Geographical Pressures to Deviate from Franchise Formats

Introduction Background to the study Cox and Masson (2007, p.1054) define franchising as ‘contractual business relationships involving the franchisor and the franchisee, which operate as legally independent business entities’. Through such relationships, franchisees have the legal right to use the franchisors’ business name, products and services, blueprint, or specialised aspects in their trading process.Advertising We will write a custom proposal sample on Geographical Pressures to Deviate from Franchise Formats specifically for you for only $16.05 $11/page Learn More Cox and Masson (2007, p.1055) add that the ‘franchisor offers the franchisee the necessary support systems necessary to establish the business’. By 2010, the presence of franchises was evident in approximately 75% of all countries in the world (Truitt 2006). Subsequently, franchises have significantly contributed to the economic growth of the global econom y by stimulating the retail sector, creation of employment, and contribution to country’s Gross Domestic Product (GDP) (Stanworth, Stanworth, Watson, Purdy, Heleas 2004). Therefore, franchising is a proven business concept. Many investors are of the opinion that adopting the franchise format can improve the effectiveness with which an organisation maximises its profit as opposed to independent start-ups. The concept of franchising business has experienced significant challenges in different parts of the world. For example, the number of franchises declined from 1100 to 1025 during the period ranging between 2008 and 2010 (Buchan 2013). Despite this aspect, a report by the Franchise Council of Australia indicates that the franchise format has played a remarkable role in the growth of small businesses in the country (Buchan 2013). Problem statement Despite the contribution of franchising in promoting businesses’ capability to achieve high profitability, this business fo rmat has come under intense criticism due to its standardisation concept. Previous franchising literature has cited the level of autonomy and independence associated with franchising as major concerns. Tuunanen and Hyrsky (2001) argue that standardisation is one of the key components of franchising. This assertion means that business format franchising is based on the model of ‘cloning’, whereby a business deals with standardised products and services. Therefore, the products are sold under similar trademark or trade name.Advertising Looking for proposal on business economics? Let's see if we can help you! Get your first paper with 15% OFF Learn More Under the concept of standardisation, the franchisee is required to adhere to the operational parameters set by the franchisor (Hoy Stanworth 2014). Some of the standards include trademark, suppliers of inputs, promotion methods, the nature of the product, and the trademarks to be adopted. Consequently, acco rding to Fock (2001, p.173), the ‘franchisees are not given the opportunity to incorporate their own initiative in the operation of the franchise’. For example, the franchisor cannot make decision on diverse operating procedures such as operating hours, pricing, hiring of employees, and business location. Failure to comply with the contractual agreement is a major source of conflict between the franchisee and the franchisor. For example, the contract may require the franchisee to pay the franchisor based on sales revenue. This aspect might pose a challenge to the franchisees in their quest to maximise their profits, especially if the geographical area in which they operate is characterised by minimal growth. Such geographical limitations may pressurize franchisee to diverge from the set operational standards. Cox and Masson (2007, p.1054) assert that geographical dispersion ‘exposes the chain to varied local market conditions that require adaptation to maximise pe rformance’. Adopting uniform operating procedures and standards such as franchising is an ineffective strategy in some geographical locations in businesses’ effort to maximise their sales revenue and net income. Subsequently, franchising is experiencing a challenge arising from the franchisors’ demand to comply with the concept of standardisation and the franchisees need to adapt their business operations in accordance with the geographical market needs (Levy Weitz 2007). Rationale of the study Franchising has gained significance in the global business environment. Subsequently, most entrepreneurs and practising managers are inclining towards integrating the concept of franchising in their strategic management processes. The prominence of the franchising business format has arisen from the recognition of its role in stimulating business growth.Advertising We will write a custom proposal sample on Geographical Pressures to Deviate from Franchise Formats spe cifically for you for only $16.05 $11/page Learn More However, entrepreneurs and business managers have an obligation to ensure that firms achieve their profit maximisation. This goal can only be achieved if the most effective business format is adopted. However, the concept of franchising has some gaps emanating from its overemphasis of the concept of standardisation as its cornerstone. Research aims and objectives The study aims at developing a comprehensive understanding on the importance of understanding the standardisation and adaptation concepts of franchising. In a bid to achieve this aim, the researcher will follow a number of objectives, which include To assess how geographical factors affect the implementation of franchising business format. To analyse the extent to which franchisors allow franchisees to adapt to the prevailing environmental conditions. To evaluate the franchisees integrate the concept of adaptation in their effort to carry out th e franchising system. Research questions A number of research questions based on the research objectives will guide the study. The research questions are outlined below. What is the impact of geographical factors affecting the implementation of franchising business format? To what degree do franchisors allow franchisees to adapt their businesses to the prevailing environmental conditions? How does a franchisee integrate the concept of adaptation in their effort to establish the franchising system? Significance of the study This study will be of great significance to practising managers and academicians. For example, the study will provide business managers and entrepreneurs with insight on the challenges associated with the standardisation concept of franchising especially in business operating in diverse geographical areas. Subsequently, business managers will be in a position to make a decision on whether to adopt standardisation or adaptation in their effort to achieve profit maximisation. Furthermore, the study will enable academicians to appreciate the gap associated with the concept of franchising in their review of the subject. Research hypothesis This study will aim at verifying the null hypothesis (H0) or refuting the alternate (H1) hypothesis, which include Null hypothesis H0 – Geographical pressures have a significant impact on franchisees decision to deviate from the standardisation concept of franchising and adapt to the prevailing environmental conditions. Alternate hypothesis H1 – Geographical pressures do not have an impact on franchisees decision to deviate from standardisation and adapting to the prevailing environmental conditions. Literature review Franchising Entrepreneurs must make a decision on the legal structure that they will adopt in the course of establishing their business. Truitt (2006) argues that the format selected has significant tax, regulatory, legal, and business consequences. The choice of business forma t is determined by different factors such as capital requirements, liability risk involved, tax, and marketing requirements (Sorenson Sorensen 2001).Advertising Looking for proposal on business economics? Let's see if we can help you! Get your first paper with 15% OFF Learn More Some business structures are characterised by high capital requirements, liability risk, and marketing requirements (Croonen Brand 2012). The main types of business format in much legislation include partnerships, sole proprietorships, limited liability companies, and franchises. Buchan (2013, p.3) emphasises that franchising ‘has become a significant part of the global commercial landscape’. Components of franchising formats Dada (2013) asserts that the franchise business format is comprised of four main components, which include the nature of the product or service, format facilitators, system identifiers, and benefit communicators. Franchises specialise in offering customers unique products or service, which acts as its competitive niche. On the other hand, benefit communicators refer to the intangible benefits associated with the product or service being offered. Examples of such benefits include high level of professionalism in the service delivery process and rel iability. Format facilitators refer to the procedures and policies that should be followed by the franchisee, while system identifiers refer to the visual elements that associate a firm or product to a particular chain, for example trademarks, uniforms and architectural features (Yudoko 2012). Franchising; standardisation versus adaptation Cox (2002) argues that standardisation is the foundation of franchising due to its contribution in the franchisees and franchisors’ efforts to achieve its cost minimisation objective. For example, standardisation minimises the cost incurred in monitoring the franchisee. Moreover, standardisation allows businesses to develop and maintain a unique brand image amongst its customers (Michael 2002). Subsequently, an organisation nurtures a high degree of customer loyalty arising from trusting in the uniformity of the product’s quality across outlets in different locations. Therefore, standardisation in franchising enables entrepreneurs to sustain the unique customer experience. Longenecker (2012) asserts that the franchisees’ efforts to deviate from the set standards by adapting their own operational procedures may lead to erosion of the benefits associated with franchising, for example due to a decline in product quality and loss of the brand image (Rundh 2003). Furthermore, critics argue that adaptation in franchising format may influence the franchisees’ ability to innovate adversely (Chary 2009). This assertion arises from the view that the franchisee might not have sufficient knowledge to innovate the product or service offered in order to fit the geographical needs (Stanworth, Healeas Purdy 2002). Cox and Masson (2007, p.1056) argue that adapting ‘to local conditions reduces the potential for cross-fertilisation of ideas for identifying and implementing new offerings’. Despite the significance of standardisation, Megan (2010) argues that franchises operate in diverse geographical ar eas, which are characterised by different factors such as intensity of competition, customer tastes, and preferences. Therefore, the effectiveness of standardisation amongst franchisees operating in geographically diverse area is limited. Michael (2000) argues that franchisees have substantial knowledge of their local geographical market compared to the franchisor. Consequently, the likelihood of succeeding in their innovation effort is high (Michael 2003). Despite their commitment to standardisation, franchisors depend on the market knowledge and information gathered by franchisees in undertaking product or system innovation (Ryans, Grittith While 2003). However, the need to maintain a strong brand image restricts franchisees from adapting their operations to the local market situation (Pizanti Lerner 2003). From the above review, a significant gap needs to be addressed on whether franchisors should give franchisees the opportunity to deviate from the set operational standards an d procedures and adapting their operations to the prevailing market situations. Through adaptation, there is a high probability of franchising business formats gaining better significance compared to the prevailing situation. Methodology Research design The purpose of this study is to explore the decision of franchisees to incorporate the standardisation versus the adaptation strategies in their operation. The study will adopt qualitative research design. The decision to adopt this research design is informed by the exploratory nature of the study. Moreover, qualitative research design will provide the researcher with an opportunity to gather substantial amount of data to aid in making extensive and conclusive research findings. Maxwell (2005) further asserts that qualitative research design is a multi-method research strategy, which is interpretive in nature. Subsequently, the study will be of great significance to the target audience. Data collection The researcher will source dat a from secondary sources. The researcher will review previous studies and literature on standardisation and adaptation amongst franchises. Some of the main secondary sources of data that the researcher will consider include reports peer-reviewed journals and other literature. Numerous studies on franchising have been conducted previously. Therefore, the use of secondary sources will provide the researcher with an opportunity to gather substantial data. However, the researcher will ensure that the secondary data selected is from credible sources. This move will improve the reliability of the data collected. Data analysis and presentation The data gathered will be analysed using Microsoft Excel, which will enable the researcher to condense the voluminous data collected. Creswell (2003) asserts that qualitative research design enables a researcher to gather diverse data. Evaluating the data collected can overwhelm the researcher if it is not condensed effectively. By using Microsoft Ex cel, the researcher will be in a position to condense the data successfully by incorporating tables, graphs, range, and graphs. Subsequently, the researcher will assess different aspects associated with the subject under investigation. Furthermore, using Microsoft Excel will provide the researcher with an opportunity to present the data effectively using graphs. Subsequently, the target audience will be in a position to understand the research findings easily. Reference List Buchan, J 2013, Franchisees as consumers; benchmarks, perspectives and  consequences, Springer, New York. Chary, S 2009, Production and operations management, Tata McGraw, New Delhi. Cox, J 2002, Geographical dimensions of business format franchising, University of Southampton, Southampton. Cox, J Masson, C 2007, ‘Standardisation versus adaptation; geographical pressures to deviate from franchise formats’, The Service Industries Journal, vol. 27 no. 8, pp. 1053-1072. Creswell, J 2003, Research de sign: qualitative, quantitative and mixed method  Approaches, Sage Publications, New York. Croonen, E Brand, M 2012, ‘Antecedents of franchisee responses to franchisor initiated strategic change’, International Small Business Journal, vol. 69 no. 172, pp.114-126. Dada, O 2013, ‘Entrepreneurial organisation and the franchise system; Organisational antecedents and performance outcomes’, European Journal of  Marketing, vol. 47 no. 5, pp. 790-812. Fock, H 2001, ‘Retail outlet location decision-maker: franchisor or franchisee’, Marketing Intelligence and Planning, vol. 19 no. 3, pp. 171-178. Hoy, F Stanworth, J 2014, Franchising; an international perspective, Routledge, New York. Levy, M Weitz, B 2007, Retailing management, McGraw-Hill, New York. Longenecker, J 2012, Small business management; launching and growing entrepreneurial ventures, Cengage Learning, Mason. Maxwell, J 2005, Qualitative research design: an interactive approach, Sage Pu blication, New Jersey. Megan, T 2010, ‘A framework for implementing retail franchises internationally’,  Marketing Intelligence Planning, vol. 28 no. 6, pp. 689-705. Michael, S 2000, ‘Investments to create bargaining power: the case of franchising’,  Strategic Management Journal, vol.21, pp. 497-514. Michael, S 2002, ‘Can a franchise chain coordinate’, Journal of Business Venturing, vol. 17, pp. 325-341. Michael, S 2003, ‘First mover advantage through franchising’, Journal of Business  Venturing, vol.18, pp. 61-80. Pizanti, I Lerner, M 2003, ‘Examining control and autonomy in the franchisor franchisee relationship’, International Small Business Journal, vol. 21 no. 2, pp.131- 38. Rundh, B 2003, ‘Rethinking the international marketing strategy; new dimensions in a competitive market,’ Marketing Intelligence Planning, vol. 21 no. 4, pp. 249-257. Ryans, J, Grittith, D While, D 2003, ‘Standardi sation versus adaptation of International marketing strategy; necessary conditions for advancements’,  International Marketing Review, vol. 20 no. 6, pp. 588-603. Sorenson, O Sorensen, J 2001, ‘Finding the right mix: franchising, organisational learning and chain performance’, Strategic Management Journal, vol. 22 no.16, pp. 713-724. Stanworth, J, Healeas, S Purdy, D 2002, ‘Intellectual capital acquisition and knowledge management – new perspectives on franchising as a small business growth strategy’, ISBA National Small Firms Policy and Research Conference  Proceedings, vol. 2 no.5, pp. 1507-1534. Stanworth, J, Stanworth, C, Watson, A, Purdy, D Heleas, S 2004, ‘Franchising as a small business growth strategy: a resource-based view of organisational development’, International Small Business Journal, vol. 22 no.3, pp. 539-559. Truitt, W 2006, The corporation, Greenwood Press, Westport. Tuunanen, M Hyrsky, K 2001, ‘En trepreneurial paradoxes in business format franchising: an empirical survey of Finnish franchisees’, International Small Business  Journal, vol. 19 no. 4, pp. 47-62. Yudoko, G 2012, Sustainable operations strategy; a conceptual framework, ICTOM, Bandung. This proposal on Geographical Pressures to Deviate from Franchise Formats was written and submitted by user Cailyn Lee to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

Picture of a House

Picture of a House It is said that every family has skeletons in the cupboard. If only old houses could speak, they would tell a lot of fascinating stories about bad and good times of their inhabitants. At first glance, an old house in the picture may seem to be a mere building consisting of walls, windows and doors, but its atmosphere and every its part would mean a lot for several generations that were born and grew up in it.Advertising We will write a custom essay sample on Picture of a House specifically for you for only $16.05 $11/page Learn More A paved path leading to the terrace steps looks so inviting that it is hard to resist the temptation and enter the building. Stepping on this winding trail, a guest would inevitably think of those people who had walked this path millions of times day by day in the past. It is possible that these were small children who ran skipping along and perhaps even fell after stumbling over one of the stones on the path. These could also be elderly people who went slowly because it was already difficult for them to walk. Young people could walk this path in a hurry from and to work without even noticing beauty of the house. With all these thoughts in mind, a guest would find himself/herself on a desert terrace. Knocking on the door, the stranger would imagine children playing games on this terrace and an elderly man sitting in a rocky chair. However, now there are no lights in the window and the terrace is desert. Nobody would open, and it seems that now only memories and family secrets live in this house. Not able to enter the house, a stranger would stay outside and walk in the garden. It is autumn, and the bare trees share the mood and loneliness of the house. However, there are no leaves on the lawn, and it means that somebody has collected them. Someone who is now invisible has gathered the autumn leaves and neatly cut the lawn. The presence of invisible but caring owners surround the house with atmosphere of mys tery. The red tiling on the roof of the house and a gabled tower make the building look like a castle from a fairy tale. There is a small chimney on the roof, and obviously small children growing up in this house were waiting for Santa Claus to come through it every Christmas Eve. Children grew up and do not believe in miracles anymore, but a small chimney remains as a commemoration of those old good times. The large windows of the house are similar to somebody’s curious eyes and connect the inhabitants of the building with the surrounding world. It is obvious that there are even more windows in this house than it is necessary for lighting the rooms in a proper way. Most rooms of the house have two or even more windows which demonstrate the openness of the inhabitants and make the building look even more inviting. It is possible that previously the house was more hospitable than on this autumn morning and guests crowded on its small terrace and in its brightly-lit rooms. Howe ver, now the house looks desert and sleeps, hiding all its secrets behind thick curtains on the windows.Advertising Looking for essay on art? Let's see if we can help you! Get your first paper with 15% OFF Learn More Looking at the exterior of the house in the picture, strangers can only make guesses concerning the lives of its inhabitants and the true meaning of the elements of the building. A winding path, bare trees in the garden and large windows would seem only the elements of the construction to a stranger, but would tell much more to people who have spent at least a part of their lives in this house.

Management Strategies and Practices Essay Example | Topics and Well Written Essays - 1000 words - 1

Management Strategies and Practices - Essay Example (Montana.P and B. Charnov. 2000) Management is a discipline that has gained popularity over the years. Today people study and pursue degrees in managing the organization, the processes and most definitely people. It is true that employees are the asset of an organization. They are those who make the organization and lie at the foundation of it. Therefore, it is important that they be treated well, in such a way so that their skills and potential is polished. The right attitude in prospective employees is very important in order that employees give their 100% to the organization. The right attitude means a positive inclination towards one’s profession and a personality that matches the requirement of that profession. The theory lies on the premise that there must be something relevant in people that they can take up a particular profession. Just like you cannot make someone without hands, drive, it is therefore impossible to make the quietest girl in the class into a cheerleader. Hence a drive, something inborn is necessary to take up a particular profession. Therefore one must understand that while degrees, medals, reports and skills count; there’s something else which distinguishes a winner from a loser. There are also certain characteristics that organizations look for in their desired candidate in keeping with the culture of the company. For example; the Women & Infants Hospital of Rhode Island looks for doctors who are calm, composed, confident, energetic and compassionate. Even though companies are still impressed by a 4.0 gpa or a degree from Harvard University; it is not the only ingredient which makes successful employees who contribute positively to the wellbeing of the organiza tion. (Kreitner.R., 2000) UPS has also been hiring employees based on their performance on attitude and behaviourial tests. It therefore considers that the right temperament for a job is

Educational Service Journal Assignment Example | Topics and Well Written Essays - 500 words

Educational Service Journal - Assignment Example The Floor was dusty, and the walls were made of mud. In my class, I did not have students with a special need but nearly all the students were communicating in the mother tongue. The school students had a unique culture of punishing students, for example, if a student made noise in class; he was to carry a pan having all the utensils in and run all around the field five times. This culture did not value all students, and I was of a different race I would not be comfortable in the school. During classes and on playgrounds, students divided themselves basing on their cultures. Yes, in peers there was a bigger discrimination rate, and if anything that will bring them is done then they will interact. The Parent Teacher Association (PTA) meeting are held, and parents are involved and shown how their children are stuck in cultural values. The school at large struggles with the eradication of culture by mingling the students in class and within the playgrounds among the varying cultural disposition. This attempt by the school has helped much because there was a smaller cultural difference in the whole school. In any normal class, boys get boredom faster they seem not to corporate anymore compared to their colleagues; girls. When it reaches that point, I let them go and play for some minutes. Girls do cooperate actively with each fully. Girls are hyperactive, and whenever any question is asked, they are the first to answer and when given an assignment they finish in time. Boys and girls do not play together; they stay separate and play separately. With time, this trend will change when they have reached certain age levels. Equality is a uniform factor, so when dealing with either boys or girls, dealing with them in the same discipline should apply to treatment, treat them equally without any favor. The school culture and the official curriculum do not promote cultural awareness.  

Effectiveness of Exogenous Melatonin in Insomnia

Effectiveness of Exogenous Melatonin in Insomnia WOO YUN KIN CHAPTER 1 INTRODUCTION Research Background Sleep is not always a luxury. Insomnia is defined as a sleep disorder in which there is an inability to fall asleep or stay asleep as long as desired (Roth T. 2007). It is estimated that up to 34% of adults in the United States and 37% in Europe have some forms of insomnia (Leger D. 2005). Insomnia can be classified to mild, moderate and severe according to the International Classification of Sleep Disorder (ICSD). Melatonin (5-methoxy-N-acetyltryptamine) is a lipid soluble hormone secreted by the pineal gland during hours of darkness. Melatonin has several physiological functions including regulation of the circadian rhythms, modulation of seasonal change and a powerful antioxidant (Gitto et al. 2013). With age, it has been shown that the 24hour melatonin secretion is significantly reduced thus affecting the normal circadian cycle (Iguchi et al. 1982). At present, insomnia is typically treated symptomatically, often with benzodiazepine or antidepressants. However chronic insomnia requires long term treatment which may cause significant side effects and unwanted drug-drug interaction. Approximately 29-61% of older adults with insomnia complaints have preexisting sleep apnea (Krakow et al. 2001). With the combination of insomnia and sleep apnea, sedative-hypnotic treatments may worsen the sleep apnea (Mendelson et al. 1981). Exogenous melatonin is a chronobiotic drug with some hypnotic properties (Zhdanova et al. 1997), it has become of the most frequently non-prescribed sleep aid due to its role in regulating and promoting sleep (Wagner et al. 1998). some studies have shown that supplemental melatonin can increase sleep propensity, although it may not be as effective as prescribed sleep medication (Zhdanova I. 2005). Problem Statement Sleep adequacy includes, quality, timing and also duration. It has been estimated that the direct health cost of sleep disorder amounts to $1144 million Australian dollars in 2001 (NHS Aus. 2001), and 7.6% of the total motor vehicle accidents(MVA) in 2004 are indirectly caused by sleep disorders amounting to $808million net health costs. Studies have been done to show the benefits of exogenous melatonin for sleep disorders on individuals with intellectual disabilities and adolescence however very little has been done to show its effectiveness on the general population. Malaysia, has one of the highest rate of MVA in the world where according to Malaysian Institute of Road Safety (MIROS), from 1997 to 2007, there has been an increase of 59% of MVA and the main reason identified was driving fatigue due to awkward working hours/shift works (Kee et al. 2010). Availability of exogenous in Malaysia is scarce and it is not fully understood. Research Question How effective is exogenous melatonin in treating insomnia in general population? How safe is exogenous melatonin? Research Objective To review efficacy of exogenous melatonin in treating insomnia To access the safety of exogenous melatonin Significance of Research Data from available clinical trials and studies done on the efficacy of exogenous melatonin in insomnia will be compiled and compared to enable a more comprehensive and easily accessible result database. With the comprehensive database, clinicians will have a better understanding on the efficacy of MSCs and the best treatment option for the patient, thus improving patients quality of life. CHAPTER 2 LITERATURE REVIEW 2.1 INSOMNIA Insomnia is often defined by the presence of an individual’s report of difficulty with sleep (Roth T 2007). The criteria often used in diagnosing insomnia includes i)difficulty falling asleep, staying asleep or nonrestorative sleep, ii) this opportunity is present despite adequate opportunity and circumstance to sleep, iii) this impairment in sleep is associated with daytime impairment or distress and iv) this sleep difficulty occurs at least 3 times per week and has been a problem for the past 1 month (Roth T 2007). The pathophysiology of insomnia can be due to the disorder of the hyper-arousal state throughout the whole day which causes alertness during the day and difficulty in falling or maintaining sleep (Stepanski E, 1988). A cross sectional study done on 156 US air force personal found that 40% suffered from sleep disorder and 75% reported diminished sleep quality while deployed overseas (Peterson AL, 2008). A study done in 2013 (Lentino et al, 2013) showed that 25% of the 14148 army and national guard personal reported to be poor sleepers thus affecting the quality of sleep and the quality of service. 2.2 CURRENT TREATMENT FOR INSOMNIA Currently the medications used for treating insomnias and other sleep disorders includes benzodiazepine receptor agonist (eg. Zolpidem, zipoclone) which are only limited to short term use (4 weeks) (Sanofi Aventis, 2007). The medication large affects the brain through the GABA receptors and long term use has been associated with memory and balance impairment, rebound imsomnia, withdrawal symptoms and abuse potential (Rush CR, 1999). Recent short termed studies have shown that discontinuation of the benzodiazepines lead to disruption of the sleep architecture and also increases sleep latency which makes withdrawing from treatment difficult (Mann K, 1996). 2.3 MELATONIN Melatonin (5-methoxy-N-acetyltryptamine) is a lipid soluble hormone that is shown to be involved with the sleep physiology (Dijk D-J, 1997).it is also regulates the modulation of season change, in reproduction, antioxidant, oncostatic, anti inflammatory and anti-convulsant effect (Gitto E, 2013). Melatonin is mostly produced in the pineal gland in the brain during the hours of darkness and is involved in the regulation of the sleep-wake cycle (circadian cycle).the circadian process is maintained by the suprachiasmatic nucleus (SCN) which contains high number of melatonin receptors. During daytime, the SCN produces an arousal signal that maintains the wakefulness and prevents sleep drive however in darkness, there is a feedback loop which causes the release of melatonin which feeds back and inhibits the SCN (Geert et al, 2009) It has been documented that melatonin decreases with age especially in post menopausal women (Okatani Y, 2000). Other than to promote sleep, melatonin also show s sedative and anti-excitory effects (Hardeland R, 2008). 2.4 EXOGENOUS MELATONIN Exogenous melatonin has become one of the most frequently prescribed over the counter drug for those looking for non-prescription sleep medication (Wagner J, 1998). The exogenous melatonin is marketed to help promote quality sleep, helps in jet lag, or to regulate the circadian cycle due to jet lag or shift work due to its regulator role in the internal timing of biological rhythm. Some studies have shown that exogenous melatonin can help increase the sleep propensity although it may not be as effective as prescribed sleep medications (Zhdanova I, 2005). Studies have also been done regarding the use of exogenous melatonin in the treatment of sleep problems in individuals with sleep disability (Turk 2003) however there are still doubts on the efficacy of exogenous melatonin usage for the general public. CHAPTER 3 METHODOLOGY 3.1 Research Design This research was based on the PICOS guidelines : Population (P): All types of insomnia patients Intervention (I): Exogenous melatonin Comparitor (C): Insomnia patients on treatment with exogenous melatonin compared with other treatment by questionnaires Outcome (O): Efficacy and safety of treatment Study design (S): Randomized Controlled trials (RCT), Surveys 3.2 Database Literature search was done on electronic articles/ journals in Central, PubMed and Google Scholar. 3.3 Keywords Key words used to search articles with MESH terms were: Insomnia Exogenous melatonin 3.4 Quality Assessment Quality assessment of the paper was done using Jadad scoring for randomized controlled trials (RCT) and Newcastle-Ottawa Scale (NOS) for case-control and cohort studies. 1.Jaded score assesses the quality of published clinical trials based on methods relevant to random assignment, double blinding and the flow of patients. There are 7 criteria evaluated, whereby 1 point is given if the criteria is met and the last 2 crietria carries a negative mark. Range of score is from 0 (bad) to 5 (good) (Jadad et al. 1996). i. Was the study described as randomized (this include words such as randomly, random, and randomization)? [+1 point] ii. Was the method used to generate the sequence of randomization described and appropriate (table of random numbers, computer generated etc)? [+1 point] iii. Was the study described as double blind? [+1 point] iv. Was the method of double blinding described and appropriate (identical placebo, active placebo, dummy, etc)? [+1 point] v. Was there a description of withdrawals and dropouts? [+1point] vi. Deduct one point if the method used to generate the sequence of randomization was described and it was inappropriate (patients were allocated alternately, or according to date of birth, hospital number, etc)? vii. Deduct one point if the study was described as double blind but the method of blinding was inappropriate (eg. comparison of table vs. injection with no double dummy) 2. Newcastle-Ottawa Scale (NOS) is developed to assess the quality of the non-randomized studies with its design, content and ease of use directed to the purpose of incorporating the quality assessments in the interpretation of the results. A ‘star system’ is developed to judge on 3 broad perspectives (Wells et al. 2014): i. The selection of the study groups ii. The comparability of the groups The ascertainment of either the exposure or outcome of interest for case-control or cohort studies respectively 3.5 Inclusion and Exclusion Criteria Inclusion criteria Studies included in this review were chosen according to the flowing criteria : i. Papers published in English language (2010-2015) ii. All study designs were included to maximize the data collection Study subjects includes all types of insomnia patients Exclusion criteria Studies that were done in foreign language and animal studies were excluded in this review 3.6 Ethical Clearance The ethical committee of UCSI was notified regarding this thesis write-up 3.7 GAANT Chart 3.8 Milestone Proposal presentation: 27.02.2015 Submission: 31.03.2015 Data analysis complete: 30.05.2015 Thesis submission: 15.07.2015 REFERENCES 1. CATHERINE CORNU, L. R., FLORENCE NOEL-BARON, ALAIN NICOLAS, NATHALIE FEUGIER-FAVIER, PASCAL ROY, BRUNO CLAUSTRAT, M. S.-E. A. B. K. 2010. A dietary supplement to improve the quality of sleep: a randomized placebo controlled trial. BMC Complementary and Alternative Medicine, 10. 2. SZESEEN KEE, S. B. M. T., YONGMENG GOH 2010. Driving Fatigue and Performance among Occupational Drivers in Simulated Prolonged Driving. Global Journal of Health Science, 2. 3. REBECCA B COSTELLO, C. V. L., COURTNEY C BOYD, MEGHAN L O’CONNELL, CINDY C CRAWFORD, DEUSTER, M. L. S. A. P. A. 2014. The effectiveness of melatonin for promoting healthy sleep: a rapid evidence assessment of the literature. Nutrition Journal, 13. 4. DAVID R HILLMAN, M., FRCPE, FANZCA; ANITA SCOTT MURPHY, BEC; RAL ANTIC, MB, FRACP; LYNNE PEZZULLO, BEC 2006. The Economic Cost of Sleep Disorders. Sleep, 29. 5. GEERT MAYER, M. S. W.-W., MD, PHD; BARBARA ROTH-SCHECHTER, PHD; REINER LEHMANN, MD; CORINNE STANER, MD; MARKKU PARTINEN, MD, PHD 2009. Efficacy and Safety of 6-Month Nightly Ramelteon Administration in Adults with Chronic Primary Insomnia. Sleep, 32. 6. FRANK A.J.L. SCHEER, P. C. J. M., PHD; JOANNA I. GARCIA, BA; CAROLINA SMALES, BSC; ERIN E. KELLY, MSC; JENNY MARKS, MPH; ATUL MALHOTRA, M. S. A. S., PHD 2012. Repeated Melatonin Supplementation Improves Sleep in Hypertensive Patients Treated with Beta-Blockers: A Randomized Controlled Trial. Sleep, 35. 7. JONATHAN J. BASKETT, J. B. B., PHILIP C. WOOD, JOHN R. DUNCAN,MEGAN J. PLEDGER, JUDIE ENGLISH, JOSEPHINE ARENDT 2003. Does melatonin improve sleep in older people? A randomised crossover trial. Age and Aging, 32, 164-170. 8. P GRINGRAS, C. G., A P JONES , L WIGGS , P R WILLIAMSON , A SUTCLIFFE , P MONTGOMERY, W P WHITEHOUSE , I CHOONARA, A EDMOND, R APPLETON 2012. Melatonin for sleep problems in children with neurodevelopmental disorders: randomised doubl emasked placebo controlled trial. BMJ, 354. 9. LIIRA J, V. J., COSTA G, DRISCOLL TR, SALLINEN M, ISOTALO LK, RUOTSALAINEN JH 2014. Pharmacological interventions for sleepiness and sleep disturbances caused by shift work (Review). The Cochrane Collaboration. 10. VENKATARAMANUJAM SRINIVASAN, D. D. B., TIMO PARTONEN,RAHIMAH ZAKARIA,ZAHIRUDDIN OTHMAN 2014. The use of melatonin for treating sleep disorders in patients with Parkinson’s disease. ChronoPhysiology and Therapy, 51-57. 11. THOMAS ROTH 2007. Insomnia: Definition, Prevalence, Etiology, and Consequences. Supplement, 3 12. LUCIA MARSEGLIA, G. D. A., SARA MANTI, SALVATORE AVERSA , TERESA ARRIGO, RUSSEL J. REITER, ELOISA GITTO 2015. Analgesic, Anxiolytic and Anaesthetic Effects of Melatonin: New Potential Uses in Pediatrics. Int. J. Mol. Sci., 1209-1220. 13. SCHWAB, N. S. G. P. G. I. G. E. A.-S. E. M. R. 2010. Effectiveness of Ramelteon for Insomnia Symptoms in Older Adults with Obstructive Sleep Apnea: A Randomized Placebo- Controlled Pilot Study. Journal of Clinical Sleep Medicine, 6 14. ROSEANNE DEFRONZO DOBKIN, M. M., KARINA L. BIENFAIT, LESLEY A. ALLEN, HUMBERTO MARIN, AND MICHAEL A. GARA 2009. Ramelteon for the treatment of insomnia in menopausal women. Menopause Int., 15, 13-18. 15. JAMIE M. ZEITZER, B. K., DOUG OTA, B. JENNY KIRATLI 2014. Randomized controlled trial of pharmacological replacement of melatonin for sleep disruption in individuals with tetraplegia. The Journal of Spinal Cord Medicine, 37. 16. GIULIANA GALLI-CARMINATIA, N. D., GILLES BERTSCHY 2009. Melatonin in the treatment of chronic sleep disorders in adults with autism: a retrospective study. S W i S S M e d W k ly, 139, 293-296.

Alcoholism among Victorians Essay -- Victorian Era

Alcoholism among Victorians Wrayburn: â€Å"It will be necessary, I think, to wind up Mr. Dolls, before anything to any mortal purpose can be got out of him. Brandy, Mr. Dolls, or - ?† Mr. Dolls: â€Å"Threepenn’orth Rum.† --Our Mutual Friend by Charles Dickens Throughout Victorian society â€Å"gin was the preferred spirit of the lower class, while wine and brandy were imbibed by the more comfortable citizenry† (Alcoholic Beverages 12). During the nineteenth century, the Victorians had high expectations of their class system to make sure the classes were distinct and properly represented. They â€Å"valued controlled, propitious behavior† and would tolerate nothing less (Harding Victorians and Alcohol). There was a â€Å"cultural value placed on teetotaling,† total abstinence from alcoholic drinks, but despite this value â€Å"alcohol consumption became a popular pastime† (Harding Victorians and Alcohol). Behavior such as drunkenness was strongly disapproved of because of its association with the lower class. Alcoholism: Representation of the Working Class It was widely known that â€Å"drunkenness, and the related loss of self-control, was associated with the lower classes† and therefore had negative connotations (Harding Victorians and Alcohol). Spirits, a popular hard liquor, â€Å"had become the everyday drink for less wealthy people† and â€Å"laborers commonly used spirits to flee from their desolate everyday lives† (Harding Victorians and Alcohol). The awful working and living conditions of the working class contributed to their â€Å"hard, controlled, and monotonous life, [leading] to excessive drinking of hard liquor† (Harding Victorians and Alcohol). This excessive drinking would sometimes result in public intoxication which was â€Å"regarded as anti-s... ...ss, Inc. 1996. 12. Distad, Merrill N. â€Å"Food and Diet.† Victorian Britain: An Encyclopedia. New York: Garland Publishing, Inc. 1988. 304-307. Garwood, John. â€Å"Religious and moral Character of the Pensioners, and Provisions made for their Instruction.† Social Investigation/Journalism – The Million-Peopled City. (1853): 94-96. 11 Mar. 2005 Harding, Stephen. â€Å"Alcohol.† Victorians’ Secrets. â€Å"Absinthe and Victorians.† Victorians’ Secrets. 2000. University of Texas at Arlington. 24 Feb. 2005. Kent, Christopher A. â€Å"Drink.† Twentieth-Century Britain: An Encyclopedia. New York: Garland Publishing, Inc., 1995. 239-240. Murdock, Catherine Gilbert. Domesticating Drink: Women, Men, and Alcohol in America, 1870-1940 . Baltimore, MD: Johns Hopkins University Press, 1998.

Healing Hospital

Healing hospital paradigm is centered on the removal of stress and other health risks for the patients and their families in the hospital environment. Healing hospital paradigm is important because treating a patient’s illness is not the only intrinsic component when they are admitted to the hospital. A good example for this is stress. Stress can be brought about due to many things when a patient is in the hospital, for example painful treatments, financial problems due to being admitted, loss of social life etc.Reducing these sort of stressors may ensure that the patient’s wellbeing is being maintained and the comprehensive care Minimization of these stressors ensures that the patient’s well-being is maintained while the comprehensive care part of the treatment makes certain that the patient’s recovery process is done without breaking confidentiality. The healing hospital paradigm can also be looked as healing the whole patient rather than just curing the ailment (Young & Koopsen, 2006).According to Dr. Milstein, paradigm doesn’t only focus on healing the physical body but â€Å"it aims to enhance the overall well being by addressing the patient’s and their families’ cognitive, emotional and spiritual concerns† (Milstein, 2005). This paper will describe healing hospital paradigm, its impact on the process of care giving and its components expanding on it relationship with spirituality. Components of Healing HospitalBased on the paradigm of healing hospital, Caring for a patient is not limited to only medical interventions and medication but it also includes how the healthcare provider engages the patients and their families to the process of treatment. This theory is based on the notion that both spiritual and emotional wellbeing applies to physical wellbeing. The healing hospital comprise of three major components. The first component is the culture of radical loving care. This may include the kind of ca re the patient receives and the type of conditions he/she is exposed to in the hospital.This component focuses on making the patient comfortable and preparing the patient psychologically for the treatment they would receive. Caregivers most have compassion to meet the spiritual and emotional needs of a patient and not only their physical needs. They most be able to demonstrate loving care and show the patients that they are willing to go the extra mile for them. Being compassionate and showing love can help reduce the stress for the patients and their families, healthcare provides bring hope. The next component is the healing physical environment.The physical environment in which a patient is being treated is also very crucial in the treatment process (Samueli, 2010). Hospitals should be free of stressful disturbances for the patient and their families. This kind of disturbances may include dull settings, noise and disorganization. A good healing physical environment must be well or ganized and constructed. Evidence has shown that rest is an important part of a patient’s healing process, but many hospitals are noisy with pagers beeping here and there and lots of people talking along the hallways.A good healing physical environment should address these kinds of challenges. Other things such as lighting and temperature must be well regulated to keep the patient as comfortable as possible. The final component of healing hospital is the integration of technology with work design. Technology is intertwined into the healthcare field to help the healthcare team help their patients recover in a good environment. Technology allows the staff members to work efficiently and to work in a manner that maximizes the comfort of the patients.In a good healing environment, patients get more sleep which helps with their healing. Staff members are giving technological equipments such as cordless phones, vibrating pagers and dynamaps for blood pressure, and they are educated to use them efficiently to promote healing in a noise-free environment. These technological advancements help to create stress-free environment for the patients and helps reduce medical errors. The healing hospitals also use technology to provide satisfaction, security, decreased cost and privacy for the patients and their families.These are crucial in the psychological needs of the patient. Challenges of Creating a Healing Environment There are various challenges involved in implementing a good healing hospital environment. First and foremost, the advancement of technology (e. g. more tubes and more wires) has complicated healthcare and is dominating in that healthcare providers are forgetting the original essentials of healing such as the compassion and the loving care. If the balance between technology and compassion can bee implemented, the results of patient satisfaction will increase.Another challenge with technology advancement also focuses on the profits rather the compassi onate care of the patient. The next challenge is that there are a lot of similarities between prisons and hospitals. Patients’ clothing’s are replaced by gowns, their names with barcodes and identification numbers, there is no longer any intimacy and they share their living space with strangers. Even restriction in visiting hours can make an individual feel like a prisoner. This is all due to that fact that healthcare providers are suppose to their tasks with robotic precision.According to Chapman, the hospital system is a â€Å"bureaucracy† and it is â€Å"an organization that acts as machines and are difficult to work with† (Chapman, 2010). Another challenge is that some healthcare providers or even family members and patients could be cynics. Cynicism is damaging to the care of patients. Healthcare providers should not be skeptic to the fact that love is a vital part of a patient’s recovery. Finally, leadership is an important aspect of healing hospital paradigm. The leaders in a healthcare setting have the responsibility to make sure love and compassion is at the top of the list in their plan to care for a patient.Biblical Passage that Supports the Concept of Healing Hospital In psalm 107 verses 17-22, the message version, David wrote â€Å"then you called out to God in you desperate condition; he got you out in the nick of time†. Here he describes how God heals the sick when they call on him. The sick in this passage have faith and are not cynics or skeptics which is and important part of healing. David explained the reality, living a bad life could get you sick and having faith that you would get better can heal you. It’s all about the positivity. David went on saying â€Å"So thank God for his marvelous love, for his miracle mercy to the children he loves†.This goes on to show that God’s love brings healing. This passage supports the paradigm of healing hospital because it has to do with hea ling the overall person and God does that too. The healing hospital is gaining more popularity now because there are a lot of benefits to it. This care system helps to enhance the overall wellbeing of the patient and their relatives and not only their physical body. This paradigm focuses on compassionate care that helps patient with stress and coping mechanisms through spirituality. This will help the community at large and bring it solace and hope. ReferencesChapman, E. (2010). Radical loving care: building the healing hospital in America. Nashville, TN: Vaughn Printing. Milstein, J. (2005). A paradigm of integrative care: healing with curing throughout life, â€Å"being with† and â€Å"doing to†. Journal of Perinatology, 25, 563-568. doi: 10. 1038/sj. jp. 7211358 Samueli Institute (2010). Optimal Healing Environments. February 12, 2013. Retrieved from http://www. siib. org/news/280-SIIB/version/default/part/AttachmentData/data/OHE_final. pdf Young, C. , & Koopsen, C. (2006). Spirituality, health, and healing (1 ed. ). Sudbury, MA: Jones and Bartlett Publishers.