Robotic surgery

zombiic mathematical executionInformation Technology in medicament Should patients self-confidence zombieic process1 Introduction to the topicRobots argon present to solar day. They argon found in our cars, in our houses, in our industries inside buildings and to places we neglect to notice. We trust automatons to do everyday chores for us either by k instantering directly or indirectly. Robots argon becoming part of our lives and we thrust all accepted it. instantly technology has advanced so that it allows for innovative robotic clays to be inserted in the medical field. New materials, ideas and technological advancements act upon robotics into medicine. Robotics in medicine entails many advantages and gain grounds for both the doctors and the patients. But on that point argon also any(prenominal) limitations in robotic operative process that cause doubt and uncertainty to slew.However, as it happens with every juvenile technological development, people pick up t ime to go familiar with it, to accept it and finally trust it. So the question is if the world is urinate to accept and trust robots in health and much specifically in cognitive process. in that respect depart be people who are pioneers and enjoy trying some(a)thing new, people who are skeptical and need to bed everything approximately it before agreeing and people who will be afraid no matter how much proof theyre given. There dejectionnot be an abrupt transition from classical surgeries without robots to surgeries all aided with robots. Gradually, the surgeries aided with robots will increase as peoples experience and trust increases.2 IT Background2.1 History of robotics Most of us when we hear the word robot we think of science fiction movies showing robots of the forthcoming, performing outstanding tasks. In fact, to the highest degree of these robots seen are now everyday reality making our lives more convenient. peerless definition that could be given to a robo t is a re platformmable multi-functional manipulator designed to carry material, parts, tools, or specialized devices through variable programmemed motions for the performance of a variety of tasks.1Robotics is the engineering science and technology of robots, their design, manufacturing, and applications. It is related to electronics, mechanics, and software.ht_2bunimate_080415_sshRobots could not be manufactured until the 1960s when transistors and integrate circuits were invented. Compact, reliable electronics and a growing computer industry added intellect to the power of already existing machines. In 1959, researchers demonstrated the calamity of robotic manufacturing when they disclosed a computer-controlled milling machine.2The low gear digitally operated and programmable robot, the Unimate, was installed in 1961 to lift naughty pieces of metal from a die casting machine and pile them.3Commercial and industrial robots are ubiquitous in performing jobs cleanse, cheaper, more accurately and reliably than mercifuls. They are also found in jobs that are too hazardous, dirty or tedious for humans.42.2 Robotics in surgery5Robotics in medicine is a fairly new, in so far forward field. It is now introduced in medicine, in the field of surgery as it allows for exceptional control and preciseness of surgical devices in minimally invasive procedures. Robotic surgery has as its main goal to design robots that will be able to be apply in performing closed-chest, beating-heart surgery in collaboration with the surgeons.Munich_OR_415Today legion(predicate) surgical robots hit been adopted by many in operation(p)(a) rooms all over the world. operative robots are not developedly autonomous surgeons capable of performing assignments on their own, solely a aid assistant of the surgeons.A number of commercial corporations wipe out been founded in place to create surgical robotic outlines. calculating machine Motion, Inc. developed the AESOP Endoscope Po sitioner a voice-activated robotic system for endoscopic surgery.In January 1999, Intuitive launched the DaVinci surgical administration, which is classified as a master-slave surgical system as it uses true 3-D visualization.In 2001 electronic computer Motion, Inc built the SOCRATES Robotic Telecollaboration System as well. It includes integrated telecommunication equipment along with the robotic devices in order to provide remote surgical telecollaboration.figurer Motion merged with Intuitive Surgical, Inc., in June of 2003.They introduced the ZEUS Surgical System.3 Robotic surgical procedure SystemsRobotic surgery systems are divided into iii types supervisory-controlled systems, shared-control systems and telesurgical systems. These systems differ in the sense that in each courting in that respect is a different degree of involvement of the surgeon. In some cases, the operation is carried out by the robotic system with a minimal intervention of the doctor. In other cases, the surgery is performed by the doctor with the help of the robotic system.3.1 Supervisory-controlled systems 6supervisorySupervisory-controlled systems are the most(prenominal) automated systems of all. But they still need the guidance of the surgeon and an extensive preparation before the inauguration of the surgery. The surgeon inputs information and programs the robotic system to follow certain instructions. However, once these robots form been programmed, and inception operating there is no option for adjustments and thats why the surgeon must keep a close watch of the surgery in the need of intervention.As it is known, not all people have the homogeneous clay construction and so it is not possible to have standard instructions for the robot to follow.This is invite in trinity stages planning, registration and navigation.In the planning stage, the surgeon captures images of the patients body. As soon as the surgeon has imaged the patient, he must determine the path that the robot will take to operate.The next stage is registration, in which the surgeon cogitate the images obtained before with points on the patients body. In order for the surgery to be completed successfully, the points must be positioned solely according to the patients body.The final stage is navigation, which is the actual surgery. In this stage the surgeon places the patient and the robot so as the efforts of the robotic system to follow the programmed instructions. When all preparations are complete, the robot is activated and the surgery is carried out.3.2 Shared-control robotic systems7Shared-control robotic systems are a helping hand for the surgeons. The operation is carried out save by the surgeon who uses the robotic system manually in order to have greater efficiency. The robotic system monitors the surgeons actions during the operation and provides support and stability by active coldness.7 Active constraint is the process of labelling regions of the patients body with one of the four possibilities safe, close, boundary and prohibit. Surgeons label safe regions the regions that are appropriate for the robot to be and to operate. For instance, a close region buttocks be found in orthopaedic surgery in orthopaedic surgery, near the soft tissues. umpteen orthopaedic surgery tools can damage the soft tissue and so the robot limits the area that the surgery is safe to take place. This is done using haptic technology8, which is the science and physiology of the sense of touch. This means that as the surgeon approaches the boundary region he will start feeling a resistive force and as he proceeds to the forbidden region the force is getting larger and once he enters the forbidden region the robotic system simoleons operating immediately. But in order for the robotic system to know which are those regions, the surgeon must program it first as it is done with the supervisory controlled systems.3.3 Telesurgical systems 9Telesurgery is a field of telemedicine that was developed in recent years and holds great interest. Today it can be seen as a two way transmission of examine and sound, allowing the communication between surgeons of little experience and surgeons of great experience to cooperate no matter the outdo separating them.Also it is understood, this technology needs highly advanced software in order for the simulation to be feasible in the remote surgery room. For this purpose, systems of virtual reality are required that allow the surgeons that are in a different room or city or country to have an actual image of the operating room and of the procedure. Robots with photographic camera will provide a better quality of the images as they will be in colour and enlarged.3.3.1 Da Vinci Surgical System 10The Da Vinci Robot is believably one of the most well-known robotic surgery systems in the world. It is a robotic system that is use in minimally invasive surgery, which means that the robot makes a petite aper ture in the patients body that brings many positive results.DaVinci-Robot During the surgery, the surgeon sits in a console inside the operating room and handles the surgical tools of the robot. After the patient has been anaesthetized, lead apertures are make on the patients body allowing the rods to enter. On the screen the surgeon observes the 3D image that the camera is transmitting through the patients body and which is handled by joysticks. The camera sees every movement of the robot and can be activated or deactivated any time from a button.11 Every surgical arm is connected with a surgical tool and there is camera in the end of the main arm. One of the rods has a camera on it while the others have surgical tools able to cut, remove or stitch the tissues. The robotic system uses the same stitches and materials utilize in the traditional surgery.The surgeon can bend and rotate the arms like the human wrist guaranteeing increased destiny of success and important benefits much for the patient as for the surgeon.The Da Vinci robotic system includes a lenses system of three-dimensional view, which can make the surgical field as 15 clock larger. Also, the camera allows the surgeon to go closer at the point of surgery than the human vision can and so the surgeon can perform the operation in a smaller scale than the unoriginal surgery allows.3.3.2 genus genus Zeus Robotic Surgical System12The robotic surgical system Zeus was the first system to be used in 1999 to perform the first full endoscopic robotic surgery bypass with a beating heart.It consists of three basic parts1. 1zeusconsoleAn ergonomic control console2. the central control computer3. Robotic arms, which move with the movement of the surgeons hand.The surgeon sits comfortably in the surgical seat and handles the tools that are placed inside the patient. After the surgeons movements have been digitalized they are filtered, thinned and transmitted to the computers control station, which transfers those movements through an electromechanical interface to the robotic arms and to the tools.In addition, Zeus robotic system enhances the optical field of the surgery by enlarging it and also with the help of AESOP robotic system the surgeons hands are free to handle the surgical tools.3.3.3 AESOP Robotic Surgical System 13AESOP Robotic surgical system was developed by Computer Motion Inc. The period when it first came out, the surgeon could control the robotic arm remotely, manually or with a seat pedal but the most recent edition of AESOP 3000 is controlled with voice commands.The robotic arm contains and moves a camera which is used in MIS surgeries for the observation of the surgical field. The camera is placed at the edge of the robotic arm and is inserted in the patients body through an aperture of about 2cm. The robotic system AESOP is the surgeons third arm. By using simple commands such as AESOP, move up or AESOP, move left, the surgeon tells the robot to move the camera as he wishes. Every surgeon records his voice and has a voice card that is inserted into the system whenever he operates, in order for the robot to identify the commands. Usually the system builds well. The robot whitethorn sometimes not signalise the tone of the voice of the surgeon is different from the recorded voice. But there is a support system with which the surgeon can handle manually if something like this happens.3.3.4 SOCRATES Telecollaboration System 14Socrates telecollaboration system was the first system to be approved (October 2001) for the new-founded category telesurgery robotic systems. It consists of advanced telecommunication equipment that is connected with medical devices and robotic systems. The system gives the surgeon who is at a remote location the opportunity to work with another surgeon who may be in an operating room across the globe. The system provides real time view of the surgery. In collaboration with Zeus robotic system, Socrates is the first fu ndamental step that marks the start of minimally invasive telesurgery. In 2001 Socrates robot along with Zeus robotic system performed the first translantic surgery. On September 7th, 2001 a group of surgeons in New York performed a cholecystectomy surgery on a patient located in France with the help of doctors that were there. The console and the robot were connected with graphic symbol optic wires. This surgery was first tested on six pigs.That was the first complete telesurgical process that was performed by surgeons 7000 onward from their patient. The patient left the hospital 48 hours after the operation and returned to his social activities a week later.4 Advantages and Limitations 154.1 AdvantagesThe advantages of robotic surgery are listed below1. Tinniest incisions result in* Faster recovery* Shorter hospital catch ones breath and reduced be* Less pain and fear* Less blood loss* Cosmetic benefit* Reduced risk of infection or complications* Less anesthesia required2. Be tter sterilization3. Robot immune to radiation and infections.4. No muscle tremor or fatigue.5. Elimination of need for personnel resulting in lower costs for the hospitals.6. Shorter return to everyday activities(1-2 weeks)7. Telesurgery The ability to perform surgery from a different operating room.8. A 3D camera provides an enhanced view.9. Robots reach places that surgeons alone couldnt before.10. Can be designed for a wide range of scales.11. Surgeons dont get tired quickly as theyre seated and have less centre strain and they have the ability to control their natural flinching or nerves more effectively.4.2 LimitationsHowever some of its disadvantages and concerns are1. Robotic systems have highly complex software and it is very difficult to program and debug them.2. cost including the robotic systems ($750.000-$1 million), the maintenance and the procreation of surgeons are considerably high.3. Since the need of personnel will be minimized, some surgeons will be left unempl oyed.4. Telesurgery is based by a large percentage on the transmission of information between two locations. The more the distance between the two locations the more the time clutches is inserted. This increased the period between the action and the result and after a certain point this makes surgery impossible in real time.5. Synchronization during telesurgery is very critical and is not easy to attain.6. Telesurgery is highly subject on the security and reliability of the network.5 Robotic Surgery in Greece 16The first robotic navigation system used in a surgery procedure in Greece is the Vector Vision II system in Ygeia (see www.ygeia.gr) hospital in Athens.In February 2003 the robotic surgical system Aesop 1000 was used to perform the first laparoscopic operation in the General Hospital of Crete, Greece.Aesop 1000 is being improved in the labs of University of Crete and will be released as Aesop 2000 and Aesop 3000 and soon is expected to be used in more complex operations and surgeries.In addition, the initiate of medicine in the University of Athens offers advanced courses on robotic surgery. The course aims to teach basic robotic surgery skills such as instrument manipulation, camera control among others. This is done using the Da Vinci surgical system.171stdayIn November 8th,2006 the open airing day of the Da Vinci robotic system took place in the Athens Medical Center Hospital.The president of the Hellenic scientific Robotic Surgical Association Prof. K. Konstantinidis explained the fundamental principles of the Da Vinci robot to Greek ministers and the establishment of the Hellenic Scientific society of Robotic Surgery.The first total hysterectomy in Greece was successfully carried out with the latest-generation Da Vinci Robotic Surgery System at the symptomatic and Therapeutic Centre of Athens HYGEIA. the operation was broadcasted in real time during the daily conference held at the Hospital on Tuesday, July 1st 2008, titled Robotic Surgery in Gynaecology.185.1 Survey analysisA check up on was conducted during October and November 2009 in Athens about robotic surgery, in which 73 people answered (ages 14-50). The pile included a questionnaire and it was distributed by email. Robotic surgery in Greece is in its infancy so it is sooner reasonable to see that 72% of the people asked knew nothing about robotic surgery.6 Social Concerns 6.1 Safety Safety is the prime concern of patients and doctors. mint today have trouble trusting robotic devices in general and in the case of their healthcare the issue of trust is intensified. First of all, there is always the possibility of errors happening as total safety is a fallacy. Robots are programmed by humans who in turn are not infallible and are prone to make mistakes. In the case of robotic surgery a fault could have wicked health injuries or death. Thus, the prospect of errors must be kept at a very low level and in the case of a malfunction the system must be programmed to shut down immediately. Afterwards, the surgeon will have to take over complete the operation manually. So, it is obvious that the presence of a human doctor is mandatory and critical. There are many things that can go wrong which experts must take under serious consideration. Some problems resulting in system failures can be flawed design of the system, malfunction of software and hardware19or misinterpretation and inadequate specification. In order to eliminate the possibility of errors, mechanics must undergo heavy testing and reasoning about infinite scenarios. Also surgeons must prepare the robotic system cautiously so as not to forget anything which can backfire. They also need to have contingency plans like converting the robotic surgery to open surgery.20The increased testing and reasoning is time-consuming and usually involves high costs.Even though safety is a big issue, 41% of the people asked would go through a robotic surgery.This can be considered a reliable percen tage as 65% of the people asked believed that robotic surgery is safe and reliable.6.2 Reliability and knowledgeNowadays most people dont trust robots very easily. The reason for this is the neediness of information and the fear that these robots/machines can harm them in a physical level or in a professional level.As it can be seen from the above 88% of the people asked have heard of robotic surgery but 56% of the people asked claimed to know very little about it.As it is stressed in a website about robotic surgery, and prostate pubic louse surgery in particular, most people worry about the side effects it could have on them such as sexual dysfunction and impotence.21 Another concern was the fear of the robotic system and the probability of errors, but most people do a little research before resorting to robotic surgery. This way they minimize their worries and concerns. However, there still are people who despite the evidence dont trust robots with their health.Therefore, roboti c surgery needs time to become known and trusted by the people. This percentage of 56% must be minimized and increase the percentage of knowledge. In the future, as robotic surgery will start being implemented into hospitals, there will be many surgeries done, successful or not, which will enhance robotic surgery by correcting the errors, the failures and any problem that may arise. This way, patients who had successful operations will spread the word and people will become more aware(p) and acquainted with this new technological development.7. Elevating concerns, resolving problemsRobotics in surgery is a great helping tool, which holds many benefits and advantages for the surgeons and the patients. However, since it is still at an early stage of development there are problems in need for resolutions.One great concern is the reliability and safety in delicate surgical procedures. We cannot deny that machines are make from humans, who are not infallible and thus tend to make mistak es. Whether the surgery is done by a plethora of surgeons or by a single surgeon and a robot there is in spades the possibility of error.As with every new technology, people need time to get familiar with it and to start trusting it. Thus robotic-aided surgery just needs time to advance and to become more well-known. People who go through robotic surgery procedures will spread the good news. The media will start making more coverage of the issue as they learn about more cases. As mentioned by many patients in the Da Vinci website, they were very pleased with the surgery and the recovery time which proved to be shorter than expected.22 Furthermore, the training of surgeons may take a while but it does not compare having to do a 6-hour surgery above the patient, getting tired and stressed with a 4-hour surgery sitting in the robotic device some metres away from the patient. The surgeon will tire less and will finish the surgery in less time. As far as the costs are concerned, patients in the Da Vince website did not worry about the costs so much because they were dealings with their health. And most people will do anything for their well-being.238. FutureRobotic surgery has made quite a progress and development but it still has a long way to go. Many obstacles will be dealt with time and undoubtedly some new concerns may appear. Questions such as malpractice liability, credentialing, training requirements and license granting will have to be resolved in the future.Most people on the survey (49% to be exact) answered that robots could have negative implications on employment as robots will do most of the work that humans currently do and many of related jobs will be reduced.However, as mentioned in the advantages chapter, new fields are inserted into robotic surgery such as telemedicine, which shows that new needs for personnel emerge.Also it is quite interesting to note how the people asked are divided into three groups based on their answers concerning robotic surgeries in the futureThere is a 64% of the people asked who have a positive outlook on robotic surgeries in the future and a 36% who are quite intimidated and afraid of this potential change. Part of this comes from the lack of information about robotic surgery and from the fact that it is still in an early stage.As far as robotic surgery is concerned, there is much to be done until it can reach its full potential. Even though, these robotic systems have enhanced dexterity significantly, they still need to advance the full potential in instrumentation or to integrate the full range of sensory input.Most people when hear about robotics, they think of automation. The possibility of automating some tasks is both exciting and controversial. Future systems might entail the ability for a surgeon to program the surgery and merely supervise as the robot performs most of the tasks. The possibilities for improvement and advancement are only limited by imagination and cost.9. ConclusionRobot ic surgery may be at an early stage, but that does not mean that it has not demonstrated its potential and significance, particularly in areas previously inaccessible by traditional procedures. However, it still remains to be seen if robotic surgery will replace completely conventional instruments in less technically demanding procedures.Robotic technology will bring major changes in surgery by enhancing and expanding laparoscopic procedures, advancing surgical technology and thus bringing surgery into the digital age. Not to mention, it possesses the potential to expand surgical treatment beyond the limits of human ability. The benefits of robotic surgery outweigh the costs.10. Bibliography10.1 Online (World Wide Web) SourcesPearl Tesler, Universal Robots The history and working of robots, 10 October 2009Wikipedia, Robotics,16 July 2009History of robotic surgery, Overview of Major Surgical Robotic Systems and Companies,17 July 2009William Harris, How Haptic Technology Works, 4 Sep tember 2009http//electronics.howstuffworks.com/gadgets/other-gadgets/haptic-technology.htmYoutube, Robotic surgery demonstration, July 24, 2007, 7 September 2009http//www.youtube.com/watch?v=0NZLpWrJGgk Youtube, Robotic Surgery, April 05, 2007,15 September 2009Youtube, Robotic Heart Surgery, February 12, 2007, 19 September 2009Youtube, Robotic Heart Surgery Allen Raczkowski, MD, February 03, 2009, 25 September 2009http//www.youtube.com/watch?v=LezbxU5P1ucRobotic Surgery in Greece,22 April 2009,8 October 2009http//roboticsurgery.grRobotic Surgery, Simulation assisted training in Robotic Surgery,15 January 2010Robotic SurgeryROBOTIC SURGERY IN TELEMEDICINE HYGEIA S.A. The first total hysterectomy in Greece with the da Vinci S Robotic System,1 July 2008,20 January 2010http//www.kapetanakis-center.gr/www_eng/news/010708.pdfRobotic Surgery blog, Robotic reliability, 2 March 2007,17 January 2010http//www.njurology.com/RoboticSurgeryBlog/robotic_surgery_basics/Da Vinci Surgery, Patient S tories, 25 January 2010http//www.davincistories.com/search-stories/search-stories-result.html?start=15condition=Prostate%20Cancer10.2 Works-research papers , (da Vinci, Ze ,Hermes). .( Despoina Xisaroglou ,Robotic Surgical Systems, Problems and perspectives (accessed July 23rd,2009) Caroline GL Cao Gary Rogers, Tufts University, Robotics in healthcare, (accessed June 12th ,2009) Sunitha M.V, Robotic surgery, seminar writing, August 2008 (accessed July 10th, 2009) (Grinis Athanasios), (robotic surgery) (accessed September 13th,2009)11. Appendix 11.1 Robotic surgery Questionnaire1. Have you heard about robotic surgery?a) Yesb) No2. How much do you know about robotic surgery?a) A lotb) Very littlec) roughly nothing3.Do you know anything about robotic surgery in Greece?a) I know quite a some thingsb) I know very littlec) I know nothing4.Have you heard of any of the spare-time activity robotic systems?a) Da Vincib) Zeusc) AESOPd) Socrates Robotic Systeme) None of them5. Do y ou think robots can perform surgery better than humans?a) Yesb) Noc) Im not sured) Maybe in the future6. Do you think that robots could have negative implications on employment?a) Yesb) Noc) Im not sure7. Would you undergo a surgery aided with a robotic system?a) Yesb) Noc) Im not sured) If absolutely necessary8. Do you think that robotic surgery is safe and reliable?a) Yesb) No9. Would you avoid a robotic surgery due to costs?a) Yesb) No10. How would you delineate a future where all surgeries are done by robots?a) Very appealingb) Very utilitarian and time-savingc) Not so happy about it.d) Quite frightening.61 Robot Institute of America, hf issues in surgery. PDF(accessed June 12th ,2009)2 http//www.thetech.org/robotics/universal/index.html (accessed October 10th,2009)3 http//en.wikipedia.org/wiki/Robotics (accessed July 16th ,2009)4 http//en.wikipedia.org/wiki/Robotics (accessed July 16th ,2009)5http//biomed.brown.edu/Courses/BI108/BI108_2004_Groups/Group02/Group%2002%20Website/h istory_robotic.htm (accessed July17th,2009)6 Robotic surgery, a seminar report by Sunitha M.V. (accessed July 10th, 2009)7 Robotic surgery, a seminar report by Sunitha M.V. (accessed July 10th, 2009)8 http//electronics.howstuffworks.com/gadgets/other-gadgets/haptic-technology.htm (accessed September 4th, 2009)9 (robotic surgery)- (pdf file)(accessed September 13th,2009)10 (robotic surgery)- (pdf file)(accessed September 13th,2009)11 http//www.youtube.com/watch?v=0NZLpWrJGgk (accessed September 7th, 2009)12 (da Vinci, Ze ,Hermes). .(Robotic Surgical Systems, Problems and perspectives) by Despoina Xisaroglou. (pdf file) (accessed July 23rd,2009)13 (da Vinci, Ze ,Hermes). .(Robotic Surgical Systems, Problems and perspectives) by Despoina Xisaroglou. (pdf file) (accessed July 23rd,2009)14 (da Vinci, Ze ,Hermes). .(Robotic Surgical Systems,Problems and perspectives) by Despoina Xisaroglou. (pdf file) (accessed July 23rd,2009)15 Robotic Surgical Systems,Problems and perspectives) by Despoina Xisaroglou. (pdf file) (accessed July 23rd,2009)http//wikipedia.com/robotics (accessed July 16th,2009)http//www.youtube.com/watch?v=mR-PC8kCi_A (accessed September 15th,2009)http//www.youtube.com/watch?v=0NZLpWrJGgk (accessed September 7th,2009)http//www.youtube.com/watch?v=k3gIa_w4GXQ (accessed September 19th,2009)http//www.youtube.com/watch?v=LezbxU5P1uc (accessed September 25th,2009)16 http//roboticsurgery.gr (accessed October 8th,2009)Robotic Surgical Sy

Development of Controlled Drug Delivery Systems (CDDS)

Development of Controlled Drug Delivery Systems (CDDS)1.1 CONTROLLED DRUG actors line SYSTEMS (CDDS)Now a twenty-four hour periods on the breeding of newfangled do medicates voice communication arrangements (NDDS) marked consideration has been foc single-valued functiond. The method of point economy to the site of action shows a signifi sack upt effect on its efficacy. It leads to the development and evolution of novel medicate address systems that enhanced per mildewance of electromotive force dose tittles. Novel dose pitch shot systems play a let on role in pharmaceutical investigate and development. Since when compared new chemical mediety the developmental personify and time required for introducing NDDS is relatively low.Oral pass remains hotshot of the most natural r come verbotenes of drug validation and has seen infrequent accomplishments in the last couple of decades towards optimization of impromptu carry throughy of drug molecules. Oral ing estion is one of the oldest and most extensively utilise routes of drug administration. They provide an effective method of obtaining systemic and local effects.Drug voice communication describes a process whereby a sanative agent is administered to the body in a figureled manner. The products commercial and clinical value, product specialization can buoy be improved by developed drug saving technologies. These advanced technologies serve as an advanced resource to outreach the competition. By simplifying the administration and dosing regimen drug delivery technologies make medicine more than satisfactory and convenient to a patient.Any drug molecule by victimisation Novel drug delivery system (NDDS) can get a new life, and thus improving the competitiveness, patent life and market value. Among distinguishable NDDS present in the market, the major share in the market is consort by the oral controlled rel fill-in systems because of its greater benefits of patient complianc e and ease of administration. The development of novel and highly versatile delivery systems and osmotic drug delivery systems are the major contribution in oral NDDS.Basically, thither are three novel modes of drug delivery, i.e.Targeted delivery,Modulated relax andControlled release.Targeted delivery refers to the administration of a drug carrier systemically in order to deliver drug to the specific type of cells, tissues or organs. Modulated release implies use of a drug delivery thingamajig that releases the drug under controlled environmental conditions, bio feedback, sensor input or an external control device at a variable esteem. Controlled release refers to a specific device that delivers the drug at specific release profiles or at a mold rate into the patient body.1.1 CONTROLLED DRUG DELIVERY SYSTEMS (CDDS)The nature of the controlled release back breaker nervous strain is such that the release is determined by the flesh of the system and the physiochemical propertie s of the drug and is in appearent of the external factors or the microenvironment in which the dosage form is placed. These products typically provide significant benefits over immediate-release conventional dosage formulations. optimum therapy with repetitive administration of conventional dosage forms (e.g. injectables, liquids or tablets) can classically be pursued by dosage scheduling. The aim of this process is to prevent drug parsimony in a therapeutic range, above the negligible effective stringency and below the toxic concentration.Thus CDDS avoids the undesirable truism tooth characteristics of the plasm concentration vs time profiles of the conventional drug products.A delineate illustration of controlled versus conventional dosage delivery is shown in Figure-1.Fig 1.1 plasm Time profile of controlled drug release and conventional releaseThe plasma concentration of the drug reaches a maximum (crest) with conventional dosage forms and past decrease (trough) at the point where repeated administrations becomes necessary to maintain the plasma drug concentration. Very lots the initial concentration is above the therapeutically effective level that may increase the risk of side effects. effected dosage forms can thus result in a drug regimen in which the drug concentration oscillates between alternating fulfilments of dose and inefficiency.The delivery of drug at controlled rate over an extended period of time is represented mathematicallyRate in = Rate out = Ke x Cd x VdWhere Cd is the desired drug level, Vd is the volume of distribution and Ke rate content for drug riddance from the body.Added to this, the high cost of development of new, safe, specific and effective drug molecule is prohibitive and developing nations virtually cannot afford such integrated multi-group cost intensive drug development ventures. Therefore, many pharmaceutical industries and drug research institute oriented their efforts to develop pre-programmed unattended d elivery of drug at a rate and for a period to meet and achieve the therapeutic need. These systems are coined as Controlled drug delivery systemsTable 1.1 Classification of oral controlled release systems depending on mechanism ofRelease 3 (vyas etal,2002)1.1.1. ADVANTAGES OF CONTROLLED RELEASE PRODUCTS 4As controlled release dosage form are slightly pricy than conventional formulations, they cannot be justified unless they offer come clinical or practical advantages given belowReduction in dosing frequencyto a greater extent uniform effectReduced fluctuation in steady levels change magnitude safety margin of high potency drugsImproved patient restroom and complianceReduced in total amount of dose administered turning away of night time dosingReducing of GI irritation and another(prenominal) dose related side effects andReduction in health palm cost.1.1.2.DISADVANTAGES OF CONTROLLED RELEASE PRODUCTS 4However, controlled drug delivery systems also have virtually disadvantages. They include,High costPoor systemic avail cogencyUnpredictable and often poor invitro-invivo correlationPossibility of dose dumpingDosage adjustments say-so is reducedFirst pass clearance potential is increasedIn case of hypersensitivity reactions, toxicity or poisoning drug retrieval is rockyEffect of oral dose depends on Mean Residence Time.To control or change the drug release from a dosage form there will be a tally of design options. close to of the per oral controlled release dosage forms comes under the category of osmotic, matrix or rootage systems. The polymer matrix contains embedded drug in matrix systems in which the release occurs by partitioning of drug into the release medium and polymer matrix. In case of reservoir systems a rate controlling tissue layer is skirt and coated around the drug core. But, drug release from conventional controlled systems i.e., reservoir and matrix systems is affected by various factors like presence of food, pH and different physiol ogical factors. In case of osmotic systems the drug is delivered establish on the rulers of osmotic closet. The drug release from this system doesnt depend on the pH and various physiological parameters and thus by optimizing the drug and systems properties the release characteristics can be modulated.1.2. OSMOTIC DRUG DELLIVERY SYSTEMS A suss out1.2.1. HISTORICAL BACKGROUNDIn 1955 Rose and Nelson utilized the principles of osmotic storm in drug delivery for the first time. They described two systems one that delivered 0.02 ml/day for 100 days and another that delivered 0.5 ml/day for 4 days, both for use in Pharmacological research.In the 1970s, Higuchi and Leeper proposed a series of variations of the Rose-Nelson pump5. Theeuwes further modified the Rose-Nelson pump and developed a system. teentsy osmotic pumps of these forms are sold under the trade name ALZET (Alza Corp., CA). The device has a volume of approximately 170l, and the normal delivery rate is 1l/hr.A major mile stone was achieved in 1974 with the translation by Theeuwes and Alzas co-workers of a tablet design composed of a compressed tablet-core surrounded by a trucking rig permeable membrane with a single orifice, so-called Elementary osmotic pump (EOP). This design adaptation for human use was conveniently processable using standard tabletting and coat procedures and equipment. The first two products indomethacin, Osmosin6 and phenylpropanolamine, Acutrim TM6 were launched in the 1980s.Oral osmotic drug delivery system (OODS) development continued with two new OODS designs, the controlled-porosity osmotic pumps (CPOP) and the push-pull osmotic pumps (PPOP). The first of these was the CPOP, which was designed to decrease the risk of extremely localized drug-induced irritation at the site close to the orifice.In the 2000s, a new drug product based on OODS technology was formulated to deliver methylphenidate to children (above the age of 6 years) with attention-deficit hyperactivity diso rder (ADHD). These delivery systems were based on a new design, the push-stick osmotic pumps (PSOP), which combined immediate and sustained drug release phases.The drug release from this system doesnt depend on the pH and various physiological parameters and thus by optimizing the drug and systems properties the release characteristics can be modulated. In the last few years more number of patents are granted on these oral omotic drug delivery systems. These systems has ability to improve therapeutic agents clinical profile and so they are go one of the most attr combat-ready technologies today.osmotically controlled oral drug delivery system for the controlled delivery of active agents follows osmotic pressure principle. For the controlled drug delivery osmotic devices are most assured strategy based systems. Among the controlled drug delivery systems these are most reliable systems. osmotic systems could be used in the form of implantable devices or oral drug delivery systems. Os motic pump tablet (OPT) generally consists of a core including the drug, an osmotic agent, other excipients and semi-permeable membrane coat.1.2.2. THEORYOsmosis can be defined as spontaneous movement of a result from a solution of lower solute concentration to a solution of higher solute concentration through an ideal semi permeable membrane, which is permeable only to the solvent and impermeable to solute. The pressure utilize to the higher-concentration side to inhibit solvent flow is called osmotic pressure8.Osmotic pressure is a colligative property, which depends on concentration of solute that contributes to osmotic pressure. Solutions of different concentrations having the same solute and solvent system exhibit an osmotic pressure proportional to their concentrations. Thus a constant osmotic pressure, and thereby a constant influx of wet supply can be achieved by an osmotic delivery system that results in a constant zero order release rate of drug8. doctrine OF OSMOSISAn osmotic system releases a therapeutic agent at a predetermined, zero order delivery rate based on the principle of Osmosis, which is movement of a solvent from lower concentration of solute towards higher concentration of solute across a semi-permeable membrane.When osmotic system is administered, from the one or more delivery ports the drug that contain suspension or solutions is pumped out of the core due to the hydrostatic pressure developed by the drunkenness of water in to the core osmotically through the semi-permeable membrane. By the water influx through semi-permeable membrane the delivery of drug from this system can be controlled.Osmotic pressure is directly proportional to temperature and concentration and the future(a) equation describes the relation between them = cRTwhereOP = osmotic pressure, = osmotic coefficient,c = molar concentration,R = gas constant,T = Absolute temperature.OSMOTIC PUMPSOsmotic pump is a new delivery device, which delivers drugs or other acti ve agents at a controlled rate by the principle of osmosis. Control resides in the water permeation properties of the formulationsTable 1.2 Examples of some marketed band of Osmotic drug delivery system7DEPARTMENT OF PHARMACEUTICAL TECHNOLOGY, SVCPPAGE 1

Gender Victimization in Contemporary World The Cauldron of Crime

G caner Victimization in present-day(a) World The Cauldron of CrimeThe article presents a dupeological analysis of plague victims on the basis of their intimate urge victimisation performance of the teenage little girls, functional wo men, opposite effeminates and as well as of homophile(a)s, lesbians and transgender. The article progresses by tracing and analysing the fe potent pick up as organism women as sister be atomic number 18rs, internal objects for men, and nurturers. This piece tends to high spot respective(a) forms of victimisation perpetrated on women wish domestic ferocity, genital mutilation, rape, cozy set on, stalking, trafficking for sexual exploitation, honour killings and female infanticides, and showing that the slur of legal and hearty hold dearion of iniquityd females is critical. Further moving on to lesbians, courageouss, bisexuals or transgender a whole array of forms of victimisation soak up been explained which take on verba l abuse, humiliation in their loving perspective, forsaking by family members and relatives, natural/violent attacks several(prenominal)(prenominal)(prenominal) of which might lead them to put suicides. Thus all these forms of development inflicted upon the one-half-hearted and vulnerable sex would be analysed elaborately in this musical composition and discordant reasons that lead to their using engage excessively been explored. The paper would as well as shine up the imp crook of victimization on these race by looking at its non-homogeneous consequences over fiscal, in-person, genial, psychological and social aspects of the victims life and also assessing the tie-in of the stain of victim with the vicious offense which imprint the extent of their vulnerability to plague. The paper tends to emanate possible solutions from within the ambit of criminology and victimology that would help understand the position of a victim and the offender in a collapse co unsel which in turn would help implement various recommendations do in this paper for eradicating all kind of gender victimization.IntroductionThe path of tuition of law from ancient period till the 21st century has perpetually been complex and challenging with ever changing perspectives of the society. Through appear this period, umbrage and criminology has molded up the overall facet of law as what it stands today. thither has been a profound effect of crime on the society and its law in each era. However, the perspective of society towards crime has generally been narrow and unrivaled-sided, as the besides concentration of criminology stands on the crime perpetrators, their behaviour, their characteristics and the penalties and punishments im simulated on them. Criminology has failed to spy the other side of the crime i.e. the victims and their authority in crime which has at once gained prominence owing to the serious repercussions of crime on society as a whole. This co ntemporary concept of studying the behaviour of victims before and later on crime has be sleep with an authorised partition of the study of crime fall under victimology. Thus victimology has helped us segregate various types of crime perpetrated on victims, the reason why particular victims fall prey to the offenders, the effect of crime on victims and m whatever more(prenominal). In this detailed analysis we also pay heed that at many an(prenominal) occasions crimes perpetrated argon gender establish and atomic number 18 concentrated against vulnerable section of females handle teenage girls, married women, split up women, girl child, mothers and the trans-genders or spankings or lesbians become an easy tar rifle for this. at that place be a plethora of reasons which make them vulnerable to crime namely, somatogenetic attri moreoveres, social status, ideologies, orientation and the impact of criminal victimization is affected by factors like sex of the victim, age, a victims prior history of victimization or that of persons kn give to the victim, overall perceptions of crime, the type and severity of crime experienced, and the relationship in the midst of the victim and the offender.1The discussion close gender bagd victimization also encompasses various types of crimes perpetrated on females and trans-genders which overwhelm sexual victimization, physical victimization, emotional victimization and sexual orientation victimization in type of braws and lesbians. Thus this paper aptly traces the trajectory of gender based victimization from various dimensions focal point on the af shapeath of victimization from the victims as well as societys perspective.The rude forms of gender victimizationGender based victimization is something which has always been there, entirely was hardly condemned owing to the patriarchal society masterd by men. However, with various social reforms according the equal status to women, there has been a pregnant shift in the ideology of society which has started paying attention to the issues link to women. Thus in this scenario the moot-able point that demands a lot of discussion and make come on is that why is there so much of gender based victimization? And how the females, trans-genders, gays or lesbians atomic number 18 victimised in the open daylight, within quadruplet walls of their homes, offices etc.? To regard an answer to these questions we impart now look into various forms of crime perpetrated against women and other vulnerable groups of the society. New terms to describe forms of fierceness concentrated on women include domestic terrorism, marital rape, date rape, conversance rape, degrees of sexual encroachment, wife abuse, wife battering, intimate-partner violence, emotional abuse, stalking, sexual harassment, and gender harassment. walkThe degree and intensity of stalking vary from situation to situation. Usually, stalking implies harassing or threatening behavi our often reiterated by an individual, like continuously interest a person, secretly appearing at a persons home or place of work, making blank phone calls to harass, putting written messages or objects, or damaging the objects or property of a person. Thus any unknown or known but unwished extend to among dickens mickle that directly or indirectly create a threat or put the victim in precaution piece of tail be regarded as stalking.Anyone open fire be a fink, just as anyone can be a stalking victim.Stalking is a crime that can have serious after(prenominal)-effects on anyone, unaffected by gender, race, sexual orientation, socioeconomic status, geographic location, or personal associations. However, if we follow the general blueprint of stalking its the female sex that generally falls prey to the stalking. accord to the statistics of stalking in United States of America every year 1,006,970 women and 370,990 men argon stalked. These figures show that stalking incidents ar magnanimously higher when it comes to female sex. Most stalkers of these females are young to middle-aged men with above- average parole and many a times from very respectable families and background. Most of the stalking moorings crop up from some previous personal or amorous relationship between the stalker and the victim. In such situations, stalkers listen to dominate over every aspect of the victims life. Gradually, the victim becomes the stalkers source of self-esteem, and the loss of this contact takes up the shape of greatest fear for stalker. This dynamic makes a stalker dangerous where he can go to any extent to march on contact with.Unfortunately, the stalking of a female leaves her depressed and puts her in the situation of paranoia where she finds it difficult to come to the social terms out of continuous fear in her promontory. To aggrandize the situation some stalkers retrieve obsessed for other person with whom they have no personal relationship and when the victim does non reciprocate this, the stalker tries to abuse and threaten the victim and some stalkers whitethorn even turn to violence. Thus stalking today has become a very special K form of victimization of college girls, working women, teenage girls and it pose a great risk to their mental as well as physical health . domestic violenceMoving on to other forms of victimization, domestic violence is also one of the most common forms in which the victim bears the brunt non of st lamrs but of their own family members. Domestic violence is one of the crimes against women which are linked to their disadvantageous position in the society. Domestic violence refers to violence against women especially in matrimonial homes. Domestic Violence can be described as when one adult in a relationship misuses power to control another. It is the establishment of control and fear in a relationship through violence and other forms of abuse. The violence whitethorn involve physical abuse, se xual assault and threats. Sometimes its more subtle, like making someone feel worth slight, not letting them have any money, or not allowing them to leave the home. Social isolation and emotional abuse can have long-lasting effects as well as physical violence. Therefore domestic violence is recognized as the significant barriers of the empowerment of women, with consequences of womens health, their health health-seeking behaviour and their adoption of small family norm. Many studies are of the view that violence by intimate partner most liable(predicate) undermines the sexual and reproductive health of the women. This extensive violence has significant insidious effects like unwanted pregnancy, gynaecological deflects and physical injuries to private separate besides life-sized-scale mental health impacts. Again, many of the comm that associated disorders/problems are found to be inadequately addressed. Violence by husbands against wife should not be seen as a break down in th e social order rather than an affirmation to patriarchal social order. Similarly, is of the view that not just wife beating is deeply entrenched, but also people justify it. Thus, domestic violence is simply not a personal abnormality but rather it roots in the cultural norms of the family and the society. foul up/ sexual assault fluff is an assertion of power and not an act of lust. Violence on women is an extension of patriarchy, which means male rule. The two principal(prenominal) features of patriarchy are sexual power and supremacy. By rape it is take a firm stand that dominance is the male temperament and subordination the womens. Rape is a aware process of intimidation by which man keeps woman in a state of fear in the confidence that the victim forget not reveal the event to others. It is not like murder to him, though in actuality he murders the life of a woman. Rape can occur when the offender and victim have a pre-existing relationship (sometimes called date rape), o r even when the offender is the victims spouse (called marital rape).However, the scene just doesnt end here as rape victims face serious after-effects of rape which include psychological trauma, impression, physical injuries. The plight of rape victims is also aggravated by various myths attached to rape which bring forward victimizes the victim. These include statements like Rape is rarely a casual encounter women ask for it and they get it by their own acquaintances. If women stay at home, where they belong, they would not get raped. The victims behaviour contributes towards her own victimisation. Most rapes are false accusations filed by women who are trying to get even with some men. Women who get raped are somehow morally corrupt, they are considered to be of loose character and even their tradition is like that. lot try to find fault with the victim rather than the culprit. These are a a few(prenominal) myths which significantly contribute in the agony of a rape victim. In any case, a traumatized rape victim finds it lump to stand up to the courts scrutiny. When such a vulnerable person is further exposed to a battery of embarrassing personal questions, she would naturally feel psychologically disadvantaged. Thats the reason why we have such few convictions in rape cases in India. Most victims either end up withdrawing their cases or reaching an out-of-court settlement. It does not only victimise her, but it also leaves a lifelong stigma on the character and dignity of a woman, causation her and her relatives, pain and agony. The mental torture is so deep that it hardly heals and if it heals at all, it takes a very long time to heal. The woman generally fuck offs in silence and endures in shame.Gender ine gauge Abandonment/ abortion of girl childAround the world, a number of different devotes conduct in physical and emotional harms to girls. In several countries, girl children are viewed as a drain on family resources, and having one or more s ons and few or no daughters is valued. Thus, in China and India, girls are abandoned in public places or whitethorn be neglected as infants and whence die women in South Korea often abort a foetus that is known to be female.Usually, an unbalanced sex ratio of boys to girls is used to tell selective abortion of girls or neglect that gist in their death. An perchance low ratio of girls to boys is referred to as the problem of missing girls. Female-selective abortion is originally but not exclusively practiced in China, Taiwan, South Korea, Pakistan, and India it also is not uncommon for Asian immigrant populations, including those in the United States andCanada. Abortion, life-threatening neglect, and abandonment to ensure that a daughter is not added to the family is related to cultural beliefs and to gender inequality. Countries with the greatest number of missing girls are those having the most patriarchal gender arrangements, according to which males control property, have th e only inheritance rights, and have better employment options. Complementary cultural beliefs about sons support sex-related abortion in countries with resources to detect sex during pregnancy and for people who can pay for contracting and abortions, as well as neglect or abandonment of newborn girls in countries with less advanced economies and technologies. Thus these practices of gender inequality affect not only one single female child but the whole female partnership. This leads to further degradation in the status of women in society which victimizes the whole community in terms of equal opportunities or equal treatment at home and at workplaces.Female venereal mutilationGirls who are born and who survive can be reminded of their inferior status through the practice of female genital mutilation (FGM). Specific beliefs and norms that promote the practice of FGM vary between countries, but in general the notion that women moldiness be submissive to their husbands provides the rationale for continuing the practice. Women in regions of Africa where the practice is common believe that without the procedure, girls will be wanton and will not stay put a virgin before marriage or faithful afterward, and that FGM will protect them because they will not seek sexual relations for pleasure, so their bodies belong totally to the men who marry them. Women support their male family members extremity of FGM both out of concerns that their daughters will be married, which in some places is the only way that a female can survive economically or socially, and also to avoid their own ostracism by being shamed, throw out of the house, or divorced. Thus this is another form of gender based victimization which cripples many societiesTrafficking for sexual exploitationHuman Trafficking, which involves the secret conveyancing of people across local or national borders for the sole causality of sexually exploiting them, is a heinous crime that in most dowery victimizes g irls and women. Women, teenage girls, and sometimes boys are duped or labored into relocating to another knowledge domain of their country, generally from rural to urban areas, or to other nations, where they are entrapped and swindled to lock in in harlotry. In worse situations some poor families living on a lower floor want line sell their female children to traffickers. According to the international entropy available on trafficking around 1 million people are trafficked for sexual exploitation throughout the world each year. International trafficking of women gained luxuriant pace after the collapse of the economic system of erstwhile Soviet Union and other African and Asian nations, as the situation was correct for prohibited illegal opportunities and the demand for prostitutes and the hefty profits that could be make from them, along with minimum risk compared to drug and arms trafficking, accentuated the steep heighten in trafficking.Although gender-related poverty i s an element that makes trafficking possible, it is an influence only when it is coupled with two other things motivated traffickers, usually operating in organized criminal groups, and countries or cities that are large sex industry centres where prostitution is tolerated or is legal. The recruiters (sometimes women allowed to escape their work as prostitutes), the pimps, and the traffickers, plus the international inequalities in chances for pick and a good future, are the essential influences on the movement of large numbers of women to settings where they are founted to abuse and forced to prostitute themselves. For example, in India moneylenders or their agents will visit areas that are affected by desperate poverty. Moneylenders may own whorehouses, where they place the girls and women to work. In other cases, they may supply the women and girls to brothel keepers for a fee, and then require them to work until the fee is paid off. once involved in prostitution, women ar e forced, in various ways, to continue. Asian-Indian women have name to researchers that despite desires to stop, they continued prostitution because of illiteracy, beatings, starvation, rape by family members, and sexual exploitation in alternative jobs that paid less than prostitution, and that therefore created the reality that prostitution provided a higher rate of pay for sexual acts that they would have been forced into regardless of not working as a prostitute. Thus in this way forced prostitution is the face of horrendous monster haunt women who are in desperate need of financial help and renders them victimized both sexually and psychologically.Sexual orientation-motivated crimeThe victimization of lesbian and gay men, through either verbal harassment or varying degrees of physical assault, is the most common kind of bias related violence. More than half of the lesbian and gay male adult population have been estimated to have encountered some form of verbal harassment or violence in their lives. The victimization of gays, lesbians and trans-genders may be in varied forms which might include hate crimes directed against their whole community or in some countries like India abandonment by own relatives and family members. The ideology of various societies is impossible towards this concept of differently sexually oriented people and thence people punish gays, lesbians and trans-genders for not being the same as they are. This is very ironical that people fail to appreciate ones own preferences about life and try to impose upon them such conditions which are considered as i strike in a society. This in itself is that facet of victimization of such people who feel neglected, unwanted at the hands of stereotypes in society. Victimization of lesbians, gays and bisexual youth compromises with their mental health as an impact of assault on youth. Thus those youths who are open about their sexual orientation must not only cope with difficult personal matte rs but must also deal with negative reactions of family and friends. As a resultant role of these cumulative speech patternes lesbians, gays and bisexual youths may be specially at high risk for suicide. Thus this depicts that ingrained cases of victimization of bisexuals and homosexuals might even lead them into the dark lanes where they end their lives out of depression.Impact of victimizationGender-related and sexual orientation-related victimization can be particularly traumatic because possible victims are at risk by right of gender, which for women and girls is readily apparent, and because it can be motivated by misogyny, dislike of gay and lesbian individuals, and other forms of hate directed at the very personal identity of a person. For women and girls, because victimization is so often within the family or association of acquaintances, there is the profital disquietude introduced by violation of trust and the potential for continued contact with the victimizer.Ps ychological traumaVarious researches across the clod have demonstrated severe and complex effects of gender-related victimization. In addition to physical injury and in some cases disability, battering can result in depression, anxiety, and PTSD. A report sponsored by the World Bank think that throughout the world, wife abuse is a serious threat to health and quality of life, results in injury or death, and has negative spill-over effects on children, the workplace, and the broader community. As a result of this larger percentage of victims become subject to ongoing emotional and psychological abuse, a form of violence that many battered women consider worse than physical abuse.Domestic violence also has psychological effects that include fear, anxiety, fatigue, and post-traumatic var. disorder. Some victims of incest and other forms of child sexual abuse, wife battering, and stalking are traumatized over a protracted period. Compared to women who are infrequently stalked, those who are relentlessly stalked over a period of time not only are at greater risk for physical, sexual, and emotional abuse but also satisfyed more depression and PTSD. Repeated victimization can produce long-term changes in how survivors set up their emotions, self-perceptions, and relationships with other people, and the meanings they attach to actions and events. The term complex posttraumatic syndrome refers to these sorts of long-term changes.Coming to homosexuals and bisexuals, gay and lesbian survivors of hate crimes are more depressed, angry, anxious, and stressed they also have more crime-related fears and more often describe personal setbacks that resulted from attacks. Victimized gay and lesbian youths from both rural and urban areas reported high order of suicide attempts. Many victims of sexual orientation-motivated hate crimes are afraid to report their victimization, and some turn their feelings inward and feel shame or immorality about their identities.Financial l ossThe economic effects of gender-related victimization could be profound. Many people who are battered in intimate relationships, stalked, raped, and utilise by people who benefit financially from their prostitution are economically marginalized by their victimization. If they are physically or psychologically traumatized, they may be unable to work in legitimate settings. Whether or not individuals simultaneously hold the statuses of victim and offender, the economic impact of gender-related victimization can result in immediate loss of financial resources and long-term declines in quality of life if it is necessary to live in less desirable neighbourhoods. system AbuseThe suffering endured by crime victims does not end when their attacker leaves the scene of the crime. They may suffer more victimization by the jurist system. While the crime is still fresh in their minds, victims may find that the police interview following the crime is handled callously, with innuendos or insin uations that they were somehow at fault. They have difficulty learning what is going on in the case property is often kept for a long time as evidence and may never be returned. Some sexual assault victims report that the treatment they receive from legal, medical, and mental health services is so destructive that they cant help feeling re-victimized. Victims may also suffer economic hardship because of wages lost while they testify in court and find that authorities are indifferent to their fear of requital if they cooperate in the offenders prosecution.Long-Term StressVictims may suffer stress and anxiety long after the incident is over and the evaluator process has been forgotten. For example, girls who were psychologically, sexually, or physically abused as children are more apparent to have lower self-esteem and be more suicidal as adults than those who were not abused. Children who are victimized in the home are more plausibly to run away to escape their environment, which puts them at risk for recent arrest and involvement with the justice system.Stress does not end in childhood. Spousal abuse victims suffer an extremely high prevalence of depression, post-traumatic stress disorder (an emotional disturbance following exposure to stresses outside the range of normal human experience), anxiety disorder, and obsessive-compulsive disorder (an extreme immersion with certain thoughts and compulsive performance of certain behaviours). One reason may be that abusive spouses are as likely to abuse their victims psychologically with threats and intimidation as they are to use physical force psychological abuse can lead to depression and other long term disabilities.Some victims are physically disabled as a result of serious wounds sustained during episodes of random violence, including a growing number that suffer paralyzing spinal cord injuries. And if victims do not have adequate indemnity coverage, the long-term effects of the crime may have devastating financial as well as emotional and physical consequences. worryPeople who have suffered crime victimization remain fearful long after their wounds have healed. Even if they have escaped attack themselves, hearing about anothers victimization may make people timid and cautious. For example, women who are being abused by their partner may be fearful of inform the abuse to authorities, especially when they read media reports about women who have been stalked and dispatch by their partners following disclosure of the abuse to police. Victims of violent crime are the most deeply affected, fearing a repeat of their attack. There may be a spillover effect in which victims become fearful of other forms of crime they have not yet experienced people who have been assaulted pause fears that their house will be burglarized. Many go through a fundamental life change, viewing the world more suspiciously and less as a safe, controllable, and meaningful place. These people are more likely to su ffer psychological stress for extended periods of time.Antisocial BehaviourThere is growing evidence that crime victims are more likely to commit crime themselves. Being abused or neglected as a child increases the odds of being arrested, both as a insipid and as an adult. Young people, especially those who were physically or sexually abused, are much more likely to smoke, drink, take drugs, and become involved in criminal activities than are non abused youth. Incarcerated offenders report significant amounts of post-traumatic stress disorder as a result of prior victimization, which may in part explain their violent and criminal behaviours.Some Progressive developments in IndiaIn the recent past there has been an upsurge in rape cases apart from above solutions, there has been a unparalleled improvement in the Indian scenario where many progressive developments have been made by judiciary to protect the interests of victims affected by sexual assault, rape, domestic violence and other manifestations of male dominated society. Thus in the wake of current discussion it becomes important to put some light on one of the most remarkable judgement delivered by Supreme Court of India in the case of Delhi Domestic Working Womens Forum Vs. Union of India, which laid down various guidelines for protect the dignity and integrity of rape victims and sexual assault victims.The complainants of sexual assault cases should be provided with legal representatives who are well acquainted with the criminal justice system. The victims advocate must also provide her guidance to go for mind counselling or medical assistance whenever needed.Legal assistance will have to be provided at the police station since the victim of sexual assault might very well be in a distressed state upon arrival at the police station.The police should be under a duty to inform the victim of her right to theatrical before any questions were asked of her.In pursuance of the directive principles containe d under A. 38(1) of the musical composition of India to set up Criminal Injuries Compensation Board whether or not a conviction has interpreted place.The court also held that in cases where fines and compensation orders were given together, the payment of compensation should take priority over the fine. These developments gumption a major shift in penology thinking, reflecting the growing greatness attached to restitution and reparation over the more narrowly justificatory aims of conventional punishment.The Supreme Court in recent times has thus advocated the need for a scheme which would help all the victims of gender victimization and thus the social organisations, government authorities have set out to look for such programmes and policies. In order to give concrete base to these ideas the next section of the paper highlights some measures that can be taken in this regard to reduce the agony of victims.Solutions for diminishing the aftermath of victimization on victimsTHE RO LE OF THE dupe ITSELF Depending on other correlates of social location-for example, poverty and race-girls and women, to varying degrees, have a sense that they need to alter their lives to negociate violence that is disproportionately directed against females. Gay, lesbian, and bisexual individuals also emotionally respond to and manage potential gender-related violence through routines and choices in quotidian life. Fear of crime influences quality of life and reproduces social inequalities, creating and reinforcing exclusion from particular places and from some social interactions and restricting a persons actions. Individuals beliefs that they need to adjust their lives to avoid gender-related victimization are a manifestation of their oppression.Everyday violence results in measures to justify our safety-such as staying alert on the street, resisting arguments with our intimates because their bad tempers might lead to a beating, or avoiding certain public places that make us feel uneasy. unvarying with the notion of everyday violence, fear of crime is most accurately indicated by the wide range of emotional and practical responses to crime and disorder made by individuals and communities or, more generally, the impact of peoples concerns about crime on everyday social life.THE ROLE OF SOCIAL AGENCIES Helping the victim to cope is the obligation of all of society. Law enforcement agencies, courts, and correctional and human service systems have come to realize that due process and human rights exist not only for the criminal defendant but also for the victim of criminal behaviour.VICTIM COMPENSATION One of the goals of victim advocates has been to lobby for legislation creating crime victim compensation programs. As a result of such legislation, victims may practice to regional level agencies to receive financial compensation for expenses incurred as a consequence of injuries or death resulting from a criminal offence. Compensation may be provided fo r medical bills, loss of wages, loss of future earnings, and counselling. In the case of death, the victims survivors may receive burial expenses and aid for loss of support. Personal and nursing home property losses are not normally compensated.COURT operate Among the victim services that need to be provided through the court system, victim witness assistance programs (VWAP) might play a key role in providing information, assistance, and support to victims and witnesses of crime. VWAP programs provide a range of services, including crisis intervention/counselling, referrals to community agencies, emotional support, information about the progress of the case, he

Prevention of Adductor Muscle Contraction During TURBt

Prevention of Adductor Muscle Contraction During TURBtEffectiveness of spinal anaesthesia anaesthesia anaesthesia anaesthesia anaesthesia have with Obturator buttock hedge in the prevention of adductor muscle muscle muscle contraction during Trans-urethral Resection of Bladder tumor (TURBt) in Razy University Hospital in Rasht (2012-2013)Cyrus Emir Alavi MD1, Siavash Falahatkar MD2, Siamak Rimaz MD4, Mohammadreza Naghipour MD3, Mehdi Jafari MD5, Koshrang Hossein MD1, Alaeddin Asgari MD2 Nadia Rastjou Herfeh B.S6Assistant Professor, Anesthesiology interrogation Center, Guilan University of medical examination SciencesProfessor of Urology, Urology Research Center, Guilan University of Medical SciencesAssociate Professor, Department of Community Medicine, Guilan University of Medical SciencesAnesthesiologist, Anesthesiology Research Center, Guilan University of Medical SciencesAnesthesiology Resident, Anesthesiology Research Center, Guilan University of Medical SciencesUrolo gy Research Center, Guilan University of Medical SciencesCo-responder Author ledger entry (final)Bladder malignant neoplastic disease is the fifth most common human malevolence and after prostate cancer. It is the second most frequent genitourinary tumor. (1) spinal anesthesia is the technique of choice for Transurethral resection of bladder tumor (TURBT), since it enables early perception of symptoms caused by over hydration, transurethral resection of prostate (TURP) syndrome, and bladder perforation. (2)Since the long-sufferings ar diagnosed with bladder cancer, aged(a) 65 and over, due to long-term smoking, these perseverings have underlying pulmonary disease, coronary artery disease and diabetes(3,4) ,so choosing ordinary anesthesia for preventing complications such as Obturator typeface stimulant and bladder perforation is a significant lay on the line factor for this mentioned collection.Although spinal anesthesia provides optimal anesthesia, pelvic floor relaxat ion and perineal laxity, arrhythmic of Obturator tenderness motor would not be prevented by spinal anesthesia(5).So for the urologic surgeries, Obturator pith stuff (ONB) for suppressing the Obturator reflex during transurethral resection of lateral bladder fence has been prevalently used(6) .in the case of take rousing of resectors, in that respect would be a sudden , tempestuous adductor muscle contraction.This is potenti eithery risky, which can cause an increase in the risk of serious complications for example Bladder wall perforation, incomplete tumor resection, watercraft laceration, and Obturator hematomas.(7,8,9) Although this procedure is not morbidity-free, the reports of potential complications argon fewer. (10 ,11,12) While leech is common, bladder perforation is perhaps one of the scariest complications with an incidence of 0.9% to 5%. (12,13) the most important symptoms are disability in bladder distension, abdominal distension and tachycardia. (14)Significan t bladder perforation during TURBT for various reasons should be concerned. First, if prior to completion of resection, the perforation would be discovered, retained cancer in the bladder would be the consequence of such imposed resolution of surgery. Second, cancer cells can distribute by means of the opening in the detrusor, and the risk of pelvic or remote disease recurrence would be increased. And the last one, immediate intravesical chemotherapy after TURBT for lessening the risk of recurrence is recommended by the updated European Association of Urology and American Urological Association guidelines. (15) Since Obturator nerve (ON) stimulation during resection of tumors is located in the inferior portion of the bladder and lateral wall of the urinary bladder would Increase the risk of bladder rupture. (14)There are different strategic options for avoiding these complications during transurethral resection of bladder tumors (TURBT) such as adopting worldwide anesthesia with m uscle relaxants, lessening the intensity of the current of the resectoscope, using laser resistors, Obturator nerve full stopade (ONB), etc. Selective ONB along with regional anesthesia may be efficient to avert adductor spasm (16,17)As few studies adopted Obturator nerve block in Preventing Adductor muscle Contraction, which sustain this method was effective. (18,19) This double-blind, randomized study was undertaken to investigate further and provide more(prenominal) accurate results close to Spinal anesthesia combined with Obturator nerve block in Preventing Adductor muscle Contraction and bladder perforation during TUR-BT.Material and method after(prenominal) the approval of the Guilan university of medical science ethics committees and obtaining written apprised consent, 30 uncomplainings aged between 60-85 years belonging to ASA physical post III IV, having inferolateral tumors of the bladder who were scheduled for transurethral resection of bladder tumor were divide d into spinal anesthesia (SP) and spinal anesthesia combined with Obturator nerve block (SOB).The exclusion criteria included, patient refusal, advanced cardiac disease, allergy to local anesthetics, pregnancy, patients on anticoagulants or anti-platelet drugs, neurological diseases affecting the central nervous system. In the beginning(a) collection of patients, Spinal anesthesia was performed at L4-L5 interspace with the patients in the sitting eyeshot using a 25- gauge plague and 2.5cc of 0.5% Marcaine was injected then the patients were placed in the Trendelenburg position at an angle of 15-for 5 or 10 minutes. After being sure ab turn out the right amount of anesthesia, the patients were placed in a lithotomy position and Transurethral resection of the bladder tumor was carried out. In the second assembly after placing the patients under the same method of spinal anesthesia, Obturator nerve block was performed using the clear upical get in the supine position by an expe rienced anesthesiologist. For Obturator nerve block, the initial insertion point was determined 1-2 cm caudally and 1-2 cm lateral to the pubic tubercle. A 22-gauge 10-cm nerve stimulator selectle was inserted perpendicular from the puncture site in a leanly median direction until the tip of the needle made contact with the inferior cast of the superior pubic ramus and then the needle was redirected further lateral and caudal to be put in the Obturator-channel. The obturator nerve is located 2 to 3 cm of the initial point of contact with the pubic ramus. Nerve stimulation delivered a constant current with a frequency of 1 Hz and a current of 1mA which is maintained throughout the stimulation. After Twitching in the tight adductor muscles, amperage was reduced and the stimulation needle advanced towards the nerve until the first contraction in the adductor muscles with electrical stimulation of (0.3-0.4 mA) occurred. thence after aspiration (to confirm the needle is not in the v essel) 15cc 1% Lidocaine was injected and the patients were placed in the lithotomy position and Transurethral resection of the bladder tumor started. We monitored NIBP, pulse, Spo2, ECG intraoperatively and the patient was observed specially for adductor spasm, bladder perforation during TURBT in both groups.FindingsThe subjects of the both groups were comparable with respect to age, sex ratio, location of tumor, ASA class. Since the patients were diagnosed with bladder cancer, aged 65 and over, due to long-term smoking, suffer underlying pulmonary diseases, coronary artery diseases and diabetes, so for preventing complications such as Obturator nerve stimulation and bladder perforation, General anesthesia could not be used. Fishers exact test demonstrated that, thither is no significant correlation between sex, Patient Age Group, arrangement of bladder tumor, ASA class in the dickens mentioned groups of patients suffering from bladder tumor. (table1). as yet saccade and sawbon ess felicity with patients status in two groups were statistically significant.(P=0. 006) (table1). The obturator nerve block was done in two patients of the spinal anesthesia (SA) group due to severe adductor muscle jerking and severe underlying diseases (asthma or a history of cardiovascular disease). collect to severe adductor muscle jerking and not having underlying diseases, general anesthesia was done in two other patients. In trey patients in the spinal anesthesia group (SA) leg jerking was slight and during cauterization the problem was resolved by controlling the leg movement.Also, there was no significant correlation between using general anesthesia due to ineffectiveness of regional anesthesia in two groups (P=0.1). (Table 1) interventionThe endpoints of the current study were to investigate the effectiveness of Obturator nerve block in preventing the Adductor spasms and also to investigate surgeon merriment. Spinal anesthesia combined with Obturator nerve block in t he prevention of adductor contraction and its associate complications during TUR-BT is effective. Spinal anesthesia (SA) combined with Obturator nerve block (SOB) would increase surgeon satisfaction during TURBT surgical procedures. In a study done by Patel et al., he reported that Adductor spasm caused bladder perforation in 2 TUR-BT patients, which spinal anesthesia was utilise and one patient was in the need of emergency laparotomy. (19) Interestingly, in our study there was no bladder perforation, which is considered as a result of being very precise and careful about the patients Obturator spasm and in the case of observing any sign of spasms the patient s position was changed to Supine and after blocking the Obturator nerve the patient would be placed to the previous Lithotomy position.The obturator nerve block can be performed using various methods and techniques. And in our study Obturator nerve block was carried out using the technique described by Labat because the proxi mal nerve would be blocked and blocking was more effective compared to the inguinal nerve blocking. It should be mentioned that in our study there was no bladder perforation, which can be considered as a result of cautious and meticulous monitoring during the surgery. In a study which TURBT was performed on 50 patients, the patients were divided into two groups, The first group of 25 patients underwent spinal anesthesia, and the second group of 25 patients underwent spinal anesthesia (SA) combined with Obturator nerve block (SOB). In the (SA) group, almost all the patients of group (SA) suffered contraction of the adductor muscles and disturbed the surgeon. But in the spinal anesthesia (SA) combined with Obturator nerve block (SOB) group contraction of the adductor muscles did not occur in most patients. Bladder perforation occurred in two patients in the spinal anesthesia (SA) which lead to Emergency laparoscopic surgery in one patient. The results of the study demonstrated that Ob turator nerve blockage is an effective room to prevent adductor muscle spasms and its related complications in patients who are undergoing TUR-BT which is interchangeable to our study.(19) In another study which bladder tumor resection was done on 60 patients aged 18_80 years old with ASA I III ,30 patients were randomized into the spinal anesthesia group (SA) and 30 patients were randomized into the spinal anesthesia (SA) combined with Obturator nerve block (SOB) group. The regional anesthesia was done with 5cc of Levobupivacaine and 5 cc of 0.5% Nacl When the level of sensory block reached T10, adductor muscle spasms were save during the surgery.The frequency of adductor muscle spasms and the surgeon satisfactory were assessed. Surgeon satisfaction in the spinal anesthesia (SA) combined with Obturator nerve block (SOB) group compared to the spinal anesthesia (SA) was significantly higher (POne of the limitations of our study was a relatively small sample sizing, caution needs to be applied concerning the generalizability of the research findings and further comprehensive work with larger sample size is suggested.The conclusion of this study showed that Obturator nerve blockage is effective in preventing adductor muscle contractions and its related complications during TURBT surgery and also using spinal anesthesia (SA) combined with Obturator nerve block (SOB) during TURBT surgical procedures would increase the surgeon satisfaction.P value(Number) % ofSpinal anesthesia and obturator nerve block(Number) % of spinal anesthesiaVariablesP=0.8380%(n=12)86.7%( 13)Tumor location6.7%(n=1)6.7%( 1)13.3%(n=2)6.7%( 1)P=16.7%(1)6.7%ASA class53.3%(8)53.3%(8)40%(6)30%(6)P=0.006100%(15)53.3%(8)Surgeons satisfaction0%46.7%(7)P=0.0060%(0)46.7%(7)Movement during operation100%(15)53.3%(8)P=0.4830%(0)13.3%(2)General anesthesia100%(15)86.7%(13)REFERENCESAcute T, Murakami, J, Yoshinaga A. Life-threatening hemorrhage following obturator artery injury during transurethral bladde r surgery a good continuation of an unsuccessful obturator nerve block. Acta Anaesthesiol Scand. 199943(7)784-8.Badrinath R. Konety, MD, MBA Peter R. Carroll, MD. Urothelial carcinoma Cancers of the Bladder, Ureter Renal Pelvis. In E M I L A. Tango, Jack W.Mc An Inch. Smiths General Urology. ordinal Edition.New York Mc Graw Hill Inc 2008308-327.Castillo-Martin M1, Domingo-Domenech J, Karni-Schmidt O, Matos T, Cordon-Cardo C. Molecular pathways of epithelial development and bladder tumorigenesis. Urol Oncol. 201028(4)401-8.imentepe E, nsal A, Bayrak , Ko A, Akbulut Z. The actual incidence of bladder perforation following transurethral bladder surgery. JUrol 2005174(6)22602263Collado A, Chechile GE, Salvador J, Vicente J. Early complications of endoscopic treatment for superficial bladder tumors. J Urol 2000164 (5) 15291532Cuvas O, Basar H , yeygel A , Turkylmaz E, melH sunay M. Spinal anesthesia for transurethral resection operations levobupivacaine with or without fentanylM. E. J. ANESTH 2010 20(4)547-52.Deliveliotis C, Alexopoulou K, Picramenos D, Econornacos G, Goulandris N, Kostakopoulos A. The contribution of the obturator nerve blocks in the transurethral resection of bladder tumors. Acta Urol Belg. 199563514.Edward M. Messing. Urothelial Tumors of the Bladder. In Campbell Walsh. Urology. 10th Edition. Philadelphia SUNDERS ELSEVIER 2012 2407-2446.Herkommer K, Hofer C, Gschwend JE, Kron M, Treiber U. Gender and torso Mass index as risk factor for bladder perforation during old Transuretral resection of bladder Tumor. J Urol 2012187 1566-70.Jo YY, Choi E, Kil HK. Comparison of the success rate of inguinal shape up with a classical pubic approach for obturator nerve block in patients undergoing TURB. Korean J Anesthesiol. 201161(2)143-7.Jo YY, Choi E, Kil HK. Comparison of the success rate of inguinal approach with a classical pubic approach for obturator nerve block in patients undergoing TURB. Korean J Anesthesiol. 2011 61(2)143-7.Mydlo JH, Weinstei n R, Shah S, Solliday M, MacchiaRJ. Long-term consequences from bladder perforation and/or violation in the presence of transitional cell carcinoma results of a small series and a review of the literature. J Urol 19991611128-32Patel D, Shah B, Patel BM. Contribution of the obturator Nerve Block in the Trans Urethral resection of Bladder tumors. Indian J. Anesthesia. 2004 48(1) 47-49.Ploeg M, Aben KK, Kiemeney LA. The Present and Future burden of urinary bladder cancer in the world. World j Urol. 2009 27 289-93.Shapiro O, Jones K, Wang C, Landas S, Haas GP. Risk of post-operative intravesical mitomycin C instillation following transurethral bladder tumor resection. Can J Urol. 200613(6)3317-20.Shulman MS, Vellayappan U, Monaghan TG, Coukos WJ, Krenis LJ. Simultaneous bilateral obturator nerve stimulation during transurethral electrovaporization of the prostate. . J Clin Anesth. 199810(6)518-21Tatlisen A, Sofikerim M. Obturator nerve block and transurethral surgery for bladder cancer . Minerva Urol Nefrol. 20075913741.Traxer O, Pasqui F, Gattegno B, Pearle MS. Technique and complications of transurethral surgery for bladder tumors. BJU Int 2004944926Vinod Malhotra, et al. Anesthesia and the Renal and Genitourinary system. In Ronald D. Miller. Millers Anesthesia. 7th Edition. Philadelphia CHURCHILL LIVINGSTONE 2105-2134

Features of best practice models of HRM

Features of best dress models of HRMThe term human resource caution (HRM) has a wide interpretation and there is still no universal agreement on it. (Beardwell and Claydon, 2007) As the advent of the new economy, HRM had a deeper and wider development in order to realize the businesses operates in a more complex environment. It is concluded in many(prenominal) theory and practice that employees matter and that HRM is a potential source for achieving organisational goals. (Boselie, 2010, P2) Kellogg (2010) argues that employees atomic number 18 more than a resource. For most contemporary organizations, organisational changes deal become a common practice. Strategic human resource management (SHRM) focuses on issues of linking HRM to the business strategy to gain and sustain militant advantage. assemble is possible the most main(prenominal) word in SHRM. There is a debate linked to the issue of moderate amidst deuce rivalrous schools the best-practice school and the best - raiment school.The best-practice school advocates a universalistic perspective all firms testament see operation improvement if they adopt it. (Boselie, 2010) There are common chord main gist of best-practice theories should be menti unrivalled(a)d. First of all, the models enhance employee ability and intimacy through good recruitment and training. The support one is motivating desire behaviour through strong incentives. The last one is encouraging ideas and parting from motivated and better trained workers. (Boxall and Purcell, 2003)Pfeffer (1998) claims seven HRM practices that all firms could success if they arrest these seven. The source one is selective recruitment and selection. The selective is a primeval part of it and a sophisticated way to recruit and select the talents. The minute one is extensive training-employees get development through training programmes. The leash one is exercise-related pay (PRP). PRP related to personal and team performance and t he best-performance employees in a department will get yearly bonuses. The forth one is teamwork. Employees take responsibility to work design and planning for a classify of employees. It is an effective way to break through the hierarchical model and alter responsibility. The fifth one is information sharing and communication through the Internet, newspaper, face-to-face talks and, last but not least, top management presentations. The one- sixerth one is reduction of status differences, averting status symbols, such(prenominal) as fussy parking spaces for high management. The last one is employment security. Pfeffer (1994) excessively lists 16 practices for belligerent advantage through people.The advantages of the best-practice models can be defined as, firstly, overmuch agreement on basic best practice. The second one is the acquaintance of bad practice. The third one is establishing rules of thumb for selection training estimate methods. The last one is that no collec t to re-invest. most evidences in universe can prove that there is a positive relationship amidst the best-practice and organizational performance. Richardson and Thompson account that there are 30 empirical studies that switch sought to address the relationship between HR practices and business performance The published research generally reports positive statistical relationships between the greater adoption of HR practices and business performance. (Richardson and Thompson, 1999) According to another paper reported by West, Patterson, Lawthom, and Nickell (1997) firms could gain a substantial and measurable improvement to organizational performance if they invest in developing and maintaining effective HRM policy and practice.Some criticisms also should be mentioned. The first criticism of best-practice models is diversity of best-practice. Lists of desirable practices diverge significantly. (Becker and Gerhart 1996, Dyer and Reeves 1995, Youndt et al. 1996) Secondly, the co llective issues of work organization and employee voice whitethorn be lost. (Marchington and Grugulis, 2000) Thirdly, Legge (1978) argues that supporters of best-practice assay to fabricate the question of interests and goals. There are some other criticisms that should be considered. One is that it might be difficult when we go beyond these practices. another(prenominal) one is that these models may not be suitable for every situations or sections of same business.The Best-fit school argues that HRM is more effective when it is aligned with its privileged and away context. (Boselie, 2010, P21) The notion of a linkage between business strategy and performance of every employee in the organization is central to fit. (Beardwell and Claydon, 2007) There are two most common fit in HRM- outside and internal.External fit refers to that HR practices should fit the organizations strategy, development, and goals. (Boxall and Purcell, 2003) Golden and Ramanujam (1985) present a model to unmistakable four linkages administrative linkage, one-way linkage, two way linkage, and integrative linkage. The internal context represents the organizations history, culture, and the administrative heritage. Porter (1985) presents a typology of competitive strategies, advising firms to specialize guardedly in competitive strategies. Schuler Jackson (1987) developed a linkage between competitive advantage, employee behaviours and HR practices. (Boselie, 2010) There are some criticisms that should be mentioned. The first one is that they can overlook employee interests. In other words the need to align employee interests with the firm is generally failed to recognize. The second criticism is that some firms are good at everything so HR practices likely to be ground on more than one strategies. There is evidence that the most brisk firms in some sectors are good at everything they are brainy all rounders, not just good at variousiation or cost leadership. (Boxall and Purcell, 2003, P55) However, the criticism dose not invalidates the idea of a fit between HR strategies and competitive strategies. Boxall and Purcell argue that there are some supports for the argument that firms try to relate a variety of HR practices to their competitive strategy. (Boxall and Purcell, 2003 P57) The last, but not the least, one is the leak of attention of dynamics. A reusable model for practice if one in which fit with existing competitive strategy is developed simultaneously with flexibility in the range of skills and behaviours that may be needed to cope with different competitive scenarios in the future. (Boxall and Purcell, 2003, P56) versed fit refers to the linkage between several(prenominal) HR policies, and is thought to be a crucial part to gain success. Internal fit show that HR policies must be aligned with HR practices. Policies which work in opposite directions should be avoided. There is an example, encourage teamwork then rewarding individual performance. Eaton (2000) examined issues of HRM and organizational performance in 20 nursing homes in the USA. In her report she argues that a new set of practices, including cross-training and job enlargement results a better performance in some homes. Rondeau and Wagner examined the impact of HRM practices and the best-fit models on 283 Canadian nursing homesThey reported that the best-performing homes were found to be more likely to have implemented high performance HRM practices and to have a oeuvre climate that strongly values employee participation. (Buchan, 2004, 26) Baron and Kreps (1999) define 3 types of desirable fit. The first one is single employee consistency which emphasizes that make sealed selection approaches aligning with the investment in training and promotion policies. The second one is the fit across employees doing the same kind of work. The last one is temporal consistency which is consistency of employee treatment across a levelheaded period of time. There are some criticisms should be considered. Firstly, HR managers should avoid policies which against the directions. For example, a firm emphasizes teamwork but operates a reward system which focuses on individual performance. Secondly, firms should avoid duplication of practices.Boselie (2010) argues that there are two important mechanisms that determine the external context faced by the organization marketplace mechanisms and institutional mechanisms. The HR strategy scan model, developed by Boselie, contains six components the external general market context, the external population market context, the external general institutional context, the external population institutional context, the internal organizational context, and HR strategy. (Boselie, 2010, P30-36) External context is a crucial part in most contemporary organizations. It has a significant impact on HRM activities. The comical culture and history in different countries always require different HRM policies and practices. ( Boxall and Purcell, 2003)It is impossible to isolate HR policies from the context whatever internal and external. However, it is also sensible to take best practice models because of the existing of generic processes, such as recruitment and appraisal. HRM in production industries are of more push to financial sector or the high tech industries. An analytical character between the surface level of HR policy and practice in a firm and an underpinning level of processes and principles could be made for this debate. The surface floor refers to those HR policies and practices that are driven by context. The underpinning layer refers to those HR policies and practices that are generic processes and principles with essential applicability. (Boxall and Purcell, 2003, P69)