Determining Cognitive Functioning of Individual

Determining Cognitive Functioning of Individual Serial assessment in neuropsychology is necessary to make inferences regarding an individual’s level of functioning, i.e. to determine whether there has been ‘real’ improvement or decline, outside of measurement error, normal variation and clinically insignificant change [1]. A number of psychometric methods have been developed in order to interpret changes in test scores over repeated occasions of assessment. The associated problems and processes that are involved in delineating observed scores into their subcomponents of measurement error and true scores are complex and problematic [1]. Acquiring knowledge and understanding of issues pertaining to measurement error, such as the standard error of measurement (SEM,) is crucial to accurate interpretation of neuropsychological test results and change scores. The SEM refers to the total error variance of a set of obtained scores, where the obtained scores are an unbiased estimate of an individual’s true score [2]. It is the standard deviation (SD) of an individual’s test scores had the specified test been undertaken multiple times, and is calculated by multiplying the baseline SD of a measure by the square root of one minus the reliability coefficient of the measure [3]. The SEM is inversely related to a test’s reliability, such that larger SEMs reflect less reliable tests, and therefore denote diminished accuracy with the measure taken and the scores obtained [1]. This leads to greater variability within a test battery and thus any interpretation of results in such a case should be undertaken with a considerable degree of caution [4]. SEMs are useful in preventing the unwarranted attachment of significant meaning to between-score differences. That is, SEMs and their corresponding confidence intervals may overlap, indicating that some of the observed score difference may actually be attributable to error in measurement [1]. However, whilst the SEM is useful for estimating the degree of measurement error, it is not a suitable predictive measure as it is based on a distribution that presumes true score knowledge, which will always be unknown as tests do not have perfect reliability. As such, utilising the standard error of estimate (SEE) for such purposes may be the more appropriate method [2]. The SEE is a method which utilises a regression-based approach and measures the dispersion of predicted scores [5]. The SEE reflects the SD of true scores when the observed score is held constant, and is the statistic from which confidence intervals should be constructed [2]. The construction of confidence intervals is closely related to a test’s reliability. More reliable tests, in terms of internal consistency, represent homogeneity within the test itself. Thus, the associated confidence intervals will encompass a more narrow range of scores, with the resulting estimate being more precise [2]. It is therefore necessary to consider a test’s reliability coefficient, as below a certain point, the utility of a test is compromised [2]. Furthermore, as the reliability of a test is the single largest factor in determining the degree of change needed to occur over time from which the observed difference can be deemed to reflect actual change, using tests with high reliability coefficients is of paramount importance [6]. The consideration of measurement error in neuropsychological test results may also incorporate the assessment of observed score differences in terms of clinical significance. Clinically significant change can be interpreted on the basis of whether an individual’s change in test performance over two occasions reflects sufficient improvement, so that the individual has shifted classification categories, for example from ‘impaired’ to ‘normal’ [6]. Therefore, if a change is to be considered clinically significant, the tests being used to assess observed score differences need to be reliable. However, interpreting clinically significant change may also be problematic. Whilst there may be a considerable observed change in test scores from one measurement occasion to the next, if the starting point is at the extreme low end of a category, and the end point is at the extreme high end of a category, then an individual’s classification will not change and clinically significant improvement will not be deemed to have occurred [6]. This is a problematic interpretation as these changes may well have had important functional consequences for the individual that underwent assessment, and thus it is important to employ sensible clinical judgement [6]. Caution also needs to be applied to the interpretation of statistically reliable change, to avoid the implication that it represents real change. In reality, the observed change may instead reflect measurement error [6]. Statistically meaningful differences may also be a common occurrence within a particular population [7], but these are not necessarily clinically significant differences. Whilst neuropsychological test interpretation must consider, amongst other things, base rates of expected differences and abnormalities, the number of measures in a battery must also be taken into account, as abnormal performance on a proportion of subtests within a battery should be regarded as psychometrically normal [4]. A number of methods for calculation of reliable change have been proposed, adopted and further modified. These methods are usually given the designation of Reliable Change Index (RCI), and are used to estimate the effect of error variance on test score accuracy [6]. The value of the RCI is used to indicate the probability of the difference between two observed scores being the result of measurement error, and thus if the resulting probability is low, the difference is likely due to factors external to the test itself [1]. The notion of reliable change originated in classical test theory, with the standard error of the difference used as the criterion for determining whether an observed difference is credible under the null hypothesis of no real change [8]. However, the original, unmodified classical approach assumes that there are no practice effects. Certain subsequent variations of this approach have aimed to account for practice effects, in one of two ways. Either by a simple adaptation of the Jacobson and Truax approach (a widely used, simplified version of the classical approach, called the JT index), or via estimation of true change by using a regression equation, with the latter method being the favoured alternative in this context [8]. This regression-based approach does not require the test scores at each of the time points to have equal variance, and thus practice effects can occur [6]. There are many further approaches to calculation of RCIs, with no real consensus about which method is superior and should represent the ‘gold standard’ approach [8]. Furthermore, whilst RCI methods do have a number of advantageous features, there are still inherent limitations when considering factors such as real change that remains undetected if it falls below the RCI threshold [6]. Additionally, whilst reliable change methodology adjusted for practice effects has the potential to reduce measurement error and improve clinical judgement, it utilises a constant value the group mean – and so does not take into account the full range of possible practise effects, nor does it traditionally account for regression to the mean, so that error estimates are not proportional to the extremities of observed changes [1]. However, this methodology does at least provide a systematic and potentially empirically valid approach to assessment of real change [6]. In contrast, whil st regression methods do also have their own inherent limitations, such as greater utility in larger sample sizes, these are considered less extensive than RCI methodology [1]. The methods discussed thus far are primarily distribution-based approaches, meaning that they express observed change in a standardised format. A primary disadvantage of this type of approach is that they are purely statistical measurements which do not reveal the clinical significance of any observed change [9]. Alternative approaches include the use of reference states to estimate the minimal important difference or change, which refers to the smallest change in health quality that the patient is able to perceive and that is considered clinically relevant change [3]. However, these approaches have their own inherent limitations, with direct and subjective patient involvement in the change assessment process increasing the complexity of the measurement [3]. As the determination of an individual’s current cognitive functioning, as well as whether this functioning has improved or declined since prior assessment, is fundamental to the efficacy of clinical neuropsychology, the ability to reliably determine change via comparison of test scores is crucial [6]. However, as has been outlined above, the approaches involved in this determination are varied in their efficacy, and come with inherent limitations. As such, when considering the clinical significance of test results, a patient’s performance needs to be interpreted contextually, taking into account relevant behavioural, medical and historical information, as psychometric variability alone is not sufficient [4]. Furthermore, examination of the functional outcomes of any measured change is crucial, as this is of at least equivalent importance in determining whether improvement or decline has taken place [6]. References 1. Brooks, B.L., et al., Developments in neuropsychological assessment: Refining psychometric and clinical interpretive methods. Canadian Psychology/Psychologie canadienne, 2009. 50(3): p. 196. 2. Charter, R.A., Revisiting the standard errors of measurement, estimate, and prediction and their application to test scores. Perceptual and Motor Skills, 1996. 82(3c): p. 1139-1144. 3. Rejas, J., A. Pardo, and M.à . Ruiz, Standard error of measurement as a valid alternative to minimally important difference for evaluating the magnitude of changes in patient-reported outcomes measures. Journal of clinical epidemiology, 2008. 61(4): p. 350-356. 4. Binder, L.M., G.L. Iverson, and B.L. Brooks, To err is human:â€Å"Abnormal† neuropsychological scores and variability are common in healthy adults. Archives of Clinical Neuropsychology, 2009. 24(1): p. 31-46. 5. McHugh, M.L., Standard error: meaning and interpretation. Biochemia Medica, 2008. 18(1): p. 7-13. 6. Perdices, M., How do you know whether your patient is getting better (or worse)? A users guide. Brain Impairment, 2005. 6(03): p. 219-226. 7. Crawford, J.R., P.H. Garthwaite, and C.B. Gault, Estimating the percentage of the population with abnormally low scores (or abnormally large score differences) on standardized neuropsychological test batteries: a generic method with applications. Neuropsychology, 2007. 21(4): p. 419. 8. Maassen, G.H., E. Bossema, and N. Brand, Reliable change and practice effects: Outcomes of various indices compared. Journal of clinical and experimental neuropsychology, 2009. 31(3): p. 339-352. 9. Ostelo, R.W., et al., Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine, 2008. 33(1): p. 90-94.

The Ancient Art of Feng Shui Essay -- History Research Papers China Es

The Ancient Art of Feng Shui The History of Feng Shui Feng Shui has been practiced in China for thousands of years and is believed to have started in 2953 B.C. when Hu of Hsia found a tortoise that had a perfect "magic square" on its back. From this discovery evolved the I Ching, the oldest book in Chinese history, and possibly the world (Webster 1). This book contains the first written instructions on the theory of Feng Shui. Feng Shui was seen as a sacred power, so much so that in ancient China, only the privileged class had access to the knowledge. There are even stories of members of the Imperial family who went out of their way to obscure the texts in order to prevent those who might be a threat to them from obtaining the sacred knowledge. The first Ming emperor even ordered that the country be flooded with books containing misleading theories and incorrect guidelines on Feng Shui (Too 2). When Chiang Kai Shek fled the mainland he took thousands of books on Feng Shui with him to Taiwan and used its principles in building a regime there. From there it traveled to Hong Kong and eventually to the Western World through Marco Polo (Cassidy). Modern Feng Shui is based on the commentaries from Wang Chi and other scholars from the Sung dynasty, 1126-960 B.C. (Webster 3). What is Feng Shui? Feng Shui is the ancient Chinese art of living in harmony with nature and your surroundings, in order to maximize your health, prosperity and luck. It literally translates as "wind and water" and it involves the placement of buildings in relation to their surroundings, and the placement of furniture within the building in order to maximize the ch’i, the original energy source on the earth, from which everything else was created (Webster 4). As the dragon is seen as the most revered celestial creature of Chinese philosophy, ch’i has been called the breath of the dragon. Ch’i is an invisible energy that circulates throughout the world but also gathers in certain areas. The basic idea of Feng Shui is to harness as much ch’i as possible by allowing it to gather where you are, whether it is in your home or in your office. Ch’i is the life force that is all living things, and can be found, in its perfection wherever things are done perfectly. An arti st who creates a masterpiece is creating ch’i. Through Feng Shui, we are looking for places where ch’i is ac... ...ents and residential, family dwellings. It is the art of placement, a science and a philosophy that was meant to bring harmony through the observance of our environments and how the balance of the energies created can affect all the aspects of our lives. "All we do is connected to Mother Earth and Ch’i, the Natural Order or Energy which permeates the universe" (Feng Shui Innovations). Within the past ten years there has been an amazing amount of interest in this science in the western world as people, for various reasons, look for answers, and search for a way to be in harmony with the world. An ancient Chinese saying lists the five basic principles of successful living: "First comes destiny, and then comes luck. Third comes Feng Shui, and with that comes philanthropy and education" (Webster 33). Works Cited: Cassidy, William L. "www.qi-whiz.com". Feng Shui Innovations. "www.fengshui-innovations.com". Feng Shui Society. "www.fengshuisociety.org.uk/". Too, Lillian. Basic Feng Shui. Oriental Publications, Australia:1997. Webster, Daniel. Feng Shui for Beginners. Llewellyn Publication, St. Paul:1997. Xing, Wu. The Feng Shui Workbook. Tuttle Pub., Boston:1998.

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I am always really impressed and excited by the girlstudents wearing Ao Dai coming out of schools every where in the city at the end of class time. That image is indeed beautiful and so rich in the Vietnamese culture! However, we may be forgetting such a lovely image because of the current tendency for cultural intergration . The white Ao Dai has been gradually replaced by the self-designed skirts matched with shirts as usually seen in the Korean or Japanese movies . Seeing this reality, we, highschool students support the concept of maintaining the Ao Dai as the official uniform for highschool girlstudents. Introduce members of group) So why do we should keep using Ao Dai as school girls’ uniform? 1. First of all, the Ao Dai is a kind of dress that represents most deeply the nationality of the Vietnamese people. People never take the Vietnamese Ao Dai for the Japanese Kimono, for the Korean Hanbok or the Chinese Xam gown. With a long history related to that of the development of the Vietnamese people, the Ao Dai has become a typical tradition, rich in national cultural essence. In other words, the Ao Dai is the national costume for the Vietnamese women.That is why female delegates, leaders’ Ladies dress themselves in Ao Dai at the national or international conferences in order to affirm the sense of national superiority. The contestants for the global beauty contests always wear Ao Dai to promote the Vietnamese image. Right in our country, every day, every hour do we see the Vietnamese women in the national Ao Dai at hotels, restaurants, banks, post offices, schools and offices as well. The Ao Dai bears in itself the image of a country, Vietnam with an abundant cultural core. . The Ao Dai not only symbolizes the national tradition, but also glorifies the beauty of the Vietnamese women, especially the white Ao Dai has been connected with the softness and purity of the Vietnamese girlstudents for long time. With the simple but fine features, the pu rely white Ao Dai brings about the sense of nobility for highschool girlstudents. No one can forget the image of the girlstudents of Dong Khanh Highschool on their way back home. That image has been the endless inspirations for writers and poets since then.Young girlstudents may like the youngness and the modernity of the new fashionable uniforms, but the Ao Dai is always the best choice for the dress that represents the dynamic and modern aspects of present-time girlstudents, but still keeps the non-mistakable of the Vietnamese women. 3. Finally, the Ao Dai honors not only the external beauty but also the internal beauty of the Vietnamese girls’soul more than any other costumes. To some extents, the dress we wear influences our behavior. In this sense, the Ao Dai has educational value.In the white, charming Ao Dai, the girls’ conducts, speech, attitudes and manner are even more valued. That is the thought of holding a representative,and national image ,the preservatio n and the development of the cultural values for the nation. The educational aspect of the Ao Dai not only spreads over the grirlstudents but also over the community . Every day, at any time we can happen to see the Ao Dai on any streets in the city: that is not just a beautiful image , but it is a symbol that reminds people of the typical, traditional, cultural beauty and profound, national sense of superiority.Consequently, for its national, educational and aesthetic values, represented in the girlstudents’ Ao Dai, we strongly recommend the Ao Dai to be the official uniform for highschool girlstudents. Vietnam being in its process of renovation and intergration; we may easily leave the traditional beauties behind. For this reason, we should not allow the imported foreign fashions or styles to bring the Ao Dai into decadence. Beautify ourselves and our city with your white alluring Ao Dai! Toi v? n luon ? n tu? ng va xuc d? ng khi m? i gi? tan tru? ng, nh? ng ta ao dai tr? n g c? a cac b? n n? sinh ua ra kh? cac n? o du? ng thanh ph?. Hinh ? nh ? y th? t d? p va d? m ch? t Vi? t Nam bi? t bao. Th? nhung, v? i xu hu? ng van hoa h? i nh? p hi? n nay, chung ta dang d? n m? t di m? t hinh ? nh d? p nhu th?. Chi? c ao dai tr? ng dang d? n b? thay th? b? i nh? ng b? d? ng ph? c t? thi? t k? , di? n hinh nhu cac ki? u vay k? t h? p v? i ao so mi ma ta v? n thu? ng th? y trong cac b? phim Han Qu? c hay Nh? t B? n. Tru? c th? c tr? ng nay, nhom h? c sinh chung toi mu? n th? hi? n quan di? m v? vi? c chung ta nen duy tri vi? c s? d? ng ao dai nhu d? ng ph? c c? a h? c sinh trung h? c. (Gi? i thi? u nhom)V? y t? i sao chung ta ph? i duy tri vi? c s? d? ng ao dai nhu d? ng ph? c c? a cac n? sinh? 1. Tru? c h? t, ao dai la trang ph? c th? hi? n tinh dan t? c sau s? c c? a ngu? i Vi? t Nam. Ngu? i ta khong th? nh? m l? n ao dai c? a ngu? i Vi? t v? i kimono c? a ngu? i Nh? t, hanbok c? a ngu? i Han hay su? n xam c? a ngu? i Trung Hoa. V? i l? ch s? lau d? i g? n li? n v? i l? ch s? phat tri? n c? a dan t? c VN, ao dai da tr? thanh m? t net truy? n th? ng d? c trung, d? m da b? n s? c van hoa dan t? c. Noi cach khac, ao dai chinh la qu? c ph? c c? a ngu? i VN. Do la ly do vi sao ? cac h? i ngh? qu? gia hay qu? c te, cac n? d? i bi? u hay phu nhan cac nha lanh d? o v? n m? c ao dai d? kh? ng d? nh s? t? ton dan t? c. Cac d? i di? n tham gia cac cu? c thi s? c depk toan c? u luon mang tren minh chi? c ao dai VN d? qu? ng ba hinh ? nh Vi? t. Ngay ? d? t nu? c chung ta, hang ngay, hang gi? chung ta d? u co th? nhin th? y hinh ? nh ph? n? Vi? t trong chi? c ao dai dan t? c ? cac khach s? n, ngan hang, buu di? n, tru? ng trung h? c va cac co quan khac. Nhu v? y, co th? noi r? ng ao dai da mang tren no hinh ? nh c? a c? m? t d? t nu? c Vi? t Nam d? m da b? n s? c van hoa. 2. Ao dai khong ch? ang d? m tinh dan t? c ma ao dai con ton vinh v? d? p c? a ngu? i ph? n? Vi? t Nam va ao dai tr? ng da g? n li? n v? i s? d? u dang, net trong sang c? a ngu? i n? sinh Vi? t t? r? t lau r? i. V? i s? don gi? n nhung tinh t? , chi? c ao dai tr? ng tinh khoi mang d? n c? m giac thanh thoat cho cac n? sinh trung h? c. Khong ai co th? quen du? c hinh ? nh n? sinh D? ng Khanh ngay xua m? i khi tan tru? ng v?. Hinh ? nh ? y cung la ngu? n c? m h? ng cho r? t nhi? u cac thi si tru? c day cho t? i t? n bay gi?. Co th? net hi? n d? i va tr? trung c? a nh? ng ki? u d? ng ph? c m? i khi? n cac b? n n? inh yeu thich, nhung d? v? n v? a th? hi? n tinh nang d? ng, hi? n d? i c? a n? sinh th? i nay ma v? n gi? du? c net d? p khong th? nh? m l? n c? a ngu? i ph? n? Vi? t, ao dai v? n luon la s? l? a ch? n t? i uu nh? t. 3. Cu? i cung, hon b? t c? m? t lo? i trang ph? c nao, ao dai khong ch? ton vinh v? d? p ben ngoai ma con nang cao cai d? p tam h? n ben trong c? a ngu? i con gai Vi? t. B? ng cach nay hay cach khac, trang ph? c ta m? c luon co ? nh hu? ng t? i hanh vi c? a ta. Ao dai co tinh giao d? c theo cach nay. Trong nh? ng ta ao dai tr? ng d? p nh? nha ng, y th? c v? c? ch? , thai d? cach di d? ng va l? i noi c? a cac b? n n? sinh cung du? c nang cao. Do chinh la y th? c v? vi? c gi? gin m? t hinh ? nh d? i di? n c? a m? t dan t? c, la b? o t? n va phat huy nh? ng gia tr? van hoa c? a d? t nu? c. Tinh giao d? c c? a ao dai con co tinh ch? t lan t? a b? i khong ch? rieng cac n? sinh ma toan th? xa h? i d? u du? c giao d? c y th? c. B? i l? , hang ngay, c? m? i gi? d? n tru? ng hay tan h? c, ngu? i ta d? u co th? b? t g? p m? t ta ao dai tr? ng nao do tren b? t ki m? t n? o du? ng nao trong thanh ph?. Do khong ch? la m? t hinh ? nh d? p ma con la bi? u tu? ng nh? c nh? m? ngu? i v? cai d? p van hoa truy? n th? ng d? c trung va long t? ton dan t? c sau s? c. Nhu v? y, b? i tinh dan t? c, tinh th? m m? , va tinh giao d? c th? hi? n ro qua chi? c ao dai n? sinh, chung toi d? cao vi? c duy tri s? d? ng ao dai nhu d? ng ph? c h? c sinh ? tru? ng THPT. D? t nu? c cang d? i m? i va h? i nh? p, chung ta cang d? dang m? t di nh? ng net d? p truy? n th? ng. V? y nen d? ng d? nh? ng thi? t k? th? i trang ngo? i nh? p lam ao dai n? sinh c? a chung ta b? lang quen. Hay t? lam d? p chinh chung ta va lam d? p c? thanh ph? nay v? i nh? ng chi? c ao dai tr? ng c? a cac b? n!

Post Korean War Relations And The Rise Of The People s...

Post Korean War Relations and the Rise of the People’s Republic of China The Korean War was able to develop the People’s Republic of China as a major up and coming nation. The mid 1950s saw the rise of Chinese agricultural collectivization, making them an influential power in the world. With the country improving every year that passes, Mao wanted to move in the direction of Socialism, but was worried that those in the CCP were restricting him on making that leap. In a statement in 1957, Mao claimed that the Imperialist nations, like the United States, are more afraid of Socialist nations than the other way around (p.198). Mao shows how the transition into Socialism has created increased tension between Sino-Soviet relations. He states, â€Å"At present there exists some controversies between Chine and the Soviet Union. Their ways of thinking, behavior, and historical traditions differ from ours† (p.198). 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