I’Ve Witnessed the Arrival of a Golden Age Essay

The article â€Å"I’ve witnessed the arrival of a golden age† was published 14th August, 2007 and written by the Guardian’s Delhi correspondent, Randeep Ramesh. Throughout the article, Randeep Ramesh describes the development of India. Among other things he tells the story about some years ago when he visited an Indian software millionaire, who shows him around the computer industry. The software millionaire comments on the correspondents’ education, because he thinks it is a shame that he was not born in Indian for that cause that the British system makes scientists become journalists instead. The headline, â€Å"I’ve witnessed the arrival of a golden age† is mainly factual, because it informs us. It actually tells that the writer has witnessed a golden age and what we will find within. The language which is used is formal or rather a quotation. It tells us what we will find within. The structure of this article is basically like any other article. It is structured with a lot of sections. It has a headline and beneath it there are three sentences which briefly give the reader a general idea of what the article is about and then a little introduction which is an experience where a software millionaire shows him around. The memories from his past are mentioned. Then it moves on to the body of the article which is a description of how India has developed and how he had witnessed the arrival of the golden age while he was living in Delhi. The body only sticks to one topic and that is India. In the ending there is a sum up which also solve the problem in the article. Besides that there is an interesting point in the three last sentences. That is, you see that India has put the past behind and now see a bright future coming and still is optimistic. The writer does not use a figurative language. Many of the sentences are long and some complex etc. â€Å"In the unselfconscious, no-nonsense manner of many educated Indians, the entrepreneur quizzed me on which university I had gone to (Cambridge) and the subject I had studied (physics), before triumphantly declaring that I had been â€Å"born in the wrong country†. (p. 1, line 8-11) Language is formal, there is not used any kind of slang nor sarcasm or irony. There is much appeal to logos in the article because it is based on logic or reason and there are several facts. The article is argumentative for the reason that the reader becomes wiser and informed. The arguments which are used are objective and the choices of words are neutral. The purpose of writing the text could be that the Randeep Ramesh wants to influence the reader and express his own opinion. He generally informs the reader and makes his point clear.

Electronic Medical Records Essay

Electronic Medical Records (EMR) are becoming more widely used across the healthcare spectrum. One of the reasons for their popularity is the potential that is presented for increasing the quality of care delivered to patients by decreasing handwriting interpretation errors, reducing medication administration errors and eliminating lost charts. Time management is a crucial skill to have as a nurse. It allows for a smooth workflow which translates into quality patient care. Much time can be wasted not only by the nurse signing off illegible handwritten orders, but also by the other nurses that have to help interpret the handwriting. The EMR requires the physician to enter orders electronically, thereby eliminating handwritten orders. Electronic orders are more precise and more accurately followed (Sokol, 2006). Fewer errors make it to the patient, reducing unnecessary tests and increasing the quality of care that patients are receiving. Electronic medication administration records (MAR) are useful in displaying medications due at specific times. Not only is it possible to sort the medications due at one time, the MAR will also alert the nurse to potential drug interactions. Late medications will be displayed in red to be easily seen. If bar coding is implemented, medication errors can be reduced by a range of 60%-97% (Hunter, 2011). A lost chart can be very frustrating while trying to deliver seamless care to a patient. Paper charts are easily misplaced. Since there is only one, if a single provider is using it, no one else of the medical team can view the chart. The EMR can be viewed from any computer with secure internet access or on a handheld device. When the internet is down, a downtime view only access is available. Nursing Involvement Nurses are known as patient advocates. In advocating for their patients, nurses strive for what is best in their patient’s care. Since nurses will be using the EMR most frequently, it is imperative that they are part of the selection and implementation on an EMR. A nurse, on the EMR team, will represent all nursing. Nurses will be accessing the EMR through their shift several times and will become familiar with the layout and workflow and will be able to provide insight into what would work best to ensure quality of care. There is a saying that you don’t know what you don’t know. A nurse knows what she will need and is the best to supply this information. While researching which EMR would be the best for a facility, a nurse can provide information on time saving workflows between systems. Nurses must also be trained as super users to provide a seamless change from paper charting to electronic charting and provide support to fellow nursing staff. A nurse on the EMR team will be able to deliver new information in a way that other nurses are more receptive to. Handheld Devices If nurses were to use handheld devices in delivery of patient care, there would be a noticeable savings of time as well as more accurate charting. Nursing personnel carrying a handheld device would have immediate access to their patients chart to notice new orders, lab results, or medication admission records. The need to review the paper chart repeatedly throughout the day would be eliminated along with the long search that commences every time you have to look for the paper chart. This could add several minutes to a nurse’s time at the bedside, improving patient satisfaction. When vital signs are taken, written on a slip of paper and then transcribed into the paper chart, there are many opportunities for error and delay. Numbers can be transposed, written incorrectly or the wrong patient’s information could go into a chart. With the immediate availability of a handheld device, the information from the vital signs monitor would have the ability to interface into the patient’s chart virtually eliminating late charting and errors. Security Standards The Health Insurance Portability and Accountability Act (HIPAA) was initiated in 1996 as a standard for protecting individually identifiable health information (U. S. Department of Health and Human Services). HIPAA requires that all information, either written or electronically, that falls under the criteria is protected from unauthorized viewers. An EMR carries more stringent HIPAA guidelines than a paper chart due to the risks associated with computer based files and there are a few key steps that must be taken to ensure compliance with this act. Access control: each user will have a unique user name and password that must not be shared. Firewall protection must be used on the internet server the hospital utilizes to prevent hackers from obtaining access to protected information. If users are authorized to access patient information from home, there must be a secure server used (Arevalo, 2007). Storage: Data must be encrypted to enhance the security while information is being stored and while it is transferred. Encryption entails protection of files and data that is only viewable to authorized users. Compliance of these regulations should be audited on a regular basis with any violation being swiftly remedied (Medical Records, 2013). Healthcare Costs Purchasing an EMR can cost hundreds of thousands of dollars. In order to justify such a large purchase, one must examine the potential ways that money can be saved while using an EMR. After spending hours training users and with a little practice, nurse’s workflows will improve and less time will be wasted. A chart will not have to be searched for, double or triple charting is eliminated by using handheld devices for immediate charting. The quality assurance team will be able to run reports on compliance of core measures and be able to recommend changes to nursing personnel to implement. Fewer medication errors will be made by using the electronic MAR. Most importantly, these time and money saving factors will enhance patient safety. With fewer paper charts to store, valuable space can be remodeled into patient care areas that offer services not previously offered due to space issues (Power, 2013). This will increase revenue for the facility. Comparison Epic offers a computerized management system that is utilized by everyone in the healthcare setting including, nurses, nurse aids, physicians, dietary, radiology, emergency department and the business office. Each department will have a unique look and functionality to their program. There is no need to use multiple systems to gather information on a patient. It can be used in medium size ambulatory settings such as a clinic as well as in a hospital setting for either inpatients or outpatients. With all departments having access to the same information on a patient, errors will be reduced in delivery of patient care. The chance for entering erroneous lab results or miss- documentation will also be reduced with department specific workflows. Not only will this result in better patient care, but also in a nurse’s ability to delivery effective, efficient, quality care without delay. In addition, all physician order entry is electronic, every time. Order sets can be customized for each prescriber, saving time and hassle while maintaining meaningful use and following core measures. For added security, the system can be set to automatically sign a user out after a specified length of time of non-use. And while all of the patient’s information is available to each user, audit trails are left enhancing patient security. Epic has pre-loaded patient teaching materials available as well as the option to custom make information. After visit summaries are easily printed upon discharge and an electronic copy is permanently attached to the chart. Patient would benefit from a facility the uses the Epic system by having access to MyChart. MyChart is a portal of access between a patient and their provider for communication as well as a portable computerized health record. IF a patient were to access care from a facility that does not utilize the Epic system, that patient would have access to MyChart and would then be able to provide critical information that would enhance their care. Another computerized management system available is one from Cerner. This system can be used in all settings in a hospital including nursing. For medication administration, Cerner has available barcode identification of medication to help nursing staff complete their five rights verification prior to administration. It also allows charting at the bedside to enhance accuracy either through a handheld device or a stationary computer. All order entry by physicians is done on the computer allowing the providers to follow built in prompts for allergy information and adverse drug interactions as well as prompts that will aid in the order of care protocols to enhance patient care. Cerner also has a portal designed for patient to have access to their records no matter where they are as well as tracking information for health goals a patient and their provider have established. The portal allows progress tracking and provides information on steps that can be used to help the patient reach their goals. This gives patients more responsibility for their health while providing the incentive needed. Nursing care will be escalated similarly to the way it would be in Epic. Patient information is easily accessible through intuitive workflows allowing nursing staff to make responsible decisions regarding patient care. My recommendation for a computerized management system would be the one available from Cerner. It is the most user friendly for staff including nursing and offers intensive training and yearly upgrades. The different departments systems appear to work together seamlessly resulting in increased savings of time and money (Cerner, 2013).

Reaching the Top Case Study Example | Topics and Well Written Essays - 750 words

Reaching the Top - Case Study Example Churchill has successfully used the postmodern displacement of time to dramatize the sacrifices made by women in business and in the society. The first scene opens with a dinner party at a restaurant to celebrate the success of Marlene, the central character , in her profession. Many legendary women including Pope Joan, the world traveler Isabella Bird and the Japanese courtesan Nijo attend the party. Marlene is a highly successful career woman who has become the General Manager of an employment agency called 'Top Girls' Acutely ambitious, she has achieved power and prestige in a male dominated territory by abandoning her social responsibilities. In this, she is like Isabella, who is a world traveler in an age where traveling abroad was mostly a male prerogative. Traveling the world, Isabella too has sacrificed her social responsibilities. Isabella wears trousers because she "feels like it".(Churchill 29) , and refuses to "live the life of a lady".(Churchill 29) Marlene too does not' live like a lady' as her choice of food and her dominating attitude indicate. Marlene's story has a parallel with the stories of Pope Joan, Griselda and Nijo, all of whom had to give up or abandon their children. While Marlene does it voluntarily, the other women are forced to do it. Joyce is Marlene's supposedly sterile sister who has adopted Marlene's daughter Angie. There is a troubled relationship between Joyce and Angie, with the latter hating her supposed mother and the former nursing a resentment against Angie. Joyce thinks that she lost her unborn child because of the difficulties of raising Angie. Joyce can be compared to Pope Joan who was stoned to death with her child. In scene three of Act I, Angie is hiding from Joyce with her friend Kit when Kit says,"Do you want to watch the Exterminator'" (Churchill 45) The Exterminator can be linked to Joyce who is hated by Angie. Joyce's story has a parallel in the story of Nijo, who had to give up her own children to please the Emperor, whom she hated. Motherhood, which is the natural right of a woman,is sacrificed by these women. The sixteen year old Angie is a troubled adolescent . Both her adopted as well as natural mothers consider her to be less than intelligent. Marlene says, "She is not going to make it" (Churchill 66), while Angie idolizes her aunt Marlene. Angie can be compared to the inarticulate Dull Gret, who, clad in an armour and apron, leads an army of women to battle. Angie, though considered dull, manages to go to her aunt's office. This shocks Marlene, who asks in astonishment, "How did you get past the receptionist '" (66) Angie has sacrificed her whole career by giving up her intelligence. Success comes to woman only through sacrifice. Only those women who give up something very valuable can become 'Top Girls'. To achieve power and position, a woman might have to sacrifice her relationships, even her identity as a woman as evidenced in the case of Marlene and Isabella. A top girl might have to renounce her ability to procreate. She can achieve her goal in a negative way by sacrificing her intelligence . To accomplish anything, be it professional or social, the top girl has to give up a part of herself in a male dominated society. Works Cited Churchill, Caryl. Top Girls : London: Methuen Student Edition

Technology Management Research Paper Example | Topics and Well Written Essays - 1500 words

Technology Management - Research Paper Example Too much automation and aggressive strategy can damage the performance of the organization when the decisions do not support the corporate directions. This aggressive automation can expose the organization to several unmanaged risk factors due to the lack of effective knowledge about the balanced approach. Short term thinking and lack of expertise can damage the business operation management of the organization. This report will determine the bottom-line impact of unmanaged technology on the business performance of the organizations. Analysis It is discussed earlier that too much automation can affect the business operation of a corporation. In terms of industrial fluid disposal and usage, list of poor fluid maintenance practices combined with several in adequate fluid choice can result loss of goodwill and significant operational cost. However, inadequate cost management due to the lack of effective knowledge can erode the bottom line on the daily basis that can impact the long term viability and competitiveness of several strategies and operational facilities (Hunt & Weintraub, 2007). The corporations are exposing themselves to excessive business operation cost and unmanaged risks due to seven key reasons. These reasons are discussed below. Poor Process Control Majority of the organizational facilities utilize more fluid than are required. It exposes the corporations to critical risks due to lack of establishment of robust and control strategy for all the fluid applications. However, this fluid condition can be changed dramatically. An effective and specific control plan needs to be undertaken by the organization management. An effective management programme can enhance the significant process control that is important for the productivity and cost control. In several cases, the acceptable range of the fluid condition can be extended as it may not result in the fluid related events. A strict and tightly management control plan can eliminate excessive use of f luids. Decisions based on data vs. Feelings Every manufacturer knows that, analytical data is quite important when addressing a particular manufacturing issue, responding to a specific quality concern or developing plan for the next step. It is true that, most of the facilities are effective at collecting quality, financial and production related data, but fluid analysis data is rarely collected, correlated, compiled and interpreted due to the specific specialized nature of the interpretation (Haneberg, 2012). Fluid management generally tends to non-core expertise in a particular manufacturing environment. Major characteristic of this fluid management is non-core focus. Several organizations consider that the fluid condition can effectively impact manufacturing, quality and availability, but major significance of this aspects to drive daily decision making process. It is the corrective action executed on daily basis based on the information and data that result in risk management an d cost minimization. Hesitance to change Management risk and direct costs are associated with the product change. This relation is quite significant. Due to this, the organization hesitates to implement product change management process on the floor of several manufacturing plants. Recently, the product vendors are making various critical claims about the significance and benefits of greatest and modern developed

Conservative Muslims In Liberal Britain Essay Example | Topics and Well Written Essays - 750 words

Conservative Muslims In Liberal Britain - Essay Example It emerges that despite the desire by the Muslim parents that their children embrace the liberal culture in Britain, there is still a high incidence of segregation in terms of education that is offered to the children. The parents who insist on taking their children to the Muslim schools majorly fuel the segregation. Young Muslims between the age of 16 and 24 years who are better educated as compared to their parents in Britain are more conservative. Thisgroupstronglysupports sharia laws, anti-gay activities and even dem and death penalties for the act. Itthusshowsthatdevelopment in a close-knit society with a Muslim education makes the children more conservative. It emerges that despite the desire by the Muslim parents that their children embrace the liberal culture in Britain, there is still a high incidence of segregation in terms of education that is offered to the children. The parents who insist on taking their children to the Muslim schools majorly fuel the segregation. Young Muslims between the age of 16 and 24 years who are better educated as compared to their parents in Britain are more conservative. Thisgroupstronglysupports sharia laws, anti-gay activities and even dem and death penalties for the act. Itthusshowsthatdevelopment in a close-knit society with a Muslim education makes the children more conservative. The social and the cultural way of life of the conservative Muslims are also put to question in the program with eliciting of response from the leaders of Islam.

Solar Energy Harvesting Term Paper Example | Topics and Well Written Essays - 750 words

Solar Energy Harvesting - Term Paper Example The device is essentially composed of a ‘light sponge’ of nanoparticles. The dye-sensitized property means that the titanium has a monolayer of absorbed dye which increases the likelihood of photon capture (Tulloch, 2004). Nanostructured semiconductor films have been identified as suitable for applications in solar cells as their physical and chemical properties make them ideal. These nanostructured films utilize these dye-sensitized photoelectrochemical solars(PES) cells. The large surface area of nanoparticles means that they are capable of harvesting large amounts of solar energy. There is a sensitizer grafted into the titanium. Light induced electrons are injected from the absorbed dye into the nanocrystalites and makes the titanium conductive (Gratzel, 2003). There are so far two concerns which have been identified in the application of these PESs. They are related to the ‘maximum light harvesting of sunlight and the efficient collection of photocarriers at electrons’ (Rodriguez et al., 2007). Both of these issues have attracted a large amount of research interest. This is mostly due to the interest which many governments have shown in recent years in developing ‘green technologies’ for energy generation. Solar panels are an ideal way of harvesting energy in a green way, but for them to be successful on a large scale as a replacement for power stations they must be efficient at harvesting and storing large amounts of solar energy. To address the issues of PES optimization research has focused on a number of issues with the composition of the solar cells. One of the key areas on which manufacturers have focused is in optimizing the chemical composition of titanium. Improvements in technology may allow for a thinner form of titanium to be manufactured which would overall allow for thinner titanium layers to be applied to solar applications. This would result in a reduction in recombination of photoexcited carriers, which would increase PES cell efficiency.

Application of Enginerring Principles Essay Example | Topics and Well Written Essays - 2500 words

Application of Enginerring Principles - Essay Example However, this increase in deflection is going to be minimal. iii. Discuss the possibilities of errors occurring in the tensile test. Errors may be introduced into the tensile test due to various reasons such as: incorrect measurement of length of the sample due to incorrect reading from vernier calliper due to: zero error; parallax error. errors in dial calliper; zero error during initial calibration; parallax error while reading dial calliper. c. The figure shows a bar consisting of four lengths. i. Find the load carried by the bar at B, if the total extension is 0.063 mm. ii. Find the total extension of the bar, if loads applied at both ends are increased by 10%. If the loads at both ends are increased by 10% then inserting the new values into (1) gives: Take E = 2 x 105 N/mm2 for both the cases. d. A load of 500kN is applied on a short concrete column 400mmx500mm. The column is reinforced with 3 steel bars of 20mm diameter and 3 bars of 30mm diameter. If the modulus of elasticity for steel is 20 times that for concrete, find the stresses in both concrete and steel bars. Areas for concrete and steel bars are: AS = 400 x 500 = 2 x 105 mm2 AC = 3?(10)2 + 3?(15)2 = 3063.45 mm2 Solving simultaneously we get: Now: e. Discuss the load shared by composite cylinder will be more than the conventional cylinder. A composite cylinder can bear greater load than a conventional cylinder. This is due to the presence of materials that have greater tensile strength than the majority composing material. For example, in the case of steel reinforced steel bars, the steel has a greater tensile strength and being stronger can bear larger loads than what concrete could otherwise bear. Moreover, the steel in question tends to deform as much as the concrete which helps it to bear greater loads too. Another reason for composite cylinders being better at load bearing is because the constituent materials are distinct and are trying to move past each other within the overall structure. Th e presence of friction between the composing materials of a cylinder enable it to take larger loads too because the friction would need to be overtaken if the cylinder were to disintegrate. Question Two a. Based on the results obtained from Shear Force Measurement Experiment in the laboratory: i. Name the type of beam used. ii. Critically analyse the variations of theoretical shear force and experimental shear force at the sensor for the given load condition in the laboratory. iii. Usually measuring instruments absorbs some input energy to respond. Discuss how this affects the measurement. Measuring instruments absorb some of the energy that is produced in an experimental or other situation. The instruments need energy to generally overcome their own internal inertias. The absorption of energy tends to lower the amount of force actually available for measurement. However, in most situations the instruments are kept simple and light enough to ensure that the loss of energy is not t oo high to affect the actual measurement process. iv. Analyse the indication of a sudden change in shear force from negative to positive value. Positive shear tends to produce positive bending with geometrical minimas becoming apparent. On the other hand, negative shear tends to produce negative bending with geometrical maximas becoming apparent. As soon as the shear changes from negative to positive, the shape of the sag in the object changes as mentioned

Emiratisation Thesis Proposal Example | Topics and Well Written Essays - 750 words

Emiratisation - Thesis Proposal Example By 2005, up to 29,000 nationals had registered in the national  job  seeking  body; among them were those who had never been employed while others had only had high school certificates and no further evidence of higher education.  The government sought to reassure nationals’ priority in the recruitment and hiring processes in the private sector by establishing laws compelling privately owned companies to  employ  nationals in case of any openings.  This move by the UAE government has given nationals an  entitlement  to jobs, which has, in turn, lead to them being unappreciative of their jobs and at the same time, employers do not  take  them seriously (Kerr 24). Imposing the employment of nationals to the UAE private sector has resulted in the nationals thinking possess the right to a job resulting in them becoming unmotivated and adopt a relaxed attitude towards the job.  This has  consequently  compelled  company  managers to  limit  the workload on nationals as the employers  consider  the former as  flippant  in performing their duties. In addition, these private companies have to pay hefty salaries to inexperienced University graduates who  demand  salaries above the more professionally  experienced  and  qualified  expatriates. Further to receiving hefty salaries, these nationals expect to receive  rapid  promotions despite their minimal  work  input  (Al-Ali 369). Such demands  place  company  managers at a disadvantageous  position  as they have to  balance  the company’s need for profitability against the fact that they cannot fire unproductive employees who are natio nals of UAE (Kerr 26). Providing employment to those poorly  qualified  and  inexperienced  is  detrimental  to the performance of companies and the economy as a whole. This is because this move impedes on business’ progress, which may lead to downsizing, compounding the problem that emiratization

Legal-business auto accidents Term Paper Example | Topics and Well Written Essays - 1250 words

Legal-business auto accidents - Term Paper Example Honda Motor Company, â€Å"where the court ruled that the regulation foreclosed the filing of injury suits under the state law by the people contending that manufacturers had made the wrong choice† (Liptak). II. Facts of the Case: Petitioner, Alexis Geier, was driving a 1987 Honda Accord, which collided in a tree and caused the petitioner serious physical injuries, despite the fact that the shoulder and lap belts were fastened at the time the accident happened. The car was not also equipped with airbags. Petitioner, together with her parents, sued American Honda Motor Company, Inc. before the District of Columbia tort law, on the ground that Honda negligently was remiss in its obligation as a car manufacturer for failure to set an airbag at the driver’s side. The Court dismissed the case on the ground that it was the discretion of Honda to whether or not install an airbag in its car models. Hence, this ruling concluded that it was not mandatory for the automakers to ins tall a passenger-side airbag, and shall not be liable for a personal injury case based on such ground. The Court of Appeals reaffirmed the decision of the District Court which resulted to a dismissal of the case. Thus, an appeal to the Supreme Court was filed by the petitioners. ... s in conflict with the existing provisions of FMVS 208 Act, particularly on the express pre-emption provision Ruling: The Supreme Court ruled that: With regard to the first issue, the court held that the ordinary principles of pre-emption shall not apply in the case of the petitioners. The provision contained in the Act states that the federal safety standard does not relieve a person from any liability on the basis of the common law. Hence, the petitioners are not precluded from setting up a claim against American Honda. The language of the provision clause enacted by Congress does not prohibit common-law actions. The spirit of the law must be followed and not its literal meaning of the law. In case of doubt, the intention of the law must prevail over the strict context of the law. Thus, â€Å"express pre-emption provision that excludes common-law tort actions gives actual meaning to the saving clause’s literal language, while leaving adequate room for state tort law to oper ate† (Cornell). For the second issue, the Court held that ordinary pre-emption principles apply in the case of the petitioners. In its decision, the Court anchored its conclusion on the basis of â€Å"the express pre-emption and saving provisions when taken together, shall create a â€Å"special burden,† which a court must impose â€Å"on a party† who claims conflict pre-emption under those principles. A â€Å"special burden† would also promise practical difficulty by further complicating well-established pre-emption principles that already are difficult to apply† (Cornell). In one of the dissent of the justices, one justice commented that if the â€Å"special burden† would be made applicable in such a case, where the state law penalizes the requirement of the federal law which is an absolute

Alien Social Scientist Essay Example | Topics and Well Written Essays - 500 words

Alien Social Scientist - Essay Example I wanted to understand why westerners spend so much time and energy on their physical grooming. What is the reason how they appear to their peers is so important for them? Therefore, in western cities like Miami which is flooded with people from a wide range of ethnicities, the residents mostly have no scarcity of basic necessities (like food) and hence have ample leisure time and money to spend towards other activities involving glamour and beauty. People in western cities like Miami try vigorously to maintain their status which often is a combination of physical appearance (even if they are obtained artificially through surgeries and waxing) and financial resources. The citizens here are motivated to keep the momentum going by looking great and acting decent. From small kids to adults, each person was willing to walk the extra mile to ensure that they attract recognition and prestige as per their respective plans (University of Alberta). I was surprised to see young people in Great er Miami so obsessed with beauty that they could spend hours in one still position without moving while applying makeup with the sole aim of the colleagues adoring their appearance. This patience is mostly observed while tattooing. Even men invest in shaving, grooming, expensive fashionable clothes, creams and cosmetic products and shoes.

Learner Analysis Essay Example for Free

Learner Analysis Essay Background Summary Flight nurse’s and Flight Paramedics perform as members of an aeromedical crew on helicopters (rotor wing), and airplanes (fixed wing) aircraft, providing for in-flight management and care for all types and ages of patients. Responsibilities of this job include the planning and preparation of each flight, to include such things as; safety, evaluation of an individual patients in-flight needs and request of appropriate medications, supplies, and equipment to provide continuing care from origination to the destination facility. They act as liaisons between facilities during an interfacility transport and from scene location to trauma center during medical and trauma related emergencies. They also initiate emergency treatment in the absence of a physician during in-flight medical emergencies. Flight nurses and flight paramedics have training in mechanical ventilation, hemodynamic support, vasoactive medications, airway, and other intensive care skills. Most air medical businesses expect nurses to have at least 2 to 5 years of experience in emergency or critical care units, and the more trauma experience, the better (flightnursetraining.com). This means nurses that have a proven ability to manage multiple patients with vastly different conditions, as well as being able to make split-second decisions about patient care with maximum attention to patient care and safety. Flight paramedics are expected to have a minimum of three years current experience as a paramedic on an advanced life support team and/or critical care transport team. Both of these roles may have to tend to multiple critical cases all at once, so it is important that he or she have the skills to cope with high stress situations. Even though those hired into the role of a flight nurse and flight paramedic come into the role with a core background in critical care and expected level of baseline knowledge,  higher level of autonomous critical thinking and rapid decisio n making is a new skill encountered for many coming into this role. A well-structured training program is an integral part of laying a strong foundation to build the necessary knowledge base needed to assure both a flight nurse and flight paramedic are prepared to perform in their role as a crew chief. Approximately six years ago a well-structured crew chief training program was in place that allowed for consistent and structured learning that allowed all crew member 2 (CM2) to obtain the necessary skills and knowledge expected to hold a position of crew chief. These modules covered areas of navigation, communications, safety, aviation, critical thinking; and incorporated reading material, practical exercises, quizzes and tests which the CM2 worked through in a systematic process. At the completion of the training module; the crew member then went through a question answer board (QAB) process. In the QAB, the crew member was asked a series of questions by a board consisting of a crew chief, clinical manager, pilot, medical director and given multiple scenarios. If the QAB was completed successfully the CM2 then advanced to status of a crew chief. Current State of Problem Currently a structured training program that assures all flight nurses and flight paramedics obtain this baseline level of knowledge that is expected of those in the crew chief role does not exist. The current practice is the assumption that all CM2’s obtain the skills and knowledge necessary by reaching their seventy fifth patient transport. This training plan does not allow for the structured delivery of expected skills and knowledge nor does it allow for a baseline competency to be demonstrated before being promoted from CM2 to crew chief. The current process was put into place to meet the increased demand for staffing experience by the company during a rapid growth period where eight bases turned into sixteen in four years. This current process put into place at this time did allow for rapid streamlined training of new staff; but it failed to take into account quality over quantity. This new process has resulted in CM2’s being promoted to the level of a crew chief w ithout the necessary knowledge that is expected of this role as determined by the management. Goal State All crew members at CM2 status go through a structured crew chief training program. This training will allow for the delivery of consistent, well-structured necessary skills and knowledge. A well-structured training program will assure that all flight crew who obtain crew chief status will have obtained the same base of knowledge and will have all demonstrated the same level of desired competence. Learner Analysis Demographic Information The instructional setting is primarily on the job training; information gained through the live patient care transport environment via ground, rotor or fixed wing aircraft. Nurses and paramedics work as partners in patient transport. This team configuration can be two nurses, or one nurse and one paramedic; but at all times one team member must be a nurse. The third person at the base is the pilot in command, who does not provide any patient care but does and can assist in aviation and safety training. These teams are on shift; stationed at their assigned base for a 24 hour period of time; where training through simulations, reading, and discussions will occur during non-patient transport times. There are 16 bases in the company; located in California, Texas and Oregon. There are 8 full time medical crew assigned to each base and an additional 2-3 part time staff at each base. Age of paramedics and nurses range from 27-61. English is native language spoken by all medical crew members. Educational levels in addition to holding an accredited paramedic license or registered nurse license are ranging from associate degree to doctorate. All Registered nurses in the capacity have received specialized training in critical care, trauma and hold specialized certificates in these areas. All paramedics in this capacity have also obtained additional critical care related training and certificates. Both the nurses and the paramedics receiving the crew chief training have been employed with this company in the flight role for a minimum of 1 year and have obtained the CM2 status. The content area is focused on five areas; to include aviation, safety, communications, navigation, and critical thinking. All medical crew have obtained the basic level of training in these areas have been deemed CM2 which puts them at â€Å"novice† status which deems them competent to s afely complete patient transports. The crew chief level of training is aimed at bringing crew  members from novice to expert level. Prior Knowledge Prior knowledge of all who will receive the crew chief training are those who are at the current CM2 level. They have been working in the capacity as flight nurses or flight paramedics at this company for a minimum of 1 year and have been on at least 75 patient transports. 25% of the total crew members have prior experience working as Flight Nurses or Flight Paramedics at another company; 10% of the flight paramedics have prior flight crew experience through the military prior to coming to this company. Those crew members who achieved crew chief status per the current model will be given a baseline written assessment and go through a crew chief QAB. Those who pass these two items will remain at the status of crew chief; and those who do not pass these assessments will complete a bridge crew chief training program, focusing on those areas of the training they did not pass during their assessments. A written assessment and QAB will be repeated at the conclusion of the bridge training. All crew members surveyed have positive feedback regarding this proposed process. Entry Skills Required Entry level skills required to the crew chief training is to be a CM2 and to have successfully passed the CM2 questions answer board. Successful completion of CM2 training demonstrates successful objectives completed as stated in the CM2 training. In addition to CM2 status; all crew members must have obtained a national certification. National certifications the nurses may obtain are critical care registered nurse (CCRN), care flight critical nurse (CFRN), or certified emergency nurse (CEN). These are each a 100-150 questions tests that are scheduled to be taken at independent test centers as determined by the certifying agencies. The CM2 must also be in good standing with the company; meaning no disciplinary actions in the crew members personal file in the previous six months. Attitudes and Motivation The majority of the flight nurses and flight paramedics are very driven; intense people with a high desire to obtain the crew chief status. Primary motivation comes from the desire to obtain the title status of â€Å"crew chief† and the increased pay rate of 5% per hour. Secondary motivation is the drive that comes from internal motivation to achieve additional training to  reach expert level knowledge in this field. Current attitudes towards training are positive with an overwhelmingly stated desire to have a more structured training program; with higher standards and rigor needed to become a crew chief. Based on the annual employee survey; one of the indicators as stated by employees to improve morale is for a more structured and rigorous crew chief training program. Unique Characteristics and Learning Styles The majority (70%) of the learners described themselves as learning best through â€Å"doing.† Those who stated they learn better through hands-on and learning state reading, watching or hearing the learning material is helpful if they can then have additional hands-on training through simulations or live on-the-job situational experiences. Another 40% of learners said they were not sure how they learned best; but felt having access to the material in writing or reading to be studied was very helpful. All learners wanted tangible resources available such as protocols, standard operating procedures, drug calculators, and other tools that could be obtained through electronic means such as their phones or IPADS; to be accessed as needed during simulated training and live patient transports. According to Kolbs Adult Learning Styles; adults have four distinct ways of preferred ways for examining, analyzing and integrating new knowledge. Converging (doing and thinking), diverging (f eeling and watching), Assimilating (watching and thinking) and Accommodating (doing and feeling). In the VARK model; Neil D Fleming described the primary ways adults acquire new knowledge; the preferred learning styles. In this VARK model; 41% are kinesthetic learners, 16% visual, 25% auditory and 18% readers. Crew member feedback of preferred learning styles and research based evidence regarding preferred adult learning styles appear to correlate. This will allow support from management to build a new crew chief training program that will be based in the delivery methods that will allow consumption of material to be presented through the desired learning styles of adult learners. Unique characteristics of this group of learners is their collective attitudes and internal drive to desire a more rigorous and structured training program with an extreme minority of the crew members desiring to hold title of crew chief without demonstration of knowledge and skills required. It will be  important to build a training program that accommodates all of the stated learning styles so as to use the crew member’s desire for the training to have a product that matches in quality and desired outcome of trainees. Accommodations According to Gregg, Talbert and Lentz (1999),An appropriately selected instructional accommodations not only provides equal awareness to learning opportunities but also minimizes the learners likelihood of failure. Appropriate educational accommodations are determined by taking into account the adults unique leaning needs. All crew members have demonstrated a prerequisite knowledge required to begin this training through successful completion of the CM2 training. All learners are primary English language learners without physical disabilities; as this is a requirement to obtain the role of flight nurse or flight paramedic in this company. The accommodations that should be considered for this training program is one that utilizes all learning styles to ensure the best possible success by all those beginning the training program. Performance Context Managerial Support Learners can expect full organizational support in the training process. One of the top goals of the organization as identified in their â€Å"Strengthen from Within Plan† is to re-build and strengthen a training strategy that will allow for employees to have a structured, well planned out, standardized training program. Employees have overwhelmingly voiced concern in the area of clinical training with regards to the crew chief training in the annual employee survey and through the Best of Practice Suggestion Forum. Management has acknowledged the priority of a structured crew chief training process lost priority in recent years; stating it has been likely to the rapid growth experienced by the company in the last 5 years and with this comes a need to recruit employees bring them to novice status in order to staff new bases. This has caused an oversight in strengthening crew chief training which brings employees to that of expert level in the field. Management has also acknowledged that current process that was put into place approximately 6 years ago; which brings a CM2 to crew chief status via a CM2 completing 75 patient transports and obtaining a national  certification has fallen short of hopes and expectations for this modality of crew chief training. All management are in agreement a more structured training program is needed. All would agree that the skills learned through a structured crew chief training program bring medical flight crew members from a novice to an expert level which translates to superior patient care, superior customer service, which lead to strengthening of the company as a whole. Physical Aspects of the Site The crew chief training takes skills learned by flight crew members during their CM2 training program and adds depth, strengthens critical thinking and problem solving processes and brings a CM2 at novice level up to crew chief which is considered expert level. This training will take place while the crew member is on shift. Training will occur via reading material, videos, discussion with preceptor, clinical manager and base manager, scenarios through case studies and live demonstration during patient transport. The CM2 will be required to complete a written test and sit on a QAB at the end of the crew chief training Process. All required training materials and equipment will be available at each of the 16 bases in the company. Base managers and clinical managers will work with the preceptors to assure all materials and equipment will be kept at each base, kept current with what is being used in live environment and kept in working order. Social Aspects of the Site In the performance setting, medical crew members work in teams. The teams always consist of two nurses, or one nurse and one paramedic. The third team member is the pilot; who are not involved directly in the patient care. Medical crew member’s work in team’s independent of direct supervision of a supervisor. Supervisors such as clinical managers, base managers and a medical director are always available by phone 24 hours a day 7 days a week as needed by the medical crews. The skills obtained in the Crew Chief training will not be being utilized by the medical crews for the first time. Many of these skills learned will have already been used by the crew members in the crew chief training; as much of the training had already been presented to some degree during the CM2 training. It is possible that some patient care skills learned by CM2 and again as crew chiefs will have only  been completed on mannequins in simulations and not on live patients until that patient condition presents itself. These skills are referred to as â€Å"infrequently used skills† and are practiced routinely by all medical crew members in the company. Those receiving initial first time skills and knowledge in their role are the crew member 1 (CM1) team members who are gaining the on-the-job training needed to achieve CM2 status. In these instances; a CM1 is always assigned into a work partnership with another crew member who is at least at the CM2 status. Relevance of Skills to Workplace All skills learned in the training will relate directly to all skills utilized in the actual workplace. There are not current perceived physical, social or motivational constraints. Crew members are highly motivated to have structured crew chief training due to the relationship between skills learned and skills used in work environment. High motivation also exists due to the desired status achievement of crew chief and due to the increased monetary stipend received. References Fleming, N.D. and Mills, C. (1992), Not Another Inventory, Rather a Catalyst for Reflection, To Improve the Academy, Vol. 11, 1992., page 137. Flight Nurse Training. (n.d.). Flight Nurse Training. Retrieved May 8, 2014, from http://www.flightnursetraining.com Suggested Considerations Regarding Accommodations. (1999, January 1). Suggested Considerations Regarding Accommodations. Retrieved May 8, 2014, from http://kairos.technorhetoric.net/7.1/coverweb/grover_hendricks/accommodations.htm Wikipedia, the free encyclopedia. (n.d.). . Retrieved May 8, 2014, from http://en.wikipedia.org/wiki/Main_Page Workplace Training and Education: Adult Learning Styles. (2013, January 1). Workplace Training and Education: Adult Learning Styles. Retrieved May 8, 2014, from http://tribehr.com/blog/workplace-training-and-education-adult-learning-styles/

Forming a regional trade agreement advantages and disadvantages

Forming a regional trade agreement advantages and disadvantages Since World Trade Organization (WTO) was established in 1995, the number of its membership has increased to 153 countries by 2010. Recently, a phenomenon is observed. As countries pursue trade liberalization under the multilateral standard of WTO, more and more regional economic integration are conducted. Many members in WTO sign new regional trading Arrangements (RTAs) to deepen each regional trade reaction. Because positions and demand for different trade issue are often diverse to the regional member countries, the negotiations become more and more difficult. Consequently, the trend of bilateral and multilateral free trade agreement rises gradually. Besides, due to the bitter competition in the global market, countries also exert to obtain trade partners. Countries found thorough forming regional trade agreements could be an easy way to enhance trade reaction with their close trade partners. According to RTA database offered by WTO (2010), 371 RTAs related to WTO have been announc ed and 193 of them were in force by 31 July 2010Figure 1 shows the evolution of the average number of RTA partners for the current members of the World Trade Organization (WTO): the average WTO member now has agreements with more than 15 countries. Therefore, regional economic integration has become one of the main trends in the present global economic development. In recent years, the global economic system expands gradually by the reaction between the forces of regionalization and globalization. The following offer a general historical data of regional integrations. First, the trend of Regional Integration can be traced back to the 1950s. The 1950s saw European Communities (EC), the most important and representative regional integration case, was established. Then in the 1960s, numerous regional integrations were conducted by Africa, Latin America and other developing countries. Continually, United State is considered to be the main thrust of regional economic cooperation during the mid 1980s and the1990s. During this period, except for lasting the free trade agreement with Canada and Israel, also United State promoted to arrange North American Free Trade Agreement (NAFTA) and Free Trade Area of the Americas (FTAA). Meanwhile, In Europe, the target of expansion and cross-regional cooperation are approached by European Union (EU). On the side of the expansion, Greece, Spain and Portugal were subsumed in the 1980s and the steps were followed by Sweden, Finland and Austria during the 1990s. Then, in the 2000s, Czech Republic and other eleven countr ies also attended European Union and four more countries, for instance, Turkey, are candidate to join. A growth in membership in European Union is expected. On the other hand, the aspect of cross-regional economic integration is also approached. To ensure the market share and position in America area, European Union urged to conduct free trade agreements with Mexico and MERCOSUR. As a result, the free trade agreement was announced with Mexico in 2000 and became the first free trade agreement conducted with Latin American Countries. Compared with Europe and America area, it is entirely reasonable to make the analogy in East Asia. One of the representative regional integrations in East Asia is ASEAN. ASEAN, namely Association of South East Asian Nations, was established in 1967, including Indonesia, Malaysia, Philippines, Singapore and Thailand five countries. The original motivation of ASEAN is to prevent the spread of communism and to improve the regional trade reaction and cooperation. Since its establishment, there has been 40 year of its history. On 8 Jan 1984, the membership increased to six with the join of Brunei, and these six countries are called the founding members of ASEAN. Then they were followed by Vietnam, Laos, Myanmar and Cambodia in the 1990s so that current membership expands to 10 countries. The communism prevailed when the time ASEAN was formed. As a consequence, the political purpose was more than economic one in that period so there was no free trade agreement until 1992 the founding membe rs signed ASEAN Free Trade Agreement (AFTA). A gradually tariff reduction in member countries, which is called Common Effective Preferential Tariff (CEPT), was planed to be achieved before 2008. As in 1999 the thirteenth meeting of the ASEAN Free Trade Area decided CEPT should be achieved earlier and decided non-tariff among members instead of the initial target. Then AFTA was in force with the founding countries of ASEAN in 2003 and non-tariff in all members was planed to be reached by 2015. Above is the development of ASEAN free trade agreement. Next, a difficult position of Taiwan will be introduced. Asian financial Crisis happened in 1997 and conduced the willingness of East Asia countries to cooperate. Since 1999, those important trade partners of Taiwan in Asia have committed to access the forming of free trade agreement. For example, Japan and Singapore signed Japan-Singapore in 2002 and in force in the same year. Also after AFTA was conducted, China, South Korea and Japan, three large economy countries in East Asia, had pursued to sign FTAs with ASEAN. In December 1999, ASEAN announced to impose cooperation in their economic with China, Japan, and South Korea, which is called ASEAN+3. According to Picture I, it reveals the ASEAN+3 member countries on the world map: the dark ink represents the members and, comparatively, Taiwan is circled to be pointed out. An interesting discovery is found: although being a country located in East Asia, Taiwan is excluded from ASE AN+3. Due to some political problem, Taiwan has just signed 5 free trade agreements with other countries and none of them are Asia countries. Table 1 see the export trade amount of Taiwan with ASEAN+3 countries. The export amount occupied 66% of total Taiwan export so that if ASEAN+3 non-tariff target is achieved (in fact ASEAN and China free trade agreement has progressed on 1 Jan 2010), Taiwan would face a difficult trade position. Therefore, to avoid being isolated away by other trade partners and to deepen the cooperation with them, accessing advantages and disadvantages of forming a regional trade agreement become necessary. To analyze those advantages and disadvantages of forming a RTA, an understanding in regional trade agreements is important. Also, to know whether any limit exist to forming a RTA, a good way is to review the international trade criteria given by GATT and WTO. Hence, in the discussion, a two-phase study was designed to explore the advantages and disadvantages of forming regional trade agreements. First of all, there are three branches in the former phase. In the first branch, to realize what regional trade agreement is, the paper examines the theories of regionalism and all types of regional economics integrations. It is worthy to understand regional trade agreement from its original intention and distinguish those differences. Second branch provides an overview of the organizations, which aim for improving international trade. For example, a comparison between World Trade Organization, Asia-Pacific Economic Cooperation (APEC), Europe Union and Association of Southeast Asian Nations ( ASEAN) will be made to clarify their objectives of the establishment. We will see a conflict between the globalization and the regionalization. Last branch reveals two forces which against each others, namely trade creation and trade diversion. These two forces determine the gain or loss of a regional economic integration. In the second part of the study, an analysis of the advantages and disadvantages will be offered, based on the knowledge provided in the first part of the studies. The remainder of this paper is divided into four sections. The next section of the article is a review of the literature; addressing both empirical and theoretical aspects of regionalism, worldwide trade organizations, trade creation and trade diversion. Section III describes the development of regionalism and provides empirical economic integration to support that. Using the background provided in the section III, section IV analyses the advantages and disadvantages of forming regional trade agreement. In the end of the paper, section V concludes. Trade Creation and Trade Diversion Trade economists have being going the effort on whether the formation of a regional trade agreement will lead member countries to be better off. A common concept to analyze gain or loss of a RTA was given by Viner. In his crucial work, The Customs Union Issue, two forces, which decide whether a RTA better off the member countries, were well indicated, namely trade creation and trade diversion. Viner noted that preferential agreement member countries would have lower tariff barrier than non-members due to the preferential tariff and therefore trade creation effect and trade diversion effect are produced. Trade creation effect is generated because the bloc members increased each others intra-bloc import and export when a preferential tariff reduction or removal is induced, and consequently bilateral trade amount increases. In addition, the low-efficiency production in domestic provider would be replaced by high-efficiency providers in other bloc countries so that home countries can con sume this product with lower social cost. In contract, Trade diversion might be happened when a preferential treat is offered in member countries. Originally home country imports products form those high-production efficiency countries; however, due to the preferential tariff home town might import products from those low-production efficiency countries so that the social cost to consume this product rise and decrease domestic social welfare. Trade creation is a positive effect to domestic social welfare and trade diversion is negative. If trade creation effect is greater than trade diversion effect, home social welfare increase. Conversely, it would be harmful if trade diversion is greater. In The Customs Union Issue, Viner made a crucial conclusion that the formation of customs union has no certain welfare effect to members welfare due to these two trade forces. Accordingly, economists doubt whether we can prevent trade diversion as forming an RTA. Ohyama , Kemp and Wan proved customs union improve the welfare of members as given a fixed trade amount between members and non-members. On the contrast, if a change in nonmember trade amount would lead an uncertain welfare effect. Even Kemp and Wan theoretically showed that members improve their welfare completely in the fixed trade amount with outsider, that sounds once given an unchanging treat to outsider, the world must be better off. It implies through a negotiated optimal tariff we can create economic benefit and prevent being hurt from trade diversion; however, many empirical observations reveal that countries usually choose the trade policies which results trade diversion when they forming a RTA, namely RTAs benefit members and worse off nonmembers. The implication is Kemp-Wan result might not be the trade equilibrium. In fact, there exist other factors influencing the trade outcome of RTAs. The formation of an RTA related to political, economic and regional factors, the external tariff might be influenced not only economically but also politically. For example, lobbying might cause a distortion in government optimal external tariff adjustment. Thus, as we analyze the trade effect we better to account those factors in. In these few decades, economists focus on these two trade effects in RTAs and question whether RTAs generate more trade diversion or trade creation. Is RTA more trade diverting? Freund and Ornelas noted in principle RTAs can generate either net trade creation or net trade diversion, we must remember that participation in any RTA is a political decision. Thus only some types of agreements will be formed, depending on the objectives of governments. Except for the intension to maximize the social welfare, the decision whether to take RTAs might be influenced by specific-interest groups. Some literatures indicate domestic political factor might be a better way to explain FTA phenomenon. Grossman and Helpman reckoned domestic powerful specific-interest group usually lobby their government with huge money and resources to conduct RTAs which advantage them. Milner offered a similar viewpoint as well. He considered those export-oriented companies usually push government to enter a preferential trade agreement (PTA) to enlarge the bloc market which disadvantage outside companies. The powerful domestic companies have influences to the government election outcome so th at the relationship between lobbying and election outcome is another factor to be taken to examine the influence on RTAs. Above sounds RTA generates more trade diversion due to non-trade effects, but it still needs evidences Empirics of trade creation and trade diversion Unfortunately, the estimation of trade diversion is not an easy work. As above mentioned, the estimation has to account into both trade and non-trade factors which influence RTA outcome, therefore, a gravity equation is used to help this issue. The equation provides a theoretical way to examine whether a RTA generates more trade creation or trade diversion. The concept of natural trading partners were first proposed by Wonnacott and Lutz . They pointed that the agreements, which are conducted with those geographically close countries and similar culture countries, are likely to attain more trade creation. Tinbergen and Poyhonen successively used gravity model in international trade analysis and used it to research world trade flow and size. Tinbergen hence pointed bilateral trade flow and bilateral economic size have a positive relationship and have a oppose relationship with their geographical distance. Frankel applied gravity model to examine the natural trade partner hypothesis. He analyses the trade flow effect in different regional integrations by using different dummy variables like culture, whether they have common border or same languages etc. He reckoned gravity model is the best instrument to judge trade creation effect and trade diversion effect. Frankel used the data between 1965 and 1992 to examine the regional effect. When two countries belong to the same regional integration, then regional dummy effect is 1; therefore 0. The estimated correlation coefficient represents how many trade flows can be attributed to specific regional trade effect. The empirical result revealed the correlation coefficient in each variable was all significant. He found two-country GNP coefficient is less than 1. That means trade amount will not rise proportionally when the economic size of both countries increase 1. Also the distance coefficient is negative, that represents the trade decrease with an increase in distance. The distance result is similar to the result of Tinbergen. Frankel also found the same language and the same border has a positive influence to trade flow. For each regional variable, the outcome shows the regional trade effect is significant in Europe Union, MERCOSUR, Australia-New Zealand Closer Economic Relationship, and Andean Group, yet not significant in NAFTA. Frankel provided evidence for natural trade partners hypothesis by using gravity equation. Clausing used HS-10 digit import data of United State to access CUSFTA. She found due to the agreement signed in 1994 the import of the US from Canada had increased 26 percentage. the import from Canada increased half amount since 1989 to 1994 and Clausing attributed it to tariff reduction decision in CUSFTA. She found that trade creation are more general than trade diversion in most of cases. Furthermore, RTAs increase bilateral trade between members . Their research points there is no significant trade reduction between members and non-members be found. Other studies also examined the impact of regional integration to trade effect. For Europe Union, Kreinin pointed the establishment and east-expansion of EU would cause little trade diversion and huge trade creation. A distinct evidence was provided by Chang and Winer . They found the formation of MERCOSUR do hurt non-members but as Calvo-Pardo et al. pointed, MERCOSUR is a customs union (CU), which is different from CUSTA, NAFTA those FTAs. According to the literatures above, we found in most cases RTAs except MERCOSUR are likely to trade creating more than trade diverting. As well, if countries, which are natural partners, sign an RTA, it would benefit them. That is because the similar culture, for example, language, may reduce transaction cost. Consequently, the trade creation effect has more opportunity to be greater than trade diversion. That gives the incentive of government to negotiate an RTA with their close countries. Adjustment in External Tariffs Another issue trade economist cared is optimal external tariffs after forming a RTA. The original Vinerian assessments of trade creation and trade diversion are normally constraint to the policies fixed. However, there is at least a trade policy those RTA members would use: external tariff policy. Kennan and Riezman (1990) were the first to examine the optimal external tariffs after RTA was formed and they found the formations of RTAs are usually with external tariff reduction. Also, the same result was in several literatures. To avoid the welfare costs of trade diversion, optimal external tariffs seem to be lower in RTAs. Kennan and Riezman pointed there is coordination of common external tariff under CU. Unlike CU, FTA members have authority to set their external tariff unilaterally. Kennan and Riezman use this key different chrematistic between CU and FTA to see the external tariff adjustment outcome after the formation of RTAs. Another issue we will discuss in this section is the influence of lobbying to the formation of a RTA. In section II we reviewed those structural characteristics, which lead to more trade creation or trade diversion, of RTA members. Intuitively, bloc countries are willing to attain more trade creation and to reduce more trade diversion so that they can achieve the objective of social welfare maximizing, yet as mentioned in Section II the formation of RTAs are not only economically, more important, also politically. There are some incentives bloc countries hold to adjust their specific product external tariff rate so that they can achieve their objectives (no matter what that is). Thus, this section will introduce those incentives that members are likely to alter their external tariff and the reaction to members external tariff under the formation of RTAs, which is what we concerned. That will help us to figure out whether the political force would lead distortion among the RTA formati on. Incentives to alter external tariffs in RTAs with empirics The incentives to alter external tariffs in RTAs can be clarified generally in three main parts: the incentive due to CU, due to FTA and due to domestic producer influence. We will discuss them in the following content. The external tariff policy adjustment might be influenced by different types of RTAs. In CU their external tariff are coordinated by all members, on contrast, FTA members have more authorities on their own external tariff. Thus, the motivation in different types of RTAs might be different. Firstly, we examine the incentive to alter external tariff rate of CU members. According to Kenan and Riezman , the equilibrium external tariffs are also observed being higher than FTAs. They concluded two points. One is a custom union allows its members to internalize their tariff externality when bloc members import the same product. Another, a customs union makes several countries into one larger one and enlarges their market power. Similarly, the analysis of Bond, et al. also clarified the external tariff in an FTA would be lower in a CU due to the lack of external tariff coordination. Preferential margin is the differences between external tariff and preferential tariff rate. Higher external tariff leads to higher preferential margin. Also, the higher the preferential margin is, the larger the discrimination and trade diversion effect are. Therefore, inter-bloc countries benefit more from the CU agreement due to the discrimination effect. As what Kennan and Riezman found, Richardson indicated there is an intention of external tariffs to be reduced under FTA. The phenomenon is called the tariff complementary effect. Relative to customs union, there is neither large market power nor external tariff coordination effect under FTAs. Even so, motivations to alter external policies still exist. A simple way to think is that: trade creation is created due to the preferential tariff among the FTA members and trade diversion is generated simultaneously. An effective trade policy against trade diversion that government holds is external tariff policies. Hence, if a preferential trade agreement comes with a reduction of external tariff, it would enhance both the total welfare in the world and reduce a hurting on non-members. However, an issue is whether the external tariff should be removed under a FTA. Bond, et al. reckoned the implication of the lack of external policy coordination is that the optimal external tariff for an FTA should be positive. Logically, a principle is that external tariff for outsider should no less than preferential tariff for insider so that the agreement would not be meaningless. As what have mentioned in Chapter 2, there are some non-trade factors also affect the trade effects. The one which is broadly discussed is the effect of lobbying to external tariff in a RTA. When political motivations are concluded in, the net trade effect will become ambiguous. Empirics of external tariff adjustment in RTAs With protection, are RTAs more trade diverting? The impact of regionalism on multilateralism Kyle and Robert examined whether exceptions from MFN for the purpose of forming preferential agreements can lead to lower external tariffs, and thereby to a more efficient tariff structure unter the multilateral agreement. imply that the formation of the FTA benefits ROW. These findings differ from those that arise under a CU where typically there is a smaller external tariff reduction (or even an increase). This occurs because CU members jointly choose the external tariff to maximize union welfare, thus internalizing the positive tariff externality that exists whenever two countries import the same good from ROW. With the objective function that we consider, a CU will always be preferred to an FTA for symmetric member countries because of its more favorable market power effects25. Thus, while this model does not provide a positive theory of FTA formation, it does point out how international distributional effects differ between FTAs and CUs. It also suggests that, in the short run, FTAs are more appealing from a world welfare perspective because they imply relatively less aggressive tariff setting for their members.

The Outsourcing Industry Philippines Health And Social Care Essay

The Outsourcing Industry Philippines Health And Social Care Essay The outsourcing industry is currently a growing trend in the Philippines providing employment opportunities for many young professionals. The Philippine outsourcing industry has grown 46% annually since 2004 (Rivette, 2010) and is currently representing 21% of the $7.2 billion of total Business Process Outsourcing (BPO) revenues worldwide. With the increase in BPO employment opportunities, more and more young Filipino professionals are applying for and working as call center agents. Approximately 400,000 Filipinos are already employed as call center agents (Rivette, 2010) and with a growth rate of 46% annually, it can be estimated that another 200,000 Filipinos will be joining this work force next year. However, despite the economic benefits of the expansion of BPO in the Philippines, an increase in work-related diseases in call center companies have also been reported. The most researched work-related disease in call centers in the Philippines is on sexually transmitted infections, particularly HIV-AIDS. According to the study done by the UP Population Institute (2010), 20% of male call center agents are commercial sex workers while 14% of them give payment in exchange for sex. The study also showed that 1/3 of call center agents have had casual sex in the last 12 months. These statistics validate the increase in risky sexual behavior among call center agents in the Philippines. However, increase in risky sexual behavior is only a part of the lifestyle of most call center agents. Other poor lifestyle choices observed among call center agents is their patronage of fast food, smoking, consumption of alcohol, increased caffeine intake, decreased sleep, and decrease physical inactivity. Besides poor lifestyle choices, the nature of their work also predisposes them to stress and disturbances in their sleeping pattern. All of these factors predispose them to health problems particularly hypertension, obesity, and diabetes. A number of studies have already been condu cted on the incidence of sexually transmitted diseases and call center agents in the Philippines but there are currently no studies yet on the incidence of other diseases among call center agents. This study would like to bridge this information gap because knowledge on the development of other diseases like hypertension and diabetes are also as important as knowledge on the increased transmission of STIs among call center agents.    In this study, the researchers would like to explore the association between the development of Diabetes Mellitus Type II among call center agents in the Philippines. As mentioned above, call center agents and their lifestyle predisposes them to developing diabetes. The researchers would like to address the problem of potentially developing Diabetes Mellitus because of the long-term complications of this disease on the quality of life. The researchers would want to specifically address Type II Diabetes Mellitus for the basic reason that this type of Diabetes develops primarily because of lifestyle factors. The researchers believe that knowledge on the association between call center agents and the development of Diabetes Mellitus Type II is highly significant because of the health implications of this disease and its potential to be prevented. II. Significance of the Study The increasing trend of call center agencies in the country provides job opportunities to the increasing supply of graduates in the country. Being employed as a call center agent in a call center agency is assumed to increase the risk of predisposition to different disease entities because of the radical lifestyle changes one undergoes. With the increasing number of employed call center agents, there is therefore an increase in the number of people who are at risk of acquiring diseases. Few literature deals with call center agents that discusses the acquisition of certain diseases secondary to their occupation. This study aims to increase the fund of literature with regard to this. Diabetes Mellitus, Type II is a chronic and debilitating disease. Also, as said, this is a life-long disease. Once a person acquires this disease, he or she will forever be predisposed to the co-morbidities and effects of the disease; which in turn, will decrease ones number of productive life years.   Prevention is the most cost-efficient approach when targeting populations. If the results of this study will show an association between being a call center and acquiring Diabetes Type II, we would be able to address the gap in knowledge with regards to the association of being an employed call center agent and acquiring Diabetes Mellitus, Type II. Also this would provide additional data for policy makers to address measures with regards to the prevention of this disease. III. Scope of Limitations   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The study will only include employees in call centers in Ortigas, Philippines. The study will be done for a period of 5(?) years and will only determine if an individual will develop Type II Diabetes Mellitus (DM) or not. The study will not quantify the degree and severity of the disease upon diagnosis. Fasting blood glucose (FBG) will be used in the diagnosis of DM, as it is the most reliable and convenient test for identifying DM in asymptomatic individuals (Fauci et al, 2008) and part of the guidelines used by the American Association of Clinical Endocrinologists (AACE Diabetes Mellitus Clinical Practice Guidelines Task Force, 2007). Individuals will be counted as cases if diagnosed with Type II DM through the course of the study. Cases will be provided with appropriate interventions (non-pharmacological, referral).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  The study will exclude those who have the following at the start of the study: Type II DM, history of Diabetes in the immediate family, body mass index (BMI) above or below the normal value as per Asian standard, and more than or equal to 30 years of age. These exclusion criteria are the factors that can be controlled in selecting the individuals within the population that may predispose them to be identified as cases. IV. Review of Related Literature Call Center Industry According to a review done by OMaley (2008), the Philippines has been a major player in the outsourcing industry over the past ten years. Six major factors were identified to be the reasons why the Philippines participate radically in the said industry. One is the increasing government support for information technology investment despite the erratic political climate. Second is the continuous pooling of college graduates with good English communication skills and proficiency. It was stated in the review that 75% of the total population in the Philippines (according to a United Nations data) speak English fluently with a 94% literacy rate which gives a relative advantage in the industry as compared to other countries. Third is high knowledge about Information and Communications Technology (ICT). Fourth is the easy establishment of a reliable and reasonably priced telecommunication infrastructure. Fifth are the low costs but high quality locations of call center agencies. And lastly, sixth, the increasing trends of outsourcing globally. In that same article written by OMaley, it was said that the Philippines consistently ranks among the top five Business Process Outsourcing (BPO) locations globally. This shares a five-year-compounded annual growth rate of 38%. The Philippine BPO system was also coined as the major player in the growth of the service sector in the country. The Philippines plays a major role in supplying the demand for more call center agents as an effect of the global trending of outsourcing worldwide. According to the Philippine National Statistic Office (2010), call center activities ranked first among all BPO activities covering almost half of the total industry with 219 (48%) call center establishments.    With the increasing number of call center agencies, it is logical to say that there is also an increasing need for call center agents to work for such industry. Call center activities employ majority of the workers among all BPOs. In 2008, call center agencies employed about 150,000 workers (Philippine National Statistics Office, 2010). There are about 400,000 Filipinos who are currently employed as call center agents according to Rivette (2010). Call Center Agents According to  a policy provided by the Employment and Immigration Department of the Government of Alberta (2008), call center agents are the ones who respond to questions and inquiries, build customer relationships, resolve customer problems and provide information about company policies, products and services over the phone and via electronic communication. Working conditions from one call center to another may differ. According to that same policy, call center agents usually work indoors but in a rather open environment to decrease privacy. Further, managers are allowed to record and monitor the conversations of an agent and his or her customer. Working shifts also differ from one agency to another. Some agencies provide services 24-hours a day, seven days a week. Lifestyle of Call Center Agents and Associated Health Risk Factors Because of the nature of their work, call center agents usually live a lifestyle that may put them at risk for development of certain diseases. First, call center workers remained in a static sitting position 95% of the time (Rocha, 2005) which makes them prone to physical inactivity that may lead to obesity. Development of obesity is of significance because it is a risk factor for the development of Diabetes Mellitus Type II according to the AACE Diabetes Mellitus Clinical Practice Guidelines Task Force of 2007. Second, call center workers are exposed to a highly stressful environment. Call center workers identified call-time pressures i.e., having to process a customer call within a specific number of seconds as having the strongest relationship to job stress (Di Tecco et al, 1992). Another study identified having to deal with difficult customers as the most significant source of job stress in 54.0% of call center agents handling inbound services and 54.4% of call center agents handling outbound services (Lin et al, 2010). High levels of stress can lead to increased cortisol levels in the body which is of significance because of its effects on body metabolism. Abnormalities in body metabolism can lead to metabolic problems such as stress-induced obesity which may give rise to hypertension, hyperlipidemia, and hyperglycemia (Andrews, 2002). Third, the usual diet of call center agents is high in cholesterol and fat and low in fiber which puts them at risk for dyslipidemia and hypercholesterolemia. In a study conducted by the UP Population Institute, they identified the usual lifestyle choices of young professionals in Metro Manila and Metro Cebu. They studied the economic, social and health status of 929 young professionals less than 35 years old working at call centers and non call centers. The study revealed that there is a high level of consumption of chips, burgers, fries and fried chicken among the workers and a few number consume instant noodles and street food regularly. It was found out that fried chicken was the most popular food choice among Business Process Outsourcing (BPO) workers with 78% saying that they consume it regularly. Chips were the next most popular food choice with 54% saying they consume it regularly, followed by fries at 53% and burgers at 49%. High caffeine intake was also reported in 2/3 of a ll young professionals drinking coffee daily. However, the study pointed out that call center workers drank more coffee than non-call center workers. Call center workers drank 2.3 cups of coffee daily while non call center workers drank 1.7 cups daily. Tea intake was also reported where 1/4 of all call center workers drank tea while only 1/5 of non-call center workers drank tea. The study also revealed that 50% of all young workers drink soda daily at an average of 1.5 bottles or cans daily. The study also explored leisure activities of call center agents. Based on the UP Population Institute survey, 72% of call center agents said that their most common leisure activity is drinking compared to partying (62%) or videoke gimmicks (59%). The study said that overall there is a very high level of current drinking among workers, 85% for call center agents and 87% for non-call center agents. Fatty food and consumption of alcohol can increase triglyceride and cholesterol levels which is a risk factor for the development of diabetes (AACE, 2007). Fourth, sleep deprivation is common among call center agents. In the same study, they also found out that instead of the recommended 8 hours of sleep, call center agents only get 6.2 hours of sleep each day. Sleep deprivation can lead to metabolic disturbances and hormonal changes causing obesity (Merck) and consequently diabetes. Fifth, due to fatigue and lack of sleep, call center agents resort to smoking to cope with stress. They reported that 43% of call center employees smoke while only 21% of non call center agents smoke. A call center agent who smokes usually consumes 9 sticks a day on average. Smoking is a known risk factor for the development of atherosclerosis leading to hypertension and cardiac disease. Since hypertension and cardiac disease are risk factors for the development of Diabetes Mellitus Type II (AACE, 2007), smoking may then predispose an individual in developing diabetes. Diseases Associated with Call Center Employees An increase in the turnover, absenteeism, and occupational diseases in call center employees resulted from lack of modernization of processes and organizational planning in call centers in Brazil (Rocha et al, 2005). A focused group investigation conducted in a call center employed with 200 individuals observed the presence of complaints of muscular pain, stomach aches, sleep alterations and irritability (Westin in Rocha et al, 2005). Work-related muscular disorders were found to be highly prevalent among the female than male call center employees, specifically on the neck/shoulder region (43%) and on the wrists/hands region (39%). It was observed that a combination of high demands and lack of work control among the female call center employees   reflect a highly stressful job that predispose them to the increased risk of having musculoskeletal disorders (Theorell in Rocha et al, 2005). The limitations of the study done by Rocha et al (2005) are that the analyses were limited to on e call center linked to a bank, cross-sectional design, small sample size, and symptom-based diagnosis (such as pain, numbing, dizziness, tingling sensation, stiffening, burning sensation). In a study done by dErrico et al (2010), the presence of musculoskeletal symptoms in the same region was assessed using the following inclusion criteria to preserved the specificity of the outcome, although it likely decreased its sensitivity: a) presence of musculoskeletal symptoms (pain, burning, stiffing, numbness or tingling) at any time during the last 28 days and b) consultation to a physical and or self-medication because of the symptoms. Also, the presence of any disease known to be associated with musculoskeletal disorders such as hypertension, diabetes, systemic lupus erythematosus, gout, thyroid diseases, rheumatoid arthritis), previous injuries in the last five years, leisure physical activity, body mass index, smoking, marital status, educational level, gender, and age class were explored as potential confounders of the association between workplace factors and musculoskeletal symptoms. It was found in this study that 45% of workers reported musculoskeletal symptoms wher ein neck (39%) symptoms were the most prevalent, followed by the shoulder (22%), handwrist (10%), and elbow (4%). Neck/shoulder symptoms were associated with low job control, elevated noise, poor desk lighting and impossibility to lean back while sitting. Elbow/hand-wrist symptoms were associated with short intervals between calls, insufficient working space, lack of forearm support, job insecurity, and long seniority in the industry. Other study that reported the presence of musculoskeletal symptoms among call center employees were done by Halford and Cohen (2003) wherein computer use factors and individual psychosocial factors were significantly associated with self-reporting of musculoskeletal disorder symptoms. Sudhashree et al (2005) stated in a column letter that the call center industry in India ranked high for attrition due to health reasons such as sleeping disorders (83%), voice loss (8.5%), ear problems (8.5%), digestive disorders (14.9%) and eye sight problems (10.6%). Burnout stress syndrome, which includes chronic fatigue, insomnia, and complete alteration of biological rhythm of the body are routine cause for sickness absenteeism. Chronic level of stress also affects other systems of the body such as the cardiovascular and endocrine. In a study done by Lin et al (2010) in a bank call center in Taiwan, call center employees have had prevalent complaints of musculoskeletal discomfort, eye strain, hoarseness, and sore throat. Also, it was found that those who perceived higher job stress had significantly increased risk of multiple health problems, including eye strain, tinnitus, hoarseness, sore throat, chronic cough with phlegm, chest tightness, irritable stomach or peptic ulcers, and musculoskeletal discomfort. In the Philippines, there are no studies about the health risks and occupational diseases associated among call center employees. However, there is a report of a rise in the number of Filipinos infected with Human Immunodeficiency Virus (HIV) and includes the call center employees (Ruiz, 2010). Diabetes Mellitus,Type II Type II Diabetes Mellitus and Epidemiology   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Diabetes mellitus (DM) is a group of metabolic disorders wherein there is an increase in blood sugar (hyperglycemia) resulting from absolute or relative deficiency of insulin, or both. There are many classifications of this disease entity based on the pathologic process that leads to hyperglycemia. In Type II DM, hyperglycemia resulted from a range of predominantly insulin resistance with relative insulin deficiency to a predominantly insulin secretory defect with insulin resistance (Fauci et al, 2008). It usually occurs among the older age group (> 30 years old) but there is an increasing diagnosis in the younger group (Tidy, 2009). Most symptoms of diabetes appear very late in the stage of the disease. A lot of diabetics do not have symptoms when their blood sugars are elevated for the first time (National Objectives for Health, 2005).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   There is a dramatic increase in the prevalence of Diabetes Mellitus worldwide, from ~30million cases in 1985 to 177 million in 2000. Type II DM is increasing more rapidly because of increasing obesity and reduced activity levels as countries become more industrialized, as in the case of many developing countries in Asia (Fauci et al, 2008). A nationwide prevalence survey in the Philippines by the Department of Health showed that four (4.1%) out of one hundred Filipinos are diabetics, and the prevalence was higher in urban (6.8%) than in rural (2.5%) areas. The World Health Organization estimates that there will be a doubling of prevalence of diabetes in Southeast Asia every five to ten years. Using this as assumption, the prevalence of diabetes in the Philippines is around 8 to 16 percent (National Objectives for Health, 2005). Also, the death rate in diabetes has risen from 4.3 per 100,000 population in 1984 to 7.1 per 100,000 population in 1993. It is important to note that there is underreporting of deaths due to diabetes, as shown by local studies, because of misclassification as deaths due to cardiovascular or renal disease both of which are chronic complications of DM (National Objectives for Health, 2005; Fauci et al, 2008). Type II Diabetes Mellitus Risk factors and Diagnostics According to the American Association of Clinical Endocrinologists (AACE) Medical Guidelines for Clinical Practice for the Management of Diabetes Mellitus (AACE Diabetes Mellitus Clinical Practice Guidelines Task Force, 2007), there are several risk factors to developing prediabetes and Diabetes Mellitus. Such risk factors are (a) family history of diabetes, (b) cardiovascular disease, (c) overweight or obese state, (d) sedentary lifestyle, (e) Latino or Hispanic, Non-Hispanic black, Asian American, Native American, or Pacific Islander ethnicity, (f) previously identified impaired glucose tolerance or impaired fasting glucose, (g) hypertension, (h) increased levels of triglycerides, low concentrations high-density lipoproteins cholesterol, or both, (i) history of gestational diabetes, (j) history of delivery of an infant with a birth weight > 9 pounds, (k) polycystic ovary syndrome, and (l) psychiatric illness. To diagnose Diabetes Mellitus, any one of the three criteria is sufficient in diagnosis the patient according to the AACE. These criteria are: (a) symptoms of diabetes such as polyuria, polydipsia, unexplained weight loss and casual plasma glucose concentration of greater than or equal to 200 mg/ dL, (b) fasting plasma glucose concentration of greater than or equal to 126 mg/ dL, and (c) 2-hour postchallenge glucose concentration of greater than or equal to 200 mg/ dL during a 75-gram oral glucose tolerance test.    Diabetes Mellitus Prevention A study done by the Diabetes Prevention Program (DPP) showed that intensive changes in lifestyle, quantified as diet and exercise for 30min/day five times/week in individuals with impaired glucose tolerance (IGT) delayed the development of Type II DM by 58%. (Harrisons, 2008). It was also found out that Metformin slowed down the progression or halted the development of Type II DM by 31% compared to placebo. People with a strong predisposition to diabetes due to family history or impaired glucose tolerance or impaired fasting glucose (IFG), are strongly advised to maintain a normal BMI and engage in regular exercise. According to the recent ADA Consensus panel, individuals with IFG and IGT who are at a high risk for progression to diabetes (age 35 kg/m2, family history of diabetes in the first-degree, elevated triglycerides, reduced HDL, hypertension, or A1C > 6.0%) could be appraised for Metformin treatment but not other medications. Acute complications of DM The acute complications of diabetes are diabetic ketoacidosis (DKA) and hyperglycemic hyperoslomar state (HHS). Both disorders are associated with absolute or relative insulin deficiency, volume depletion, and acid-base abnormalities. These may lead to serious complications if not promptly remedied. Diabetic Ketoacidosis The usual signs and symptoms of DKA are   nausea and vomiting, hyperglycemia, hypotension, Kussmaul respirations, fruity oder on the patients breath, excessive thirtst, and polyuria. DKA is characterized by hyperglycemia, ketosis, and metabolic acidosis that is accompanied by secondary metabolic abnormalities. Hyperglycemic Hyperosmolar State HHS may usually be seen in an elderly individual with Type II DM, with symptoms of polyuria, weight loss, and lessened oral intake that preceded mental confusion or coma. Physical examination shows profound dehydration and hyperosmolarity with concomitat hypotension, tachycardia, and altered mental state. In contrast to DKA, HHS does not present with nausea, vomiting, abdominal pain and Kussmaul signs. Chronic complications of DM The chronicity of the disease brings about systemic involvement that affects multiple organ systems. Complications may be divided into nonvascular and vascular complications. Nonvascular complications include gastroparesis, skin changes, and cataracts. Vascular complications can be further subdivided into micro and macrovascular. Microvascular changes, which result from long standing hyperglycemia include retinopathy, neuropathy, and nephropathy. Macrovascular changes include coronary artery disease and peripheral arterial diseases. (NIkki, Ill send you my draft. di ko lam kung tama. i Cant do the framework here.) Figure 1.Conceptual Framework V. Objectives   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   With the nature of the work and environment in a call center industry, the study aims to determine if working in a call center predisposes an individual to the development of Type II diabetes mellitus (DM). Specifically, it aims: a.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  To determine the incidence of Type II Diabetes Mellitus within the period of study. b.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  To determine the etiologic factors associated with the development of Type II Diabetes Mellitus. VI. References AACE Diabetes Mellitus Clinical Practice Guidelines Task Force (2007). American association of clinical endocrinologists medical guidelines for clincial practice for the management of diabetes mellitus. Endocrine Practice. 13:3-68 Andrews, R.C., O. Herlihy, D.E.W. Livingstone et al. (2002). Abnormal cortisol metabolism and tissue sensitivity to cortisol in patients with glucose intolerance. The Journal of Clinical Endocrinology 87 (12): 5587-5593. Di Tecco, D., Cwitco, G., Arsenault, A., Andre, M. (1992). Operator Stress and Monitoring Practices. Appl Ergon 23, 147-53. dErrico, A., Caputo, P., Falcone, U., Fubini, L., Gilardi, L., Mamo, C., Migliardi, A., Quarta, D., and Coffano, E. (2010). Risk factors for upper extremity musculoskeletal symptoms among call center employees. Journal of Occupational Health. 52:115-124. Employment and Immigration. (2008). Alberta Occupational Profiles: Call Centre Agent. Government of Alberta. Retrieved September 10, 2010 from   http://alis.alberta.ca/occinfo/Content/RequestAction.asp?aspAction=GetHTMLProfileformat=htmloccPro_ID=71002991 Fauci, AS., Braunwald, E., Kasper DL., Hauser, SL., Longo, DL., Jameson, JL.., and Loscalzo, J. (2008). Harrisons Principles of Internal Medicine. 17th ed.   USA: The McGraw-Hill Companies, Inc. Halford, V., and Cohen, HH. (2003). Technology use and psychosocial factors in the self-reporting of musculoskeletal disorder symptoms in call center workers. Journal of Safety Research. 34(2):167-173 Lin, YH., Chen, CY., HONG, WH., and Lin YC. (2010). Perceived job stress and health complaints at a bank call center: comparison between inbound and outbound services. Industrial Health. 48:349-356 Merck Manuals Online Medical Library (2010). Obesity. Retrieved September 11, 2010 from http://merck.com/mmhe/sec12/ch156/ch156a.html National Objectives for Health. (2005). Retrieved 9 September 2010 from http://www2.doh.gov.ph/noh/3-2-3.pdf National Statistics Office. (2010). 2008 Annual Survey of Philippine Businesss and INdustry: Business Process Outsourcing Activities. Manila Philippines. Retrieved September 10, 2010   from http://www.census.gov.ph/data/sectordata/aspbi08_bpotx.html OMaley, R. (2008). Special Report Call Centres in the Philippines. Retrived September 10, 2010 from: www.callcentrehelper.com/special-report-in-the-philippines-2231.htm Rivette, D. (2010). The Emerging Philippine Value Proposition. Trestle Group Consulting. Retrieved September 11, 2010 from http://www.bpap.org/bpap/publications/ TG_SDS_PhilippineValueProposition_March2010%5B1%5D(2).pdf Rocha, LE., Glina, DMR., Marinho, MdF., and Nakasato, D. (2005). Risk factors for musculoskeletal symptoms among call center operators of a bank in Sà £o Paulo, Brazil. Industrial Health. 43:637-646 Ruiz, J. (2010). HIV cases soar among Filipino yuppies, call center workers. ABS-CBN News. Retrieved 10 September 2010 from http://www.abs-cbnnews.com/lifestyle/01/27/10/hiv-cases-soar-among-filipino-yuppies-call-center-workers Sudhashree, VP., Rohith, K. and Shrinivas, K. (2005). Issues and concerns of health among call center employees. Indian Journal of Occupational and Environment Medicine. 9 (3): 129-132 Tidy, C. (2009). Diabetes mellitus. Philippine Medics. Retrieved 10 September 2010 from http://www.philippinemedics.com/diabetes-mellitus/ UP Population Institute (2010). Lifestyle, Health Status and Behavior of Young Workers in Call Centers and Other Industries : Metro Manila and Metro Cebu. Retrieved 11 September 2010 from http://www.abs-cbnnews.com/lifestyle/08/05/10/call-center-workers-diet-fast- food-caffeine-and-alcohol