Russian and Eastern Europe Essays

Russian and Eastern Europe Essays Russian and Eastern Europe Paper Russian and Eastern Europe Paper Essay Topic: Literature When Ivan IV took power, he named his vast territory Russia. Who is credited with creating the Russian Empire? Ivan IV The Byzantine influence can be seen in Kievs government because the legal code was created on the basis of Byzantine law. Moscow was given more power under Mongol rule because Moscow was loyal to the Mongols. The resurgence of Russia under Ivan IV began in the middle of the 1500s CE. What effect did the Mongol invasion have on Kiev? The invasion destroyed Kiev and power shifted to Moscow. Ivan III made an early contribution to the eventual resurgence of Russia by bringing in foreign architects to rebuild Moscow. What happened to Kiev when Yaroslav the Wise died in 1054 CE? Kiev was divided among Yaroslavs five sons. The most dramatic example of the influence of the Byzantine Empire occurred when Vladimir I forced all Russians to convert to Orthodox Christianity. After Ivan IV took power, how did he deal with the code of laws? He revised and updated the code of laws to make it more relevant.

10 Fascinating Facts About Spiders

10 Fascinating Facts About Spiders Spiders: some people love them, some people hate them. Regardless of if youre an arachnophile or an arachnophobe, youll find these 10 facts about spiders fascinating. 1. Spider Bodies Have Two Parts: A Cephalothorax and an Abdomen All spiders, from tarantulas to jumping spiders, share this common trait. The simple eyes, fangs, palps, and legs are all found on the anterior body region, called the cephalothorax. The spinnerets reside on the posterior region, called the abdomen. The unsegmented abdomen attaches to the cephalothorax by means of a narrow pedicel, giving the spider the appearance of having a waist. 2. With the Exception of One Family, All Spiders Are Venomous Spiders use venom to subdue their prey. The venom glands reside near the chelicerae, or fangs, and are connected to the fangs by ducts. When a spider bites its prey, muscles around the venom glands contract, pushing venom through the fangs and into the animal. Most spider venom paralyzes the prey. The spider family Uloboridae is the only known  exception to this rule. Its members do not possess venom glands. 3. All Spiders Are Predators Spiders hunt and capture prey. The majority feed on other insects and other invertebrates, but some of the largest spiders may prey on vertebrates such as birds. The true spiders of the order Araneae comprise the largest group of carnivorous animals on Earth. 4. Spiders Can't Digest Solid Foods Before a spider can eat its prey, it must turn the meal into a liquid form. The spider exudes digestive enzymes from its sucking stomach onto the victims body. Once the enzymes break down the tissues of the prey, it sucks up the liquefied remains, along with the digestive enzymes. The meal then passes to the spiders midgut, where nutrient absorption occurs. 5. All Spiders Produce Silk Not only can all spiders make silk, but they can do so throughout their life cycles. Spiders use silk for many purposes: to capture prey, to protect their offspring, to assist them as they move, for shelter, and to reproduce (more on that in a moment). Not all spiders use silk the same way. 6. Not All Spiders Spin Webs Most people associate spiders with webs, but some spiders dont construct webs at all. Wolf spiders, for example, stalk and overtake their prey, without the aid of a web. Jumping spiders, which have remarkably good eyesight and move quickly, have no need for webs, either. They simply pounce on their prey! 7. Male Spiders Use Modified Appendages Called Pedipalps to Mate Spiders reproduce sexually, but males use an unusual method to transfer their sperm to a mate. The male first prepares a silk bed or web, onto which he deposits sperm. He then draws the sperm into his pedipalps, a pair of appendages near his mouth, and stores the semen in a sperm duct. Once he finds a mate, he inserts his pedipalp into her genital opening and releases his sperm. 8. Males Risk Being Eaten by Their Female Mates Females are typically larger than their male counterparts. A hungry female may consume any invertebrate that comes along, including her suitors. Male spiders sometimes  use courtship rituals to identify themselves as mates and not meals. Jumping spiders, for example, perform elaborate dances from a safe distance and wait for the females approval before approaching. Male orb weavers (and other web-building species) position themselves on the outer edge of the females web, and gently pluck a thread to transmit a vibration. They wait for a sign that the female is receptive before venturing closer. 9. Spiders Use Silk to Protect Their Eggs Female spiders deposit their eggs on a bed of silk, which they prepare just after mating. Once a female produces the eggs, she covers them with more silk. Egg sacs vary greatly, depending on the type of spider. Cobweb spiders make thick, watertight egg sacs, while cellar spiders use a minimum of silk to encase their eggs. Some spiders produce silk that mimics the texture and color of the substrate on which the eggs are laid, effectively camouflaging the offspring. 10. Spiders Don't Move by Muscle Alone Spiders rely on a combination of muscle and hemolymph (blood) pressure to move their legs. Some joints in spider legs lack extensor muscles entirely. By contracting muscles in the cephalothorax, a spider can increase the hemolymph pressure in the legs, and effectively extend their legs at these joints. Jumping spiders jump using a sudden increase in hemolymph pressure that snaps the legs out and launches them into the air.

Bio project Essay Example | Topics and Well Written Essays - 750 words

Bio project - Essay Example Treatment options are very few with varying degree of success percentage. This paper briefly explains Leukemia, probable reasons and treatment options. Exact reasons of blood cancer are still unknown, but genetic effects and exposure to retroviruses are generally considered as the reasons of blood cancer (Mamgain). Leukaemia means ‘white cells in the blood. â€Å"The white cells are part of the body’s immune system, and there are several sub-groups of white cells that have different sorts of roles in recognizing and dealing with ‘invaders’ such as bacteria and viruses as well as other types of foreign protein. All of the blood cells originate in the bone marrow and leukaemia is a disease where the bone marrow produces large numbers of abnormal white cells. This means that the normal marrow is pushed into smaller and smaller areas. This results in fewer normal cells being produced and gives rise to some of the symptoms† (Dr  Ã‚  Green) Blood test and born marrow test is used to confirm leukemia. Based on the nature and seriousness, Leukemia can be classified into four categories; ALL (Acute Lymphocytic Leukemia), AML (Acute Myelocytic Leukemia), CLL (Chronic Lymphocytic Leukemia), CML (Chronic Myelocytic Leukemia) (CHRONIC LEUKEMIA TREATMENT INFORMATION) Symptoms of leukemia include’ Fatigue, Malaise (vague feeling of bodily discomfort), Abnormal bleeding, Excessive bruising, Weakness, Reduced exercise tolerance, Weight loss, Bone or joint pain, Infection and fever, Abdominal pain or "fullness", Enlarged spleen, lymph nodes, and liver etc (Leukemia Signs and Symptoms, 2009) It is difficult to diagnose blood cancer because of the similarities blood cancer symptoms have with other diseases. For example, fatigue weight loss fever etc is generally associated with many other diseases and the doctors will try to treat such diseases initially before going for a detailed

Participatory model in leading change Essay Example | Topics and Well Written Essays - 500 words

Participatory model in leading change - Essay Example Zink et al. (2008) found that failures result from the lack of planning for change management. Better results could be achieved from planning for comprehensive change management. The use of comprehensive change management allows overcome â€Å"lack of integration.† In order to achieve this, the relationship between policy and strategy has to be achieved, followed by logical fit between individual concepts. The participative approach allows planning for comprehensive change management. A comparison of participatory and autocratic leadership styles has been illustrated in table below. The comparison of advantages and disadvantages of both leadership styles indicate that participatory leadership could produce better results in the management of organizational change. Organizational change is a complex process, and the participatory style can enhance the change management process. Uhl-Bien (2006) argues that participation allows a relational leadership. This style of leadership allows focus on identification of individual attributes of individuals for engaging in relationships. The process views leadership as a process of social construction. According to Cummings and Worley (2008), a thorough diagnosis is required to reveal the causes of problems, or identify opportunities for development. There is complexity in change that could range from relatively simple processes to small workgroup for transformation of strategies and features of design for the whole organization. An overview of change management activities has been illustrated in the figure above. A critical issue is that people and organizations seek to preserve the status quo, and are willing to change only when there are compelling reasons for doing so. Creating a vision for change is aligned with leadership. The vision provides a purpose and reason for change,

Tuning Out to be Heard Loud and Clear Essay Example for Free

Tuning Out to be Heard Loud and Clear Essay There is a reason TVs and radios come with an on-off switch, so people can use them. TV and radio are as commercial as any other industry, and they should be.   Preserving the people’s interest in available public broadcasting by presenting information in a balanced manner is a nice ideal, but ultimately a foolish one if you want to maintain a free and capitalistic society.   It is drafted in The First Amendment to the U.S. Constitution that â€Å"Congress shall make no law.    .   .   abridging the freedom of speech, or of the press.† Yet in 1949 the Fairness Doctrine was enacted which stifled this right.   It was a point of much controversy in broadcasting for nearly 40 years until it was repealed in 1987, but now there are discussions about re-enacting it.   The FCC should not require radio and television to comply with the Fairness Doctrine if they want to maintain the rights of U.S. citizens. At their core, radio and television are forms of entertainment.   One of the initial arguments of the Fairness Doctrine was that there were a limited number of frequencies available to license and that â€Å"there are many fewer broadcast licenses than people who would like to have them† (Rendall, 2005). Following that rationale there are a number of different entertainment venues people would like to operate, but they are limited by space or money or the abundance of that business present in their community.   Television and radio aren’t essential to life; they are a luxury, a form of entertainment and should be viewed as such. It is true that they also act in an informative and educational way, but it is and should be at the discretion of the broadcaster what to publish, just as it is and should be at the discretion of the recipient whether or not to tune in.   Radio and television may be available to the public, but stations/ frequencies are owned and operated by corporations.   What they offer will be driven by public interest in so much as the public will disengage if it doesn’t like what is available. Particularly with the advent of cable/ satellite television and digital radio the possibilities for viewers are virtually endless.   In 1984 the Supreme Court in FCC v. League of Women Voters concluded that the â€Å"scarcity rationale underlying the doctrine was flawed and that the doctrine was limiting the breadth of public debate† (Thierer, 1993).   Ultimately broadcasting is just another sellable product.   Mark Fowler, the FCC chair appointed by Regan in the 80s was quoted as saying, ‘The perception of broadcasters as community trustees should be replaced by a view of broadcasters as marketplace participants.’ To Fowler, television was ‘just another appliance—it’s a toaster with pictures,’ and he seemed to endorse total deregulation) ‘We’ve got to look beyond the conventional wisdom that we must somehow regulate this box.’ (Rendall, 2005). Fowler is right; it is not a broadcaster’s responsibility acting as a mouthpiece for entertainment, providing a marketable product that we have to ‘buy’ into, to act in the community interest.   Eventually the broadcaster will respond to community interest because they are the audience and essentially determine what is played on the air by their willingness to engage, but it is not a broadcaster’s responsibility to do so.   Government should not be regulating available information because broadcasting is a consumer driven market. The only discrepancy would be if we were talking about national or local government owned stations.   In the special case of those, it is in the best interest of citizens to have a balanced stream of information available particularly in a democratic political system.   Those stations would be used to inform and should be objective and/ or balanced because citizens would be using them as trusted unbiased resources.   However all other ‘public’ broadcasting sources currently available are privately owned by corporations and are and should be exclusively market driven to protect our right to free speech. It is interesting that PBS the touted public broadcasting station was generated out of a demand from citizens to create just such a network of more balanced and educational information.   It was created and driven by the market and is funded primarily by its viewers (it does get some government grant funding and private grant funding for programming), so it is clear that tuning out or more to the point demanding alternate forms of entertainment (ultimately even PBS is still a just an alternate form of entertainment) works and there is no need for regulations. The Fairness Doctrine addresses more specifically the coverage of political or current social issues. The Fairness Doctrine had two basic elements: It required broadcasters to devote some of their airtime to discussing controversial matters of public interest, and to air contrasting views regarding those matters. Stations were given wide latitude as to how to provide contrasting views: It could be done through news segments, public affairs shows or editorials. (Rendall, 2005). In enacting such a doctrine you limit the diversity available on the airwaves. In trying to follow regulations stations will be more guarded in what they present to avoid being fined or shut down by the FCC.   It actually stifles the opportunity for rigorous debate and challenges to opinion; by either not offering up the discussion of more controversial issues or by censoring them.   In 1974 the Supreme Court, while still upholding the doctrine in the Miami Herald Publishing Co. v. Tornillo case concluded that it, inescapably dampens the vigor and limits the variety of public debate (Thierer, 1993). It also runs into the issue of who decides what fair coverage is.   .   .   a bunch of bureaucratic stuffed shirts at the FCC a board ultimately designed to enact ‘rules for censorship’.   How do we ensure that their own views wont taint their ‘fairness’ decisions. With the amount of available stations, forms of media, just access to get information in general, the concept of a Fairness Doctrine is outdated when people can just change the channel or disconnect all together.   Broadcasting whether for public or private availability is still just a form of entertainment and should be treated as such.   Its regulation should be deemed by its market segments because viewers are (or at least should be) more than capable of influencing what is available to them. Viewers should also be allowed to filter their own information, seek out differing opinions; after all just because an opposing view might be offered doesn’t mean that listener is obliged to stick around.   Just tuning out is the loudest and clearest form of speech and is all the regulation that is really needed. References Rendall, Steve. (2005). The Fairness Doctrine How We Lost it, and Why We Need it Back. FAIR, February 12, 2005. Retrieved March 15, 2009, from http://www.commondreams.org/views05/0212-03.htm Thierer, Adam. (1993). Why the Fairness Doctrine is Anything But Fair. The Heritage Foundation, Executive Memorandum #368, October 29, 1993. Retrieved March 15, 2009, http://www.heritage.org/Research/Regulation/EM368.cfm The Constitution of the United States. Amendment 1.

Diversity Statement - The Appalachian Mountains :: College Admissions Essays

Diversity Statement - The Appalachian Mountains    I was raised in an ultra-conservative Pentecostal Holiness church in the Appalachian Mountains. There were snake handlers in our church. It was thought that it tested one's faith to pick up a poisonous snake -- God wouldn't allow it to bite you if you had faith. However, I was always afraid that to pick up a snake would greatly increase God's propensity to smite me via death by snakebite. I did not have enough faith. I've never encountered a miracle -- I've never had a dream come true. I therefore can't help but lack faith.    To my great fortune, I've had many people help me along the way who didn't have to and who stood nothing to gain by helping me. Teachers gave me after-hours help; when I didn't know how I would pay for school, the financial aid office gave me a scholarship. These people helped me for no reason other than the mere fact that I am a human being, worthy of help when in need. Although I didn't have faith, they gave me hope.    This is why I have worked at a local homeless shelter for the past two years.   I feel like I can do the same thing -- help a person or two merely on the basis of our shared humanity. I enjoy paying back some of the help society has given me. I teach a computer class at the shelter, but everyone gets free therapy on the side. Most of those people aren't different in some essential way from the homed or those who have jobs, but life has often dealt them a losing hand to begin with. I tell them that I also had a losing hand, but I never gave up hope. Often, hope is all I had -- but it was enough to keep me pressing onward.

Notebook: Love and Noah

The Notebook By Nicholas Sparks Major Characters * Allison Hamilton – seventeen year old heiress, who shared an epic summer romance to Noah. * Noah Calhoun – local country boy who fell in love to a city girl, Allison. * Anne Hamilton – Allison’s mother. * Lon Hammond – Allison’s fiance. Minor Characters * Martha Saw – a war widow, Noah’s girlfriend. * Frank Calhoun – Noah’s father. * John Hamilton – Allison’s father. * Fin – Noah’s friend. * Nurse Esther – a nurse working in the nursing home. Setting of the storyIn the movie, the setting took place in a modern day nursing home and in the story of the elderly man, the setting took place in Seabrook Island, North Carolina in the summer months of year 1940. Mood of the story The movie begins with an elderly man begins to read a story to his fellow patient. His story starts with a light and romantic moments of two young lovers sharing both their epic summer romance. As the story goes, the couple face conflicts and the characters are developing various emotional themes.At the peak of the conflict, the antagonist finally ceded on letting go and decided to make the protagonist chose her path essay writer site. It is revealed that the fellow patient is her wife and is suffering from a disease essay writers world reviews. The movie ends with gloomy scene and at the same time able to show the meaning of unconditional love. Biography of the author Sparks wrote his first novel in 1985 which never got published and another one in 1989, also not published. Sparks experimented with various careers trying to fit in but didn’t succeed.After trying his luck in publishing, law school, real estate and even waiting tables, he finally co wrote a novel named ‘A Lakota Journey to Happiness and Self-Understanding’ with Billy Mills Wokini. It sold about fifty thousand copies in the first year of being published. I n 1992 he tried a business in pharmaceuticals and the next year moved to Greenville, SC. That was when he wrote his renowned novel ‘The Notebook’. This novel was to become a launch pad for Sparks. A literary agent Theresa Park discovered his novel from her agency and offered to represent him.In 1995 Sparks had one million dollars in cash for ‘The Note Book’ from the famous Time Warner Book Group. After being published in 1996, ‘The Notebook’ made the best seller list of The New York Times instantly. Following this successful novel were exceptional writings one after the other out of which six were made into film adaptations. In 1999 ‘Message in a Bottle’, in 2002 ‘ A Walk to Remember, ‘The Note Book’ in 2004, ‘Nights in Rodanthe’ in 2008, then in 2010 ‘Dear John’ and ‘The Last Song’ . Nicholas Sparks has written 16 novels till 2010.His last novel till now ‘The Safe Hav en’ was published on 14th September 2010. His books ‘The Best of Me’ and also in the list ‘The Safe Haven’ are made into films and released in 2011. Another one of his book ‘The Lucky One’ is currently being filmed and will be released some time in 2012. Currently Nicholas Spark is living with his wife and five children in North Carolina. Being a religious man and firm believer in God, Sparks constantly contributes to various charities and schools. He also promotes writers by funding different scholarships, intern programs and fellowships.Sparks also started ‘MFA’ that is a creative writing program at the university he studied in (University of Notre Dame). He donated more than ten million dollars for the building of a Christian International School. Summary At a modern-day nursing home, an elderly man, whom people call â€Å"Duke† begins to read a  romantic love story from his notebook to an elderly woman, fellow p atient. His story begins in 1940. In  Seabrook Island. North Carolina, local country boy Noah Calhoun) is smitten with a seventeen-year-old heiress named Allie Hamilton after seeing her at a arnival, and they share an idyllic summer romantic love affair. Noah takes Allie to an abandoned house, which he explains he intends to buy for them. Later that evening, she asks him to make love to her, but they are interrupted by Noah's friend Fin with the news that Allie's parents have the police out looking for her. When Allie and Noah return to her parents' mansion, they ban her from seeing Noah, whom they say is â€Å"trash, trash, trash not for you! † The two break up, and the next morning, Allie's mother announces that the family is returning home to Charleston.Noah writes a letter each day to Allie for one year, but her mother, Anne, intercepts them all and keeps them hidden from Allie for an unknown reason. As each sweetheart/lover sees there is no contact from the other, Noah and Allie have no choice but to move on with their lives; Noah and Fin enlist to fight in  World Was II and Fin is killed in battle. Allie becomes a volunteer in a hospital for wounded soldiers, where she meets an officer named Lon Hammond, Jr. , a young lawyer who is handsome, sophisticated, and charming, and comes from old Southern money.The two eventually become engaged, to the delight of Allie's parents, but Allie pictures Noah's face when Lon asks her to marry him. When Noah returns home from the war, he discovers his father has sold their home so that Noah can buy the abandoned house, fulfilling his lifelong dream to buy it for Allie, whom by now he has not seen for several years. While visiting Charleston, Noah witnesses Allie and Lon playing cards at a restaurant; he convinces himself that if he fixes up the house, Allie will come back to him. Later, Allie is startled to read in the newspaper that Noah has completed the house, and she visits him in Seabrook.In the present , it is made clear that the elderly woman is in fact Allie, who is suffering from  Dementia   and cannot remember any of the events of the film so far. Duke, the man who is reading to her is, in fact, her husband, Noah, but Allie cannot recognize him. His children on a visit to see them, tells him that he needs to accept that she can't remember anymore. Duke tells them that the more he reads to their mother, the more she'll remember and he won't give up on her. Back in the 1940s, the day after Allie arrives in Seabrook, she and Noah renew their strong romantic relationship and make love.In the morning, Anne appears on Noah's doorstep, telling Allie that Lon has come to Seabrook to take her home. She takes her out for a drive and reveals that, twenty-five years earlier, she also loved a common man. Her parents disapproved of him and after banning her from seeing him again, she married her father whom they approved of being from a rich family. Anne leaves Allie with a bundle of le tters—all of Noah's letters, revealing that she had intercepted them as an attempt to protect her from getting her heart broken and hopes that she will make the right choice.Allie and Noah have an argument with each other and she leaves. While driving upset with him, she reads the last letter that he wrote her and feels betrayed by Anne for what she did in keeping the letters away from her. Allie returns to the hotel and confesses to Lon that she has been spending time with Noah. He is angry, but says that he still deeply loves her. Allie tells him she knows she should be with him, but she remains indecisive. In the present, Duke asks Allie whom she chose. Becoming lucid, she remembers that the story Duke was reading is the story of how they first met.After reading all of the letters, young Allie appears at Noah's doorstep, having left Lon at the hotel and chosen him. Elderly Allie suddenly remembers her past; after finding out about her illness, she herself wrote their story in the notebook with instructions for Noah to â€Å"read this to me, and I'll come back to you. † But minutes later Allie relapses, losing her memories of Noah again. She panics, not understanding who he is, and has to be sedated. The elderly Noah has a heart attack, and Allie is alone for a time.However, as soon as he is sufficiently recovered, Noah (â€Å"Duke†) goes to Allie's room one evening to find her lucid again. Allie questions Noah about what will happen to them when she will not be able to remember anything anymore, and he reassures her that he will never ever leave her. She asks him if he thinks their strong and mutual romantic love for each other is strong enough to â€Å"take them away together†; he replies that he thinks their strong romance could do anything. After telling each other they love one another, Noah adds â€Å"I'll be seeing you†.The next morning, a nurse comes into Allie's room, only to find Allie and Noah dead in each otherà ¢â‚¬â„¢s arms. As the camera pans out, we see they died holding hands. Interpretation The Notebook, a novel of Nicholas Sparks, his first published novel, and was based on true story. According to him, he was inspired to write this novel by the grandparents of his wife who has been married for a long time, and he tried to express that long romantic love in his novel. In the story, the socio economic status played an important role in an individual, as in the case of Anne Hamilton, on barring Noah to Allie and describing him as a trash.Much of her attitude is revealed when she believed and told Allie, that â€Å"Status is more important than feelings and our future is dictated by what we are as opposed to what we want†. This serve as antithetical statements regarding important themes in the story. Understandably she is an antagonist. In this case she acted to keep Noah away from Allie but also succeeded for 14 years. Fate and destiny is also showed in the movie which also happ ens in the real world. The one scene in the movie effectively shows the image of long lost lovers reunited.Fate may lend a hand in Allie seeing the newspaper clipping, she chose to lie to Lon and seek out Noah. The movie also embraces the exploration of love, the author also provides complications of the messiness that makes up real world love. The kind of love depicted in the movie clearly shows that it is more than a word, it covers the actions that accompany with words. Elements of the Novel Character Analysis Noah is the main character (protagonist) of  The Notebook. In many regards, Noah is the ideal man — he is faithful, idealistic, strong, good looking, a poet, and helpful to those in need.The Noah of the main narrative is almost too good to be true. He has a strong relationship with family and friends and is respectful to both nature and authority. He seemingly has no faults. Allie wants the best of both worlds as she represents the different types of love that exis t. In essence she is the embodiment of a thematic topic. As Allie grows and matures, so does her understanding of love. Her growth symbolizes the development of real love. Lon s the stereotypical, self-obsessed individual who realizes too late that his self-absorption is going to cost him his fiancee.Lon is also the embodiment of the conflict in  The Notebook. As a character, he is the one readers know as the obstacle to Allie's love. He is a dynamic character, but his change is a little too late. Anne is the antagonist. Although she works to keep Noah and Allie apart, she cannot be considered a villain, for she is not evil. Anne represents the difficulties that many parents have when trying to steer their children to adulthood. Fourteen years later, she attempts to atone for earlier mistakes, first by preparing Allie for Lon's impending visit, then by offering her support without being pushy.She also finally gives Noah's letters to Allie, and her final words may be encouraging Al lie to follow her heart. Point of View Instead of starting at the beginning and telling the story in chronological order, Nicholas Sparks beginsThe Notebook  near the end of what would be a linear narration and then employs both the framing technique and flashback to tell his tale. The main storyline is the reunion of Noah and Allie and the conflict that they face as they must decide the path their lives will now take.This particular event only lasts three days in 1946; however, important information that shapes their reunion occurred weeks and years earlier. If you imagine a picture in a frame, the reunion is the photograph. And the opening and closing chapters of the novel are set in the present, some 49 years later. The present-day storyline frames the reunion story. Although the frame represents the present and current storyline and the picture represents the reunion, within these two main storylines are other stories, some are episodes and others are vignettes, which are told in the form of a flashback.These stories, told within the context of the other storylines, fit within both the picture and the frame. And some of these smaller stories of earlier events frame even smaller stories of other events. Each story is distinct within itself while simultaneously being an integral part of a greater whole; every individual picture is a part of a bigger picture. This framework technique provides the structure of the plot, and flashback is the technique Sparks uses to tell the stories.Characters reveal these â€Å"framed† stories through their shared and private memories. Often the reader shares a flashback with a character that is not shared with any other character. The narrator also provides information. The narrator of  The Notebook  in the opening and closing chapters is Noah. But the narrator of the middle chapters provides a limited, third-person omniscient point of view. This perspective sometimes allows the readers into the mind of a charact er — typically Noah and Allie — but sometimes does not — such as Anne and Lon.This technique is important because it allows the storyline to flow seamlessly from past to present and back again. Stylistically, the narrative techniques work well because  The Notebook  is not just a love story; the novel also explores the nature of fate and free will and the way people interact with one another. The intricacies of relationships parallel the intricacies of poetry and the framing technique enables Sparks to weave the past together with the present, leading to the emotional climax and creating a compelling read along the way.

Total Hospital Information System Hospital Selayng

1. 0 Hospital Information System (HIS) – Overview 1. 1 Definition Hospital Information System (HIS) is an integrated information system which spans through the organization crafted to manage clinical, administrative, financial and operational functions of a hospital. HIS strives to achieve the most effective support for patient care and administration through various different electronic data processing and analyzing tools (Ismail, et al. , 2010). HIS serves as a platform to provide the required information to each level of the management at the correct time, in the correct form, and in the correct place, contributing towards improved decision making. HIS plays a pivitol role in planning, initiating, organizing and controlling the operations of the subsystems of the hospital and thus equips an organization with synergy and integrity required for it to function. More importantly, HIS also enhances patient care and comfort by offering personalized suggestions for care and enables a hospital to move from retrospective to a concurrent review quality (Ismail, et al. 2010). 1. 2 Global Trend in Hospital Information System (HIS) In early 2009, the market value of Hospital Information Systems (HIS) market was $7. 8 billion worldwide and this figure has been predicted to leap to an alarming $18 billion by 2016. The boom is primarily driven by governments’ dynamic motives and hospitals continually trying to increase workflow effi ciency Hence, hospitals are confident that embracing HIS will result in increased efficiency and reduced medical errors, which later translates into uplifting the quality of care provided to patients (Global Data, 2010). Growing evidence has demonstrated that the current systems fail to deliver adequately safe, high standard, efficient and economical healthcare. This can be curbed through computerization, with electronic medical record (EMR) as the fundamental component. This has resulted in clinicians and healthcare organizations around the globe scrutinizing into adopting more EMR technologies in their respective hospitals. France, UK, US, Canada, Finland, Denmark, Australia, New Zealand and several other countries have proposed plans to construct a fully intergrated computer-based hospital infrastructures with the electronic medical record systems laying the cement work. In the Asia-Pacific region alone, umpteen successful HIS implementations have taken place in various hospitals such as in Japan, South Korea, Singapore and Malaysia (Global Data, 2010). 1. 3 The Malaysian Outlook The federal government had adopted a national-level strategy to create a paradigm shift in the nation’s healthcare system. The Federal Government aims to revamp the healthcare system so as to produce a county of healthy individuals and communities through the adoption of information technology (IT). Major projects which has been undertaken include Multimedia Super Corridor Telehealth Project and MSC Telehealth Blueprint (1997) (Malaysianmedicine, 2004). Dr. H. M. Goh, secretary of both Malaysian Health Informatics Association and Asia-Pacific Association for Medical Informatics mentioned that it is impossible to provide good, safe and efficient healthcare ignoring IT, thus the the cost of healthcare would rise. He also stated that without computerisation, we won’t be able to retrieve timely information. ( Malaysianmedicine, 2004). Following this, Malaysia has witnessed several significant developments in the health care sector. One such eminent development is the establishment of total hospital information systems in Selayang Hospital (Malaysianmedicine, 2004). 2. Overview of organization – Selayang Hospital 2. 1 Brief History Located along the Kepong Selayang road of Gombak District, Selayang Hospital is a 960-bedded hospital which has been in operation since 1996. Selayang Hospital (SH) is the pioneer in being the paperless and filmless hospital in Malaysia. Though classified as a government hospital, it has sophistication of a luxury private medical center with a leading-edge on technology. The need for this ultra-modern hospital came about as Hospital Kuala Lumpur (KLH) was already bursting to its limits with its overworked staffs. Organized and accurate documentation and archiving was impossible with mislaid or missing patients' records. This had resulted on KLH being entangled in legal matters. Increasing number of patients expressed their displeasure and quality of patient care was deteriorating. These circumstances surged MOH to come up with SH project with proper incorporation of HIS (Yook, 1999) 2. 2 Clinical services at Selayang Hospital Among the services offered at Selayang Hospital are Gastroenterology, Hepatobiliary, Cardiology, Nephrology, Urology, Hand and Micro and Surgery. All the rest are categorised under secondary services, outpatient services and supportive services. The core business of Selayang hospital is providing a exclusive tertiary referral services to patients across Malaysia and a broader range of clinical services to customers who rely on Selayang Hospital as their regional or local hospitals. High quality specialist services in a large number of other fields is also a highlighted aspect of this hospital (Yook, 1999). 2. 3 Vision The Selayang Hospital project was designed by the Ministry of Health (MOH) in accordance with the Malaysia’s Vision of 2020, where the country would become a developed the country's Vision for Health was formulated proposed a national health policy. Besides, it was particularly mentioned in the Seventh Malaysian that there will thirty three paperless public hospitals launched in Malaysia. More specifically, eight of these hospitals will be using Total Hospital Information System (T. H. I. S), Selayang Hospital being one of them (Yook, 1999). 2. 4 Mission The mission of Selayang Hospital is to be a role model for Malaysian hospital, in using innovative, dynamic and cost effective technology and delivering a friendly, caring, compassionate and humanistic service. This wiIl be achieved through teamwork in partnership with the community to provide quality care to the satisfaction of our customers (Yook, 1999). 2. 5 Organizational Structure Patients at Selayang Hospital are of top priority so the structure is designed to maximize patients/customers' satisfaction with emphasis on staff efficiency. The Board of Directors (BOD) with the assistance of Total Hospital Information System and a Medical Advisory Board committee oversees the hospital overall operation. There are five distinct divisions in the hospital administration. The total medical and non-medical staffs amounts to 1090 people. The BOD is accountable to the State Health Directors (Image could not be retrieved) (Yook, 1999). 3. 0 Total Hospital Information System (THIS) in Selayang Hospital Selayang Hospital, the pioneer paperless and filmless hospital in Malaysia, uses Total Hospital Information System (THIS) for its fundamental operation. THIS combines aspects of clinical, administrative and financial management, enabling continual data flow between separate areas (Ismail, et al. , 2010). THIS would aid in meeting the objective of enhancing productivity, effectiveness, efficiency, quality and safety. THIS facilitates communication between care providers through sharing of information, enables automation of work processes, integration and interfacing with other components of HIS in addition to providing clinical decision support and maintaining a permanent record as a medico-legal requirement (Abdollah, 2011). For the incorporation and functionality of THIS, Selayang Hospital had opted to vendor solutions like Cerner for electronic medical record, Seimens for radiology department, Spacelabs for critical care unit, Oracle for materials management, finance and administration and Microsoft Office for internet and intranet usage (Li, 2010). Figure 1 depicts the system architecture as well as the technology partners that associate to Selayang Hospital (Abdollah, 2011). Figure 1 : Information Technology System Support and Technology Partners in Selayang Hospital (Abdollah, 2011). Figure 2 illustrates the structure of THIS in Hospital Selayang. Selayang Hospital incorporates clinical, administrative as well as financial processes as their total hospital information system within their hospital operations. There are various information system being deployed to cater specific needs and wants of patients and care providers as described in the following sections (Abdollah, 2011). Figure 2: Structure of Total Hospital Information System in Hospital Selayang (Abdollah, 2011) 3. 1 Types of Hospital Information System 3. 1. 1 Electronic Medical Record (EMR) Clinical Information System (CIS) is thought of as the system that mediates direct patient care. Within it, also lies the mechanical framework for capturing, storing and displaying the data generated by all clinical care activities. A defined portion of patient-specific collected from disparate sources by care-providers working in the various clinical services is put together as the Electronic Medical Record (EMR). EMR essentially provides for the recording of the following groups of data: a. profile of the patient b. information gathered regarding the patient’s illness, allergies and health status c. ctivities performed on the patient d. events that occurred (planned and unplanned) e. results or findings emanating from these activities and events (numeric, text or images) f. communications between care providers i. e. instructions, opinions, referrals and advice g. decisions and plans both immediate and long term (diagnosis, treatment plan) This consolidation is essential for the availabililty of future data for tracking puposes which in turn governs clinical management and patient data mining, in addition to report generating (Abdollah, 2011). EMR largely benefits government and health care providers. The need and requirement to document is both professional and legal as documentation enables care providers to communicate with each other thus facilitating continuity of patient care. Thus, in the form of the EMR, documentation satisfies the legal requirement of maintaining a record of events. It is accessible from multiple access points and units within the hospital and selective access outside the hospital. This largely reduces the time taken to retrieve medical records. Hence, the time taken to retrieve patient records are reduced. This would pave the way for increased productivity and quality of care. In the mean time, it would contribute towards better knowledge in clinical practices. Besides that, administrative benefits include easier report generation, better organization of clinical information, enhanced claiming and ordering processes, reduced billing timings which translates into providing better service to patients. Futhermore, THIS improved clinical decision making and disease management, patient education in addition to better documentation, increased time allocated per patient, and rejuvenated perception of care and quality of a healthcare institute. The incorporation of DSS into drug management, result generation and disease management are essential in good clinical practise. On the other hand, for researchers and policy makers can utilize EMR to device long term strategies for towards development country’s health care and proper allocation of resources (Haslina and Sharifah 2005). The workflow process such as the improvement of data inputting by avoiding duplications of data’s, reduction is transcriptions costs as well as improved communication is also benefited by Selayang Hospital due to the successful implementation of EMR (Erstad, 2003). Hence, in a nutshell, implementation of EMR such as improved decision making, disease management enhanced records and has made it possible to eliminate the use of papers for medical records. As a result, medical records become more trustworthy and easily comprehendable. Figure 3 : Electronic Medical record system . Source : http://level8systems. com/page. php? 3 3. 1. 2 Patient Management System (PMS) This system encompasses Patient Registration, Client-Resource Management and Charging, Billing and Payment system. For example, during patient registration, a identification number unique to that particular person is issued. This would act as the Medical Record (index) Number (MRN). It allows data regarding a single patient to be kept in a single record, shared between systems and used for subsequent visits and encounters without the need for repeated data acquisition and entry of static data. Staff job assignment is be part of the Client Resource Management System. It should enable all categories of staff to be allocated to work areas, rooms, wards, cubicles, beds, machines etc. according to dates and work shifts. Care providers need to sign in to confirm that they are available. The system should allow for constant updating of staff assignment. The Patient Tracking facility through PMS would also provide real-time status display and reports on attendances, location of patients, status of service provision and discharges Next, The Charging-Billing System would be able to calculate charges based on factors according to policies set by the hospital. It would be able to charge differently based on the service delivery such such outpatient service, emergency service and Inpatient service in addition to scrutinization by financial class. Figure 4 illustrates a typical Patient Management System software which stores and updates patient records. Hence, PMS enables patient’s records to be compiled and accessed in an organised manner. Besides that, subsequent processes like patient administration, clinical support tools and generating reports also is made easy. In addition, it also enables quicker diagnosis with proper relevant treatments available (Netripples, n. d. ). Figure 4: Typical Patient Management System. Source http://hpathy. com/software/hompath-classic8. asp 3. 1. Picture Archiving and Communication System (PACS) Pictures Archiving & Communication System (PACS) is majorly used in medical imaging unit. X-ray, echocardiogram, ultrasound machines capture digital images of a patient’s clinical condition. These images are sent to appropriate destinations using this system. It can be imagined as a pipeline network which carries water, which in this case are the images. Every laboratory at Selayang Hos pital is equipped with a high-end resolution computer screen to view these images captured from the machines. This service is provided by Siemens in Selayang Hospital. With the help of PACS, images are viewed on screens rather than the conventional x-ray images which are as bulky as a spreadout newspaper. More importantly, PACS reduces the radiation exposure in both patients and care providers. This leads to a healthier working environment; better image distribution; timeless retrieving of data and images; image quality improvement as well as easier handling of images Dr. Zaharah (n. d. ). Thus it can be understood that PACS is not a stand alone system but a subsidiary support system of Radiology Information System (RIS) described in next section. 3. 1. 4 Radiology Information System (RIS) The Radiology Information System (RIS) is a system, which enables care providers who to capture, store and distribute images by interacting with the machines that produce these images and also the clinicians who request for the images. The Radiology Information System (RIS) is a system, consists of the following major functional areas: 01. Ordering of examination 02. Scheduling of appointments for examination 03. Creation of work lists 04. Tracking of examination and reporting status of cases 05. Image Tracking and Management 06. Clinical Result Reporting, 07. Storage and retrieval of reports To summarise, RIS which belongs to the radiology department, is a huge database which can be used to perform x-ray imaging, echocardiograms, computerized axial tomography (CAT) scans, positive emission tomography scans (PET) and magnetic resonance imaging (MRI) tests when necessary ( Dr Zaharah , n. . ). The RIS creates and schedules the patient order for an image study. The RIS allocates a unique accession number to the order, sends a message to the PACS and the imaging modality to maintain accuracy in patient demographic details (Figure 5). Figure 5: Integration of RIS and PACS in acquiring and processing of images Source:http://www. pukkaj. info/NewsArchive2007/SendingradiotherapyimagestoPACS/tabid/1111/language/en-GB/Default. aspx) In a fully functional THIS system, RIS must be a high degree of integration between with EMR, PACS and PACS. In this sense PACS is a sub-set of RIS. Radiology images are considered as part of each patient`s EMR. Images need to be treated just like other patient data. Images as data are managed by Picture Archiving and Communications System (PACS). RIS is also linked with scheduling system to schedule appointments for patients. Figure 6 shows the schematic representation of functions and relationship between RIS, PACS and EMR (Abdollah, 2011). Figure 6: Schematic representation of functions and relationships between RIS, PACS and EMR (Abdollah, 2011). 3. 1. Pharmacy Information System (PhIS) Pharmacy Information System (PhIS) operates in the pharmacy department for numerous activities which includes clinical screening, inventory management, prescription tracking etc. PhIS are elaborate computer systems that were structured to meet the needs and wants of a pharmacy division to function effectively and efficiently. Pharmacists will be able to overlook how medications are used in a hospital usi ng insights from this system (Biohealthmatics, 2010). Clinical screening is one of the most important usage of PhIS. Drug interactions, allergies and all plausible drug-related disorders can be monitored using the assistance of PhIS. When a prescription is issued, the system checks for all possible interactions between all the drugs prescribed together to a patient at one time or with any particular food, reported allergies to the drug, and even if the sufficient and appropriate dosage has been given based on the individual’s body mass index (BMI), age, and other physiological factors. Instant alerts and warning messages are displayed if adverse drug interaction is detected (Biohealthmatics, 2010). Inventory Management is a another major component of the PhIS. Pharmacists need to know the drugs available, usage pattern and balance of stock. This inventory can be separate from or be a part of the Procurement and Storage Information System of the hospital’s integrated Management Information System. Continuous inventory monitoring is an essential requirement of a pharmacy in order to ensure that drugs never goes out of stock. Besides, multiple dispensing locations and manual inventory keeping is not only tedious but can also lead to inaccuracy in inventory management (Biohealthmatics, 2010). In addition, prescription management for both in patients and outpatients is also a vital segment of PIS. For instance, when the issued prescription arrives to the pharmacy, the orders are checked and matched against available drugs in the pharmacy and then dispensed accordingly to respective patients. More interestingly, prescriptions that passes through the system that can track the physician prescribing the drug, date of prescription, to whom was it prescribed and when was it was dispensed. Automated label printing which bears directions on how medication should be followed is also possible (Biohealthmatics, 2010). Besides, patient drug profiling can also be achieved through PIS. These are patient profiles and holds particulars of their present and previous medications history, known allergies, family history and other parameters. These profiles are also during clinical screening. A physican who prescribes a particular drug to a patient would be able to instantly see the patient’s profile and decide on whether or not this drug is appropriate (Biohealthmatics, 2010). Figure 7 shows a typical pharmacy information system modal provided by Siemens. This includes relevant information such as patient name, name of the drug, route of administration, dosage and frequency of administration. PIS works hand-in-hand with EMR to detect contraindications due to drug allergy, streamlines workflow in addition to assisting billing and charging in administrative and financial system. Figure 7: Pharmacy information system modal by Siemens Source:http://www. medical. siemens. com/siemens/en_US/rg_marcom_FBAs/files/presskits/SiemensMAC. pg 3. 1. 6 Laboratory Information System (LIS) Laboratory Information System (LIS) manages all the laboratory faculties which includes clinical chemistry, parisitology, hematology, immunology and microbiology in terms of receiving orders, performing tests and producing results. It also provides modules for sending laboratory trials order to the appliances through its multiple instrument interfaces so that the results can then be anal ysed instantly and a reports can be generated. Patient management is an important aspect of LIS. Patient particulars such as the date of admission, consulting doctor, and respective reference number would be maintained by this system. Data pertaining to the patient’s samples including the consulting doctor, corresponding department, specimen type, method of collection and the technician-in-charge of the collection can also be monitored (Nationmaster Encylopedia, n. d. ). In summary, LIS is used for processing and storage of information generated by medical laboratories. EMR, PMS as well as order management system are customized in order to allow interferences between LIS which supports in-patient as well as out-patient services. Moreover, the system produces barcode sample labels which are therefore used for acknowledgment of test samples. In Selayang Hospital, there are around 150 barcodes readers that are being widely used daily (Abdollah, 2011). 4. 0 Impact of Total Information System (THIS) 4. 1 Benefits of Total Hospital Information System (THIS) Total Hospital Information System (THIS) is an enterprise-wide system which spans the organisaton, designed to enhance clinical outcomes, operational efficiency and to improve financial management for healthcare industry. THIS serves as a secured and dependable meticulously integrated system that allows hospital officials to record, store and selectively disseminate clinical and other patient related information to appropriate entities (Netripples, n. d. ). T. H. I. S. provides effective solutions to hospitals which plan on reducing the administrative burden and clinical transactions, in addition to providing compassionate services to their patients. On a typical day in Hospital Selayang, the inpatient admissions reach 150/day whereas outpatient visits would reach upto 1000/day amounting to 250GB of patient records. T. H. I. S has enabled effective management of such high flow of patients, data storage, processing and retrieval. Figure 8 illustrates the daily usage of T. H. I. S shows the heavy reliance and interdependance between Selayang Hospital and the information systems. Figure 8: Daily Utilization of T. H. I. S (Abdollah, 2011). With the presence of THIS, most of the patient care demands can be met because it computerizes the process of collecting, arranging, filing and retrieving patient information. Furthermore, world class patient care can be provided by the hospital when equipped with good decision support system from THIS. Additionally, T. H. I. S. benefits in various other methods such as comprehensive patient record keeping, much lesser paperwork, quicker information sharing means between various departments, more flexible organization, reliable and timely information and adequate inventory management. A user satisfaction survey conducted in 2003 among staffs of Selayang Hospital revealed that T. H. I. S was appreciated and well received among nurses and doctors followed by allied staffs and clerks as depicted in Figure 9. (Abdollah, 2011) Figure 9: User satisfaction survey 2003 (Abdollah, 2011). Productivity wise, Selayang Hospital has evidently shown higher productivity after the successful implementation of Total Hospital Information System (T. H. I. S. ). As Selayang Hospital had incorporated T. H. I. S. from the start of its operation, studies analysing the effectiveness of T. H. I. S. before and after implementation is not possible. However, a comparative study comparing T. H. I. S. n Selayang Hospital with a traditional government hospital, Hospital Klang is currently being carried out. Few early findings from this study shows implementation of T. H. I. S. has managed to reduced time taken for admission by 40%, patient stay by 10% and discharge processes by a remarkable 70%. Qualitative benefits of this system highlighted in this study include easy availability of data, bett er patient record management and improved workflow (Abdollah, 2011). The ability of Pharmacy Information System (PIS) to keep track of the entire drugs inventory within the hospital is commendable. The PIS head manager is also able to make orders when an alert is raised on a particular drug. This therefore ensures proper inventory management and that all drugs are always in stock. In addition to the privileges that pharmacies’ will get through the implementation of T. H. I. S, doctors of the hospitals are also able to reap off its benefits as well. For the clinicians, EMR and PMS aid in clinical management of patients. A medical officer no longer requires the doctor-in-charge to be physically present but still can receive consults from him/her utilizing EMR and PMS. All these systems has indeed helped Selayang Hospital to manage the hospital effectively with efficient decision making. Moreover, T. H. I. S. aids hospital administrators whereby it significantly improves operational control. Lastly, in addition to enhancing patient care, T. H. I. S also increases the profitability of the respective organization. In summary, there are a number of direct benefits of THIS in hospitals. The most important advantage of this system is the ability to meet patients’ demands in a timely manner owing to the automation involved in data collection. Other uses include great reduction in paperwork and more efficient patient particular collection and management. Considering the unwavering benefits from implementation of Total Hospital Information System, it will soon become a necessity in terms of hospital management. 4. 2 Ethical Concerns The number and the magnitude of challenges faced by healthcare organizations are unprecedented. Selayang hospital is no different. Increasing financial bruden, rising public an payer expectations and increasing number of consolidations have placed these hospitals under immense stress. Heavy usage of information systems have provided record-keeping which is otherwise impossible. However, this leads to rapid and easy access to medical records raising issues of privacy against expediency (Boyle, 2001). In Selayang Hospital, these issues are handled with utmost priority. Patients’ privacy and confidentiality is protected through several measures. Only authorised users are allowed to access these information. Authorised users who are found to be misusing their access would be tracked in audit trails and stringent disciplinary actions would be taken against them. Therefore, patients are assured of their personal data protection (Abdollah, 2011). 4. 3 Drawbacks and challenges of Total Hospital Information System (THIS) Like any other information system implementation, in T. H. I. S. , users’ resistance to change is one of the major concerns. This is largely related to individual acceptance of IT application particularly by doctors and nurses. Though this is now not an issue in Selayang Hospital, failures in HIS has been repeated reported over the years. Unrealistic goals, complex user-interface, lack of clarity on the functionality required and lack of sensitivity to the local systems were some of the key reasons contributing towards failure of THIS in many fledgling hospitals (Cassels, 1995). The developing countries face even deeper problems such as inadequate electricity supply, lack of proper infrastructure, unsustainable funding, and the inadequate educational levels of the hospital staffs who are likely to be the primary users of the system rather than doctors in these countries. Other concerns include slow response time, absence of easy login-procedures, and tedious data entry (Chandrasekhar and Ghosh, 2001). Selayang Hospital though comparatively better in IT receptiveness, initial reluctance was present. Even today, reluctance to change and accept an IT application especially the EMR system in a conventional society still persists. Appropriate strategies like IT training and incentives need to be deviced to make both patients and hospital officials more receptive towards these systems (Haslina and Sharifah 2005). 5. 0 Future Plans Following these victorious execution of T. H. I. S, Selayang Hospital is currently looking a step ahead into developing a entirely automated Pharmacy Information System (PIS) with Decision Support System (DSS). Besides, management is also emphasizing on improving reporting and data analysis, enhance clinical documentation module with decision support and introduce mobile computing function to facilitate better hospital management (Abdollah, 2011). 6. 0 Conclusion It is beyond doubt that T. H. I. S has been the backbone in assisting hospital administration to ensure Selayang Hospital runs smoothly. However, without the staunch commitment from top management, physicians and other users and adequate number of IT professionals, this success would have remained as a dream. Thus, information systems only when coupled with good recipience would prove beneficial. 7. 0 References Abdollah, 2011. Hospital Information System in Selayang. [Booklet] September 2011 ed. Selayang Hospital Information Technology Department. Biohealthmatics, 2010. Pharmacy Information System, [online] retrieved from http://www. biohealthmatics. com/technologies/his/pis. aspx [accessed on the 2nd October, 2011] Boyle, P. 2001. Organizations ethics and healthcare: principles, cases and practical solutions. San Francisco: Jossey-Bass. Cassels, A. ,1995. Health sector reform: key issues in less developed countries, Journal of International Development [online] retrieved from http://www. ncbi. nlm. nih. gov/pubmed/12290761/ [accessed on the 3rd October, 2011] Chandrasekhar, C. P. and Ghosh, J. , 2001. Information an d communication technologies and health in low income countries: the potential and the constraints, Bulletin of the World Health Organization, Vol. 79, No. 9, [online] retrieved from

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