American Government assignment three Essay Example | Topics and Well Written Essays - 1250 words

American Government assignment three - Essay Example 205). Perhaps the most interesting aspect of the media exposure given to politicians is the negative advertisement used in negative campaigning. While this form of publicity – highlighting the negative aspects of an opposition candidate rather than merely proposing positive principles and intentions – is unacceptable to some, and even considered immoral, it has become very much a part of the political landscape. It is also not only restricted to the mainstream: Party websites, blogs, public video platforms, even social networking sites were all used in the latest American Presidential elections. Since newsworthy events rely on conflict, it is so that the more negative aspects of campaigning and the candidates’ actions and histories are published more readily. While the coverage of the President is perhaps generally more circumspect (Gitelson, Dudley, and Dubnick, publication date: pp. 265-269) politicians campaigning for office cannot escape the negative news that may emerge from the media. Given the freedom of the press and the freedom of speech that are such cornerstones of the US Constitution, it must be asserted that while negative advertising is perhaps not tasteful or even valuable in gaining votes, it should not be regulated or prevented. Political life is public, and the people who enter it should be able to stand up to public scrutiny on all

Case study Example | Topics and Well Written Essays - 1250 words - 17

Case Study Example The other cause was the statement by the apprentices that they never felt that they were learning anything and were preparing to leave. The apprentices did not do any meaningful work apart from chopping and cutting things, sweeping and mopping the floor. The other reason is that Hank, the banquet chef failed to meet with her and discuss her work schedule as had been promised. The action proved the statements from the other apprentices. The leadership and the management of Shady Lane Inn played a big role in the negative perception of Marietta concerning the company in various ways. First, they did not follow the training schedule and did not review the apprentices journals. The management did not supervise the apprentices as seen when Hank left Marietta with the others and arrived very rate. The leaders are not trustworthy from the way they do not review their apprentices work as they promised, which make them stay there longer than anticipated. The management of the company also lacks honesty, a fact displayed when Hank forces Marietta to have a positive attitude towards the company for her to stay longer. The steps that were necessary for Marietta to have a positive attitude are good supervision for instance Hank should have given her work himself instead of leaving her in the hands of the other apprentices. The apprentices should have explained to Marietta on the method to slice the onions instead of waiting until she was half way. Hank should have made an effort to meet Marietta as promised to create a good relationship and a sense of commitment. Shady Lane Company should do a number of things to avoid creating a negative attitude to the future apprentices by employing responsible managers for supervisory work. The top leaders should always make a follow-up ensure that the other managers are doing their work perfectly. The company management should analyse the apprentices views and their feelings about the company and

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

Macbeth Soliloquy

Macbeth’s Soliloquy In Macbeth’s soliloquy Shakespeare uses many rhetorical devices to magnify Macbeth’s change in attitude about killing Duncan. Two of the main rhetorical devices used in the soliloquy are rhetorical questions and allusions to Hecate and Tarquin. These two devices help Shakespeare depict the change in Macbeth’s attitude about killing Duncan and also represent his decision to kill Duncan. Macbeth’s rhetorical questions share his lack of clarity and conviction to kill Duncan while the allusions represent his decision forming and becoming clear to him.At the beginning of Macbeth’s soliloquy Shakespeare uses rhetorical questions to represent Macbeth’s feelings about killing Duncan. In the first seven lines we see three rhetorical questions. These questions lead into the conversation Macbeth has with himself to decide if he will kill Duncan. At the beginning of the soliloquy he seems unsure if he actually wants to go throu gh with the plan. This uncertainty is represented by his uncertainty of the dagger’s existence. The first question he asks is whether or not he actually sees a dagger in front of him.It is a simple question but leads us into the others. The second question he asks is if the dagger was sent by a â€Å"fatal vision† (II. i. 35). Here, the word fatal acts as a double entendre. Fatal can either mean someone’s destiny or it can mean a deadly action and in this case it works with both definitions. Macbeth wonders if it is his fate to kill Duncan with the dagger and the dagger is the deadly weapon that will be used to kill Duncan later on in the play. The final question Macbeth asks himself is whether this dagger is real or not and if it is formed by his â€Å"heat-oppressed brain† (II. i. 38).The fact that he does not even know if he really sees a dagger or not makes it clear to the audience that he is going crazy over the thought of killing Duncan. When Macbet h asks himself this question he is wondering whether he really wants to kill Duncan or if he is just caught in the moment. Later in the soliloquy he even says â€Å"[his] eyes are made†¦fools† (II. i. 43) and that it is â€Å"the bloody business which informs/ [the dagger] to [his] eyes† (II. i. 47-48). Since the dagger is not real we know Shakespeare is telling us that Macbeth is thinking about killing Duncan but is still too scared to actually do it.As the soliloquy progresses, and so does his idea of killing Duncan, he starts talking about more concrete ideas, such as witchcraft, and this represents his growing desire to kill Duncan. In the second half of the soliloquy Macbeth finally decides to kill Duncan. When Macbeth says â€Å"now o’er the one half-world† (II. i. 48) he is talking about the time when people are asleep, or nighttime. While he does this he alludes to two famous and immoral people, the goddess Hecate and the Roman King Tarquin. At the time when Shakespeare was alive the audience knew who Shakespeare was referring when Macbeth said the names Tarquin and Hecate.This simple connection would allow the audience to understand where Macbeth’s decision would go and why he finally came to that decision. Shakespeare draws many parallels between Macbeth and these two people. Shakespeare alludes to Hecate because she was the goddess of magic, witchcraft, the night, the moon, ghosts, and necromancy. All of these things are affiliated with evil and when Macbeth says that â€Å"witchcraft celebrates/Pale Hecate’s offerings† (II. i. 50-51) he is trying to persuade himself that even though she is the goddess of these evil things, people still celebrate her and something good may come from killing Duncan.Shakespeare draws a parallel between Hecate and Macbeth because Macbeth finally decides he will kill Duncan after the bell rings in the same way Hecate’s ritual sacrifices were summoned by the wo lf’s howl. Shakespeare also connects Macbeth to Tarquin in a similar way. Tarquin became the King of Rome by killing King Tullius. After Tarquin became the King of Rome he started a reign of terror. Besides killing King Tullius, Tarquin put many senators to death, his son raped a woman named Lucretia and eventually the Tarquin family was banished from Italy.By connecting Tarquin to Macbeth Shakespeare wants to show that they both knew what they were doing before committing the crime and chose to do it anyway. Also, Shakespeare is showing Macbeth’s change from an innocent man to a ruthless king whether Macbeth wants that or not and we see this later on in the play when Macbeth orders men to kill Banquo and his son, Fleance in fear that they may try to overthrow him. Shakespeare ends the soliloquy by saying that the â€Å"words to the heat of deeds too cold breath gives† (II. i. 60). By ending the soliloquy with this statement shows the change in Macbeth’s decision to kill Duncan and become king.The reason why Shakespeare included the soliloquy into the play is to show the audience how Macbeth finally comes to the decision to kill Duncan. Through the rhetorical devices used in the soliloquy Shakespeare is able to give the audience insight on how Macbeth goes from a guiltless man with no gall to a cold blood killer. We know by the end of it Macbeth has decided to kill Duncan and when the bell rings he goes to Duncan’s room to complete the job. We also know that later on he sends men to kill more people in order to keep his position as king and it is much easier for him to make that decision.

The Crucible By Arthur Miller - 1829 Words

Humans are inherently drawn to chaos. Humanity is involved in an endless war between madness and logic. Though society attempts to preserve logic and maintain order, a single event can trigger chaos and lead to the deaths of thousands; this has happened several times in every civilization and in every time period, and will continue to happen in the future. One example of this is the Red Scare in the 1900s, which disrupted decades of peace and harmony. The fear of McCarthyism was tangible and widespread; people were accused of being Communists based solely on circumstantial evidence and unfounded suspicions. Reputations and careers were destroyed over simple rumors. In some cases, innocent people were killed. Arthur Miller drew a parallel between the Salem witch trials in the late 1600s and the Red Scare in the 1950s in his novel, The Crucible. Through careful exposition, Miller argues that mayhem and hysteria can occur in any society at any time, and that logic and truth are needed i n order to overcome the dark evil in the world. Underneath the surface, Salem has an extremely rigid theocratic government with an almost cult-like, bitter society, needing only a small trigger to push it to complete chaos. The town of Salem is governed by a theocracy, meaning that God is the ultimate ruler, and reverends are given almost complete power to interpret the bible to their liking and arrest individuals. According to Miller, the theocracy ultimately fails because â€Å"the repressions ofShow MoreRelatedThe Crucible By Arthur Miller1269 Words   |  6 PagesAt first glance, the playwright Arthur Miller in The Crucible highlights the historical significance of the Salem Witch Trials of 1692, but in fact it is an allegorical expression of his perception of McCarthyism. If the reader has some background information on Arthur Miller’s victimization as a communist, it is evident that the play is a didactic vessel illustrating the flaws of the court system in the 1950à ¢â‚¬â„¢s. The communist allegations were launched at government employees, entertainers and writersRead MoreThe Crucible By Arthur Miller1681 Words   |  7 Pagesof their way to the last dying breath to make sure they leave with a good or bad reputation. In one of the recent literature study in class â€Å"The Crucible† by Arthur Miller, Miller uses characterization to illustrate reputation throughout the play. â€Å"The Crucible† takes place in Salem, Massachusetts. It is based upon the Salem witch trails. In â€Å"The Crucible†, we journey through the life of three characters who reputations plays a major role in the play. The three characters are John Proctor, AbigailRead MoreThe Crucible By Arthur Miller1333 Words   |  6 PagesAs the various characters in The Crucible by Arthur Miller interact, the dominant theme of the consequences of women’s nonconformity begins to slide out from behind the curtains of the play. Such a theme reveals the grippin g fear that inundated the Puritans during the seventeenth century. This fear led to the famous witch-hunts that primarily terrorized women who deviated from the Puritan vision of absolute obedience and orthodoxy. Arthur Miller presents his interpretation of the suffering by subtlyRead MoreThe Crucible By Arthur Miller998 Words   |  4 Pagesmotivated by jealousy and spite. The Crucible is a four-act dramatic play production that was first performed on January 22, 1953. Arthur Miller used dialogue within the characters to cover the multiple themes; conflicts and resolutions, plus the few directions for the different actions of the play. The Salem Witch Trials were intended to be performed as the play however, when read, it can be more carefully examined and broken down to analyze the techniques. Miller, the playwright, uses literaryRead MoreThe Crucible By Arthur Miller1145 Words   |  5 PagesUnbalance Through The Centuries In Arthur Miller’s play, The Crucible, the author reflects the persecution of communists in America in the 1950’s through a recount of the Salem witch trials. It is often presumed that Miller based his drama directly off of events that were particularly prevalent in the years surrounding the publication of The Crucible- which was released in the year 1953, towards the conclusion of the Korean War. Although there was not a literal witch hunt occurring during this timeRead MoreThe Crucible By Arthur Miller1063 Words   |  5 PagesIn the English dictionary, there are three definitions of the word crucible. One is a metal container in which metals are mixed and melted. Another is a severe test. But the third definition, and the one that I think fits the best for this book, is a place or situation in which different elements interact to create something new. In my mind, this fits because all of the characters had their little grudges and dirty secrets. But when all th ose seemingly little things interact, they formed somethingRead MoreThe Crucible By Arthur Miller1285 Words   |  6 Pages Rationale, Morality, Stereotypes, Pressure, Self-Censorship, Unanimity, and Mindguards. Groupthink has also taken place in our history a a country. The play, The Crucible by Arthur Miller is about a the real-life Salem Witch Trials that happened in 1692 - 1693, in Salem, Massachusetts. Some symptoms of Groupthink found in the Crucible are Rationale, Pressure, and Self-Censorship. The Groupthink symptom, Rationale, is described as when victims of Groupthink ignore warnings: they also collectivelyRead MoreThe Crucible By Arthur Miller811 Words   |  4 Pages While The Crucible, by Arthur Miller, is only a four act play, it still resembles the format of a five act play. The five-act structure evolved from a three-act structure, which was made famous by Roman Aelius Donatus. Donatus came up with three types of plays: Protasis, Epitasis, and Catastrophe. The five-act structure helped to expand the three act structure, mainly made famous by Shakespeare through his many tragedies. Even though The Crucible contains only four acts, it still has the commonRead MoreThe Crucible By Arthur Miller1052 Words   |  5 PagesBuddy Al-Aydi Ms.Healy English 9 CP 14th October 2014 The Crucible Essay The Crucible was a novel written by Arthur Miller in the 1950’s. It was written in a format of the play, portraying an allegory of the Salem Witch-Hunts led by Senator Joseph McCarthy. The book is known to have a inexplicable plot. This plot is advanced by multiple characters in the book in order to ensure that the reader maintains interest with the material that is being read. The farmer, John Proctor, would be theRead MoreThe Crucible By Arthur Miller841 Words   |  4 PagesThe Crucible is a chaotic play, throughout this American classic Arthur Miller takes the reader through multiple events of terror and insanity. While creating a great on-stage play, Arthur Miller portrays his life through the events, the characters, and plot of The Crucible. Using vivid imagery and comprehensible symbolism, Miller manipulates the real personalities of the characters and events in 1600 Salem, Massachusetts to create a symbolic autobiography. Throughout this play, the reader experie nces

Henry Ford Health Systems Human Resources Models Essay

During my senior year of undergraduate studies at Wayne State University, I shadowed a pediatrics physician at a Henry Ford Medical Group center in Dearborn, MI. The HFMG is part of Henry Ford Health Systems. The Henry Ford Health Systems employs over 23,000 employees while the HFMG employs over 1,300 senior staff physicians and researchers along with 3,100 non-physician providers and support staff. â€Å"The HFMG generates $750M in net revenue, which represents about 33% of total HFHS provider revenues† (Kelley 2011). The HFMG physicians specialize in over 40 different medical specialties and work in 30 different medical centers and 5 different hospitals across southeast Michigan. The specialties include cardiology, cardiovascular surgery,†¦show more content†¦However, the HR department is a staff operation within the organization chart of Henry Ford. Meaning that if the HR department was suddenly removed, there would be no short-term effect on the workflow of the he alth system (Fallon 2007). According to a human resources department job description posted by Henry Ford, the many functions of the HR department at Henry Ford include working on issues and policies of employee benefits, employee compensation, employment, e-HR, organizational performance and learning, payroll, training and education, performance evaluation, employee retention, and legal and regulatory issues, among many other functions (Linkedin). Having a wide range of duties like this requires a complex model that can cover all aspects of the job without over-stepping the boundaries between HR and other departments. â€Å"The human resources department of any healthcare entity is responsible for the people side of the business. Not only must human resources department protect and encourage the quality of the patient’s relationship with the healthcare entity, but it also must protect and encourage the quality of the employee’s relationship with the healthcare entity† (Shi 2007). This is a macro look at the basic function of the HR department within a health setting. From myShow MoreRelatedManaging An Effective Workforce Ie People Essay1512 Words   |  7 Pagesor as a manager in a coffee shop or as a director of the Human Resources department in a private company, the common aspect here is the ‘responsibility of managing an effective workforce ie people’. In any field, the four important resources are men, material, machinery and money. Out of these, I believe that ‘men’ ie humans are the most important because they are the ones that effectively and strategically employ and use the other resources/factors of production. Years ago, workers were treated asRead More The History of the Ford Motor Company Essay examples3137 Words   |  13 Pagesbreathed easier, and a young Ford Motor Company had taken its first step. During the next five years, young Henry Ford, as chief engineer and later as president, directed a development and production program which started in a converted wagon shop on Mack Avenue in Detroit and later moved to a larger building at Piquette and Beaubien Streets In the Ford Motor Companys first 15 months, 1,700 Model A cars chugged out of the old wagon shop. Between 1903 and 1908, Henry Ford and his engineers used theRead MoreThe Between Authority And Other Forms Of Power Essay1465 Words   |  6 Pageshierarchal structure by which the power flows downward from those with the greatest authority; (2) counter-balancing power, by which those below the most powerful may relationally exercise control using their personal characteristics, expertise, force, resource control, application o f sanctions via rules and cultural assumptions and values, and accessing people with more power; (3) authoritative power based on a legitimized source that, in the members’ perceptions, has become accepted and expected, andRead MoreProfiles of Ford Motor Company and Toyota Company4248 Words   |  17 PagesResearch on TOYOTA MOTOR CORPORARION and the FORD MOTOR COMPANY †¢ Describe and critically analyze the supply chain management practices employed by both of these companies. †¢ Are they involved in strategic alliances with major trading partners? If so, how and for what purpose? †¢ What strategies do they apply to procurement and outsourcing? †¢ What challenges and risks do they face internationally? How does each attempt to overcome these challenges? †¢ Compare how these organizations areRead MoreThe MAS Corporation: Case Study and Analysis2617 Words   |  10 Pagesrelevant management theories and/or models (frameworks of analysis) which are *Mintzbergs management model *Ford and Taylor Scientific Management theory and apply these to the MAS case study. Introduction The following case study is of the MAS Corporation that has integrated a high level of organizational structure and operation with an admirable level of philanthropy and sustainability. In some ways, its structure resembles the Mintzbergs Management Model and in other ways its operation andRead MoreFactors affecting women entrepreneurs success1224 Words   |  5 PagesStevenson 1-2 Introduction to Operations Management Operations Management Figure 1.1 The management of systems or processes that create goods and/or provide services Organization Finance Operations Marketing 1-3 Introduction to Operations Management What Do Operations Managers Do? †¢Ã¢â‚¬ ¯ What is ‘Operations’? †¢Ã¢â‚¬ ¯ †¢Ã¢â‚¬ ¯ a function or system that transforms inputs into outputs of greater value What is a Transformation Process? a series of activities alongRead MoreA Comparative Study of Lean and Mass Production System: Toyota and Ford5245 Words   |  21 PagesPRODUCTIVE MAINTENANCE TERM PAPER TOPIC: - A COMPARATIVE STUDY OF LEAN AND MASS PRODUCTION SYSTEM: TOYOTA AND FORD Date of Submission: 13th Sep’10 By GROUP-11 Yashraj D. Pawar -09258 Chaintanya Sharavanth C. - 09211 Harshita M. - 09217 Batch - XVII VIGNANA JYOTHI INSTITUTE OF MANAGEMENT Bachupally, Hyderabad, A.P – 500072, India SUMMARY: This paper deals with the production systems of two major leaders in the automobile market. Mass production is briefly touched up on andRead MoreHow Has the World of Work Changed in Post-Fordism Era3142 Words   |  13 PagesIntroduction Capitalism is a political, social and economic system subject to periodic instability, change and the like which influences the business world in many ways. The Post-Fordism era in broaden sense is generic description of Capitalism period which mainly is characterised by flexible production of non-standardized, better-quality goods embracing adaptability of production processes in harmony with the unpredictable nature of markets to meet customers’ satisfaction. The changes made in notionRead MoreDegree of Globalisation of Ford Motor Company3667 Words   |  15 Pagesdegree of globalisation of the automotive industry with special interest in Ford motor company. This analysis begins with an introduction to the automotive industry then it covers industrialisation of the automotive industry, also globalisation of the automotive industry and lastly global integration of the automotive industry. Secondly we focus more on a case study of ford motor company which covers a brief background of Ford, then i consider the challenges of competing globally and end with productRead MoreCompany Analysis : Ryan Company1449 Words   |  6 Pagesthat specializes in integrated project delivery, building information modeling (BIM), Lean construction practices and sustainable design for office, retail, industrial, public sector, alternative energy (biomass and gasification,[2] wind, solar), health care, higher education, hospitality, mission critical, multi-family and senior housing and mixed-use projects. With in-house construction, design, development, capital markets and real estate management, Ryan uses integrated project delivery (IPD)

Diagnosis And Treatment Of Cancer Essay - 1844 Words

Cancer is very large throughout the U.S. and Canada, it is said that one and a half million people will receive a new diagnosis of cancer each year (Ignatavicius Workman, 2013).Many years back a diagnosis of cancer had a very poor outcome and you were basically considered dead. Technology and research have been focusing on cancer, and how to prevent it. This paper will review the diagnosis of cancer as well as the staging of cancer, as well as possible treatment options and side effects related and how to deal with the psychological burden that cancer patients deal with. Diagnosis and Staging of Cancer The body consists of millions of tissues and cells that are grown from conception to adulthood. Cancer cells are cells that are not normal and have the capability of infinite replication, they are harmful to the normal cells and serve no benefit to the body (Ignatavicius Workman, 2013).Cancer cells are also defined as malignant cells; they tend to start in one spot which is called the primary location. They may break from the primary location and spread to other locations to establish more colonies. When the cancer spreads it is known as metastasis. There are several tests that are needed to be done prior to confirming a cancer diagnosis. Depending on the cancer suspected, different tests may be done. It is very common to take a biopsy of the infected area and wait for pathologists to evaluate the specimen. Blood work is also very important forShow MoreRelatedCancer Diagnosis And Treatment Of Cancer Essay1480 Words   |  6 PagesCancer is characteri zed by abnormal, uncontrolled cell growth, and it disrupts normal body function, as it increases energy demands and alters body systems. There are many factors that can lead to the development of cancers, including genetic, behavioral, and environmental influences. The presence of disease is not always obvious; therefore, it is imperative for individuals to participate in screening interventions to promote early detection. Cancer diagnosis and treatment requires a patient-centeredRead MoreThe Treatment Of A Cancer Diagnosis951 Words   |  4 PagesA Cancer diagnosis may bring on many negative emotions, questions and uncertainties in a patient. Even though we now have different types of treatments for cancer, there are still numerous deaths annually attributed to the diagnosis. The World Health Organization has described the number of mortalities to be greater than 8.2 million annually around the world (World Health Organization [WHO], 2015). As nurses, we must serve as the patientà ¢â‚¬â„¢s advocate and empower them throughout the course of theirRead MoreDiagnosis And Treatment Of Cancer1954 Words   |  8 PagesIntroduction When it comes to the topic of cancer, most people readily agree that we have made leaps and bounds in diagnosis and treatment mechanisms. Where this disagreement usually begins, is on the question if finding a â€Å"cure† for cancer can be a reality. While some are convinced that a cure will come with time, others believe that a single cure is just not logical. The US waged a war on cancer when Nixon was in office, 1971, yet we haven’t overcome it yet (Gorski). After research, I believeRead MoreThe Diagnosis And Treatment Of Breast Cancer1947 Words   |  8 Pages3D Mammography The diagnosis and treatment of breast cancer and other non-cancerous diseases are very important in improving the quality of life for many women. The early diagnosis of the non-cancerous disease can reduce the incidence of breast cancer through effective treatment of mastopathy (fibrocystic of the breasts tissue). In the area of study, a variety of imaging modalities is implemented to assist with the diagnosis. These imaging modalities includes multi-frequency electrical impedanceRead MoreDiagnosis And Treatment Of Prostate Cancer1681 Words   |  7 PagesWhen we have diseases or don’t feel well, we tend to seek treatments and try to cure it as soon as possible. However, what if there is no reliable treatment or nearly no treatment available? Then, the only option is to do research. Life can be really difficult and no one wants any sickness or diagnosed with such a hard-to-cure disease like cancer. Prostate Cancer is a known cancer that happens to men only and a lot of men i n the U.S are diagnosed with it, and happens to male’s reproductive systemRead MoreCancer : Etiology, Symptoms, Diagnosis, And Treatment1718 Words   |  7 Pages Colon Cancer: Etiology, Symptoms, Diagnosis, and Treatment Harold Scott Delaware Technical Community College Biology Professor Riggio November 18, 2014 Abstract A well-known fact is that cancer plays a major role in the area of health science in the United States. Cancer touches many individuals and many families across the nation. With a variety of types of cancer as well as causes, symptoms, and treatments cancer is a very broad topic of research. In particular my research focuses onRead MoreOvarian Cancer: Symptoms, Diagnosis, and Treatment1264 Words   |  5 PagesOvarian cancer symptoms, diagnosis, and treatment Ovarian cancer is a malignant form of cancer that develops from the ovary and it is unlikely to be discovered by most patients during its early stages because its symptoms are very delicate. The fact that prognosis is sometimes difficult to perform makes it impossible for some individuals to be able to effectively fight the tumor. Many women are unable to understand that changes occurring in their bodies are actually a result of ovarian cancer. HundredsRead MoreCancer Diagnosis, Treatment, Complications, And Interventions Essay1807 Words   |  8 PagesOverview of Cancer Diagnosis, Treatment, Complications, and Interventions Grand Canyon University Ola Glezen NRS-410V Pathophysiology and Nursing Management of Clients’ Health Professor J. Jones September 18, 2016 An Overview of Cancer Diagnosis, Treatment, Complications, and Interventions In just 2016, about 595,690 people in the United States will die because of cancer. (American Cancer Society [ACS], 2016, p. 1). Even though the number of people who die because of cancer is decliningRead MoreDiagnosis And Treatment Of Breast Cancer2197 Words   |  9 PagesOne out of every eight women in the US is diagnosed with breast cancer every year. When women get older, their chances of developing breast cancer increases. In fact, 80% of all breast cancer patients are women ages fifty and up. As the number of breast cancer patients increases year after year, identification methods and treatments are beginning to advance. Doctors and pathologists are using the highest levels of technology to treat abnormalities inside of the body. The tumor is discovered throughRead MoreBreast Cancer Research : Diagnosis With Treatment1844 Words   |  8 PagesBreast Cancer Research Including the Diagnosis with Treatment Ellie A. Rider New Castle Career Center Health Science Education Mrs. Talbott December 2, 2014 Author Note Ellie A. Rider, Health Science Education, New Castle Career Programs. Correspondence concerning this article should be addressed to Ellie Rider, Health Science Education, New Castle Career Programs, New Castle IN, 47362. Contact: erider2015@gmail Abstract This paper will explain to you an in depth description of an illness