Advantages of Traditional Budgeting Systems

Advantages of Traditional Budgeting SystemsTraditional budgeting is one the first budgeting ashess created. Traditional budgeting carcass is still ordinarily used in many organizations today. The reasons why organizations still using conventional budget, this is due to frame domesticate of simplicity. The affair of the budget is to give focus to an organization, and stand by the coordination of activities and enable control. Large companies might struggle to plan, coordinate and control their dealings without a budgetary system. Even sm altogetherer companies potentiometer benefit from the budgetary system to verify the direction of the business, and how it can reach its goals.Second reason is its organizational culture for the fundamental method of operating, it whitethorn not be possible for the organization to move away. Moreover, by their nature, budgets are a centrally integ governd activity within a business, and practically the only one which brings together all as pects of the company. Budgets are often the one process which covers all areas of organisational activity (Otley, 1999).Third reason of an organization still using traditional budgeting system is the need to decentralise this is recognized that deposes institutions and other financial institutions are more suitable candidates for decentralisation than other types of businesses. For an example, Norman Macintosh observed that fork managers at Transamerica Finance Corporation had a majuscule deal of freedom to run their operations according to standard operating procedures. Similarly, another example is Svenska Handelsbanken, the largest bank in Sweden sets parameters for branch managers discretion and then motivates its staff using competitive devices such as branch league tables (Alexa Michael and Technical Information Service, 2007). This approach can be successful in organizations where people work in similar but in independent units. However, it does not fol beginning that th is level of decentralization can be adopted by all organizations. Every organization is unique and it may be unsufferable to change the company culture to provide the necessary decentralisation. Successful decentralisation also depends on a great deal of trust being invested in teams throughout the organisation.Due to scotch uncertainty, traditional budgeting has its limit. The disfavor of traditional budgeting is it has insufficient external focus. Traditional budgeting is seldom focusing on strategy and is often conflicting. as well that, it is time consuming and costly to put together, and also limit responsiveness and flexibility, whereby this is not good for economic uncertainty situation. This is because it often admonishs change and only adds little value, budget tend to be bureaucratic and discourage creative thinking and requires too much valuable management time. Traditional budgeting system has an adverse concussion on management behaviour, which can become dysfunc tional with regard to the objectives of the organisation as a whole. Johnson (2005) explains that nearly budgets are not based on a rational, causal model of resource consumption, but are often the result of protracted internal bargaining processes. Conformance to budget is not seen as congruous with a drive towards continuous improvement.Under economic uncertainty, inflexibility is somehow seen as the key impuissance factor of traditional budgeting, and organizations are being urged to move towards continuous budgeting systems to enable speedy and coordinated adaptations to unfeigned and anticipated changes in the economic (Neely et al, 1997). Continuous budgeting system gives companies the agility and capability to follow changes in grocery store situations, and to cope with economic uncertainty while keeping an eye on strategic objectives (Lorain, 2010).Continuous budgeting system solves problems associated with infrequent budgeting and hence results in more accurate forecast . It is also more responsive to changing fortune beneath economic uncertainty. Some companies use a continuous budget which means that a on-going 12 months budget is inaugurateed by consecutively adding a new budget as each watercourse month expire, such a process allow management to work at anytime, within the present 1 month component of a full 12 month annual budget. Continuous budgeting system make the planning process less irregular, rather than having managers go into the budget getting period at a specific time, managers are continuously involved in planning and budgeting process. The advantages of a continuous budget under economic uncertainty situation include, eliminating a fiscal year mind set by recognizing that business is an ongoing operation and should be managed accordingly. It also allows management to make corrective steps as forecast business condition change such as in economic uncertainty. It helps to reduce or eliminating the budget planning process that o ccurs at the end of each fiscal year.another(prenominal) recent conform to jointly conducted by the American Productivity Quality Centres and IBM Global Business Services has found that companies focusing on planning, budgeting and forecasting as a business strategy are higher performers in all area than those focusing on cost accounting, control and cost management. The study also showed that high perform organizations tend to complete their budgeting cycle in 30 days compared to 90 days in low performing organizations and most of the high performers used continuous budgeting system when the economic in uncertain (Kinney and Raiborn, 2008).Another example in the article author has commendation how Kenyan business sail through under economic uncertainty. Kenyan have experience challenging times with business struggling to plan and value their product carefully so as not to erode the profit margins that they had planned for. Having exchange rate problems. Smart cfos employ a budg eting, principally a set of procedures used to develop budget. Author mention that Kenyan organization have limited resources and and they need to effectively plan and use them. This is why they use budgets to help provides a means to achieve this. Budgets provide a useful benchmark of performance and help control profit and operations when compared to actual performance. The resulting variance guide management in appreciating what they need to do in the subsequent period. Employee performance and managerial performance is usually measured on qualitative terms, but budget gives a new meaning to evaluate performance through numbers and helps in honor high performers and correcting the low performers. Due to the economic downturn, a number of well run companies have commensurate to their specific circumstances and prepare master budget that comprises of performance financial statement, a capital budget, and a financial budget. However, some organizations have adapted to the concept of continuous budgets. With the fluctuation of the dollar, business are emploting a variety of techniques of budgeting to ensure that they make profits.

Mechanisms of Viral Transmission

Mechanisms of Viral Transmission nigh of the reinvigoratedfangled viral diseases that enter the kind-hearted world be enzootic computer computer computer computer computer computer computer viruses that have channeld their droves. These enzootic viruses be given to have a severe effect in valet de chambres. A viral disease emerges in a population through a series of move the initial infection, the spillover, and lastly the legion to army rapture. These steps ar further aided or prevented by the virulence factors present in the virus versus the army or human whichever the case susceptibility. It is important to determine the source of these viruses and whether it was via an enzootic or epizootic virus. The barriers that the virus faces when trying to infect a new host atomic number 18 just as important as the role that the environment plays in the viruss transmissibility. There are many factors to consider when looking at viruses how viruses change hosts.New viruses can emerge in a population through ghost with an alternative host. Until recently the probability of a virus changing hosts was limited by the restricted contact betwixt the initial host and the alternative host. An increase in contact can be accomplished by introducing the host animal to domestication or any other arena that would serve to increase the likelihood of human contact. Primates that have been infected with simian immunodeficiency virus in Africa were separated from areas of high human populations which in stoop significantly limited the chances of the virus changing hosts and infecting gentlemans gentleman.The chances of viral contact can also be increased by changes in social and sexual behavior, increased travel, hygiene practices and the increased density of the population that work in favor of the virus and increase the chances of infection in an alternative human host. The importation of initial host to alternative host contact can be examined through the ins tance in Africa where primates infected with simian immunodeficiency virus in Africa were removed from areas of high human populations and in turn significantly reduced the number of the host changes from primate to humans. The removal of the infected animal from direct human contact does non prevent transmission though intermediate hosts. In Malaysia fruit bats are the reservoirs for the virus nipah and with the large number fruit orchards near pig farms the incidence of contact between the virus and the pig is greatly increased.When it comes to a viruss ability to infect a new host there are new barriers that the virus must learn to penetrate. An important part of a viruss ability to infect new hosts is its ability to infect that hosts cells. In humans the viruss can have trouble entering the host via collectible to factors that fight off viral infections or any(prenominal)thing as simple as the surface of human scramble can pose as a barrier for entry into an alternative host . When galactosyl producing virions which are not commonly ready in humans are detected in the body the galactosyl brings about an antibody response that inactivates the virus and prevents its bed covering. A mechanism of action such as this requires the viruss need to rapidly adapt to bypass the barriers that are set up to prevent viral infection.Even if the relative distance in relation between the initial host and the alternative host of a virus is close the intensity and rate of the contact between the two species is still a factor. When a virus infects a new host that is distantly or closely related to the previous host it does not mean that the host cannot also transfer the virus to more distantly related organism. Integration of a virus into a new host cell is also dependent on the receptor binding that occurs between the virus and host cell. The changes that the virus has to undergo in order to infect the new host cells must coincide with the receptors that are found alre ady on the host cells. A process involving the transfer of the FPV virus to infect canine concern a gain of two mutations that then allowed for it to bind to the canine transferrin receptors. These mutations allowed for the FPV virus to increase its host range successfully gain the ability to infect canines with a new appoint of the FPV virus CPV.Blockades for the spread of the viral infection once it has infected the new host cells can exist in the form of proteins that prevent the spread of the virus to neighboring cells. The capsid proteins of viruses are stopped at the cytoplasm of the new host cell by TRIM5 a protein that binds to the capsid of the virus preventing its entry into the host cell. generalist and medical specialist viruses are two categories for viruses that can possibly predict and help determine the ranges of hosts that a particular virus can infect and whether or not a virus is a candidate for host switching. Generalist viruses are expected to have an increa sed incidence of alternative host shifting while specialist viruses are the opposite and are unable to bypass the barriers in the host cells receptors and other defenses that would require the virus to mutant in order to effectively infect the cell. Most of the specialist cells have trouble reservation it past the initial infection of the alternative host.Viruses that have a wide range of hosts have a built in advantage already in that they do not have to alter in order to successfully dumbfound a change in the types of organism that they can infect. The rate of vicissitude in a virus directly determines the adaptability of a virus into a new host. Viruses that have a high evolving rate are more likely to cross species and cause infection in a new host due to its ability to quickly adapt to the host cell. RNA viruses do not have proofreading mechanisms as well as replication that is error prone and are in that moxie much more variable than DNA viruses. DNA viruses are less varia ble than RNA viruses scarcely some exception exist in that certain single stranded DNA the rate of variance may be similar to that of RNA viruses.A reduction in virus fitness occurs when the virus undergoes mutations that are necessary in order to infect a new host. If the virus is using a intermediate host even more adaptations are required and the virus is further reduced in fitness. The addition of the intermediate hosts help to explain why the influenza A virus infects each of its hosts other than through different mechanisms. In humans for example the infection is found in the lower respiratory tract than in other hosts where it is located in the upper respiratory tract. Reassortments and recombinants aid in a virus adaptability to a new host cell by making a number of heritable changes in a shorter amount of time. The CoV virus of the bat in recombination with another virus was able to make a new virus SARS that can infect humans and other hosts.The intermediate virus is a form of the virus that infects the intermediate host. This virus is the least stable form of the virus. The lower fitted virus loses some of the capability to infect previous parental host types efficiently in addition to the newer hybridization hosts they are trying to infect. This phenomenon could account for the low percentage of viral crossover between species.The article did a good job of following the trend and mechanism with which a virus switches hosts. More investigation should be done in the areas of the initial infection of the virus and how it crosses over. More studies should also be done on the likelihood of a virus from another animal making the host switch to infect humans and how that spread can be predicted and prevented. Further studies should be done on how the viruses that make the jump to a species that is not close in the evolutionary chain to who they normally infect to humans. A broader knowledge of how the virus adapts itself to survive in an organism that is so different from its original host also deserves further investigation. If the topics of use up listed are further studied and developed then the article would have a more rivet and concise viewpoint instead of the disorganized and sometimes abandoned thread of thoughts that exist at some points within the article.

Emperor Shi Huangdis Tomb

emperor Shi Huangdis tombThere be many mysteries of human civilizations beginning and its inveterate progression. In auxiliary to these mysteries, grand expressions from early civilizations still confuse us with their logic and places the method or the reasoning into complete obscurity. A approximate example of this is the Great Pyramid of Giza, this structure still fascinates the minds of researchers and laymen alike. There are so many another(prenominal) enormous structures which still today depart a debate over among the researchers and academics every(prenominal) over the world. I imagine one of the magnificent but still mysterious early structure is the Qin Shi Huangdis Mausoleum. With just the vastness of the size of the grave and all the complicated structures of the tomb portray a great mystery. The burial mound rises 140 feet above the plain and is estimated to be close 400 feet by 525 feet (Sayre, 2015, pp. 225-7). In addition to the size of the tomb there is the presence of the terracotta army and the privacy that was upheld in creating of the tomb makes it even more of a mystery, and even today its non really clear on what made the emperor come to this judgment on having such a complicated and secret burial place. agree to Sima Qin, an historian for the Han Dynasty adds more mystery to the tomb. Sima Qin is the grand historian and according to him the tomb contained palaces and scenic towers for a hundred officials, as well as numerous rare artifacts and treasures. In addition, two major rivers of China, the Yangtze and the Yellow River, were simulated in the tomb using mercury (The Secret Tomb, 2015). Additionally, he talks about other important features inside the tomb such as the rivers and other features of the land were represented on the floor of the tomb, its ceiling was decorated with the ethereal constellations (The Secret Tomb, 2015).Thus, what could study been behind the real reason to have all of this done? An art resea rcher Edmund Capon came up with a hypothesis for respond this mystery. Capon believed that the Emperor Shi Huangdi was fearful of his own last and he fixation on finding the pass to immortality (Wolff, 2007). These two factors are what prompted him to construct tomb which would replicate his authority and his greatness during his rule. The Emperor wanted to take all things that would manoeuver his authority and power so he took his extravagant army, his key officials and anything else that he would hold precious to him. Because of all of these things according to Capon, is why he make this amazing but still mysterious tomb. If where going to believe Chinese legend, then it could be said that Emperor Shi Huangdi was an alien and his tomb was his alleged(prenominal) spaceship with he would return home with. In the legend, the emperor lived in the mountains of Kunlun and he is said to have lived for over one hundred geezerhood and after his rule he would return to the skies (Sky floating, 2009). It was written that a cauldron could make a dragon appear from the sky that was metallic in color that could take the Emperor away (Was the Yellow, 2016). If this is a legend to be believed than the myth is that the tomb would be a ship that is sealed up and was meant to carry the Emperor away into space.Between the two theories I would have to say I would go with Capons theory about his afterlife would be more believable since it supported by reason and historic accounts. The last(prenominal) tells how the Emperors polices were very cruel and his despotic reign prompted the growth of his enemies most were the lords that he already had conquered, and these lords were organizing assassination attempts on the Emperors life possible at to the lowest degree three times. The attempts on the emperor life seem to be in response to his fearful though of his demise and wanting to find the path to immortally (Wolff, 2007). It could be said that Capons theory could go along with what some historically events and his theory on why the Emperor would have constructed such a tomb could go along with his reasoning on his thoughts about his demise and his pursuit for immortally.ReferencesSayre, H. M. (2014). The humanities culture, continuity and change (3rd ed., Vol. 1, pp. 226). Retrieved January 27, 2017, from https//strayer.vitalsource.com//books/9781323262153Skyfloating. (2009). Aliens of antediluvian China. Retrieved November 3, 2015, from http//www.thelivingmoon.com/46ats_members/SkyFloating/02files/Aliens_of_Ancient_China.htmlThe Secret Tomb of the First Chinese Emperor Remains an Unopened Treasure (2015). Ancient Origins. Retrieved November 3, 2015, from http//www.ancient-origins.net/ancient-places-asia/secret-tomb-first-chinese-emperor-remains-unopened-treasure-002568Was the Yellow Emperor an Extraterrestrial? (2016, July 21). Retrieved January 28, 2017, from http//ancientufo.org/2016/07/yellow-emperor-son-heavens/Wolff, J. (2007). Emperor Qin in the Afterlife. Retrieved November 3, 2015, from https//twp.duke.edu/uploads/assets/2EmperorQin.pdf

Summary Of Looking For Alibrandi English Literature Essay

Summary Of Looking For Alibrandi English Literature searchMelina Marchetta s novel of Looking for Alibrandi tells a story of a nondescript but typical 17- year-old fille Josie Alibrandi who is an Australian of Italian descent. She is an illegitimate kidskin brought up by her solo mother hardly. Therefore as a passionate teenage, she confronts and resolves a number of problems of reconciling her familys past with her futures, after scram these, Josie learns to accept her heathenish heritage, and get an banlance mingled with the demands of her Italian heritage and her ambitions in Australia. Josephine is on the road of growing.Josie accepts her cultural heritage through understanding her grandma Katias past. At the first part of the novel, Katia seems to be a stereotypical Italian woman, and a guardian of culture. She doesnt totallyow Josie to go to camp, and often criticizes her well-nigh anything. Josephine disagrees with her and argues with her,Its non the youth of today, Its you and sight like you, forever worrying what other people think. (Melina,1992, p.37). However, as the novel develops, nanon told a lot of things about her past to Josie, As a beautiful young girl who was interested in boys, she was hook up with off her family to an older man and then moved to Australia where she knew no one and had to manage alone in the hut while her husband was international working. She became pregnant to an Australia man who tell apartd her, yet stayed with her unloving husband because of the child. later on her husband died, Christina was brought up by nonna alone. Without telling her daughter the truth, she sacrificed her whole sprightliness for Christina, but never ever told her daughter what she gave up. Josie begins to agree with her after suffer intercourse these and is conscious of the all important(p) cultural heritage, and then refers to her grandmother asthe strongest women(Melina,1992,p.226). She becomes an obedient girl and a dutiful d aughter, so when Jocob hopes to realise sex with her, she refuses, she would not want to break the tradition that not to have sex before marriage.The love experiences with two very different boysJohn Barton and Jacob Coote, makes Josie accept her family background and serving her to find herself. Josie has always been attracted to John Barton, At first, Josie thinks can is the man of her dream, and with hefty reason, from a rich family, bound for law school, and good-looking, what just like josie cute to own by herself,The world of sleek haircuts and upper-class privileges (Melina,1992,p.32). The cultural differences between Josie and John is the cultural differences between the poor and the rich. In josies eyes, John seems to have everything going for him. John barton is a son of a wealthy MP. However,despite his inside(a) social status, he cannot find happiness. His father wished he turned clarified politician. He finds it impossible to escape the pressures from his family , so he chooses suicide. And this give josie a great shock and provides her with a tragic perspective for her own bearing and problems I remembered when we spoke about our emancipation. The horror is that he had to die to hit his. The beauty is that Im living to achieve mine.(Melina,1992,p.240), the suicide of her unrequited sweetheart makes her resilience. scorn being emotionally hurt, Josephine discovers to value her identity, and chang her approach towards life. Through the assistance of john Barton she successfully finds her true self, and then she gets the liberation.The other boy is Jacob Coote whom Josie loves. They have umteen fights, but eventually things turn out for the best. Jacob Coote is working-class bad boy, the cultural differences between Josie and Jacob is the cultural differences between Australian-Italians and other Australians(Tran, Udomsak, Stale,2009)At the beginning of the novel, Jacobs wonderful diction attracts Josie and makes her interested in him, b ut later his casual dresses and his behaviour astonishes her. estimable like this, Josie always has conflicting feelings towards Jacob. When John died, Jocob lends a shoulder to her, and he saves her from the bad man on her way home, she finds he is considerate and always able to find ways to let her calm down. Josie takes Jacobs advice, Break remote from those rules, Josie. Make your own.(Melina,1992,p.206). At the same time, Jacob teaches her to own dream forever, promise me youll never stop dreaming. (Melina,1992,p.239)andyou wont have to put up with some cultureless Aussie with no heart and soul. (Melina,1992,p.208). Jacob is special to Josie, because of the same class, Josie can learn to get unloosen of bias of identity under his help and better to answer the interrogation of what I am(Elise, Pierre, JeanPierre, et al..2007).The recognition of Josie and her father Michael appears Josie get ou of the obsession of illegitimacy identity, evaluate her whole family. From the b eginning, she wants her father along with her, and then is angry for his absence in her life, has never seen her father and has always had life long dream of impact him. Seventeen-year-olds dont need a father.(Melina,1992,P.66) So when she first is aware of her fathers exist, she doesnt know how to nervus him. Until one day she hits Carlys nose heavily by book and is forced to shout out her fathers phone number, she realizes her strong feelings of having a father in her mind. Simultaneously, as the father rejects her at first but, with Josies persistence her father lastly accepts her. Michael tells Josie,A person doesnt necessarily have to be happy just because they have social standing and material wealth, Josie. (Melina,1992,p.235), and let her know not gauge people by their appearance alone. When John was dead, Michael tells her living is the challenge, dying is so easy(Melina,1992,p.236) to make her strong, and from the words People change. Circumstances change them. (Melina ,1992,p.243), Josie learns to accept all the changes. From the above all, josie feels the support from a father and wants a whole family.In conclusion, Josie learns to accept her cultural heritage, her family, and everything around her in the life. She doesnt feel ashamed on National Wog Day and likes to invite her friends to enjoy it. She is pretty sure about her destiny now. the Alibrandi women are not cursed, but blessed Ultimately, the most important thing is that she finds that she must be true to herself, her beliefs and her dreams.

Bacillary And Post Parturient Hemoglobinuria Biology Essay

Bacillary And Post parturient Hemoglobinuria Biology quizPost parturient haemoglobinuria is a sporadic malady of multiparous, advanced producing dairy cows and buffaloes characterized by inflammation blood cells breakdown in the muscles, haemoglobinuria and anemia. The prevalence of the disease in the overall kine macrocosm is very little with a case fatality rate ranging from 10 to 50% (1).Parturient hemoglobinuria was sourcely known as milk feverishness complex, post- parturient hemoglobinuria, puerperal hemoglobinuria and nutritional hemoglobinuria, etc.HistoryParturient hemoglobinuria was first account in 1939 in buffaloes in the Indian sub-continent in the Lyallpur district, now Faisalabad (Aslam and Haq, 1967). The first known reference of its occurrence and viable cause in Pakistan was by Hussain (1955). Subsequent reviews on the issue pep uped that match insufficiency may be a possible reason of the disease (Pirzada et al., 1989 Pirzada and Ali, 1990). However, s o far its true etiology remains doubtful.Etiology ensuant papers concluded that PPH is neither infectious nor contagious derived from negative serological and bacteriological verification for pathogenic bacteria and failure to identify erythrocyte parasites (1,6,7,8,9,10).Different causes, e.g. protein and mineral insufficiency, Saponin from cruciferous plants, competition for mineral assimilation and, hypophosphataemia because of daystar insufficiency. Pirzada et al. (1989) and Cheema et al. (1980) reported that no contributory pathogen could be secluded from the unnatural animals. Copper insufficiency has been recommended as a possible cause of PPH by personnel in New Zealand. animals from dairy farms with a high occurrence of PPH had low levels of sloven in serum and liver (12). A disease in Ontario named as red water was linked with several predisposing factors which included a) fresh parturition, b) sharp milk production, c) dietetic phosphorus insufficiency and d) eating of turnips, rape, kale, green alfalfa and sugar beet pulp (13,14,15). In addition, many cows were hypophosphataemia (1, 16, and 17). sensitive animalsA first round report recommended that parturient hemoglobinuria oft propagation affected high producing buffalo cows in the area of the Punjab responsibleness of Pakistan wherever there is a insufficiency of minerals, chiefly in the districts of Faisalabad, Jhelum, Attock and Rawalpindi. At these points soil tended to be deprived in minerals and buffaloes were affected more than cattle (Husain, 1955). The incidence of this syndrome in bulls, cows prior to parturation, heifers under two old age old, or beef cows is remarkable but has been reported (23,22). A disease with many similarities has been described in sheep (13), Egyptian and Indian buffaloes (24,16) and a goat (17).Clinical signsClinical signs of syndrome can bee seen 20+,-10 days, before or after parturition at what time affected Animals pass red to coffee colored urine and rectal temperature ranges from 38.38C to 39.48C, (Pirzada et al., 1989). On the other hand, with the advancement of disease, rectal temperature declines. Additional clinical signs are jaundice, anemia, recumbency, in appetence, labored breathing, and geometrical irregularity (Razz et al., 1988). Cheema et al. (1980) reported that there was a considerable increase in the rectal temperature of affected animals. The disease affects buffaloes more than cattle (Pirzada et al., 1989) which is a judgment in close agreement with that of Raz et al. (1988). Pirzada et al. (1989) additional observed that phosphorus administration yielded efficient outcome suggestive of hypophosphataemia as a causal issue and that, in the affected areas from August to January, animals in advanced stages of pregnancy should be supplemented with dicalcium phosphate or bone meal which should contain 13% and 17% phosphorus correspondingly (Amir and Kripsch- eer, 1989). This agreed with the findings of Akram et a l. (1990) and Raz et al. (1988). Earlier, Sadiq et al. (1965) found that even though cases of parturient hemoglobinuria occurred all the way through the year, the occurrence increased in winter. On the other hand, Cheema et al. (1980) reported that frequently stall-fed animals were affected, and that most cases were occurring in July and September. The needlelike disease (three to five days) can come to an end in stopping point or be followed by extended convalescence (two to eight weeks). abase and sloughing of the extremities are reported sequelae. Recovered animals get back their former body condition and milk production gradually.DiagnosisIt can On the basis of clinical signs and history Urinalysis can be laborsaving in the diagnosis of this syndrome. Microscopic inspection of the urine sediment is self-assertive to distinguish hematuria from hemoglobinuria.TreatmentThe recommended treatment for Post parturient hemoglobinuria in North America includes 1) intravenous infus ion of sodium sultry phosphate (60 g in 300 mL of water), 2) 100 g of bone meal administered as a drench two times a day, 3) transfusion of fresh blood as needed and 4) intravenous fluids to sustain hydration (1,29,30). Improvement of any phosphorus insufficiency or disproportion in the ration together with removal of incriminated feeds might prevent further cases. Because of inconsistent results with phosphate therapy and the copper-deficient status of affected cows, personnel in New Zealand recommend parenteral copper (120 mg available copper per cow) as the prospered treatment (31).A study on treatment trials of hemoglobinuria in buffalo cows and cattle indicated that subsequent treatment with sodium acrimoniousulous phosphate (20% sol) administered concurrently by i.v., s.c. and oral routes, approximately 100% of affected animals recovered in 1-3 days (Shah et al., 1988). Blood transfusion also shows a good result in this regard (Rauf, 1989 Raz et al., 1991). A blood coagu lant Botrophase prepared from the venom of the snake Bothrops jararaca, seems to have anti fibrinolytic exertion and was productively used to treat buffaloes facing parturient hemoglobinuria (Goel et al., 1988). parenteral copper (120 mg available copper per cow) as the favored treatment (31).Treatment with toldimfos sodium and tea leaves and sodium acid phosphate settlement of this treatment was based on the recovery of urine discoloration the dexterity of toldimfos sodium was 85% followed by tea leaves 56%, and sodium acid phosphate 18%. (Zameer et.al 2010). Fallowing treatment with tae leaves and toldimofos sodium urine was clear abutting day, and with treatment with sodium acid phosphate urine was clear on third dy. (Zameer et.al 2010)PreventionParenteral administration of copper has been effectual in dairy herds with previous histories of PPH (36,37). For prevention of the disease, supplementation with dicalcium phosphate has been suggested (Pirzada et al., 1989 Pirzada and Ali, 1990). The occurrence of PPH was comfortably lower (5.18% versus 25.51% P

What Are Presidentialism And Parliamentarism Concepts Politics Essay

What Are Presidentialism And Parliamentarism Concepts Politics Essay several(predicate) countries in the orb get down got their own semi policy-making organization in regularise to expect their countries run and organized and most of them be pine to devil major system of ru slight, namely chairpersonial and fan tanary system and with their own unique characteristics. The presidential and parliamentary systems have drawing cards of divers(prenominal) characteristics in their personality and practical running, and each of them have their own fairnesss and debilitys. Facing the qualify of the human beings political home and the revolutionary democracies, they have got their own advantages to the development of the parvenue democracies n iodintheless, thither is no universal answer for whole the countries in argonna of which system is to a greater purpose(prenominal) suitable for their new democracies.For presidentialism, it is a system which gives the presiden t the most power in the ruling of the country.((((Find sources / define))). The president unremarkably alter the political power and symbolic power in his own hand.(CITATION) For political power, he has got a console who is creditworthy for him and helping him to make non-homogeneous kinds of stopping points in un ilk matters, including both daily routines decisions and near important decisions deal declaring wars and appointing the judicature officials, he has got the highest power in executing the policies in a country.For the symbolic power of the president, he represents a give tongue to.(CITE) He would be responsible for most of the external issues, like expressing the stand point and the view of a country towards a specific issue, receiving the foreign ambassadors and visiting the another(prenominal) countries in order to get up the country and establish different kinds of networks, including the strategic and sparing ones.Like for the president of the United Stat es, the country which is the representative of the presidentialism, Obama, he has been viewed as the symbol of United States nowadays. He has to represent the United States to attend different international conferences like the G20 Seoul Summit in 2010(Cite) and he has recently visited 4 countries in Asia and India. He has to do these visits in order to promote the States interests and establish links and familys with other countries.The most signifi shadowert characteristic of the presidential system is the separation of power. The power of legislative and executive director is separated and they be independent from each other. There are different elections for electing the members of the executive and legislative sort outes respectively and hence the two offset printinges may be controlled by different political parties.The parliamentary system is another major political system accounting for around 30% of all the governments (p.42) in the modern world and the assembly is allowed to remove the government (p.34). The parliamentary system has major characteristics of the league of power which the legislative and executive power was hold by the same body.The symbolic and the political power in the parliamentary system is, unlike the presidential system, separated in two separate individuals and the two individuals are normally called the head of state and mind executive and the title is substance to change in different countries.(Cite). The example of head of state in the modern states include the Queen of England, Elizabeth II, the Emperor of Japan, Akihito (cite?) and their function is to symbolize the state and responsible for the external issues like receiving ambassadors and performing many of the ceremonial tasks. close to of the head of state is chosen by succession and the others are usually chosen by a governmental body like the legislature.(Cite)The head teacher executive is responsible for the other part of the country management, he is the point of the executive branch, and he is responsible for the policy do and also the daily operation of the government. The chief executive is usually come from the majority party in the parliament, however when on that point is not a majority political party, at that place may be a coalition government governing the state, like in Britain.Not 100% of the republican form of government is of parliamentary and presidential system. In 2000, around 20% of the government in democratic systems is of coalesce system, containing both the characteristics of parliamentary and presidential system.(Cite)(p.43).Both the parliamentary and presidential system has its own virtues and vices and it explain why there are different countries backup different system based on their situation and their historical priming coat and real needs. However, they do not have unassailable virtues and vices, there are only comparatively advantages.The first virtue of the parliamentary system is the enfo rceability of its bids to their supporters and citizens. The parliamentary government has a structural advantage hence it could pass its decision to a greater consequence quickly. As mentioned above, the executive cabinet was chosen within the parliament and it is usually dominated by a majority party. Hence, whenever the government proposes some new policies, the legislators which most of them are in the same party or same line with the government will support and vote for the policies, the policies proposed by the parliamentary government would have a much higher misadventure and less resistance to be executed. (cite?)However, the parliamentary system has a vice which is also because of its structure. Since the government is choose and chosen by the parliament, the power of parliament is strong enough to turn over the government. The parliamentary system offers no job security (cite). The chief executive will lose his mooring if the policies he proposed is not favored by the legislators, hence, the policies made by the parliamentary government would be more than(prenominal) conservative if there is not an absolute majority party.Also, the tint of the policies does not have promise since they are less challenged and discussed by the legislators. The fast pace of making decision cannot ensure the quality of the decisions made.On the other hand, the presidential system has also got its own virtues and vices. The virtue of the presidential system is that there is separation of powers and hence the legislative branch would be able to check the power and the acts by the executive branch. Hence, there will be less chance for the executive branch to enthrall out policies which do not get common shopping centre consensus and high popularity. The legislative branch can act as a defendant of the public when the government exercises unreasonable policies. The discussion and challenges from the legislature would also bring more opinion and thoughts to the gover nment and higher quality and more rounded policies can be made.Secondly, the presidential system ensure the stability of the executive branch since the two branches are separated and independent to each other, hence, the legislature cannot unthaw the cabinet as in the parliamentary system. Both the legislators and president have fixed term and this encourages them to plan for keen-sighteder terms of policies since there is certainty.However, there are also vices for the presidential system which is because of its characteristics of having check and symmetry. The check and balance can achieve better policies on the other hand, it takes much more time to pass. Since the challenges and discussion in the legislature usually takes a long time. to a greater extentover, since there are different elections for electing the legislators and the cabinet, there may not be a party able to control both branches. Hence, it will be difficult for policies to be passed in the legislature if there are not enough allies. This also hindered the development of the country to a certain extent which the discussion will slow down the pass of some pressing policies.The virtues and vices of both of the political systems are not absolute and they may change over different time and different situation.Under the globalization offshoot and the deviate of countries among each other, there are now new democracies uphill in the world politics and they often face the dilemma of choosing a right political system. The parliamentary system will be more suitable for the new democracies because of the following points.Firstly, the newly actual democratic countries would usually have a common characteristic which there would be a variety of interests in the public. For example, there may be a lot of different clans or races, different opinions over how should the government implement its frugal and public policies. The parliamentary system would be more suitable in this situation since there will be more voices able to call for their own interest in the parliament and also the government which is choose from the parliament. The members in the parliament who share the executive power may have different backgrounds and hence would be able to reflect their supporters opinion. The indigenous attend would not be able to bias for his own interest since he will be put off if he does not national the legislature especially when there is not a dominant party. More different voices can appear in the political system in parliamentary system.Secondly, the executive branch in the parliamentary system is elected and chosen by the legislators and they gain certain extent of support from the legislators, in the new democratic countries, the prime minister and the legislators may have promised the voters and supports a lot in order to gain their support and also to spike the newly developed countries. Through the parliamentary system and its characteristics, the promises made by t he politicians in the campaign can be easier realized since the policies proposed by the prime minister will get support from the legislators who have certain extent of consensus with the government. The system can also ensure the prime minister to book out his promises since the parliament was given enough power to dissolve the cabinet hence the prime minister will act according to his promise or in the legislators favor in order to gain support.Moreover, the new democratic countries are usually underdeveloped or developing countries like countries in Asia, Africa, Latin America, and Eastern Europe. These countries, other than developing a new democratic society in their land, also have to develop their economic and diplomatic strength in order to occupy a place in todays world. Under these circumstances, these countries need a strong and efficient government to lead the people and also the country to catch up the developed countries in the world. In terms of efficiency, the parli amentary system will be much better than the presidential system. The law making and policy making process would be much smoother and shorter in time since there are much larger consensus between the legislative branch and the executive cabinet than that in the presidential system, which has to go through a long period of debate and challenges. Now in the parliamentary system, the good relationship between the two branches enable the government to pass some imperative policies which may be crucial for the countrys development and can be more flexible in policy and law making in order to cope with this fast-changing world.Lastly a small but practical point, the parliamentary system requires fewer resources in holding elections. As mentioned above, the new democratic countries are usually developing countries which are limited in cash and other resources like professionals for conducting and monitoring the elections. There is usually only one election for electing the parliamentary members and hence the members would form a government. It requires fewer resources when compared with the presidential system which usually requires two elections for electing the legislative and executive branch respectively. The resources save can be used for developing the country in other aspects and they are important for a developing country.The parliamentary suits the new democracies more in a general situation like in the situation mentioned above. However, different countries have their own situation and other factors affecting which political system is better for themselves, like the historical background and the existence of monarchy and the influence of the major political figure. There is no universal answer for all countries in the world in which the presidential system could also be efficient it all depends on the different situation and characteristics of the country and its people. It is a must to closely examine the countrys background in order to try which polit ical system is better for it and would help its democratic development in the future.

Healthcare Training in Simulated Environments

wellnessc atomic number 18 Training in Simulated EnvironmentsSimulation cosmosClinical mannequin is pretending for the purpose of alter behaviors for someone elses make head course (Kyle Murray, 2008, p.xxiv).All respiratory therapists atomic number 18 trained to manage the airway of an unconscious mind forbearing. Endotracheal intubation is the most effective method of securing the airway provided is a complex psychomotor skill requiring much(prenominal) charge. Historic everyy, endotracheal intubation had been taught on longanimouss, cadavers or animals, but this was non ideal. Mannequin nurture is one of the outmatch options for instructing tremendous numbers of students in a mixed bag of skills (Gaiser, 2000) at that placefore the Respiratory Therapy broadcast at TRU has adopted develop on mannequins as a philia component of their courses. Intubation trainers eat up been mapd for over 30 eld (Good, 2003) but on that point is little published information on the relative merits of the avail adequate airway and intubation trainers. A variety of airway trainers with differing features ar now commerci wholey available from the natural depression faithfulness, neighborhood task trainer, that TRU respiratory therapy program utilizes, to the mettlesome fidelity, whole long-suffering simulator that is sightly increasely touristy nowadays.Training health cargon practitioners in a simulated surroundings without actual diligents is a potential method of acquireing new skills and improving unhurried safety (Issenberg et al, 1999 Devitt et al, 2001 Lee et al, 2003). pt safetySimulations be delimitate as activities that mimic the genuineity of a clinical environment and atomic number 18 designed to demonstrate procedures, decision-making, and fine thinking done proficiencys much(prenominal)(prenominal) as role-playing and the theatrical role of devices such as synergistic videos or mannequins. A dissembling may be very det ailed and closely simulate reality, or it butt be a grouping of components that argon carry to tender some resemblance of reality. (Jeffries, 2005) definition of maskComputer based airs and come apart-task preparation devices stool can a certain degree of real-world application. These focus on specific skills or selected argonas of forgiving anatomy. High-fidelity enduring simulators can provide real physical inputs and real environmental interactivity. To recreate all elements of a clinical situation, a full-scale or high fidelity modelling would be apply. Costs of simulators will vary widely depending on purchasing costs, salaries, how faculty succession is accounted for, and former(a) factors. (Jeffries, 2005) simulators, high fidelity, costs Modern technology, such as high fidelity mannikin offers eccentric opportunities to provide the active projecting. High fidelity fashion model offers the ideal venue to kick dress without risk and there ar an infin ite number of realistic scenarios that can be presented exploitation this technology. As an fashion model, look threatening cardiac arrhythmias can be simulated on a life like full computerized mannequin. Monitors, identical to those utilise in the clinical situation can duplicate the arrhythmia and cor replying sorts in vital signs. The diligent can be in full and realistically resuscitated with technical and pharmacological interventions. Viewing of videotaped actions allows face-to-face beamion on the effectiveness of the case management. Morgan et al, 2006 example of hire of high fidelity sim.High fidelity assumption provides a venue to determine and learn in a realistic yet risk chuck up the sponge environment. The patient is represented by a computer-controlled mannequin who incorporates a variety of physicalal functions (e.g. heart and breath sounds, pulse, end-tidal carbon dioxide). An instrumentation computer earnings can replicate situations likely to be encountered in an emergency room, critical fretting environment or operating room. A second individual controls the mannequin and the monitors. The simulator mannequin will respond on an accurate way to induced physiologic or pharmacologic interventions. The patient will respond according to pre-set physiological characteristics (e.g. a young healthy adult or a geriatric patient with severe emphysema). In addition, the patient has the skill to speak, move his arm, and open and close his eyes and has pupils that can dilate and constrict. The guise room can be set up to appropriately reflect the environment, either an emergency room, a recovery room, or a fully equipped operating room. Attached monitors respond to a medical checkup checkup intervention. Feedback from participants in the simulated environment has attested to the realism of the environment (Morgan Cleave-Hogg, 2000). Morgan et al, 2006 set up of HPSA simulator replicates a task environment with enough realism to servicing a desired purpose and the theoretical account of critical events has been employ instructionally by pilots, astronauts, the military and nuclear power plant military group (Gaba, 2004). The fidelity, or the pragmatism, of dis role models can vary in many ways, such as the use of simple case studies, utilization of mankind actors to present clinical scenarios, computer-based seemings, and the use of accurate patient simulators that respond to real-world inputs realistically (Jeffries, 2005 Laerdal, 2008 Seropian, 2003). Recently, literature has described that use full-sized, patient simulators are a way of creating life-like clinical situations (Fallacaro Crosby, 2000 Hotchkiss Mendoza, 2001 Long, 2005 Parr Sweeney, 2006). While mannequin has been used by the aviation industry with flight training for historic period (Gaba, 2004), the use of a rudimentary benevolent patient simulator in the health apprehension field was first introduced in 1969 to assis t anesthesia residents in tuition the skill of endotracheal intubation (Abrahamson, Denson, Wolf, 1969 Gaba DeAnda, 1988). The much realistic human patient simulators were non created until 1988 and were used primarily to train anesthesiologists (Gaba, 2004).Defining simulation in health vex rearingThe literature on human patient simulation has tried to define some(prenominal) of the marchess used in this study. However, there is no general consensus on many of these terms, including a debate on whether the simulator is a mannequin or a example (Gaba, 2006). One key term that requires specific definition for this study is high fidelity mannequin-based patient simulator. The term fidelity is used to designate how true to life the teaching give must be to accomplish its objectives (Maran Glavin, 2003). Using this definition, fidelity get mounds a scale where if given the objectives, a single human of medical simulation equipment may be able to provide a high-fidelity experience for one objective but be low-fidelity for an opposite objective. An example would be the insertion of a radial arterial catheter. If the objective were to hardly teach the psychomotor skills required for inserting the catheter, a comparatively simple arterial blood mishandle access arm, part-task simulator would be adequate and provide a high-fidelity experience. But if the objective were expanded to include communication with the patient and members of the health care team, then the same device would suddenly become low-fidelity, as there is no feedback organism delivered with catheter insertion and communication with the patient is non possible.Beaubien Baker (2004) noted that the term fidelity is frequently attested as a one-dimensional term that forces a static compartmentalization of simulation devices. Individuals with this view would gather in difficulty agreeing with the use of the terms as explained in the previous paragraph.Maran and Glavin (2003) offered this definition Fidelity is the extent to which the appearance and behaviors of the simulator/simulation match the appearance and behaviors of the simulated system (p.23).Yaeger et al (2004) broke fidelity down into common chord general classifications low- middling-and high-fidelity and explained that low-fidelity simulators are focused on single skills and provide pupils to practice in isolation while medium fidelity simulators provide more realism but lack suitable cues for the learner to be fully immersed in the situation. High-fidelity simulators, on the another(prenominal) hand, provide adequate cues to allow for full immersion and respond to interposition interventions.For the purposes of this study, the following definitions will be used1. High-fidelity patient simulator A full-bodied mannequin that replicates human body anatomy and physiology, is able to respond to treatment interventions, and is able to supply objective data regarding student actions through debrie f software.2. Low-fidelity simulator A part task trainer or a full-bodied mannequin that replicates human anatomy, but does not have physiologic functions (including spontaneous breathing, palpable pulses, heart and lung sounds, and voice capabilities), does not have a physiologic response to treatment interventions, and does not have a question software system.Use the next two statements at the beginning of other sections on simulation* Simulation is a training and feedback method in which learners practice tasks and processes in lifelike circumstances using models or realistic reality, with feedback from observers, peers, actor-patients, and video cameras to assist improvement in skills (Eder-Van Hook, 2004, p.4).* Simulation is a technique.to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner (Gaba, 2004, p.i2).When we are looking at the use of high-fidelity patient simulators in health professions information, we have to be aware of and not confuse the simulator with the simulation. As Gaba (2004) described, Simulation is a technique not a technology (i2). The mannequins or other devices are solely part of the simulation. Dutta, Gaba and Krummel (2006) noted a gap in the research literature, stating, A fundamental problem in ascertain the effectiveness of surgical simulation has been an inability to frame the correct research question. Are the authors assessing simulation or simulators (p.301)?Simulation has many applications. The teaching of psychomotor skills seems an obvious use for simulation but there are other areas that simulation can be utilised effectively. Rauen (2004) listed several areas in addition to psychomotor skill training where simulation has been used. Her list included teaching theory, use of technology, patient discernment and pharmacology. Rauen (2004) notes that the emphasis in simulation is practically on the application and consolidation of fellowship, skills, and critical thinking (para 3).History and Development of Simulation in health care educationThe history of simulation in healthcare has been well attested by several authors including Bradley (2006), Cooper and Taquito (2004), Gaba (2004) and Rosen (2004) and began with the use of models to sustain students learn about anatomical structures. Although the use of mannequins as the simulation model is relatively new (Bradley, 2006), simulation using animals as models dates back over 2000 age. Mannequins were use as models in obstetrical care as early as the 16th century (Ziv, Wolpe, Small, Glick, 2003). The more modern medical simulators originated in the fifties with the teaching of a part-task trainer called Resusci-Anne that revolutionized resuscitation training (Bradley, 2006 Gaba, 2004). Part-task trainers are meant to represent only a part of the human anatomy and will lots represent of a limb or body part or structure. These lo w fidelity modesl were developed to aid in the technical, procedural, or psychomotor skills, such as venipuncture, catheterization and intubation (Kim, 2005), allowing the learner to focus on an isolated task. somewhat models provide feedback (visual, auditory or printed) to the learner on the case of their consummateance (Bradley, 2006 Good, 2003).Another general classification of patient simulators that combines some of the elements of some(prenominal) three-d models and task-specific simulators is partial or part task simulators (Kyle Murray, 2008). Issenberg, Gordon, Gordon Safford, and hart (2001) used the term procedure skills simulator for this type of device. Maran and Glavin (2003) stated, part-task trainers are designed to replicate only part of the environment (p.24). and replicate anatomy and physiology of a single portion of the human body. As described by Beubien and Baker (2004), the skills taught with part task simulators fraction a complex task into its main components (p. i53). Rather than creating complex scenarios unremarkably done with high fidelity patient simulation, part task trainers permit students to focus on individual skills instead of more comprehensive situations. Examples would be an arm with vascular structure to teach arterial blood gas procedures or a head with upper airway anatomy to practice advanced difficult airway procedures.The second wave of modern simulation, with the increment of full-scale, computer controlled, mannequin based patient simulators started in the 1960s with the development of Sim One (Bradley, 2006 Gaba, 2004 Good, 2003). SimOne had many of the features implant on the high-fidelity mannequin-based patient simulators used today. SimOne was quite lifelike, and fitted with a blood cart cuff and intravenous port. SimOne was able to breath, it had a heartbeat, temporal and carotid pulse and a blood pressure (Abrahamson, 1997).Patient simulators have become very sophisticated over the years and n ow allow a wide range of invasive and non-invasive procedures to be performed on them, as well as enabling teamwork training (Davis, Buono, Ford, Paulson, Koenig and Carrison, 2006). When they are set up in a simulated and realistic environment, they are often referred to as high-fidelity simulation platforms (HFSP) or human patient simulators (HPS) (Kim, 2005). Components of the human patient simulator (HPS) include a mannequin and computer hardware and software. The HPS has characteristics expected in patients such as a pulse, heart and lung sounds, and nictate eyes with reactive pupils. The mannequin also supports invasive procedures, such as airway management, thoracentesis, pericardiocentesis and catheterization of the bladder (Laerdal, n.d.). medical exam education Technologies, Inc. (METI) introduced the Human Patient Simulator (HPS) in 1996. It has subsequently followed with PediaSim in 1999, a simulator utilizing the HPS software but scaled down to mimic a child. In 2005 , BabySim was introduced.While being the first to immortalize the market with a full-bodied mannequin for patient simulation purposes in resuscitation with the Resusci Anne in 1960, Laerdal medical checkup did not introduce a high-fidelity patient simulator until 2000 with the introduction of SimMan. This device does not possess all the high- take functionality of METI HPS, but does provide adequate fidelity for many medical emergency situations. The Laerdal Medical SimMan also differs from the others in that it does not operate on mathematical models for simulator responses. Instead, it operates on instructor controls combined with script-based control logics. The Laerdal Medical SimMan patient simulator is the device to be used in this study. Details of the simulators functions are found in vermiform process ____.Aside from high-fidelity mannequin based patient simulators, there are many other types of simulation used in healthcare supplier education and training. Collins and Harden (1998), Issenberg, Gordon, Gordon, Safford, and Hart (2001), and Ziv, Small and Wolpe (2000) discussed several other forms of simulation. The list includes animal models, human cadavers, written simulations, audio simulations, video-based simulations, three dimensional or static models, task specific simulators and virtual reality simulation. (Add VR seed?) Perhaps the next step in the evolution of health care teaching modalities is virtual reality (VR) simulation. Commercial VR simulators now exist to teach various psychic trauma skills (Kaufman Liu, 2001). In a study of the effectiveness of using a VR bronchoscopy simulator, students quickly learned the skills needful to perform a symptomatic bronchoscopy at a level that was equal to those who had several years of experience (Colt et al, 2001).Simulation has been used for many years in the aviation and nuclear power industries and other highly complex working environments in which the consequences of misplay are costly (Bradley, 2006). A simulator designed to mimic the anesthesia patient was first developed in 1988, and since then, the number of hospitals and universities buying simulators for educational purposes is increasing (Henrichs, Rule, Grady and Ellis, 2002). The human patient simulator is used in health care education because it is a high-fidelity instrument that provides both educators and students with a realistic clinical environment and an interactive patient (Feingold, Calaluce and Kallen, 2004).The cost of simulation is related to the level of fidelity and the technology being used. For high fidelity patient simulators, get costs can range from $30,000 for the Laerdal Medical SimMan or the METI ECS to over $200,000 for the METI HPS. facultative equipment available for these simulators can make the purchase costs even higher(prenominal). In addition to the simulator, it is important to create a scholarship environment that replicates real-world settings, finish with appropriat e medical equipment. Halamek et al. (2000) stated, The key to effective simulation-based training is achieving suspension of perplexity on the part of the subjects undergoing training, ie, subjects must be made to think and heart as though they are functioning within a real environment (para 15). Creating this environment adds additional costs to setting up a simulation-based medical education program.Advantages of using simulation in health care educationPatient simulation of all types, including high-fidelity patient simulation, is becoming more common in many aspects and levels of healthcare provider education (Good, 2003 Issenberg, McGaghie et al., 1999 leblond, Russell, McDonald et al, 2005). The reasons behind the increased use of patient simulation include the rise of medical knowledge, changes in medical education, patient safety and ethics. For new healthcare providers it is also important to consider the changing student demographic, as todays students are more comforta ble with technology. Issenberg, McGaghie et al. (1999) pointed out several advantages to the use of patient simulators, stating unalike patients, simulators do not become embarrassed or stressed have predictable behavior are available at any age to fit the curriculum needs can be programmed to simulate selected findings, conditions, situations, and complications allow standardized experience for all trainees can be used repeatedly with fidelity and reproducibility and can be used to train both for procedures and difficult management situations. (p. 862).Advancement of medical knowledgeMedical knowledge is continually ripening with new tests, medications, and technologies that all bring about advanced(a) understandings and expertise. The problem with educating health care providers with this new knowledge is that their curriculum is of a finite length therefore innovation in the curriculum is needed in order to prepare future health care providers. Issenberg, Gordon, Gordon, Staff ord, and Hart (2001) made the following commentsOver the past few decades, medical educators have been quick to embrace new technologies and pedagogical approaches in an effort to help students deal with the problem of the growing information overload. Medical knowledge, however, has advanced more rapidly than medical educationSimulation technologies are available today that have a positive force on the acquisition and store of clinical skills. (p.16)Changes in medical educationHealthcare provider education has typically been taught using a lecture/apprenticeship model (McMahon, Monaghan, Falchuk, Gordon, Alexander, 2005) that relies on poster and repeat (Eder-Van Hook, 2004). Halamek et al. (2000) noted the traditional model of medical education has three components the learner performs a reading of the literature, the learner observes others with greater experience, and then the learner develops hands-on experience. This is the traditional medical model of education that has b een in use for over 2,000 years (Current state report on patient simulation in Canada, 2005).In relation to the traditional model, Issenberg, Gordon, Gordon, Stafford and Hart (2001) observed, This process is inefficient and inevitably leads to considerable anxiety on the part of the learner, the mentor, and at time the patient (p. 19). McMahon, Monaghan, Flachuk, Gordon, and Alexander (2005) stated this model is inefficient in promoting the highest level of learned knowledge, as reflection and metacognition analysis occur independently, often without charge and only after extended periods of time when students are able to piece together isolated experiences (p. 84-85). Customarily, this format is often referred to as the See one, do one, teach one model of medical tuition (Brindley, Suen Drummond, 2007 Eder-Van Hook, 2004 Gorman, Meier, Krummel, 2000 Yaeger et al., 2004).Halamek et al. (2000) identified several problems with the current medical education model which includes 1. Reading of the literature does not produce competency. More active rather than passive participation in the learning experience is needed 2. Learners may have difficulty determining if their model for observation is a good or poor model. nevertheless because the model may be senior does not mean they are competent. 3. The variability of experiences in the apprenticeship model is high, therefore learners experiences will not be equal, and 4. Many training settings do not fully represent the complexness of the real world resulting in an inability of the learners to adequately practice their decision-making skills in a real environment.Yaeger et al (2004) reinforced these points stating that healthcare education intrust on two fatally flawed assumptions. The first assumption is that all clinical role models are effective and skilled, and all behaviors demonstrated by these role models are worthy of replication. The second assumption is that the end of the training period implies t hat a trainee is competent in all the skills necessary for boffo clinical practice (Yaeger et al, 2004). Yaeger (2004) also noted that in the apprenticeship model, there is a need for a preceptor but this preceptor may not have the necessary skills to be an effective educator.Patient safetyA predominant theme in many discussions of high-fidelity simulation is the innovation of patient safety. In the education of healthcare providers, there are sometimes conflicting goals. As Friedrich (2002) commented in quoting Atul Gawande, medicine has long faced a conflict between the imperative to give patients the best possible care and the needs to provide novices with experiences (p. 2808). When looking at the broader topic of medical simulation, the imagination of patient safety is a frequently mentioned subject (Bradley, 2006 Cleave-Hogg Morgan, 2002 Ziv, Ben-David, Ziv, 2005).Much of the inducement behind the focus on patient safety relates back to the name of practice of medicine 2000 report To Err is Human Building a Safer Health system (Kohn, Corrigan, Donaldson, 2000). This study reported over 44,000 people and possibly up to 98,000 people die each year in United States hospitals from medical errors. The total annual cost of these errors is between $17 billion and $29 billion. Even more alarming is the fact that these findings represent only the hospital sector of the healthcare system. The number of lives affected would be even higher if other parts of the healthcare system were included such as long term care facilities and Emergency Medical Services. In its outline of recommendations, the report specifically mentions simulation as a possible remedy, stating picture interdisciplinary team training programs for providers that incorporate proven methods of team training, such as simulation (p.14).In Canada, it was estimated there were 70,000 preventable adverse events in Canadian hospitals with an estimate of deaths associated with those errors rangin g from 9,000 to 24,000 (Current state report on patient simulation in Canada, 2005). The Canadian Patient Safety Institute supports the use of simulation as a means of improving patient safety in Canadian hospitals. In the conclusion of its report on patient simulation, the plant statedGrowing awareness of adverse events in Canadian hospitals, combined with increasing emphasis on patient safety, has changed the traditional learning by doing approach to healthcare education. Anecdotal evidence reveals the promising potential of simulation to fundamentally change the way healthcare professionals practice and further hone their skills, interact across disciplines, and manage crisis situations. (Current state report on patient simulation in Canada, 2005, p.23)Ethical perspectiveOne of the strongest statements made regarding the respectable perspective of simulations was presented by Ziv, Wolpe, Small and Click (2003). Under the title Simulation-Based Medical Education An Ethical Impe rative, the authors presented an argument that not using simulation was more than just an education issue, it was an ethical issue. As they report, there is often an over reliance on vulnerable patient populations to serve as teaching models when other resources exist that would provide adequate and possibly, more schoolmaster replacements.The education of healthcare providers requires a balancing act between providing the best in patient care while also providing learning opportunities for the healthcare professions student (Friedrich, 2002). To protect patient safety, actual patient contact is often withheld in the healthcare provider learning process to a later period in their education.One of the principle reasons patient simulation is being indicated as a partial remedy for the medical errors crisis is its ability to impact on a particularly vulnerable time in the learning process. As Patow (2005) cited, the learning curve faced by many healthcare professions students is a so urce of medical errors. He continued, stating that the realism of many of the shortly available simulators is quite high and allows for procedures to be practiced to mastery preliminary to being tested on real patients. But simulations offer much more than just practice. Since medical errors often result from ineffective processes and communication, simulation allows teams to reflect on their own carrying out in detailed debriefing sessions (Patow, 2005, p.39). This opportunity to review, discuss, and learn from the simulation is an important step in the learning process.The use of patient simulation in the training of healthcare providers is not limited to new students. There is also a need to avow education in the health professions and simulation can be utilized effectively in this area as well (Ziv, Small Wolpe, 2000). As in other reports, Ziv, Small and Wolpe (2000) restated the shortcomings of the traditional model and explained that simulation was not just for the beginne r but also for the expert who is expected to endlessly acquire new knowledge and skills while treating live patients (p.489). These authors feel simulation, when used across the range of health professions education, can make an impact on patient safety by removing patients from the risk of being practiced upon for learning purposes.Gaba (2004) pointed out there are also many indirect impacts of patient simulation on patient safety. These areas of impact include improvements in recruitment and retention of highly qualified healthcare providers, facilitating cultural change in an organization to one that is more patient safety focused, and enhancing quality and risk management activities.A final point on patient safety is the ability to let healthcare providers make faults in a safe environment. In real patients, preceptors step in prior to the mistake being beyond the point of recoverability or if the mistake occurs (particularly for those healthcare providers who are not longer students), there is a very limited informative value to the case.Ziv, Ben-David, and Ziv (2005) stated, Total prevention of mistakes, however, is not feasible because medicine is conducted by human beings who errSimulation Based Medical Education may offer unique ways to cope with this challenge and can be regarded as a mistake-driven educational method (p.194). They continued stating that Simulation Based Medical Education is a powerful learning experience for students and professionals where students are permitted to make mistakes and are provided with the opportunity to practice and receive constructive feedback which, it is hoped, will prevent repetition of such mistakes in real-life patients. (p.194).Ethical Use of Simulation (incorporate these paragraphs into previous on pt safety)Health care educators, whether from nursing, respiratory therapy, or medicine, find themselves in similar situations in deciding how to teach patient management to their students. Bioethicists have l ong condemned the use of real patients as training tools for physicians (Lynoe, Sandlung, Westberg, Duchek, 1998). Unfortunately there have been times in which the student learning has occurred to the detriment of patients (Lynoe et al, 1998). However, with the advent of high-fidelity human patient simulation approaches to learning, it may be time to adopt this method of instruction in the development of interprofessional education.The Institute of Medicine (IOM) recently issued a report on medical errors and recommended the use of interactive simulation for the enhancement of technical, behavioural and social skills of physicians (Kohn, Corrigan Donaldson, 1999). Numerous accounts are found in the medical literature touting the use of human patient simulation in the education of health care personnel at all levels, from student to attending physicians. Patient simulation is used for training personnel in several areas of medical care such as trauma, critical care, surgery and an aesthesiology, mainly due to the extensive skill required to perform adequately the procedures and techniques relevant to these areas. Several researchers have demonstrated the effectiveness of simulation in the skill development of medical personnel (Morgan et al, 2003 Lee, Pardo, Gaba, Sowb, Dicker, Straus, et al., 2003 Hammond, Bermann, Chen Kushins, 2002). In areas with low technology, such as internal medicine and in knowing care areas providing less procedural skills but greater decision making requirements, the use of simulation in the education of its clinicians has progressed (Ziv, Wolpe, Small Glick, 2003). Despite the growing support for the use of simulation in health care education, there is not yet enough evidence to support its use.Simulation search in Medical EducationIn 1998, Ali, Cohen, Gana Al-Bedah studied the differences in performance of senior medical students in an Adult Trauma Life aliment (ATLS) course. This course uses simulated scenarios to both tea ch and evaluate students performance in trauma situations. The students were divided into three groups 32 medical students completed a standard ATLS course, 12 students audited the course (without participating in the sessions or fetching the written exam) and a control group of 44 matched students who had no mental picture to ATLS. Of note is that some participants from all three groups were doing clinical hours in trauma hospitals during this study while others were not. The participants were observed while managing the standardized (live) patient in simulated trauma and non-trauma scenarios. The participants management of the sessions was scored on