How Artificial Intelligence Will Impact The World - 900 Words

Zoltan recently spoke at the Artificial Intelligence and The Singularity Conference in Oakland, California. It had AI specialists Peter Voss and Monica Anderson, New York University educator Gary Marcus, science fiction author Nicole Sallak Anderson, and futurist Scott Jackisch. We were fascinated in how artificial intelligence will impact the world. My subject was The Morality of an Artificial Intelligence Will be Different from our Human Morality. Elon Musk an entrepreneur made the headlines when he cautioned on Twitter that, AI could be â€Å"potentially more dangerous than nukes. Some days after, a writer reached out to me, for my reaction to his announcement, and I replied. AI likely will likely be the most significant event in human history. This can either go badly or catapult humans to unimaginable trans humanist heights warned Elon Musk. The launch of AI, expects most science and technology book to be completely rewritten with improved and complex ideas. I expect an era of learning and superior human lifestyles. The important thing, is to not allow AI to run wild, however, to already be part machines ourselves, so we will be able to plug into it wherever it leads. Whatever happens next, in spite of everything, we don’t want to overlook the Singularity. The pressing philosophical question is whether human morals can be translated effectively into AI ethics. Does AI relativism exist, if so, is the difference more noticeable than comparing apples and oranges?Show MoreRelatedResearch Paper On Artificial Intelligence1641 Words   |  7 PagesXTIB Introduction to Information Systems and Data Analytics Artificial Intelligence Brittany Cook July 20, 2017 Abstract This research involves discovering how Artificial Intelligence (AI) has progressed and how it could potentially replace mankind. The goal of this research is to provide examples of how Artificial Intelligence is incorporated into our daily lives and provides an easier way of living. Today, we live in a world where technology is constantly advancing and executing tasksRead MoreIntroduction To Weakness Artificial Intelligence1060 Words   |  5 Pages301 October 10, 2017 Over the past decade, Artificial intelligence has grown to become a prominent element in the technological world and continues to expand rapidly. Artificial intelligence, defined by Dictionary.com, is the theory and development of computer systems able to perform tasks that normally require human intelligence, such as visual perception, speech recognition, decision-making, and translation between languages. Artificial intelligence has advanced far enough to the capability ofRead MoreArtificial Intelligence In Technology1612 Words   |  7 Pages â€Å"The increasing use of artificial intelligence in technology will transform our societies for the worse.† Module: FC-503 Tutor Name: Assessment type: Essay Student Number: T0061516 Word Count: The theme of the 2017 Summer Davos meeting was about the fourth revolution of science and technology and artificial intelligence was undoubtedly one of the main topics discussed by people. From driving interactive voice with nobody to Alphago defeat the invincible chess champion Ke Jie (GibneyRead MoreArtificial Intelligence Essay1008 Words   |  5 Pagesrobots already run most of the world. We’ll be their butlers soon enough.†(Brain Quote) Artificial Intelligence is the development of computer systems that normally require human intelligence. This (Artificial Intelligence) has lead to countless short-term positives such as â€Å"improving the speed, quality, and costs of available goods and services (Karsten and West 1). (This being said from the Brooking institution) However, as businesses continue to use Artificial Intelligence to increase extra goods andRead MoreBenefits Of Artificial Intelligence761 Words   |  4 PagesArtificial Intelligence, more commonly ref erred to by its abbreviations AI, is defined as intelligence displayed by machines rather than humans. Its aptitudes include successfully recognising and comprehending human speech, computing simulations and analysing an immense amount of elaborate data. As there is limitless potential for this technology, there is a lot of research currently underway to develop AI with the ability to outperform humans at virtually every cognitive task, rather than specificRead MoreArtificial Intelligence Impact864 Words   |  4 Pages Artificial Intelligence and Its Impact to The Modern World Artificial Intelligence is something that us humans have known about for many years now. It is something that has been brought up and popularized in movies and books, and is a subject matter that a lot of people enjoy reading up on. The benefits of artificially intelligences out weighs the risks, but it is something that should be treaded carefully. Based on movies and known theories artificially intelligence has the possibilityRead MoreHow Close Are We Really Artificial Intelligence?1249 Words   |  5 PagesHow Close Are We Really to Artificial Intelligence? In The Hitchhiker’s Guide to the Galaxy, written by Douglas Adams, a man named Arthur Dent wakes up and finds himself at the beginning of beyond a bad day. When he learns that a friend of his is actually an alien with advanced knowledge of Earth s impending destruction, he is transported off the Earth seconds before it is exploded to make way for a new hyperspace motorway. And as if that s not enough, throw in being wanted by the police, EarthRead MoreImportance Of Artificial Intelligence1409 Words   |  6 Pagesmost famous science fiction writers, artificial intelligence ( AI) is taking root in our everyday lives† ( Science Fiction to Reality 1). Artificial Intelligence is a machinery which includes network and a probabilistic model. Artificial intelligence is the computer that can now spontaneously translate spoken and written conversation. It can also recognize and accurately cations photos, identify faces and can be your personal assistant. Artificial intelligenc e has specific technologies, like theRead MoreArtificial Intelligence During The World Today855 Words   |  4 Pages Artificial Intelligence in The World Today The 19th and 20th Centuries came in a wave of technological advances that have become intertwined in humanity. Smartphones are the most commonly used technology that contain artificial intelligence today. Artificial intelligence continues to advance and expand surpassing the aspiring ideas from the 1920’s. Artificial Intelligence has a strong impact on the future. In fact, IBM’s â€Å"question answering machine† (Markoff 212), Watson, confirmed the advancesRead MoreEssay On Artificial Intelligence738 Words   |  3 PagesArtificial intelligence is a beneficial form of technology used daily by humans around the world, and is widespread across society. It is used in almost every field of our lives, from our phones, to our food, and is devoted to making our day-to-day life easier. However, there is much debate worldwide about whether this technology is truly beneficial or not for society, as some choose to believe that it is doing more harm than good. Artificial intelligence (AI) is usually defined as the science

The Issue Of Child Welfare Essay - 1735 Words

Child welfare is an issue that is vastly debated today in the United States. Regardless of party lines, socioeconomics, gender, religion, or race, it seems like everyone has a stake in shaping this issue. As such, progression in policy can be difficult and is often controversial. Throughout the 1900s, the United States Supreme Court heard and decided several cases that set forth precedent, giving more power to, and enabling, parents to raise their children as they see fit. As constituents, parents have a substantial say in what policy should and will be enacted. However, as individuals, parents do not have nearly as much power alone as they do in groups to influence public policy. Therefore, by banning together and creating interest groups, as well as participating in political parties, individuals who have an interest in child welfare, are more likely to make a substantial difference. For the most part, parents have the best interest of their children at heart. However, there are unfortunately many cases throughout the United States where parents are unable to, for one reason or another, take care of their children. Sometimes, this can be seen as a health issue of the parents. Sometimes, parents are unable to raise their children well due to physical, financial, and/or emotional issues. Other times, parents do not have the best interests of their children in mind and can be neglectful or abusive to them. In these circumstances, the state may become involved and step intoShow MoreRelatedThe Issue of Child Welfare999 Words   |  4 PagesThe issue of child welfare is typified in the society mainly because of freedom of choice to be given to the children. There are certain social problems which are discussed frequently in this context. The major problems include the rights of child and access to privileges. It is argued that child is an individual who has no lesser rights than any other individual and he must be given the liberty to enjoy these rights. He must be given food, shelter and clothing without his contribution in the economicRead MoreThe Issue That I Am Most Passionate About Is Child Welfare Essay817 Words   |  4 PagesThe issue that I am most passionate about is child welfare. Included in this topic are many, very troubling issues. Given the enormity of the problem, it is difficult to pick just two or three issues, but I chose two that I found especially disturbing, child fatalities and child sexual abuse. I will also briefly discuss some statistics regarding child abuse as a whole, and measures that could be taken to help address the issues. Nationally in 2012, there were an estimated 686,000 unique childRead MoreAnnotated Bibliography On Child Welfare System1220 Words   |  5 Pages Child Welfare System: An Annotated Bibliography The child welfare system is a child protective agency. Their focus is to protect children. Without the agency, there will be a lot of hurt children. The focus of my paper is make to you aware of the child welfare system. Including the history, racism, issues, and outcomes of the system. I chose this topic because child welfare doesn’t receive enough attention. That is my own personal belief. I believe people need to be aware of the child welfareRead MoreChild Welfare Services Essay1439 Words   |  6 Pageschose to research about is Child Welfare Services. This topic has a variety of different regulations and forms that makes this program run. Child Welfare Services have been around for quite some time and has been helping out as much as they are allowed to. This program has a time line of many important events that all build up the Child Welfare program. First off in 1909 the white house had the first national Conference on the Care of Dependent Children (Child Welfare League of America, n.d.). TheseRead MoreChild Welfare Services Is A Social Work1740 Words   |  7 Pagesreality is that not every child is provided with an environment that fosters a child’s needs, parents are not always able to meet the basic needs of a child, and the childhoods of approximately 742,000 children were not free from abuse and neglect in 2011 (U.S. Department of Health and Human Services, 2012). The social work profession is filled with numerous areas of practice that include areas such as gerontological social work, military social work, and child welfare services which is the secondRead MoreThe Child Welfare System That Could Benefit From Technological Advancements1135 Words   |  5 PagesSOCIETAL CONCERNS There are so many aspects of the child welfare system that could benefit from technological advancements the societal concerns revolve around priorities. Between educational consistency, funding, caseloads, connectedness and training society needs to consider which aspect should be addressed first that will most significantly impact the best interests of the child. If case workers are tasked with providing additional services, this may increase turnover and decrease the qualityRead MoreIn 1853, Charles Loring Brace Started The Free Foster Home1448 Words   |  6 Pagesthem in bettering their lives. Charles Loring Brace’s Free Foster Home Movement began our journey to the foster care system we have today. Not only did the Free Foster Home Movement help foster care, it helped social welfare as a whole. Foster care is a pivotal part of child welfare, it assists children in inadequate homes to leave and prosper. The Movement instigated a solution for unsatisfactory living conditions. I believe the Movement was flawed; however, we have come a long way. Yes, childrenRead MoreChild Welfare Worker Essay1718 Words   |  7 PagesThe job of a child welfare worker appears to be a demanding profession that promotes the child’s safety, but also strengthens the family organization around them in order to successfully raise the children. This child welfare workers work in the system known as the Child Protective Services whose initiative is to protect the overall welfare of the child. The short novel From the Eye of the Storm: the Experiences of a Child Welfare Worker by Cynthia Crosson-Tower demonstrates the skills necessaryRead MoreAn Analytical Comparison Between England And Florida s Child Protection1619 Words   |  7 Pagesdelivery issues drawing on good practice from, at least, another part of the world. This assignment will begin by defining child protection. This will lead to an analytical comparison between England and Florida’s child protection approaches, structure of the system and possible practice issues. This will include will include relevant legislation and policies. Following this suggestions on the improvement of provisions and services will be made in accordance to the above findings. Child protectionRead MoreThe Social Work Policies1506 Words   |  6 Pages Social Work Policies Social Welfare Q 1 Income support policies in the United States Income support policies in the United States view the monetary aspect of individual and family well-being. Income support policies are categorized into two that is direct cash transfers and indirect cash transfers. Income support programs are aimed at reducing poverty levels and boosting the economic growth of United States. Major historical developments took place in the late 1950s. In 1958, social security

How Does Music Affect Your Mood Essay Example For Students

How Does Music Affect Your Mood Essay Many studies have shown that the simple answer is yes. Music is an international language in a sense. You may not be able to speak Korean, but the song, Kananga Style, was popular in the United States for some time. If a tune is catchy and people can dance to the song, everyone can speak music. After all, music has been around for a really long time. The amount of activity that popular sites such as, Pandora or Spottily also suggests how much music is a part of our culture today. Studies continue to show that music is an important part of our health. According to Ferguson research in The Journal of Positive Psychology, people can improve their overall happiness in Just two weeks by listening to the right music. In his study, he conducted an experiment which involved having people listen to music that was upbeat as well as sad music such as, Stravinsky. The participants that listened to upbeat music, including Copeland and other similar artists, reported oiling happier and ready to have fun. The other participants who listened to music that wasnt as upbeat reported feeling gloomier and not as happy before. In a similar study, The Journal of Consumer Research explained that people who had Just been through a sad event in their life heavily preferred sad music over happy music. In the same study, the participants who had been through a sad or frustrating event such as, breaking up with a boyfriend or girlfriend, getting in trouble, or being stood p on a date explained that after listening to sad music, they felt a little better about what had happened. For this reason, people often use music as therapy. On a similar note, music has an enormous effect on our brain. It can often trigger multiple secondary responses such as, moving with the music or tapping your foot to the beat. This happens due to the stimulation of neurons in the motor cortex of your brain. Moving to the music or tapping your foot can, incidentally improve your mood. Music as also shown to increase energy. Recent studies have shown that if you listen to music while you work out, you can get one to two more reps on average in every set you do. So does music affect your mood? Studies would indicate it does. But, music doesnt Just affect your mood. Music affects life. People spend money to buy it, listen to it live, or Just enjoy it while their driving down the highway. It can become a large part of your life depending on how much you listen to it or how much you pay attention when you listen.

The Great Gatsby Essays (930 words) - The Great Gatsby,

The Great Gatsby The Great Gatsby is a thrilling tale about a very wealthy man named Gatsby. The story is told through the eyes of the narrator, Nick Carraway. In the beginning Nick is showed as someone for all people to tell their problems. They vent their anger and frustration to him. Nick meets Tom and Daisy Buchanan. Nick is not very fond of Tom. Nick then becomes acquainted with Jordan Baker, whom happens to be a golf champion. Baker is portrayed as snotty and stuck up. Hints then begin to arise that there are problems between Daisy and Tom. Jordan Baker then implies that Tom is having an affair. Gatsby is mentioned a couple of times in conversation for his grand parties but not much else is said. A little later Myrtle and her husband Wilson are introduced. Myrtle is the woman that Tom is having an affair with. Myrtles husband, Wilson, is very intimidated by Tom. Tom buys an apartment for him and Myrtle. They call people up for a little gathering. While there Myrtle and Tom have an argument. Tom becomes violent and breaks Myrtles nose with his bare hands. Nick then receives an invitation to one of Gatsbys huge parties. While Nick is there he sees Jordan Baker. While the two of them walk around and talk, Nick hears more rumors about Gatsby. He himself then begins to look for Gatsby. Nick soon finds out that although Gatsby throws these huge parties, he does not like to stand out or to be very social. He prefers to just observe the festivities rather than to take part in them. Later that night, Nick finally gets to meet Gatsby. In this next chapter, Nick receives an invitation from Gatsby to join him for lunch. When Nick arrives, him and Gatsby talk. Gatsby tells him how he went to Oxford and how he inherited his fortune through his family fortune. Gatsby then introduces Nick to one of his friends/partners in business. Mr. Wolfshiem is a man that is involved in a shady business. Wolfshiem is used to indicate that Gatsby may be involved in shady deals as well. Jordan then tells Nick how Daisy and Gatsby were old lovers and how Gatsby wants her back. She also tells Nick that Gatsby wants him to set up a reunion between the old lovers. Nick reunites Gatsby and Daisy at Gatsbys request and without Daisys knowledge. Gatsby wants to show Daisy his house. He does so to show Daisy what he has become through his possessions. Gatsby becomes confused because his dream is right in front of him and she isnt as perfect as he imagined her to be. Gatsby expects Daisy to be perfect she isnt. Later on, Tom and Daisy attend one of Gatsbys parties. Tom does not enjoy himself and begins to suspect something between Gatsby and Daisy. A couple of days later, Tom finds figures out what is going on between Gatsby and Daisy; this infuriates him. Gatsby asks Daisy to tell Tom that she never stopped loving Gatsby and never did love Tom. Wilson now discovers Myrtles unfaithfulness but does not know with whom she is cheating. Wilson locks up Myrtle but she escapes. Upon her escape, Gatsbys car hits Myrtle and kills her. Daisy was in the drivers seat of the car, not Gatsby. Wilson now becomes insane. He had no one in his life but Myrtle and she has been taken away from him. Wilson discovers that it was Gatsbys car that killed Myrtle. He hunts down Gatsby and kills him and then takes his own life. Well, on a lighter note, lets talk about the roaring twenties. They are fitfully named because that is exactly what they were. Most people didnt have a care in the world. They worked during the day and partied all night long. The Great Gatsby picturesquely portrays what upper class life mostly consisted of in the twenties. It throws a love story in the mix to spice it up a little bit and to add drama; but this does not significantly add to the historic aspect of the book. This book did not really have an affect on life in the twenties as, lets say, The Jungle did have on American

Center5812100 Essays - Economy Of Kazakhstan, Economy, Free Essays

Center5812100 Essays - Economy Of Kazakhstan, Economy, Free Essays center5812100 Development of measures to implement controlling in the management system of investment projects of Samruk-Kazyna Invest LLP Location: Astana Course Code: TOP101 Course Name: Business Research Professor: Dr Oliver Elliott Student(s) Name(s): Nurzhan Sikhimov 1. Research proposal The theme of my research is "Will the introduction of a controlling system in the management of investment projects of Samruk-Kazyna Invest LLP be effective?" The relevance of the chosen topic is that today the issue of improving the management system of companies' activities is acute. We have chosen one of the most promising enhancements to the effectiveness of the management system, this is the introduction of controlling, as a modern toolkit that is gaining popularity all over the world. The purpose of our study was to study and analyze the development of practical measures to introduce controlling in the investment project management system. The work is the result of a study, where the materials of practical research clearly demonstrated the effectiveness of the process of implementing projects controlling in the investment activity of the company with application in practice. The entry of Kazakhstan into the world economic space gives impetus to the improvement of the management system at the largest companies of the country. The condition for the formation of a successful state, its strong economy and huge human potential is itself the development of a high level of innovation and variability, as well as the search for new approaches in the management, monitoring and subsequent forecasting of companies' activities. We can confidently say that in the current conditions of reforming the country's economy, the application of the controlling system that we offer becomes an integral part of the process of forming competitive enterprises and companies, as well as a competitive state. The thoughtless introduction of foreign experience in the management of companies in the companies of the CIS countries, based on the still not fully formed conditions of the developing economy, did not give the desired effect. Hence, the need arose to find new effective ways of managing. Our analysis of this problem demonstrates the inadequacy of its study in the work of economists and specialists in the field of management. In the course of the study, it became clear that there was a need for comprehensive and comprehensive monitoring and, accordingly, analysis of the activities of companies without which it is impossible to manage complex economic processes and make rational decisions. Therefore, we conducted a detailed study and systematization of methodological approaches to project management and, as a result, the application of the controlling we propose. Given the development of market relations, a particular influence of a number of factors on the control, management and adoption of important decisions will increase: competitive struggle, universal computerization in the process of processing economic information, constant processes of introducing amendments to the tax system of countries and so on. All indicators of the company's activities can be obtained by making an objective control and analysis, through which the actual position of the company is evaluated, and as a result, a reasonable objective allocation of all resources: material, labor and financial, with the introduction of innovative achievements in scientific and technological progress, productive forms of management and management of the company's production, activation of entrepreneurship, and mobilization of previously unused reserves. Formation and development of controlling in Kazakhstan is conditioned by unified objective requirements and conditions, satisfaction of practical needs and solution of many theoretical issues in project management. In our study, we will consider the activities of one of the largest investment company of Kazakhstan - Samruk-Kazyna Invest LLP, which manages and monitors investment projects in Kazakhstan. Within the framework of this company, there is a need to reorganize the control system for investment projects, to improve this process and increase the effectiveness of the activities undertaken to increase sustainability, and the level of competitiveness. Thus, the study of the conceptual framework and identification of the problems of implementing the controlling system in project management in the investment activities of Kazakhstan companies made it possible to determine the importance and necessity of their solution, search and make recommendations for practical impleme ntation. 2. Literature Review The study of the problems of formation and development

Free Essays on Stocks

During this stock project I have learned a lot of strategies on how to buy stocks and what stocks is. When I first started the stock game, I really didn't know what I was doing and which companies to buy. Therefore, I just pick the companies that have the best dividend and did well in the past. Also I picked the companies that I've heard of and familiar with. But now after taking the business class and playing the stocks game I know what stocks is good to buy and what is not good to buy. Through out the game I think I have sold about 10 stocks at a lower price. The first day of class when you told us that we have to play the stocks game, I didn't want to play it at all. Because it seem like it is really boring. As I kept on playing the game, I got very hooked on the game. It was fun and exciting both at the same time. The second week into the game, I remember every time whenever I get home at 10:45 I would run to my room really quick and turn on the computer and was looking at my stocks to see if it's going up or down. Also every couple of seconds I would keep on clicking the refresh button to see if my stocks is going up and down, and every time my stocks is going up I would be very happy and if it's not going up I would be sad. As I keep playing the game my knowledge of stocks has progress. Before I buy any stocks I would look up the status of how the stocks is doing right now and how it has been doing in the past couple of months. The places that I looked up for my stocks were mainly Yahoo and Bloomberg, sometime I would also watch channel 128, which is the Bloomberg channel. This is the channel that has stocks information and update twenty-four seven. When I look up for what stocks to buy, first I looked up how low the stocks has been going down and if it went down a lot then I would buy it because I figure out that if the stock has been going down for the past couple of days or months then and it has to go back up anytime dur... Free Essays on Stocks Free Essays on Stocks You buy or trade stocks, bonds and mutual funds. Perhaps you invest in a 401(k) plan. Did you know you may be using a form of options as part of your everyday life? Do you pay a premium every quarter for house, auto, and medical insurance? You have purchased insurance as a safeguard against a fire in your home, a crash in your car, or large medical bills. Some investors use options on stocks or cash indexes to protect and insure the value of their portfolios. A major advantage of options is their versatility. They can be as conservative or as speculative as your investing strategy dictates. Options enable you to tailor your position to your own set of circumstances. Consider the following benefits of options:  · You can protect stock holdings from a decline in market price  · You can increase income against current stock holding  · You can prepare to buy a stock at a lower price  · You can position yourself for a big market move even when you don' t know which way prices will move  · You can benefit from a stock price rise without incurring the cost of buying the stock outright There are many strategy discussions for the new investor. The most basic are buying calls and buying puts. You can take a look at the prices which are known as the options premium. You have the bid and ask prices. You take that price and multiply it by $100 to get the total premium amount of the options. You can also see the amount of options that have traded throughout the day. Open Interest is also given and represents the total open contracts in a particular option series. You may want to begin slowly with options and an effective way to do that is to create a simulated option position. This valuable educational tool gives you a detailed overview of options and charts many of the strategies that you may be interested in pursuing. HOW OPTIONS WORK Much like stocks, options can be used to take a position on the market in an effort to capita... Free Essays on Stocks During this stock project I have learned a lot of strategies on how to buy stocks and what stocks is. When I first started the stock game, I really didn't know what I was doing and which companies to buy. Therefore, I just pick the companies that have the best dividend and did well in the past. Also I picked the companies that I've heard of and familiar with. But now after taking the business class and playing the stocks game I know what stocks is good to buy and what is not good to buy. Through out the game I think I have sold about 10 stocks at a lower price. The first day of class when you told us that we have to play the stocks game, I didn't want to play it at all. Because it seem like it is really boring. As I kept on playing the game, I got very hooked on the game. It was fun and exciting both at the same time. The second week into the game, I remember every time whenever I get home at 10:45 I would run to my room really quick and turn on the computer and was looking at my stocks to see if it's going up or down. Also every couple of seconds I would keep on clicking the refresh button to see if my stocks is going up and down, and every time my stocks is going up I would be very happy and if it's not going up I would be sad. As I keep playing the game my knowledge of stocks has progress. Before I buy any stocks I would look up the status of how the stocks is doing right now and how it has been doing in the past couple of months. The places that I looked up for my stocks were mainly Yahoo and Bloomberg, sometime I would also watch channel 128, which is the Bloomberg channel. This is the channel that has stocks information and update twenty-four seven. When I look up for what stocks to buy, first I looked up how low the stocks has been going down and if it went down a lot then I would buy it because I figure out that if the stock has been going down for the past couple of days or months then and it has to go back up anytime dur...

Capital Punishment Research Paper Example | Topics and Well Written Essays - 3750 words

Capital Punishment - Research Paper Example eval times that even sometimes stretched itself in modern times some were boiling the victim to death, the infamous Mongolian breaking back, catherine or breaking wheel, buried in ground while still alive, burning alive, crucifixion, crushing, decapitation, disembowelment, throwing down from a height, impalement and many other forms of capital punishment were practiced to deliver death to the concerned convict (10 Unusual methods of Capital Punishment, n.d.; Botsman, 2005, p.71). It is worth mentioning that type of capital punishment often differed depending upon the type of crime. A lingering death often awaited a serious convict who is subject to a heinous crime; while a less serious convict might be delivered a quick and almost painless death. Death through thousand cuts or slow slicing that was widely practiced in China in medieval period, reveals another ironical fact (Diehl & Donnelly, 2009, p.150). Here the convict was cut slowly keeping his vital organs intact so that he does not die quickly and suffers each moment of the last moment of his life. The relatives of the victim, if socially powerful and had adequate money often bribed the executioner to end the life of the prisoner after a couple of blow mainly on chest, throat or belly (Min, 2005, p. 15). The modern era ironically (the term used here to reflect the fact that whatever be the means the outcome would always be the same for the victim) brought some sophistication in execution, shooting, electric chair, hanging, electrocution, gas chamber poison injection replaced the brutal medieval acts and were considered to be more humane in nature (Volti, 1999). In USA much controversy has taken place regarding the use of electric chair and gas chamber while executing a convict and most of the states are now... A study of this stature is multidisciplinary and multifaceted. Though exploring the legal realms that governs the current system is my primary objective, yet the study carries many inherent potential apart from that which will explore like each buds of a flower as I move on with my research. In true terms the expected outcome of this study holds the potential to keep a balance between personal and professional augmentation. Capital Crime by Juveniles and the legal dilemma that follow suit will certainly be explored in this study. It is expected to be shown that capital punishment has little to do with curbing juvenile capital crime. On personal ground I will be able to know that what actually leads an adolescent to the world of crime from petty one to as large as capital crime. I am sure that this will reveal more than I expect and explore the multifaceted reasons that lie behind the juvenile capital offenders. This study will also introduce me with an unknown world that is riddled w ith chilled penury and perhaps the breeding ground of juvenile capital and other forms of crime. This might help me to have a different outlook towards juvenile criminals and might even compel me to extend my helping hands towards them. One of the major findings of this study might be ‘looks can be deceptive’ and so our society that we live within.

Autism in Qatar Term Paper Example | Topics and Well Written Essays - 1250 words

Autism in Qatar - Term Paper Example Despite various governments not heeding this noble advice, the effect of such ignorance presents easily foreseeable outcomes. Such inclusion is no doubt one of the many reasons through which poverty and social disruptions can be endured, in addition to reducing the burden of disability to the society. The arising question then is â€Å"can inclusion of the people with disability in various aspects of the society contribute to their empowerment and hence reduced level of depependence in Qatar.† Like many other nations in the Middle East and the world at large, the problem of autism in Qatar has attracted substantial attention. Autism, like other forms of disabilities has been touted to ramifications on both the social and economic aspects of various countries across the globe. Their non-inclusion in day to day activities, more especially social and economic activities has been found to not only have negative consequences on the affected individuals but also on the families as well as the community. Baron-Cohen & Bolton (1993) found that integration and accommodation of people with disabilities into the work force are a critical way of public expenditure reduction, reduction of cost incurred by the families, and also ensuring that the ASD affected persons are able to engage in productive work. Formulation of policies and plans that integrate persons with disabilities into each and every aspects of social and economic life, ranging from education, vocational rehabilitation a s well as employment will no doubt offer immense benefits to both that affected individuals and the society at large (Bertrand et al., 2001). The recent past has seen more and more people getting diagnosed with ASD and consequently extreme emphasis is being placed on their social inclusion and involvement in aspects of social and economic life. Sadly, in various nations, Qatar inclusive, the disabled persons among them the disabled, are

Consultancy Report Essay Example for Free

Consultancy Report Essay As a subsidiary of one of the largest cosmetics organizations in the world, you are in a position to dramatically increase your potential and further capitalize on your brands recognition. My hope is that you will establish and maintain a broader, more diverse customer base and increase your overall profitability. Based on an in-depth analysis and research conducted on your organizations behalf, I have identified several problematic areas in need of immediate attention. The following document will serve to provide valuable information to address these issues accordingly. One such issue and perhaps one of the most crucial is that of the organization’s brand awareness levels in the United Kingdom. This is due in part to the fact that Mary Kay U.K. is not as widely recognized in the United Kingdom as it is in the Americas. I recommend increasing your presence to reach potential customers who would otherwise be unaware of your organization. We will seek to address the significant growth of new potential competitors while developing a means of competing effectively against already established competitors. You will learn of new methods in which to remain relevant and a viable global contender in the cosmetics industry. New products will serve to provide your organization with a competitive edge and differentiate your organization from all its competitors. New policies and changes in the organization’s infrastructure will increase employee satisfaction an important factor for employee retention. These enhancements to the organization’s current dealings can ultimately increase profitability, improve customer satisfaction levels, and increase employee productivity. As Mary Kay U.K. adopts these changes and once in effect, there will be a need to take on additional employees to tend to the day-to-day operations and supplementary qualified/experienced executive-level professionals, allowing for a more focused approach on the management aspects of the organization. Effective documentation of the organization’s financials will allow for more educated and informed decision-making procedures. Adequate fiscal records serve as effective management tool for predicting future success, identify problem areas and to make decisions that will assist in the organization’s overall effectiveness. In addition to significantly changing the inner workings of the organization in the United Kingdom, substantial changes to the organizations image and frontend interfaces may be required to assist with the issue of brand awareness. The organization must become a well-oiled machine internally as well as an aesthetically pleasing entity for potential customers, future investors and for those considering strategic business alliances. Creating a more convivial atmosphere with which your organization would then be associated will give these interested parties a respectable first impression. It is apparent that lacking presentation and unfocused management gives rise to the decrease or stagnation of profitability and employee retention. Changes to policy, organizational image, and infrastructure will not only prove beneficial but may in fact be necessary for the success of the organization and its future viability within the United Kingdom. In addition, there must be changes in customer behavior to increase the probability of the organization’s adoption. The organization needs to appeal to a broader customer base after shifting consumer views of cosmetics to match that of American consumers. Thus, by implementing novel, eye-catching, and feeling invoking imagery or advertisements, people will in turn be more inclined to purchase Mary Kay products. In order to be more successful, I recommend the transformation of current marketing strategies. Implementation of a marketing plan that encompasses the arguably successful word-of-mouth strategy in addition to overt and persistent adverts by way of social media will benefit the organization’s image. Because a constant stream of information pertaining to the actual products will allow the consumer to easily recall the information and develop a need for the product as presented by the advertisement. In addition, there must be a vested interest in appealing to the variety of potential consumers within the United Kingdom. Mary Kay U.K. would be wise to capitalize on United Kingdom’s ever-growing and diverse population, via the translation and representation of the multitude of languages spoken within the target areas of operation. This will allow for a more comfortable customer experience and personalized identification with the Mary Kay brand. Brand Awareness is at an all-time low as target populations fail to recognize the Mary Kay Brand. The organization must increase its visibility in the growing cosmetics market in the United Kingdom. This is possible with improved advertising and re-imagined brand association. Increased brand recognition will assist with declining profits. The proposals presented in this consultancy report, should Mary Kay U.K. opt to adopt them will serve to promote the organization’s business aptitude and increase overall profitability and effectiveness. My hope is that this educated and informed counsel will effectively navigate the organization into a state of increased viability and the optimization and growth of Mary Kay U.K. business operations and clientele. INTRODUCTION This consultancy report will serve to provide the Mary Kay U.K. Ltd. Subsidiary of Mary Kay Cosmetics with informed suggestions to increase the organization’s revenues and improving the day-to-day dealings of the organization from a management perspective. Following extensive research of the organization’s operations, I have prepared a comprehensive examination of the organization in its entirety. This research has been comprised of a thorough analysis of the organization’s fiscal and promotion facets. This report also takes into account the consumer aspect of the organization, and the organizations image as viewed by the public. In addition, it will serve to demonstrate the manner in which the target audience does or fails to accept this image. Crucial organizational issues have been identified and addressed accordingly, supplemented with recommendations for minimizing or eliminating potentially negative effects. These suggestions may prove insightful for the achievement of further profitability and consumer satisfaction should the organization choose to implement any or all of the changes proposed in this report. The information provided in this report comes via thorough research and analytical dismantling of data and industry trends and its reassembling in the form of a well-formulated business plan. Suggestions provided will seek to address Mary Kay U.K.’s organizational structure, the organization’s inclination to incorporate a corporate social responsibility element, consumer satisfaction, employee turn-over rates, decreasing or non-existent profits, brand recognition and awareness among target consumers and product quality, to name the most imperative of organization’s issues. In all, if implemented, these changes could ensure a significant turnaround for the Mary Kay U.K. entity. Numbers will rise to the status of or potentially rival those of its American contemporary. The organization would hold a strong position before its global competitors and open the door for future business strategic affiliations. The organizational redesign will prove beneficial for Mary Kay’s United Kingdom division as an organization, for the consumers now receiving increased quality services, and for the leveling of the cosmetics industry in the United Kingdom. ANALYSIS OF CLIENT BUSINESS Company Description and History Mary Kay Inc. is one of the largest cosmetics companies in the world to date. Headquartered in Addison, Texas at 16251 Dallas Parkway Addison, TX 75001 in the United States, it has manufacturing plants located in Dallas, Texas, Hangzhou, China and La Chaux-de-Fonds, Switzerland for its European market. Mary Kay Inc. operates as a subsidiary of Mary Kay Holding Corporation. Founded by Mary Kay Ash in 1963 and based on personally established values that guided her everyday life she sought to help women live the life of their dreams. Company values include integrity, honesty and a belief in the Golden Rule; â€Å"Do unto others as you would have them do unto you.† The mission, to assist and provide the vehicle that would allow prospective independent beauty consultants to have their respective dreams come true via the distribution, promotion, and retailing of a handful of products. Mary Kay Inc. identifies itself as a â€Å"Generation Everything† organization, meaning it serves everyone from all walks of life and of all ages. The organization recently posted that its revenues are up to 3 billion due to sales in its 35 + markets globally. All made possible by its 25 million global independent sales force.

Analysis of LAP and Modified LAP

Analysis of LAP and Modified LAP 1. Critically review a test item that you have designed for inclusion in an assessment instrument It is nearly two decades since the St Vincent Declaration (1989) called for a marked reduction in morbidity with diabetes related problems to be achieved through better patient management. The available evidence suggests that the process of care in Britain is still very variable in quality. (J. Mason, 1999) et al. conducted trial on diabetes foot care, and provided an important message that vigilant and trained health care professionals can identify the emerging risk factors for ulceration at relatively low cost. The National Institute for Clinical Excellence (NICE 2004) clinical guideline on type 2 diabetes foot care on the prevention and management of foot problems recommends that healthcare professionals and other personnel involved in the assessment of diabetic feet should receive adequate training. Hence, it is imperative that the Diabetes Specialist Registrars [SPR], the future diabetologists, who look after diabetic feet in the community and secondary care, should be trained and adequately assessed if they want to make an impact on patient outcomes. Thus, the need arises for a training CME [Continued Medical Education] day for the management of diabetes foot and assessment before they treat patients with these problems. The main aim of the assessment is to optimize the capabilities of all learners and practitioners by providing motivation and direction for future learning. The assessment has to be formative in this case guiding future learning by providing reassurance, promoting reflection and shaping values. At the end of the training day (Appendix 2) the plan is to conduct a modified, observed, long case type of assessment tool with 3-4 items and knowledge based assessment. One such item an observed modified long case is described in Appendix 1. The plan to use a real case is to illustrate the some of the day to day difficulties and uncertainties one faces during clinical judgement. The time breakdown is to prepare them for thinking about various aspects in given time. They are assessed in different generic skills as well as speciality knowledge and management of the case. Appendix 1 [page 24-26] Properties Even though it is used as an item here, the long case has traditionally been used as a summative tool by itself in the past and its properties in those situations have been studied extensively. Hence, the properties like reliability and validity have been discussed briefly with others of the items such as facility. The reliability of a long case can be improved by structuring the long case i.e. elements of discussion and questioning (Olson et al 2000, Wass and Jolly 2001). Thus observation and structuring is applied here to improve the reliability. This increases student perception of fairness. Validity This can be addressed by introduction of examiners who observe trainee performance throughout and so the trainee is observed by the team in all parts of the long case out here (Olson et al 2000). Facility It could be made low facility depending on the complexity of the case. Discrimination is not really applicable since it will be used as part of formative tool but can be made into a highly discriminatory one by following global assessment. The other properties of the assessment tool are not discussed as it is used mainly as an item. Item Response Theory This is not discussed here as it is mainly used in the context of Multiple Choice Questions. There is not much in the literature about the strengths and weaknesses of the long case when used as an item in a formative assessment tool. So here is an attempt to look at both the positive aspects and potential drawbacks of this item should this be used in the context of this formative assessment. The positive aspects of this item Observed Modified Long Case Holistic and Robust This item in the long case is real and looks at competency and some aspects of performance. Multidisciplinary Approach mimics how the clinics are conducted in most hospitals and assess candidates knowledge across specialities. Written and Verbal Constructive feedback Ende (1983) proposed that the process of feedback should be expected and well timed, based on first hand data (observable behaviour) and regulated in quantity. In a systematic review by Best Evidence in Medical Education (BEME) collaboration (Veloski, et al., 2006) the positive impact of the feedback process was confirmed, with the most marked effects if provided by an authoritative source. These principles are strictly followed in this item. The method of feedback can be either Pendleton or ALOBA- Agenda-Led Outcome Based Analysis. Some of the potential drawbacks of this item-How they can be overcome Risk of assessing the short term memory This argument stems from the fact that the assessment is done just after the CME program as suggested. Based on Bligh (2000), the above graph, demonstrates the retention power if tested early after the learning experience. Hence the argument: the item should be administered immediately after the CME to increase retention. Resources and Standardisation The number of people including specialists involved and the organisation will require resources, including money, but some of the funding could be organised by the educational fund for the SPR in the region. Some contribution can be arranged from other sources including pharmaceutical company help. Since it is a formative assessment tool, it need not be rigidly standardised in assessment and it is to promote the professional development of the SPRs. Why rigid time limits and not just global assessment? This rigid structure is to give an opportunity for each of specialists to have an opportunity to observe and feed back. In real life, the time spent on each task may be different but giving stringent time limits also gives the opportunity to observe how the candidates perform within these time constraints. The global assessment is avoided so that the feedback component needs to be broken down to each level to make sense and promote specific areas for improvement. Bias Since some of the examiners and experts would have taught these SPRs in the course there may be bias from these examiners after observing the candidates interaction over a day and might want them to do well or otherwise in the assessment. This can be avoided by formal training of the examiners. Organisational consideration The main difficulty will be getting the team of assessors together as given in the item and making sure they are trained in giving constructive feedback to the candidates. Getting a real life patient to participate in such a scenario might not be difficult as patients are often happy to share their experiences. CONCLUSIONS If used in conjunction with variety of other items, perhaps it can be used as a cog in the wheel of summative assessment for the high stake assessment e.g. as a part of portfolio in final year Rotation In Training Assessment [RITA]. It fulfils the learning objectives of the course and what the item intends to measure. This item also comes close to what is usually measured in items of work place based assessment [WPBA]. Element 2 Assessment option Using relevant theoretical and/or research literature, critically review one instrument of assessment used in clinical education. LAP and Modified LAP BACKGROUND In the traditional long case candidates spend 30-45mins with a patient from whom they take a history and examine. An examiner is not present and the candidate is not observed. The student summarises and is examined by a pair of examiners over a 20-30 minute period. The usual format of practice in long cases is to examine patients that are already known to the examiner or are in the examiners own specialty. The long case, patient based examinations have been used for decades both in undergraduate and postgraduate settings both as a formative and summative tool. They were specifically used for final certification exam for postgraduates both here and elsewhere. They had their strengths in that it evaluates performance with real patients and enables candidates to gather information and develop treatment plans under realistic circumstances (Norcini, 2002). However, this method has drawn lot of criticism. The problem lies with inter case reliability (Wass, et al., 2001) and whe n subjected to psychometric analysis, these examinations were found to be unreliable and so have fallen from favour (Turnbull, et al., 2005). Particular problems were with the reproducibility of scores generated by the long case. To improve this required large sampling which itself required a lot more resources which made the long case difficult to use as a summative assessment tool. Recent work suggests that the long case is still a highly relevant tool in that it appears to test a different clinical process to that of the structured short case examination (Wass and Jolly, 2001). A study, performed with undergraduates in London found that, by observing the process in the long case, the above problems could be overcome. This probably led to a return of long cases in the form of OSLER Objective Structured Long Examination Record introduced by Gleeson(Gleeson, 1997) and LAP the Leicester Assessment Package. The LAP was originally developed to assess the consultation competence of general practitioners in the UK. In the LAP, the patient is not known to the examiners and at least one of the examiners is not an expert in the specialty being examined. It has been designed for use in live and/or video recorded consultations with either real or simulated patients. It was subsequently adapted for use in undergraduate teaching. The LAP is designed to provide assessment by directly observed consultations with real patients/simulated patients, but to present this in a structured format closer to an OSCE, which also allows other aspects of performance to be assessed. Seven prioritized categories of consultation competence which need to be mastered are assessed with marking (Appendix 3). The modified LAP varies from the LAP in a couple of areas. Performance is assessed against predefined standards which are different compared to the LAP. The examiners attend training before they become assessors in the modified LAP. The guidelines to the examiners [how to mark and assess] and the assessment forms are appended (Appendix 4 5). Inevitably, some overlap occurs between components of differing categories. (Bhakta, et al., 2005) acknowledge that no single assessment format can adequately assess all the learning objectives within the course blueprint, a combination of assessments (including OSCE, EMQ, essays, short case, and long case) are currently used to assess the students competence. The authors main objective is to use theoretical and research literature to critically review the LAP and modified LAP used in the assessment of clinical practice. This review is based on the seven key concepts (Van der Vleuten, 1996; Schuwirth and van der Vleuten, 2006; PMETB, 2007) liste d below: Purposes Alignment Properties Standards Sampling Evidence Level 1. PURPOSES It can be used for both formative and summative assessment. (Fraser, et al., 1994) argued that the modified LAP is designed for both purposes. The focus of the examination in the intermediate clinical exam for undergraduate is to promote further improvement as they have done only one clinical year [e.g. WMS and Leicester Medical School]. Hence, the feedback is handed to the students which helps them to focus on their strengths and improve on their performance The 3rd and 4th year medical students of these Schools believed that it was likely to enhance their consultation performance (McKinley, et al., 2000). It has also been used as a formative tool in improving professional competence in different countries and different specialties (Lau, et al., 2003, Redsell, et al., 2003). When (Teoh and Bowden, 2008), arguing for the resurrection of the long case, state that the observed long case such as the Modified LAP doesnt encourage the reductionist approach as in Objective Structured Clinical Examination [OSCE ]. Thus, it can be an ideal summative assessment tool for the high stake exam but perhaps has to be used in conjunction with other tools as discussed below. Additionally, in most cases, the assessment is an end of year high-stakes assessment and, for failing students, there is generally only a short time available for remediation. The feedback provides a way to focus them on the areas of their consultation skills and prepare for their remedial exam. 2. ALIGNMENT The Education Committee of the General Medical Council (GMC) sets and monitors standards in all UK medical schools. Medical students must be able to demonstrate their competency and professionalism through a list of educational outcomes set out in the publication of Tomorrows Doctors (2003 and 2009) prior to graduation. The intended outcome envisaged by WMS is to produce a generation of doctors who have knowledge, proficient clinical skills and the appropriate attitudes and behaviours ready for work as Foundation Year one doctors. The modified LAP forms a part of the summative assessment in assessing mainly clinical skills e.g. examination techniques. As described, it has various components and proper, planned blueprinting against the learning objectives of the MBChB course and competencies of the various specialties (Wass, Van der Vleuten, Shatzer and Jones, 2001). Thus, assessment and curriculum design should be intricately interwoven and the assessment of course drives the learning (Wass, Van der Vleuten, Shatzer and Jones, 2001). Similarly, in postgraduate exams, it usually follows knowledge based assessment in the form of MCQs and careful alignment should be done considering the curriculum set by the institutions like the Royal Colleges. 3. PROPERTIES The property of an assessment or more commonly described as the utility or usefulness of an assessment, was originally described by Van der Vleuten (1996) as a product of its validity, reliability, educational impact, cost-effectiveness and acceptability. In later years, the term feasibility is explicitly acknowledged and has been described as an added component of an assessments utility in clinical education (Schuwirth and Van der Vleuten, 2006; PMETB, 2007). Validity Validity represents the extent to which a measurement actually measures what it intended to measure. In medical education, this signifies the degree of meaningfulness for any interpretation of a test score. (Downing, 2003) A recent study demonstrated that observation does measure a useful and distinctive component of history taking clinical competence over and above the contribution made by the presentation (Wass and Jolly, 2001). It would seem logical that, rather than relying on a presentation alone, observation of the candidate while eliciting the history and carrying out the examination would be a more valid assessment of the candidates competencies in LAP. There is data in the literature for the face validity and content of the seven categories and the various components of consultation competence as contained in the Leicester Assessment Package (Fraser, McKinley and Mulholland, 1994). Whether or not the test scores obtained, in any particular LAP, are an accurate representation of real world competency is subjected to a vast array of variables (Downing and Haladyna, 2004). For instance, the design of the test items, number of representative cases, experience training and leniency of examiners, co nsistency of simulated patients [ used mainly in psychiatry], completeness of marking schemes and the characteristics of the candidates, can all affect the validity of a LAP, making it a valid assessment in one education institute, but not another. However McKinley et al in their study of modified LAP in the general practise setting concluded that students will be exposed to a valid set of challenges to their consultation skills during consultations with minimum six largely unselected patients(McKinley, Fraser, Vleuten and Hastings, 2000). Concurrent validity whether the results are consistent with those tests of similar constructs? There are studies comparing OSCEs with observed long cases [which is similar to LAPs in some ways]; however, the author has not come across studies comparing different types of observed long case e.g. OSLER vs. Modified LAP. Does it predict the future performance need to be assessed by more studies by following up the generation of students where the LAP is used as an assessment tool. Also, more studies are needed to investigate the construct validity of LAP. Reliability Reliability refers to the degree of consistency within a measurement tool, the extent to which an instrument is capable of repeatedly producing the same test score even when administered at different times and locations, with different candidates (Schuwirth and van der Vleuten, 2006). An assessment approach may be considered reliable when it yields consistent results regardless of when it is used, who uses it and which item or case is assessed. The importance of a specific type of reliability depends upon what is being assessed and the method by which it is being assessed. Generally speaking, the reliability or generalisability coefficient [since there is multiple potential sources of variability in this assessment tool] of 0.8 or higher are desirable (Shea and Fortna, 2002). Since the LAP has its roots in the long case and considering that it has evolved as a modified observed long case the author will attempt to address how the deficiencies in reliability of long cases were addressed to make it a LAP. Attempts to improve the reliability of the long case and make it into an effective LAP fall into three categories. First, studies have considered how many additional long cases would be required, with Kroboth et al (1992) suggesting that 6-10 long cases (each of 1-1.5 h) would achieve a generalisability coefficient of 0.8. Thus it would take a minimum of 4 different cases with at least 2 assessors in each to be reliable and therefore, careful sampling of representative cases with the use of blueprints is of paramount importance (Cangelosi, 1990).Second, commentators have attempted to increase the number of long cases, but have done so by employing a format that draws on shorter assessments (20-45 min) and multiple cases (4-6) assessed directly after each other in a single session (McKinley et al, 2000; Wass Jolly, 2001; Hamdy et al, 2003; Norcini et al, 2003). Third, elements of the discussion and questioning aspects of the long case have been stan dardised in an attempt to improve reliability and student perceptions of fairness (Olson et al, 2000). Thus, having all relevant domains and enough numbers would increase the reliability and validity of the instrument. All these are incorporated in LAP and modified LAP to make a reliable instrument. This is further demonstrated by McKinley et al that the required levels of reliability can be achieved when the modified LAP is used by multiple markers in assessing the same consultation, that is, the package produces inter-assessor reliability. Their generalizability analysis indicates that two independent assessors assessing the performance of students across six consultations would achieve a reliability of 0ÂÂ ·94 in making pass or fail decisions. Also in this study ninety-eight percent of students perceived that their particular strengths and weaknesses were correctly identified, 99% that they were given specific advice on how to improve their performance and 98% believed that the feedback they had received would have long-term benefit(McKinley, Fraser, Vleuten and Hastings, 2000). The example of assessment criteria and guidelines of the modified LAP used in the study are incorporated as Appendix 4 and 5. Reliability of the LAP would not be severely threatened if the details of the test items have leaked out to the candidates unintentionally. However, it might if they have seen this patient before in the clinical setting. There were chances of this happening as the same banks of patients were used. This has been rectified by updating the bank and recruiting different patients. Broad sampling across cases is essential to assess clinical competence reliably (Wass and Vleuten, 2004). Feasibility The design and running of the modified LAP has significant resource implications. The crux of the issue for this kind of assessment is feasibility and cost effectiveness in terms of finance, space and manpower. Lots of time and effort are required to prepare and administer the instrument with high quality. Recruiting enough assessors, real patients, [simulated patients in case of psychiatry] and the equipment is always a huge challenge. Finding the trained assessors, who mostly tend to be busy clinicians, to take time from their heavy work schedule is also a challenge. However, lots of these issues can be overcome if this test is administered regularly i.e. sequential testing. This is further helped by having a database for the patients and assessors. Good advanced planning will also go a long way. Acceptability John B Cookson, et al. (2008), in a letter to the BMJ, say that feedback from students who have faced this examination in Leicester for the past 9 years strongly indicate that it is perceived as a fair and acceptable test of their abilities. From the organizational point of view it has been acceptable because of sequential testing. There is a healthy debate about replacing this with OSCEs or at least using OSCEs to supplement this for the assessment of clinical based practice. Educational Impact From the students point of view, the high-stakes LAP certainly exerts a great educational impact. The outcome of the examination will be used to decide the fate of the students. The LAP provides a platform for students to demonstrate their knowledge, skills, attitudes and behaviours in a single direct observational setting. Among other advantages it encourages students to develop the essential links between history, physical examination, diagnosis and management in each clinical challenge as the consultation progresses, not at some remote point thereafter. This is true as they practise for these exams in this way with peer group or supervision. It definitely has a huge educational impact as the students keep the final assessment in mind and practice the required domains in a structured way from various colleagues and peers. The impact is even greater in some medical schools like WMS as the feedback is given to the students in the formative intermediate exams. This enables the students to reflect on their performance and improve upon them. 4. STANDARDS The Standards can be criterion-referenced (absolute standard) or peer-referenced (relative standard). Borderline approach , fixed percentage , Angoffs and Hofstee methods are but a few of the many methods described in the literature for standard-setting (Norcini, 2003). Livingstone and Zieky (1989) proposed that the higher the stakes of the assessment, the greater the significance in using criterion-referenced standards. Thus criterion referenced can be used for LAP in the setting of high stakes exams like final professional exams in WMS or postgraduate exit exams SAMPLING It is impractical to combine all of the learning outcomes into a single, summative assessment. On a practical note one has to be careful while allotting the students and examiners for the different station/patients/item so that they get a wide variety of sampling that gives a different case mix. Thus, it also needs to be made sure that they are observed and examined by different examiners to increase the sampling. Thus a careful and effective blueprinting should be done to make LAP a high utility instrument. Moreover, qualitative triangulation of evidence [sampling] from different sources such as satisfactory performance in each block, including other types of exams likes OSCE for practical skills will further improve the reliability (Stern, et al., 2003). 6. EVIDENCE Evidence from a single point is not sufficiently generalisable to be extrapolated to all occasions (PMETB, 2007). Studies regarding validity and reliability are costly and difficult to design. Triangulation is an excellent solution to critique the evidence collated qualitatively, where evidence from at least 3 occasions/ resources indicating the same outcome is analyzed (PMETB, 2007). Each LAP item should be treated independently, as an entity of its own, and, although literature can prove LAP do possess the potential to be highly valid and reliable, such study would need to be conducted on separate occasions to demonstrate convincing evidence. This is continuous ongoing process at most of the institutions including WMS. 7. LEVEL It is suggested that using the LAP for direct observation of the consultation would be a useful tool to assess whether the student has successfully acquired the necessary competencies expected at the end of undergraduate or postgraduate training. One of the interesting components is to attempt to judge the overall relationship with the patient. Attitudes are most likely to be conveyed to the patient through the doctors behaviour and should, therefore, be assessed by the observation of behaviours in the clinical setting (REZLER, 1976). Nevertheless, this approach relies on judgements, made by experts, of non-standardised material and is, therefore, open to question. Because professionalism is a complex construct, it is unlikely that a single assessment will adequately measure it even though this assessment makes the attempt. Systematic assessment of professionalism should also include many different assessors, more than one assessment method and assessment in different settings (Lynch , et al., 2004). Hence, these assessments are a continuous process throughout the MBChB and, indeed, afterwards. In essence the LAP, as an assessment tool, is close to competency based assessment and demonstrates shows how in the Miller triangle. CONCLUSIONS Long cases on their own have been criticised for poor reliability of examiner assessments and the lack of direct observation by the examiner of the trainee patient encounter [reducing the validity of the assessments]. There is evidence that adding an observing examiner to the history and physical examination part of the long case assessment increases reliability and helps to reconcile the complex interactions between the context and the skills/knowledge (construct) that the long case attempts to measure (Wass and Jolly, 2001). The LAP is one such tool where there is observation during history and physical examination and structured assessment and proves to be of high utility. This is supported by some studies in the formative setting(McKinley, Fraser, Vleuten and Hastings, 2000) The LAP, when analysed via its properties, is a good tool to assess observed clinical practice. It might not be so effective for practical skills and, for these, it probably needs to be supplemented by work based assessments or even OSCEs. When supplemented with other assessment tools [Triangulation] LAPs can be used effectively for summative assessment in high stake assessments such as the final examinations for medical students. The main drawbacks are feasibility, difficulty in blue-printing and cost effectiveness. It encourages students to develop the essential skills together rather than combining them afterwards. REFERENCES Bhakta, B., Tennant, A., Horton, M., Lawton, G. and Andrich, D. (2005) Using item response theory to explore the psychometric properties of extended matching questions examination in undergraduate medical education. BMC Medical Education, 5 (1): 9. Fraser, R. C., McKinley, R. K. and Mulholland, H. (1994) Consultation competence in general practice: establishing the face validity of prioritized criteria in the Leicester assessment package.[see comment]. British Journal of General Practice, 44 (380): 109-113. Gleeson, F. (1997) AMEE Medical Education Guide No. 9. Assessment of clinical competence using the objective structured long examination record (OSLER). Medical Teacher, 19 (1): 7-14. J. Mason, C. O. K. A. M. A. H. A. B. R. J. Y. (1999) A systematic review of foot ulcer in patients with Type 2 diabetes mellitus. I: prevention. Diabetic Medicine, 16 (10): 801-812. Lau, J. K. C., Fraser, R. C. and Lam, C. L. K. (2003) Establishing the content validity in Hong Kong of the prioritised criteria of consultation competence in the Leicester Assessment Package (LAP). Hong Kong Practitioner, 25 (12): 596-602. Lynch, D. C., Surdyk, P. M. and Eiser, A. R. (2004) Assessing professionalism: a review of the literature. Medical teacher, 26 (4): 366-373. McKinley, R. K., Fraser, R. C., Vleuten, C. v. d. and Hastings, A. M. (2000) Formative assessment of the consultation performance of medical students in the setting of general practice using a modified version of the Leicester Assessment Package. Medical Education, 34 (7): 573-579. Norcini, J. J. (2002) The death of the long case? BMJ, 324 (7334): 408-409. Norcini, J. J. (2003) Setting standards on educational tests. Medical Education, 37 (5): 464-469. Redsell, S. A., Hastings, A. M., Cheater, F. M. and Fraser, R. C. (2003) Devising and establishing the face and content validity of explicit criteria of consultation competence in UK primary care nurses. Nurse Education Today, 23 (4): 299-306. REZLER, A. G. (1976) Methods of attitude assessment for medical teachers. Medical Education, 10 (1): 43-51. Shea, J. A. and Fortna, G. S. (2002) 3 Psychometric Methods. International handbook of research in medical education, 97. Stern, D. T., Wojtczak, A. and Schwarz, M. R. (2003) The assessment of global minimum essential requirements in medical education. Medical Teacher, 25 (6): 589-595. Teoh, N. C. and Bowden, F. J. (2008) The case for resurrecting the long case. BMJ, 336 (7655): 1250. Turnbull, J., Turnbull, J., Jacob, P., Brown, J., Duplessis, M. and Rivest, J. (2005) Contextual Considerations in Summative Competency Examinations: Relevance to the Long Case. Academic Medicine, 80 (12): Wass, V. and Jolly, B. (2001) Does observation add to the validity of the long case? Medical Education, 35 (8): 729-734. Wass, V., Van der Vleuten, C., Shatzer, J. and Jones, R. (2001) Assessment of clinical competence. The Lancet, 357 (9260): 945-949. Wass, V. and Vleuten, C. v. d. (2004) The long case. Medical Education, 38 (11): 1176-1180. APPENDIX 1- PROPOSED ITEM AN OBSERVED MODIFIED LONG CASE CONTEXT- Following Continued Medical Education day for Diabetes Specialist Registrars-SPRs[CME Appendix 2] Aimed at senior SPR that is year 4-5 just a year before completion of their training Formative Assessment Can be used in their portfolios for Continued Professional Development CPD Generic skills assessed- Communication, Professionalism, Clinical reasoning in uncertain environment, Teamwork and Multidisciplinary Approach Assessment involves 4 items of observed long modified long cases and MCQ-paper aiming mainly at knowledge base. One such item an observed modified long case has been described below. Expected learning outcomes for this formative assessment item- Able to assess vascular, neurological status of foot and in a patient with diabetes Diagnose pedal pathologies in the

Hemingway: The Relevance of Biography to Interpretation Essay

Even a cursory examination of the literature addressing Hemingway’s writing and his life can seem overwhelming. The purpose of this paper, however, is to demonstrate that some of Hemingway’s writing can be best understood through reference to his own life experiences. This is not meant to suggest that the text does not at times provide some internal textual evidence regarding the meaning of the piece as a whole, for it most certainly does, but that external biographical evidence must also be considered and weighed when interpreting Hemingway’s work. In this paper it will be suggested that an examination of the external evidence, as it relates to Hemingway’s own life experiences, is particularly relevant to any interpretation of Ten Indians or Hills like White Elephants and that in these short stories a reconciliation of the external biographical evidence with the internal textual evidence may better aid in understanding the stories themselves. Significant Biographical Characteristics: Machismo and Gender Relations In order to better understand Hemingway’s writing it is necessary to know about the man himself and some of the major events and experiences which shaped his thought process. With reference to the short stories specifically addressed in this paper there are two biographical characteristics which seem to aid in efforts to interpret meaning or to otherwise try to make sense of the text. The first biographical characteristic is often referred to as Hemingway’s extremely masculine lifestyle or what some scholars have referred to as his macho orientation. It is well-established among scholars and historians, for instance, that Hemingway thoroughly enjoyed rigorous physical activities and pursuits; it has been noted that Hemingway was known for his â€Å"highly developed skills in such ‘manly’ fields as hunting, fishing, boxing and sailing. ( Harry Sylvester, who used to box with Hemingway frequently, once told me that Hemingway was the strongest man he had ever known. )† (McCaffery 12). He was, in short, an independent-minded writer whom enjoyed physical exertion, challenging himself through a variety of pursuits, and outdoor activities. While some scholars, such as McCaffery, have viewed Hemingway’s manliness in a positive light there are some whom have viewed him in a less flattering light; indeed, as a leading Hemingway scholar has pointed out â€Å"Others view his masculinity as negative machismo. They consider him the worst example of a sexist, racist, homophobic man, and often refuse to read or teach Hemingway, or make apologies when they do. † (Moddelmog 2). Whether loved or hated, therefore, scholars seem to agree on his manliness and his abrasively macho view of life. For purposes of interpretation, this informs us that though a gifted writer, and an artist, Hemingway was not the sort of intellectual that was confined to a library or a desk at home; quite the contrary, unlike many other writers, he actually did live in many respects the very type of life which he wrote about. His were not speculative musings, or romantic idealizations, but reflections and comments on situations and characters with which he was intimately familiar. Any attempt to understand or interpret his written work, therefore, must to some extant take note of Hemingway’s own life experiences and philosophical mind-set.. The second biographical characteristic which can aid in the interpretation of Hemingway’s text more specifically, with respect to Ten Indians and Hills like White Elephants, involves his personal experiences with women and how he dealt with gender issues such as relationships and fatherhood in his writings. Hemingway, to put it mildly, experienced the company of many women and seemed almost forever to have troublesome or difficult relations with the opposite sex. He loved women and yet he seemed to struggle to understand them in reference to his own lifestyle and psychology. Referring to Hills like White Elephants, one researcher has observed that â€Å"the subtle and dramatic dialogue in ‘Hills Like White Elephants’ reveals a clear, sensitive portrait of two strong personalities caught in a pattern of miscommunication due to gender-linked language patterns† (Smiley 92); another researcher, referring to Hemingway’s writing more generally, has argued that he must be understood as a human being whom was never quite comfortable about â€Å"his own failed or failing marital and/or extramarital relations. † (Spilka 299). Gender communication or the lack thereof, particularly that dealing with romantic relationships, is pervasive in Hemingway’s writing and can to some degree be related to his own life. In sum, external biographical evidence is extraordinarily relevant when attempting to interpret Hemingway’s writing and it must be considered alongside the internal textual evidence of each written piece of work. Ten Indians An initial and superficial reading of Hemingway’s Ten Indians suggests a rather common plot in which a young boy falls in love, in which he is subsequently betrayed, and in which innocence is lost or diminished in the process. In the instant story, the protagonist is Nick Adams and he falls in love with a young Indian girl whom he apparently adores and whom he trusts feels the same as he does; the twist is that she has been spotted with another boy and that Nick is forced to confront the betrayal. The betrayal, however, is not easily predicted; it is not easily predicted because Hemingway creates a pleasant setting and a happy family atmosphere within which to develop his more depressing plot. Indeed, the protagonist Nick Adams returns home to his father after spending a happy Fourth of July with his friends the Garners. Over a late meal of cold chicken and huckleberry pie the father, who â€Å"made a big shadow on the kitchen wall,† informs Nick that his Indian girlfriend Prudence Mitchell spent her Fourth of July â€Å"threshing around† in the woods with one Frank Washburn (Carter 103) Everyone had seemed quite happy. The Fourth of July is a joyous occasion for friends and family, and young Nick Adams is in love. Although scholars have debated Hemingway’s intentions, because of different conclusions discovered in preliminary and final drafts of the manuscript, it is true that â€Å"In the final part of the published story, Nick goes into his room after the conversation with his father, gets undressed, and climbs into bed, lying with his face in the pillow and thinking, ‘My heart’s broken†¦. If I feel this way my heart must be broken'† (Nolan n. p. ). Thus, the story would appear to be a familiar one of trust, betrayal, and heartache. Further and more careful readings of the text, however, suggest deeper and, possibly, more metaphorical intentions by Hemingway. If from a superficial point of view the story appears to characterize the fallen world of young love then from a more careful examination of the text, reference to the aforementioned biographical characteristics and the relevant scholarly literature the story may also be said to characterize the fallen world of a man’s sense of orderly nature itself. This notion of metaphor, that the text sets forth a young boy’s broken heart to represent a larger type of destruction, is persuasive given the context in which Hemingway set the story and given the way in which the destruction of the wilderness is simultaneously presented in the text. As an initial matter, it is important to understand that Ten Indians was one of many short stories written by Hemingway which detailed and explored the coming of age of Nick Adams. Some scholars have suggested that the protagonist, Nick Adams, was in many ways a personal reflection of Hemingway’s own coming of age story and that he was an autobiographical figure for Hemingway in certain respects. Indeed, there are several interesting connections between Hemingway’s personal history and the people and places created in the short story, Ten Indians. First, although Hemingway was born in Illinois, it is commonly understood that he considered his spiritual home to be in Michigan. This area served as the setting for this particular short story. Second, he relied upon the local Indians of the region to create some of his important characters; in fact, he drew upon his real life observations of the Ottawa and Ojibwa Indian tribes. Indeed, the Indians and their country had a profound effect on Hemingway’s imagination. From his first attempts at fiction and in his later Nick Adams stories, he would draw upon his experiences at Walloon Lake, using Indian characters and wilderness settings. (Nagel 108) Together, these real life experiences helped Hemingway to create both the setting and many of the main characters for his short stories. In addition to providing inspiration for his setting and characters, there was a deeper conflict which Hemingway’s real-life experiences contributed to his writing design in Ten Indians; more specifically, drawing upon Indian tribes whose lives had become fundamentally changed through close contact and interaction with a different American culture, Hemingway was able to cleverly depict a metaphorical illustration of innocence lost through the betrayal of Nick Adams by the Indian girl. Nick’s innocence, it can be argued, has been destroyed in much the same way as the Indian wilderness. Hemingway lamented the modernization which infringed on the forests of northern Michigan and the parallels between the destruction of the wilderness and the destruction of Nick Adams’ heart are striking. These parallels have been noted by one scholar whom has suggested that: Hemingway shows the wilderness being destroyed and, with the loss of the trees, the end of the Indian way of life. This fallen world is the setting of â€Å"Ten Indians,† a story that centers on the adolescent Nick Adams’s first disappointment in love as he learns that his Indian girlfriend, Prudence Mitchell, has been unfaithful (Nagel 108-109) When examining the text of Ten Indians, therefore, it is important to note these important parallels, Hemingway’s love of nature and his view of man’s place in nature. Literally speaking, Hemingway drew on a familiar and beloved setting and populated much of the story with the type of Indian characters that were well-known to him. Figuratively speaking, or metaphorically speaking, Hemingway managed to link the fallen world of the pristine natural wilderness with the fallen world of a young man’s broken heart. It is against this contextual framework that any analysis of Ten Indians must proceed. This is not meant to suggest that either fallen world was the predominant theme; to be sure, both the text and the scholarly literature would seem to demonstrate that Hemingway found both the destruction of the wilderness and the destruction of a first love as betrayals that would inevitable shatter an individual’s innocence and mark another stage in the coming of age of young boys. A young boy, reconciling the external evidence with the internal evidence, might be better advised enjoying the beauty of the forests than the beauty of insincere wiles of young girls. Hills like White Elephants Although a comparatively short story, Hemingway’s Hills like White Elephants is full of tension and moral dilemma; more specifically, the text appears to suggest that the man and the woman are debating whether the woman should have an abortion and what the implications will be depending on whether the abortion is done or not done. What is most striking, from a textual analysis, is the contrast between the rather relaxed atmosphere or setting and the deeply personal nature of the discussion. On the one hand, for instance, the man and the woman are relaxing at a train station, drinking alcohol, and waiting for a train. This would seem to imply a happy couple, an anticipated journey, and a relationship that will endure at least until the train arrives. These contextual clues, however, are sharply betrayed by the underlying discussion regarding whether the woman, Jig, will undergo an operation to have an abortion. One might anticipate some form of closure, some final decision arrived at by the main characters, but instead Hemingway leaves the reader grasping for answers as the story comes to a conclusion. He leaves them grasping for answers because rather than stating what decision has been made, and whether the American and Jig will actually ever see each other again, Hemingway finishes his story without a definitive declaration in either respect. With respect to the operation for the abortion, the woman states that she is willing to have the operation; the American man, however, doubts her sincerity. The reader is therefore forced to wonder, as the American wonders, whether the woman is agreeing or temporarily attempting to placate her partner and lover. With respect to the relationship itself, the reader desiring a firm and resolute statement is left grasping for straws. This is because, rather than departing on the train to Madrid together as planned, the American places their bags or luggage at different positions on the platform before rejoining Jig. The story then finishes up with the man being suspicious of the woman’s true motives and convictions and with the placement of the bags providing a possible clue that the relationship is doomed. The couple is together and yet the bags are separate; this is where Hemingway leaves his readers and scholars themselves have grappled with both the meaning of the story and the likely outcomes. The scholarly analysis of Hills like White Elephants has traditionally tended to focus upon the use of internal textual clues to determine whether Jig intended to have the operation and the fate of the relationship between Jig and the America; more recently, however, some scholars have begun to analyze whether and to what extant the short story may have been influenced or otherwise inspired by Hemingway’s own life. This bifurcated focus has been summed up, analyzed, and synthesized by one leading Hemingway scholar whom has stated the scholarly emphasis thusly: â€Å"Two recurring themes in analyses of Ernest Hemingway’s ‘Hills Like White Elephants’ are the debate over whether or not Jig will carry her pregnancy to term and the search for biographical experiences that may have inspired and influenced the story. † (Wyche n. p). This section will examine each of these scholarly inquiries in turn. The traditional scholarly interest has involved an examination of the text for clues in order to determine whether an abortion was actually pursued and the fate of the couple. A review of the literature reveals at least four possibilities: Three different scenarios have been seriously considered: the girl will have the abortion (albeit reluctantly) and stay with the man; the girl will have the abortion and leave the man; or, the girl will not have the abortion, having won the man over to her point of view. However, there is strong support in the narrative for a fourth outcome that fits in, with the dark overall prognosis presented in other scholarly interpretations: the girl will indeed have the abortion, expecting in this way to stay on with the man, but after the operation has been performed, he will abandon her. Various verbal and non-verbal indications found in the story support this interpretation of the narrative, as does the very symbolism of the title itself. (Hashmi n. p. ) Although an extended analysis of each scenario is beyond the scope of this paper, a rationale for selecting the most plausible outcome based upon the text is not. The most persuasive outcome would appear to be the fourth; more specifically, a superficial reading of the text suggests that Jig will indeed have an abortion and that the American will abandon her despite her attempt to maintain the relationship. First, the American places their bags in different parts of the platform. Analyzed literally, this seems to suggest that he doubts her sincerity regarding the abortion and that he is preparing for a separation. Second, they stand together and Jig tells the American that despite the strain of the abortion decision she remains fine. The man has made the decision to separate the bags whereas Jig would appear to believe that things will work out in such a way as to maintain the relationship. The man’s actions represent separation whereas Jig’s actions and words represent togetherness. It is therefore plausible to argue that she will pursue togetherness by having the abortion and that the man will pursue separation by encouraging the abortion and then abandoning or otherwise terminating the relationship. Although never explicitly stating such a conclusion, the fourth scenario is supported by the aforementioned textual clues. Other scholars have instead focused on Hemingway’s own life in order to understand the story; in this way, the abortion issue is treated figuratively rather than literally. As one scholar pursuing this biographically-oriented type of analysis explains â€Å"While the figurative abortion in ‘Hills Like White Elephants’ can be understood on the basis of internal evidence, the concept of abortion as metaphor invites consideration of a number of biographical influences on the story,† (Wyche n.  p. ). While such an analysis requires a reconciling of certain parts of the text with information known about Hemingway’s personal life there are interesting parallels. One illustration involves the fact that Hemingway has been reported to have said that the birth of his first child led to the dissolution of his first marriage, that he was at the time too young to have become a father, and that â€Å"the author’s ambivalence toward fatherhood is well-documented† (Wyche, n. p. ). Against this larger framework, comparing the author’s real life with his written work, it may become plausible to argue that the scholarship dealing with the outcomes regarding the abortion and the relationship are in actuality tangential or irrelevant concerns insofar as the author was concerned; more precisely, it might be argued that Hemingway was merely incorporating difficult moments from his own coming of age experience without intending to offer concrete conclusions. In the final analysis, while it is both challenging and interesting to explore what Hemingway may have intended as a conclusion, it is perhaps more enlightening to view Hills like White Elephants as a writer’s reflections about his own past in which firm and absolute conclusions were never intended. Hemingway was placing the reader in his own shoes and asking what the reader might do, what the reader ought to do, in similar circumstances. Such an interpretation is consistent with the biographical data known about Hemingway and makes the story more powerful and personal by forcing the reader to draw his or her own conclusions rather than being force-fed a set of conclusions by the author. Conclusion In conclusion, what makes Hemingway so alluring is that he actually lived the type of life that he wrote about. It is therefore impossible to completely separate his own life from his writing as one might be able to do with other writers. As a consequence, interpretation must necessarily involve a balancing act in which external biographical evidence is weighed and considered alongside the internal textual evidence. It is this interplay, between real life and fiction, that perhaps makes Hemingway appear larger than life.

The Silver Linings Playbook Chapter 45

Break Free of a Nimbostratus A week after my cast has been removed, I stand alone on the footbridge in Knight's Park, leaning my weight on the railing, gazing down at a pond I could walk around in less than five minutes. The water underneath me has a thin layer of ice on top, and I think about dropping rocks through it, but I do not know why, especially since I have no rocks. Even still, I want to drop rocks through the ice so badly, to puncture it, proving that it is weak and temporary, to see the black water below rise up and out of the hole I alone will have created. I think about the hidden fish – mostly those big goldfish people stock the pond with so old men will have something to feed in spring and little boys will have something to catch in the summer – fish now burrowed in the mud at the bottom of the pond. Or are these fish burrowing just yet? Will they wait until the pond freezes completely? Here's a thought: I'm like Holden Caulfield thinking about ducks, only I'm thirty-five years old and Holden was a teenager. Maybe the accident knocked my brain back into teenager mode? Part of me wants to climb up onto the railing and jump off the bridge, which is only ten yards long, only three feet above the pond; part of me wants to break through the ice with my feet, to plunge down, down, down into the mud, where I can sleep for months and forget about all I now remember and know. Part of me wishes I never regained my memory, that I still had that false hope to cling to – that I still had at least the idea of Nikki to keep me moving forward. When I finally look up from the ice and toward the soccer fields, I see that Tiffany has accepted my invitation to meet, just like Cliff said she would. She is only two inches tall in the distance, wearing a yellow ski cap and a white coat that covers most of her thighs, making her look like a wingless angel growing and growing – and I watch her pass the swing sets and the large pavilion with picnic tables inside. I watch her walk along the water's edge until she finally reaches her usual height, which is five feet and a few inches tall. When she steps onto the footbridge, I immediately look down at the thin layer of ice again. Tiffany walks over to me and stands so her arm is almost touching mine, but not quite. Using my peripheral vision, I see that she too is now looking down at the thin layer of ice, and I wonder if she also wishes she could drop some rocks. We stand like this for what seems like an hour, neither of us saying anything. My face gets very cold, until I can no longer feel my nose or ears. Finally, without looking at Tiffany, I say, â€Å"Why didn't you come to my birthday party?† which is a stupid question to pose at this time, I realize, but I can't think of anything else to say, especially since I haven't seen Tiffany for many weeks – not since I screamed at her on Christmas Day. â€Å"My mom said she invited you. So why didn't you come?† After a long pause, Tiffany says, â€Å"Well, like I said in my letter, your brother threatened to kill me if I made contact with you. Also, Ronnie came to my house the day before your party and forbade me to go. He said they never should have introduced us in the first place.† I had already talked to Jake about his threat, but I have a hard time imagining Ronnie saying such a thing to Tiffany. And yet I know Tiffany is telling the truth. She seems really hurt and vulnerable right now, especially because she is sort of chewing on her bottom lip as if it were a piece of gum. Surely Ronnie said these words against Veronica's wishes. His wife would never let him say something so potentially ego-damaging to Tiffany, and the thought of Ronnie keeping Tiffany from attending my party makes me a little proud of my best friend, especially since he went against his wife's wishes to protect me. â€Å"Bros B4 Hos† is what Danny said to me every time I would lament Nikki, back when we were both in the bad place – before he had that second operation. In art therapy class, Danny even made me a little poster with the words written in stylish gold letters, which I hung on the wall space between my bed and my roommate Jackie's – back in the bad place – but one of the evil nurses took Danny's artwork down when I was not in the room, a fact Jackie confirmed by blinking and banging his head against his shoulder. Even though I realize the phrase is sort of sexist (because men should not refer to women as hos), saying â€Å"Bros B4 Hos† in my mind now sort of makes me smile, especially since Ronnie is my best bro in New Jersey, now that Jake and Danny live in PA. â€Å"I'm sorry, Pat. Is that what you want to hear? Well, I'll say it again, I'm really, really fucking sorry.† Even though Tiffany uses the f-word, her voice sort of quivers like Mom's when she says something she truly means, and it makes me think that Tiffany might actually start crying right here on the bridge. â€Å"I'm a screwed-up person who no longer knows how to communicate with the people I love. But I meant everything I told you in my letter. If I were your Nikki, I would have come back to you on Christmas Day, but I'm not Nikki. I know. And I'm sorry.† I don't know what to say in response, so we stand there for many minutes, saying nothing. Suddenly – for some crazy reason – I want to tell Tiffany the ending of the movie, the one that was my old life. I figure she should know the ending, especially since she had a starring role. And then the words are spilling out of me. â€Å"I decided to confront Nikki, just to let her know I remember what happened between us but do not hold any grudges. My brother drove me to my old house in Maryland, and it turns out that Nikki is still living there, which I thought was sort of strange, especially since she has a new me – this guy Phillip who works with Nikki as a fellow English teacher and always used to call me an illiterate buffoon because I never used to read literary books,† I say, leaving out the part about my strangling and punching naked Phillip when I caught him in the shower with Nikki, â€Å"and if I were Phillip, I probably would not want to live in my wife's ex-husband's house, because that is just sort of weird, right?† Tiffany doesn't say anything when I pause, so I just keep on talking. â€Å"When we drove down my old street, it was snowing, which is a little more rare in Maryland and therefore a big deal to little kids. There was only maybe a half inch on the ground – a dusting – but enough to scoop up in your hands. I saw Nikki outside with Phillip, and they were playing with two children – by the colors each was dressed in, I figured the one in navy blue was a little boy and the one mostly in peach was an even littler girl. After we rolled by, I told Jake to circle the block and park the car half a block away so we could watch Nikki's new family play in the snow. My old house is on a busy street, so we weren't likely to draw Nikki's attention. Jake did as I asked and then killed the engine but left the windshield wipers on so he could see. I rolled down my window, as I was in the backseat because of my cast, and we watched the family play for a long time – so long that Jake finally started the car back up and turned on the heat becaus e he was too cold. Nikki was wearing the long green-and-white-striped scarf I used to wear to Eagles games, a brown barn coat, and red mittens. Her strawberry blond hair hung freely from under her green hat, so many curls. They were having a snowball fight; Nikki's new family was having a beautiful snowball fight. You could tell the kids loved their father and mother, and the father loved the mother, and the mother loved the father, and the parents loved the children – as they all tossed the snow at each other so lovingly, taking turns chasing each other, laughing and falling into one another's heavily bundled bodies, and †¦Ã¢â‚¬  I pause here because I am having trouble getting the words out of my throat. â€Å"And I squinted hard trying to see Nikki's face, and even from a block away I could tell she was smiling the whole time and was so very happy, and somehow that was enough for me to officially end apart time and roll the credits of my movie without even confronting Nikki, so I just asked Jake to drive me back to New Jersey, which he did, because he is probably the best brother in the entire world. So I guess I just want Nikki to be happy, even if her happy life doesn't include me, because I had my chance and I wasn't a very good husband and Nikki was a great wife, and †¦Ã¢â‚¬  I have to pause again. I swallow several times. â€Å"And I'm just going to remember that scene as the happy ending of my old life's movie. Nikki having a snowball fight with her new family. She looked so happy – and her new husband, and her two children †¦Ã¢â‚¬  I stop talking because no more words will come out. It's as if the cold air has already frozen my tongue and throat – as if the cold is spreading down into my lungs and is freezing my chest from the inside out. Tiffany and I stand on the bridge for a long time. Even though my face is numb, I begin to feel a warmth in my eyes, and suddenly I realize I am sort of crying again. I wipe my eyes and nose with my coat sleeve, and then I am sobbing. Only when I finish crying does Tiffany finally speak, although she doesn't talk about Nikki. â€Å"I got you a birthday present, but it's nothing much. And I didn't wrap it or get you a card or anything, because, well †¦ because I'm your fucked-up friend who does not buy cards or wrap presents. And I know it's more than a month late, but anyway †¦Ã¢â‚¬  She takes off her gloves, undoes a few buttons, and pulls my present from the inside pocket of her coat. I take it from her hands, a collection of ten or so heavily laminated pages – maybe four by eight inches each and held together by a silver bolt in the top left corner. The cover reads: SKYWATCHER'S CLOUD CHART An easy to use, durable identifying chart for all outdoor enthusiasts â€Å"You were always looking up at clouds when we used to run,† Tiffany says, â€Å"so I thought you might like to be able to tell the difference between the shapes.† With excitement, I rotate the cover upward so I can read the first heavily laminated page. After reading all about the four basic cloud shapes – stratus, nimbus, cumulus, and cirrus – after looking at all the beautiful pictures documenting the different variations of the four groups, somehow Tiffany and I end up lying on our backs in the middle of the exact soccer field I used to play on when I was a kid. We look up at the sky, and it's a sheet of winter gray, but Tiffany says maybe if we wait long enough, a shape will break free, and we will be able to identify the single cloud using my new Skywatcher's Cloud Chart. We lie there on the frozen ground for a very long time, waiting, but all we see up in the sky is the solid gray blanket, which my new cloud chart identifies as a nimbostratus – â€Å"a gray cloud mass from which widespread and continuous rain or snow falls.† After a time, Tiffany's head ends up on my chest, and my arm ends up around her shoulders so that I am pulling her body close to mine. We shiver together alone on the field for what seems like hours. When it begins to snow, the flakes fall huge and fast. Almost immediately the field turns white, and this is when Tiffany whispers the strangest thing. She says, â€Å"I need you, Pat Peoples; I need you so fucking bad,† and then she begins to cry hot tears onto my skin as she kisses my neck softly and sniffles. It is a strange thing for her to say, so far removed from a regular woman's â€Å"I love you,† and yet probably more true. It feels good to hold Tiffany close to me, and I remember what my mother said back when I tried to get rid of my friend by asking her to go to the diner with me. Mom said, â€Å"You need friends, Pat. Everybody does.† I also remember that Tiffany lied to me for many weeks; I remember the awful story Ronnie told me about Tiffany's dismissal from work and what she admitted to in her most recent letter; I remember just how bizarre my friendship with Tiffany has been – but then I remember that no one else but Tiffany could really even come close to understanding how I feel after losing Nikki forever. I remember that apart time is finally over, and while Nikki is gone for good, I still have a woman in my arms who has suffered greatly and desperately needs to believe once again that she is beautiful. In my arms is a woman who has given me a Skywatcher's Cloud Chart, a woman who knows all my secrets, a woman who knows just how messed up my mind is, how many pills I'm on, and yet she allows me to hold her anyway. There's something honest about all of this, and I cannot imagine any other woman lying in the middle of a frozen soccer field with me – in the middle of a snowstorm even – im possibly hoping to see a single cloud break free of a nimbostratus. Nikki would not have done this for me, not even on her best day. So I pull Tiffany a little closer, kiss the hard spot between her perfectly plucked eyebrows, and after a deep breath, I say, â€Å"I think I need you too.†