Maquiladora Industry in United States

In this paper I will discuss the history and practices of the Maquiladora industry. I will discuss its background, its problems, the benefits it offers to United States companies, and the impact the NAFTA has and will have on the industry. In addition, I will make a suggestion on a possible strategy the Maquiladoras can adopt in order to address the challenges brought on by the NAFTA, to ensure it remains a strong force in the future. Mexican agricultural workers had been granted temporary work visas allowing them to work in the United States† agricultural industries through a program called the Bracero Program until 1965 when this program was terminated. As a result of this termination, the unemployment rate had exceeded 70% in certain border cities. In May of 1965 the Border Industrialization Program was established as a replacement for the Bracero program. It was later renamed the Maquiladora Program. The program was established by the Mexican government to provide employment for Mexico†s rapidly growing population along its border with the United States. This program was utilized to keep Mexicans from entering the United States. The idea was that Mexican workers would be kept on the Mexican side of the border if they were given factory jobs on the Mexican side. The Maquiladora program also wanted to attract foreign manufacturing facilities, technology, and know-how by giving a permanent tax holiday to manufacturing companies that would set up â€Å"twin plants† on the Mexican side of the border. In the beginning of the program, all foreign-owned operations had to be located within a 20-kilometer strip along the US-Mexican border. Since 1972 they can be located anywhere in Mexico. In 1996 there were around 2,500 Maquiladoras – 35% of them were located in the interior states of Mexico. Last year there were over 3,000 and more and more of these operations are being located outside of the border regions. Each of Mexico†s 31 states has at least one Maquiladora. Maquiladoras, also referred to as â€Å"in bond† or â€Å"twin† plants, are allowed to temporarily import into Mexico (free of tax) machinery, equipment, replacement parts, raw materials, and just about anything that was used in the assembly or manufacture of semi-finished or finished products. Once assembled or manufactured, the Maquila products must be exported unless special permission is obtained to sell a limited amount of output in the Mexican market. When these products are imported back to the United States, import duties are levied on the foreign value-added only. If Maquila products stay in Mexico, the are subject to applicable Mexican duties. The largest issue surrounding the Maquiladora industry is the exploitation of cheap labor. The working conditions are often unsafe, workers are not compensated adequately for their labor, attempts to unionize are discouraged; and sexual discrimination and harassment are too common. The conditions in and outside the Maquiladoras are terrible. Workers perform tasks such as welding without protective masks, leather gloves, or goggles (in many instances) and industrial accidents and toxic exposures are common. This, along with malnutrition caused by low salaries, produce skin illnesses, cancer, irregularities in menstruation, abortions, tumors, intoxication and birth of undernourished or disabled babies. Of the employees, many are young girls and women ranging from the ages of 14 to 20. They work 6 days a week in 10-hour shifts. The average weekly salary for a Maquiladora worker is US$35 – $45 even though the average monthly rent for a house with public services such as running water and electricity is around $200 a month. For the most part, Maquiladoras are unorganized. In those that are organized, state-controlled unions represent the workers. Although some companies are unionized on paper, the unions, for the most part, function to reinforce management policies rather than for the benefit of workers. Then there are what are called â€Å"phantom† unions. These unions do not fight for the worker†s rights. The workers do not even know them and have never seen their union leaders. When a conflict arises in a factory, management informs the worker that their unions have accept these or those conditions. Not only are they not protected by existing unions, those that attempt to unionize and are often threatened or bribed by plant managers and the government. In many companies, discrimination against and harassment of the female employees is very common. Female job applicants are required to produce urine samples to be used for pregnancy test, while some have company doctors and nurses examine the applicants or ask confidential information concerning their contraceptive practices. This is done because pregnant women are refused employment. Sexual harassment is often the rule rather than the exception. Rapes occur frequently and few are reported because women fear being fired or blacklisted. Shame and humiliation also keep them quiet. In Mexico, men and women are equal before the law, but the law does not recognize discrimination as a problem to be solved. The Pollution Brought on by the Maquiladoras The increased pollution, accompanied by the dumping of tons of hazardous wastes, poses a serious health threat to the residents of Mexico as well as the resident of the bordering US states. There are several canals that are â€Å"black† with chemical wastes that have been measured at levels that greatly exceed permissible standards. One factory was caught dumping drums of paint, solvents, and shellac into a drain. In other areas there are abandoned lead smelters and air full of soot and dust from brick-making ovens and smoldering tire dumps. Main Advantages for the United States† Companies For the United States companies this was a great advantage since Maquiladoras operates at very low costs in places where the currency is weaker than the dollar–such as Mexico. The less a currency is worth, the more relative value the dollar has. Since Mexico†s peso is relatively week, companies can trade their dollars for pesos with which they pay workers and expenses. The products they manufacture, however, are sold for dollars, increasing their profits by huge margins whenever the local currency falls. They could enhance competitiveness, reduce their costs, and maintain quality by placing their labor-intensive operations in the less developed Mexico, benefiting from the lower wage rates there. For many US companies, manufacturing in Mexico has become necessary to battle overseas competition. Since many manufacturers are moving to â€Å"just-in-time† inventory systems, the quick delivery possible from Mexico†s border towns offers a substantial advantage over Asian alternatives. The NAFTA†s Impact on the Maquiladora Industry Traditionally, Maquiladoras offered foreign businesses several advantages over other forms of direct foreign investment. Since the signing of NAFTA, however, many of these advantages are either being phased-out or granted to all Mexican companies. The most significant advantages of operating as a Maquiladoras include: 100% foreign investment, operation without ownership of assets, tax sheltering of cost centers, and 100% duty-drawback or waivers for temporary imports. Furthermore, the NAFTA attempted to address the labor exploitation and environmental problems associated with the Maquiladora industry. One of the benefits of the Maquiladora program is 100% foreign investment of Mexican operations, which formerly was not allowed. However, Mexico†s Foreign Investment Law has changed through the years (most significantly in 1989 and 1994)-full investment is now allowed in most business ventures. Operation Without Ownership of Assets Another advantage that Maquiladoras have is that they can receive production materials and capital goods as loans from their parent and client companies. As a result, most Maquiladoras have little of no inventory of fixed assets, eliminating the need to pay the Mexican asset tax of 2% of all assets. In January 1995, the Mexican IRS reported that Maquiladoras would now have to factor the depreciation of â€Å"loaned† assets in price-transfer calculations, which is the first step toward phasing-out this advantage by 2001. When Maquiladoras are structured as cost center (providing manufacturing services for a foreign parent) the foreign corporation has traditionally paid the Mexican company for operating costs plus negligible profit. By doing this they avoid Mexico†s 34% corporate income tax, 10% mandatory profit sharing, and asset taxes. Now the Mexican IRS is changing the way Maquiladoras must declare assets. Over the next few years, Maquiladoras will be forced to raise their declared profit percentage to a rate that is comparable to that of two unrelated companies performing the same transaction at â€Å"arm†s length†. This is the type of transfer pricing procedure that is implemented by most trading blocks, like the EC. It will soon be effect throughout North America. 100% Duty-Drawback or Waivers for Temporary Imports Maquiladoras have always allowed Mexican companies 100% duty drawback or waivers in imported components that are exported as final goods. Since 1994, this has provided many Maquiladora programs a way to use non-NAFTA materials within products without the need to pay the corresponding duties over those materials when importing or exporting goods to other NAFTA nations. On January 1, 2001, Maquiladoras that manufacture goods for export to NAFTA partner countries will no longer be allowed to take the waiver. The waiver will still be available for goods that are going to non-NAFTA countries. In 1995 the NAFTA†s of Labor created the National Administrative Office (NAO) as well as the North American Agreement on Labor Cooperation (NAALC). Both were intended to stop labor abuses. The NOA was established to monitor labor complaints that NAFTA critic†s voice regarding unfair labor practices. The NAO can recommend â€Å"ministerial consultations† as well as imposed heavy sanctions against Mexico. Unfortunately, the side agreements proved useless. The NOA cannot force Maquiladoras to allow unions-the most they can do is recommend â€Å"ministerial consultations.† Sexual harassment and discrimination continues as well. The NAFTA has also created side agreements covering the environment. One of them is the North American Development Bank (NAD Bank). Its purpose was to finance wastewater treatment projects along the border in the poorer communities. However, the most important criteria that needed to be met in order to receive funds were meeting certain market considerations. With this program NAFTA â€Å"encouraged† growth without regard for the environment through its practice of placing market consideration above environmental protection. Another is the Commission for Economic Cooperation (CEC). The CEC was established to investigate governmental non-enforcement of environmental laws. Unfortunately it has no power to enforce ,they can only investigate-and they can†t even do that until Mexico collects the data on the pollution for them. Possible Strategy for the Maquiladora Industry As long as the Mexican currency is weaker than the US dollar I don†t think that the changes are going to dramatically effect the flow of US companies to the south. However, the Maquiladora industry cannot count on this for continued growth. By the year 2001 the Maquiladora industry as we know it now will have significantly changed when the phasing out is complete. Maquiladoras will no longer be â€Å"tax break† establishments; they will be just like other foreign investments. In order for them to fully compete in the near future they must become more efficient and leaner. The impact of globalization is forcing manufacturers to produce more rapidly and cheaply than ever before and to continuously improve. Because there will be no differentiation between the non-Maquiladora and Maquiladora industries I feel the inefficient producers will be wiped out. Therefor, Maquiladora employees will need better training, education, incentives as well improved working conditions and higher wages. Operations will also have to be streamlined in order to reap the benefits of economies of scale and scope. In addition, Mexicans as well as US citizens will start to demand more accountability from the Mexican government and the Maquiladora industry. They need to be more responsible for their actions. What will the U.S. corporations do when human rights activists and environmentalists start lobbying and protesting on their US sites? Do they want to risk losing their shareholders to this type of negative attention?

Lawrence Joy Panged Jinn Jinn Shank Hannah Amanda

What are the various types of mallard? How do worms differ from viruses? D o Trojan horses carry viruses or worms? The various types of mallard are viruses, worms, Trojan horses, polymorphic threats, virus and worm hoaxes, back door or trap door, dentifrice's and distributed dentifrice's, and mail bomb. B. A virus must be executed such as opening an infected email attachment while a worm can be initiated with or without the user downloading or executing the e file. C. A Trojan horse carries neither a virus or worm. 2. Why does polymorphism cause greater concern than traditional mallard?Ho w does it affect detection? A polymorphic virus is a complicated computer virus that affects data types and functions. It is a selflessness virus designed to avoid detection by a scan near. Upon infection, the polymorphic virus duplicates itself by creating usable, alb tit slightly modified, copies of itself. Polymorphism, in computing terms, means that a single definition can be use d with varying amounts of data. In order for scanners to detect this type of virus fourscore programs must be written to combat and detect the polymorphic iris with novel variant configurations. Polymorphic virus might have a virus decryption n routine (AVID) and an encrypted virus program body (EVE). When an infected applicant launches, the AVID decrypts the encrypted virus body back to its original form so the virus can perform its intended function. Once executed, the virus is reentry De and added to another vulnerable host application. Because the virus body is not al tired, it provides a kind of complex signature that can be detected by sophisticated an diverts programs. 3. What is the most common violation of intellectual property? How does an org nation protect against it? What agencies fight it?The most common violation of intellectual property is theft, which is illegal taking of another's property. The value of information suffers when it is copies d and taken away without the owner's kn owledge. Within an organization, that prop retry can be physical, electronic, or intellectual. Physical theft is controlled relatively ease Electronic theft is a more complex problem; the evidence of crime is not read apparent. Physical theft can be controlled quite easily. A wide variety of mess urges can be used from simple locked doors to trained security personnel and the install action of alarm systems.Electronic theft, however, is a more complex problem to man GE and control. Organizations may not even know it has occurred. The World Intellectual Property Organization (WIPE), an organ of the United Nations, suggests laws t enforce Intellectual property rights worldwide. The convention of this organize action establishing on July 14, 1967 focuses on protecting the right of intellectual pro Perry. 4. How is technological obsolescence a threat to information security?

Rural Community Health Service Provisions Health And Social Care Essay

Chronic diseases can be a fatal, yet, returns on gradual procedures toward morbidity and mortality that include cardiovascular diseases, both types of diabetic conditions, and hapless respiratory position. These conditions are mostly related to the life style that persons lead, with their consumptive wonts of dietetic nutrients, baccy and intoxicant ingestion, as accompanied by physical activity modus operandis ( Halpin, Varela & A ; Martin-Moreno, n.d. ) . In a survey on the incidence of cardiovascular conditions in some developed states of North America and Europe, it had revealed that hypertensive episodes in older age groups had been more controlled in the former bunch, with Canada included, compared to the higher survey results in the latter, 8 % and 23 % severally ( Wolf-Maiser, et al. , 2003 ) . The better direction strategy in the North American opposite numbers could hold demonstrated better wellness attention systems, yet, reverse could still be observed in such locations. At this point, the chronicity of diseased instances prevalent in older age groups seemed to further expose them to vulnerable state of affairss, topped with the devolving physiological maps associated with progressing phase of chronological adulthood. As such, higher incidence of cardiovascular diseases with older age brackets appeared to present a serious community issue that requires close examination and inclusion of wellness reforms to holistically back up their present position. In peculiar, the distribution of wellness attention services in Canada ‘s rural communities had been identified as one of the important countries that seemed to be neglected in the bureaucratic procedure in wellness reforms. Unlike any definition on rural construction, Slack, Bourne & A ; Gertler ( 2003 ) admitted that the state do non hold clear differentiation of what rural community is, depicting non-urban zones as rural in construction. Compared to the wellness services provided in the urban countries of Canada, the farness of several of its rural units had been fraught with several defects in wellness services, with inclusions in primary wellness unavailability, lower wellness forces figures, and hapless attention installations, as geographic distance and lifestyle position are said to be deteriorating in these countries ( Ryan-Nicholls, 2003 ) . As such, the job of cardiovascular diseases with older age groups had been compounded with the want of quality wellness services that should hold been more both timely and well-supported by involved wellness sectors As portion of the job associated with wellness attention in rural communities, wellness forces and societal public assistance officers have the primary duty to look at the general and wellness public assistance of the citizens in the community, particularly the defenseless groups of both immature and old age bunchs, yet treatments above revealed the lower keeping rates of wellness staff in rural units. The job with this is non the low work force in wellness workers, but instead, there appeared to be an unequal distribution of labour force between rural and urban locations ( Ryan-Nicholls, 2003 ) . Acknowledging the root of wellness attention forces deficits, such reverse seemed to add to the lifting job of ageing population in Canadian communities. At big, Arah, Klazinga, Delnoij, Asbroek, and Custers ( 2003, p. 384 ) emphasized that despite the wellness attention duties centered on wellness forces, reform in primary attention will still come from parts in other related sectors, such as the networking commissions in â€Å" national, regional and local degrees. † With the prevailing tendency of wellness publicity in Canada ‘s wellness system, the function of the bureaucratic authorities in support service plans for the ageing population had been established ; yet, subsequent studies demonstrated oversights in following through the undertaking plans towards the execution and existent direction stage. Hence, such projected wellness publicity efforts appeared fall more in ineffectual efforts-federal engagement had been well limited in local community enterprises ( Boyce, 2002 ) . The wellness attention issue in rural communities, affecting ageing populations with cardiovascular conditions, so, would necessitate the conjunct attempts of the local wellness forces, every bit good as the national wellness commissions responsible for resource support and allotment of just and quality services to remote rural countries in Canada.Literature ReviewCanada is a state with well-managed resources, and as its population grows, so will the demands of the people become higher. As emphasized by Clark and Leipert ( 2007 ) , the incidence of widening figures in the older age groups, runing from 65 old ages old above, had caused ruffling effects in its aftermath. On one manus, their worsening wellness that had been combined with cardiovascular conditions indicates that they need more clinical aid more. On the other, their age prevents them from happening employment as their physiological and mental wellness are said to by and large worsen with the rise of figures in their age. Such observations had been relevantly reflected in several surveies conducted in European states. Peoples nearing center to old age exhibited higher medical outgos compared to those in really old age ( 85 old ages old and above ) ( Rechel, Doyle, Grundy and Mckee, 2009 ) . At which point, ingestion of medical intervention may accountably lift when old persons believe that the y have better opportunity of widening their lives beyond 65 old ages old, bring forthing more government-assisted wellness services in the long tally. Their medical attention non merely consists of availing the services of clinical installations and wellness suppliers, but besides the medicine supplies and place attention care particular in their status, like in persons with cardiovascular conditions. More common than non, there is hapless attachment to order medicines as the costs can non afforded by persons with lower income ( Mojtabai & A ; Olfson, 2003 ) . In the instance of old population who are retired, there is no generated income at all, merely the retirement pensions for some. There are personal jobs that these groups had to face, and these are reflected on the quality of wellness they sustain. Historically, rural communities had long since experienced the job of reverses associated with delayed wellness commissariats from the cardinal authorities well funding the national wellness plans. In every bit early as the twelvemonth 1969, those in political power have already recognized the deficiency of wellness attention staff willing plenty to shack in distant countries, for the interest of executing their pledged undertaking, to function the people in equal chances. Yet, it seemed that by the passing of the decennaries, such job had non lessened with clip, this, alternatively, became a grim instance of reduced attention practicians in such locations, where at that place used to be a solo wellness supplier in every communities, now, they have become more scarce in several 1s ( Pong & A ; Russell, 2003 ) . In line with this, the laterality in big medical establishments had shifted towards community wellness Centres and smaller attention clinics in the late sixties ( Groene & A ; Garcia-Barbero, 2001 ) . At this point, it must be recognized that no affair how updated the installations are and how willing the community citizens undertaking in collaborating for better wellness allowances, they all will be in vain when there are no wellness attention staff to ease such resources in the field. In such scenario, it appeared that oversights in support from higher authorities sectors had led to decomposition of wellness attention structures in the said countries. In the traditional design followed by Canada ‘s wellness sector section during the late fifties, no specific policies had been constructed in every bit administering wellness forces on the different countries in the state. Such deficiency of systematic attack had been dramatically revised in 1966, where practising medical forces have more autonomy in puting private pattern for definite fees, restricting wellness services that are low-cost in the state. Acknowledging a figure of disagreements with su ch clinical freedom, federal authorities placed more stiff parametric quantities to protect consumer rights, punctually supplying for services that are out of privately-insured medical strategies, such as â€Å" place attention, nursing places, outpatient pharmaceuticals † ( Tuohy, 2002 ) . As observed in such authorities reforms in wellness, precedences had been more on administering more wellness services to more people, ignoring the equal chances for communities to obtain wellness forces to help in their wellness issues. Aid in rural locations, particularly the fiscal 1s, is transferred from the Provincial divisions through established transportation undertakings. The ideal system postulate that the divider of authorities ‘s countries of duties into sub-divisions denote faster distribution and use of much demand commissariats and services, as the local scenes are given adequate entree to resources to ordain on issues that needs prompt actions ( Slack, Bourne & A ; Gertler, 2003 ) . However, such scheme had presented several oversights, as it had non been plenty in turn toing the cut downing figure of wellness forces in rural communities, certifying that fiscal resources are non the lone country that require examination in turn toing wellness unfairness of old population-federal committedness for effectual primary attention reform should be strengthened. As authorities support is mostly required to advance communities that are well-sustained in back uping the demands of its local citizens, their function in the procedure of accomplishing such nonsubjective is critical. Retrospective surveies revealed the deficiency of consolidation between the divisions, federal and provincial systems, in authorities opinion and duties, as struggle on sum of financess transferred from federal to provincial offices had non been settle in the past decennaries. Revisions in the support transportation had taken topographic point during the 1995 budgetary cuts, allowing out several protests at the lower degree of the authorities offices in provincial subdivisions. Where some countries had still remained the precedence, such as wellness publicity schemes, and wellness installations, wellness policies back uping community wellness development through better supply of wellness attention staff remained written in commission studies, but ne'er to the full realized ( Tuohy, 2002 ) . With such complecting constructs on ageing population, cardiovascular conditions, and attendant habitation in distant rural countries, the class of progressing developmental age is more at hazard than any other age groups in the same state of affairs. The capacity of the topics in the survey to flexibly get by seemed to travel reciprocally with age. As such, this reappraisal of valid surveies had shown that small attending had been given to strip older persons. Relative with this, spreads on how to turn to the wellness conditions normally bing in persons, every bit good as reconstituting the primary attention construction, must be analyzed and given prompt and efficient attending, as their go oning tendencies may take to more unfairness that takes advantage of the clustered exposure of seniors shacking in distant rural communities.DiscussionThe primary issue of the paper centres on the combination of old age with chronic cardiovascular status and the deficiency of system support in r ural communities, which increases the hazard for lower wellness attention commissariats and services. Noting such incidents, a figure of priority solutions can be recommended to ease the wellness unfairness imparted to this group. The events taking to this may be summarily explained through the sensed barriers to hapless primary wellness attention bringing: ( 1 ) work force scarceness, ( 2 ) sustainable Economic barriers, ( 3 ) geographical unavailability, ( 4 ) cognition shortages ( Hutchinson, Hawes & A ; Williams, 2010 ) . As such, these may necessitate a comprehensive model of schemes which jointly reconcile each issue towards more effectual wellness attention construction. The efficient attacks in guaranting that older population have the critical wellness plans they need are to prosecute in the run towards â€Å" wellness publicity and disease bar † ( Burns, 2006 ) . The precedences of such constructs had been clearly delineated in the Ottawa Charter, particularly in the former context. This international end chiefly calls for the shared committedness of meeting stakeholders and involved parties in guaranting an efficient model that pursues wellness, above all. Particularly, the said committee had listed the entities involved in such an embracing wellness committedness, including â€Å" persons, community groups, wellness professionalsaˆÂ ¦institutions and authorities, † appealing that they abide with each of their duties in prolonging excellent for all, particularly the vulnerable ripening groups ( Lopez-Acuna, Pittman, Gomez, de Souza, & A ; Fernandez, 2000 ) . Medical schemes are non the primary focal point of the said end ; alte rnatively, it goes manner beyond the healing side to advance a wellness organisation that holistically meets the demands of possible clients in communities-physically, cognitively, psychologically, and spiritually. With the changing demands of ageing population with chronic conditions, a multi-dimensional declaration of perceived jobs may be required in this scenario. In a conceptual model observed in Figure 1 ( delight see Appendix A ) , it well review the general barriers to wellness development of rural community as a whole and ageing populations with chronic disease in peculiar. Schemes to hapless wellness conditions of ageing population in rural communities must non merely turn to their individualised conditions, as considerations on other societal and environmental factors environing these groups must besides be given sufficient attending. More significantly, the roots of the job must be addressed judiciously in order to continue in executing efficient wellness attention publicity and disease intercessions for the targeted group, the aged citizens. As identified earlier, there are five extenuating barriers to the hapless conditions of rural wellness units, and the people shacking in such countries. Earlier subdivisions in the paper had comprehensively reviewed the struggles between two divided subdivisions of the authorities, the federal and provincial authorities offices. As such, their budgetary differences seemed to halter the flow of resource support towards relevant wellness plans, likely decelerating the operations of receiver sectors that require attending, such as wellness attention constructions and issues. Through amalgamate and collaborative attempts by both authorities divisions, the flow of resources that will fund executable plans can be initiated and procedurally executed. In Action Plan instigated by the Canadian authorities in 1998, wellness promoting attacks, wellness communicating links, installations and wellness constructions had been given adequate precedence, while wellness work force and pharmacological supports had been left behind ( Tuohy, 2002 ) . In the proposed plan, all subdivisions needed in communities, particularly the rural countries, will be decently meted. . Workforce scarceness. Nursing forces deficits, particularly physicians and nurses, seemed to prefer big infirmary establishments in urban countries, instead than remain and function in tranquil and friendly vicinities in rural communities. As such, a figure of attacks can be recommended in pulling the involvement of wellness forces into rural locations. For one, the influence of pecuniary compensations can be one country to fulfill in professional workers. For another, satisfaction besides comes with the efficaciousness of wellness forces in their work environments. With updated and well-supplied wellness equipments and supplies, wellness professional can carry through their pledged responsibilities without negative feelings as they can execute significant undertakings for the community and its citizens, while maintaining their households near in supportive plans that finance several constituents of wellness staffs ‘ household members with them ( Pong & A ; Russel, 2003 ) . Wit h more wellness forces flocking rural communities, better wellness attention proviso can be rendered, and wellness instruction can be offered to seniors enduring from chronic conditions. Sustainable economic barriers. Government funding can non last in prolonging community development and its growing. At the initial stage, provincial sector of the authorities can supply for resources in get downing up community undertakings that may heighten the flow of economic gross towards rural communities. The chief economic issue in rural communities is that these units offer businesss that are non diversified in character, where professionals tend to look for occupations elsewhere as they lack the necessary comfortss to hike micro-business that could hold provided occupations for more local people. With this being the instance, authorising the citizens to move can be disputing. Like most enterprises, injection of fiscal capital for purchase of necessary resources is required to incite plans that address the economic demands of communities. For case, â€Å" Ontario Small Town and Rural Development Initiative ( OSTAR ) † had been established to assist the indicated sector in stabilising local economic systems and substructures ( Enid, Bourne & A ; Gertler, 2003 ) . Local organisers have the duty to take the remainder of the citizens towards preparation activities and concern ventures that may likely pull in occupations from suburban countries, and can even undertakings a sustainable position that depends less on provincial authorities in shouldering community betterments, such as local building costs and other plans related to better selling and consumer engagement in sceptered communities. Geographic unavailability. As Canada is non far behind its neighbouring world power states in economic advancement and enlargement, the issue of geographic distance could hold been easy resolved through modern agencies of communicating. The debut of medical specialty in the context of computerized engineerings had been introduced a few old ages back. Through the external supports attached with such technological inventions, picture cyclosis and Internet-based synergistic conversations can be possible. Termed as telemedicine, such scheme covers the distance between wellness suppliers and receivers during the proviso of attention and services ( Hutchinson, Hawes & A ; Williams, 2010 ) . Alternatively of aged patients with chronic conditions going far merely to run into their physicians for scheduled check-ups, this population can use their computing machine units in making so, without the excess disbursal and attempts. Health forces at certain distances can be accessed through practica l medium, from their ain places. Knowledge Deficits. With such reverse in several rural communities, aged people can non be updated with the true nature of their conditions. The deficiency of cognition on how to continue with ageing position can be compounded with low resources and uncoordinated webs in local rural zones to advance wellness consciousness. Through wellness publicity attacks, factual information can be distributed in timely and effectual ways. There are a assortment of ways in executing such ends, such as community consciousness, information thrusts, persuasion in societal policy alteration, go oning preparation and instruction, and active runs which demonstrate better wellness position ( Laverack & A ; Labonte, 2000 ) . Performing most of them, it is rather safe to state that lifestyle alteration, avoiding destructive baccy and intoxicant wonts while keeping better diet and exercising degrees, particularly in cardiovascular diseases in aged can be controlled. Furthermore, medicine regimen can be bett er complied, as this plays a portion in commanding several sorts of bosom diseases, such as high blood pressure ( Halpin, Varela & A ; Martin-Moreno, n.d. ) . These schemes must be systematically drilled in community scenes, concentrating on aged groups who are more vulnerable than the remainder. When there is betterment in wellness behaviours and informational follow-through in ageing population, they have better opportunity at forestalling farther patterned advance of acquired wellness conditions ; merely so can the enforced plans on wellness publicity and disease bar be viewed as partly successful in accomplishing community ends of better wellness through the coaction of different sectors in such schemes.DecisionAll in all, the job in older populations had converged, with inclusions of high prevalence of developing chronic cardiovascular conditions, and societal unfairnesss brought approximately by shacking in rural countries. Sing their distance from big infirmary establishments , this group is at higher hazard of developing shortages in cognition sing their current wellness position, as rural communities seemed to be prone to work force deficits, but in wellness and economic sectors. Furthermore, it seemed that the great distance projected by rural communities seemed to drive big concern ventures, worsening jobs of community sustainability of its citizens. Sing the drawn-out differences between the federal and provincial authorities sing budgetary affairs, jobs in community subdivisions remained dead and unattended for most of the clip. As proposed in the paper, the authorities in Canada plays a critical function, particularly in its capacity to supply resources and sufficient support, in developing the hapless wellness and communal conditions of several rural units. As such, fiscal and political support served stable anchors to induction of plans, from socioeconomic sustainability, set uping telemedicine connexions, and building effectual attacks in welln ess publicity ; all these contribute in their alone facets in hiking the overall position of rural communities. For the ageing population, support in wellness and day-to-day life seemed hearty plenty for some, while others continue to be involved in community engagement, as several seek authorization and independency, peculiarly on pull offing wellness more quickly and efficaciously.

Internet Exercises Speech or Presentation Example | Topics and Well Written Essays - 1500 words

Internet Exercises - Speech or Presentation Example By extreme we mean: far from what we would expect to observe if the null hypothesis is true. In other words, a small P-value indicates that observation of the test statistic would be unlikely if the null hypothesis is true. The lower the P-value, the more evidence there is in favor of rejecting the null hypothesis. The z-test for a mean is a statistical test for a population mean. The z-test can be used when the population is normal and ÏÆ' is known, or for any population when the sample size n is at least 30. The test statistic is the sample mean and the standardized test statistic is z. A chi-square test can be used to test if the variance (square of standard deviation) of a population is equal to a specified value. This test can be either a two-sided test or a one-sided test. The two-sided version tests against the alternative that the true variance is either less than or greater than the specified value. The one-sided version only tests in one direction. The choice of a two-sided or one-sided test is determined by the problem. For example, if we are testing a new process, we may only be concerned if its variability is greater than the variability of the current process. Sample Problem: A hospital administrator believes that the standard deviation of the number of people using outpatient surgery per day is greater than 8. A random sample 15 days is selected. The data are shown. At ÃŽ ± = 0.10, is there enough evidence to support the administrator’s claim? Assume the variable is normally distributed. Sample Problem: A researcher wanted to see if women varied more than men in weight.   Nine women and sixteen men were weighed.   The variance for the women was 525 and the variance for the men was 142.   What can be concluded at the 0.05 level of significance? Since we are testing to see if the variance for the women

Curriculum History of the United States Essay Example | Topics and Well Written Essays - 1000 words

Curriculum History of the United States - Essay Example tes formal education system experienced a relative period of stabilization that allowed institutions to come together under a common ideal (Zais 1976). Even as curriculum development began to gain structured form, initial developments occurred through the gradual accumulation of diverse subjects: mathematics was followed by an array of sciences, including botany, anatomy, physics, astronomy, and geology. Soon after this subjects for non-college bounds students were added, such as typewriting, woodworking, and metallurgy. However, the ultimate array of subjects remained haphazard, unlike the well-structured form it progressively attained. Recognizing the haphazard curriculum, in 1892 a famous committee was formed to help add structure to the loosely formed curriculum. The group was termed the Committee of Ten and was headed by the President of Harvard at the time – Charles Eliot. The committee understood that the unstructured format of the current education system was pernicious to societal development, so they set out to bring order to the chaos (Zais 1976). Eliot and the committee determined that the greatest means to accomplish this would be to have the curriculum adhere to the already established college structure and function solely to prepare students for higher education. As a result, the core courses that had come together immediately after the Civil War were kept and substantiated, yet the elements of the curriculum designed for students not college-bound was discarded as unnecessary. Historians and educational theorists regard this last point as especially relevant to the changing view of learners ov er time, as its underlining assumption was that these core courses, even if they didn’t target specific vocational aspects of the learner’s development, would have the ultimate benefit in preparing them intellectually for whatever task they undertook. Even as these earlier curriculum formulations considered the development of the human, it wasn’t

Historical Documentary of Civil War Movie Review

Historical Documentary of Civil War - Movie Review Example The films show the war in different manners and applying different methods, and it is rather interesting to compare some of them. The aim of this paper is to compare such memorable documentaries about the Civil War as The Civil War of Ken Burns, Gettysburg Stories of Valor - CIVIL WAR MINUTESTM III by Keith Carradine and The Last Days of the Civil War. The paper will compare and contrast these films and show the importance of the documentaries for our understanding of American history and its main features, characters and events, as well as explain and evaluate how they are useful and not useful in their representation of history through television. 2. The Civil War of Ken Burns is a significant example of historical documentary. The filmmakers showed the Civil War with photos, voices of people who lived through the war and informative narration that helped spectators to feel the sense of epoch and time. In addition to that, Ken Burns "often gives life to still photographs by slowly zooming-in on subjects of interest and panning from one subject to another" (Ken Burns, From Wikipedia). This effect gives spectators a good opportunity to trace the main features of the film objects and events. The film consists of nine episodes and also includes about sixteen thousand photos, images, newspaper paintings, anecdotes and insights of different historians. It covers the period from the beginning of the war with the explanations of its causes till the end of the Civil War in 1865. Ken Burns underlined that "It was something that also became a kind of 'emotional archaeology,' trying to unearth the very heart of the American experience" ( Why I decided to make The Civil War). The film photos, as well as the narration give a good notion of the Civil War events and characters - so, the film is rather useful in its representation of the Civil war and American history in general. While watching the film, people can get a vivid understanding of real war characters and events - it is very important for those who are interested in American history. Such documentaries have in general very positive significance - they develop young people's historical knowledge and induce them to be proud of their country and their heroes, and television can play one of the main roles in this process. The Ken Burns' film The Civil War proves this statement - people have an opportunity to understand the historical process, find appropriate parallels with contemporary history events and analyze the events from the historical point of view. Television is a great instrument for people's education (especially for youth), and such documentaries whe re real pictures and impressions of real people are clearly shown can promote our interest for history. Documentary films (such as Ken Burns' The Civil War) can give an evident picture of the Civil War, and from this point of view documentary films differ from historical books. In addition to that, television and media technology play growing role in our understanding of historical and as follows world problems and

Literature review Essay Example | Topics and Well Written Essays - 5000 words - 1

Literature review - Essay Example Health Organization (WHO), 2007, p.1, defines falls as â€Å"inadvertently coming to rest on the ground, floor or other lower level, excluding intentional change in position to rest in furniture, walls or other objects†. As age increases so does the incidence of falls. Consequently it is the older people that face the brunt of the problem of falls, which is demonstrated by the incidence of falls being between 28 to 35% in people between 65 and 70 years and between 32 to 42% in people over the age of 70 years (The World Health Organization, 2007). Falls among the older population and the consequent injuries suffered are a major public health problem. The reason for this is that besides the enhanced frequency of falls in the elderly, such falls result in mild to severe injuries to the tune of 20 to 30%. This leads to more than 50% injury related hospitalization among the elderly and 10-15% emergency of all emergency department visits (The World Health Organization, 2007). In comparison to hospital stays for other injuries among the elderly, hospital stays due to injuries from falls are much longer. In the United Kingdom hospital admission rates owing to falls to individuals over the age of sixty is between 1.6 to 3.0 per 10,000 of the population and the emergency department visits as a result of falls in the elderly is between 5.5 to 8.9 per 10,000 of the population (The World Health Organization, 2007). In addition, to high hospitalization rates, falls in the elderly carry the higher risk of mortality, with falls being responsible for about 40% of all deaths from injuries to the elderly (The World Health Organization, 2007). Post-hospitalization complications can also arise in the form of post-fall syndrome that include the elements of dependence, loss of autonomy, immobilization and depression. This reduces the ability to perform daily activities, making them dependent on caregivers from the family. In the United Kingdom, the average earnings per annum lost on

Health care Essay Example | Topics and Well Written Essays - 500 words

Health care - Essay Example Although the coverage changes will largely take effect after 2014, yet the changes made so far are likely to benefit the rural people by improving their coverage rates. Children in the family plans would be qualifying for coverage up to 26 years of age as dependents. The implementation of changes would develop high-risk pools which would be particularly meant for those whose health conditions have existed for quite a while in the past. Owners of petty businesses as well as their workers would benefit from the subsidies and the addition of tax credits. People in rural frontier and nonadjacent areas conventionally have very low rates of health care insurance as compared to those in the urban regions. Therefore, effects of the provisions of ACA will generally be much more profound in the rural areas as compared to the urban areas. Rural people happily accept to work for little compensation. Volume of business does not matter much for them. It is important to note that the effect of ACA in rural regions will be the aggregate of appreciable advancements in coverage, which would be steadied by the imposed limitations on payments to the health care providers in rural areas particularly through such programs as the Medicare program.

Immorality of Abortion Research Paper Example | Topics and Well Written Essays - 1500 words

Immorality of Abortion - Research Paper Example Contrary to popular belief that abortion is a modern operation, there is retrospective evidence that it was practiced as long ago as the 5th century BC by ancient civilizations. Even in biblical times, a form of abortion was practiced, as is evidence in the book of numbers where a woman accused of infidelity would be made to drink â€Å"the bitter water† which would bring out the â€Å"curse† (Fox). Other recorded cases of abortion were in ancient Egypt (1550 B.C.E.) and China in the 5th century where among other things used to induce it was mercury (Fox). Notably, many the methods used in the past were dangerous and could have killed the mother just as easily as induced the abortion. In the recent past, abortions were illegal for moral, religious and health issues. However, after the 20th century, women rights groups and doctors have been often able to repeal this ban and as a result, many countries, especially in America and Europe, have legalized it to the chagrin of the pro-life groups. The issues that have made abortion such a controversial and pertinent issue include the fact that apart from the guaranteeing the unborn child’s death, it also jeopardizes the life of the mother; in addition, several of those who undergo abortions are underage girls who are pregnant and have no one to support them or the baby. Bearing in mind that it is the moral duty of the strong to protect the weak and comparably pro lifers consider it their duty to protect the life and rights of the unborn child. While the modern methods of carrying out the operation are mostly safe and performed by qualified doctors, from an objective perspective the action is immoral. Nonetheless, in view of the fact that a woman has agreed consciously and actively to end the unborn life in her is immoral in itself (Lee and Robert 13). Proponents of abortion have been trying to justify abortion and paint it with a moral brush for as long as the pro-lifers have been condemning it. O ne of the principal arguments put forward to humanize abortion and portray it in a moral light is that the fetus is not yet human being. They claim that if the pro-life side agrees a sperm and ovary are not considered human, yet they have potential to become human then the same should be said of the fetus. Therefore, should the pro choice concede it is human, they will go ahead and claim for one to be recognized as a person; thus, they would need to be self-aware. As such, anything in the womb is not self aware, ergo, cannot be human and the same argument has been proposed by advocates defending suspects of infanticide (Lee and Robert 15). However, these arguments are untenable and illogical at best; therefore, comparing the sperm to the fertilized egg flies in the face of logic since the sperm will only have potential for life if it is merged with the egg. On its own, it does not have a chance to generate life, the fertilized egg, on the other hand, in an autonomous genetic unit on ly requires the parent to host it and supply it with nourishment for the duration of the pregnancy. This is no different from when a child stays with its mother fully dependent on her for the first few months. However, at this point, even the diehard pro-choice people will not agree that the mother is free to terminate

Matriarchy versus Patriarchy Research Paper Example | Topics and Well Written Essays - 1500 words

Matriarchy versus Patriarchy - Research Paper Example Such a society implies male privilege and rule, and entails women's subordination (Asadi 4). Most patriarchal societies are as well patrilineal, indicating that only males inherit the title and property. Women, in a patriarchal society are matriarchal. On the other hand, matriarchy is a social system in which women or older females are the headers of their families. In such societies, women determine relationships and descent and they play major roles in the government. Currently, many religions believe that males should be the leaders in their families and society and both children and women must obey to their authorities (Asadi 72). The main purpose of this paper is to compare and contrast how women are presented, treated and importance in different religious. The content of this paper compares and contrasts women treatment in Islamic and Christian religions. Women treatment in Christianity and Islam Religions Throughout the religious history, men believe that they are more superio r to women in most diverse religions (Eller 121). Is this belief true in Islam or Christianity religions? In Christianity view, a woman's role is different from other religions since their roles are equal to those of males. In Galatians chapter 3 verse 28, Apostle Paul writers, â€Å"in Christ there is neither female nor male in Christ, Greek or Jew†¦Ã¢â‚¬  all human beings are equal before Christ. However, the two religions have expressively denied accepting the significant roles that women can influence in the society. Despite the advent of civilization, the prevalence of male chauvinism has served to suffice the importance of women in the society. Majority of the people professing the two religions hold that women are subjects to their husbands and they can never be equal. Similarities In both religions of Islamic women and Christian women, worship is a vital part of their responsibilities although the reasons behind this worshiping differ. Women from Islamic religion wors hip by adhering to a schedule of prayer and fasting, therefore, after their death, their good actions and ability to keep the Islamic laws, will enable the women enter â€Å"paradise† (Kanra 111). While Islamic men in â€Å"Paradise† are assured the company of various virgins for their pleasures, Koran does not offer much information for those women who afford their way in. It is evident that Islamic men derive the assurance that they will dominate the women in paradise since it is the case on earth while still the women are knowledgeable of passing into paradise as virgins to become subjects to their men. On the other hand, Christian women love God because He initially showed love to them. God offered is only beloved son, Jesus Christ, to die on the cross for the sinners since they were unable to earn any of the heavenly grace. Similarly, Christian women worship God through praying and fasting, but this is practiced in response to God’s commandments, and not fo r earning God’s favor (Kanra 42). A Christian woman is always aware of the awesome ease of acquiring God’s favor. As Jesus Christ said in John chapter 3 verse 16, â€Å"whoever believes in me shall not perish, but have everlasting life†. Christian women worship and praise the Lord to enable them to enter the Kingdom of heaven after death. Further, Christian women abide by Biblical teachings in order to draw God’s favor and become certain of the resurrection after death and acquisition of eternal life in paradise. In both religions, women play a major role of taking care of their husbands and children. They have the role of preparing and serving meals for their husbands and children. Women are only supposed to concentrate with home duties such as

Arthur Millar Essay Example for Free

Arthur Millar Essay In this essay I am going to analyse the dramatic techniques that Arthur Millar uses in his 20th century drama called, A View From The Bridge. The play is set in Brooklyn in the 1940s when the Italians were immigrating to America to find work as they were poor and they needed to get away from Italy to find work to feed their families in Italy. Many of these immigrants entered America Illegally. The play is about a skilled docks worker in Brooklyn named Eddie Carbone. Eddie lives with his wife Beatrice and their niece, Catherine. Beatrices cousins named Marco and Rodolfo come to America from Italy to find work to feed Marcos family in Italy, as they are very poor. They plan to enter illegally. Eddie has feelings for his niece Catherine that he should not have. Meanwhile Catherine falls in love with Rodolfo and Eddie hates him because he is jealous as he loves her and he cannot stand any other man looking at her and touching her. As a result Eddie decides to let the Immigration Bureau know that there are illegal immigrants in his building. In the play, Arthur Miller uses a number of dramatic devices many of which are seen in the first act but their significance only becomes apparent to the audience in the second act. These dramatic devices are: use of language, dialogue and its sub textual meanings, stage directions, characters actions, props and lighting. The first dramatic technique I am going to analyse is the use of language in Alfieris speech at the start of the play. Miller has put this at the start of the play to prepare the audience for what will happen later on in the play. The speech starts to develop tension because there are a lot of negative and violent words used. For example, Alfieri uses terms such as Machine Gun. The effect of using a term like this is to create tension for the audience, as they now know that something bad is going to happen later on in the play. As the play progresses the audience realise that this is the only time when Alfieri uses negative and violent language. So his words take on a deeper meaning when the audience realises this. I am now going to look at Eddies language in the first act. His speech is simple but at the start of the play his words are more vibrant towards Catherine as he tells he that she is walking wavy. At the same time he also refers to her as a Madonna. This gives the audience the idea that she is pure and she is a virgin and Eddie wants her to stay as she is. Listen, B. , shell be with a lot of plumbers? And sailors up and down the street? This illustrates Eddies feelings for Catherine and it can also mean that he does not want any other men looking at Catherine or marrying her. Eddies dialogue changes when the cousins arrive. He uses working class American colloquial words, such as Yiz have a nice trip? when he asks the cousins Marco and Rodolfo about their journey. Eddie wants to make it clear that he is the man of the house and that he is in charge. These expressions are only used in the first act when he is speaking to Marco and Rodolfo. This builds tension because the audience know that Eddie is going to start trouble with Marco and Rodolfo later on.

Exploring the Relationship Between Mother and Baby Essay Example for Free

Exploring the Relationship Between Mother and Baby Essay Exploring the relationship between mother and baby in the NICU in relation to nursing support. Abstract Aim -To explore the effect of interaction related to care-giving and information exchange between nurses and mothers in relation to maternal stress and maternal-infant relationship in the newborn intensive care unit (NICU) throughout the hospital stay. Background Mothers in the NICU experience depression, anxiety, stress, and loss of control, and they fluctuate between feelings of inclusion and exclusion related to the provision of health care to their neonate. This literature review helps to identify nursing interventions that promote positive outcomes between mother and baby by reducing maternal feelings of stress and anxiety. Search Method A literature search covering the period 2008-2012 was conducted. Five articles reporting both quantitative and qualitative studies relative to the subject were retrieved. Findings Findings reveal that positive and trustful relationships between nurses and mothers develop when nurses communicate and interact with mothers. This alleviated mother’s anxiety and enhanced their confidence when interacting with their baby. Discussion Critical analysis as well as strengths and weaknesses of the relative journals reviewed is given together with useful recommendations that emerge from the evidence. Conclusion The literature reviewed shows that nurse-mother interaction improves mother-infant relationship. In turn, this will eventually assist in decreasing maternal stress and improve the maternal well-being. INTRODUCTION Mothers develop attachment to their baby during pregnancy, which continues and develops more fully after the child is born (Cleveland 2009). However, the pathway to becoming a mother is threatened with the admission of the baby to the NICU. This occurs due to the unfamiliar and intimidating environment of the NICU (Obeidat et al 2009). During the initial admission parents can believe that the healthcare team is more able to care for their baby and this can instill feelings of inadequacy (Cockfort 2011). As a result, maternal attachment may be delayed by the lack of socialisation between mother and baby as most of the care is done by nurses (Cleveland 2009). DeRouck and Leys (2009), found that the parents of an infant admitted to the NICU face challenges including access to information, disclosure about the diagnosis, treatment and prognosis of their newborn, as well as a lack of control over the care of their newborn. Adding to this distress is the uncertainty of survival or the eventual impact of the infant’s condition on later health and well-being. In addition, feeling guilty to mother an unhealthy infant creates fear of social prejudice. Further, the structure of the NICU places significant barriers on mothers’ abilities to enact the parental role since decision-making and the daily care of the infant is taken over by medical and nursing staff restricting interactions with the babies stripping off their maternal authority (Cleveland 2009). In fact, when babies are in the NICU, traditional conceptualizations of the parental role are altered. The situation demands heightened parental participation while simultaneously placing severe restrictions on parental involvement. In response, parents need to negotiate this tension and traditional definitions of the parental role, which must be continually redefined throughout their experience What emerges is that the predominant source of distress is inability of the mother to protect the infant from pain and provide appropriate pain management. (Fenwick et al 2008). A lot of procedures cause pain in the neonate creating concerns for the mother, starting from peripheral cannulas, indwelling catheters and intubation to mention a few. In intubated babies, even though morphine infusions are administered, the baby still shows signs of distress during nursing times. In this case, we administer a small bolus of pain relief prior to nursing so that the baby would be more comfortable. Conversely, Fenwick et al (2008) describes factors that contribute to parents’ satisfaction in the NICU. These include; assurance and psychological support, the provision of consistent information, education, environmental follow-up care, appropriate pain management, and parental participation and proximity, as well as physical and spiritual support. Therefore, it is imperative that nurses should do their best to improve the mothers’ sense of confidence, competence and connection with her infant through guided participation (Domanico et al 2011). Johnson (2008) notes that skin-to-skin holding or kangaroo care promotes maternal-infant feelings of closeness, builds maternal confidence, and may be a stress-reducing experience for both the mother and infant. Hence the importance of providing the opportunity for kangaroo care to occur. Hunt (2008), notes that KMC is also crucial to stabilize parameters, such as cardio-respiratory parameters whilst being beneficial for maintaining body temperature. They add that even the incidence of nosocomial sepsis and the duration of hospital stay decreased with practicing KMC. In addition, Ali et al., (2009), found that Kangaroo mother care also showed positive outcomes towards practicing exclusive breastfeeding. Cockfort (2011) notes that, continuity of care needs to be ensured hence the importance of documentation. Therefore, it is suggested that handover should not be rushed, whilst a more comprehensive handover can ensure the smooth transition of care for staff and the family. When parents ask questions relating to their baby they feel assured in the competency of staff when information has been passed on correctly. When information is not shared effectively parents can lose trust and the partnership breaks down. In Malta, even though handover of 2 consecutive days is given, conflicting advice is still given at times due to the nurses’ different view-points. Consequently, this requires ward meetings in order to clarify important issues so that advice given and practice is consistent. In Malta, about 373 babies are admitted yearly (Grech et al 2012). In view of the benefits discussed, nurses should do their utmost to improve the overall experience of the mothers of such babies. Search Method A review of published research consisted of the following steps; broad reading to determine areas of focus, identification of inclusion and exclusion criteria, literature search (appendix 1) and retrieval, critical appraisal and analysis of the research evidence and synthesis of evidence. Evidence was reviewed with the aims of identifying barriers that affect the motherinfant interaction within the neonatal intensive care unit and how nurses can actively support attachment. Articles were included if the setting was primarily in a neonatal intensive care unit (neonatal unit or neonatal intensive care unit) and the participants were mothers of infants admitted to neonatal intensive care units or nurses working within that setting. In addition, All articles were critically analyzed with two primary questions in mind: (a) What are the needs of parents in the NICU? (b) What nursing behaviors support parents in meeting these needs? Articles were also included if they were primary research studies published between 2008 and 2012 and written in the English language. Primary and secondary literature searches were conducted through the EBSCO, ERIC, Sciencedirect and Medline databases. The primary search terms included â€Å"NICU,† â€Å"Neonatal Intensive Care Unit,† â€Å"family support,† â€Å"communication,† â€Å"nurse† and â€Å"early intervention.† The secondary literature search terms included â€Å"nursing support,† â€Å"efficacy,† â€Å"family,† â€Å"communication,† â€Å"support†, â€Å"neonatal† and â€Å"Kangaroo Mother Care†. These terms were used and utilised in all possible combinations to perform an extensive literature search of the above mentioned electronic databases. Thirdly, a review of references was conducted of the identified articles for any further studies. Eighteen articles were found through the search. Six studies met the inclusion criteria of which, 3 were qualitative and 3 quantitative (appendix 2). The subject was limited to the last 5 years. This time frame helps in the getting the most recent experiences since NICU is a changing environment especially as regards to technology which effects the mothers as well as the nurses. Both quantitative and qualitative studies were found. Both qualitative and quantitative research was conducted to identify what is known about the needs of NICU parents and what behaviours support these parents. Both methods of research were included because of the potential for each to contribute to a more complete understanding of this topic. In selecting a research design, researchers should be guided by one overarching consideration: whether the design does the best possible job of providing trustworthy answers to the research questions. One needs to note that both studies have limitations (Cottrell McKenzie, 2011). In quantitative research, the researcher’s aim is to determine the relationship between one variable (an independent variable) and another (a dependent or outcome variable) in a population (Morrow 2009). In contrast to quantitative designs, qualitative designs do not result in numerical data for statistical analysis (Schira, 2009). In qualitative methods, researchers are interested in interpreting social phenomena and exploring the meanings that people attach to their experiences (Polit and Beck 2010). Moreover, views, attitudes and behaviours may be explored (Wood Kerr, 2011), through grounded theory as it develops theories that are grounded in the groups observable experiences, but researchers add their own insight into why those experiences exist. Findings Table 1 includes information about the 5 studies that met the inclusion criteria . Once an infant is admitted into an NICU, many factors account for parental stress. Admission of the infant to the NICU places mothers in a stressful situation where they must cope with the NICU environment and its associated demands. In the study conducted by Parker (2011), a grounded theory approach was used to understand feeling and stressors of 11 mothers whose new-borns were in the NICU. It was found that the early days shock and numbness accompanied feelings of none or little control over their lives. Moreover, all mothers described feeling unprepared for the premature delivery and the sight of their baby in the NICU. Comparative results were found by Lee et al (2009), with regards to the shock experienced with the initial sight of the baby. Everyday unpredictable changes occur leaving no time for adjustment or preparation. Constant fears about the life and death of the baby do not subside and several mothers spoke about their experience of always anticipating the death of the baby. These findings are also reflected in my clinical setting when mothers would be recounting their experience once the baby’s condition improves. This is in line with the findings of Fenwick et al (2009) and Lee et al (2009). In addition, the findings imply that the positive reassurance of the effects of a positive and caring environment and support network between parents and nurses in the NICU is not always evident among every unit. Nicholas-Sargent (2009) found that assurance is the most important aspect to be fulfilled. Her quantitative study of 46 mothers found that the length of stay in the NICU and mothers’ information needs were found to be significantly inversely correlated. Therefore, this suggests that the longer an infant remains hospitalized in the NICU, the less emphasis the mother places on receiving information about the infant’s condition. This shows that the needs of the mothers in the NICU can change over time. My observations match these findings since mothers familiarise themselves and adapt to the situation. Moreover, they would eventually want to be successful with the care of the baby. This is reflected in the grounded theory analysis conducted by Fenwick et al (2008), using semi-structured interviews. They found that the nurse-mother relationship had the potential to significantly affect how women perceived their connection to the infant and their confidence in caring for their infant which occurred through a three way interaction. Being successful in their desire to care for the baby, engendered feelings associated with being a ‘‘real’’ mother. However, not all women in this study were able to successfully employ these strategies. In the situation where the mother perceived herself as ‘‘quiet and unassertive’’, and in a position without any power, it was very difficult to gain the confidence needed in order to be able to openly question, negotiate and direct the care of her infant. Therefore, it is very important to identify these mothers in order to help them by giving them continuous reassurance. This would particularly be required when the situation changes from support needing to encouragement in participation. Lee et al (2009) found that mothers received support from the healthcare professionals and the social networks that mothers made. These helped to create the connections that developed between the mothers and infants making their journey towards parenthood possible. They discovered that challenges are further compounded in Taiwan, where women are traditionally required to practice the cultural ritual which includes confinement to the house with a special balanced diet for the first month postnatal. Lee et al (2009) used the grounded theory approach with in-depth interviews and constant comparison. All interviews were audio-taped and notes were made during and immediately after the interview concerning actions and body language of the mother during the interview. The finding of this study further indicated that the initial sight of the life-support equipment was shocking. The technological environment created a fearful atmosphere, and the medical equipment attached to their infants caused the mothers further physical separation. The mothers indicated that they were so afraid of the equipment that it took them a long time to be able to participate in their infants’ care. In turn, this hampered them from establishing positive mother–infant interactions. Chiu and Anderson (2008), found that preterm births often negatively influence mother–infant interaction due to lack of physical contact. In addition, they found that skin-to skin contact post-birth has positive effects on infant development. These researchers conducted a randomized controlled trial (RCT) using questionnaires for data collection. In addition, mothers were further video-taped during a feeding session. Ali et al., (2009),highlight the importance of kangaroo care in their RCT where the researchers conducted their study with one hundred and fourteen infants. This study showed that the infants exposed to kangaroo mother care had an increase in rectal temperature compared to conventional care, therefore having a decreased risk of hypothermia. The mean temperature during kangaroo mother care was of 37 degrees Celsius while the mean temperature during conventional care was of 36.7 degrees Celsius. The data collected was through posted questionnaires. Discussion In the 3 qualitative studies found, the data was collected through interviews of which 2 were semi-structured while 1 was unstructured. Parker (2011), Fenwick et al (2008) and Lee et al (2008), used the Grounded theory approach. However, while Parker and Fenwick use semi-structured interviews, Lee uses unstructured interviews. In semi-structured interviews there is a topic guide with list of areas or questions to be covered with each respondent. This technique ensures that researchers will obtain all the information required, and gives respondents the freedom to respond in their own words, provide as much detail as they wish, and offer illustrations and explanations. Lee et al (2009) uses ground theory approach but incorporated with unstructured interviews. Unstructured interviews also known as are flexible but are more time-consuming than semi-structured since the interviewer listens and does not take the lead. The interviewer listens to what the interviewee has to say. The interviewee leads the conversation (Wood Ross-Kerr, 2011). However, anonymity for confidentiality which is of utmost importance is not possible. When using unstructured interviews, the researchers have to be able to establish rapport with the participant. The reason is that the interviewers have to be trusted if someone is to reveal intimate life information. This may lead to interviewee bias. Also, it is important to realise that unstructured interviewing can produce a great deal of data which can be difficult to analyse. Lee et al (2008) and Fenwick et al (2008) conducted the interviews themselves while Parker (2011) did not, thus reducing the bias. However, interviewer bias occurs even if someone else is conducting the interview. The number of mothers in the study of Lee et al (2008) was adequate since with in-depth interviews 20 participants are enough. However, to account for the small sample, more interviews and observations were done with the same participants in order to reach theoretical saturation. Usually informants are selected for in-depth interviews in a purposive manner questioning the generalizability of the results (Wood Kerr, 2011). A major controversy among grounded theory researchers relates to whether to follow the original Glaser and Strauss procedures or to use the adapted procedures of Strauss and Corbin (Polit Beck 2010). Grounded theory method according to Glaser emphasizes induction or emergence, and the individual researchers creativity within a clear frame of stages, while Strauss is more interested in validation criteria and a systematic approach. Parker (2011) uses the original Glaser and Strauss (1967) paradigm while Lee et al (2008) and Fenwick et al (2008) use Strauss and Corbin (1998) procedures. One of the fundamental features of the grounded theory approach is that data collection, data analysis, and sampling of study participants occur simultaneously. A procedure referred to as constant comparison is used to develop and refine theoretically relevant categories. Categories elicited from the data are constantly compared with data obtained earlier in the data collection process so that commonalities and variations can be determined. As data collection proceeds, the inquiry becomes increasingly focused on emerging theoretical concerns. All 3 studies use constant comparison. All the above 3 studies use audio-taping for data collection except for Fenwick et al (2008) who used field note documentation as well. Audio-taping enables eye contact to be maintained and to have a complete record for analyses, however, some interviewees may be nervous of tape-recorders. On the contrary, in note taking on the other hand, a lot of eye contact is lost unless a type of short-hand is learnt. However, the interviewer will have plenty of useful quotations for report when transcribing the interview. Randomized controlled trials consist of a complete experimental test of a new intervention, involving the random assignment of a large and varied sample to different groups (Polit Beck, 2010). The intention of an RCT is to arrive to a judgment as to whether the novelty of an intervention is more effective than the traditional intervention (Polit Beck, 2010). This intention was well noticed throughout the RCTs chosen by Ali etal., (2009). Wood Kerr, (2011) sustain that RCTs are the most rigorous method to determine a cause-effect relationship between the treatment and the outcome. Furthermore, RCTs were also described as the gold standard trial for evaluating the effectiveness of a clinical intervention ((Muijs 2010). One of the primary aims of RCTs is to prevent selection bias by distributing the patient, randomly between the two groups, so that the difference in the outcome and results can be justified and attributed only to the intervention under study. Thus, through random selection there is a better balancing of any confounding factors, therefore creating similarity between the groups (Cottrell McKenzie, 2010). In effect in this literature review, RCTs were found to be useful and beneficial to compare the effect of KMC and conventional care on the physiological aspects of the infant. Ali et al., (2009) chose to add blocking to randomisation so as to ensure a better balance in the number of infants allocated in the groups. These groups were randomized through simple randomization and the disruption of groups was achieved by delivering a concealed envelope technique. Through random sampling, Polit Beck (2010) explain that each element in the population has an equivalent, autonomous chance of being chosen. However, this design is not used frequently as it is lengthy and may be expensive (Wood Kerr, 2011). Chiu and Anderson (2008), use mixed methods of data collection by using both questionnaires and video-taped interviews. The use of multiple sources or referents to draw conclusions about what constitutes the truth is called triangulation. This is one approach in establishing credibility as it enables the researcher to counteract the weaknesses in both designs. The use of video-taping provides the most comprehensive recording of an interview since it captures body language, facial expressions and interaction (Gerrish and Lacey 2010). However the interviewee may become uncomfortable and act differently than in normal circumstances questioning the reliability of the data collected. In addition, questionnaires are the main research tools used in quantitative research. They are very advantageous as they can be constructed in such a way as to meet the objectives of almost any research project. In the Family Needs Inventory used by Nicholas-Sargent (2009), the ‘not applicable’ part was removed from the Likert scale in order to report definite opinions. Questionnaires can measure the participants factual knowledge about a certain subject or an idea or else they can be used to explore opinions, attitudes or behaviours (McNabb, 2008). Moreover, questionnaires are also less expensive than most other research instruments and are also less time-consuming . Self-administered questionnaires provide the participants with anonymity, and responses are not affected by the interviewers mood or presence (Wood Ross-Kerr, 2011). On the other hand, the main disadvantage of questionnaires is that there is a high possibility of a poor response rate since some questions are ignored, misinterpreted, incorrectly completed or inadequately detailed (Polit and Beck 2010). The RCT of Chiu and Anderson (2009) and Ali etal. (2009),, is one of the most powerful tools of research where people are allocated at random to receive one of several clinical interventions. However RCT’s are vulnerable to multiple types of bias at all stages of their workspan (Geretsegger et al 2012). Hence the need to establish validity and reliability. In the study done by both Ali etal.,(2009) and Chiu and Anderson (2009),the researchers increase the rigor on the study by using a large number of participants. In addition, Chiu and Anderson (2009) use the Nursing Child Assessment Satellite Training Program (NCAST) Feeding and Teaching scales. Nicholas-Sargent (2009), improved the rigour by using the Critical Care Family Needs Inventory (CCFNI), as a framework for the FNI. CCFNI has been thoroughly reported with results indicating internal consistency and construct validity (Gerrish and Lacey 2010). Despite this, Nicholas-Sargent (2009), use a small scale study and therefor e the results cannot be generalized. Limitations In the study done by Lee et al (2008), the data were only collected from one hospital in this present study causing generalisability of the results to be low. Moreover, the sample was restricted to those who did not have additional social, cultural or medical circumstances to consider. Moreover, coding was done by researcher itself and this might have caused some bias. Both Nicholas-Sargent (2009) and Parker (2011) use small scale studies but these were qualitative studies. Therefore, to a certain extent the findings cannot be generalized across the population of families involved with the NICU. In addition, Parker (2011) uses a retrospective study, which might have been subject to bias in recalling information. There was absence of pilot study in both Nicholas-Sargent (2009) and Chiu and Anderson (2009). The use of pilot studies helps to assess the design, methodology and feasibility of the tool and typically includes participants who are similar to those who will be used in the larger research study ( Wood Kerr 2011). Hence, their importance. Also, the instruments chosen by Chiu and Anderson (2009), being the (NCAST and the feeding and teaching scales) for this study might not be sensitive enough to capture any between-group difference in changes resulting from the intervention. Finally, Ali et al., (2009) fail to mention intention to treat analysis where researchers can introduce reality into research by outlining that not all randomised participants will continue throughout the study. Therefore, this might be a potential weakness in this study. It was also noted the there was no detailed report about the time intervals between the two different groups. Hence, this may also have introduced performance bias. In the grounded theory approach taken by Fenwich et al (2008), limitations lie in the method of data collection itself through semi-structured interviews that were tape-recorded and field note documentation done. The authors did not acknowledge limitations in the study. Recommendations Maternal contact Fenwich et al (2008) suggests prioritising maternal-infant closeness when underpinning policies and protocols and suggests the unrestricted access to their child. Lee et al (2008) found that in Taiwan mothers are allowed to visit for 30 minutes twice a day. In Malta, mothers are allowed to stay with the child 24 hours a day. In addition, skin-to-skin contact is recommended by both Lee et al (2008) and Chiu and Anderson (2009). The latter suggests that all mothers, if they are able and whether or not they ask for it, skin-to-skin contact should be encouraged. My suggestions on interventions for critically ill infants include encouraging the parents’ presence at the bedside, assisting the parents in personalizing the bedside, and teaching the parents to gently touch their infant. Another approach is to hang a simple picture board with the first names of nurses and practitioners near the entrance to the unit. This picture board helps anxious families feel welcomed in this healing environment. In our unit, those babies who have central lines such as umbilical arterial catheters (UAC), the mothers are not allowed to hold the baby for fear of bleeding if the UAC gets dislodged. However, if the mother shows signs of needing contact with the baby, we allow her to hold the baby with constant supervision. In the case of babies that are ventilated mothers are only allowed to hold their baby if the prognosis is very poor. Therefore, this shows that, if the baby is on long term ventilation, skin-to-skin is hindered from being introduced. Fenwich et al (2008), recommend the development of tools that can better evaluate the satisfaction of the mother. Hence, the need for longitudinal qualitative research. In my opinion this would yield good results when past experiences would show which improvements were helpful and which were not. NICE standards (2010), specify the use of surveys. We can incorporate these surveys after consideration with the midwifery officer. Mother-nurse-infant interaction Because of the complexity of illness, parents of critically ill infants are anxious and fear the worst with every visit to the NICU. Strategies need to be adapted to decrease maternal anxiety while supporting the needs of these infants. (Nicholas-Sargent 2009). Nurses play a vital role in helping parents throughout the stressful and challenging experience of the NICU by developing therapeutic relationships and providing emotional support. These approaches enable parents to feel more supported, more involved, confident, and more effective as parents of their vulnerable newborn. The experience of parents in the NICU occurs during an emotionally intense period fraught with anxiety, stress, depression, and feelings of hopelessness. Therefore, Nicholas-Sargent (2009) suggests that, it would be vital to do an NICU orientation for expectant parents with a high risk of giving birth to a premature infant or a compromised newborn. Supporting and facilitating their parenting role will help decrease their stress, strain, anxiety, and depression. Lee et al (2008), nurses need to respect the cultural preferences of mothers as this would promote desired health outcomes. This would aid in meaningful, holistic and individualized care. According to Nicholas-Sargent (2009), personalized one-to-one as opposed as opposed to group support would be helpful. In addition Nicholas-Sargent (2009), suggests that nurse education is needed to improve the awareness of the impact of the counselling service. However, the service needs to be more flexible due to fluctuations in the health condition of the baby. In fact, what we notice is that mothers would require counselling at different stages of the hospitalization. Therefore, if the service was refused once, it may still mean that mothers would need it at some other point in time. Nicholas-Sargent (2009), further suggests that the counselling service would be extended to the whole family from the hospital as well as in the community., Both the DH (2009), and NICE (2010) highlight the importance of Family-Centered Care (FCC) views the family as the ‘child’s primary source of strength and support’ and allows for collaboration, respect, and support with the parents and family during all levels of the service delivery. To foster participation in care for the infant, unrestricted visiting hours should be encouraged for the nuclear family of the neonate. In Malta, visiting hours are restricted to parents only due to increase in cross infection when family members were allowed to visit for 1 hour everyday during the day. However, timing of care may still be arranged to facilitate parents’ participation. In addition, special moments such as baby’s first time off CPAP (continuous positive airway pressure) needs to take place during parents’ presence. Cockfort (2011), highlights that missed opportunities to involve parents in care, heighten anxiety and can create a sense of sadness and loneliness . Information for mothers Mothers vary in the amount of information they can assimilate under stress. Therefore identifying parents’ feelings through active listening and observing will help us to pick up on parents cues and respond appropriately in order to provide parents with accurate and clear information (Fenwick et al 2008). Nicholas-Sargent (2009), adds that, information regarding the health status of the baby needs to be give in a timely provision. Parker (2011), recommends the access to certified interpreters for non-English speaking parents to enable them to ask questions and get the information they need as well as information regarding the counselling services. Likewise, an updated information board at the infant’s bedside helps mothers retain information while feeling welcome at the bedside. In my opinion, these interventions create an environment that facilitates maternal- infant attachment by promoting maternal competence with meaningful positive parenting skills and fostering partnership in care.. Conclusion In summary, the findings showed that parents of infants admitted to the NICU experience stress, depression, anxiety, and feelings of powerlessness, hopelessness, and alienation within the environment of the NICU. These situations are often overwhelming and catastrophic for the mothers keeping in mind that the process of motherhood is a protecting and loving phenomenon. Therefore mothers should participate in the care of their sick, fragile infant in the NICU through mother-infant interaction. Nurses need to be supportive and informative in dealing with parents in the NICU. Therefore, the need for parents to be given the access of interpretation by certified interpreters in order to overcome language barriers has been identified. Further, information and emotional support is required throughout the stay in the NICU, However, it was further found that information in preparation for discharge planning is vital. This enhances parental knowledge and decreases stress, which promotes more effective parenting. Further, as understanding of the parents’ experience of having an infant admitted to the NICU increases, nurses will be better prepared to meet parental needs and alleviate parental suffering. Providing holistic, developmentally supportive care and open communication with parents in this stressful experience is essential. Moreover, the need for family-centered care has been identified. REFERENCE LIST Ali, M.S., Sharma. J., Sharma. R., Alam. S. (2009). Kangaroo mother care as compare to conventional care for low birth weight babies. Dicle Tip Dergisi. 36(3), 155-160. Chiu S. Anderson G.C., (2009). Effect of early skin-to-skin contact on mother–preterm infant interaction through 18 months: Randomized controlled trial. International Journal of Nursing Studies, Vol. 46, pp.1168–1180. Cleveland, L.M., 2008. Parenting in the neonatal intensive care unit. Journal of Obstetric, Gynecologic, and Neonatal Nursing, Vol. 37 (6), 666e691. Cockfort S., (2011). How can family centred care be improved to meet the needs of parents with a premature baby in neonatal intensive care? Journal of Neonatal Nursing, Vol.95(5), pp.365-368. Cottrell, R.R. McKenzie, J. F. (2011). Health Promotion and Education Research Methods using the Five-Chapter Thesis/Dissertation Model (2nd ed.). Sudbury, Canada, United Kingdom: Jones and Bartlett Publishers. DeRouck, S. Leys, M., (2009). Information needs of parents of children admitted to a neonatal intensive care unit. A review of the literature. Patient Education and Counselling, 76 (2), pp.159-173 DH: Department of Health, 2009. Toolkit for high-quality neonatal services. DH, London. Domanico R., Davis D.K., Coleman F. Davis B.O. (2010). Documenting the NICU design dilemma: comparative patient progress in open-ward and single family room units. 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Literature Review: Access to Care for Addicts

Literature Review: Access to Care for Addicts Hettema, J., Sorensen, J. L. (2009). Access to Care for Methadone Maintenance patients in the United States. International Journal Mental Health Addiction. 7 (3) 468-474. DOI:10.1007/s11469-9204-6 This paper was presented to increase the awareness of individual with Opiates treatment programed Dependency are denied access to residential treatment. Although, Methadone Maintenance Therapy has been proven to reduce illicit drug use, improve psychosocial functioning, ability to keep employment, decrease criminal activities, and contracting HIV, AIDS, and Hepatitis. There are great concerns for those clients in Methadone Maintenance Therapy who need more intensive treatment. MMT does provide basic medical screening, dosing, and outpatient counseling. The more services provided for the client leads to a better outcome. The study found that treatment dose measured by number of days in treatment, number of treatment session attended and number of services received leads to a positive outcome. Some factors to consider are limited availability of residential treatment, insurance payment and the impact of abstinence philosophy. Mainstream views addiction as a moral problem rather than a medical issue. Hettema Sorensen (2009) identifies philosophical differences separates mental health and addiction services is hard to integrate. Society regards methadone as a necessary evil. There are ongoing empirically evaluated treatment approaches who do not follow an abstinence oriented philosophy. There are issues with the Americans with Disability Act because client is being denied services because of their use of a prescribed for their substance dependency. There are ambiguities in the interruption of that. The author is not aware of any litigation now. Ducharme, L.J., Knudsen, H.K., Roman, P. M. (2006). Evidence-based treatment for Opiate-Dependent clients: availability, variation, and organization correlates. The American Journal of Drug and Alcohol Abuse. 32.569-576. DOI: 10;1080/009529906000920417 This article examines the availability and correlates with evidence-based practices for opiates dependence in the United States. This research sampled addiction treatment with and without MMT services. This article also examined community based treatment programs with MMT units as one of their modalities. The researchers included both methadone available and non-methadone setting, then compared the number and type of service available to users. The method used was a data analyses collected in 2002-2003 national representative sample of addiction treatment centers in public and private sector. There was extensive face to face interviews conducted with administrators and clinical directors of 763 treatment center. The data collected in 2002-2003 face to face interviews included  organizational characteristic, size, ownership, accreditation, staffing, treatment practice methadone availability, level of care, pharmacotherapies, wraparound service, The findings suggested the majority of opiate dependents clients are not in Methadone Clinics. Many agencies are not willing to refer opiates dependent patient. to MMT. The opiate dependence client would benefit from the referral that uses evidence practices if referred. The research suggests further study to determine which opiate dependence client would benefit from evidence client care. Parks, C., Fullerton, C.A., Kim, Meekee, Montejano,, L., Lyman, Russell, Dougherty, R. H., Daniels A. S., Ghose, S. S., Delphin- Rittmon, M. E.., (2013). Medication-Assisted Treatment with Buprenorphine: assessing the evidence. Psychiatric Services in Advance.DOI10.1176/appi.ps201300256 This article reviews Buprenorphine treatment as an alternative to Methadone Maintence Treatment for long term treatment of Opioid Use Disorder. Buprenorphine is not considered as abstinence treatment. The purpose of buprenorphine is to reduce or eliminate opioid use. The authors conducted the research that examined abstracts of identical articles for compliance with the review. The research provided evidence of the effectiveness of improving treatment retention and decreasing illicit opioid use. The evidence is growing both BMT and MMT improved pregnancy outcomes. Ongoing treatment is necessary.