Flexible Budgets Essay Example | Topics and Well Written Essays - 250 words

Flexible Budgets - Essay Example This paper will outline the difference between the two methods of budgeting. Flexible budget records and outlines different information than static budget since it records the daily activities of budgeting and accommodates the accountings entries and activities that are new to the budget system. Unlike static budget which is prepared before the beginning of accounting period, flexible budget is prepared daily and continues till the end of the period (Mowen, 2012). Static budget ensures comparison and variance analysis is done due to presence of actual budget and estimated budget while the flexible budget does not involve comparison of budgets as there is only one budget. A flexible budget is not always better as it does not involve many activities like variance analysis to evaluate the performance of the company. Static budget is usually preferred where a business estimates the budget and wants to compare the difference between the estimated budget and actual budget (Mowen,

Computer information Essay Example | Topics and Well Written Essays - 500 words

Computer information - Essay Example Both outlook express and MSN messenger support electronic messaging and the sending of electronic documents. The advantage of MSN messenger is that communication is faster rather than having to walk across the staff room to the person whom you wish to talk to. Documents can be sent via MSN messenger too. The disadvantage is that communication has to be real-time. If the person to whom you wish to communicate to is teaching classes, communication is impossible. Fortunately, there's always outlook express. The advantage of outlook express makes up for the disadvantage of MSN messenger. Communication is possible at different times from different places, in addition to the capability of sending documents. The disadvantage of outlook express is that verbal and non-verbal cues such as tone, inflection, and facial expression are missing (Montoya, 2003). Office automation systems include the electronic office such as computers, fax, and computerized telephone systems, as well as office automation applications such as word processing, electronic mails, desktop publishing, fax, image processing, and teleconferencing. The trend is to integrate these applications (Williams, Sawyer, & Hutchinson, 1997). In the school where I am teaching, we use computers, Microsoft office applications such as w

Hydration Management in Acute Stroke Patients

Hydration Management in Acute Stroke Patients Introduction Stroke is a global public health concern with many sufferers presenting with varying levels of confusion (Oh and Seo 2007). Management of hydration in acute stroke patients is not standardised and variations in practice can be very wide between different continents. The sheer number of possible comorbidities and the relative ease with which hydration can trigger concomitant problems can lead to increasing incidence and prevalence of long-term patient care resulting from inadequate hydration management. Optimum hydration assessment and management are key clinical activities; however, inadequate hydration controls by health professionals persist (Oh and Seo 2007). Research shows that to guide fluid management to desired levels, a regular assessment of the volume status has to be made Scope This literature review is based on works that are found on Medical Literature Analysis and Retrieval System Online (MEDLINE), the Cumulative Index to Nursing and Allied Health literature (CINAHL), Cochrane, Department of Health (DoH), National Institute of Clinical Excellence (NICE), National Medical Council (NMC), World Health Organisation (WHO), Wiley Interscience and CKS databases that relate to hydration in stroke patients and nursing awareness of hydration in stroke patients. There is wide literature on different aspects of stroke and many authors have studied the effects of hydration in stroke patients. This review looks at literature that discusses management of hydration and/or the impacts of variations in hydration management on acute stroke patients outcomes like method of feeding, time- compliance in taking readings or measurements, legal issues and ethical issues. Relevance to clinical practice This literature review looks at relevant studies by experts that are found on credible databases. The purposes of the expert studies are reviewed and analysed to inform better understanding of current nursing practice in hydrating acute stroke patients. Several studies on hydration highlight specific difficulties relating to the assessment and management of hydration in acute stroke patients. There are differences between the management and the assessment of hydration in different hospitals and these complicate improving awareness of managing hydration for nurses in practice. If optimum hydration is directly linked to improved outcomes in acute stroke patients, research will be required to identify and overcome barriers to effective hydration management, including the development of specific tools (and knowledge base) to facilitate interventions that promote optimum hydration in seeking improved outcomes in acute stroke patients. Methods of search and documentation n on-line literature search of MEDLINE, CINAHL, COCHRANE, DOH, NICE, NMC, WHO and CKS from 1999 to May 2009 failed to identify enough relevant articles on hydration in stroke patients. Other sources were then reviewed for available literature on medical journals including the BMJ and American Family Physician. For the on-line computer-based literature searches, the following keywords were used: stroke, fluid balance, hydration, cerebrovascular accident (CVA), dehydration, stroke outcome, cerebrovascular disorders, medical management, artificial nutrition and hydration, dysphagia, dysphasia, pyrexia, acute brain infarction, enteral tube feeding, fluid and electrolyte balance, neurology, withholding treatment, pathophysiology and nurses and hydration Hydration and hydration management in acute stroke patients This literature review looks at one of the issues encountered globally in the treatment of acute stroke patients optimum hydration. It takes a particular look at the nursing awareness, measurement, assessment, methods of intervention and the legal issues associated with hydration in acute stroke patients. Stroke is a debilitating condition and can be caused by an ischaemic event or a subarachnoid/intracerebral bleeding. Stroke patients usually present in hospital with co-morbidities (Oh and Seo 2007). Variations exist in stroke fatalities across geographical regions even within the same continent. Studies by Bhalla et al (2003) across four European centres (London, Dijon, Erlangen and Warsaw) have shown significant variation (after adjusting for case mix) in stroke case fatality, in incontinence, dysphasia, dysphagia, conscious level, pyrexia, hyperglycaemia and comorbidity. There were also significant intervention differences between centres in intravenous fluid use, enteral feedin g, initiation of new antihypertensive therapy and insulin therapy, with the London centre having the lowest uptake of interventions. In another European BIOMED Programme, significant variations in case fatality for stroke between European centres (after adjustment for stroke severity) were observed, with the United Kingdom (UK) centres having the highest case fatality and the lowest levels of independence (Wolfe et al., 1999). There were lower intervention rates in the UK centre to correct abnormal physiological parameters in the acute phase which may reflect a difference in philosophy of acute medical supportive care compared with other European countries (Wolfe et al., 2001). Awareness of optimal hydration balance and assessment of the patients hydration condition (in the care of acute stroke patients) is a fundamental part of critical care nursing and optimising the hemodynamic situation can be seen as a team-effort. One of the important factors determining quality of the circula tion is the amount of circulating blood (Hoff et al 2008). Following a stroke, patients may have swallowing impairment and other changes of the gastro-intestinal (GI) tract that could affect nutritional and hydration status and that lead to aspiration pneumonia (Schaller et al 2006). Such changes affect the ability of the acute stroke patient to lead a normal nutritional life. Although the Schaller et al (2006) work did not show a direct link between hydration and other comorbidities, they agree that impaired hydrational status is associated with reduced functional improvement, increased complication rates, and prolonged hospital stays. Hydration and hydration status Hydration balance is a measure of the bodys ability to manage fluids and electrolytes. In order to identify the urgency of interventions, nursing staff should characterize an individuals fluid and electrolyte imbalance as mild, moderate, or severe based on pertinent information including lab tests and other relevant criteria. It is important to recognize that the main electrolyte in extracellular fluid (ECF) is sodium and that of intracellular fluid (ICF) is potassium (Edwards, 2001). Toto (1998) pointed out that large increases or decreases in fluid volume can cause infarct, coma and confusion. This knowledge becomes significant in maintaining cerebral blood flow and in preventing secondary brain insult after an acute stroke. In a complication, respiratory or metabolic acidosis will promote the movement of potassium from the ICF and give rise to high serum potassium levels, which may affect cardiac function (Edwards, 2001). This phenomenon can be seen in many traumatic insults to th e brain. A basic knowledge of this physiology in addition to the homeostatic mechanisms for fluid and electrolyte balance is a vital foundation for nursing practice, and essential to the nurses role in hydration management. Cook et al (2005) highlighted the significance of fluids and hydration in the neuroscience patient and in Cook et al (2004) they highlighted that an understanding of the physiological mechanisms that surround stroke is important for nurses to monitor and treat such patients. Kelly et al (2004) in their study of dehydration and venous thromboembolism (VTE) after acute stroke believed dehydration after acute ischaemic stroke (AIS) is strongly independently associated with VTE, reinforcing the importance of maintaining adequate hydration in these patients. Their study of hydration over a 9-day period showed indication that dehydration was largely hospital acquired and that the association was causal. Although the possibility that VTE was already present at entry to hospital cannot be discounted, tests have shown that VTE is rarely present before the second day post stroke, and then it becomes increasingly prevalent over the next few days. This could be for one of many reasons including poor communication between patient and hospital staff, change of environment for the patient and the physiological impacts of stroke Hydration balance and nutritional/electrolyte balance The differences in how hydration is assessed in different hospitals have been subject of study for some time. The significance of fluid electrolyte homeostasis becomes very relevant in trauma and shock situations such as subarachnoid haemorrhage where an inflammatory response is triggered which causes a significant change in capillary membrane permeability in a short period of time. In such situations, water, electrolytes and albumin move into the interstitial space to permit the site of injury to receive the required factors (third space shift) (Edwards, 2001). A number of physiological mechanisms are required to maintain homeostasis of hydration status, all of which inform proactive nursing assessment, intervention and evaluation. Those with trauma to the nervous system are vulnerable to disruption to the homeostasis of fluid and electrolyte balance (Cook 2005). Older adults may have a poorer capacity to adapt to shifts in acute fluid balance, leading to the possibility of cardiac and renal functions being impaired and, as a result, a lower glomerular filtration rate (Sheppard, 2001). Managing the fluid balance of the stroke patient by intake and output measures needs to be exercised cautiously because even though the patients fluid volume may not have changed, his/her circulatory volume may be significantly lower in instances of major trauma (Edwards, 2001) Good hydration has been shown to reduce the risk of urolithiasis (category Ib evidence) (see Appendix 2), constipation, exercise asthma, hypertonic dehydration in the infant, and hyperglycemia in diabetic ketoacidosis (all category IIb evidence), and is associated with a reduction in urinary tract infections (UTIs), hypertension, fatal coronary heart disease, venous thromboembolism, and cerebral infarct Complications of measurement/control Naso-gastric v PEG, enteral v parentera Patient history taking on presenting in the hospital differs from hospital to hospital. History taking should include assessment of fluid intake and loss, baseline hydrational status, skin turgor, heart rate, blood pressure and urinary output. Normal fluid intake for the average adult is approximately 2-2.5 litres, obtained from food, fluids or metabolic by-products (Edwards, 2001). Methods of measurement are not standardised across hospital settings with Wise et al (2000) showing that faecal fluid losses are often neglected in daily fluid balance charts with the possibility of inaccurate hydration assessment. Fluid assessment must include estimating, as accurately as possible, the quantity of fluid taken in. It must take into consideration the entire processes by which water, potassium and sodium are obtained. Measurements are often mainly focused on the extremes of hydration (optimal hydration and extreme dehydration) and this should not be the case. Assessment of hydrational statu s and need is continuous and begins somewhere along a continuum of severe hypovolaemia/ dehydration to severe hypervolaemia/ overhydration. In looking at dehydration, not only extreme dehydration should be noted. Manz and Wentz (2005) highlight that there is increasing evidence mild dehydration may also account for many morbidities and play a role in various other morbidities. The way in which stroke is managed acutely, such as measures maintaining physiological homeostasis may also vary between different populations (Bhalla et al 2003). The physiological indicators of acute deficits in fluid balance may be masked in individuals where compensatory mechanisms are intact. A history of acute events, mainly from baseline documentation and history taking, may enable better identification of such imbalances (Sheppard, 2001). Fluid and electrolyte homeostasis is brought about by the interaction between the renal, pulmonary, neuroendocrine, integumentary and gastrointestinal systems (Edward s, 2001). According to (Cook 2005), fluid and electrolyte management is a fundamental aspect of the role of the neuroscience nurse. Artificial feeding and fluids are the options for a patient who has an advanced, life-threatening illness and is dying. The patient, family members and doctor can talk about these options and the benefits and risks (Ackermann 2000). Hydration and electrolyte status are crucial mediators to the extent of the neuro-hormonal response to trauma. Edwards (1998, 2001) highlighted that homeostasis is maintained by a constant movement of water, sodium and potassium between intra- and extracellular compartments. While the movement of water and electrolytes between the cellular compartments is highly significant, it is important to recognize that in acute and chronic illness intracellular fluid (ICF) is reduced and extracellular fluid (ECF) increased almost to the extreme (Edwards, 2001). This is highly relevant for cerebral metabolism, because transport of oxyge n, glucose, proteins and other products for cellular metabolism—and their by-products—may be severely impaired. Stroke may affect ones level of alertness, perception of thirst, ability to access liquids, and ability to swallow them when offered. Stroke victims with such impairments may be at increased risk for diuretic-induced dehydration (Churchill et al 2004). Managing hydration balance is of crucial importance and the mechanisms for the adequate monitoring and controls need to be in place. Nursing management questions in the assessment of hydration in acute stroke patients should include whether use of intravenous fluids during the first week of stroke was recorded. Questions should also include whether the patient was fed orally, by nasogastric tube, through percutaneous gastrostomy tube, by intravenous methods or not at all? The fact that these questions can be raised enforces the need for adequate documentation and recording of acute stroke patient records. Bhall a et al (2002) says that the use of artificial ventilatory support with intubation or nasal intermittent positive pressure ventilation should be documented as well as the use of supplemental oxygen given through nasal catheters or masks. Enteral tube feeding is a vital means of feeding and balancing hydration levels in patients with stroke. There are no set standards for hospitals in the UK and hospitals have recorded much variation between them in the timing of the start of enteral tube feeding and whether a nasogastric or percutaneous endoscopic gastrostomy (PEG) tube is used (Ebrahim and Redfern 1999). Some clinicians delay tube feeding for 2 weeks or more, and although early nutrition is unlikely to be harmful, whether any nutritional benefits offset the difficulties and complications of initiating and maintaining early enteral tube feeding is unclear. If the timing or route of enteral tube feeding does affect outcome, the present variation in practice means that large numbers o f patients are being denied best treatment. Whether enteral tube feeding via PEG rather than nastrogastric tube or early initiation of enteral tube feeding improve outcomes was tested in the FOOD trials and no evidence of significant benefit from PEG rather than nasogastric tube feeding was found. Neither was any hazard from early tube feeding found (The FOOD collaboration 2003). The explanation for any difference between PEG and nasogastric groups is not clear, but one factor might be the effect of a long-term PEG tube on dependency since more patients in the PEG group were still receiving such tube feeding than in the nasogastric group at follow-up (The FOOD collaboration 2003). The survivors in the PEG group were also more likely to be living in institutions and had lower quality of life. Another intriguing finding was the excess of pressure sores in the PEG group, raising the possibility that those with such tubes might move less or be nursed differently. Weaknesses in this test results include insufficient statistical power to exclude more modest differences between groups; no information about the proportion of eligible patients enrolled in each centre; our use of an informal (although reliable and highly predictive) assessment of nutritional status; absence of precise monitoring of patients daily intake of nutrients (rather than fluids); absence of on-site source data verification or collection of information on changing nutritional status (e.g. in-hospital weights); possible bias due to masking of secondary outcome measures. Although compliance was not 100%, this fact results from the inevitable difficulties of adhering to rigid schedules when patients conditions change. Difficulties with nasogastric feeding in stroke patients (who are often confused and uncooperative) have led to increasing use of PEG tubes at an early stage. Enthusiasm for this method has been encouraged by the results of a trial that reported much lower case fatality rates in patien ts fed via PEG (13%) rather than nasogastric tube (57%) (The FOOD trial collaboration 2003). Due to significant alterations in fluid balance after enteral tube-feeding in patients, close attention to the recording of fluid balance such as intake/output measurements, body weights and simple bedside assessments is needed to detect fluid imbalances and other serious complications at an early stage (Oh and Seo 2007). One explanation for the varying and inconsistent readings in fluid hydration between enteral and PEG might b Stroke patients and the impacts of stroke on life Difficulty with swallowing is a common problem in acute stroke patients, and can lead to aspiration pneumonia, dehydration, and exacerbation of any existing malnutrition (Finestone and Greene-Finestone 2003). In Oh and Seo (2007) the authors set out to examine the fluid and electrolyte complications after enteral tube feeding in acute brain infarction patients. The background is that inconsistencies in the results of the water and electrolyte complications associated with enteral tube feeding are partly because of uncontrolled disease-related variables. The implication is that these variables were not adequately managed. Stroke patients very often present with dysphagia and this is very commonly dehydration associated with undernutrition (The Food Trial 2005). Up to half of stroke patients in hospital have dysphagia, which precludes safe oral nutrition for the first few days and can persist for long periods (Mann et al 1999). Although a 50% prevalence can be considered to be high, th e nutritional/fluid status of a stroke patient can rapidly deteriorate in hospital. The difficulty in feeding stroke patients with dysphagia coupled with the discomfort associated with stroke can exacerbate undernutrition and/or dehydration. Studies show that undernutrition shortly after admission is independently associated with increased case fatality and poor functional status at 6 months (The FOOD trial collaboration 2003). The current financial burden of efficiency savings and reduced budgets in the NHS hospitals results in reduced staff numbers so that patients can not be attended to on a one-on-one basis so that ensuring appropriate hydration levels is done by periodic but regular monitoring of charts. An option for the future in this area may be to involve the patients family members in hydration monitoring and provide them with appropriate training if evidence can show that being around loved ones improves outcomes and early warnings. In acute stroke, artificial nutrition t hrough an enteral route is needed because of dysphagia and since oral feeding is unsafe in some dysphagic patients, enteral nutrition is often administered as nasogastric or percutaneous endoscopic gastrostomy (PEG) tube feeding (Finestone and Greene-Finestone 2003). Naso-gastric tube feeding (a prevalent enteral method) has been reported to improve clinical outcomes more than the parenteral route in brain-injured patients (Rhoney et al 2002). Oh and Seo (2007) in their study used 85 subjects, but their work was limited by the fact that it was performed retrospectively and some of the subjects records were incomplete. Also, because the patients in the study were from one hospital it is not conclusively known whether the results can be generalised to the whole population./p> Legal and other aspects Japanese physicians attitudes towards artificial nutrition and hydration (ANH) as a life-sustaining treatment (LST) were examined to find out if they withhold or withdraw the LST when treating older adults with stroke-caused profound impairment with no hope for recovery. The study findings show that the informants held different views towards LST because most doctors considered ANH to be indispensable and ANH is automatically provided to patients (Aita and Kai 2006). With the advancement of medical technology, decisions to withhold or withdraw LST are among the most difficult to make for health professionals (British Medical Association 2001). Physicians caring for stroke patients often encounter comatose or semi-comatose patients with severe stroke for whom it is difficult to determine whether or not to continue care (Asplund and Britton, 1989). By administering LST, some patients in this patients group, whose bodily functions other than brain function could remain stable, could pot entially survive for months or years without achieving awareness or being able to interact with others (Aita et al 2008). Certain Japanese physicians have criticized the current efforts regarding life prolonging as Aita et al (2008) states: Prolonging the process of dying like this constitutes the violation of dignity and human rights. The life-prolongation only serves hospital operators who want to make profits by keeping hospital beds occupied. They also said this practice impacted the carers and that some nurses also feel emptiness toward the manipulative life-prolongation when taking care of these elderly patients. In the West, some countries have worked out nation-wide guidelines related to withholding or withdrawing LST that say stroke-caused profound impairment with no hope for recovery is a potential reason to withhold or withdraw LST (British Medical Association, 2001). Ackermann (2000) believes withholding and withdrawing therapy challenge family physicians to be excellent communicators with patients and families and recommends that family physicians should continue to be strong advocates for dying patients. Sprung et al (2003) highlighted differences between withholding and withdrawing therapy showing that withdrawal of therapy is followed by a nearer and more rapid death than withholding therapy, and that physicians and nurses were more inclined towards withholding rather than withdrawing therapy. Food and water are considered symbols of caring (Ackermann, 2000), therefore, it may be natural for physicians to give a special status to ANH as food and water. Whether to withdraw ANH from a patient in persistent vegetative state has also drawn substantial media attention in the U.S. (Casarett et al., 2005; Ganzini, 2006). The findings of the study also suggest that the physicians double standard is partly based on their subjective judgment whether the treatment is ordinary or extraordinary. However, the standard of ordinary/extraordinary care has long been criticized as too vague to guide decision-makers in the U.S. (Beauchamp and Childress, 2001). It is believed the current legal framework has also inappropriately led some physicians to simply continue care regardless of the patients conditions, thus resulting in putting an unnecessary burden on patients. The physicians subjective interpretation of the current legal framework may lead to decisions not to initiate mechanical ventilation in some older adults for fear of facing a situation in which physicians cannot withdraw it at a later stage Conclusion Hypovolemia and hypervolemia occurred frequently after acute stroke but were often not recognized as such by nurses. The nurses predictions of current volume status do not seem sufficiently reliable to serve as a basis for therapeutic decisions. More advanced techniques for bedside assessment of volume status may be indicated for optimizing volume status in patients with acute stroke (Hoff et al 2004). Whereas studies have looked at the optimal method of improving hydration, whether correcting dehydration in stroke improves outcome is not very clear. Given the complexity of the cell death cascade following brain ischemia, novel approaches and combination therapy are inevitable for victims of stroke (Fisher and Brott 2003). The review indicates that standards vary from country to country in the legal framework for withdrawing and withholding hydration and nutrition during end stage care.

Ridged Puritan Society in Hawthornes The Scarlet Letter :: Scarlet Letter essays

The Scarlet Letter: Ridged Puritan Society In Nathaniel Hawthorne's The Scarlet Letter, life is centered around a rigid Puritan society in which one is unable to divulge his or her innermost thoughts and secrets. Every human being needs the opportunity to express how he or she truly feels; otherwise the emotions are bottled up until they become volatile. Unfortunately, society did not permit this kind of expression; thus characters had to seek alternate means to relieve their personal needs and desires. Luckily, at least for the four main characters, Hawthorne provides such a sanctuary in the form of the mysterious forest. Hawthorne uses the forest to provide a kind of "shelter" for members of society in need of a refuge from daily Puritan life. In the deep, dark portions of the forest, many of the pivotal characters bring forth hidden thoughts and emotions. The forest track leads away from the settlement out into the wilderness where all signs of civilization vanish. This is precisely the escape route from strict mandates of law and religion, to a refuge where men, as well as women, can open up and be themselves. It is here that Dimmesdale openly acknowledges Hester and his undying love for her. It is also here that Hester can do the same for Dimmesdale. Finally, it is here that the two of them can openly engage in conversation without being preoccupied with the constraints that Puritan society places on them. Truly, Hester takes advantage of this, when Arthur Dimmesdale appears. She openly talks with Dimmesdale about subjects which would never be mentioned in any place other than the forest. "What we did..." she reminds him, "had a consecration of its own. We felt it so! We said to each other!" This statement shocks Dimmesdale and he tells Hester to hush, but he eventually realizes that he is in an environment where he can openly express his emotions. The thought of Hester and Dimmesdale having an intimate conversation in the confines of the society in which they live is incomprehensible. Yet here, in the forest, they can throw away all reluctance and finally be themselves under the umbrella of security, which exists. In Puritan society, self-reliance is stressed among many other things. However, self-reliance is more than stressed- it is assumed. It is assumed that you need only yourself, and therefore should have no emotional necessity for a "shoulder to cry on". Ridged Puritan Society in Hawthorne's The Scarlet Letter :: Scarlet Letter essays The Scarlet Letter: Ridged Puritan Society In Nathaniel Hawthorne's The Scarlet Letter, life is centered around a rigid Puritan society in which one is unable to divulge his or her innermost thoughts and secrets. Every human being needs the opportunity to express how he or she truly feels; otherwise the emotions are bottled up until they become volatile. Unfortunately, society did not permit this kind of expression; thus characters had to seek alternate means to relieve their personal needs and desires. Luckily, at least for the four main characters, Hawthorne provides such a sanctuary in the form of the mysterious forest. Hawthorne uses the forest to provide a kind of "shelter" for members of society in need of a refuge from daily Puritan life. In the deep, dark portions of the forest, many of the pivotal characters bring forth hidden thoughts and emotions. The forest track leads away from the settlement out into the wilderness where all signs of civilization vanish. This is precisely the escape route from strict mandates of law and religion, to a refuge where men, as well as women, can open up and be themselves. It is here that Dimmesdale openly acknowledges Hester and his undying love for her. It is also here that Hester can do the same for Dimmesdale. Finally, it is here that the two of them can openly engage in conversation without being preoccupied with the constraints that Puritan society places on them. Truly, Hester takes advantage of this, when Arthur Dimmesdale appears. She openly talks with Dimmesdale about subjects which would never be mentioned in any place other than the forest. "What we did..." she reminds him, "had a consecration of its own. We felt it so! We said to each other!" This statement shocks Dimmesdale and he tells Hester to hush, but he eventually realizes that he is in an environment where he can openly express his emotions. The thought of Hester and Dimmesdale having an intimate conversation in the confines of the society in which they live is incomprehensible. Yet here, in the forest, they can throw away all reluctance and finally be themselves under the umbrella of security, which exists. In Puritan society, self-reliance is stressed among many other things. However, self-reliance is more than stressed- it is assumed. It is assumed that you need only yourself, and therefore should have no emotional necessity for a "shoulder to cry on".

Education Is Jkey to Sucess Essay

â€Å"Change is the essence of life† said one philosopher, and keeping phase with the change is the meaning of education. There are different connotations of education. One is formal education and other is the daily education. Education is not only classroom studies but learning. In many cases what we study at class is completely different from what we practice outside. We may study the outdated technology or the old philosophy, to live in the present world we have to learn quickly what is happening in front of our eyes and try to understand it. We have seen children, always active, curious and full of vigor. the reason for that attitude is their interest in learning new things and to know the world. So they are quick learners and they enjoy life even better than us and are happier than us. So it is the innate of a person to educate himself to the changes. If he fails to do that he trails in the race of life. So education plays very important role in the nation building too. The rate of development of the country depends on the educated human resource of that nation. The educated human resource possess global competency and global etiquette. So it is the education which is the real GDP growth of the country and the investment on education is the real investment which will bear rich dividends than any other type of investments. We can learn from history how countries have progressed through their strong education system. take example of US, EUROPE and other developed countries, the universities are the real technology generators and industries are the buyers of the technology. Education is the inevitable investment the state has to do on its subjects to sustain itself and to be in the race to the global superpower. The so called global powers have invested on education so much, now they are tasting the fruit of that tree which they planted long ago. The countries instead of investing on defense and arms, if they invest on education, it will certainly pay back in large scale.

King tuts tomb

Egypt appointed pharaoh age 9 in 1334-1323 BC during period of â€Å"New Kingdom† Died at around 18 or 19 in 1352 B. C. Death unknown Located in the Valley of the Kings (upper Egypt west of Nile) – contains many tomb of kings from the New kingdom Howard Carter – worked In Egypt for 31 years before discovery, started at 17 copying wall scenes and inscriptions.In 1907, George Herbert the 5th was the Earl of Canaan place in England (Lord Canaan) hired Howard Carter after his first season f searching for sites was unsuccessful. Canaan funded Carter's whole excavation, and if it wasn't for Lord Canaan, he would not have been able to fund it himself. They Discovered the Tomb on November 4th 1922. The tomb was Incredibly well Intact, which was quite astounding for them to see, because most others found were pretty well destroyed.It had over 3,500 objects in it and took around ten years to excavate and unveil because he took a photo, Drawer it, and catalogued it every si ngle artifact Layout – antechamber largest room, found 6 dismantled chariots, animal couches, chests, bows and arrows, 2 large statues of the king guarding a sealed doorway everything was stored messily which indicated robbery probably by the guards Annex (like a storeroom) – smallest room contained more than half of tombs contents. Hundreds of reed baskets and pottery Jars, elaborate urns intricate designs and some royal furniture such as couches Burial chamber – only room with wall paintings. Here the kings sarcophagus (coffin) lay. There were 3 coffins making up the sarcophagus they all had faces on them. ND the lid alone weighed over 1 and a quarter tone. 4 shrines, took 4 months to dismantle, very brittle some parts weight almost a tone. He put off working on them for 4 years so he could work on the mummy. The mummy had over 143 Jewels and amulets on It or In the wrappings, gold mask, headdress, fake beard and gold hands. The body remains were actually burn ed away from the scented oils that were placed upon the body during burial Treasury – this was dominated by Tutankhamen canonic shrine which held all of his organs.A successful navigation of the Underworld will allow Tutankhamen to be welcomed into the Afterlife as an immortal. South Wall – The God-King welcomed to the Afterlife by Anabas god of embalming Hath, goddess of the west. Tutankhamen, who is now immortal, will begin the life-giving daily ritual. These paintings are significant because they show that TUTU as a Pharaoh and the society at the time were very religious and obviously had very strong beliefs in death and the underworld and they were very committed addressing death in the correct way.

The Causes and Effects of U.S. Economic Intervention in Latin America

The Causes and Effects of U.S. Economic Intervention in Latin America "We should consider any attempt on [Europe's] part to extend their system [of government] to any portion of this hemisphere as dangerous to our peace and safety," President James Monroe proclaimed in his 1823 State of the Union address to Congress. His famous address, subsequently known as the Monroe Doctrine, declared the Western Hemisphere closed to European colonization and influence, thus establishing an American sphere of influence for the first time in the nation's young history. Shortly before the Monroe Doctrine, the United States formally recognized the new republics of Latin America, beginning the first century of Latin American-U.S. foreign relations with Monroe's address before the House of Representatives on January 30, 1822. The relationship between the United States and its neighbors to the South grew gradually. The United States slowly shifted from acting as an arbiter in Latin American affairs, merely looking out for its best interests from the outside, to a steady, escalating period of U.S.English: Newspaper cartoon from 1912 about the Mon...investment and political intervention. A mounting desire for economic prosperity and profit by the United States government and American-owned businesses led to the shift in involvement and caused the political and economic interventions that characterized the first century of Latin American-U.S. relations, interventions that resulted in American domination in the economic development of Latin America.In the first half of the nineteenth century, the United States exhibited a growing lust for new land. In the age of Manifest Destiny, expansionist fervor denominated American political and social thought. With the establishment of Latin America as the United States' sphere of influence, many Americans looked to their proverbial backyards for new territories. For example, Secretary of State John Quincy Adams suggested Cuba and Puerto Rico as perfect additions to the United States. In a letter to a U.S. diploma t for Spain, Hugh...

Habits and Traits of Gall Wasps

Habits and Traits of Gall Wasps Have you ever seen those misshapen lumps on the twigs of oak trees? Those peculiar growths are called galls, and theyre almost always caused by gall wasps. Although theyre quite common, gall wasps (family Cynipidae) often go unnoticed because of their diminutive size. How Are Gall Wasps Classified? Kingdom: AnimaliaPhylum: ArthropodaClass: InsectaOrder: HymenopteraFamily: Cynipidae What Do Gall Wasps Look Like? Cynipid wasps are quite small, with few species measuring over 5 millimeters in length, and usually drab in color, which makes them rather inconspicuous. Its often easier to identify gall wasps from the galls themselves. Tracks and Sign of Insects and Other Invertebrates is an excellent reference for identifying North American gall-makers from the galls they leave behind. Cynipids infest plants in the rose, willow, aster, and oak families. Cynipid galls vary greatly in size, shape, and appearance, depending on the host plant and the gall wasp species involved. Gall wasps arent the only organisms that trigger gall development in plants, but they are probably the most prolific gall-makers, especially in oak trees. About 80% of gall wasps target oaks specifically. In North America, well over 700 gall wasp species create galls in oaks. Gall wasps look like tiny hunchbacks. When viewed from above, the abdomen may appear to have just two segments, but the rest are simply compressed beneath, in telescoping fashion. Gall wasps have minimal wing venation and filiform antennae (usually consisting of 13 segments in females, and 14-15 segments in males). Youre unlikely to see gall wasp larvae unless youre in the habit of dissecting galls. Each tiny, white larva lives within its own chamber, feeding constantly. They lack legs and have chewing mouthparts. What Do Gall Wasps Eat? Gall wasp larvae derive nutrition from the galls in which they live. Adult gall wasps are short-lived and do not feed. Surprisingly for an insect that eats so much, the larvae dont poop. Gall wasp larvae dont have anuses, so there is simply no way for them to expel their waste. They wait until the pupal stage to rid their bodies of fecal matter. The Life Cycle of Gall Wasps The cynipid life cycle can be quite complex. In some species, male and female gall wasps mate and the female oviposits in the host plant. Some gall wasps are parthenogenetic, and produce males rarely, if ever. Still others alternate sexual and asexual generations, and these distinct generations may use different host plants. In very general terms, the gall wasp life cycle involves complete metamorphosis, with four life stages: egg, larva, pupa, and adult. The female deposits an egg into the meristematic tissue of the host plant. When the egg hatches and the larva begins to feed, it triggers a reaction in the host plant, causing the formation of the gall. The larva feeds within the gall and eventually pupates. The adult gall wasp usually chews an exit hole to escape the gall. Special Behaviors of Gall Wasps Some gall wasps dont produce galls in their host plants but are instead inquilines of other species galls. The female wasp oviposits into an existing gall, and her offspring hatch and feed on it. The inquiline larvae may indirectly kill the larvae that induced the gall to form, simply by outcompeting them for food. Where Do Gall Wasps Live? Scientists have described 1,400 species of gall wasps worldwide, but many estimate that the family Cynipidae may actually include as many as 6,000 species. Over 750 species inhabit North America. Resources and Further Reading   Capinera, John L., editor.  Encyclopedia of Entomology. 2nd ed., Springer, 2008.Frogge, Mary Jane. â€Å"Most Leaf Galls Dont Hurt Trees (Galls).†Ã‚  Institute of Agriculture and Natural Resources: The Nebline, University of Nebraska-Lincoln in Lancaster County, May 2012.Johnson, Norman F., and Charles A. Triplehorn.  Borror and DeLongs Introduction to the Study of Insects. 7th ed., Cengage Learning, 2004.Leung, Richard, et al. â€Å"Family Cynipidae - Gall Wasps.†Ã‚  BugGuide.Net, Iowa State University, 13 Apr. 2005.

Case study#1 Julia Study Example | Topics and Well Written Essays - 1000 words

#1 Julia - Case Study Example She then receives negative comments the following year on issues of being unfriendly and absenteeism in some faculty meetings. She is even interrupted in her conversations or ignored completely (Szybinski & Jordan, 2010, p. 4-6 & L. 1-99). Julia’s situation has to do with her positive attitude towards her new job, something that is not tradition in the department. Most of the faculty members are not motivated to apply for grants or get involved in research with students but Julia wants to make a difference. This is in accordance with the academic duty of a professor. This makes her colleagues feel like she is trying too hard to make an impression. The senior faculty then decides to put her down by ignoring her and giving negative feedback during review. They see her as unfriendly because she doesn’t exchange pleasantries with colleagues. She looks like she is alienating herself from the rest of the faculty members by no attending some meetings. Her situation is made worse when she does not involve herself with office gossip. This makes the seniors feel like she is being intimidating and rebellious (Cariaga-Lo, et al, 2010, P.19-22 & L. 1-98). Julia’s colleagues refuse to vote for her tenure because as they stated, she does not relate well with her colleagues. This however is much deeper than that. Considering that she has the best skills in research and worked for the benefit of the department, the seniors did not take this positively. The faculty feels that they are being undermined by a junior staff. They alienate her and use it against her during evaluation. Julia makes the situation worse when she decides to take matters in her own hands. She ignores her colleagues completely by closing her office door and only opening it during office hours. She makes it even worse when she decides to discuss her colleagues with other faculty members from other departments instead of taking her concerns to the department chair. This is

Fonterra Ltd, a diary company in New Zealand Assignment

Fonterra Ltd, a diary company in New Zealand - Assignment Example The number of employees working for Fonterra is around 16800. The strategies adopted by the company are to make business in the emerging economies like China, Latin America and ASEAN; thus creating a strong presence. Optimizing the business of milk in New Zealand, protect the exports of milk exports in New Zealand by building integrated offshore milk pools, so that the higher value returns gets back to the country; focusing on creating quality product for its customers with special concern for mother and babies (Fonterra Ltd., 2011, pp.2-20). Computer fraud and abuse Accounting information system is a process by which the accounting of the company is done based on the Generally Accepted Accounting Principles (GAAP) by the use of the modern information technology. The Accounting Information System (AIS) of a company is composed of six main elements of the company, namely, people who will operate the system, procedure and instructions based on which the data is retrieved from different sources of the company, the related data which is very essential for the organization’s business practices, the required infrastructure for the information technology of the company so as to smoothly operate the system comprising of both the software and the hardware and lastly the internal controls so as to adopt security measures which will prevent the leakage of the sensitive data. Thus Fonterra can be exposed to the risk of fraud and abuse related to the theft of equipment, inventory or cash of the company. Even the fraud and abuse in the accounting information system of the company may result in false invoicing; payroll fraud arising out of the accounts made for directing the salary to a non-existing employee of the company; e-commerce frauds which have become very common now a days; for high level of outsourcing forgeries takes place on the ground of assets of the company being used for personal uses. If the employee of the company is not loyal then the risk of fraud a nd abuse of the company on the ground of accounting information system may lead to the disclosure of information and the intellectual property of Fonterra. Generally the fraud of a company usually occurs on the ground of poor internal control of the company. Thus Fonterra must take precautionary measures to tighten the internal control system of the company. If the items of the company is highly desirable the chances of forgery increases leading to fraud and abuse. Other reasons behind the occurrence of fraud and abuse of the company may arise from insufficient preventive measures and detection strategies having loop holes. The company should also know how to deal with the detection of the fraud; for example if a person is convicted of committing forgery in the company, just looking at the reputation of the company the concerned person is asked to resign. But in a situation like this civil or criminal action should be taken against the fraudster. Thus the fraud and abuse of the comp any generally arises from lack of strong internal control of the company. Since the AIS department is the heart and soul of the company, on the basis of which the company is able to carry out its operations. So, the personnel being appointed in the department of AIS should go through extensive interview process in order to appoint the most appropriate person for the concerned department. Fraud and abuse are ought to happen with the increase

M5A1-Conflict Essay Example | Topics and Well Written Essays - 750 words

M5A1-Conflict - Essay Example There conflict scenario entails several positives (for resolution) and negatives (for resolution) in favor of management group and in favor of the employee group. Some positives for resolution that are in favor of management include the high experience and training that is provided to the employees to build performance review systems and information systems. Accordingly, the low turnover, the visionary leadership of the three business partners and fair and comparable salaries will also help Metro services in resolving the conflict. In addition, 92 percent of employees assert that the owners have positive attitudes towards specialists and while 78 percent assert agree that Metro services offers opportunities to work in various companies. Some negatives for resolution that face the management include the inability to allow the specialists an opportunity in negotiating fees with the contracting companies, and lack of promotion opportunities in the company. In addition, the failure to ho ld employee/owner meeting for the past three years is a challenge for the management group in resolving the conflict. ... Accordingly, employees are allowed to demonstrated individual performance and 64 percent claim that the company offers job security. In addition, 80 percent of employees perceive the salary as fair and comparable and 74 percent assert that specialist positions allow them to utilize their knowledge and skills. Some negatives that may hinder employees in cooperating during the conflict resolution include lack of adequate opportunities for promotion, the confrontation with Mr. Baker that happened in 1999 and inability of the management to belief that there is a union movement by employees since it will be detrimental to all concerned. Some of the points of contention that relate to the positives and negatives include the possibility of implementing a bonus sharing system for the excess profits earned by the management. Some positive points of contention that may create conflictual conditions include the job security since some employees perceive six months full time position as temporal position that does not guarantee any job security. Another contention is the intention of employee to create a union since the management group does not believe whether such movements are necessary when the salaries and additional benefits like 401K securities are fair. The last contentious issue is the monitoring of contracting companies and requirement for a higher performance level than agree with contracting companies. The refusal of temporary specialists to participate in negating fees with contracting companies will also be contentious. Time phased strategy of addressing the conflict The management must analyze the employee survey and identify the source of conflict in the organization. The management must identify any barriers in

Proposal Assignment Example | Topics and Well Written Essays - 500 words

Proposal - Assignment Example SpeakEasy ® technology is published in several professional journals. We have improved performance for over 100 companies through our workshops. This technology will work for you. Each day begins at 9 AM and ends 3:30 PM. Workshop attendance is limited to 6-12 participants for individualized instruction. Attendees are encouraged to bring laptops and PowerPoint software. Attendees will receive the videotape, a workbook and a certificate of completion. SpeakEasy ® offers mentorship and consulting by email or telephone for six months after attending a workshop. Discounts are available for future workshops. Just like the food business, we cherish repeat customers. Your people deserve the very best training; in a family business, 70 years and three generations is amazing; they are your most precious asset. We will call you this week to set a time to schedule a workshop at your convenience; and weekends are

Answering questions Essay Example | Topics and Well Written Essays - 500 words - 1

Answering questions - Essay Example I think, this is the main ambivalence of the first paragraph. Also, the author calls this desire a â€Å"shame†, but at the same time he is angry that his wood is intercepted by a public foot-path. His feelings of a property owner are interfered with his consciousness. Forster assumes that â€Å"creation, property, enjoyment form a sinister trinity in the human mind† (Forster 263). According to the author, a man owning property â€Å"ought to do something to it†. Property brings restlessness, which is different from the same restlessness accompanying the act of creation. Property can substitute the material basis needed for creation and enjoyment (which are both good, as the author writes). He thinks that our world is â€Å"material and carnal† and that we should learn how â€Å"to manage our materialism and carnality†. I can’t agree with the author on that. Forster, for example, mentions Tolstoy and his negative attitude to property. But, as a matter of fact, Tolstoy was an earl; he owned a large estate with slaves and was definitely a man of property. Property allowed him to obtain a good education and a material basis to create, i.e. he could waste no time on earning his living, but spend it on thinking and wr iting. Therefore, possessing property does not always mean â€Å"restlessness† about it. However, there are exceptions, but it only means that one should not be so categorical in this issue. II. In her essay Toynbee elaborates on Richard Wilkinson’s idea that inequality is the main peril of society. For her â€Å"equality for its own sake† means a better and healthier society. This opinion is based on Wilkinson’s assumptions that â€Å"social environment can be more toxic than any pollutant† (cited in Toynbee 365). In simple words, poor people see the rich and it leads to envy and other negative emotions, which, in their turn, lead to unhealthy life. It can be proved, the author argues, by the experiments with animals. And since

Oil Crisis Essay Example | Topics and Well Written Essays - 750 words

Oil Crisis - Essay Example Oil is the major source of energy worldwide and it is expected to remain so over the next few decades. Ever since, then crude oil has become the main "raw" material in every economy no matter it is a developed one or it is in the developing process. The changes in the prices of the crude oil are making positive and negative implications on every economy (Itzkoff, 2008).When these changes of prices are severe ones, one might easily conclude that an economy is going to face problems such as unfavorable supply shocks. When these kinds of problems arise in the world oil market, it is usually described as a world oil crisis. The world has witnessed 2 major oil crises and it is facing another one at the moment (Campbell, 2005). In order to discuss the recent oil crisis and its economic implications I am going to refer to the appropriated economic theory. As mentioned previously the major problem that an economy is facing during every oil crisis is the adverse supply shock. Adverse supply shocks are unexpected events that reduce aggregate supply and therefore the output decreases and prices increase. In the language of economy it can also be said stagflation (Venn, 2002). Firstly, the basic economic tool of demand and supply would be examined in reference to the oil prices. The overall world demand of oil has risen over the period mainly due to the increase in the number of automobiles, which as a matter of fact is a result of higher living standards. Considering local factors, leasing and the easy loan repayment options have made it easy for the every individual living in this world to afford a certain motor vehicle. This in turn has lead to the consumption of oil to the highest. So accordingly, when demand is high and supply is low the prices obviously will tend to rise. Secondly, if the oil pricing mechanism is considered it can be known that oil is a leading resource used by all the industries in this world in one way or the other. Some industries use it in the transporting sector while some use it to produce goods (Prince, 2008). Oil prices are set around the world by OPEC (The Organization of Oil Exporting Countries). What OPEC basically does is how cartels work around the globe; they limit output to guarantee high oil prices and profit margins. Again when the output is limited, the demand supply function puts itself to work and the result is a surge in the oil prices. Thirdly and most importantly, oil is used as a lubricant and raw material in this era of industrialization and again the rise is population speaks for itself why the world demand for oil has risen (Frieden, 2007). Increasing oil prices have far reaching effects on an economy. Just recently, when the oil prices rose to as high as $140/barrel many important countries were seemed to be undergoing a tough time with their budget management (Klare, 2008). On a wider perspective, the effects are far more on ground level then at the macro economic level. When oil prices rise, the prices of those commodities which are dependent on oil also rise. Now when the prices of the latter product rise then the products which use this latter product as a raw material, even their prices rise. The point conveyed through this paragraph can also be known as the multiplier effect in economics. Multiplier effect leads to inflation on a grand scale and its results are mainly felt by the poor who are thus brought into the limelight (Eccleston, 2008). Linking to the upper paragraph, concerns about inflation depress the stock market and even when that does not happen, speculation itself acts as a rodent and thus this diverts away investment from a country. Studies have proved that an increase in the rate of inflation leads to an increase in the poverty level, crime and suicide rates. This is one of the reasons

Analysis of Three Books in Literacy Development among Children Essay

Analysis of Three Books in Literacy Development among Children - Essay Example The aim of the commentary will be to develop a case study using various approaches. The three sources acknowledge the fact that earlier cognitive abilities by children are essential for future literacy development. Arnold (2003) indicates the process that enhances Harry’s cognitive ability. At this point, the mother plays an important role in ensuring Harry undergoes the learning process successfully. Adams (1990) states that early cognitive ability determines how a child will grasp literacy concepts while in school. Adams applies the concept to a child’s earlier phonemic awareness using an earlier cognitive ability. Peccei (2006) uses the cognitive ability of a given child to recognize complex structure words. The common approaches the three authors deploy relates to Piaget cognitive theory. The three concepts of the theory are visible in the books in that parents and the pre-school environment is identified by the authors as Schemas. They also indicate the development of this cognitive ability through different stages before a child is enrolled into the formal educational systems. The books, however, use different writing style. Arnold (2003) uses a descriptive style where he gives a day-to-day account of Harry and hence giving the reader the ability to make a conclusion based on the events. Harry’s life events are based on observations and the author uses these events to ascertain the early cognitive ability of a child. Peccei (2006) and Adams (1990) use an analytical approach in displaying cognitive abilities among children. They both draw from existing researchers to explain certain events in a given child’s life. They analyze the environment in which children would best learn their cognitive ability and focuses majorly on the literacy developmental stages. The differences in style indicate the diverse nature in which cognitive abilities are displayed and learned.  Ã‚  

Oil Crisis Essay Example | Topics and Well Written Essays - 750 words

Oil Crisis - Essay Example Oil is the major source of energy worldwide and it is expected to remain so over the next few decades. Ever since, then crude oil has become the main "raw" material in every economy no matter it is a developed one or it is in the developing process. The changes in the prices of the crude oil are making positive and negative implications on every economy (Itzkoff, 2008).When these changes of prices are severe ones, one might easily conclude that an economy is going to face problems such as unfavorable supply shocks. When these kinds of problems arise in the world oil market, it is usually described as a world oil crisis. The world has witnessed 2 major oil crises and it is facing another one at the moment (Campbell, 2005). In order to discuss the recent oil crisis and its economic implications I am going to refer to the appropriated economic theory. As mentioned previously the major problem that an economy is facing during every oil crisis is the adverse supply shock. Adverse supply shocks are unexpected events that reduce aggregate supply and therefore the output decreases and prices increase. In the language of economy it can also be said stagflation (Venn, 2002). Firstly, the basic economic tool of demand and supply would be examined in reference to the oil prices. The overall world demand of oil has risen over the period mainly due to the increase in the number of automobiles, which as a matter of fact is a result of higher living standards. Considering local factors, leasing and the easy loan repayment options have made it easy for the every individual living in this world to afford a certain motor vehicle. This in turn has lead to the consumption of oil to the highest. So accordingly, when demand is high and supply is low the prices obviously will tend to rise. Secondly, if the oil pricing mechanism is considered it can be known that oil is a leading resource used by all the industries in this world in one way or the other. Some industries use it in the transporting sector while some use it to produce goods (Prince, 2008). Oil prices are set around the world by OPEC (The Organization of Oil Exporting Countries). What OPEC basically does is how cartels work around the globe; they limit output to guarantee high oil prices and profit margins. Again when the output is limited, the demand supply function puts itself to work and the result is a surge in the oil prices. Thirdly and most importantly, oil is used as a lubricant and raw material in this era of industrialization and again the rise is population speaks for itself why the world demand for oil has risen (Frieden, 2007). Increasing oil prices have far reaching effects on an economy. Just recently, when the oil prices rose to as high as $140/barrel many important countries were seemed to be undergoing a tough time with their budget management (Klare, 2008). On a wider perspective, the effects are far more on ground level then at the macro economic level. When oil prices rise, the prices of those commodities which are dependent on oil also rise. Now when the prices of the latter product rise then the products which use this latter product as a raw material, even their prices rise. The point conveyed through this paragraph can also be known as the multiplier effect in economics. Multiplier effect leads to inflation on a grand scale and its results are mainly felt by the poor who are thus brought into the limelight (Eccleston, 2008). Linking to the upper paragraph, concerns about inflation depress the stock market and even when that does not happen, speculation itself acts as a rodent and thus this diverts away investment from a country. Studies have proved that an increase in the rate of inflation leads to an increase in the poverty level, crime and suicide rates. This is one of the reasons

Studo Guide Mis Essay Example for Free

Studo Guide Mis Essay Data gathering and reporting by manual process can affect the business as humans mistakes happen with the data entry. It is also time consuming as it keeps back the completion of the profit and loss statements, as some departments inquire to update data after submitting in which the analyst has to send the original copy and wait for completion before entering it into the final document. By collecting data of fifty headquarters at the same time and entering it into a spread sheet won’t tell which business branch is experiencing problems and if they are making a lost or a profit. It will impact the business as this spreadsheet software doesn’t specify in detail the business braches performance and will lead to make a lost in some branches. The business should implement software that will permit them to have a closer look of the business performance of each branch. If a business branch is always making mistakes in their reports the person in charge of that CASE STUDY Snyder’s of Hanover: New Systems for an Old Family Company Harry V. Warehime began tempting the taste buds of southern Pennsylvanians with his Hanover Olde Tyme Pretzels in 1909. Since then, Snyder’s of Hanover, as the company came to be known, has expanded its business beyond any scope that its founder might have dared to imagine. Snyder’s of Hanover remains a family-owned and family-run company, but it has become the world’s second largest pretzel maker, with 12.1 percent of the pretzel market. Snyder’s pretzel and chip varieties include Old Tyme Pretzels, Jalapeno Pieces, Butter Snaps, and EatSmart All Natural Veggie Crisps, as well as other popular snacks. In 2002, Snyder’s posted revenues of $164 million, trailing only Rold Gold, the reigning champion of the pretzel industry. In addition to manufacturing its complete line of snack foods, Snyder’s distributes its own products, as well as those of other snack food companies such as Tasty Baking Company’s Tastykakes. With 40 distribution facilities all over the United States and Europe, over 4,500 products, and over 150 product lines, the home office in Hanover, Pennsylvania, has a considerable amount of data to manage. If there was one last vestige of old-fashioned business left at Snyder’s, it was the company’s method of managing and analyzing data. Although Snyder’s sells more than 78 million bags of pretzels, chips, and organic snack items each year, some of its core systems were still heavily manual and paper-based. Snyder’s financial department was using electronic spreadsheets for much of its data-gathering and reporting. Lois Stambaugh, Hanover’s financial analyst, would spend the entire final week of each month collecting Excel spreadsheets from the heads of more than 50 departments worldwide. Then she would consolidate and reenter all the data into another Excel spreadsheet, which would serve as the company’s monthly profit-and-loss statement. The financial data were harvested and consolidated the same way at the end of each fiscal quarter and the end of each year. The overwhelming presence of the human factor made data-entry mistakes a concern. If a department needed to update its data with last-minute information after submitting its spreadsheet to the main office, the head analyst had to return the original spreadsheet, and then wait for the department to resubmit its data, before finally entering the updated data in the consolidated document. Perhaps most important, this system of gathering the company’s financial statistics at regular, but infrequent, intervals meant that important data simply were not available as often as they were needed. Snyder’s lacked the ability to react to sudden trends and unpredictable events because the data were supplied too late to adjust shipping schedules, pricing schedules, or delivery counts. CEO Michael Warehime and his management team could track the gross profits of business units but not the performance of each of Snyder’s 4,500-plus products and over 150 product lines. For example, the spreadsheet-based system lacked the detail to show whether a specific snack product such as Sourdough Hard Pretzels or Pumpernickel Onion Sticks was actually making or losing money. For a business focused on both production and distribution, this was a hindrance to growth. Additionally, the spreadsheets could not reveal which distribution routes were worthwhile and which were cutting into the company’s profit margin. Under these circumstances, Snyder’s could only use the sales data it collected to make rough predictions about how much of a product should be manufactured and how quickly a product run should be repeated on a particular distribution route. Snyder’s market share had been growing steadily until 2002, when it suddenly stalled; its annual sales growth, which had outpaced the industry’s for years, was then no better than average. It was time to leap forward to a more modern approach in which the company could react to data immediately. In late 2002, Snyder’s of Hanover solicited the help of Satori Group, a provider of business performance management solutions to the consumer packaged goods industry that is headquartered in Conshohocken, Pennsylvania. Satori Group demonstrated how Snyder’s could implement its proCube software to gather better sales and marketing data and, therefore, make better business decisions. ProCube would automate Snyder’s budgeting processes, creating accurate forecasting facilities, improving financial reporting techniques, and refining Snyder’s product marketing analysis so that Snyder’s could evaluate the viability of each of its individual brands and products. Such analytical power was just what Snyder’s would need to compete with Rold Gold, which is backed by the corporate powerhouses of Frito-Lay and PepsiCo. What Snyder’s found so appealing about proCube was the ease with which it could be integrated with the company’s existing in formation systems. ProCube enables Snyder’s department heads to continue using Microsoft Excel spreadsheets to collect sales and returns data. These data are collected in a large data repository, where they are consolidated and organized before being used by proCube reporting software for analysis. The proCube software also uses manufacturing data from Snyder’s enterprise system. Snyder’s financial department now spends a couple of days preparing those same monthly, quarterly, and yearly statements that used to devour weeks’ worth of productivity. This is only the first step in what Snyder’s hopes is a chain of improvements that will result in new growth. The next step is to add new levels of detail to the profit and loss data that Snyder’s can collect and report so that the company can track and assess the profitability of individual products. Management could then use the proCube software to find out information such as how many bags of Honey BBQ Pretzel Piec es were sold in Michigan last week, or which stores and delivery routes are best servicing customers who like this product. The system will also enable managers to project sales for their unit for the next quarter or next year. Such a system requires additional work to implement. Dave Thomas, Snyder’s director of information technology, noted that to achieve the desired level of detail in its data analysis, the company must study all of its business processes. A comprehensive review will enable Snyder’s to determine what types of data result from their business processes and which data they actually want to use. These system enhancements will eventually provide information enabling Snyder’s to increase production and distribution frequency of its most popular products almost immediately, rather than having to wait for an end-of-the-month report. Likewise, production and shipping of less popular products can be curbed. In other words, Snyder’s will be able change its business model from one dependent on forecasts to one that’s more demand-driven. The first two phases of the proCube implementation carried a price tag of approximately a quarter-million dollars. The next phase introduced a corporate portal to provide Snyder’s department heads and executives with easier access to sales figures and distribution plans. The portal features a user-friendly Web interface through which managers can retrieve key data, as they require them. Upon completion, the cost of the entire venture should approach a half-million dollars. Snyder’s has also incorporated improved IT into other areas of its business. In 2003, Snyder’s chose Gelco Trade Management Group’s TMS Passport solution for its trade promotion funds management. Again, Snyder’s found an IT solution that could be implemented quickly without sacrificing power. Gelco’s TMS Passport promises a quick return on investment (ROI) for a competitively priced and scalable package. The package features fund management, deduction management, payments, and analysis and reporting capabilities. In turn, Snyder’s is confident that it can effectively plan and manage its trade promotion activities for years to come, even as the business continues to expand. The American consumer has continued to increase its intake of pretzels over the last decade, and the snack food industry as a whole continues to boom. Snyder’s faces stiff competition from rival Frito-Lay and other major players in the snack food industry such as Utz, Kellogg’s, and Kraft Foods. At the very least, Snyder’s has made a sincere attempt to transform its business practices with an eye toward rocketing to the top of the boom. The question remains whether a family-owned organization can continue to compete with major corporate players in an industry that has yet to hit its ceiling.

Robotic surgery

Robotic surgery Information Technology in Medicine: Should patients trust robotic surgery 1 Introduction to the topic Robots are ubiquitous today. They are found in our cars, in our houses, in our industries inside buildings and to places we neglect to notice. We trust robots to do everyday chores for us either by knowing directly or indirectly. Robots are becoming part of our lives and we have all accepted it. Today technology has advanced so that it allows for innovative robotic systems to be inserted in the medical field. New materials, ideas and technological advancements bring robotics into medicine. Robotics in medicine entails many advantages and benefits for both the doctors and the patients. But there are also some limitations in robotic surgery that cause doubt and uncertainty to people. However, as it happens with every new technological development, people need time to become familiar with it, to accept it and finally trust it. So the question is if the world is ready to accept and trust robots in health and more specifically in surgery. There will be people who are pioneers and enjoy trying something new, people who are skeptical and need to know everything about it before agreeing and people who will be afraid no matter how much proof theyre given. There cannot be an abrupt transition from classical surgeries without robots to surgeries all aided with robots. Gradually, the surgeries aided with robots will increase as peoples experience and trust increases. 2 IT Background 2.1 History of robotics Most of us when we hear the word â€Å"robot† we think of science fiction movies showing robots of the future, performing outstanding tasks. In fact, most of these robots seen are now everyday reality making our lives more convenient. One definition that could be given to a robot is â€Å"a reprogrammable multi-functional manipulator designed to move material, parts, tools, or specialized devices through variable programmed motions for the performance of a variety of tasks.[1] Robotics is the engineering science and technology of robots, their design, manufacturing, and applications. It is related to electronics, mechanics, and software. ht_2bunimate_080415_sshRobots could not be manufactured until the 1960s when transistors and integrated circuits were invented. Compact, reliable electronics and a growing computer industry added intellect to the power of already existing machines. In 1959, researchers demonstrated the possibility of robotic manufacturing when they disclosed a computer-controlled milling machine.[2] The first digitally operated and programmable robot, the Unimate, was installed in 1961 to lift hot pieces of metal from a die casting machine and pile them.[3] Commercial and industrial robots are ubiquitous in performing jobs better, cheaper, more accurately and reliably than humans. They are also found in jobs that are too hazardous, dirty or tedious for humans.[4] 2.2 Robotics in surgery[5] Robotics in medicine is a fairly new, yet advancing field. It is now introduced in medicine, in the field of surgery as it allows for exceptional control and precision of surgical devices in minimally invasive procedures. Robotic surgery has as its main goal to design robots that will be able to be used in performing closed-chest, beating-heart surgery in collaboration with the surgeons. Munich_OR_415Today numerous surgical robots have been adopted by many operating rooms all over the world. Surgical robots are not actually autonomous â€Å"surgeons† capable of performing assignments on their own, but a helping assistant of the surgeons. A number of commercial corporations have been founded in order to create surgical robotic systems. Computer Motion, Inc. developed the AESOP Endoscope Positioner: a voice-activated robotic system for endoscopic surgery. In January 1999, Intuitive launched the DaVinci Surgical System, which is classified as a master-slave surgical system as it uses true 3-D visualization. In 2001 Computer Motion, Inc built the SOCRATES Robotic Telecollaboration System as well. It includes integrated telecommunication equipment along with the robotic devices in order to provide remote surgical telecollaboration. Computer Motion merged with Intuitive Surgical, Inc., in June of 2003. They introduced the ZEUS Surgical System. 3 Robotic Surgery Systems Robotic surgery systems are divided into three types: supervisory-controlled systems, shared-control systems and telesurgical systems. These systems differ in the sense that in each case there is a different degree of involvement of the surgeon. In some cases, the operation is carried out by the robotic system with a minimal intervention of the doctor. In other cases, the surgery is performed by the doctor with the help of the robotic system. 3.1 Supervisory-controlled systems [6] supervisorySupervisory-controlled systems are the most automated systems of all. But they still need the guidance of the surgeon and an extensive preparation before the initiation of the surgery. The surgeon inputs information and programs the robotic system to follow certain instructions. However, once these robots have been programmed, and start operating there is no option for adjustments and thats why the surgeon must keep a close watch of the surgery in the need of intervention. As it is known, not all people have the same body structure and so it is not possible to have standard instructions for the robot to follow. This is done in three stages: planning, registration and navigation. In the planning stage, the surgeon captures images of the patients body. As soon as the surgeon has imaged the patient, he must determine the path that the robot will take to operate. The next stage is registration, in which the surgeon links the images obtained before with points on the patients body. In order for the surgery to be completed successfully, the points must be positioned precisely according to the patients body. The final stage is navigation, which is the actual surgery. In this stage the surgeon places the patient and the robot so as the movements of the robotic system to follow the programmed instructions. When all preparations are complete, the robot is activated and the surgery is carried out. 3.2 Shared-control robotic systems[7] Shared-control robotic systems are a helping hand for the surgeons. The operation is carried out only by the surgeon who uses the robotic system manually in order to have greater efficiency. The robotic system monitors the surgeons actions during the operation and provides support and stability by â€Å"active constraint†.7 â€Å"Active constraint† is the process of labelling regions of the patients body with one of the four possibilities: safe, close, boundary and forbidden. Surgeons label safe regions the regions that are appropriate for the robot to be and to operate. For instance, a close region can be found in orthopaedic surgery in orthopaedic surgery, near the soft tissues. Many orthopaedic surgery tools can damage the soft tissue and so the robot limits the area that the surgery is safe to take place. This is done using â€Å"haptic† technology[8], which is the science and physiology of the sense of touch. This means that as the surgeon approaches the boundary region he will start feeling a resistive force and as he proceeds to the forbidden region the force is getting larger and once he enters the forbidden region the robotic system stops operating immediately. But in order for the robotic system to know which are those regions, the surgeon must program it first as it is done with the supervisory controlled systems. 3.3 Telesurgical systems [9] Telesurgery is a field of telemedicine that was developed in recent years and holds great interest. Today it can be seen as a two way transmission of picture and sound, allowing the communication between surgeons of little experience and surgeons of great experience to cooperate no matter the distance separating them. Also it is understood, this technology needs highly advanced software in order for the simulation to be feasible in the remote surgery room. For this purpose, systems of virtual reality are required that allow the surgeons that are in a different room or city or country to have an actual image of the operating room and of the procedure. Robots with camera will provide a better quality of the images as they will be in colour and enlarged. 3.3.1 Da Vinci Surgical System [10] The Da Vinci Robot is probably one of the most well-known robotic surgery systems in the world. It is a robotic system that is used in minimally invasive surgery, which means that the robot makes a petite aperture in the patients body that brings many positive results. DaVinci-Robot During the surgery, the surgeon sits in a console inside the operating room and handles the surgical tools of the robot. After the patient has been anaesthetized, three apertures are made on the patients body allowing the rods to enter. On the screen the surgeon observes the 3D image that the camera is transmitting through the patients body and which is handled by joysticks. The camera sees every movement of the robot and can be activated or deactivated any time from a button.[11] Every surgical arm is connected with a surgical tool and there is camera in the end of the main arm. One of the rods has a camera on it while the others have surgical tools able to cut, remove or stitch the tissues. The robotic system uses the same stitches and materials used in the traditional surgery. The surgeon can bend and rotate the arms like the human wrist guaranteeing increased percentage of success and important benefits much for the patient as for the surgeon. The Da Vinci robotic system includes a lenses system of three-dimensional view, which can make the surgical field as 15 times larger. Also, the camera allows the surgeon to go closer at the point of surgery than the human vision can and so the surgeon can perform the operation in a smaller scale than the conventional surgery allows. 3.3.2 Zeus Robotic Surgical System[12] The robotic surgical system Zeus was the first system to be used in 1999 to perform the first full endoscopic robotic surgery bypass with a beating heart. It consists of three basic parts: 1. 1zeusconsoleAn ergonomic control console 2. the central control computer 3. Robotic arms, which move with the movement of the surgeons hand. The surgeon sits comfortably in the surgical seat and handles the tools that are placed inside the patient. After the surgeons movements have been digitalized they are filtered, thinned and transmitted to the computers control station, which transfers those movements through an electromechanical interface to the robotic arms and to the tools. In addition, Zeus robotic system enhances the optical field of the surgery by enlarging it and also with the help of AESOP robotic system the surgeons hands are free to handle the surgical tools. 3.3.3 AESOP Robotic Surgical System [13] AESOP Robotic surgical system was developed by Computer Motion Inc. The period when it first came out, the surgeon could control the robotic arm remotely, manually or with a foot pedal but the most recent edition of AESOP 3000 is controlled with voice commands. The robotic arm contains and moves a camera which is used in MIS surgeries for the observation of the surgical field. The camera is placed at the edge of the robotic arm and is inserted in the patients body through an aperture of about 2cm. The robotic system AESOP is the surgeons third arm. By using simple commands such as â€Å"AESOP, move up† or â€Å"AESOP, move left†, the surgeon tells the robot to move the camera as he wishes. Every surgeon records his voice and has a voice card that is inserted into the system whenever he operates, in order for the robot to identify the commands. Usually the system works well. The robot may sometimes not recognize the tone of the voice of the surgeon is different from the recorded voice. But there is a support system with which the surgeon can handle manually if something like this happens. 3.3.4 SOCRATES Telecollaboration System [14] Socrates telecollaboration system was the first system to be approved (October 2001) for the new-founded category â€Å"telesurgery robotic systems†. It consists of advanced telecommunication equipment that is connected with medical devices and robotic systems. The system gives the surgeon who is at a remote location the opportunity to work with another surgeon who may be in an operating room across the globe. The system provides real time view of the surgery. In collaboration with Zeus robotic system, Socrates is the first fundamental step that marks the start of minimally invasive telesurgery. In 2001 Socrates robot along with Zeus robotic system performed the first translantic surgery. On September 7th, 2001 a group of surgeons in New York performed a cholecystectomy surgery on a patient located in France with the help of doctors that were there. The console and the robot were connected with fiber optic wires. This surgery was first tested on six pigs.That was the first com plete telesurgical process that was performed by surgeons 7000 away from their patient. The patient left the hospital 48 hours after the operation and returned to his social activities a week later. 4 Advantages and Limitations [15] 4.1 Advantages The advantages of robotic surgery are listed below: 1. Tinniest incisions result in: * Faster recovery * Shorter hospital stay and reduced costs * Less pain and fear * Less blood loss * Cosmetic benefit * Reduced risk of infection or complications * Less anesthesia required 2. Better sterilization 3. Robot immune to radiation and infections. 4. No muscle tremor or fatigue. 5. Elimination of need for personnel resulting in lower costs for the hospitals. 6. Shorter return to everyday activities(1-2 weeks) 7. Telesurgery: The ability to perform surgery from a different operating room. 8. A 3D camera provides an enhanced view. 9. Robots reach places that surgeons alone couldnt before. 10. Can be designed for a wide range of scales. 11. Surgeons dont get tired quickly as theyre seated and have less eye strain and they have the ability to control their natural flinching or nerves more effectively. 4.2 Limitations However some of its disadvantages and concerns are: 1. Robotic systems have highly complex software and it is very difficult to program and debug them. 2. Costs including the robotic systems ($750.000-$1 million), the maintenance and the training of surgeons are considerably high. 3. Since the need of personnel will be minimized, some surgeons will be left unemployed. 4. Telesurgery is based by a large percentage on the transmission of information between two locations. The more the distance between the two locations the more the time delay is inserted. This increased the period between the action and the result and after a certain point this makes surgery impossible in real time. 5. Synchronization during telesurgery is very critical and is not easy to attain. 6. Telesurgery is highly dependent on the security and reliability of the network. 5 Robotic Surgery in Greece [16] The first robotic navigation system used in a surgery procedure in Greece is the Vector Vision II system in â€Å"Ygeia† (see www.ygeia.gr) hospital in Athens. In February 2003 the robotic surgical system â€Å"Aesop 1000† was used to perform the first laparoscopic operation in the General Hospital of Crete, Greece. â€Å"Aesop 1000† is being improved in the labs of University of Crete and will be released as â€Å"Aesop 2000† and â€Å"Aesop 3000† and soon is expected to be used in more complex operations and surgeries. In addition, the school of medicine in the University of Athens offers advanced courses on robotic surgery. The course aims to teach basic robotic surgery skills such as instrument manipulation, camera control among others. This is done using the Da Vinci surgical system.[17] 1stdayIn November 8th,2006 the opening day of the Da Vinci robotic system took place in the Athens Medical Center Hospital. The president of the Hellenic Scientific Robotic Surgical Association Prof. K. Konstantinidis explained the fundamental principles of the Da Vinci robot to Greek ministers and the establishment of the Hellenic Scientific Society of Robotic Surgery. The first total hysterectomy in Greece was successfully carried out with the latest-generation Da Vinci Robotic Surgery System at the Diagnostic and Therapeutic Centre of Athens HYGEIA. the operation was broadcasted in real time during the daily conference held at the Hospital on Tuesday, July 1st 2008, titled Robotic Surgery in Gynaecology.[18] 5.1 Survey analysis A survey was conducted during October and November 2009 in Athens about robotic surgery, in which 73 people answered (ages 14-50). The survey included a questionnaire and it was distributed by email. Robotic surgery in Greece is in its infancy so it is quite reasonable to see that 72% of the people asked knew nothing about robotic surgery. 6 Social Concerns 6.1 Safety Safety is the prime concern of patients and doctors. People today have trouble trusting robotic devices in general and in the case of their healthcare the issue of trust is intensified. First of all, there is always the possibility of errors happening as total safety is a fallacy. Robots are programmed by humans who in turn are not infallible and are prone to make mistakes. In the case of robotic surgery a fault could have serious health injuries or death. Thus, the probability of errors must be kept at a very low level and in the case of a malfunction the system must be programmed to shut down immediately. Afterwards, the surgeon will have to take over complete the operation manually. So, it is obvious that the presence of a human doctor is mandatory and critical. There are many things that can go wrong which experts must take under serious consideration. Some problems resulting in system failures can be flawed design of the system, malfunction of software and hardware[19]or misinterpretation and inadequate specification. In order to eliminate the possibility of errors, mechanics must undergo â€Å"heavy† testing and reasoning about infinite scenarios. Also surgeons must prepare the robotic system cautiously so as not to forget anything which can backfire. They also need to have contingency plans like converting the robotic surgery to open surgery.[20] The increased testing and reasoning is time-consuming and usually involves high costs. Even though safety is a big issue, 41% of the people asked would go through a robotic surgery. This can be considered a good percentage as 65% of the people asked believed that robotic surgery is safe and reliable. 6.2 Reliability and knowledge Nowadays most people dont trust robots very easily. The reason for this is the lack of information and the fear that these robots/machines can harm them in a physical level or in a professional level. As it can be seen from the above 88% of the people asked have heard of robotic surgery but 56% of the people asked claimed to know very little about it. As it is stressed in a website about robotic surgery, and prostate cancer surgery in particular, most people worry about the side effects it could have on them such as sexual dysfunction and impotence.[21] Another concern was the fear of the robotic system and the probability of errors, but most people do a little research before resorting to robotic surgery. This way they minimize their worries and concerns. However, there still are people who despite the evidence dont trust robots with their health. Therefore, robotic surgery needs time to become known and trusted by the people. This percentage of 56% must be minimized and increase the percentage of knowledge. In the future, as robotic surgery will start being implemented into hospitals, there will be many surgeries done, successful or not, which will enhance robotic surgery by correcting the errors, the failures and any problem that may arise. This way, patients who had successful operations will spread the word and people will become more aware and acquainted with this new technological development. 7. Elevating concerns, resolving problems Robotics in surgery is a great helping tool, which holds many benefits and advantages for the surgeons and the patients. However, since it is still at an early stage of development there are problems in need for resolutions. One great concern is the reliability and safety in delicate surgical procedures. We cannot deny that machines are made from humans, who are not infallible and thus tend to make mistakes. Whether the surgery is done by a plethora of surgeons or by a single surgeon and a robot there is definitely the possibility of error. As with every new technology, people need time to get familiar with it and to start trusting it. Thus robotic-aided surgery just needs time to advance and to become more well-known. People who go through robotic surgery procedures will spread the good news. The media will start making more coverage of the issue as they learn about more cases. As mentioned by many patients in the Da Vinci website, they were very pleased with the surgery and the recovery time which proved to be shorter than expected.[22] Furthermore, the training of surgeons may take a while but it does not compare having to do a 6-hour surgery above the patient, getting tired and stressed with a 4-hour surgery sitting in the robotic device some metres away from the patient. The surgeon will tire less and will finish the surgery in less time. As far as the costs are concerned, patients in the Da Vince website did not worry about the costs so much because they were dealings with their health. And most people will do anything for their well-being.[23] 8. Future Robotic surgery has made quite a progress and development but it still has a long way to go. Many obstacles will be dealt with time and undoubtedly some new concerns may appear. Questions such as malpractice liability, credentialing, training requirements and license granting will have to be resolved in the future. Most people on the survey (49% to be exact) answered that robots could have negative implications on employment as robots will do most of the work that humans currently do and many of related jobs will be reduced. However, as mentioned in the advantages chapter, new fields are inserted into robotic surgery such as telemedicine, which shows that new needs for personnel emerge. Also it is quite interesting to note how the people asked are divided into three groups based on their answers concerning robotic surgeries in the future: There is a 64% of the people asked who have a positive outlook on robotic surgeries in the future and a 36% who are quite intimidated and afraid of this potential change. Part of this comes from the lack of information about robotic surgery and from the fact that it is still in an early stage. As far as robotic surgery is concerned, there is much to be done until it can reach its full potential. Even though, these robotic systems have enhanced dexterity significantly, they still need to advance the full potential in instrumentation or to integrate the full range of sensory input. Most people when hear about robotics, they think of automation. The possibility of automating some tasks is both exciting and controversial. Future systems might entail the ability for a surgeon to program the surgery and merely supervise as the robot performs most of the tasks. The possibilities for improvement and advancement are only limited by imagination and cost. 9. Conclusion Robotic surgery may be at an early stage, but that does not mean that it has not demonstrated its potential and significance, particularly in areas previously inaccessible by traditional procedures. However, it still remains to be seen if robotic surgery will replace completely conventional instruments in less technically demanding procedures. Robotic technology will bring major changes in surgery by enhancing and expanding laparoscopic procedures, advancing surgical technology and thus bringing surgery into the digital age. Not to mention, it possesses the potential to expand surgical treatment beyond the limits of human ability. The benefits of robotic surgery outweigh the costs. 10. Bibliography 10.1 Online (World Wide Web) Sources Pearl Tesler, Universal Robots: The history and workings of robots, 10 October 2009 Wikipedia, Robotics,16 July 2009 History of robotic surgery, Overview of Major Surgical Robotic Systems and Companies,17 July 2009 William Harris, How Haptic Technology Works, 4 September 2009 http://electronics.howstuffworks.com/gadgets/other-gadgets/haptic-technology.htm Youtube, Robotic surgery demonstration, July 24, 2007, 7 September 2009 http://www.youtube.com/watch?v=0NZLpWrJGgk Youtube, Robotic Surgery, April 05, 2007,15 September 2009 Youtube, Robotic Heart Surgery, February 12, 2007, 19 September 2009 Youtube, Robotic Heart Surgery Allen Raczkowski, MD, February 03, 2009, 25 September 2009 http://www.youtube.com/watch?v=LezbxU5P1uc Robotic Surgery in Greece,22 April 2009,8 October 2009 http://roboticsurgery.gr Robotic Surgery, Simulation assisted training in Robotic Surgery,15 January 2010 Robotic Surgery ROBOTIC SURGERY IN TELEMEDICINE HYGEIA S.A.: The first total hysterectomy in Greece with the da Vinci  ® S Robotic System,1 July 2008,20 January 2010 http://www.kapetanakis-center.gr/www_eng/news/010708.pdf Robotic Surgery blog, Robotic reliability, 2 March 2007,17 January 2010 http://www.njurology.com/RoboticSurgeryBlog/robotic_surgery_basics/ Da Vinci Surgery, Patient Stories, 25 January 2010 http://www.davincistories.com/search-stories/search-stories-result.html?start=15condition=Prostate%20Cancer 10.2 Works-research papers Ø ΔÎ ­ÃÆ'πΠ¿ÃŽ ¹ÃŽ ½ÃŽ ± ÃŽ §ÃŽ ¹ÃÆ'ÃŽ ¬Ã ÃŽ ¿ÃŽ ³ÃŽ »ÃŽ ¿Ãâ€¦,ÃŽ ¡ÃŽ ¿ÃŽ ¼Ãâ‚¬ÃŽ ¿Ãâ€žÃŽ ¹ÃŽ ºÃŽ ¬ ÃŽ §ÃŽ µÃŽ ¹Ã ÃŽ ¿Ãâ€¦Ã ÃŽ ³ÃŽ ¹ÃŽ ºÃŽ ¬ ÃŽ £Ãâ€¦ÃÆ'Ï„Î ®ÃŽ ¼ÃŽ ±Ãâ€žÃŽ ± (da Vinci, Ze ,Hermes). ÃŽ  Ã ÃŽ ¿ÃŽ ²ÃŽ »ÃŽ ®ÃŽ ¼ÃŽ ±Ãâ€žÃŽ ± ÃŽ ºÃŽ ±ÃŽ ¹ Ï€Ï ÃŽ ¿ÃŽ ¿Ãâ‚¬Ãâ€žÃŽ ¹ÃŽ ºÃŽ ­Ãâ€š.( Despoina Xisaroglou ,Robotic Surgical Systems, Problems and perspectives (accessed July 23rd,2009) Ø Caroline GL Cao Gary Rogers, Tufts University, Robotics in healthcare, (accessed June 12th ,2009) Ø Sunitha M.V, Robotic surgery, seminar report, August 2008 (accessed July 10th, 2009) Ø ΓÎ ºÃŽ ¹Ã ÃŽ ¹ÃŽ ½ÃŽ ·Ãâ€š ΑÎ ¸ÃŽ ±ÃŽ ½ÃŽ ¬ÃÆ'ÃŽ ¹ÃŽ ¿Ãâ€š(Grinis Athanasios), ÃŽ ¡ÃŽ ¿ÃŽ ¼Ãâ‚¬ÃŽ ¿Ãâ€žÃŽ ¹ÃŽ ºÃŽ · χÎ µÃŽ ¹Ã ÃŽ ¿Ãâ€¦Ã ÃŽ ³ÃŽ ¹ÃŽ ºÃŽ ® (robotic surgery) (accessed September 13th,2009) 11. Appendix 11.1 Robotic surgery Questionnaire 1. Have you heard about robotic surgery? a) Yes b) No 2. How much do you know about robotic surgery? a) A lot b) Very little c) Almost nothing 3.Do you know anything about robotic surgery in Greece? a) I know quite a few things b) I know very little c) I know nothing 4.Have you heard of any of the following robotic systems? a) Da Vinci b) Zeus c) AESOP d) Socrates Robotic System e) None of them 5. Do you think robots can perform surgery better than humans? a) Yes b) No c) Im not sure d) Maybe in the future 6. Do you think that robots could have negative implications on employment? a) Yes b) No c) Im not sure 7. Would you undergo a surgery aided with a robotic system? a) Yes b) No c) Im not sure d) If absolutely necessary 8. Do you think that robotic surgery is safe and reliable? a) Yes b) No 9. Would you avoid a robotic surgery due to costs? a) Yes b) No 10. How would you describe a future where all surgeries are done by robots? a) Very appealing b) Very useful and time-saving c) Not so happy about it. d) Quite frightening. 6 [1] Robot Institute of America, hf issues in surgery. PDF(accessed June 12th ,2009) [2] http://www.thetech.org/robotics/universal/index.html (accessed October 10th,2009) [3] http://en.wikipedia.org/wiki/Robotics (accessed July 16th ,2009) [4] http://en.wikipedia.org/wiki/Robotics (accessed July 16th ,2009) [5]http://biomed.brown.edu/Courses/BI108/BI108_2004_Groups/Group02/Group%2002%20Website/history_robotic.htm (accessed July17th,2009) [6] Robotic surgery, a seminar report by Sunitha M.V. (accessed July 10th, 2009) [7] Robotic surgery, a seminar report by Sunitha M.V. (accessed July 10th, 2009) [8] http://electronics.howstuffworks.com/gadgets/other-gadgets/haptic-technology.htm (accessed September 4th, 2009) [9] ÃŽ ¡ÃŽ ¿ÃŽ ¼Ãâ‚¬ÃŽ ¿Ãâ€žÃŽ ¹ÃŽ ºÃŽ · χÎ µÃŽ ¹Ã ÃŽ ¿Ãâ€¦Ã ÃŽ ³ÃŽ ¹ÃŽ ºÃŽ ® (robotic surgery)- ΓÎ ºÃŽ ¹Ã ÃŽ ¹ÃŽ ½ÃŽ ·Ãâ€š ΑÎ ¸ÃŽ ±ÃŽ ½ÃŽ ¬ÃÆ'ÃŽ ¹ÃŽ ¿Ãâ€š (pdf file)(accessed September 13th,2009) [10] ÃŽ ¡ÃŽ ¿ÃŽ ¼Ãâ‚¬ÃŽ ¿Ãâ€žÃŽ ¹ÃŽ ºÃŽ · χÎ µÃŽ ¹Ã ÃŽ ¿Ãâ€¦Ã ÃŽ ³ÃŽ ¹ÃŽ ºÃŽ ® (robotic surgery)- ΓÎ ºÃŽ ¹Ã ÃŽ ¹ÃŽ ½ÃŽ ·Ãâ€š ΑÎ ¸ÃŽ ±ÃŽ ½ÃŽ ¬ÃÆ'ÃŽ ¹ÃŽ ¿Ãâ€š (pdf file)(accessed September 13th,2009) [11] http://www.youtube.com/watch?v=0NZLpWrJGgk (accessed September 7th, 2009) [12] ÃŽ ¡ÃŽ ¿ÃŽ ¼Ãâ‚¬ÃŽ ¿Ãâ€žÃŽ ¹ÃŽ ºÃŽ ¬ ÃŽ §ÃŽ µÃŽ ¹Ã ÃŽ ¿Ãâ€¦Ã ÃŽ ³ÃŽ ¹ÃŽ ºÃŽ ¬ ÃŽ £Ãâ€¦ÃÆ'Ï„Î ®ÃŽ ¼ÃŽ ±Ãâ€žÃŽ ± (da Vinci, Ze ,Hermes). ÃŽ  Ã ÃŽ ¿ÃŽ ²ÃŽ »ÃŽ ®ÃŽ ¼ÃŽ ±Ãâ€žÃŽ ± ÃŽ ºÃŽ ±ÃŽ ¹ Ï€Ï ÃŽ ¿ÃŽ ¿Ãâ‚¬Ãâ€žÃŽ ¹ÃŽ ºÃŽ ­Ãâ€š.(Robotic Surgical Systems, Problems and perspectives) by Despoina Xisaroglou. (pdf file) (accessed July 23rd,2009) [13] ÃŽ ¡ÃŽ ¿ÃŽ ¼Ãâ‚¬ÃŽ ¿Ãâ€žÃŽ ¹ÃŽ ºÃŽ ¬ ÃŽ §ÃŽ µÃŽ ¹Ã ÃŽ ¿Ãâ€¦Ã ÃŽ ³ÃŽ ¹ÃŽ ºÃŽ ¬ ÃŽ £Ãâ€¦ÃÆ'Ï„Î ®ÃŽ ¼ÃŽ ±Ãâ€žÃŽ ± (da Vinci, Ze ,Hermes). ÃŽ  Ã ÃŽ ¿ÃŽ ²ÃŽ »ÃŽ ®ÃŽ ¼ÃŽ ±Ãâ€žÃŽ ± ÃŽ ºÃŽ ±ÃŽ ¹ Ï€Ï ÃŽ ¿ÃŽ ¿Ãâ‚¬Ãâ€žÃŽ ¹ÃŽ ºÃŽ ­Ãâ€š.(Robotic Surgical Systems, Problems and perspectives) by Despoina Xisaroglou. (pdf file) (accessed July 23rd,2009) [14] ÃŽ ¡ÃŽ ¿ÃŽ ¼Ãâ‚¬ÃŽ ¿Ãâ€žÃŽ ¹ÃŽ ºÃŽ ¬ ÃŽ §ÃŽ µÃŽ ¹Ã ÃŽ ¿Ãâ€¦Ã ÃŽ ³ÃŽ ¹ÃŽ ºÃŽ ¬ ÃŽ £Ãâ€¦ÃÆ'Ï„Î ®ÃŽ ¼ÃŽ ±Ãâ€žÃŽ ± (da Vinci, Ze ,Hermes). ÃŽ  Ã ÃŽ ¿ÃŽ ²ÃŽ »ÃŽ ®ÃŽ ¼ÃŽ ±Ãâ€žÃŽ ± ÃŽ ºÃŽ ±ÃŽ ¹ Ï€Ï ÃŽ ¿ÃŽ ¿Ãâ‚¬Ãâ€žÃŽ ¹ÃŽ ºÃŽ ­Ãâ€š.(Robotic Surgical Systems,Problems and perspectives) by Despoina Xisaroglou. (pdf file) (accessed July 23rd,2009) [15] Robotic Surgical Systems,Problems and perspectives) by Despoina Xisaroglou. (pdf file) (accessed July 23rd,2009) http://wikipedia.com/robotics (accessed July 16th,2009) http://www.youtube.com/watch?v=mR-PC8kCi_A (accessed September 15th,2009) http://www.youtube.com/watch?v=0NZLpWrJGgk (accessed September 7th,2009) http://www.youtube.com/watch?v=k3gIa_w4GXQ (accessed September 19th,2009) http://www.youtube.com/watch?v=LezbxU5P1uc (accessed September 25th,2009) [16] http://roboticsurgery.gr (accessed October 8th,2009) Robotic Surgical Sy