How Does Bronte Make You Feel Sympathy For Jane Eyre? Essay

This story is written in a first person narrative, so it helps us sympathize with Jane as you share her thoughts and feelings. Jane was an orphan. Her maternal uncle looked after her, but later died. She then lives with her Aunt Mrs. Reed and her three cousins. (Mrs. Reed is Jane’s uncle’s widow.) There is a lack of relationship in the family in which she now lives in. Mrs. Reed made a promise, on Jane’s’ uncles’ deathbed that she would look after Jane, but because they weren’t maternally related there was no love and warmth from them. Bronte first makes you sympathize for Jane as she is sent to the Red Room, where her maternal uncle died, as a punishment, for retaliating to John, as he hit her. Despite her injury, her aunt has no sympathy for Jane. All the blame gets put on Jane and her cousin John gets away unpunished. This shows favoritism making you sympathize with Jane as she is bullied and blamed. Jane is a young girl, terrified by the Red Room, because of the death of her uncle; † I resisted all the way.† This shows that Jane does not want to go there and will do anything not to go there, as she acts out of character, by kicking and screaming. This makes you sympathize for Jane as I seems as if she is being tortured and punished for a mild offence. She also makes you sympathize with Jane as she has to call her cousin â€Å"Master,† and she is described as † Less than a servant.† This shows that Jane has no status in the house and is not respected or loved by anyone in there making you feel sorry for her as she is only a little girl. Miss Abbott is the head servant of the house. She talks about Jane in her face, as if she is not there, â€Å"She is an underhand little thing.† This is degrading Jane, calling her sly and showing no compassion for her what so ever. This again shows Jane has no status in the house as she is being described as a â€Å"Thing† by a servant, making us sympathize for her. Bessie on the other hand, who is also a servant, tries to sympathize with Jane, and sticks up for her, but, she still treats Jane as a low status person. † If you don’t sit still, you will have to be tied down.† Although she is only warning Jane of the consequences, she is treating her like an animal, â€Å"Tied down.†

Parole and Truth in Sentencing Essay

To understand parole one needs to know what parole is and what it means. Parole is the status and early release of a convicted offender who has been conditionally releases from prison by a paroling authority before his or her sentence is expired. Parole and Probation have similar conditions. While an offender is on parole they have certain rules they need to follow. There is another form of parole which is Federal parole. Federal parole was determined by the Parole Board under the United Stated Parole Commission. Federal parole was changed after the Sentencing Reform Act. The Sentencing Reform Act was a part of the U. S. Federal statute that was intended to increase the consistency in the United States federal sentencing; this abolished federal parole all together. Parole was introduced by Brockway Zebulon in 1876 as a way to reduce jail overcrowding and as a way to rehabilitate offenders by encouraging them to win back their freedom with good behaviors. The role of parole was to reduce prison terms based on good behavior. Another role of probation was to supervise the convicted after being granted parole and grant freedom to those who had uncertain sentences. The reduction of jail terms after good and responsible behavior use to reduce indeterminate sentences. â€Å"There are 25 percent of inmates who are freed from prison are still paroled by the paroling authority, such as a parole board† (Schmalleger, F). Some conditions that affect parole would be the specific terms needed to be followed by the parolees. A parolee must check in with his parole officer within 24 hours after his release, they may be required to live in a certain area or with a certain person, and they may be required to stay away from certain people. If any of these stipulations are broken the parolee will go back to prison to serve out the remainder of their time of incarceration. This is also known as revocation of probation. Revocation of probation is an administrative action of a paroling authority removing a person from parole status. Once an offender is back in prison he has to serve out the remainder of his time and also anytime he may get from any other crimes he may have committed. Some typical conditions that affect whether a person gets parole are the nature of their crime, prior criminal record, and most importantly the amount of time already served. The goals of truth in sentencing are to improve the delivery of proportionate punishment and promote stability and predictability in offenders. â€Å"The abandonment of the rehabilitation goal, combined with a return to determine sentencing in many jurisdictions including the federal judicial system has reduces the amount of time an average corrections client spends on supervised parole†(Schmalleger,F pg. 424). In 1981 there was a revision that ensured that the credits to good behavior would exceed the length of the jail term: The more number of years one was to serve in prison the more the number of months they were likely to get. The credits were as follows five days per month on sentences between six months and one year, six days per month on sentences between 1 years and three years, and eight days per month on jail term between 5 years and 10 years. Convicts that were sentenced to life in jail were to be released on the basis of parole once they served 15 years in prison. There were other amendments that were done in the year 1930 and years after which have overseen the current parole regime that we have today. The probation and parole system is very intricate and is changed greatly overtime. Parole and probation are used all over the country and varies from state to state: even the truth in sentencing laws differ state to state. There are more parolees on parole than there has ever been all across the country and that number will only rise. As overcrowding continues to go on in prison, offenders will be released I feel like before they should be. Prison is meant to rehabilitate and to make the criminal think twice before committing a crime or giving him the skills he need to conduct a legal life style. Probation and Parole are 2 things that are an important part of the criminal justice systems.

Answers for final exam Assignment Example | Topics and Well Written Essays - 1250 words

Answers for final exam - Assignment Example ...........................Discrete Participation in online auction............Discrete Amount spent online .........................Continuous Time ............................................... Continuous (McBurney and White, 2009) b) In addition to the variables above, data were also collected on total sales each month. Using the SPSS output provided below, describe the distribution of ‘Monthly Sales’. Remember to comment on Centre, Shape and Spread. (1 ? marks) Distribution of sales has a mean value of $ 4178.29 per month with a standard deviation of 7011.633. The data is further skewed to the right, and is widely scattered apart. The skewedness value, the plots and the standard deviation explains this (Gravetter and Forzano, 2010). c) Is the distribution of ‘Monthly Sales’ normal? Explain. (1 mark) The distribution is not normal. This is because of the observed deviation of the plats from the straight line as observed in the Normal Q-Q plot. (Hahn and Meeker, 2011) Question 2 (3 marks) An investor wants to compare the performance of three managed funds, so she performs an ANOVA test to compare their returns. The results of this ANOVA test and the post-hoc Tukey test are provided below: ANOVA Return Sum of Squares df Mean Square F Sig. Between Groups 4191.977 2 2095.988 9.627 .000 Within Groups 669510.465 3075 217.727 Total 673702.442 3077 Multiple Comparisons Return Tukey HSD (I) Fund (J) Fund Mean Difference (I-J) Std. Error Sig. 95% Confidence Interval Lower Bound Upper Bound 1.00 2.00 -1.07173 .65147 .227 -2.5993 .4559 3.00 -2.83090* .65147 .000 -4.3585 -1.3033 2.00 1.00 1.07173 .65147 .227 -.4559 2.5993 3.00 -1.75916* .65147 .019 -3.2868 -.2316 3.00 1.00 2.83090* .65147 .000 1.3033 4.3585 2.00 1.75916* .65147 .019 .2316 3.2868 *. The mean difference is significant at the 0.05 level. a) Explain why the investor used an ANOVA test. (1 mark) The investor used an ANOVA test because the test is suitable for comparing more than two means and compares means of each pair of variables to determine the one with the highest mean (Rumsey, 2007). b) Interpret the results of the one-way ANOVA test. (1 mark) The low p-value, 0.00 that is less that 0.05, from the ANOVA test shows that a significant relationship exists among the different funds at 0.05 level of significance (Comrey and Lee, 2006). c) Based on the post-hoc Tukey test, which of the funds had the highest returns? Explain. (1 mark) The mutual fund 3 had the highest returns. This is because its mean is significantly different from, and larger than the means for fund 2 and fund 3 (Hanna and Dempster, 2012). Question 3 (10 marks) A large company wants to compare the performance of two of its franchises. To complete this study, they collected monthly sale revenue data from the Sydney and Newcastle franchises. They believe that the Sydney store is performing better, but want to conduct a statistical test to prove this fact. If Newcastle is seen to be underperfor ming, management intends to increase advertising for this store. A two-sample t-test is conducted and the following output is reported from SPSS: a. Explain why an independent two-sample t-test was used rather than a paired samples t-test. (2 mark) An independent two-sample-t test was used because the two sets of observations were made from different samples, franchises, instead of paired sample test’s two sets of observations, each pair from same participants in a sample (Walkenbach, 2013). b. Write the null and alternate hypotheses (2 marks). HO:

Refection on Call Girl and readings Essay Example | Topics and Well Written Essays - 250 words

Refection on Call Girl and readings - Essay Example It also offers society a mirror to construct a desired reality. However, this differs with Hedlong’s perception who believes that films mainly achieve an aesthetic value and this revolves around explicit mystery and murder notable in most Swedish movies (Miller et al., 2008). Overall, the two authors agree that films have role to play in the wider society. Notably, Hedlong continues with this trajectory by asserting that the location of Swedish Media is largely influenced by regional aesthetics as demonstrated by the Call Girl film. This shows that filmmakers have a role in transforming society while also entertaining the masses. Similarly, cinema as a modern invention of technology, according to Sundholm, should manipulate people’s thoughts, views, and perceptions toward a positive direction. Alternatively, Miller in his paper Global Hollywood attests on the muzzling culture of Hollywood of foreign cinema. Consequently, this curtails the growth of other forms of cinemas with creative and innovative messages as notable with Call Girl that castigates bad political behavior (Reijnders, 2008). In other words, artistic success is a challenge if industries do not allow cooperation. Hedlong, O. et al. (2010). Murder, Mystery and Megabucks?: Films and Filmmaking as Regional and Local Place Promotion in Southern Sweden. In Hedlong, O et al (Ed.), Regional Aesthetics: Locating Swedish Media (pp.263-290). New York, NY:

Longitudinal Strategy Essay Example | Topics and Well Written Essays - 2250 words

Longitudinal Strategy - Essay Example These include vaccines, over-the-counter medicines as well as other broad range of health-consumer related products. The company therefore has a profile of operating in the different segments of pharmaceutical and consumer healthcare products within the UK as well as other parts of the world. Besides operating on medical supplies and research, GSK produces other health products such as beverages, which are used worldwide. Besides the operations of the company within the UK market, the company has major markets within the US, Germany, Italy, Japan, Spain as well as in France (StockMarketsReview.com, 2013, para 1). GSK, as a trading company, has a statement of mission, which is provision and development of immunotherapeutic, as well as vaccines that are necessary for improvement of human health globally. The company has made strategic milestones in the field over years and is credited for having great and significant contributions towards the global health as it is today. The company’s profile reveals that the formation of the company as it is today has involved merger efforts by many companies and thus would have a history from the early years of 20th century. It has also made great development milestones in the past since the millennium, where the scope of this paper will be. This paper intends to evaluate the strategic development milestones that the company has undergone with a special attention to the last thirteen years (since 2000). This is because the existence of the corporate identity of GlaxoSmithKline plc is only that old from the merger of SmithKline Beecham and Glaxo Wellco me in December 1999 (Addison and Lawson 2012: 3-5). In line with the company’s strategic mission, it has special focus on some fundamental areas such as realizing sustainable growth, improving long-term financial performance as well as reducing risks. The company realizes these goals through embracing diversification in global business, delivering high-value products as well as adoption of simplified business models. The recent developments have seen the company adopt generic branded manufacturing to add to the previously existing patented strategies in order to command higher influence and relevance in the modern day market. Addison and Lawson through a recent discourse analysis study concerning the strategic development move of generic branding found out that this was necessary and very effective in lowering the associated performance risks as well as in increasing the range of products being traded on. Research studies show that the shift in production models into the inco rporation of generic manufacturing has greatly revolutionized the industry through lowering the costs of production and in the process lowering the prices of the commodities on offer. Through the move, the GSK is able to manufacture cheap pharmaceutical products through lowered costs in research as well as in awareness creation. The move was strategic in that it enabled the company to focus the competitive strategies in manufacture of the trading products at higher efficiencies in order to continue in the lead over the world market amidst heightened competition (Addison and Lawson 2012: 32). In fact, it is through such a move that the company is acknowledged to diversify

I am a nurse nursing students learn the art and science of nursing Article

I am a nurse nursing students learn the art and science of nursing - Article Example The meaning of experience came through in five themes that were threads throughout the responses from the students (Idczak, 2007). The first was fear of interacting with patients in which nursing students talked about how they felt about their first interactions with patients. Those feelings included fear, anxiety, nervousness, and lack of confidence. They did not have the confidence in how they might respond to feel comfortable. They found that they were afraid to ask RN's on the floor and so they were dealing with these feelings alone. Developing confidence was a second issue in which nursing students felt insecure, however, most of them felt that if they performed skills well that their level of confidence improved rapidly and that this confidence then helped with their interactions with patients. Becoming aware of oneself was felt to be something that was needed in order to interact well with patients. These nursing students felt that they developed self awareness through : "reflecting on their thought, reflecting on an interaction with a patient, comparing their thoughts to the actions of another nurse, and seeing inner role conflict" (Idczak, 2007 pg. 69). Nursing students must connect their new found knowledge of the science of nursing with their need for the art of nursing and their ability to interact with patients.

Hinduism, Buddhism, and Sikhism all spring for the same part of the Essay

Hinduism, Buddhism, and Sikhism all spring for the same part of the world and share many of the same symbols, concepts, and prac - Essay Example Hinduism, Sikhism, and Buddhism all originated from India though at different times in history. Buddhism is a form of religion that is based on virtues such as wisdom, freedom from greed, compassion, and love. The term Buddha was the name of an individual who is believed by the Buddhists to have attained the listed virtues. It is believed that Buddhism is 2500 years old. Buddhists view life as a process of change, where an individual develops systematically towards attaining the good personality. Buddhists believe that the mind is the channel through which an individual can change for the better and therefore meditation is an important practice among the Buddhists. Buddhists believe that meditation is the cure to problems of the mind such as lack of sleep, confusion, anxiety, and hatred among others. Festivals are considered important in Buddhism religion as it brings the followers together. The Buddha has various festivities around the year. For instance, the Buddha day marks the ce lebration of the full moon when the followers celebrate enlightenment by reviewing their lives and works. Dharma day is another festivity in Buddhism that marks the full moon and followers commemorate how Buddha shared his experience with the first disciple. Other celebrations include, Sangha day which the community celebrate spiritual community and the Parinirvana which symbolized the death of Buddha. Hinduism is a religion characterized by religious traditions and philosophy. The Hindu religion is also believed to have originated in India. The noble people who lived in India and recorded their ideas, beliefs, and practices on books founded it. The key teaching in Hindu religion is that human nature is not confined in the mind or the body. The Hindus believe that there exist spirits in the human souls all other things that are visible. Hinduism believe on wisdom, joy and peace among the things that make be considered good. Hindus believe in the existence of god in all creation and that god can incarnate is something. Hinduism also believes that god is infinite and manifests in different ways by which he can be contacted or prayed to. The behavior of Hindus is determined by the position an individual hold in life and the responsibilities attached to it. The religion also believes that human beings undergo development stages in life. Hinduism have many festivities around the year. These festivals are marked with prayers, worships, magic, and processions among others. The rituals are meant to cleanse the society, expel bad omen, and revive the power of nature. Some of the Hindu festivities include, celebrations of birthday for the gods, bonding festivals, celebration of victories among others. Sikhism is a form of religion that was founded by a man called Guru Nanak in India approximately five hundred years ago. The Sikhs believe that there is only one god and that all people are equal before god. The Sikhs also believe that before the soul becomes human form, i t undergoes a cycle of development. Another aspect of Sikhism is the practice of leading a virtuous life while balancing between temporal and spiritual obligations. Sikhism religion does not believe in some rituals such as fasting, superstitions, and idol worshiping. In the ritual dimension on religion, it is evident that all these three religions perform certain rituals to

Autism Essay Example | Topics and Well Written Essays - 500 words - 1

Autism - Essay Example Generally individuals afflicted with this neurological condition have difficulty in social interaction and communication. Repetitive and obsessive behavior frequently occurs, as individuals with autism will oftentimes develop intense and focused interests in specific subject matter. A number of theories have emerged regarding the origins and causes of autism. One of the newly emergent theories involves considerations of the individual’s biological clock. Within this mode of understanding, autism is understood as a timing disorder wherein individuals have difficulty determining communication timing. One important consideration in this context of investigation is that of the biological clock. Theorists have explored notions regarding biological clock genes regulating neuronal oscillators in the brain that potentially affect the timing problems of autism. There has been research that has supported this hypothesis, with findings noting that, â€Å"Two Single nucleotide polymorphisms (SNPs) are enriched in clock genes in DNA obtained from autistic children† (‘Autism’, ppt). The two nucleotides referred to are the Period-1 (Per-1) and the NPAS2. Still, these nucleotides are in non-coding segments, complicating their potential as causing a d isorder. Recognizing the challenge of non-coding nucleotide mutations contributing to a disorder such as autism, researchers have explored the microRNA ("Micrornas provide new," 2011). In these regards, RNA forms secondary nucleotide structures. The miRNA functions through recognizing a seed sequence, as 7 nucleotides at 5’ end binds to a 3’ end of target. Notably, there are basepairing consequences that occur in relation to the microRNA functioning. Among these consequences include the degradation of the mRNA target, a block in translation resulting in new mechanisms of action, and subsequently new data that can activate translation. This is central to the understanding of autism as related to the human’s biological

Impact of WorkLife Balance on Job Stress Essay Example | Topics and Well Written Essays - 3000 words

Impact of WorkLife Balance on Job Stress - Essay Example Maclnnes, 1987 and Pollert, 1988 says that flexibility is only one managerial concern and it cannot be abstracted from its other areas of goal and interest. Core and peripheral framework of work division allows company to use the part-time labour and increase its functional flexibility. The overall conclusion from the survey of Saudi Aramco is that they haven’t explicitly and comprehensively reorganized their work force on a flexible basis. Consistent with argument developed in Godard (1991), these considerations vary in accordance with three sets of structural variables: size, technology and market conditions. Flexible model looks more appropriate for large corporations instead of small organisations as their employee consciousness is generally more problematic because of alienating effects of size. Second flexible practices is more appropriate in capital intensive corporations because they have uncertain and complex technologies requiring high levels of formal and informal training. They also employ advance process production technique. Also flexible practices are more likely to affect the firms producing essential goods and services with a high degree of capital and they are operating in concentrated markets. As Godard concluded that to argue that size, technology and market conditions determine the extent to which it is rational for management to adopt flexible practices is not to suggest that they rigidly determine variation in these practices. It left to suggest, however, that failure to adopt the flexibility paradigm and not reflect mistaken strategic choices as much as it does cost-benefit considerations consistent with the rational pursuit of profit: considerations which vary in accordance with structural variables. ... Though there are undoubtedly limits to managerial rationality, it is a mistake to think that these considerations are not at the core of managerial decision processes or that they do not become reflected in the extent to which flexible practices are adopted. Therefore, strategic choices are of less importance that structural variables, it may be that they serve as rationalizations. Still they don't serve as determinants. There are further researches required in understanding the processes underlying the formation of management policies and practices in deep intensive ways. Further study will also benefit including an extended set of new and structural variables. Presently it looks that flexible firm model can be generalized across countries and occupations, but they cannot be used as long term setting before any firm can set it as usual practice. The criterion of fairness applies through acceptability of the contract defined in terms of offers and expectations. The theoretical concept was supported by empirical investigation. The psychological contract is a hypothetical contract. Rawls, 1971 suggested that hypothetical contract can be accepted as psychological contract only if it is assessed as fair. Psychological contract consists of offers and expectations which cannot be measured in terms of promises and obligations for both parties involved in contract. This terminology is considered in accordance with legal contract definitions (cf. Applebey, 2001; Atiyah, 1989; Bucher, 2003; Knapp & Chrystal, 1987; Lando & Beale, 1999), which is contract without agreement from both sides and doesn't produce obligations. It depends on employment relationship and their track record for success. The empirical studies

Where burgers are smashed Essay Example | Topics and Well Written Essays - 750 words

Where burgers are smashed - Essay Example However, if one looks into the business more closely, it could be observed that there are a few who are able to succeed while many are simply able to make the business going and there are still others who totally fail. This brings one to consider what could be special about a burger product that makes a business survive in a world where pioneers are already commanding much of the American taste. Surely, a business cannot survive solely on the management skills of business people but also relies on the quality of the product. Smashburger, a burger business that could still be considered an infant, birthed in 2007 is one of the ambitious companies that only wished to bring better tasting burgers to the consumers, has proven that bringing quality products can expand the business to one hundred and forty three outlets throughout the nation in just a few years. The company is fast expanding and foresees a more promising future in the next two years. So what makes their quality burger diff erent from others who claim to offer the same quality? Jennifer, a waitress at the outlet near our place says, â€Å"Our burgers are made from freshly smashed quality beef, that is why the name. And I think that is what makes us different because of the manner the burger is cooked, making it juicier and more delicious.† ... I think that is simply brilliant because it causes a domino effect from the company to the employees and of course, to the customers.† I ask Freda what she meant by this statement and she further say, â€Å"Our employer looks for a good location where the atmosphere gives us a positive outlook, we in turn appreciate this and come to work everyday with that attitude. We make sure that the place looks just like how it is expected by our customers and employers, have our ready smiles which I believe are very important in any business, because we are naturally attracted to places where the ambiance is good and the people are not rude.† I approach a third person, this time a customer, Jerome. I ask him what he thinks make Smashburger different from other burgers and he replies, â€Å"I come to this place a lot of times and what I like most is not just the delicious foods but also the variety they offer. You go to one place and all they offer are burgers, French fries and hot dog. You can just get sick with the same food everyday, you know and that usually drives me off from places like this. Here, I do not just get my favorite burgers; I can also try other menu like chicken sandwiches or make my own burger. I really like the grilled chicken. I can smell how it is perfectly marinated, just with the aroma, as it is served on the table. And it is tender, which is very important because most grilled products tend to dry and become tough. The color looks perfect without the burnt look that makes me off.† The comments about this fast growing food chain are just awesome and nothing negative seems to be said about it. It seems I am in for a treat for myself with all the words of those people and I guess I owe myself a

Participative Management Essay Example for Free

Participative Management Essay Participative Management (A Critical Study) Assignment Advanced Management COURSE CODE:-EM-517 Prepared for Mr. Muhammad Mohiuddin Professor Department of Management Studies University of Dhaka Date of Submission: July 30, 2012 Acknowledgement At first I desire to express my deepest sense of gratitude to almighty God. With profound regard I gratefully acknowledge our respected course teacher Mr. Muhammad Mohiuddin for his generous help and suggestion during preparation of the report. I would like to give thanks especially to my friends and many individuals, for their enthusiastic encouragements and helps during the preparation of this assignment by sharing ideas regarding this subject and for their assistance in proofreading this manuscript. Sincerely yours, Siddhartha Bhowmik ID: 03-10-19-056

Plant Diseases Through Image Processing Techniques Computer Science Essay

Plant Diseases Through Image Processing Techniques Computer Science Essay Damage of plant is an important issue in agriculture. There are lots of factors involving weather, fungi, artificial drying, and mechanical damage during harvest and storage which can cause damage. NIR spectroscopy for classifying sound and damaged soybean seeds is very useful. NIR spectrometer is used to collect the spectra of single seed then PLS and neural network are used for classification of sound and damaged seeds. Near infrared spectroscopy is used because machine vision cannot provide information related to chemical composition because it is only useful for visible regions. NIR spectroscopy is useful for both physical and chemical properties. Seeds of six categories are used which are sound, weather damaged, frost-damaged, sprout-damaged, heat damaged and mold damaged. Grams/32 software is used for changing reflectance of spectrum in color space L, a , b. L ranges from 0(black) to 100(white), a ranges from -100(green) to 100(red)and b ranges from -100(blue)to 100(yellow). NIR spectrometer is used to collect spectra at a rate of 30/s. Spectrum of 700 sound seeds and 900 seeds damaged by other factors were measured. Two class and six class models are used for classification of sound and damaged soybean seeds with the help of Partial Least Square (PLS) software. Two class model is used for classifying sound and damaged soybean seeds whereas six class model is used for classifying sound seeds and weather, frost, sprout, heat and mold damaged seeds. In order to develop a neural network model for classification of sound and damage soybean seed the Neural Works Professional II/Plus software package is used. The neural network model package is based on back propagation networks. In back propagation networks increment or decrement in weights is needed because of the errors. At first weights are randomly allocated but after every trial weights are adjusted until the errors are reduced to acceptable values. Physical and chemical properties of sound and damaged soybean seeds are totally different so by using only visible wavelength region results in poor classification. By using near infrared region important information can be obtained. Highest classification accuracies can be obtained by using full wavelength region (490-1690nm). By using visible and NIR wavelength region alone results in lower classification accuracy. The best classification can be obtained by using neural network without hidden layer. PLS gives higher classification accuracy if two class classifications is used but in case of classification of six categories classification neural network (NN) gives higher accuracy results. Computer Vision Based Weed Identification Under Field Conditions Using Controlled Lighting Identification of weeds in crops is done by using methods of digital image analysis. Different kind of weeds often grow up with crop and its difficult to differentiate crop and weed so digital image analysis are used which are useful for differentiating both. Images were captured through MatroxMeter(RGB) ,this device provides controlled lighting. Two crops cabbage and carrot are used in greenhouse and open field experiments . For greenhouse experiments weed was added but for open field experiments natural weed population In digital images, it is difficult to differentiate between crop plants and weeds especially when they reached on advanced growth stage. Segmentation algorithm is used for differentiating crops and weeds and soil. This algorithm is based on union of two sets of each image which are S(soil) and V(vegetation). V has two components C (crop) and W (weed). The crop image data used in this research was the image of cauliflower at four different growth stages which are grouped. Experiments were performed on the 12 images. Colour is an important distinguishing feature and used as one component of the selection algorithm. Noise can occur in images through which misclassification occur and can deal by using square morphological closing filter. in a large bright region this filter can reduce the noise by removing small dark holes. Erosion is used for suppressing small bright region and removed pixels from the outer edge of large bright regions. The central position of each plant is located by processing Pv with a large erosion filter. The output of erosion filter is bright central position of crop plant. At growing stage 4 this approach is modified, centroid of soil region has to be found instead of centroid of crop plant. weeds are the main source of bias in the location of grid point. Segmentation algorithm is used to identify crop plant pixels but there was a higher probability of weed pixels being classified as crop plant pixels because they are very close to crop plants and grew in rows. So the difference between the size and texture of crop plant and weed is used in order to find the location of crop plant boundary. Morphological opening filter separates crop from adjoining areas of weed. The last stage involved thresholding the output of opening filter. Improving Plant Discrimination In Image Processing By Use Of Different Colour Space Transformation Image processing is becoming popular in different agricultural applications. color images taken by a digital camera stored in RGB colour space. Colour cameras can deal with large variety of situation for differentiating single object from an image. Thresholding is applied on each colour channel. Separation of object can be improved by transforming RGB by weighting each channel in different way in order to emphasize specific features. Different colour transformations were performed and then compared them. 40 images of RGB colour spaces are used discriminant analysis, canonical transformation, i1i2i3, HSV, HSI and Lab colour spaces were used for transformation. Thresholding is performed on transformed image to convert it into binary images in order to differentiate plant and soil. Manual and automatic thresholding was for i1i2i3,thresholding according to hemming was used for HSV,HSI and Lab colour spaces. Discriminant analysis consists of colour transformation and binarisation. Thresho lding was not needed in discriminant analysis. Linear and logarithmic discriminant functions were used. Logarithmic discriminant analysis is the most effective in discriminating but it takes much time for processing of one image. HSV,HSI am Lab colour spaces gave better results but not in open field.i1i2i3 were recommended for plant detection . This transformation is more useful if the reflection occur due to high solar radiation or some water on leaf. Image pattern classification for the identification of disease causing agents in plants For the identification of plant diseases machine vision system is used. Different images of cotton crops which shows diseased region were used, enhanced, segmented and the feature extraction is performed. The extracted features were then used as inputs to SVM classifier and then testing will be performed to choose the best classification model. Different features such as shape, texture, greylevel, connectivity etc were extracted from segmented region. Co-occurrence matrix was used in order to calculate the image texture. This method is used to measure occurrence of greylevels between a specific position in image and neighboring pixels according to distance and direction. Fractal dimension is a feature which measured dimension of object and box counting algorithm is used to estimate this measurement. Lacunarity was a multiscaled method which measures texture associated with spatial dispersion and gliding box algorithm was used to calculate lacunarity. Different features extracted from 117 images of cotton crops were labeled according to disease they belonged. SVM used Radial Basis Function kernel. There are different problems in classification if it involves more than two classes are used then multiple classes classification was used which uses one-against-one method. Different approaches were used to identify best classification model. Each feature is used as a single input to classifier .the groups of feature were used as inputs to classifier and then all the features except one is used as input. All features were not give the same amount of information so 7 fold cross validation is used. . Fall Armyworm Damaged Maize Plant Identification Using Digital Images An algorithm is developed to identify damaged maize plant by the fall armyworm at simplified lighting conditions using digital color images. Eight different stages of diseased and non-diseased maize plant were taken in three different light intensities. This algorithm involves processing and image analysis. First, the binary images were created by segmentation and then the images were divided into blocks and classified as diseased or non-diseased. The algorithm starts by converting original RGB image into greylevel image then by iterative threshold method it is converted into binary image then by applying 383 median filter its is converted into binary filteres image. These steps are part of first stage which is image processing. For next stage image analysis binary image is subdivided into 12 blocks. Blocks were selected from the subdivided image and then by object identification and counting damaged and non-damaged blocks were classified A review of advanced techniques for detecting plant diseases Diseases in plants are major issue in field of agriculture as they result in major production and economic losses. There is a mechanism called scouting is used for this purpose but this is not only expensive but also time consuming so there is need for a mechanism which is rapid, cost-effective so there are different technologies spectroscopic and imaging based and volatile profiling based plant disease detection methods. In the spectroscopic and imaging techniques, fluorescence spectroscopy, visible IR spectroscopy, fluorescence imaging and hyperspectral imaging involved. In VOC profile-based metabolite analysis released by healthy and diseased plants as a tool for identifying diseases. These methods can accurately detect plant diseases. Automatic Identification of Weed Seeds Image processing techniques were used to obtain seed size, shape, color and texture characteristics. Large database of images were used. Naà ¯ve bayes classifier was used for evaluation. It gives excellent results. Not only the color images were used but also the black and white images of weed seeds were used. By using morphological and textural characteristics as classification feature, it would reduce the complexity and cost. Naà ¯ve bayes classifier and Artificial Neural Network (ANN) were used for weed seed identification but naà ¯ve bayes has an excellent performance as compared to ANN. Identification of citrus disease using colour texture features and discriminant analysis Machine vision and AI techniques are used to achieve intelligent farming including early detection of diseases. Colour co-occurrence method is used to determine whether HIS color features in conjunction with statistical classification algorithms would be used to identify diseased and normal citrus leaves under laboratory conditions. Greasy spot, melanose, normal and scab are four different classes of citrus leaves used. By using image processing techniques, algorithms were designed for feature extraction and classification. Colour cooccurence methodology is used for feature extraction. It used colour and texture to get unique features. SAS discriminant analysis is used to evaluate the potential classification accuracies and this can be achieved by a traditional statistical classifier. Image texture feature dataset appeared as the best data model for citrus leaf classification, it uses reduced hue and saturation feature set. It gets high classification accuracy, less computation time and the elimination of intensity features which is beneficial in highly variable outdoor lighting conditions. Fast and accurate detection and classification of plant diseases First the images were acquired using a digital camera then the image processing techniques were applied to extract features which are useful. Then the classification is performed. The algorithm starts by acquiring RGB images. In the next step colour transformation is applied on RGB images. Images were then segmented using K-means clustering techniques. Green pixels are masked by using Ostus method. Pixels with zeros red, green, blue values and boundary pixels of infected objects were removed. The infected cluster is then converted into HIS from RGB. In the next step SGDM matrix were generated for H and S. For calculation of features GLCM function is used. Neural Network is used as a classification tool. Statistical and neural network classifier for citrus disease detection using machine vision Image data sets of common disease of citrus were collected and then CCM is used for detection of diseases. Different strategies and algorithms were developed for classifications which were based on feature obtained from CCM and then compared the classification algorithm in order to check accuracies. After acquiring images image processing algorithms for feature extraction and classification were developed. Feature extraction used CCM methodology. SAS discriminant analysis was used to evaluate the classification accuracies. Classification tests were applied on different classification algorithms. Statistical classifier using Mahalanobis minimum distance method achieved 98% classification accuracy. Neural network classifier using back propagation algorithm and neural network classifier using Radial Basis Function achieved 95% accuracy rate so the Mahalanobis minimum distance method is the best for classification. Rice disease identification using pattern recognition techniques For the identification of rice disease , software prototype system is described. Image segmentation techniques used to detect infected parts of the plants. These infected parts were further used for classification using Neural Network. For feature extraction first the segmentation is performed and for this entropy based bi-level thresholding method is used. After segmentation boundary detection algorithms were applied this uses 8- connectivity method. In the next step spot detection is applied for the normalization of spot size and interpolation method is used for fractional zooming. After this when all the uniform size spots were obtained, unsupervised learning technique Self Organinzing Map is used. Classification of grapefruit peel diseases using colour texture feature analysis Colour texture feature were used for detection of citrus peel disease.images of normal and five common peel diseases which are canker, copper burn, greasy spot, melanose and wind scan were used. Using colour cooccurence method, 39 image texture features were determined. Before applying CCM, RGB is transformed into HSI. SGDM( Spatial Gray level Dependence Matrix)was used to develop color cooccurence texture analysis. Texture feature were then calculated by SGDM. SAS procedure STEPDISC can find variables which are important for discriminating samples and it will use for texture feature selection. SAS procedure DISCRIM creates a discriminant function which was used to develop classification model. This is also used to test the accuracies of classification models. Plant leaves classification based on morphological features and a fuzzy surface selection technique Artificial vision system is designed to extract special features from plant leaves. Feature selection approach is used to identify significant image features and for the classification test Neural Network is used. In morphological feature extraction, morphological and geometrical features were extracted from plant leaves. These features provide critical information. Feature selection is very important task which is needed to determine the most relevant features for pattern recognition. Neural Network take features as inputs and perform classification. Weed seeds identification by machine vision There is a need of fast and reliable method for the identification and classification of seeds. Seeds of 57 weed species were used. Different features extractes were used as classification parameter . 12 classification parameters were used in which 6 morphological, 4 colour and 2 textural were involved. With the help of these parameters naà ¯ve bayes and Artificial Neural Network were compared for the identification of seed species. ANN performed better than naà ¯ve bayes.

Research into Cancer Stem Cells

Research into Cancer Stem Cells Cancers are composed of a heterogeneous mix of cells with varying differentiation, proliferation and tumourigenic properties. In vivo studies have demonstrated that within a cancer population, only percentage of cells are able to initiate tumour development [1]. It is widely believed that the heterogeneous groups of cells include a small population of cancer cells with stem cell properties: the cancer stem cell (CSC). These cells have the capacity to self-renew and differentiate asymmetrically and give rise to bulk populations of nontumourigenic cancer cells. Current cancer treatments may eradicate the tumour bulk but spare the populations of stem cells which are able to restore tumour tissue causing recurrence of the cancer. This may explain why initial tumour regression does not necessarily translate to improved patient survival in many clinical trials. Identification and characterisation of these stem cells may offer means of targeting cancer at its root. Cancer Stem Cell Definition The AACr workshop in 2006 defined a cancer stem cell as: A cell within a tumour that possesses the capacity to self-renew and to cause the heterogeneous lineages of cancer cells that comprise the tumour. Cancer stem cells can thus only be defined experimentally by their ability to recapitulate the generation of a continuously growing tumour.[2] Therefore the stem cell definition requires that cell possess 2 fundamental properties. Self renewal, the process whereby at least one daughter cell of a dividing stem cell retains stem cell properties Potency, the ability of cells to differentiate into diverse cells that comprise the tumour. [3]. It was agreed that defined CSCs may not necessarily derive from normal tissue stem cells, indeed one important and unanswered question is whether tumours derive from organ stem cells that retain self renewal properties or whether tumour stem cells are proliferative progenitors that acquire self-renewal capacity [2]. Normal Tissue Heterogeneity The continuous replacement of differentiated, functional cells by proliferation of more primitive cells in human tissue is a normal homeostatic process. Organs are composed of collections of differentiated cells that perform discrete functions [4]. The total cell population is regarded as constituting a cell division hierarchy [5]. The stem cell is central in the renewal hierarchy and has two functions within this model. It can act as the initiating cell in a cell division and differentiation process, producing a large family of differentiated descendants, a process known clonal expansion. Another function is for the cells to undergo division to produce two stem cell daughters identical to the initial stem cell and to replace the stem cells used in clonal expansion. This process is called self-renewal [6] and is shown diagrammatically in Figure 1. As cells move down the hierarchy they acquire the differentiated features associated with tissue function and the proportion of differenti ated cells increases. In this way the stem cell has the ability to maintain organ life [4]. This concept predicts the existence of three categories of cell within the population: Proliferating, self renewing stem cells; Proliferating non-renewing transitional cells (transit amplifying); Non-proliferating, differentiated end cells. Following division the stem cell can give rise to a transit amplifying cell that will undergo further rapid proliferation to produce offspring which expand the populations of cells arising from the initial division and progressively commit irreversibly to differentiation along one or several lineages[4]. An important feature of a stem cell is their ability to undergo asymmetric cell division giving rise to a progenitor cell and to a new stem cell. Somatic SCs reside in confined tissue compartments referred to as the niche. Here the microenvironment suppresses SC proliferation, resulting in a quiescent SC population. This population maybe triggered to proli ferate and differentiate in response to injury (Ghotra, 2009). Seven common and distinguishing features of stem cells have been described [4]: Stem cells comprise a small subpopulation of a given tissue. Stem cells are ultra-structurally unspecialized, with a large nuclear-to-cytoplasmic ratio and few organelles Stem cells can be pluripotent Stem cells are slow cycling but may be induced to proliferate more rapidly in response to certain stimuli Stem cells have a proliferatve reserve that exceeds an individuals lifetime An intermendiate group of transit amplifying cells exists The microenvironment plays a critical role in the homeostasis of the stem cell and the differentiation of its progeny. The stem cell is capable of division and clonal expansion. As cells differentiate they lose their proliferative potential. The stem cell can self renewal or divide to produce proliferative transitional cells. Tumour Heterogeneity It has been recognised for many years that tumours exhibit morphologic heterogeneity but they are also functionally heterogeneous in terms of cell proliferation and tumour forming capacity based on transplantation assays [7]. Heterogeneity within tumours is seen within individual tumours in terms of morphology, cell surface markers, cell proliferation kinetics and response to therapy. In vitro and in vivo observations suggest that most cancer cells do not proliferate and that loss of capacity to divide is a feature of the tumour. Only a small proportion of cells have the ability to form tumours in vivo, referred to as tumourgenicity. The cancer stem cell theory posits that neoplasms, like physiological tissue can be hierarchically organised, and that CSCs at the apex of this of this cellular hierarchy and seem to comprise of only a subpopulation of tumour cells are essential for its initiation [8, 9]. Two models have been proposed to explain tumours heterogeneity Stochastic and Hiera rchy, summarised in Figure 2. Both models account for the existence of a cell with stem cell properties, but only the hierarchy model predicts the existence of a stem cell at the top of a hierarchy, which the potential to produce all other cell types within the tumour. Stochastic Model The stochastic model predicts that a tumour is biologically homogeneous and the behaviour of the cancer cells is influenced by intrinsic (eg signalling pathways, levels of transcription factors) or extrinsic factors (eg host factors, immune response, and microenvironment). It is suggested that the randomness and unpredictability of these factors result in heterogeneity in many aspects of marker expression and tumours initiation capacity [10]. A key requirement of the stochastic model is that all cells are equally sensitive to such influences and that the cells can revert from one state to another. For this model to be functional all tumour cells are not permanently affected and all have equal capacity to be induced to one state or another and the changes upon the cell are not permanent [11]. A growth fraction of Hierarchy Model The second model is the hierarchy model which predicts that the tumour is a caricature of normal tissue development and a hierarchy where the stem cell is at the tops is maintained (Pierce) [7]. The cancer stem cell maintains itself and its clones by self-renewal. The cells also mature to produce differentiated offspring which form the bulk of the tumour and lack stem cell properties. As in normal tissue only a small percentage of the tumour population maintain the capacity for long term proliferation while most cells proceed forward down the differentiation pathway resulting in aberrant terminal differentiation [4]. Due to differences in characteristics, stem cells can be selected and enriched for. Variations in tumour growth rates may be due the effects of normal homeostatic mechanisms that regulate stem cells and transit amplifying cell reproduction or alterations of the stem cell niche microenvironment [4]. Much of the evidence for this comes from clonogenic and tumourgenic assay s, which will be discussed further. Hierarchy model contains cells that are composed of biologically distinct cells including cancer stem cells which are all have different functional properties. The stochastic model predicts that all cells are equal the cell heterogeneity is due to intrinsic and extrinsic influences upon the cells which result in heterogeneity of cell function. Experimental Evidence Early Work The first evidence for the existence of cancer stem cells came from functional cell proliferation studies in the1940s 1960s. Radiolabelling cells and autoradiography enabled measurements into the proliferation, lifespan and hierarchical relationships in normal and neoplastic tissues [10, 12]. From these studies came the proposal that tumours are caricatures of normal development including the existence of stem cells [7]. Much early work was on the cancer of the haematopoietic system. In the 1970s Clarkson and other groups carried out pioneering studies that established cancers exhibited functional heterogeneity [10, 13]. These include cytokinetic studies carried out in cell lines, murine models of the acute leukaemias and in vivo examination of leukaemia blast proliferation kinetics in human AML and ALL patients. The data showed that the majority of leukemic blasts were post mitotic and needed to be continuously replenished from a relatively small proliferative fraction. Only a smal l number of leukemic blast cells were cycling in vivo and of these two proliferative fractions were observed: a larger, fast cycling subset with a 24 hour cell cycle time and a smaller, slow cycling, with a dormancy of weeks to months. From this data it was suggested that the slow cycling fraction was generating the fast cycling fraction thought to be the leukemic stem cell population because they had similar kinetic properties to those observed for normal haematopoietic stem cells. This was a clear suggestion that tumours exhibit functional heterogeneity in terms of proliferative potential. Following the identification of these slow cycling cells it was predicted the inability to kill the leukaemic stem cells (LSCs) was the cause of relapse and failure of chemotherapeutic therapies. Whilst combining treatment with in vivo cytokinetic studies, investigators observed that LSCs respond to the depletion of the of the leukemic cell mass by go into cycle after chemotherapy. It was sugges ted the way to eliminate dormant LSCs was to find the window when they are cycling. Identifying and assaying the potential LSCs was a major stumbling block and characterising them was impossible. This was when attention focused on the clonogenic assay was adapted by several groups to assay AML which identified phenotype of AML cultures in vitro with differing proliferative potential, providing the further proof for hierarchy in AML [14-16]. Clonogenicity Definition of a clone A clone is an operationally defined as a group of cells derived from a single ancestor cell. Clonogenicity is the ability of a given cell population, when plated as single cells, to produce one or more clones. This can be measured by the clonogenic assay which can quantify the proportion of colony forming cells, as a percentage of plated population, referred to as colony forming efficiency (CFE). It has been suggested that colony-forming cells possess two fundamental properties of progenitor cells: the ability to give rise to differentiated descendents and the capacity for self-perpetuation [17]. Therefore the ability to measure the capacity of cells to form clones is a useful tool in the study of the cancer stem cell concept. Quantitative measurement of clonogenicity Development of the clonogenic assay. Puck and Marcus The first clonogenic assay In 1956 Puck and Marcus published a paper describing a cell culture technique for assessment of colony forming ability of single mammalian cells [18]. Plated in culture dishes with a suitable medium human cervical carcinoma cells (HeLa) were supplemented with a large number of irradiated feeder cells and the number of colonies formed was counted. Their technique was a simple rapid method for growing single mammalian cells into macroscopic colonies with a colony forming efficiency of 80 100% . The authors developed this assay further to enable quantification of the effects of high energy radiation on cell populations in vitro [18-20]. They plated HeLa cells and measured their response to x-rays, producing the first in vitro radiation cell survival curve [21]. This assay has since been used for a wide variety of studies with many cell types using improved culture conditions, and for the testing of many potential chemotherapeutic agents. Till and McCulloch Following the work of Puck and Marcus, Till and McCulloch generated the first in vivo survival curves [22, 23]. They showed that when mouse bone marrow cells were injected into recipient mice that had been given total body irradiation to suppress endogenous haematopoiesis, visible colonies developed in the spleens that derived from cells in the graft. This work demonstrated that the cells injected into the mice were capable of self-renewal and it was speculated that these cells were stem cells. The evidence for this conclusion was that the curve from the number of marrow cells transplanted proportional to the number of colonies developed within the spleen. In addition, the radiation survival curve of cells that form colonies closely resembled survival curves developed by Puck and Marcus for in vitro cells [21]. This, however, was only indirect evidence and did not prove that the colonies originated from single cells, so the group carried out further experiments to determine the singl e cell origin on the colonies within the spleens [24]. Heavily irradiated bone marrow was transplanted into heavily irradiated recipient mice. The idea was that some cells containing genetic abnormalities caused by irradiation in the donor bone marrow cells would retain the ability to proliferate and produce clones containing this abnormality [24]. This worked to some extent, with a small number of colonies containing cells which all showed the same chromosome abnormality within that colony. It was hypothesised that if the capacity to form colonies is to be considered as a criterion to identify stem cells, then cells must lose this capacity upon undergoing differentiation. This hypothesis was tested by applying hypoxia as a differentiating pressure to mouse bone marrow, which resulted in a reduction in colony formation in the spleens of hypoxic mice [17]. They described how the number of colonies form in the spleens of mice in hypoxic conditions is reduced. This was thought to be du e to hypoxia stimulating erythropoiesis which stimulates erythropoietin, indicating that erythropoietin reducing colony forming production in the spleen. This data suggested that an increased demand for differentiated cells reduces the number of stem cells, resulting in the reduction of colony forming ability. Later Developments Since its development, the in vitro clonogenic assay has become a valuable tool in the study of cell growth and differentiation. [25]. Several adaptations to the original method have been made including immobilising cells in a top layer of 0.3% agar to avoid formation of tumor cell aggregates by random movement which might be confused with colony growth [26]. Agar has also been replaced by some groups with agarose, which is easier to handle (Laboise 1981) or methylcellulose which allows better recovery of the colony for replating. Others have simplified the culture medium and omitted the need for feeder cells. The exact protocol depends largely on cell type, but the basic system remains the same. The development of a protocol for secondary plating efficiency has proved a useful tool for the measurement of self-renewal and has the advantage of being able to identify cells that are able to undergo a large number of cell divisions [26]. This involves selecting specific colonies to deter mine their proliferative potential over a number of passages. Clonogenicity and Cell Renewal Hierarchy Clonogenic assays have been used to identify and morphologically characterise the three cell types above. Barrandon and Greens [27] work identified the clonal types of keratinocytes and linked this to their capacity for multiplication. They defined colonies as Holoclone, Meroclone or Paraclone. The Holoclone was described as a colony with a larger smooth nearly circular perimeter containing many small cells, which it has been suggested that these cells represent the proliferating self renewing stem cells. Paraclones were described as differentiated end cells which are more elongated and flattened in appearance, however paraclones can divide quite rapidly therefore classification of clonal type cannot be deduced form the study of growth rates alone or morphology alone. Meroclones were described as a combination of holoclones and paraclones. Relating morphology and colony size to clonogenicity can be used to further identify potential stem cells within the clonogenic assay and give mor e detail to the fate of their descendents. The differences in growth unit size may reflect several properties including different proliferative capacities and clonogenic cell kinetics. However, clonogenicity in vitro alone, does not define a stem cell, and other subpopulations, such as transit amplifying cells may also be able to produce a colony size of 32 or more cells. Although ability of a cell to form a colony implies substantial proliferative capacity, this does not unambiguously identify a stem cell [28]. Tumor Cell Heterogeneity and Hierarchy Certain characteristics have emerged from clonogenic studies on cells derived from human tumors. It was noticed that a few cells in each tumor were able to give rise to colonies in culture, whilst some colonies contained transit amplyifing cells undergoing a limited number of terminal divisions. Other cells (usually the majority) were non-proliferating stem cells. Looking at CFE and colony size of human tumors and replating experiments has demonstrated the heterogeneity of a wide range of tumor types including neoplastic human urothelium [29], melanoma [30, 31] and squamous carcinoma [32]. This supports the idea that cells within solid tumors consist of cellular hierarchies, which will be discussed further. The cancer stem cell model accounts for heterogeneity within a primary cancer by proposing that each cancer consists of a small population of cancer stem cells and a much larger population of cells which have lost their self-renewal capacity [5]. The clonogenic assay has been used explore this cellular heterogeneity present in human tumors, lending support to the stem cell model of tumor growth. Multiple myeloma has served as a valuable model in early clonogenic assay development. This was studied by Hamburger and Salmon in 1977 [33], who created an essentially selective system which restrict proliferation to cells capable of anchorage independent growth, thought to be a characteristic of stem cells [34]. They described an in vitro bioassay for human myeloma colony-forming units in culture which was applied to the study of patients with multiple myeloma and related monoclonal bone marrow derived B cell neoplasm. Bone marrow samples from patients with multiple myeloma and normal volun teers were cultured in the presence of an agar feeder layer prepared by either human type O+ washed erythrocytes or adherent spleen cells of BALB/c mice. They found a linear relationship between colony formation and the number of nucleated bone marrow cells plated. Multiple myeloma patients exhibited much higher numbers of colonies formed compared to normal volunteers. It was shown that the number of colonies was proportional to the number of colonies plated, suggesting that colonies were derived from single myeloma stem cells. This was the development of the human tumor stem cells assay. The Human Tumor Stem Cell Assay clonogenicity and cancer stem cells The ability to grow human solid tumors in two-layer soft agar culture was developed for the clinical application of testing in vitro tumor sensitivity or resistance to chemotherapeutic agents. It is a possible means by which anticancer drugs can be selected for activity against tumor cells from a patient [35] as a way of tailoring chemotherapeutic regimes to individual patients and of testing new cytostatic agents [36]. The assay assesses treatment effects of stem cells by a testing their ability to reproduce and form a colonies of cells. Using semi-solid agar with enriched medium supports colony growth from cell suspensions from a variety of human tumors. A semi-solid medium suppresses the growth of most normal cells and there is evidence of the malignant nature of these colonies [33] . An important consideration is the relationship between the response of clonogenic cells to drugs in vitro and the response of the tumor to the same drug in the patient [10]. The stem cell model of human cancer suggests that cure or duration of remission after clinical treatment should correlate only with killing of stem cells. Assessment of treatment effects on an unselected cell population (eg on the basis or morphological criteria) is therefore likely to be misleading since the effects on a small population of stem cells will be masked by those on the large population of stem cells. Human tumors of a single histological type appear to have a pattern of response in vitro that is similar to their clinical behaviour. Within a histological type, tumours are heterogeneous in response both in vitro and in vivo. Studies directly comparing the response in vitro with the subsequent clinical response have shown important correlations. The proportion of human tumors that grow with a plating efficiency sufficient for assessment of drug activity (à ¢Ã¢â‚¬ °Ã‚ ¥30 colonies per 500,000 cells plated is frequently less that 50%. Usually only a proportion of these tumors will manifest in vitro sensitivity [37]. There have been a wide range of predictive value positives reported for the human clonogenic tumour cell assay when applied to a patient population with an expected clinical response rate of 15-49% [38]. This value could be misleading and in practice may only be workable for cytotoxicity testing for only one third of specimens tested. The limitation exits that not all sam ples will produce clones in vitro so those that do may exhibit a treatment bias [35]. Other problems with the use and interpretation of human tumor clonogenic assays include low plating efficiency and small proportion of tumors available for testing; difficulty in preparing single cell suspensions, production of only small quantities of data, and problems defining drug sensitivity and response criteria [35]. Factors influencing size of sub-populations It has been proposed that as in normal cell populations, human tumor cell populations are also heterogeneous and comprise stem cells, non-stem transitional cells with limited proliferative capacity and end cells [6]. MacKillop suggested that four factors may influence the relative size of these subpopulations: The probability of self-renewal (Psr) of stem cells (producing two daughter stem cells). The distribution of cells within the system can be treated mathematically by assuming probability functions. The potential of the transitional cells for further cell division, as defined by clonal expansion number (n=number of generations between the first generation non-stem cells and the end cells.) The relative effect of cell loss on each subpopulation (Stem cells, transit amplifying, end cells) as described by cell loss factors (ÃŽÂ ¦s, ÃŽÂ ¦t ÃŽÂ ¦ ec). The number of generations of cell proliferation following initiation of the tumor cell population for individual stem cell. Stem cell division in normal tissue must provide a supply of differentiated functional cells to compensate for physiological losses and at the same time maintain a constant stem cell population. A probability of self-renewal in which two stem cells daughters Psr =0.5, would yield a steady state [28]. If no cell loss occurs, it has been modelled that the number of stem cells will increase exponentially with Psr > 0.5 [6]. For the simplest case in which all non-stem cells are end cells (n=0) the proportion of stem cells increases linearly with increasing Psr. and the proportion of stem cells in a tumor decreases as the extent of multiplication of the transitional cell compartment. This results in the stem cell being the less common cell type numerically than transit amplifying and differentiated end cells. These scenarios are affected by cell loss which may occur through necrosis, migration or differentiation, of which only differentiation is selective of cell type. A selective loss th rough differentiation increases the population of stem cells. The modelling of tumor cell growth has implications for the use of clonogenic assays as predictors of the stem cell fraction on human tumors, especially in regards to cut-off points in terms of colony size and determining which cells represent the stem cell fraction [6]. Between studies there are differences between how colonies are scored morphologically and numerically and how long cells are allowed to grow [31] and considering this evidence may be an important issue when comparing data between different studies. Clonogenicity in cell lines and stem cells in cell lines Clonogenicity has recently been used to identify stem cell properties of cells in long term culture cancer cell lines. The colony forming efficiency and secondary plating efficiency of carcinoma derived cell lines including head and neck squamous, breast [39] and prostate [39-42] were investigated and considered to contain potential stem cells. These studies show that cell lines show clear differences between clonal types (holoclone, meroclone, paraclone) and have similar properties in this respect to normal epithelial cells [39]. The proportions of clonal types between the carcinoma cell lines vary greatly. DU145 colonies were evenly spread in number between the clonal types, whereas PC3 cells produced mainly meroclones and LNCaP cells produced mainly paraclones [41], all based on colony morphology. These studies have also looked at the relationship between potential cancer stem cell markers and clonogenicity. CD133 enriched DU145 cells were assayed for clonogenicity, but no difference was found between the positive and negative cells [41], but when isolated CD44+ integrin ÃŽÂ ±2ÃŽÂ ²1+ CD133+ sorted cells were compared against CD44+ integrin ÃŽÂ ±2ÃŽÂ ²1low CD133low a higher CFE was observed in conjunction with a marked difference in morphology to CD44+ integrin ÃŽÂ ±2ÃŽÂ ²1-/low CD133- in DU145 MACS sorted cells [40]. Immunocytochemistry demonstrated that different clonal types showed varying levels of expression of CD44, ÃŽÂ ±2ÃŽÂ ²1 integrin and ÃŽÂ ²-catenin in PC-3 [42] and DU145 clones [39]. There is further evidence to suggest the presence of cells with stem cell behaviour such as dye-exclusion and higher clonogenicity, in several human epithelial cell lines [39, 43-45], which further supports the idea that cell lines contain stem cells. The ad vantage of cancer cell lines that contain cells displaying stem cell characteristics would facilitate the study of molecular pathways and the properties that define the cancer stem cells in vitro. Recent Developments Much progress has been made in the modelling of the leukemic diseases, where the level of heterogeneity was first and most thoroughly explored. Human cells fulfilling the properties expected of drug resistant cancer stem cells were initially isolated from blood cancers [2]. Improvements in the genetics of recipient mice have led to the definition SCID-repopulating cell (SRC). Many improvements to the NOD/SCID murine model continue to be made by using recipient mice that are engineered to be deficient in natural killer (NK) and macrophage activity; part of that innate immune system. It has been demonstrated that a small subpopulation of acute myeloid leukaemia cells with an immature immunophenotype possess the ability colonise immune deficient NOD/SCID mice to give rise to more differentiated leukaemia cells and to recapitulate the heterogeneous phenotype of the bulk tumour [46]. The phenotypically more mature cells failed to engraft in mice, suggesting the presence of an identifiable tumour cell hierarchy. These cells are referred to as tumour initiating cells. Cancer Stem Cell Identification CSCs have been defined on the basis of their ability to seed tumours in animal hosts, to self renew and to spawn differentiated progeny (non-CSCs)[47]. Pioneering work in this area originated from studies on leukaemia stem cells and later included demonstrations of CSCs in solid tumours, particularly breast and brain cancers. However, work in solid tumours has proved challenging. The frequency of CSCs in solid tumours is highly variable [48]. Difficulties with tumour CSC identification Evidence for the existence of cancer stem cells in solid tumours has been more difficult than in the haematopoietic system to obtain for several reasons: 1) The cells within the tumour are less accessible. Tissue has to undergo mechanical or enzymatic digestion to obtain a single cell suspension which can be analysed. 2) There is a lack of functional assays suitable for detecting and quantifying normal stem cells from many organs. 3) Only a few cell surface markers have been identified and characterised. Of these there is no one marker which is specific for a stem cell or cancer stem cells and for selection they often have to be used in combination. Cancer Stem Cell Markers Stem cells are most commonly identified by staining for cell surface markers, exclusion of fluorescent dyes or labelling with tritiated thymidine [3] . The technology to develop monoclonal antibodies to specific molecules and flow-cytometery based sorting and analysis has been a big driving force in recent CSC developments. Much work has been done to define cell surface markers. It has been shown that two distinct subpopulations can be separated from a single tumour that differ in their cell surface markers and their ability to seed new tumours in vivo. Most of the currently used markers do not recognise functional stem cell activity. By using combinations of cell surface markers, the homogenous purification of stem cells can be obtained [3]. Table 1 below reviews the current suggested markers for some tumour types. The use of animal models has allowed identification and assessment of markers that are expressed by cancer stem cells. The most convincing demonstration of identity CSC s elected by biomarkers comes from serial transplantation of cellular populations into animal models. The CSC containing fraction should re-establish the phenotypic characteristics of the original tumour [48]. In 1997 Bonnet et al showed that the ability to transfer human leukaemias into NOD/SCID mice was retained by a small proportion of cells with the CD34+, CD38- phenotype [46]. The CD44 and CD133 markers have emerged as potential markers of immature epithelial cells for isolating CSCs in several tissue types including brain and prostate. Cells have been isolated from several tumour types and serially transplanted in xenograft models: Breast CD44+ CD24-/low established tumours in recipient mice. Brain CD133+ enriched cells. Prostate Side population CD44+ enriched. In these experiments small numbers of selected cells produced tumours in recipient mice. In this instance CSCs can on

James Fenimore Coopers The Last of the Mohicans Essay -- Last Mohican

James Fenimore Cooper's The Last of the Mohicans The French and Indian War of the eighteenth century had uniquely complex qualities, matched by the gravity of its outcome. The myriad of cultures involved the French, Canadian, American, English, Algonquians, and Iroquois whom make this era fascinating. The multi-ethnic element made it a war built upon fragile alliances, often undermined by factional disputes and shifting fortunes. Violent as it was, its battlefields encompassed some of the most beautiful country to be found anywhere. Its richness in diverse cultures, the severity of its bloody violence, and the beauty of its landscape, all combine to make this an era with great depth of interest. It is entertaining and educational to witness a re-enactment event of a historical film and novel called The Last of the Mohicans. In the wake of the 1992 debates about Columbus, the discovery of the Americas, and whether terms such as 'holocaust', 'genocide', and 'racism' should be applied to what happened to Native Americans, Michael Mann's film remake of James Fenimore Cooper's The Last of the Mohicans continues a process of historical erasure or forgetting that Cooper and his contemporaries began. The sentimental racism expressed in Cooper's novel involves the ideas of the auto-genocide of 'savagery' and the inevitable extinction of all Native Americans. Though Mann purported to take great pains in his film to be historically accurate, the film is only accurate in relation to trivial details. It thoroughly scrambles major aspects of Cooper's text, including converting the ageing Natty Bumppo into a young sex symbol (Daniel Day-Lewis). More importantly, the film completely erases Cooper's sentimental racism by, for instance, turning Chingachgook rather than his son, Uncas, into the 'last' of his tribe, and th ereby overlooking the motif of the futureless child central to that racism. But in eliminating Cooper's racism, the film in a sense perfects the novel, because the sentimentalism that softened the racism was already a form of erasure or forgetting. Reading the novel, The Last of the Mohicans, I was actually able to appreciate Cooper’s work, as it was interesting and very different from the movie. While it is true that he is long-winded and very shallowly treats character development, I think that the original work does merit its study. I found that ... ...nd political correctness. There are no dialogs to speak of, no historical, anthropological, geographic, political, social, explanations or orientation. So you don’t learn much about world history from their conversations and dialogue. What you do grasp about the history of this period is by soaking in the environment, traditions, rules, surroundings, behaviors, clothing, and styles of living. The movie and novel of The Last of the Mohicans are both great representations of the French and Indian War as they are attempts to resurrect and redefine the American hero. There was an emphasis on the concept that no man has dominion over another. The novel and film both have strong and weak parts that help us understand and to learn the styles and ways of this time period. They are both great tools for learning about modern world history in their own ways about war and tragedy. The Last of the Mohicans is a bold and stirring story that will always be very memorable adventure years to come. Bibliography The Last of the Mohicans. Produced by Michael Mann. 1 hour 54 minutes. 1992. Cooper, James Fenimore. The Last of the Mohicans. Albany: State University of New York Press, 1983.

The Theme of Man vs. Environment in The Grapes of Wrath :: Grapes Wrath essays

The Theme of Man vs. Environment in The Grapes of Wrath  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     The Grapes of Wrath is a novel by John Steinbeck that exposes the desperate conditions under which the migratory farm families of America during the 1930's live under.  Ã‚   The novel tells of one families migration west to California through the great economic depression of the 1930's.   The Joad family had to abandon their home and their livelihoods.   They had to uproot and set adrift because tractors were rapidly industrializing their farms.   The bank took possession of their land because the owners could not pay off their loan.   The novel shows how the Joad family deals with moving to California. How they survive the cruelty of the land owners that take advantage of them, their poverty and willingness to work.     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The Grapes of Wrath combines Steinbeck adoration of the land, his simple hatred of corruption resulting from materialism (money) and his abiding faith in the common people to overcome the hostile environment.   The novel opens with a retaining picture of nature on rampage.   The novel shows the men and women that are unbroken by nature.   The theme is one of man verses a hostile environment.   His body destroyed but his spirit is not broken.   The method used to develop the theme of the novel is through the use of symbolism. There are several uses of symbols in the novel from the turtle at the beginning to the rain at the end.  Ã‚   As each symbol is presented through the novel they show examples of the good and the bad things that exist within the novel.     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The opening chapter paints a vivid picture of the situation facing the drought-stricken farmers of Oklahoma. Dust is described a covering everything, smothering the life out of anything that wants to grow.   The dust is symbolic of the erosion of the lives of the people.   The dust is synonymous with "deadness". The land is ruined ^way of life (farming) gone, people ^uprooted and forced to leave.   Secondly, the dust stands for ^profiteering banks in the background that squeeze the life out the land by forcing the people off the land. The soil, the people (farmers) have been drained of life and are exploited:   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The last rain fell on the red and gray country of Oklahoma in early May.   The weeds became a dark green to protect themselves from the sun's unyielding rays.

Power Relationships in Hughess Father and Son and Lawrences The Prussian Officer :: Essays Papers

Power Relationships in Hughes's "Father and Son" and Lawrence's "The Prussian Officer" There are many similarities in plot and theme in Langston Hughes’ "Father and Son" and D. H. Lawrence’s "The Prussian Officer." While each story is told in a very different style, the general tone is similar in each. The focal point in each story is a relationship between one man in power, and another man who is a subordinate. The dominant man has generally benevolent feelings towards his subordinate, information which is related to the reader through an omniscient narrator. Due to societal influences, the man in power suppresses this emotion not only from others, but from himself. This suppression later erupts into violence. Colonel Tom ("Father and Son") feels affection for his illegitimate black son, whereas the Prussian officer ("The Prussian Officer") harbors a homoerotic attraction to his orderly. These feelings are socially unacceptable to the point that neither man is capable of admitting this attraction even to himself. A description of oppressive heat occurs i n both, increasing the feeling of futility of the younger man’s struggle. The characters seem locked into their situation, and just as the heat is unavoidable, so is the conflict. The feeling that the dominant male is hiding a secret from those around him is more explicitly stated in "Father and Son." From the very beginning, the narrator informs the reader that Bert is Colonel Tom’s son. "Today his youngest son was coming home†¦.Bert was coming home" (Hughes, "Father" 599). This occurs before the reader realizes that there is a problem in the relationship: that Bert is illegitimate and has a black mother. Additionally, Colonel Tom is hiding his interest, and even pride in this boy who is so similar to him in appearance: "‘He’s too damn much like me,’ the Colonel thought. ‘Quick as hell†¦.Well, anyway, he must be a smart darkie. Got my blood in him’" (Hughes, "Father" 601). On the other hand, in "The Prussian Officer," there is more of an implied denial of the feelings the officer is harboring for his orderly because the officer’s homoerotic attraction is never explicitly stated: "Gradually the officer h ad become aware of his servant’s young, vigorous, unconscious presence about him†¦.It was like a warm flame upon the older man’s tense, rigid body†¦.And this irritated the Prussian. He did not choose to be touched into life by his servant" (Lawrence, "Prussian" 3).

Hospital Administration

Quality Improvement Programme (Toward Excellence Health center for the Community) Excellence Health center for the Community) CoH CoH Quality Improvement Programme CoH Quality is very Sweet for speak, but difficult to implement. â€Å"Quality at Grassroots levels: Patient Perspectives † because because Quality is Never Improved without accepting facts without accepting facts. Dr. J. L. Meena State Quality Assurance Officer Commissionerate of Health & FW Government of Gujarat Email:- [email  protected] com Web:- www. gujhealth. gov. in/quality-assurance-program. htm www. gujhealth. gov. in Dr. J. L. MeenaHealth & Family Welfare, Govt of Gujarat Old Scenario of Health Centers. 1 CoH www. gujhealth. gov. in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat Old Scenario of Health Centers. 3 CoH Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat 5 2 CoH †¢ Poor sanitation and cleanliness. †¢ Very poor Drainage facility. †¢ Poor housekeeping service. â € ¢ Very poor Biomedical waste & infection control practice. †¢ No cattle guard. www. gujhealth. gov. in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat Old Scenario of Health Centers. †¢ Non sterile suction tube & oxygen mask? †¢ Empty Oxygen Cylinders. Instrument with rust & Non sterile. www. gujhealth. gov. in Health & Family Welfare, Govt of Gujarat Old Scenario of Health Centers. Building maintenance was extremely unsatisfactory – Leaking roof, eroded floors, over flowing toilets, broken doors, No patient safety (Open transformer with Parking facilities. Invite for disaster ? ), No safe drinking water facilities. no employee safety, poor lighting and no ventilation sign. www. gujhealth. gov. in Dr. J. L. Meena 4 CoH †¢ Un-used instrument & equipments †¢ No proper used of instruments Crush Card trolley contained:- Comb, Toothpaste, Oil, Glass etc for save the pt. th www. gujhealth. gov. in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat 6 Old Scenario of Health Centers. CoH CoH †¢ Very poorly managed end of life †¢ No respect to Human body †¢ Very worst condition of Post Martum Room. www. gujhealth. gov. in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat 7 CoH ?Why should we care? should we care? ?Is improvement possible? ?What seems to make seems to make a difference? ?Why aren’t we doing a better job? www. gujhealth. gov. in GOAL Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat National Human Right Commission (NHRC Report 1999 NHRC ) Report – 1999 CoH D Grade for Mental Hospital Ahmedabad www. gujhealth. gov. in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat HOW TO ACHIEVE EXCELLENCE IN HEALTH TQM-NABH†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 9 †¢ To develop a healthcare system based on total quality management principles (NABH / NABL) and application of information technology to achieve efficiency in operations, faster & standard communication across the state. †¢ To enhance the quality of healthcare services by providing specialized treatment and preventive healthcare at free / affordable cost. MISSION VISION †¢ To develop a pool of healthcare professionals in he public health sector trained in the implementation of health care quality standards and information technology to bring productivity and effectiveness in health care delivery system. †¢ â€Å"To be the network of finest Public Healthcare Institutions which providing quality medical care services, preventive, promotive, curative & rehabilitative health care services with the state of art technology, easy accessibility, affordability and equity to the people of Gujarat and beyond. 12 8 ?Health centers is committed to provide quality healthcare services. ?To provide the treatment as per the national and international standards. To provide treatment with the latest technology. ?To conduct trainings and workshops on regular intervals for skill development of the staffs. ?To improve the quality on continuous basis. ?To improve the quality of treatment as per the patient satisfaction survey. www. gujhealth. gov. in Dr. J. L. Meena Quality Objectives CoH CoH Quality Policy Health & Family Welfare, Govt of Gujarat 13 ? Implementation of safety and quality practices. ? Incorporation of management tools. ? Building sustainability ? Benchmarking the indicators ? Continuous Quality Improvement ? To provide 24X7 quality services to the community. To organize and implement all the national programs. ? To provide right treatment through latest technology. ? To ensure safety of patient & employee. ? To manage Human Resources for enhancing productivity. www. gujhealth. gov. in PRACTICES IMPLEMENTED CoH ? Formation of the committees & give role and responsibility. ? Gap analysis in a standards formats and fulfilled these gaps. ? Patient and employee satisfaction survey ? Clinical protocol & Standard Operation Procedure (SOPs). ? Monitoring of the qu ality indicators. ? Implementation of Patient Rights & Responsibilities ? Facility Management Practices www. gujhealth. gov. in Dr.J. L. Meena Health & Family Welfare, Govt of Gujarat A Case Study JOURNEY TOWARDS QUALITY JOURNEY TOWARDS QUALITY 15 1 2 †¢ Internal assessment by Quality Assurance Team. †¢ Gap analysis and submission of report and Planning for full filling the gaps. 3 †¢ Develop the action programme for filled these gaps. †¢ Proposed to TSP, NREGA, NRHM, State budget and Vanbandhu for financial requirements to full fill the gaps. 4 role & www. gujhealth. gov. in Cont†¦. Health & Family Welfare, Govt of Gujarat www. gujhealth. gov. in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat A Case Study JOURNEY TOWARDS QUALITY JOURNEY TOWARDS QUALITY 7 8 17 Health & Family Welfare, Govt of Gujarat 14 ? Disaster Preparedness Plan ? Basic Infection Control Practices ? Management of Medication of Medication Code alerts ? Incidence Reporting System RED for FIRE, YELLOW for EXTERNAL ? Hospital Safety Programme CALAMITIES, BLUE for CARDIAC ARREST, ? Patient Information BLACK for BOMB THREAT, ? Inventory Management PINK for CHILD ABDUCTION ? Quality Control & Safety in diagnostics Control Safety in diagnostics 5 †¢ Regular training of core team on standards and objective elements. †¢ Formation of QA Manual, Policy, Procedure, Forms & Formats and implement. Dr. J. L. MeenaPRACTICES IMPLEMENTED CoH CoH †¢ Orientation to Quality & NABH Standards to staffs. †¢ Formation of Committees and clarified their responsibility. CoH 16 CoH †¢ Fulfilled the Human resource, Infrastructure, equipment, instrument related gaps and Statuary requirements. †¢ AMC, Calibration & insurance of the instruments. †¢ Internal Quality Control, External Quality Control. †¢ Regular Internal audit. †¢ Plan, Do, Check & Act (PDCA Cycle for improvement) †¢ Application for Pre Assessment. †¢ Pre Assessment done by NABH Assessors from Quality Council of India. †¢ Fulfilled the Pre assessment gaps and application for final Assessment. Final Assessment done by NABH Assessors from Quality Council of India. †¢ Fulfilled the Final assessment gaps and accredited by NABH board, Quality Council of India. www. gujhealth. gov. in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat 18 CoH CoH Journey of Quality Improvement (Cont)†¦ 5 Years Back CoH Today Lack of standards of standards NABH Standards for Health Centers Standards for Health Centers No Gap analysis report in standard format. Health & Family Welfare, Govt of Gujarat Journey of Quality Improvement (Cont)†¦ 5 Years Back 19 CoH Hygienic, Clean & Green Hospital environment with infection control audit.Recruitment of staff as per workload through RKS and take specialist service outsource. Lack of trained health care staff for emergency (resuscitation) services, patient care service & Healthcare management. No concept of internal audits (medical audit, clinical audit & death audit etc). Dr. J. L. Meena Written policies & procedures available. Poor sanitation, cleanliness & infection control practices. Staff shortage so very poor specialist service. www. gujhealth. gov. in Statutory requirements fulfilled Absence of written policies & procedures. Outcomes†¦.. Gaps identified and addressed. Lack of Statutory requirements (e. . Licenses, Acts, Rules & Certificates). Staff trained in Basic Life Support, Advanced Cardiac Lif Ad Life Support, PG QM & AHO, NABH / NABL Assessors & Kaizen. Staff trained as internal auditors, audits conducted to find out non conformances, corrective & preventive measures taken to rectify it Dr. J. L. Meena www. gujhealth. gov. in Journey of Quality Improvement (Cont)†¦ Today 5 Years Back All required practices in place No Blood storage, CSSD, no separate OT for Eye & Gynec. , Patients attendant launch facilities. Gynec Patients attendant launch facilities Blood s torage, CSSD, separate OT for Eye & Gynec,Patients attendant launch facilities are available Patients attendant launch facilities are available. Damaged and poor condition of building & Staff Quarters. Repairing & renovation done gynecology No Calibration system of Instruments for Quality check. Calibration system of Instruments for Quality check are available. CoH Shortage of equipments and proper ambulances (transport vehicle) . Sufficient equipments and ambulances with regular monitoring by a responsible person. Lack of accountability & planning. Policy and processes for care of the patients in place Non Implementation of Different Codes in the facilities. Poor signage system.Well developed signage and displays for patient information. Absence of Patient & Employees’ satisfaction. Established. No measurable parameter for patient safety. Measurable parameters for patient safety are available. No realization of problems and weaknesses. A clear understanding of what is lackin g and what needs to be done. No monitoring or reporting of adverse events, needle stick injury, Sentinel events etc. These are being reported and are monitored. Practically non-existent security arrangement Availability of well trained security guards Absence of quality standards. Quality standards e. g. medical audit, management f medication, care of patients etc practiced No participation in EQAS/ inter laboratory Participation in EQAS / inter laboratory comparison comparisons and achieving good scores in it. Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat Journey of Quality Improvement (Cont)†¦ 21 5 Years Back BLACK for BOMB THREAT, PINK for CHILD ABDUCTION www. gujhealth. gov. in Today Poor publicity of available services in the villages and in the community. Name of the Facility 3rd Party evaluation & monitoring system by PRI members. All the service which are provide by the healthcare centre are display in the community and emergency ontact number also display. D r. J. L. Meena Health & Family Welfare, Govt of Gujarat A Success Story Quality Improvement Programme:- Gujarat Team work is available, role and responsibility of all staff is cleanly mention. No Evaluation and monitoring system by PRI members (3rd party evaluation). (3 RED for FIRE, YELLOW for EXTERNAL CALAMITIES, BLUE for CARDIAC ARREST, CoH No team work, only Individual approach rather then team . Unidentified role and responsibility of staffs. Total Facility Under NABH /NABL Total Facility Under NABH /NABL which catering Tribal population Total Accredited facilities CoH 23 11 2 Medical college Hospitals 2 0 0 Medical college, Blood banks 0 6 2 5 2 No display of the Right and responsibly of the patients and employees in the facilities. www. gujhealth. gov. in Dr. J. L. Meena 4 2 1 2 1 2 0 0 0 1 1 0 0 Primary Health Centers (PHCs) 29 14 12 6 Community Health Centers (CHCs) Proper display of Right and responsibly of the patients and employees in the facilities. 2 2 Paraplegia Hospi tal, Ahmedabad Progress of the referred patient also monitoring by th the health centre on regular basis. ( Bi directional referral service). 6 Mental Hospitals Dental Hospitals No responsibility of referred patients . Medical college, LaboratoriesProper monitoring of Up time, down time & utilization of the instrument & equipment. 26 11 1 1 NABL Food & Drug Laboratories Total Health & Family Welfare, Govt of Gujarat 23 22 Total Accredited facilities which catering tribal population District Hospitals No monitoring of Up time & down time of the instruments. 20 Today Inadequate infrastructure for handling biomedical waste and infection control safety practices www. gujhealth. gov. in Health & Family Welfare, Govt of Gujarat www. gujhealth. gov. in 2 1 103 45 Dr. J. L. Meena 2 1 28 13 Health & Family Welfare, Govt of Gujarat 24 India’s 1st & 2nd NABH Accredited PHC CoHCoH from Tribal Area from Tribal Area www. gujhealth. gov. in Dr. J. L. Meena Health & Family Welfare, Govt of G ujarat Benefits to Patients 25 CoH Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat Quality Improvement Programme High Quality of Care cont High Quality of Care cont†¦ www. gujhealth. gov. in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat 29 Time Morning: 9. 00 to 13. 00 Evening: 16. 00 to 18. 00 ,, ,, ,, 24 hours ,, ,, ,, ,, 9. 00 to 14. 00 Tuesday & Friday 9. 00 to 16. 00 Daily ( Except holidays) Morning: 9AM to 1 PM Evening: 4 to 6 PM Dr. J. L. Meena Health & Family Welfare, Govt of GujaratProvided baby kits to new born for prevent Infection & hypothermia www. gujhealth. gov. in CoH Day Certificates of age, fitness and sickness Lab services Homeopathic treatment treatment Indoor services Delivery Emergency services Vehicle for referral Medico legal services MAMTA Clinic ( Immunization, medical check-up, treatment IEC Family planning services for treatment, IEC & Family planning services for expectant mothers, children & adolescent) 11 NSV, Abdominal tubecto my , MTP & Hydrocele operation 12 All National Programme www. gujhealth. gov. in 26 Daily ( Except holidays) ,, ,, ,, Daily ,, ,, ,, ,, Monday OPD Services 2 3 4 5 6 8 9 10 27 CoH Availability of Services at PHC level 1 CoH Health & Family Welfare, Govt of Gujarat www. gujhealth. gov. in Sr Name of service ?Availability of Health services with High quality of care. ?Dedicated and sincere medical staff ?Access to a quality focused organization ?Rights respected and protected ?Patient Satisfaction evaluated ?Involvement in care process ?Patient safety ?Pain management ?Safe transport ?Continuity of care www. gujhealth. gov. in India’s 1st NABH Accredited CHC Welcoming infrastructure†¦Ã¢â‚¬ ¦ infrastructure†¦Ã¢â‚¬ ¦ Dr. J. L. Meena 28 CoH Health & Family Welfare, Govt of Gujarat 30 Quality Improvement ProgrammeHigh Quality of Care cont High Quality of Care cont†¦ www. gujhealth. gov. in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat Quality Improvement P rogramme High Quality of Care cont High Quality of Care cont†¦ www. gujhealth. gov. in CoH CoH CoH Health & Family Welfare, Govt of Gujarat Quality Improvement Programme Management of Medicine Management of Medicine†¦ 31 33 CoH Quality Improvement Programme High Quality of Care cont High Quality of Care cont†¦ www. gujhealth. gov. in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat 35 Health & Family Welfare, Govt of Gujarat Quality Improvement ProgrammeQualitative Laboratory services Qualitative Laboratory services†¦ www. gujhealth. gov. in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat Safety of patients & employees†¦ of patients employees www. gujhealth. gov. in 32 CoH Change the Scenario†¦Ã¢â‚¬ ¦. Before www. gujhealth. gov. in CoH 34 CoH After Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat 36 Change the Scenario†¦. Biomedical waste practice†¦ waste practice Before www. gujhealth. gov. in After Dr. J. L. Meena H ealth & Family Welfare, Govt of Gujarat Recreational & skill development www. gujhealth. gov. in CoH CoH Dr. J. L. Meena CoH Health & Family Welfare, Govt of GujaratOccupational Therapy Unit 37 39 CoH Change the Scenario†¦Ã¢â‚¬ ¦ Safe drinking water†¦Ã¢â‚¬ ¦ drinking water After Before www. gujhealth. gov. in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat Recreational & skill development www. gujhealth. gov. in Dr. J. L. Meena CoH CoH Health & Family Welfare, Govt of Gujarat Quality Improvement Programme Quality food services to patients attendants Quality food services to patients & attendants†¦ 38 40 CoH CHC Bardoli, which catering Tribal Population www. gujhealth. gov. in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat 41 www. gujhealth. gov. in Health & Family Welfare, Govt of Gujarat 2 India’s 1st NABH Accredited Mental Hospital Vadodara Hospital Vadodara CoH CoH NO. OF DELIVERY AT PHC CoH 44077 45000 41146 585 36867 40000 35000 600 3372 9 31359 582 586 513 500 30000 400 25000 20000 282 300 15000 200 10000 5000 86 1777 1719 1530 1414 1386 100 0 2008-09 2009-10 2010-11 No. of OPD per Year 2011-12 Dr. J. L. Meena www. gujhealth. gov. in 0 2012-13 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 IPD Number per Year Health & Family Welfare, Govt of Gujarat 43 PHC:- Salun, Dist:- Kheda www. gujhealth. gov. in CoH Adverse Donor Reaction CoH Health & Family Welfare, Govt of Gujarat 44 CoH Issue of Components CoH 9 59,481 50 45 40 40 35 30 25 20 15 10 5 0 60,000 39 54,067 50,000 42,033 32 40,000 25 20 30,000 23,849 20,000 13,820 10,000 0 2008-09 www. gujhealth. gov. in 2009-10 2010-11 2011-12 Blood Bank:- Civil Hospital Ahmedabad 2012-13 2008-09 Health & Family Welfare, Govt of Gujarat Specimen Analysis 100000 45 CoH CoH 98 2012-13 Health & Family Welfare, Govt of Gujarat 46 100 105 85 70 80 60000 2011-12 Critical value reporting CoH CoH 100 69010 59897 2010-11 Blood Bank:- Civil Hospital Ahmedabad 120 88660 78105 80000 www. gujhealth. gov. in 2009-10 60 40000 30522 40 20000 20 0 0 2008-09 2009-10 2010-11 2011-12 2012-13 2009 2010 011 2012 www. gujhealth. gov. in Biochemistry Lab:- Sir T Bhavnagar Health & Family Welfare, Govt of Gujarat 2008-09 2009-10 2010-11 2011-12 2012-13 2008 2009 2010 2011 2012 47 www. gujhealth. gov. in Biochemistry Lab:- Sir T Bhavnagar Health & Family Welfare, Govt of Gujarat 48 Benefits to Staff Surgical Site Infection (SSI) CoH CoH ?Professional staff development ?Provides education on laid down standards ?Provides leadership for quality improvement within medicine and nursing ?Increases satisfaction with continuous learning, good working environment, leadership and ownership 0. 59 0. 6 0. 5 0. 35 0. 4 0. 27 0. 3 0. 16 0. 0. 1 0 2009-10 www. gujhealth. gov. in 2010-11 2010 2011-12 2011 Dist Hospital:- Gandhinagar 2012-13 2012 Health & Family Welfare, Govt of Gujarat Professional staff development Managerial / Administrative training to MO / Head. www. gujhealth. gov. in CoH Health & Family Welfare, Govt of Gujarat Professional staff development Special clinical skill training on minor surgical procedure, obstetrics care, new born care, basic life support and local anesthesia block. www. gujhealth. gov. in 49 Programme implementation training to MO / Head. Dr. J. L. Meena Dr. J. L. Meena CoH CoH 51 CoH www. gujhealth. gov. in Dr. J. L. MeenaHealth & Family Welfare, Govt of Gujarat Professional staff development Induction training to staff at all levels. ll www. gujhealth. gov. in 50 CoH Job based skills training. based skills training. Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat Quality Management & Internal Audit Training Audit Training 52 CoH Disaster Management Disaster Management Health & Family Welfare, Govt of Gujarat 53 www. gujhealth. gov. in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat 54 NABH ACCREDITATION AWARD FUNCTION BY GOVT. OF GUJARAT & QCI, NEW DELHI www. gujhealth. gov. in Dr. J. L. Meena CoH CoH Health & Fami ly Welfare, Govt of GujaratAward for India 1st NABH Accredited Mental Hospital :- Hospital for Mental health – Vadodara, Govt of Gujarat given by Shri Jaynarayan Vyas, Hon’ble Health Minister, Government of Gujarat 55 Award for NABH Accredited PHC :- Primary Health Center – Kandolpada, Navsari-Gujarat, Govt of Gujarat given by Shri Jaynarayan Vyas, Hon’ble Health Minister, Government of Gujarat Benefits to Hospital CoH ?Improves care care ?Brings in Corporate Governance ?Stimulates continuous improvement ?Demonstrates commitment to quality care commitment to quality care ?Raises community confidence ?Opportunity to benchmark with the bestAward for NABH Accredited PHC :- Primary Health Center – Tankal, Navsari-Gujarat, Govt of Gujarat given by Shri Jaynarayan Vyas, Hon’ble Health Minister, Government of Gujarat www. gujhealth. gov. in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat 60 Main entrance should be easily identifiable, welc oming, well lit and with mattress. CoH CoH PHC Mahuwas, Tribal area PHC www. gujhealth. gov. in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat 61 Quality Improvement Programme Welcoming infrastructure†¦Ã¢â‚¬ ¦ infrastructure†¦Ã¢â‚¬ ¦ CHC Bardoli, which catering Tribal Population www. gujhealth. gov. in Dr. J. L. MeenaHealth & Family Welfare, Govt of Gujarat Quality Improvement Programme District Hospital Godhara (Tribal area) Hospital Godhara (Tribal area) CHC Bardoli, which catering Tribal Population CoH HMH Ahmedabad presents an excellent example of effective functioning of Boards of Visitors and active involvement of NGO sector in patients Care, Capacity building & rehabilitation , and has the potential to become a good center of education and research in Mental Health Field Field. www. gujhealth. gov. in A – Grade Health & Family Welfare, Govt of Gujarat 62 CoH DH Godhara, which catering Tribal Population www. gujhealth. gov. inRemarks of representativ e of National Human Right Commission (NHRC) now†¦ CoH 65 Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat Benefits to Community 64 CoH ?Quality revolution ?Disaster preparedness preparedness – Epidemics – Physical ?Access to comparative database www. gujhealth. gov. in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat 66 All the Services provided by PHC Gadboriad are displayed in all the villages & roadside www. gujhealth. gov. in Dr. J. L. Meena CoH CoH Health & Family Welfare, Govt of Gujarat Mock drill and training for disaster management management 67 CoH Mock drill and training for disaster anagement management www. gujhealth. gov. in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat Quality Improvement Programme Involvement in National Programme Involvement in National Programme†¦ www. gujhealth. gov. in Dr. J. L. Meena 68 CoH PHC PHC Tankal, Kandolpada & Mahuwas, Navsari 69 CoH Health & Family Welfare, Govt of Gujarat Health & Fam ily Welfare, Govt of Gujarat Mock drill and training for disaster management management PHC Tankal, Kandolpada & Mahuwas, Navsari www. gujhealth. gov. in Dr. J. L. Meena CoH 71 www. gujhealth. gov. in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat Quality Improvement ProgrammeInvolvement in National Programme Involvement in National Programme†¦ www. gujhealth. gov. in 70 CoH Health & Family Welfare, Govt of Gujarat 72 Quality Improvement Programme Malnutrition awareness Malnutrition awareness†¦ www. gujhealth. gov. in CoH CoH Health & Family Welfare, Govt of Gujarat PRI Monitoring & Evaluation of CHC 73 CoH Quality Improvement Programme AIDS awareness programme AIDS awareness programme†¦ www. gujhealth. gov. in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat National & International Team Visit Niziriya Team Visit CoH 74 CoH Visit by Rajasthan Govt. MLAs with Speaker WHO Team Visit www. gujhealth. gov. in