Post-Traumatic Stress Disorder in the Military Essay Example for Free

Post-Traumatic Stress Disorder in the Military Essay I.  Ã‚  Ã‚   Abstract Stoked by an adversarial media and the run-up to Presidential elections next year, the trauma afflicting our body politic often seems more important than the deaths, physical disability and post-trauma stress disorder that afflict servicemen on the frontlines. In this paper, I review the historical origins and verify the prevalence of what was whimsically called â€Å"soldier’s heart† in the Civil War and â€Å"disordered action of the heart† (DAH) or neurasthenia at the turn of the century and has now gained cognizance as â€Å"battlefield fatigue† or PSTD.    The etiology is vast, since combat stress seems to provoke a great many physical, physiological and anxiety-related disorders.   Lastly, I investigate the treatment options.   War is ever a violent business.   If the North-South Civil War shocked Americans with unheard-of casualty counts and the violence of battles waged at the dawn of the industrial age, World War I traumatized the world with the unremitting violence brought to bear in hopes of breaking the stalemate that was the Western front.   Poison gas, the machine gun, barbed wire, and massed artillery bombardment sent casualty counts sky high.   Besides the United States, 17 other countries on both sides of the â€Å"war to end all wars† suffered no less than 5.7 million soldiers killed and another 12.8 million wounded. Soldiers at the frontline were brutalized by the sheer violence of artillery bombardments, the random deaths these caused and the experience of seeing an unceasing number of their fellow soldiers slaughtered by gas or machine gun fire.   It was then that the nervous condition first termed â€Å"war neurosis† or â€Å"neurasthenia† manifested in great numbers.   Eventually, the equivalent term â€Å"shell shock† came into wider use. Combat stress reactions first came to the attention of the medical establishment (psychiatry was in an embryonic stage then) in the second half of the 19th century and early in the 20th when physicians came to recognize adverse reactions that had more to do with sustained exposure to battle conditions than any physical injury.   In retrospect, the Civil War condition then termed â€Å"soldier’s heart† was really a form of â€Å"combat stress reaction†. During the Boer War waged by the British in South Africa (1899-1902), due notice had already been given to either â€Å"disordered action of the heart† (DAH) or neurasthenia/shellshock.   Retrospective analysis of British soldiers who had been pensioned off for these conditions (Jones, Vermaas, Beech, Palmer, et al. 2003) found no especially significant difference in mortality compared to comrades who filed for disability owing to bullet or shrapnel wounds. The Russia-Japanese War of 1904 and 1905 gave Russian physicians their first reported exposure to, and the opportunity to try and treat, nervous breakdowns owing to the stress of warfare, compounded by the demoralization of losing to the Japanese. Later in the 20th century, the evolving nature of the battlefield and the enemy – World War II, the Vietnam War, the Iraq and Afghan occupations being the more prominent examples – created unexpected new sources of stress that complicated the combat fatigue syndrome and led to the broader â€Å"post-traumatic stress disorder† coming into wide use.   So whereas â€Å"combat fatigue† referred to â€Å"a mental disorder caused by the stress of active warfare†, â€Å"PTSD† revolved on post-combat â€Å"fatigue, shock or neurosis†. V.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Statement of the Problem: In this research paper, we review the available authoritative sources to assess: The continuing prevalence of PSTD in the varied conditions of modern warfare. Short- and long-term therapy employed to resolve the disorder. The extent to which familial and community support ameliorates PSTD and improves patient outlook. For a world that has experienced unremitting conflict since World War II, whether orthodox warfare, low-intensity conflict or insurgency, chances are that anticipating and providing therapy for stress disorders will be a continuing concern. VI.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Literature Review A.  Ã‚   The Character of Modern Conflict In the aftermath of the Great War many people believed that they had seen the most terrible war the world will ever see. History would prove them wrong. In the century that followed, war became even more traumatic and horrifying in its brutality. From the Russian civil war to the present conflict in Iraq, war took an ever-heavier toll on the human psyche. Technology improved the methods by which death might be delivered but it has done nothing to strengthen the minds of those who had to bear it. The Russian civil war that succeeded until after World War I was a horror to behold. Thousands died in the fighting between the White Russians and Red Russians. Thousands more froze in the winter for lack of appropriate gear. Worse, many civilians were murdered by both sides on mere suspicion of being collaborators. World War II was a litany of terrors. Whole societies were brainwashed into supporting the war from an ideological standpoint. Millions of Jews were gassed and burned in the holocaust simply being Jews. The SS, the KGB and the Kempetai would murder anyone at whim. Thousands of women were kidnapped and raped as â€Å"comfort women† by the Imperial Japanese Army. More than the individual or large-scale slaughter of men, the true horror of WWII was the torture it inflicted on societies. Entire cities were razed to the ground in terror bombing. Cities became prison cells where starving denizens were forced to labor endlessly. Men went off to war leaving women to tend the factories and leaving no one to care for the children. Then there was the Atomic Bomb. A scant few scores of thousands died. Both cities were leveled to the ground. The radioactive damaged would endure for years. Even those who tried to help the victims were themselves victimized by the radiation. In Korea and Vietnam, millions were fielded in grueling civil wars. Korean fought against Korean backed by Communist and Imperialist masters. The same would be true for Vietnam but with the inclusion of terrible chemical weapons that defoliated forests and would cause harm for generations to come.   In turn, the Viet Cong and Khmer Rouge executed savage campaigns against their own people. The Arab-Israeli and Iraq-Iran wars would institutionalize child-soldiery. Israel had a scant 4 million citizens to oppose over 200 million Arabs. When attacked by the Arabs, Israel would be forced to deploy all its manpower, along with women, to help fight off the invaders. Chemical weapons were also used. The Israelites were left to defend their small nation against all their neighbors. Iraq and Iran would field child soldiers in countless thousands. They would be given rifles then thrown into battle against hardened veterans in the hope of at least slowing down the enemy. Muslim killed each other over essentially religious disputes. But perhaps the worst war of the 20th century would be the War on Terror. In the past the enemy was a specific country or group of countries. If they bomb our territory we can bomb theirs. But today, the enemy is not a nation. Today, servicemen in Iraq or Afghanistan do not know where or when the enemy will strike. All they know is that the enemy is out there lurking amongst a hostile population. The war on terror also has another unsavory aspect. The ‘enemy’ resort to bombing civilian targets back home. Worse, the soldiers know that their victories will only make the enemy more desperate and make them retaliate more against innocent civilians. As if the violence of outright warfare and low-intensity conflict were not enough, American and British forces of occupation as well as the soldiers of every nation that serve in U.N. peacekeeping forces confront at least equal prospects of PTSD.   Whether in the Korean DMZ, the former Yugoslavia, Iraq, Afghanistan, Somalia, Lebanon, Ireland, or Timor, every soldier on such assignments faces a multitude of perils. In many cases, peacekeeping forces are in a low-intensity-conflict situation but hampered by rules of engagement that deny them the right to shoot first and shrug it off as a mistake.   The potential for battlefield fatigue climbs higher with alien cultures and religions, a seemingly ungrateful, resentful and even hostile native population, suicide attacks, well-armed guerillas, booby traps, mortar and improvised missile attacks.   Such occupying forces are also apt to lose the public relations war for being unable to stop factions from slaughtering each other such as happened in Iraq, Afghanistan, Israel, Lebanon, East Timor and Rwanda.   And perhaps the unkindest cut of all is when their own country’s media deliberately distort the casualty count from fratricidal or genocidal conflict as having been caused by the occupying or peacekeeping forces! B.  Ã‚   Incidence of â€Å"Shell Shock†, PTSD and Precipitating Events When â€Å"shell shock† came to be widely recognized in World War I, the initial hypothesis was that it was induced by an inordinate number of fatal casualties.   In fact, about 10% of all military forces then engaged succumbed on the battlefield, double the rate in World War II (less than 5%, in great part because the wide availability of sulfanilamide averted more deaths from battlefield infection).   Later came the realization that it was total casualty count that really mattered.   Historical research shows that around 56% of soldiers on the Western Front were either killed or wounded.   When every other fellow in one’s platoon gets hit, fatally or not, it is no wonder that stress casualties were as numerous as battle casualties. The term itself, â€Å"shell shock† reveals the ingrained belief that psychiatric casualties from the horrors of the battles of the Somme, Marne, Ypres, etc. had suffered concussion (physical trauma to the head or brain) from a close call with an exploding artillery shell.   Nearly a decade elapsed before a British War Office Committee realized (Military History Companion, 2004) that battle exhaustion and other varieties of war neuroses accounted for a far greater proportion of cases than concussion did. Great Britain having entered the fray early, the numbers of servicemen afflicted with â€Å"shell shock† and assorted neuroses were significant. By 1939, some 120,000 British ex-servicemen had received final awards for primary psychiatric disability or were still drawing pensions – about 15% of all pensioned disabilities – and another 44,000 or so †¦ were getting pensions for ‘soldier’s heart’ or Effort Syndrome. (Shephard, 2000) In the post-World War II era, the Vietnam war can be counted the most traumatic for the U.S. military, not least because of the failure to achieve a clear-cut victory and the dissatisfaction of the American public with a war that dragged on so long.   Since the fall of Saigon in 1975, estimates of the long-term incidence of â€Å"post-Vietnam syndrome† (now recognized as PTSD) among veterans varied from a high of 30% in 1989 and a slightly lower 21% in 1996 (Allis, 2005). The most authoritative review in recent years, by researchers from Columbia University and other institutions, suggested that the lower end of the range was the more realistic figure: nearly 19 percent of Vietnam War veterans succumbed to PTSD as a direct result of military combat.   In addition, The more severe the exposure to war zone stresses, the greater the likelihood of developing post-traumatic stress disorder and having it persist for many years, said Bruce P. Dohrenwend, an epidemiologist at Columbia University. (McKenna, 2006). Fast forward to the current occupation of Iraq.   The Defense Department reports, based on a sample survey of over 1,600 Army soldiers and Marines, that around one-third (30 percent) of those who had been in â€Å"intense combat† were diagnosed with such mental health problems as PTSD and depression.   Incidence appeared higher among soldiers deployed to Iraq at least twice and for more than six months at a time (Bookman, 2007).   So distressing is the occupation, according to an Army study, that one in six of close 1 million soldiers â€Å"surged† to Afghanistan and Iraq will very likely be afflicted with PTSD (Allis, op. cit.). The reality turned out to be worse.   Even more appalling estimates of incidence were reported by what has to be the most thorough accounting of the prevalence of post-traumatic stress disorder (PTSD) and conditions resembling chronic fatigue syndrome (CFS), a survey by Kang, Natelson, Mahan, Lee, Murphy (2003) on the entire population of 15,000 Gulf War and 15,000 non-Gulf-War veterans.   Information was gathered in 1995-97. Gulf War veterans reported significantly higher incidence of PTSD (adjusted odds ratio = 3.1, 95% confidence interval: 2.7, 3.4) and CFS (adjusted odds ratio = 4.8, 95% confidence interval: 3.9, 5.9). Furthermore, â€Å"the prevalence of PTSD increased monotonically across six levels of deployment-related stress intensity (test for trend: p 0.01). Back home, the Department of Veterans Affairs reported on an investigation of principally Persian Gulf War veterans (79%) who had availed of the National Referral Program (NRP) and visited war-related illness and injury study centers meant for combat veterans with unexplained illnesses . Over the period from January 2002 to March 2004†¦ The more common diagnoses were chronic fatigue syndrome (n = 23, 43%), neurotic depression (n = 21, 40%), and post-traumatic stress disorder (n = 20, 38%). Self-reported exposures related to weaponry†¦ environmental hazards, stress†¦A small increase in mean SF-36V mental component scores (2.8 points, p = 0.009) and use of rehabilitation therapies (1.6 additional visits, p = 0.018) followed the NRP referral (Lincoln, Helmer, Schneiderman, Li, et al. 2006). The political furor over U.S. deployment in the Middle East has led to permutations, including what Baker (2001) refers to as â€Å"Gulf War Illness†.   The more combat exposure they had had, the greater the likelihood that veterans manifest depression, PTSD, fibromyalgia, anxiety, and have generally poorer â€Å"health-related quality of life†. For the British, a more sanguine view about involvement in Iraq may explain a finding that deployment to that strife-torn arena does not necessarily lead to increased risk of PTSD. Simon Wessely of the Kings Centre for Military Health Research at Kings College London reports that there is no evidence of anything like an Iraq war syndrome and that British troops returning from deployment were no more likely than U.K.-based soldiers to succumb to PTSD, anxiety or depression (New Scientist, 2006).   Wessely seemed heartened by the fact that PTSD casualties this time around were significantly lower than during the earlier, even less controversial Persian Gulf War of 1991. He also explained the advantage vis-à  -vis incidence of around 20% for U.S. troops on three facts.   First of all, British troops are more battle-hardened. Two-thirds of British troops have been in deployments elsewhere, compared with only 10 per cent of US troops.   Secondly the US also uses more reservists (in the form of National Guard units) and has responsibility for the worst of the hostile combat zones.   To an outside observer, the adversarial stance of the U.S. press and the inability of the American public to withstand sustained conflicts not amenable to victory over a visible enemy also count as contributing factors. It would take an Englishman to look into the topic but tongue-in-cheek analysis by Ismail et al. (2000) of U.K. Gulf War veterans revealed that the chances of falling prey to PTSD are greater with lower rank (and, presumably, lower social status) and if one leaves the service. Some research has shown that, far from being a steady state or amenable to permanent remission, PTSD has a way of recurring with the re-occurrence of the original precipitating factors or other less specific pressures, such as with serious illness or the sudden lifestyle change of retirement.   In Israel, reactivation is a constant possibility owing to the fact the nation is always in a state of war with recalcitrant enemies so this potential trigger has come under scrutiny (Nachshoni Singer, 2006).   Case studies suggested that PTSD can recur even when the call to duty is for a family member. C.  Ã‚   Symptomatology In World War I, â€Å"shell shock† was observed principally as nervous fatigue.   The famous photograph (see Figure 1, above) of a patient manifesting the â€Å"thousand-yard stare† became the enduring image of intolerable combat stress: glassy-eyed fatigue, slow reactions, indecisiveness, being detached from one’s immediate surroundings, and a certain vagueness about that needed doing first. So great were the numbers afflicted and so vividly did the novel phenomenon manifest itself that even the popular press in the U.K. could accurately report the symptoms of battle trauma: â€Å"Something was wrong. They put on civilian clothes again and looked to their mothers and wives very much like the young men who had gone to business in the peaceful days before August 1914. But they had not come back the same men. Something had altered in them. They were subject to sudden moods, and queer tempers, fits of profound depression alternating with a restless desire for pleasure. Many were easily moved to passion where they lost control of themselves, many were bitter in their speech, violent in opinion, frightening. (Shephard, op. cit.) The unfortunate circumstance of decades of unending small-scale conflict and insurgency campaigns post-World War II have enabled military psychiatrists to more fully define three key facets of combat neurosis and PTSD: fatigue, psychosomatic manifestations and neurotic symptoms. Fatigue is the common denominator behind indecision and inability to concentrate, memory loss, constant waffling about priorities, little initiative, significantly slowed reaction time, seriously downgraded alertness and thought processes, taking refuge in obsessing and nitpicking unimportant details, and, most telling of all, difficulty with even routine tasks. The element of neurosis crops up as fearfulness, anxiety, irritability, depression, confusion, paranoiac tendencies, fear of loss of control, and self-destructive behavior such as substance abuse or suicide. Consequently, PTSD patients manifest the entire spectrum of somatically-induced disorders: headaches, backaches, (see also Mayor, 2000) being constantly high-strung, shaking and tremors, sweating, nausea and vomiting, loss of appetite, abdominal distress, frequency of urination, urinary incontinence, palpitations, hyperventilation, dizziness, muscle and joint pain (see also Ricks, 1997),   insomnia and other sleep disorders.   Barrett et al. (2002) found this psychosomatic explanation incomplete.    In a telephone survey of 3,682 Gulf War veterans and control subjects of the same era, the authors revealed that â€Å"Veterans screening positive for PTSD reported significantly more physical health symptoms and medical conditions than did veterans without PTSD. They were also more likely to rate their health status as fair or poor and to report lower levels of health-related quality of life.† D.  Ã‚   Long-term Effects No doubt, psychosomatic disorders are of a piece with another syndrome physicians like to point to chronic multisymptom illness (CMI).   Building on earlier studies that demonstrated CMI being more common among veterans who deployed to Saudi Arabia and Kuwait in contrast with those who had never participated in that campaign, Blanchard, Eisen, Alpern, Karlinsky, Toomey, Reda, Murphy, Jackson and Kang (2006) set out to assess the situation ten years after deployment and found that veterans were twice as likely to develop CMI: Cross-sectional data collected from 1,061 deployed veterans and 1,128 nondeployed veterans examined between 1999 and 2001 were analyzed. CMI prevalence was 28.9% among deployed veterans and 15.8% among nondeployed veterans (odds ratio = 2.16, 95% confidence interval: 1.61, 2.90). Blanchard et al. noted that those who did suffer from CMI had already been diagnosed for anxiety and depression unrelated to PTSD prior to 1991.   Common CMI manifestations comprised frank medical symptoms, metabolic and psychiatric disorders.   And those afflicted were more likely to smoke, besides reporting distinctly inferior quality of life. M Hotopf, Anthony S David, Lisa Hull, Vasilis Nikalaou, et al. (2003) carried out one of the more comprehensive and authoritative studies of long-term effects, a two-stage cohort study on British soldiers who had deployed during the 1991 Persian Gulf War or on peacekeeping duties in Bosnia. The study relied on four instruments: â€Å"self reported fatigue measured on the Chalder fatigue scale; psychological distress measured on the general health questionnaire, physical functioning and health perception on the SF-36; and a count of physical symptoms.†Ã‚   Military personnel who had been deployed elsewhere served as control group. Table 1 Prevalence of Categorical   Outcomes (Values are percentages [.95 CL] unless otherwise indicated) Gulf Bosnia Era Stage 1 Stage 2 Ratio* (new cases/recovered cases) Stage 1 Stage 2 Ratio* (new cases/recovered cases) Stage 1 Stage 2 Ratio* (new cases/recovered cases) Fatigue cases 48.8 (45.4 to 52.2) 43.4 (39.9 to 46.8) 0.65 (0.45 to 0.85) 29.0 (25.6 to 32.4) 32.7 (28.6 to 36.8) 1.21 (0.83 to 1.59) 22.8 (20.0 to 25.6) 22.0 (18.6 to 25.4) 0.91 (0.56-1.26) Post-traumatic stress reaction cases 12.4 (10.7 to 14.2) 10.8 (9.1 to 12.5) 0.73 (0.47 to 0.99) 5.7 (4.0 to 7.4) 6.0 (4.2 to 7.8) 1.07 (0.49 to 1.65) 4.0 (2.6 to 5.3) 6.6 (4.8 to 8.4) 2.45 (0.88-4.02) General health questionnaire cases 40.0 (36.8 to 43.2) 37.1 (33.8 to 40.4) 0.79 (0.59 to 1.00) 29.2 (25.5 to 32.9) 31.5 (27.4 to 35.6) 1.25 (0.84 to 1.67) 25.3 (21.7 to 28.9) 23.8 (20.1 to 27.6) 0.88 (0.56-1.20) Self reported Gulf war syndrome 18.6 (16.2 to 21.1) 15.8 (13.3 to 18.2) 0.58 (0.25 to 0.90) All prevalence estimates are weighted for sampling. * Values of 1 indicate declining prevalence. Ratios are weighted for sampling. Gulf veterans evinced a higher prevalence of fatigue, post-traumatic stress reaction, self-reported Gulf War syndrome and general health compared to the other two cohorts. The difference is consistent throughout stages 1 and 2. However, the veterans in question did show some improvement on all four measures over time. Table 2 Scores (.95 CL) for Continuous Measures, by Cohort and Stage Gulf Bosnia Era Stage 1 Stage 2 Difference Stage 1 Stage 2 Difference Stage 1 Stage 2 Difference SF-36* physical function 90.3 (88.3 to 91.3) 88.7 (87.6 to 89.9) -1.6 (-2.5 to -0.7) 95.4 (94.4 to 96.4) 92.9 (91.6 to 94.1) -2.6 (-3.8 to -1.3) 92.1 (90.6 to 93.6) 90.8 (89.2 to 92.3) -1.3 (-2.7 to 0.1) SF-36* health perception 65.8 (64.1 to 67.5) 65.9 (64.2 to 67.6) 0.1 (-1.2 to 1.4) 76.2 (74.4 to 77.9) 72.9 (71.0 to 74.8) -3.3 (-5.1 to -1.6) 76.8 (75.0 to 78.6) 74.4 (72.4 to 76.4) -2.4 (-4.2 to -0.6) General health questionnaire 14.5 (14.1 to 14.9) 14.2 (13.8 to 14.5) -0.3 (0.1, -0.6) 13.1 (12.7 to 13.6) 13.2 (12.7 to 13.7) 0.1 (-0.4 to 0.6) 12.4 (12.0 to 12.8) 12.9 (12.5 to 13.3) 0.5 (0.05 to 1.0) Fatigue 17.8 (17.4 to 18.1) 16.9 (16.5 to 17.2) -0.9 (-1.2 to -0.6) 15.6 (15.2 to 16.0) 15.3 (14.9 to 15.7) -0.3 (-0.7 to 0.2) 14.7 (14.3 to 15.0) 14.9 (14.5 to 15.3) 0.2 (-0.2 to 0.6) Total symptoms 11.0 (10.4 to 11.6) 10.7 (10.1 to 11.3) -0.3 (-0.8 to 0.1) 6.2 (5.6 to 6.8) 7.9 (7.3 to 8.5) 1.7 (1.2 to 2.3) 5.3 (4.8 to 5.8) 6.4 (5.8 to 7.0) 1.1 (0.6 to 1.6) All scores are weighted for sampling. For SF-36 scores, negative differences in mean indicate a worsening in health. For other scales, negative scores indicate an improvement in health. * SF-36 scales range from 0-100, with higher scores indicating better health.   Table 3- Incidence and Persistence of Outcomes. (Values presented with 0.95 CLs) Incidence Persistence Cohort Risk Crude odds ratio Corrected odds ratio* Risk Crude odds ratio Corrected odds ratio* General health questionnaire cases: Gulf 20.2 (16.4 to 24.0) 1.0 1.0 61.8 (57.3 to 66.3) 1.0 1.0 Bosnia 21.2 (16.7 to 25.8) 1.1 (0.7 to 1.5) 0.9 (0.6 to 1.4) 58.9 (51.9 to 65.8) 0.9 (0.6 to 1.1) 1.1 (0.7 to 1.6) Era 15.4 (11.4 to 19.4) 0.7 (0.5 to 1.1) 0.7 (0.5 to 1.1) 48.4 (41.0 to 55.9) 0.8 (0.6 to 1.1) 0.6 (0.4 to 0.8) Fatigue cases: Gulf 18.8 (14.4 to 23.1) 1.0 1.0 69.7 (66.4 to 73.0) 1.0 1.0 Bosnia 19.8 (15.1 to 24.4) 1.1 (0.7 to 1.6) 0.9 (0.6 to 1.5) 59.9 (54.2 to 65.6) 0.6 (0.5 to 0.9) 0.7 (0.5 to 1.0) Era 11.2 (7.5 to 15.0) 0.6 (0.3 to 0.9) 0.5 (0.3 to 0.9) 58.2 (53.1 to 63.4) 0.6 (0.5 to 0.8) 0.7 (0.5 to 0.9) Post-traumatic stress reaction cases: Gulf 5.0 (3.6 to 6.4) 1.0 1.0 51.8 (44.8 to 58.9) 1.0 1.0 Bosnia 4.0 (2.5 to 5.5) 0.8 (0.5 to 1.3) 0.8 (0.4 to 1.5) 38.9 (24.3 to 53.3) 0.6 (0.3 to 1.2) 0.8 (0.4 to 1.8) Era 4.6 (3.0 to 6.2) 0.9 (0.6 to 1.5) 0.9 (0.5 to 1.5) 54.8 (37.8 to 71.9) 1.1 (0.5 to 2.4) 1.2 (0.6 to 2.7) * Controlled for demographic variables (age, sex, rank, marital status). Comparing scores for continuous measures, one sees that Gulf War veterans were less healthy at both stages of the longitudinal study, though they were stable as far as health perceptions were concerned and reported a statistically-significant, if slight, reduction in fatigue. One concedes that physical functioning declined for all three cohorts. Additionally, Gulf veterans were more likely to experience persistent fatigue compared with the Era and Bosnia cohorts, a finding that remained significant after controlling for potential confounders (P = 0.009). Overall, despite being less likely to manifest less fatigue (48.8% at stage 1, 43.4% at stage 2) and a lower prevalence of psychological distress (40.0% stage 1, 37.1% stage 2) over time, veterans of the Gulf War reported a decline in physical function on the SF-36 (90.3 stage 1, 88.7 stage 2).   By all measures used, this group also attested to worse health indicators: a higher incidence of illness and more persistent symptoms. Twelve years after helping smash the Iraqi incursion into Kuwait, the authors concluded, â€Å"Gulf war veterans continue to experience symptoms that are considerably worse than would be expected in an equivalent cohort of military personnel. However, Gulf war veterans are not deteriorating and do not have a higher incidence of new illnesses† (Hotopf et al., op. cit.) E.  Ã‚   Treatment Recommendations and Best Practice 1.  Ã‚  Ã‚  Ã‚  Ã‚   World War I Since little is known about the methods Russians used to treat their shock casualties during the Russo-Japanese War, the noted English psychologist Charles Myers – first University Lecturer in Cambridge (for the course Experimental Psychology) and appointed Consulting Psychologist to the Army in 1916 – is generally credited with the first systematic effort to treat PTSD (Bartlett, 1937). While espousing the benefits of a congenial environment, psychotherapeutic regimens and even hypnosis, Myers was very emphatic about the value of providing succor as promptly as possible.   Key to his proposals, therefore, was the establishment of special centers and rest homes close to the frontlines. By Christmas 1916, two developments led to modifications of Myers’ preferred regimen.   First, the British Adjutant General resisted physicians’ opinions that a soldier was a shock casualty and insisted on obtaining a certification from the victim’s commanding officer to the effect that the trauma was due to physical causes.   This attitude was shared by the eminent British neurologist Sir Gordon Morgan Holmes, CMG CBE FRS, who was put in charge of the very active northern part of the front in December.   Physicians reacted to the delays in committing victims to neurological centers by sending the men back to their units and urging their superiors to both monitor and engage with them. By 1917, therefore, treatment for â€Å"not yet diagnosed nervous† (NYDN) had evolved to embrace the so-called â€Å"PIE principles†: Proximity – treatment close to the front and within earshot of the fighting to convince the soldier there was nothing wrong with him; Immediacy treat without delay and give equal priority with wounded casualties; and, Expectancy – assure all victims of their return to the front after due rest and recovery. Reviewing the CSR toll after the war, the British War Office saw fit to recommend treatment programs that included: Physical therapy – baths, application of mild electric current (recall that medicine has advanced greatly in the eight decades since then), massage rest and general recuperation; Psychotherapy emphasizing â€Å"explanation, persuasion and suggestion†; and, Crafts and hobbies; Hypnotherapy in selected cases for inducing deep sleep and evoking repressed memories. As a rule, the British view of the time was weighted toward returning the afflicted soldier to useful employment in civilian life.   For the military establishment was gravely concerned about the battlefield dangers of patients who manifested severe anxiety neuroses, other neuroses that required confinement in a mental institution or expert treatment back in the U.K itself. Exhaustive research on combat stress reactions in the intervening years failed to prove conclusively that PIE-based programs were effective in forestalling PTSD (U.S. Dept of Veterans Affairs, n.d.).   Hence, American Armed Forces are now more likely to be administered some variation of the BICEPS model: Brevity Immediacy Centrality or Contact Expectancy Proximity Simplicity 2.  Ã‚  Ã‚  Ã‚  Ã‚   World War II The catastrophic experiences of World War I did not   seem to adequately inform or pervasively improve Allied preparations as war clouds loomed in Europe.   A generation had passed and British army doctors had generally served in France in the earlier conflict.   Still, Shephard notes (op. cit.), they initially floundered about and it was not until 1942 that the first psychiatric hospital was even set up (for the then-beleaguered Middle East Force).   When the time came to invade Normandy in June 1944, British army physicians quickly forsook the expectancy principle and routinely returned battle trauma patients home over the Channel. For their part, the Americans initially imposed rigid screening pressures for mental ability in the rush of patriotic fervor that followed Pearl Harbor.   Soon enough, this was abandoned for having no validity.   Too many who tested well succumbed to â€Å"battlefield exhaustion†.   In late 1943, the U.S. military approved a plan to add a psychiatrist to the T.O. E. of every Army division shipping overseas but it was not implemented until March 1944, when the drive up the Italian â€Å"boot† was well underway. This late in the war, nonetheless, the Allies made an important discovery: camaraderie and unit cohesion were effective shields against â€Å"exhaustion†.   This finding naturally enough placed a premium on strong, effective leadership. The Germans were more unequivocal in placing great reliance on the quality of the officer corps.   In their view, the â€Å"war neuroses† that sapped the will of their fighting men was tantamount to cowardice and deserved to be treated as such.   Beginning in 1942, however, when the Allies started the counterattack and the Afrika Korps was stymied, hospitalizations owing to battlefield trauma became too numerous to ignore (Belenky, 1987). 3.  Ã‚  Ã‚  Ã‚  Ã‚   New approaches in the Post-War Period Among other developments, the Israelis simplified PIE procedures by heightening the degree of support administered but keeping therapeutic confinement short.   That this works at all is testimony to a nation of citizen-soldiers who must keep the economy working while perpetually staying on a war footing. F.  Ã‚  Ã‚   Treatment Success Rates There is some evidence that proximal treatment is successful   Despite the dual stress of fighting another occupying force, the Syrian Army, and Palestinian â€Å"refugees†, nine in ten CSR were reported fit to return to their units within three days but only 40% for those evacuated to a hospital ship cruising the eastern Mediterranean or back home (Gabriel, 1986).   In turn, the U.S. Army claims in its manual â€Å"Combat Stress Control in a Theater of Operations† a similar success rate for proximate treatment (85%) in the Korean War (U.S. Army, Combat Stress Control in a Theater of Operations, n.d.).   However, neither source tracked the long-term mental health of these soldiers, precisely the context in which one would expect PTSD to manifest. A ray of hope is, however, cast by an authoritative Columbia University study (McKenna, op. cit.) suggesting that the majority of Vietnam war veterans spontaneously recovered from PTSD over time, frequently without having recourse to treatment from mental health professionals. VII.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Conclusions This review of the literature affirms that the advent of combat stress went hand-in-hand with the advent of industrial-era weaponry (in the Civil War) and mechanized warfare in succeeding conflicts.   PTSD has many manifestations, can recur without warning and is certainly debilitating. Even with the advent of psychotherapy, occupational therapy and tranquilizers, treatment centers still purvey variations on the BICEPS and PIE theoretical models, the latter developed by British physicians during World War I.   There remains a great deal of uncertainty about the proximity component of the PIE model – returning the soldier to combat – after suffering CSR.   It seems battlefront physicians take â€Å"successful cure† to mean being able to return warm bodies to the frontlines.   Critics assert that re-exposure to combat is likely to aggravate matters in the future and perhaps even precipitate PTSD altogether.   Though the longest available cohort study spanned just 10 years, there is no question now that PSTD has long-term effects. Future researchers need to investigate more thoroughly the psychosocial, military, and environmental risk factors that stimulate onset or, on the other hand, recovery.   One factor that bears investigation in-depth is the impact of victory or setbacks in a campaign. To the extent that high morale and good leadership have been shown to have a moderating or even protective effect, one wonders what are the effects of fighting for survival (e.g. Israel), of community and country united behind a war effort (the Korean War, the Malayan emergency), of service in prior conflicts (the British SAS), of guilt and angst over being the globe’s last remaining policeman, and of coping with feudal cultures whose people are just as willing to apply savage tactics against U.S. servicemen as against each other.   At the very least, further research might seek to determine the impact of attainable victory in sharp contrast with the ennui and self-destructive impatience over protracted conflict that mark American discourse today.   VIII.  Ã‚  Ã‚   References Allis, S. Globe Staff (2005). â€Å"Frontline† examines wars psychological toll  :[THIRD Edition]. Boston Globe, p .E.5. Baker, D. G. (2001). Diagnostic status and treatment recommendations for Persian Gulf War Veterans with multiple nonspecific symptoms.  Military Medicine,166(11), 972-81. Barrett, D. H, Doebbeling, C. C., Schwartz, D. A, Voelker, M. D, et al.  (2002). Postraumatic stress disorder and self-reported physical health status among S. military personnel serving during the Gulf War period: A population-based study. Psychosomatics,43(3),  195-205. Bartlett, F.C (1937). Cambridge, England, 1887-1937. American Journal of Psychology 50, 97-110. Belenky, G. (1987) Contemporary studies in combat psychiatry: (Contributions in military studies). Westport, CT: Greenwood Press. Blanchard, M.S. Eisen, S. A., Alpern, R. Karlinsky, J. Toomey, R., Reda, D. J. et. al. (2006). Chronic multisymptom illness complex in gulf war I veterans 10 years later. American Journal of Epidemiology,  163(1),  66-75. Bookman, J. (2007,  May  9). OUR OPINIONS: War strains troops, U.S. credibility  :[Main Edition].  The Atlanta Journal Constitution, A.14. Brits less fazed by iraq war.  (2006,  May). New Scientist,190(2552),  7. FM8-51: Combat Stress Control in a Theater of Operatio ns US Army Publication. Ismail K.,   Blatchley N.,   Hotopf, M.,   Hull L.,   et al.  (2000). Occupational risk factors for ill health in Gulf veterans of the United Kingdom.  Journal of Epidemiology and Community Health,54(11),  834-8. Lincoln, A. E., Helmer, D.A., Schneiderman, A. I., Li, M. et al. (2006). The war-related illness and injury study centers: A resource for deployment-related health concerns. Military Medicine, 171(7), 577-85. Gabriel, R.A., Ed. (1986) Military Psychiatry. Hotopf, M., David, A.S., Hull, L., Nikalaou, V., et al. (2003) Gulf war illness-Better, worse, or just the same? A cohort study. British Medical Journal. (International edition). London: Dec 13, 2003. Vol. 327, Iss. 7428; pg. 1370. Jones, E., Vermaas, R.H., Beech, C., Palmer, I. et al.  (2003). Mortality and postcombat disorders: U.K. veterans of the boer war and world war I.  Military Medicine,168(5),  414-8. Kang , H. K., Natelson, B. H.,   Mahan, C. M., Lee, K. Y.,   Murphy, F. M..  (2003). Post-traumatic stress disorder and chronic fatigue syndrome-like illness among gulf war veterans: A population-based survey of 30,000 veterans.  American Journal of Epidemiology,157(2),  141. Mayor, S. (1997). Gulf war research given go ahead.  British Medical Journal,314(7074),  95. Mckenna, Phil (2006). Stress syndrome affected one in five Vietnam veterans. (August 21) Boston Globe, C.3. Military History Companion (2004) The Oxford Companion to Military History. Oxford: Oxford University Press. Nachshoni, T. Singer, Y. (2006). Reactivation of combat stress after a family members enlistment. Military Medicine, 171(12), 1211-4. Ricks, T. E. (1997). Many military officers say gulf war syndrome results from the stress of war, not chemicals. Wall Street Journal (Eastern Edition), p. A14. Shephard, B (2000). A War of Nerves. Cambridge: Cambridge UP. United States Department of Veterans Affairs Treating Survivors in the Acute Aftermath of Traumatic Events.

Food Safety Management Strategies

Food Safety Management Strategies Food Issues Abstract The following essay on food safety will discuss about the importance of food safety and why governments and food standards agency now a days focus on the devastating consequences of food borne illness and diseases. It will deal with food poisoning and its risks. Apart from it the most common types of pathogens (salmonella, e coli, and campylobacter) have been mentioned describing the outbreaks. The main thing is that all the above-mentioned things have been explained here with a focus on the food safety management. Some of the tools such as irradiation and specially HACCP (Hazard Analysis and Critical Control Points) to support hospitality management have also occupied some space here with its importance. As a final point, it has been thought to be practical to examine the solution with recommendations for practical adoption for the hospitality industry to deal with the complexity and cost of the above food safety management tools Introduction The world is full of various kinds of problems and it is true that everyday efforts are made to find out solution to these problems and some of them are sorted out too. Among the issues concerned directly with the human survival, which are posing a very big challenge in front of the world, one is the issue of food safety. According to Nestle 2004, food ‘poisonings, causing death, raise alarm not only about the food served in restaurants and fast-food outlets but also about the food bought in supermarkets. Consumers, industries as well governments are together taking food safety as a serious issue. There is a saying â€Å"health is wealth† and any carelessness which may cause food poisoning or any problem like this may lead to a very fatal consequence, so it becomes essential to take necessary food safety measures. To make sure food is safe to eat the Food Standards Agency carries out a range of work, including funding research on chemical, microbiological and radiologica l safety, as well as food hygiene and allergy.. As Griffths 2000 says, the food chain, like any other chain, is only as strong as its weakest link and the responsibility for food safety lies not only with producers and processors of food, but also governments and consumers themselves. Food Poisoning its risks Food is essential to life but if contaminated can cause illness and even death. But fortunately only in a minority of cases the latter happened although there is social and economic consequences associated with the millions of cases of food related illness. The WHO definition embraces all food and waterborne illness regardless of the presenting symptoms and includes â€Å"any disease of an infectious or toxic nature caused by, or thought to be cause by, the consumption of food or water† (Griffith 2006). Food borne disease therefore includes illness caused by various chemical, physical or microbiological hazards, which may be present in food or water. Anything that interferes with the safe foods is a food hazard (Hemminger, 2000) which can be present in the product that can cause harm to the consumer either through illness. Biological hazards include food borne infection which occurs eating something with live germs inside them. On the other hand it also consists of food intoxication occurring when a person eats something with bacteria- produced poisons that wont be killed by heating. The agents causing these food infections are bacteria, toxins, virus, parasites and fungi. Current food trends reveal that more and more frequently today we buy pre-prepared ready-to eat convenience foods, dine out in restaurants and cafà ©s, prefer fresh over frozen products and have a growing demand for foods of animal origin. While this gives us many new choices in the food we eat, this vast selection of foods we expect to be available to us â€Å"now† has possibly created a greater risk of bacterial food poisoning. Germs or bacteria grow in the food themselves when people dont store it properly or handle with care. Even in the fridge, the food may get bacteria. Food poisoning bacteria are often present naturall y in food but usually only in small numbers. However, given the right conditions their numbers can increase extremely quickly, so that 1 single bacteria could multiply to over 16 million in only 6 hours. This is where the food poisoning problem begins. As Eley 1996 says, some food poisoning is of mild level and some is strong level. Accordingly the food affects the human body and causes health problems while sometimes it result to be fatal too. For food poisoning to occur there must be bacteria or their toxin present in the food. Secondly the food must be suitable for organisms growth. There must be right conditions of warmth and moisture for the bacteria to grow while with sufficient tome for bacteria to grow and multiply. Adding above all there must be enough bacteria or their toxin present to cause present to cause illness and the food should be consumed. This is commonly called the food poisoning chain which is diagrammed below. (resources.ccc.govt.nz) Food Poisoning Bacteria Contaminate High Risk Foods . HIGH RISK FOODS Common Pathogens (in the Hospitality Industry) The three principle food poisoning pathogens that are dealt with that might affect the hospitality industries are Salmonella, E-coli and Campylobacter. Salmonella is usually heard of in the catering industry with reference to chicken and eggs. Some pets like birds and turtles also carry this Salmonella. The most appalling thing about it is that it can even go into the lymph tracts, which are known for tracking water and protein to the blood, and the blood itself. Thus it may cause some serious complications too. The main symptoms associated with the disease salmonellasis are fever, nausea, vomiting, diarrhoea, cramps, and headache. Time frame lasts for 12-36 hrs normally 4-7 days. The prevention could be to chill food quickly, using pasteurized milk and egg products. Raw and cooked cross-contamination should be avoided and equipment should be sanitized properly. Escherichia coli (E. coli) belong to the host of bacterial germs and is mainly found in beef. However, its dangerous relative, E.Coli 0157 H7, only appeared in the 1970s, perhaps coevolving in Argentina or Chile, two cattle raising countries with a high meat diet. E Coli 0157 is a mutant form which lives in the intestines of some cattle, sheep and goats but is not naturally found in the intestines of man but it can produce toxins which can be very fatal even if ingested in small amounts. It was first recognised as a pathogen in 1982 as a result of outbreak of unusual gastrointestinal illness. The illness was traced to contaminated hamburgers and it was similar to the other outbreaks in Japan and America. Among other known sources of infection are eating of vegetables like sprouts, lettuce, salami,unpasteurized milk and juice, and swimming in or drinking sewage-contaminated water. In September 2006, there was an outbreak of food-borne illness caused by Escherichia coli (E. coli) bacteria found in uncooked spinach in 26 U.S. states. By October 06, 2006 199 people had been infected, including three people who died and 31 who suffered a type of kidney failure called hemolytic uremic syndrome[3] after eating spinach contaminated with the E. coli O157:H7. A subsequent outbreak, in November-December 2006, was initially attributed to green onions served by two restaurant chains — Taco Bell and Taco Johns — but later was determined to have been caused by prepackaged iceberg lettuce. Overall, at least 276 consumer illnesses and 3 deaths have been attributed to the tainted produce. (en.wikipedia.org) Among the most recent outbreaks of E Coli 0157 in U.K. was in August 2009 which lead to severe illness in a number of visitors to Godstone Farm in Surrey. It was reported by the Health Protection Agency (HPA) that the total number of cases of E Coli O157 linke d to Godstone Farm in Surrey is 86 ( www.ecoli-uk.com). Campylobacter bacteria differ from E.Coli and Salmonella as it is a food-borne pathogen, as opposed to a food poisoning pathogen and is transmitted by food. In contrast with food poisoning bacteria it does not develop and multiply in food. However only a few bacteria are required to cause illness, with the food acting as the vehicle of transmission. This bacteria is found on poultry, cattle, and sheep can contaminate meat and milk of these animals. Symptoms occur are severe vomiting, diarrhoea, cramps and prostration. Time frame is usually 2-4hrs and lasts for 2-3 days. This can be prevented by keeping hot food and cold food cold while washing hands properly. Appendix A provides the various causes and symptoms of the pathogens that can impact on the hospitality industry. FOOD SAFETY MANAGEMENT TOOLS Food Irradiation its costs Food irradiation is a processing technique that exposes food to electron beams, X-rays or gamma rays, and produces a similar effect to pasteurization, cooking or other forms of heat treatment, but with less effect on look and texture (www.food.gov.uk). It is used to kill bacteria listed above like Salmonella, Ecoli, and campylobacter. Irradiation stops vegetables such as onions and potatoes from sprouting and also delays fruit ripening. Generally beams of radiation are passed into food transferring energy which kills the bacteria. It can prevent the division of microorganisms which cause food spoilage, such as bacteria and moulds, by changing their molecular structure. Any food process will add cost which In most cases just dont rise just because a product has been treated. Many variables affect it ,one of them is the cost of processing. Irradiation costs range from US $10 to $15 per tonne for a low-dose application (for example, to inhibit the growth of sprouts in potatoes and onions) to US $100 to $250 per tonne for a high-dose application. The cost to build a commercial cobalt-60 food irradiation plant is in the range of US $3 million to $5 million, depending on its size, processing capacity, and other factors but this is within the range of plant cost for other technologies (www.iaea.org). Often the capital costs of irradiation equipment are seen as too expensive, even though low operating costs for most products make per unit costs very competitive with other treatments. Commercial contract multipurpose irradiators work in many countries offering irradiation services at reasonable cost. Since irradiation gives the added economic benefit of lon g-lasting fresh market life for many foods, decreased waste and increased market potential of the food should be considered in a cost-benefit analysis. Implementation of HACCP its costs HACCP is a systematic approach to be used in food production as a means to assure food safety (Corlett Pierson 1992). (Appendix B provides the seven principles). But according to Mayes Martimore, 2005 â€Å"absolute safety is absolutely unattainable, but effective HACCP implementation is the surest way of delivering safe food†. If implemented properly (Appendix C), there are benefits in the area of product quality which is primarily due to the increased awareness of hazards in general and people participation from all areas of operation. While on the other hand if HACCP is not properly applied then it may not result in an effective control system. This may be due to improperly trained or untrained personnel not following the principles correctly or it may be through lack of maintenance of the HACCP system. HACCP is carried out by people. If the people are not properly experienced and trained then the resulting HACCP system is likely to be ineffective and unsound (Mortimore Wallace 1998). Small and Medium sized enterprise (SMEs) rarely have the skills, knowledge or resources needed to develop and implement a HACCP programme. This is where the use of internal or external expert consultants can be a good way of getting started. But it is also debated that the SMEs might lack the internal resources to organize the training themselves and the financial resources to use an external training provider. Naturally the larger the company the smaller the percentage and so it makes it more difficult and costly for small businesses to implement HACCP which will need the services of external consultants as they can not afford full time staff. Another major issue related to the implementation of HACCP is its costs which come from staff training, investing in new equipment, external consultancy service, structural changes to buildings and employing new staffs. Not only has the cost of HACCP for hospitality industry depended on the requirements of the system but also on the improvement of the current status of the food safety-related practices in the company. It is better to acknowledge that there will be an investment in order to reap the benefits of HACCP. How much will depend on its available resources within the organization and what training is needed. However accurate estimation of benefits and costs prior to implementation is difficult and should be based on actual experience. Conclusion To sum up it is seen that food borne illness is always at a high in some countries. Whilst it is difficult to predict events, strategies and research in the future are likely to recognise not only the importance of food safety management systems, but the role of individuals, working with their peers and superiors, within a business food safety culture. It is understood that this actively involves the businesses and managers themselves and they must consider the active and unconscious food safety messages they communicate to their employees. Failure to do so might result in high volume of food borne illness in some day among ourselves. Recommendations for Hospitality Industry The following recommendations were being suggested that can be applied to the hospitality industry. * Hospitality Industries must follow the four basic steps to reduce food borne diseases Clean: Washing hands and surfaces often Separate: Dont cross- contaminate Cook: Cooking to proper temperature Chill: Refrigerating properly * Realistic guidance should be provided to the caterers to identify the hazards present and deal with the complexity of HACCP. It must reflect the working conditions of hospitality operations and be produced by professional caterers with operational experience. It must deal with all the possible hazards involved in producing food for immediate consumption, from the source to the customers plate. * Effective training should be given to the senior management, the HACCP team and team leader and other production staff which will develop awareness and motivation as well as provide technical and practical knowledge. It should not be an classroom activity but an ongoing programme in the workplace. * To deal with the complexity of HACCP, proper documentation should be made of the hazards together with the critical control points in order to make it safe, which in turn will allow chefs to see HACCP as useful and easy to apply. * A base line audit of training requirements, researching the available resources and then drafting a casted training plan can be made. From the total of these costs and a comparison with the annual sales of food and beverage a percentage will be found that is what is the percentage of food and beverage sales which needs to be spent on a HACCP system. Based on the above percentage managers could implement a strategy for menu pricing to cover up the cost. * Finally developing and distributing clear guidelines to the food service mangers in the event of a suspected food borne illness outbreak will improve food safety within the hospitality industry. Bibliography Corlett, Jr. A. D and Pierson, D. M. (1992). Haccp: Principles and applications. Chapman Hall: London. Eley, A. R. (1996), Microbial food poisoning, 2nd edition, Chapman Hall, London, pp. 200 Griffiths, O. A. (2001). Haccp works: Integrated Food Safety Management for Food Business. Highfield publication: Doncaster. Hemminger, M. J. (2000). Food Safety: A guide to what you really need to know. Blackweel publishing:U.S. Mayes, T. and Mortimore, S. (2001), Making the most of HACCP: Learning from others experience, Woodhead Publishing Limited, Cambridge. Nestle, M. (2003) Safe Food:bacteria, biotechnology and bioterroisism. University of California press: London. Wallace, C. and Mortimore, S. (1994). Haccp: a pratical approach. Chapman Hall: London. Griffith, J. C. (2006). Food Safety:where from and where to? British Food Journal 108 (1),pp 6-15. Available at http://www.emeraldinsight.com/Insight/viewPDF.jsp?contentType=ArticleFilename=html/Output/Published/EmeraldFullTextArticle/Pdf/0701080101.pdf (Accessed: 18th Nov 2009) Food Irradiation . Retrieved from http://www.food.gov.uk/safereating/rad_in_food/irradfoodqa/ at 10 pm on 20th Nov,2009 Food Irradiation .Retieved from www.iaea.org/nafa/d5/public/foodirradiation.pdf at 11pm on 19th Nov,2009 E Coli. Retrieved from http://www.ecoli-uk.com/news.php at 8pm on 15th Nov,2009 E Coli Outbreaks. Retrieved from http://en.wikipedia.org/wiki/2006_North_American_E._coli_outbreak on 15th Nov, 2009 Food Poisoning. Retrieved from resources.ccc.govt.nz/files/FoodPoisoning-healthsafety.pdf on 11th Nov,2009 Food Borne Illness. Retrieved from http://www.fightbac.org/content/view/11/18/ on 9th Nov,2009

The Successful Business Of Google Inc Commerce Essay

The Successful Business Of Google Inc Commerce Essay The aim of this study is to explore the features of an organization that contribute towards successful technological innovations. We would use a case study approach to analyze the same, with company in focus being Google Inc. We would use the book Managing Innovation by Joe Tidd and John Bessant as the base for our literature review. This would be supported by the following articles: The Innovation Value Chain, The Ambidextrous Organization, Innovation Management in context: Environment, Organization and Performance, Managing Innovative RD teams and Leadership and Innovation: Relations between Leadership, Individual Characteristics and the Functioning of RD teams. The study showcases that there is no single best structure that facilitates innovation. An organization needs to develop the most suitable fit between the structure and the operating contingencies. There are numerous things that affect the innovative performance of the company and innovation should not be looked at in isolation but as a whole cross-functional system. Literature Review and Case Study: Tidd and Bessant (2009) state that an innovative organization needs to align itself with the external environment and build internal structures, processes and culture that enable innovation to flourish. Innovation depends on a range of factors and the innovation process should change itself with changes in the business environment. There is no single best measure of innovation and some indicators work well for certain sectors while others dont. In short, fostering innovation is a lot more complex than it sounds. A set of components, which appear to be linked with success, have been drawn out by Tidd and Bessant (2009). Let us examine these components in greater detail. Shared Vision, Leadership and the Will to innovate: Leadership is perhaps the most critical ingredient in any successful company. Without this, an organization cannot move forward. Not everybody is able to recognize opportunities. Leaders need to have an alert mind to spot them and have the risk taking ability, ability to motivate others in the team and the will to innovate and exploit the opportunity. Stoker et al (2001) state that the role of leaders keeps changing according to different stages of innovation. The leadership style also keeps evolving, from being visionary at the initial stage and take the first step, to involving employees and then to facilitating self-managing teams. A leader has to exercise a style that fits not only the team, but also the environmental characteristics and individual characteristics of the team members. It has been observed that empowering people is directly related to the quality of work and it also enhances the loyalty of employees. Top managements commitment and shared sense of purpose among the employees/team members are key features of a successful organization. The founders of Google Inc., Larry Page and Sergey Brin, had the mission to organize the worlds information and make it universally accessible and useful (Corporate Information). It is this mission of theirs that motivated them and provided them with the courage to take it forward. They struggled quite a lot to get initial funding to get the venture started (Casey, 2007). It was due to their will and leadership qualities that Google took off and now adds value to the whole world. Appropriate Structure: If an organization wants to thrive, its structures and processes need to enable technological change. As innovation does not happen in isolation, smooth flow of information and cross-functional co-operation are required to foster innovation. An innovation is like a fragile flower that needs right kind of environment to flourish. It does not take long for a potentially great innovation to simply die out. Tidd (2001) argues that complexity and uncertainty of the environment affects the degree, type, organization and management of innovation the greater the fit between these factors, the greater the performance of the innovation. Organizational structures are influenced by the nature of task to be performed and by the business environment. Increasingly, innovation is becoming a corporate-wide task, involving not only RD but also production, marketing, administration and other external entities such as customers, suppliers, consultants, etc. It is important to note that not always do loose models/structures for innovation work and appropriate balance needs to be sought between the flexibility and rigidity of the structure. Thamhain (2003) states that the key challenge is not so much of generating ideas in the RD department, but effective transfer of technology from the inception to the market. Here, an appropriate structure is required to enable the transfer. One of the toughest challenges faced by companies is to balance current/present opportunities with future ones (OReilly Tushman, 2004). Under such circumstances, it is suggested that an organization has separate structure/process/culture for new innovations as the existing system might cause hindrances for the new ones. According to the book, The Google Story, the initial employees of the company were actually friends who studied at the Stanford University with Larry Page Sergey Brin. Due to this, the environment in Google was always casual and had little hierarchies. Even though the environment has always been casual, the co-founders still hold a tight grip on many of the companys decisions (Smith, 2007). It is this casual atmosphere and horizontal management style that forms an appropriate structure to foster innovation. Key Individuals: As there are various uncertainties and complexities involved with innovations, it is helpful to have a key individual (or a group) who is passionate and enthusiastic about the innovation and is willing to take it through the organizational system. These key individuals may be product champions or the leaders of the organization. Through their passion, they motivate others in the organization to look at their innovative idea / invention that could add value not only to the customers but also the organization. They have to have the ability to solve problems that could arise during the development / commercialization process and should be committed towards it. Even if they do not have detailed technological knowledge, they need to strongly believe in the potential of the innovation. Key individuals would also need to face other issues such as procuring resources, convincing skeptical or hostile critics elsewhere in the organization. Their faith in the potential should be so strong that they manage to overcome all the barriers. Larry Page Sergey Brin have been the leaders and key individuals behind Google. They had a complete understanding of the technology. They faced a lot of challenges initially, especially with regards to funding, but they stuck to what they believed in and overcame all the barriers. Now, they encourage their employees to embrace the role of key individuals with regards to their respective innovative idea (Weldie, 2009) and take their ideas forward. High Employee Involvement in Innovation: Just like the saying, The more the merrier, the more the number of people involved in an innovation, the chances are that feedback and suggestions provided by them would help to improve the offering. Innovation is no longer confined to specialists in RD, Marketing or IT departments. It should be realized that creative skills and problem-solving abilities are possessed by almost everybody in the organization. Although each individual may only be able to make limited, incremental innovations, the sum of these efforts can have far-reaching impacts. Continuous improvements, involving large number of motivated individuals and taken over an extended period of time, has the potential to significantly impact the strategic development of the organization. This could also turn out to be an inimitable source of competitive advantage over the long term. Effective Team Work: The only factor that equals Leadership of the organization to achieve successful innovation is an effective team work. It is the team that is at the heart of the innovation activity. If innovation is primarily about combining different perspectives in solving problems, then teams/groups have more to offer than individuals in terms of fluency of idea generation and in flexibility of solutions developed. Cross-functional teams can bring together different knowledge sets required to take the innovation forward. They also represent a forum where deep rooted differences in perspectives can be resolved. As an innovation is not confined to a single department, a cross-functional team can help other departments understand different perspectives and help facilitate smooth flow of information and integration between different departments. With this in mind, teams are increasingly being seen as a mechanism for bridging boundaries within an organization and in solving inter-organizational issues . In order to develop an effective, high-performance team, tasks and objectives must be clearly defined, there should be effective team leadership, there should be a good balance of team roles and it should be matched to the individuals behavioral style and a continuous interaction with other factors that could affect the innovation. It should be noted that such teams rarely happen by chance. They result from a careful selection which is aligned with the needs and requirements of the innovative idea in hand. An effective team is a critical determinant of the projects success and the corporate management should be responsible for putting together a capable, cross-functional team. As the team members may come from varied backgrounds, a mechanism should be in place to resolve conflicts as soon as possible so that the speed of the innovation process is not hindered. Soon after launching, the founders realized that if they want to grow, they need to bring in professional management. In 2001, they appointed Eric Schmidt as the CEO to bring to table the capabilities that they lacked (Casey, 2007). It was then they stared their process of building professional/experienced team with defined tasks. Creative Climate and Culture: Creativity of individuals needs to be fostered through the right environment. An organization needs to set up conditions within which innovative ideas can flourish. Under this, a firm needs to put its people at the heart of innovation. The structures and processes should be designed around people and not the other way round. In the knowledge economy, it is about managing the minds of individuals by providing them with right infrastructure suited for growth. Culture is a complex concept which mainly refers to shared values, beliefs and agreed norms which shape behavior of individuals. Changing the culture of an organization is one of the toughest things for the management as it is path dependent. But by bringing about alterations in the structure or processes, an organization can gradually move towards the desired culture. However, this is a time consuming process and requires acceptance by the employees. One way to facilitate this is by rewarding / incentivizing employees based on the new structure. In an organization with a supportive and innovative culture, individuals with bright ideas can progress them with support and encouragement from the system. Management needs to ask itself whether the current structure is supporting or acting as a hurdle to innovation. Also, do employees have all the resources and freedom required to innovate. Innovation is inherently uncertain and will often involve failures as well as successes. The management needs to understand this and build a culture where people take risks and failures are accepted as an opportunity for learning and further development. The biggest barrier lies in the minds of individuals, who are reluctant to innovate due to risks associated with failures. Failures should not be looked down upon and the senior management and leaders should clearly communicate this to the organization. Managerial leadership style, both at RD and senior management, has significant impact on creativity (Thamhain, 2003). Googles organizational culture provides enough space for employees to learn, experiment and grow. The casual and friendly environment promotes interaction between employees which results in enhanced knowledge base and thus promotes innovation. In each of its offices, Google has a big cafeteria with large tables and maximum seating capacity. Managers have observed that people like to talk while having their food. People from different product teams sit together for meals and interact with each other. As people from different product teams come together, the interactions become quite diverse. This mechanism of knowledge sharing leads to collective learning and thus benefits the organization as a whole (Merrill, 2007). Looking Inwards and Outwards for Innovative Ideas: An organization can no longer just look inwards for innovative ideas. As innovation is increasing becoming an open process, collaboration with external parties is gaining importance. This includes associations with suppliers, customers, consultants, etc. the top management needs to ensure that the organization does not face the Not invented here syndrome (Hansen and Birkinshaw, 2007) and looks forward to exploit relevant innovative ideas thrown at them by the external partners. The leaders also needs to provide opportunities for its employees to be part of various conferences, seminars, networking events, etc and tap into the knowledge base of those outside the organization. Knowledge accumulation is a slow and steady process and idea generation does not happen overnight. Keeping this in mind, the management should not pressurize it employees to come up with innovative ideas just after being a part of a single workshop, for example. Hansen and Birkinshaw (2007) argue that companies need to assess whether they are sourcing enough ideas from outside the company or even outside the industry. Many firms do this poorly, resulting in missed opportunities. Clear Understanding of User Needs and User Involvement: The base of every business is its understanding of user needs. It is this point that determines the success or failure of the organization. Any user-focused innovation needs to know exactly what the user wants, how he wants it and how much is he willing to pay for it, among others. Having the end point in mind, the organization can draft its strategies accordingly, in order to meet the customers needs. Increasingly, companies are involving customers in the innovations process. This sort of arrangement is helping organizations develop more personalized offerings while creating a sense of loyalty in the minds of the customers. Involving the users also provides great insights into how the user uses the product or service, how is their experience like, what they expect at the end of the usage journey, etc. All these insights can highlight areas that require further innovation and this can be a source of competitive advantage for the company. Understanding of the Macro and Micro Environment: An organization needs to analyze it Macro environment in order to understand the changes that are taking place in the Political environment, Economic situation, Society, Technological arena, Ecological and Legal frameworks. This would provide a sense of direction where the world is heading, and based on this, potential areas of innovation can be explored. Analysis of the Micro environment is useful in providing a clear picture of the industry the company operates in. It would showcases the position of competitors in the market, bargaining power of customers and suppliers, threats from substitutes and threats from new entrants into the market. Based on this, an organization can draft it differentiation strategy and establish a foot hold in the market. Conclusion:

Utilitarianism :: Philosophy essays

Utilitarianism    This was written in responce to the following questions:    What is the principle of utility? Do you regard it as an adequate basis for judging the progress of society or the desirability of different social institutions? What are its virtues and limitations? How would a utilitarian aproach to judging society differ from a more traditional moral approach?    The principle of utility was Jeremy Bentham's idea on how society progresses through maintaining the greatest happiness / good for the greatest number of people. The ideology utilitarianism, was later formed by John Mill who offered the phrase and an explanation with regards to its moral implications. It sounds logical for a society to want the greatest happiness or good for itself. In general we regard individuals who are well (cultured) and who do not do (bad things) to be happy and we respect them for it. However, that depends on what we see (cultured) and (bad things) to mean.    We have already seen that the idea of what is morally correct and the notions of what is (more morally correct) are philosophical, sociological and theological problems that almost every philosopher has tried to answer; and all come up with varying responses. Everyone sees murder as being wrong and as being an act that could not bring happiness or good. However, this does not account for those who like to kill. They are part of society, so does their happiness not matter? Now if you had a population of murderers or even people who did not necessarily kill but liked seeing others kill/killed (maybe on TV or the movies), does their happiness still show a society of progress? I would hope not. To this Mill would say that I was probably right, but that people would not choose to live like that. Instead they would opt for a moral happiness. They would look for the (higher) levels of happiness like knowledge and culture. I would then reply that he has either left our human nature or his timeline for people moving towards a (higher) level of happiness is insane.    I do believe that utilitarianism is the means by which we live; in general people do whatever they want as long as it brings them happiness (at least what they think is happiness). The fact is that we cannot truly equate happiness to being (good) so we cannot use it as means of judging progress.

Scholarly Discourse Paper -- Sociology

In the views of society today children are taught by example. Monkey see, monkey do. The Saturday morning cartoons, parents, the latest video games, teachers, and the media all showed kids that you can be anything you want to be, as long as you set your mind to it. The majority of little girls wanted to be a princess and little boys wanted to be a super hero when they grow up. In reality, the princesses didn’t grow up to be aristocrats and the super heroes are not fighting the cities’ latest crimes. Children are told to use their imagination and creativity, but in todays society their imaginations and life aspirations are refocused by their social class. . Considering the research done by C.H Knoblauch, Johnathan Kozol, and Jean Anyon, the education system specifically prepares each student for his or her future based on their parents’ income level, social class, and zip code. Parents’ income level and where they live directly correlates with what type of education their children will receive. Anyon argues that the students’ curriculum is either modified or enhanced based on the different areas of social class, and parental salary. â€Å"One’s social class, then, is a result of the relationships one has, largely ‘work,’ ‘capital and power,’ and ‘activity’† (Anyon 398). By living in a wealthier neighborhood, the property funds and taxes the residents pay are able to provide more funding to the surrounding schools. When living in a poor and underprivileged neighborhood, the taxes are significantly lower; therefore, the school system is left with a small amount of funding available to them.. The working class students live in the underprivileged neighborhoods. They read textbooks; when it rains water leaks from the ceiling into the ha... ...s. All of those toddlers in tiaras are going to be heartbroken when they are pushed off the throne and onto their hands and knees just like Cinderella. For some reason the pumpkins stay pumpkins even after midnight. As for the cape and tights, the boys would not last more than a minute in a high school without someone calling them a derogatory name. Whatever happened to the cliche saying, ‘dreams really do come true?’ They should probably put a disclaimer on it next time. Work Cited Page Anyon, Jean. "Social Class and the Hidden Curriculum of Work." Journal of Education, Vol. 162, no. 1. Fall 1980. Kozol, Jonathan. â€Å"Still Separate, Still Unequal.† Journal of Education, Vol. 162, no. 1. 2005. Knoblauch, C. H. "Literacy and the Politics of Education." The Right to Literacy. Ed. Andrea A. Lunsford, Helene Mà ¶glen, and James Slevin. New York: MLA, 1990.

Learning English Essay

The English language has paced a long way on upgrading the holistic system – personal, professional and economic elevation of peoples’ lives. It has uplifted a country’s modern status through its elaborated way of touching human lives. In the context of complex and fast fluxed present situation, English language to the global market has taken vast undertakings on boasting a country’s development. Thus, English is a prerequisite to the learners who definitely need to be bilingual so as to be flexible to the dynamics of modern changes. To Brown (2000) becoming bilingual is a way of life, for it is difficult for a country to live on isolation, as no nation can afford to rely on its domestic store of knowledge alone, hence there is a need for students to learn English as a second language in the Philippines. English is the language of international communication, higher learning and better career options and choices. And due to its significance as a global language, Philippines’ basic education considers English as a major subject for the elementary and secondary levels of learning. In order to be effective with the current pedagogic system, teaching English as a subject should always be natural, agreeable and stimulating to expect optimum learning results because a motivated student who is eager to learn and acquire language skills, upturn good responses to their mentors. Educators, however, clearly admit that, most of the students commonly encounter difficulties in learning English language as a subject. Though, it provides an immense stream of knowledge to the academic clienteles still the learning of English has for its goal developing communicative competence which is essential in enabling learners to use language in multiple functions both correctly and appropriately. Considering the students as the most crucial key elements for a progressive nation, teachers must channel on numerous ways to prepare students to become proficient and skillful in communication to be more competitive. Moreover, they should profoundly analyze that honing student skills is more than feeding them the right grammar rules or assisting them to master their four macro skills. Tapping their skills and harnessing their full potentials is of great use in promoting interactive and dynamic learning in the classroom using approaches and methodologies from conventional to the non-traditional  if only to provide opportunities for students to learn the English language effectively. The ability of the students to use English is required in interactional learning activities where they create novel utterances and understand meaning in situational context. Sad to say, however, that there is a continuous decline of the quality of English learning in our education today. The language problem, particularly the deteriorating quality of English in many schools poses a threat to the efficiency and quality of the educational system as the English language is the medium of both instruction and the learning process in the secondary and tertiary levels of learning.

Judicial Study Guide

Name: Period: Date: AP Government Unit 2 (Judicial Branch) Study Guide Directions: Using your notes and Chapter 16 reading, answer the following questions. 16. 2 Outline the structure of the federal court system and the major responsibilities of each component How is the federal judicial system organized? What role does the federal judicial system play in contemporary American government? What limits are there on the interpretation of the law and the Constitution by federal judges? What powers do judges have to ensure that their rulings are enforced? 16. 3 Explain the process by which judges and justices are nominated and confirmed Do politics play a role in judicial appointments? How are federal judges selected? Should senatorial courtesy be abandoned—why, or why not? 16. 5 Outline the judicial process at the Supreme Court level and assess the major factors influencing decisions and their implementation Do dissenting opinions matter? Why is the doctrine of stare decisis important in our judicial system? How do court justices evaluate cases based on original intent of the Founders? 16. 6 Trace the Supreme Court’s use of judicial review in major policy battles in various eras of American history Explain the development of judicial review. 16. 7 Assess the role of unelected courts and the scope of judicial power in American democracy How well does the Supreme Court conform to the criteria for democracy? What changes would need to be made to make the Court more democratic? Would these changes have any impact on the effectiveness of the Court? DIRECTIONS: Look at the Chapter Test on pg. 498-499 of the textbook. Circle your choice for the correct answer on the questions listed below. 1. a b c d e2. a b c d e 3. True False5. a b c d e 6. a b c d e7. True False 9. a b c d e11. a b c d e 12. True False14. a b c d e 15. True False16. True False 19. a b c d e20. True False