Cultural Interviews and Assessment Essay

I am interviewing a 32-year-old male (X) from the India who has been a resident of the San Jose in the US state of California since the last 10 years. He is employed as a Software engineer in one of the software MNCs in urban parts of California. Regarding, the Asian and Pacific Islander Americans (APIA) population in the US, they are one of the fastest growing population in the US. In the year 1999, the population was about 11 million and it is expected to grow to about 20 million by 2020. In 1999, 4 % of the US population was APIA, 12 % Hispanics and 11 % African-Americans. The APIA come from several parts of the world including India, China, Pakistan, Polynesia, Micronesia, Papua New Guinea, Hawaii, Japan, Philippines, Indonesia, Korea, Vietnam, etc. One of the favorite locations in the US, the APIA population would like to settle is in the state of California. The APIA make up for about 12 % of the California population in 1999. They come from various cultural backgrounds and have diverse needs. They are one of the most diverse groups in the US, and it is difficult to fulfill their health problems due to diverse healthcare needs. Let us now go through the entire interview process: – Socio-economic factors – Mr. X earns about 45, 000 US dollars every month. He is employed in a software-MNC. None of his other family members are working. He is married and has one child. Although he came to the US in 1997, he brought his family down to the US about a year back. Mr. X feels happy that he is able to earn a good income in the US and is more or less settled. He feels that many of the Indians in the US are earning far less and are belonging to the poverty groups. However, he also feels that the organization he is working in is a small organization and the income provided is less compared to other organizations. Lifestyle – MR. X is not leading a very healthy lifestyle. Earlier as his family was not with him, he used to eat his food in eat-outs and restaurants. Due to this, he is unable to lead a healthy life. However, once his family has come home, he is able to eat a traditional Indian meal and due to this, his nutritional status has improved. He is now able to consume a balanced diet. Mr. X and his family members consume a vegetarian diet. Mr. X smokes about 5 cigarettes a day and consumes about 2 servings of alcohol (especially whisky and rum) on Saturdays and Sundays. He is able to sleep only for about 6 to 7 hours a day. This is due to excessive workload. Although his duty timings are only 8 hours, he puts in an extra 5 hours work at home. During the weekend, he has to work from home at least for 5 hours on Saturdays and Sundays. He usually gets together in family meeting and religious ceremonies on Saturdays and Sundays. Family Values – Mr. X has not had much of a family life in the US. This is because his wife and child were staying back in India, as they were unable to come to the US earlier. However, in the last one-year his wife and child have come down to California and are staying with him. His son is an 8-year-old kid, who has just joined a US Elementary school. The child goes to school for about 4 hours in a day, from Monday to Friday. Prior to this one-year, the only members of his family in the US were his cousins, uncles and aunts, who reside about 20 miles from his home. Mr. X feels that in India, family values are given a great amount of importance. Down in India, people stay in a common house with the family members. This is especially seen in villages and small towns. Family meetings are conducted every day and usually food is consumed and prayers are said in a family. During the earlier days when he had just come to the US, Mr. X had stayed with one of his maternal aunt in California. However, as his condition began to improve and his job was settled, he shifted to a separate residence. However, he continues to meet his family members during weekends. Mr. X also makes important decisions after taking the advice of the elders in the family. This is also the case in India, where elders are given a lot of respect and value. In case of any personal problem, he would first call up his uncle, a man of 67 years, and explain his problem to him. Religious preferences – Mr. X belong to a high caste Hindu family in India, and actively practice his religion. During the weekends, he attends for prayers in a temple in California. He usually makes a trip along with family members. He does follow intricate religious practices at home and at his workplace. He consumes a vegetarian diet and would take care especially whilst eating out. During the morning and before starting work, Mr. X chants a few short prayers. This he also does after he finishes work and before going to bed. His wife and child are also religious like him. He accompanies his family members during the weekends for a trip to their local temple. The local temple is about 25 miles away from their home. They also consume a vegetarian diet. In California, the number of vegetarian restaurants and eat-outs are less, due to which he has experienced problems. Health and practices – Mr. X enjoys a good state of health compared to the other APIA’s in the US. It is also important to note that the APIA’s enjoy a much better health status compared to the Whites, African-Americans and the Hispanics. In the year 1999, Mr. X suffered a bout of malaria. He suffered from the illness for about 15 days, and required admission in the Hospital. During his earlier days in the US, Mr. X did not have health insurance. Hence, he had to pay for his hospital bills. In the year 2000, the organization he was working with provided him with health insurance, which helps him to meet with his health expenditure. As Mr. X smokes excessively and due to his work-related habits, he suffers from asthmatic attacks frequently. He uses a small pump that provides Broncho-dilators. He has to consume two puffs twice a day as suggested by the physician. He also follows the advice on food and exercises suggested by the physician. Sometimes during winter months, Mr. X requires hospitalization for difficulty in breathing. This has occurred frequently in the last 4 years. His hospital bill is now covered by health insurance. The physician has repeatedly suggested to give up smoking and to follow better work-related practices, which Mr. X has ignored. The access to health is good, as Mr. X resides in an urban area. He has a hospital providing ultra-modern facilities located about 1 mile from his residence. The hospital also has physicians, specialists and nurses who are from an Indian background. This makes him a special patient at the hospital. He does feel that his physician is able to communicate with him appropriately and understand his health problem. As Mr. X has his family come in newly into the US, they do not have health insurance. However, he plans to subscribe to health insurance for them within the next six months. So far his wife and child did not require hospitalization. However, MR. X frequently takes his son for health checkups and immunizations to the pediatrician. His wife visits a female gynecologist frequently, to ensure that problems with her periods are addressed properly. She does prefer going to an Indian female gynecologist, but is unable to do so as there is a shortage of medical staff from other cultures in the US. Due to problems with financing (uninsured), she is unable to afford seeing an Indian gynecologist from another hospital. MR. X’s physician and pediatrician both belong to the Indian community. Child-bearing/parenting practices – Mr. X has just one son, and he plan to have one more child in the near future. However, he says that during the pregnancy period, he plans to send his wife and son back home to India, as he may be unable to take appropriate care of his wife. As family values are give great importance in India, Mr. X wishes that his son stays with him even after crossing the age of 16 or 18. He wants his soon to mix about with other children in the US, but at the same time follow Indian traditions regarding religion, diet and customs. Other issues – Mr. X and is family members do understand English and do not have any problem communicating with the people in the US. Mr. X may not consider preventive medical care. However, he does visit the local physician frequently to take medical advice and go in for routine checkups. Mr. X feels that more physicians, nurses and specialists from the Indian communities should be available to fulfill the need of the Indians in California. Mr. X also feels that the local government and the Federal government have not addressed several of the problems faced by the APIA communities in the US. This is with regards to health insurance, health access, education, working conditions, immigration status, etc. References: Ro, M. â€Å"Overview of Asian and Pacific Islanders in the United States and California. † Center for Alternative Policies. 1999. 9 Nov 2007. http://www. communityvoices. org/Uploads/om3gfk55hhzyvrn00n4nerbf_20020828090003. pdf Srinivasa, S. â€Å"Toward Improved Health: Disaggregating Asian American and Native Hawaiian Pacific Islander Data. † American Journal of Public Health 90. 11 (2000): 1731-1734. http://www. ajph. org/cgi/reprint/90/11/1731. pdf

Communication in Criminal Justice Settings Paper Essay

There are different forms of communication, as we go through our everyday process we use different forms of communication all day long withier we are aware of it or not. Within those forms there are verbal and nonverbal communications, and in the criminal justice field there are defiantly times you should use these two forms of communication. Non-verbal communication, also known as body language according to research it states that only about 10% of communication involves the actual words people say, but 30% of communication is the way in which people say those words, called voice intonation. All the rest of our communication, about 60%, is done nonverbally. You can use your non-verbal skills such as active listening, understanding body language, and detecting deception. For instance a person’s body language is called cues. A person can sometimes communicate without even speaking by using their body; you can tell by the way a person walks/movement whether the person is happy, sad or even mad. Also when a person is being nonverbal they use their facial expressions and behaviors that communicate with other independent of words. In the criminal justice field you non-verbal communication is very important. This form of communication would be considered your best friend no matter what it is you are doing, wither it may be talking to a witness, out on patrol, or integrating a criminal. Verbal communications involves conveying thoughts or ideas. When it comes to verbal communication you are going to want to be aware of three components Speech, Language, and Conversation. Speech is the most progressive component in verbal communication. Language is the complex component of verbal communication. Conversation is the most important component of verbal communication. There are many barriers; they may include physical, emotional, and semantic barriers. Emotional barriers may include police officers having low self-esteem or another form of depression. Officers with low self-esteem questions themselves/ lacks self-confidence and even fears being put down or even ridiculed by former officers. The physical barriers can also develop a form of a breakdown in communication. Some physical barriers messages can’t be transmitted and that can be caused by faulty equipment. An example a defunct radio transmitter a way officer communicates with one another in which they can’t because the transmitters are not working. Semantics involve the selection of words you choose to aid you with your communication. If the wrong word is chosen obviously, the communication will not be as effective and the entire message can be misread. Ineffective listening also plays its role in hindering the communication process. If an individual is not fully engaged in the speaker perhaps because the topic does not interest them, , or development of your own biases or set opinions on what is being said have been established in which you with a closed mind, this can lend to ruining the communication between you and the sender. To develop strategies to overcome the barriers that occur as a police officer you must first understand the barriers. You must see the barrier just as you would any other obstacle how can you get around or through certain barriers/obstacle. Once you understand different types of barriers and how they come about is how you as an officer develop strategy to overcome the different types of barriers. In summary you need to develop all these key components of communication in order to better yourself and to enhance your career. Each of these component will allow you to perform your job the best as possible, wither it may be used to testify in court, questioning a witness/criminal, talking to your supervisor, etc. These components of communication that we use on a daily bases are key essentials and a must need in this field in order to survive. Without communication both verbal and non-verbal there will be no success. You will not be able to effectively do your job wither it may be communicating to you peers, to suspects, lawyers or judges. Everything we do revolve around proper communication, it is the key and essential part of the criminal justice process. References CJ Communications in the USA, Module 1 (2nd ed.) CJ Communications in the USA, Module 3 (2nd ed.) CJ Communications in the USA, Module 8 (2nd ed.)

Kiva Instead

Instead, informal systems and relationships, including loans from neighbors or relatives, and rotating savings/ credit clubs, have filled this gap. While such solutions have worked for some and are often the only option available, they can be inconsistent and unreliable during times of tremendous need. In addition, poor entrepreneurs can become trapped in vicious cycles of borrowing from local moneylenders, who may demand exorbitant interest rates.Traditionally, banks were unwilling to provide loans to poor entrepreneurs due to the perceived risk. Common concerns included the fact that the unbanked were often illiterate, had no collateral, no prior credit history, and were not employed by anyone other than themselves. However, in 1976, Muhammad Yunus, seen by many s the visionary behind the microfinance movement, bucked conventional wisdom and loaned the equivalent of $27 of his own money to 1 This section is excerpted and modified from the Stanford 6SB case: Equity Bank (A), case no .E-260. Bethany Coates prepared this case under the supervision of Professor Garth Saloner as the basis for class discussion rather than to illustrate either effective or ineffective handling of an administrative situation. Copyright 2008 by the Board of Trustees of the Leland Stanford Junior University. All rights reserved. To order copies or request permission to reproduce materials, e-mail the Case Writing Office at: [email  protected] stanford. du or write: Case Writing Office, Stanford Graduate School of Business, 518 Memorial Way, Stanford University, Stanford, CA 94305-5015. No part of this publication may be reproduced, stored in a retrieval system, used in a spreadsheet, or transmitted in any form or by any means † electronic, mechanical, photocopying, recording, or 0th the Stantord Graduate School of Business. Kiva E-288 erwise wit hout the permission ot some poor craftsmen in Jobra, Bangladesh.After all of the borrowers repaid, he repeated the experiment with more villages, and over the years, grew his series of xperiments into a multibillion dollar bank that has provided small loans to over 5 million people worldwide. Years later, Yunus noted, â€Å"At Grameen, we don't have any legal instrument between the lender and the borrower†¦. Everybody asks, What will happen if nobody pays back? I say, ‘But everybody pays back, so why should I worry about Grameen Bank charged 20 percent interest and reinvested all but 10 percent of earnings back into its operations.As Grameen grew, other leading microfinance institutions (MFIs), including ACCION International and Opportunity International, began to emerge and based their work on the same old ideas as Yunus: that the poor could reliably repay their loans, with interest, and could use the profits to grow their businesses. Mission-driven, nonprofit MFIs also entered the market. These organizations tended to pursue very rural or otherwise unreachable clients, even at great cost. They were ab le to provide financial services, including credit, tailored to the unique needs and limitations of the poor.

Online education Essay Example | Topics and Well Written Essays - 500 words

Online education - Essay Example There is no doubt about the fact that online education is increasing, however, just how effective is it and what exactly are its advantages and disadvantages are questions that need to be answered. There is no doubt that online education has some advantages; whether it is saving a lot of valuable resources, like time and money, or being more convenient for certain students, online education does have an edge over traditional education. Students can log on from their homes and not have to spend so much time commuting to and from the institution, for instance, what is more the institutes do not have to spend so much money on infrastructure when the classes are online, resulting in lowered tuition fees. However, online education also has certain disadvantages. The students taking online courses do not have much, if any, social interaction with their peers, as they would in a traditional classroom, therefore, they might end up not only missing out on normal social growth, but most defini tely also on the total experience of school life, which is considered a rite of passage in our society. Moreover, by missing out on face-to-face instruction by their teacher, the students also have less of a chance to be monitored for comprehension, i.e. it is harder for the teacher to know whether the student has understood the lesson or not.

Coaching and aligning a team Term Paper Example | Topics and Well Written Essays - 500 words

Coaching and aligning a team - Term Paper Example This cooperation among team members can be enhanced further by the leadership of the team leader. For the time being, the Chairman must play the role of the team leader and must consider the fact that even when team members are intelligent or hard-working, each member has their own strengths and weaknesses. His experience and wisdom can ably guide the management team to work together. However, initially it can be a daunting task to ensure that each team member has left any previous experiences and biases behind so they can focus solely on the current situation. Katzenbach and Smith (1993), write in an article titled, The discipline of teams, note â€Å"When individuals approach a team situation, especially in a business setting, each has preexisting job assignments as well as strengths and weaknesses reflecting a variety of talents, backgrounds, personalities, and prejudices† (p. 168). This meant being very effective in coaching the management team to focus on their rolees and stay out of politics. The chairman must also learn how to listen to the members of the Board but he must be firm in emphasizing that they should not be involved in the operational aspects. Another advice that the Chairman of the Board can take is that he must employ his excellent interpersonal skills. This would mean being open, frank, or straightforward in his transactions with both management team and board members. It would be helpful to have good demeanor in communicating with the team since they are all professionals; however, as Chairman, he must speak out his mind to arrest the situation. He could start by having a personal briefing to each member ( both mgt, team and board members) so he can address the issues directly and succinctly. By doing so, he is evaluating the opinion of each person which can help him make his own decisions later. In short, he is consulting the people as a coach. Managers do appear to prefer medium by corresponding it to the richness of the

History Essay Example | Topics and Well Written Essays - 750 words - 19

History - Essay Example In 1957, when Martin Luther King was just 28 years old, he took upon the mission to make the soil of America free from racism and give its people the dream for bringing America into the threshold of racial justice and instill in African-Americans to fight for their immutable rights with dignity and discipline. He gave this memorable speech as a part of the civil rights movement at the Lincoln Memorial in Washington, D.C. Just in the midway of the speech, King improvised the speech and gave to the world the words in which were interwoven the dreams of millions of Americans to emerge from the debris of subjugation and racism. He said: â€Å"I still have a dream. It is a dream deeply rooted in the American dream. I have a dream that one day this nation will rise up and live out the true meaning of its creed: We hold these truths to be self-evident: that all men are created equal. I have a dream that one day on the red hills of Georgia the sons of former slaves and the sons of former slave owners will be able to sit down together at the table of brotherhood†¦.† (U.S. Constitution Online, Online) It was not just the dream for the people of that era but is also a dream for the people of today’s generation too. His words stirred among people feeling of hope and aspiration that one day they would be free and one day America would see dawn in which there would be no racial discrimination in the name of color, caste or creed, and the place where everyone would be free. America celebrates Independence Day every year on July 4, the day when the foundation was laid for the most powerful and democratic nation of the world. The report I read to commemorate the independence was published in online edition of â€Å"New York Times† on 1st July 2007 written by Maya Jasanoff titled â€Å"Loyal to a Fault†. 4th July 1776 was the most commendable day for the American independence after the prolonged

The Position of Biofuels In Europe Currently Literature review

The Position of Biofuels In Europe Currently - Literature review Example The rising consciousness with regard to the environmental problems have augmented the degree of emphasis on the production of biofuels and promoting it to be a fresh energy source. It needs to be mentioned in this context that Europe has been identified to be amongst the leading producers of biodiesel. This particular form of fuel was found to symbolise a major portion of the biofuels market in Europe (The European Association for Bioindustries, 2007). Europe has been found to further encourage the usage as well as production related to the biofuels with the help of numerous strategies accompanied with many action plans. The Reason for Development of Biofuel in Europe The prices associated with oil which appeared to scale escalating heights of volatility along with the climatic alterations was turning out to be the grave problems which needed immediate attention and solution both nationally as well as internationally. The ‘Kyoto Protocol’ which was developed by Japan mad e it mandatory for the member countries included in the European Union (EU) to bring down the level of greenhouse gas releases by 8 percent. This made the EU focus on the aspect of biofuel production (Gross & et. al., 2003). The production in relation to the biofuel was found to experience a sharp increase in Europe in the last few years owing to the need of trimming down releases of greenhouse gases. It was stated by Hammond & et. al. (2008) that the transport segment of Europe involved the major emission rates. It was further mentioned in this regard that spreading and enhancing the protection related to fuel supply was proficient of being attained by bringing down the immense dependency of transport on the fossil fuels (Hammond & et. al., 2008). The increase in the production was attributed to the development and application of the different policies that were undertaken and implemented by the European Union (EU). The EU had indulged in developing an assortment of directives for the reason of encouraging the European market related to biofuel. The EU was found to be aggressively engaged in structuring guiding principles which would aid in supporting and prompting in the market of Europe the usage of biofuel (European Commission, 2006). Therefore, the need for the production of biofuel in Europe was identified from the ‘Kyoto Protocol’. This made Europe embark on certain policies which were considered to prove encouraging for the production of biofuel. Second Generation of Biofuels & its Benefits to Europe The EU Commission was found to recommend in the beginning of 2007 an overall strategic aim which focused on restricting the boost in the international average temperature. This proposed plan was mentioned to be accomplished with the help of certain strategies. The definite set of strategies entailed the practice with regard to renewable energy to 20 percent in the year 2020, bringing down the degree of greenhouse gas releases by 20 percent and reduction in the consumption of energy by 20 percent. The most important strategy on which the proposed plan was based was mentioned to be the increase of biofuels by 10 percent by the year 2020. It becomes necessary to mention in this regard that the 10 percent increase of biofuels even entailed a net boost by 120, 000 in the field of employment which further entails the increase in the Gross Domestic Product (GDP) of EU by 0.17 percent. These objectives were made based on the

Creativity Essay Example | Topics and Well Written Essays - 3000 words

Creativity - Essay Example However, Csikszentmihalyi suggested that young students "cannot be creative, but all creative adults were once young students' (Csikszentmihalyi, 1966:156). The entire idea of this statement by Csikszentmihalyi is dependent on the fact that young students "can show tremendous talent, but they cannot be creative because creativity involves changing a way of doing things, a way of thinking, and that in turn requires having mastered the old ways of doing/ thinking. No matter how precocious a student is this he cannot do' (1996:155). In other words Csikszentmihalyi stated that it is education that makes an individual creative. In this context it would be relevant to mention that Amabile suggested that "...creativity by individuals and teams is a starting point for innovation; the first is a necessary but not sufficient condition for the second" (Amabile et al 1996). As it is Csikszentmihalyi viewed creativity as the highest achievement of human mind as he states that "Creativity is the central source of life for several reasons. Most of the things that are interesting, important and human are the result of creativity." (1997: 1) Csikszentmihalyi's views in this context suggested that there is an attempt of invoking creativity within young students but there can be no conviction that the method proved the usher of creativity within young students of 12-16 years. It s... knowledge that they wish to acquire but they stressed on the particulars of methods and neglected creativity by keeping it aside as they implied that it is a inheriting part of the young student's mechanism. In this regard we can enumerate the ideas put forward by Emerson who suggested that "by our tempering and thwarting and too much governing he may be hindered from his end and kept out on his own" (Emerson 251) In other words Emerson believed that the students should be given enough liberty to formulate their own approach towards education or they are creative enough to formulate one. This again is an alternative view of Csikszentmihalyi's views that suggested that even if there are no direct evidence of creativity there always remains an element of attempt to be creative all along. Literature review View of Csikszentmihalyi states that "creativity results from the interaction of a system composed of three elements: a culture that contains symbolic rules, a person who brings novelty into the symbolic domain, and a field of experts who recognize and validate the innovation." (1997: 6) but in the same context Freire suggests that it " emerges through invention and reinvention, through the restless, impatient, continuing, hopeful enquiry men peruse in the world, with the world, and with each other." (Freire 319) Thus it can be enumerated that this element according to Freire is more of a reflex action rather than a formulated procedure and it can be further mentioned that this process of learning is an instrument of survival that was incorporated within us from the prehistoric era and he expects every young student to be creative. Freire stressed that the education of young students must involve their senses. He presents guidelines for creating an educational

Basic difference between Behavior therapy and Psychoanalysis Essay

Basic difference between Behavior therapy and Psychoanalysis - Essay Example The therapist (psychoanalyst) helps the client "uncover" unconscious motivations, unresolved problems from childhood and early patterns to resolve issues and to become aware of how those motivations influence present actions and feelings. Once the Behavior therapist enquires Jack about himself and few formal questions, Behavior therapist will ask some more specific questions related to his way of treatment. The questions would be regarding Jack's interests, motivations, Friends, Academics, fantasies, strengths, goals, ambitions, aspirations, happy moments, distractions, weaknesses, other phobias (if any), disinterests, irritations, cultural values, relaxation techniques etc., Once Behavior therapist finds the reason behind the phobia, he will try to motivate the Jack to encounter the phobia on face, but with suitable rewards. Say Jack is interested in Sports, then the Behavior therapist will offer him a pair sport shoes for every encounter Jack faces with the phobia. This will make the situation into a competition rather than problem. Once this competition attitude sets in, Jack will unknowingly transfer his 'energy of phobia' into competitive spirit. And this is what Behavior therapist would like to achieve. Jack's treatment is properly scheduled with/without medication

The violence currently facing Colombia's dispossessed is indicative Essay

The violence currently facing Colombia's dispossessed is indicative that the country could soon experience a revolution - Essay Example Observe, do not fulfill† (Brenner 8). From this background, different leaders arose and rebelled against the government: although these leaders had different agendas, the support of the Mexican masses lied on one desire: the desire to change the social structure, to implement reforms that would give economic and socio-political empowerment to the majority of the people (Brenner 35-40). From the above statement, the researcher of this paper thinks that a similar revolution is also brewing in Colombia: a revolution to empower the dispossessed and make radical reforms that would change society’s structure and give more opportunities to the poor. As the Mexican Revolution of the 1910s sought to overthrow the elites and give â€Å"Mexico back to the Mexicans† (Brenner 62), so will happen with Colombia, where several rebel guerilla groups, most notably the FARC-EP, are already there proclaiming itself as the army of Colombia’s poor and dispossessed. ... s â€Å"The Wind That Swept Mexico† and Alfredo Molano’s â€Å"The Dispossessed: Chronicles of the Desterrados of Colombia.† One of the main characteristics of Mexican society in the 1910s was the monopoly of political power by the elite. In the time of the dictatorship of Diaz, almost all of the positions on the government bureaucracy were given to the elites, either to the â€Å"biggest landowner or businessman† (Brenner 10). Such political tradition gave Diaz the support of the elite for much of his administration. In addition, this political; system was justified with the fact that Mexico is not ready for democracy, given that ninety percent of its people is dominantly Indian, viewed as â€Å"racially inferior† and â€Å"subhuman† (Brenner 10). While the idea of open elections was also dismissed by Diaz due to the fact that only â€Å"not even fifteen percent (of the population) can read† (Brenner 10), it was also declared that dem ocracy was a utopia that must not to be toyed with. In addition to political power was economic power: both the elites and foreign corporations controlled the Mexican economy (Brenner 14). Much of the economy was driven buy investments from foreign corporations, most notably the United States, using cheap Mexican labor that neither have control over their own land or their country’s national resources (Brenner 14). Most of Mexico’s industries where controlled by foreign enterprises, reaping much revenues, making Mexico a â€Å"bonanza land† for investors using a steady supply of Mexican â€Å"cheap and docile labor† (Brenner 15). Meanwhile, in the countryside, haciendas ruled the land, with them owning almost all of the arable lands, making the land reform of the previous Juarez regime useless (Brenner 19). In fact, it was actually

Regional economy Essay Example | Topics and Well Written Essays - 1000 words

Regional economy - Essay Example Regarding political context, consolidated investments in Research and development activities are particularly promoted to be enhanced, especially in business sector. Correlation analysis of the European Union Research and development policy, higher education activities, innovative business participation and regional economic growth justifies the European Union Research and development policy and financial mechanisms applied in the European Union regions, where coherence is stimulated. According to the conducted research it can be stated that in these regions expenditure of business sector on Research and development activities increases the GDP per capita in PPS, the labour productivity per hour worked, but governmental sector expenditure on Research and development activities has a small negative influence on the GDP per capita in PPS. Higher education sector expenditure on Research and development activities in these regions induces the increase of the number of students, but no in fluence on economic indicators is noticed. However, the correlation analysis shows the differences exist regarding the influence on regional economic development between the different regions of the European Union, the USA and Japan. Some premises could be made, which may create difficulties in the European Union regions, where cohesion is stimulated, to implement some financial and management mechanisms, aimed to stimulate Research and development activities, and that are used in the European Union regions, where cohesion is not stimulated, in the USA and in Japan. Paragraph Sources:- i. European Communities (2006). Creating Innovative Europe. Report of the independent expert group on R&D and innovation appointed following the Hampton Court Summit and chaired by Mr. Esko Aho Luxembourg: Office for Official Publications of the European Communities ii. Eurostat (2009). Accessed on 2009-01-10 by http://epp.eurostat.ec.europa.eu/portal iii. Melnikas, B.; Dzemydiene, D. Evaluation of Re gional Economic Clusters In Central And Eastern Europe. Intellectual Economics. 2007, 1: 46–54. 2. How has regional policy within the union developed in an attempt to promote cohesion and balanced geographical growth Substantial progress has been made in understanding the sources of uneven economic Development at the regional, national and international scales, but no single theory or Disciplinary perspective is up to the task of such understanding. This literature review Suggests that traditional theories of economic growth have been complemented by three Principal advances in theory and measurement: economic geography, and especially Theories of the relationship between transport/trade costs and spatial agglomeration; Economic growth theories and especially those that focus on the sources of innovation And knowledge-creation in the economy, and on their territorial distribution; and Institutional theories, which centre on the capacities of economies to absorb knowledge And innovate, to organize them efficiently, to adapt to change, and to avoid lock-in By inefficient practices or rent-seeking interest groups. Taken together, they go a long Way toward

Why I want To Be President Essay Example for Free

Why I want To Be President Essay Hola! â€Å"Why did the chicken cross the road?† Well, according to George W. Bush, the President of the United States, a proper answer could be. â€Å"We dont really care why the chicken crossed the road. We just want to know if the chicken is on our side of the road or not. The chicken is either with us or it is against us. There is no middle ground here.† However, I am not George Bush, and this speech is about me running for president of the Foreign Language Honour Society. But what about language? Let us consider our own language, English, which is considered by many to be one of the hardest languages in the world to learn or speak. I read an interesting quote about the English language that goes: â€Å"Lets face it: English is a terrible language. There is no egg in the eggplant, no ham in the hamburger and neither pine nor apple in the pineapple. English muffins were not invented in England, French fries were not invented in France. We sometimes take English for granted. But if we examine its paradoxes we find that Quicksand takes you down slowly, boxing rings are square and a guinea pig is neither from Guinea nor is it a pig. If writers write, how come fingers dont fing. If the plural of tooth is teeth, shouldnt the plural of phone booth be phone beeth. If the teacher taught, why didnt the preacher praught. If a vegetarian eats vegetables, what the heck does a humanitarian eat!? Why do people recite at a play, yet play at a recital? Park on driveways and drive on parkways. You have to marvel at the unique lunacy of a language where a house can burn up as it burns down and in which you fill in a form by filling it out. And a bell is only heard once it goes! English was invented by people, not computers, and it reflects the creativity of the human race (which of course isnt a race at all). That is why when the stars are out they are visible, but when the lights are out they are invisible. And why it is that when I windup my watch it starts but when I wind up this story it ends?† But back to the real reason for this speech. Why I want to be president? Because I think I would be a good one! Of course, everyone would say that, wouldn’t they? But I really mean it.   Every elected official wants to make a difference, and though, not all of them do, they all want to. Yet, I know I can make a difference in this Society, a difference that will not only improve things but make being a member of this Society something to be really proud of. Language is an art and the more languages a person knows then the broader their abilities to communicate with others. Communication is the key to any problem or any situation so when true communication is achieved, then the world can only improve from the classroom to the world of nations. This always reminds me of a quote I once read by a former politican. â€Å"When I was a young man, I wanted to change the world. I found it was difficult to change the world, so I tried to change my nation. When I found I couldnt change the nation, I began to focus on my town. I couldnt change the town and as an older man, I tried to change my family. Now, as an old man, I realize the only thing I can change is myself, and suddenly I realize that if long ago I had changed myself, I could have made an impact on my family. My family and I could have made an impact on our town. Their impact could have changed the nation and I could indeed have changed the world.† No matter how small a group is, they can always make a difference and as the president of this Society, I know that I can help this Society make a big difference in our school and in our own lives.

History Of Fairness And Ethics Business Essay

History Of Fairness And Ethics Business Essay Fairness is a very broad concept which requires scholars to define the term fairness comprehensively and clearly because the term fairness is a dimension, meaning it is conceptual and we cannot use our senses to know what does the term actually means or set the boundary of the term. Therefore, we need to scholars to define the term and as more scholars define the term, the clearer or precise the definition will be. Taylor (1975, p. 109) defined fairness as inquisition into the character and area of morality which included rules of conduct, moral judgments and standards. Rawls (1971, p. 194) define fairness as the understanding of other peoples need. Aristotle (1968, p. 140) defines as equals should be treated equally and unequally. Plato (1974, p. 181) defines as à ¢Ã¢â€š ¬Ã‚ ¦ the requirement we laid down at the beginning as of universal application when we founded our state, or else some form of it. We lay down; if you remember and have often repeated that in our state, one man wa s to do one job, he was naturally most suited for. Cooke (2011, p. 84) defined fairness as peoples position in society which able to determine by factors within their control. From the definitions above, we can conclude that fairness is derived from several variables. Therefore, fairness consists of variables where the single variable is unable to define the term as a whole. Therefore, when the variables add up, it forms or creates the term. We can observe that the dimensions of fairness consist of needs, equal and morality. Hence, we can conclude that fairness requires the equality in the way peoples are treated and the difference in treatment are based on morally justifiable reasons such as need, effort or merit (Velasquez, Andre, Shanks Meyer, 1996). There are several types of fairness from the concept of fairness which are distributive fairness, procedural fairness and interactional fairness and Hornibrook, Fearne and Lazzarin (2009) suggested that if these three aspects of fairness are perceived positively, it will reflect to the organizational outcomes. Types of fairness 1.1 Distributive fairness Distributive fairness, a theory based on writings of John Rawls, has a major focus of distributing assets fairly among a dynamic and diverse group of members from a community. Rawls argues that everything must be done in an act of achieving fairness throughout and he did not want anything to be done that may hurt or damage another person. For example, Rawls (1971) felt that throughout a society, every demographic should be allowed the same treatment and goods as any other. Issues of distribution are pervasive in society, existing in any situation where there is an exchange type of relationship (Deutsch, 1985). Velasquez et al. (1996) refers distributive justice as the extent to which societys institutions ensure that benefits and burdens are distributed among societys members in ways that are fair and just. When the institutions of a society distribute benefits or burdens in unjust ways, there is a strong presumption that those institutions should be changed. For example, the American institution of slavery in the pre-civil war South was condemned as unjust because it was a glaring case of treating people differently on the basis of race. There are four specific principles of distributive fairness that can be considered in situations involving the distribution of material goods and resources, especially those that are scarce (Munson, 2004). The principle of equality requires that all benefits and burdens be distributed equally. The advantage to this concept of fairness is that everyone is entitled to an equal share of resources. However the principle becomes problematic when not everyone is perceived as equally deserving of an equal share. The second principle is the principle of need, which suggests that resources should be distributed based on need so that those with greater need will receive a greater share. In theory, this supports the principle of equality in that everyone will end up with the same share of goods. A problem occurs from this principles is the question of exactly what material goods and resources we are entitled to. Definitive agreement has not been reached in this society as to whether health care is such a good although Lamont (2002) argued that the poor should receive the same health care as the rich. The third principle is the principle of contribution which maintains that persons should benefit in proportion to their individual contribution. Those who contribute proportionately more to the production of goods should receive proportionately more goods in return. Finally, the principle of effort similarly recognizes the degree of effort made by an individual as the determining factor in the proportion of goods to be received. Obvious difficulties with these principles lie in defining the exact nature and impact of a contribution and accounting for the inherent differences in the outcomes of individual efforts regardless of the amount of effort spent. In organizations, distributive fairness affects performance when efficiency and productivity are involved (Charash Spector, 2001). According to Honans (1961) fairness in organizations concerns with distributive fairness that is, the manner in which organizational resources are distributed among personnel (Freedman Montanari, 1980; Leventhal, 1980) and on employees reactions to those resource distributions (Greenberg, 1982). Furthermore, performance appraisal and salary are some of the important determinants of employees perceived fairness (Lawler, 1971). Similarity, Chang and Hahn (2006) define distributive fairness as the perceived fairness of the quantity of compensation that employees get. Hence, in a business relationship, distributive fairness is based on the evaluation of the outcomes or results (Ferrell, 2010). The outcomes or results in distributive fairness may be tangible such as salary as well as intangible such as praise. Perceptions of distributive fairness can be fostered when outcomes are perceived to be equally applied (Adams, 1965). According Adams (1965) people compare the ratio of their own outcomes such as salary or promotion and inputs such as effort or qualification and make compare with others (Greenberg, 1982). On the other hand, when people perceive or expect fairness to occur, they may react positively towards the organization and recommend the organization to others, thus building on the positive image of the organization as a potential employer as well as an organization as a whole (Hà ¼lsheger Anderson, 2009). When an organization is perceived to be distributively just, employees tend to support of the organization by doing tasks outside the scope of their job description (Charash Spector, 2001; Karriker Williams, 2009) or in other word, improving perceptions of fairness increases performance (Karriker Williams, 2009). On the other hand, perceptions of distributive fairness are also strongly related also to the withdrawal of employees from the organization (Charash Spector, 2001) and the relationship between effort invested and outcome received often results in legal issues which can damage an organizations image (Anderson, 2004; Anderson, 2011; Anseel, 2011). If employee found out that he or she is being treated unfairly, he or she will be unmotivated to do the work. Suliman (2007) once said that, organizations that distributed the resources unfairly will create argument, disrespect and mistrust among them. It is because employees perceptions on distributive fairness are mainly based on comparisons with colleagues. If the comparison comes out with positive result, they will feel positive toward the organization management. Hence, the organization performance will be improved. However, if the comparison is negative, the outcome will become negative too. Therefore, managers must notice employees perceptions on distributive fairness as well as procedural fairness since these two dimensions play a main role related to intentions to quit and job dissatisfaction (Dailey Kirk, 1992). It is very important to make employees feel in part of the decision making when amending appraisal and reward systems. Organization can seek for employees opinion when making the changes to show respect to employees. 1.2 Procedural fairness According to Leventhal (1980, p. 156) procedural fairness is define as ones perception of the fairness of procedure components of the system that coordinate allocation process. Rawls (1971) argues that the procedure used is pivotal to the outcome reached and if fair procedure is utilized, principles of justice based on fairness and equality will be an inevitable result. The procedure is referring to the means whereby various ends are attained. Whether the outcomes are pay raises to be distributed to employees, labor disputes to be settled, or performance evaluations to be recorded, a key determinant of these decisions involves how they are made (Folger Greenberg, 1985). In short, procedural fairness concerns about the processes through which decisions are made from (Thibaut Walker, 1975). Thus, this concept is opposite of distributive fairness, which is concerned with the perceived fairness of the content and consequences of those decisions (Walker, Lind Thibaut, 1979). Forret and Love (2007) define procedural fairness as the perceived fairness of an organizations procedures and policies used to determine an individuals outcomes. It influences a wide range of human behaviors, perceptions, emotions, and across diverse social settings. Leventhal (1980, p. 160) define procedural fairness as ones perception of the fairness of procedure components of the system that coordinate allocation process. Leventhal (1980) and Forret and Love (2007) have identified several similar criteria and perception of procedural fairness. Viewpoints of procedural fairness are related to employees morale and trust and they are characterized by solidity in the procedures, accuracy of the information, and free of bias (Forret Love, 2007). Leventhal (1980) classify six criteria of perception of procedural fairness which are procedures are fair when they are consistency, bias minimization, accurate information, consist of technology gadget for wrong decisions correction, maintain usual concept of morality and the last is it is representative. Procedural fairness has been found that it able to increase the feelings of being appreciated. Hence, it is very important that procedural fairness is perceived positively in order to an organization to achieve maximum productivity and its strategic goals (Prooijen, 2009). If there is unfair procedures occurred, trust between the employees and company will be low, and therefore employees will have low commitment and motivation (Cremer, 2005). An organization who wants to have positive outcomes should have a good perception of procedural fairness. Research has showed that there are few benefits of procedural fairness for organizations. A good perception of procedural fairness creates positive attitudes toward management control and hence produces a number of good behavioral reactions (Collett, 2008). It is important for an organization especially in performance appraisal to create harmony among employees in order to increase organization performance. Organizational researchers found that procedures are perceived to be more fair when affected individuals have an opportunity to either influence the decision process or offer input (Thibaut Walker, 1975; Gilliland, 1993; Muhammad, 2004). The decision making can be included in salary determination or promotion of employees. If procedural fairness is used in salary determination, it will eventually improve the ability of organization to manage the salary determination process effectively (Cloutier Volhuber, 2007). Bagdadli, Roberson and Paoletti (2006) said that fair promotion decisions influence feelings of organizational commitment of employees. By other words, organizations are able to keep employee commitment when promotion decision making involve procedures fairness and employees will perceive it to be fair. For example, Wainwright Bank and Trust Corporation in Boston have made a commitment to promoting fairness to all stakeholders by providing a sense of inclusion and diversity that extends from the boardroom to the mail room. In other words, the bank uses method of procedural fairness to establish positive stakeholder relationships by promoting understanding and inclusion in the decision making process. Furthermore, Gilliland (1993) states that perceptions of procedural fairness are influenced by the extent to which procedural rules are satisfied or violated. Procedural rules, listed by Leventhal (1980) suggest that in order to be fair decisions should be made consistently; without personal biases, with as much accurate information as possible, with interest of affected individuals represented in a way that is compatible with their ethical values, and with an outcome that can be modified. Other researchers have suggested additional rules such as the importance of two-way communication (Greenberg, 1986). . 1.3 Interactional fairness Interactional fairness is defined by sociologist John R. Schermerhorn (2006, p. 140) as the degree to which the people affected by decision are treated by dignity and respect when executing procedures and determining outcomes. Therefore, the quality of interpersonal treatment that people receive from authorities during the decision-making procedures is very important (Bies Moag, 1986; Greenberg, 1993). In other word, interpersonal fairness reflects the degree to which people are treated with politeness, dignity, and respect by authorities and third parties involved in executing procedures or determining outcomes (Colquitt, 2001; Kickul Troth, 2003; Janssens, Sels Brande, 2003).This concept focuses on explanations provided to the people that convey information about why procedures were used in a certain way or why outcomes were distributed in a certain fashion (Greenberg, 1993). The assessment of organizational practices and behavior of authority in terms of fairness does not usually depend on how fairly the employee was actually treated, but rather on how fairly the employee perceives that he or she was treated (Greenberg, 1990). Perceptions of interactional fairness play a role in the determination of employees work attitudes and behavior (Cohen Spector, 2001; Colquitt, Conlon, Wesson, Porter Yee, 2001). According to Greenberg (1993) interactional fairness can be broken down into two fairness which are interpersonal fairness and informational fairness. Interpersonal focuses on treating people with dignity and respect while informational fairness deal with the justifications provided to people. There are four factors that affect perception of employees on fairness of the interpersonal treatment get from the organization (Narcisse Harcourt, 2008). These factors are the organization is unreliable, interfere employee privacy, make offensive judgments and disrespectful to employees (Narcisse Harcourt, 2008). The explanation for interactional fairness in the workplace is grounded in social exchange theory and norm of reciprocity (Cropanzano Mitchell, 2005). From the social exchange perspective, employees expect fair, honest, and truthful treatments from the organization or its agents. Based on the norm of reciprocity, employees who perceive fair treatments by authorities are more likely to evidence positive actions through greater commitments to the values and goals of the organizations, exhibit increased job satisfaction, organizational citizenship behaviors, improved job performances and reduced withdrawal behaviors (Cohen Spector, 2001; Colquitt et. al., 2001). Research on psychological contract indicated that employees expect their employers to provide pleasant work environment that supports harmonious working relationships (Kickul Troth, 2003). Because of the importance of good quality social exchange relationships in workplaces, organizations strive to encourage supervisors and employees to willingly interact with each other. However, regular supervisor-subordinate social exchange relations are important in influencing desirable individual and organizational outcomes (Becker, Billings, Eveleth Gilbert, 1996; Zdaniuk Levine, 2001; Raabe Beehr, 2003). Muzumdar (2011) found that the organizational commitment (loyalty) and work satisfaction are the most affected variables of the interactional fairness system. This showcases that the treatment by a supervisor directly influences the variables of loyalty and work satisfaction of an individual employee. Reward satisfaction is the least affected variable by the treatment by a supervisor. As such, being rewarded could be a reduction in the influence of the treatment given by the supervisor on the employee. In the business relationship, interactional fairness is based on evaluating the communication processes used. Because interaction fairness is linked to fairness in communication, it often involves the individuals relationship with the business organization through the accuracy of the information the organization provides. Employees can also be guilty in interactional fairness disputes. For example, many employees admit that they stay at home when they are not really stick if they feel they can get away from it. Such workplace absenteeism costs businesses millions of dollars each ear. Being untruthful about the reasons for missing work is an example of an interactional fairness issue. Part B: Origin According to Dr. Angie Hobbs (2010) fairness started to appear in the ancient Greece where Plato raised the debate on justice, but a lot of issues that were raised are the same issue with fairness. In the dialogue, Plato challenged the Athens democrats by saying that it is fair or just by having the same equal voices in the democratic Athens and also goods and power should also be shared equally. However, against Platos concept is the oligarchy thinkers who debated that equal voices, goods, or power should be shared proportionally, whether proportional to marriage or statuses in the society. Thus, there should be no equal shares exist in the oligarchys concept. There are several scientific researches on fairness to date. Dr Waal found that the sense of fairness might be developed in our genes naturally. Primatologist Frans de Waal and his team found that our closes mammal, chimpanzees do have the same human senses of fairness. This is because there are concrete evidences in evolution that argues chimpanzees are sensitive to unequal distribution of outcomes. Teamwork is shown during hunting, defending territory and distributing foods (Boesch, 1994; Muller Mitani, 2005). A clear illustration of sensitivity of chimpanzees in fairness is when the chimps refused to participate in an experiment where their partner received more rewards for the same accomplishment and also refused to accept better rewards when partner receive less (Brosnan, Schiff Waal, 2005). The advantage of using chimpanzees is humans cannot ask questions to them, thus by observing their behavior, we can know their decision. In animal kingdom, fairness and reciprocity elements are also found, not just in human societies. There are many animals such as zebras, deer, and wolves survive in groups by unity or reciprocity where empathy and teamwork is essential survival mechanism, just like humans as humans are highly cooperative species. (Waal, 2012) The second scientific research on fairness is done by archaeologist  Brian Hayden who  excavated an ancient settlement in British Columbia near Keatley Creek and  uncovered evidence indicating that two distinct classes lived within large  pit houses  that sheltered several families under one roof. Hayden supports Waals research by showing that inequality grew out of the natural variability in human personality traits, among which are inclinations to be greedy or to share. He found that self-serving individuals were presented with new opportunity with the availability of surpluses of resources in Keatley Creek. They exploited the extra resources to their favor, raising the survival odds of themselves and their successors and simultaneously accumulate wealth and power in societies. Thus, phenomenon enables the rich to redefine the meaning of fairness in the society economically and politically and this process is the repeating itself around the globe, explaining how power has been distributed (Hayden, 2012). The importance of fairness and ethics to organization and its effects on the organization performance Fairness is important in organizations because there are a lot of benefits by practicing the concept in the organizations. The first benefit is the practices of fairness are proven to be able to increase profitability. This is because the connection between fairness and profitability is proven to have positive correlation with each other (Donaldson, 2003). Research found that fairness in organization responsibility is able to increase corporate financial performance (Allouche Laroche, 2005). Thus, it can be considered as one of the manipulative variable on profitability because fairness and profitability can be the source of major competitive advantage (McMurrian Matulich, 2011). The competitive advantage is referred to higher levels of efficiency in operations, having firm relationship with the stakeholders and higher levels of customer loyalty and retention (Ferrell 2004). Another importance and effects of fairness in organization is able to produce high quality of employees as the role of fairness in the workplace can impact heavily on the employees attitude and behavior (Greenberg, 1990; Cropanzano Greenberg, 1997; Colquitt, Conlon, Wesson, Porter, Ng, 2001). Hence, organizations that practice high value of fairness and justice are able to produce better individual work performance (Cohen Spector, 2001; Colquitt et al., 2001). Furthermore, these individuals tends to have greater job satisfaction which is very important to increase revenue growth and profitability (Heskett, James, Earl Leonard, 1997) as high level of job satisfactions are able to generate higher levels of loyalty and subsequently showed by the customers behavior such as repeat purchases and referrals of additional customers (Robert Erika, 2006). The importance of the fairness and ethics and its effects on society and in general According to Al-Hassar (2010) found that fairness is the final outcome of the process of the law, whereby fairness is distributed by the State. Based on this definition, fairness is the mechanical process of the structure of law which mean set in place and agreed to by the people of the State. Another definition is concerned with the value inherent in fair behavior. One distinction between these two definitions is the difference between an individual viewpoint and the larger view of the society. Either view incorporates the concept of moral judgment: good as opposed to bad (Al-Hassar, 2010). Unfairness in our society can be seen in the execution of criminals and whenever there is an execution, the morality of capital punishment usually causes heated debate (Al-Hassar, 2010) although many people believe that the death sentence discourages those who might commit horrible crimes. To these people, they feel that since life is precious, the death penalty helps to affirm this fact. However, Richard (2011) define that a majority of countries in the world has now abandoned the use of the death penalty and he state that a civilized society has no right to put another person to death especially when there is a lack of strong evidence. Most of the industrialized world has abolished the death sentence, because they consider it barbaric. Instead, barbaric or not, the law of the land must be followed even if we do not like the death penalty. Moreover, the officers of the law must always avoid errors of sentencing based on skin color, poverty, class, and political gain. If we create a society in which fairness is not tolerated and racism at play then more incidents of state killing will continue and the law of jungle will take place (Al-Hassar, 2010). In ancient Greece, fairness was believed to be derived from the order of society-a good society fostered fairness, and fairness fostered a good society. According to Plato (2000) fairness is the bond that holds a society together. Both individualism and personal rights had little to do with the Platonic conception of fairness those appeals even today to collectivists who emphasize the social context of fairness. Fairness was seen as the supreme virtue with respect to our relations with others. Al-Hassar (2010) also state that fairness must be distributed equally to all members of society in order to live in harmony and peace. Judicial and police officers must not use the law as a shield to insulate their racism, hatred, and political gain. In the eye of the law, fairness must not differentiate between the poor and rich, the weak and the strong. To solve the poverty problem, the state should spend more money on education, employment, and child welfare. The state must give the individual his rightful place of dignity as a free man equal to all his fellow men where he shall have the right to live under a rule of law based on a sense of obligation. In that society, respect for law must be the cohesive force holding it together and not mere obedience based on surrender to the weapons of state power. Relevant Theories Ethics is closely related to fairness. Ethics studies are focused on how an employees beliefs influence their perception of fairness in the organization. Research on fairness is also concerned with how the situation will influences an employees perception in the organization (Schminke, Ambrose Noel, 1997). According to Greenberg (1990) people who have experienced being treated unfairly would be more likely to taking some unethical behavior to the organization. For example, if employees perceived that they are being treated unfairly such as pay cut and they will probably taking some unethical behavior such as steal from the organization. Employees who perceive unfairness in the workplace will look for opportunities to increase their own benefit in their own ways and may shift to unethical conduct in order to balance the unfairness that have been done to them (Trevino Weaver, 2001). According to Gartenstein (n.d.) ethical human resource policies are also vital when creating and maintaining an ethical culture in an organization. Employees who are treated fairly are more likely to be satisfied with their works. When employees feel that they are being treated unfairly, they will prone to explicit some unethical behavior such as using company resources for personal gain. However, when they are fairly compensated for their work, they will contribute more to the organization and less taking opportunities to exploit situations for personal gain. On the other hand, when employees perceived that they are being treated fairly such as when top management fairly distribute the resources, they have the intension to preserve well-being of their organization (Manrique, 2010) and reduce their own interest to the organization (Lind Tyler, 1998). Furthermore, their behaviors also tend to be ethical and in line with the organizations expectations (McCain, Tsai Bellino, 2010). Trevino and Weaver (2001) agree that there is a strong relationship between employee perceived general fair treatment and ethics-related outcomes in an organization. Their study shows that if employees believe that their organization generally treats them fairly, those unethical behaviors will significantly decrease. According to Trevi (2001), employees perceptions of being treated fairly not only reduce a broad range of unethical behaviors that may harm the organization, but it can also increase their positive behaviors. For example, employees are willing to cooperate with organization to achieve the organizations goals by reporting ethical problems to management. The values that shape an organization to be ethical will influence the relationships between the organizations with its customers. An ethical organization will train employees to treat their customers with respect and to be fair with them. For example, when employees know that such ethical behaviors as an important part of customer services, they will understand the strength of the organizations obligation to those behaviors. Hence, they will more likely to perform their work accordingly because ethical behavior can inspire fairness (Gartenstein, n.d.).

Long Bone Fractures in Children: IN Fentanyl Treatment

Long Bone Fractures in Children: IN Fentanyl Treatment Introduction The clichà © that states children are just small adults is certainly not true in the case of long bone fractures. A childs experience of long bone fractures is dramatically different from that of an adult on account of their rapidly developing physiology (Wood et al 2003). This rapid development results in biochemical and physiological differences between a childs and an adults skeleton, the mechanisms of fracture and healing, are an important component of their treatment needs and consequently crucial part of emergency care management (Bonadio et al 2001). In addition, children, from infancy through to adolescence, have common fracture patterns related to their stage of development. The structural differences between the bones of a child and an adult enable childrens bones to endure greater forces and to heal quicker a childs remodeling potential supports full recovery with limited or no long term side effects from long bone fractures (Lane et al 1998). Injuries of all types are the second leading cause of hospitalization among children younger than 15 years (Landin 1997). Musculoskeletal trauma, although rarely fatal, accounts for 10% to 25% of all childhood injuries (McDonnell 1997, Landin 1997, Lane et al 1998). Boys have a 40% risk and girls a 25% risk of incurring a fracture before the age of 16 years (Landin 1997, Ritsema et al 2007). The most common site of fracture is the distal forearm which accounts for 50% of paediatric fractures. The rates of fracture increases with age as children grow; peaking in early adolescence. Fortunately, most fractures in children are minor greenstick and torus fractures constitute approximately 50% of all fractures in children (Landin 1997, Lane et al 1998, Gasc Depalokos1999, Richards et al 2006) and only 20% require reduction. Thus, the management of paediatric fractures is often straightforward. Without exception children will experience pain at the time of injury, attending the accident and emergency department and during recovery. The most common pain management strategies involve a multi-modal approach that includes both pharmacological and non-pharmacological components delivered via the least invasive technique (Worlock et al 2000). In practice this includes oral medication, such as oramorph, paracetamol, and NSAIDs, inhaled entonox, intranasal diamorphine (IND) or intravenous opioid where necessary and distraction with age appropriate devices, such as interactive books, bubbles, music and computer games in older children. Notably, IND is currently embraced as the key route of opioid delivery for children attending AED with fracture pain in the UK British Association for Accident and Emergency Medicine (BAAM E 2002). Parents and guardians of children frequently seek care in AED for the relief of pain from traumatic injuries and as a result the field of emergency medicine has assumed a leadership role in paediatric pain management. However, despite this the literature suggests the provision of pain relief for children attending AED remains suboptimal when compared to adults with the same injuries. Further discrepancies are reported between paediatric accident and emergency departments (PAED) and district general accident and emergency departments (DGAED) (Emergency Triage 2004). One reason suggested for these differences is the geographic distribution of specialised services, which are predominantly located in large cities where they are affiliated with universities. However, a recent audit by the British Association for Emergency Medicine (BAAEM 2005) of their guideline for the management of pain in children shows inconsistencies in provision of analgesia particularly for fracture pain throughout the country with no measurable difference between PAED and DGAED. A key feature of this guideline is the algorithm which advocates the use of IN diamorphine for acute moderate to severe pain in children over the age of one year (see appendix 1). The whole topic of analgesia in the paediatric population is complex and still imperfect especially in acute moderate to severe pain requiring urgent treatment in the emergency department (Schechter et al 2002). The road to pain free suffering is still paved with impediments such as failure of pain recognition and methods of delivery of analgesia (Murat et al 2003). Oral administration can be inadequate in an emergency situation with particular limitations in potential choice of drug and delay in gastric absorption and gastric emptying. Intramuscular (IM) and intravenous (IV) administration can be distressing to children and have been shown to influence future response to painful procedures (Gidron et al 1995, McGrath et al 2000, Fitzgerald et al 2005, Walker et al 2007). Rectal administration has limited acceptability given unpredictability of onset together with occasional problems of consent (Mitchell et al. 1995). By contrast, the efficacy and safety of the IN route has been well documented for desmopression acetate (DDAVP), insulin, antihistamines, midazolam and calcitonin (Jewkes et al 2004, Loryman et al 2006). In contrast, intranasal administration has a number of advantages. It is technically straightforward, socially acceptable and demonstrably effective. The nasal mucosa is richly vascular and administration by this route avoids the first-pass metabolism phenomenon Summary Studies in the 1990s such as Yearly Ellis (1992) have also demonstrated the efficacy of administration of intranasal medication via a nasal spray rather than drops in adults, although the efficacy of this application in the paediatric population remains to be proven. Intranasal administration is possibly the ideal route of analgesic administration in children. Currently, within the accident and emergency department (AED) of Bristol Royal Hospital for Children (BRHC) intranasal diamorphine is used as the first rescue analgesia in the paediatric population presenting with acute moderate to severe pain, most frequently in patients with long bone fractures who do not require intravenous access for resuscitation. Diamorphine is a semi synthetic derivative of morphine with a number of properties that render it a desirable analgesic agent for administration via the nasal route. It is a weak base with a pKa of 7.83 and is water soluble allowing high concentration to be administered in small volume (Rook et al 2006). Unfortunately the legal use of diamorphine is limited to two European countries i.e. United Kingdom (UK) and Sweden. Furthermore periodic problems with its availability during the past few years (with further shortfalls in availability predicted by the NHS purchasing and supply agency) have resulted in an alternative efficacious analgesia being sought for this population. Fentanyl, however, is a short rapidly acting opiate has several qualities that render it useful as an IN analgesia and a potential candidate to replace IN diamorphine in the AED for acute facture pain management in children. It has a very high lipid solubility, potency and diffusion fraction, and unlike diamorphine it is not a prodrug and does not cause histamine release (Reynolds et al 1999). Assessment of a patients pain experience is not directly accessible to others, collecting and analyzing information about the processes of pain relief and pain prevention is not straightforward and presents significant challenges to health care professionals. In children, this task is further complicated by their varied stages of physical and cognitive development. Recent research by Bruce Frank (2004) however, has shown that the ability to measure pain in the paediatric population has improved dramatically and that today there now exists a plethora of age appropriate pain assessment tools for acute pain in children ranging from pre-term infants to adolescents, the majority claiming validity (strength and robustness) and reliability (consistency). However, most clinical research into pain management strategies continue to rely on the gold standard self report and visual analogy score tools (mostly 0-10) (Chalkiadis 2001, Walker et al 2007). Although these tools are reliable they are not always adapted appropriately for a childs stage of development. Childrens understanding of pain and their ability to describe pain change with increasing age in a developmental pattern consistent with the characteristics of Piagets preoperational, concrete operational and formal operational stages in cognitive development (Smith et al 2003). The quality or int ensity of the pain can be difficult to determine in children, as most tools rely upon a patients relative judgment between the intensity of present pain versus a patients worst pain experience (Murray et al 1996). These tools can therefore be unreliable where a childs age of development means they have limited or no memory of pain experience. Stevens et al (2002) recently described a conflict of understanding that resulted in a study bias and an insignificant reported power of (p=0.6). In the study an 8 year old boy had chosen the VAS (0-10) but frequently reported his score as 10, although he understood the increasing value of the scoring system further questioning identified he perceived 10 of 10 to be a good score and 0 of 10 to be poor. The boy was at a stage of development that limited his understanding of less is more. This case highlights the importance of utilizing a pain assessment technique that reliably accounts for a childs age of development. A preliminary search of literature suggests there is currently exists limited research to support for the use of intranasal diamorphine or intranasal fentanyl for the management of acute pain in long bone fracture in children as evidenced based medicine. Despite this lack of evidence it remains a key strategy within paediatric AED for the pain management of long bone fractures and is anecdotally reported as a gold standard for paediatric pain management. Therefore; its lack of availability could profoundly compromise pain management for this population. Thus, this extended literature review will examine the efficacy of intranasal fentanyl as an alternative to intranasal diamorphine for traumatic fracture pain in children attending accident and emergency departments. However, in these days of evidence based medicine, it clearly needs to be established beyond all reasonable doubt. In view of that only research into paediatrics will be included increasing the credibility of its applicat ion to practice. SEARCH STRATEGY A range of complimentary search techniques were used to capture key research including a systematic electronic literature search of the Cochrane library, Embase, CINAHL, Proquest, Medline, PubMed since 1990 up to 2009 (this has to be to year of submission). The scope of the search was extended beyond the recognised five years of current research so as to include the empirical work into the development of IN analgesia in children. Key words used included the following: pain, acute pain management, intranasal diamorphine, intranasal fentanyl, procedural, accident and emergency, emergency department, child, pediatric, paediatric, child and fracture pain, as well as various combinations. In addition, in order to ensure the completeness of the search, an internet search was completed using the Google search engine, IASP, Pain Journal, Paediatric Nursing, BAAEM, NICE, Medline, EBM; the RCN was also utilised. Backward chaining of references found was also performed to ensure all relevant papers were identified. Although this review identified twenty seven citations it should be noted that historically there are fewer Randomised Controlled Trials (RCT) in children compared to adults possibly due to problems gaining ethical approval and consent. Additionally even experienced researchers will be unable to find all relevant papers and much research is not submitted for publication. The studies identified were divided into the three modalities of IN route, IN diamorphine and IN fentanyl with the majority presenting evidence for the IN route. All papers were critiqued using a tool published by the Learning and Development Department within the Public Health Resource Unit of the NHS (www.phru.nhs.uk/casp). The tool facilitated critiquing different forms of quantitative research and is based on work by Sackett (1986), Sackett et al (1996) and Phillips et al (2008) (see appendix 2). The results of the critique process for each paper and level of evidence applied in line with the modalities they address informed understanding of current practice and development of a research proposal. STRUCTURE OF THE LITERATURE REVIEW This literature review will focus on determining whether IN fentanyl is an effective alternative to IN diamorphine for the management of long bone fracture pain in children attending an AED. The scope of the literature review considers literature from 1990 onwards although occasionally earlier research has been referenced. Given the limited available evidence on the topic the following review structure has been selected. Chapters 1, 2 3 will present the evidence sourced on each theme intranasal route, intranasal diamorphine and intranasal fentanyl with a short summary to conclude each chapter. Chapter 4 will present an in-depth discussion and conclusion on the utility of the evidence, its application to practice and the requirement for a multi-centred comparative randomised control trial to improve the credibility of the evidence base for this field of treatment. Finally chapter 5 will present a research proposal for a comparative study of these modalities. Intranasal (IN) route of medication delivery in children. Nasal administration of drugs has been reported as having several significant advantages over current practice which are predominately oral, IM, IV and rectal (Williams Rowbotham 1998). It is emerging as a low-tech, inexpensive and non-invasive first line method for managing either pain or other medical problems (Wolf et al 2006). Nasal medication delivery takes a middle path between slow onset oral medications and invasive, highly skilled delivery of intravenous medications. The nose has a very rich vascular supply, IN facilitates direct absorption to the systemic blood supply due to increased bio-availability of the drug by missing first pass metabolism, It avoids the potentially technically difficult of sterile intravenous access, is essentially painless and is considered acceptable to children when compared to other routes of administration (Shelly Paech 2006) (see table 1). a theory which will be considered when reviewing the studies within this chapter Therefore suggesting th e IN route will result in therapeutic drug levels, effective treatment of seizures and pain without the need to give an injection or a pill, furthermore; it is quite inexpensive, an advantage in this era of increasingly expensive medical technology (Shelly Paech 2006). Additionally given the complexity of the developing child and the known consequence of poorly managed pain on the future responses to pain the IN route does, if it is as efficacious and as safe as suggested offer one of the most acceptable, definitive forms of analgesia delivery in children. The degree of accuracy of the previous statements will be established within this chapter by critically reviewing the 16 studies identified on IN medications other than intranasal diamorphine or intranasal fentanyl in the paediatric population (see table 2) as these agents are considered individually in later chapters. The rigour of the studies will be addressed within this chapter and reflect the level of evidence applied according to Sackett (1986) criteria (see appendix 3). Most studies reviewed were randomised clinical trials and in some cases compared against a placebo Conversely, this does not concur with the trials discussed earlier (Lahat et al 1998, Al-rakaf et al 2001, Fisgin et al 2002, Mahmoudian and Zadeh 2004 and Holsti et al 2007) where significant dosing was applied or in Wilson et al (2004) who retrospectively studied 30 children age 2-16 years receiving 0.3mg/kg at 5mg/1ml INM and 13 patients receiving rectal 0.2mg/kg diazepam for seizures. The authors report equal efficacy for both routes. Success of these agents was considered on cessation of seizures, no reported complication and not needing to attend A+E. A total of 27/30 families who had used INM found it effective and easy to use. Although 20/24 (83%) who had previously used rectal diazepam still preferred it mostly due to the coughing and the volume of liquid administered via the IN route. Given it is generally considered that the optimum IN dose as stated above is 0.1- 0.2 ml per nostril, all but the studies discussed so far were using drug concentration and dosing regimes whic h resulted in large volumes of liquid being dripped in to the nasal cavity. This is particularly poignant in Wilson et al (2003) who compared buccal to IN midazolam in 53 children aged 3-12 years experiencing seizures lasting > 5 minutes attending AED. A key feature of this study is the mean age of the children (age 9 years), mean weight (24kg) the study drug concentration as with previous studies was of 5mg /ml. IN dosing was at a dose of 0.3mg/kg. Given these figure the average dose would have been 7.2mg = a volume of 1.4ml being administered. Since the comparative route of administration for this study was buccal there is a possibility that part of the IN dose was buccally absorbed therefore creating a flaw in this study methodology, raising questions over why this comparative route was chosen and suggesting the only real conclusion to be taken from this particular study is buccal midazolam is effective and safe in children. Furthermore although this is described as a blind RCT and the authors claim the time to cessation of seizure was quicker for the INM group 2.43 (SD 1.67) to 3.52 (SD 2.14) for buccal route there is little detail on the blinding process or data collection procedure suggesting the rigour of the study maybe flawed therefore the efficacy and safety claimed for the IN route should not be embraced without further study. On the other hand Fisgin et al (2002) and Hardord et al (2004) compared the INM with rectal diazepam. In Fisgin et al (2002) in an unblinded RCT equivalence study the authors compared INM with rectal Diazepam to ascertain the safety and efficacy of INM for the development of a clinical protocol in the management of prolonged seizure in children attending the AED. Forty five infants and children age 1 month -13years experiencing prolonged seizures > 10 minutes were either given INM 0.2mg/kg or rectal diazepam 0.3mg/kg. The authors report proven efficacy (p Intranasal Diamorphine (IND) The delivery of opioids via the IN route is perhaps one of the most valuable indications for IN medication delivery. Acute pain is a frequent experience for children whether attending an AED, hospital and hospice setting (Hamer et al 1997). Furthermore it is not unusual for them to experience frequent episodes of breakthrough pain which requires additional support from fast acting analgesic agents. Owing to the developmental and physiological difference in the paediatric population there is a need for a variety of effective treatment option from which to select and individualise the patients therapy to meet their needs. IN opioid is simply one such option available which may be useful in children. It has been suggested that the delivery of medications via the IN route results in rapid absorption with medication levels within the cerebral spinal fluid (CSF) being comparable with (IV) administration (Chien and Chang 1997). Diamorphine hydrochloride is a semi-synthetic derivative of morphine. It is extremely hydrophilic, which makes it ideal to use when preparing in high concentrations in solution, thus allowing high doses to be administered in smaller volumes via the intranasal route (Kendall Latter 2003). However, this route of administration can be a painful process as reported by adults (Henry et al 1998). Despite this the intranasal route is considered more acceptable to children and their parents and is thought to lessen the opioid side effect profile seen in IV administration (Stoker et al 2008). This concept has been well recognised throughout the UK and many centres already use intranasal diamorphine for acute pain in children, following the guidelines by the British Association for Accident and Emergency Medicine Clinical Effectiveness Committee (2002) (BAAEM). Although the administration of intranasal diamorphine is now a first line choice for moderate to severe acute pain for children atten ding AED, as is the case within our institution, there is very limited research to substantiate this practice although as noted above it has been readily accepted by the BAAEM for acute pain management in children and very successfully used within our institution A recent shortage of diamorphine evoked the search for an equally effective and acceptable alternative. Early research in animals and adults reported pharmacokinetics of nebulised inhalation and intranasal administration of diamorphine as detected morphine in plasma at six minutes (Masters et al 1988, Kendall 2001). Despite the age of this research and the fact that the later study was in adults, it is still quoted as creditable evidence to support this practice in paediatrics. However the legitimacy of this should be questioned, due to children not being just small adults but have physiological differences intrinsic to their age and stage of development which may affect the bodys absorption and level of toxicity in different ways to adults. The extensive literature search highlighted four randomized controlled trials (RCT) that demonstrate IND to be clinically superior to intramuscular morphine and inferior to IV morphine particularly in the management of acute pain in children, a case study of an 8 year old boy and clinical audit of IND for pain relief in children attending AED (see table 3). The key methodology in the RCTs by Wilson et al (1997), Kendall et al (2001), Brennan et al (2004) and Brennan et al (2005) suggest these are superiority studies where the authors hypothesised improved pain management with the IND when compared to a variety of routes. The rigour of the studies will be discussed later in the chapter. Although while the critiquing process takes place it is fundamentally accepted that RCT are considered level 1 or 2 evidence as opposed to case study or audits at Level 3b and therefore generally sourced to Latest published clinical evidence to support the use IND in the paediatric population is presented in an audit by Gahir Ranson (2006) of 54 children whose care was managed by the use of an integrated care pathway for acute pain management while attending the local AED. This integrated care pathway focused strongly on the use of IND. Data collection was on a one page performa and included consent, date, patient demographic, pain score and side effect profile. Data collection was retrospective and data analysis illustrated limited recording of side effect profile but improved pain scores. However only 60% of patients have this information documented so data collection was difficult. Despite this lack of hard evidence no clinical incident, including the side effect profiles, were reported. Thus suggesting the practice of IND for acute fracture pain management in children could be safe, effective and more acceptable to children than the more painful alternative of IM or IV administration. However there is limited strength in an audit, other than a review of practice (Bowling Ebrahim 2005) and in this case a key feature for review should be the documentation process in the department as there were facets in the care pathway administration documentation missing. Therefore this audit suggests that IND is safe and effective pain management for children, but this conclusion can not be categorically drawn from the limited data available. The potential outcome of this audit could be education on documentation, to do a more rigours prospective audit of practice. Unfortunately at this point it only offers an insight to their clinical practice which is favourable for this agent and route. Albeit as noted before IND has improved childrens pain management and over all experience of acute care in our PAED additionally as with the results of the audit we have experienced no side effects or complications, further highlighting the importance of seeking an alternative to IND which offers equally efficacy. Intranasal Fentanyl (INF) Monitoring of the usual observations and pain scoring in the child was recorded prior to the administration of fentanyl (20 micrograms for 3-7 year olds and 40 micrograms for 8-16 yrs) and continued at 5 minute intervals for the 30 minute period. Additional doses of fentanyl (20  µg) were available if required at 5 minute intervals. Pain assessment was achieved with two validated pain assessment tools, the visual analogue scale (VAS) in older children and the Wong-Baker Faces (WBF) for younger children. Both are reliable and known to support consistency in pain assessment. Though there was no mention of training for those assessing this primary end point using these tools in the paper therefore this should be considered in the overview of the standard of evidence produced by this study. Additionally although forty five patients were randomized following consent unfortunately no details on the randomization process was disclosed in the paper either. This may not be significant, but when reviewing the credibility of the authors claims these obvious omissions could be responsible for a flaw in this study and remains to be established. On the other hand, the methodology that has been disclosed in the paper appears sound as it addresses key areas of sample calculation (power of the study) as a superiority study with the sub groups size adequate to detect a significant difference (Greenhalgh 2004); demographics, blinding of the drugs, assessors and appropriate statistical analysis of the data therefore supporting the validity of the results claimed and the application of the results to the age of patient targeted that this literature review is aiming to find an analgesic alternative to IND for. The results concluded by Borland et al (2002), are a reduction in pain score at 10 minutes to 44.6 mm (95% confidence interval) 36.2-53.1 mm from 62.3 mm 53.2-69.4 mm (95% confidence interval) at assessment using the VAS and 2.2 (95% confidence interval 1.3-3.1) at 10 minutes from 4.0 (95% confidence interval 3.3-4.7) at assessment in 16 children using WBS. Visual analogue pain scores demonstrated clinically significant reductions in pain scores by 5 minutes that persisted throughout the entire study (up to 30 minutes) for both INF and IV morphine. The second primary end point of this study (side effect profile) showed no significant change in physiological parameter of the childrens pulse or respiratory rate, blood pressure or oxygen saturations, interestingly the side affect profile chosen for monitoring such as pulse and blood pressure are not considered to be one of the primary side affects of morphine, however nausea and vomiting which are was not assessed. Ultimately, there wer e no negative side-effects and the sizeable reduction in pain scores (compared to baseline assessments) was accomplished in children using INF by 10 minutes and maintained throughout the 30 minute period with the mean INF dose at 1.5 µg/kg and ranging from 0.5-3.4  µg/kg. Interestingly 35.5% of children in the INF group only required one dose. Given the clinical equivalency of these two agents and routes the authors conclusion that INF offers the benefits of a simple painless technique for treating acute pain is substantiated. These benefits suggest that the IN route could be a valuable technique not only in an AED but also for breakthrough pain by offering a fast onset of pain control in moderate to severe painful conditions. It could also provide pain relief and allow topical anaesthetics to take effect on the skin prior to IV establishment. Therefore this may be a suitable alternative to IND. A similar and more recent double blinded RCT trial by Saunders et al (2007) claimed efficacy of a larger dosing regimen with a mean dose of 2 µg/kg INF (50 µg/ml) for pain reductions in paediatric orthopaedic trauma compared with IVM at 0.1mg/kg in 60 3-12 year old children. This study reports positive outcome for INF following both patients and carers reporting very effective pain management and satisfaction using this treatment method. However there is little information in the paper of methodology and results are given in percentages rather than a P value or NTT which should be expected in a rigorous creditable RCT of two agents (Bowling Ebrahim 2005) reducing the level of evidence applied to the paper to L3. Even supposing the results are an accurate reflection of the efficacy and safety of INF, particularly the fact that no significant difference in pain score or side effect profile and INF is a way forward, the lack of detail the randomisation process and analysis of data in the study methodology merely implies that these results maybe flawed. Interestingly given the concentration of fentanyl 50 µg/ ml a dosing volume for a 25kg child would have required one ml = 0.5ml per-nostril therefore suggesting some of the administration may have been oral rather than IN and present the issues of bad taste which is put forward as a possible study limitation by the authors. Then again there are no complications or reports on taste presented in the results and the authors conclusion on the efficacy of INF for acute pain management in children may be founded. However, without sourcing more details from the authors it cannot be considered evidence to inform this dissertations aims but merely an ex ample of poor research or appropriate omission by publishers. Further suggesting there remains a requirement for more research on the topic within double blind, equivalence, RCT focused on INF efficacy and dosing with sound methodology that is transparent in publication to answer the dissertation question. Conversely an older and more rigorous study which also looked at dose related analgesic effect between routes of administration is by Manjushree et al (2002). The authors demonstrated the clinical efficacy of INF in a cohort of 32 children (aged 4-8 yrs) in a postoperative situation and with a double blind level 1 RCT. The study design gives the impression of sound methodology as blinding, assessment and analysis of data was appropriate and available for scrutiny in the paper, particularly the analysis of both nonparametric and nominal data. The only weakness is possibly the sample size of 32 patients. Although the authors performed a power calculation which identified 40 patients to show a significant affect, they only recruited 32 patients, furthermore, this appears to be an equivalency study where the authors hypothesised INF would be equal to and not inferior to IVF therefore would have needed a larger sample to de