Smart Medical Diagnosis for Common Diseases

Smart Medical Diagnosis for Common Diseases 1. Introduction 1.1. Present Scenario Internet is the latest and the most powerful innovation of mankind. In present era of internet we used computer technology to solve our many problems. Today in every field we use computer technology from education, business, social networking to order a dinner or health check-up. Nobody knows from when human are start using medicine for cure themselves from illness. Many years ago when uncivilized human are lives in cave, deep forest they used various tree, plants leaves as medicine. They give their knowledge to the next generation. There is no MBBS doctors are available at that time. The anytime anywhere availability of Internet has made a great impact specially in-terms of reaching customers and making themselves aware of ones products base and services. (Roche, 2010) Going back 15 or more years, when hardly anyone had access to the internet; you would have had to go out to find a doctor for solving your health problems. But now, that the internet is available to many people, so people can visit a virtual doctor clinic. In todays modern society we have MBBS doctors, thousands of medicine for thousands of diseases. If we feel sick, we go to the doctors clinic and doctor diagnosis us, then prescribed some medicine and after taking medicine will fine within few days. But if you went out from your city or you go someplace, where you get sick and you dont have any doctor nearby. What you do then? In Africa there is only 1 doctor among 5000 people. Presently, Kenya has slightly more than 5,000 doctors. There are many places where people are dying because of some common diseases. Just some common medicine can help them. Now if I asked you What if you could visit a doctor, any time of day or night, without leaving your home and that doctor could review your history, diagnose your problem and also give you prescription? Now you are thinking how is it possible? Ok you need just an internet connection and computer and Smart Medical Diagnosis for Common Diseases onlinesoftware will do it for you. 1.2. Topic of the Project The Project is titled â€Å"Smart Medical Diagnosis for Common Diseases†. It will be a generic software package for a medical clinic. The system will be able to act as a web-based solution for medical symptom checker. It will prove to be asset for both the doctor as well as their patient. 1.3. Targeted Audience Target audience or user is one of the main concerns on how and why a system is been developed, who is going to use this system. The target users of Smart Medical Diagnosis for Common Diseases with Medicine Search Engine have been categorized into three types. 1.4. Problem Context Internet enthusiastic people want to use internet to solve their medical problems. But there is no good local site that can provide this kind of facility. This kind of website is perfect for them who dont have time to visit a doctors clinic for minor Where doctor is unable, we used this kind of technology to help people. Presently, There are only 54 doctors per 100,000 peoples in Africa. Kenya has slightly more than 5,000 doctors. In this country this kind of system will help people if it can be implemented. . 1.5. Rationale behind the System The following has highlighted some of the most common benefits of the â€Å"Smart Medical Diagnosis for Common Diseases with Medicine Search Engine† Because of the existence of the identified problems, there is a need for such project. This project consists of some on-line web application which provides guides to the patient. The system will be using advanced algorithm to design a virtual medical agent. The benefits gained from this project are: User can contact with doctor easily from their home or office. Doctor can easily manage their patient. Patient can gain medical knowledge from using this system. Smart Symptom checker can help patient anytime. 1.5.1. Proposed Solution Ø Patient who have some knowledge of using internet doesnt need to visit to doctor for common diseases life fiver, Pain, stomatitis etc. Ø It also helps community and skilled health workers, supported by automated assessment and treatment protocols, can rapidly expand the delivery of health care in developing countries Ø The spread of mobile phones and web services makes new models of healthcare delivery possible at everyones hand. Ø Proven technology will allow developing countries to leapfrog the knowledge gap between doctors and patients Ø User can learn about healthcare tasks from this system. Ø Doctor doesnt need to remember all the name of medicine and their purpose. Doctor can find details of a medicine just a click of a search button. Ø Ground-breaking but proven technology allows rapid development, review, and updating of complex automated guidelines by medical professionals without it intervention. 1.6. Benefits of the System Development and Implementation of such a system will bring in a lot of benefits for the business, its employees and its customers (both current and potential). These benefits can be classified into Tangible and Intangible which are discussed in details below:- Ø The system help doctor to make faster diagnosis. Ø Using medicine search engine doctor can get any medicine information with in a second. Ø Various medical tools like BMI calculator, symptom checker etc. will help doctor as well as patient to solve their problems easily. Ø System administrator can easily manage the system using content management system. Ø The system will use roles and permission levels, to maintain confidentiality of private data of administrator, doctor and patient. Ø Patient can use chat services to chat with doctor. Ø The presence of certain services offered by the system on the mobile web will also ensure that the system can be accessed from anywhere anytime. 1.7. Challenges Involved Developing a system such as this will involve a host of challenges for the developer. The major challenges can be classified under:- 1.7.1. Domain Challenges: Ø Data Gathering and Domain Analysis: Due to the developers unfamiliarity with the work-flow and the processes followed in the online Symptom Checker it will become a challenging task to develop awareness about the medical service domain. Ø Implementation of Customizability: The biggest challenge of developing a system like this is its implementation itself. There is high percentage of risk involved in development and implementation of a system like this. The main challenge is to understand the base concepts involved in designing and developing Smart Medical Diagnosis. The developer will also need to follow a modular and object oriented approach in developing this system for enhancing reusability, abstraction, encapsulation and polymorphism. Ø Content Management System (CMS): Understanding and Implementing a CMS integrated with a system like this will require the developer to design the complex architecture of the system in prior so that his/her concepts are clear regarding the control flow of the system and no module infringes each other. This will also require him/her to study existing CMS such as Joomla and Drupal and understand their architecture and working. Ø Database Designing and Normalization: Designing a database for a generic customizable system like this is challenge in itself. The fields and data types of the table along with the tables itself are not fixed or pre-defined. The developer needs to code keeping in mind user customization may need to create these database objects dynamically and hence needs to keep a scope for their creation and modification. Apart from this, there needs to be a big centralized database, which is capable of storing large amount of data and about a large number of entities. The relation between these large numbers of entities will be needed to be figure out and a complex normalization has to be implemented in designing a database like this. Ø Implementation of 3-Tier Architecture: In order to enhance scalability, performance, reliability and robustness of this system, the developer will need to implement 3-Tier architecture for developing this system which is a challenging task keeping in mind the size and complexity of the systems database. Ø Algorithm for Customizing the site and Symptom Checker: The developer will require to showcase solid understanding for logics and algorithms in order to develop the module where the administrative users can add or edit new pages, new symptom option where he/she will be able to add its name description along with the algorithm that will be followed for generating a definite result. 1.7.2. Technical Challenges: PHP: The system will require the developer to use advanced PHP functionalities like Personalization, Forum, Blog and Emailing which will be used in various modules of this system. Develop a PHP base application is harder as compare to develop same application in ASP.NET using visual studio. Visual studio generates code for you debug for you and its also save time. But PHP is challenge as compare to asp.net. Cause PHP doesnt have any IDE and very code you need to write it down in a text editor. Finding an error is also a head ace. But for learning purpose PHP is great. Thats the reason I chose PHP as main web development language. Web Based system: Making an interactive web based system is difficult. Implement a dynamic web site is harder than making a desktop application. We need to take care of network, client server, band width to make project successful. AJAX and JavaScript / jQuery: For designing an intuitive and dynamic interface so that users have a rich experience availing features like data entry assistance, error prevention, etc. The developer needs to have in depth knowledge of AJAX as well as JavaScript or jQuery. Implementation of AJAX is not easy task for a developer who is new to web development. I just know little PHP and HTML. It will be a challenge for me to implement Ajax in this project. AJAX makes web application fell like a desktop application. CSS: Most people who are new in web development cant able to understand how to lay out a page. They just try to drug and drop div, table using Dreamweaver or any HTML design tools with underrating the advanced concept of CSS. And ended up with Advanced Database Concepts with MYSQL: For designing such a complex database that the system requires the developer needs to have a concrete understanding of database concepts like Normalization, Query Optimization, Views, and Permissions. He/she should also require familiarity with MYSQL. MOBILE OPTIMIZATING : For optimizing the web application for mobile phones and handheld devices the developer needs to have extensive skills in WML, mobile web as well as an understanding of how to integrate WML with server side scripting technologies 1.8. Goals behind developing the System 1.8.1. Project goal â€Å"When people are sick, they must make critical decisions about when and where they should receive healthcare. Unfortunately, most people lack the medical knowledge needed to make these decisions safely. Online smart diagnosis is powered by a computer program that performs symptom triage. The goal of symptom triage is to decide when, and where, you should seek care when you have symptoms. Symptom triage does not replace a physician evaluation or make a diagnosis.† 1.8.2. Academic Goal Ø To recall and analyse and implement the understanding and concepts learnt in the complete course curriculum through various modules as well as on individual level and implement all of it in order to come out with a complete computing project of industry standard Ø To document and publish the deliverables professionally following the standards followed in industry. 1.9. Objectives of the System 1.9.1. Project Objectives Ø To come up with a complete automation solution for online symptom diagnosis. Ø To keep the design, architecture, implementation flexible so as to allow customization by the system administrator. Ø Optimize information presentation and service interface according to the capability of the device requesting it. Ø To use communication channels apart from HTTP like Email, SMS and WAP for supplying quality information and services to customers and company employees. Ø To ensure that the web is bug free and that it runs equally and efficiently on all browsers and platforms 1.9.2. Academic Objectives Ø The prime objective is to learn nitty-gritties of project management and project development lifecycle, implementing it in developing the system and gaining experience in it. Ø Learn Content Management System (CMS) Ø To learn and apply the various Web Development Methodology and Human Computer Interaction Design Principles to the system design. Ø Web accessibility Ø To learn and master the advance features of PHP, MYSQL and associated technologies. Ø To learn the internal work-flow and procedures that is followed medical diagnosis. 1.10. Success Criteria To determine whether the project is a success or a failure parameters such as the quality of application developed as well as the quality of project documentation will be analysed. The quality of application will include the degree to which requirement was fulfilled, the degree of user-friendliness of the system as well as the ability to run swiftly, consistently and error-freely on multiple browsers. 1.11 Scope and Functionalities of the System Scope limits the project. It defines where in the project the developer should call it stop. It determines to what extent the system will support functionalities and beyond what the system facilitates no feature or functionalities. 1.11.1. Functionalities to be implemented The functionalities to be incorporated into the system which in turn will decide the scope of the system have been classified into 3 categories on the basis of their complexity and exclusiveness. They are:- 1.11.1.1. Core Functionalities:. Ø Symptom checker is an automatic smart software agent that can ask question to patient about their problem and it analysis the problems and diagnosis the debases of the patient Ø Chat Services Patients can text chat with doctor. Ø Forum User can create, post delete thread in forum Ø Messaging User can send message to each other Ø CMS(Content management System) Admin can create update and delete pages. Ø Medicine search engine Doctor can use medicine search engine to know about works of a particular medicine Ø Registration of Doctor And Patient . Ø Patient Can upload his/her medical history. Ø Secure and configurable user access through individual user logins and passwords. Ø Users can change their password. 1.11.1.2. Enhanced Functionalities: Ø Design the virtual doctor using artificial intelligent Ø Video chat service Ø Create user blog Ø Full Mobile based services Ø Full customizing user profiling. 1.11.1.3. Special Functionalities Ø Various tool boxes for doctor BMI Calculator, BRM calculator, Body fat calculator. Ø Voice chat and VoIP 1.11.2. Scope of the Project This projects main aim is to give perfect medical information to the user through internet. It will save time and money of both doctor and patient. The patient who dont have the time to visit the clinic of the doctor for some common issue they can use this system. This kind of system already in market like virtual doctor, WEB MD, Online health, but none of them works on mobile platform. As Smart Medical Diagnosis also works on mobile platform, anyone with wap enable mobile with GPRS, EGDE or 3G can access his web services and get information about medicine and diseases. 1.11.2.1 Scope Limitation Ø Smart Medical Diagnosis for Common Diseases is an online application. Without internet this system doesnt work Ø WAP Based mobile not able to display the webpage Ø chat required high speed internet connection Ø Symptom checker may be diagnosis wrong if patient give wrong input Ø Serious medical problems cant be solved using this system Ø Only some common diseases can be diagnosis 1.12. Feasibility Study By the means of feasibility study one can find out if an information system project can be done, and if so, how. A feasibility study should answers the following question: Ø Whether the project can be done; Ø What are alternative solutions? Ø What are the criteria for choosing among them? Ø Is there a preferred alternative? After a feasibility study, a decision is taken on the go ahead/no go of the project. There are a many types of feasibility study that are used for analysis of Information System. In this project the developer has restricted the feasibility study to Technological Feasibility Study and Schedule Feasibility. 1.12.1. Technical Feasibility Study The technical feasibility study compares the level of technology available in the software development firm and the level of technology required for the development of the product. Here the level of technology consists of the programming language, the hardware resources, Other software tools etc. (All About Information Technology) In this project the hardware and software required as the application will be deployed on a apache server, PHP 5.3 With ZEND Framework and mysql 5 Server will not be big ask at present scene. On the Client End the application just requires any current java script enable web browser. 1.12.3. Operational Feasibility Study Operational feasibility study tests the operational scope of the software to be developed. The proposed software must have high operational feasibility. The usability will be high. It is basically used to analyse whether the system will be used if it is developed and implemented. Whether there will be resistance from users that will affect the possible application benefits? Data gathering methods such as questionnaire and interviews have been incorporated in the development plan to ensure all user requirements are collected well in hand to develop the system. We also provide help manual to better understand the tystem. 1.12.3. Schedule Feasibility Study Schedule Feasibility is an assessment whether the project will be able to complete on time. Since the project deadline is fixed i.e. 32 weeks. Each project phase time-line has been established with certain milestones also including some form of deliverables like PPF, PSF and Mid-Point the project-schedule is realistic and well within reach if the established schedule is followed precisely. 1.13. Major Project Deliverables Final Year Project Documentation Page | 18 Draft Proposal PPF Ethical Form PSF log sheet Hard copy Soft copy Final Year Project Documentation Page | 18 Start date: 27th July 2010 Duration: 31 Weeks End date: 20th March 2 Planning (total 18 days) Work Breakdown Structure Schedule and Time Estimation Critical Path Method Interviews Gantt Chart Project Proposal Form Weeks -2.5 3 Analysis (total 49 days) Identify project specifications Project Background Resources required Techniques to be learnt Goals and Objectives Determine System Functionalities Identify scope of research Project Specification Form Investigation ad Research Programming Human Computer Interaction Multimedia Design Principles User requirements Drifting Analysis User Profiling Domain analysis System analysis Risk analysis Weeks -7 4 System Design (Total 49 days) Tasks: Navigational Design Story Boarding Process Diagram Abstract Interface Design Screen layout Content Design Interactivity Design Functionality Design Midpoint Interview Weeks -7 5 Implementation (Total 28 days) Code generation Module Integration Weeks -4 6 Testing and Evaluation (Total 35days) Test Plans Unit Testing Integration Testing System Testing Critical Evaluation Weeks -5 7 Project Ending (Total 35days) Submission of the finished product Presentation Weeks -5 2. Problem Description When people are sick, they must make critical decisions about when and where they should receive healthcare. Unfortunately, most people lack the medical knowledge needed to make these decisions safely. Online Smart Diagnosis is powered by a computer program that performs symptom triage. The goal of symptom triage is to decide when, and where, you should seek care when you have symptoms. Symptom triage does not replace a physician evaluation or make a diagnosis. Over the past 12 years, healthcare professionals in the U.S. government and major managed care organizations have used the program extensively, proving its effectiveness. Like FreeMD.com improves medical outcomes by helping consumers determine the most appropriate time and place to receive care from a healthcare professional. (How it Works) With so many options for care today, its becoming more important for you to know where you should get care when you develop symptoms. Choices include: Emergency Room Urgent Care Center Physician Office Physician eVisit (via the web, e-mail, or phone) Dentist Office Nurse Retail Clinic Your choice on where to get care is important because not all of these locations are equipped to treat all health problems. If you make the wrong choice, you risk delaying your diagnosis and treatment. A wrong choice could also lead you to over-pay for the same care you could have received in a less expensive setting. Online Smart Diagnosis was created to safely direct you to the right location: where you get the care you need, without paying more than you need to. Online Smart Diagnosis performs a medical interview, just like a real doctor. During the interview, you answer questions about your symptoms and past medical history. Online Smart Diagnosis is designed to be fast (average encounter time is less than 2 minutes), so you get help fast! At the end of the process, FreeMD.com generates a report that provides the following information: What might be causing your symptoms? When should you see a doctor? Where should you seek care? What kind of doctor should you see? What should you do to care for yourself? There are many palaces in the world where you cant find a single doctor. There are only 54 doctors per 100,000 peoples in Africa. Presently, Kenya has slightly more than 5,000 doctors. In many parts of the world, far too many children and adults are dying unnecessarily from easily treatable diseases. In a world where many of us take basic healthcare for granted, one in six children in Zambia will still not reach the age of five. Too often this problem is simply due to the lack of access to effective primary healthcare. Whether it is the huge distances to health centres and lack of transport, the lack of doctors in many regions, or the simple shortage of resources such as medications, very often easily treatable conditions are left until it is too late. From above information we can say, there is a desperate lack of primary healthcare available to rural communities in many parts of the world due to their geographical isolation, shortage of doctors, and lack of resources. The Smart Medical Diagnosis for Common Diseases Project is an innovative new venture that aims to use mobile clinics and internet to save lives. 3. Literature Review Development of successful project starts with a solid and deep Research. Thus, Research will be an on-going process throughout the project. Researches need in every phase let it be planning, user interface designing or anything and especially when you are in process of building comprehensible website. The research area will also consist of the development process model which will be used for the project. Getting good hands on programming languages and mastering back-ends will also be a challenge and research work. For developing this project I am going to flow Web Engineering model. I think this is the best model to make web based project. 3.1. Web Engineering and WebE Process model: As Web-based systems play increasingly important roles in a number of applications, the demands placed on these systems and their complexity have also increased significantly. Also, there is growing need for improved quality, performance and availability of Web-based systems as we are now more dependent on Web-based systems than ever before. But, most Web-based systems are poorly developed in ad hoc manner and hence they exhibit poor performance and are susceptible for major failures. Web-based system development, in most cases, lacks rigour, systematic approach to design, disciplined development process and quality control and assurance procedures. Hence, there is growing concern about the performance, quality, integrity, maintainability and scalability of complex Web based systems. Web engineering advocates a process and a systematic approach to development of high quality Web-based systems and aims to bring the potential chaos in Web-based system development under control and enha nce scalability, maintainability and quality. It is a rapidly emerging as a new discipline for successful development and deployment of large Web-based systems in a range of applications. Web Engineering is an evolving development methodology dedicated to the development of superior Internet and Web Applications. It advocates a standardized process and follows a systematic approach. (S. Murugesan, Y. Deshpande, S. Hansen and A. Ginig, 1999) Web engineering principles and approaches can fix the issues related to web development methodology gaining complete control over the process, minimizing risk and improving the quality and maintainability (Ginige Murugesan, 2000) Web Engineering Activities Successful Web-based system development and deployment is a process, not just an event as currently perceived and practiced by many developers and academics. Web engineering is a holistic approach and deals with all aspects of web-based development, starting from concerting and development to implementation, performance evaluation, and continual maintenance. (Suh, 2005) (Suh, 2005) Web Engineering Development Process: Reasons behind choosing the WebE process model Smart Medical Diagnosis for Common Diseases :going to be a web based project and as developer have chosen web engineering model, it would be easy and profitable to follow the process model suggested under the web engineering. The WebE process model is deliberately developed for the web applications and it addresses the specific needs of a web application which differs from the traditional software and is not addressed by the traditional software methodologies, too. Developers system is a web based system and would have a feature that can be looked after only by a dedicated web process model and thats why I found WebE useful. Take time to understand the business needs and product objectives, even if WebApp details are vague. Describe how users will interact with the WebApp using a scenario-based approach Develop a brief project plan. Spend time modeling what you are going to build 3.2 Academic Research Smart Medical Diagnosis for Common Diseases with Medicine Search Engine is a project where research is going to be very crucial. I have contact with doctor for gathering information. Some of friends who are medical student are going to help in making the database. There are already some system are on the market. From this kind of system I can learn, how I can make this kind of system. Academic Research means extracting information from others hard earned experiences like going through books, journals, paper presentations and other published materials. My project has multidirectional requirements Medical Since this project deals with Medical, patient and so I will need to go through various Medical books so that at least I should have an idea how can I make a virtual medical agent. Patient I have to understand what a patient want from a doctor. What kind of patient should able to use this kind of system? Software Engineering Techniques Web engineering , Mobile WEB technologies Network and Internet Databases there will be a huge use and requirements for databases, since everything will be stored at backend. So I will need a secure, big database Reports generation Smart Medical Diagnosis for Common Diseases Smart Medical Diagnosis for Common Diseases 1. Introduction 1.1. Present Scenario Internet is the latest and the most powerful innovation of mankind. In present era of internet we used computer technology to solve our many problems. Today in every field we use computer technology from education, business, social networking to order a dinner or health check-up. Nobody knows from when human are start using medicine for cure themselves from illness. Many years ago when uncivilized human are lives in cave, deep forest they used various tree, plants leaves as medicine. They give their knowledge to the next generation. There is no MBBS doctors are available at that time. The anytime anywhere availability of Internet has made a great impact specially in-terms of reaching customers and making themselves aware of ones products base and services. (Roche, 2010) Going back 15 or more years, when hardly anyone had access to the internet; you would have had to go out to find a doctor for solving your health problems. But now, that the internet is available to many people, so people can visit a virtual doctor clinic. In todays modern society we have MBBS doctors, thousands of medicine for thousands of diseases. If we feel sick, we go to the doctors clinic and doctor diagnosis us, then prescribed some medicine and after taking medicine will fine within few days. But if you went out from your city or you go someplace, where you get sick and you dont have any doctor nearby. What you do then? In Africa there is only 1 doctor among 5000 people. Presently, Kenya has slightly more than 5,000 doctors. There are many places where people are dying because of some common diseases. Just some common medicine can help them. Now if I asked you What if you could visit a doctor, any time of day or night, without leaving your home and that doctor could review your history, diagnose your problem and also give you prescription? Now you are thinking how is it possible? Ok you need just an internet connection and computer and Smart Medical Diagnosis for Common Diseases onlinesoftware will do it for you. 1.2. Topic of the Project The Project is titled â€Å"Smart Medical Diagnosis for Common Diseases†. It will be a generic software package for a medical clinic. The system will be able to act as a web-based solution for medical symptom checker. It will prove to be asset for both the doctor as well as their patient. 1.3. Targeted Audience Target audience or user is one of the main concerns on how and why a system is been developed, who is going to use this system. The target users of Smart Medical Diagnosis for Common Diseases with Medicine Search Engine have been categorized into three types. 1.4. Problem Context Internet enthusiastic people want to use internet to solve their medical problems. But there is no good local site that can provide this kind of facility. This kind of website is perfect for them who dont have time to visit a doctors clinic for minor Where doctor is unable, we used this kind of technology to help people. Presently, There are only 54 doctors per 100,000 peoples in Africa. Kenya has slightly more than 5,000 doctors. In this country this kind of system will help people if it can be implemented. . 1.5. Rationale behind the System The following has highlighted some of the most common benefits of the â€Å"Smart Medical Diagnosis for Common Diseases with Medicine Search Engine† Because of the existence of the identified problems, there is a need for such project. This project consists of some on-line web application which provides guides to the patient. The system will be using advanced algorithm to design a virtual medical agent. The benefits gained from this project are: User can contact with doctor easily from their home or office. Doctor can easily manage their patient. Patient can gain medical knowledge from using this system. Smart Symptom checker can help patient anytime. 1.5.1. Proposed Solution Ø Patient who have some knowledge of using internet doesnt need to visit to doctor for common diseases life fiver, Pain, stomatitis etc. Ø It also helps community and skilled health workers, supported by automated assessment and treatment protocols, can rapidly expand the delivery of health care in developing countries Ø The spread of mobile phones and web services makes new models of healthcare delivery possible at everyones hand. Ø Proven technology will allow developing countries to leapfrog the knowledge gap between doctors and patients Ø User can learn about healthcare tasks from this system. Ø Doctor doesnt need to remember all the name of medicine and their purpose. Doctor can find details of a medicine just a click of a search button. Ø Ground-breaking but proven technology allows rapid development, review, and updating of complex automated guidelines by medical professionals without it intervention. 1.6. Benefits of the System Development and Implementation of such a system will bring in a lot of benefits for the business, its employees and its customers (both current and potential). These benefits can be classified into Tangible and Intangible which are discussed in details below:- Ø The system help doctor to make faster diagnosis. Ø Using medicine search engine doctor can get any medicine information with in a second. Ø Various medical tools like BMI calculator, symptom checker etc. will help doctor as well as patient to solve their problems easily. Ø System administrator can easily manage the system using content management system. Ø The system will use roles and permission levels, to maintain confidentiality of private data of administrator, doctor and patient. Ø Patient can use chat services to chat with doctor. Ø The presence of certain services offered by the system on the mobile web will also ensure that the system can be accessed from anywhere anytime. 1.7. Challenges Involved Developing a system such as this will involve a host of challenges for the developer. The major challenges can be classified under:- 1.7.1. Domain Challenges: Ø Data Gathering and Domain Analysis: Due to the developers unfamiliarity with the work-flow and the processes followed in the online Symptom Checker it will become a challenging task to develop awareness about the medical service domain. Ø Implementation of Customizability: The biggest challenge of developing a system like this is its implementation itself. There is high percentage of risk involved in development and implementation of a system like this. The main challenge is to understand the base concepts involved in designing and developing Smart Medical Diagnosis. The developer will also need to follow a modular and object oriented approach in developing this system for enhancing reusability, abstraction, encapsulation and polymorphism. Ø Content Management System (CMS): Understanding and Implementing a CMS integrated with a system like this will require the developer to design the complex architecture of the system in prior so that his/her concepts are clear regarding the control flow of the system and no module infringes each other. This will also require him/her to study existing CMS such as Joomla and Drupal and understand their architecture and working. Ø Database Designing and Normalization: Designing a database for a generic customizable system like this is challenge in itself. The fields and data types of the table along with the tables itself are not fixed or pre-defined. The developer needs to code keeping in mind user customization may need to create these database objects dynamically and hence needs to keep a scope for their creation and modification. Apart from this, there needs to be a big centralized database, which is capable of storing large amount of data and about a large number of entities. The relation between these large numbers of entities will be needed to be figure out and a complex normalization has to be implemented in designing a database like this. Ø Implementation of 3-Tier Architecture: In order to enhance scalability, performance, reliability and robustness of this system, the developer will need to implement 3-Tier architecture for developing this system which is a challenging task keeping in mind the size and complexity of the systems database. Ø Algorithm for Customizing the site and Symptom Checker: The developer will require to showcase solid understanding for logics and algorithms in order to develop the module where the administrative users can add or edit new pages, new symptom option where he/she will be able to add its name description along with the algorithm that will be followed for generating a definite result. 1.7.2. Technical Challenges: PHP: The system will require the developer to use advanced PHP functionalities like Personalization, Forum, Blog and Emailing which will be used in various modules of this system. Develop a PHP base application is harder as compare to develop same application in ASP.NET using visual studio. Visual studio generates code for you debug for you and its also save time. But PHP is challenge as compare to asp.net. Cause PHP doesnt have any IDE and very code you need to write it down in a text editor. Finding an error is also a head ace. But for learning purpose PHP is great. Thats the reason I chose PHP as main web development language. Web Based system: Making an interactive web based system is difficult. Implement a dynamic web site is harder than making a desktop application. We need to take care of network, client server, band width to make project successful. AJAX and JavaScript / jQuery: For designing an intuitive and dynamic interface so that users have a rich experience availing features like data entry assistance, error prevention, etc. The developer needs to have in depth knowledge of AJAX as well as JavaScript or jQuery. Implementation of AJAX is not easy task for a developer who is new to web development. I just know little PHP and HTML. It will be a challenge for me to implement Ajax in this project. AJAX makes web application fell like a desktop application. CSS: Most people who are new in web development cant able to understand how to lay out a page. They just try to drug and drop div, table using Dreamweaver or any HTML design tools with underrating the advanced concept of CSS. And ended up with Advanced Database Concepts with MYSQL: For designing such a complex database that the system requires the developer needs to have a concrete understanding of database concepts like Normalization, Query Optimization, Views, and Permissions. He/she should also require familiarity with MYSQL. MOBILE OPTIMIZATING : For optimizing the web application for mobile phones and handheld devices the developer needs to have extensive skills in WML, mobile web as well as an understanding of how to integrate WML with server side scripting technologies 1.8. Goals behind developing the System 1.8.1. Project goal â€Å"When people are sick, they must make critical decisions about when and where they should receive healthcare. Unfortunately, most people lack the medical knowledge needed to make these decisions safely. Online smart diagnosis is powered by a computer program that performs symptom triage. The goal of symptom triage is to decide when, and where, you should seek care when you have symptoms. Symptom triage does not replace a physician evaluation or make a diagnosis.† 1.8.2. Academic Goal Ø To recall and analyse and implement the understanding and concepts learnt in the complete course curriculum through various modules as well as on individual level and implement all of it in order to come out with a complete computing project of industry standard Ø To document and publish the deliverables professionally following the standards followed in industry. 1.9. Objectives of the System 1.9.1. Project Objectives Ø To come up with a complete automation solution for online symptom diagnosis. Ø To keep the design, architecture, implementation flexible so as to allow customization by the system administrator. Ø Optimize information presentation and service interface according to the capability of the device requesting it. Ø To use communication channels apart from HTTP like Email, SMS and WAP for supplying quality information and services to customers and company employees. Ø To ensure that the web is bug free and that it runs equally and efficiently on all browsers and platforms 1.9.2. Academic Objectives Ø The prime objective is to learn nitty-gritties of project management and project development lifecycle, implementing it in developing the system and gaining experience in it. Ø Learn Content Management System (CMS) Ø To learn and apply the various Web Development Methodology and Human Computer Interaction Design Principles to the system design. Ø Web accessibility Ø To learn and master the advance features of PHP, MYSQL and associated technologies. Ø To learn the internal work-flow and procedures that is followed medical diagnosis. 1.10. Success Criteria To determine whether the project is a success or a failure parameters such as the quality of application developed as well as the quality of project documentation will be analysed. The quality of application will include the degree to which requirement was fulfilled, the degree of user-friendliness of the system as well as the ability to run swiftly, consistently and error-freely on multiple browsers. 1.11 Scope and Functionalities of the System Scope limits the project. It defines where in the project the developer should call it stop. It determines to what extent the system will support functionalities and beyond what the system facilitates no feature or functionalities. 1.11.1. Functionalities to be implemented The functionalities to be incorporated into the system which in turn will decide the scope of the system have been classified into 3 categories on the basis of their complexity and exclusiveness. They are:- 1.11.1.1. Core Functionalities:. Ø Symptom checker is an automatic smart software agent that can ask question to patient about their problem and it analysis the problems and diagnosis the debases of the patient Ø Chat Services Patients can text chat with doctor. Ø Forum User can create, post delete thread in forum Ø Messaging User can send message to each other Ø CMS(Content management System) Admin can create update and delete pages. Ø Medicine search engine Doctor can use medicine search engine to know about works of a particular medicine Ø Registration of Doctor And Patient . Ø Patient Can upload his/her medical history. Ø Secure and configurable user access through individual user logins and passwords. Ø Users can change their password. 1.11.1.2. Enhanced Functionalities: Ø Design the virtual doctor using artificial intelligent Ø Video chat service Ø Create user blog Ø Full Mobile based services Ø Full customizing user profiling. 1.11.1.3. Special Functionalities Ø Various tool boxes for doctor BMI Calculator, BRM calculator, Body fat calculator. Ø Voice chat and VoIP 1.11.2. Scope of the Project This projects main aim is to give perfect medical information to the user through internet. It will save time and money of both doctor and patient. The patient who dont have the time to visit the clinic of the doctor for some common issue they can use this system. This kind of system already in market like virtual doctor, WEB MD, Online health, but none of them works on mobile platform. As Smart Medical Diagnosis also works on mobile platform, anyone with wap enable mobile with GPRS, EGDE or 3G can access his web services and get information about medicine and diseases. 1.11.2.1 Scope Limitation Ø Smart Medical Diagnosis for Common Diseases is an online application. Without internet this system doesnt work Ø WAP Based mobile not able to display the webpage Ø chat required high speed internet connection Ø Symptom checker may be diagnosis wrong if patient give wrong input Ø Serious medical problems cant be solved using this system Ø Only some common diseases can be diagnosis 1.12. Feasibility Study By the means of feasibility study one can find out if an information system project can be done, and if so, how. A feasibility study should answers the following question: Ø Whether the project can be done; Ø What are alternative solutions? Ø What are the criteria for choosing among them? Ø Is there a preferred alternative? After a feasibility study, a decision is taken on the go ahead/no go of the project. There are a many types of feasibility study that are used for analysis of Information System. In this project the developer has restricted the feasibility study to Technological Feasibility Study and Schedule Feasibility. 1.12.1. Technical Feasibility Study The technical feasibility study compares the level of technology available in the software development firm and the level of technology required for the development of the product. Here the level of technology consists of the programming language, the hardware resources, Other software tools etc. (All About Information Technology) In this project the hardware and software required as the application will be deployed on a apache server, PHP 5.3 With ZEND Framework and mysql 5 Server will not be big ask at present scene. On the Client End the application just requires any current java script enable web browser. 1.12.3. Operational Feasibility Study Operational feasibility study tests the operational scope of the software to be developed. The proposed software must have high operational feasibility. The usability will be high. It is basically used to analyse whether the system will be used if it is developed and implemented. Whether there will be resistance from users that will affect the possible application benefits? Data gathering methods such as questionnaire and interviews have been incorporated in the development plan to ensure all user requirements are collected well in hand to develop the system. We also provide help manual to better understand the tystem. 1.12.3. Schedule Feasibility Study Schedule Feasibility is an assessment whether the project will be able to complete on time. Since the project deadline is fixed i.e. 32 weeks. Each project phase time-line has been established with certain milestones also including some form of deliverables like PPF, PSF and Mid-Point the project-schedule is realistic and well within reach if the established schedule is followed precisely. 1.13. Major Project Deliverables Final Year Project Documentation Page | 18 Draft Proposal PPF Ethical Form PSF log sheet Hard copy Soft copy Final Year Project Documentation Page | 18 Start date: 27th July 2010 Duration: 31 Weeks End date: 20th March 2 Planning (total 18 days) Work Breakdown Structure Schedule and Time Estimation Critical Path Method Interviews Gantt Chart Project Proposal Form Weeks -2.5 3 Analysis (total 49 days) Identify project specifications Project Background Resources required Techniques to be learnt Goals and Objectives Determine System Functionalities Identify scope of research Project Specification Form Investigation ad Research Programming Human Computer Interaction Multimedia Design Principles User requirements Drifting Analysis User Profiling Domain analysis System analysis Risk analysis Weeks -7 4 System Design (Total 49 days) Tasks: Navigational Design Story Boarding Process Diagram Abstract Interface Design Screen layout Content Design Interactivity Design Functionality Design Midpoint Interview Weeks -7 5 Implementation (Total 28 days) Code generation Module Integration Weeks -4 6 Testing and Evaluation (Total 35days) Test Plans Unit Testing Integration Testing System Testing Critical Evaluation Weeks -5 7 Project Ending (Total 35days) Submission of the finished product Presentation Weeks -5 2. Problem Description When people are sick, they must make critical decisions about when and where they should receive healthcare. Unfortunately, most people lack the medical knowledge needed to make these decisions safely. Online Smart Diagnosis is powered by a computer program that performs symptom triage. The goal of symptom triage is to decide when, and where, you should seek care when you have symptoms. Symptom triage does not replace a physician evaluation or make a diagnosis. Over the past 12 years, healthcare professionals in the U.S. government and major managed care organizations have used the program extensively, proving its effectiveness. Like FreeMD.com improves medical outcomes by helping consumers determine the most appropriate time and place to receive care from a healthcare professional. (How it Works) With so many options for care today, its becoming more important for you to know where you should get care when you develop symptoms. Choices include: Emergency Room Urgent Care Center Physician Office Physician eVisit (via the web, e-mail, or phone) Dentist Office Nurse Retail Clinic Your choice on where to get care is important because not all of these locations are equipped to treat all health problems. If you make the wrong choice, you risk delaying your diagnosis and treatment. A wrong choice could also lead you to over-pay for the same care you could have received in a less expensive setting. Online Smart Diagnosis was created to safely direct you to the right location: where you get the care you need, without paying more than you need to. Online Smart Diagnosis performs a medical interview, just like a real doctor. During the interview, you answer questions about your symptoms and past medical history. Online Smart Diagnosis is designed to be fast (average encounter time is less than 2 minutes), so you get help fast! At the end of the process, FreeMD.com generates a report that provides the following information: What might be causing your symptoms? When should you see a doctor? Where should you seek care? What kind of doctor should you see? What should you do to care for yourself? There are many palaces in the world where you cant find a single doctor. There are only 54 doctors per 100,000 peoples in Africa. Presently, Kenya has slightly more than 5,000 doctors. In many parts of the world, far too many children and adults are dying unnecessarily from easily treatable diseases. In a world where many of us take basic healthcare for granted, one in six children in Zambia will still not reach the age of five. Too often this problem is simply due to the lack of access to effective primary healthcare. Whether it is the huge distances to health centres and lack of transport, the lack of doctors in many regions, or the simple shortage of resources such as medications, very often easily treatable conditions are left until it is too late. From above information we can say, there is a desperate lack of primary healthcare available to rural communities in many parts of the world due to their geographical isolation, shortage of doctors, and lack of resources. The Smart Medical Diagnosis for Common Diseases Project is an innovative new venture that aims to use mobile clinics and internet to save lives. 3. Literature Review Development of successful project starts with a solid and deep Research. Thus, Research will be an on-going process throughout the project. Researches need in every phase let it be planning, user interface designing or anything and especially when you are in process of building comprehensible website. The research area will also consist of the development process model which will be used for the project. Getting good hands on programming languages and mastering back-ends will also be a challenge and research work. For developing this project I am going to flow Web Engineering model. I think this is the best model to make web based project. 3.1. Web Engineering and WebE Process model: As Web-based systems play increasingly important roles in a number of applications, the demands placed on these systems and their complexity have also increased significantly. Also, there is growing need for improved quality, performance and availability of Web-based systems as we are now more dependent on Web-based systems than ever before. But, most Web-based systems are poorly developed in ad hoc manner and hence they exhibit poor performance and are susceptible for major failures. Web-based system development, in most cases, lacks rigour, systematic approach to design, disciplined development process and quality control and assurance procedures. Hence, there is growing concern about the performance, quality, integrity, maintainability and scalability of complex Web based systems. Web engineering advocates a process and a systematic approach to development of high quality Web-based systems and aims to bring the potential chaos in Web-based system development under control and enha nce scalability, maintainability and quality. It is a rapidly emerging as a new discipline for successful development and deployment of large Web-based systems in a range of applications. Web Engineering is an evolving development methodology dedicated to the development of superior Internet and Web Applications. It advocates a standardized process and follows a systematic approach. (S. Murugesan, Y. Deshpande, S. Hansen and A. Ginig, 1999) Web engineering principles and approaches can fix the issues related to web development methodology gaining complete control over the process, minimizing risk and improving the quality and maintainability (Ginige Murugesan, 2000) Web Engineering Activities Successful Web-based system development and deployment is a process, not just an event as currently perceived and practiced by many developers and academics. Web engineering is a holistic approach and deals with all aspects of web-based development, starting from concerting and development to implementation, performance evaluation, and continual maintenance. (Suh, 2005) (Suh, 2005) Web Engineering Development Process: Reasons behind choosing the WebE process model Smart Medical Diagnosis for Common Diseases :going to be a web based project and as developer have chosen web engineering model, it would be easy and profitable to follow the process model suggested under the web engineering. The WebE process model is deliberately developed for the web applications and it addresses the specific needs of a web application which differs from the traditional software and is not addressed by the traditional software methodologies, too. Developers system is a web based system and would have a feature that can be looked after only by a dedicated web process model and thats why I found WebE useful. Take time to understand the business needs and product objectives, even if WebApp details are vague. Describe how users will interact with the WebApp using a scenario-based approach Develop a brief project plan. Spend time modeling what you are going to build 3.2 Academic Research Smart Medical Diagnosis for Common Diseases with Medicine Search Engine is a project where research is going to be very crucial. I have contact with doctor for gathering information. Some of friends who are medical student are going to help in making the database. There are already some system are on the market. From this kind of system I can learn, how I can make this kind of system. Academic Research means extracting information from others hard earned experiences like going through books, journals, paper presentations and other published materials. My project has multidirectional requirements Medical Since this project deals with Medical, patient and so I will need to go through various Medical books so that at least I should have an idea how can I make a virtual medical agent. Patient I have to understand what a patient want from a doctor. What kind of patient should able to use this kind of system? Software Engineering Techniques Web engineering , Mobile WEB technologies Network and Internet Databases there will be a huge use and requirements for databases, since everything will be stored at backend. So I will need a secure, big database Reports generation

Frostbite Chapter 19

Nineteen I HATE BEING POWERLESS. AND I hate going down without a fight. What had taken place outside in the alley hadn't been a real fight. If it had- if I'd been beaten into submission †¦ well, yeah. Maybe I could accept that. Maybe. But I hadn't been beaten. I'd barely gotten my hands dirty. Instead, I'd gone quietly. Once they had us sitting on the floor of the van, they'd bound each of our hands behind our back with flex-cuffs- strips of plastic that cinched together and held just as well as anything made of metal. After that, we rode in near silence. The men occasionally murmured something to each other, speaking too softly for any of us to hear. Christian or Mia might have been able to understand the words, but they were in no position to communicate anything to the rest of us. Mia looked as terrified as she had out on the street, and while Christian's fear had rapidly given way to his typical haughty anger, even he didn't dare act out with guards nearby. I was glad for Christian's self-control. I didn't doubt any of these men would smack him if he got out of line, and neither I nor the other novices were in a position to stop them. That was what really drove me crazy. The instinct to protect Moroi was so deeply ingrained in me that I couldn't even pause to worry about myself. Christian and Mia were the focus. They were the ones I had to get out of this mess. And how had this mess started? Who were these guys? That was a mystery. They were human, but I didn't believe for an instant that a group of dhampirs and Moroi had been random kidnapping victims. We'd been targeted for a reason. Our captors made no attempts to blindfold us or conceal our route, which I didn't take as a good sign. Did they think we didn't know the city well enough to retrace our steps? Or did they figure it didn't matter since we wouldn't be leaving wherever they were taking us? All I sensed was that we were driving away from downtown, off toward a more suburban area. Spokane was as dull as I'd imagined. Unlike where pristine white snow lay in drifts, slushy gray puddles lined the streets and dirty patches dotted the lawns. There were also a lot fewer evergreen trees than I was used to. The scraggly, leafless deciduous trees here seemed skeletal by comparison. They only added to the mood of impending doom. After what felt like less than an hour, the van turned down a quiet cul-de-sac, and we drove up to a very ordinary- yet large- house. Other houses- identical in the way suburban homes often are- stood nearby, which gave me hope. Maybe we could get some help from the neighbors. We pulled inside the garage, and once the door was back down, the men ushered us into the house. It looked a lot more interesting on the inside. Antique, claw-footed sofas and chairs. A large, saltwater fish tank. Swords crossed over the fireplace. One of those stupid modern art paintings that consisted of a few lines splayed across the canvas. The part of me that enjoyed destroying things would have liked to study the swords in detail, but the main floor wasn't our destination. Instead, we were led down a narrow flight of stairs, down to a basement as large as the floor above. Only, unlike the main floor's open space, the basement was sectioned off into a series of halls and closed doors. It was like a rat's maze. Our captors led us through it without hesitation, into a small room with a concrete floor and unpainted drywall. The furniture inside consisted of several very uncomfortable-looking wooden chairs with slatted backs- backs that proved to be a convenient place for rebinding our hands. The men seated us in such a way that Mia and Christian sat on one side of the room, and the rest of us dhampirs sat on the other. One guy- the leader, apparently- watched carefully as one of his henchmen bound Eddie's hands with new flex-cuffs. â€Å"These are the ones you especially have to watch,† he warned, nodding toward us. â€Å"They'll fight back.† His eyes traveled first to Eddie's face, then Mason's, and then mine. The guy and I held each other's gaze for several moments, and I scowled. He looked back over at his associate. â€Å"Watch her in particular.† When we'd been restrained to his satisfaction, he barked out a few more orders to the others and then left the room, shutting the door loudly behind him. His steps echoed through the house as he walked upstairs. Moments later, silence fell. We sat there, staring at each other. After several minutes, Mia whimpered and started to speak. â€Å"What are you going to- â€Å" â€Å"Shut up,† growled one of the men. He took a warning step toward her. Blanching, she cringed but still looked as though she might say something else. I caught her eye and shook my head. She stayed silent, eyes wide and a slight tremble to her lip. There's nothing worse than waiting and not knowing what'll happen to you. Your own imagination can be crueler than any captor. Since our guards wouldn't talk to us or tell us what was in store, I imagined all sorts of horrible scenarios. The guns were the obvious threat, and I found myself pondering what a bullet would feel like. Painful, presumably. And where would they shoot? Through the heart or the head? Quick death. But somewhere else? Like the stomach? That would be slow and painful. I shuddered at the thought of my life bleeding out of me. Thinking of all that blood put me in mind of the Badica house and maybe having our throats slit. These men could have knives as well as guns. Of course, I had to wonder why we were still alive at all. Clearly they wanted something from us, but what? They weren't asking for information. And they were human. What would humans want with us? Usually the most we feared from humans was either running into crazy slayer types or those who wanted to experiment on us. These seemed like neither. So what did they want? Why were we here? Over and over, I imagined more awful, gruesome fates. The looks on my friends' faces showed I wasn't the only one who could envision creative torments. The smell of sweat and fear filled the room. I lost track of time and was suddenly jolted out of my imaginings when footsteps sounded on the stairs. The lead captor stepped into the hall. The rest of the men straightened up, tension crackling around them. Oh God. This was it, I realized. This was what we'd been waiting for. â€Å"Yes, sir,† I heard the leader say. â€Å"They're in here, just like you wanted.† Finally, I realized. The person behind our kidnapping. Panic shot through me. I had to escape. â€Å"Let us out of here!† I yelled, straining at my bindings. â€Å"Let us out of here, you son of a- â€Å" I stopped. Something inside of me shriveled up. My throat went dry. My heart wanted to stop. The guard had returned with a man and a woman I didn't recognize. I did, however, recognize that they were †¦ †¦ Strigoi. Real, live- well, figuratively speaking- Strigoi. It all suddenly clicked together. It wasn't just the Spokane reports that had been true. What we'd feared- Strigoi working with humans- had come true. This changes everything. Daylight wasn't safe anymore. None of us were safe anymore. Worse, I realized these must be the rogue Strigoi- the ones who had attacked the two Moroi families with human help. Again, those horrible memories came to me: bodies and blood everywhere. Bile rose in my throat, and I tried to shift my thoughts from the past to the present situation. Not that that was any more reassuring. Moroi had pale skin, the kind of skin that blushed and burned easily. But these vampires†¦their skin was white, chalky in a way that made it look like the result of a bad makeup job. The pupils of their eyes had a red ring around them, driving home what monsters they were. The woman, actually, reminded me of Natalie- my poor friend whose father had convinced her to turn Strigoi. It took me a few moments to figure out what the resemblance was because they looked nothing alike. This woman was short- probably human before becoming Strigoi- and had brown hair with a bad highlighting job. Then it hit me. This Strigoi was a new one, much as Natalie had been. It didn't become obvious until I compared her with the Strigoi man. The Strigoi woman's face had a little life in it. But his †¦ his was the face of death. His face was completely devoid of any sort of warmth or gentler emotion. His expression was cold and calculating, laced with malicious amusement. He was tall, as tall as Dimitri, and had a slender frame that indicated he'd been Moroi before changing over. Shoulder-length black hair framed his face and stood out against the bright scarlet of his dress shirt. His eyes were so dark and brown that without the red ring, it would have been almost impossible to tell where pupil ended and iris began. One of the guards shoved me hard, even though I'd been silent. He glanced up at the Strigoi man. â€Å"You want me to gag her?† I suddenly realized I'd been hunching into the back of my chair, unconsciously trying to get as far away from him as possible. He realized this too, and a thin, toothless smile crossed his lips. â€Å"No,† he said. His voice was silky and low. â€Å"I'd like to hear what she has to say.† He raised an eyebrow at me. â€Å"Please. Continue.† I swallowed. â€Å"No? Nothing to add? Well. Do feel free to pipe up if something else comes to mind.† â€Å"Isaiah,† exclaimed the woman. â€Å"Why are you keeping them here? Why haven't you just contacted the others?† â€Å"Elena, Elena,† Isaiah murmured to her. â€Å"Behave yourself. I'm not going to pass up the chance to enjoy myself with two Moroi and †¦Ã¢â‚¬  He walked behind my chair and lifted my hair, making me shudder. A moment later, he peered at Mason and Eddie's necks as well. â€Å"†¦three unblooded dhampirs.† He spoke those words with an almost happy sigh, and I realized he'd been looking for guardian tattoos. Strolling over to Mia and Christian, Isaiah rested a hand on his hip as he studied them. Mia could only meet his eyes for an instant before looking away. Christian's fear was palpable, but he managed to return the Strigoi's scrutiny. It made me proud. â€Å"Look at these eyes, Elena.† Elena walked over and stood beside Isaiah as he spoke. â€Å"That pale blue. Like ice. Like aquamarines. You almost never get that outside of the royal houses. Badicas. Ozeras. The occasional Zeklos.† â€Å"Ozera,† said Christian, trying very hard to sound fearless. Isaiah tilted his head. â€Å"Really? Surely not†¦Ã¢â‚¬  He leaned closer to Christian. â€Å"But the age is right†¦and that hair†¦Ã¢â‚¬  He smiled. â€Å"Lucas and Moira's son?† Christian said nothing, but the confirmation on his face was obvious. â€Å"I knew your parents. Great people. Unparalleled. Their deaths were a shame†¦ but, well†¦ I daresay they brought that on themselves. I told them they shouldn't have gone back for you. Would have been wasteful to awaken you so young. They claimed they were going to just keep you around and waken you when you were older. I warned them that that would be a disaster, but, well†¦Ã¢â‚¬  He gave a delicate shrug. â€Å"Awaken† was the term Strigoi used among themselves when they changed over. It sounded like a religious experience. â€Å"They wouldn't listen, and disaster met them in a different way.† Hatred, deep and dark, boiled behind Christian's eyes. Isaiah smiled again. â€Å"It's quite touching that you should find your way to me after all this time. Perhaps I can realize their dream after all.† â€Å"Isaiah,† said the woman- Elena- again. Every word out of her mouth seemed like a whine. â€Å"Call the others- â€Å" â€Å"Stop giving me orders!† Isaiah grabbed her shoulder and shoved her away- except that the push knocked her across the room and almost through the wall. She just barely threw her hand out in time to stop the impact. Strigoi had better reflexes than dhampirs or even Moroi; her lack of grace meant he'd completely caught her off guard. And really, he'd barely touched her. The push had been light- yet it had packed the force of a small car. This further enforced my belief that he was in another class altogether. His strength beat hers by magnitudes. She was like a fly he could swat away. Strigoi power increased with age- as well as through the consumption of Moroi blood and, to a lesser extent, dhampir blood. This guy wasn't just old, I realized. He was ancient. And he'd drunk a lot of blood over the years. Terror filled Elena's features, and I could understand her fear. Strigoi turned against each other all the time. He could have ripped her head off if he wanted. She cowered, averting her eyes. â€Å"I†¦ I'm sorry, Isaiah.† Isaiah smoothed his shirt- not that it had been wrinkled. His voice took on the cold pleasantness he'd affected earlier. â€Å"You clearly have opinions here, Elena, and I welcome you voicing them in a civilized manner. What do you think we should do with these cubs?† â€Å"You should- that is, I think we should just take them now. Especially the Moroi.† She was clearly working hard not to whine again and annoy him. â€Å"Unless†¦you aren't going to throw another dinner party, are you? It's a complete waste. We'll have to share, and you know the others won't be grateful. They never are.† â€Å"I'm not making a dinner party out of them,† he declared loftily. Dinner party? â€Å"But I'm not killing them yet either. You're young, Elena. You only think about immediate gratification. When you're as old as me, you won't be so †¦ impatient.† She rolled her eyes when he wasn't looking. Turning, he swept his gaze over me, Mason, and Eddie. â€Å"You three, I'm afraid, are going to die. There's no avoiding it. I'd like to say I'm sorry, but, well, I'm not. Such is the way of the world. You do have a choice in how you die, however, and that will be dictated by your behavior.† His eyes lingered on me. I didn't really get why everyone seemed to be singling me out as the troublemaker here. Well, maybe I did. â€Å"Some of you will die more painfully than others.† I didn't need to see Mason and Eddie to know their fear mirrored mine. I was pretty sure I even heard Eddie whimper. Isaiah abruptly turned on his heels, military-style, and faced Mia and Christian. â€Å"You two, fortunately, have options. Only one of you will die. The other will live on in glorious immortality. I'll even be kind enough to take you under my wing until you're a little older. Such is my charity.† I couldn't help it. I choked on a laugh. Isaiah spun around and stared at me. I fell silent and waited for him to throw me across the room like he had Elena, but he did nothing else but stare. It was enough. My heart raced, and I felt tears brim in my eyes. My fear shamed me. I wanted to be like Dimitri. Maybe even like my mother. After several long, agonizing moments, Isaiah turned back to the Moroi. â€Å"Now. As I was saying, one of you will be awakened and live forever. But it will not be me who wakens you. You will choose to be awakened willingly.† â€Å"Not likely,† said Christian. He packed as much snarky defiance as he could manage into those two words, but it was still obvious to everyone else in the room that he was scared out of his mind. â€Å"Ah, how I love the Ozera spirit,† mused Isaiah. He glanced at Mia, his red eyes gleaming. She shrank back in fear. â€Å"But don't let him upstage you, my dear. There's strength in common blood, too. And here's how it will be decided.† He pointed at us dhampirs. His gazed chilled me all over, and I imagined I could smell the stink of decay. â€Å"If you want to live, all you have to do is kill one of these three.† He turned back to the Moroi. â€Å"That's it. Not unpleasant at all. Just tell one of these gentlemen here you want to do it. They'll release you. Then you drink from them and are awakened as one of us. Whoever does this first walks free. The other will be dinner for Elena and me.† Silence hung in the room. â€Å"No,† said Christian. â€Å"No way am I killing one of my friends. I don't care what you do. I'll die first.† Isaiah waved a dismissive hand. â€Å"Easy to be brave when you aren't hungry. Go a few days without any other sustenance †¦ and yes, these three will start to look very good. And they are. Dhampirs are delicious. Some prefer them to Moroi, and while I myself have never shared such beliefs, I can certainly appreciate the variety.† Christian scowled. â€Å"Don't believe me?† asked Isaiah. â€Å"Then let me prove it.† He walked back over to my side of the room. I realized what he was going to do and spoke without fully thinking things through. â€Å"Use me,† I blurted out. â€Å"Drink from me.† Isaiah's smug look faltered for a moment, and his eyebrows rose. â€Å"You're volunteering?† â€Å"I've done it before. Let Moroi feed off me, I mean. I don't mind. I like it. Leave the rest of them alone.† â€Å"Rose!† exclaimed Mason. I ignored him and looked beseechingly at Isaiah. I didn't want him to feed off me. The thought made me sick. But I had given blood before, and I'd rather him take pints from me before he touched Eddie or Mason. I couldn't read his expression as he sized me up. For half a second, I thought he might go for it, but instead he shook his head. â€Å"No. Not you. Not yet.† He walked over and stood before Eddie. I pulled against my flex-cuffs so hard that they dug painfully into my skin. They didn't give. â€Å"No! Leave him alone!† â€Å"Quiet,† snapped Isaiah, without looking at me. He rested one hand on the side of Eddie's face. Eddie trembled and had gone so pale, I thought he would faint. â€Å"I can make this easy, or I can make it hurt. Your silence will encourage the former.† I wanted to scream, wanted to call Isaiah all sorts of names and make all sorts of threats. But I couldn't. My eyes flicked around the room, searching for exits, as I had so many times before. But there were none. Just blank, bare white walls. No windows. The one precious door, always guarded. I was helpless, just as helpless as I'd been from the moment they'd pulled us into the van. I felt like crying, more from frustration than fear. What kind of guardian would I be if I couldn't protect my friends? But I stayed quiet, and a look of satisfaction crossed Isaiah's face. The fluorescent lighting gave his skin a sickly, grayish hue, emphasizing the dark circles under his eyes. I wanted to punch him. â€Å"Good.† He smiled at Eddie and held his face so that the two made direct eye contact. â€Å"Now, you won't fight me, will you?† As I've mentioned, Lissa was good at compulsion. But she couldn't have done this. In seconds, Eddie was smiling. â€Å"No. I won't fight you.† â€Å"Good,† repeated Isaiah. â€Å"And you'll give me your neck freely, won't you?† â€Å"Of course,† replied Eddie, tilting his head back. Isaiah brought his mouth down, and I looked away, trying to focus on the threadbare carpet instead. I didn't want to see this. I heard Eddie emit a soft, happy moan. The feeding itself was relatively quiet- no slurping or anything like that. â€Å"There.† I glanced back when I heard Isaiah speak again. Blood dripped from his lips, and he ran his tongue across them. I couldn't see the wound on Eddie's neck, but I suspected it was bloody and horrible too. Mia and Christian stared wide-eyed, both with fear and fascination. Eddie gazed off in a happy, drugged haze, high from both the endorphins and the compulsion. Isaiah straightened up and smiled at the Moroi, licking the last of the blood off his lips. â€Å"You see?† he told them, moving toward the door. â€Å"It's just that easy.†

The Great Arsenal of Democracy (Ethos, Pathos, Logos)

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