buy custom Technology and Patient Safety essay

buy custom Technology and Patient Safety essay Using a national representative and large sample of Medicare patient data, the authors of this article sought to link implementation of health IT to the clinical outcomes, which allowed them to apply a difference-in-differences method to measure adjustments in patient safety with adjustments in health IT investments. Data spanning four years (1999-2000) was observed for each hospital that was examined. Three health IT applications were analyzed and these included picture archiving and communications systems (PACS), electronic medical records (EMRs), and nurse charts applications. The outcome measures of the study included three patient safety indicators and these were: post-operative hematoma or haemorrhage, infection as a result of the medical care, postoperative deep vein thrombosis (DVT) or pulmonary embolism. The authors selected these indicators after consulting with the health care professionals to get the outcomes that were likely to be influenced by health IT. Patient charact eristics such as sex, race, and age among others were controlled. Multivariate regression analysis was used to determine the relationship between the patient safety indicators and a group of health IT indicators, patient controls, as well as interactions between time and health IT applications. The authors also included a complete set of hospital, as well as time fixed effects which allowed for estimation of changes in patient safety outcomes following the adoption of health IT. The stud found EMRs to be the only health IT application having a distinct and statistically significant effect on patient safety. EMRs use was particularly associated with significant reductions in infections due to medical care. However, nurse charts and PACs were found to have no systematic association with any indicator. This study contributes to the inconclusive literature that exists about the issue of technology/informatics in promoting the patients safety. Kilbridge, P.M. Classen, D.C. (2008). The Informatics opportunities at the intersection of patient safety and clinical informatics. J AM Med Inform Assoc, 15: 397-407. This position paper addresses obstacles that prevent the use of health informatics in improving patient safety. The authors of the article note that while health informatics has been demonstrated to promote patient safety, various challenges make it quite difficult to improve it. The article aims at offering recommendations on ways of dealing with these challenges. The authors provide recommendations on how health informatics can be effectively used to promote and improve patient safety. Some of the recommendations include adequate health staff training on the use of available informatics, conduction of more research addressing health informatics and patient safety, and encouragement of hospitals to adopt electronic health records. The authors believe that once the arising challenges of the use of health informatics are addresssed, the greater improvement in patient safety will be achieved. IOM (2011). Health IT and Patient Safety: Building Safer Systems for Better Care. Consensus Report, Institute of Medicine. Realizing the widespread use of IT in medical care, IOM was directed by the Department of Health and Human Services to compile this report which is basically an evaluation of health safety issues arising from the use of health IT and recommendations on how these issues can be addressed at both the governmental and private sector levels. According to the report, an effective use of health IT depends on many factors including patients and healthcare professionals. The report found that the safety concerns of health IT should not be addressed from a single cause perspective, but from a much wider perspective involving the whole care system, in order to come up with an intervention to improve the safety of the system. According to the report, all stakeholders including patients, health professionals, private sector, and the government have distinct roles to play. In the report, the IOM makes certain recommendations, which include promotion of sharing of safety data, improving measures, s tandards, and criteria for the safe use, and finally promoting accountability and transparency. It is important to note that these recommendations are not similar to the ones found in Kilbridge and Classen study cited above. Buy custom Technology and Patient Safety essay

Act One of Bruce Norriss Play Clybourne Park

Act One of Bruce Norris's Play Clybourne Park The play Clybourne Park by Bruce Norris is set in a modest three-bedroom bungalow in central Chicago. Clybourne Park is a fictional neighborhood, first mentioned in Lorraine Hansberrys A Raisin in the Sun.   At the end of A Raisin in the Sun, a white man named Mr. Lindner tries to convince  a black couple not to move into Clybourne Park. He even offers them a substantial sum to purchase back the new home so that the white, working-class community can maintain its status quo. It isnt mandatory to know the story of A Raisin in the Sun to appreciate Clybourne Park, but it certainly enriches the experience. You can read a detailed, scene by scene summary of A Raisin in the Sun to enhance your comprehension of this play. Setting the Stage Act One of Clybourne Park takes place in 1959, in the home of Bev and Russ, a middle-aged couple who are preparing to move to a new neighborhood. They bicker (sometimes playfully, sometimes with underlying hostility) about various national capitals and the  origin of Neapolitan ice cream. Tensions mount when Jim, the local minister, stops by for a chat. Jim hopes for a chance to discuss Russ feelings. We learn that their adult son committed suicide after returning from the Korean War. Other people arrive, including Albert (husband of Francine, Bevs maid) and Karl and Betsy Lindner. Albert arrives to take his wife home, but the couple becomes involved in the conversation and the packing process, despite Francines attempts to leave. During the conversation, Karl drops the bombshell: the family that plans to move into Bev and Russ home is colored. Karl Doesnt Want Change Karl tries to convince the others that the arrival of a black family will negatively affect the neighborhood. He claims that housing prices will go down, neighbors will move away, and non-white, lower-income families will move in. He even tries to obtain the approval and understanding of Albert and Francine, asking them if they would want to live in a neighborhood like Clybourne Park. (They decline to comment  and do their best to stay out of the conversation.) Bev, on the other hand, believes that the new family could be wonderful people, no matter the color of their skin. Karl is the most overtly racist character in the play. He makes several outrageous statements, and yet in his mind, he is presenting logical arguments. For example, while trying to illustrate a point about racial preferences, he recounts his observations on a ski vacation: KARL: I can tell you, in all the time Ive been there, I have not once seen a colored family on those slopes. Now, what accounts for that? Certainly not any deficit in ability, so what I have to conclude is that for some reason, there is just something about the pastime of skiing that doesnt appeal to the Negro community. And feel free to prove me wrong†¦ But youll have to show me where to find the skiing Negroes. Despite such small-minded sentiments, Karl believes himself to be progressive. After all, he supports the Jewish-owned grocery store in the neighborhood. Not to mention, his wife, Betsy, is deaf - and yet despite her differences, and despite the opinions of others, he married her. Unfortunately, his core motivation is economic. He believes that when non-white families move into an all-white neighborhood, the financial value decreases, and investments are ruined. Russ Gets Mad As Act One continues, tempers boil. Russ doesnt care who is moving into the house. He is extremely disappointed and angry at his community. After being discharged because of disgraceful conduct (it is implied that he killed civilians during the Korean War), Russ son could not find work. The neighborhood shunned him. Russ and Bev received no sympathy or compassion from the community. They felt abandoned by their neighbors. And so, Russ turns his back on Karl and the others. After Russ caustic monologue in which he claims I dont care if a hundred Ubangi tribesman with a bone through the nose overrun this goddamn place (Norris 92), Jim the minister responds by saying Maybe we should bow our heads for a second (Norris 92). Russ snaps and wants to punch Jim in the face. To calm things down, Albert places his hand on Russ shoulder. Russ whirls toward Albert and says: Putting your hands on me? No sir. Not in my house you dont (Norris 93). Before this moment, Russ seems apathetic about the issue of race. In the scene mentioned above, however, it seems Russ reveals his prejudice. Is he so upset because someone is touching his shoulder? Or is he outraged that a black man has dared to put hands on Russ, a white man? Bev Is Sad Act One ends after everyone (except Bev and Russ) leaves the house, all with various feelings of disappointment. Bev tries to give away a chafing dish to Albert and Francine, but Albert firmly yet politely explains, Maam, we dont want your things. Please. We got our own things. Once Bev and Russ are alone, their conversation feebly returns to small talk. Now that her son is dead and she will be leaving behind her old neighborhood, Bev wonders what she will do with all of the empty time. Russ suggests that she fill the time up with projects. The lights go down, and Act One reaches its somber conclusion.

Changing the Requiring for Filing for Chapter 7 Bankruptcy Research Paper

Changing the Requiring for Filing for Chapter 7 Bankruptcy - Research Paper Example Sometimes it is enough to push a person to the brink of financial disaster. At one time a person could seek Chapter 7 bankruptcy protection and discharge the debt they could not afford to pay, but it is not so easy any more. When a person files for Chapter 7 bankruptcy protection, s/he acknowledges that s/he is unable to pay some or all of his/her creditors. Prior to 2005, people with jobs who just overextended themselves could file Chapter 7 bankruptcy and be free of credit card or other debt such as medical bills, without relinquishing much of their property as long as they continued to make payments on the property on which they still owed money. Chapter 7 bankruptcy, also known as liquidation, â€Å"contemplates an orderly, court-supervised procedure by which a trustee takes over the assets of the debtor's estate, reduces them to cash, and makes distributions to creditors, subject to the debtor's right to retain certain exempt property and the rights of secured creditors† (Office of the U.S. Courts, 2011). Often times, the debtor has no assets—that is s/he does not own a house, car, or other valuable goods, or, if the debtor does own them, s/he owes so much debt on them, they are foreclosed or repossessed, or, before 2005, as long as the debtor was not in arrears, creditors could not repossess or foreclose on assets of those who filed Chapter 7 as long as their payments on those assets were current. Before 2005, people who declared Chapter 7 bankruptcy often walked away from their debts with a stain on their credit history that, after a few years, no longer affected them in an adverse way. Some of these people got into trouble because they lacked the ability or desire to budget properly. Others experienced some sort of financial setback like a catastrophic illness or injury. Some went on to rack up insurmountable debt again, only to have it discharged again through Chapter 7 bankruptcy. However, in 2005 the law regarding Chapter 7 bankruptcy f ilings changed so that deadbeat debtors could not file Chapter 7 bankruptcy so easily, and if they did file, the penalties were much greater. In 2005, the bankruptcy laws changed from one that favored the debtor to one that favored the creditor. People now cannot get into debt over their heads and then just file Chapter 7 bankruptcy to alleviate the debt they cannot afford. â€Å"The Bankruptcy Abuse Prevention and Consumer Protection Act of 2005 [BAPCPA] require the application of a ‘means test’ to determine whether individual consumer debtors qualify for relief under chapter 7. If such a debtor's income is in excess of certain thresholds, the debtor may not be eligible for chapter 7 relief† (Office of the U.S. Courts, 2011). In other words, if the debtor has a job, s/he may not be eligible for Chapter 7 bankruptcy. The â€Å"means test† requires that petitioners for Chapter 7 bankruptcy â€Å"complete Official Bankruptcy Form B22A, entitled "Statement o f Current Monthly Income and Means Test Calculation - For Use in Chapter 7." This then â€Å"determine[s] whether a presumption of abuse arises† (Office of the U.S. Courts, 2011). Form B22A consists of eight pages similar to a federal tax form that examines every source of income and debt a person has, allows for exemptions of some, and sets a limit of debts between $7025 and $11,725 and a limit of greater than 25% disposable income over five years to be eligible for Chapter 7. The Golden Gate University Law Review offers a hypothetical case of a couple with $28,000 of

OES SPS an Innovation in Repair and Conversion for the Offshore Essay

OES SPS an Innovation in Repair and Conversion for the Offshore Industry - Essay Example Rob Duffin presented a number of issues ranging from the significance of SPS in the transformation of FPSO’s which includes reduction of operational costs, life extensions and easier repair of the current station assets without disruption or operational effects. Another issue presented in the meeting was the compliance of the new technology to anti-piracy measures. I will report each of the issues separately as presented by Rob. The Director of the Institution of Civil Engineers introduced the presenter. Sandwich Plate System (SPS) overview Rob described the SPS is a structural complex consisting of two metal plates joined together using a polyurethane elastomer laminate a definition he got from Lehmann and Egge book published in 2009. Rob asserted that SPS is easier and tougher compared to hardened steel plate and is not as heavy to use as the strengthened concrete. SPS has found various applications in several areas such as structural flooring, pitch and field terraces, fixi ng and construction of ships of ships, and construction of bridges. SPS the Global Perspective Rob derived the global perspective of SPS technology from Kennedy and Ferro’s book published in 2007. Rob reported that all the Global stakeholders have acknowledged SPS as beneficial in the construction industry particularly concerning enhancing performance, sustainability and safety. In the maritime constructions, SPS has replaced the usually hardened steel used in making components such as hulls and bulkheads of ship. SPS reduces the stiffening problem and makes the components less prone to rust and fatigue. SPS is used in the construction of bridge supports and structure floors in replacement of the conventional strengthened concrete. SPS eliminates the problems of fatigue and rust associated with the use of strengthened concrete and steel. SPS place are easier to design and customize to the required dimensions. Some of the benefits of SPS plates include reduction of stiffness i n structures, ease of application and enhancement of designs in deeper-water construction. FPSO conversions –compact Double Hull Just as mentioned by McDermotte in his article Tanker Structural Analysis for Minor Collisions published in the Journal SNAME Vol. 102Technical Note FPSO P-57, typical SPS Overlays in the FPSO conversions entail the cleaning of the existing plate, fusing solid steel perimeter bars to create boundary functions. Rob pointed out that some of the advantages of the SPS Overlay include quicker repair schedules, reduced labor and minimized downtime. The overlay provides permanent upgrading at minimized repair expenses, lessened operating expenses and enhanced revenue potential. Offshore Life Extension According to Rob, McDermott in his article also emphasized the significance of offshore life extensions. SPS Overlay is a quicker and efficient method of reinstating and intensifying offshore crafts and structures. The Overlay thus strengthens the structures and prolongs their lifespan by offering permanent solutions to the previous short-lifespan projects. SPS Overlay allows for construction of high quality vertical and horizontal supports that possess strong impact resistance, lessened fatigue and controlled crack propagation. An advantage with the SPS Overlay application is that is employs the pre-existing or damaged plating to construct parts of the steel laminate panel. This is a cost-saving process while still increasing the

Impact of the Recession on Construction Contractors Essay Example for Free

Impact of the Recession on Construction Contractors Essay The current crisis in the world’s financial system has left the construction industry facing its toughest challenges for a generation. Salaries are falling; job cuts are predicted to reach 400,000 in England alone; and the impacts look set to get much worse before they get better. No country is immune from the impact of this and the UK, and much of the rest of the world, is already in, or about to enter a recession. Even buoyant construction markets such as the United Arab Emirates (UAE) are starting to feel the effect, with construction growth rate expected to slow from 20% to 15% in 2009 (Al Mal Capital). The United Nations (UN) predicts world economic output will shrink by as much as 0.4% in 2009 (UNs World Economic Situation and Prospects Report, 2009). These are serious times, however, the industry needs to be prepared to contribute to the recovery by retraining workers, maintaining the highest of standards of quality and supporting innovation. Construction professionals must not lose sight of their commitment to issues of sustainability, health and safety, ethical business practices and improved building standards. These will future-proof the industry and allow it to grow after the economy recovers. Companies seeking to find an extra edge in an increasingly competitive marketplace are likely to employ greater innovation as they look to become more efficient. This could have far reaching benefits for the industry in the future, where innovation has never been more vital. Construction Output It is clear that construction is in for a period of deflation. Forecasts suggest that there will be a 7% decline in output over the next three years, however, this figure is heavily contingent on Government spending coming through as planned (Construction Products Association). In the second quarter of 2008 new order figures were at their lowest level since 2004; 14% below the average last year. Housing orders were down 30%, private industrial orders by 36% and commercial orders by more than  £1bn from 2007 (Construction Products Association). A rapid decline in private work has been partly propped up by more public sector spending, however the outlook for the private sector over the next few quarters is set to get worse. The Olympics will prop up the industry to a certain extent but the cessation of office development will have a much greater effect. Overall, even if all public sector funding was spent next year, the construction industry in 2009 would still see the largest percentage of fall in output since the early nineties, when over 500,000 left the industry. This has been brought about by the sharp fall in private sector investment in construction – offices, retail, entertainment, as well as private house building. Public Sector Spending The Government’s decision to bring forward  £3bn of capital spending on infrastructure was cautiously welcomed by the construction industry (Pre-budget statement, November 2008). Given the extremely high levels of borrowing that the Treasury is expecting over the next few years, there is a risk that Government will fund later debt repayments with cuts in capital spending on construction further down the track. There is also a risk that delays in the Government’s existing build programmes will lead to increased under-spend. Programmes such as the Building Schools for the Future Programme have already fallen behind schedule, and reports suggest that this is as a result of bureaucracy rather than lack of funding. Business Finance and Loss of Confidence According to the Confederation of British Industry (CBI), more than half of British firms have seen a decline in the ease of access to capital since the onset of the credit crunch; 30% of businesses have been, or expect to be refused new credit; and 78% expect business conditions to be worse next year. The Government must urgently take steps to unblock the financial markets and improve the flow of capital to business. The fiscal mitigation measures that were recently announced by the Chancellor (Pre-budget statement, November 2008) were not sufficient to address the underlying loss of confidence facing all UK businesses (and people). More innovative ways could be investigated by Government to help the industry survive, such as providing credit insurance; relaxing bonding requirements on public projects; setting up project bank accounts; and providing tax breaks/concessions for sustainable construction RD. At present, the latter has effectively ground to a halt largely as a result of the deeply entrenched uncertainty that abound. Jobs Loss of Skills Almost 400,000 jobs in the construction sector in England could be lost over the next two years (assuming GDP shrinks by 2.2% in 2009 and rises by 0.75% in 2010). It is predicted that the worst affected area will be London, where 23% of workers are expected to be made redundant (Public and Corporate Economic Consultants for the Local Government Association). On the other hand, Eastern Europeans are responding to the downturn in the market by returning home, and this has eased the severity of the job situation in many instances. Given the forecasts for construction output in 2009, it could be assumed that jobs in the public sector may offer more security than those in the private sector. This reinforces the need for Government to establish how an accelerated public spending package will be implemented. It is essential that the government makes sure timetables don’t slip, and that it does what it can to speed up deal flows and bidding times. Through no fault of its own, the Construction Industry, in particular the house-building Industry, is having to dramatically re-structure and down-size merely to survive. The loss of technical resource and therefore expertise has been considerable and there are already signs that an upturn in the fortunes of the UK economy will not see these people return. This is a real concern, particularly as the science and technology that underpins UK sustainable construction is becoming even more complex and at a time when we need experienced people if we are to meet our sustainability objectives. Furthermore, it is not something that can be addressed overnight by short-term training and/or education. Procurement It has been reported that the credit crunch is likely to reverse the industry’s trend towards negotiated contracts and partnering. Instead, there could be a swing back towards single-stage, lowest bid tenders aimed at achieving the lowest possible outturn cost. While single-stage tendering may be seen as a quick fix during the economic downturn, this does not take the long-term view, nor adequately consider best value for money. It does however provide a more risky financial environment which is likely to become a fertile breading ground for claims and liquidations as contractors cut their profits to secure work in a decreasing market. Partnering has proved itself as the most efficient way of undertaking all kinds of construction work including new buildings and infrastructure, alterations, refurbishment and maintenance. Indeed the figures show that that in the four years from 2001 to 2005,  £700m of public money was saved, and the potential for two and a half billion in savings, would have been feasible had best practice been adopted across the board. When times are hard, best practice is at its most crucial to successful business. Fraud An unexpected knock-on effect of the credit crunch has been a dramatic rise in worldwide construction fraud. Evidence suggests that the average construction companys loss to fraud has increased by 69% in the last year (Kroll Global Fraud Report), driven largely by tough economic conditions. A total of 890 senior executives participated in the worldwide survey, which covered 10 industries, with just over one-quarter based in Europe. More than 95% of the construction companies surveyed said they had suffered from corporate fraud in the past three years up by 77% from last years survey. Most frequent types of fraud occurring in the construction industry include theft of physical assets or stock, financial mismanagement, management conflict of interest, and corruption and bribery. Companies will need to be even more vigilant than usual to reduce fraud in the construction industry. Sustainability Opinion is divided about the impact of the credit crunch on the sustainability agenda. A recent survey from the UK Green Building Council (UK GBC) suggests that while the conventional building industry suffers, the sustainable building sector is experiencing growth. Asked whether the financial crisis has impacted on their organisation in tackling sustainability, 56% of UK GBC members said sustainability had become a bigger focus. Only 18% said the credit crunch has had an adverse effect on efforts to address sustainability. On the other hand, a survey of small-medium sized contractors suggests that tough government targets on sustainable construction are being missed, as buildings fail to achieve the standards set by the Code for Sustainable Homes (National Federation of Builders). The survey revealed that contractors appeared to be quite knowledgeable about the driving issues and regulations for sustainability, but in over half (53%) of projects tendered for, sustainability was not a client requirement. Either way, it is important that new buildings, not least those procured by government, are of the highest possible environmental standards. Green building can be at the heart of a low-carbon economic recovery, boosting growth and creating green collar jobs. This is particularly true in existing homes and buildings, where we need a massive programme of refurbishment to cut carbon, reduce energy bills and produce more comfortable places to live and work. By continuing to build using sustainable technologies the built environment will be preserved for future generations, and a proven record in sustainable design will be invaluable in gaining new contracts in the growing sustainable market. Education and Training The future success of the construction industry depends on the availability of skilled professionals. The credit crisis poses a significant threat to the number of students enrolling in graduate construction courses. Students may be apprehensive about pursuing a career in construction in this unstable climate. This would result in a loss of specialist skills, which in turn would hinder the recovery and future development of the industry. Sandwich courses could be at particular risk because of the lack of available placements available. Many companies are reducing the number of placements they have for students or not taking on any at all. This could result in a reduction in the number of places available on the courses because they can not guarantee work experience placements. Apprenticeships in the UK house-building industry have also suffered as a direct result of the credit crunch. However, opportunities still exist in the bigger public sector infrastructure projects such as schools, hospitals, railways and roads. As a result of these risks the Government is working with Construction Skills to try and secure as many positions as possible for students. A new taskforce is being created to ensure that construction training is as effective as possible, and apprenticeship funding will also be increased to over  £1 billion to try and prevent skill shortages (Department for innovation, Universities Skills). For professionals already within the industry, there is research to suggest that individuals with specialist skills or training could potentially gain a competitive advantage in the current economic climate (Chartered Institute of Management). The research predicts that professional qualifications could result in an additional  £152,000 in lifetime earnings. It also suggests that a working knowledge of sustainable building and other innovative methods will be a particular advantage, with major projects on the horizon requiring an extensive skilled workforce in these areas. It is important for employers to train and encourage further development if they want to secure the future of the construction industry. This will ensure that their workforce is properly trained in up-to-date techniques and will put them in a stronger and more competitive position to win new contracts when market conditions improve. Although it may be inevitable for some to make financial cuts to survive, it is crucial to maintain a constant number of new innovative minds that will allow the industry to recovery and continue to grow.

Nature Imagery and the Life Cycle in Robert Frost’s The Wind and the Ra

Nature Imagery and the Life Cycle in Robert Frost’s The Wind and the Rain In his poem â€Å"The Wind and the Rain,† Robert Frost develops a central theme, presenting a man’s reflection upon his life. As the man ages, he realizes that he spent much of his life worrying about his inevitable death instead of living his life to the fullest. The man expresses his desire to renew life at all costs; he would rather die living than spend the rest of his life concerning himself with death. Robert Frost’s theme in â€Å"The Wind and the Rain,† therefore, is that life should be lived, and one should not worry about his inevitable death, for he does not have the power to control death, only the way he lives his life. Frost uses images of nature throughout the poem to support his central theme. In part I of â€Å"The Wind and the Rain,† the speaker discusses the fact that he is aging, and his death is undeniable. He realizes that he has â€Å"let [his focus on death] drive [him] deathward,† yet he has done little to change his focus. The man regrets that he spent much of his life â€Å"[singing] of death,† wishi...

Overview Of Trocar Insertion Procedure Health And Social Care Essay

2.1 Introduction: This subdivision introduces the trocar interpolation process to the reader. The apprehension of the mechanics of this process is critical for in depth research into assorted parametric quantities involved in the interpolation procedure. There are chiefly two constituents involved in this process viz. trocar or cannula placed on top of patient and the implicit in unrecorded tissue. Due to peculiar nature of the interpolation procedure, chiefly two types of organic structure forces are applied on trocar organic structure i.e. interpolation force in longitudinal way and jumping torsion for incursion. This action can be thought to be similar to a drill being alternately rotated while perforating a stuff block. However, there are other boundary conditions and initial analysis parametric quantities introduced. 2.2 Description of the process: Minimally invasive surgical processs are frequently named based on the type of sing range used to see the country of the organic structure which is the operative site. For illustration, laparoscopic processs use a laparoscope to see the operative site and are performed in the inside of the venters through a little scratch. A gas such as CO2 is introduced in the tummy pit to set up pneumoperitoneum wherein the peritoneal pit is sufficiently inflated for the interpolation of trocars into the venters. Pneumoperitoneum is established through the usage of a usage insufflation acerate leaf, called a Veress acerate leaf, utilizing a spring-loaded obturator that slides over the crisp tip of the needle every bit shortly as the needle enters the peritoneal pit. This acerate leaf is inserted through the facia and through the peritoneum. The sawbones entirely depends on tactile feedback generated at the fingertips to find the proper arrangement of the acerate leaf. After set uping pneumoperitoneum, the following measure in laparoscopic surgery involves the interpolation of trocar/obturator assembly into the abdominal pit. Based on the type of surgery, there may be one or more trocar interpolations to entree the interior organic structure volume related to surgery. A simple conventional diagram for description of the process is given below Figure 1. Schematics of trocar interpolation process [ Ref Web [ 1 ] ] Degree centigrades: Documents and SettingsYongMy DocumentsMy Pictures rocar rocar6.jpg Figure. Trocar being inserted into abdominal pit [ Ref 24 ] Above figures depict the assorted forces and torsions involved in a regular trocar interpolation operation. Trocar is held with one manus for proper arrangement of trocar on the abdominal part. The other manus is used for using torsion every bit good as for uni directional force application. The magnitude of applied force with regard to clip and figure of bends applied while tissue incursion are of import parametric quantities for imitating this process realistically. There are different methods for cannula interpolation: by puting a trocar under direct vision into the peritoneal pit ( Hasson technique ) [ Ref 22 ] or â€Å" blindly † with a bladed trocar with the venters desufflated direct puncture and direct puncture with visual image through an optical trocar. Alternatively, a needle system could be used to entree the peritoneum to at the same time insufflate the venters and present a sheath through which a blunt trocar could be placed [ Ref 23 ] . Harmonizing to the port a rrangement guidelines, there are by and large multiple interpolations of trocars into abdominal part in order to handily entree different surgical sites with coveted tools. Some tools are used for catching and review of the tissue while others are used for cutting or suturing intents. There is a cardinal scratch through which a camera is inserted into the abdominal pit in order to project the surgery being performed on a picture screen for ocular mention intents. The full process is carried out under general anaesthesia. 2.3 Description of trocars and design parametric quantities: There are a figure of types of trocars that are available for interpolation, depending on the application. Choice of trocars by and large depends on several factors such as the type of entree site, debut of tools of proper size at the site including stapling machines, cartridge holder applicants and retractors. Harmonizing to the rule of cutting, there are cutting trocars and distending trocars. Cuting trocars integrate some signifier of blade at the site of cutting while the dilating trocars try to press and distend the tissue without cutting it first [ Ref 4 ] . Earlier trocars integrated conelike or pyramidic terminals in order to consequence interpolation, while the newer version incorporates safety shields and blunter plastic blades. Trocars are available in both metal tip and plastic assortments. A hollow or solid conelike plastic tip is a preferable design. Newer version of trocars attempts to unite design characteristics of both cutting and blunt type trocars to cut down the opportunities of hurt and for less applied force demands [ Ref 4, 25 ] . Five different types of trocars were compared in a publication and perforations were performed on the porcine tissue. A figure of different parametric quantities such as defect size, interpolation force and removal force were measured under standardised clinical conditions for 12 mm entree trocars [ Ref 4 ] . The trocars used were shown in figure below which involve a individual blade cutting type trocar, a blunt and radically distending trocar, plastic blade which is really common, triangular cutting blade type and the most modern design i.e. intercrossed distending type trocar. Figure 12-mm entree systems used in the survey. ( A ) Single blade film editing ; ( B ) blunt-radial dilating ; ( C ) plastic blade ; ( D ) trigon blade film editing ; ( E ) hybrid distending [ Ref 4 ] Figure. a ) Pyramidal blade reusable B ) Pyramidal blade disposable trocar [ Ref 25 ] Figure. a ) Flat blade trocar B ) Non bladed trocar 1 degree Celsius ) Non bladed trocar 2 [ Ref 25 ] It was found that radially distending and intercrossed types are similar in footings of perforations while removal force was more or less similar in each instance [ Ref 4 ] . This survey nevertheless underlines that characteristics of cannula design i.e. ridges, togss and textures are responsible factors for minimising remotion forces. While new designs cut down the interpolation forces, they do n't lend towards drastically improved interpolation consequences over the traditional bladed trocar design [ Ref 4 ] . Besides it has been found that there are differences in defect sizes and lesion parametric quantities associated with trocar geometry and type [ Ref 25 ] . It is desirable that we cut down the affected country of the lesion and herniation of facia caused by the remotion of trocar at the site ; nevertheless it is difficult to document all the design factors impacting different lesion parametric quantities. A more matter-of-fact attack can be to prove the trocar on latest FEM p ackage for failure analysis of the environing tissue membrane and secret plan different emphasis affected zones next to the interpolation site. 2.4 Modeling of trocar interpolation process: The research work proposed in this thesis uses two different methodological analysiss to near the job of realistic mold of the trocar interpolation process 1 ) Interactive Haptic simulator for patterning force feedback interaction 2 ) Finite element mold of trocar interpolation process 1 ) Interactive Haptic simulator for patterning force feedback interaction: This process is a premier campaigner for practical world simulation based trainers for sawboness to derive valuable simulation experience before they pattern existent trocar interpolation on patients. There have been several efforts to develop a needle interpolation based simulator for sawbones preparation undertakings, the outstanding amongst them uses an synergistic user interface based system, which gives the expert sawbones, a freedom to tune different mechanical tissue parametric quantities in order to leave different kinaesthetic esthesiss to the user [ Ref 3 ] . It is really difficult to reproduce the exact tissue behaviour experienced during surgery in a feasible Haptic simulator. Hence this closed cringle method provides a benchmarking expression to set up tissue belongingss in a Haptic sense. Figure. Block diagram exemplifying minimally invasive surgery [ Ref 26 ] Above figure gives an thought about the closed cringle schematic for minimally invasive surgery which is applicable to trocar interpolation process as good. However, trocar interpolation process in itself is non a surgical process but a precursor to the existent minimally invasive surgery process. As shown in above figure, the sawbones has a limited position of the surgical site and force, place, speed and torsion are the active applied inputs on trocar, which are so transmitted bit by bit to patient abdominal tissue. During the full process, the sawbones receives distorted kinaesthetic feedback. The feedback is discontinuous since every bit shortly as equilibrium between applied and reaction force is established momently, there is no feedback force. The opposition to incursion is chiefly determined by the implicit in local tissue belongingss and trocar geometry and stuffs used. Figure. Block diagram exemplifying Virtual world preparation with force feedback for minimally invasive surgery [ Ref 26 ] Above figure illustrates the closed cringle system integrating a Haptic based practical world preparation simulator which involves a practical instrument interface. The interface transmits applied force, place, and speed and torsion vector information many times every 2nd to tactile environment underlying the simulator to calculate the hit sensing with practical tissue and update the force feedback vector. Trainee sawbones feels the fake force feedback through the practical instrument interface which uses commercially available tactile devices such as Phantom Omni or usage built Haptic devices. Simulated ocular feedback is provided through either 2 dimensional show on computing machine proctors or two-channel vision [ Ref 26 ] . One of the jobs faced while constructing a trocar interpolation simulator, is imitating proper tissue behaviour at the point of braking through tissue beds, i.e. the feeling of sudden giving off of the tissue when trocar brakes through the rectus abdominis part. For the finding of proper force profile for this simulator, a through literature reappraisal was carried out to garner informations about assorted tissue parametric quantities, braking force values for different tissue beds and existent secret plans of force profile informations, found in old documents. We have determined that, there are two attacks for obtaining the force profile – plotting of the reaction force experienced by sawboness with regard to clip and with regard to distortion distance. Rendering process utilizing tactile devices has been explored antecedently in a figure of surgery simulations. There are assorted attacks to turn to the job of visio tactile simulation of deformable objects based on spring mass based systems. There are many finite component based fluctuations for spring mass based simulations such as finite component method ( FEM ) [ Ref 27 ] and boundary component method ( BEM ) [ Ref 28 ] . Current research job nevertheless offers a alone challenge since it involves tissue distortion simulation and in writing rendition of tissue cutting during the procedure of trocar interpolation. For the simplification of our research job, during the first stage we concentrated our attending on tissue distortion and non on tissue cutting simulation since it ‘s a separate research job. Trocar interpolation chiefly involves tissue distortion, opposition force to weave distortion, braking force and frictional opposition to torquing gesture [ Ref 2, Ref 5 ] . T here is no literature available on torque measuring and word picture of tactile belongingss for opposition to rotatory gesture of trocar. The literature that is straight related with this topic is slightly obscure in nature such as the torsion measuring and word picture while managing of machine tools and rotary motion of prison guard driver [ Ref ] . Another research paper which is more relevant trades with measuring of torque interactions while managing laparoscopic tools [ Ref 29 ] . Hence we needed to trust on ergonomic mentions for approximative calculation of torque feedback magnitude and nature of torque interaction. For simplifying the tactile theoretical account, it is proposed that there are two primary mechanisms or provinces for grip force and torque interaction of trocar with regard to abdominal tissue. These two provinces are described in the figures below. In these figures, the transverse plane in which trocar geometry resides is termed as cutaneal plane and the angle between this plane and y-axis is termed as I ± , the angle between omega axis and cutaneal plane is termed as I? ( tilt ) and the rotary motion of the trocar around the trocar axis is defined in footings of angle I? ( tortuosity ) . 1. Mechanism for first province: First phase consists of gradual addition in distortion forces in a way analogue to the axis of trocar. As applied force additions, the reaction force reaches a maximal threshold value called braking force after which, trocar interruptions through facia and so through the peritoneum. There is by and large really small clip slowdown between these two incursion phases therefore, it is difficult to separate between the centripetal feeling for these extremums. Please refer to calculate below. We see that there is a gradual addition in applied force ( on applied force V clip graph ) after which there is a plateau part when farther really small addition in force causes the applied force to transcend the braking force value. Depending on local tissue belongingss, there can be several extremums after the first tableland part is reached, and so sudden lessening in force is experienced. This generalised nature of the force profile is verified through several mentions. If we observe the force pr ofile in Ref 6, we see that for 12 millimeter bladeless trocar, the extremum force value reached is about 70 N, while for 5 millimeter bladeless trocar, the recorded extremum force value is about 35.84 N [ Ref 6 ] . However, this research work was carried out utilizing unreal tissue under tenseness, without expert accomplishment. Another research paper that trades with existent extremum force measuring, on human tissue, utilizing piezoelectric detector mounted between sawbones ‘s manus and trocar, has produced a spike natured force profile [ Ref 1 ] . The maximal peak force recorded utilizing a detector in this instance is tantamount to 5 millimeter of HG force per unit area at the trocar reaching surface country [ Ref 1 ] . It is to be noted that the interpolation clip for trocar, in this instance is really short since the expert sawboness have right centripetal standardization which allows them to infix the trocar utilizing fewer figure of bends and with lesser force magnitu de [ Ref 2 ] . However, we observe that after extremum force value is reached, in all force profile instances, there is a sudden lessening in opposition force since the material failure standard is reached. 2. Mechanism for 2nd province: After tissue incursion, 2nd phase prevails during which trocar wall surface is in direct contact with environing penetrated tissue. It is difficult to depict the nature of destroyed tissue and the local coefficient of torsional every bit good as skiding clash. These forces are of import because, during the backdown stage, sawbones has to carefully abjure the trocar in such a manner that there is no injury to internal variety meats. The easiness with which trocar is withdrawn is a direct consequence of these forces and trocar geometry. The magnitudes and the nature of the force profile ( force V clip secret plans ) are discussed in following few subdivisions. Figure. Four grades of freedom of trocar while interpolation, applied and reaction forces during tissue distortion province Figure. Frictional peripheral force along the walls and Torsional frictional twosome at the fringe, after tissue incursion 2.5 Force and torque parametric quantities: Force Data Different techniques are available to obtain realistic mean extremum entry force informations plotted against clip or distortion. One of the direct techniques involve, mounting a force or force per unit area detector on existent trocar while the process of minimally invasive surgery is carried out. Another technique involves measuring of incursion force based on porcine tissue incursion utilizing a research lab device. However there are a figure of variables involved and it is really difficult to set up a aureate criterion or a scope of values for a peculiar instance. Body aggregate index of the patient, age, degree of exercising are some of the factors that affect the force profile informations. One of the documents reported utilizing existent piezoelectric transducer fond regard mounted between trocar surface and sawbones ‘s manus to obtain specific force profile informations for each patient with regard to clip [ Ref 6 ] ; nevertheless upon observation of the force profile, we see that the force profile informations does n't give us an thought about gradual addition in trocar force opposition. This force profile represents a spike in footings of reaction force experienced, which is unequal to imitate a complete trocar interpolation, since it does n't enter gradual alterations in force profile happening merely before incursion. However, the magnitude of braking force for each instance is noted down and we can utilize this statistical information to construct a simulator which allows for different braking force values based on correlativity between patient ‘s age and average extremum entry force [ Ref 6 ] . A old experiment to mensurate the entry force utilizing laboratory experiment uses a mechano chemical examiner which tests the incursion of a stretched alternate tissue, to plot a force versus incursion distance informations. This trial uses changeless velocity of incursion for the trocar and does n't pay attending to application of torsion while infixing trocar, as in existent process [ Ref 5 ] . Another paper related to old work, for imitating trocar interpolation uses a parametric theoretical account to imitate three separate parts for a force profile informations utilizing multinomial fit [ Ref 1 ] . We found that this attack is really utile for readily incorporating a given force profile into tactile simulator, for experimentation intents. However the usage of any such force profile is arbitrary, till it has been verified by adept sawboness to be as close an experience to the existent undertaking of trocar interpolation. Table I clip in s Force in N clip in s Force in N 0 0 1.25 20 0.2 8 1.4 30 0.5 7 1.5 35 0.7 5 1.6 40 1 10.1 1.7 50 Time in seconds Force in N Force in N Time in seconds Figure ( a ) Rough secret plan of Force profile [ Ref 1 ] , ( B ) Force profile after re-parameterization and curve adjustment Figure ( a ) Typical spike force profiles obtained from 5mm and 10 millimeter diameter trocar interpolations [ Ref 6 ] Another important research work performed utilizing instrumented trocar systems against 20 swine theoretical accounts was reported in one of the recent documents by Paserotti et Al. [ Ref 29 ] . The full experimental process was repeated for two bladed non retractile trocars and four bladed retractile trocars. Table II [ Ref 29 ] Fd, entire thrust force ( Newton ) ; Ff, force needed to travel through facia ( Newtons ) ; Fp, force needed to travel through peritoneal liner ( Newtons ) ; Fl, loss of drive force after come ining the peritoneum ( Newtons ) ; Ld, the sum of tissue distortion ( centimeter ) ; Lt, the length of trocar exposed in the venters after the peritoneum retracts ( centimeter ) ; NA ; non applicable ; Td, clip to drive the trocar into the venters ( sec ) ; Tr, continuance of blade exposed unprotected ( sec ) [ Ref 29 ] The characteristic nature of force profile obtained in this research, confirms the fact that there are multiple extremums encountered during incursion for get the better ofing different tissue beds ( facia and peritoneum beds severally ) . After the braking force magnitude is reached, a sudden loss of opposition or giving off of the tissue is experienced which should be efficaciously simulated with the lowering of Haptic opposition during the simulation. Torque Data: Measurement of torsion informations for trocar interpolation procedure, is a complex undertaking since interpolation normally involves 2 to 5 bends in clockwise and anticlockwise waies [ Ref 2 ] . The clasp features and the mode in which torsion is applied is non unvarying for all the instances, besides some sawboness use small to no torquing when it comes to interpolation. Hence, we have to trust on informations from old research work in order to acquire an thought about the torsion magnitude. There are other ergonomic mentions from which we can mention to the industrial class torquing attempts in assorted types of clasps such as power clasp, cardinal pinch and tip pinch clasps etc. There are two major classs of clasps viz. prehensile and non prehensile clasp [ Ref 31 ] . The clasp used for catching trocar organic structure is a prehensile type of clasp ( specifically cylindrical ) and based on the carpus rotary motion and gripping force, variable sum of torsion can be transmitted a t the interpolation point. For the screwdriver interpolation gesture which is about tantamount to the trocar interpolation gesture in some ways, the maximal torsion that can be exerted is about 5 Nm for a feed force of about 60 N [ Ref 30 ] . However a more dependable projection for torque measuring is found in another mention [ Ref 31 ] , for both instrument to organ interaction during laparoscopic surgery and trocar abdominal wall interaction during interpolation procedure. There are a scope values that have been documented in this mention, which suggest that rotational gesture in the clasp produces approximately 0 to 0.7 Nm of torsion at the interface. Besides, the frictional force opposing the rotary motion is found to be about 3 N in magnitude at the interface. A major guideline for design of Haptic simulator is stated in this mention that Haptic esthesis is greatest at the low value of translational or interpolation speed and at the smallest angles of tilt I? [ Ref 31 ] .