Applying People CMM to Your Organization-Part 2 Essay

Applying People CMM to Your Organization-Part 2 - Essay Example Each defined goal has peculiar practices that explain the activities anticipated to result in attainment of the goal. Toyota, for example, its specific aims of the project planning course involve setting up estimates, obtaining commitment to the plan, and developing a project plan. The exact practices associated with â€Å"establishing approximate† goals involves estimating the extent of the project, coming up with estimates of project characteristics, outlining the project life cycle, and establishing estimates of cost and effort. The process areas portray behavior that are exhibited at Toyota, practices are interpreted using in-depth understanding of the model, the Toyota’s organization, its business environment, and any other specific conditions considered. Generic goals refer to all Toyota’s process areas. Accomplishment from each goal in a process area shows whether the institutionalization and implementation of each process area is impressive, lasting, and repeatable. Each generic goal is linked to generic practices. Toyota’s generic goal is to â€Å"run a quantitatively managed process†; this is achieved through two generic practices, â€Å"stabilizing sub-process performance† and â€Å"establishing quality objectives.† Toyota’s capable process is outlined, practiced, documented, supported, controlled, maintained, validated, measured, and can be improved. Furthermore, the model allows both explanation (interpretation) and partial changes (modifications) needed to satisfy Toyota’s size and business objectives. People CMM at Toyota have been made in two representations, staged and continuous. These representations avail alternative way of process improvement. These representations have essential content that are identical, but are organized differently. The Toyota’s continuous representation foundation is based on ability within specific process area—the limits of anticipated results that can be obtained by applying a process.

A Complete Specification of the Asymptotic Variance Assignment

A Complete Specification of the Asymptotic Variance - Assignment Example The le contains 6,808 observations for individuals living in Ontario. b) Estimate two human capital earnings models, one for men and one for women. Use wage as the dependent variable and include exp, exp2, Educ, not grad, hs grad somepse, uni1, uni2, and marras independent variables. Discuss the goodness of the of the two equations. From the regression table, we observe that the F-computed is 257.6> 1.88260439 (F-critical), we thus reject the null hypothesis that all regression coefficients are equal to zero. This shows that F-test is significant indicating that the observed R-squared is reliable, and is not a spurious result of oddities in the data set. Also, it shows that the proposed relationship between the response variable and the set of predictors is statistically reliable, and can be useful when the research objective is either prediction or explanation. From the regression table, we observe that the F-computed is 356.47> 1.88266598 (F-critical), we thus reject the null hypothesis that all regression coefficients are equal to zero. This shows that F-test is significant indicating that the observed R-squared is reliable, and is not a spurious result of oddities in the data set. Also, it shows that the proposed relationship between the response variable and the set of predictors is statistically reliable, and can be useful when the research objective is either prediction or explanation. c) Interpret the results of the test of overall significance for each equation. Do not forget to state the decision rule for the test, the level of significance you are using, and the critical value of the test statistic. The p-value for the overall model is 0.0000, a value less than 5%, we thus reject the null hypothesis. The null hypothesis states that the coefficient is equal to zero (no effect). We, therefore, conclude that the model is appropriate and that there is the significant effect on the dependent variable (sewage) by the independent variables.  

Menu Driven Interface Essay Example | Topics and Well Written Essays - 1000 words

Menu Driven Interface - Essay Example Menu in Graphical User Interface plays an imperative for human interaction with the computers. Menu driven interfaces facilitate the users by providing a catalogue of options for selection to navigate from one page to another. Several strategies and approaches have been developed to create or select menu for the user interface of the computer application. And one of the strategies for the development of menu-driven interface is recognized as user dialog. In user dialog strategy, the control of the computer application is transferred back and forth between the computer application and the user. The user passes a command to the computer application by selecting a menu item and the computer application respond by executing the command. Usually, the related menu items of the computer application’s user interface are categorized into the groups that can be displayed in the dialogue boxes. This approach facilitates the users to search and navigate to the pages of the computer applic ation (Senn, 2009). Importance / Popularity of Menu Driven Interface There are various reasons for the popularity of the menu driven interfaces and most of the imperative reasons is the high level of usability. The users do not require remembering the commands for using the software application efficiently; therefore, the users can effectively utilize the computer application easily. Furthermore, the menu driven graphical user interface is suitable for even the novice computer for not generating the errors, as they do not require typing the commands. The effort required for utilizing the GUI application is much reduced as compared to the command line interface, hence, it can be stated that the productivity of the users is increased. Above all, a user guide is available to facilitate and help the users to successfully employ the application and achieve the required objectives of the computer application deployment. The menu driven interfaces are becoming more popular even in modern computing age because of their appealing features. The menu driven inte rface is not only beneficial for the users or clients, however, the software development companies also find it advantageous as they do not require developing the menu again and again. The software components are developed once and reused to development cost and time. Moreover, comparatively less training is required to use the computer system; therefore, the software companies can save the cost of extensive trainings. Hence, keeping in view the facts, it has been identified that the graphical user interface having menus has made the human computer interaction simpler and easier (Norman, 1991). Strategies of Menu Driven Interface So far diverse categorizations of the menu driven interfaces have been developed, however, mainly the menu driven interface can be categorized into three (3) major strategies include: the full screen menus, the bar and pull down menus and pop-up menus. These different strategies can be used to make menu driven interfaces visually more appealing as well as u ser friendly. The full screen menus usually represented on the entire screen of the computer application and the user selects the options given on the screen. The Pop-up menus (may also be called as user dialogue) are presented in the boxes with a list of

Cross-Culture Management - the Breakdown of Industrial Relations at HM Term Paper

Cross-Culture Management - the Breakdown of Industrial Relations at HMSI and HRM Strategy - Term Paper Example This outcome resulted due to the malfunction of both management as well as the workers. The ultimate effect was on the breakdown of the Industrial Relations. The failure of the company stemmed from a breakdown of strategic sustenance. The environment on the shop floor was made harsh by the behaviour of the top executives. For instance, the VP from Japan kicked off a worker in his leg, another worker was not allowed to go to the toilet. These instances show the failure of following the HR strategies which was to have respect for each worker stemmed from equality, trust and initiative. The strategy was to avoid partiality on workers but the scenario was formed as such that it violated the norms of this strategy (Saini, â€Å"People Management Fiasco in Honda Motorcycles and Scooters India Ltd.†). Among the three joys that the company provided, the most important one was the joy of producing high-quality products. Along with these joys, an extension was made to its mission and that was the joy of creating which was to help workers obtain happiness in their daily work. Somewhere justice was not provided to the workers due to the prevalence of cross-cultural issues (Saini, â€Å"People Management Fiasco in Honda Motorcycles and Scooters India Ltd.†). Management of the above cross-cultural issues is essential to a firm’s success but the most important trait of an organizational success is the communication portrayed at the right time in the right form. The communication approach leads to a reduction of trade union violence within the  companies.  

Role of Values Based Education in Personal and Professional Life Essay

Role of Values Based Education in Personal and Professional Life - Essay Example The first pillar committed to academic advancement not merely implores the students to gain knowledge, but rather nudges them to evaluate the imbibed knowledge in the laboratory of critical thinking and analytical evaluation. Mere knowledge makes a well informed person, but, approaching knowledge with a critical bent of mind makes a creative and original personality. At Grand Canyon University, the learning styles resorted to are such that they push a student to extend one’s intellect and ingenuity to its limits, thereby shattering all preconceived notions and challenging the inherent biases, prejudices and myths. The outcome of such an approach appears in the form of students who possess an open and inquisitive attitude towards life, resting securely on dependable and time-tested spiritual and moral foundations. Grand Canyon University encourages its students to develop a personality that is just the right blend of grass root practicality and an essentially Christian vision. The second pillar that is Christian camaraderie not only intends to facilitate an interactive and friendly mindset towards society, but also gauds the students to evaluate people not merely on the basis of worthless superficialities, but rather on the criteria of shared values and morals that are quintessentially Christian, yet at the same time, timeless and universal. The modern times defined by a fast paced life and the necessity to make quick decisions require professionals to adhere to a reliable system for understanding people. Isn’t it really great that the young people come to terms with this system while acquiring education, when they could test it in an emphatic and informed environment? Extracurricular activities constitute the third pillar of this hub of knowledge and learning. Really, life is not merely about practice and contemplation, but has as much to do with healthy recreation and a positive sense of humor. One comes across several instances in the New Testam ent when Jesus is shown as playing with children and resorting to good natured bantering with apostles and common people (Sheen, 1977). Extracurricular activities at GCU not only give the students a chance to recharge their batteries, but to many they offer an honorable and satisfying career in professional sports. The fourth pillar of GCU is committed to health and spiritual well being. A healthy body is the repository of a sound mind and an enlightened spirit.

The Ethical Treatment of Animals Essay Example for Free

The Ethical Treatment of Animals Essay Utilitarianism values equality of all interest parties. It is on the principle that when making a decision, thorough consideration on the consequent cost and benefit must be made, and it is on the basis of impartial consideration of all related interest parties that the final decision should be made. Rights-based ethics, however, value the right of individuals. It is more like individualism. It is on the principle that when making a decision, whether the right of individuals or groups will be upheld or violated should be evaluated, and it is on the basis of the benefit maximization of certain individuals or groups that the final decision should be made. The major conflict between utilitarian and rights-based moral reasoning lies in the conflict between the right of one party and the whole party. Utilitarian accepts and sometimes requires the sacrifice of the right of one individual or a small group for the well being of a bigger group. This is absolutely an absurd decision in rights-based moral reasoning. For example, in the spelunking case, a utilitarian would detonate the dynamite to save 19 lives at the sacrifice of the one stuck in the hole, while the decision made on rights-based moral reasoning will be not to detonate the dynamite. This is because according to utilitarianism the benefit of detonating the dynamite is way too higher than the cost, while in rights-based moral reasoning by detonating the dynamite the right of the one who got stuck will be violated. In my opinion, the â€Å"crime† of killing fighting dogs is acceptable in right-based moral reasoning but is unacceptable in Utilitarianism. According to the utilitarian moral reasoning, the sacrifice of the interest of a smaller group is acceptable for the good of a bigger group. However, in this case, if dogs count as one group, the sacrifice of the poorly performing dogs is no necessary requirement of the survival of other fighting dogs, nor of the livelihood of any human group. If they do not count as one group , the people who love dogs must count, the behavior of killing dogs would hurt their feelings, so when impartial consideration of all related interest parties is made, the cost of letting these dogs live must be less than the benefit. Therefore, the behavior of killing dogs is against the Utilitarianism values. Rights-based ethics, nevertheless, defends the right of any individual or group, and the  duty is not taken into consideration. Just like the defender’s said, the dogs are Vick’s property, and he can do what he like to them, despite the fact that he also has the duty to take good care of them. Even though there is no doubt the right to live is one of the most fundamental rights of any creature, the right-based moral reasoning are for the right of human, dogs, sadly, are not included. So when this right-based moral system is at work, any kind of disposal of one’s property is acceptable. That is why I say the â€Å"crime† of Vick the â€Å"crime† of killing fighting dogs is acceptable in right-based moral reasoning but is unacceptable in Utilitarianism.

Cutaneous Tuberculosis Disease: Challenges of Treatment

Cutaneous Tuberculosis Disease: Challenges of Treatment CHAPTER -1 CUTANEOUS TUBERCULOSIS INTRODUCTION: In this innovative world while progress in medicine has helped up to deal with many diseases Tuberculosis and Cutaneous Tuberculosis is still a challenge for doctors. A resurgence of Cutaneous Tuberculosis in areas of high HIV incidence, drug resistant present in patients with pulmonary tuberculosis and in immunosupressed patients are the main challenges for clinicians. (6) Cutaneous TB is caused by Mycobacterium tuberculosis, Mycobacterium bovis, Bacillus Calmette-Guerin (BCG) vaccinations and the Tuberculids whose pathogenesis is poorly understood. Cutaneous TB is very variable in its clinical presentation, significance prognosis. Factors which effect on variability are: The pathogenesity of the organism involved. The Previous treatment given. The Immune status of the patients which can be related to the presence of Acquired Immunodeficiency Syndrome (AIDS) or Immunosuppressive therapy. The Port of infection. Any Local factors like, the recent Trauma, the lymphatic drainage, the vascularity of area and the proximity to lymph nodes). PREVALANCE: Thirty years ago it was assumed world wide that tuberculosis would be eradicated in the developed countries, as its incidence increased only on by average 6 % in the United States and 10% in Europe between the years 1953 and 1985. However, in 1983 tuberculosis was declared a global emergency by the world Health Organization because of a sharp increase in incidence. (9) Among infectious diseases, Tuberculosis is an important cause of death. Tuberculosis was responsible for 6% of deaths worldwide. Global prevalence of TB currently is greater than 32%. More than 50% of new patient occurrences were in 5 Asian countries, i.e. India (largest worldwide patient load), China, Indonesia, Bangladesh, and Pakistan(ref ?) The current global burden of Tuberculosis is mind boggling. In 1997, the incidence of new Tuberculosis patients approached 8 million in addition to more than 16 million patients already diagnosed. Around 2 million people died of Tuberculosis in 1997 with a global fatality rate of 23%, fatality rates exceed 50% in some African countries in which there is a high HIV incidence. Approximately 8% of tuberculosis patients are HIV infected. (2) Prevalence of tuberculosis infection in 1985, 1995 and 2005 (10) Prevalence of tuberculosis has increased between 1985 and 2005.According to the World Health Organization case reports statistics, in 1985 there were around 3 million patients of tuberculosis of all types with the highest no of cases in Asia and Africa. In Asia the highest numbers of cases were in India, Pakistan, China, Philippines, Bangladesh, Afghanistan and Vietnam. In Africa the highest number of case were in Ethiopia, Nigeria, South Africa, Congo, Morocco and Tanzania. (10) During the last two decades the number of cases increased all over the world. In 1995 the total number of cases increased to 4.6 million and in 2005 to 7.5 million worldwide. In Asia in 2005 the highest numbers of cases were in India, China Pakistan. In Africa in 2005 the highest numbers of cases were in South Africa, Ethiopia Congo. (10) There is an increasing rate of tuberculosis in the developing countries is approximately 500/100,000/y. Great alarm has been the progressive increase in numbers of strains of tuberculosis that are resistant to antibiotics. Since 1984, that incidence of extra pulmonary tuberculosis has increased at even faster rate than that of pulmonary tuberculosis and is considered to be a diagnostic criterion in the case definition for AIDS. Because immunocompromised individual are at increased risk of extra pulmonary tuberculosis, so dermatologist are renewing their historic role in the diagnosis of cutaneous lesions of tuberculosis. (11) EPIDEMIOLOGY: Epidemiological analysis is used to detect the changing trends in the incidence and prevalence of mycobacterial disease in the community. The main objectives of these methods are to determine the natural behavior of disease and factors which affect his behavior and to calculate future trend if possible to help in the design of any control measures and to assess the usefulness of these measure.(8) Even though 1 of 3 individuals on this planet is infected with tubercle bacillus, the incidence of Cutaneous TB appears low. In areas such as India or China where TB prevalence is high, cutaneous manifestations of TB (overt infection or Tuberculids) are found in less than 0.1% of persons seen in dermatology clinics. The frequency of patients with Cutaneous Tuberculosis seen between 1980 and 1993 in a hospital dermatology clinic in Madrid was 16 per 10,304 which was 0.14%. In a ten year retrospective survey of patients seen in governmental dermatology clinics in Hong Kong between 1983 and 1992, the detected incidence of Cutaneous Tuberculosis among patients was 179 per 267,089 which was 0.07%. Among patients with Cutaneous Tuberculosis only15% had classic Cutaneous Tuberculosis and 85% had tuberculids. In that classical cutaneous tuberculosis approximately 5% had lupus vulgaris, 5% had Tuberculosis Verrucosa cutis and 5% had scrofuloderma. (2) In a tertiary-care hospital in northern India, 0.1% of dermatology patients seen between 1975 and 1995 had Cutaneous Tuberculosis. Lupus vulgaris was the most common manifestation around 55%, followed by scrofuloderma 27%, TB Verrucosa cutis 6%, tuberculous gumma 5%, and tuberculids occurred in 7%. (2) FREQUENCY: USA: In the United States, tuberculosis cases decreased from 84,304 cases in 1953, when national reporting was first began, to 22,201 in 1985.   This represented fairly steady decline of about 5.8% per year. However, the turn down in tuberculosis cases stopped in between 1985 and 1992. In 1992 the annual number of cases increased by 20% to 26,673 cases. (12) The increases were concentrated geographically in several states, with over 90% of the 14,871 cases in California, Florida, New Jersey, New York, and Texas and demographically tuberculosis occurred in racial and ethnic minorities, in people aged 25 to 44, males and in those born abroad. Especially troubling, and indicative of increasing transmission of new infections, was a 36% increase in tuberculosis among children 4 years old or younger. Tuberculosis appears to be on the decline again in the United States as numbers with only 14,871 cases in 2003. (12) Reported tuberculosis cases in United States, 1982-2002 (12) The percentage of Tuberculosis patients who were born abroad individuals was 42%. People born in Mexico, the Philippines, and Vietnam account for one half of born abroad Tuberculosis patients in the United States. The Tuberculosis rate among born abroad people was 4 to 6 times higher than for US-born peoples. Minimum estimates of the proportion of TB patients with coincident HIV infection were approximately 10-15%. Among people aged 25-44 years, this proportion increased to 20-30%. (12) The fundamental origin of this new Tuberculosis epidemic in troubled states reflects a minimum of four major factors including (1) the involvement of Tuberculosis with the HIV epidemic, (2) the increased migration from countries where Tuberculosis is common, (3) the spread of Tuberculosis in congested settings (health-care facilities, prisons, homeless shelters), and (4) the worsening of the basic health-care infrastructure. (2) Molecular typing of Mycobacterium tuberculosis isolates in the United States in a restriction fragment-length polymorphism study suggests more than one third of new patient incidence results from people-to-people transmission, and the remainder result from reactivation of latent infection. Approximately 1 of 13 Mycobacterium tuberculosis isolates currently shows a form of drug resistance. (2) The modern introduction of biological agents that block tumor necrosis factor-alpha in the treatment of rheumatoid arthritis, psoriasis, and several other autoimmune disorders has additional raised about the necessity of the identification of patients with latent Tuberculosis. At present, several hundred cases of Tuberculosis have been reported in patients who receive these tumor necrosis factor-alpha antagonists. (2) HISTORY: Tuberculosis has an ancestry which can be traced to the earliest history of mankind. It was recognized as a contagious disease by the time of Hippocrates and Aristotle in 350 BC. Signs of skeletal Tuberculosis were identified in Europe since Neolithic times and in ancient Egypt around 3700 BC in mummified bodies. Evidence of TB appears in Biblical scripture, in Chinese literature dating back to around 4000 BC, and in religious books in India around 2000 BC. (5) During1600s and 1800s tuberculosis was known ass the Great White Plague in Europe.   Other names for Tuberculosis were Phthisis which was from Greek term phthinein, meaning to waste away, scrofula which were used for swellings of the lymph nodes of the neck and consumption which were used as progressive wasting away of the body.(2) In 1826 Laennec first reported cutaneous tuberculosis which he called PROSECTOR WART. Following Laennec, Rokitansky and Virchow described the histological features in detail comparing them to those of visceral tuberculosis. (6) The Incidence of TB increased with population density and urban development so that by the Industrial Revolution in Europe in 1750, it was responsible for more than 25% of adult deaths. Indeed, in the early 20th century, TB was the leading cause of death in the United States. In 1882, a German biologist ROBERT KOCH presented his discovery of the organism that caused TB. NEIL FINSEN won the Nobel Prize in Medicine in 1903 for introducing UV light into the treatment of skin TB. (2) With the help of better living conditions and the introduction of the antibiotic streptomycin on 20th November 1944, the number of reported TB patients in the United States steadily declined around 126,000 TB patients in 1944, 84,000 in 1953, 22,000 in 1984, and 14,000 in 2004.(2) MODE OF TRANSMISSION: Tuberculosis is an airborne contagious disease that occurs after inhalation of infectious droplets expelled from patients with laryngeal or pulmonary Tuberculosis during coughing, sneezing, or speaking. Each cough can generate more than 3000 infectious droplets. Droplets are so small around 1 to 5 micro meter, that they remain airborne for hours. (2) The likelihood that disease transmission will occur depends upon the infectiousness of the tuberculous patient, the environment in which exposure takes place, and the duration of exposure. Roughly 20% of people in the infected household contact develop infection. Micro epidemics have occurred in closed environments such as transcontinental flights and submarines. Tuberculin sensitivity develops 2 to 10 weeks after infection and usually is lifetime. (2) Because Tuberculosis induces a powerful immune response, individuals with positive tuberculin reactions are at a considerably lower risk of acquiring new tuberculous infection. In HIV-infected individuals, active Tuberculosis is more likely to occur from reactivation of existing disease than from superinfection with a new mycobacterial strain. (2) Without treatment, an estimated 10% lifetimes possibility exists of developing active disease after tuberculous infection, 5% occurs within the first 2 years and 5% thereafter. An Increased risk of acquiring active disease occurs during HIV infection, Intravenous drug abuse, diabetes mellitus, silicosis, immunosuppressive therapy, cancer of the head and neck, hematological malignancies, end-stage renal disease, intestinal bypass surgery or gastrectomy, chronic malabsorption syndromes and low body weight. Infants younger than two years are associated with increased risk. (2) 1) DIRECT INHALATION: The most common mode of entry via portal in to the lungs usually resulting from the Inhalation of airborne droplets containing a few bacilli, expectorated by individuals with â€Å"open† pulmonary disease.(8) 2) INDIRECT INHALATION: A) Ingestion: Less often bacilli may be swallowed and lodge in to the tonsil or in the wall of the intestine. These infections are chiefly related to the consumption of contaminated milk products. (8) 3) INOCULATION: Cutaneous tuberculosis manifestations depend upon the method of cutaneous inoculations, which may be exogenous that is from an out side source, may occur by autoinoculation, or may be by endogenous .Direct exogenous inoculation in an individual not previously infected with tuberculosis causes primary tuberculosis infection, will led to the tuberculous ‘chancre or to tuberculosis Verrucosa cutis depending upon the immune status of the patient. Another example of exogenous transmission is lupus vulgaris at the site of BCG vaccination. (9) Endogenous transmission can occur by continuous extension of tuberculous process underlying the skin as in scrofuloderma, by the way of lymphatic as in lupus vulgaris and by hematogenous spread as in acute miliary tuberculosis or lupus vulgaris. (9) Infrequent mode of transmission is direct implantation in to the skin through cuts and abrasions. These troubles usually in persons, working with infected material or cultures of tubercle bacilli. These skin lesions were called as â€Å"Prosector warts† (8) CLASSIFFICATION OF CUTANEOUS TUBERCUCLOSIS: Cutaneous tuberculosis clinical manifestations comprise a considerable number of skin changes, usually sub classified in to more or less distinct disease forms. Classification depends on morphology more recently mode of transmission or the immunological state of host, but none of them satisfies completely. 1)INOCCULATION TUBERCUCLOSIS (Exogenous Source) Tuberculosis chancre Warty tuberculosis(Verruca cutis) Lupus vulgaris(some) 2) SECONDARY TUBERCULOSIS (Endogenous source) A) Contiguous spread Scrofuloderma B) Auto-inoculation Orifical tuberculosis 3)HAEMATOGENOUS TUBERCULOSIS Acute miliary tuberculosis Lupus vulgaris(some) Tuberculous gumma 4)ERUPTIVE TUBERCUCLOSIS (Tuberculids) A) Micropapular Lichen scrofulosorum B) Papular Papular/Papulonecrrotic TB C) Nodular Erythema induratum(Bazin) Nodular Tuberculids (CLASSIFICATION OF TUBERCULOSIS, MODIFIED FROM beyt et al) (4) CHAPTER-2 CLASSIFICATION OF MYCOBACTERIA: Tuberculosis is an infectious disease which is caused by the Mycobacterium species. Mycobacteria are acid fast, non-sporulating, non-motile weakly gram positive organisms. TEM micrograph of Mycobacterium tuberculosis Table 3: Kingdom Bacteria Phylum Actinobacteria Order Actinomycetales Suborder Corynebacterineae Family Mycobacteriaceae Genus Mycobacterium Scientific classification by Lehmann Neumann. (3) In 1950s Runyon classified the atypical mycobacteria according to their ability to form pigment, their rate of growth colony characteristics. This classification also includes obligate human pathogens and facultative human pathogens. (1) Today more then 60 species of mycobacteria are identified. Around 41 of these were included in the approved lists of bacterial names in 1980. (9) 30 species of mycobacterium are known that can cause disease in humans. The most common causative organism includes: Mycobacterium tuberculosis Mycobacterium Leprae. Atypical mycobacteria. The species which produce disease in tuberculosis primary complex include: Mycobacterium tuberculosis. Mycobacterium Bovis. Mycobacterium Africanum. Sometimes Bacillus Calmette Guerin (BCG) may also cause disease. (1) MEDICAL CLASSIFICATION: For the purpose of diagnosis treatment mycobacteria can be classified in several major groups. Mycobacterium tuberculosis complex, which can cause tuberculosis by the pathogens Mycobacterium tuberculosis, M Bovis, M Africanum M microti. Mycobacterium Leprae, which causes Hansens disease. Nontuberculous mycobacteria are the mycobacteria which can cause pulmonary disease, lymphadenitis, and skin disease disseminated disease. SLOW GROWING MYCOBACTERIA RUNYON GROUP 1)Obligate human pathogens M. tuberculosis-bovis group including bacillus Calmette-Guerin(BCG) M Africanum (not included in runyon classification 2)Facultative Human pathogens M. kansasii I M. marinum I M. simiae I M. scrofulaceum II M. szulgai II M. gordanae II M. avium-intracellualr complex III M. haemophilum III M. Ulcerans III M. xenopi III 3) Nonpathogens M. flavescen II M. terrae complex III M. trivale III M. gastri III RAPIDLY GROWING MYCOBACTERIA 1))Facultative Human pathogens M. fortuitum I V M. chelonae I V M. abscessus I V 2) Nonpathogens M. smegmatis I V M. phlei I V M. vaccae I V others STAINING CHARACTERISTICS OF MYCOBACTERIA: Mycobacteria are aerobic, facultative, intracellular non-spore forming and non-motile curved rods measuring 0.2- 0.5 by 2-4 um. Mycolic acid rich long chain glycol lipids and phospholipoglycans, a mycocides present in the cell wall of mycobacteria protect them. (2) Mycobacteria do not gram stain readily but their most valuable staining characteristic is Acid Fastness. This ability retains carbol fuchin dye after washing with acid or alcohol occurs because of the high content of cell wall mycolic acids, fatty acids other lipids. Other staining methods used include Dietrele, auramine-Rhodamine and phenolic acridine orange stains. Nocardia rhodococcus, legionella dadei, isospora cryptosporidium also share acid fastness. (1) The Ziehl-Neelson acid-fast stain, while highly specific for mycobacteria, is relatively insensitive, and recognition requires at least 10,000 bacilli per mL; most clinical laboratories currently use a more sensitive auramine-rhodamine fluorescent stain (auramine O). Routine culture uses a nonselective egg medium called Lowenstein-Jensen or Middlebrook 7H10 and often requires more than 3-4 weeks to grow because of the 22-hour doubling time of mycobacterium tuberculosis. Radiometric broth culture, BACTEC radiometric system of clinical specimens significantly reduces time 10 to 14 d for mycobacterial recovery. DNA probes specific for mycobacterial ribosomal RNA categorize species of clinically significant isolates after recovery. In tissue, polymerase chain reaction (PCR) amplification techniques can be used to detect Mycobactereria tuberculosis-specific DNA sequences and thus, small numbers of mycobacteria in clinical specimens. (2) The cell wall of mycobacteria consist of: (3) Outer lipids Mycolic acid Polysaccharides(arabinoglactan) Peptideglycan Plasma membrane. Lipoarrabinomannan(LAM) Phosphatidylinositol mannoside. Cell wall skeleton. PATHOGENESIS: The most common site for Tuberculosis disease is lungs and 85% of TB patients present with pulmonary symptoms. The most common sites of extrapulmonary disease are mediastinal, retroperitoneal, and cervical lymph nodes, vertebral bodes, adrenals, meninges, and the GI tract. Pathology of these lesions is similar to those in the lung. Extrapulmonary TB can occur as part of a primary or late generalized infection or as a reactivation site that may, coexist with pulmonary reactivation. (2) Mycobacterium tuberculosis is an obligate pathogen. It is a slender aerobic rod, characterized by high lipid content. This lipid is responsible for resistance to phagocytosis. Identification of organism is easy in tuberculous chancre, scrofuloderma, orificial lesions and the miliary variant. This may be difficult to find or absent in lupus vulgaris, gummata and warty tuberculosis. The organism is highly resistant to drying to drying and therefore can retain infectivity by inoculation or contamination of minor wounds. (19) The reaction of the bacterium depends on: the size of inoculum. the virulence of organism. <