Secondary Source Review Essay Example | Topics and Well Written Essays - 1250 words

Secondary Source Review - Essay Example the Russian Empire or within the Russian Army during the Seven Years War; due in part to the fact that most of the battles and exploits of the war did not take place within Russian territory of that time. Nonetheless, the shifts and changes that this level of Western exposure effected on the Russian Empire, specifically upon the military, paved the way for rapid success and development that would be effected during and after Peter the Greats reign as Tsar. The main source of primary material that is utilized was drawn from the art of the era and the sketches of officers and cadets that sought to capture in drawing the changes in tactics, dress, and discipline that were being effected on an army that had otherwise changed very little over the past several centuries. The addition of these sketches is essential in helping the reader t o visualize the changes not only in the way that troops dressed but with respect to the way in which military service was performed and the changes that existed between the new Western models and the older traditional model of military strategy and engagement that had been the staple of the Russian army for such a long period of time. The primary argument of the author is concentric upon the fact that even though most scholarship concerning the Seven Years War has been focused on Western Europe, important changes were also being exhibited within the Russian Empire of Peter the Great; changes that would ultimately lead this newly resilient Russian Empire to defeat the Swedish and claim further territory throughout Northern Europe. Moreover, the author also points to the understanding that it was the Seven Years War, and by extension Peter the Great that ultimately set the stage for Catherine the Great and the era in which this Tsaress would capitalize on the modernizations and improvements in tactics, approach, equipment, and training that Peter the Great had made as a means of expanding the Russian Empire to a degree not previously

Article Assignment Example | Topics and Well Written Essays - 250 words

Article - Assignment Example a. Selection: Depending on the two classes chosen, the demographics of the school itself can greatly influence the outcome of the experiment due to goals. Both classes belonged to a small public secondary school. Depending on who the subjects are, the outcome could be seen as different. c. Mortality: The dropping out of subjects can lead to an overall attrition but should not have an impact on the internal validity of the experiment. As long as the control group is consistent within the rest of the experiment, people dropping out only lessons the subject amount and not the quality of the subjects. d. Regression: This has to do with aiming towards to average. The people with the lowest score aim to get a higher mark because they can only â€Å"get better†. Instead of looking at it from and â€Å"improvement† standpoint, it is important to view the subjects as making gradual strides to improve instead of an obvious jump. e. Testing: If you repeatedly test a student, this could easily lead to a bias that causes change within the experiment. Subjects may remember the correct answer from previous questions and therefore, they are not coming from an unbiased perspective but instead, using memory to help them get through. Also, sometimes too much testing does not give enough room for actual growth. f. Instrumentation: Depending on what instruments or manipulatives is used during the experiment, the outcome can be different. The Partial experiment is different from the full experiment due to its implementations. g. History: History can affect the outcome because students are affected every day by their environment and therefore, without the control of the variables, nothing is consistent. This can greatly affect the experiment as history changes perspective. The findings of the study are that the pupils involved in the â€Å"full experiment† and the partial experiment scored differently due to exposure of manipulatives and

Does globalisation explain the crisis in European Welfare states Essay

Does globalisation explain the crisis in European Welfare states - Essay Example There is nothing much in common between the welfare regimes of major nations in the Western Europe as they function under varieties of capitalism. Of course, globalisation has certain effects on the welfare states in Europe, especially Britain and France. The increasingly intense economic competition from the new economic giants such as India and China has undermined the capabilities of the European states in retaining their economically less viable welfare measures. However, the extent of spending cuts and reduction in welfare provisions in the United Kingdom and France shows that it is the erosion of political consensus than economic necessities driving the current ‘rolling back of the welfare state’. The paper intends to argue that although globalisation has catalysed the process of shrinking of welfare state, it is not an adequate explanation for the grand scale reduction in spending on social security. For the purpose, it would examine the major turning points in th e history welfare state in Europe such as the oil crisis, the abandoning of gold standard, erosion of post war consensus on welfare and so on. Spending Cuts Going Ideological Globalisation is not simply about economic changes. The very beginning of globalisation was marked by the collapse of Soviet Union and the consequent rise of neoliberal orthodoxy and market fundamentalism. More than the economic crisis, it is the collapse of an ideologically coherent leftist politics that helps the neoliberal governments to go on with their anti-people politics of cuts. It is especially true in the case of Britain and France as the economic polices of these countries increasingly subsidise the super rich at the expense of ordinary tax payers. One could bear in mind that how eagerly the government in Britain bailed out big banks at the time of recession. It is ironical the same governments do not find funds for conserving vital community services such as schools and hospitals. In France and Brit ain, it is not difficult to see that economic polices are predominantly favouring the finance capital and speculators. The increasing homogenisation of political parties in terms of economic polices too is a reason for the rolling back of welfare regimes. For instance, in Britain, both the Labour party and the Conservative party prefer the same course correction measure to ‘recover’ the economy. Needless to say, such economic policies are derived from neoliberalism and Washington Consensus which ideologically opposes any kind of subsides to the poor and the weaker sections of the society. Globalisation has helped the transnational consolidation of elites who want to divert the economic resources for the welfare of the rich. Once could call it socialism for the rich and capitalism for the poor. This consolidation is especially facilitated by the rise of far right groups in the United States, Britain and France. The Floating Currencies The invention of floating currencies was the beginning of the making economic globalisation. On August 15, 1971, the United States withdraw from the Bretton Woods system and it marked the end of Gold Exchange Standard. Here, the US dollar achieved the status of the exchange standard and became a floating currency. Britain also had to switch to floating system. Then, most of the countries of the West had followed the same. The difference is that in the new system each currency has to constantly fix

HR Plan Essay Example | Topics and Well Written Essays - 2000 words

HR Plan - Essay Example This false gesture of making the workers feel important can motivate them to work more efficiently. Human relations (HR) theory needs also to focus on retention of skilled employees for the benefit of the organization. In order to maintain satisfaction within employees and to make the organization attractive for potential employees, management must provide them employment benefits like health benefits. In many organizations, there is a one person HR department in which a solo individual is given the responsibility of performing all aspects of human relations management. It is up to the efficiency of that person which determines how well he can face the challenges and takes advantages of the opportunities to prove himself as a strong leader (Brady, 2006, p.1). For an effective human relations management, the strategy is to learning how to balance different aspects of the departments. Working tirelessly for long hours will reduce the efficiency of the manager as he will lose focus on h is critical responsibilities. In this paper, a HR program is created for a retail business firm that sells variety of products ranging from beauty products to apparels. It has over 1,000 stores in several U.S. states with over 120,000 employees. The retail organization has set up a one person HR department, and the new HR manager has designed and initiated a program for the benefit of the employees. The next section will talk about this program. Recruitment is the â€Å"process by which prospective employees are located and they are encouraged to apply for the job† (Khurana et al., 2010, p.65). There are several internal factors that determine the recruitment and selection process in an organization. First, salary and other benefits direct affect the recruitment of efficient employees. The promise of high salary in this competitive market can attract

Rocky Mountain Chocolate Factorys sweet success Essay Example for Free

Rocky Mountain Chocolate Factorys sweet success Essay The major competing sweet producers Rocky Mountain Chocolate Factory and Hershey’s company have different business strategies, which give them distinct status in the market of the USA. RMCF is concerned in its perspectives and long-term goals to make the company more profitable and successful in the sphere of chocolate business. Hershey’s company deals with the short-term objectives and tries to obtain profit in an abridged period of time. The business strategy of profit-making Rocky Mountain Chocolate Factory has the competitive advantage over prosperous Hershey’s company in corporate governance, organizational structure and confection distribution in the USA. The first difference between the companies is that the corporate governance of RMCF is structured more efficiently than Hershey’s. Corporate governance of RMCF consists of directors who have equal rights. RMCF administers its main rules with three to nine directors (Wheelen and Hunger, 2012, p263). Despite the main principals, the specific board of directors operates as a head of the whole organization and it is able to elect directors itself. This condition is likely to motivate the directors, so they try to accomplish their part of business as accurate as possible. Shareholders have a right to vote in yearly meetings and they can have an influence on the election of the potential directors by giving the additional number of votes (Wheelen and Hunger, 2012, p264). In consequence, the shareholders who have invested money into the company can be confident in the liability of the people to whom they give the opportunity to control the business. Unlike RMCF the Hershey’s c ompany has different types of directors who have their special responsibilities in conducting the business. The governance of the company consists of three types of directors, namely independent, informed and engaged, also a board of directors, which perform various functions in management. Such a bureaucratic structure makes the decision-making process more complicated and creates difficulties with the overall performance of the company. Board members of the company can easily intervene into the tasks of the workers and they can hire new employees without any restrictions (The Hershey Company, 2013). This action may disrupt employees from work and directors can have another option that will not be considered due to their limited liability. Corporate governance of Hershey’s company does not include the participation of shareholders in arranging managers for the firm, so the shareholders are not aware of the financial environment of the company. Thus, the exact number of directors and the role of the Board of directors make the RMCF’s governance organized in a beneficial form, whereas Hershey’s faces several difficulties with it. The second privilege of RMCF is an adept and profit-seeking organizational structure. RMCF has its own shops and franchises which are situated in the regional malls, tourist-oriented retail areas, ski resort, specialty retail centers, airports, neighborhood centers, and factory outlet malls (Harrison, 2003, p240). This location of the chocolate shops creates positive selling opportunities by attracting customers and promoting the product as well. According to the Success Magazine, in 1995-96 the Rocky Mountain was in the seventh position of the 100 top franchisers (cited in Harrison, 2013, p420). Spreading its name recognition through company-owned stores and franchisers, RMCF had gained such a high result in determining its market force and competitive advantage over a majority of companies working in the same field. Crail (1996) states ‘We find the location, negotiate the lease, design the store, coordinate the build-out, bring the franchise here for training, send a distinct manager to the store opening, and have ongoing field support and regional and national convention’ (cited in Harrison, 2003, p420). Taking into consideration all the aspects of organizing the structure of the whole business helps RMCF achieve success without any inadvertences. For example, the total revenue of the company in 1995 was 13,616, 134 USD and up to 1998, it had a tremendous increase showing 23,763,82 USD (Harrison, 2003, pp.423-424). In contrast to RMCF’s organizational structure, Hershey’s company decided to form special commercial groups in order to obtain the significant part of the market share (New Organizational Structure to Leverage U.S. Scale and Accelerate Global Growth, 2005). They were aimed to spread the producing companies all around the world. Hershey’s has its selling premises in 50 countries of the world (Keidel et al., 2010). The company was not concerned in the thorough organization of its structure; that is why it had to fund its company in other countries too. To summarize, RMCF establishes its franchises around the USA and increases the sales by allocating stores in the places with target audience while Hershey’s fail in organizing the right structure, consequently the company has to move into the market of foreign countries. The third quality that makes the business strategy of RMCF more valuable rather than Hershey’s is product distribution. RMCF delivers its products through shipments to distribution outlets from the premise of manufacturing Durango, Colorado. Franchisees are not provided with the immense space to hold the goods, so they ask the company to give them the quantities that they are able to sell during 14 to 28 days (Wheelen and Hunger, 2012, p.26-10). By following this strategy, RMCF chocolate can be a reliable product in terms of freshness. ‘RMCF believed that it should control the manufacturing of its own products in order to better maintain its high product quality standards, offer unique proprietary products, manage costs, control production and shipment schedules, and pursue new or underutilized distribution channels’ (Wheelen and Hunger, 2012, p.26-10). At the same time, the Hershey’s company distributes its products through â€Å"grocery stores, mass merchandisers and drug stores and functions as a single entity†. More than the half of total sales is received from â€Å"merchandisers† and â€Å"supermarkets† (Keidel, et al., 2010). In case the Hershey’s has a delayed delivery; it needs to pay fine for the customers who will not promote Hershey’s products, so losses in sales and credibility will probably occur (Zsidisin, 2006). Hershey’s company faces losses of capital in the period of distribution process; the borders of the time that the delivery of the products should last are not clearly stated. That can be harmful for the customers as the chocolate products are likely to spoil through time. Taking all the aspects into consideration, RMCF is dominating in distribution by saving the quality of chocolates, whereas Hershey’s company is not able to protect freshness without dec reasing the budget of the Company in its business strategy. To conclude, Rocky Mountain Chocolate Factory has more productive venture planning than Hershey’s company in controlling authority, confirmation scheme and product distribution. Controlling authorities in the RMCF have equal opportunities and reliabilities in business, while Hershey’s company is regulated mostly by a board of directors who can set the rules and hire the new employees without discussing with other directors. Conformation scheme of the companies differs from each other by allocating the stores and establishing the outlets. RMCF spreads its products to the places where many people can purchase them; in contrast, Hershey’s company delivers its products to particular stores. As RMCF is worried about its future goals, it achieves lucrative results, so Hershey’s company should also concentrate on its remote future aims.

Historical cost accounting Essay Example for Free

Historical cost accounting Essay Advantages †¢Historical cost accounts are straightforward to produce †¢Historical cost accounts do not record gains until they are realized †¢Historical cost accounts are still used in most accounting systems Disadvantages †¢Historical cost accounts give no indication of current values of the assets of a business †¢Historical cost accounts do not record the opportunity costs of the use of older assets, particularly property which may be recorded at a value based on costs incurred many years ago †¢Historical cost accounts do not measure the loss of value of monetary assets as a result of inflation. Current purchasing power accounting Advantages †¢CPP method adopts the same unit of measurement by taking into account the price changes. †¢Under CPP method, historical accounts continue to be maintained. CPP statements are prepared on supplementary basis. †¢ CPP method facilitates the calculation of gain or loss in purchasing power due to the holding of monetary items. †¢CPP method uses common purchasing power as measuring unit. So, the comparative study is easy. †¢ CPP method provides reliable financial information for taking management decision to formulate plans and policies. †¢CPP method ensures keeping intact the purchasing power of capital contributed by shareholders. So, this method is of great importance from the point of view of the shareholders. Disadvantages †¢CPP method considers only the changes in general purchasing power. It does not consider the changes in the value of individual items. †¢CPP method is based on statistical index number which cannot be used in an individual firm. †¢ It is very difficult to choose a suitable price index. †¢CPP method fails to remove all the defects of historical cost accounting system. †¢The use of general price index for CPP method is questioned. While general price index deals with consumer goods, business is interested in the price movement of producer goods. Current cost accounting Advantages †¢More relevant †¢Provides up to date information with financial markets †¢Takes inflationary adjustments into account. â€Å"Critics have argued market value(current cost) reveals economic realities that are hidden by historical cost accounting. †¢Investors and creditors also prefer the market value accounting. â€Å"the information about the market value at the reporting date, the changes in that value and the components of that change- all provide the investors the valuable information for his decision making.† †¢In F/S, easier to view and determine whether the asset or liability is at risk or not Disadvantages †¢Unreliable   Ã¢â‚¬ ¢Volatile, when market price of an asset and liability is not available, the value is estimated (inappropriate) Continuously contemporary accounting Strengths †¢CoCoA provides information about an entitys capacity to adapt. Chambers considers such information crucial for effective decision making †¢It solves the additivity problem-there is a common basis of valuation (net-market values) so it makes logical sense to add the various asset values together. †¢There is no need for arbitrary cost allocations through depreciation. Weaknesses †¢Not all assets will have a readily determined market price-hence a deal of subjectively will be involved. †¢Some assets can generate income within a particular entity, but have little or no value to anybody else (for example, the case of the blast furnace). The value in use of such assets is ignored. †¢It values assets on the basis of the separate disposal of the respective assets. The implication of this is that assets which cannot be separately sold are deemed to have no value-for example, goodwill. This attribute of CoCoA has attracted a great deal of criticism. †¢CoCoA has never had widespread acceptance within the business community and hence there would be numerous obstacles to its implementation. †¢Because CoCoA would represent a radical departure from current methods of accounting, its adoption could cause major social and economic implications. †¢People are used to preparing and reading historical cost accounting reports, hence there would be a need to re-educate them about the strengths and limitations of CoCoA-this might be costly. †¢If an entity does not expect to sell an asset, it is questionable whether the selling price is really that relevant. †¢Tied to the above point, valuing all assets on the basis of selling prices has been criticised if it is considered that the entity is a going concern. †¢Determining the market price of unique assets introduces a degree of subjectivity into the accounting process.

Analysis of Child Immunisation Programmes

Analysis of Child Immunisation Programmes Introduction Child immunisation programmes rank highly among the most successful public health interventions and are believed to have contributed substantially to the overall increase in life expectancy observed during the 20th century (Gellin et al. 2000). Global immunisation coverage has increased considerably since the introduction of the WHO Expanded Programme on Immunization in 1974. It is estimated that twenty million deaths have been prevented through immunisation over the past twenty years (Tickner et al. 2006) and many vaccine-preventable diseases such as diphtheria, tetanus, measles, mumps, rubella and polio are now rare in developed countries (Bardenheier et al. 2004). However, in countries including the UK, there are fears that immunisation programmes may have become victims of their own success. Low prevalence rates of vaccine-preventable diseases have led to public belief that these diseases no longer pose a serious health risk, while concerns over the safety and side effects of vaccines are now greater than those relating to the diseases these vaccines were designed to prevent. The past thirty years has seen continuing controversy over vaccine safety. Concerns over the whole-cell pertussis (whooping cough) vaccine were first raised during the 1970s following a study which reported severe neurological complications in children following immunisation with DTP, a combined vaccine for diphtheria, tetanus and pertussis (Kulenkampff et al. 1974). Controversy surrounding the measles, mumps and rubella (MMR) triple vaccine followed in the early 1990s after widespread reports suggested a link between this vaccine and both autism and bowel disease. In a study of 12 children referred to a paediatric gastroenterology unit with concurrent developmental regression and gastrointestinal problems, nine developed autism. The parents of 8 of these children associated the onset of their condition with MMR vaccination (Wakefield 1998). While more recent research has shown these fears to be unfounded (Peltola et al. 1998; Taylor et al. 1999), some parents remain unconvinced and vaccine uptake has fallen across the UK, with decreases in MMR uptake of up to 30% in some regions. Declining vaccine coverage rates are also linked to disease outbreaks. A 30% drop in uptake of the pertussis vaccine was recorded following extensive adverse media publicity in 1974 (discussed previously), which was then followed by an epidemic of pertussis (Vernon 2003 ). Similarly, since the decline in MMR coverage, outbreaks of measles have been reported in a number of European countries including the UK, Ireland, Germany, Italy, Denmark and the Netherlands (Department of Health 2004). Suboptimal vaccine uptake has also been reported for other vaccines including diphtheria, tetanus and polio (Tickner et al. 2006). Although the trend for decreased vaccine uptake appears to be reversing in recently years, many Primary Care Trusts (PCTs) in England are still failing to reach the 95% uptake target recommended by the WHO, which is essential to achieve ‘herd immunity’, i.e. where a sufficiently high proportion of the population is immune to a particular disease, thereby preventing transmission of the infectious organism (Health and Social Care Information Centre 2005). For example, data collected in 2004–2005 demonstrated an MMR uptake of 81% across England, a 1% increase on the previous 8-year period. It should be also noted that considerable regional variations were observed, with rates below 70% by some PCTs (Henderson et al. 2008). Immunisations frequently require multiple doses for maximum disease protection. Between 5–10% of children remain unprotected after the first dose of the MMR vaccine, whereas this is reduced to below 1% after the second dose (Tickner et al. 2006). However, there is evidence of poor compliance with childhood immunisation schedules. A study involving a cohort of 18,819 infants in the UK reported that 3.3% were partially immunised, compared with 95.6% of fully immunised infants (Samad et al. 2006). In the UK, statistics show that among children who reached the age of 5 years in 2004-2005, uptake levels of the primary immunisation of diphtheria, tetanus and polio vaccine plus the pre-school booster vaccination were 14% lower than those of the primary immunisation alone (Health and Social Care Information centre 2005). Similarly, uptake of the first and second doses of the MMR vaccine was 16% lower than the first dose alone. This pattern of poor compliance has also been observed in other countries including Sweden and Australia (Heiniger and Zuberbuhler 2006; Ferson et al. 1995). In order to maximise vaccine coverage rates, a full understanding of the factors affecting vaccination uptake and compliance is required, both to identify and address existing unmet needs and to develop and implement effective health promotion strategies. In the case of childhood immunisation, it is also important to consider how parental knowledge, attitudes and beliefs may influence decision-making regarding immunisation. The aims of this review are to explore those factors associated with low rates of vaccination uptake in children and poor compliance with immunisation schedules, with particular emphasis on the knowledge, attitudes and concerns of those parents who decide not to immunise their children. The specific objectives are to perform a search to identify relevant published literature, critique selected articles using an appropriate conceptual framework, and discuss the relevance and implications of the findings of this research. Overview [Client: this section isn’t really an overview, more background material – you may therefore wish to consider re-naming this as ‘Background’] Public health within the UK Public health may be defined as â€Å"the science and art of preventing disease, prolonging life, and promoting health throughout the organised efforts of society† (Acheson 1988). Public health services within the UK cover a broad range of areas which include general health (e.g. issues such as obesity, smoking and blood pressure), environmental health (e.g. food hygiene and pest control) and disease. The NHS national immunisation programme which focuses on childhood immunisation against diseases including tetanus, diphtheria and polio forms a key component of public health provision within the UK (NHS 2007). The public health system comprises a number of core functions which include the health surveillance and monitoring the health status of communities, identifying health needs, developing disease screening and prevention programmes, managing health promotion, and evaluating the provision of health care (Department of Health 2008). Principles of immunisation [Client: I’ve assumed a detailed knowledge of immunity is already held and have therefore kept this section brief] Immunisation may be active or passive. Whereas passive immunisation provides short-term protection, active immunisation also known as vaccination induces protective long-lasting immunity. Active immunisation involves the administration of an antigen which elicits an immune response similar to that which a naturally-acquired infection (Robinson and Roberton 2003). This response results in the development of immunological memory and is achieved through the activation of both T and B cells, which produces a high yield of memory cells which, after initial exposure, are able to recognise a particular antigen again in the future. Active immunisation can be performed using live or killed whole organisms, components of organisms such as subunits, or fractionated or recombinant (manufactured) vaccines (Robinson and Roberton 2003). Importance of immunisation programmes Immunisation programmes play a key role in the control of infectious disease. Disease-related morbidity and mortality places a substantial burden on healthcare systems and preventing individuals from becoming ill is more favourable in terms of healthcare-associated costs than treating them once they are ill. Immunisation has a direct effect by offering protection to the immunised individual and an indirect effect by reducing the incidence of disease among others, (i.e. by providing herd immunity) since vaccinated individuals are less likely to act as a source of infection, unvaccinated individuals have less chance of being exposed to that infection, thus vaccination also benefits the community (ScotPho 2008). If vaccine coverage rates are high enough to induce high levels of herd immunity within a population, it is possible for a disease to be eradicated, as illustrated by the global eradication of smallpox in 1980. However, if high coverage rates are not sustained, the disease coul d return. Immunisation programmes may be aimed at children, adolescents or adults. Routine immunisation against measles, polio, diphtheria, tetanus, pertussis and tuberculosis is now provided in all developing countries but many countries also include a wider range of immunisations against influenza, mumps (usually in combination with measles and rubella) and predominant strains of pneumococcal disease (WHO 2005). In addition, hepatitis B immunisation is also recommended by WHO for all countries, while Haemophilus influenzae type b (Hib) is recommended for those countries with a significant disease burden and who have sufficient resources (WHO 2005). UK childhood immunisation programme The UK immunisation programme for children and adolescents from birth to the age of 18 years is shown in Table 1 below. Each vaccination is administered as a single injection into either the thigh or upper arm. The use of combination vaccines is advantageous in reducing the number of injections administered. For example, children in the UK receive only 7 vaccinations before the age of 15 months, instead of the 21 single-antigen injections they would otherwise receive. In the US, children receive up to 21 injections by the age of 15 months (CDCP 2006). Vaccinations are not mandatory in the UK and are offered free of charge by the NHS. This is in contrast to countries such as the United States and Australia where vaccination is compulsory (Salmon et al. 2006) and proof of immunisation is required for school entry (Vernon 2003). However, despite the lack of a mandatory immunisation policy, coverage rates in the UK are still high compared with many other developed countries, although the current levels of MMR coverage are cause for concern. Table 1. UK childhood immunisation programme (from NHS 2007). When to immunise Diseases protected against Vaccine given Routine immunisation Two months Diphtheria, tetanus, pertussis (whooping cough), polio and Haemophilus influenzae type b (Hib) Pneumococcal infection DTaP/IPV/Hib + Pneumococcal conjugate vaccine Three months Diphtheria, tetanus, pertussis, polio and H. influenzae type b (Hib) Meningitis C DTaP/IPV/Hib + MenC Four months old Diphtheria, tetanus, pertussis, polio and H. influenzae type b (Hib) Meningitis C Pneumococcal infection DTaP/IPV/Hib + MenC + PCV Approx. 12 months H. influenzae type b (Hib) Meningitis C Hib/MenC Approx. 13 months Measles, mumps and rubella Pneumococcal infection MMR + PCV Between 3 years 4 months and 5 years Diphtheria, tetanus, pertussis and polio Measles, mumps and rubella DTaP/IPV or dTaP/IPV + MMR 13–18 years Tetanus, diphtheria and polio Td/IPV Non-routine immunisation At birth (to babies who are more likely to come into contact with TB than the general population) Tuberculosis BCG At birth (to babies whose mothers are hepatitis B positive) Hepatitis B Hep B Literature review A literature search of English language articles was performed using the electronic databases Pubmed and CINAHL. Search terms included: immunisation OR vaccination plus uptake OR compliance OR parent AND belief OR attitude OR knowledge. A number of conceptual frameworks have been developed for use in the critique of both quantitative and qualitative research (Cormack 2000). In this paper, the framework proposed by Cormack (2000) was employed both in the initial selection of relevant, high-quality research articles and in the subsequent critique of those articles. The use of evidence-based practice is necessary to provide high-quality healthcare, and it is therefore essential that all healthcare providers possess the understanding and expertise to review and evaluate published research. By following Cormack’s framework, an informed judgement can be made regarding the findings of a particular research article and their relevance and implications for practice. A total of 8 articl es, including both quantitative and qualitative research, were selected for this review. The article by Gellin et al. (2000) describes a telephone survey study conducted in the United States which investigated parents’ understanding of vaccine-preventable diseases and immunisation practices and procedures. The article abstract is concise, informative and presents the main points of the study in a clear and easy to understand way. The introduction provides the relevant background information needed to set the study in context and clearly states the aims of the research. Study participants were recruited via random digit dialling which is a widely accepted method of ensuring selection of a random population sample. The selection criteria are stated and the study sample size (n=1600) was large enough to yield a confidence interval of  ±2.5% for the population overall. The survey was conducted using by trained market researchers using a pre-tested scripted interview but a full list of the questions is not provided in the article, nor is the script included as an app endix. Further, no mention is made of ethical considerations such as confidentiality or the right to withdraw participation. The statistical analyses used to analyse the data are described fully. The results section of the article is well structured and clear with appropriate use of tables to present data. However, for additional clarity, it may have been better to present the demographic characteristics of the study respondents in a table rather than as a list of percentages in the main text. Results showed that 87% of study respondents believed immunisation to be extremely important and believed there to be a high level of overall vaccine safety (X2=8.6; standard deviation (SD)=1.6). Respondents were asked to state their level of agreement with a series of belief statements. Findings showed that while the majority of respondents held beliefs that were consistent with the available evidence on vaccine efficacy and safety, misconceptions were held by a substantial number of respondents. For example, 25% believed their child’s immune system could become weakened as a result of too many immunisations, while 23% believed that children got more immunisations than were good for them. Doctors were cited as the key providers of information on immunisation. The article includes a comprehensive discussion of the relevance of the study findings with reference to other published research and addresses the limitations of the study (e.g. only those households with telephone could be contacted via random digit-dialling and the inclusion of English-speaking participants only). A separate conclusions section is not included but the implications of the research are discussed in the context of the future of immunisation programmes and public health. The paper by Pareek and Pattison (2000) reports the findings of a prospective cross-sectional UK survey to investigate the factors which influence the intention of mothers to vaccinate their children with the two-dose MMR vaccine. The paper contains a well-structured abstract that present the main points of the study. The introduction is comprehensive with clearly stated aims and lists the theoretical framework used in the study (i.e. the Theory of Planned Behaviour). Study participants were randomly selected from confidential records held by Birmingham Health Authority, after written consent had been obtained. A total of 300 mothers of children aged between either 5-12 months or 21-35 months received a pre-piloted 48-item questionnaire with the assurance of confidentiality. The full questionnaire is not provided but a list of the three sections in the questionnaire is given. The response rate was 59%. A brief description of the statistical analyses used to analyse the data is given. The results section is unstructured making if difficult to read but is comprehensive in nature. No figures or tables are included. Results showed that significantly fewer mothers intended to take their children for their second MMR immunisation (Group 2), compared with the number intending to take their child for their first immunisation (Group 1) (Group 1: 87% vs Group 2: 78%; p Kennedy et al. (2005) reported the findings of an analysis of data from the 2002 annual, mail panel survey of adults in the United States performed to examine the socio-demographic factors and immunisation beliefs/behaviours associated with parental opposition to compulsory vaccination. This article contained a brief abstract which nonetheless detailed the key points of the study but did not list the number of study participants. A comprehensive introduction is included with extensive reference to other published research and the aims and objectives of the study are given, together with the model used (i.e. the Health Belief Model). The method of study participant recruitment is described but this is confusing and difficult to follow. In summary, a total of 6,027 adults received surveys with a response rate of 73%. However, these individuals were not selected randomly. The questions in the survey are not listed and a copy of the questionnaire is not included. However, responses to relevant beliefs statements are listed in a table in the results section, which provides the reader with some insight into what was included. No mention is made of ethical considerations. The statistical analyses used are described adequately. The results section is clear and well-structured with tabulation of relevant data. Study findings showed that 12% of respondents were opposed to compulsory vaccination. Compared with parents who were supportive of compulsory vaccination, those who were opposed were significantly more likely to agree that the ‘the body can protect itself without vaccines’ (opposed 24% vs supportive 10%; pvs 17%; pvs 32%; pvs 13%; p Sporton and Francis (2001) performed a study to explore the decision-making process of parents who have chosen not to have their children immunised. Their paper contains a very detailed abstract which describes the study in detail. A short introduction sets the study in context and includes the rationale for performing the study, with a clearly stated aim. The selection of the 13 final study participants (12 mothers and 1 father) is described in detail and details of ethical approval are included. Semi-structured interviews were used to gather information, a widely accepted method in qualitative research which allows the researcher to be guided by the study participant while still allowing key points to be covered. All interviews were conducted by the same researcher, thus ensuring consistency. Although all interviews were transcribed, no mention of consent or other ethical considerations is made in the paper. The results section has a clear and logical structure with a relevant table and figure. Narrative accounts from the study participants are also included within each section. Findings showed that while parents often cited more than one reason for choosing not to immunise their children, the risk of side effects, particularly long-term effects, was identified as a reason by every parent. Other reasons included moral reasons, alternative methods of protection (e.g. homeopathy), practical reasons (lack of access to clinics) and personal parental experiences of immunisation (e.g. lack of immunisation has not resulted in any adverse effects on their own health). Many parents believed that healthcare providers did not provide balanced information and were unwilling to acknowledge the perceived association between immunisation and adverse effects. The discussion makes very limited reference to other published research an fails to address the limitations of the study (i.e. the extremely limit ed sample size and the extreme bias towards mothers). The conclusion and discussion of implications for the future are brief but adequate. In their recently published article, Pearce et al. (2008) report the findings of a nationally representative UK cohort study performed to estimate uptake of the combined MMR and single-antigen vaccines and explore the factors associated with uptake. This article contains a comprehensive abstract which includes a detailed results section, while the introduction discusses previous research that supports the purpose of the current study. Data from a longitudinal study of 14,578 children born in the UK between 2000 and 2002 were used in this analysis. These data were obtained via face-to-face interviews between trained researchers and the main care giver (usually the mother) conducted at home when the child was approximately 9 months old and again at the age of 3 years but no mention is made of whether consent was obtained from participants. The study sample included adequate representation from all 4 countries within the UK including those from deprived areas and ethnic minorities. A de tailed description of the analysis performed is provided in the paper. Results showed that 6.1% of children in the study were not immunised and that various socio-demographic factors were associated with immunisation uptake. For example, children were less likely to be immunised if they lived in a household with other children or a single parent; if the mother was aged 34 years at the time of the birth; or if the mother was more highly educated, unemployed or self-employed. Ethnicity was also strongly associated with single-antigen vaccine uptake. Almost three quarters (74.4%) of parents who had not immunised their children stated that they had made a conscious decision not to do so. The discussion section addresses the studies strengths (e.g. the large sample size) and limitations (e.g. using maternal report of immunisation status in which only one fifth of participants actually checked their child’s health record) and compares the findings with that of previous research. The implications for future practice and policy-making are discussed in de pth with recommendations and appropriate conclusions have been drawn. Gust et al. (2004) conducted a case-control study in the United States to examine the attitudes, beliefs and behaviours of parents whose children were incompletely immunised, compared with those of fully immunised children. This article includes a well-written abstract that provides the reader with all the relevant information about the study. The introduction refers to existing research and clearly identifies the study’s aims. Both case and control study participants were randomly sampled from children participating in the National Immunization Survey (NIS) and who had adequate provider-reported immunisation data. Case participants were those children who were incompletely immunised with respect to ≠¥2 of diphtheria-tetanus-pertussis (DTP)/diphtheria-tetanus-acellular pertussis (DTaP), hepatitis B and/or measles-containing vaccine (MCV) vaccines (‘incompletely immunised’ defined as The results are presented in a structured, logical way which includes tabulation of the data. Findings showed that among case subjects, 14% of incomplete immunisation was due to parental beliefs, attitudes and behaviours. It is interesting to note that while these beliefs are more common among parents of incompletely immunised children, the parents of fully immunised children also report similar beliefs and attitudes. Parents/guardians of case subjects were more likely not to want their child to receive all immunisations, to rate immunisations as unsafe or somewhat safe and to ask the doctor or nurse not to administer a vaccine to their child for reasons other than illness. The discussion section of this paper is comprehensive but makes limited reference to other published research but the limitations of the study are addressed (e.g. potential inaccurate reporting of beliefs and attitudes through inaccurate recall, due to the length of time since their children were vaccinated). Valu able recommendations are made, together with information to guide the reader to the source of potentially useful educational materials for both healthcare providers and parents. A UK focus group study conducted by Evans et al. (2001) investigated what influences parents decisions on whether to accept or refuse primary MMR vaccination. This article contains a comprehensive abstract that informs the reader about the key points of the study. The introduction is brief but states the study aims. Six focus group discussions (a commonly used method of gathering qualitative data) were held, which were conducted by a moderator using appropriate open-ended questions which are described in the paper. Assistance was provided by a member of the research steering group, thereby ensuring consistency across the groups. A total of 48 participants were recruited purposefully rather than randomly, such that three of the groups contained ‘immunisers’ and three contained ‘non-immunisers’, from a variety of socio-economic backgrounds. Ethical approval was obtained for the study. The methods section describes how data collected was analysed and sorted int o themes. The results section of the article is easy to understand and includes narrative accounts from study participants within each section. All parents who participated in the study believed the decision about whether to vaccinate was difficult and felt under undue pressure from healthcare providers to comply. Four key factors were found to influence parents’ decisions: (1) their beliefs about the risks and benefits of the MMR vaccine and compared with the risk of contracting those diseases; (2) information on the safety of the MMR vaccine; (3) trust in healthcare providers about the accuracy of the advice they had given and attitudes towards this advice; and (4) views on the importance of individual choice. The paper contains a balanced discussion which refers to other published research and includes both recommendations for practice and the limitations of the study (i.e. that over half of study respondents were highly educated, with a mean age of 35 years), and appropriate conclus ions are drawn. Flynn and Ogden (2004) conducted a prospective questionnaire study in the UK to explore which parental beliefs are the best predictors of MMR vaccine uptake. Their paper contains a short abstract which nonetheless details the key points of the study. The introduction to the paper refers extensively to other published research and presents a strong rationale for the study with clearly stated aims. Study participants (n=511) comprised parents whose children were due to receive an invitation for MMR vaccination. A questionnaire was used to gather data, together with additional follow-up data taken from child health records. The various sections within the questionnaire are described in the paper, together with examples of typical questions within each section; however, a copy of the questionnaire is not included. A response rate of 56.9% was recorded. Ethical approval for the study was obtained which also complied with the Data Protection Act. The method used for data analysis is descri bed