Domestic Production of Marijuana and the Implications of Legalization Essay Example

Domestic Production of Marijuana and the Implications of Legalization Paper Widespread marijuana production and use, and lately, the calls for its legalization have created a stir in recent years. As such, there are a lot of things we need to know in order to understand this issue. What is the current state of marijuana domestic production? Who are the players in the legalization issue and what are its implications? This paper posits that legalization is being pushed primarily by business wanting a share of the market which is currently dominated by illegal organizations and users who wish to ease the moral and legal restrictions on its use. As such legalization will increase domestic marijuana production. Overview of the Domestic Marijuana Production Current Domestic Marijuana Availability Canabis has earned its status as the most valuable cash crop today. In 2006 alone, the current gross value of the estimated 68. 1 million marijuana plants in the U. S. stood at $35. 8 billion, far exceeding the value of legal, essential crops such as wheat. Outdoor marijuana made up 82. 8% of total production with a corresponding value of $31. 7 billion. Indoor marijuana accounted for 5. 2% pegged at $4. 1 billion (Gettman, 2006). Weed is typically for local consumption but its export is also viable. The annual supply of domestically produced weed is estimated between 8. 7-21. 8 million kilograms, a manifold increase since the 80’s (Gettman, 2006). Marijuana growing has been found everywhere. However, Alabama, California, Florida, Hawaii, Kentucky, North Carolina, Oregon, Tennessee, Washington and West Virginia rank as the top ten producers (Gettman, 2006), despite intensive eradication operations by the DEA. Large-scale production outdoors is easy and inexpensive with minimal plant care. We will write a custom essay sample on Domestic Production of Marijuana and the Implications of Legalization specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Domestic Production of Marijuana and the Implications of Legalization specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Domestic Production of Marijuana and the Implications of Legalization specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Radical improvements in quality or potency have been achieved with advancements in technology such as the hydroponic system. As such, potency rates (measured in total plant THC content, the main mind-altering component) can now reach as high as 8. 77% from the 1. 5% average in the ‘70s (NDTA 2008). Local marijuana is expensive compared to other countries. According to one site, the average price for a quarter ounce of weed is $40 for low quality, $50 for medium quality and $80 for high quality and has remained steady for the past years (e-stoned. com). This proves that there is an established consumer base, proof that it is a very lucrative business and tax free too! Current Domestic Marijuana Consumption Among all the available illegal drugs, it is the most commonly used with consumers from all ages, genders, race and economic status (DEA website). However, use is most common among young people with its treatment as a recreational drug. There is no current government data on the actual number of marijuana users but the results of latest DHHS drug use survey show that there were 2. 1 million Americans, mostly minors, who used marijuana for the first time in 2006, a figure that has not changed dramatically since 2002 (NSDUH 2006). An estimate by one group using the current estimated supply and average consumption/user puts the number of American marijuana users at 15 million (NORML. com). This corresponds to 5% of the total population. The Global Youth Network also ranks the U. S. as one of the top 6 marijuana using countries in the world. Who Controls the Domestic Marijuana Production and Distribution? DEA 2008 reports show the involvement of drug trade organizations from Cuba and Asia in marijuana trafficking all over the country and they are now into indoor marijuana production as well, with expansions targeting the northern states. Mexican DTO’s, on the other hand are targeting outdoor marijuana production in the eastern states and marijuana smuggling in the border areas. Although there are freelance dealers who operate small-scale, widely commercial grade marijuana cultivation and sale, the wider, more systematic production and distribution targeting densely populated areas is controlled by drug-trade organizations. In addition, there is also a proliferation of internet pharmacies that offer marijuana (Scott hearing on the DEA’s Regulation of Medicine). Medical or Research Grade Marijuana Legal high potency Cannabis is used for FDA-approved studies or as prescription medicine. Medical marijuana is now legal in 13 states, permitting doctors to prescribe high-potency marijuana to increase the appetite of patients suffering from AIDS, alleviate pain or decrease the pressure in the eyes of glaucoma patients among others. Research grade marijuana cultivation is currently exclusive to the National Institute on Drug Abuse. Medical marijuana is produced only after acquisition of a license. In the case of California, which was the first state to legalize, patients/care providers are allowed possession of 6-12 plants or a maximum 8 ounces of dried marijuana (SB 420). Further, possession in excess of this is permissible if prescribed by a doctor. Counties and municipalities can also impose local ordinances that allow possession/cultivation beyond the limits set by state law. Further, the joint efforts at marijuana cultivation by patients/caregivers as well as marijuana dispensaries are also allowed (SB 420). The Legalization of Marijuana In 2001, the U. S. Supreme Court voted unanimously not to allow the use of medical marijuana and the drug remains in the DEA Schedule 1 (DrugFreeAmerica. com). However, states can adopt state-wide laws with regards to Canabis. Of the 13 states that legalized medical marijuana, 6 of them have further adopted decriminalization. There are 6 other states that decriminalized but did not legalize marijuana. Fourteen qualify â€Å"drug use in driving† as a criminal offense while 20 states issue marijuana tax stamps (NORML. com). Legalization efforts range from lobbying for the legal cultivation and use of marijuana for medical and research purposes to its commercial production and distribution alongside other substances like alcohol or tobacco. Subsequently, decriminalization aims to apply the individual freedom of choice and eliminate the penalties for marijuana-related offenses. Lobby work for federal legalization has resulted in H. R. 2592, initiatives and referendum polls in the various states. The Arguments for Legalization and Counterviews The primary arguments for legalization are 1. marijuana has medicinal properties, 2. marijuana will bring in more revenue and save taxes on the federal marijuana eradication drives, 3. marijuana is relatively harmless and 4. legalization will actually decrease marijuana use. That it does have medicinal properties for specific ailments is already proven by initial research and actual practice. That marijuana will contribute to state revenue along with cigarettes is also not debatable. An economist calculated that the state of California can put up $1 billion from taxing a joint for $1, up to $400 million retail sales taxes and save $156 million from law enforcement (CANORML. com). That the federal government has been largely unsuccessful in its well-funded marijuana eradication drives also holds true as indicated in various news reports. That marijuana legalization will actually decrease its use will depend on a lot of factors. It might lessen the number of first time users if we reason that alcohol consumption was at its peak when it was illegal. However, habitual users will continue to be a steady market. Finally, that marijuana is a safer alternative to harder drugs, alcohol or even coffee is relative. Federal government agencies and anti-legalization groups also argue that there are alternative drugs for the same that cause no â€Å"highs†. They also present the immediate and cumulative ill-effects of marijuana while the more liberal call for more extensive research on it for commercial, federally approved medical use. For people who put premium on their health, using marijuana or any other addictive substance for that matter might not be acceptable. The government’s main reasons for not budging on the issue besides citing the health effects of its use include the membership of the U. S. in international treaties banning marijuana (Scott hearing on DEA’s Regulation of Medicine). Some Proponents of Marijuana Legalization There are 2 prominent groups campaigning for legalization. The Marijuana Policy Project is the advocacy arm of the Multidisciplinary Association for Psychedelic Studies (MAPS. org), the first pharmaceutical company aiming to break NIDA’s monopoly over research grade marijuana by funding the construction of a medical marijuana production facility in the University of Massachusetts. This is the first step in a 5-year marijuana drug development study worth $5 million (MAPS. org). The National Organization for the Reform of Marijuana Laws, a non-profit public-interest advocacy group representing the interests of millions of responsible American marijuana smokers, started its advocacy way back in 1970. Working with the NORML Foundation, it currently has community/school chapters in 45 states and in 7 other countries. Active in lobby work and media campaign, it also provides legal assistance to people charged with marijuana offenses. It favors the Democrat campaign as it hopes to have a more favorable response to pro-legalization from Congress. Conclusion Marijuana’s promising medicinal values is a minefield for pharmaceutical companies which would explain their financial involvement in and all-out support for the pro-legalization advocacy. The equally promising possibility of being granted the right to choose to use marijuana without fear of being punished legally and morally anywhere in the country is motivation enough, given the vast number of users. Politicians will also be happy with more taxes and guaranteed votes. Legalization, especially at the federal level, will affect production by stimulating legal private enterprises involved in medical/research grade as well as commercial marijuana production. Canabis will become another profit commodity which does not need much effort in marketing with the intensive campaigning by pro-legalization groups that target recreational users and patients as well. However, the effect of legalization on illegal production remains to be speculated but it will surely lose a portion of the occasional users market to legal marijuana producers. Finally, the greatest challenge and burden will fall on parents and law-enforcement agencies in how they can successfully educate children to prevent future marijuana addiction. For one, legalization makes further access to marijuana a whole lot easier because unlike other drugs that are manufactured in laboratories, this is planted everywhere. References Clint. Marijuana Prices in the USA. Retrieved February 12, 2008 from http://www. e- stoned. com/rec/44-Marijuana-Prices-in-the-USA/ Economics of Canabis Legalization. Retrieved February 13, 2008 from http://www. norml. org/index. cfm? Group_ID=4421 Gettman, John. (2006). Marijuana Production in the United States (2006). Retrieved February 12, 2008 from The Bulletin of Cannabis Reform, http://www. drugscience. org/bcr/index. html National Drug Threat Assessment, 2008. (2007). Retrieved February 12, 2008 from http://149. 101. 1. 32/dea/concern/18862/2008. pdf National Survey on Drug Use and Health. (2006) Retrieved February 12, 2008 from http://www. oas. samhsa. gov/nsduh/2k6nsduh/2k6Results. pdf MAPS DEA Lawsuit. Retrieved from Multidisciplinary Association for Psychedelic Drugs, http://www. maps. org/mmj/DEAlawsuit. html#6 Marijuana Overview. Retrieved February 13, 2008 from the Drug Enforcement Agency, http://149. 101. 1. 32/dea/concern/marijuana. html Medical Excuse Marijuana. (2008) Retrieved from DrugFreeAmerica, http://www. dfaf. org/marijuana/excuse. php Putting a Value on Cannabis. (2008) Retrieved February 12, 2008 from National Organization for the Reform of Marijuana Laws, http://www. norml. org/index. cfm? Group_ID=4424 Results from the 2006 National Survey on Drug Use and Health. Retrieved February 13, 2008 from the Office of Applied Studies-SAMSA, http://www. oas. samhsa. gov/nhsda. htm Rep. Robert C. Scott Holds a Hearing on the Drug Enforcement Administrations Regulation of Medicine. Retrieved February 12, 2008 from http://www. maps. org/mmj/dealawsuit_congressional_hearing. html Senate Bill 420. Retrieved February 13, 2008 from http://www. albanyca. org/archive/pdf/022007_8_1_AttF. pdf

The impact of part-time work on the academic performance of international students in Glasgow. The WritePass Journal

The impact of part-time work on the academic performance of international students in Glasgow. Part 1: Introduction The impact of part-time work on the academic performance of international students in Glasgow. Part 1: IntroductionRationale:Objectives:Questions:Part 2: Literature ReviewPart 3: MethodsTimeline:Part 4: Ethical ConsiderationsPart 4: ReferencesRelated Part 1: Introduction Rationale: Some researchers (e.g. Steinberg Suzanne, 1993; Lee Ju, 2010) claim that part-time work experiences have negative effects on adolescent development, which are mainly study on the effect of their problem behaviors and school disengagement. Other research (Rochford et al, 2009: 601) also have found an inverse relationship between working time and course performance. However, there is little data relating to international students and it is still not clear enough how part-time works affect the students’ performance in their academic classes at school. This research will explore that how part-time work affects the international students in Glasgow on the scope of academic performance at college. In particular, this research will focus on the influence of different variables, such as the impacts from different kinds of part-time jobs, the impacts from different working hours per week, and so on. Such research would give insights into reasonable standards for international student s to choose part-time jobs, which could also provide useful data for the further researches in the relevant aspects. Objectives: 1. To explore the advantages for international students to have part-time jobs. 2. To explore the disadvantages for international students to have part-time jobs. 3. To examine the impacts on international students academic performance from different variables, such as different kinds of part-time jobs, different working hours per week, and so on. Questions: 1. What are the positive impacts of part-time work on the academic performance of international students in Glasgow? 2. What are the negative impacts of part-time work on the academic performance of international students in Glasgow? 3. What variables affect the impacts on international students academic performance? Part 2: Literature Review Many students have part-time jobs during their academic years. Both the positive and negative impacts on students course performance from their term-time works have presented by many researches. For instance, according to Rochford et al (2009), in the nursing subject, approximately 90% of students engaged in part-time jobs, 47% of them do part-time jobs with the purpose of financing their every day expenses, and almost 25% of students worked in more than one job. However, from these data, the research of Rochford et al found that there was only a slight negative result on students course performance caused by part-time work types. Except the types of part-time jobs, other factors in term-time jobs which could have an influence on students’ academic achievements also have been considered, for example, working hours (Rochford, Connolly, and Drennan, 2009: 601-609). According to Derous Ryan (2008), in the United States, 80% of students are employed during the school time, with 46% working over 20 hours per week. The result of investigation illustrated that undergraduates working hours were inversely related to students study motivation, study attitude, and academic achievement, the worst effects also appear when students worked excessively long hour (Derous Ryan, 2008:118-131). In addition, similar finding also have been discovered in other researches with more clear working-hour criterion, which show that students who work exceeded the standard of sixteen hours per week will more likely to have negative outcomes in their academic performance. (Sorenson Winn, 1993; Taylor Smith, 1997; Carney, 2000; Salamonson Andrew, 2006). However, some of the above research only choose the sample from a specific major (e.g. nursing subject in the research of Rochford et al), while others may merely survey in one area and unable to generalize the situation in other places. Though the results from them are valuable for future research in some extent, it did not consider much about the different impacts from students nationalities and background, also lack of information to gain a general conclude for other specific groups or places, for example, the group of international students in the city of Glasgow. On the other hand, Derous Ryan (2008) assert that part-time work also have advantages for students academic outcomes and preparation for the future career when the job relevant for students major and ran in a balanced way. Both students study attitudes and performance benefited more when working hours was combined with high autonomous motivation to perform the job, more specific, most positive effects would from the combination of low working hours and high job demands. Their research found plenty of information to illustrate the impact of employment and leisure activities on students study attitude and well-being, while fewer significant effects on the aspects of academic performance. Also, sample chosen there were psychology students, mostly white and female, therefore limit the general covering for other group of students. It can be seen that still further research is needed to expand the variety of samples in different places and nationalities of relevant study fields. This research will in some extend to fill this gap by mainly focus on the international students in Glasgow who have or used have part-time jobs during their academic year, and examine that whether different kinds of term-time jobs, different working hours per week and other variables would affect the international students academic performance. Both advantages and disadvantages would be given based on the collected data in order to provide suitable suggestions for international students to keep balance between work and study, and help the relevant education institutions making decisions on future policies. Part 3: Methods The purpose of this research is to find both the advantages and disadvantages for international students to enroll part-time works, and to examine the various impacts of part-time jobs on international students academic performance. Surveys will be chosen as the research strategy for this topic. One reason for choosing surveys is the restrictions of time. Only a few weeks will be given to collect relevant data, therefore, using surveys could more likely to gain sufficient data within the short-limited time compare to other research strategies (Saunders, Lewis Thornhill, 2009:144-145). Another reason is the monetary limitation, according to Saunders et al; surveys could allow the collection of data in a relatively economical way.  Ã‚   In addition, the choice of population for this research is all international students in Glasgow who have or used have part-time jobs during their academic years. According to Creswell (2007), 25 to 30 interviews will be a sufficient sample for a wide range of research questions. Therefore, data of this research will be collected from a non-probability sample of 30 international students at Glasgow University. The reason for using non-probability sampling technique is that lack of information to create the complete list of all international students in Glasgow. As a result, this research can not use probability technique to provide equal opportunity for each sample unit. More specifically, snowball sampling will be used as the consideration of the strain on time. Though snowball samples might be criticized as unrepresentative, for those researches which aim to study the behaviors in real society, such as this research do, snowball samples may produce better results than other sample methods ( Wright Stein, 2005: 495-500). For the methods of this research, both self-questionnaires and unstructured interviews will be used. Because this research can be defined as an explanatory research, and standardized questions in questionnaires will enable to examine the causal relationships between different variables   (Saunders, Lewis, Thornhill, 2009: 361-366). On the other hand, unstructured interviews will help to find the in-depth reasons behind these collected data and to seek new insight (Robson, 2002). Timeline: Week 1 Week 2: Preparing suitable questions for questionnaires; Week 3 Week 6: Collecting data; Week 7 Week 9: Data analyzing; Week 10 Week 11: Finishing the full research. Part 4: Ethical Considerations Firstly, this research will collect the answer of questionnaires from at least 30 participants, also may record five or more interviews. Therefore, in order to protect the participants rights and show full respect to them, every participant in this research will be informed complete information about research nature, purpose, and the use of research. In addition, all the participants have right to withdraw at any times. Secondly, for mitigating the participants worry of privacy information disclosure, all questionnaires for this research will be conducted anonymously and the responds will be destroyed after the research (British Educational Research Association, 2004:8-9). Thirdly, for non-malfeasance consideration, some pilot questionnaires will be tasted in a small group of people to check whether those questions will misunderstand participants or make interviewees under stress or feel anxious. Finally, the data analyzing of this research will objective and not aims on predict any suitable result (Saunders, Lewis Thornhill, 2009:199-200). Part 4: References BERA: British Educational Research Association. (2004). Revised Ethical Guidelines for Educational Research. Pp. 8-9. Carney, C. (2000). The Impact of Part-Time Employment on Student Health and Well-Being. A Report Commissioned by the Principal of the University of Glasgow, Glasgow. Creswell, J. (2007). Qualitative inquiry and Research Design: Choosing among Five Approaches (2nd edn). Thousand Oaks, CA: Sage. Derous, E. Ryan, A. M. (2008). When earning is beneficial for learning: The relation of employment and leisure activities to academic outcomes. Journal of Vocational Behavior, 73, pp. 118-131. Lee, M. Ju, E. (2010). Effects of part time work on adolescent development in Korea. Procedia Social and Behavioral Sciences, 2, pp. 3226 3230. Robson, C. (2002). Real World Research (2nd edn). Oxford: Blackwell. Rochford, C., Connolly, M., Drennan, J. (2009). Paid part-time employment and academic performance of undergraduate nursing students. Nurse Education Today, p.601. Salamonson, Y. Andrew, S. (2006). Academic performance in nursing students: Influence of part-time employment, age and ethnicity. Journal of Advanced Nursing, 55 (3), 342–349. Saunders, M., Lewis, P. Thornhill, A. (2009). Research Methods for Business Students. (5th ed.). Harlow: FT/Prentice Hall. Sorenson, L. Winn, S. (1993). Student loans: a case study. Higher Education Review, 25, pp. 48-65. Steinberg, L., Fegley, S. M. Dornbusch, S. M. (1993). Negative impact of part-time work on adolescent adjustment evidence from a longitudinal study. Developmental Psychology, 292, pp. 171 180. Taylor, P. Smith, N. (1997). The ‘Student Worker’: The Glasgow Evidence. Scottish Low Pay Unit: Glasgow. Wright, P. Stein, M. (2005). Snowball Sampling. Encyclopedia of Social Measurement. USA: Academic Press. pp. 495-500.

Print Ad Analysis Essay Example | Topics and Well Written Essays - 500 words - 2

Print Ad Analysis - Essay Example It became obvious that the drink corresponds to the character of this director- bold, outrageous, and manly so he served as literal symbol of the beverage and its most typical consumer. It is well known that consumers tend to associate themselves with those whom they see in the advertisement. Tarantino is therefore a cult figure for numerous cinema fans because he crated the image of the perfect gangster in a suit, and such life seems attractive to many. All in all, whisky is often perceived as the beverage for real men because it contains a high percentage of alcohol. So basically one can get drunk very fast with whisky that is why only those who know how to drink it right usually choose this beverage. Whisky is often served with ice and is drunk slowly in a company of good friends. Dewar`s hints with this advertisement that the beverage is for those men who value style and quality and who can choose the best in any situation. Whisky is also the type of beverage for which the age is important- the longer it is kept the better it is eventually. So Dewer`s teaches its consumers to appreciate not only status and quality but time as well. The message of the ad is clear: Tarantino is sitting in a dark room of some luxurious restaurant on a leather sofa drinking his glass of Dewar`s with ice. This image implies everything that most men probably want when they dream of status and money. The appearance of Quentin on the ad symbolizes that on this stage of recognition and success people do not need attention; they need their good old glass of whisky to savor life. The motto of the advertisement fits the overall mood â€Å"there are two types of people in this world, those who are planning to do something and those who do†. This slogan is some kind of a call for action for most men because action is the only possible way for achievement, and we, people living in the

Policing Functions Paper Essay Example | Topics and Well Written Essays - 750 words

Policing Functions Paper - Essay Example Commonly to gain many duties these standards/levels and organizations work together. Whilst every level of law enforcement has its personal obligations and methods, there functions have quality of comparison (Dempsey and Forst‎, 2011). The occupation of law enforcement officers are commonly for police officers who arrest the felons and investigate felony. One significant view is to settle the functions are the organizations/agencies of police. The structure of functions are enforcing the laws, seizing the offenders, obstruct the crime, at the time of need provide the service and maintain the peace. The government made enforcing the law sometimes comprises to arrest the criminals and maintain the peace in those results. It can help to maintain the peace in future by preventing the crimes. The main function of the agencies of police contain law enforcement, arresting criminals, stopping crime, maintain command and equipping other services to the citizens at the time of need. Most of these functions can tally with one another. Like a sample when enforcing the laws, to arrest the criminal by officers is a demand, hat is the results of maintaining the command. These functions successively help to stop the crime in future. The government of federal preserves different agencies of law enforcement with the aim of dealing with trouble spreading over lines of state and pretending territory of the country, if not the integrity of the United States. The agencies of federal law enforcement contain the FBI, Drug Enforcement Administration, Bureau of Alcohol, Tobacco, Firearms and Explosives, and Border Patrol. These agencies treat with problems like immigration, sales of drug and its importation, rule of weaponry and dangers to native security like terrorism. Agencies of federal law enforcement have competence on the agencies of local and state. The department of local police is the extremely usual

HSA 535 WK10 DB1 and DB2 Coursework Example | Topics and Well Written Essays - 500 words

HSA 535 WK10 DB1 and DB2 - Coursework Example Although the causes of the infant’s deaths from SID have not yet been established, there is clear need of creating awareness to the mothers. The young mothers need to ensure that they take care of the sleeping positions of the infants so that do not cause their deaths. Additionally, young mothers should be taught on how to talk care of their children, especially when they are sleeping on the baby cots, because that is where many infant deaths occur (Fowler et al., 2013). Therefore, to reduce the alarming rate of deaths caused by SID, mothers should be informed on the ways to lay their babies while they sleep the right food to eat while pregnant to avoid low birth weights and keeping the babies warm to avoid respiratory infections. Fowler, A. J., Evans, P. W., Etchegaray, J. M., Ottenbacher, A., & Arnold, C. (2013). Safe Sleep Practices and Sudden Infant Death Syndrome Risk Reduction NICU and Well-Baby Nursery Graduates. Clinical pediatrics, 52(11), 1044-1053. Your post was very informative and I agree with your point of view, because childhood obesity is not only a problem in Georgia, but also the whole of the United States. Lack of physical education in school and at home has contributed greatly to the increased number of children with obesity in Georgia. Therefore, making it important for the schools to change the nutrition program and increase physical activity to reduce the number of obese children. I agree with you on the focus of health services management should be and that is the on the health population they serve and not on the fiscal health of the institutions. This means we need a change of agents in the health care system in relation to aligning economic and social objectives to allow the improvement of population health. This course has been informative and there are various concepts that I have learned. First, there is need for creation of awareness in areas that are causing

2D Guidance in Minimally Invasive Procedures

2D Guidance in Minimally Invasive Procedures Research Strategy (a) SIGNIFICANCE: The use of two-dimensional (2D) Ultrasound (US) guidance in minimally invasive procedures such as percutaneous biopsies,1,2 pain management,3,4 abscess drainages,5 and radiofrequency ablation6 has gained popularity. These procedures all involve insertion of a needle towards a desired anatomical target. Image-guidance facilitates localization of the needle throughout the procedure, increasing accuracy, reliability and safety.7 US offers several advantages over other imaging modalities traditionally used in interventional radiology such as fluoroscopy, magnetic resonance imaging (MRI) and computed tomography (CT): It provides real-time visualization of the patients anatomy (including soft tissue and blood vessels) vis-à  -vis the needle, without exposure to ionizing radiation.8 Additionally, being portable and low cost (compared to other imaging modalities) are the added advantages of US imaging. Despite these advantages, the effectiveness of 2D US in needle guidance is highly operator dependent. In the in-plane approach, where needle shaft is parallel to the imaging plane, the needle shaft and tip should ideally be continually visible.9 However, aligning the needle shaft with the scan plane is difficult. Even when the needle is properly aligned, steep orientation (required in most procedures) of the needle with respect to the US beam causes nonaxial specular reflection of the US signal off the needle surface due to a large angle of incidence.10 In this imaging condition, the needle shaft will appear discontinuous and/or the tip will be invisible. This scenario is common with deep targets, for example during liver biopsies and epidural blocks. The challenge of needle visibility at increasing depths is compounded by attenuation of the US signal. Further, high intensity soft tissue artifacts, acoustic shadowing from dense structures such as bone and speckle noise obstruct needl e visibility. To recover needle visibility, clinicians conduct transducer manipulation by translation or rotation, movement of the needle to and fro (pump maneuver),11 stylet movement, needle rotation, and hydrolocation.12 These techniques are variable and subjective. An invisible needle can have detrimental effects on procedures, for example, reduced procedure efficacy, increase in procedure duration, neural, visceral or vascular injury, and infection. Diagnostic accuracy of 90-95% has been reported for US guided breast biopsies,13-15 and 83-95% for US guided liver biopsies.16 It is known that targeting errors due to insufficient needle tip visualization contribute to false negative results.17 In pain management, accidental intraneural injections have been reported in 17% of ultrasound-guided upper- and lower-extremity blocks, even when the procedures were conducted by expert anesthesiologists.18,19 Most of these arise because of poor needle tip localization, which makes it difficu lt to distinguish between subfascial, subepineural, or intrafascicular injections.20 In our ongoing work, we have developed an algorithm for needle enhancement and tip localization in 2D US. This, we achieved by modelling transmission of the US signal.21 We incorporated US signal modeling into an optimization problem to estimate an unknown signal transmission map, which was then used to enhance the needle shaft and tip while considering US specific signal propagation constraints.22 Automatic tip localization was achieved using spatially distributed image statistics limited to the trajectory region. However, incorrect tip localization occurred when high intensity soft tissue interfaces were present along the needle trajectory. The algorithm also required a visible portion of the shaft close to the transducer surface, necessitating proper alignment of the needle with the scan plane. We have also conducted preliminary work on needle detection and enhancement in three-dimensional (3D) US, a modality with potential to obviate the limitations of 2D US in needle guidance. Instead of the latters planar view (one slice at a time), 3D US displays volume data, allowing better visualization of anatomy and needle trajectory at all needle axis orientations. This alleviates the challenge of needle alignment in the scan plane.23 Nevertheless, needle obliquity at steep insertion angles, depth dependent attenuation, as well as acoustic shadowing, imaging artifacts and speckle remain.24,25 Needle visibility is also affected by low dimension of the needle with respect to the US volume. In fact, reported false-negative results for breast biopsies under 3D US show no improvement over those with 2D US.26,27. Consequently, 3D US has not replaced 2D US as the standard of care. To overcome the limitations, researchers have proposed computational methods for needle enhancement and local ization in 3D US. These include: Principal component analysis based on eigen-decomposition,28 the 3D Hough transform,29 the 3D Radon transform,30 parallel integration projection,31 and iterative model-fitting methods such as random sample consensus (RANSAC)32. The accuracy of these methods is affected by attenuation and high intensity artifacts. Besides, computational complexity arises from processing the large amount of volume data.33 Projection based methods fail when a good portion of the shaft is not visible and the tip intensity is low. A more robust needle localization framework based on oscillation of a stylus was recently proposed, although it fails in a single operator scenario, especially for shallow angles.34 All the mentioned methods are based on modeling B-mode image data. The current need, in interventional radiology for needle guidance, is a cost-effective, easy to use, non-radiation based real-time imaging platform with an ability of providing continuous guidance with high accuracy during needle insertion without intercepting the clinical workflow. Our long-term goal of developing a computational 3D US based imaging platform for enhancement and localization of needles is informed by this need. To address this pressing need, we hypothesize that automatic, real-time, accurate, and continuous target identification using 3D radiofrequency (RF) US data is feasible and potentially could be used to provide guidance during interventional radiology for needle insertion.Our preliminary work on modeling US signal transmission in 2D US, as well as needle detection and enhancement in 3D US, are strongly supportive that modeling the RF US signal coupled with advanced reconstruction methods will improve needle visualization and localization in 3D US. The envisaged 3D US reconstruction techniques will incorporate emerging work from machine learning and advanced beamforming to achieve needle enhancement and localization. We envision new pathways of processing and presenting US data, which should make this rich modality ubiquitous to all end-users for needle guidance in interventional radiology. The impact of the proposal will be multiplied since the developed algorithms, using open-source software platform, can also be incorporated as a stand-alone component into existing US imaging platforms. (b) INNOVATION: Previous work on needle enhancement has mostly been focused on enhancement of B-mode images. B-mode images are derived from RF data (the raw signal backscattered onto the US transducer) after several proprietary processing steps. The raw signal is known to contain more statistical information35 which is lost along the processing pipeline. Parallel integral projection in order improve needle visibility in soft tissues using 2D and 3D RF data has previously been investigated although no image visualization, needle enhancement or localization was demonstrated.36 It has been shown that the post-beamformed 2D RF signal allows for a more improved enhancement of local features in US images. 37,38 Image enhancement methods applied to RF signal have also shown to produce improved display of orientation of a biopsy needle.37,38 This study is innovative in three respects: 1) To the best of our knowledge, it is the first to investigate needle enhancement and localization from 3D pre-beamformed RF data (previous approaches were using post-beamformed RF information). 2) The utilization of machine learning approaches, such as deep learning for needle enhancement in 3D US will be a first. 3) Although this pilot will focus on validating the developed framework on pain management and liver biopsy procedures as a case study, the new mathematical and computational approaches proposed in this work will lead to developments that can easily be adopted for enhancement and localization of needles in other interventional radiology procedures. We expect that the achieved results will lead in gradual adoption of 3D US as the standard of care in problematic minimally invasive procedures where 2D US is challenged, thus improving therapeutic and diagnostic value, reducing morbidity and optimizing patient safety. (c) APPROACH: We propose to test the hypothesis that needle detection, enhancement and localization based on the raw 3D RF signal will provide a more accurate and robust platform for needle guidance than current state of the art. The basis for this hypothesis is found by precedent in the use of the RF signal for bone localization,39 and our published21,22 and unpublished work on needle enhancement and localization based on 2D/3D B-mode image data. This preliminary data is presented below. Preliminary work 1 Modeling 2D US signal transmission for Needle Shaft and Tip Enhancement When the US signal pulses are sent by the transducer into tissue, they undergo reflection, scattering, absorption and refraction. These phenomena all contribute to attenuation; the loss in intensity of the US pulses as they travel deeper into tissue. Attenuation is responsible for non-conspicuity of the needle tip and shaft at increasing depths. Previously, we have shown that modeling signal transmission in 2D US based on 2D image data, while considering depth-dependent attenuation leads to enhancement of the needle and more accurate tip localization.21 The modelling framework yields signal transmission maps, which are then used in an image-based contextual regularization process to achieve tip and shaft enhancement (Fig.1). A tip localization accuracy of mm was achieved in ex vivo tissue. However, the localization accuracy is lower when soft tissue interfaces are present along the needle trajectory, and when the needle is not properly aligned in the scan plane. In the context of th is proposal, our objective is to apply similar US signal modeling and contextual regularization, this time based on RF data. Preliminary work 2 Machine learning approaches for needle detection and enhancement in 3D US Since 3D US is multiplanar, the challenge associated with needle alignment in the scan plane is partially eliminated when it is used in needle guidance.   Nevertheless, 3D US is also affected by US signal attenuation. Previous methods proposed for needle enhancement and localization in 3D US did not address this need. In addition, most were computationally demanding because of the requirement to process the entire US volume. In this work (results submitted to 20th MICCAI conference, 2017), we have developed a learning-based method for automatic needle detection in 3D US volumes. The pixel-wise classifier generates a sub-volume containing only slices with needle information. In so doing, computational complexity on the subsequent enhancement and localization algorithms is reduced (Fig.2). The tip is automatically localized in 3D. We achieved 88% detection precision, 98% recall rate, a slice classification time of 0.06 seconds, a localization accuracy of mm, and a training time of 1 5 seconds. Figure 2. Learning based needle detection, enhancement and localization in 3D US. Top row: an example of needle detection. Here, the original volume contained 41 slices, and the classifier identified only 7 containing needle data. Bottom row: The enhancement process on the sub-volume. Left, enhanced intensity projection image. Middle, automatically localized tip (red) displayed on the relevant axial slice. The blue cross is the manually localized tip. Right, trajectory estimation indicated by the green line. Specific Aim 1. To develop RF-signal modeling algorithms for improved 3D US image reconstruction For this aim, we hypothesize that adaptive beamforming methods applied to pre-beamformed 3D RF data will enhance needle visibility and improve quality of US volumes. During the formation of an US image, the reflected US signals are received by the transducer elements at different time points due to varying signal travel distances. Beamforming on each scan line is meant to establish signal synchronism before aggregation. The conventional method of beamforming in both 2D and 3D US is delay and sum (DAS). Here, received signals are electronically delayed, followed by application of a beamformer whose weights are reliant on echo signals, leading to undesirable wide main-lobe and high side-lobe levels resulting in imaging artifacts, thus decreasing the image resolution and contrast. 40 In this architecture, the angular resolution is dependent on the length of the scan aperture and the fixed operating frequency.41 In a fixed hardware configuration, these parameters cannot be increased, hen ce resolution cannot be improved. To overcome this challenge, adaptive beamforming methods based on minimum variance42-45 and multi-beam covariance matrices46 have been proposed. Using adaptive beamformers signal detection can be maximized while minimizing the beam-width and side lobe artifacts.47,48 Recently, phase factor beamforming, where phase variations are tracked across the receive aperture domain, has been shown to improve the appearance of bone surfaces from 2D US data49. Bone features, similar to needle features, are hyper-echoic when imaged with US. Therefore, during this aim we will develop an adaptive phase-factor beamforming method in order to enhance the hyper-echoic targets such as the needle from 3D pre-beamformed RF data. Specifically, adaptive beamformer that combines ideas from Minimum Variance (MV) adaptive beamforming,50 signal regularization based on statistical information in RF data,51 and Toeplitz structure covariance matrices52 to minimize computational co mplexity will be investigated. It is expected that this reconstruction technique will adapt the data to the clinical application of needle enhancement through improving image resolution, contrast, and speckle suppression. The algorithms will be incorporated into an open source imaging platform for real-time data collection and processing.   Ã‚  Ã‚   Overall, we expect that the algorithms developed in Aim 1 will allow enhanced representation of US needle data with increased diagnostic value. The images obtained from this aim will be used as an input to the algorithms proposed in Aim2. Specific Aim 2. To develop methods for needle enhancement and tip localization in 3D US images Our working hypothesis for this aim is that learning based approaches for needle detection coupled with image reconstruction methods in 3D US will achieve improved needle enhancement and tip localization. In our previous work, we have shown that a linear learning based pixel classifier for needle data in 3D US, based on local phase based image projections, improves needle enhancement and reduces computational load.   The detector utilizes Histogram of Oriented Gradients (HOG)53 descriptors extracted from local phase projections and a linear support vector machine (SVM) baseline classifier. Recently, deep learning (convolutional neural network (CNN)) based image processing approaches have shown to produce very accurate results for segmentation of medical image data54. However, enhancement or segmentation of needles from US data using convolutional neural networks has not been investigated yet.   Therefore, for during this aim we will develop a needle enhancement and segmentation m ethod using convolutional neural networks. Needle images with various insertions angles and depths will be labeled by an expert radiologist. Our clinical collaborator Dr. Nosher and several radiologists from RWJMH will be involved during this labeling process. We will use two different datasets during the labeling process. The first data set will be retrospective US images downloaded from the Robert Wood Johnson Medical Hospital (RWJMH) database. Specific focus will be given to liver biopsy and epidural management procedures where US has been used to guide the needle insertion and biopsy procedure. The second data set will involve collecting needle US scans using ex vivo tissue samples as the imaging medium. These scans will be collected at the PIs laboratory using an open source platform US machine with 3D imaging capabilities. The collected ex vivo data will be enhanced using the beamforming methods developed in Aim 1.   Labeling process will involve manual identification of the needle tip and shaft from the two datasets. A fully convolutional neural network54 will be trained using the labeled data. The architecture of this network does not require extensive data sets in order to train the network and yields high segmentation results. Previously this approach was used for segmenting cell structures54. The output of this operation, which will be a fuzzy 3D probability map (high probability regions corresponding to needle interface), will be used as an input to our previously developed needle tip localization method. The automatically identified needle tips will be compared against the manually identified needle tips. More details about the specific clinical data collection and validation are provided in Specific Aim 3 and Protection of Human Subjects. Overall, at the end of Aim 2 we expect to have a system providing continuous real-time monitoring of needle insertion using 3D US for improved guidance in interventional radiology procedures. Specific Aim 3. To validate the developed imaging platform on clinical data To validate the algorithms developed in Aims 1-2, we plan to perform extensive validation on ex vivo and clinical data. No clinical trial will be conducted during this proposal. Our initial validation will be limited to epidural administration and liver biopsy procedures. Ex vivo data: This study will be conducted for validating Aims 1-2. US scans will be collected from two different needles: 1-) A general 17-gauge Tuohy epidural needle (Arrow International,Reading, PA, USA),   and 2-) 18-gauge biopince full core liver biopsy needle (Argon Medical devices, Athens, Texas, USA). The needles will be inserted at varying insertion angles (300−700) and depths (up to 12 cm). Ex vivo porcine, bovine, liver, kidney and chicken tissue samples will be used as the imaging medium. 3Dpre-beamformed RF data will be collected using a SonixTouch US system (Analogic Corporation, Peabody, MA, USA) equipped with the 3D phased array transducer. The US machine, provides an open-source research interface allowing for custom-made applications directly run on the machine, and the 3D transducers. The image resolution for different depth settings will vary from 0.1mm to 0.3mm. In total, we will collect 300 different 3D US scans for each tissue sample (making the total n umber equal to 1500 3D US scans). The collected scans will be enhanced using algorithms developed in Aim1. From the enhanced data, our clinical collaborators will manually identify the needle tips. Three different radiologist, with varying expertise, will be involved during the validation process in order to calculate the inter-user variability error. We will also ask the same users to repeat the needle tip identification process after two weeks to assess the intra-user variability error. The labeled data will be used in order to train the CNN proposed in Aim2. For testing the CNN algorithm, we will collect additional new 500 US scans. The manually identified needle tip locations, from the new dataset, will be compared to the automatically extracted needle tip locations obtained from the algorithms developed in Aims1-2. Euclidean distance error between the two tip locations (manual vs automated) will be calculated for quantitative validation. Clinical data: This study will involve collection of retrospective US data from patients who are enrolled for a liver biopsy or epidural administration as part of their standard of care. Women and minorities will be appropriately represented in the recruited patients. Sex or race will not play a role as an inclusion or exclusion criteria. Specific focus will be given to patients who are 21 years and older and require a liver biopsy or epidural administration. All the US data and the patient information (age, sex, height, weight, and laboratory data) will be assigned a non-identifying alpha-numeric code that will ensure that the risk of re-identification of participants from the acquired data is not possible. Additional information is included in the Protection of Human Subjects. In total, we will collect 1600 different US scans, from 400 patients. For labeling (manual tip and needle shaft localization) in order to train the CNN method developed in Aim2 we will use 1200 scans. During testing, 400 US scans, not part of the training dataset, will be used. Again expert radiologist will be involved during labeling and testing procedures for tip and shaft identification. Error calculations will involve calculating Euclidean distance between the two tip locations (manual vs automated).

Elderly Abuse: Nursing Home Abuse and Neglect Essays -- Nursing Homes,

I. INTRODUCTION Of nursing home staff interviewed in 2004, nearly 40% admitted to committing at least one psychologically abusive act toward a resident and 10% admitted to physically abusing a resident in the preceding year.[1] Not only are nursing home residents at risk of being abused by their caretakers but they are also at risk of being restrained, which may lead to a form of abuse. With five percent of the elderly population, or one to two million instances of elder abuse occurring yearly there is no doubt that elder abuse deserves serious consideration.[2] Upon growing older there are many decisions to be made. Among one of the most difficult and perhaps most important decisions is where the elder person will live and how long-term care needs will be met when he/she is no longer capable of doing so independently due to the incapacity that accompanies many with old age. Nursing homes seem to be the popular choice for people no matter the race, gender, or socioeconomic status with 1.5 million Americans being admitted to them yearly.[3] Because nursing homes are in such a high demand and are not cheap, $77.9 billion was spent for nursing home care in the United States in 2010 alone, they are under criticism of many professions including the legal profession, which is in the process of establishing elder law as a defense to issues with in the elder community. Nursing homes have a duty to provide many things to the elderly including medical, social, pharmaceutical, and dietary services so that the individual may maintain the highest wel l-being possible.[4] Stated another way 'a nursing facility must care for its residents in such a manner and in such an environment as will promote maintenance or enhancement of the q... ...dling abuse- does the person know this procedure and is the policy well accessible? 9) Talking to other resident or families of residents- are they happy? What do they think of they facility and employees? 10) Ask for a list of activities, including community activities, the residents are able to participate in- are they on grounds or off grounds? Will they accommodate the residents? ability? Though this checklist is not all encompassing it provides simple guidelines a person can easily look to in order to put his/her mind more at ease and feel secure in placing a loved one in a nursing home facility. Because there is no guarantee against elder abuse occurring in nursing homes it is important that the resident, where possible, and the family of the resident remain involved on a daily basis and demand the quality of care the elder person deserves. Elderly Abuse: Nursing Home Abuse and Neglect Essays -- Nursing Homes, I. INTRODUCTION Of nursing home staff interviewed in 2004, nearly 40% admitted to committing at least one psychologically abusive act toward a resident and 10% admitted to physically abusing a resident in the preceding year.[1] Not only are nursing home residents at risk of being abused by their caretakers but they are also at risk of being restrained, which may lead to a form of abuse. With five percent of the elderly population, or one to two million instances of elder abuse occurring yearly there is no doubt that elder abuse deserves serious consideration.[2] Upon growing older there are many decisions to be made. Among one of the most difficult and perhaps most important decisions is where the elder person will live and how long-term care needs will be met when he/she is no longer capable of doing so independently due to the incapacity that accompanies many with old age. Nursing homes seem to be the popular choice for people no matter the race, gender, or socioeconomic status with 1.5 million Americans being admitted to them yearly.[3] Because nursing homes are in such a high demand and are not cheap, $77.9 billion was spent for nursing home care in the United States in 2010 alone, they are under criticism of many professions including the legal profession, which is in the process of establishing elder law as a defense to issues with in the elder community. Nursing homes have a duty to provide many things to the elderly including medical, social, pharmaceutical, and dietary services so that the individual may maintain the highest wel l-being possible.[4] Stated another way 'a nursing facility must care for its residents in such a manner and in such an environment as will promote maintenance or enhancement of the q... ...dling abuse- does the person know this procedure and is the policy well accessible? 9) Talking to other resident or families of residents- are they happy? What do they think of they facility and employees? 10) Ask for a list of activities, including community activities, the residents are able to participate in- are they on grounds or off grounds? Will they accommodate the residents? ability? Though this checklist is not all encompassing it provides simple guidelines a person can easily look to in order to put his/her mind more at ease and feel secure in placing a loved one in a nursing home facility. Because there is no guarantee against elder abuse occurring in nursing homes it is important that the resident, where possible, and the family of the resident remain involved on a daily basis and demand the quality of care the elder person deserves.