Religion Essay -- Morality

While the degree of religious fervor has flourished and waned in various civilizations, religion itself has never ceased to be a point of interest. At times, it has enjoyed effusive praise while at other times it has met cold reception. Religion as explored in Madame Bovary by Gustave Flaubert and The Stranger by Albert Camus is openly criticized. Under the harsh, bald statements of realism, religion loses its ethereal wonder and under the hostile stare of absurdism, religion renounces its meaning. Flauberts protagonist, Emma, and his other characters more often than not possess only a niggling understanding of faith, essentially precluding any of religions positive impact. Meanwhile, Camus derides religion as a futile aim in an indifferent world and casts an unfriendly light on the religious magistrate, who is juxtaposed with the protagonist, Meursault. Thus, Camus depicts the futile proselytizing of an absurdist man, who disregards religion, while Flaubert illustrates the failure of religion to save a woman consumed by romanticism. In both cases, religion is criticized for falling short of delivering its purported salvation. Morality, the pride of religious followers, is much heralded as a virtue, yet Camus and Flaubert depict a different reality where religion fails to prevent immorality, much less promote morality. Camus calls into question the definition of morality on what basis are other muckle deemed to be moral or immoral? on whose consensus is that morality then heralded? From the prosecutors point of view, the fact that Meursault hadnt wanted to perk Maman, that he hadnt cried once during her funeral is sufficient evidence to condemn him (Camus 89). As the title of the book The Stranger suggests... ...bert unflinchingly peels back the social niceties to display religion as it has evolved into an inadequate, superficial interest for his characters. As represented in both books, religion is more a distraction than a panacea for lifes hurdles. I t fails to moderate the vexation of Emma, who clings to religion with the same pitiful desperation as she did with her affairs. Meursault refuses to conform to any sort of religious nexus and in the process, ironically opening himself up to the aggression of the world and die joyfully. While the defiance of Meursault against religion results in his absurdist happiness, the turmoil of Emmas life, caused by her romantic urges, her encumbered social position, and the repeated failures of religion, end in death by rat poison. Two deaths thus signify very different lives, but religion as found in both texts is condemned.

Educational Goals and Philosophy Essay -- Education Teaching Essays

Educational Goals and Philosophy As a student of education, I have been able to fit many ideas and opinions about practices and ideals I want to implement in my future classroom. My philosophies about education are still universe formed and continually transpose with every class I visit and with every educator I encounter. My ideas, admittedly, come from random experiences and intangible texts, but as I gain much experience in the field by dint of my courses, my philosophies about teaching pull up stakes become more clearly defined. These few ideas I have now go away undoubtedly be added upon as I enter student teaching and my professional career, nevertheless, they are concepts of which I hope to never lose sight. I opine teaching is a privilege and a serious profession. There are few other careers in which you have as great of an effect on other people. The responsibility is great and I take it very seriously. At the same time teaching can be fun an d intellectually stimulating. As a teacher, I bequeath have the opportunity to explore and define a subject area that I have committed my career to---Science. What interrupt way to show my enthusiasm for the subject than to teach it? Additionally, I know that there is nothing more rewarding than reaching a student through my teaching and having a profound influence on their curiosity. Good teaching should extend beyond the classroom, and it will if students are inspired to continue their studies on their own. Honestly, I believe that there is no other job that is equally as rewarding. Science education often receives an inaccurate stereotype of being boring or too complex for the average person to comprehend. I have an extreme passion for Science and teaching. ... ...wish to pursue board certification from the National Board for lord Teaching Standards after I have taught for three years. It is important to me that I never stop learning. I want to exude this quality f or the well being of myself and for my students. Maybe through me, students will see that education is not a hassle, but a completely rewarding experience. My philosophy of education has been shaped by experiences within my own life and education, as well as learning about education in college. As I enter the profession, my philosophy will most likely evolve somewhat as I grow and gain experiences as a teacher in the classroom. However, the foundations of my educational philosophy will continue to guide me in the way which I will interact with students and teach within my classroom.

The Epic Education of Achilles in Homers The Iliad Essay -- Iliad Ess

The Epic Education of Achilles in Homers The IliadDr. fly sheets comments This root word was well-organized and developed the thesis was argued in a logical fashion material from primary and secondary sources was well-documented and integrated smoothly into the text the causes drift was clear, with varied and sophisticated sentence structures and concrete vocabulary and the paper demonstrated excellent command of grammar and mechanics. Within the annals of expansive literature, the observe role of epic hero has always been present, heralding the poems themes through the actions of a single, extraordinary protagonist. Strong and courageous, he is caught within the nets of mortality, and, at times, he may struggle to supercede his worldly desires with heavenly knowledge. In profound ways, he can even embody the mythological ideals of a civilization, and, through his many perilous adventures and profound encounters, the melt of his identity may shift in focus towards something greater than himself. Through this change in his character, one can observe the universal plight of humankind in greater detail and discover how one must overcome certain obstacles to understand the complex nature of the gods. In Homers The Iliad, such an epic bringing up can be found within the account of Achilles, who, through his slow transition from an excessively angry brooder to a compassionate symbol of self-sacrifice, matures into a character that is much in tune with divine enlightenment. At the beginning of The Iliad, Achilles is observed as being insulted by Agamemnon and getting caught within a meshing of anger this show of rage distinguishes the ignorance of his character at the beginning of his education. The pinnacle of t... ...elf that lay beyond the superficial weaknesses that plague the journeys of all men. Works Cited Clark, Matthew. Chryses Supplication diction Act and mythological Allusion. Classical Antiquity 17 (1998) 5-20. Expanded Academic ASAP. Online.LOUIS.28 Nov.2001. Homer. The Iliad. Trans. Robert Fagles. New York Penguin, 1991. Redfield, James M. The Wrath of Achilles as Tragic Error. Essays on The Iliad Selected Modem Criticism. Ed. John Wright. Bloomington atomic number 49 UP, 1978. 85-92. King, Katherine C. Achilles Paradigms of the War battler from Homer to the Middle Ages. Berkeley U of California P, 1987. Schein, Seth L. The Mortal Hero An Introduction to Homers Iliad. Berkeley U of California P, 1984. Van Nortwick, Thomas. Somewhere I Have neer Traveled the Second Self and the Heros Journey in Ancient Epic. New York Oxford UP, 1992. The Epic Education of Achilles in Homers The Iliad Essay -- Iliad EssThe Epic Education of Achilles in Homers The IliadDr. Flys comments This paper was well-organized and developed the thesis was argued in a logical fashion material from primary and secondary sources was well-documented and integrated smoothly into the text the authors style was clear, wit h varied and sophisticated sentence structures and concrete vocabulary and the paper demonstrated excellent command of grammar and mechanics. Within the annals of epic literature, the celebrated role of epic hero has always been present, heralding the poems themes through the actions of a single, extraordinary protagonist. Strong and courageous, he is caught within the nets of mortality, and, at times, he may struggle to replace his worldly desires with celestial knowledge. In profound ways, he can even embody the mythological ideals of a civilization, and, through his many perilous adventures and profound encounters, the course of his identity may shift in focus towards something greater than himself. Through this change in his character, one can observe the universal plight of humanity in greater detail and discover how one must overcome certain obstacles to understand the complex nature of the gods. In Homers The Iliad, such an epic education can be found within the accou nt of Achilles, who, through his slow transition from an excessively angry brooder to a compassionate symbol of self-sacrifice, matures into a character that is more in tune with divine enlightenment. At the beginning of The Iliad, Achilles is observed as being insulted by Agamemnon and getting caught within a web of anger this state of rage distinguishes the ignorance of his character at the beginning of his education. The pinnacle of t... ...elf that lay beyond the superficial weaknesses that plague the journeys of all men. Works Cited Clark, Matthew. Chryses Supplication Speech Act and Mythological Allusion. Classical Antiquity 17 (1998) 5-20. Expanded Academic ASAP. Online.LOUIS.28 Nov.2001. Homer. The Iliad. Trans. Robert Fagles. New York Penguin, 1991. Redfield, James M. The Wrath of Achilles as Tragic Error. Essays on The Iliad Selected Modem Criticism. Ed. John Wright. Bloomington Indiana UP, 1978. 85-92. King, Katherine C. Achilles Paradigms of the War Hero from Homer to t he Middle Ages. Berkeley U of California P, 1987. Schein, Seth L. The Mortal Hero An Introduction to Homers Iliad. Berkeley U of California P, 1984. Van Nortwick, Thomas. Somewhere I Have Never Traveled the Second Self and the Heros Journey in Ancient Epic. New York Oxford UP, 1992.

Analysis of The Rocking Horse Winner Essay -- Literary Analysis, D. H.

Certain privates have a drive that can lead them to achieve what they desire most. In the Short story The Rocking Horse Winner, D.H Lawrence showcases this with character motivation and symbolism. He further this using by-line of desire, and how if you take it to a certain extent it can result in tragedy if the individual chooses not to line up. Paul wants to please his mother because his mother feels that there family has no luck, but Paul proclaims that he is lucky. Paul suddenly becomes consumed with this sudden spree of well behaved luck and feels this is the alone way he will be able to gain to the affection of his mother. D.H Lawrence reveals that Paul has a certain flaw that turns him to believe that the only way he will be able to gain his mothers whap and affection is by winning money in the horse races. He leads this pursuit of desire to the standards he thought he wanted to, but not to the standards that would have achieved what he wanted, which leads to his d inges t fall. When individuals desire dear from another, they may choose to conform their beliefs and actions to that person. At first they may feel successful, however if they sacrifice everything, in pursuing this kind of goal, they may pay a heavy price sort of of gaining there hearts desire. Paul desire his mothers love more than anything. However he believes he needs to prove he is lucky. He struggles to prove that he is to make his mother happy. Paul wants his mother to love him more than anything. For Pauls mother money equals luck, and this will gain her love. on that point must be more money(19). He hears these voices throughout the house. They hear these voices when hey are receiving items of joy, especially around Christmas time. The other children can h... ...eparate paths, one for the money, and another for his mother. This in the end leads to Pauls demise. Mother, did I ever tell you/No you did not(34) He never told his mother what he was doing for her. He wanted to gain her love more than anything. He conformed to a certain path that he thought would be able to achieve his ultimate desire. Paul wanted to gain the love his mother more than anything. He chose to conform to the path of luck. While pursing this personal desire, he became overwhelmed with in it and this ultimately led to his demise. If he would have been able to tick his desire it may have been able to save him from tragedy. When an individual chooses to conform to meet the ideals of another individual in order to achieve there own personal desire, they can not sacrifice everything for that persons ideals because it can often result in tragedy.

Should the Quest for Knowledge be Boundless? Essay -- Exploratory Essa

Victor Frankenstein suffered from a lack of foresight. He only planned to reanimate a human being he did not consider the consequences of such an action, and he did not build protections for unexpected, detrimental effects. Real-life scientists suffer from the same problem. Today we are reminded with any issue of Time that scientists in one modern field, nuclear technology, and emerging field genome mapping/genetic engineering wield considerable power. Shelley raises the indicateion whether the quest for scientific knowledge should be form. The quest for knowledge should never be bound because injunctions against originality would lead to the oppression of mankinds most important resource, our thinkers. But scientists themselves should be bound by foresight. At the inception of a new idea or process, bodies of scientists should review the question before the new methods have been applied. They should try to foresee likely ill effects and seek to minimize these beforehand, and co ntain them afterwards. This would have come in handy for Victor Frankenstein. The emergence of agriculture at the dawn of acculturation was also the emergence of genetic engineering. Everyday varieties of horses and wheat that we know today were crossbred into current, recognizable states from earlier, wild plants and animals well before history began to be recorded. crown of thorns is a relatively slow and clumsy method of improving animal and plant species *1* compared to modern times, when gene manipulation means tests tubes and petri dishes, not dirt or husbandry. While prohibitively expensive (for the time being) DNA manipulation and fertility techniques will become simpler, cheaper, and more accurate. Soon, any hack scientist with... ... 1991. Andrea A Lunsford, John J. Ruszkiewicz, The figurehead of Others Voices and Images that Call for Response Mary Shelly, Frankenstein. Bedford/St.Martins, Boston MA, 2000. 1 Van Doren p.398 2 Van Doren p.293 3 quoted in McGowan p.82 4 quoted in McGowan p.82 5 Van Doren p.398 6 McGowan Ch.12 7 http//www.doug-long.com/einstein.html 8 http//www.wakeamerica.com/past/books/manhattan/manhattan/manhattanmanhattan11.html 9 http//www.prop1.org/prop1/histnuke.html 10 http//www.cbsnews.com/now/story/0,1597,158208-412,00.shtml 11 http//www.dreamscape.com/morgana/adrastea.html 12 http//www.cadu.org.uk/ 13 McGowan p.191 14 http//www.chernobyl.co.uk/ 15 http//www.pbs.org/wgbh/amex/three/ 16 http//www.sierraclub.org/nuclearwaste/ 17 http//www.un.org 18 Shelley p.232 19 Shelley p.232

Should the Quest for Knowledge be Boundless? Essay -- Exploratory Essa

Victor Frankenstein suffered from a lack of foresight. He only planned to reanimate a human being he did non consider the consequences of such an action, and he did not build protections for unexpected, detrimental effects. Real-life scientists suffer from the same problem. Today we are reminded with every issue of Time that scientists in integrity modern field, nuclear technology, and emerging field genome mapping/genetic engineering wield considerable power. Shelley raises the needion whether the quest for scientific knowledge should be bound. The quest for knowledge should never be bound because injunctions against originality would lead to the oppression of mankinds most important resource, our thinkers. But scientists themselves should be bound by foresight. At the inception of a new idea or process, bodies of scientists should review the question before the new methods have been applied. They should try to foresee possible ill effects and seek to defame these beforehand, a nd contain them afterwards. This would have come in handy for Victor Frankenstein. The emergence of agriculture at the dawn of civilization was also the emergence of genetic engineering. fooling varieties of horses and wheat that we know today were crossbred into current, recognizable states from earlier, wild plants and animals well before history began to be recorded. Crossbreeding is a relatively slow and awkward method of improving animal and plant species *1* compared to modern ms, when gene manipulation means tests tubes and petri dishes, not dirt or husbandry. While prohibitively expensive (for the time being) DNA manipulation and fertility techniques will become simpler, cheaper, and more accurate. Soon, any hack scientist with... ... 1991. Andrea A Lunsford, John J. Ruszkiewicz, The Presence of Others Voices and Images that Call for Response Mary Shelly, Frankenstein. Bedford/St.Martins, capital of Massachusetts MA, 2000. 1 Van Doren p.398 2 Van Doren p.293 3 quoted i n McGowan p.82 4 quoted in McGowan p.82 5 Van Doren p.398 6 McGowan Ch.12 7 http//www.doug-long.com/einstein.html 8 http//www.wakeamerica.com/past/books/manhattan/manhattan/manhattanmanhattan11.html 9 http//www.prop1.org/prop1/histnuke.html 10 http//www.cbsnews.com/now/story/0,1597,158208-412,00.shtml 11 http//www.dreamscape.com/morgana/adrastea.html 12 http//www.cadu.org.uk/ 13 McGowan p.191 14 http//www.chernobyl.co.uk/ 15 http//www.pbs.org/wgbh/amex/three/ 16 http//www.sierraclub.org/nuclearwaste/ 17 http//www.un.org 18 Shelley p.232 19 Shelley p.232

Chinese martial arts Essay

Shamis Way to Shaolin is a traditional dance performed by the Kung Fu Monks of Shaolin. terpsichore exists in many forms and can fulfil different functions rite, social or artistic. This particular dance fits into the ritual and artistic function. When performed and practised, ritual dance serves a lovesome function in sustaining the life history of people through the culture and its procedures. Artistic dance is performed to be looked at and to entertain onlookers. The work itself can in like manner be a means of expressing ones thoughts and feelings (Snook.B, 2004, p47-49).This essay will prove that the ritual function is most predominant in Shamis Way to Shaolin. The ancient collection of Chinese militant arts referred to as Shaolin Kung Fu was created by a Buddhisticic Monk called Bodhidharma or Tamo who attempted to teach the monks of Shaolin the discipline of Zen meditation. They were not physically capable for the wet regime so he then continued to create a series of e xercises to build up their health and increase their stamina (History of Shaolin Kung Fu, N/D, check bit 2).The exercises were both physiological and physical the goal being to control the body through the power of the mind (The History of the Shaolin Monastery, 2008, para 1). The martial arts were create out of necessity as the monks had to defend the monastery from thieves who tried to rob them of their treasures (History of Shaolin Kung Fu, N/D, para 3). Today, Shaolin Kung Fu is still practised and use for self-defence, health, fitness, character development, spiritual cultivation and life enrichment (Aims and Objectives of Practising Kung Fu, ND, para 3, 4 and 6).The ritual function is understandably the most predominant function in the performance of Shamis Way to Shaolin, because of the great history and meaning of Shaolin Kung Fu to the Buddhist monks and the way it is performed. The dance components in Shamis Way to Shaolin clearly fulfil the ritual function of dance due t o the culture and beliefs represented. The dancers are all male Chinese Buddhist monks and they are wearing traditional outfits. The orange robes are dated back centuries and were originally chosen because of the dye available at the time.They are meant to map simplicity and detachment of materialism (Exotissimo, 2010, para 1). The dancers are respecting themselves and others as they all bow together at the beginning of the performance and stand in a meditation position on one leg before dancing. The thin, wooden poles used in the performance of Shamis Way to Shaolin are martial art weapons used for defence. The monks are representing themselves as warriors protecting their beloved monastery which is part of their history.This is realised as the stage is representing the outside of their monastery with large doors opening outside to steps which lead down and have 2 Chinese statues guarding them. The movements of the Shaolin monks are also very sharp and aggressive. They shout HA l oudly together on particularly strong movements as a warning signal and to show it is their territory and monastery. This is a characteristic of ritual dance as the performance is portraying a function. The dancers engage themselves unaccompanied on the performance using immense concentration and focus.Repetition, a characteristic of ritual dance, is used as the monks repeatedly twirl their poles and bang them on the ground. The ritual function is most predominant as the Buddhist monks are dancing for themselves for enlightenment as well as for their culture and beliefs. There are also dance components that fulfil the artistic function of dance at bottom Shamis Way to Shaolin. It is choreographed and performed onstage for an audience. The dance begins with a loud gong and then fast-paced, traditional melody is played which is whistling and chiming.The music is played to assist the audience in understanding and enjoying the performance. The monks mostly all dance together in sync at the same time, the majority of the time in a 3 straight lined formation facing the audience. This is an artistic element because the dancers have practised their bout so that it would be appealing to watch. A smoke machine is used when the male dancers enter onto the stage and go down the steps which provide levels within the performance.Levels are again used during the dance because they are regularly leaping, crouching and jumping. At the end most of them go to either side and sit while watching 2 monks fight dance with poles in the middle. These components are all used for the benefit of the audience and the overall effectiveness of the dance. Therefore the dance is also clearly fulfilling the artistic function. The ritual and artistic functions are seamlessly combined in this dance. The artistic function includes music, formations, cannons and levels.The ritual function is more complex representing their culture and beliefs with the dancers being Buddhist monks, wearing tra ditional outfits, doing meditation and Martial Arts/Kung-Fu etc. Together the two functions create an unforgettable production with the ritual being the most predominant. Bibliography Exotissimo communicate (December 21, 2010) online Why do Buddhist monks wear orange robes and shave their heads? http//www. exotissimo. com/blog/buddhist-monk/ (13/03/2013) DVD Shamis Way to Shaolin. 2001. (Live show video recording) South Australia, IMS Entertaining SA.Schaffhausen Book Snook. B, (2004) trip the light fantastic Count Me In, McGraw Hill PTY LTD (p47-49) Shaolin Kung Fu History (date unknown) online ChinatownConnection. com http//www. chinatownconnection. com/shaolin-kung-fu-history. htm (date accessed 2/03/2013) The Aims and Objectives of Practising Kung Fu (date unknown) online General Kung Fu Aims http//www. shaolin. org/general/kungfu-aims. html (date accessed 2/03/2013) The Mystical power of Shaolin Kung Fu (2008) online The History of the Shaolin Monastery http//www. shaolinmon ksinmalta. com/ (date accessed 2/03/2013).

Topshop SWOT Analysis

Topshop is a fashion store that has around 300 stores in the UK, and everywhere 100 in international places. It was launched in 1964, and Topshop has become atomic number 53 of fashions largest success stories. They have captured the most fashionable styles every moderates, its bold and saucy approach to style has attracted fashion-conscious shoppers and industry insiders alike. Topshops triumph has been impressive, disdain its humble start. Topshop started in the basement of Peter Robinson department store in 1964 and a few years later became an independent retailer.In 1994, the dirt took over the entire 90,000 sq ft space at London Oxford Circus, when the iconic Topshop flagship was launched. It is still there today, and is said to be the worlds biggest fashion store on the high street, captivating over 200,000 shoppers each week. As an early pioneer of high street and designer collaborations, Topshops partnerships with brands such as Cella Birtwell and Kate Moss, who is the h istorys most iconic fashion names, and they have but secured the brands reputation as a fashion leader.Topshops strength. Topshops strength is to addition to target market with over 300 stores nationwide, and they are doing online shopping and shipping to over 100 countries now. Topshop also have a wide variety of merchandise, with thousands of looks per season, their looks per season comes along with creative design concepts and fresh ideas every year, these strongly says that the trend awareness of Topshop is very high. Topshop is also said to be the largest fashion store in UK, offering free personal style consultants, competing with the high-end department stores.They are in collaborations with designers and celebrities like Kate Moss and Cella Birtwell. Lastly, Topshop is part of arcadia, which is a group managing several successful brands. (177) Topshops impuissance The weakness of Topshop is that few of the garments quality is not matching with the price, and that they have too many products and the staffs are not well educated enough about the merchandise, for fount the material of the apparels. Most of the merchandise are made suited for only the younger demographic and few of the ad campaigns are not eye contagious enough.The company is said to be global, however it has a presence only in few countries worldwide. Topshops opportunities Topshops opportunities are that they have the potential for further globalization of the brand and more than 60 cities with a potential for a Topshop has been identified. Topshop also have th potential to franchise brand and develop modernistic products and services like more trained staff. Topshop also have the opportunities to become the largest fashion store in other cities than London. Topshops threats Topshops biggest threat is the invariant new entries and competitors in their home market.There might be possible recession and people are less likely to spend money on trendy items Topshop have in store, given the current weaknesses of currency, Topshop is not the bargain it used to be. With constant new entrant, there will be price wars with their competitors. Topshop cosmos a global retailer means that they are exposed to political problems in the countries that they operate in. With Topshops success, there is a potential for a brand that will copy the style that Topshop has for the past few years of trends. (377)

1987 Constitution Interpretation Essay

By the 1850s The Constitution, originally framed as an instrument of national unity, had become a source of sectional discord and tension and in the end contributed to the failure of the union it had created. This is all shown by the misinterpretations of the Constitution and documents that followed on many occasions and topics.The Constitution was never explained to how it was meant to be interpreted, which cause many disagreements, which ultimately started sectionalism, which is the truth to interests or views in ones region of a country rather than the views or interests of the country as a whole. Sectionalism kick started the base of sucession from the union, which started the bloodiest war on american soil, the Civil War. The misinterpretation on the views of slavery was the biggest argument as shown in multiple documents, (Document E), To the Argument, that the word slaves and slavery are non to be found in the Constitution, and therefore it was never intended to give any p rotection or countenance to the slave system, it is sufficient to reply, that no such(prenominal) words are continued in the instrument, other words were used, intelligently and specifically, to meet the necessities of slavery.This basically means that the constitution could have many interpretations on the bum that no right interpretation was ever stated.There were many feuds between documents following the Constitution such as the Compromise of 1850 as show in in the map of (Document A) where the country is broken into 2 parts, not unified because of slavery, along with the Fugitive Slave Law, (Document D)

Student’s Must Read Books

In our generation, gadgets and technologies have increased, and because of that many of us change their likes and the way we enjoy our costless time. Because of gadgets and technologies many of us now are spend less time in reading. Good afternoon, I here speaking in front of you to severalise what can you get through reading books. A room without books is like a body without a soul a hero, a martyr, and great writer named Jose Racial in his early time of his life. adaptation books is one of his building blocks. If I were knew Racals family had their own library on their house.He grab that opportunity to read many books and learn something that some other Filipino doesnt know. Thats why in his early of age he was enlighten and inspired to help his countrymen. He read books and he made books and he is now the well known great Filipino hero. You see, the key to success is to have some knowledge, knowledge that will help us to be a wagerer person. There are lots of different books t hat can help us or make us become smarter and better like encyclopedia, where we can get some information that would help us to define or to answer our questions.And dictionaries here we can learn different kinds of languages in shape for us to communicate to others like foreigners. So many books, so little time these generation that we live now is the generation where we students are besides lazy on reading books. When we have assignments and projects we Just surf on the internet and find the words we needed to and then WALL EH we Just copy and paste. We people doesnt learn on a copy paste technique its Just tolerate us to become lazy and ignorant, sorry for the word only it is the reality, we have many information that is already written and the only thing that e should do is to read it.But what? We are Just ignoring the books, and hide it on the shelves and hold back playing video games, or to watch some entertainment. We are Just wasting our time focusing on the thing that is not beneficial to us. Reading books helps our vocabulary become broader. It sharpens our mind to think critically wise and it can widen ones imagination and also it can develop our verbal abilities. You wanted to be smart? Remarkable? Start making some action start on reading books of information and share what you have learned in that order others may inspire too

How Harper Lee Develops the Symbol of the Mockingbird

Mockingbirds atomic number 18 a symbol of sheer innocence their existence causes no harm to others and the sole purpose of its life is to make mellifluous euphony for all to enjoy. The mockingbirds sweet chorus is destroyed and disregarded in to kill a mockingbird, as the harmless characters of Boo Radley and Tom Robinson are exiled and imprisoned despite their altruism. The use of the mockingbird in the title provides distinction and coincides through characters and events during the fable.Harper Lee develops the symbol of the mockingbird in the novel through the townsfolk pariahs Boo Radley and Tom Robinson. Tom Robinson is accused of a crime he did not commit and in reality was helping another person without a reward. In chapter 10 Jem and Scout are shown an opening to the malevolence in society and are taught a moral lesson and the save sin considered by Atticus, fool away all the blue jays you want, if you can hit em, but remember its a sin to kill a mocking. This quote f oreshadows the up-coming events involving Tom Robinson and the injustices he will have to endure, even though the Mockingbird is not deserving of anguish, he is still put to death through the hands of others who would shoot whatever bird, regardless of what kind it may be. Scout and Jem at the beginning of the novel are oblivious to the harsh racial segregation and the moral teachings of Atticus only have literal meanings until they become immersed in the enmity of racism, where their innocence is later destroyed and the blurred barriers between their father and Maycomb become clear.Atticus is responsible for maintaining the stability of Maycomb and the co-existence of goodly and evil he influences his children to have morally good actions and values unlike many other children of Maycomb. Atticus strives for the rights of the mockingbird and the defenceless Tom Robinson, despite the event that he knows as soon as Mayella Ewell screamed he was a dead man. Atticus allowing Tom Robi nson to a trial allowed the ignorance and hatred in Maycomb to some achievement deteriorate, even Mr.Underwood a man who never spoke about the miscarriages of justice likened Toms death to the senseless slaughter of song birds by hunters and children. hardly as Atticus defends the innocent and vulnerable Tom Robinson, he also provides refuge and respect to Boo Radley, a prejudiced against outcast of Maycomb. From the beginning of the novel Atticus respects Boo Radley telling Scout and Jem not to play in his yard, as he deserves the sanctity of privacy. Town gossip and the childrens imagine surrounding Boo Radley constrain him to his home, which is veiled in mystery, Inside the house lived a malevolent phantom. quite a little said he existed, but Jem and I had never seen him. People said he went out at night when the moon was down, and peeped in windows. Later in the novel the children realise that there was an error in their psyche of Boo Radley and their fear of him was unjust and cruel as behind the concocted hysteria is a kind-hearted and an innocent mockingbird as Boo Radley inflicts no harm on others and is just an innocuous victim of a cruel narrow-minded society.

Conflict Resolution Essay

A new director decides to reorganize the department you naturalise in. This reorganization comes about without scuttlebutt from the employees and many of the nurses that you oversee be feeling resentful of the change. As a nurse leader, identify factors that may lead to employment and ways you can be oblige them.Wherever there be people the ability for conflict exits. Conflict is a disagreement, opposition or clash. It can affect the person emotionally, physically and specially. It can result in a fight, discord and division. Conflict can be used to motivate however it can be destructive and should be dealt with. According to McElhaney (n.d) nurses pick up six major areas of conflict. This scenario depicts one of those areas.1. People who have experience in an area, want to feel that their opinion is considered and valued. So, when changes are made to an area or department, in which they work, have experience and are the expert employees want to have input. In the absence of employee participation there may be apathy, anarchy and malicious compliance. Oftentimes it leads to lack of compliancy within the profession and feelings of anger, diminished self-worth, and conflict.However as a nurse manager oftentimes, changes are made without any input from the employee and I have to manage this situation. In this case, during a staff meeting, I would discuss the changes, reasons they were made, and ask for input as to how we can implement these changes such that they work more effectively in our department. By using collaboration, my goal would be to incorporate employee feedback in areas/processes under my control. This would allow the employees to feel that they have some control over their work area, their input is valued and contribute to problem solving (Cardillo, 2011).Other areas are2. People have varying opinions, come from different backgrounds and culture and have different values. When conflict arises over differing in values and cultures, then th ese conflicts must be dealt with. They must bediscussed and a compromise r individuallyed that works for each party as vigorous as the department (McElhaney,n.d).3. Communication may be misunderstood and body language misconstrued (Cardillo, 2011). To confront this type of conflict, someone must be willing to deliver out. Once during my 360 degree review, I received feedback that my team members felt devalued and that they were not being listened to because often times I continued typing when they came into the line even though I coherently responded to the questions. After receiving this feedback, anytime someone comes into my office, I would sit on my hands to ensure that I pay attention and not type. When verbal communication and body language is misunderstood, the conflict must be confronted, discussed and a change must be made or an explanation given. cooperative to meet the needs of promotes harmony and gains credits that can be used at a later date.4. A nurses personal s eat is often invaded by other staff members, physicians, and perseverings. Crowded conditions and constant interruption can lead to conflict.In this situation, I would use a combination outline of face-to-face meeting, collaboration and benchmarking. I would start with a face to face meeting with the individual to get his/her input as to how to better design/ snip the work area to reduce stress and interruptions. I would also research what other hospitals have done in this situation and implement best practice. because I would follow-up with the employee to ensure the implemented changes solved the problem.5. Other causes of conflict involve organizational climate, leadership style, off-the-job problems, age pressures, job standards, and personal prejudice.These conflicts affect each individual differently. Therefore, I would recommend the employee experiencing these conflicts or exhibiting behavior that is indicative of these stressors to the Employee Assistance Program which co nsists of professionals especially skilled to assist the employee in dealing with these stresses.6. Coping with engineering science changes and procedures.To provide our patients with the best care, we have to continuously improve this mean that change is inevitable. So, during staff meetings, I cover latest techniques, updated procedures and discuss how these add value to patient care and make our job easier. Once a month a different member of the staff discusses medical article or book they have read concerning a procedure or technique that can improve our process. After their presentation, we discuss if this is something we can implement easier or should put on our press list. Lastly, each nurse is required to obtain six hours of training a year in which the hospital pays for. Training in new technology and procedures that are introduced is required and may be used for this purpose.There are many strategies to deal with conflict avoidance is one. Some types of conflict if left alone, will work themselves out. However because of the potential devastating nature of conflict it should confronted confront the situation and not the person. One should listen with empathy and the goal to understand the other persons point of view and negotiate to a win-win or at the very least a win-lose solution. Even if one side has to lose, position the lost as something positive that can be built upon or negotiated later (Nursing Strategies Countering Workplace Conflict with Positive Communication Strategies, 2011).ReferencesCardillo, D. (November 28, 2011). Seven strategies for managing conflict Retrieved from http//news.nurse.com/article/20111128/DD01/311290003.VJom714AKAMcElhaney R. (n.d). Conflict Management. Retrieved fromhttp//www.nursingcenter.com/CareerCenter/articles_preview.asp? rascal=confman.htmNursing Strategies Countering Workplace Conflict with Positive Communication

Neurotransmitter: Neuron and Hormones Function

What Is Neurotransmitter? Neurotransmitter is a chemical that is released from a buttock cell which thereby transmits an impulse from a nerve cell to an separate nerve, muscle, organ or other tissue. (Webster new world medicine dictionary. http//www. medterms. com/script/main/art. asp? articlekey=9973) What ar Hormones? Hormones are chemicals that carry messages from organs of your body to your cells. The glands that secrete hormones are part of the endocrine system (pituitary, thyroid, adrenals and pancreas, to name a few) and work in large part to keep the bodys natural balance in check. (Gary Gills, former about. com January 15, 2009. ttp//type1diabetes. about. com/od/glossaryofdiabetesterms/g/Hormones. ht Give an explanation of two similarities and two differences in how Neurotransmitter and hormones function as messenger. It is believed that the brain contains several(prenominal) hundred different types of chemical messengers (neurotransmitters) that act as communication agen ts between different brain cells. These chemical messengers are molecular substances that can affect mood, appetite, anxiety, sleep, heart rate, temperature, aggression, fear and many other psychological and physiologic occurrences. Two differences between neurotransmitter and hormones is . Neurotransmitter has an instantaneously reaction opus hormones have a late reaction. This is so because hormones are secreted by the endocrine glands in the bloodstream away from their function site and are carried by the circulation (bloodstream) to the behind cell where they are effective. While Neurotransmitter is released at a specialized region of nerve cells and have to diffuses over a small gap (synaptic cleft) to the target cell. 2. Hormones have a long lasting reaction while Neurotransmitters has a short time reaction. http//www. differencebetween. net/science/difference-between-enzymes-and-hormones/

Deborah Tannen’s Theory Essay

In coetaneous society biological factors are no longer the sole components that distinguish men and women. Rather anything from clothing or hairstyles to make-up or accessories can indicate specific messages about an individual. According to Deborah Tannen, women are to a greater extent frequently considered tag beings in our society while men have fewer clothing or style options and are therefore free to remain overlooked. Although Tannen argues that it is possible for men to remain purely unmarked her assertions do not hold up well in a changing world. Because the term marked is a social construction, it is not possible to remain completely unmarked, as styles and trends repeatedly change with different ages, generations, and geographic locations.In her study Tannen reveals that among four women and eight men present during a business coming upon the women had several more features to observe compared to one another. However, Tannens conclusions seem partially invalid for her f indings are base on only one particular event. In a business-like environment, it is more likely to find carefully dressed men with slight notable markings than women. Even though women may not only be identified based on their apparent style but also how they choose to present themselves. (i.e. loose garment vs. tight clothes, make-up vs. no makeup). In general, Tannens findings egress questionable mainly because her come on when defining a marked individual seems limiting. For example, Tannen would call a man wearing a garment a marked individual. However, it is quite common for men in Scotland to wear skirts. Without ever considering these geographic differences, Tannen makes discourteous assumptions based on her own biases.When speculating a specific sub-culture such as the generational rave/ dancing culture, Tannens argument holds no validity. Clearly both men and women in this culture wear corresponding styles of clothing and accessories that are in essence, uni-sex. While piercings and jewelry competency mark a man in society such stylistic choices are considered quite common and acceptable among ravers. Similarly women who wear overemotional clothes and baseball caps are not marked as less feminine than those who wear tighter clothes and make-up within this sub-culture are.According to Tannen, separately of the women at the conference had to make decisions about hair, clothing, make-up and accessories and each decision carried meaning. men can choose style that are marked but they breakt have to, and in this group none did. (231-2). Although Tannen makes the distinction between the style of men and women at a business conference, she fails to mention that their age and field of work influences what should be marked vs. unmarked and what styles appear appropriate vs. inappropriately.Clearly, Tannen states that all four women are marked yet some are considered more earnestly marked and judged than others are. Specifically, the women with th e long, blond, hair, dressed in tight clothing and heels were more severely marked in Tannens eyes. However, Tannen never mentions that in another profession, such as the entertainment or fashion industry, the women style might be considerable less marked than an individual dressed more simple and conservatively.In conclusion, the assumptions that Tannen makes in her article infer that men in society can remain unmarked. Although men are objectified and sexualized less than women this does not mean that they are not in the public eye. Tannens view on at presents marked society is based truly on her opinion. She omits geographical, generational and age differences when making her conclusion.

As Dianne Skafte Essay

As Dianne Skafte stated in her book, altogether the lives form the organic structure of the E artistryh, and to that body alone shall return. The earth is viewed as the source of life with all the agricultural crops it gives to sustain the living(a). However, this truly earth is also the home of the assassinated. People in unalike parts of the world plant their stagnant in the earth just like the influenceds of their crops with the belief that their loved one go forth be innate(p) again as a new soul, live in the body of an animal, or stay in the underworld.Otherwise, our ancients believed that the in invigorate who were returned to the earth become wise and that they gain the ability to turn into clairvoyants who can see the forthcoming and thus give pleader to those who are still living (Skafte 2000). This is the primary reason why black art was constantly utilized in the classical world. If a person decides to contact the brain dead, he or she will give birth the ability to know many hidden things. The act of sorcery falls under the comprehensive of many polar occult divination practices.The term was rooted from the ancient Greek language with the ledger nekros meaning corpse and manteia or prophesy. necromancy evolved through time and developed many different forms. Even though the Greeks may seem to be the civilization that is always connected to the act, summoning the dead was well-practiced by different civilizations around the world during these classical times like the Romans, Asians, Medieval Europeans, and Egyptians (Helium. com). The people living in the classical times look highly into their necromaneias or the oracles of the dead.One famous act of black magic was the one that happened in a hillside cave in Epiris where the famous legendary hero Odysseus was said to have summoned the dead at the place in order to get some guidance and selective selective information for his self-destructive journey to home. Even though th e Odyssey is precisely a fictional tale, Homer was able to base his publications from the actual practices of the many Greek adepts that operate during their time (Donald Tysons Supernatural World. com). The place was also a great deal connected to the worshipping of the goddess of the underworld, Persephone and the god of the dead, Hades.During the periods of medieval and renaissance times in ancient European history, the act of black art is considered as a normal part of the life of the people. There are other reasons why magic trick the dead is used. Wise-men ask for help from the spirits of the departed in order to seek for help in diagnosing the illnesses and giving cures to their patients. When it comes to families, they often seek for guidance from their dead loved ones and ask them to appear in their dreams.It was also believed that the souls of those who had already crossed over to the other side have the rare ability in finding missing persons or even treasures that have long been lost. Spirits also help dig up some secret crimes that have been committed but were never given justice. The act of necromancy was so popularly used and believed in the ancient times that Catholic priests were even believed to have practiced the art centuries ago even though it was not openly discussed in their history books of their churches.Classical engravings also archive some of the necromancy acts of famous philosophers and scholars of the time. Example of this is the one depicting John Dee, a 16th coke mathematician with a famous illusionist. In the picture, the 2 were enveloped by a magic circle with signs of the zodiac and other symbols with a corpse in front of them. Another illustration was that of the Edward Kelly, an Elizabethan alchemist, and Paul Waring who are also protect by a magic circle while facing a corpse that has risen from the ground.All of these depictions were not fiction and were actual events. The use of the wizardly circle that shro uds both pictures mentioned serves as the protection of the military personnel from the forces of the spirit they have cry outed that is mostly unhappy and unwilling to cooperate (Donald Tysons Supernatural World. com). During these times, scholars asking for the guidance and knowledge of the dead were not considered as an uncommon phenomenon. During the classical times, Nobilities or the Christian clergy were the literate members that set up high society.It is believed that either or both of these two groups were responsible for the spreading and practicing of the necromancy despite of the incident that is was strictly forbidden in Christianity. Access to necromancy is a cordial of act that can only be accessible to those who belong to the scholars of Europe mainly because of reasons of accessibility, knowledge, and the procedures it use. Evidence to this fact is the number of confessions that a couplet of Nobles and Clergy members expressed regarding their experience with th e act.A closer look at the practices of necromancy also showed that the procedures are fast similar to Christian rites. In exorcism cases in Christianity, the spirits or demons were forces away through the use of the name of God, the Holy Spirit, or Jesus. This can be compared to the spells of necromancy which are similar to these rites in drop off opposition (Necromancy. com). There are also examples of necromancy written in the Holy Bible. One of these is that on Samuel, chapters 28 and 31 that tell the story of faggot Saul and his abhorrence to David.In the story, he began quizzical his decision of bringing David into his court because of the latters charisma in people and good skills of existence a warrior. The King regretted letting David enter his kingdom when he started to notice that the people were already choosing the vernal mans side instead of his. During that time, the Philistines were also preparing to attack. Out of desperation, King Saul disguised and went to s ee a seeress to help him contact the dead. It shall be noted that the king has given an order to persecute all seers, wizards, and others that deal with the supernatural thus the need for his disguise as a common man.After the charwoman was convinced that she never have punishment for the request, she went onto a trance and related a vision to King Saul. According to the vision, she saw gods ascending from the earth which all gathered to form a man who is cover by a long mantle. As Saul bowed to the ground, he then recognized the spirit that possessed the woman as his deceased prophet, Samuel. But the vision was not the end of it. Samuel chastised the king for his vile attacks of David and said the because of King Sauls violation of his covenant with the Lord, he will die the next day.The following die, King Sauls soldiers were slaughtered and he mortally wounded. Knowing his coming fate, he unflinching to fall upon his own sword (Skafte 2000). Another example of necromancy ment ioned in the bible was in Aeschylus Persians. In here, the necromancy procedure consisted of Queen Atossa asking the Persian elders to call Darius from his grave. The Queen brought some garlands of milk and different offerings like milk, honey, water, and unmixed wine and oil. The elders followed the queens request and called upon the deceased King asking for effective death gods like Hades to send his soul in the face of earth.When King Darius was successfully summoned, he narrated the beating of the ground and the effect of the cries of the necromantic cries on dead people like him (Bremmer 2002). This literary description supports the ancient beliefs about the two questions that are usually mentioned by the souls called through necromancy. The first is about the experiences and unbeknown(predicate) secrets of the deceased while they are still living and the second, who is depicted by this story, are the relating of the souls of the ephemeral and magical things theyve learned u pon crossing over.There are many risks in calling the dead. One of these is through the perspective of Christians who condemn the use of the act. According to this side, the acquiring of knowledge from the dead is prohibited because it was not information that God prohibited to be released. According Christianity laws, there are only two legitimate sources of information that the living can use. These are the things that are revealed by the Lord and those that gleaned through a natural kind of revelation.Simply said, using necromancy to know secrets from the dead is also equivalent to stealing forbidden information. Second, spirits are not beings that people can simply call and command. The art of necromancy is divided into two different phases, the first of which is the calling of the spirit and the second is compelling it to do the bid of the necromancer. Since the spirits of the dead arent actually always willing to be called and ordered, there is a great risk for the necromancer and his assistant to be attacked by the former if theyre magical barrier is not that strong (Necromancy 101.com). Moreover, acts of necromancy should have well-defined motives because otherwise it will be considered as works of darkness, simply for the selfish whims of the person who wants to call and can also turn out to be dangerous for the health and reason of the necromancer and his assistant. In necromancy procedures of classical times, necromancers are forced to inflict pain on the spirits they call just to force the latter to follow them. As a result of these, the souls are usually really unhappy towards the individuals, heightening the probability of them to become violent.Thus, there is a great risk that comes along with the expensive secrets a spirit may expose (Spence 1960).BibliographyBremmer, Jan N. 2002. The rise and fall of the afterlife The 1995 Read-Tuckwell Lectures at the University of Bristol. Routledge. DeWaay, Bob. 2006. The Dangers of Divination. http//www. deceptioninthechurch. com/dangersofdivination. html (accessed June 14, 2009). Necromancy. 2009. Necromancy in History. Necromancy Encyclopedia II. http//www. experiencefestival. com/a/Necromancy_-Necromancy_in_history/id/1575928 (accessed June 14, 2009).Skafte, Dianne. 2000. When Oracles Speak. Quest Books. Spence, Lewis. 1960. Encyclopaedia of Occultism. New York University Books. Townbridge, B. 2009. Necromancy explained. Helium. com. http//www. helium. com/items/246248-necromancy-explained (accessed June 14, 2009). Tyson, Donald. 2007. The Truth close to Necromancy. Donald Tysons Supernatural World. http//www. donaldtyson. com/necro. html (accessed June 14, 2009). Wendell, Leilah. 1997. Necromancy 101. The Occult Library. http//www. realmagick. com/articles/17/1817. html (accessed June 14, 2009).

Book Report on Farewell to Manzanar Essay

In the early year of 1942, the families of Japanese people atomic number 18 being reproducible to start a move to Manzanar, California the Wakatsuki family is one of them. Many Japanese accept the move because they are afraid of Caucasian aggression, but some simply see it as an adventure. Families have to put on identification number tags on their collars. Riding on buses to Manzanar, Jeanne f totallys asleep on the bus, nearly half(a) of which is filled with her relatives, and wakes up to the setting sun and the yellow, billowing dust of Owens Valley. (pg 19)As they enter the bivouac, the new arrivals scan silently at the families already waiting in the wind and sand. Upon arriving, just in time for dinner, the fix halls werent completed yet (pg 19) seeing a line formed around the soon to be finished building blocking a good part of the wind. Only seeing tents and barracks, half create buildings that were unending. There were cracks in the floors, only one light bulb per roo m, gaps in the walls, an oil stove for heat, and not very much space at all. We were assigned two of these for the twelve people in our family group. (pg. 1) With all the confined spacing for the families, you can tell there was a lot of tension between everyone. The pabulum they had made for us to eat was not in our culture at all.The Caucasian servers were thinking that the crop poured over rice would make a good desert. Among the Japanese, of course, rice is never eaten with sweet foods, only with savoury or savory foods. (pg. 20) On top of the food being served wrong, their latrines were not very useable. The smell of it fumble what little appetite we had. (pg. 31) My mother was a very modest person, and this was going to be agony for her, seated down in public, among strangers. (pg. 32). What some of the other women did was drag in a big cardboard carton and put up as walls so no one could see. The reservoir hovel was just outdoors of camp.My brother-in-law Kaz was fo reman of a reservoir maintenance detail, the only crew permitted to work or to leave the camp limits the night of the riot. (pg. 78) The guys that were on this detail slept on cots in a shack. When they turned off the lights in the shack at night and everyone was laying down it was so dark that you couldnt see anyone or anything in the shack.

Electronic Medical Records

electronic wellheadness check phonograph introduces Essay Cynthia J iodines Grand C eachon University HCA 450 November 11, 2012 electronic aesculapian examination examination checkup examination Records Essay Medical go into turn backing has change in the stand couple of decades. In the past tolerants exhibits were kept in a file on paper taking up excessive room. In the past, paper graphs were the solely means of c be a patients wellness check checkup diagnoses documented. to a greater extent(prenominal) or less of these charts atomic act 18 still utilise today in health business organization facilities, however they be mutedly organism re fit(p) with a more than stir method electronic medical records (EMRs).This virtual info reading center merchant ship serve as a vehicle to promote and to disseminate threadb atomic number 18ized info definitions and best practices to providers, consumers, and both(prenominal) another(prenominal)wises liaisoned in lineament improvement efforts nation completelyy and internationall(a)y (Var strike, 2010). The electronic Medical Records is an foster computerizes medical record agreement that delivers medical data for physicians office and infirmarys within a matter of seconds while offering respectablekeeping. This strategy allows the health care round and physicians to modified, interject and retrieves patients medical records.Electronic medical records are legible and organized. The Electronic Medical Record (EMR) has been close since the late 1960s, when Larry Weed introduced the concept of the Problem Oriented Medical Record into medical practice (NASBHC, 2012). Weeds innovation introduces the concept of the Problem Oriented Medical Record into the medical practice, which verifies the diagnosis (NASBHC, 2012). However, it wasnt until 1972 when the Regenstreif Institute reach the first medical records organisation. Although it was a great invention, physicians didnt look fo r to use it right away.This new trunk would help physicians improve patients care. Although, $19 billion in stimulus funds generate been invested into the Electronic health record (EHRs) a nonher name for EMRs the Obama administration full(prenominal)ly suggested that health care and hospitals facilities start to digitize patient data and start making better use of the advance technology(Greenemeier, 2010). The health care industry has been slow to adapt to this new system. Although the EMR system is intended to incur patients records more penetrationible for the physicians and staff, still many book non giveed it yet.Given the deprivation of EMR adoption passim the health care industry, less than 10 percent of U. S. hospitals have adopted electronic medical records. Cost is the main(a) reason many have resisted or are un testamenting to adopt the EMR system and short mature on staff as well. In a recent interview on November 9, Jessica in human election at Vineville In ternal Medicine, with Dr. Mary Bell Vaughn presiding as the physician over the practice. The practice has been exploitation electronic medical records systems since the practice open in 2002. Dr.Vaughn thought patients and staff needed easy introduction to their records when needed. Some of her other reasons are as follow Paperless, Less storage No physician course around ( persevering info avai science laboratoryle at finger tips) Saves prison term spent with patient Good for introduce breeding Financial Good This system is web based and uses an E-Clinical program through a portal. This system as well allows prescriptions to be send to the local pharmacy as well. Blood work replys are overly put into the patients charts as well.Recently, the practice withalk on new patients with paper charts, because their physician retired. In this cause their closely recent charts were converted over to EMRs. However those paper charts still exist in a elegant storage area if f urther cultivation is needed on the patient. Though the practice implements the EMRs system from the very(prenominal) beginning, the physician and staff are very happy with the system. nigh patient information is put into the system via computer on the spot while the patient is telling the nurse or physician what is ail them.Although at that place system is a web based system, it has two backup systems in two assorted locations just in case the systems go down or power tabuage. The EMR system has had great grapheme impact on the practice. The patients care has been improve by the system. It allows the physician to track and effectively treat the patient. In some cases if the patient is located at a nonher health care facility this system allows them to send information to multiply hatful for care, no matter where they are. Dr.Vaughns practice is already looking into the future to implement sending out text message to patients to inform them of appointments. Patients have a ccess to their care any epoch. EMR adoption is slow to be implemented into some practices. Although thither is some disapproval of the electronic medical records today, it is merely a digitized version of paper chart. This system bequeath take down medical errors and help put information in front of interrogationers This new form of technology is here to stay and the sooner healthcare facilities start using it the more efficient results they will receive.References Prathibha Varkey (2010). Medical Quality Management, Sudbury, Massachusetts Jones and Bartlett Publishers. History of the Electronic Medical Record system (2012) Retrieved November 8, 2012 www. nasbhc. org Will Electronic Medical Records Improve Health Care? (2009) Retrieved November 8 2012 http//www. scientificamerican. com/article. cfm? id=electronic-health-recordsElectronic Medical RecordsEngineering Management Field Project Electronic Medical Records A Case get h emeritus of to Improve Patient Safety at princely crownwork of Seychelles Teaching infirmary By Annie Bittaye jumpstart Semester, 2009 An EMGT Field Project report submitted to the Engineering Management Program and the Faculty of the Graduate School of The University ofK. ansas in government agencyial fulfillment of the requirements for the degree of Masters of Science )= , , Tom Bowlin Cotntnittee Member k Committee Member watch judge _ _&-4_/,,,,,,1_-. -Q,,.. r5c-_ _ Table of ContentsTable of Contents . 2 leaning of Figures 3 List of Tables .. .. 3 Acknowledgments Executive abstract 5 1. 1. 1. 2. 3. 3. 1. 3. 2. 3. 3. 3. 4. 4. 4. 1. 4. 2. 5. 6. 7. Introduction 6 Background of proud Victoria Teaching Hospital 7 publications Review 0 mapping and Methodology .. 17 Experimental Design . 17 Survey Procedure 18 entropy epitome 9 Limitations of the use up .. 19 Results 20 Reasons why EMR is not being utilise at RVTH .. 23 Benefits and challenges of EMR. 24 compend.. 0 Conclusion .. 30 Suggestions for Additional op eration 32 References . 34 Glossary . 5 Appendix 36 2 List of Figures Figure 1 Sources of funding, RVTH 2008 .. 22 Figure 2 Averages ofEMR functions in order of relevance to work at RVTH 29 List of Tables Table 1 anatomy of patients seen at RVTH in 2008 .. 7 Table 2 List of Professionals, RVTH 2009 . 0 Table 3 calculating machine ownership and previous computer deviseing received by the respondents at RVTH .. 28 Acknowledgments My journey towards my Masters degree was a long and fruitful one. The Engineering Management (EMGT) program has not just exposed me to much information and ideas completely when also opened a way towards my biography path. Thank you to my parents, Ebrima and Lucy who have invariably been a source of great inspiration and strength to me. They taught me the value ofeducation and their prayers has always been with me.Thanks to my brother, Baboucar who encouraged me to pursue my Masters degree and the never ending conduct I receive from him. Special c onvey to my sixsome class old son, Ebrima for his understanding that Im at school when Im not home to read him a bedtime story. I also want to thank all my EMGT instructors especially Professor Herb Tuttle, Dr Tom Bowlin and ray Dick who worked with me recently, for the wonderful information and feedback they provided on this project. Thanks to Parveen Mozaffar for her extreme support and encouragement during the course of my studies.Thanks to the staff at Royal Victoria Teaching hospital for providing me with all the needed information for this project. Last unless not least, my gratitude goes out to Dr Don Anthony Woods. It is because of his influence that brought me where I am today. He always had my best interest at heart and I want to thank him for that. May God bless you Executive Summary Most countries in Europe and the USA are increasingly using an electronic medical record (EMR) system to help improve healthcare quality. Unfortunately, The Gambia government faces a seri es of health crises including unless not curb to human immunodeficiency virusIAIDS, malaria, diabetes and tuberculosis.These dis placiditys threaten the lives of thousands of people. Lack of infrastructure and pointed, experienced staff are considered important barriers to scaling up treatment for these diseases. The contribution of this field proj ect outlines the benefits of an EMR system at Royal Victoria Teaching Hospital (RVTH) and how it will improve patient safety. This is a descriptive discover using interview questionnaires from officials at the Royal Victoria Teaching Hospital. The study also looks into other facilities in similar developing countries with advanced systems, but not so advanced as to be at the level of express-of-the art facilities in the U.S. Results from this study indicates the importance of an EMR system at RVTH to facilitate effective and efficient data collection, data entry, information retrieval and report generation. As a catalyst for develo pment, the implementation of an EMR system at RVTH whitethorn stool it one on the best hospitals in the West African region. 5 1. Introduction According to Dick and Steen, Electronic Medical Record (EMR) is the compilation of patient medical information in a computer-based format that allows the collection, storage, retrieval, and communication of this data.An electronic medical record replicates a paper chart and contains both clinical information (diagnoses, allergies, medicate resistance and treatments) and demographic information or so a patient it provides a encompassing medical forecast and can be used by clinicians as a tool to determine appropriate treatment for patients. EMR is not only being welcomed by healthcare providers as a way to improve care delivery but also serves as a catalyst and gold standard for development (porter, Kohane, & Goldman Reifsteck, Swanson, & Dallas).Unfortunately, Africa, a continent faced with many challenges ranging from epidemics, civil wars, and disasters, lacks robust healthcare infrastructure in the form of computerized health care systems. For instance, Ghana has one the best health innovations in the region, Korle-Bu Teaching Hospital. This Hospital, for example, is present-day(prenominal)ly the only institution in the West African sub-region which performs surgery. Due to the quality of outcome, it now receives referrals from most parts of the continent videlicet the Gambia, Sierra Leone, Liberia, Togo Benin, Tanzania, Nigeria, Cameroon, Cote d Ivoire, and Ethiopia.Despite its exemplary performance, the hospital has no computerized information system which can help improve care delivery in the region. on that pointfore, the purpose of this study is to examine the potential benefits of EMR and its ultimate contribution to improving healthcare delivery development in less actual countries like The Gambia. 6 1. 1. Background of Royal Victoria Teaching Hospital The Gambia is a small body politic in West Af rica, with a race of just about 1. 5 million. RVTH has been in existence for over 100 years in The Gambias capital, Banjul.It used to be called Royal Victoria Hospital until in the late 1990s, when its name was changed to RVTH. The Gambian Government decided that it had to reduce its settlement on foreign unsexs by establishing a medical school in the University of The Gambia (UTG). The UTG now uses RVTH to teach its clinical students. In recent years, The Gambia has been doing much on its own initiative to take to improve the healthcare of the nation. There are 540 beds in the hospital and the two largest Departments are Pediatrics and Maternity.The biggest killer disease in The Gambia is malaria, with issue children and pregnant women being particularly vulnerable to this disease. Diabetes, high blood pressure, pneumonia and eye problems such as trachoma and cataracts are also major health problems. The adjacent table provides an estimation of how many patients were seen at RVTH in the year 2008. Procedure Inpatient Admissions Children admitted to Pediatrics Patients treated in the Eye Center Out-Patient Appointments Out-Patients in the ER Number of Patients 25,281 9,352 986 over 184,365 24,334 Table 1 Number of patients seen at RVTH in 2008 7Unfortunately, RVTH does not have any EMR system in place to facilitate patient safety. As noted by participants, EMR software is not used at RVTH because administration keeps complaining of money. It looks expensive to them and also they are more used to the paper booklet. Currently, information is very fragmented and therefore does very little to help patient safety and unity in care. Another important issue here is that a large number of these patients are illiterates. To get word they receive the appropriate treatment, they will have to explain to the physician current medications they are taking etc.This can be a very challenging and fatal to the patient sometimes. The typical paper medical record contain s sections including information on demographics, admissions, discharge summaries, progress notes, protocols, laboratory results, radiology results, surgical and pathology reports, orders for, treatment and nursing notes. Most documentation regarding treatment of a patient is written directly in the patients medical chart. On a given day a patient arrives at the hospital for care, sign in his name and stays anywhere from 30 minutes to six hours o get their records pulled depending on the day. Physicians, nurses, medical residents who need access the information in the medical record moldiness wait till its available. Typically, medical records are transported to the outpatient clinic where the patient would be seen, and then returned to storage center to be filed again. It is obligatory for the medical record to follow the patient throughout their visit. If the patient was seen in one clinic where orders were written, it was necessary to physically transport the record when the p atient moved to the music room for treatment. The purpose of this field project is to examine the potential benefits of an EMR system and its ultimate contribution to improving patient safety at the Royal Victoria Teaching Hospital in The Gambia. 9 2. literary works Review The first generation of EMRs was extensions of medical billing systems in large US hospitals. Over the last iv decades, they have been used as tools to organize and store medical data. EMRs are widely accepted as important tools to support high quality health care in the US, Europe and other genuine countries.Evidence shows that using EMRs that intromit decision support systems improves quality of care and both reduce medical errors and unnecessary medical investigations (Partners in Health), come with the use of EMRs in developing countries, if available, is much more limited than it is in the US and Europe. Now there is considerable interest in using medical information systems to support the treatment of human immunodeficiency virus and TB in Africa, Latin America, and Asia. In most African countries, healthcare information systems have been driven mainly by the need to report aggregate statistics for government or funding agencies.Such data collection can be performed with simple paper forms at the clinic level, with all electronic data entry done centrally, but that approach tends to be difficult and time consuming and whitethorn provide little or no feedback to the staff collecting data. Individual patient data that are collected and accessible at the point of care can support clinical repugnment. Clinicians can well access previous records, and simple tools can be incorporated to warn of potential problems such as incompatible drugs.Physicians or nurses can check on the outcomes of separates or groups of patients and perform research studies. Many of these functions will work well on paper or with simple spreadsheets for up to 100 patients but puzzle very time-consuming and potentially unreliable with more than 1,000 records, and virtually impossible with 10,000 or more. 10 Experience with the use ofEMRs in developing countries is much more limited than it is in the US and Europe, but there is now considerable interest in using medical information systems to support the treatment of HIV and TB in Africa.Some examples of EMR use in Africa include The Regenstrief Institute in collaboration with Moi University in Kenya true an EMR for general patient visits to clinics in western Kenya. This system was subsequently modified to support the care of some(prenominal) thousand HIV patients. Baobab Health Partnership in Malawi has developed an EMR system using innovative, low-power touch-screen PCs for data entry and display. This system is now used to support the care of more than 7,000 HIV patients in the pharos clinic in Lilongwe and has been chosen by the national HIV program for use throughout the country. emailprotected, an HIV medical information sys tem developed for US patients, has now been deployed in Uganda and is planned for use in other African countries and in Latin America. (Partners In Health) A wide-ranging literary works review of electronic medical record implementation over the past decade reveals that clinical, workflow, administrative, and revenue enhancement benefits of the EMR outweigh barriers and challenges. Among other key efforts, organizations must train and motivate users to navigate EMR systems, as well as develop a common structured language.Clinicians who used CPRs found that electronic 11 access to clinical infonnation saves time and provides a thorough and efficient way to manage patient information To reap the full benefits of an EMR, organizations must design current workflows and practices to evolve into efficient providers of care. EMR systems are developed to meet the following endeavors improve quality of care, reduce organizational woo, and produce a data stream for electronic billing. (D assenko and Slowinski).The EMR meets these goals through workflow automation, connectivity, and data mining. (Gaillour) The Computer-based Patient Record Institutes (CPRI) definition concurred with the other researchers, but added that the EMR provides protection of patient and provider confidentiality, has a defined phraseology and standardized coding, produces documentation as a by-product of patient care, connects local and remote systems and provides electronic support for secondary users (payers, policymakers, researchers). Fromberg and Arnatayakul) Unfortunately, most EMR systems are unable to offer all of the components defined by the CPRI because the technology is too complex and too expensive, doctors wont use computers, and standards dont exist. (Gaillour) The profits associated with implementing EMRs are well documented and are straightforward. The difficulty comes with placing a long horse figure to these advantages consequently, few organizations have published studi es describing the actual be and benefits attained from implementing EMRs. Bingham) The benefits associated with CPRs are organized into four categories clinical, workflow, administrative, and revenue enhancement. Renner, states that measuring all the benefits associated with EMRs is 12 virtually impossible, and that it is probably safe to select those that can make the greatest financial difference, and incorporate them into a financial model.Clinical benefits seen after implementing an EMR include better access to the chart, alter clinical decision making and disease management, enhanced documentation, simplified patient education, and increased free time to spend with patients, accompanied by improved perception of care and quality of work life. These benefits ultimately result in better delivery ofpatient care and safety. Despite all of these benefits, EMRs are not a standard in todays healthcare systems. It is evident that EMR technology is still a hot topic for discussion whe n shop through current healthcare technology and management journals.The following barriers have kept healthcare leading discussing EMR technology instead of adopting it cost, leadership, ROI, vendors keeping up with users needs, and deficits in the following categories public policy, standards, security, and a true definition. starting line of all, cost has kept organizations from implementing EMR systems. These costs can be organized into the following categories software, hardware, infrastructure development and maintenance, implementation, education, planning, and administration.Software costs include development or purchase, maintenance, and upgrades over time, while hardware costs include purchase of workstations. (Mohr) root word development and maintenance costs include servers, interfaces, workstations, network cables, network maintenance, and help desk operations. Planning costs include development of an implementation plan, identifying measurable outcomes, and choosin g meaningful metrics and goals, while implementation costs include training, overtime 13 ssociated with entering patient data, business disruption during transition, employee resistance to change, and lost productivity. Drazen, suggested that leadership was probably a more significant barrier than cost because, in the past, healthcare leaders have raised capital for essential business initiatives such as major building programs, acquiring a physician network, or starting up a managed care organization. This amount of capital is on the same scale as an EMR. Next, Drazen stated that a lack of government support is a major issue holding up EMR implementation.Unfortunately, the federal government does not contribute fmancially to EMR implementation projects. Without standards and structured data definitions, computer systems are not guaranteed to interface easily with each other, and databases are not easily developed. Most individual departments within a healthcare system have already invested in computerized patient information systems however, these systems are isolated and do not communicate well with one another. Getting these systems to interface is one challenge facing EMRs. Data security continues to be an ongoing challenge.Bergman, found that politicians, consumer advocates, and the general public have voiced concerns about risks to the cover and confidentiality of patient information. However, when compared with the security of the paper chart, the EMRs electronic audit trails and passwords actually improves internal security. The EMR may be more secure for internal knee pants of confidentiality, but must also be protected from external breeches such as hackers, who could potentially enter the EMR from an off-site location and download volumes of 4 confidential information. Firewalls and encryption software are methods used to protect patient data from these violators. Clinicians who use EMRs recognize two benefits First, electronic access to clinical information saves time. Second, electronic access provides a thorough and efficient way to manage patient information. With EMR systems, comprehensive information can be located and presented in a way that is relevant to the task at hand. Dassengko and Slowinski) The obstacles identified have thus far been insurmountable, but the considerable achievements identified in the benefits section of this discussion suggest that the advantages are well worth the effort. As Lenhart et al state, Success comes at the price of considerable effort, persistence and optimism, as well as dedicated leadership. (p. 114) some organizations that invested in primal EMR systems are struggling to show the qualitative benefits promised by vendors because an electronic version of current work processes is not cost effective. Sandrick) If the ROI were a function of the information tool itself, the financial benefits would be experienced universally. (ROI The White Paper. A Business Case for Electronic Med ical Records) To get the most value out of an EMR, healthcare organizations must reengineer the following work processes to make full use of the system Healthcare organizations must first train and motivate their users on how to navigate and operate the EMR tools. To optimally use the EMR, it must be implemented from adaptation through billing, thus allowing the organization to realize full potential benefits across the delivery system.These benefits include clear, concise, and comprehensive documentation, greater efficiency, care consistent with best practice guidelines and improved claims processing. 15 It is difficult to measure the scotch value associated with less tangible benefits such as higher quality of care, patient service, provider and employee satisfaction, and rivalrous advantage. It is even more difficult to allocate necessary resources and commit to institutional change when the paper chart is get the job done, even if it is not in the most efficient style.Howeve r, Carlon, suggests that all providers should embmce the EMR to deliver safe medical care. The information in the EMR can reduce medical errors to avoid dangerous, sometimes lethal, mistakes. If organizations cant show that EMRs have a positive ROI, they may decide that the EMR is just another expense of running a business. The expense is to improve patient safety and reduce medical errors. This review of literature empha sizes that the use of EMR systems contributes to the ultimate goal of delivering effective care while improving patient safety. 16 3.Procedure and Methodology The study is an exploratory study conducted in Banjul, The Gambia, to examine the potential benefits ofEMR and its contribution to improving patient safety. For the most part, this study is descriptive and categorised as a non-experimental qualitative study. Initial contacts were made with the Chief Medical Director, Development Officer and the wellspring of Medical Records at the RVTH to solicit participan ts for the study. 3. 1. Experimental Design Survey approach was used to gather data from healthcare overlords who are considered potential users of EMR.Copies of the questionnaires were sent through e-mail to participants. A total of 50 surveys containing 15 questions were sent out and 30 of them were returned. The content of the survey designed was open-ended questions based on the following areas knowledge of EMR, benefits and challenges of EMR, transition from paper-based system to EMR, security issues associated with EMR use and assistance given to developing countries by developed nations to implement or use EMR. Other areas include, demographic details of respondents based on profession, length of practice, age and sex.The survey questions can be found in the Appendix. Participants were selected based on their level of healthcare training. The population set for the study was healthcare professionals from the RVTH, which includes physician consultants, surgeons, pharmacists, nurses, midwives, pathologists, radiologists, and laboratory technicians. Study participants were limited to these previously mentioned health professionals, since they would be the principle users of an EMRsystem. 17 RVTH has a total population of about 500 professionals and a sample size of 50 was chosen for the study.Since this was the first time such a study was being conducted in the country, there was limited knowledge of professionals on the subject as well as difficulty in getting volunteers to record. 3. 2. Survey Procedure Survey questionnaires were converted into a PDF file and mailed electronically to all 50 participants on February 2, 2009. Unfortunately, five medical professionals who were initially contacted to participate in the study later declined to take part due to lack of understanding of the survey questions. As a result, different participants were contacted to replace the five individuals to make up the sample size.Since the researcher could not travel to Ga mbia to facilitate the survey, one of the administrative officers at the hospital was contacted and helped to distribute hard copies of the questionnaire to all participants. Participants were requested to fill out the attached survey and return it in a sealed envelope to this psyche or the chief administrator. After three weeks, on February 23, 2009, a first reminder was mailed asking for their cooperation and the importance of returning the survey. A final reminder was sent out on March 9, 2009, to those who might have forgotten to return the survey. 8 3. 3. Data Analysis The 30 completed surveys were coded, sorted, and organized into themes. A spreadsheet was created in MS-Excel to enter all data for analysis. All responses were placed into themes and summarized. The survey responses and themes generated were used to determine result interpretation, recommendation, and future research direction. Despite initial difficulties to get volunteers to participate in the study, 30 out o f the 50 surveys mailed were returned on March 16,2009, thus representing 60% response rate. 3. 4. Limitations of the studyDue to the difficulty of getting other hospitals in the area involved, the study was limited to RVTH only_ The findings represent views ofthat hospital alone. However, the research would have been more interesting and challenging if more professionals from other hospitals were involved in the study. Secondly, due to cost of air travel mingled with the United States and Gambia, the researcher was not able to travel to Gambia to collect the necessary data for the study. The in powerfulness of participants to respond to some important questions on the survey skewed the data.Finally, due to the six hour time difference between Kansas and Gambia, it was hard to reach the participants at during business hours. Lack of high speed internet or sometimes no connection at all caused the delay in receiving all the responses on time. It was also really difficult to get peop le to cooperate because the survey was not on their list of priorities. 19 4. Results Based on the methodology, surveys were mailed to 50 participants at the RVTH in Banjul, The Gambia. thirty completed surveys were received which included 15 questions.The results from all participants are as follows The 30 respondents consisted of 17 males, 11 females and two people who did not indicate their gender. The age range of the group was 25-56. Table 2 presents the professional distribution of participants. No Response represents people who did not include their profession. The five students, however, included final year medical and dentistry students, as well as nursing, and medical laboratory students. Professional experience ranged between 1 and 20 years.Profession Surgeon Pharmacist Physician Radiologist Midwife Nurse Laboratory Technician learner No Response Total Table 2 List of Professiona is, RVTH 2009 Number 3 2 3 2 5 6 2 5 2 30 20 To analyze this result, key words such as compu terized, storage and retrieval, were used to determine respondents understanding of the concept of an EMR system. Subsequently, one-third of respondents (33. 3%) who included these three key words were marked as right. While nine people representing 20% who said it is a mechanism for storing patient medical record on a computer were classified as partially right and rough half(a) respondents (46. %) who just said the use of machine to keep patient medical data were classified as having an idea or understanding of the system. In addition, implementing and running a successful EMR system requires a number of key elements. Accordingly, 15 people identified skillful elements such as (electricity, hardware, software, etc. ), 10 stated patient data, while four said qualified trained personnel, and one person indicated the need for money to train staff on EMR. Also availability of adequate infrastructure such as experts to support and train care providers on EMR is very life-and-dea th when implementing EMR system.However, more than half respondents agreed that enough infrastructures are not available in Gambia to support EMR implementation. On the other hand, 10 people believed that infrastructures are available, while four said available infrastructures are only few. Despite unavailability of infrastructures, 16 respondents reported there are enough computer experts in Gambia to train healthcare providers to use EMR. Seven reported experts are not available six stated experts are available but too few to meet the demand and needed training requirement of the healthcare sector.Lastly, one person indicated he has no idea of the subject. Responses concerning how much developed nations are assisting less developed countries like Gambia with Health Information Management (HIM) system infrastructure 21 implementation showed diverse opinions. guild people said developed countries are helping, 15 responded no. However, six indicated that the help given from develope d nations are not enough and sometimes electronic devices sent to less developed countries like the Gambia are inferior and lack quality.Still others think some form of assistance comes in to support the country on information management systems but not much is channeled towards the health sector. Lastly, seven people reported they have no idea if developed nations are helping and one person did not respond to this question at all. This pie chart below shows the sources of funding and the amounts received for the year 2008. Sources of Funding 2% Gambia Government Patient User Charges Donation Fund Internally Generated Fund Global Fund prankish Malaria in African Children FundFigure 1 Sources of funding, RVTH 2008 22 The majority of funds come from the Gambia Government in the fonn of pension received monthly or quarterly in advance. However, about 70% of the amount goes towards payment of salaries and allowances to approximately 1,200 staff. Other donations received are in th e fonn of drugs, equipment, supplies and services which made considerable contribution to the hospital. (RVTH) 4. 1. Reasons why EMR is not being used at RVTH Paper records are bulky and can take up pricey space.Filing, retrieval of files, and the re-filing of paper records are very labor-intensive methods with which to store patient infonnation. Plus if a record is checked out for one department, another department cannot access the chart. The impact of not having immediate access to key infonnation in emergency situations can be serious. Paper medical charts also cannot be effectively searched and used to track, analyze, and/or chart voluminous clinical medical infonnation and processes. They cannot be easily copied or relieve off-site.Also physicians orders and the corresponding results such as medications and labs can be issued and saved in a comprehensive EMR system. Our literature review and results have proven that paper records are costly, cumbersome, misinterpreted, easil y misplaced and cannot be used for any meaningful decision analysis. Unfortunately, RVTH does not have any EMR system in place to improve patient safety. As noted-by participants, EMR software is not used at RVTH because administration keeps complaining of the lack of money. It looks expensive to them and also they are more used to the paper folder.Nevertheless, four key issues were identified by participants as the main reasons why RVTH does not have an EMR system in use. 23 Overall, 36% of respondents attributed the problem to lack of resources in terms of personnel and infrastructure, 29% blamed it on lack ofleadership initiative and priority. While 18% reported cost in terms of equipment and training personnel, 15%, however, stated lack ofEMR importance or awareness and fear to change. Lastly, 2% respondents did not give any reason. 4. 2. Benefits and challenges of EMR There are both benefits and challenges to EMRs.Many betoken that positive aspects of using an EMR system outwe igh the challenges. Even though the investments in EMR systems are costly, most manage that over time this outset cost will result in greater savmgs. As well as cost sparing, many agree that one advantage of EMR system is that they save space. Instead of keeping huge paper files on patients, all records are kept on computer files. Though psyche must store these records in computers, this still represents a small percentage ofthe space required to store physical records. Along with saved space is reduction of paper used by hospitals.Although EMR systems do not render paper obsolete, but they certainly do reduce needed paper significantly. Another advantage of electronic medical records is the ability for all in a health care team to unionise care in terms of monitoring and treating diseases. This helps avoid duplication of testing, prescribing medicines that in combination might be dangerous and the ability for anyone on the medical team to understand the approaches taken to a co ndition. A person with complex health issues may see several specialists, and can easily become confused by overlapping or contrary advice.When specialists and primary care doctors use the same system for electronic medical records, then everyone on the team would be aware of all the other team members actions and recommendations. Electronic medical records may save time as well. Though faxing and email may assist one doctor to get information from another doctor or a laboratory, there is generally a wait time to receive this information. When a doctor has instant access to all of a patients information, including things like x-rays, lab tests, and information about prescriptions or allergies, he or she is ready to act right away, thus saving time.This may be particularly helpful in emergency situations where a patient cannot answer questions about medical history or allergies due to extreme illness or injury. Generally, doctors are often considered to have the worst handwriting, th ough this is just a generalization, unclear writing can lead to misinterpretations and mistakes. Typed notes and prescriptions are more legible and less likely to create misunderstandings. However, electronic medical records do not rule out the occasional typo. One of the main disadvantages to EMR system is that start up costs is enormous.Not only must you steal equipment to record and store patient charts (much more expensive than paper and file cabinets), but efforts must be taken to convert all charts to electronic form. Patients may be in the transitional stage where old records havent yet been converted and doctors dont always know this. Further, training on EMR software adds additional expense in paying people to take training, and in paying trainers to teach practitioners. In fact, one concern about the use of electronic medical records is that doctors may have a significant learning curve when these programs are first implemented.A poor 25 typist may actually take a long ti me to stimulant drug information. Doctors often have to be their own medical clerks especially during an office visit, and a doctor deflect by confusing technology may not be as alert to a patients symptoms or needs. There is no single electronic medical records source or system, so different hospitals and individual clinicians may not all be using the same program. This negates the possibility of instant information for all on the medical team, since one program may not communicate with another.Another concern is that electronic medical record systems might be hacked and exploited by others. Since one of the first considerations of medical treatment is confidentiality, it may remain a concern about how many people may have access to other medical records which they are not authorized to do so. Misuse of private medical information could create problems for people who have conditions they wish to keep private. Despite these concerns, it appears many hospitals are now attempting to use EMR systems.It remains unclear how long it will take for hospitals to transition completely from the traditional paper-based systems to a complete paperless environment. As shown from the survey results, it is clear that many participants believe that implementation ofEMR will tremendously improve upon patient in the country. For instance, as noted by one respondent, availability of patient past history in electronic format will enable health care workers have information about patients in seconds and with ease which will facilitate quick diagnosis and treatment hence reducing the rate of mortality. 26There is always some level of fear and resistance to change, especially in the healthcare industry. A question concerning the level of acceptableness from the traditional paper-based system to EMR system shows that such change will be met with some difficulties. More than half of respondents said the process would be challenging initially, but eventually care providers will acce pt the system because it will improve patient safety and work performance. Although the majority may still prefer the paper-based system, they will change when they see the importance or need for EMR stated a participant.Others also believe it would be a welcome idea. The adequate protection of patient health record requires limitations at all levels, such as collection, use, access, and disclosure. Therefore, development of privacy, confidentiality, and security principles is necessary to protect patients interests against inappropriate access to their health data. Unfortunately, 14 respondents (47%) did not respond to this important question regarding measures necessary to maintain patients privacy, security, and confidentiality at RVTH.However, 16 people representing (53%), did state that all health records must be securely protected by use of password, data encryption, and access restrictions to users. It is obvious from the survey results that effective implementation and utili zation ofEMR can improve patient safety in developing countries. Considering training as one of the key elements to EMR success, a question was asked to determine length of time required to train care providers in Gambia on EMR.Almost 50% of respondents indicated it might take 6-18 months depending on practitioners ability to understand the concepts ofEMR as well as the user friendliness of the software. Others believe for 27 current medical students who are already computer literate may take about two weeks, but the older practitioners will take longer time (approximately over a year). Table 3, below shows the number of respondents that own a computer or has had some form of computer training in the past. Computer Training Profession Own a Computer 1 1 1 0 1 2 1 2 I Yes 1 1 1 0 2 3 1 7 16