Montana Plants & Native Americans Essay -- essays research papers

Montnana Plants and Native Americans      Since the start of humankind humanity has relied upon the characteristic assets in their condition for endurance. They used the accessible verdure to support their body, recuperate their injuries, comfort their illnesses and to make items to facilitate their every day lives. A significant number of similar plants used a great many years back by the indigenous individuals have been incorporated into cutting edge meds. The logical intrigue and information on plants for sustenance, mending, and functional uses is called ethnobotany.      The different utilization of plants utilized for sustenance, restorative purposes and functional use were disregarded by Lewis and Clark during their grand trek over the United States. As opposed to consider the Native Indian’s utilization of local plants they persevered on utilizing Dr. Rush’s Thunderbolt pills that most likely messed more up than the condition that incurred them. Numerous cutting edge societies keep on disregarding local cures and have come to rely upon manufactured pharmaceutical medication creation. As of late the abundance of indigenous information has been recognized uncovering the utilization of local plants and the significance it had in the endurance of indigenous individuals.. Pharmaceutical organizations have used the tremendous information on the indigenous individuals and their utilization of regular plants. The utilization of characteristic plant species have uncovered the primary reasons humankind has made due into present day. Following is a couple of the plants, their application and their particular purposes. Kinnikinnick Arctroaphylos uva-ursi (L.) Spreng. Normal Name: Bearberry This plant has an assortment of names all through Montana. This plant develops in poor soil making for the most part out of sand or rock and is regularly found close to Ponderosa Pine trees. Kinnikinnick and Bearberry are the most usually utilized names in western culture. The word kinnikinnick implying what is blended, is gotten from the Algonkian Indian’s language. Different adaptations originated from western trackers who called it larb, Canadian dealers called it sacacommis or sagack-homi, and the Europeans called it bearberry.â â â â â      The American Indians blended Kinninninnick leaves with tobacco to reduce the quality and add flavor to their solid tasting tobacco. Flathead Indian, John Pelkoe, clarified ... ...ong, and shorter stalks are 20-100mm long. The blossom length from the axils are one to three centimeters in length. The ideal blooming time is from May through August. The natural product are unit molded with seedlings wound into a few spirals with a solid net vein three to four millimeters in length (montanaplant-life.org).  â â â â â â â â â â â â â â â â â â â â â â â â Where noted data was gotten from, http://www.montanaplant-life.org Retrieved 3-19-2004.â â â â â â â â â â â â â â â â â â â â â â â â â â â â â â â â â â â â â â â â All other data was gotten from: Hart, J. Montana Native Plants and Early Peoples. Helena. Montana Historical Society Press. 1992.  â â â â â â â â â â â â â â â â â â â â â â â â â â â â â â â â â â â â â â â

Assignment#2 Assignment Example | Topics and Well Written Essays - 1500 words

#2 - Assignment Example A model is the earthy colored eyes allele that is predominant over blue eye allele. A person with both blue and earthy colored eyes alleles would have earthy colored eyes. The term depicts a living being that has two unique alleles for a specific attribute at a particular locus. The two alleles are spoken to with the lower and capitalized of a similar letter. A genuine model is a plant with a couple of alleles that decide if it would have smooth or serrated edge. The pair would be composed as (Ss) to mean the distinctive hereditary data conveyed. This is the hereditary make-up of a life form that portrays the hereditary data contained by alleles in the cells of the living being. A genuine model is a quality that would characterize a person as defenseless against a specific ailment. The standard declares that, allele sets speaking to a specific attribute in a life form separate during the arrangement of gametes and haphazardly joins after the procedure of treatment. This is as dependent on the accompanying defenders; a specific quality can exist in various structures, new life forms acquire a couple of alleles for every attribute from guardians, and meiosis result to cells where each gain a solitary allele for a given characteristic. A couple of various alleles results to predominant and passive alleles that are communicated diversely phenotypically. An ordinary inquiry is the shade of seeds in peas. Arrangements of gametes lead to partition of alleles that decide shading in the seeds. They arbitrarily join during preparation. Seed shading in the peas become an issue of which allele is prevailing; either the green shading allele or yellow shading allele. Yellow shading allele is predominant over green shading allele. Nearness of the two alleles in a pea results to yellow pees. (YY) and (Yy) genotypes result to yellow seeds. (yy) genotype results to green peas. The guideline expresses that, for qualities situated on various chromosomes,

Shirley Jackson and the Mundane Horrors of Motherhood

Shirley Jackson and the Mundane Horrors of Motherhood Shirley Jacksons 101st birthday is this month. She is a premier writer of psychological suspense, horror, and the dark fantastic(1). So now seems like a good time to remind readers that, between writing beloved and bone-chilling books, Shirley Jackson also wrote about the life of a wife and mother in the mid-20th century. Jackson published her essays on family life in womens magazines such as  Good Housekeeping  and  Womans Home Companion.  In the 50s, they  were collected in two memoirs(2):  Life Among the Savages  (1953) and  Raising Demons  (1957). These two books recount amusing anecdotes from the lives of Jackson, her husband Stanley Hyman, and their four children: Laurie, Jannie, Sally, and Barry.  Yes, the writer known for such creepy and macabre tales as The Lottery and  The Haunting of Hill House also wrote charming accounts of her familys hijinks and foibles. For those of you unfamiliar with Jacksons work, her usual subjects include haunted houses, apocalyptic scenarios, unexplained happenings, etc. You know, the stuff that makes you scared to walk down a dark hall. Some writers employ blood, gore, and monsters to scare the wits out of you. Jacksons horror is more subtle, even mundane. It is often cemented in a real world, but one gone slightly off-kilter.  The Haunting of Hill House, one of my favorite novels, is about a house that may not even be haunted. The ghost never appears, is never made explicit; all occurrences could be blamed on the main character, an anxious woman named Eleanor. Thats the thrill of Jacksons work: the monster is in your head, and scarier than words can describe. So at first glance, Jacksons family stories appear to be a complete departure from her usual style. They deal with the mundane issues of daily livingâ€"picky eaters, car repairs, and bank visits. While undeniably amusing, they seem lighthearted, even trivial. Many early critics were disappointed that the author of the disturbing novel  Hangsaman had penned inconsequential stories of motherhood and managing house. It is something of a shock, one wrote, to read such ephemeral fluff. (3) But really, the books are classic Shirley Jackson. Each story displays the signature humor she lends to all her writing. Sometimes it is a dark, creeping humorâ€"funny, but unsettling. Furniture refuses to stay put, a flower arrangement is delivered, apparently from Sallys imaginary friend, and you can never quite get your bearings on who is telling the truth and what is  actually  real. Other times, it is a humor that will have you in stitchesâ€"like when Stanley and Shax, the familys cat, attempt (and fail) to capture a bat flying around the living room. So yes, these are family stories, but they are pure Shirley Jackson: hilarious, unnerving, and wry. She tunnels in on the tiny details that make up a life, creating a dynamic and expansive view of her world: balancing the needs of four children and a husband, while also being a prolific writer andâ€"crazy as it soundsâ€"a person in her own right. The books give a picture not just of Jacksons personal life, but of what life was like to be a woman in the 40s and 50s. Whats truly unsettling about Jacksons writing is the way she perfectly skewers societal expectations. On the surface, Jackson chuckles over an inept husband, a car that wont start, and missing sneakers. In between the lines youll notice a searing commentary on the life of a housewife when women shouldered most (read: all) of the child-rearing and housekeeping duties. When she checks in at the hospital for her third pregnancy, she has a difficult time with the receptionist filling out her intake form: Occupation? Writer, I said. Housewife, she said. Writer, I said. Ill just put down housewife, she said. She lets this little anecdote speak for itself, moving briskly on to a hazy and drawn out childbirth. But these lines stuck with me. They are so evocative of the difficulty women had (and still have) of being taken seriously. In her lifetime, Jackson published six novels, about a hundred short stories, two memoirs, and three childrens books. Remember this as youre reading. Marvel at how she managed to write prolifically, raise four children, and be a housewife. In the end, what I love about  Life Among the Savages  and  Raising Demons  is how they manage to be both compulsively readable slice-of-life stories and social commentary. As usual, Jackson draws you in expecting one thing, spins you around and presents you another.  There are dishes and dirty laundry, but also magic and intrigue. These books are as funny as they are sharp, and I hope well start referencing them as often as we do The Lottery. If youre not yet a Jackson fan, check out our Reading Pathway recommendations for where to start. Alternatively, if youve already read everything shes written, weve got some recommendations for you too. (1) The Shirley Jackson Awards (2) Think of these two books as memoir in the loosest of terms; as biographer Ruth Franklin writes in  Shirley Jackson: A Rather Haunted Life,  the writing straddles the line between fiction and fact; it is autobiographical but not necessarily true.  But then again what memoirs can claim theyre just the facts? (3) from  Shirley Jackson: A Rather Haunted Life  by Ruth Franklin Also In This Story Stream Best Reading Apps for Kids Never Too Young For a Fandom: My First Fandom Board Books View all children posts--> Sign up for True Story to receive nonfiction news, new releases, and must-read forthcoming titles.

Lloyd Augustus Hall - Chemist and Inventor

An industrial food chemist, Lloyd Augustus Hall revolutionized the meatpacking industry with his development of curing salts for the processing and reserving of meats. He developed a technique of flash-driving (evaporating) and a technique of sterilization with ethylene oxide which is still used by medical professionals today. Earlier Years Lloyd Augustus Hall was born in Elgin, Illinois, on June 20, 1894.  Halls grandmother came to Illinois via the Underground Railroad  when she was 16. Halls grandfather came to Chicago in 1837 and was one of the founders of the Quinn Chapel  A.M.E. Church. In 1841, he was the churchs first pastor. Hall’s parents, Augustus and Isabel, both graduated high school. Lloyd was born in Elgin but his family moved to  Aurora, Illinois​, which is where he was raised. He graduated in 1912 from East Side High School in Aurora. After graduation, he studied   pharmaceutical chemistry  at  Northwestern University,  earning a bachelor of science degree, followed by a  masters  degree from the  University of Chicago. At Northwestern, Hall met Carroll L. Griffith, who with his father, Enoch L. Griffith, founded  Griffith Laboratories​. The Griffiths later hired Hall as their chief chemist. After finishing college, Hall was hired by the  Western Electric Company  after a phone interview. But the company refused to hire Hall when they learned he was black. Hall then began working as a chemist for the Department of Health in  Chicago  followed by a job as chief chemist with the John Morrell Company. During  World War I, Hall served with the  United States Ordnance Department  where he was promoted to Chief Inspector of Powder and Explosives. Following the war, Hall married Myrrhene Newsome and they moved to Chicago where he worked for the Boyer Chemical Laboratory, again as a chief chemist. Hall then became president and chemical director for Chemical Products Corporations consulting laboratory. In 1925, Hall took a position with Griffith Laboratories where he remained for 34 years. Inventions Hall invented new ways to preserve food. In 1925, at Griffith Laboratories, Hall invented his processes for preserving meat using sodium chloride and nitrate and nitrite crystals.   This process was known as flash-drying. Hall also pioneered the use of antioxidants. Fats and oils spoil when exposed to oxygen in the air. Hall used lecithin, propyl gallate, and ascorbyl ​palmite as antioxidants, and invented a process to prepare the antioxidants for food preservation. He invented a process to sterilized spices using ​ethylenoxide gas, an insecticide. Today, the use of preservatives has been reexamined. Preservatives have been linked to many health issues. Retirement After retiring from Griffith Laboratories in 1959, Hall consulted for the  Food and Agriculture Organization  of the  United Nations. From 1962 to 1964, he was on the American  Food for Peace  Council. He died in 1971 in  Pasadena,  California. He was awarded several honors during his lifetime, including  honorary degrees  from  Virginia State University,  Howard University​  and the  Tuskegee Institute,  and in 2004 he was inducted into the  National Inventors Hall of Fame​.

Myers Brigg Type Indicator, And The Four Dimensions Of...

Myers-Brigg Type Indicator The Myers-Brigg Assessment, and the four dimensions of personality types based on the findings of Carl Jung, Isabel Myers and Katharine Briggs, indicates Katie as an ISFJ (intuitive, sensing, feeling, and judging). People falling into this category are often known as nurturers. Additionally, individuals of this personality type tend to be practical, and sensitive towards other’s feelings. These traits make the ISFJ personality ideal for careers such as counseling where they are needed to give practical and emotional support. ISFJ personality types are reliable, and exhibit a strong sense of responsibility and duty (Sharf, 2013). Moreover, this personality type prefers organization, planning, and schedules, (Neukrug Fawcett, 2015); qualities that Katie has presented in her coaching positions. These characteristics have been noted in jobs that Katie has held. Furthermore, ISFJ individuals carry high standards of work ethic (ISFJ-Introverted, Se nsing, feeling, Judging). Careers where they serve others best suit their personality style. Both of Katie’s career pursuits necessitate serving others. ISFJ’s are warm, sensitive to others feelings, and value kindness; additional qualities essential qualities to being a genuine counselor and caring, nurturing, supportive coach (Portrait of an ISFJ, 2015). Krumboltz’s Social Learning Theory The Social Learning Theory developed by John Krumboltz is based on social learning asShow MoreRelatedEssay On Myers Briggs Type Indicator1465 Words   |  6 PagesMyers–Briggs Personality Indicator Introduction The Myers-Briggs Type Indicator (MBTI) is based on the Jung’s theory of psychological types. The test is a self-report questionnaire that gives insight in how people interpret the world around them. This can be significantly important, as it can help someone better understand themselves, as well as their relationships, education, career, and role in the workplace. The MBTI was was developed by Katharine Cook Briggs together with her daughter IsabelRead MoreRecruitment Selection: Myers Briggs1568 Words   |  7 PagesThe Myers-Briggs Type Indicator ® (MBTI) is a psychometric test used to measure psychological preferences in how a person makes decisions and perceives their surrounding environment. A mother-daughter pair, Katherine Briggs and Isabel Myers developed the test based on the typological theories of Carl Gustav Jung. After more than fifty-years of research and development, the MBTI has become the most widely used and respected personality tool. Eighty-nine compa nies out of the US Fortune 100 make useRead MorePersonality Testing And The Benefits Essay1138 Words   |  5 PagesThis paper will take a brief look at personality testing and the benefits it has in the workplace. 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The MBTI problem-solvingRead MoreThe Keirsey Temperament Sorter And The Big Five Personality Test1200 Words   |  5 Pages Personality is defined as the unique way in which each individual thinks, acts, and feels throughout life (Ciccarelli, 2014). Numerous individuals are curious in regards to their actions and how their mind works, thus leading companies to create personality tests, in order to provide individuals with some perspective on their personality. While individuals can take personality tests for leisure, personality tests are often utilized in situations such as job interviews, dia gnosing mental disordersRead MoreExam Paper7169 Words   |  29 PagesChapter 4 Personality and Values MULTIPLE CHOICE Personality 1. Which of the following statements about personality is correct? a. Personality is always stable. b. Personality is a part of a person. c. Personality is an aggregate whole. d. Personality is for the most part comprised of traits that cannot be measured. e. Personality is the primary source of emotions in most people. (c; Easy; Personality; p. 105) 2. Which of the following statements about the

Women rights, education, economy, politics Free Essays

Fundamental aims of Islamic culture include welfare, happiness and progress of human society. Human being was created as the representative of Allah. Both man and woman are required to play an imperative role for the cause of serving humanity in a better way. We will write a custom essay sample on Women rights, education, economy, politics or any similar topic only for you Order Now No progress in the field of culture can be possible unless and until woman plays her divergent role in the society. Islam raised the status of woman to a great extent. She has been given rights to property, rights to take part in economic activities, rights to choose life partner, rights to determine his financial requirements and to overcome these and an honorable social status which was not given by the prior and other contemporary cultures and societies. It is a matter of fact that woman occupied an important place during the Islamic Era and played an active role for the uplift of Society. In this article, I have tried to bring out the importance of the role of woman for the development of Islamic Culture and improvement of an Islamic Society. Key words: Islamic culture; Purpose of creation; Status of women; Right and duties of women; Distinction of Islam Women in ancient civilization There had not been a single civilization in ancient world which did not inflict various forms of pains and cruelties to woman. Study of history reveals that that during different era, women had lost their recognition in their respective civilizations. * Assistant Professor, Department of Islamic Studies, NIJML, Islamabad, Pakistan Jih ¤t al-lsl ¤m Vol. 5 Oanuary-June 2012) No. 2 Not only had she lost her capabilities but also her freedom. Moreover, she had to lose her worth and status. She was maltreated in each society and every part of the world. As far as her moral and lawful rights concerned, she had fallen to the lowest level. In different nations of the world, she was living her life in miserable and terrible conditions. She was forced to marry and sometimes into adultery. Other became heirs of her wealth irrespective of the intensity of her financial needs. She secondary to her husband and father or any male member of her family. Her husband used to become the owner of her wealth even before her death and also became her master. It all happened when the nature was changed. It all happened hen nations left the way of God and followed the path of Satan. However, a moderate way, which harmonized with nature, wisdom and human interest, existed there. And this way is Islam which is established by God himself. Women in Greek civilization: Despite the fact that Greek civilization was the most modern civilization among the ancient nations, the Greeks considered woman the essential inconveniences and fountain head of all problems. She was cut-off from society. She had only one Job to do i. e. , to give birth to children. There were many women who were compelled to do adultery. Mothers were also forced to do adultery. Furthermore, sisters were forced to marry against their will. She was looked down up in the society; she was treated as a servant; she was maltreated. Their concept of woman was faulty (1) . Famous writer Demosthenes says, â€Å"Women were used to quench the thirst of sex and men had them as girl friends. They had wives to produce children and girl friend enjoy their physical contact with them†. How to cite Women rights, education, economy, politics, Papers

Rajiv Arogyasri Essay Example

Rajiv Arogyasri Essay Rajiv Aarogyasri Health Insurance Scheme is being implemented in the state of Andhra Pradesh in India to assist poor families from catastrophic health expenditure. The scheme is a unique PPP model in the field of Health Insurance, Tailor made to the health needs of poor patients and providing end-to-end cashless services for identified diseases through a network of service providers from Government and private sector. The scheme introduced on 01. 04. 007 in three backward districts of Mahaboobnagar, Anantapur and Srikakulam on pilot basis was subsequently extended to the entire state in phased manner to cover 20. 4 million BPL families encompassing 70 million population spread across 23 districts of the state from 17. 07. 2008. The scheme started with coverage to 163 identified diseases in 6 systems was gradually extended to 330 diseases in 13 systems under Aarogyasri-I. The coverage under the scheme was extended to 942 procedures in 31 systems with addition of 612 procedures through Aarogyasri-I. The scheme was formulated in consultation with specialists in the field of Medicine, Health and Insurance to address the needs of catastrophic health expenditure among the BPL families of the state and at the same time not to sideline the existing infrastructure in government hospitals. However the scheme is designed in such a way that the benefit in the primary care is addressed through free screening and outpatient consultation both in the health camps and in the network hospitals as part of scheme implementation. Vision, objectives and goals: . Vision: Rajiv Aarogyasri is the flagship scheme of all health initiatives of the State Government with a mission to provide quality healthcare to the poor. The aim of the Government is to achieve â€Å"Health for All† in Aarogyandhra Pradesh (Healthy Andhra Pradesh state). In order to facilitate the effective implementation of the scheme, the State Government has set up the Aarogyasri Health Care Trust under the chairmanship of the C hief Minister. The Trust is administered by a Chief Executive Officer who is an IAS Officer. We will write a custom essay sample on Rajiv Arogyasri specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Rajiv Arogyasri specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Rajiv Arogyasri specifically for you FOR ONLY $16.38 $13.9/page Hire Writer The trust, in consultation with the specialists in the field of insurance and medical professionals, runs the scheme. b. Objective : To improve access of BPL families to quality medical care for treatment of identified diseases involving hospitalization, surgeries and therapies through identified network of health care providers through a hybrid model consisting of tailor-made policy (serviced by Insurer) and self funded reimbursement mechanism (serviced by Trust) to assist BPL families for their catastrophic health needs without compromising the importance of existing Health Care Delivery system of the Government. However the scheme is designed in such a way that the benefit in the primary care is addressed through free screening and outpatient consultation both in the health camps and in the network hospitals as part of scheme implementation and areas of catastrophic health expenditure is met by the insurance scheme. The scheme combined with existing public health infrastructure together meets the total health needs of people thus providing universal coverage. c. Goal : Since the scheme is unique and unparalleled in the country, and having introduced for the first time in the state, there is no available data to indicate the disease load and morbidity in the state. However, based on some non-specific data from the tertiary care government hospitals and incidence rate of certain diseases it is construed that around 10% of population suffer from ill health at any point of time. Out of this 60% require medical treatment and 40% require surgical treatment. Out of the total patients who require surgical treatment 10% require surgical interventions listed in the scheme. In addition, there is enormous pre-existing load in the state for which estimation is not available. †¢ Trust is aiming at providing universal coverage in the long run through extended coverage within the budget on account of constant decrease in the premium due to open bidding process for each phase and decrease in pre-load of diseases. Further the elimination of financial burden for catastrophic health expenditure because of the scheme and rehabilitation of working family member will lead to increased quality of life and purchasing power. †¢ Improvement of infrastructure in Govt. ealth Care Providers through utilization of funds earned by implementing the scheme thus enabling them to provide quality care in all areas of health care. †¢ The scheme takes care of screening and primary level treatment for common ailments through the interventions in health camps and distribution of medicines in these camps thus supplementing existing primary care providers in Govt. secto r. Founders and CEO’S: The chief minister Y. S. Rajasekhara reddy launched ‘Rajiv Aarogya Sri’, a health insurance scheme to provide free medical treatment to the poor and the downtrodden. About 1. 82 crore people holding white ration cards are assured under the scheme. The scheme covers health insurance, in cases of cancer, heart, kidneys, neurology and trauma. The Prime minister Dr Manmohan Singh was all praise for Dr Reddy’s pet scheme ‘Aarogya Sri’ and wanted to implement the health insurance scheme at the national level. Speaking to media, the Chief Minister, Dr. YS Rajasekhara Reddy, Finance Minister, K Rosaiah said that Rajiv Aarogya Sri would be a public private partnership scheme. Role of ICT(Information and Communication Technology): The Primary channel through which Rajiv Aarogyasri Scheme is utilized by the Target groups is through its ICT Website (http://www. aarogyasri. org). The Website Portal is a workflow oriented integrated system which takes care of the target groups right from the registrations of a patient to the discharge, claim settlement and then administering of follow up medicine to the patients. Each phase through which a patient goes through, be it In patient registration/Out Patient registration/Surgery Updates/Discharge Updates/Claim Settlements etc. , everything is taken care by the ICT itself. Every user who facilitates the Patient is provided with a Login Id and Password using which he/she should login to the system and operate on the patient pertinent details. The Users who facilitate the patients would have to use the ICT and provide their appropriate inputs and use the responses obtained from the ICT to help the patient get a successful treatment and happy discharge. Furthermore the ICT allows for online payments to the Service providers, aids in Auto generation of Tax filing information, Empanelment of Hospitals, Grievance handling etc. 1. General Information on the scheme. 2. Details of patients reporting and referrals from the PHC/CHC/ Government Hospitals/ District hospitals on daily basis 3. e-Health Camps system and daily reporting of health camps 4. Details of patients reporting and getting referred from the health camps. 5. e-Empanelment system. 6. Emergency approval system 7. Call centre application. 8. Patient registration by Aarogya mithra in Network Hospitals 9. Details of in-patients and out patients in the network hospitals 10. On-bed reporting system. 11. Costing of the Tests done in the network hospitals 12. e-preauthorization. 13. Surgery details. 14. Discharge details. 15. Real-time reporting, active data warehousing and analysis system. 16. Claim settlement 17. Electronic clearance of bills with payment gateway 18. Follow-up of patient after surgery 19. Distribution of Follow-up medicines. 20. Aarogyasri Messaging Services. 21. Enhancement workflow 22. Grievance and Feedback workflow 23. Bug Tracking system 24. e-Office management 25. Accounting system 26. TDS workflow. 27. Death reporting system. On the whole, the ICT forms the core of the Scheme which makes sure that the scheme is run in a smooth way and flags any irregularities to the appropriate authorities at appropriate points in time. The role of ICT: The ICT plays a very vital role in implementing Rajiv Aarogyasri in Andhra Pradesh. The ICT incorporates various software modules that cater to a gamut of services Viz. a Potential Beneficiary Calling the Call center and obtaining a suggestion, Registration of a Patient, Approval of Preauthorization’s, Settling of Claims, Management of Grievances, Online Empanelment of Hospitals, Health Camps, TDS, Online Accounting modules etc The following the Various important modules incorporated in Rajiv Aarogyasri and their brief descriptions. 1. General Information on the scheme: It Provides for comprehensive details of the Scheme, Organization of the Trust and contact details, recent happenings and updating of Guidelines, details of Health Camps such as place, date and name of the Hospital with details of treated Specialty, FAQ’s, Feedback etc. 2. Details of patients reporting and referrals from the PHC/ CHC/ Government Hospitals/ District hospitals on daily basis: User friendly interface is provided in the portal to capture the details of the patients reporting to the PHC’s, CHC’s etc through Call Centre mechanism. . e-Health Camps system and daily reporting of health camps: Planning, Scheduling and comprehensive information on Health Camps to all the Stake holders, obtaining confirmation on the Network Hospitals, details of personnel attending the camps, forwarding the information to the District Administration, monitoring of IEC activity and finally processing of Claims are being done through Online System. 4. Details of patients reporting and getting referred from the health camps: User friendly interface is provided in the portal to capture the details of the patients reporting to the Health Camps through Call Centre mechanism. 5. e-Empanelment system: Elaborate Online Empanelment procedure through portal ensures capturing of entire data related to the hospital such as Civil infrastructure, availability of equipment and professionals, details of Specialties available, past performance etc. The Online empanelment procedure carried through the portal ensures transparency in dealing with empanelment and disciplinary actions against the hospitals. 6. Emergency approval system: The portal provides for Emergency approvals through â€Å"Telephonic Approval† system where in a provisional preauthorization is given through Call conference facility between the treating doctor/Ramco, preauthorization executive and preauthorization medical officers to deal with life saving situations. 7. Call centre application through toll free no (1800-425-7788): 24*7*365 call centre with 280 executives provide facilitation services to the beneficiary by way of explaining the scheme, guiding the beneficiary for proper referral, answering specific queries, registration of complaints, coordination with other stake holders in resolving issues. Further it also helps in the collection and transmission of patient data. I virtually acts as a centralized reception for all the beneficiaries. 8. Patient registration by Aarogyamithra in Network Hospitals. 9. Capturing the Details of in-patients and out patients in the network hospitals. 10. On-bed reporting system. 11. Costing of the Tests done in the network hospitals. 12. E-preauthorization: Robust Online system provides for e-preauthorization unique to the scheme. It facilitates Online transmission of entire medical data of the Patient including reports, image logy films, video recordings of procedures such as Angiogram, Laparoscopic procedure etc for efficient and transparent approval procedure. 13. Capturing the Surgery details through Online. 14. Capturing the Discharge details through Online. 5. Real-time reporting, active data warehousing and analysis system. 16. Claim settlement: The Online system ensures outcome based claim settlement through screening of online evidence for error free and timely claims settlement. 17. Electronic clearance of bills with payment gateway: The ICT solution provides for online bill clearance through paperless mechanism directly into the payees acco unt without human intervention thus ensuring most transparent way of clearing and payment of the claims. Further payee receives mobile alerts on receipt of the payment. 18. Follow-up of patient after surgery: The solution enables Online follow up of the patient by way of capturing follow up treatment details in the portal even after discharge. 19. Distribution of Follow-up medicines: The follow up module captures details of consultation, evaluation tests and medication given to the patient with photographic evidence. 20. Aarogyasri Messaging Services: The AMS (Aarogyasri Messaging Services) provides for dedicated communication gateway for effective interaction with service provider, field force and other stake holders thus ensuring prompt dissemination of information in resolving the issues. 1. Enhancement workflow: Provides for Online enhancement of packages in specific cases. 22. Grievance and Feedback workflow: Ensures prompt and timely grievance redressal through efficient online system from registration to escalation and final disposal. 23. Bug Tracking system 24. e-Office management: The ICT solution is integrated with e-office management to enable paperless transaction within and o utside the project office for efficiency, transparency and accountability. 25. Accounting system: Online accounting system provides for error free management of finances in paperless manner. 6. TDS workflow: For the first time among government Institutions scheme established TDS deductions through Online System. 27. Death reporting system: Each of the above mentioned modules have two or more workflows where in the users intervene and take appropriate actions and continue the workflow and track it to closure. Target groups and impact: Target Groups: The Target Groups of the scheme are the members of below poverty line (BPL) families identified through digitally generated White ration card / Rajiv Aarogyasri Health Card with photograph and name of the beneficiary. Impacts: The following statement define the different target groups identified based on the health need and the way the project reaches the beneficiary and brief impact of the scheme on account of implementation for last 3 years viz. ,1st April 2007. i. Catastrophic health needs (identified tertiary care services – 942 procedures through insurance scheme) – 6,86,812 beneficiaries treated for identified diseases in 339 Network Hospitals. ii. Primary care through free screening and treatment of common ailments in health camps 3375655 -Patients Screened and treated for common ailments in 19504 -Health Camps iii. Preventive care through IEC activity – 339 Network Hospitals conducted IEC activity thorough 19504 health camps held predominantly in rural and remote areas. iv. Additional services provided by the Network Hospitals under the scheme. 794316 -In Patients 1120666 -Out Patients were counseled and treated in Network Hospitals. The scheme proactively reaches the beneficiaries through scheme details on health cards, patient education brochures, posters, bill boards, audio and video CD’s, health Camps, IEC activity, Aarogya mithra (facilitator)services in PHC’s, round the clock toll free call centers , 108 ambulance services Further independent evaluation of the scheme by IIPH (Indian institute of Public Health) established the fact that the scheme had profound impact on the health needs of the poor population as following conclusions were drawn by the agency after rapid evaluation. 1. CONCLUSION BY IIPH : RAJIV AAROGYASRI is a government funded scheme that ensures preferential benefit to vulnerable sections of population by providing targeted care to the BPL group. It fulfils in part an important recommendation of the WHO Commission on Social Determinants of Health to ensure universal access to health care regardless of ability to pay, building on targeted health care programmes for the poor as an important step towards universalism. Approximately half of the beneficiaries interviewed were illiterate and a similar proportion had a low Standard of Living Index (SLI). The unemployed together with unskilled laborers made up nearly half the sample, confirming that the scheme was appropriately benefiting economically poor households. 2. CONCLUSION BY IIPH: The beneficiaries were unanimous that the scheme had transformed their lives. Eighty seven percent of beneficiaries reported improvement following treatment of their condition. The beneficiary satisfaction survey elicited the highest scores for doctors, nurses and cleanliness. Approximately half of the beneficiaries interviewed were illiterate and a similar proportion had a low Standard of Living Index (SLI). The unemployed together with unskilled labourers made up nearly half the sample, confirming that the scheme was appropriately benefiting economically poor households. 3. CONCLUSION BY IIPH: The beneficiaries were unanimous that the scheme had transformed their lives. Eighty seven percent of beneficiaries reported improvement following treatment of their condition. The beneficiary satisfaction survey elicited the highest scores for doctors, nurses and cleanliness. Both the beneficiaries and providers of care acknowledge the transformational role played by the RAJIV AAROGYASRI in improving the access and availability of health care to the poor in AP. The evaluation has demonstrated that the RAJIV AAROGYASRI has reduced the financial burden of serious ill health among the BPL population of AP. The District Medical Health Officers (DMHOs), RAMCOs, MSs and PHC MOs applauded the equity of access achieved as a result of the RAJIV AAROGYASRI and the opportunity for BPL populations to avail of specialist treatment free of cost. The scheme had also enabled some infrastructure improvements in the hospitals. Working Pattern: Achievements, milestones and wins: Since inception of the scheme Trust faced many a challenges in its execution and implementation. As the Scheme is unique and first of its kind with no parallels either in the state or in the country, the Trust has to face the challenges on its own and find solutions for effective implementation of the Scheme. Apart from the unique and robust ICT solution many innovative implementation methods were incorporated to achieve best results in the scheme. The following are the few select achievements which needs mention under the scheme. 1. The Reach of the scheme: The Scheme launched on pilot basis on 01-04-2007 in three backward districts was quickly scaled up in phased manner to cover 23 districts of entire state within a period of 15 months. Scheme underwent continuous changes since inception due to overwhelming response from the beneficiaries. The following comparative average figures handled in the scheme over a period of time indicate the same: Refer to Diagram 1 2. Cashless packages: Cashless treatment to the patient was envisaged. For this the Trust constituted 31 teams of specialist doctors from government and private hospitals and analyzed all the diseases, listed more than 1500 medical and surgical procedures and finally basing on the criteria mentioned above finalized a list of 942 diseases and packages for inclusion in Rajiv Aarogyasri scheme. The package includes ? Screening in Health Camps. ? Consultation, medicines, diagnostics, specialist services, complications ? Implants, grafts, prosthetics ? Food. ? Cost of transportation ? Hospital charges etc. In other words the package should cover the entire cost of treatment of the patient from date of screening at villages/date of reporting at network hospital to his discharge from hospital and 10 days after discharge and any complications while in hospital, making the transaction truly cashless to the patient. 3. Preventive and primary care through Health Camps: Universal Coverage While Insurance scheme is addressing the needs of catastrophic health expenditure of poor patients, the health camp screening and treatment of common ailments coupled with Government health care setup is able to meet complete health needs of poor in the state. Further the upward revision of financial limit for BPL status by the Government enabled 85% of state population to get coverage under the scheme thus achieving universal health coverage in the state. 33. 38 lakh patients were screened and treated for common ailments in 19315 health camps held under the scheme 4. Facilitation Services: The following facilitation services are provided to the beneficiary to guide, counsel, facilitate referral and ensure quality medical services under the scheme. 1. 24 Hour Toll free Call Centre Number 2. Aarogya mithra at PHCs and Government Hospitals . Aarogya mithra at network hospital 4. District level grievance cell 5. Central level grievance cell 6. Services of RAMCO (Rajiv Aarogyasri Medical Coordinator) 7. Health Camps 8. Health Cards 5. E-Preauthorization: Rajiv Aarogyasri Health Insurance scheme envisages e-preauthorization through online data verification. Though preauthorization process is a common process in all insurances schemes the unique feature of Rajiv Aarogyasri scheme is the final approval by the Trust as the custodian of insured and not by the Insurance Company. The conflicting interest of service provider, insurer and Trust thus ensure fair approval of the cases and takes care of poor people insured under the scheme. 6. Follow-up Services: To optimize the benefit of the surgery/therapy taken under the scheme, packages are also approved for one-year follow-up services (Consultation, Testing and Treatment) to the beneficiary in 125 identified procedures. 7. Awareness In order to create awareness among the stake holders the following activities were successfully undertaken in the scheme: †¢ Health Cards: All the families below poverty line were given Health Cards based on the ration card database to make the people aware of their entitlement under the scheme. This has not only created awareness among the beneficiaries but brought in feeling of possessiveness, empowerment and financial protection among the illiterate people. †¢ Mega-Health Camps: The scheme was launched by Chief Minister through Mega Health Camps in all 23 districts where in around 50-60 network hospitals with their men and machines (including portable equipment such as CT, Endoscopy, Echo etc) participated. In each of these camps more than 10000 patients were screened. For this purpose assistance from NRHM was also received. †¢ Awareness Camps: Awareness camps were held to the stake holders in all the districts repeatedly, where in people’s representatives from village level, self help groups, Aarogya mitras, Anganwadi workers, ANMs, Para medical staff and Medical Officers were made aware of the scheme by explaining the scheme followed by lectures in the local language by Specialist doctors to guide these people in identifying diseases. Workshops: Separate Workshops were held for the Government Hospital Doctors, Network Hospitals and network hospital Aarogya Mithras to apprise them of the scheme and online processing. †¢ Health Camps: All the network hospitals have to conduct at least one free health camp in identified rural areas to screen the BPL population. Further the hospitals will conduct Information, Education and Communication activities, including that of preve ntive measures and provide basic treatment facilities for the common ailments for other patients. These health camps are providing advanced screening and treatment of common ailments at the door step of the patient. 8. Patient friendly SLA’s: The processing time in the patient workflow has been considerably reduced and made real-time by integrated use of online workflow, toll free call centre and 24*7*365 working pattern of the Trust. The following are the response timings: ? Registration – Immediate ? Pre-authorization-Within 12 working Hours ? Call Center Response- Round the clock and Immediate ? Aarogya mithra Services- Round the clock Claim Settlement-Within 7 days of claim submission. 9. Better beneficiaries feedback Trust it is initiated beneficiary feedback system . As per the system a letter from the Chairman of the Trust is dispatched independently to the beneficiary enquiring about his present health status after he underwent treatment at network hospital with details of treatment plan approved and package amount sanctioned to the identified hospital. It w ill also have a self addressed (Trust) post paid inland letter with a request to answer queries about the services of various people (i. . Aarogya Mithras, hospital reception, staff, doctors, satisfaction about treatment and present status about his health after the treatment and finally suggestions to improve) All this communication is done in local language. Till date Trust received more than 70000 feedback letters hand written by beneficiaries (see patients feed back in the home page www. aarogyasri. org). This system is working as a strong social auditing mechanism. 10. Improvement in measurable indicators: Before the initiation of the scheme the people below poverty line were not having access to such services and were suffering silently or getting in to debt trap. Hence the benefit as indicated below which are reaching the beneficiaries can be taken as first time benefit. Refer to Diagram 2: 11. Changing Tertiary care profile: As the scheme progressed the pre-load of diseases is coming down, particularly in relation to the high end diseases in cardiology, neurosurgery, gynecology and obstetrics etc. the following table indicates the change in disease load of top three performers (category wise) of the 3 pilot districts where the scheme completed 3 years of implementation. Refer to Diagram 3 The above table indicates the perceptible reduction in disease reporting under the scheme from 3 pilot districts of Anantapur, Mahaboobnagar and Srikakulam. As is evident from the table above the disease reporting in procedures involving Cardiac and Cardiothoracic Surgeries, Neurosurgery, Gynecolog y and obstetrics which were introduced in April 2007 in the above districts are showing decreasing trends. This may be attributed to the decrease in pre-load which is contributed by procedures under the scheme such as valve replacement surgeries and congenital cardiac defects, SOLs in brain and chronic disorders in gynecology. 12. Changing Disease predominance: The scheme also brought in changes in the disease predominance and changes in the priorities of disease treatment as shown in the profile of 3 pilot districts depicted below. Refer to Attachment Diagram 4 The above diagram indicates the upward change in disease reporting of the cases pertaining to the specialties of Nephrology, Genito Urinary Surgery and ENT in the 3 pilot districts of the scheme. The upward reporting may be due to two factors. 1. The treatment procedures in specialties like ENT, Nephrology were introduced into the scheme only in July, 2008. Hence, still pre-load is contributing to the disease load. 2. The increase in Genitourinary may be due to extended coverage for more procedures from Dec, 2007 thus the pre-load is yet to have an impact on disease reporting. . This is a relative phenomenon as the disease load of procedures introduced in the beginning is declining. 13. Disease stabilizing: While above data indicates changing trends of disease predominance, diseases in number of other systems such as Cancer, Neurosurgery, and Pediatrics are getting stabilized as the scheme is progressing in the state as observed in the diagram shown below. Refer to Attachment Diagram 5 14. Simplified procedures: With the introduction of total web based online solution, the entire process starting from registration of the patient till his discharge from hospital and post discharge follow-up are all real time, transparent, fool proof and simplified to the end user. 15. Regulatory effect on Hospitals : The empanelment procedure, defined diagnostic and treatment protocols, capturing of admission notes, daily clinical notes, operation notes, discharge summary and uploading of diagnostic reports including films, webex recording of Angio and Laparoscopic procedures and other photographic evidences have profound regulatory effect on the hospitals. 6. Quality improvement in services: Continued monitoring of the services both online and in the field by the elaborated field mechanism coupled with disciplinary action against erring hospitals is greatly contributing to the quality of treatment under the scheme. 17. Establishing Medical Protocols tailor-made to local situations: Though laid down internati onal diagnostic and treatment protocols are available, the hospitals were not able to follow these protocols due to various reasons such as non-availability of infrastructure, affordability of the patients and lack of monitoring by authority. The scheme by taking into consideration of availability of local infrastructure and standard medical practices successfully redefined the medical protocols with the help of senior specialists in each field. 18. Employment Generation: The scheme generated indirect employment potential as the insurance company, network hospital and other stake holders have to employ number of people in different cadres such as Aarogya mithra, RAMCO, AAMCO, duty doctors, Para medical technicians, staff nurses etc. , 19. Health Awareness: Since implementation of the scheme 15,909 health camps held in rural areas not only screened 27, 82,303 people but also played key role in bringing health awareness among the population through IEC activity. Counseling by field staff and Para- medical staff is also contributing to the health awareness among rural poor. As pre-evaluation of the patient is also cashless under the scheme, the people are motivated to approach network hospitals as and when suspected of suffering from identified diseases. 20. Morbidity pool and Disease Mapping: As the entire patient data of people attending health camps, network hospital OP, in-patient treatment details and treatment details of the beneficiaries approved under the scheme are captured online, it created huge morbidity data of the population. 21. Early recognition and Disease Prevention: The IEC activity, health camps, counseling by field staff and awareness campaigns by Trust and district administration is helping in early recognition and disease prevention. 22. Changing Scenario in Government Hospitals: Hospitals from Govt. sector with requisite infrastructure are empanelled to provide services under the scheme. All the network hospitals from Govt. and Private hospitals thus empanelled are entitled to the same package amount on providing services. This is helping Govt. hospitals to earn much needed finances for improving infrastructure, provide quality care to the patients and improve the performance by recouping the deficient services through outsourcing and by providing incentives to the performing team. As on date 95 Govt. hospitals, 26 Tertiary care and specialty hospitals under the control of Director of Medical Education and 69 APVVP Hospitals (District Hospitals, Area Hospitals and CHCs) are empanelled under the scheme . Till 21. 01. 20