Airport Security and the Transportation Security...

Abstract Through the history of aviation the importance of airport security has steadily increased. Since the terrorist attack of September 11, 2001, many changes have taken place at airports to prevent such an attack from occurring again. The purpose of this paper is to: outline airport security procedures, discuss the different technologies involved with airport security, as well as examine the components of airport security. In addition I will also discuss the Transportation Security Administration’s role in our nation’s airport security. Airport Security Airport Security is a necessity of Life both in America and through out the world. Without airport security our airports would not be able to function and terrorist attacks†¦show more content†¦The TSA was tasked with the tremendous challenge of building a large federal agency responsible for securing all modes of transportation. Funding for the TSA is accomplished by a $2.50 charge per flight segment not to exceed $10.00 round trip, per customer. The mission as described by the TSA website (www.tsa.gov) is as follows, â€Å"The Transportation Security Administration protects the Nations transportation systems to ensure freedom of movement for people and commerce.† The vision of the TSA is, â€Å"The Transportation Security Administration will continuously set the standard for excellence in transportation security through its people, processes and technologies. The TSA also states that its values are to have excellence in public service through: inte grity, innovation, and teamwork. As with any government organization the TSA has taken much criticism on its security practices. However, one must keep in mind that this administration is still in the beginning stages, and much is still to be learned from the mistakes that have been made thus far. The TSA employees a work force of over 50 thousand federal passenger and baggage screeners at 429 commercial service airports. Out of those 429 airports five have been chosen to be part of a pilot program. In this program the five commercial service airports that were chosen can hire their own passenger and baggage screeners, after aShow MoreRelatedThe United States Aviation Security888 Words   |  4 Pagesof terrorist who were able to infiltrate our security system from all angles. It was a very tragic event for the U.S, when terrorist attacked two landmarks in New York City, a densely populated area. Although this terrorist attack was very unfortunate, it was also the largest infiltration of the United States Aviation system through multiple breaches of aviation security. Immediately after the attack many changes were made to aircrafts and the airport system. This Day brought America to its kneesRead MoreA Method of Terrorist Prevention Essay examples1085 Words   |  5 Pagesfor freedom and security to protect it. September 11, 2001, was a day when over three thousand people lost their lives due to targeted attacks (â€Å"US Government†). An attack on an area with a significant purpose such as the World Trade Center invades the minds and hearts of the country’s residents and changes its methods of functioning in the future. In an airport, several people venture in and out without a single person knowing who they are or their intentions. The administration vigorously discussedRead MoreCase Analysis On Airport Security Screening1209 Words   |  5 PagesCase Analysis on Airport Security Screening Following the tragic events of September 11th, 2001, the 107th Congress passed the Aviation and Transportation Security Act, establishing the Transportation Security Administration (TSA) (History, 2014), and transferred the responsibility for civil aviation security from the Federal Aviation Administration (FAA) to the TSA (Statute and Regulation History, 2012). The Act was passed in just two months following the terrorist attacks, and likely wouldRead MoreWhy We Need The TSA Essay1341 Words   |  6 Pagesof Homeland security was founded and within the department fell a new agency known as the Transportation Security Administration (TSA). The TSA was instructed to secure all modes of transportation and they committee was instructed that they wanted to see result soon. Additionally the Aviation and Transportation Security Act required the screening of passengers, cargo and luggage for explosives as the primary priority. Even though the TSA is charged with the transportation secu rity the primaryRead MoreTsa And Transportation Security Administration916 Words   |  4 Pagesestablished a Transportation Security Administration (TSA) and heighten its security throughout the transportation system, which were designed to prevent similar attacks in the future. This research paper will discuss the history of the TSA and what it does, how TSA improve aviation security, and the cargo screening process. This paper will conclude an overall debrief of my discussion about the TSA and transportation security. The Transportation Security Administration (TSA) was establishRead MoreAirport Security : A Security935 Words   |  4 PagesBrandon Barstad Mr. Popko English IV 20 November 2014 Airport Security Airport security is a problem in the United States. As a nation we should improve airport security so that we don’t suffer terrorist attacks. One lack of airport security was 9/11. 9/11’s problem with security was that the people signed up to be airline pilots, but they were terrorists. Another was the shoe bomber. There the problem was at the time they never scanned the shoes for anything in them. Richard Reed is the one thatRead MoreAir Transportation Security Act : A Common Target For Terrorism And Crime1607 Words   |  7 Pages1974, the Air Transportation Security Act was passed mandating the screening of passengers and any carry-on property at U.S. airports to ensure the safety of all passengers. After the terroristic attack against the twin towers, in 2001, there was an increase in the amount of precaution for greater security throughout the United States. As result, the Transportation Security Administration was put in the position of taking over responsibility for airport screening. Many new security measures wereRead MoreThe Transportation Security Administration is Ineffective Essay631 Words   |  3 Pagesgovernment created the Transportation Security Administration (TSA) to protect air travel and prevent similar attacks. In 2012, the TSA had a budget of $8.1 billion, and while it claims to improve airport security, it fails to do so. Additionally, their checkpoints are privacy-invasive and cumbersome, negatively impacting the air travel industry. For these reasons, the agency should be abolished. As a response to the 9/11 attacks, one would expect that the TSA would improve airport security. In reality, itsRead MoreEssay Aviation Security Case Analysis722 Words   |  3 Pagesï » ¿ Aviation Security Case Analysis Embry-Riddle Aeronautical University Aviation Security Case Analysis I. Summary Since September 11, 2001, airport security has undergone some major changes. The Department of Homeland Security (DHS) and the Transportation Security Administration (TSA) were formed and airport security was transitioned from private contractors to government run security through TSA. Since that time, there has been great debate on II. Problem The problem is whether to continueRead MoreAirport Security Ethics : International Security1622 Words   |  7 Pages Airport Security Ethics Brandon Yates Embry-Riddle Aeronautical University Introduction On September 11, 2001, the world of aviation and airport security became drastically different. Since the attacks the government, Department of Homeland Security (DHS), has amped up airport security by creating the TSA (Transportation Security Administration). In essence, the TSA is responsible â€Å"for security at the nation’s airports and deployed a federal workforce to screen all commercial airline passengers

Communication Essay - 837 Words

Communication Communication is key to any family dynamic; without communication no one knows what is going on and people get isolated. In Franz Kafka’s Metamorphosis, the family’s communication, or lack thereof, is a big problem. Gregor’s metamorphosis into a world of complete isolation is seen through four stages of communication. Gregor understands what his family is saying when he first morphs into a bug and he assumes that his family can understand him as well. â€Å" Because the door was made of wood, the alteration in Gregor’s voice was probably not noticeable, since his mother was pacified by that explanation.†(13) Gregor has to explain why he didn’t go to work and since his mother never said anything about not being able to hear†¦show more content†¦That is the first time that Gregor grasps the fact that he can’t even trust his own judgment anymore because he truthfully doesn’t know what he sounds like. Gregor’s lines of communication have been cut off from any other human beings. Gregor’s sister and Gregor enter into a nonverbal communication where she brings him food twice a day, but never says anything directly to Gregor. â€Å"He could never have guessed what his sister in her kindness actually did. In order to test his likings, she brought him a big selection, all spread out on an old newspaper.†(26) Greta, the sister, is taking car of Gregor because no one else will. Even though Greta won’t talk to Gregor, she still helps him out and that shows that Gregor is not totally isolated. â€Å"If Gregor had only been able to speak with his sister and thank her for all she had done for him.†(31) Gregor wants desperately to thank his sister but he can’t which makes it seem as though the sister’s help is worthless. The communication, verbal, makes it hard for both parties. Gregor and his father enter into a more negative nonverbal communication. The one time Gregor leavesShow MoreRelatedUnderstanding Communication : Commun ication And Communication1345 Words   |  6 PagesHANDBOOK UNDERSTANDING COMMUNICATION TYPES OF COMMUNICATION METHODS OF COMMUNICATION INTERPERSONAL COMMUNICATION STYLES COMMUNICATION STYLES COMMUNICATION ROADBLOCKS HOW TO OVERCOME COMMUNICATION ROADBLOCKS THE DO’S AND DO NOT’S OF EFFECTIVE COMMUNICATION HOW TO LISTEN EFFECTIVELY CONTENT PERTINENT TO SPORT STUDIES SYLLABUS SHELL PORTFOLIO EXIT EXAM STUDY GUIDES 3 AND 4 YEAR PLANS FOR MAJORS WRITTEN COMMUNICATION CHECKLIST ELECTRONIC COMMUNICATIONS PURPOSE OF THE COMMUNICATION HANDBOOK TheRead MoreCommunication Is The Science Of Communication1066 Words   |  5 PagesCommunication is important to strive in life, as well as, in integrated marketing communication. Human communication is described as having the creativity to contribute instead of the information. Creativity can help by making more efficiently with less. In a way, an individual has a collection of discoveries at their disposal (Downs, 1298). Mass communication plays a role in design. Moreover, mass communication and its activities are influenced by cybernetics. Cybernetics is the science of communicationRead MoreCommunication As A Communication Tool1043 Words   |  5 PagesIntroduction to the Topic The assigned reading for forum 5 discussed interpersonal and organizational communication channels in the workplace. The different types of communication are oral communication, formal written communication, non-verbal communication, and presentations. Satterlee (2013) shows the communication process to involve a sender, a receiver, meaning, encoding, the message transmittal, a channel, decoding, interpreting, and feedback. A successful leader will be able to communicateRead MoreCommunication And Human Communication1131 Words   |  5 PagesHumans, by nature, are social beings. Communication has been a part of people’s everyday lives long before conventional language, which are gestural and vocal, was even created. The first uniquely human forms of communication were pointing and pantomiming (Tomasello 2). These forms then have gradually evolved through the means of technology. Technology is known as the practical application of scientific knowledge in order to pro-duce goods and to provide services. This is one of the most powerfulRead MoreCommunication and Personality in Communication1434 Words   |  6 PagesRunning head: COMMUNICATION AND PERSONALITY IN NEGOTIATION PAPER Communication and Personality in Negotiation Paper MGT/445 University of Phoenix Communication and Personality in Negotiation Paper Negotiation can take place anywhere and at anytime. Negotiations can take place at home, at work, with family members, with friends, and co-workers. â€Å"Negotiation is a process by which we attempt to influence others to help us achieve our needs while at the same time takingRead MoreReflection Of Communication And Communication1152 Words   |  5 Pages The first resources that I’ve learned from this course are using the multiple job websites online, we’ve had excellent communication between classmates on how we can benefit from using these sites out and look for specific jobs in our area. This will assist in work as a counselor because it will help in my networking about the city I currently work in and learning about how to make my resume stick out. The second fact that I’ve learned in this course is finding balance in your life so that youRead MoreCommunication Is The Language Of Communication1473 Words   |  6 Pagessaid, â€Å"The art of com munication is the language of leadership.† Communication is essential to business as well as interpersonal relationships. The ability to express oneself with coherence and cogency is of the utmost importance to your professional and personal success. Effective communication solves and also prevents problems. Think back to all those times you endured a conflict with a person or institution as a result of poor communication or a complete lack of communication. When people are notRead MoreInterpersonal Communication, Intercultural Communication And Communication1699 Words   |  7 PagesMy friend Vikas, told me everything he had to do and the struggles he conquered in order to make his own successful business here in the U.S. Some things he told be reminded me of interpersonal communication, intercultural communication, and intracultural communication. He had to have a lot of communication with his friend who also happened to be from India and some new friends and colleagues he met through his journey. Of course there was homesickness and the occasional depression, but that didn’tRead MoreQuestions On Communication And Communication1815 Words   |  8 Pages1. Analysis 1.1 Communication Talking about communication involves talking about the identity of the person talking as a communicative being therefore about his right to communicate. In other words, for every subject speaking, the question is to know whether or not it makes sense for them to do so. If not, they would not exist as a subject. Sometimes norms, more or less institutionalized, help answering that question: for example, a lecturer presented as so in a conference finds himself entitledRead MoreVerbal Communication And Written Communication1201 Words   |  5 PagesThere are 2 types of communication that will be discussed below, which are verbal communication and written communication 2.3.1 Verbal communication Verbal communication exchange their information between different people by communicating orally. The examples of verbal communication would include face-to-face conversation, meetings, interviews, conferences, speeches and phone calls. Verbal communication allows us to exchange ideas, understand the difference in perception and come out with resolution

Bipolar Disorder Essay Research Paper Bipolar DisorderThe free essay sample

Bipolar Disorder Essay, Research Paper Bipolar Disorder The phenomenon of bipolar affectional upset has been a enigma since the sixteenth century. Bipolar upset or as the surrogate names, frenzied depressive unwellness or affectional bipolar upset can be classified as a temper upset characterized by temper swings from Manis ( overdone feeing of wellbeing ) to depression. History has shown that this affliction can look in about anyone. Even the great painter Vincent Van Gogh is believed to hold had bipolar upset. It is clear that in our society many people live with bipolar upset ; nevertheless, despite the copiousness of people enduring from the it, we are still waiting for definite accounts for the causes and remedy. The one fact of which we are distressingly cognizant is that bipolar upset badly undermines its? victims ability to obtain and keep societal and occupational success. It is besides believed that the Li degree is what causes these temper swings. Because bipolar upset has such debilitating symptoms, it is imperative that we remain argus-eyed in the pursuit for accounts of its causes and intervention. A smorgasborg of symptoms that can be broken into manic and depressive episodes characterized by affectional upsets. The depressive episodes are characterized by intense feelings of unhappiness and desperation that can go feelings of hopelessness and weakness. Either the manic or the depressive episodes can rule and bring forth few temper swings or the spiels of temper swings my be cyclic. Some of the symptoms of a depressive episode include anhedonia, perturbations in slumber and appetency, psycomoter deceleration, loss of energy, feelings of ineptitude, guilt, trouble thought, indecisiveness, and perennial ideas of decease and self-destruction ( Hollandsworth, Jr. 1990 ) . Some of the other symptoms that may happen in the depressive phase can be besides fatigue that can last anyplace from hebdomads to months and a individual may non be cognizant of why this is really go oning. Daytime drowsiness can besides happen doing it difficult for a individual with this unwellness to keep down any kind of a occupation for a length of clip. Unintentional weightloss can do the physician go in a different way in this doing it hard for them in diagnosing because of all the possible symptoms that a individual may exhibit. A individual may besides hold some memory loss episodes or episodes of memory loss, traveling space for a periods of clip. They may non even be cognizant that they have a household to take attention of their occupati ons. The frenzied episodes are characterized by elevated or irratable temper, increased energy, decreased demand for slumber, hapless judgement and penetration, and frequently foolhardy or irresponsible behaviour ( Hollandsworth, Jr. 1990 ) . When a individual is in the frenzied statge they may go agitated which makes them more chatty than usual or they feel pressured to maintain speaking, they besides may contorting their custodies or restlessness because they feel unsure of the state of affairs that they are in and seem to hold merely utmost restlessness to them. They might look to hold put on rather a spot of weight and choler highly easy. Their fickle behaviour can do it difficult for their households to be around them. Finally forcing their households aside and the diagnosing is harder to acquire because of the deficiency of support from others and their behaviour is frequently so away. In this phase the sexual activity can be increased dramatically, doing the patient seek other people to be with if they are non fulfilled in their relationship at place. This can take to the break of the household unit. This disease is really serious and can impact anyone. Bipolar upset affects about one per centum of the population ( about three million people ) in the United States. Bipolar Disorder can impact both males and females and involves episodes of passion and depression.. Bipolar upset is diagnosed if an episode of passion occurs whether depression has been diagnosed or non ( Goodwin, Guze, 1989, p 11 ) . Persons with frenzied episodes most normally see a period of depression. The rarest symptoms were periods of loss of all involvement and deceleration or agitation ( Weisman, 1991 ) . As the National Depressive and Manic Depressive Association ( MDMDA ) has demonstrated, bipolar upset can make significant developmental holds, matrimonial and household breaks, occupational reverses, and fiscal catastrophes, loss of occupations and 1000000s of dollars in cost in society.As the patient ages or acquire older they report that the depressions are longer and increase in frequence. Many times bipolar provinces and psychotic provinces are misdiagnos ed as schizophrenic disorder. Particularly if the household history exhibits schizophrenic disorder or some other unwellness. Bipolar is most distinguished with households that have mental unwellness in their background and can happen most frequently in those scenes than in any other, although it can impact anyone. Speech patterns assist separate between the two upsets ( Lish, 1994 ) . The oncoming of Bipolar upset normally occurs between the ages of 20 and 30 old ages of age, with a 2nd extremum in the fortiess for adult females. A typical bipolar patient may see eight to ten episodes in their bipolar Disorder 3 life-time. However, those who have rapid cycling may see more episodes of passion and depression that win each other without a period of remittal ( DSM III-R ) . Rapid cycling agencies that their temper alterations several times a twenty-four hours. The three phases of passion Begin with hypomania, in which patients report that they are energetic, extrospective and self-asserting ( Hirschfeld,1995 ) . The hypomania province has led perceivers to experience that bipolar patients are addicted to their passion. Hypomania progresses into passion and the passage is marked by loss of judgement ( Hirschfeld, 1995 ) .Often, euphoric grandiose features are displayed, and paranoiac or cranky features begin to attest. The 3rd phase of passion is apparent when the patient experiences psychotic beliefs with frequently paranoid subjects. Address is by and large rapid and overactive behaviour manifests sometimes associated with force ( Hirschfeld, 1995 ) . When both manic and depressive symptoms occur at the same clip it is called a assorted episode. Those afflicted are a particular hazard because there is a combination of hopelessness, agitation, and anxiousness that makes them experience like they could leap out of their tegument ( Hirschfeld, 1995 ) . Up to 50 % of all patients with passions have a mixture of down tempers. Patients study experiencing distressed, down, and unhappy ; yet, they exhibit the energy associated with passion. Rapid cycling passion is another presentation of bipolar upset. Mania may be present with four or more distinguishable episodes within a 12 month period. There is now grounds to propose that sometimes rapid cycling may be a transeunt manifestation of the bipolar upset. This signifier of the disease exhibits more episodes of passion and depression than bipolar. Lithium has been the primary intervention of bipolar upset since Bipolar Disorder 4 it s debut in the 1960’s. It is chief map is to stabilise the cycling feature of bipolar upset. In four controlled surveies by F. K. Goodwin and K. R. Jamison, the overall response rate for bipolar topics treated with Lithium was 78 % ( 1990 ) . Lithium is besides the primary drug used for long- term care of bipolar upset. In a bulk of bipolar patients, it lessens the continuance, frequence, and badness of the episodes of both mania and depression. Unfortunately, every bit many as 40 % of bipolar patients are either unresponsive to lithium or can non digest the side effects. Some of the side effects include thirst, weight addition, sickness, diarrhoea, and edema it may besides rise the suicide potency that is present with sustained depression. Patients who are unresponsive to lithium intervention are frequently those who experience distressed passion, assorted provinces, or rapid cycling bipolar upset. One of the jobs associated with Li is the fact the long-run Li intervention ha s been associated with reduced thyroid operation in patients. Preliminary grounds besides suggest that hypothyroidism may really take to rapid-cycling ( Bauer et al. , 1990 ) . Pregnant adult females experience another rporblem associated with the usage of Li. Its usage during gestation has been associated with birth defects, peculiarly Ebstein’s anomalousness. Based on current informations, the hazard of a kid with Ebstein’s anomaly being born to a female parent who took Li during her first trimester of gestation is about 1 in 8,000, or 2.5 times that of the general population ( Jacobson et al. , 1992 ) . There are other effectual interventions for bipolar upset that are used in instances where the patients can non digest Li or have been unresponsive to it in the yesteryear. The American Psychiatric Association # 8217 ; s guidelines suggest the following line of intervention to be Anticonvulsant drugs such as valproate and carbamazepine. These drugs are utile as antimanic agents, particularly in those patients with assorted provinces. Both of these medicines can be used in combination with Li or in combination with each other. Valproate is particularly helpful for patients who are lithium defiant, experience rapid-cycling, or have comorbid intoxicant or drug maltreatment. Major tranquilizers such as Haldol or Thorazine have besides been used to assist stabilise frenzied patients who are extremely agitated or psychotic. Use of these drugs is frequently necessary because the response to them are rapid, but there are hazards involved in their usage. Because of the frequently terrible side effects, Benzodiazepines are frequently used in their topographic point. Benzodiazepines can accomplish the same consequences as Neuroleptics for most patients in footings of rapid control of agitation and exhilaration, without the terrible side effects. Some physicians as intervention for bipolar upset have used antidepressants such as the selective 5-hydroxytryptamine re-uptake inhibitors ( SSRI? s ) fluovamine and Elavil. A double-blind survey by M. Gasperini, F. Gatti, L. Bellini, R.Anniverno, and E. Smeraldi showed that fluvoxamine and Elavil are extremely effectual interventions for bipolar patients sing depressive episodes ( 1992 ) . This survey is controversial nevertheless, because conflicting research shows that SSRI? s and other antidepressants can really precipitate frenzied episodes. Most physicians can see the utility of antidepressants when used in Bipolar Disorder in concurrence with temper stabilising medicines such as Li. In add-on to the mentioned medical interventions of bipolar upset, there are several other options available to bipolar patients, most of which are used in concurrence with medical specialty. One such intervention is light therapy. One survey compared the response to light therapy of bipolar patients with that of unipolar patients. Patients were free of psychotropic and hypnotic medicines for at least one month before intervention. Bipolar patients in this survey showed an norm of 90.3 % betterment in their depressive symptoms, with no incidence of passion or hypomania. They all continued to utilize light therapy, and all showed a sustained positive response at a three month followup ( Hopkins and Gelenberg, 1994 ) . Another survey involved a four hebdomad intervention of bright forenoon visible radiation intervention for patients with seasonal affectional upset and bipolar patients. This survey found a statistically important decrease in depressive symptoms, with the maximal antidepressant consequence of visible radiation non being reached until hebdomad four ( Baur, Kurtz, Rubin, and Markus, 1994 ) . Hypomanic symptoms were experienced by 36 % of bipolar patients in thi s survey. Predominant hypomanic symptoms included rushing ideas, deceased slumber and crossness. Surprisingly, tierce of controls besides developed symptoms such as those mentioned above. Regardless of the account of the outgrowth of hypomanic symptoms in undiagnosed controls, it is apparent from this survey that light intervention may be associated with the ascertained symptoms. Based on the consequences, careful professional monitoring during light intervention is necessary, even for those without a history of major Bipoler Disorder. Another popular intervention for bipolar upset is electro-convulsive daze therapy. ECT is the preferable intervention for badly frenzied pregnant patients and patients who are murderous, psychotic, catatonic, medically compromised, or badly self-destructive. In one survey, research workers found marked betterment in 78 % of patients treated with ECT, compared to 62 % of patients treated merely with Li and 37 % of patients who received neither, ECT or Li ( Black et al. , 1987 ) . A concluding type of therapy is outpatient group psychotherapeutics. Dr. John Graves, interpreter for The National Depressive and Manic Depressive Association has called attending to the value of support groups, and challenged mental wellness professionals to take a more serious expression at group therapy for the bipolar population. Research shows that group engagement may assist increase Li conformity, lessening denial sing the unwellness, and increase consciousness of both external and internal emphasis factors taking to manic and depressive episodes. Group therapy for patients with bipolar upsets responds to the demand for support and support of medicine direction, and the demand for instruction and support for the interpersonal troubles that arise during the class of the upset. The bipolar upset can impact anyone at anytime. It is still ill-defined as to what and why this happens. Some physicians believe that the organic structures? chemical sometimes acquire out of whack and that the intervention of Li every bit good as the other drugs will assist battle the normal degrees in our organic structures. Whether we of all time fins a remedy or truly how this familial and emotional upset does come about, we all can hold that this does happen in households and most of the clip it affects adult females more so than that of the work forces. I think that is because adult females are so emotional to get down with and that AIDSs in the frenzied depression episodes. Hopefully scientist will go on to analyze and dissect this upset that affects so many people.

Master of Public Health for Childhood Vaccination - myassignmenthelp

Question: Discuss about theMaster of Public Health for Childhood Vaccination. Answer: Introduction: The rate of full immunization coverage for children has not been achieved equally in low developed countries compared to developing countries. According to the WHO report for achieving target immunization coverage for vaccine like DTP, countries like Africa and South East Asia are still short of the target of 90%. Many barriers to achieving vaccination target has been found to contribute to the trend in low developing countries. Some of these barriers include poor parent education, low income and poor access to health care facilities (World Health Organization, 2017). As a staff working in health department of Maharashtra, India, I have been given the task of evaluating the effectiveness of various interventions to determine whether investment should be done to improve vaccination rate according to new policy directive or not. Hence, this report mainly review the findings from the Cochrane review of the article on Interventions for improving coverage of childhood immunization in low and middle-income countries and evaluates the applicability of the Cochrane review findings on improving vaccinate rates in India particularly Maharashtra. The structured assessment is likely to influence the decision regarding investing for vaccination efforts in the chosen country. Childhood vaccination issues in India: The Government of India focused on intensification of childhood immunization in remote and inaccessible rural areas in the year 2012-2013 and their target was also to eradicate polio transmission and measles from the country by 2010 (Bhatnagar et al., 2016). According to national immunization coverage for 2015, 87% vaccination rate was achieved for BCG, DTP3 and MCV1. The government was involved in 39% spending on vaccines and 42% spending on routine immunization programme (EPI Fact Sheet, 2017).This reflects that advances in immunization coverage rates has been achieved, however still India has fallen short of coverage for all children because of many management challenges. Some of the reasons for poor vaccine coverage back in the 1990s included extreme focus on polio eradication at the expense of other vaccines, insufficient investment of government in vaccination coverage, presence anti-vaccine advocates as well as poor education in people. The quality of supply chain and infrastr ucture was also found to affect the vaccination coverage because 25% of vaccines did reached health care clinics and doctors and they were wasted (Centre for Public Impact, 2017). The evaluation of more recent statistics on coverage for DPT vaccine revealed that 19.3 million infants in 2010 remain unimmunized globally and India achieved only 61% immunization coverage in 2011. The investigation regarding the reason for such trend revealed that dropout rates was higher in migrant groups because of poor service utilization and inability to complete full course of vaccination (Progress Towards Global Immunization Goals, 2017).As 2012 became the year of intensification of routine vaccination particularly in remote and backward areas, Nath, Kaur, Tripathi, (2015) investigated about the challenges in vaccination rate among migrant population in Uttarakhand, India. The main findings from the study was that gap in immunization coverage was seen because of inadequate cold chain maintenance, poor tracking of dropouts and poor training in staffs regarding maintaining the temperature of vaccines. In case of mothers, the main reason for non-immunization included the prefer ence for vaccinating child in resident district only and lack of awareness about session site location. Review of these challenges in achieving vaccination rates in India mainly suggest that tailored strategies as intervention were not taken to specifically target immunization coverage in people living in rural and remote areas particularly with low education. It also points out to weakness in counseling efforts to change the attitude of parents towards the immunization process. As this report is mainly focused on evaluating applicability of Cochrane review findings particularly for Maharashtra, analyzing the challenges in vaccination coverage in the state is also necessary. The study by Gatchell, Thind, Hagigi, (2008) pointed that for children in Maharashtra, education in parents increased the likelihood of completing immunization in children compared to uneducated parents. Receipt of antenatal care and exposure to TV was a strong predictor of complete immunization however household standard of living also affected the immunization status of children. One unique finding for Maharashtra was that children in rural areas were more likely to be completely immunized compared to those in urban areas. This is an indication that rural infrastructure is strong in Maharashtra and more efforts is required in improving coverage in urban areas. Scheduled caste related biasness in coverage was also seen suggesting more interventions targeting this group. Hence, consider ation of state level determinant of immunization is crucial to improving overall immunization rates in India. Summary of the findings of the Cochrane review: The Cochrane review of the article on Interventions for improving coverage of childhood immunization in low and middle income countries revealed about types of interventions implemented in countries like Ghana, India, Nepal, Pakistan and many other low developing countries. Some of the relevant interventions implemented for improving childhood immunization coverage included providing community based health education, facility based health education and redesigned reminder cards, monetary incentives, home visits, immunization outreach with and without incentives and integration of immunization with other health services. In terms of effectiveness, moderate evidence was found for communication regarding vaccination in parents and other community members (Oyo?Ita et al., 2012). However, for other interventions like use of reminder card, regular immunization outreach home visits and integration of immunization with primary health care service, low certainty evidence was found for immuniz ation coverage. This indicates that strong evidence was not present for the effectiveness of one type of intervention to improve the coverage. The author also presented limitations in each intervention with proper arguments and raising arguments regarding varied intensity and content of each intervention. For example, the community based education intervention was given with the purpose of educating people about the benefits and risk of vaccination and how and where to received vaccine services. However, the feasibility of this approach is not clear because no evidence is present for the impact of such intervention in improving completion of the immunization schedule (Oyo?Ita et al., 2012). Another intervention identified in the Cochrane review was related to community based health education and again effect of such intervention was questioned in a community with low literacy. Another study also regarding monetary incentive intervention to beneficial in imprpvong immunization rate in a family with poor economic resource, but the methodological challenge in this process is that how donor support and incentive could be arrang ed in specific locations (Oyo?Ita et al., 2012). This mainly indicates that studies are presented but poor presentation of effectiveness restricts the wider applicability of the study. The study was useful in showing about the lack of evidence on the approach taken to promote the sustainability of the interventions. The author also presented the barrier to the applicability of the interventions in real setting. For instance, applicability may be affected by the level of education in immunization health workers and poor access to relevant resource and infrastructure related to immunization coverage. Hence, it can be said that resource played an critical role in the success of any intervention and to determine the long-term sustainability and cost effectiveness of any interventions, data related to resource implications must be comprehensively analysed. In addition, there is a need for well-conducted RCT studies to get high certainty evidence regarding the efficacy of intervention in improving childhood immunization coverage. Structure discussion of five support questions: The main purpose of evaluation of interventions mentioned in the Lavis et al., (2009) is to determine whether any of the intervention can be applied in the health care system of India and particularly the state of Maharashtra or not. The author of the Cochrane review mainly supported interventions like providing information to parents and community members about immunization, combination of health education and redesigning immunization reminder card, home visits and integration of immunization with other service to improve immunization coverage in low and middle income countries (Oyo?Ita et al., 2012). The structured assessment for applicability of the Cochrane review is mainly done by use of five questions from the Lavis et al., (2009) as the support tool particularly ensures that decisions are well-informed and critical assessment of intervention according to local context is possible. Consistency of findings across settings or time periods The first criterion for evaluation of the study are to find out whether the findings are based in the same setting as the policy maker or the reviewer or not. The main purpose of this study is to evaluate the applicability of the intervention for the health care system of India. However, the systematic review included fourteen studies and it include two studies from India and other studies from the country of Ghana, Mexico, Honduras, Pakistan, Zimbabwe and Nepal (Oyo?Ita et al., 2012). This means that local applicability of the intervention is doubtful for the health care system of India. However, consistency of finding across all settings can also give an idea about local applicability of the interventions. For all the studies done across different settings, low certainty evidence was present for effectiveness. Therefore, consistency across different settings was not found. In addition, major studies were published between the 2004 to 2011, however some were published in 1998 and 19 96 too. It is not clear whether the finding is consistent across time periods. Hence, the study done in Indian settings needs to be evaluated to understand whether they can be implemented in the state of Maharashtra or not. The intervention done in Indian setting investigated about the immunization outreach with and without incentives by means of a clustered randomized controlled trial. The study was done in a rural setting of Rajasthan and three groups in the study included monthly immunization camp, immunization camps with incentive and the controls groups. The survey with participants in randomly selected households revealed that full immunization rate was higher for the immunization group with incentive compared to the control group. The average cost per immunization was higher for group with incentive compared to without intervention group. The main conclusion from the study was that small incentives can have a positive impact in improving immunization coverage in areas with poor resource (Banerjee et al., 2010). As this study has been done in rural setting, it can be said that this type of intervention can be applied in Maharashtra only in rural and remotes areas where people do not have access to reliable immunization camp. The transferability and effectiveness of this intervention is high for low income areas. This is considered a reliable intervention for rural setting because another study showed that introduction of food/medicine vouchers as incentive to mothers increases the completion of DTP coverage by two fold in low socio-economic area (Chandir et al., 2010). Hence, similar approach is likely to work in rural areas of Maharashtra or any other state in India. In the context of Maharashtra and India, immunization with incentive intervention is not likely to be effective and reliable in urban areas. Review of studies done in other countries will also not help to determine the applicability of any intervention for India because the health care system of India will differ from that of other countries. The immunization service outreach urban children may differ based on standard of living index. The review of challenges faced in achieving immunization target in India or Maharashtra may also help in determining the most effective intervention for urban areas. The study on trends in child immunization across geographical regions in India has revealed that urban-rural different and gender equity in different states has an impact on immunization coverage. In Maharashtra, particularly, the gender equality ratio is high and gender inequality challenges in full immunization coverage needs to be considered (Singh, 2013). Hence, this element needs to b e considered in intervention for improving coverage in Maharashtra. Factors affecting the feasibility or acceptability of intervention options: The systematic review proposed various interventions for improving the childhood immunization coverage. However, their feasibility and acceptability may be affected by ground realities and political or other constraints faced in India, hence before deciding on any intervention for Maharashtra, the links with ground realities needs to be analysed. In terms of ground realities, the main challenges is that health worker density is low in India and the distribution of health workers remains a barrier to Universal Health coverage. Association has been found between shortage of health workers and poorer health outcomes in Indian state. Hence, if any interventions focuses on community based health educations, the shortage of community health workers in any Indian state will reduce the applicability of the intervention. The rural-urban division also affects immunization coverage and for rural areas of Maharashtra, the trend is different as the immunization coverage is rural area of the state is much better than other Indian states. Another insight from evaluation of immunization coverage in Maharashtra was that only 60% has immunization card and in this aspect, the interventions related to redesigned reminder cards might work for the target setting (Gupta, Pore, Patil, 2013). Hence, in the context of health care system of India, the facility based health education plus redesigned reminder cards may be feasible as an intervention for immunization coverage. Another factor affecting the feasibility of any interventions in Indian setting is the issue of gender bias in the population. Mathew et al., (2017) studied about the barrier to immunization among women in an Indian state and this mainly showed that attitudinal barrier to immunization was high. For instance, poor male participation, gender bias, lack of family support, poor attitude towards vaccinisation in elderly, strange rumors and apprehension of getting many vaccines acted as the barrier in immunization coverage. Hence, an intervention may become less applicable for Indian context if it does not address attitudinal barriers in interventions. In this context, role of health personnel and effective counseling and health education sessions is likely to be feasible in improving immunisation rate in the health care system of India. This type of evaluation in terms of ground realities is necessary to confirm the applicability of any intervention in local setting because diffusion of e vidence into policy depends largely on the factors involved at each stage of the adoption process (Bowen Zwi, 2005). Role of health system arrangements in affecting the feasibility of intervention Oyo?Ita et al., (2012) included articles in the studies which included low developing countries like Nepal, Pakistan, Zimbabwe and others which might have different health system arrangements than India. In such case, the evaluation of the intervention needs to be done on the basis of health system arrangements that alters outcome of the intervention. For instance, the monetary incentive intervention in the form of household cash transfer done in Zimbabwe and Nicargua may give alternative results in India. In the context of health care system arrangement in India, the universal immunization program in India covers free vaccination against 12 life threatening diseases and there is an impetus to develop new vaccines and improve the quality of vaccines. Work is also going on address gaps in cold-chain management (Dang, 2017).However, no systematic arrangement has been found to permanently provided incentive related benefits to target group to achieve the full immunization goals. Without such arrangement, any incentive related intervention is less likely to be feasible. However, the study done in Zimbabwe did not considered about the health system arrangement to extend incentive benefits to enhance vaccination coverage (Crea et al., 2015). Another health system arrangement that significantly affects the performance in immunization coverage is the timeliness in immunization coverage. For all types of intervention, whether it is home visits or immunization outreach, the purpose fails until appropriate strategies are not in place for timeliness in coverage. The review of timeliness of immunization coverage is a concern in India, because Barman, Nath Hazarika, (2015) has showed poor progress in age-appropriate immunization coverage of children due to caste, religion and socioeconomic status of the population in Assam. This implies that timeliness in coverage has been affected by these factors. In the context of Maharashtra, the challenges in timeliness in coverage is reflected by the disparities in coverage in tribal and schedule caste group. The study Mathew, (2012) proved that proportion unvaccinated children was high in four states of India and this was mainly due to imbalance in rural vs urban, girls vs boys, schedule d caste vs others and literate vs illiterate parents. Although Maharashtra had good progress in rural vaccination than urban vaccination, but lower complete vaccination was found in families belong to scheduled caste in the state. This means different in social characteristics of Maharashtra is likely to affect the feasibility of any intervention. Difference in baseline considerations: The baseline conditions in any study is also likely to give idea about the effectiveness of interventions. The study included in the systematic review can be evaluated for feasibility in Maharashtra, India by analyzing the relation between baseline conditions and absolute effects. The review of characteristics of included studies has shown that baseline condition was not similar to those of Maharashtra, India in all case. For example, there was an article that focused on evidence based discussion on immunization in poorest districts of countries (Andersson et al., 2009) and another study focused on disadvantage rural community in India for vaccination coverage (Banerjee et al., 2013). However, this is not applicable for the state of Maharashtra because improving immunization rate in rural areas is not their priority. Statistics reveals that immunization rate for rural areas in Maharashtra are good because of good rural infrastructure. Hence, interventions focusing on rural areas stan d irrelevant for brining improvement in the context of Maharashtra, India. Review of studies of cash transfer gave idea about impact of intervention on eligible village community and the education component. This again is not feasible for the baseline condition of Maharashtra (Oyo?Ita et al., 2012). However, on intervention is found to have greater baseline similarity to that of Maharashtra state as it aimed to address immunization coverage in spite of developed immunization infrastructure by means of home visit. This is relevant to the target state because despite the good immunization infrastructure, the state has not achieved equal immunization coverage for scheduled caste group. Hence, use of home visits can be considered an intervention to improve immunization rates. Many others studied focused on pregnant women and endemic areas and this is not related to the context and issues for Maharashtra. The RCT study done in Pakistan can be considered for applicability in Maharashtra as it focused on communities with low literacy and low immunization with use of targeted pictorial messages (Owais et al., 2011). Similar approach might help to improve immunization rates in scheduled caste tribe in Maharashtra. Insights regarding the implementation of evidence from systematic reviews The review of the abstract of the systematic review has given idea that there was lack of high certainty evidence regarding any interventions. Petticrew, (2003) mainly suggest that many systematic reviews fail to reach any conclusion because they contain few outcome evaluation or meta-analytic approaches in reviewing of observation data might be missing. In addition, the main problem in deciding the applicability of the interventions for the public health system of Maharashtra India was that studies were done in other country setting apart from India. However, some conclusion can be drawn from this study even if the evidence are not directly applicable for local setting. For example, Owais et al., (2011) was not done in India, however it focused on communities with low literacy and low immunization rate. Hence, some strategies or ideas can be gained from this intervention to address the problem of low immunization rate in schedule caste group in Maharashtra. The intervention focused on immunization promotion educational interventions by trained community health workers and this might help to address perception of immunization in scheduled caste tribe. In addition, the strategy of incentive can be considered in initial stages if the immunization coverage rate is too low in any group. However, in that case. accurate funding arrangements should be there for target groups. Home visits is likely to effective in addressing attitudinal barrier to vaccine uptake. The main gap identified in the systematic review was there was no focus on studies in any racial group and presence of studies in this participant group might be the most feasible for addressing the immunization coverage issues in Maharashtra. Conclusion: From the critical review of Cochrane review article on intervention to address immunization coverage in low developing countries, the main conclusion is that no intervention is directly applicable for the health care system of Maharashtra, India. However, considering the poor immunization coverage in urban areas and schedule caste tribe of Maharashtra, home visits along with education intervention and incentive is considered to be beneficial for local application in Maharashtra. Hence, as India is mainly focusing on improving the technologies related to vaccination, there is a need to move to the direction of investment in training of health care professional, education intervention and incentive arrangement to address the challenges in achieving full immunization coverage in Maharashtra. Hence, health of the Vaccination section can focus on investment to extend incentive scheme, increase home visits and improve the quality of immunization education program. Reference Andersson, N., Cockcroft, A., Ansari, N. M., Omer, K., Baloch, M., Foster, A. H., ... Soberanis, J. L. (2009). Evidence-based discussion increases childhood vaccination uptake: a randomised cluster controlled trial of knowledge translation in Pakistan.BMC International Health and Human Rights,9(1), S8. Banerjee, A. V., Duflo, E., Glennerster, R., Kothari, D. (2010). 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