The Nursing Career

Nursing is a profession focused on assisting individuals, families and communities in attaining, re-attaining and maintaining optimal health and functioning. Modern definitions of nursing define it as a science and an art that focuses on promoting quality of life as defined by persons and families, throughout their life experiences from birth to care at the end of life.

In pre-modern times, nuns and the military often provided nursing services. The religious and military roots of modern nursing remain in evidence today. For example, in Britain, senior female nurses are known as “Sisters”. In recent times in the US and Canada many nurses are flowing back into working in a “religious” field through “Parish Nursing”. These nurses work within a church community to perform health education, counseling, provide referrals to community support agencies, and connect volunteers from the church community with those in need of assistance.

Nurses acknowledge that the nursing profession is an essential part of the society from which it has grown. The authority for the practice of nursing is based upon a social contract that delineates professional rights and responsibilities as well as mechanisms for public accountability. The practice of nursing involves altruistic behavior, is guided by nursing research and is governed by a code of ethics.

Nursing continues to develop a wide body of knowledge and associated skills. There are a number of educational paths to becoming a professional nurse but all involve extensive study of nursing theory and practice and training in clinical skills.

In almost all countries, nursing practice is defined and governed by law and entrance to the profession is regulated by national, state, or territorial boards of nursing.

The American Nurses’ Association (1980) has defined nursing as “the diagnosis and treatment of human responses to actual or potential health problems.” Just as medical diagnoses help in the planning, implementing, and evaluation of medical care, Nursing diagnoses help in the planning, implementing, and evaluation of nursing care.

Like other maturing disciplines, nursing has developed different theories that are aligned with diverging philosophical beliefs and paradigms or worldviews. Nursing theories help nurses to direct their activities in order to accomplish specific goals with people. Nursing is a knowledge based discipline committed to the betterment of humankind. Nursing has not only developed into a profession, but an art as well.

Nursing is the most diverse of all healthcare professions. It is a universal role appearing in some form in every culture.

Nursing may be divided into different specialties or classifications. In the U.S., there are a large number of specialties within nursing. Professional organizations or certifying boards issue voluntary certification in many of these areas.

These specialties encompass care throughout the human lifespan based upon patient needs. Many nurses who choose a specialty become certified in that area, signifying that they possess expert knowledge of the specialty. There are over 200 nursing specialties and sub-specialties. Certified nurses often earn a salary differential over their non-certified colleagues, and studies from the Institute of Medicine have demonstrated that specialty certified nurses have higher rates of patient satisfaction, as well as lower rates of work-related errors in patient care.

Nurses practice in a wide range of settings from hospitals to visiting people in their homes and caring for them in schools to research in pharmaceutical companies. Nurses work in occupational health settings (also called industrial health settings), free-standing clinics and physician offices, nurse-run clinics, long-term care facilities, and camps. Nurses work on cruise ships and in military service. They act as advisors and consultants to the healthcare and insurance industries. Some nurses are attorneys and others work with attorneys as legal nurse consultants, reviewing patient records to assure that adequate care was provided and testifying in court. In many cities, nurses can even enter their names in a “registry” and work a wide variety of temporary jobs.

In the modern world, there are a large number of specialities within nursing:
Ambulatory care nursing
Advanced practice nursing
Behavioral health nursing
Camp nursing
Cardiac nursing
Cardiac catheter laboratory nursing
Case management
Clinical nurse specialist
Clinical research nurse
Community health nursing
Correctional nursing
Critical care nursing
Developmental disabilities nursing
District nursing
Emergency nursing
Environmental Health nursing
Flight nursing
Forensic nursing
Gastroenterology nursing
Genetics nursing
Geriatric nursing
Health visiting
Hematology oncology nursing
HIV/AIDS nursing
Home health nursing
Hospice nursing
Hyperbaric Oxygen Therapy Nursing
Intavenous therapy nursing
Infectious disease nursing
Legal nursing
Legal Nurse Investigator
Maternal-child nursing
Medical-surgical nursing
Military and uniformed services nursing, including Public Health Service
Neonatal nursing
Neuro-surgical nursing
Nurse anesthetist
Nurse-midwife
Nurse practitioner
Nursing educator
Nursing informatics
Nursing management
Obstetrics gynecology nursing
Occupational health nursing
Oncology nursing
Operating room nursing
Orthopaedic nursing
Ostomy nursing
Pain management and palliative care nursing
Pediatric nursing
Perianesthesia nursing
Perioperative nursing
Plastic and reconstructive surgical nursing
Private duty nursing
Psychiatric or mental health nursing
Public health
Pulmonary nursing
Quality improvement
Radiology nursing
Rehabilitation nursing
Renal dialysis nursing
Renal nursing
Research
School nursing
Sub-acute nursing
Substance abuse nursing
Tele-medicine nursing
Telemetry nursing
Telephone triage nursing
Transplantation nursing
Travel nursing
Urology nursing
Utilization management
Wound care
Professional organizations or certifying boards issue voluntary certification in many of these specialties.

Nursing assistant skills are the set of learned tasks used in helping residents or patients with activities of daily living (ADLs) and providing bedside care—including basic nursing procedures—under the supervision of a Registered Nurse (RN) or Licensed Practical Nurse (LPN).

In today’s hospitals and extended care facillities a nurse assistant is an important part of a healthcare team that includes many personnel outside of nurses. In the quest to make a profit from providing care many hospitals in the United States have reduced their nurse to patient ratios, requiring one nurse to take care of as many as twelve or fourteen patients at a time. In order for good care to be provided to those patients a nurse assistant is needed to provide the routine care so that the nurse can focus on tasks only he/she can do, such as care plans, nursing assessments, administering medication, and assist in surgery room preparation. The nurse assistant must not only be very skilled in the actual procedures being performed but must also be able to make quick observations of a patient’s condition and report that information back to the nurse. Since the nurse cannot spend large amounts of time in the room with the patient, the nurse assistant is known as the nurse’s “eyes and ears”.

A nurse assistant must also have a strong grasp of emergency procedures and be able to stay calm in stressful situations. They must be able to initiate a Code Blue and be well-drilled in CPR.

The Many Shortages Of Doctors In US

Currently there is a widespread shortage of qualified physicians to fill the many vacancies that have been left by individuals who have left their positions to retire, for better opportunities, or for a change of life and career. In addition to the vacated positions, the natural growth of the field has created an increased need for health care services especially in suburban communities. This shortage has created a dynamic market for job seekers, but has left many institutions in compromising positions.

Interestingly, despite the demand to fill these positions, particularly senior management positions, pay has remained relatively steady since about 2001. Some specialties, such as both invasive and non invasive cardiologists, have even experienced a decrease in pay. Many institutions are struggling with implementing incentives to hire new physicians while still trying to balance a practical budget. A common practice among these institutions is to shift their budgets to include performance-oriented incentives and substantial hiring bonuses to attract potential employees. Some institutions are offering target bonuses of up to 28%, the highest wage earners falling into the physician executive categories.

Another move that many hospitals and health systems have made is the implementation of chief medical officer positions since the shortage has allowed them to recognize a need for a senior executive position that can build important alliances with physicians. Once a position that was a bonus to have in a medical institution this chief medical officer position has grown into a necessity, especially in the face of such manpower shortages.

On top of this shortage, it has been noted that there has been a faster turnover in many physician positions than in past years. Recent studies have shown that over 10% of the physician workforce changes position in a year.

To curb this turnover many institutions have moved to create better job security and better job satisfaction. Eventually this trend of job change will effect the industry as a whole and likely create an even more competitive environment for the ever tightening pool of qualified individuals.

The physician workforce has also been influenced by a cultural change of individuals seeking a better quality of life for themselves. Many physicians, new and old, are wanting to spend more time with their families and friends in recreational activities instead of working the demanding hours that these medical positions often require. This has created a clear decrease in job attractiveness that institutions have found difficulty improving upon.

As the need for health care increases, so will the obligation of hiring institutions to show flexibility in meeting the demands of qualified candidates. Attracting physicians through programs that support and balance their jobs and personal lives will become vital in reducing turnover rates and in attracting those looking for new opportunities. In the end, both the physician workforce and the medical institutions seeking to employ them must understand each other’s viewpoint and find a balance that meets the needs of the other as well as the needs of those serviced.

A simulating idea … The use of simulation in training

The use of simulation as a training tool is not new; indeed, it has been used since the 1900s to enhance the overall learning experience. The most well understood use of simulation is flight simulators in the aviation industry.

Several minutes into US Airways A320 Flight 1549 from LaGuardia Airport, N.Y. to Charlotte, N.C., the Captain was put in a position where a difficult decision had to be made: could he guide his US Airways plane to a small airport from just 1,600 feet above the Bronx or would he have to attempt a ‘landing’ in the Hudson River? In the end, he had no choice. Captain Sullenberger executed a text-book landing in the Hudson River. The wings were perfectly balanced, the speed of the aircraft was slow enough to not tear the aircraft apart, and so the Captain was able to save the lives of 155 people. Of course, it didn’t take long for Internet bloggers to claim that they had been landing planes in the Hudson River on Microsoft Flight Simulator for years!

Pilots must spend time on simulators. They have no choice. In simulators, pilots are presented with a problem or scenario and then asked what to do next – to which they must respond as they would in real life. A range of routine emergencies are practiced on a regular basis, for example: engine failures, wind shear, total hydraulic failure and two-engine loss at high altitude. Simulators also allow pilots to practice ‘not so normal’ emergency situations which are all undertaken in the safe confines of a land-based computer controlled flight simulator.

Military use of simulation is also well understood. For years US and Australian military forces have trained together in simulation exercises known as Tandem Thrust to enhance their military skills and develop better cooperation. Tandem Thrust 2003 provided training for a maritime-based commander and staff in crisis action planning and for execution of contingency operations. It involved approximately 8,000 personnel.

Military exercises occur every year. Exercise Cooperative Spirit 2008 was a multinational exercise intended to test and improve interoperability and strengthen ties amongst American, British, Canadian, Australian and New Zealand armed forces. This multinational exercise provided a realistic, counterinsurgency-based, Afghanistan-focused environment, used to test and improve interoperability and ultimately prepare units for coalition combat operations.

Stories emerge from battlefields around the globe where troops are fighting in real-life. Most stories link the strength of our military forces (and their successes) to the highly professional and sophisticated training methods we use.

The investment made in simulation appears to be paying significant dividends in the airline industry and in the military; but can simulation deliver benefits to the broader community or other industries within it?

To answer these questions we must take a step back and look at the history of simulation, its application and its use as a training tool.

What is simulation?

Put simply, simulation is a training tool. The term training is used deliberately. In my view simulation is a planned activity and training is something you do, while learning is something that happens. Of course, people learn while they are training; indeed, the use of simulation creates a synthetic learning environment for participants.

While there are many learning activities that can contribute to a person altering or improving their knowledge, skills and attitudes, the objective of using simulation is to train a person through planned activities.

Simulation-based training generally focuses on the ‘application’ of knowledge. This is the key to understanding its importance. It is one thing for a pilot to learn the theory of landing a plane in a river, but it is another thing to actually apply this acquired knowledge without having practiced it in a controlled environment. Through simulation it is possible to train a pilot to land a plane in a river.

Tips for landing your plane in a river
(Source: John Ladd, Pilot, American Airlines)

Land the airplane as slow as possible without stalling Catch both engines in the water at the same time.
(Note: Hit one wingtip first, and you will ‘cartwheel’ the plane) Keep the landing gear retracted Extend the wing slats and flaps Maintain the optimal glide speed Set the tail of the plane into the water first Land as soft as possible and as slow as possible.
(Note: If the nose is too low and going too fast, you risk flipping the plane tail-over-nose)

Fidelity of training

Simulation is a ‘synthetic’ environment; however, it is made to represent reality. The term fidelity is commonly used to describe the extent to which a simulation replicates the reality. For example, the flight simulators used to train Qantas pilots are considered ‘high-fidelity’, i.e. the simulators look, feel and behave like a real plane.

To create a synthetic learning environment that mimics reality, a significant investment must be made. The extent of investment depends on the subject matter and level of fidelity and resources needed. On 14 October 2008, Captain Mark Ford guided the new $300 million Qantas Airbus A380 in for touch-down at Perth International Airport for the first time. He had been trained on the plane’s $34 million flight simulator so that he could confidently carry out this activity in real-life.

Simulation does not necessarily need to be high-fidelity in order for it to be effective. Role play is a common low-fidelity simulation technique. Role play involves a scenario set by the facilitator where training participants are assigned different roles. The roles assigned to participants usually relate to their real-life role; however, this form of simulation also provides an opportunity to ‘act out’ a role not normally performed by the participant in real life. Role play simulations can sometime use external (professional) actors to increase the level of fidelity (e.g. in the health sector).

One important outcome from simulation is that participants are given the opportunity to consider a scenario from the perspective of others. This opportunity can result in the development of a greater level of sensitivity when working in the real-life environment. The corollary is that simulation can also be used to challenge the conventional way of doing things, assumptions, attitudes and working environment.

In their research paper – A Comparison of Simulation-Based and Conventional Training Methods – Experience Builders llc conclude with the following statement: “A sizable body of research suggests that simulation-based training is generally superior to conventional training methods”. Their paper highlights how participants in simulation-based training can: achieve a deeper understanding of the subject matter, retain knowledge for longer periods of time, display a greater level of interest in the subject matter and be better able to transfer their learning experience to their job than participants using conventional training methods.

More and more organisations are turning to simulation-based training to produce meaningful outcomes.

Advances in technology

Flight simulators are very effective. The 9/11 Commission in the US concluded in 2004 that those responsible for flying the planes into World Trade Centre and Pentagon had used PC-based flight simulators during training.

Flight simulators have been in existence for a long time. Pilots of the first powered aircraft trained by proceeding through a graded sequence of exercises; i.e. they used simulation-based training back in the early 1900s.

Over time, there have been significant advances in technology. Computers entered our everyday lives in the 1960s. Those computers had less processing power than the typical modern mobile phone. Today, computers can recreate virtual environments – clearly demonstrated in flight simulators.

Flight simulators come in many shapes and sizes. Even the most basic home computer can be turned into a powerful flight simulator which can download real-time weather data to ‘fly’ in; fly to thousands of different airports; simulate numerous aircraft types; offer multiplayer ‘games’, operate within a virtual airport and also facilitate online talking with other ‘pilots’. These simulators use real charts and ‘navigate’ using typical instruments and aviation navigation beacons.

It is also possible to include moving cars, trucks, boats, and other aircraft into the surrounding environment as you fly. Finally, you can even join the Virtual Pilots Association.

Today, no airline would dream of sending their pilots up without simulation-based training. The use of these high-fidelity simulators has been so successful it is firmly established as a training tool in pilot certification programs throughout the world.

Law enforcement and intelligence agencies have also entered the simulation scene, one of the largest exercises in Australia being Mercury 04. This multi-jurisdictional counter-terrorism simulation was designed by the National Counter-Terrorism Committee. The objective was to exercise the Australian, state and territory government agencies’ ability to prevent, respond to and recover from terrorist threats and acts of terrorism simultaneously in multiple jurisdictions, testing Australia’s approach to national security and the National Counter-Terrorism Plan.

The exercise ran from 22-26 March 2004 and was Australia’s largest and most ambitious counter-terrorism exercise ever undertaken. It encompassed four jurisdictions, with the primary jurisdictions being the Northern Territory and Tasmania, and secondary jurisdictions being Victoria and South Australia.

A simulation such as Mercury 04 enhances capability, understanding and agency interoperability and contributes to the effectiveness of any response to a real terrorist event.

Two things emerge when one analyses the well-understood simulation environments created for pilots and military/law enforcement participants:

participant ‘immersion’ (i.e. whether the simulation is being taken seriously) is critical. Without it, reality is missing, and simulation-based training is particularly useful in high-risk environments.

Simulation in the Healthcare industry

It makes sense that healthcare professionals are embracing simulation as a highly-effective training tool. Simulation in this environment seems blindingly obvious to the mere mortal – why not practice on a synthetic mannequin before trying out the new surgical procedure on a patient?

When you scrape the surface, there are some more interesting (but less well-known) uses of simulation being deployed in the healthcare environment. Firstly, there are two distinct forms of training in healthcare:

technical skills training, and non-technical skills training.

Technical skills training typically relates to the following:

patient assessment and clinical diagnostic reasoning judgment and decision-making regarding therapy, and procedural knowledge and skills relevant to execution of medical procedures.

Simulation facilitates technical skills training in a risk-free environment.

Non-technical skills training is effectively ‘soft skills’ training which is used to develop practitioners so that they may manage sensitive situations surrounding medical procedures. A simple example of a non-technical skill is the ability to sensitively break bad news to a patient’s family. Non-technical skills are also recognised skills underpinning safe and effective clinical practice.

In the healthcare environment, simulation technologies can involve the use of:

Mannequins - Life-like aspects of people and situations are generated by a mannequin. This can also include ‘theatrical’ interaction of actors and props with mannequins to present high fidelity simulations.

Synthetic Models – These allow users to practise technical skills on synthetic tissue.

Virtual Reality – Where a realistic environment is reproduced on a computer display. The user interacts using instruments similar to those used in real life. Sometimes the realism can be improved by the addition of other sensory inputs, such as tactile (haptic) or auditory feedback.

Haptics – Where tactile information is fed back to the participant; for example, the feel of surgical instruments on tissue.

Actors – The use of real people who role play (act) to reproduce a real-life scenario.

Part-task trainers – Part-task trainers break a skill down into its component parts, which the trainee then practices. They allow repeated practice of individual skills while developing competency and confidence.

Augmented reality – A combination of real-life and virtual objects.

(Source: Australian Society for Simulation in Healthcare. Reproduced and modified with permission)

Teaching methods used within a simulation include (but are not limited to) the following:

Scenarios – Using any of the simulation technologies to enact whole events or components of events.

Case-based – Using other formats including written and oral presentations to present scenarios.

Role play – Using any of the simulation technologies to enact interactions between people, for example, in the health industry by health professionals, patients and the community.

Procedural training – Using any of the simulation technologies as a platform from which to conduct a procedure.

Multimodal formats – Refer to activities which integrate two or more discrete teaching methods or curricula which use a variety of specific formats to address specific individual training objectives.

Debriefing and reflection – To ensure participants maximise training outcomes.

(Source: Australian Society for Simulation in Healthcare. Reproduced with permission)

Advantages of simulation-based training

In the health industry, there are many advantages that arise from using simulation-based training.

The risk to patients or trainees is removed. Many scenarios can be presented, including uncommon but critical situations in which a rapid correct response is needed. Participants can see the results of their decisions and actions; errors can be allowed to occur and reach their conclusion (where in real life a more experienced clinician would have to intervene) so that trainees might be permitted to learn from their mistakes without undesirable consequences. Identical scenarios can be presented to different clinicians within teams. When using mannequin simulators, clinicians can use actual medical equipment, exploring the ergonomics of the human-machine interface. With full re-creations of actual clinical environments, complete interpersonal interactions with other clinical staff can be explored and training on teamwork, leadership, and communication provided. Intensive and non-intrusive recording of the simulation session is feasible, including audio taping, videotaping, and even physiological monitoring of participants (such as ECG or EEG). There are no issues of patient confidentiality and the recordings can be preserved for research, performance assessment, or accreditation. The use of simulation makes the learning experience highly realistic.

(Source: Gaba D. Anesthesiology as a model for patient safety in health care, British Medical Journal 2000; 320:785-8)

In his thesis Virtual Reality Simulators in Surgical Education undertaken at the University of Sydney in 2006), Dr Peter Cosman observed that surgical practice is changing in three fundamental ways:

Surgical technique is evolving rapidly. The general public are becoming increasingly aware of aspects of healthcare provision that impact on outcomes, and are demanding high standards of highly trained health professionals. Workforce and resource issues diminish training opportunities for specialists-in-training, but do not address questions of how to train more specialists in a broader spectrum of practice in a shorter period of time with decreased resources and without causing adverse outcomes for patients.

Medical technology and innovation in procedures has evolved since the beginning of mankind; and it is not expected to stop evolving anytime soon.

His final two conclusions ring very true in the current political landscape. The general public and Ministers react to (very disturbing) news stories of deaths, serious injuries and emotional distress when the health system fails. The general public and the people directly involved then get caught in the standard Health System Crisis Cycle – a cycle of health system failure, media attack, political reaction, blame attribution, enquiry outcomes and band-aid measures until the next failure starts the cycle again.

In all the news surrounding patient safety, the general public find it difficult to understand why attention isn’t being paid to quality training. Dr Cosman succinctly concluded in his paper: “There is no doubt that simulation has a significant function in this environment”.

Simulation is being used to improve patient safety

For all the bad news that emerges from Royal North Shore Hospital, Sydney, Australia there are many goods news stories that go unheard.

At about 3:00am on the morning of 1 May 2008 a half-cabin marine vessel, allegedly stolen from its berth at Balmain overnight, was hit by a trawler heading out to sea off Bradleys Head in Mosman, NSW.

Dr John Vassiliadis, an Emergency Medicine Specialist at Royal North Shore Hospital (Sydney), was on-call; however, sound asleep when his pager sounded. He awoke to a crisis. As reported in the media, the nine survivors were taken to Royal North Shore Hospital, while five were killed. Dr Vassiliadis quickly prepared himself for a difficult day at the office.

Dr Vassiliadis applied all his skills, both technical and non-technical, to deal with the situation at hand which involved serious injuries, traumatised patients, distressed family and friends, media interest, politicians and the health bureaucrats from all corners of the system. When a crisis happens, everyone wants to be kept ‘fully informed’.

On that day, the patients, families, friends, and the health system was very fortunate to have Dr Vassiliadis involved. Not only is he a highly regarded clinician, but he also delivers the Emergency Medicine Crisis Management (EMCM) course for the Sydney Clinical Skills and Simulation Centre. Developed and run by specialists in Emergency Medicine and Anaesthesia, this course prepares doctors to manage serious acute problems in the Emergency Department.

This course provides an interesting insight into contemporary training techniques used in the healthcare sector. Not only does the course encompass technical skills training, recognition is given the importance of non-technical skills training – the latter being just as important in the context of healthcare, particularly in events such as the one mentioned earlier.

Crisis Resource Management (CRM) – Seven Key Behaviours

1. Know your environment

2. Prepare and plan

3. Call for help early

4. Take a leadership role

5. Allocate attention wisely and use all available resources

6. Prioritise and distribute the workload

7. Communicate effectively

(Source: Sydney Clinical Skills and Simulation Centre)

Developments in the Healthcare sector

The Commonwealth Department of Health and Ageing provided funding for the Australian Society for Simulation in Healthcare (ASSH) to conduct a project in non-technical skills training in synthetic learning environments. This project will conclude in April 2009.

In their Request for Tender[1]to engage a consultant for this project, ASSH state, “overall, simulation is under-utilised by all specialties”. One of the stated project objectives is to inform specialist colleges about simulation-based training for non-technical skills and the potential to incorporate this into training curricula.

The Request for Tender identifies that – “even the specialties that have adopted simulation can do more to integrate its applications into the implementation of training curricula”. It also states – “Factors contributing to low utilisation include:

low awareness of its potential low engagement by stakeholders inadequate understanding by curriculum designers and clinical teachers of how it can be incorporated into curricula and training activities lack of knowledge of factors underpinning purchasing decisions and evaluation of its impact and value for money perceived or actual lack of infrastructure, funding and other resources, and a lack of awareness of, or access to, appropriate learning technologies and facilities”.

The adoption of new approaches is always challenging and the Request for Tender acknowledges that “new practices will be more successfully adopted and sustained if a strategic approach is employed”. One objective of the ASSH project is to see simulation better utilised by increasing awareness amongst stakeholders, engaging early adopters to champion it and drive change within their specialty and establishing a sustainable model for delivery which overcomes some of the identified obstacles.

The Commonwealth are also supporting other related initiatives.

The Royal Australasian College of Surgeons, through its Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), was engaged by the Commonwealth Government in 2007 to undertake research into the use of simulation in surgical skills training.  The programme, which will conclude at the end of 2010, aims to evaluate different classes of simulation to determine the utility of each in a variety of settings. Professor Guy Maddern, ASERNIP-S Surgical Director, states in the Annual Report 2007 “this important initiative will enable the College over the next three years to define the curriculum and infrastructure support required to provide simulation environments to trainees and Fellows at a variety of sites around the nation”.

These projects are timely in the context of new investment in the healthcare sector.

Show me the money

The Final Report of the Special Commission of Inquiry into Acute Care Services in NSW Public Hospitals by Peter Garling SC, 27 November 2008 identified a health system in a period of crisis. The report is known as the Garling Report.

NSW Health: A typical day
(Source: The Garling Report)

On a typical day for NSW Health across the state of NSW, there will be:

an ambulance responding to an emergency 000 call every 30 seconds; 6,000 patients arriving at Emergency Departments seeking treatment; 4,900 new people being admitted as an in-patient at a hospital; 17,000 people occupying a hospital bed of whom 7,480 are over 65 years old; 7,000 separate procedures performed; and $34 million spent on providing care in public hospitals and for the health of the people of NSW.

Many recommendations contained in the report focused on the need for increased or expanded workforce training capacity and capability. Not surprisingly, simulation was featured in recommendations to enhance skills training. It is worth noting that Garling described NSW hospitals as “good by world standards, in many cases ranking towards the top, but too often unable to deal with the sudden increase in patients, the rising cost of treatment, and the pressures on a skilled workforce spread too thinly and too poorly supported in the dozens of administrative tasks which take them away from their patients”.

The National Health Workforce Taskforce was established in 2006 by the Council of Australian Governments (COAG). In November 2008, COAG agreed to an unprecedented health workforce reform package of $1.6 billion – the single largest investment in the health workforce ever made by Australian governments. It comprises $1.1 billion of Commonwealth funding and $540 million in State funding. Amongst this was a $175.6 million investment in capital infrastructure to support training of the future health workforce, including funding for the construction of new and mobile high-tech simulated learning environments and the expansion of education and training facilities at major regional hospitals.

The cheque made out to: Greater use of simulation in the healthcare sector appears to be in the mail. The challenge will be to implement a coordinated approach to leverage the considerable simulation experience already evidenced in the healthcare sector. A national framework would surely serve to improve outcomes for the general public; however, the challenge may be too great for the system to deal with.

With the benefits of simulation being formally recognised in a high-risk sector; and with simulation being used for non-technical skills training, perhaps it is worth exploring the use of simulation in management training.

Simulation in management

A quick search on ‘Simulation in Management Training’ in Google will result in masses of gunk (that’s Google Junk for short); however, when you start wading through it, a number of areas emerge where simulation is being used:

Project Management Disaster Management Event Management Incident Management Call Centre Management Business Strategy & Planning Safety & Risk Assessment, and Corporate governance and business ethics.

There are countless business game providers. According to one provider, “A policy game offers the ultimate in business education”. While the marketing hype is sometimes hard to take, the complexities of live exercises can be overcome to a large extent through use of integrated gaming and simulation models that allow staff to train across multiple levels and even across multiple organisations to be exposed to the same scenario.

The Simulation Industry Association of Australia (SIAA) exists to advance the research, development, and use of simulation technologies and practices in Australian industry, academia and government. A key activity of the Association is to host SimTecT – the annual Simulation Technology and Training Conference.

At SimTecT 2008, David Urquhart, Macquarie Graduate School of Management (Sydney) and Associate Professor Debbie Richards, Macquarie University (Sydney) demonstrated that the Monte Carlo simulation is an effective way to value a bundle of Human Resource Management (HRM) policies. According to their paper, “the field of HRM addresses issues such as staff costs, performance and turnover – all of which have a basis in uncertainty”. Urquhart and Richards used the GoldSim Monte Carlo simulation software to underpin the project. See www.goldsim.com for more information on this software.

This project served to demonstrate that simulation can be used to model business management scenarios and has the advantage of not interrupting operations. Importantly the modelling demonstrated that simulation software can make it easier for business people to understand and experiment with simulation models.

Many organisations currently reacting to the Global Economic Crisis could be utilising simulation techniques to model the consequences of change. Both economic and social outcomes could be tested. Indeed simulation could also play a role in training those involved in the fall-out from decisions effecting large numbers of people. Just how many senior executives have been trained appropriately to react to angry staff, a media pack and the politician looking for a head to roll?

Approach to simulation

There doesn’t appear to be a prescription for the perfect approach to developing and conducting a simulation. The SIAA website (www.siaa.asn.au) contains a vast amount of material to reference when considering using this training tool.

Simulation should be approached on the basis of:

Planning

The scope of developing and conducting a simulation can be a substantial project – even for a low fidelity approach. The design of course, the resources needed, the tasks which need to be identified and coordinated and the quality assurance all contain significant effort.

Investment

The total effort required to develop and conduct a simulation can be a significant cost. The business case to support this investment must be sound to in order to secure resources needed.

Resources

The human resources, administration systems, simulation technology, infrastructure, facilities and related costs with utilisation of each can add up. Such an investment can require high-level stakeholder support.

Support

In any decision-making process there will be a variety of stakeholders involved. Critical stakeholders are the decision makers, essential stakeholders are those who influence critical stakeholders and those who remain are less important (but not necessarily useless). It is vital that critical and influential stakeholders are ‘on-side’.

The planning, total investment and resources needed means a simulation will need to be supported by those whose opinions count. It is therefore important to undertake careful stakeholder analysis to ensure you gain the right level of support needed.

Conclusion

Simulation is now recognised as a high effective training tool. By default, the exercise must simulate reality; therefore, immersion by participants is critical. Examples presented in this paper highlight the results that can be achieved when simulations are properly planned, investment is made, resources are used effectively and support is gained.

The use of simulation in the Military, Law Enforcement and Healthcare sectors has paved the way for other private and public sector organisations to make greater use of this training tool in its workforce development programmes.

 

[1] Request For Tender (ASSH/001/07), issued by Queensland Health on behalf of the Australian Society for Simulation in Healthcare (ASSH)

Medical Tourism is a Low Cost Alternative to the American Healthcare System

Medical patients are traveling internationally to: receive higher quality healthcare, bypass wait lines and save money.

According to the 2006 Health Confidence Survey: · 31% of Americans rated the healthcare system as poor1. · The primary cause for dissatisfaction among Americans is the increasing healthcare costs1. Currently medical travelers are seeking treatments that are not covered by insurance or are simply too expensive such as dental care and cosmetic surgery. On the other hand with 45.7 million uninsured citizens in 20072, medical tourism may offer a feasible alternative to the existing system.

The U.S. Healthcare System

The current American healthcare system is made up of both private and public insurers. What is unique about the US system is that the private element dominates the public2.

Public Health Insurance Companies

These insurance companies are owned by the government. For the most part they cover seniors, the disabled, children from low income households, very poor parents, pregnant women, and veterans. According to federal law, the states are required to cover these groups2.

Often people insured with public healthcare have to purchase supplemental insurance due to 2:

· Incomplete coverage

· No dental care

· And more

Adults with no children are not entitled to public healthcare and many individuals who cannot afford healthcare are not eligible because their income is considered too high2.

Private Health Insurance Companies

The current private insurance system offers most citizens with low quality care at a high cost. This may be caused by the lack of competition as well as the predetermined costs and procedures that an insurance company will cover. As a result, the quality of care is based on a patient’s level of financial coverage and the amount of money the doctor will receive for the treatment3.

The following factors contribute to the high costs of healthcare available in the U.S.:

· Price and service are not sensibly packaged resulting in higher costs and lower quality4.

· Healthcare is fragmented among specialties and different providers, and communication among providers treating the same patient is often nonexistent.

· Out-of-pocket expenses are increasing each year. In 2003, 43.1% of Americans under age 65 spent over $2000/year in out-of-pocket health care costs, including that of health insurance5.

· Wasteful spending of increased healthcare budgets. Inefficiencies, excessive administrative expenses, inflated prices, poor management, and inappropriate care, waste and fraud significantly increase the cost of medical care and health insurance for employers, workers and families6.

Medical Tourism a Cost Effective Solution

With patients paying out-of-pocket expenses in addition to health insurance costs, it is becoming increasingly popular for U.S. patients to travel abroad for surgery and other medical treatments3. Treatment centers abroad typically offer low cost packages that include:

o Cost of the full treatment

o Physician and hospital and administration fees

o High quality of care

o Facilities and phy­sicians that meet American standards

o The use advanced technologies for patient security and safety

o Lodging and airfare

For more details and to learn more about medical tourism read: Medical Travelers and the American Healthcare System – A Cost Effective Solution

References

1. 2006 Health Confidence Survey, Employee Benefit Research Institute, 2006 ,November 2006, Vol. 27, No. 11

2a. Center on Budget & Policy Priorities: Poverty and Share of Americans Without Health Insurance Were Higher in 2007 – And Median Income for Working-Age Households Was Lower – Than at the Bottom of Last Recession For Poverty Rate and Non-Elderly Median Income, Worst Performance on Record For Any Six Years of Economic Growth Robert Greenstein, Sharon Parrott and Arloc Sherman August 26, 2008 2.Kao-Ping Chua, AMSA Jack Rutledge Fellow 2005-2006: Overview of the U.S. Health Care System, February 10, 2006

3. The Market for Medical Care: Why You Don’t Know the Price; Why You Don’t Know about Quality; And What Can Be Done about It.

NCPA Policy Report No. 296 (ISBN #1-56808-169-3), February 2007 (http://www.ncpa.org/pdfs/st296.pdf)

4. Michael E. Porter and Elizabeth Olmsted Teisberg, Redefining Health Care: Creating Value-Based Competition on Results (Boston, Mass.: Harvard Business School Press, 2006).

5. Agency for Healthcare Research and Quality. Out-of-Pocket Expenditures on Health Care and Insurance Premiums Among the Non-elderly Population, 2003, March 2006. (http://www.ahrq.gov/news/nn/nn031506.htm)

6. The National Coalition on Health Care. Facts on the Cost of Health Insurance and Health Care. 2009 (http://www.nchc.org/documents/Cost Fact Sheet-2009.pdf)

7. McKinsey Global Institute. Accounting for the Cost in the United States. January 2007

8. Catharine W. Burt and Jane E. Sisk, “Which Physicians and Practices Are Using Electronic Medical Records?” Health Af­fairs, Vol. 24, No. 5, September/October 2005, pages 1,334-43.

9. Mercer Health & Benefits predicts this will be the case. See Judy Foreman, “Bon Voyage, and Get Well!” Boston Globe, October 2, 2006.

10. Medical Tourism: Health Care Free Trade. Devon Herrick, NCPA Policy Report No. 623, 2008 (http://www.ncpa.org/pub/ba623)

Lunar One copyright 2005

   Bill Larantz stepped out of a door accompanied by three, armed security officers. They turned left down the long corridor, walking methodically slow. He noticed the dark blue stretch uniforms they were wearing, which had a bright-yellow triangular shaped stripe across the front, centered by a large chrome star – the symbol for the World Federation.

   “What’s it like to work as a security officer?” He asked cheerfully, hoping to somehow break the solemn atmosphere of his companions. But it was to no avail as they didn’t respond nor even acknowledge that he had spoken.As they marched along Bill surveyed the faces of the officers and found that they looked straight ahead intently but saw nothing. It was as if they were locked inside their heads.

   The corridor was oval shaped and dimly lit with neon lighting that streamed along each side behind glass covers. The walls were faced with a gloomy blue-gray material, which was disturbing to look at.

   They quickly approached a large four section portal at the end of the corridor, next to which was located an elaborate keypad. The lead officer deftly typed a code in order to gain access to the entrance. The large door opened up by the two top sections separating and moving up while the bottom sections separated and moved down respectively. Passing through the opening they entered a spacious white colored chamber at the center of which was an enormous console. Surrounding the control panel was a bright florescent-green field, which extended up from the floor about eight feet.

   They continued on heading for the green field. The doorway behind them closed with a surprising boom giving him a bit of a start. He could feel his heart flutter for a moment and then it quickly recovered when he realized what it was. Upon entering the field a large three-dimensional head appeared before them sporting a very menacing look. The group took a few steps closer and then stopped abruptly.

   “Bill Larantz please step forward,” a loud voice blasted from some unseen speaker system. Bill complied a little weak in the knees.

   “I am Holax Maddan, Chief Arbiter West-zone district, World Federation,” the voice continued fatefully. “Case WF-SH-448xx7 Sentence hearing commencement 4:45:00pm-07/24/2110,” Holax said, as if it were an aside, sending the communication to some other unknown audience.

   Attention was quickly directed back to him however as Holax said, “You have been convicted of the following crimes: Three counts attempted overthrow of the World Federation, Two counts conspiracy against mankind and Two hundred counts murder of Federation personnel.”

   There was an abrupt momentary pause as the large head glared at him grimly, then it continued with, “Because of the violent and terroristic nature of your crimes, you have been categorized as a Level Six Convict – maximum danger and destructiveness to society. Therefore, this court hereby sentences you to life imprisonment at the maximum-security Lunar-One criminal institution. You will be leaving at 8:30am-07/25/2110. All of your personal records are – as we speak – being deleted from all databases. You are no longer Bill Larantz, that identity has been permanently erased just as if you had never been born. You are now the property of the World Federation. Your identity is now L-1/INM-448xx7. As the property of the WF you can and may be subjected to any psychiatric-experimentation, including drugs, shock and surgery. Do you have anything to say for yourself before your sentence begins?” Holax asked in conclusion with a most invalidating tone and expression.

   “I am neither a criminal nor a terrorist!” Bill began his challenging retort looking squarely in the eyes of the giant head facsimile before him. “Me and my fellow Freedom Fighters are attempting to restore liberty to this planet that the World Fe–––,” he attempted to say but the hologram image vehemently cut him off midstream with:

   “We don’t want to hear any of your old-world democratic ideas here. Personal liberty was a failure, as everyone knows, for it is just too dangerous. The American Republic is out and the One World Order is in. You have failed to keep up with the times and just like all the rest of your freedom-advocate brethren, your true purpose – while beating the drum for liberty – is to commit crimes and protect criminals,” Holax stated with finality and evaluation.

   As Bill considered the ridiculousness of the statement he had just heard and the comical seriousness with which it was uttered, he suddenly broke out into uncontrolled laughter.

   The head’s features became enraged as it bellowed to the security officers, “Restrain this criminal at once!”

   The three officers complied in a hectic manner, by pulling out their electrified nightsticks, turning them on and touching them to Bill’s midsection in unison, sending him into immediate violent convulsions for a few short seconds, after which he collapsed unconscious to the floor.

9:45:00-AM-08/15/2110

   John Smith was not his real name, it was actually Nolan Pool, but that name was just too unique. You see Nolan had the fortune or misfortune – however the case may be – of having been born with the most average features. He had the mean height of five feet eleven inches. His brown hair and brown eyes were very common. To accentuate this he wore run-of-the-mill clothes and shoes, had an average-Joe hair cut and maintained a work-a-day manner in all of his actions.

   Now most people who were quite average in looks would have probably considered this to be a real problem and might have tried to make themselves a bit out of the ordinary in some way, by getting an odd haircut, donning strange clothes, or something. But not Nolan; instead he thought of it as an asset, an advantage to be utilized to the fullest. All the while he was growing up he practiced being ordinary. He specifically watched films and movies to spot the people who didn’t stand out, which were usually in the background and were quite often missed by everyone else. He would then mimic their every move, practicing and drilling constantly, getting their actions down cold. He would then seek out new films and movies for more every-day characters and then mimic them and so on…

    He was now fifty-seven and having made this average behavior a habit for many years now, had become a true master of the common man, his every move a letter-perfect regularity. So good in fact that he was now able to virtually disappear. He could get multitudes of people to become unaware of him. Everyone he met and even those he saw on a regular basis had a very hard time remembering his name. Some would try hard for a while to pay attention to him and keep track of him, but after only a short time they would begin to lose him, eventually he became just part of the background. All communication to him would start being on an automatic basis. And he went about his business making very certain that he kept all of his actions mundane.

   Nolan had done very average in High School and College, though he could have done much better, but that would have gone against his every-day guy persona. After finishing school he became a reporter for a newspaper in Pittsburgh. He was not an exceptionally great journalist, but could get into places and get stories that others could not, because of his invisible man ability. He worked at the paper for the better part of ten years and gradually befriended a beautiful woman columnist named Stasha. They worked together closely for years as good friends and eventually fell in love with each other, ultimately marrying. Yes he could remember those times vividly. That was back in the old days when the United States was still intact, before The One World Order had taken over. They had a really great relationship as she was the one to stand out and he was just the opposite. And because he was so average he took nothing away from her. Nobody ever really noticed them as a couple, but rather her as a star journalist and beautiful woman. So that worked out great because he didn’t want distinction at all and she lived on it.

   Each year their love grew stronger and stronger and understanding between them was inviolable. They became such a great team together that they felt nothing could get in their way and could therefore accomplish anything. And so it was they endeavored together with the intention of changing the world for the better. But sometimes it seems that perfect situations such as theirs are not meant for a world as imperfect as this, and – just when it seemed that things could not possibly get any better – the wonderful individual that he cherished so dearly, was murdered, ending forever their life and love together.

   She had been working on a story and was uncovering evidence of a secret state government conspiracy, proving that revenue allotted for education, was being used instead to drug children between the ages of six to twelve. The “medications” being administered – though legal – would in effect render all of these young people mentally disabled, thus permanently nullifying their chances of getting any kind of education. And so when she had uncovered and exposed too much, the vested-interest-powers-that-be did her in but good. They did not just kill her but riddled her body with thirty plus rounds from a semi-automatic machine gun.

   He was – to say the least – overwhelmed and devastated by his loss for nearly a year. He couldn’t think or function. He went through the daily motions of life – eating, dressing, showering and working – kind of on an auto-pilot basis, never really doing any of it at all. He had completely lost his purpose and drive to go on living. But then one day he realized what he must do. He needed to avenge his wife’s tragic death by exposing the responsible group as the bloodletting totalitarians that they were. And so his every waking moment was spent ferreting out their dastardly schemes and plots.

   He soon discovered that the group he was after was much larger and higher up than he had expected. The true source was a corporate elite that ran the entire planet. The more he penetrated the operations of these people the more hate he developed for them. He realized two years ahead of time that something like the World Federation was on its way. He knew there was nothing he could do to stop it from arriving. But knowing this did not, in any small way, deter his determination to rid the world of this atrocious group.

   He of course no longer worked for any newspaper, as they had all been taken over and slanted with WF propaganda. His methods of both finding and distributing the truth about The One-World-Order were simple and insidious. He would get jobs in which he would correct the books of large corporations, thus enabling him to poke around and research, collect evidence, then move on to the next gig and do the same. After a while he would have the information necessary to release an exposé over various private media such as underground computer networks and home broadcasting (television and radio). In addition he would publish articles anonymously in various secret evolutionary and revolutionary magazines, papers etc.

   Nolan walked along Canal Street heading for Saxon center – the newest fifty story corporate office building in lower Manhattan. As he went along he noticed the people on foot near him, but they noticed him not at all. Their expressions were all very nervous as they tried to avoid the many security cams above the street. Everywhere you looked there were cameras of various kinds, there were different sizes and shapes, placed in every type of location. They were all perfectly designed to watch your every move. The people were no longer free and the atmosphere was anxious and troublesome.

   Upon reaching the front doors of his destination he took care to enter the building in the exact manner he did everyday and was not thrown off by the unexpected, “Hi” from some unknown passerby.

   He responded with an average “Hello” and a slight bow of the head then continued on. He made sure that each and every step and motion that he took was an exact duplicate of prior ones he had taken each time before. He stepped into the elevator and monotonously pressed twenty-four, watched the doors close and started on his ascent. It took some time to reach floor twenty-four, what with all the stops made along the way but finally he arrived and the doors opened. He stepped out and turned right to walk up the long corridor towards suite 2469.

   Once he had reached the correct office he rang a buzzer located next to the door. Shortly thereafter a voice from an intercom said, “Good morning Mr. Smith, come on in.”

   The door latch-light went from red to green and then he opened the door and entered.    “Hello Mr. Benkins,” he said as he closed the door behind him. He noticed that some unknown person stood next to Benkins.

   “Ah-Jim right?” Benkins asked, obviously already having trouble with his first name.

   “It’s John sir,” he replied, not in the least disturbed by his forgetting.

   “Oh yes John that’s right. I would like you to meet Daran Oldemayer, he is the Chief Executive officer of our company,” Benkins introduced nervously.

   “Pleased to meet you,” Nolan said, as he shook the VIP’s hand making sure not to be effusive, keeping in his usual everyday manner as well.

   “Nice to meet you,” The executive said, not meaning it at all as he had an attitude of “I am the most important person you have probably ever met.”

   “There are the files that I need you to correct today,” Benkins said distractedly as he pointed towards two or three Super-Disk-ROM cartridges of one hundred “googol-bit” capacity – one hundred googol bytes of information. And then he continued with, “We were just on our way to our quarterly meeting so I will check back with you later. Alright?”

   “Ok Mr. Benkins see you later on,” Nolan said quite nonchalantly and noticed that they didn’t even stay to hear him finish, as they had already left. The VIP he had greeted was not aware that he had infected his hand with over a million nano-percept recorders. These micro-robots were beyond state-of-the art. They were so far undetectable by any system or device – of course this would be so, for just so long, perhaps two or three months longer and then he would have to improve and miniaturize them yet again. He had infected the Chief executive because he had heard rumors of an ultra-secret convention comprised of the most elite and wealthy individuals on the planet. And he wanted to record this meeting in its entirety as this might just be the breakthrough event that could completely expose the true intentions and nature of the World Federation.

   He sat down at the computer, slid in the twelve inch Super-Disk-ROM and began correcting the books as requested but at the same time infected the network with several virus code mechanisms. He also planted a few million hardware and program nano-bots in the main computer so as to redesign and reconstruct the whole system from afar – all undetectable of course. In not too long a time he would have such total control over the company software that he could do whatever he wanted with it and the users would only see what he wanted them to see, nobody ever suspecting anything different.

   In just four hours time he had successfully installed the proper corrector modules that would right the entire database while taking care of his own agenda as well. There was not much else he could do at this point but sit back and let everything takes its course.

10:15:00-AM-09/10/2110

   Erick Land was a little more than just a bit nervous as he walked about with the personnel director who was currently giving him his orientation. You see this was his very first day on a job he had been striving at for more than fifteen years. Somewhere in the back of his mind he felt as if somehow something would go wrong and all of his hard work would be for naught. This was mixed with intermittent positive feelings and thoughts like “Wow I really made it.”

   The Personnel director – Harve Migel – started his orientation lecture with, “I am going to give you a complete rundown of the Lunar One control station, a little of it’s history and what it is exactly that we do here.” Harve stated this importantly and you could tell that he thought that working here was of a very high status. He continued on with, “We abbreviate the prison facility to L-1 and the control station to L-1-Con. Now, L-1 is located at Anderson crater 150 kilometers south of where we are here at Freundich crater, which is the home of L-1-Con. We have to run the prison remotely, as the inmates that are sent there are the most dangerous in the solar system. We control – by way of robots and robotic systems and equipment – the entire L-1 facility. We feed the prisoners, keep watch on them, maintain the grounds and structures, and additionally administrate all new construction and planning all from L-1-Con. The inmates come in by small one-way capsules, which become – upon landing – prison cells. All supplies and equipment are shipped from here via automated mini-rail, so as not to allow for a way of escape. The mini-rail cars are so small that there is no way that any human being – including a small child – could possibly fit aboard it. Additionally there is no way to carry or produce oxygen on the rail cars, making it doubly impossible as an escape route. So you see we have here the most escape proof prison ever constructed, one hundred percent fail-safe in my opinion.”

   Harve paused for a moment in his speech to take a drink of water from his refrigerated thermos unit. And then he continued with, “Now the history of L-1 and L-1-Con began thirty years ago when construction was initiated. It took the better part of ten years to finish and the first inmate arrived nineteen years ago. Since then more than seven thousand prisoners have been sent here, not one has ever escaped and it is not expected that any ever will. The idea for L-1 was conceived by Helmer Aswit, he was a noted psychiatrist and prison director. The current inmate population is four thousand, one hundred and fifty six. This is due to the fact that since The One World Order has taken over Earth, various prisoner rights have been dropped and the government can now use these prisoners in any experiments they see fit. About forty percent of the prisoners who have died at L-1 were due to psychiatric research tests.”

   Harve again halted for a time as they made their way around a large wall, on the other side of which, was an enormous computer control center. Erik couldn’t believe how many people he saw running all manner of computerized equipment; things so high-tech and advanced that it was beyond belief. The center stretched out in all directions and was about the size of a stadium. As he stood there dumbfounded Harve resumed. “Here is where it all happens. This is where you will be working once you complete your entrance program, but for now let me give you a tour. As you can see there is quite a bit of personnel needed to operate L-1.” He stopped and looked at Erik somehow sensing that he wanted to comment.

   “Wow! I never imagined that it would be anything like this. It’s almost overwhelming,” Erik stated with obvious awe.

   “Yes it can seem that way when you have not been given any information beforehand. As you know everything that we do here is top-secret and confidential. This is why you signed the pledge stating that you will not disclose anything about what we do, what you see or what you know concerning L-1 and L-1-Con, under penalty of imprisonment,” Harve responded in a “this-is-to-be-expected” attitude.

   They continued the tour for the balance of his first day. Late that night in his quarters, Erik pondered on the next six days, which was how long his entrance program would take. His mind then went on to the next eighteen months – the length of his first tour at L-1-Con; he hoped that all would go well. He also looked forward to his three-month leave after his first tour, although it was a long way off, it was a good goal to work towards. He felt pretty good about everything now, minus the apprehension and anxiety he had earlier. He thought, “it’s all going to work out fine.” A few short moments later he was sound asleep.

2:25:00-PM-09/22/2110

   It had been nearly two months since Bill had been sentenced back on earth. He had taken off the very next morning on a prison airbus, top-security of course. He rode the bus for fifteen hours to Houston where he was transferred aboard Space-Elevator-One – better known as the thriftiest way into space. This grueling journey was most unpleasant and lasted five – seemingly unending – days. At the end of that time, already some two thousand miles in space, he was transferred to an enormous earth-moon-space-barge where he was placed aboard a small capsule – later to serve as his prison cell upon reaching Lunar-one. Traveling on the barge was not too bad; he actually almost enjoyed himself. But this only lasted for two days at which time the large ship entered the lunar orbit. Once on the far side – with the earth no longer in view – he and the capsule of his imprisonment were ejected from the barge towards Lunar-One at Anderson crater. It took the capsule under three hours to get there. Upon entering the crater, you could see what looked like some lunar settlement city scattered across it. His capsule was not going to land on the surface, but instead sought out one of four large shafts that led deep underground. Once it had made it to the shaft it was heading for, it began to slowly descend going down, down, seemingly to the depths of hell. The capsule stopped descending at about one point five kilometers underground and found an empty pre-constructed concavement, which it entered and then finally came to rest. A short time after that he could see various robotic machines doing a multitude of operations to adapt his capsule to the Lunar-One system complex.

   Bill knew that he had a very limited amount of time to save himself. If he wanted to make it out of here alive, he would have to act extremely fast, as he was aware of the fact that all technically trained prisoners, were used in experiments that ended with death – usually within the first six to eight months of imprisonment. This was – he figured – because they were trying to prevent escape. However, he had been planning his breakout well before he had arrived. In fact, he had been planning for it since the inception of the Freedom-fighter movement, over five years ago.

   He had smuggled – hidden deep within a cavity in one of his teeth – less than one microgram of nano-replicators. These nano-bots were capable of replicating at the rate of two-ex per minute. He had earlier programmed them to activate upon touching a micro magnet to the cavity in his tooth, which he had hidden in a plastic toothpick. And now, two months later, he had nearly two tons of nanobotic material. He had to be extremely prudent in his programming not to amass too much in any one area, as it would be detected. And so, during production, he carefully dispersed the microscopic material all throughout Lunar-One. He had developed a large array of different kinds of micro-equipment, each and every one of which, was designated a particular task. He had a whole series of computer reprogramming nano-bots. The first thing he did with these was to infiltrate the whole network, including all of the robotic equipment. Then he began to create a system wide simulation of L-1, using the digital footage he had collected from the video recording devices, located throughout the prison.

   He wanted to be able to handle every conceivable variation, so that those monitoring L-1 at the base-station would believe that they were seeing actual signals and not simulation. This was especially difficult to do for those robots that traveled throughout L-1 being remotely operated by L-1-Con personnel. He had accomplished this goal three days ago and was at this time, slowly, one by one, switching from video signal to simulation. He had to be very cautious in doing this, because each time he switched a machine over there was a split second in which there was an absence of signal transmission and this caused interference on the receiving end. This sort of thing was not too unusual in ordinary operations, as electronic equipment tended to do that from time to time. But he didn’t want to get too carried away on this, because were it to happen too frequently, someone could very easily become suspicious. And so he usually picked equipment that was not in operation temporarily. Sometimes however, he had to pick one that was in operation – due to the time factor – knowing very well that the change in signal would be seen at the base end.

   The next step he had planned was to record as many of the Psychiatric experiments as possible from the robotic-testing equipment. He had already captured twelve prefrontal lobotomies, twenty-two electric-shock treatments, over fifty pain-drug-hypnosis sessions and about twenty-five other miscellaneous tests. He figured he needed about double that amount to produce enough variety of simulations. He was also in the process of gaining access to the entire computer network. He desperately needed to do this, so that he could find out whom they would be choosing for each experiment. He felt a great deal of anxiety with regard to this, because his very survival depended upon it and he had about another month of work to go to complete it.

   Now because he couldn’t have any equipment in his room, he had to infect himself with various nanobotic systems. He had for instance, nano-synapse signalers, which converted nano-signals to nerve-signals that could then be seen in his mind as pictures. He had also, synapse-nano receivers, which would take his thoughts as commands and convert them to nano-signals. And in addition to that, he had a nano-digestive detoxification system, which filtered out all drugs, toxins and poison while he ate. He had discovered that they were already doing some kind of test on him, using nerve drugs and he therefore had to act as if it were affecting him by dramatizing the effects, lest anyone become suspicious. And so he worked intently on, burning the midnight oil in a race against time, to both save his life and escape from this godforsaken man made hell.

3:15:00-PM-12/21/2110

   Noland had successfully infected thirty-three people with nano-bots in the last six months. He had selected the most likely candidates he could find that were likely to attend the conference of the elite. As it turned out, only eight of those he had chosen actually had made it, but that was more than enough for his needs.

   The great convention was being held near Groom Lake, Nevada, in a location known as area 51 – a top secret government base. It had started nearly an hour ago and all the equipment he had implanted was functioning excellently. As he was constantly in need of modernizing his nano-bots, he had a system in place within each person infected that would construct each advance and then gradually replace the previous technology with the new. So far there had been no sign that any of his micro-equipment had been detected, which was all very good and well, but on the other hand, he still could not be relaxed about it, as each moment that passed brought an increased possibility of it occurring. He only hoped that he could get enough data to expose them enough to bring about their demise.

   He noted the many VIP’s that were attending: there was the President of the World Federation, the Secretary of Prisons, the Secretary of Health and Mental Stability, four Sector Governors and over one-hundred International Corporate officers from the worlds largest enterprises. Eight of the corporate leaders were infected with nano-technology and they were unwittingly sending him signals just as if they had been spies working for him intentionally. One executive in particular, Daran Oldemayer, CEO of Saxon Software Incorporated, was the central terminal through which all digital information collected was being channeled. Noland thought back to the day he had met this man, the day he had infected him, he had been so smug and self-important, and here he was betraying his fellow power-mongers.

   Noland listened in as the President of the World Federation began, “We have to do something urgently to fully quench the whole Freedom Fighter movement. We must do this immediately and we must be ruthless about it. Does anyone have any suggestions?” For a moment after he asked there was a definite silence and you could tell that this subject weighted deeply on everyone.

   “I recommend that all freedom fighters that are captured be sent to the Lunar-One facility,” the Secretary of Prisons stated suddenly, disrupting the silence. “You have already sent us five individuals, four of which have already been killed by early psychiatric experiments. We will make sure the fifth one dies within the next three weeks.” There was applause from the entire group upon hearing this.

   “I commend you highly for this and we will indeed keep sending you more captured F-F’s. But as you may know this will not totally handle the situation, as the movement seems to be growing rampantly. What we need is something that will totally eradicate this thing once and for all,” the President responded with much officialdom.

   “Our department has been working on a plan for some time now with regard to this, and I think we may have something that will do the trick Mr. President,” the Secretary of Health interjected with complete confidence.

   “Well don’t keep us waiting. Please do tell us all about it,” the President urged with some impatience.

   “Very well sir,” Frank Liben – Secretary of Health – began, a little confused at just how to start, being that his mind was racing with many different thoughts all at once. He continued with, “Here goes.” He used this to buy himself a little more time as he was still struggling to organize all the information. Finally he had some semblance of form on it and began for real with, “As you have stated Mr. President, we do have a serious problem with regard to the Freedom Fighter movement, which is a very real threat to the One World Order. Since the inception of the World Federation, the Department of Health, the Department of Justice and Imprisonment, along with many other sectors of government have been engaged in voluminous psychotropic and nanobotic drug experimentation. These experiments and tests have been performed in nearly all of the world’s prisons, mental institutions, hospitals and even many clinics. After many years of testing we have created a drug that we believe will be the total solution to citizen control. We call this drug Apathezak. It is a nanobotic-psychotropic compound that has successfully rendered every one of the subjects it has been administered to, with various degrees of apathy. It has proven to be, one hundred percent effective in creating catatonic individuals at the highest dosage and very docile, obedient workers, who have no independence or initiative at the lowest dose.”

   Frank paused momentarily, noting the fact that, all ears and eyes in the room were glued to him in avid anticipation. And so briefly collecting his thoughts, he carried on once again with, “Now, what we propose is, to take this drug and distribute it by way of the worlds water systems. In just a six-month time frame we can effect a whole new controlled society. It will be the complete solution to the Freedom Fighter movement, because we will distribute the highest dosages to those who have a technical education, rendering these individuals catatonic and no longer intelligent. Their abilities will be so absent, they will not even be able to take care of themselves, much less start another movement. The balance of the society will be given a variety of different doses, resulting in the perfect worker citizenry with an array of ability levels; none of which will be above that of the obedient laborer. No part of the civilization – with the exception of our own elite group – will have any independence or initiative and will certainly not take any part in running the world. The worker citizen will not do anything other than what they are trained and programmed to do. So as you can see, this program would effectively end our current crisis and would as well, prevent any future uprisings from occurring.” The Secretary of Health concluded in a verbal crescendo that evoked an explosion of applause from the crowd.

   Noland looked on, as he captured all this digitally and thought to himself with amazement, how they actually thought all of this was perfectly all right; his only conclusion was that they had all gone quite mad. He continued in his quest digitizing the meeting, all the while trying painstakingly to maintain non-detection by keeping all the nanobotic machinery well dispersed. So far he had been successful for almost two hours, although he already had three or four close calls. But just when he was beginning to think that he might just make it through the whole event undetected, a nano detector-scanner approached, scanning one of the attendees that he had infected. He didn’t spot it in time and suddenly the alarms were sounding, which sent him scrambling to erase all traces of his micro-electronic eavesdrop.

7:14:00-PM-012/23/2110

   Erik Land was urgently on his way to the captains deck; he had noted five instances of electronic interference in less than ten minutes and that was a lot more than what would normally be expected, even from inferior equipment, let alone anything that was state of the art. He had already alerted his direct senior via E-COM, but all that he got in response was that it was not that unusual, that he was over-reacting as he was new and not used to the way things operated. And so, not feeling satisfied, he had E-COMed the Captain of the Watch, requesting to discuss the matter with her directly.

   He made his way to the Zip-Elevator and took it up from level minus thirty-nine to plus ten, in just under one minute. Upon reaching his destination level, the doors opened quickly and he stepped out – feeling heavy and as if he were still travelling upward. He turned the corner and saw the captains-deck, thinking about the many reports he had made in which he had noted some very unusual occurrences. Now this was what he was supposed to do as part of his job per policy, but the attitude he got when he alerted his immediate superior was one of extreme complacency. He had just wanted him to file his daily reports and leave it at that. But to Erik the combination of oddities he had seen was way too strange to be normal.

   As soon as he reached the entryway of the Captain’s deck a soft but authoritative voice said, “Come on in Land.”

   He did so feeling self-conscious as – though he hated to admit it – he was to a high degree attracted to the Captain. “Hello Captain,” he uttered distractedly, trying desperately to be professional.

   “Please do have a seat,” She offered pointing to a comfortable looking air-chair. He did so and began to feel more relaxed and less vulnerable.

   “I was wondering if you had read the report I sent you earlier this evening?” He asked, becoming more focused.

   “Yes I did,” she replied calmly. “I want to thank you for being so attentive to your job, this is very commendable.”

   “Thank you,” he responded, feeling a combination of pride and nervousness at the same time.

   “I want to assure you that I am looking into these things further as a result of your report. We are, as you know, the number one top security prison, bar none. So it is important that we do check into each and every oddity, no matter how small. I am especially concerned about the numerous electronic interference incidents that you mentioned. I have appointed a small team to put in place a trace on all these disturbances and to compare them with any previous data that we may have,” the Captain stated with some seriousness.

   “I can’t tell you how much better that makes me feel to hear you say that. I have submitted many reports and was beginning to feel as if I really wasn’t being heard,” Erik stated with elation.

   “I can understand how that could be upsetting,” the Captain acknowledged, paused briefly, then resumed with, “One thing that I am really having a hard time with on this whole matter is, why nobody has forwarded any of this information to me on the proper channels?” She asked this question out loud, but seemed to be asking herself rather than Erik or anyone else for that matter. She looked thoughtful about it for a brief moment, then abruptly asked, “Is there anything else that you needed to see me about?”

   “Ah—I guess not,” he answered, feeling a resurgence of vulnerability.

   “All right then Land. Return to your post!” She commanded.

   “Yes Captain,” he responded, then complied by getting up and heading back the way he had come.

   Once he had left her quarters, she E-COMed the Sector-Four-Chief, Lands immediate senior. She told him all about the meeting with land and expressed her upset at not having been notified. She let him know as well that there was going to be an investigation into the matter and reports sent to the Secretary of Prisons.

   It took only a couple of minutes for her to receive a response from the Sector-Four-Chief via E-COMM. She could clearly see anger in his demeanor as he replied with, “Captain, I am shocked and surprised by this information as I have not been notified either. Co-workers are reporting to me that Land is quite a troublemaker, always trying to stir up problems and what not. EC (End Comm).”

   She sat there and considered his response for a time as streams of questions came up, seemingly in a flood. She decided that the situation was much worse than she had thought; the urgency to get busy and find out just exactly what was going on and fast, impelled her into prompt and vigorous action.

8:10:00-AM-12/24/2110

   Bill had now switched nearly all of the robotic equipment over to simulations. But he was having an awful time with the Psychiatric testing machinery, which had triple and sometimes quadruple back-up systems, that were very difficult to hack into. Nevertheless all of them had to be over-ridden in order to gain complete control. He was getting very worried that there might be someone at control that was catching on to him, as he had lately started picking up tracer signals throughout the system. These he had to be extremely careful around as any little signal – including the very tiny ones from nano-machinery – could be detected quite easily. This made his nearly impossible task all the more arduous. And this was just one of many projects he had going on. He was also constructing, via nano-manufacturing equipment, a powerful photon-radiation gun, which he would need in order to disable all L-1-Con communication systems.

   He had been working so diligently that he didn’t, at first, notice the telescoping snake like robot entering the top of his capsule, stealthily moving toward him. Upon becoming aware of it, he looked up abruptly and gaped in horror at the devilish machine. He knew in an instant that this was a lobotomatic-unit. He quickly pushed his terror aside and began frantically sending mental signals to all nearby nano-bots, commanding them for an all out attack to disable it quickly. His arms and legs were suddenly locked into place by the air chair he was sitting in, immobilizing him completely. He could feel a force field all around holding him. He felt as if he were a stone, as he could not even blink or move his lips. As he sat there, unable to move and barely able to think, the snake-like machine drew closer and closer.

   Bill kept his mind on the signals he was sending to the nano machines trying desperately to get his mind off of what he was experiencing. He was not at all sure that he could disable this unit before it did him in, but he kept working anyway in a last ditch effort.

   The snake machine was now upon him; looking into his eyes it did an eye-scan Identification. It touched his head and his whole body started becoming very cold and numb. He had already bypassed the initial system but had three more to go. But now he was finding it more and more difficult to concentrate as he kept finding his mind drifting to the snake-unit, which was attracting all of his attention like a black hole attracted all light. He realized almost unconsciously that he had bypassed the first back-up system, only two more to go. Two six inch electrode needles moved out from the end of the lobotomy machine, circled around to either side of his head and then headed slowly toward his temples. He knew that once these things entered his brain it would be all over for him.

9:35:00-AM-12/22/2110

   Noland had successfully, and just in the nick of time, destroyed all nano-tech equipment he had placed at the conference of the elite. He was reasonably sure that he had erased all signal traces, as he had triggered the self-destruction routine quickly and efficiently the very moment the alarms had went off. But because one could never be one hundred percent certain, he would now have to be on the look out and forever more a fugitive on the run. However he had all the information that he needed; the only thing left for him to do now was to compile it and then get it released on underground channels, before he was found out and caught.

   He had actually uncovered a two-hundred-year, double-sided plot to subvert and convert America. On the one side you had the all-science school of thought – who believed there existed only the material and there was no spirituality, no God nor need for any religion. And on the other side you had the all-is-God group – who believed that God was the only thing that mattered and that everything that was material was evil and was to be avoided and denied.

   It was plain to see that both sides were dead wrong in their far extremes. From the evidence that he had uncovered in his research and investigations, science and religion were mutually dependent and inter-related one upon the other. For one thing, science could never have been initiated without religion. A barbaric society that has no religion has no time to think of anything as advanced as science, as one is too busy struggling to avoid being robbed or killed by one of his fellow barbarians. The absolute stupidity of the idea that everything is matter and that the creation of the universe was nothing more than some kind of odd accident, is equally as ignorant as the idea that only God is allowed to be causative in nature and in the lives of men. At this time the group who had taken control was the material-no-God tribe; better known as the World Federation or The One World Order.

   There was now no longer any need for him to do accountant work. He had gathered sufficient information and the only thing that mattered now, was to distribute the truth of what was happening to as much of the populace as he could, in hopes of restoring the free nation of America and additionally all the other countries of the former free world. He felt an intense urgency in his crusade, as he was aware that far too little time remained.

   He of course continued in all of his actions in perfect everyday-form. Walking down fifty-seventh-street, heading for an area that was a secret gateway to an under ground community in a long abandoned subway system, he figured that he had approximately one week to accomplish what he needed to. If he was not successful the civilization would enter a state of no return, and freedom’s light would once again be shut off. It could be a very long time before it was ever turned back on – perhaps a millennium or two, possibly a whole lot longer than that. The thought of this happening impelled him forward; his intention became laser-direct and without the minutest thought that he could be stopped.

11:45:00-AM-12/24/2110

   Erik sat in his quarters feeling quite dispirited. He had been suspended from post until further notice and might possibly end up loosing his job all together. He was in big trouble and yet, he had no idea why, since he had simply been doing his job. He had received a very disturbing E-COMM a mere twenty-four hours after his meeting with the Captain of the Watch.

   “The alarming reports and communications to the Captain, have been found to be without validity and were made with the intention of causing trouble and trying to gain advantage over a senior!” The Sector Four Chief stated with marked hostility. This audio/video message was accompanied by a document-order stating that he was suspended, pending full investigation, the outcome of which could lead to dismissal. And all of this because he had merely reported what he had seen and thought it important enough to make sure that someone acted upon it. Maybe I tried too hard, he thought to himself. Maybe I was over-reacting and maybe I do not have the experience necessary, to know what is serious enough to be worried about. After all, this place has been operating for nearly two decades before I arrived, without a single mishap. But he certainly had not intended to cause trouble for anyone and he was not, in any way, trying to gain any kind of advantage.

    None of it made any sense to him and he knew that something was awry somewhere. He started to recall all of the dealings he had over the last three months with his senior and realized that that this man was very complacent about everything regarding his duties. He kept going over and over the whole situation in his mind, hoping to work it all out in some way or another.

   He absently flipped on the only survey-monitor he had there with him in his quarters and began to page through the inspection area that somebody else was now in charge of. At first he observed only what he normally saw as he perused the area, but as he passed area thirteen, something very definitely caught his eye. He went back to it right away. And there it was; so unmistakably obvious that he couldn’t figure out how he or anyone else had missed it before. In the middle of the screen was a long protruding object. He clicked on the building and equipment checklist for that area and tried to find any item that matched its description and location. He found none and so did an item inventory of that area. It took the system only twenty seconds to come back with a complete count of thirty-two hundred items. But – just as he had figured – the computer screen displayed: “WARNING! DISCREPANCY – THIRTEEN ADDITIONAL UNACCOUNTED FOR ITEMS FOUND! RED ALERT! NOTIFY ON ALL CHANNELS!”

   He complied immediately pressing the notify-on-all-channels button, upon which an abundant number of alarms sounded throughout L-1-Con.

1:05:00-PM-12/24/2110

   Bill Larantz had managed to stop the snake-like machine from carrying out its program instructions just as the two sharp brain electrodes entered the skin of his temples. However he had only stopped it temporarily and he was still locked down in place by its force field. He could feel the blood from his pierced temples slowly flowing down both sides of his face, but nevertheless, he went to work on getting the photon radiation gun completed. He was reasonably sure that if he had not already been detected, he would be very soon, as he had needed to amass too much nano-material in his local area in handling the snake machine.

   He frantically worked to program the final components of the gun; it was the only hope he had to keep himself alive. He had not known that his newer capsule-prison-cell model was pre-equipped with psychiatric testing machinery and that was why he had been taken by surprise. He realized that he had become just a bit too cocky in his endeavor; that attitude had nearly cost him his life and escape. As mental images – via the many nano-signal-transmitters – came to him from the gun locale, he saw the final components taking shape. He figured he needed only about twenty more minutes to complete it which was way too much time at this point, but there was no way to hasten the process.

   He worked desperately on, all the while, scanning for any detection signals from L-1-Con. The nano-timer he had set now signaled with, “Only nine-teen minutes to go.” He thought to himself that it was going to be agonizing getting through the next nineteen minutes. He tried to take his mind off of the time by working out all of the coordinates of the many communication dishes that he would have to take out with the gun, in order to cut the control station off from Lunar-One.

“Eighteen minutes to go,” a new signal communicated, piercing through his hectic activity. And though each moment that passed brought him closer to safety, he didn’t feel the least bit encouraged, but instead even more anxious. He was feeling more and more terror at the fact of being utterly immobile in the snake force field. He had always been claustrophobic in small spaces and was deathly afraid of getting into a situation where he could not move. So here he was, faced with his ultimate dread and he was beginning to succumb to it, his mental capacity getting less by the minute, as the fear took him over.

   Suddenly he realized that he had not been aware or thinking at all but was just staring into the snake machine void of mind. He wondered how much time had gone by. He was having an awful time trying to orient himself to the situation about him and the task at hand. And then the next signal communicated with, “Twelve minutes to go.” He was stunned; he had missed six minutes. Seeing that he had lost time impelled him back into action with renewed vitality. He quickly checked on the progress of the gun and was happy to see that everything – so far – was going according to plan. And right then – just as he was beginning to feel a little confidence – what he had been hoping would not happen, did. Without a moments notice a disturbing signal came through with, “WARNING NANO-BOTIC SIGNALS DETECTED BY CONTROL!” He quickly responded by scrambling and deflecting all communications, so as to keep them from discovering the source point, which was of course himself. He only hoped it would buy him enough time to complete construction, with enough left over to fire at and destroy all of the Comm-dishes. The next nano-bot signal came through with the communication, “Eleven minutes to go.”

3:05:00-PM-12/22/2110

   Noland realized that he was in fact being followed and that was very unusual, as nobody had ever put any kind of interested attention on him ever before. It was an experience he was totally unprepared for and he was not quite sure exactly how to handle it. He quickened his pace only to find his pursuers quickening as well. He turned a corner and was instantly at full scramble, running with all he could muster. He turned a second corner and bolted for yet a third. Upon reaching the third corner, he quickly slipped on a pair of motorized, super-eight-disk in-line-skates. He headed down the walkway, getting quickly up to the top speed of thirty-five kilometers per hour.

   He was sure that he had managed to evade the first set of pursuers; but knew as well and with equal certainty, that he had now been spotted and that there would now be hundreds hot on his trail. He looked about quickly in need of a place to hide and travel at the same time. He spotted and decided upon a cargo-bus that looked to be heading toward the city-central-subway and that was exactly where he needed to go. He reached it quickly, grabbed a-hold of the back end of it and carefully positioned himself uncomfortably beneath it. He was now out of site, travelling quickly, still riding on his skates. He held on tightly to the undercarriage of the bus as he unknowingly passed by his pursuers, who were still chasing after him but were heading in the wrong direction.

   The bus traveled about three miles and then came upon the entrance of the central subway system, which it entered. Because of the low level of light it was a little difficult to see, and so he waited for his eye’s to adjust, as he thought it unwise for him to do anything until he had some vision at least. The bus had now stopped as it was waiting in line for a cargo inspection – before being switched to rail-car mode and then routed to an out-of-state subway-line.

   Knowing that he could not stay where he was for very long, he slowly crept out from beneath the bus, all the while carefully surveying his surrounds, looking specifically for cameras and detection devices.

   He made his way to the far side of the bus where he was less likely to be spotted and decided to adjust the skates to no-travel mode, in which they would function as an everyday pair of shoes. He had to do this, because in travel mode he was more likely to fall, the noise of which could set off any number of security-alarm devices.

   He worked his way along the long line of cargo trucks and busses, keeping low and in the shadows where none would spot him. From time to time the vehicles would move simultaneously and he would ride one of them the short distance to the next stopping point. After some time he made his way to an opening on his side of the subway-line. Taking a telescoping-micro-cam from a compartment of his pack, he sent it to probe the opening looking for security equipment. Sure enough there were three cameras and an array of detection electronics as well. He decided that because of the positions of the equipment, he would have to crawl on the ground in an almost flat position along the base of the wall that lied below the opening. He inched his way slowly and carefully making no sudden moves.

   Once he was on the other side and well beyond the range of the security devices he stood back up slowly while checking ahead making sure there was nothing there to spot him, not finding anything, he continued on. He noticed that from time to time he came across sections of the ceiling that had once housed cameras, which were now absent – probably due to lack of funds and budget cuts. This area was one of the most non-maintained sections of the city.

   Suddenly, and for no apparent reason, Nolan remembered the time when he and Stasha had celebrated their second anniversary. It was one of the most memorable moments they had shared together; and for sure the one he personally cherished most of all. They had both taken a day off from work to spend some time together. The day started bright and early in the morning when they awoke and made spontaneous love together. After that they had taken a shower, got dressed, then walked hand in hand along the city streets, talking and enjoying the beautiful morning and each other. They eventually stumbled upon a restaurant that they had never been to before and had the most wonderful breakfast. As they ate they had discussed many things and laughed until their sides hurt. The friendliness of the staff and atmosphere of the café; the great aroma and taste of the rich coffee; the delicious food and their incredible love for each other, all blended together for what could be considered no less than a perfect early day.

   After breakfast they had continued walking, sometimes stopping to shop at various specialty shops or antique stores they had found along the way. Everything seemed magically perfect that day. It was impulsive, unplanned and yet it all occurred as if in accordance with some design. It was as though nothing they did that day could possibly go wrong. They did not have lunch; but instead had snacked at a couple of street-side-food-vendors. In the early afternoon they came upon an old, quite charming, used book store and ended up spending the rest of the daylight hours there. They eventually found a few books each; purchased and read them together, conversing intermittently.

   Later, when the sun had set and the city lights shined bright, they had found a comfortably quaint and not-too-expensive restaurant and had another unforgettable meal. Following that, they had caught a play called “Fire-Water”, which had the most innovative music along with a completely unusual but intriguing plot. It was the story of an Indian woman who saved her tribe from the many vices of the arriving European civilization by educating them about what she had seen happen to tribes further east. They had enjoyed the play very much.

   Returning home following the play they had lain together talking for some hours. And he would never forget what they had said to each other just before falling asleep in each others arms: “You are my reward in life,” Noland said to her with utmost affinity and tenderness.

   “You make me feel like the most precious and valuable jewel on earth,” Stasha responded with complete sincerity. In slumber they held each other tight.

   The memory was very clear and vivid and Noland could feel a strong tightness in his throat and tears welling up in his eyes, from the intense pain of his loss.

1:10:00-PM-12/24/2110

   Very shortly after the alarms had been sounded, Erik was suddenly no longer suspended, but was instead called to post on emergency all hands. He had then rushed, along with everyone else, to the control hub; the scene there was total pandemonium. The Captain began a series of orders with, “Has anyone identified what the discrepancy items are?” And when no one answered she immediately turned to her Second-in-Command and barked, “I NEED THIS HANDLED RIGHT NOW!” She walked quickly to the Captain of the Watch control box and spoke into the microphone, “Sector Three through Six personnel listen up. I need half of you to do inventories in your sections and the other half to do signal traces. Get on it now!”

   Erik had expected the Sector-Four-Chief to be relaying orders to the Sector-Four-personnel; but instead it was a different person altogether; someone that he had not met before.

   “All right gang, you heard the Captain,” the person began but noticed immediately the questioning looks in their eye’s and knowingly answered it with, “I’m Franz Bova, Technical Specialist L-1-Con. Your Sector Chief is currently unavailable with other matters, so I will be your temporary Chief.” He turned and looked directly at Erik and said to him, “Land, since you’re the one that discovered this discrepancy, I want you to be in charge of the inventory identification detail, ok?”

   “Yes Sir,” he responded, feeling triumphant as he had now gone from bad guy to hero in one fell swoop. He had the feeling that the Sector-Four-Chief was in some serious trouble.

   “I am going to call out the following names, those of you that I call will follow Erik as members of his team.” Franz paused briefly and was about to begin calling out names, but was interrupted by the blare of a much more dangerous, deep sounding alarm.

   “WHAT NOW!” The captain yelled in frustration.

   “Captain we have just detected nanobotic signals in sector five,” the Second in Command reported nervously.

   “OH GOD!” The Captain responded, looking sick with worry. For a moment or two she was in too much shock and did not say anything, she quickly recovered however, and gave a single order to all of L-1-Con over the I-Comm. “ALL RIGHT! CANCEL THE PREVIOUS ORDERS, I WANT ALL PERSONNEL, WITH THE EXCEPTION OF SYSTEM ADMINISTRATORS, TRACKING THE SOURCE OF THESE SIGNALS AND I WANT THIS FOUND IMMEDIATELY!” She gave a different order to the systems administrators, “What I need from you is a complete override of all L-1 and L-1-Con systems! Do you understand?”

   The administrators responded in unison with, “Yes Captain!”

1:23:00-PM-12/24/2110

   The next message came through with, “Two minutes to go.” Bill sat there still frozen, desperately trying to evade the signal trackers, which were getting closer and closer by the minute. At first it hadn’t been too difficult, as there were not very many of them and he could easily throw them off by sending signals out from several different places simultaneously. But now there were hundreds and hundreds and it was quickly becoming impossible to keep up with each and every one of them. Nevertheless, he kept working at it, hoping against all hopes that he could somehow hold them off for the next minute and a half, using nearly all of his signal nano-bots to produce decoy transmissions. When the gun was finalized the coordinates for the Comm-Dishes were pre-programmed and ready for it to fire on automatically.

   “One minute to go,” the next message informed. He decided that in this last minute, he would not send from himself nor receive any further communications via the remaining nano-signalers. To do this, he would have to clear his mind and think about absolutely nothing, as each thought he had would be a transmission that could be traced. And so he sat there staring at the snake machine, keeping all of his attention on it and the few other things that were directly in front of his line of vision. His attention was totally outward and he noticed the colors and shapes of the various objects about the capsule. He was aware also of the silence that permeated the small space, his body position, weight, the temperature and even his immobility. Despite being aware of all these things, he did not think a single thought, but instead remained cognizant of himself and everything around him.

   And then the final message came through, “CONSTRUCTION AND INITIALIZATION COMPLETE! ALL SYSTEMS GO! TARGETS LOCKED ON! FIRING NOW!” Despite the good news of the message, Bill continued to just be aware, not conceiving a single thought in regards to it.

6:15:00-PM-12/22/2110

   Noland had managed to exit out of the cargo subway tunnel by crawling into a partially open air-vent, located near the ground. He had to make sure to place the grated iron vent cover on more securely once inside, so as to be less suspect. He crawled along in the vent channel for nearly two hours before coming to a section that had an opening in the wall. The opening led to the old and forgotten New York subway system which had been constructed in the early twentieth century, but abandoned and unused for nearly fifty years now. The hole, though big, was not quite large enough for him to get through and so he had to take the small hammer that he carried in his pack and use it to slowly chip away laboriously at the hard concrete in order to enlarge it. It took more than an hour to get the hole to size. He then placed an anchor in the concrete of the vent chamber floor and tied his rope to it. He threw the rope into the opening and then, holding onto the rope, carefully maneuvered his body out of the vent chamber and began climbing down towards the bottom. He was perhaps two-thirds of the way down when the anchor unexpectedly came loose and he fell the remaining seven feet. He was completely taken by surprise, his heart racing fast, but luckily he was not injured at all.

   Once he had picked himself up, gathered all of his equipment together, checked to make sure that he had not lost anything and that nothing had been damaged, he began following the subway track in a southerly direction. He was heading for an area that was about five miles from where he now was, a place secretly known as Underworld Control. It was one of the last vestiges of liberty from which the freedom fighter movement operated. He had

Why Dental Hygiene Is So Lucrative In Canada

Everyone loves a winning smile. It’s a symbol of success as well as physically appealing to look at. This probably explains North America’s fixation with brushing, flossing, whitening and gargling; everyone aspires to those shiny pearly whites.

Chances are this isn’t going to change anytime soon. In light of the current recession, job security is at the top of everyone’s priority list. If you’re looking for job security, look no further than a career in dental hygiene.

Becoming A Dental Hygienist

Canada has a wealth of options for the post-secondary student looking to pursue a career in dental hygiene. From the University of British Columbia to Dalhousie University, schools across the country offer programs in dental hygiene.

To pursue a degree in dental hygiene, students generally must have the following secondary school credits or International Baccalaureate / Advanced Placement (IB/AP) equivalents in order to qualify for an admission to first year:

English 11, English 12, A Grade 11 language course, Biology 11, Biology 12, Chemistry 11, Chemistry 12, Principles of Mathematics 11, Social Studies 11 or First Nations Studies 12, One other approved provincially examinable Grade 12 course.

What To Expect

Dental hygienists are registered and certified health professionals trained to maintain your oral integrity. Specializing in the prevention of oral health problems and mouth diseases, dental hygienists work with individual clients or communities to prevent tooth, gum and mouth diseases and injuries that can affect a patient’s overall health.

One of the interesting aspects of being a dental hygienist is the range of the patient base. Dental hygiene services are provided to people of all ages, ranging from parents in pre-natal classes to the elderly in long-term health care centres. A typical workday could involve assessment, planning, implementing and evaluating health care data and include:

Teaching an elementary class about oral health care, Counseling a family about oral health, Providing fluoride treatments to patients during a dental visit, Administering local anesthetic for dental hygiene or dental treatment, Teaching long-term care staff about mouth care for their clients, Working with nurses to prevent sports and playground injuries, Screening seniors for signs of oral cancer, Performing head, neck and oral examinations, Applying pit and fissure sealants to teeth, Reviewing literature and conducting research, Scaling, root-planning, and so on.

Preventive health care is another part of a dental hygienist’s profession. Many dental hygienists deliver health promotion programs in their community to parent and special needs groups; schools, day cares and long-term seniors’ care facilities. These programs usually include tobacco cessation advocacy, sports/mouth guard clinics and baby care seminars.

Practicing Dental Hygiene in Canada

In order to practice dental hygiene in Canada, registered dental hygienists (RDHs) must complete a recognized dental program, and be registered or licensed with the appropriate provincial or territorial regulatory authorities.

Clinical vs. Community Practice

Dental hygienists have the option of working in both community and clinical practices.

Clinical Practice

In clinical practice, dental hygienists most often work with general practitioner dentists or specialty practice dentists. They work directly with patients to prevent and treat gum disease and tooth decay. They are trained to:

Assess tooth and gum health, Prepare individualized dental hygiene treatment plans, refer patients to a dentist for dental treatment.

The role of the clinical dental hygienist is not solely limited to looking after the cosmetic appearance of teeth and gums, but also perform complex services like scaling and root planning to treat gum infections.

Some Canadian provinces allow dental hygienists to own their own dental hygiene practice. For example, RDHs can practice independently in British Columbia, Ontario and some American states. Increasingly, as more provincial/territorial legislation allows dental hygienists to open their own clinical practice, entrepreneurial skills are becoming more important for dental hygienists.

Community Practice

Dental hygienists working in community practices varies in scope. They may work with individuals on a one-to-one basis, or deal with entire communities. Dental hygienists may perform health surveys for a community and work with other health professionals to design a health program for those communities.

They often evaluating the effectiveness of current health care procedures and programs while identifying the need for ones. A dental hygienist will work with a variety of health professionals and community members including nurses, speech pathologists, injury prevention coordinators, dentists, physicians and dietitians.

Community members may include school principals, teachers, parents, coaches, day care providers, health advocates, government departments, and administrators of other health promotion programs in the community.

Some dental hygienists choose to specialize in health programs for new Canadians, cancer (oncology) patients, expectant moms or homeless teens. Community health practice offers much variety to a dental hygiene career.

There are many interesting and exciting career opportunities for dental hygienists. Dental hygienists may find themselves with a variety of roles and responsibilities to choose from. These include roles as: Clinicians, Educators, Administrators, Researchers.

Depending on whether they choose to work in a clinical or community practice, dental hygienists may practice in a variety of environments such as: Private dental practices, Public health and community health centres, Professional dental hygiene associations and regulatory bodies, Homecare and outreach programs, Universities and community colleges, Government (policy and planning, lobbying), Industry (insurance and dental supply companies), Consulting, Research.

Salary

The median hourly wage of Canadian dental hygienists with less than one year of experience is roughly C$ 31.16, according to PayScale.

Is Dental Hygiene Right For You?

Dental hygiene is a profession that offers job security as well as a wealth of different job opportunities. Graduates of post-secondary degree institutions have the option of working in either clinical or community practices, and with a wide range of clients.

The multitude of available roles leaves room career diversity for dental hygienists to hone their various skills. If this sounds appealing, than dental hygiene may just be the career to put a smile on your face.

Rushabh one of the Best Eye Hospital In india

Rated as one of India ’s leading Eye Hospitals, Rushabh offers the most advanced Eye Care Treatment and Technology in India today. We also combine the expertise of our team which includes specialist Eye Surgeons who are highly experienced in their specialties of Cataract, Retina, Glaucoma and Laser Eye Surgeries.

Laser Vision Correction in India took a leap forward with the introduction of the Visx Star S4 at Rushabh. This Laser Technology, being the only one approved by NASA for its astronauts is the most preferred choice of Lasik Surgeries in the USA & Worldwide.

Our advanced Cataract, Retina Clinic and Glaucoma Clinic are equipped with the most sophisticated diagnostic & surgical technology. Our team will offer you the highest level of comfort & after care that your Eyes deserve. Trust and leave your Eye Care with us.  

Our Mission Statement: is to give our patients the Best & Safest in eye care at most affordable rate & in a Warm friendly manner

Cataract is the clouding of natural lens of eye.

Most people after sixty years of age will eventually develop cataract. Sometimes cataract can also occur in children and in younger individuals.

In the olden days it was a misconception that cataract had to be fully ripe or mature before it is to be operated. But in the present time the moment cataract start to interfere with the daily activities like watching T.V., reading, writing, driving, it can be operated.

After a thorough check up if you are diagnosed as having cataract, you will be advised by our Doctors or Counselors about the surgery, the various lens options available and the necessary post operative care required. In case if you wish to wait you will be given the right guidance about how long you can wait and what care to be taken during waiting period.

Cataract surgery can help restore your vision and we at Rushabh, look forward to help you to attain clear , natural vision again. We offer a range of cataract surgery techniques to suit every individual.

With advanced technology seeing as well as you did your younger days is a reality !  

Modern cataract surgery is done by ultrasound technology called Phacoemulsification. The cataract is removed and the natural cataractous lens is replaced by special lens which allow the eye to retain its ability to focus. Our Surgeons are highly experienced and certified in cataract surgery and will offer you the best lens with surgery. A combination of expertise, technology and care by the team will make your surgical experience at Rushabh memorable.

Laser Vision correction or Lasik takes you from wearing glasses or contact lenses to clear natural vision in a matter of minutes.  

Lasik at Rushabh Eye Hospital & Laser Center is done using one of the most technologically advanced and state of the art VISX STAR S4 IR Excimer Laser Systems. The first and only Lasik machine in Mumbai to offer Custom vision correction with Iris Registration, giving patients the chance to achieve exceptional visual clarity. This  Laser System can treat spectacle  numbers from + 6.0 to – 14.0 with exceptional accuracy & safety. This is the most preferred technology for refractive surgeries in the USA & worldwide. This technology is superlative in term of laser delivery & clinical outcomes aimed at giving you better & sharper vision than with glasses & contact lenses.

Procedure:

As shown below a thin protective flap of corneal tissue is folded back. The Excimer laser then reshapes tissue from the inner cornea to correct the individual’s refractive error with exceptional accuracy. The corneal flap is placed back in its position where it bonds.  

The retina is like the film in a camera.  It is the seeing tissue of the eye.  When the focused light hits the retina, a picture is created and sent to the brain through the optic nerve (the nerve of the eye), thus giving us vision.

Retina has two parts: The peripheral retina and central Macula. Macula being the central part, is capable of producing sharp and clear image. This clear images enable us to read , write and do all fine work.

Conditions like Diabetes, Age related Macular degeneration and Macular holes can damage retina.  

Rushabh Eye hospital & Laser Center is equipped with the most advanced equipments to diagnose and treat retinal diseases.

Digital Fundus Fluoroscien Angiography  

A test to detect various Retinal conditions like Diabetic Retinopathy, Diseases of the Retinal Blood Vessels, Age Related Macular Degeneration, etc. The digital imaging system gives us crystal clear images of the retina and aids in accurate diagnosis

What is Glaucoma ?

Glaucoma is a group of eye diseases that gradually steal sight without warning. In the early stages of the disease, there may be no symptoms. It is estimated that half of the people affected by glaucoma may not know they have it.

Vision loss is caused by damage to the optic nerve. This nerve acts like an electric cable with over a million wires. It is responsible for carrying images from the eye to the brain.

It was once thought that high pressure within the eye, also known as intraocular pressure or IOP, is the main cause of this optic nerve damage. Although IOP is clearly a risk factor, we now know that other factors must also be involved because even people with “normal” levels of pressure can experience vision loss from glaucoma

Glaucoma Clinic at rushabh

Early detection is vital to stopping the progress of this sight threatening disease.  

RUSHABH Eye Hospital and Laser Center has a specialized Glaucoma Clinic with a Certified Senior Glaucoma Consultant of repute specializing in Glaucoma Diagnosis and Management.

The Glaucoma Clinic is equipped with advanced Glaucoma Diagnostic Equipment like 3-D OCT, SWAP Perimetry and Orbscan 2 based Corneal Pachymetry.

Can I have Glaucoma ?  

Unfortunately glaucoma is a disease, which cannot be seen or felt by the patients in the early stages.  It is usually spotted during the course of a routine eye check-up done by an Eye Surgeon, when high IOP is suspected and more detailed test is conducted. The mistake that most people commonly make is getting only their glass numbers checked by an Optician ignoring the need for a detailed eye check up.

Sometimes the patient discovers it and come to the Doctor with complaints of mild headache, fuzzy vision in morning or seeing rainbow colours around lights. These all indicate raised IOP.

Get an Eye Check up routinely above the age of 40 years

Cornea is the transparent, dome-shaped tissue covering the front of the eye. It is like the watch glass of a wrist watch. Cornea is a powerful refracting surface and provides about 2/3rd of the eye’s focusing power. Diseases of the cornea, due to injury or infection lead to loss of its transparency, thus reducing the vision.  

Corneal Transplant or Keratoplasty

Diseased corneas can now be replaced successfully by transplanting a human donor cornea to the diseased eye. Replacing the unhealthy cornea with a healthy corneais the only way of restoring vision. CORNEAL TRANSPLANTATION is one of the most successful organ transplant surgeries.  

Corneas for tansplant come from individuals who have donated their eyes for use after death.  

Cornea clinic is an integral part of Rushabh Eye Hospital & Laser Center . About 2.5 million people in India suffer from Corneal Blindness. Hence early diagnosis, prompt management and treatment of this problem is absolutely mandatory. Rushabh Eye Hospital & Laser Center has the most advanced diagnostic treatment facilities to handle all corneal disorders.

Facilities for International Patients  

Rushabh Eye Hospital & Laser Center is State of the art Eye Center treating patients with Eye Disorders from through out India, USA, UK , Australia Sri Lanka, Bangladesh, Nepal, East Africa, and Middle East.. International patients are provided facilities and services that include help with Visa, Airport transfers, Comfortable and select accommodation & interpreter services. A dedicated international desk ensures that all international patients get the very best of Rushabh and India. Our travel affiliates combine the treatment with a memorable holiday which they customize according to your travel preferences.

Largest Drug Rehabilitation and Detox Centers in the U.S

Drug addiction is a problem that is faced by a lot of individuals in the United States. There are some drug users who want to find a solution to their problem but just cannot seem to get themselves out of the mess that they are in. On the other hand, there are some drug users who are lucky enough to have family members who care for them so much. They are brought to drug rehabilitation and detoxification centers within the country. If you are trying to battle with drug addiction, there are plenty of rehabilitation centers within the United States where you will find professional assistance when it comes to dealing with your problem. The following are among the Largest Drug Rehabilitation and Detox Centers in the U.S.

Sunset Malibu – Alcohol Rehabilitation and Drug Treatment Center

Sunset Malibu, which is located in Malibu, California, is a residential alcohol rehabilitation and drug treatment residential center. It comes fully equipped, which is very convenient for easy recuperation. One of the main reasons for the popularity of this center is its 180-degree view of the whitewater oceans of sunny Los Angeles. The facility is considered as one of the country’s exclusive Drug Rehabilitation Centers. It specializes in the treatment of painkiller addiction and substance abuse and in alcohol detoxification. It also treats co-occurring eating disorders and depression.

When you want first-class treatment for the drug addiction problem of a family member, you will get it from Sunset Malibu. This facility is highly recognized as a leading treatment center, where families and problematic individuals can seek solace and cope with drug abuse or alcoholism. The treatment program of this facility utilizes a broad range of conventional and non-conventional methods. What is more, its practitioners are considered the best all throughout the globe.

Hemet Valley Recovery Center – CDRH Licensed

Found in Hemet, California, Hemet Valley Recovery Center is a primary treatment facility for acute care. This makes the center different from most drug rehabilitation and alcohol treatment facilities in the United States. It has obtained licensing to operate as a CDRH or Chemical Dependency Rehabilitation Hospital, enabling it to offer acute medical and professional detoxification help. What is more, it is capable of providing specialty services and rehabilitation programs. Hemet Valley Recovery Center does not only cater to drug users and alcoholics. Its specialty services are catered to patients of chronic pain and to seniors.

The Watershed – Drug Rehabilitation and Detoxification Center

The Watershed is located within the state of Florida. It is a known leader in the field of medical drug detoxification. It also provides excellent treatment for substance abuse and drug rehabilitation. The Watershed is a center for drug and alcohol abuse treatment. Its other areas of specialty include drug addiction treatment, treatment of co-occurring disorders, and dual diagnosis. Its staff is comprised of professionals and highly trained medical doctors, addiction psychiatrists, nurses, therapists, and psychologists. The safe and beautiful environment of The Watershed provides optimum recovery for its in-patients.

All About Physical Therapists

Physical therapy is a broad sphere of medical practice that encompasses many needs and scenarios. Simply put, a physical therapist provides the service to the patient of helping him or her achieve, maintain, or restore maximum movement and functional ability. The patient and why they need physical therapy can be as vast as medicine itself. The old and infirm need assistance in maintaining movement. The injured need therapy to recover movement. Those born with a physical or neurological handicap need therapy to develop movement.

Just some of the conditions which a physical therapist may help with include: back and neck pain, spinal and joint conditions such as arthritis, biomechanical problems and muscular control, problems affecting children such as cerebral palsy and spina bifida, heart and lung conditions such as chronic obstructive pulmonary disease and pneumonia, sport-related injuries, stress incontinence, and neurological conditions such as stroke and multiple sclerosis.

Physical therapists usually specialize in a specific field. Just like a doctor, a physical therapist is a certified expert – in the United States requiring four years of college with an eye towards the specialty. Not many people realize this, because to watch a physical therapist work, you might at frst mistake them for a coach or a counselor.

In fact, coaching and counseling are a great deal of what physical therapy is all about. Physical therapists work in a very active role with the patient, guiding them through exercises designed to help build the patient’s mobility. They may be working on the track or the gym with a sports injury case, in a hospital coaxing a stroke survivor to take their first few steps with a walker, or in a swimming pool using the water’s buoyancy to help a recovering accident victim with a fractured pelvis to learn to walk again.

History
Physical therapy as a recognized profession goes all the way back to ancient China, though in that point in history it was more like a massage business. Physical therapists came into their first mass use in World War two, when soldiers coming home with spinal injuries provided new challenges to the profession. Orthopedic hospitals and chest clinics for veterans soon sprang up, with physical therapists running the show.

In many countries, the profession of physical therapy has grown to become the largest allied health profession, in third place only behind medicine and nursing in the number of graduating health care students.

Working with disabled children
Children are born with a mobility problem for many reasons. For just one example, there’s cerebral palsy. A baby born with cerebral palsy has a very good chance of being able to partially recover by the time of adulthood. This is due to the brain’s ability to patch itself by growing new neurons. But in order for those neurons to form in the first place, the child must have stimulus.

They say that riding a bike is something that once you learn how, you never forget. This actually applies to all mobile activities. Anything from crawling to surfing is a learned set of muscular co-ordination reflexes, and to develop them, we have to practice. Once the brain has learned how to guide the body through a set of motions, new pathways of neurons are formed in the brain to record the learned behavior. The act of learning an activity is actually one of providing physical stimulation to the body, which in turn is used by the brain as raw material to build a learned behavior from.

A physical therapist working with a disabled child who cannot crawl, for instance, may start by placing the child on his belly on a soft inflated ball. With just the feet and hands touching the floor and without the necessity to support the bodies entire weight on the limbs yet, the child can move themselves around on the ball by pushing against the floor with their hands and feet. Later the ball might be replaced with a padded board on wheels. Just like training wheels on a bike, the motion is practiced in gradual steps until the child can both develop the muscle tone and learn the gross motor skills necessary to carry out the task.

Water walking
Similarly, an older patient with a mobility problem due to a recent injury or stroke might need to teach their body how to walk again. By suspending their body in a shallow pool with a floatation vest on, they can walk around on the surface of the pool bottom and their body’s weight is mostly carried by the water. In this way the legs and feet can rebuild muscle tone and the brain can learn to remap those neurons that may have been damaged or forgotten.

Tai Chi and Pilates
Tai Chi, a “soft” Chinese martial art, has made some popular gains in senior patrons of physical therapists. The gentle, graceful movements and slow pacing are a deliberate effort to force the body and mind to focus on it’s mobility. As opposed to the “training wheels” model, this is more of a “slow and steady” model, but even those the Tai Chi class may look like slow-motion aerobics, the benefits are staggering.

Researchers have found that long-term Tai Chi practice had favorable effects on the skills of balance control, flexibility and cardiovascular fitness and helped reduce the risk of falls in elders. The studies also reported reduced pain, stress and anxiety in healthy subjects who took Tai Chi. Other studies have indicated improved cardiovascular and respiratory function in healthy subjects along with those who had undergone coronary artery bypass surgery.

Pilates is an exercise regimen with very different roots in Europe and America instead of the Far East, but with similar goals in mind. The inventor of this exercise named it “Contrology”, which refers to the way the method encourages the use of the mind to control the muscles. It is an exercise program that focuses on the core postural muscles that help keep the body balanced and are essential to providing support for the delicate muscles of the spine. In particular, Pilates teaches an awareness of breath and alignment of the spine, and strengthens the deep torso muscles which are important to help alleviate and prevent back pain.

There’s more to physical therapy than meets the mind. Indeed, the benefit is mostly applied in the mind, although physical therapists speak almost as if the body had a mind of it’s own, which the brain merely oversees. In a way, a physical therapist can be seen as a “brain programmer” – or re-programmer! No matter what your course of medical treatment in life, you’re almost bound to require the services of a physical therapist at one point or another in your life.

Houston Octg Looks To Nai For Cranes

 North American Industries (NAI) has been selected to design and install two 10-ton Class E top-running overhead cranes for Houston OCTG Group Inc. (Houston). Houston, a wholly-owned subsidiary of WSP Holdings Limited, headquarted in Jiangsu Province, China, manufactures specialty tubing and castings used to transport crude oil and natural gas from an oil or gas layer to the earth’s surface during the drilling process.

 Houston asked NAI to inspect the existing cranes in its 1,350 foot long Houston, TX-based facility. After thorough inspection by and extensive consultation with NAI technical personnel, Houston management decided to invest in new cranes. Houston also chose to replace the existing, worn rail to avoid premature damage to the new cranes. Based upon NAI’s recommendation, Houston’s engineering department and project manager chose heavier-duty Class E cranes because they must be capable of handling over 20 lifts per hour.

These double-girder cranes will be used in Houston’s manufacturing process, which includes pipe threading, heat treatment and inspection. They will also be used to load and unload raw materials. Each crane will have two five-ton hoists bolted directly to a 10-ton trolley. The trolley will move along the 79-foot bridge beam, and the entire crane will move along the 1,350-foot runway system.  

Lena Banigan, Project Manager/Assistant VP at Houston, states, “NAI has not only been a pleasure to work with but has also provided service to meet our deadlines. In business, time is critical to advancement, and NAI has been truly accommodating.”

“We are pleased to be working with Houston OCTG to meet its overhead lifting needs. We have collaborated closely with Houston’s engineers and senior management to design a system tailored to meet its unique requirements,” comments Craig Pelkola, Director of Technical Sales at North American Industries 

 Dan Osborn, Engineering Manager at North American Industries, adds, “The project has gone smoothly.  We assembled a team of engineers, project managers, operations personnel and field technicians to carefully oversee the design, manufacture and installation of the equipment”.

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