Robotic Surgery free essay sample

The Cutting Edge Surgery has been a method used to help fix people’s problems for generations. Whether it is a broken bone, dislocation, cancer, or ruptured appendix, surgery has provided the option of fixing these problems for the afflicted patients. The history of surgery is vast, and over the ages it has developed into a much more refined practice. According to Tim Lambert in A History of Surgery, it started in the Stone Age, with incisions and holes in people’s skulls for unknown reason. Egyptians then furthered the realm of surgery by removing the organs of mummies to prevent rotting (Lambert). A big problem during this time was cleanliness; it was difficult to prevent infections in addition to controlling bleeding problems and pain. As generations passed, surgeons became more skilled in operating procedures, using alcohol and honey to prevent infections. In addition, surgeons gained more knowledge about the human body through dissections that became allowed by the church around the mid-14th century (Lambert). We will write a custom essay sample on Robotic Surgery or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page The revolution of anesthetics wasn’t introduced until the 19th century; however it became a critical advancement in the field by allowing patients to receive pain relief by inhaling ether. This became especially important at this time, because new procedures such as the tracheotomy became a less intense procedure with the use of anesthetics. Options other than ether soon became available, such as chloroform, cocaine, and Novocain (Lambert). The surgical revolution didn’t end here, many technologies allowed for surgery to become a much more technical process. The 20th century led to the first eye surgery due to the invention of the laser, as well as improvements in heart surgery that led to the pacemaker, heart transplants, and artificial hearts (Lambert). In spite of all the groundbreaking steps that were made in this field, new steps are still being taken today. There is a new outlook that could prove to advance the field of surgery even further, and it is known as robotic surgery. Due to improvements in technology and programming, robotic surgery is now a better option than conventional surgery. Robotic Nurses Robotics can be used to aid in surgery in many different ways. Two main ways are using a robotic surgeon and using a robotic nurse. People may not realize that nurses can in fact have a negative impact in surgery. Research published by George Akingba shows that 31% of all communications in the Operating Room result in some sort of failure, and a third of those failed communications impact the patient (Akingba). Some of these errors are caused by team instability, which includes a lack of familiarity between nurses and surgeons, minimal staffing, and other random distractions. The use of a robotic nurse can possibly reduce the number of failed communications between surgeons and nurses (Akingba). In order for robotics to be a successful replacement, these robots must achieve a certain level of accuracy and speed. In order to determine how well a robot could achieve this, George Akingba and his team performed and recorded multiple experiments using a robotic nurse called Gestonurse. Their goal was to show that a robotic nurse could be used in an actual surgery (Akingba). In order to serve as a viable replacement, Gestonurse needed to be able to understand both verbal and non-verbal cues given by the surgeon, predict the instruments that the surgeon will require next, and doctors need knowledge of the boundaries and limitations of this fairly recent technology (Akingba). In order for Gestonurse to replace a nurse in an operating room it has to be able to replicate the same steps a regular nurse could perform. That means the robot must identify the hand gesture it is being given, match that gesture with a tool, find the tool, and transport it from the table to the surgeon. This is a difficult process for a robot to perform in a small period of time. George Akingba and his team decided to start by determining how well the robotic nurse could get instruments for the surgeon based on the distance between each instrument. They feared that the robot would not be able to distinguish between objects that were too close together (Akingba). For this experiment to be performed, non-verbal cues were assigned to surgical instruments using fingers. One finger is a scalpel, two fingers are scissors, three is a retractor, four is forceps, and five is a hemostat (Akingba). What the study found is that a robot can reliably identify and select the correct instrument for the surgeon when the instruments are separated by at least 25mm (Akingba). Next, the researchers tested different hand placements for these fingers in order to see if the robot would recognize the fingers being held up in different positions. The study showed that as long as they kept their hands parallel to the image plane, even by moving their hands in this plane, about 94% of the gestures were detected (Akingba). About 4% of the remaining error is explained by out-of-plane rotations (Akingba). For example, if three fingers are held up, but they are rotated in such a way that the robot needs depth perception to accurately view them, the robot will not always recognize each finger, and will underestimate the actual number of fingers being presented (Akingba). George Akingba and his team had one last component to test before making a conclusion. His team wanted to test how fast the robot could get the instrument to the surgeon compared to a human. They found that on average it took a human 3. 23 seconds to get an instrument for the surgeon, compared to the 4. 06 seconds it took the robot (Akingba). This results in a very minimal difference of only 0. 83 seconds longer for the robot to accomplish the task. Altogether, the experiments conducted showed the capabilities of robotic nurses in the Operating Room. During these trials, Gestonurse provided many advantageous features to surgery. Gestonurse was easy to use, and allowed the surgeons to use their hands. Additionally, Gestonurse responded to nonverbal commands that were fast and intuitive, without the need of a surgeon to wear a microphone or marker in order to use the system. And lastly, the hand gestures used by the surgeons were very accurately identified. Robotic Surgery On a more sophisticated level, robots can be used to perform an actual surgery. According to an article written by Anthony Lanfranco, Robot-assisted surgery can be done using three different types of robots; ARTEMIS, da Vinci, and Zeus. Artemis (advanced robotic telemanipulator for minimally invasive surgery) is a robotic mechanism that consists of two robotic arms that are controlled by a surgeon on a control console (Lanfranco). The da Vinci system uses a slightly more complex 3-part system, comprised of a vision cart with a dual light source, dual 3 chip cameras, a console for the surgeon, and 2 instrument arms on a movable cart and a camera arm mounted onto a cart. The Zeus machine is very similar to the da Vinci, however the console is in an ergonomically designed arrangement for the surgeon. In addition, Zeus has a third robotic arm that is voice controlled, allowing the surgeon to give audible instructions on where the camera should be placed for the best picture (Lanfranco). What this is essentially offering is surgery that can be performed by a robot that is being guided by a surgeon, which provides numerous advantages to doctors and patients. According to the article Robotic Surgery by Anthony Lanfranco, these systems enhance dexterity and allow the surgeon to better manipulate the instruments and the body tissues. Additionally, the systems produce greater control of hand tremors and sudden movements that doctors would normally have. Lanfranco adds that these robots help by allowing the surgeon to â€Å"sit in an ergonomically designed workstation† as well as â€Å"eliminate the need to twist and turn in awkward positions to move the instruments and visualize the monitor. † The advantage to this is that the system restores proper hand-eye coordination to the surgeon, and reduces the risk of slipping during a procedure as well as not being able to see clearly (Lanfranco). A video titled Minimally Invasive Robotic Surgery with the da Vinci Surgical System records a patient who prefers robotic surgery because â€Å"a surgeon can focus in 10 to 12 times magnification† and that was very important to him. This same man, named Doug Mclean, ran in a marathon within about a month after his prostatectomy (da Vinci Surgery). This leads to another critical advantage of robotic surgery. These robots have been mainly used in laparoscopic surgeries, which are also known as Minimally Invasive Surgeries (Lanfranco). These laparoscopic surgeries provide the ability for surgery to be done without the need of a lengthy recovery period or a sizeable scar. Patients who would normally need to stay in a hospital to recover are now able to leave the hospital on the same day as their surgery (Lanfranco). After his prostatectomy, Marlow Gilmore said, â€Å"I had no idea that it would be this quick to get back to my normal, functioning self† (da Vinci Surgery). Despite its amazing advantages, some disadvantages are still present in Robot-assisted surgery. Anthony Lanfranco recognizes in his article that the limitations of these robots are still not well known. Additionally, he states that the cost of installing one of these systems is close to a million dollars. As new upgrades become available for these new systems, the cost might climb even higher. This makes them difficult for some hospitals to purchase. Lastly, these robotic systems are very large. They take up a huge amount of the operating room, and can sometimes result in overcrowding between the robot and the surgical team (Lanfranco). Haptic Feedback Researchers, however, are currently working on improving the technology associated with robotic surgery. One way of doing this is using haptic feedback in robotic systems. Haptic feedback is the process of giving surgeons the same â€Å"sense of touch† that they would receive if they were performing the surgery without a robot (Robotic Surgery). Associate professor Allison Okamura is conducting experiments to provide a touch sensation during these procedures, instead of feeling what she calls, â€Å"chopsticks that have grippers on the end† (Robotic Surgery). This process is a very difficult and complex problem to solve. In order to allow for doctors to feel these sensations, physics must be combined with technology and incorporated in the machines. The machine will need to use an advanced force sensor, which will measure the force applied by the robot, and exert the same force on the surgeon’s hand (Robotic Surgery). This will create a similar feeling to performing the actual surgery. Another option is to create a computer model that tracks the movements of the robotic tools. This will allow the data collected by the computer to be converted into haptic feedback for the operator (Robotic Surgery). There is much debate to which approach would be better. Force sensors are highly accurate; however they would need to be made of sterile materials in order to be used. On the other hand, a computer model would work well but it may not respond fast enough to be beneficial to the surgeon. Until a system has been developed and is proved to be beneficial, Allison Okamura is using a light operated system that uses red, yellow, and green lights to display if the right amount of force is being used (Robotic Surgery). A new era is approaching and Robotic Surgery is at the front of it. It may be a recent and developing field, but has proved to be beneficial thus far. While human nurses are still the most common, and most surgeons are not using robotic technology, these practices may become outdated in the future with minimally invasive procedures now becoming more available. Robotics has the ability to advance surgery and perform surgical methods that are not achievable by humans. While still incredibly expensive, robotics is now beneficial to the field of surgery, and as time passes this cost will hopefully become more reasonable. While people may be using conventional surgery more often, Robotic Surgery has become a superior alternative.

Visit To The Planetarium Essays - Constellations, Ursa Major

Visit To The Planetarium Essays - Constellations, Ursa Major Visit To The Planetarium Astronomy Second Paper 11-27-00 I attended the Wagner College Planetarium(located in Spiro Hall)on November 15, 2000 at 11:00 for research and to observe the stars, planets and our entire solar system more closely. There was a clear dome on the ceiling for us to see the sky. The director of the show was Dennis Anderson. He put the latitude to forty degrees, and dimmed the lights. Up in the sky the stars are beautiful and bright. They seem, by the naked eye to be moving but the earth is what is actually moving. Everyone knows that the sky doesn't move. The earth rotates around the sun. The earth being in a different spot in its' orbit all the time gives us different stars to see at different times out of the year. A star is a huge ball of glowing gas in the sky. The Sun is a star. It is the only star close enough to the earth to look like a ball. The other billions of stars are so far away that they are no more than a pinpoint of light. A constellation is a bunch of stars in the sky that form a picture. Each Constellation has a definite time of the year when it reaches its highest point. At latitudes to far north or to far south of the equator, many constellations do not reach there culminates high enough to be seen. The constellations appear to move westward as the earth rotates around the Sun. For this reason, certain constellations can only be seen during one season of the year. There is Pegasus which is extremely large. If you connect the stars of Pegasus it is supposed to look like a horses body. However it is upside down. The instructor put a line going across the middle of the dome. It separated the sky from north to south. He said this line is called the Meridian. When a star is at the Meridian it is at its highest point. It is nine degrees elliptical on each side. The second brightest star is Mercury it has a very thick atmosphere. However the brightest star nearest to the horizon is Venus. We also saw Jupiter it was also a very bright star but not as bright as Venus. Jupiter has four moons' which was very interesting to see. We live in a spiral Galaxy. It has one to four billion stars. Some people believe we live in the barred galaxy. It is also called the Milky Way galaxy. If stars or galaxies explode we would not know until light years later. This is due to the great distance between us and other stars or galaxies. Light years are a measure of distance. Some bi-global clusters of stars are a numbered at 150,000 to one million stars bunched together. This is called Messier 13. Messier 13 is 30,000 light years away. It was discovered by a man named Charles Messier. Charles Messier also discovered the Stellar Nebular. He got a lot of credit for his time, which was around the 1700's. Many years ago stars were known as navigation systems. Sailors used the stars to guide them on where they wanted to go. They would look at the stars and try to judge where they were by where the stars were located in the sky. Thus turning the stars into a navigation system. If we were in the country side and not the city we would be able to see the stars much better. They would seem brighter to the naked eye. The instructor at the planetarium explained to us that in New York City the street lights and car lights seem to drown the energy of the stars. He also said that if something isn't done about it in a couple of decades we will not be able to see any stars from our city. A set of stars everyone is familiar with is the Big Dipper, but it is only part of a constellation called the Big Bear. There is also the Little Dipper. At the handle of the Little Dipper is a star called Polaris, which is also known as the North Star it stands out in the sky when you look

Suggest how an economist would approach the problem of alcohol abuse Essay

Suggest how an economist would approach the problem of alcohol abuse - Essay Example Numerous examinations on this subject have been conducted by economist to determine the impact of the price of alcoholic beverages to alcohol consumption. Despite the varied nature of the researches conducted, the conclusion is common. That an increase in the price of alcoholic beverages results to a decline in drinking and heavy drinking, as well as the consequences of alcohol use and abuse. This is in direct relevance to the fundamental law of economics called the downward sloping demand curve. It states that, as the price of a product rises, the quantity demanded for that product decreases. Another way to curb the abuse of alcohol is the use of government policy. Economists have found that the most ignored policy of controlling alcohol abuse is the most effective and important (Chaplouka, Grossmann & Saffer, 2002). This is the raising of the taxes levied on all alcoholic beverages. The decline of federal, state and local taxes on alcoholic beverages over the years by considerably high margins is a show of ignorance to this policy. The effectiveness of this policy of this policy is due to the fact that the use and abuse of alcoholic beverages has been found to be sensitive to price. However, to address the matter with economical intellect the policy should be implemented after accounting for the effects of inflation. Prescription drugs fall under the industry of pharmaceuticals, which is funded in the country as part of Research and Development. In the recent past and the present this industry has been found to have very large costs of maintaining and they are always fixed. It is estimated that twenty percent of sales from research based pharmaceuticals has been devoted to research and development compared to four percent for other industries (Nebbit, 2000). This huge investment in relation to prescription drugs, therefore, results to high prices for these products. Since the products are essential for life, their consumption is fixed and may not be greatly

IS Strategic planning Essay Example | Topics and Well Written Essays - 3000 words

IS Strategic planning - Essay Example Heads of department from both faculties would meet together on a regular basis. Communications and report structures would become more collaborative, involving joint reports on key strategic partnerships. The cost savings of a single faculty office would not be achieved, but estimates suggested that the joint working proposed would be less costly than Plan A. Students and staff would experience no disruption under the new arrangements, although again potential developments in terms of new courses and research were envisaged. One potential hurdle was the increased levels of bureaucracy. Staff already moaned about the amount of paperwork and there was a danger of increasing the number of committees under the joint arrangements. Re-engineering will involve integration of latest technological aspects such as cloud computing features and components to the system to ensure that all long term institution’s technological needs and IT requirements are met. The applications which are given priority include database, data warehousing components that will enable the company to meet the short term IT strategies. The hardware and other support software are also given priority. The testing should be carried in two stages. First every system unit is thoroughly tested. This is done by exposing the prototype system to the users. The errors that will be realized are fixed before system integration. Another test will be performed after the different sub systems are integrated. Training will be conducted in phases. All the employees in different business units should fully understand the system and how it works. The security issues should also be dealt with during the training. The strengths, weaknesses, opportunities and threats identified for the Midchester University were provides a wide environment and covers the elements such as support systems for information technology, academic programs and the IT

Understanding The Federal Reserve System Essay Example for Free

Understanding The Federal Reserve System Essay Operating Federal Reserve System through Stocks. The Federal Reserve System (Fed) is the principal monetary authority or the central bank of the United States of America. Its primary role is to conduct monetary policy, supervise federal and state banks and maintain stability in the system by providing payment services to depository institutions. It is made up of a seven member Board of Governors in Washington DC, 12 regional Federal Reserve Banks and their 25 branches. The Board is appointed by the President and approved by the Senate. Federal Reserve issues monetary policy guidelines and carries out stabilization activities which are particularly important in times of financial crisis such as stock market decline in 1987, the international debt crisis of 1998 and the terrorist attacks in September 2001. The principal instruments at the disposal of the Federal Reserve for maintaining stability are interest rates for loans, reserve ratio stipulations for commercial banks thereby determining liquidity and regulating circulation of new currency. The latter is carried out by the Federal Open Market Committee (FOMC) by buying securities in the open market thereby increasing money supply. This will simultaneously decrease the federal funds rate, reducing interest on mortgages and loans and generating demand. The price of bonds and securities operate within a narrow margin as these are long term instruments pledged by the government. During such times, it would be seen that the price of stocks which are volatile instruments will undergo large fluctuations as opposed to bonds and securities. Similarly an increase in money supply also results in people putting more money into the stock market. In case the economy is growing too fast, Fed can sell Treasury securities and reduce the money supply, marking higher interest rates. Stocks construe ownership of shares in the assets of a company. The price of shares is determined by the market. The New York Stock Exchange provides a facility for trading shares. Stocks are guaranteed to the extent of the liquidity of assets of the company and unlike federal bonds are not direct instruments of liquidity. There is a possibility of default in stocks unlike bonds. The US Fed will not be able to ensure stability through regulation of money supply by holding stocks. The aim is also to ensure sustained long term growth in the economy; this is achieved through investments in long term instruments as mortgages, insurance and loans. Stocks are relatively short term instruments which provide market marked returns and thus are not suitable as a policy instrument for the US Federal Reserve. Impact Open Market Purchase of Gold or Foreign Currency. Purchase of gold or foreign currency by the Federal Reserve will increase money supply in the domestic market. Buying gold or foreign exchange is similar to outright purchase of government securities from the open market. In this case money supply is altered permanently rather than temporarily. The purchase of gold or foreign currency is carried out in very few cases merely to send an appropriate signal as the impact is considerable. Similarly theoretically speaking if the Fed sells gold and foreign currency it will be decreasing money supply in the domestic market. The gold and foreign exchange markets are beyond the control of the Federal Reserve as there is no regulatory authority unlike the bond market. Thus fluctuations can be substantial and impact the domestic economy gravely. Instability in the Gold and Forex market has not been defined and can cause speculation which is related to fluctuations in the exchange rates as well as trader’s reluctance to buy and sell the commodity or foreign exchange. Maintenance of stability in the economy is the principal role of the Federal Reserve. This has to be done through specific instruments which are provided for the same and the controlling organization for it, which is the Federal Open Market Committee, the federal and the state banks. The Federal Reserve has been intervening from time to time in a small way in the foreign exchange market merely to send an appropriate signal to the investors. In this case Federal Reserve sells dollars and buys foreign currency to exert downward pressure on the price of the dollar while it buys dollars and sells foreign currency to exert an upward pressure.

Stroke Mortality Among Alaska Native People :: Article Review, Ronnie Horner

My article review is on, â€Å"Stroke Mortality Among Alaska Native People†, by Ronnie Horner. The Alaskan Natives have been suffering with the vast number of mortality rates caused by strokes. This article was written to successfully understand the Alaskan’s stroke problem or factors that contribute to this problem, and eventually find strategies that will aid in its prevention. The only problem that exists with trying to come up with strategies for prevention is the sparseness of the epidemiological data of the Alaskan Natives. It is hard to categorize the Alaskans in one separate group, the Horner states, â€Å"to its failure to consider Alaska Native People as one distinct cultural group, one among the many that comprise the American Indian/Alaska Native designation†(Horner 1). This creates a problem because it puts limitations on the efficiency of the epidemiology of the Alaskan Natives. With this being said, patterns have arisen in the number of stroke vict ims that are Alaskan Natives, â€Å"Stroke Mortality appears to be significantly elevated among relatively younger American Indians/Alaska Natives compared to US whites of similar age† (Horner 1). This shows that there must be an unknown factor that has led or caused the younger Natives to have a stroke. Something must had to change because the word â€Å"elevated† is used which indicates recently increased to what it normally was. It seems that Alaskan Natives are the number one ethnic group that is impacted by Stroke Mortality, Horner points out, â€Å"Of note, data for the 1990’s indicate that stroke mortality has decreased in all racial ethnic groups except for American Indians/ Alaskan Natives†(Horner 1). In detail this article attempts to figure out what factors are causing these elevations in stroke mortality that is not seen in any other ethnic group. Methods/Results/Conclusion The doctors had to first gather the death certificate data of the Alas kan Natives, Horner states, We conducted an analysis of death certificate data for the state of Alaska for the period 1984 to 2003, comparing age standardized stroke mortality rates among Alaska Natives residing in Alaska vs. US whites by age category, genders, stroke type, and time† (Horner 1). This will allow the doctors to examine the data to really conclude that Alaskan Natives were more prone to strokes than whites. With this data the doctors also need a population of Alaskans that they could carefully examine and study, Horner explains, â€Å"the study population was defined as all Alaskan residents who self-identified as Alaskan Native People.

Federal Health Care Essay

Federal health care is one of the biggest social and economic problems Americans face today. Due to the rising cost of medical care and health insurance, many Americans are either uninsured or do not have adequate coverage. The Patient Protection and Affordable Care Act (PPACA), commonly known as Obama Care, is part of a decade-long effort to reform the nation’s health care system and ensure that more Americans have adequate and affordable health care coverage (Salem Press Encyclopedia, 2013). This essay will briefly explain the elements of Obama Care, the pros and cons of the policy, and how the policy raises issues of federalism. President Barack Obama made health care reform the foundation of his agenda during his first year as president. According to Salem Press Encyclopedia (2013), â€Å"he charged the Democratic Congress with crafting a comprehensive bill that would provide coverage to all Americans, lower health care costs, and improve the quality of health care of the entire country.† Even though the Democratic majority embraced the idea, they had considerable difficulty in embracing a single package that satisfied liberals, moderates, and conservative Democrats alike (Salem Press Encyclopedia, 2013). However, Republicans and a growing number of independent votes immediately pushed for an appeal of the law. In light of the major controversy that surrounded the reform, the Patient Protection and Affordable Care Act had been significantly modified, removing sticky points underscored by moderates and conservatives, to make it palatable to enough moderate and conservative Democrats to gain passage (Salem Press Encyclopedia, 2013). The Ninth Amendment states that â€Å"the enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people† (Huffman, 2012). However, the federal government and the states view the Obama Care policy has a struggle for power when their central concern should be with establishing the division of powers best suited to preserve liberty. According to Huffman (2012), â€Å"Obamacare’s transparent impositions on liberty were given scant attention in the oral arguments over the law’s constitutionality, notwithstanding the fact that the reason the healthcare law has been consistently opposed by a majority of voters is their objection to the individual mandate.† President Barack Obama signed into law the Patient Protection and Affordable Care Act on March 23, 2010. Its goal is to  give more Americans access to affordable, quality insurance and to reduce the growth in health care spending in the United States through consumer protections, regulations, subsidies, taxes, insurance exchanges, and other reforms (ObamaCareFacts, 2014). According to ObamaCareFacts (2014), â€Å"ObamaCare offers a number of new benefits, rights and protections including provisions that let young adults stay on their plan until 26, stop insurance companies from dropping you when you are sick or if you make an honest mistake on your application, prevent against gender discrimination, stop insurance companies from making unjustified rate hikes, do away with lifetime and annual limits, give you the right to a rapid appeal of insurance company decisions, expand coverage to tens of million, subsidize health insurance costs, require all insurers to cover people with pre-existing conditions, among other things.† Obama Care, or PPACA, has been designed to help Americans medically and financially when it comes to health insurance.  There are many pros and cons related to the Patient Protection and Affordable Care Act, or commonly known as Obama Care. Some pros of PPACA include tens of millions of uninsured will get access to affordable quality health insurance through the marketplace, helps to curb the growth in healthcare spending, over half of uninsured Americans can get free or low cost health insurance, and even small businesses can get tax credits for up to 50% of their employees’ health insurance premium costs (ObamaCareFacts, 2014). Some cons of PPACA include in order to get the money to help insure tens of millions there are new taxes which mostly affect high-earners, focuses more on making sure people are covered than it does on addressing the cost of care, mandates that you have to obtain health coverage by January 2014, get an exception or pay a fee if you cannot afford it, and even mandates that in 2015 businesses with over the equivalent of 50 full-time employees must provide health coverage (ObamaCareFacts, 2014). The Patient Protection and Affordable Care Act has been fairly effective in achieving its goals of give more Americans access to affordable, quality insurance and to reduce the growth in health care spending in the United States through consumer protections, regulations, subsidies, taxes, insurance exchanges, and other reforms (ObamaCareFacts, 2014). According to  Dictionary.com, LLC (2014), effectiveness means â€Å"adequate to accomplish a purpose; producing the intended or expected result.† Even though there are many pros and cons to the policy, they have been fairly effective to ensure all Americans receive affordable, quality health insurance and coverage. American federalism’s constitutional framework is based off of national and state governments sharing the authority that is derived from the people (Levin-Waldman, 2012). The Patient Protection and Affordable Care Act is successful based off of the cooperation of local, state, and national authority. PPACA is consistent with American federalism’s constitutional framework because all stages of government, as well as people, are working together to ensure all Americans are taken care of medically, as well as financially, when it comes to health care and insurance. Furthermore, the Patient Protection and Affordable Care Act is part of a decades-long effort to reform the nation’s health care system and ensure that more Americans have adequate and affordable health care coverage (Salem Press Encyclopedia, 2013). It has many pros and cons, but has been effective and demonstrates American federalism’s constitutional framework because it includes all stages of government, as well as ensures all Americans receive affordable, quality health insurance and coverage. References Dictionary.com, LLC. (2014). Effectiveness. Retrieved from http://dictionary.referance.com/browse/effectiveness Huffman, J. (2012). Obamacare vs. Federalism. Retrieved from www.hoover.org/publications/defining-ideas/article/119436 Levin-Waldman, O. M. (2012). American government. San Diego, CA: Bridgepoint Education, Inc. ObamaCareFacts. (2014). ObamaCare Facts: Facts on the Affordable Care Act. Retrieved from obamacarefacts.com/obamacare-facts.php ObamaCareFacts. (2014). ObamaCare: Pros and Cons of ObamaCare. Retrieved from obamacarefacts.com/obamacare-pros-and-cons.php Salem Press Encyclopedia. (2013). Patient Protection and Affordable Care Act Overview. Retrieved from http://eds.a.ebscohost.com.proxy-library.ashford.edu/eds/detail?sid=2b1be3dd-154d-43ab-84e9-aeeaa71be0c7%40sessionmgr4004&vid=5&hid=4205&bdata=JnNpdGU9ZWRzLWxpdmU%3d#db=ers%AN=89158281