagers, and calls for attention from relevant authorities. According to Crompton et al., as a result of two studies: the 1991-1992 and the 2001-2002 studies, the increase in marijuana addiction lies in the potential change in potency of the THC (tetrahydrocannabinol) or the active ingredient in marijuana. Compton et al. also find that the trend of marijuana use among African American and Hispanic teenagers was on rise while that among white populations it was not.

Pletcher et al.bring our attention to the effects of marijuana on the pulmonary functions. According to the authors, in spite of the research having not demonstrated the effects of marijuana on pulmonary functions, their studies actually do by decelerating pulmonary functioning. This knowledge sheds more light on the detrimental effects of marijuana on the smokers, perhaps to alert them so that they can quit.

The research by Jessor et al. states that marijuana use among teenagers is linked to psychosocial phenomenon. In this regard teenagers, who are mostly idle, hopeless, ambitionless, and less religious find themselves consuming marijuana. In addition, the research shows that marijuana is used by deviant teenagers to aid them.

Two approaches of marijuana treatment are hereby suggested by extended and brief treatment. Both are found to be effective. The two approaches involve withdrawimg from smoking and other therapies that would help the addicted reduce their reliability on the drug. However, studies by Bolla et al on the available knowledge show that the effects of heavy marijuana do not evaporate overnight.

The good news is that the study was done for 28 days. More research is needed to find out if neuropsychological effects of marijuana are reversible and how so can this can help those who want to quit smoking are assured of reversibility of their addiction.

Nonetheless much attention by anti-narcotic agencies, parents, guardians and NGOs should be put on encouraging abstinence from the use of marijuana. This could be done by coming up with programs that keep the teenagers busy. Guiding and counseling should also be employed to fight this menace.

Works Cited

Bolla, K.I., Brown, K., Eldreth, D., Tate, K. and J. L. Cadet.”Dose-related Neurocognitive Effects of Marijuana Use.” Neurology, 59 (2002)1337-1343. Print.

Compton, Wilson M., Grant, Bridget F., Colliver, James D., Glantz, Meyer D., and Frederick S. Stinson.”Prevalence of Marijuana Use Disorders in the United States – 1991-1992 and 2001-2002.” Journal of American Medical Association, 291.17(2004): 2114-2121, Print.

Jessor, Richard, Chase, James A., and John E. Donovan.”Psychosocial Correlates of Marijuana Use and Problem Drinking in a National Sample of Adolescents.” ALPH, 70. 6(1980): 604-613. 1980. Print.

National Institute of Drug Abuse (NIDA). Marijuana Abuse, 2002. Accessed October 20, 2012 <http://www.drugabuse.gov/publications/research-reports/marijuana-abuse&gt;

Pletcher, Mark J., Vittinghoff, Eric, Kalhan, Ravi, Richman, Joshua et al. “Association Between Marijuana Exposure and Pulmonary Function Over 20 Years.” Journal of American Medical Association, 307.2(2012): 173-181. Print.

Stephens, Robert S., Roffman, Roger A., and Lisa Curtin.”Comparison of Extended Versus Brief Treatments for Marijuana Use.” Journal of Consulting and Clinical Psychology, 68(2000): 898-908. Print.

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Environmental Microbiology: Memo

December 19, 2012

To: Student

From: Tutor/Course Lecturer

Date: 19th October 2012 Bacterial

Subject: Examining the Changes That Occur On Matter During Bacterial Breakdown.

The experiment was carried out to establish the action of microorganisms on breakdown of matter. In the first study, two samples of organic matter were used. The first sample was carried out in an open setup to observe the action of the microorganisms on the decaying matter in the presence of oxygen. The second sample was carried out in an enclosed chamber to observe the action of microorganism in the absence of oxygen. The aim of this study was to establish the changes which take place due to action of aerobic bacteria and anaerobic bacteria on decaying matter. In the second trial, the study was carried out to establish the action of microorganisms on the oil molecules. Two trials were carried out to find out one in water and the other one in the soil. These two trials were meant to elaborate how oil molecules breakdown in the sol or water as a result of action of microorganisms.

From the first test, the students learnt that the action of microorganisms was necessary to break down organic compounds into less poisonous substances which would otherwise damage the environment. Also, because different organic matters are found in different air conditions, the action of both aerobic and anaerobic microorganisms are important to ensure that all biodegradable substances are broken down regardless of where they occur. The trial carried out in a closed chamber was the directing test with a fixed environment. It was important to have a trial in fixed conditions whose outcome could be compared with those of others carried out in varied conditions. Biodegradation refers to permanent transformation of the matter by action of microorganisms which affect its mass, feel, color and other aspects of the matter. The decomposition takes place gradually whereby the color and texture keep on changing. The mass also continues to reduce as heat is generated. However, first, the effect is rapid and later continues to reduce and almost stabilizes as mot of the contents is consumed. The structures of the oil molecules are broken down by Hydrocarbonoclastic Bacteria which makes it soluble in the water or soil and is less poisonous. After its action on oil molecules, the bacteria either get demised or gets back to its original state. The oil molecules which had not been broken down by microorganism form a coagulant of poisonous substance which is sticky and dull in color. The amount of microorganisms present in the oil sample will determine the amount of oil molecules that will be broken down. The enhanced cloudy in the trial containing oil molecules is due to the broken down oil molecules and the fact that they were not completely consumed by microorganisms. Additionally, due to the reaction between microorganisms and the oil, other substances were formed such as asphaltene which were insoluble in the water hence remained suspended and eventually increased turbidity.

The breakdown of oil by microorganisms begins by losing n-paraffin and acyclic isoprenoids compounds present in the oil. The action of the microorganism in breaking down the oil molecules into different substances is facilitated by the presence of the catalysts such as “yeast, pseudomonas and penicillium.” The biodegradation of oil is very essential in reducing adverse effects of the oil spills in the environment. The toxicity is reduced which makes it less dangerous to the aquatic life due to oil spill in the ocean and other water bodies of through ground seepage.

MARIJUANA

December 19, 2012

How to make and advice column

These are the steps we took in putting up the talk together, which we feel can be useful to the other members as well.

STEP 1

First, we identified the topic of discussion. Our talk focuses on the benefits of marijuana. It simply outlines the medical, economic, and environmental benefits of marijuana. Since time is the limiting factor, try to cramp some of the details and make the fit within the given time. On average public talks takes around 100 to 200 words per minute. Therefore, get the approximate count of words you are going to use per minute by taking the total number of words on the script and divide by 120.

STEP 2

Second, ensure that the whole story can be presented in less than five minutes by determining the points you make in every 15 seconds. Since each slide is allocated 15 seconds, make sure you cover as much details as possible. At this stage, you may need editing software like Amadeus to record your script as if you were giving a talk. Insert markers after every 15 seconds to separate between the slides and ensure that all the information covers exactly 15 seconds.

STEP 3

Third, build your slide deck, the first segment of your script should be the title slide (15 sec) followed by the second, third, fourth up to the last slide each 15 seconds. The title slide may not be interesting because it only contains the name and title of the presentation. The creativity and fu part of the presentation will start from slide to of the script. During the presentation, slides will only act as a back up to reinforce the 15-second presentation.

Points to note:

-The choice of font size is essential because it will determine the readability of the slides. So avoid using decorative fonts. Use large fonts that are visible.

-Pictures are more communicative than words, so insert them where appropriate

-Make sure that the most important elements of the slide appear at the middle of the slide

PRESENTATION TALK

Marijuana benefits includes medical, economical, environmental, and ecological.

  1. MEDICAL BENEFITS

For years, studies on marijuana have only concentrated on negative effects, but history proves otherwise. As early as, 4,000 BC – was used as a medicine for Rheumatism – loss of yin (female energy). In the first century, it was used in china to treat malaria, absent mindedness, and constipation in India. Greeks used it to treat earaches and as a pleasurable desert. In 2004, Israeli soldiers used marijuana to for pain relief and in combating stress after war. Marijuana is a useful source of drugs: Examples, Dronabinol, Nabilone, and Cannabidiol, used in treating various forms of cancer. The active ingredient, delta-9-tetrahydrocannabinol (THC) can treat the following conditions:

  • Alzheimer’s disease, insomnia, ulcers, arthritis, migraines

  • Spontaneous seizures of epilepsy

  • Multiple sclerosis

  • Marijuana reduces anxiety, depression, hepatitis and morning sicknesses

  • Helps in treatment of glaucoma, brain cancer, breast cancer, and melanoma

  • Reduces pain in cancer patients

  • Prevents vomiting, nausea, and muscle pains

  • Prevents respiratory diseases

  • Treats chest pains and heart diseases

  • Marijuana can be used as pain relievers and sedatives

  • Marijuana can solve the problem of weight loss by increasing appetite

  • Used as an anti-inflammatory agent, immune regulating abilities, and anti-bacterial properties

  1. ECONOMIC BENEFITS

The government spends millions of dollars in Hemp-hemp related crimes. One of the hemp products that can be very useful is hemp cigarette. This is a viable source of tax revenue for the government. Therefore, legalizing it will save resources spent on its crack down. This will also divert resources to combat other crimes.

  • A potential raw material for paper industry, which can save a million trees

  • Takes only four months to reach maturity

  • Requires a small space compared to paper tress

  • Hemp is a good source of fiber

  • Producers 100 times fiber than cotton

  • Its fibers are much stronger and durable

  1. ENVRIONMENTAL BENEFITS

The hemp tree is a source of various products, which are beneficial to the environmental. Some of these products include cheese, soap, paper, clothing, cosmetics, and hemp oil, which can be used by man in various areas. Other benefits include:

  • A source building materials

  • Hemp is a natural weed repellant

  • Hemp-derived materials are cheaper

  • Requires less attention while in the fields

  • Source of nutritious high-protein oil

  • Protein extraction is less expensive

  • Hemp oil is a source of varnish, paint, lubricating oil, ink, and plastic substitutes

  • Hemp oil has anti-bacterial properties

  • It will create new job opportunities

  • Hemp products are non-toxic

  • Hemp is biodegradable and renewable

  • A viable source of clean fuel/energy

  • Requires less fertilizers hence less pollution due to run-off

  1. ECOLOGICAL BENEFITS

Marijuana products are environmental friendly and even the tree itself provides so many benefits to the ecological cycle. Here is a list of some of these benefits.

  • Marijuana can make use of land used for trash disposal

  • It will lead to better protection of public land

  • Farmers will plant it in lands suited for agriculture, hence fewer forest lands would be disrupted and This will save millions of trees cleared from forests

  • It will reduce the use of petrochemicals

  • If legalized, it will get rid off guerilla farming

  • Converts sun’s energy to biomass more efficiently than other plants

  • Biomass from hemp releases less pollutants

  • It is a weed, hence not affected by pesticides

  • Holds soil particles together more strongly

  • The fuel is carbon neutral hence contributes less to global warming

  • Can replace chemical intensive crops such as cotton and imported fuel

Drug Information Paper

December 19, 2012

Introduction

There are several drugs which can be used for treatment of bipolar. This paper seeks to identify the best treatment for bipolar disorder in an adolescent patient. The four drugs under examination include: The effectiveness of using abilify 20mg at bedtime to treat mood disorders, the use of Tenex 1mg four times a day for impulsivity treatment, use of Trazadone 100mg at bedtime for treatment of sleep disorders, and the use of neurontin 600mg in the morning and bedtime for mood stabilization. In the end, the most efficacious treatment is recommended to the pediatrician for treatment of the bipolar disorder in the adolescent.

Abilify 20mg po daily at bedtime for mood stability

The use of Abilify 20mg po daily at bedtime for mood stability is appropriate in the of management bipolar disorder. Abilify has been identified as one of the safe drugs used in the management of psychological disorders (American Psychiatric Association, 2006). The main mode of action of abilify is through exertion of partial agonist activity at the dopaminergic and serotonergic receptors. Keck et al. (2003) carried out a randomized study to determine the effectiveness of abilify in patients presenting with acute bipolar disorder. After four days of administration, the maniac symptoms had significantly improved in patients who were being treated with abilify.

Tenex 1mg po four times a day for impulsivity

It is also appropriate to treat impulsivity using Tenex 1mg po four times a day. Guafenacin is an -2 agonist that has been employed by physicians for quite some time now in the management of disruptive behavior in adolescents. Numerous studies have been carried out to determine the efficacy of this drug in the management of hyperactivity in persons presenting with bipolar disorder. Childress and Berry (2012) carried out two placebo controlled studies in young people aged between 6 and 17 years to determine the effectiveness of Tenex if administered four times a day to manage impulsivity. In the two studies, patients were randomized to a fixed dose of guafenacin. The lowest dose of the drug, 1 mg, was used in the study which comprised of 324 participants. The participants were later on evaluated for psychotic disorders to determine whether their condition had improved. These studies revealed that impulsivity and hyperactivity were significantly reduced in participants who were being administered with guafenacin.

Trazadone 100mg po at bedtime for sleep/depression

Administration of Trazadone 100 mg po at bedtime is also beneficial in the management of depression associated with maniac disorders. However, Trazadone 100mg is extremely high for management of insomnia. Insomnia is usually treated with trazodone dosage of about 25 – 50 mg at bedtime (Pagel & Pandi-Perumal, 2007). Treatment of depression requires 150 mg of trazodone daily and, therefore, the use of 100 mg po at bedtime is within the normal range. Bain (2006) carried out a critical evaluation of clinical studies carried out in the past to determine whether trazodone can actually result in effective management of sleep disorders and depression in people with bipolar disorder. Bain (2006) concluded that trazodone can result in significant improvement of the psychological condition if administered daily.

Neurontin 600mg po in the morning and 600mg po at bedtime for mood stabilization

Neurontin, referred to as gabapentin, is one of the most effective anticonvulsants that are administered in the management of bipolar disorders as mood stabilizers (Medline plus, 2012). Studies have revealed that gabapentin is safe and efficacious when used in the management of mood disorders. Even though there are few studies with regard to the use of gabapentin in the management of maniac disorders, case reports reveal that this drug can significantly eliminate mania symptoms in patients. It is appropriate to administer 600 mg po of neurontin in the morning and at bedtime since this has been proven effective in stabilization of mood. Patients who have been treated using this drug agree to feeling more relaxed the next day if the drug was administered at bedtime. Caution should however be taken before administering this drug to patients presenting with kidney disorders (Miller, 2009).

Conclusion

One way of stabilizing mood disorders is administering abilify 20mg at bed time. Administering guafenacin (1mg four times a day) has the potential to lower impulsivity and hyperactivity. Trazadone is also effective in treating sleep disorders like insomnia, as well as depression; thus administering 100mg of trazadone at bedtime is appropriate for sleep/depression. Finally, mood disorders can be stabilized by administering neurontin 600mg in the morning and at bedtime, but caution should be taken with patients who have renal disorders. In this particular case study, we would recommend that the pediatrician administer guafenacin to the adolescent patient since it has been shown to be effective in managing disruptive behavior in adolescents, and the patient in this case is an adolescent.

References

American Psychiatric Association. (2006). American Psychiatric Association Practice Guidelines for the Treatment of Psychiatric Disorders: Compendium 2006. New York, NY: American Psychiatric Pub.

Secondary source available at http://books.google.co.ke/books?id=zql0AqtRSrYC&pg=PA647&lpg=PA647&dq=aripiprazole&source=bl&ots=T8_as78CWo&sig=2liAztIhXKF0bVK6hpwp8-M-GIc&hl=en&sa=X&ei=SGtoUMzrPIKDhQeE-ICIDA&ved=0CEEQ6AEwAw#v=onepage&q=aripiprazole&f=false

Bain, K. (2006). Management of chronic insomnia in elderly persons. The American Journal of Geriatric Pharmacology, 10(4): 169- 190.

Primary source Available at http://www.sciencedirect.com/science/article/pii/S1543594606000286

Childress, A. C. & Berry, S. A. (2012). Pharmacotherapy of attention-deficit hyperactivity disorder in adolescents. Pharmacotherapy of Attention-Deficit Hyperactivity Disorder, 72(3): 309-325.

Primary source available at http://adisonline.com/drugs/Abstract/2012/72030/Pharmacotherapy_of_Attention_Deficit_Hyperactivity.2.aspx

Keck, P. E. et al. (2003). A placebo-controlled, double-blind study of the efficacy and safety of aripiprazole in patients with acute bipolar mania. American Journal of Psychiatry, 160(9):1651–1658.

Primary source available at http://ajp.psychiatryonline.org/article.aspx?articleID=176418

Medline plus, (2012). Gabapentin. Retrieved on September 28, 2012 from http://www.nlm.nih.gov/medlineplus/druginfo/meds/a694007.html

Miller, L. D. (2009). Changing the autistic brain. Minneapolis, MN: Hillcrest Publishing Group.

Secondary source available at http://books.google.co.ke/books?id=u2K5Fy0Nrc4C&printsec=frontcover&dq=Changing+the+autistic+brain&source=bl&ots=JleAlD9OLX&sig=ufZX2z6f0-rH3sz-DqryPIbx7aI&hl=en&sa=X&ei=J2toUIyMCpGXhQfmnICIBQ&ved=0CC4Q6AEwAA#v=onepage&q=Changing%20the%20autistic%20brain&f=false

Pagel, J. F. & Pandi-Perumal S. R. (2007). Primary care sleep medicine: A practical guide. New York, NY: Springer.

Tertiary source available at http://books.google.co.ke/books?id=SBEjcgtL1OAC&printsec=frontcover&dq=Primary+care+sleep+medicine:+A+practical+guide.&source=bl&ots=cFezuNuhIo&sig=2hOdrQAjLefJH_n7Ny6W9NZBBF8&hl=en&sa=X&ei=ympoUMf9HsG5hAfY8YCABA&redir_esc=y#v=onepage&q=Primary%20care%20sleep%20medicine%3A%20A%20practical%20guide.&f=false

Traditional organization and organizational structure

December 19, 2012

The traditional organization structure was established in early 20th century and it became popular among business practitioners (Lim et al, 2010). The multi-layered bureaucracy was seen to be more efficient and effective in managing large organizations. There were transportation constraints and the ability to collect, present and spread information was limited. Most workers at that time did not have adequate education levels and the required skills. These factors led to development of a strong management system with centralized powers. All decision s were made by managers and the subordinates were expected to take directions from their seniors without asking any question. Globalization has led to improved communication and transportation services across the world (Jacobides, 2007). Employees are well trained and have diversified skills. Increased competition and changes in the external environment has led to changes in the organizational structures. This essay provides a comparison between traditional organization and organizational structure in modern business economy today.

The traditional organization was generally casual in nature and it was goal oriented (Butler, 1986). Under this system, the organizational objectives and incentives were clearly defined and easily controlled because everything within the business practice was predictable. The traditional organization model establishes managerial control over subordinates and managers provide subordinates with instructions. The organization is run by hierarchy, control, rules and authority. This system was similar to an effective machine that has clearly differentiated functions working in timely and reliable manner to accurately accomplish set goals. On the other hand, the modern organization emphasizes on strategic management (Lim et al, 2010). This model takes into consideration development of a decentralized organization.

The organization undergoes drastic changes due to creativity, motivation, political and power influence. There is increased flow of information in the current organization which moves in both directions. Communication between the organization`s management and employees can take place towards any direction. The modern organization has different variables as opposed to clearly defined objectives under the traditional system. This makes the organization simpler and less structured. The modern organization has few layers which limits the complexity of hierarchy among the staff. The chain of command in the modern organization is not clear making it difficult for managers to regulate and control their subordinates.

The goals and objectives in the modern organization are not as casual as they were under traditional organization. The goals have become more diversified and they are influenced by many factors including, strategic planning, creativity, individual responsibility and teamwork (Lim et al, 2010). The organizational structure is clearly defined and the flow chart together with responsible authorities and job descriptions of all employees are developed in advance. This enables the employees and managers to establish e good working and communication relationship. This structure clearly indicates duties, responsibilities, guidelines and hierarchical structure which enable every employee to know his or her position in the organization. The management and subordinates are able to understand their company and know the place they hold in the organization. This limits problems that might arise as a result of unclear structural proceedings.

Traditional organizations are generally stable. They are closed systems that cannot interact and get influenced by environmental factors. On the other hand, the modern organization structure is an open system which dynamically interacts with the external environment (Jacobides, 2007). The modern organizations take in resources from their environment and transform them into outputs to be distributed back into the environment. The processes and structure in traditional organizations were stable for longer periods. The situation has changed under modern organizations where structures undergo continuous changes. Organizations continuously improve on their competitive advantage which puts them in a state of permanent flux. Employees in modern organizations are required to frequently update their skills and knowledge in order to cope with changing trends in the business world. The employees` job description keeps on changing and the work groups are not permanent as they were under the traditional organization. Employees work in teams that consist of members taken from different sections depending on the requirements of a specific project.

Modern organizations undergo a lot of changes which includes reorganization of divisions, reengineering of business processes, replacement of permanent employees with part-timers or freelancers and outsourcing of non-critical activities (Jacobides, 2007). Managers cannot have pre-determined notions about any issues due to the dynamic nature of business environment and the constant need for change. Instead they have to be flexible and quickly adapt to changes in the environment. The work under traditional organization is individual oriented while in modern organizations the work is team oriented. Managers under traditional structures do all organization work and employees are just required to do what managers tell them to do. However in modern organizations, managers and subordinates have no differences. There is team work between all employees in the organization despites their hierarchical level. The organization works as a group of people who have a common objective and motive reflecting the success image. This increases the efficiency and effectiveness in achieving organizational objectives.

The modern organization has introduced the concept of temporary jobs as opposed to permanent jobs in the traditional system (Lim et al, 2010). Most companies are now offering temporary employment to their employees depending on various internal and external factors. The modern organizations involve workers decision-making as opposed to the traditional system where employees were only expected to take commands from their seniors. Managers encourage employee participation in order to remain competitive under the fast changing economic conditions. Involvement of employees in making organizational decisions helps the company to effectively respond to dynamic product and market demands (Jacobides, 2007). This pools the ideas of individual employees which can help the company to achieve desired results. Modern organizations aim at involving the maximum number of people in decision-making. This leads to ownership and commitment to the company decisions which improves employee retention. Employees are more satisfied when given the opportunity to participate in decision making.

There are four main levels that are followed by organizations in decision making process namely; tell, sell, consult and join (Butler, 1986). In telling leadership, the leader makes decisions without consulting employees and communicates the decision to subordinates. The leader gives complete direction to his or her subordinates. This strategy is important for issues like government legislation, safety concerns and other decisions which do not require employee input. The sell strategy involves making decisions by the company and then attempting to get employee commitment to the decision. This is used in situations where employees do not have a lot of influence over decisions but their commitment is required. The consult strategy involves inviting all employees to give their views about a particular issue but the final decision is made by the leader. Finally, the leaders and employees make decision in consensus under the join strategy. Both managers and subordinates have equal voice on decisions that are made.

The employee involvement system encourages consultation of stakeholders at every level of the organization. Stakeholders are involved in analyzing the problem, developing strategies and implementing solutions. All employees participate in the decision-making process by being involved in setting goals and developing work schedules. Participative management also involves increasing employee responsibilities, establishing self-managed teams and soliciting feedback (Lim et al, 2010). This system of management involves treating suggestions and views of the employees with respect and consideration. Decision making has been pushed down the organizational structure under the modern system. The responsibility of making decisions has been shifted from the executives to the employees.

The traditional organizations were governed by strict rules and regulations. Employees were expected to follow predetermined rules that were formed by the management without consulting them. However, modern organizations give more importance to customer satisfaction which forms the main factor for development of organizations. The organizations have become customer oriented as opposed to rule oriented (Lim et al, 2010). The main organizational aim is to offer exceptional customer services which results in higher customer retention. Customer loyalty greatly contributes to sustainable growth and profitability of the company. There is an increase in competition and any company must provide superior services for it to succeed. Companies are expected to meet current customer needs and prepare for future needs. A company that does not value customer service cannot survive in the modern business environment. The trend is towards improving customer service, increasing customization and providing exceptional customer experience. Research shows that organizational structure hinders customer orientation. Organizational structure affects important factors such as communication patterns, customer ownership, coordination, trust, integration, motivation and power.

Customer expectations have continuously increased and there is no longer brand loyalty. In the current world, customers continuously seek products and services that satisfy their needs better (Jacobides, 2007). Organizations aim at creating and retaining customers. A business that successfully creates and retains customers is able to make profit and continuously grow. However, a company that fails to attract and retain customers will experience heavy losses which may lead to its collapse. Most company today claim to be customer-focused, customer-driven and customer oriented enterprises. They conduct market surveys as well as focus groups to gain understanding about the customer. Modern organizations also invest in awareness programs and developing direct relationship with customers to increase customer satisfaction.

Globalization has led to increased interaction and development of multinational companies. This has led to diversity among the workforce in modern organizations. Companies that have diversified workforce are better placed in understanding the demographics of their customers (Lim et al, 2010). This gives the companies a competitive advantage that helps them to excel as compared to companies that hire from limited backgrounds. Organizations that have a diversified workforce are able to easily address issues related to employee satisfaction and retention. The company with a diversified workforce should take advantage of the broad range experience that exists within the employees to benefit the organization. Issues of diversity changes with time and their implementation are in most cases limited to the human resources department. Diversity enables many companies to reach new markets and is used as a marketing tool which helps to attract new customers.

Diversity can be deep-level or superficial. Superficial diversity involves differences in race, nationality and gender while deep-level diversity is differences in cultural values and knowledge (Jacobides, 2007). Prolonged interaction between diversified employees in a workplace lessens the impact of superficial diversity while increasing the significance of deep-level diversity. Individual employees learn how to work as a group and share information which impacts on their behavior. Diversity in information and knowledge has a positive impact on group performance while differences in values or cultural views may cause a negative impact. Most people in groups tend to share things that they have in common as opposed to their differences. It is important for group members to know unique things that each person has. Debates should be conducted to allow all members of the group to challenge views of their colleagues. Accepting uniqueness and diversity of every employee generates feelings of respect and trust which may lead to increased productivity. Effective handling of diversity also leads to higher employee morale and reduces conflicts.

The traditional organization structure was hierarchical in nature. Every entity under this structure is a subordinate to the other entity. This structure usually comprises of single group of power at the top of the organization and subsequent levels of less powers beneath them (Butler, 1986). Members of such organizations only communicate with their immediate subordinates and superiors. There is no communication overhead under this structure due to limited information flow. This can however be a limitation to the company because there is no free flow of information. Modern organizations have adopted a team-based lateral structure which reduces executive decision-making powers and gives more responsibilities to employees. These organizations have fewer regulations and management levels, allowing the employees to work as a team. This structure has led to improved communication, effective decision-making and employee empowerment.

Bibliography

Butler Jr., J.K. (1986). A global view of informal organization. Academy of Management Journal, 51, 3, 39-43.

Jacobides., M. G. (2007). The inherent limits of organizational structure and the unfulfilled role of hierarchy: Lessons from a near-war. Organization Science, 18, 3, 455-477.

Lim, M., G. Griffiths, and S. Sambrook. (2010). Organizational structure for the twenty-first century. Presented at the annual meeting of The Institute for Operations Research and The Management Sciences, Austin.

TRADITIONAL ORGANIZATION AND ORGANIZATIONAL STRUCTURE IN MODERN BUSINESS ECONOMY

December 19, 2012

In organizations there are so many activities which have to be dealt with, costs minimized and profit maximized (optimal production). Initially, transportation; constraints, education levels that is modest among labor force and technical ability which is limited in collection, transmission of information and displaying ability as constraints resulted to the need of having centralized system of management that was strong. Management team had to come up with thoughts which were directed to workers to implement them. This system of organization is what is referred to as traditional organizational structure. This type of organizational structure was thus goal and causal oriented (Rajaeepour, Azizollah, Mahmoud & Solmaz, 2012).

Within the organization, there were/are hierarchies, control, rules and authorities which were used by management team to run the organization. With modern organizations, the growth of organization that is decentralized with strategic management is what is being emphasized. This paper will present the differences between the traditional and modern structure in an organization while trying to explain the advantages and set backs of traditional organizational structure (Lepoutre & Valente, 2012).

There are so many differences between the two structures of the organizations. When dynamic stability is considered, traditional organization emerges to more stable natural. However, there are a lot of disadvantages that accompanies it. The system is much closed and cannot be influenced by the environment besides not interacting with it. This is why the modern structure of organization is preferred. This is because; it interacts with environment in which it is operated. It absorbs inputs or resources from the surrounding then process them or transform them into products which are distributed to the environment. It can therefore be said that, traditional structure of organization is closed while that of modern is open to the surrounding.

There is a difference in flexibility between the two structures. Initially, it was impossible to change the structure. Although traditional structure was stable, it required a long time period for it to be changed. It is thus important to use traditional structure of organization if the stability required is for long term. This is an advantage for the traditional structure in an organization. However, organizations and companies experience frequent changes which make them to require a kind of structure which is flexible. This is because of the strategy by every organization to continue improving in order to remain competitive in the market. This is why it is strongly advisable not to use traditional structure in organization that requires being competitive in order to fit and remain the market (McFarlane, 2011).

A good example is the case with companies like Caterpillar, ABN Amro and Chrysler. They use production equipment which is computerized. They thus train workers on the use of the computers in production. The processes change every now and then. The description and structur5e of the job does not remain the same as it was the time of employees’ recruitment. Thus it is unadvisable to use the traditional structure of organization in such companies (Lepoutre & Valente, 2012).

The flexibility is further illustrated at the situation whereby, initially workers could remain in the same work level or group until they retire, retrenched or resign. This was because of the inflexible nature of traditional organizational structure. In current times, organizations have do not prefer permanency in jobs and groups of work. Teams are formed every now and then by taking of members from as per the need of the project. Therefore, changes in assignment of the job given to an employee are every now and then, hence they have to adjust accordingly to fit in the every new structure that comes into use. This is somehow impossible with traditional structure (Rajaeepour, Azizollah, Mahmoud & Solmaz, 2012).

In any modern organization, there are many changes which occur every now and then in their structures. There may be reorganization of divisions, processes of businesses get reengineered from time to time, critical activities do not get outsourced and lastly, there is frequent replacement of permanent employees with part time and freelance workers. All these are dynamisms which convince managers of organizations to use structure that is flexible so that they can easily adapt to transformation as well as help other people a part from the ordinary workers of the organization (McFarlane, 2011).

There is a difference between the two structures when the issue of cooperativeness at work place is considered. The traditional structure of the organization is somehow individual oriented. A manager will have to do organization and decision making while the worker has to do what has been told by the manager. Modern organizational structure almost everything is done in teams. It may sometimes be difficult to differentiate the role of the employee from that of the manager. The team work helps so much in achieving of efficiency and effectiveness in the objectives of the organization (Lepoutre & Valente, 2012).

The issue of teamwork has a lot of disadvantages for case of traditional structure in an organization. In any business, group work ensures that the task is at hand and executed with assistance of united effort. The impacts of the combined effort is experienced when the organization which implement it work like one individual. This enhances operation quality. Group work also contributes to equality in sharing of profit besides work division. In addition, organization owners develop an enhanced system which formulate responsibilities and authorities that are appropriate. The traditional structure can also not build the spirit of teamwork due to individualism (Rajaeepour, Azizollah, Mahmoud & Solmaz, 2012).

With team work, fair and equal task distribution in an organization is enhanced. This ensures execution of task at hand by all the working units and persons, with efficiency that is possible and best to achieve. Work division ensures punctuality in completion of work on time without extending time of completion. All this cannot be achieved if traditional structure of organization is used the demerit that is postulated by the individualism at the places of work (McFarlane, 2011).

The focus on risk avoidance is another incident which has to be studied with keen interest. Executing the job with highest efficiency and contributes to decrease in risks. This is best achieved if team work is used in performing the task. Moreover, failure as a burden is not individualized for the case of teamwork thus not borne by a single person. Minimization of risks is among some of the critical strategies formulated by the organizations. This means that, management team cannot use traditional structure in case it wants to reduce risks in the organization (Lepoutre & Valente, 2012).

There is specialization in teamwork. Unlike the traditional structure, modern structure categorizes employees into groups which are assigned different tasks. As efficiency and maximization of output is enhanced in each team, the spirit of efficiency and maximization is also enhanced at individual levels. Thus, the worker can optimize quality work which he performs besides maximizing efficiency. The end results are outputs which are of high quality evaluated both at individual level and as team work (Rajaeepour, Azizollah, Mahmoud & Solmaz, 2012).

Modern structure of organization postulates a big difference when dealing with customers. Unlike traditional structure that is rule oriented the current structure in any organization appears to be customer oriented. Modern businesses and firm emphasize satisfaction of customers and adhere to it as the means to their development and prosperity. This is a strategy which can never be achieved in the corporate world which is competitive if the rule orientation is used as a strategy. The higher retention of customers is determined by the services offered by the firm to its customers. This is a setback that traditional structure portray in the state of being ruled oriented (McFarlane, 2011).

There is homogeneity of work force in traditional structure of organization, a situation that contrasts the modern structure which uses the labor force that is diversified. Organizations that use diverse labor force enjoy some benefits which are not experienced in the traditional structure of the organization. With diversified force of work, employees’ retention and satisfaction is addressed besides the incidences of inclusion. This is where the workers also enjoy the advantages which are accrued from the diversification of the work force (Rajaeepour, Azizollah, Mahmoud & Solmaz, 2012).

Moreover, customers demography served by the work force is easily understood thus giving the organization an opportunity to understand the customers better. These equip the firms better so that they have proficient competition in the market. Issues of diversity change from time to time. Companies in United Kingdom consider diversity to be a tool for good cases of economies gives them a chance of reaching to new markets. So diversity is a tool which used in attracting new customers (Lepoutre & Valente, 2012).

As stated earlier, traditional structure of organization use hierarchy in administration, it therefore has hierarchy kind of relationship. This is in contrary to the lateral relationship which is used in modern method. In traditional structures, workers are ranked into various levels, highest being at the top and other levels lower than it. Each stage of the chain has employee who has others workers, under him/her, that are then on a lower level. Thus each employee’s role is defined. The hierarchy appears to be tall with spans of control that are narrow, widening as one moves down it. This structure is centralized with most critical decision being made by the CEOs (Rajaeepour, Azizollah, Mahmoud & Solmaz, 2012).

The short comings associated with this hierarchy structure are many. Some of them are that: the bureaucracy in the organization can be adjusted at a very slower rate than that at which the market is changing. This places the organization in a position in which it cannot meet the customers’ expectation in the market of operation by the organization. There may also be poor or miscommunication across the sections especially if they are on the same level. Moreover, there can be decisions which are beneficial to the departments that made them but not others or the entire business. This mostly occurs for the case of rivalry that is inter-departmental.

The hierarchy is used in the Catholic Churches. The top most level is occupied by the popes. Under him there is Cardinals who is followed by the Archbishops as the hierarchy moves down. However, with lateral structures, organizations are embracing it as a new concept which is more beneficial to the firms. The power of decision making is not only assigned to the executives, but employers are also responsible in doing it. With this system of structure, firms need fewer levels of management and regulations (McFarlane, 2011).

The employees are thus to cooperate while working with intention of prosperity of the business. The merits associated with the lateral structure are: there is improved communication. Companies which use it have overhead management that is minimized. In addition, teamwork is encouraged since the spirit of contribution to the solution is enhanced. Lastly, the delays in output production are eliminated when the lateral structure is used (Lepoutre & Valente, 2012).

In conclusion, there are a lot differences between the traditional organizational structure and the modern structures used in the organization. The two appears to be critical and thus used by various organizations. However, traditional structures have a lot of limitations accompanied with it. This makes the managers to evaluate the essence of each structure before they put it into use. While focusing to the market competition, most organizations prefer modern structure to the traditional one.

It is therefore advisable to use modern structure in organization because of its flexibility to changes, diversity to teamwork and production, customer oriented for market competition and efficiency and effectiveness in communication. These qualities are not present in traditional structure which is considered inflexible, rule oriented, bureaucratic and time demanding especially for the cases where changes are needed urgently.

References

Lepoutre, J. N., & Valente, M. (2012). Fools Breaking Out: The Role of Symbolic and Material Immunity in Explaining Institutional Nonconformity. Academy Of Management Journal, 55(2), 285-313.

McFarlane, D. A. (2011). Are There Differences in the Organizational Structure and Pedagogical Approach of Virtual and Brick-and-Mortar Schools. Journal Of Multidisciplinary Research (1947-2900), 3(2), 83-98

Rajaeepour, S., Azizollah, A., Mahmoud, Z., & Solmaz, S. (2012). Relationship between Organizational Structure and Organizational Alienation. Interdisciplinary Journal Of Contemporary Research In Business, 3(12), 188-196

What Makes Humans Human

December 19, 2012

Human beings are not only unique but different from other forms of life. The evolutionary process that has shaped life has immensely transformed how people relate with the world around them. It is the ways in which people relate with the world that makes them inimitable from other living things. Notably, the increased technological sophistication, globalization, socio-economic convergence, political relations and other features makes human to be different from other forms of life.

What really makes human beings different from other forms of life? Studies have shown that, even though humans have a lot in common with other animal species, the biological, genetic, mental and sociological status of humans makes a significant difference. Unlike other animal species, humans have been able to advance in religion, literature, art, technology and are in a position to make more complex decisions. The following section seeks to respond to the question on what makes humans human by analyzing a number of themes. These themes include why there is a human family in the global context, technological developments and the human condition.

While there are billions of living organisms on earth, none has strategically developed a family or a form of “citizenship” as human beings. While all animals have a sense of belonging, the case of humans presents a unique picture of a family. Studies have shown that, the creation of one human family has not only been fostered by the search for common values in life, but also by the need to make man different from other animals (Rushworth,pp.3-4).

Unlike other living things, I believe humans have the ability to move to a new dimensional concept of citizenship. The self consciousness and intelligence possessed by humans is enough to utilize human diversity as a primary tool for creation of one human family that spread across the planet. This is something that is unachievable in the kingdom of other living organisms. I believe the reason is very simple: humans have access to information that can help them to conceive of morality, change situations and circumstances and reach an agreement on certain matters (Rushworth, pp.9-13). Therefore, human beings can actually unite and form an innovative dimensional concept of citizenship where every individual is part of the whole system. Even though it’s a utopian concept, the case of United Nations, European Union and other international organizations elucidates the possibility of a new consciousness that can transform how people relate to one another (Boulding, p.59).

Secondly, the occurrence of conflicts defines human relations across different societies. Historically, conflicts have been witnessed at the local, state and international levels. In many cases, ethnic conflicts have grown to be the source of greater economic, political, social and cultural disruptions to people across the societies. However, unlike other animals, human beings have devised different ways to reduce, manage and solve conflicts at all levels. The ability of humans to think and plan in time has made it possible for them to consciously handle situations that are otherwise problematic. I believe that, peace is a function of the intelligence and self-consciousness of humans. In other words, the world can never have peace if humans do not learn to make it a safe and secure place. It is true that, humans through technological advancements have contributed to the emergence of new threats such as biological warfare, terrorism, Weapons of mass destruction (WMD), global warming among others. There is no doubt that, these threats are real. The evolution of humans from primitive and fractious tribalism to the highly evolved modern individual signifies the power of change possessed by humans (Boulding, p.61).

Therefore, while humans are a risk to humanity itself, there are ways in which they can actually save the world from such threats. As mentioned earlier, the formation of a new type of citizenship where there is one human family can help to bridge the social, economic, political, cultural and technological gaps that have contributed to inequality, unequal distribution of resources and isolation. I believe human security, improved social welfare, peace, social, political and economic developments depends on the ability of humans to focus on the 99 percent similarity and use the 1 percent difference to make the world a better place for all living things. The society should move to a level were acts of violence such as war, genocides, murders and even any form of discrimination are strictly treated as wrong and one that deserve collective efforts by all humans to collectively find peaceful, amicable and working solutions (Boulding, p.63).

Another reasons why humans are humans is based on technological developments and sophistications. Few decades ago, technological machines such as computers were unimaginable. Generational changes from baby boomers to the millennials have witnessed greater technological changes that have seen transformations in the social, economic, political, and cultural spheres of people. It is apparent that, technological machines such as computers have contributed to the imminent changes in the lives of young people and the old alike. On one hand, technology has been employed to make life better for human beings. This is based on how technologies are used to increase efficiency, reliability, effectiveness in the production and distribution process thus making life much easier for people. On the other hand, technology is perceived to have outshined humans (Kotkin, para.6.). I don’t know whether this is true, it is subject to debate. It is said that, in the advent of technological advancements such as the internet, people are losing control of themselves and act in ways that appear to be incomprehensible. This means that, unlike the baby boomers who worked hard to make it in life, the millennials as the “screwed generation” keep hiding behind a computer screen. The Turing test is among some of the notable experiments carried out to measure the ability of computers to outshine human intelligence (Christian, para. 8)

Therefore, while humans still remain unique, powerful because their highly level of self-consciousness and intelligence, technological changes present a challenge on how humans will respond to issues in the future. For instance, although people have the ability to make computers, such machines have revolutionalised how people perform certain activities. In this case, the changes brought about by technology may intrinsically challenge the human mind (Christian, para.4).

The human condition is another theme that explains why humans are human. The psychological, biological and highly social nature of humans within the social context of our lives makes us unique. Humans feel the pinch of war, hunger, among other excruciating situations. They also have the ability to experience emotions such as peace, joy and conversely despair, pain and depression. I tend to imagine that, while the unique human condition has been shaped by biological and genetic compositions of our species, culture takes center stage in defining these relationships (Warner, para, 3). My culture defines who I am, so do yours. Culture is what makes Africans, Caucasians, Arabs, French, Chinese or even Americans to be unique in their own ways. Therefore, the ways in which people use culture in their lives determines how they relate to other humans and the environment at large. Culture influences our adaptability, our relationships, our thinking and our development.

Work cited

Boulding, Elise. Cultures of peace: the hidden side of history. Syracuse, NY: Syracuse Univ.

Press, 2000.

Christian, Brian. Mind vs. Machine. Retrieved on 4th October 2012 from

http://www.theatlantic.com/magazine/archive/2011/03/mind-vs-machine/308386/2/,2011

Kotkin, Joel.Are Millennials the Screwed Generation? Retrieved on 4th October 2012 from

http://www.thedailybeast.com/newsweek/2012/07/15/are-millennials-the-screwed-

generation.html, 2012.

Rushworth, Gary. What makes a human a human? Pelham, NY: Benchmark Education, 2011.

Warner, Judith. The Why-Worry Generation. Retrieved on 4th October 2012 from

http://www.nytimes.com/2010/05/30/magazine/30fob-wwln-t.html?pagewanted=all&amp;

_r=1&,2010.

Health Literacy and the Uptake of Human Papilloma Virus Vaccine: Literature Review

December 19, 2012

CHAPTER THREE: LITERATURE REVIEW

Theoretical Framework: Health promotion model

The Health Promotion model that was proposed by Nola J Pender (1982) was used to conduct this literature review (Akoulova, tsui, irwin, damme, & aguado, 2008). The model has been chosen because it provides the basic framework that is followed in health promotion activities. Establishment of health literacy levels and their effect on vaccination can be regarded as a health promotion activity.

The health promotion model (HPM) has been widely regarded as a counterpart to models that promote health protection. The model defines health as positive dynamic state that does not necessarily occur due to lack of disease (Nursing Theories, 2012). Health promotion activities should, therefore, seek to increase the levels of a client’s wellbeing (Nursing Theories, 2012). Health promotion takes into account that the fact that human beings use different dimensions to interact with the environment. The model mainly involves three areas that include: individual characteristics and experiences; behavior specific cognition and their effects; and behavioral outcomes (Nursing Theories, 2012). The health promotion model puts emphasis on the unique experiences that are encountered at the individual level, and there potential effect on succeeding actions. It also considers the fact that motivations can be drawn from a set of variables that determine our behavior. Health promoting behaviors should be able to result into an improved health and this defines the end point for the HPM (agosti & goldie., 2007).

The model can therefore be used in the current research due to the fact that increased health literacy inevitably results into improved health as the general public becomes aware of things that should be done to prevent and treat diseases. The knowledge of the presence of a vaccine that can be used to prevent human papilloma virus (HPV) infection is an activity that should be investigated within a framework such as the one outlined by the health promotion model.

The model will be an important tool for drawing several assumptions that are important to the present study. Such assumptions might include the following (Akoulova, tsui, irwin, damme, & aguado, 2008).

  • If individuals are made aware of the presence of HPV vaccination, then they can take necessary measures to ensure that they get vaccinated against the virus.

  • Social complexities subject people to different factors in the environment, some of which might be positive while others are negative. Knowledge on the negative aspects that might affect an individual’s health is important in the effort to prevent infections such as those that result from HPV infection.

  • Health professionals such as nurses can play an important role in providing vital information regarding the availability of treatment and prevention options. That way they will have a positive influence in the lives of individuals by helping them to deal with environmental hazards such as HPV.

The health promotion model (HPM) has its basis in several theoretical propositions that are relevant to the present literature review. The first proposition alleges that prior behavior, together with inherited and acquired traits influence an individual’s belief and practice of health promoting behaviors. The second proposition states that people will always engage in a behavior that can have positive effects on their health, and things that are perceived as barriers will affect commitment to action (Nursing Theories, 2012). The third most important proposition stipulates that people will be more willing to engage in behavior that promotes their health, when other entities model the behavior or expect it to occur, and provide the necessary support that is required to enable the behavior (Nursing Theories, 2012). Families, friends, and health care providers form a vital source of person to person influence that can either increase or decrease an engagement in health promoting behavior (Nursing Theories, 2012).

Research and Non Research literature

In this review, the use of research and non-research literature has been done concurrently. This is due to the fact that health literacy is a relatively new concept in which non-research data exists, as different stakeholders attempt to establish a standard that can be used to underpin acceptable international practice. Health literacy, as a health promotion concept is also remotely associated with any vaccination activity. Most research literature is found to have investigated a characteristic related to health literacy such as the lack of structures to ensure effective dissemination of health information, and not health literacy as a whole (andrus, sherris, fitzsimmons, kane, & aguado., 2008).

Additionally, concurrent use of research and non-research literature takes into account the fact that health literacy is a dynamic concept, whose elements are many and varied and whose determination cannot be exhausted within a single study (Gutierrez, Bertozzi, Conde-Glez, & Aleman, 2006).

Health Literacy

Theoretically, health literacy (HL) is a relatively new concept in medicine. The topic has however gained a lot of momentum in the last five to six years, and this has been reflected in both policy and research agendas in many countries around the world. The spirited efforts can be reflected in the activities that were undertaken during the “36th Annual Meeting of North American Primary Care Research group” (Protheroe, Wallace, Rowlands, & DeVoe, 2009). In the annual meeting, several authors deliberated on the issue of “Studying Health Literacy: Developing an International Collaboration”. Countries like the United States and the United Kingdom presented detailed information regarding their current state of health literacy.

Many other deliberations have been initiated to identify research direction that can be used to identify international agendas. The efforts have been applied to various health disciplines including nursing, general medicine and psychology (Akoulova, tsui, irwin, damme, & aguado, 2008).

The process-knowledge model of Health literacy defines health literacy as the degree to which individuals can access, process and understand basic health information and services for the purpose of making sound health decisions. The institute of medicine also uses the same definition. It is the cognitive and social skills which determine the ability of individuals to access, understand and use information in ways that lead to better health. Health literacy is a relatively new concept in the health sector (Chin, 2011). Health literacy basically involves emphasizing on patient participation in healthcare; through accessing better health information so as to make more rational health decisions. The World Health Organization and other public health organizations in different countries have identified that health literacy is an important factor in the determination of population health. Low health literacy has been suggested as a worldwide problem and a global challenge for the twenty first century (Akoulova, tsui, irwin, damme, & aguado, 2008). Low health literacy has been identified to cause detrimental impacts on health and health outcomes. The topic of health literacy has gained a lot of momentum in the last five years, which has been reflected in both policy and research agendas in many countries around the world. Health literacy can be argued to be a product of health promotion. Health promotion outcomes represent those personal, social and structural factors that can be modified in order to change the determinants of health. Health literacy outcomes include improved knowledge and understanding of health determinants, and changed attitudes and views as pertains health behaviour (andrus, sherris, fitzsimmons, kane, & aguado., 2008). Health literacy is also characterized by improved self-efficacy in relation to defined tasks. Health education actions include education for health, efforts to mobilize people’s collective energy towards the advocacy and improvement of health (fisher, darrow, tranter, & williams, 2008).

A study was conducted by Chin et.al to identify the effects domain generalized processing capacity, domain general knowledge, and the domain-specific health knowledge for two known measures of health literacy (2011). One hundred and forty six adults who dwell in communities were included in the study, out of which 103 had been diagnosed with hypertension. The results of the study showed that adults who showed higher processing capacity scored better on all both scales (Chin, 2011).

Research has shown that individuals who are currently more health literate tend to be younger, female, educated, articulate patients of higher socio-economic status. Low health literacy has been observed to be prevalent among lower socio-economic groups, ethnic minorities and older people (andrus, sherris, fitzsimmons, kane, & aguado., 2008). Communication in clinical settings is highly dependent on literacy and numeric skill. It has been noted that differences in literacy and numeric skills causes significant variations in patients’ ability to obtain and apply health information (Akoulova, tsui, irwin, damme, & aguado, 2008). People with lower literacy levels are generally 1.5 to 3 times more likely to have poor health outcomes than people with higher literacy levels. Health researchers have raised issues on the current government health policies widening the existing inequalities gap between the most and the least advantaged in society. They argue that the current government health policies only benefit the educated and the well-skilled in society while discriminating against the uneducated and unskillful (scarinci, et al., 2010). Research identified practical health communication challenges, as most printed health information leaflets had a reading age higher than the average population. Such printed health information, therefore, only benefited a proportion of the society (Akoulova, tsui, irwin, damme, & aguado, 2008).

A cross sectional study conducted by Alex et.al on health literacy and cognitive performance among older adults established a relationship between health literacy and cognitive abilities. The study was conducted in number of senior centers within New York. During the study, health literacy was measured using the Short Test of Functional Health Literacy in adults (Alex, Federman, Sano, Wolf, Sui, & Halm, 2009). The findings of the study showed that health literacy was not insufficient in 24.3%, impairment due to immediate recall was observed in 20% of the cases investigated, delayed recall scored 15%, while verbal fluency had 9.9% while MMSE (Minimal mental status exam) was 17.4% (Alex, Federman, Sano, Wolf, Sui, & Halm, 2009).

Low literacy and numerical skills also contributes to the bias of access to the benefits of prescription medication. Health literacy, which is measured on the basis of health related word recognition and comprehension, is highly correlated to general literacy. Health literacy is also associated with cognitive abilities, including processing speed and working memory (Thomson, Thomas, & shroyer, 2008). Low-literate people are more likely to make mistakes while interpreting prescription instructions and warning labels (andrus, sherris, fitzsimmons, kane, & aguado., 2008). The use of more cost-effective generic prescribing may negatively affect patients with low literacy levels. The recently introduced choose and book system, where patients choose and book their preferred service from a list of offers, will even be more difficult for patients with low literacy levels. Low health literacy is positively correlated with poor diet, smoking and lack of physical activity over a wide age range. Low health literacy is also associated with lower involvement in health screening and later presentation of illnesses. Poorer understanding of health information is associated with high mortality among old people in England (fisher, darrow, tranter, & williams, 2008).

Interventions are being implemented to reduce the effects of poor health literacy through modified communication and improved service organization. Steps being taken to correct this situation include minimizing the use of technical language in printed health information materials while using lay terminology whenever possible. Also encouraged is the use of visual aids and teach-back communication techniques by medical professionals. Other interventions include simplification of dosage instructions and dosing regimens and interactive online educational programs between the medical professionals and the patients. The self-management of chronic diseases needs more advanced forms of intervention. Intensive intervention on health literacy has been observed to reduce disease severity (Thomson, Thomas, & shroyer, 2008). Notable results include improved diabetic control, lower rates of admissions to hospitals and mortality for patients with heart failure. More comprehensive health literacy measures are being developed, that will assess higher level capabilities such as interpersonal communication skills. Medical professionals are encouraged to assess the readability of such printed materials and see that such materials can be understood even by low-literacy people. It has been observed that medical professionals tend to overestimate patients’ reading capabilities causing anxiety among patients when being given prescription instructions. Reading difficulties, caused by anxiety and shame, might lead to higher levels of depression caused by low health literacy. Good interventions encompass improving patient knowledge and empowerment as well as sensitizing the medical professionals about the difficulties experienced by the patients and ways of dealing with these difficulties (tay, ngan, chu, cheong, & tay., 2008). Research shows that there is no statistical dependence between pre-existing chronic condition and health literacy.

As people grow old, they have a general decline in cognitive performance which occurs in the absence of frank dementia. This scenario was observed with over five million Americans who were over seventy years of age who experienced cognitive impairment without dementia. Such cognitive impairment can cause increased difficulties in performing necessary health tasks. Many elderly individuals are not identified for medical support within the healthcare circle because they experience mild cognitive impairment which is difficult to detect. Mild cognitive impairment is characterised by measurable memory loss without functional impairment, and can be diagnosed using neuropsychiatric assessments. Verbal fluency, an important cognitive ability, is also often impaired in old people without dementia. Impaired verbal fluency affects meaning derivation from text or oral communications, vocabulary access and inference making from long term information. Measures of abnormal cognition in old people are significantly associated with low health literacy (Akoulova, tsui, irwin, damme, & aguado, 2008).

A study done on 414 elderly Americans found that memory impairment and verbal fluency had a strong correlation with inadequate health literacy. This correlation was still strong even after excluding individuals with abnormal cognition. The association between cognitive impairment and low health literacy shows that conveying health information to populations at risk for cognitive impairment must be designed in such a way that it compensates for limited cognitive skills. Higher literacy skills have been seen to reduce the rate of cognitive decline in old people. Health information meant for the old must limit the demand for memory and verbal fluency in order for the communication to be effective (Thomson, Thomas, & shroyer, 2008). The use of familiar language and testing for comprehension are strategies that could also be incorporated. Medical professionals might also follow up patients to reinforce learning. The identified relationship between cognition and health literacy calls for major attention by medical professionals and policy makers because they both lead to undesirable health outcomes (Akoulova, tsui, irwin, damme, & aguado, 2008).

A study was conducted which investigated how processing capacity, general knowledge, and health knowledge relate to performance on the two most commonly used measures of health literacy: the REALM and the S-TOFHLA. It was observed that performance on both measures of health literacy were dependent on multiple cognitive abilities. It was observed that older adults with higher processing capacity and knowledge levels showed better results in health literacy. It was observed that higher levels of knowledge offset the impact of limited processing capacity, thus the performance of more knowledgeable participants were less likely to be associated with processing capacity (Thomson, Thomas, & shroyer, 2008). Knowledge makes comprehension processes more efficient and economical. Processing capacity and general knowledge were most related to S-TOFHLA performance while for the REALM, general and health knowledge were most important. It was shown clearly that general knowledge, health knowledge and processing capacity were the major causes for the variances in the two measures of health literacy. Accumulation of knowledge relevant to the text topic as a result of ageing explains the resilience of the situation model processes among older adults. The two health literacy measures tap different abilities (Luque, Castaneda, Tyson, Vargas, Proctor, & Meade, 2010). The choice of the measure to use depends on an analysis of demands imposed by the criterion task. S-TOFHLA is good at predicting how well patients perform when it comes to tasks that involve general comprehension and reasoning tasks. REALM is better at predicting performance in tasks that depend heavily on illness knowledge (Alex, Federman, Sano, Wolf, Sui, & Halm, 2009).

A study was conducted on a national sample of Taiwanese adults in 2008 to assess health literacy using the Mandarin Health Literacy Scale (MHLS). The MHLS is a reading and numeracy machine that assesses health literacy in Mandarin Chinese and Standard Chinese. An approximated 30% of the sample population taken had inadequate or marginal health literacy. Lower levels of health literacy were observed in people who were older, had poorer educational entertainment and those with lower income. It was also observed that people who lived in less populated and more rural areas had a lower level of health literacy as compared to those who lived in more populated and urban areas. It was observed that health literacy was not independently associated with healthcare utilization (wright, damme, schmitt, & meheus, 2006).

A study was done based on developing predictive models of health literacy using a nationally representative sample. Data from the 2003 national assessment of adult literacy (NAAL) was analysed to predict health literacy scores. The predictors used include; gender, age, ethnicity, poverty status, marital status and length of time spent in the United States. Lower educational attainment, ethnic minority, lower income and recent immigration to the United States were associated with lower estimated health literacy. People who were not married were also observed to have lower estimated health literacy. Race and ethnicity were observed to have a strong correlation with health literacy. This may be explained by the variance in the quality and the level of education attained generally by different races and different ethnic groups (Gutierrez, Bertozzi, Conde-Glez, & Aleman, 2006). There was no association observed between the language spoken in the home and health literacy (stu., 2009).

A study was conducted by Gutierrez et.al to investigate the risk behaviors that might lead to sexually transmitted diseases. The study was based on the assumption that adolescents are more likely to indulge in behaviors that might be considered to be risky. The survey was carried out in adolescents from poor backgrounds in more than 204 tiny urban centers within Mexico (Gutierrez, Bertozzi, Conde-Glez, & Aleman, 2006). The results of that study showed the presence of Chlamydia in nearly 8% of participants that were found to be sexually active. About 12% of the participants were positive for herpes infection. The risk behaviors identified in this study were found to be associated with other behaviors (Gutierrez, Bertozzi, Conde-Glez, & Aleman, 2006). The results of this study show that health literacy among people living in poor conditions is very low and therefore, result into certain risky behaviors.

Papiloma viral infection is the passing of the human papillomavirus from one person to another through skin-to-skin contact. The virus is normally spread through vaginal, anal or oral sex, but sexual intercourse is not necessary for infection to occur. An approximate of twelve types of human papillomavirus cause genital warts. It has been established that more than 15 types of the virus cause cancer of the anus, cervix vulva, vagina and penis. The spread of this virus can be reduced by limiting your number of sexual partners and using condoms during copulation. Health literacy on papiloma viral infection should be done to sensitize people on the spread of this virus (winer, et al., 2009).

Individuals and organizations should come together to advocate for health literacy in our society. The government should form organizations that will be responsible for developing and disseminating health and safety information that is accurate, accessible and readily usable. Changes in the healthcare system should be promoted to improve health information, communication and informed decision making on matters relating to health. Health and science information and curricula should be incorporated in the education system through the university level (amnkwah, ngwakongnwi, & quan., 2009). The government should also support and expand adult education. The government should also improve research and development activities that will help in development, implementation and evaluation of health literacy (Akoulova, tsui, irwin, damme, & aguado, 2008).

Human Papiloma Virus and Vaccination Efforts

Vaccines can be regarded as “socio-technical objects that have technical, cultural historical, and economic, geopolitical, and ethical dimensions” (Graham & Mishra, 2011, p2. Currently, there are two major vaccines available for this virus in the global market. These are Gardasil and Cervarix. The v (Protheroe, Wallace, Rowlands, & DeVoe, 2009)accines are capable of protecting against the two HPV types (HPV 16 and HPV 18). Both vaccines have been shown to potentially protect against the precancerous lesions of the cervix. Particularly, Gardasil has been shown to prevent potential precursors to anal, vulvar, vaginal and penile cancers. Scientists expect HPV vaccines to protect against HPV induced cancers of these areas as well as HPV induced oral cancers (Thomson, Thomas, & shroyer, 2008).

The Gardasil is an adjuvant vaccine that is specifically formulated for four types of the Human Papillomavirus (HPV) (lowy, solomon, hildesheim, & schiffman, 2008). The Vaccine was first licensed for use in Gabon, followed by the US, Canada and other countries. The vaccination was initially indicated for females whose age ranged from 9 to 13 and also from 14 to26 year-olds who were already sexually active (tay, ngan, chu, cheong, & tay., 2008). For older women, vaccination is usually considered depending on specific circumstances.

Cervarix was developed by GlaxoSmithKline and was available in Australia in 2007, and was used for females between the ages of 10 to 45. The vaccine was available in Europe later that year and the US in 2009. The United States Food and Drug Administration (FDA) licensed the use of Gadasil for males aged between 9 and 26 years, and was mainly indicated to prevent against the development of genital warts that result due to HP6 and 11 (Graham & Mishra, 2011). Cervarix and Gardasil are vaccines intended to offer prophylaxis to individuals suffering from type 16 and type 18 HPV. In addition, Gardasil may offer protection to HPV type 6 and type 11. This was established in studies conducted on genital warts (Akoulova, tsui, irwin, damme, & aguado, 2008).

HCV vaccines are important in the sense that they help individuals to mount a mount a strong defense. Several countries have established mechanisms to facilitate the adoption of HCV vaccines in the public domain. Many countries have rolled out programs to promote the large scale use of the vaccines in the public sector and for national immunization. However, this is not the case in developing countries, in which HPV are yet to be provided through a national immunization program (Akoulova, tsui, irwin, damme, & aguado, 2008).

The utilization of HPV vaccines in developing countries has been affected by high costs of the vaccine. Studies have shown that high costs associated with the human paipiloma virus vaccine are directly related to monopoly pricing by manufacturers who want to recoup the developmental costs. Their ability to keep their patent rights and, therefore, keep prices high is also driven by the lack of compulsory licensing that will which can stimulate the competitive development of affordable HPV vaccines (Akoulova, tsui, irwin, damme, & aguado, 2008).

According to a study conducted by Graham Mishra and Mishra, HPV immunization has the potential to provide solutions for the challenges that are faced when screening for HPV. However, there are various barriers that stand in the way and prevent implementation of necessary measures, particulalry in the developing world (cutts, et al., 2007). The lack of public awareness has made it difficult to effect both primary and secondary prevention strategies. Embarrasing situations that are often associated with STIs have affected the reception of HPV immunization. Therefore, in most cases, HPV immunization is given to healthy individuals only, while those who may require it for secondary prevention are left out. This barrier can be tackled by increased health literacy in regard to HPV vaccination. Evidence based methods should be adopted to ensure increased efforts to promote free communication are used to facilitate acceptance (Graham & Mishra, 2011).

A study conducted by shows that the commercial rhetoric associated with HPV vaccination has played a major role in the lack of frameworks to ensure proper public education on HPV, its related diseases and the prophylactic effects and limitations. Commercial activities have played a role in how the vaccine is marketed and how different stakeholders such as scientists, healthcare providers and the general publich view the vaccination of HPV (Thomson, Thomas, & shroyer, 2008). In other words, HPV vaccination has been subjected to contests whereby advertisements and push for profits have turned direction from the its public health value.

In most developing countries, the mandatory immunization against HPV has been dismissed as an unncessary effort to prevent a disease that is not transmitted causually. The immunization has also been said to be side steping the mandate of parents over their children (fisher, darrow, tranter, & williams, 2008).

A study was conducted by Murthy et.al to investigate risk factors that were associated with the development of precancerous lesions of the uterine cervix(1990). During the study, factors related to cervical carcinogenesis were followed on a prospective basis. All dysplasia cases, progressed to carcinoma in situ (Murthy, sehgal, Das, Singh, Das, & Gupta, 1990).

Health Literacy in relation to Vaccination for Papilloma virus

Human papiloma virus popularly known as HPV is a virus establishes productive infections only in the keratinocytes of the skin or the mucous membrane. Majority of the currently known HPVs cause no symptoms in most people. However, some can cause warts or veruccae. Others have led to cancers of the cervix, vulva, vagina, penis, oropharynx and anus. This however happens in rare occasions. Of late, HPV has been linked with an increased likelihood of leading to cardiovascular infections. In addition HPV 16 AND 18 infections are strongly associated with an increased chance of contracting and developing throat cancer. It is worth noting that more than thirty to forty types of HPV are typically transmitted through sexual contact. These types mainly infect the anogenital region (tay, ngan, chu, cheong, & tay., 2008). Some of the sexuaaly transmitted HPVs may lead to genital warts. Medical research has showed that persisted infection with high risk HPV types whish are different from the ones causing skin warts may lead to precancerous lesions and in turn cause invasive cancer.

A recent report by the World the World Health Organization (WHO) has HPV is the most sexually transmitted infection in the world. For example some eighty percent of the American sexually active women will have contracted at least one strain of the disease by the time they clock fifty years of age. As the disease can be transmited through sexual intercourse, engaging in protective sex can lead to a significant decrease in the number of people contracting the disease globally (winer, et al., 2009).

These two strains account for seventy percent of the cervical cancers, eighty percent of anal cancers, sixty percent of the vaginal cancers and over forty percent of vulvar cancers. Studies have also showed that the HPV strains above also cause most of HPV induced oral cancers and some other rare genital cancers. Two strains of HPV, namely HPV 6 and HPV 11 cause nearly ninety percent of the genital warts (winer, et al., 2009).

Public health officials in United States, Australia, Canada and the European region as well as the

World Health Organization (WHO) have recommended vaccination of young women worldwide against this virus. This is aimed at preventing cervical cancer and reducing the number of treatments for cervical cancer precursors. In the United States, it is estimated approximately eleven thousand cancers found annually occur in women who have never had a pap smear; a screening test used to detect potentially precancerous and cancerous processes in the endocervical canal of the female reproductive system. Also most of these women probably never had had a pap smear in the previous five years. HPV has been found to be the cause of CCN (cervical intraepithelial neoplastic) (winer, et al., 2009). CIN is a precursor to cervical cancer. It is costly and painful to treat. However, there are no reliable statistics to show how many women have been diagnosed with this infection worldwide. Since these vaccines only covers some high risk types of HPV, medical experts still recommend that women get regular Pap smear screening even after the vaccination (cutts, et al., 2007). HPV vaccination is also recommended for many males in many areas. This is aimed at protecting their partners from contracting cervical cancers. Additionally, the vaccination can protect them against anal cancer and may also prevent other (sankaranarayanan, et al., 2008).

HPV associated cancers. Gardasil is accredited for protecting males against genital warts. The United States public health officials have recommended HPV VACCINATION for males where the uptake among women has been low. Also, vaccination is recommended in populations at higher risks for HPV associated cancers. These populations include in areas where men have sex with their fellow men and those with weak immune response (Thomson, Thomas, & shroyer, 2008).

Health literacy is a term which was first introduced in the 1970s. It is of increasing importance in the public health care system and public health. Health literacy is concerned with the capacities and abilities of people to meet the ever increasing and complex health demands in the modern society (Akoulova, tsui, irwin, damme, & aguado, 2008). It means placing one’s own health and that of one’s community and family into context. It involves understanding which factors are influencing it and knowing how to address them adequately. An individual is considered to have adequate level of human literacy if he has the ability to take responsibility for one’s family health and community health in general. It is worth differentiating health literacy from general literacy (Akoulova, tsui, irwin, damme, & aguado, 2008). According to the United Nations Education, Science and Culture Organization (UNESCO) during its history in English, the word literacy mostly meant to be familiar with literature or in general terms to be well educated or well learned. The focus is furthermore broadening so that literacy is not only referring to individual transformation, but also to contextual and societal transformation in terms of linking health literacy to economic growth and socio cultural change and realities (Thomson, Thomas, & shroyer, 2008).

The same phenomena can be traced to in the development of health literacy. For some time, most emphasis was to give to health literacy as the ability to handle words and numbers in a medical context. In the recent years, the concept is broadening to also understanding health literacy as involving the simultaneous use of more complex and interconnected set of abilities such as reading and acting upon written health information, communicating needs to health professionals and understanding health instructions. American studies in the 1990s linked health literacy, showing an association between low literacy and decreased medication adherence, knowledge of disease and self-care management skills (Akoulova, tsui, irwin, damme, & aguado, 2008). A report by the Institute of Medicine indicates that nearly half of the American adult population may have difficulties in acting on health information. The finding has been referred to as the health literacy disaster. In response, measures have been taken to ensure better health communication through and established health literacy guidelines. Also a trans-disciplinary approach has been encouraged to improve health literacy. To support this approach, the American Medical Association recommends an emphasis on the following four areas of research: Health literacy screening, improving communication with low literacy patients, costs and outcomes of poor health literacy, and causal pathways of how poor literacy influences health.

The research literature and on health literacy influences has been expanded exponentially with nearly five thousand publications. The majorities of them have been published since 2005 and is evident that health literacy is being explored within different disciplines and with different approaches (scarinci, et al., 2010).

Until recently, the interest in health literacy was mainly concentrated in the United and Canada.

However, it has become more internationalized over the past decade. Although the European Union produced less than a third of the global research on health literacy between 1991 and 2005,the importance of the issue is increasingly recognized in European health policies. AS a case in point, health literacy is explicitly mentioned as an area of priority action in the European Commission’s Health Strategy 2008 – 2013. This strategy is linked to the core value of citizen empowerment, and the priority actions proposed by the European Commission include the promotion of health literacy programs for different age groups (winer, et al., 2009).

In Malaysia, cervical cancer has been identified as one of the most common cancers among women. The most underlying primary cause of this cancer is the HPV. India alone has the highest number of the estimated deaths with Asia which is equivalent to a quarter of the total worldwide deaths. In Malaysia, it constituted about twelve point nine percent of all cancers. According to the statistics from the Ministry of Health Malaysia, there was an average of about three hundred thousand hospital admissions of cervical cancer per year. Majority of the patients presented late stages of the disease. The death rate due to cervical cancer from 1996 to 2000 ranged from 0.29 5 to 0.41 %. Prevention, early diagnosis and treatment have shown to reduce mortality due to cancers caused by HPV in many countries. In Malaysia the cervical cancer screening program was introduced in 1969 to ensure early detection of cervical cancer among the target group of women aged between twenty and sixty five years. Many action plans and cancer awareness campaigns have been launched over the years. However, no significant reduction in the prevalence of cervical cancer has been note to date. The coverage and the uptake of the cervical cancer screening is considered poor as the Pap smear coverage in the country is less than two percent in the year 1992, 3.5% in 1995 and 6.2 % in 1996 (Stanley, 2010). This is as per the state regulatory approval of the statistics from the Ministry of Health in 1997. There are many of the reasons behind this poor uptake. The major one is the unawareness of the general public about the benefits of screening. In the year 2006, the Malaysian government provided a regulatory approval of the vaccine. However, there are many barriers associated with the effective implementation of these regulatory guidelines. Some of them include costs, limited vaccine availability and lack of vaccine awareness. A little is known about the level of knowledge and attitude towards HPV vaccine in Malaysian women (tay, ngan, chu, cheong, & tay., 2008). Additionally, still there is a scanty of information about the barriers of HPV prevention in this country. A recent qualitative study showed that the majority of participants were not aware of HPV and HPV prevention. It was interesting to note that only ten percent of them heard about the HPV vaccine. Most of the Malaysian citizens have not heard about the existence of HPV. This figure is even higher when it comes to those who know about the existence of its vaccine. Marital status and the level of education contributed to the level of the awareness. Only 25 % percent of the respondents knew that HPV vaccination can protect women against cervical cancer. 15 % of the respondents reported the vaccine can be offered to female children of female gender of age nine years and above. Only 18% reported that HPV vaccine requires two to three injections (Graham & Mishra, 2011).

Majority of the respondents (53%) had a positive idea about the Introduction of HPV vaccine. Some of the respondents who had a negative idea about the introduction of the vaccine were concerned about its side effects. Others were concerned about the needles while the rest were concerned about the social stigma associated with this vaccination. Other barriers that the respondents reported included:

  • Do not have time to take vaccination

  • Vaccine is expensive

  • Vaccine is not easily reachable

  • Vaccination is not needed if one is not sexually active

In Norway, about twenty percent of the women have heard about HPV vaccination. Most of the respondents were not familiar with its cost and how many injections are needed (Thomson, Thomas, & shroyer, 2008). Majority of the people reported that this vaccine is only foe women with more than one sexual partner. Similar findings also reported that many young women felt that they did not require the vaccine or would prefer to wait because they were not sexually active. The study showed the failure to educate women on the importance of vaccine before sexual exposure. Governments must make deliberate efforts to make sure that women are aware of this vaccine (Thomson, Thomas, & shroyer, 2008). They must also go a step further to ensure that this vaccine is administered to young women before they become actively engaged in sexual behaviors. A study carried out in Canada showed that most women would accept HPV vaccine if it was offered free of charge (tay, ngan, chu, cheong, & tay., 2008). The recommended three dose course costs about US$360 in Malaysia. This is unaffordable to many women especially those in the lower socio economic status. To encourage a wide coverage and uptake, the vaccine needs to be incorporated in the country’s vaccination program. On the issues of needles, mothers whose daughters who did not mind about the needles, would have their daughters vaccinated. Most of the young women disliked needles due to the pain associated with it. It would be very important to address the fear of needle pain as a part of the counseling process. Accurate, reliable and supportive information needs to be availed to the members adequately (Akoulova, tsui, irwin, damme, & aguado, 2008). Consistent findings showed that the rejection of the vaccination was largely due to the newness of the vaccine. People therefore do not have enough information regarding the safety and efficiency of the vaccines. It is highly recommended for any physician to provide information on the vaccine efficiency and the duration period. This makes the patient to make more informed choices. Higher education was associated with higher levels of HPV vaccine awareness. To address this, educational materials should be developed to provide comprehensive, detailed information about the HPV and the vaccine emphasis given to women form minority groups and those with lower levels of education. Marries status was also found to significantly affect the HPV vaccine awareness. Unmarried women consider themselves at a greater risk of getting this virus. This makes them get more interested in getting vaccination.

A study was conducted by Wight et.al on the need to promote behavior change at cultural level in rural Tanzania(2012).

In the developing nations, the public sector health system benefits from national l immunization programs in collaboration with WHO’s Expanded program on Immunization (EPI). Unfortunately, despite efforts by the policy makers and donor countries, several African countries still have minimum coverage (Thomson, Thomas, & shroyer, 2008). These low levels of awareness and immunization can be attributed to lack of inadequate funds to educate the public and implement the programs. Also, these countries had already given a priority in other diseases like malaria, polio and tetanus and there is general lack of political good will to embrace nationwide HPV vaccination campaigns. Some of the traditional African groups are likely to view the HPV vaccination with caution and other conservative groups may reject the vaccine altogether. Already, suspicion of the West led some Kano leaders in Nigeria to reject immunization against polio as they thought it would result into sterilization or it contained HIV virus. Some groups view that the vaccine may raise cases of irresponsible sexual behaviors among the teenage girls leading to low levels of awareness (tay, ngan, chu, cheong, & tay., 2008).

The developed nations have recorded a commendable progress in the awareness and the subsequent introduction of the HPV vaccination programs. Licensure and approval has been obtained in over one hundred countries. Out of these some twenty eight wealthy nations have successfully incorporated HPV vaccines in their national immunization schedules. This has been prompted by the permissiveness of sexual debut among pubertal girls and the increased rates of unprotected sex among the adolescents. These countries have increased education, advocacy, acceptance and evaluation of long term vaccine efficacy. This has led to the increased uptake of HPV vaccine. Secondary prevention of cervical cancer is well established in Europe and Scandinavia (Amnkwah, Ngwakongnwi, & Quan., 2009).

A study was conducted by Vogtmann et. Al. to establish the Knowledge of HPV among Mexican college students (2011). The student intended to establish what the findings meant for intervention programs. The data was collected from 1,0109 college students with a response of 77%. The age of the students investigated ranged from 17 to 25 years old and were from the Autonomous University of the State of Morelos in 2006 (Vogtmann, Siobon, Valdez, & ponce, 2011). The investigation was conducted using questionaires.

The results of the study showed that about 16% of students had never had of HPV. Most of these student were male with no running water at home (Vogtmann, Siobon, Valdez, & ponce, 2011).

A study was conducted by Luque et.al to identify awareness on HPV among latina immigrants and Anglo American women of Southern United States. The study was based on previous “findngs tha indicate higher cervical cancer prevalence rates among Latinas. The study used a crosssectional mixed method design and explored knowledge attitude and beliefs regarding the

HPV”(Luque, Castaneda, Tyson, Vargas, Proctor, & Meade, 2010). Data analysis was conducted using a multivariate distribution one way ANOVA tests. The results of this study showed that different cultures had the same opinion on the risk factors associated with cervical cancer (Luque, Castaneda, Tyson, Vargas, Proctor, & Meade, 2010). Other findings findings showed that Anglo American and Puerto Rican women had greater awareness on the HPV and HPV vaccination. The results suggested the need to evaluate attitudes, beliefs and knowledge in various subgroups that experience cervical cancer disparities (Luque, Castaneda, Tyson, Vargas, Proctor, & Meade, 2010).

A review was conducted by Fernandez et.al to investigate how HPV vaccination can be integrated with clinical, community and policy perspectives. This review is based on the findings of growing literature that describes associations between psychological, organizational , interpersonal, social factors that influence HPV vaccination acceptability (Fernandez, Allen, Mistry, & Kahn, 2010). This led to the establishement of an integrated model that can be employed as a tool to organize factors at multiple levels and therefore guide intevention measures and future research (Fernandez, Allen, Mistry, & Kahn, 2010).

With the proliferation of health literacy research and policy measures, it becomes clear that there is no unanimously accepted definition of health literacy concept. Moreover, dimensions of health literacy remain disputed, and attempts to operationalize the concept vary widely in scope, method and quality. As a result, it is very difficult to compare findings with regard to health literacy emerging form research in different countries. This literature review has tried to address this issue by offering a systematic of the existing definitions and concepts of health literacy as reported in the international literature. It has identified the central health literacy dimensions, the target group as well as the antecedents and the consequences. In order to develop an integrated definition and conceptual model of capturing the most comprehensive evidence based dimensions of health literacy (Akoulova, Tsui, Trwin, Damme, & Aguado, 2008). There is evidence that increased knowledge of a particular disease and its associated vaccine have proven to be extremely crucial in determining an individual’s health beliefs and practices. Raising public awareness and knowledge on HPV and HPV vaccine are important determinants of health and health promotional programs implemented by any government. This literature review has clearly showed that without clear communication on vaccines, they may have little or no impacts at all on the disease burden. It is important to raise awareness among members of the public on HPV and its links to the cervical cancer. This education should include information about safety and its benefits to prevent cervical cancer. Thus public health campaign coupled with patient education is required to increase the acceptance of HPV vaccine among the members of the public. Even though HPV vaccine has been available in Malaysia since November 2006, high price of the vaccine is still a barrier which prevents many women to be vaccinated. It is therefore important to offer the vaccine in lower price to make it affordable to many women (Koulova, Tsui, Irwin, Damme, Biellik, & Aguodo, 2008).

References

agosti, J. M., & goldie., S. J. (2007). Introducing HPV vaccine in developing countries–key challenges and issues. N Engl J Med, 356:1908-10.

Akoulova, tsui, J., irwin, K., damme, P. v., & aguado, R. b. (2008). Country recommendations on inclusion of HPV vaccines in national immunization programmes among high-income countries. Vaccine2008, 26:6529-41.

amnkwah, E., ngwakongnwi, E., & quan., H. (2009). Why many visible minority women in Canada do not participate in cervical cancer screening. Ethn health, 14:337-49.

andrus, J. K., sherris, J., fitzsimmons, J. W., kane, M. A., & aguado., M. T. (2008). Introduction of human papillomavirus vaccines into developing countries – international strategies for funding and procurement. . Vaccine, 26(Suppl 10):K87-92.

cutts, F. T., franceschi, S., castellsaque, S. g., sanjose, S. d., garnett, G., edmunds, W. J., et al. (2007). Human papillomavirus and HPV vaccines: a review. Bull World Health Orga, 85:719-26.

erickson, L. J., wals, P. d., & farand., L. (2005). An analytical framework for immunization programs in Canada. . Vaccine, 23:2470-6.

fisher, R., darrow, D. H., tranter, M., & williams, J. V. (2008). Human papillomavirus L1 virus-like particle vaccine clinical trial results. Vaccine, K53-61.

foerster, V., & murtagh, J. (2007). Human papillomavirus (HPV) vaccines: a Canadian update. Issues Emerg Health Technol , 109:1-8.

frazer, I. H. (2010). Measuring serum antibody to human papillomavirus following infection or vaccination. Gynecol Oncol, 118(Suppl 1):S8-11.

galani, E., & christodoulou., C. (2009). Human papilloma viruses and cancer in the post-vaccine era. Clin Microbiol Infect, 15:977-81.

garland, S. M., & smith, J. S. (2010). Human papillomavirus vaccines: current status and future prospects. Drugs, 70:1079-98.

graham, J., & jones, M. (2010). Rendre evident: une approche symetrique de la réglementation des produits thérapeutiques. (Determining evidence: a symmetrical approach to the regulation of therapeutic products.). Sociologie et sociétés, 42:153-180.

harper, D. M. (2009). Prevention of human papillomavirus infections and associated diseases by vaccination: a new hope for global public health. Public Health Genomics, 12:319-30.

johnson, C. E., mues, K. E., mayne, S. L., & kiblawi., A. N. (2008). Cervical cancer screening among immigrants and ethnic minorities: a systematic review using the Health Belief Model. J Low Genit Tract Dis , 12:232-41.

jones, B. A., & davey, D. D. (2007). Quality management in gynecologic cytology using interlaboratory comparison. Arch Pathol Lab Med, 124:672-81.

lowy, D. R., solomon, D., hildesheim, A., & schiffman, J. T. (2008). Human papillomavirus infection and the primary and secondary prevention of cervical cancer. Cancer, 113(Suppl 7):1980-93.

ma, G. X., toubbeh, J. I., wang, M. Q., shive, S. E., cooper, L., & pham., A. (2009). :Factors associated with cervical cancer screening compliance and noncompliance among Chinese, Korean, Vietnamese, and Cambodian women. J Natl Med Assoc , 101:541-51.

maybarduk, P., & rmmington., s. (2009). Compulsory Licenses: A Tool to ImproveGlobal Access to the HPV Vaccine? Am J Law Med, 35:323-350.

mcdonald, J. T., & kennedy, S. (2007). Cervical cancer screening by immigrant and minority women in Canada. J Immigr Minor Health , 9:323-34.

monie, A., hung, C. F., roden, R., & wu., T. C. (2008). Cervarix: a vaccine for the preventionof HPV 16, 18-associated cervical cancer. Biologics, 2:97-105.

othman, N. H., & rebolj., M. (2009). Challenges to cervical screening in a developing country: The case of Malaysia. Pac J Cancer Prev, 10:747-52.

padmanabhan, S., amin, T., sampat, B., cook-degan, R., & Schandrasekharan. (2010). Intellectual property, technology transfer and manufacture of low-cost HPV vaccines in India. Nat Biotechnol, 28:671-8.

sankaranarayanan, R., bhatla, N., gravitt, P. E., basu, P., esmy, P., ashrafunnesa, K. S., et al. (2008). Human papillomavirus infection and cervical cancer prevention in India, Bangladesh, Sri Lanka and Nepal. Vaccine, 26(Suppl 12):M43-52.

scarinci, I. C., garcia, F. A., kobetz, E., patridge, E. E., brandt, H. M., bell, M. C., et al. (2010). Cervical cancer prevention: new tools and old barriers. Cancer, 116:2531-42.

srtanley, M. (2010). Potential mechanisms for HPV vaccine-induced long-term protection. Gynecol Oncol, 118(1 Suppl):S2-7.

stu., V. D. (2009). Overcoming barriers and ensuring access to HPV vaccines in low-income countries. Am J Law Med, 35:401-13.

tay, S. K., ngan, H. Y., chu, T. Y., cheong, A. N., & tay., E. H. (2008). Epidemiology of human papillomavirus infection and cervical cancer and future perspectives in Hong Kong, Singapore and Taiwan. Vaccine, 26(Suppl 12):M60-70.

Thomson, J., Thomas, L. K., & shroyer, K. R. (2008). Human papillomavirus:molecular and cytologic/histologic aspects related to cervical intra-epithelial neoplasia and carcinoma. Hum pathol, 39:154 – 166.

winer, R. L., harris, T. G., jansen, K. U., hughes, J. P., feng, Q., welebob, C., et al. (2009). Quantitative human papillomavirus 16 and 18 levels in incident infections and cervical lesion development. . j med virol, 81:713-721.

wright, T. C., damme, P. v., schmitt, H. J., & meheus, A. (2006). Chapter 14: HPV vaccine introduction in industrialized countries. . Vaccine, 24(Suppl 3):122-31.

December 19, 2012

MSE 618- Six Sigma Quality Engineering

Normality test for machine A:
Machine Shop

599
A-Squared
2.535
600
p
0.000
609
95% Critical Value
0.787
603
99% Critical Value
1.092
600
Mean
600.577
601.3
Mode
603.000
601.2
Standard Deviation
5.785
600.5
Variance
33.470
601.6
Skewedness
-2.513
603
Kurtosis
8.414
598.1
N
30.000
603

602.1
Minimum
577.600
604
1st Quartile
600.000
577.6
Median
601.550
607
3rd Quartile
603.000
602
Maximum
609.000
603

601.5
Confidence Interval
2.160
604.6
for Mean (Mu)
598.416
601.1
0.95
602.737
602.5

603.1
For Stdev (sigma)
4.607
600

7.777
604.1

591.7
for Median
600.500
589.1

603.000
605.3

600.9

598

Normality Test for Supplier A:
Supplier A

602.1
A-Squared
0.561
604
p
0.134
603.7
95% Critical Value
0.787
606.4
99% Critical Value
1.092
605.7
Mean
604.713
605.3
Mode
606.900
603.2
Standard Deviation
1.622
606.9
Variance
2.630
605.5
Skewedness
0.333
603.7
Kurtosis
-1.008
604.6
N
30.000
603.3

606.9
Minimum
602.100
605.9
1st Quartile
603.325
603.1
Median
604.300
607.7
3rd Quartile
605.900
603.3
Maximum
607.800
605.3

604.1
Confidence Interval
0.606
603.8
for Mean (Mu)
604.108
602.5
0.95
605.319
606.9

607.8
For Stdev (sigma)
1.292
605.9

2.180
604.5

603.1
for Median
603.700
606.1

605.500
602.6

604.1

603.4

Normality test for Supplier B:
Supplier B

601
A-Squared
0.461
600.1
p
0.242
605.9
95% Critical Value
0.787
602.8
99% Critical Value
1.092
604
Mean
603.193
604
Mode
604, 602, 600
602
Standard Deviation
2.538
600
Variance
6.439
602.2
Skewedness
0.533
603.1
Kurtosis
-0.470
600.2
N
30.000
604

599.9
Minimum
599.900
600
1st Quartile
601.175
603
Median
602.900
601.4
3rd Quartile
604.750
602.5
Maximum
609.000
603.7

603.9
Confidence Interval
0.948
602
for Mean (Mu)
602.246
600
0.95
604.141
607

609
For Stdev (sigma)
2.021
608

3.411
606.3

605.7
for Median
602.000
601.1

604.000
606

602

605

Normality Test for supplier C:

Supplier C

599
A-Squared
2.454
601.2
p
0.000
599
95% Critical Value
0.787
599.2
99% Critical Value
1.092
603
Mean
592.027
601.6
Mode
599, 601.1
600.6
Standard Deviation
12.937
601.9
Variance
167.371
600.1
Skewedness
-0.960
599.6
Kurtosis
-0.457
584.6
N
30.000
602.3

604
Minimum
561.900
602
1st Quartile
580.350
601.1
Median
599.400
577.7
3rd Quartile
601.500
569.3
Maximum
604.100
566.6

581.1
Confidence Interval
4.831
592.6
for Mean (Mu)
587.196
580.1
0.95
596.857
561.9

604.1
For Stdev (sigma)
10.303
603.3

17.392
580

591.1
for Median
584.600
575

601.100
577

600.7

601.1

Normality Test for Supplier D:
Supplier D

604.1
A-Squared
4.042
603.3
p
0.000
580
95% Critical Value
0.787
591.1
99% Critical Value
1.092
575
Mean
600.367
601.3
Mode
604.1, 603.3, 604.6, 603.1, 600, 603
601.2
Standard Deviation
6.875
600.5
Variance
47.265
607.9
Skewedness
-2.791
605.5
Kurtosis
8.037
602.7
N
30.000
604.6

603.3
Minimum
575.000
601.5
1st Quartile
600.050
604.6
Median
602.350
601.1
3rd Quartile
603.300
602.5
Maximum
607.900
603.1

600
Confidence Interval
2.567
604.1
for Mean (Mu)
597.800
602.2
0.95
602.934
603.1

600.2
For Stdev (sigma)
5.475
604

9.242
599.9

600
for Median
600.500
603

603.100
599

599.2

603

As we can see from the normality test charts, p-value for machine shop, the supplier C and the supplier D is less than 0.05, therefore the Weibull distribution must be used for process capability analysis. For supplier A, and B, the p-value is more than 0.05, therefore a Normal distribution should be used for capability analysis.

Xbar and R Chart of Machine Shop:

The center line on the X chart is at 597.5, implying that this process is not falling within the specification limits. Additionally, one point falls outside the control limits, indicating excess in the process variability. The center line on the R chart, 2.9, is also somewhat large considering the maximum allowable variation is +/- 2 mm. The trend maybe a sign of persistent interference with the process.
Xbar and R Chart of Supplier A:

The center line on the X chart is at 604.71, implying that this process is falling within the specification limits, all of the points fall inside the control limits, implying a stable process. The center line on the R chart, 1.97, is fairly small considering the maximum allowable variation is +/- 2 mm. Variability in under control in this process.

Xbar and R Chart of Supplier B:

The center line on the X chart is at 603.19, implying that this process is also falling within the specification limits, all the points falling inside the control limits. The center line on the R chart, 2.57, is acceptable considering the maximum allowable variation is +/- 2 mm. This means this process is within the customer’s specification, but is not as stable as the process of supplier A.

Xbar and R Chart of Supplier C:

The center line on the X chart is at 592.03, implying that this process is falling out of the specification limits. None of the points fall out of the control limits, indicating the process is fairly stable. But the center line on the R chart, 2.45, is moderate considering the maximum allowable variation is +/- 2 mm. There is large variability in this process. There is a high amount of variation as many point lie outside the range. Hence this trend maybe a sign of persistent interference with the process.

Xbar and R Chart of Supplier D:

The center line on the X chart is at 602.1, implying that this process is also falling within the specification limits, all the points falling inside the control limits. The center line on the R chart, 2.5, is moderately acceptable considering the maximum allowable variation is +/- 2 mm. This means this process is within the customer’s specification, but is not as stable as the process of supplier A.

From the control charts above, the process of supplier A is closest to the customer’s specification limit; it is also the most stable process among the entire suppliers. Thus, supplier A would be the best source of aluminum rods.

Process Capability Analysis:

We can see from the histogram that a large part of the distribution lies within the specification limit. This means most of aluminum rods pass to meet the customers’ specification.
The Pp and Ppk tell you whether the process produces rods within the tolerance limits. Pp is 1 and Ppk is 1, which means that both indices are below the guideline of 1.33.However they are closer than others. Thus, this process does appear to be feasible. The percentage defect is 3.3%
Sigma level of machine shop= 3.33

We can see from the histogram that a large part of the distribution falls mostly out of the lower specification limit. This means most of aluminum rods fail to meet the customers’ specification.
The Pp and Ppk tell you whether the process produces rods within the tolerance limits. Pp is 0.99 and Ppk is 0.98, which means that both indices are below the guideline of 1.33. Thus, this process does not appear to be capable.
Sigma level of machine shop= 4.01

The Pp and Ppk tell you whether the process produces rods within the tolerance limits. Pp is 0.99 and Ppk is 0.98, which means that both indices are below the guideline of 1.33. Thus, this process does not appear to be capable.Sigma level of machine shop= 4.88

The Pp and Ppk tell you whether the process produces rods within the tolerance limits. Cp is 1.61 and Cpk is also 1.61, which means thatwe cannot choose supplier C as well. The sigma level is 6.18.

he Pp and Ppk tell you whether the process produces rods within the tolerance limits. Cp is 1.65 and Cpk is also 1.65, which means that we cannot choose supplier C as well. The sigma level is 6.18.

Scrap Cost for machine shop and each supplier:

Machine Shop
Supplier A
Supplier B
Supplier C
Supplier D
Average Loss
$3.70
$2.33
$3.51
$4.35
$3.12
Total Loss
$110.91
$70.01
$105.43
$130.49
$93.46
# of Units Scrapped
18
7
13
24
15

60%
23%
43%
80%
50%

Conclusion:
From the analysis above, none of the processes is capable of producing the aluminum rods within statistically acceptable limits. However, of all the suppliers, Machine Shop fairs better than the others. Machine Shop has the lowest scrap cost and the lowest scrap rate. Therefore the company continue to produce rods in Machine Shop. Alternately, the company can search for a better qualified supplier.

The Globalization Paradox: Democracy and the Future of the World Economy – Book review

December 19, 2012

The Globalization Paradox: Democracy and the Future of the World Economy – Book review

In his book, The Globalization Paradox: Democracy and the Future of the World Economy, Dani Rodrik investigates the connection between international trade anddomestic policies of participant nations. Rodrik argues that global trade aims to replace local trade rules with international regulation even when such regulations conflicts domestic goals. He presents a quagmire between hyper globalization, state sovereignty and democratic politics. He argues that the three cannot coexist simultaneously. In his view, a country that pursues free trade and preserves national identity automatically gives up on democracy since it national policies align to international regulations even where these regulations contravene domestic norms. Conversely, is a state pursues free trade and democracy, it discards the requirements of the nation state and aligns all policies to international standards.

Rodrik clarifies that states cannot give up on democracy and observes that an effective global government is far from reality. As a result, he argues that the pursuit of globalization must pave the way for a shallow version of free trade. The author categorically criticizes the contemporary globalization. While doing so, the author does not present protectionist ideas in any ways. In the last chapter of the book, Rodrik calls for a change in the present architecture of globalization by proposing what he refers to as ‘ a sane globalization’. This includes suggestions for trade, finance and international labor mobility.

He argues that every nation has a desirable trade level that strikes equilibrium between benefits and costs. He opposes indiscriminate integration of global markets and advocates for state freedom so that nations choose their levels of free trade through democratic processes. He argues that attempts by the WTO and World Bank geared towards the maximization of international trade compromise domestic agendas. This makes these institutions unpopular hence ineffective in different parts of the world. Rodrik points out that global economy grew faster under the Bretton-Woods system as compared to the present regime of the WTO. As a result, he advocates for a return to the Bretton-Woods system that encouraged global integration while giving nations the freedom to pursue flexible industrial policies.

Rodrik’s book is replete with anecdotes and illustrations that help drive his argument. While most writers base their arguments from the American and European experience, Rodrik draws from diverse regions of the world. This makes his case appealing to the global audience whose perception to the world is not through the Western lens. He draws heavily from China, one of the recent success stories, to illustrate the rewards for globalization as long as states put measures to leverage their goals. Throughout the book, he argues on the need for measures to shield the welfare of the state in the international system.

Rodrik starts his arguments with a comparison between GATT and the WTO. He observes that GATT was a limited institution and, therefore, good. He argues that the WTO overreaches with no restrictions and is, therefore, bad. In his characterization of the goodness of GATT, the author notes its sensitivity in such sectors as agriculture and textiles that were exempt from rules. He also observes that developing nations were at liberty to liberalize and that import protection was achievable through anti-dumping measures. The author bluffs that the obligations of the GATT were not enforceable hence of limited effectiveness (Rodrik, 2011, p. 73). While most thinkers consider these characteristics as weaknesses in need of correction, Rodrik (p. 75) sees it as the strength of GATT to achieve maximum trade by giving nations the lee way to do their things and minimal intrusion in domestic affairs.

Rodrik argues that the WTO practices ‘hyperglobalization’ with regulations in virtually all sectors including intellectual property, health and safety, as well as subsidies (p. 78). He argues that the WTO has significant influence in domestic issues that were hitherto immune from external interference. Globalization, as presented by the WTO involves the legislation of global rules that govern states across the globe. Any use of domestic policies may be construed as a distraction of international trade. This means that global rules purport to replace domestic rules (p. 83).

The theme of the adverse effects of globalization is also presented in light of its interference with national democracy (p. 190). He cites examples such as high labor and health standards being certain countries being diluted by low standards in other countries; and high taxation rates in some states being diluted by low rates in other countries. The contemporary globalization aims at the realization of international economic integration. The practice is detrimental to developing states since it hampers with their industrialization policies. Rodrik argues that measures such as export subsidization, local content requirements, among others, are crucial in the realization of industrialization, and are prohibited by the WTO (pp. 198-199). The tension between national democracy and globalization of markets lead to what Rodrik (p. 200) calls the ‘trilemma’. He proposes three options to address this problem.

The first solution involves the restriction of democracy through the disregard of the wishes of citizens. Secondly, there can be a limitation of globalization while the third option involves the deliberate globalization of democracy. The author rules out the simultaneous co-existence of hyperglobalization, globalization and national democracy (p. 200). While recognizing the diversity of nations across the globe, the author faults the workability of common rules and, therefore, becomes skeptical of the possibility of global governance.

Rodrik presents his proposals towards the remaking of globalization so as to limit it and reduce tensions. Chapter 11 presents key principles while Chapter 12 presents proposals. Among the principles include the embedding of markets within governance systems, democratic organization within states, and dismissal of the ‘one way’ approach towards prosperity, state freedom to protect social arrangements and the imposition of restrictions on non-democratic states of some rights and privileges in the global economic system (pp. 237-247).

One of the weaknesses of the author’s work is the misrepresentation of facts with regard to the scope of GATT and the WTO. He presents the GATT as a shallow and comprised of regulations that were ‘unenforceable’. With regard to substance, the organization was not as shallow as indicated. The GATT was founded to facilitate non-discrimination. This clause required that all measures taken by governments to comply with the case for non-discrimination. This in effect had impacts in all domestic policies hence GATT had impacts in domestic politics, just like the WTO. Later in the book, Rodrik unconsciously presents evidence of this effect of the GATT’s scope when he discusses the Thailand-Cigarettes case (p. 195). The author, unfortunately, fails to connect the case to his misrepresentation of the scope of GATT.

The book ends up with a chapter with the title ‘A Sane Globalization’ that presents his vision to change the trade system. He faults the current system for the realization of little liberalization. He advocates for the enlargement of the policy space in future trade negotiations. This space encompasses the choice for countries to opt out of the WTO for such reasons as distributional concerns, prevention of erosion of domestic rules and the needs for social arrangements. This should be availed as long as states follow procedures including transparency, accountability as well as evidence-based deliberations (p. 254). While critics may argue that these proposals point towards protectionism, his policies are proposals that can be adopted. He does not call for reversal to protectionism, but rather a moderation of global trade. Rodrik’s writings take a thoughtful and balanced analysis of the present trade regime. Whether his proposals can be brought into the mainstream trade by economists and policy-makers or not, he tries to argue out the best case possible for globalization of trade.

Reference

Rodrik, D. (2011). The Globalization Paradox: Democracy and the Future of the World Economy. New York: W.W. Norton.