American Pragmatism final

People screaming at the top of their lungs for the rock band that they idolize; an individual buying all the books and imitating the writing style of his favorite author; a young girl imitating the clothes of her fashion idol; the aforementioned instances are familiar examples of people who are practicing the idea of fandom wherein they are becoming huge fans of famous personalities or things. The idea of becoming a fan is perceived by people in different ways.There are individuals who look at the idea of being a fan as simply liking something or someone in a degree that is not common to other people. On the other hand, there are also those people who negatively look at fans, as individuals who are going crazy or psychotic for something or someone to the point that they are becoming obsessed. There are even allegations that fans eventually become stalkers, who do untoward decisions and actions. The opposing perspective of the term â€Å"fan† entails a more in-depth study about the topic.To be able to fully understand the meaning of being a fan, it is necessary that it is given due attention and importance. In doing so, I conducted an interview with three individuals, who have different backgrounds but is idolizing the same pop star. The pop star that I focus on is Miley Cyrus. My main motivation for looking for individuals who idolizes Miley Cyrus is due to the popularity and influence of this personality. In 2008, Miley Cyrus is included in Time Magazine’s 100 most influential people in the world.Due to this, I want to find out the reasons why people idolize her and its corresponding effects to their life. Moreover, by conducting the interview with three individuals who idolize Miley Cyrus, I learn more about the idea of being a fan. Summary of Cavicchi’s Book and Argument Based on the book of Cavicchi (1998) the term â€Å"fan† is used as both descriptive and prescriptive when it comes to describing individuals that are regarded as fans. Cavicchi even states that,On the whole, it [the term â€Å"fan†] is used both descriptively and prescriptively to refer to diverse individuals and groups, including fanatics, spectators, groupies, enthusiasts, celebrity stalkers, collectors, consumers, members of subcultures, and entire audiences, and, depending on the context, to refer to complex relationships involving affinity, enthusiasm, identification, desire, obsession, possession, neurosis, hysteria, consumerism, political resistance, or a combination (39). The interest of Cavicchi with the concept of â€Å"fan† is rooted from the fact that Cavicchi himself is also a self-proclaimed fan.The book that he wrote entitled Tramps like us gives an in-depth research and analysis of being a fan, especially when it comes to its corresponding effects to the individual who is a fan of something or someone. Cavicchi uses Bruce Springsteen as an example for his central argument that fandom is actually a useful and me aningful behavior, which allows individuals to form their identities, establish communities, and make sense out of their lives and the society as a whole. Cavicchi (1998) points out that the contribution of Bruce Springsteen in the world exemplifies the advantageous effects of fandom.In the past, many critics have noted that the songs of Bruce Springsteen is unique from other singers in a sense that it actually exist in world of its own with its respective characters, settings, words, and images. The world that Springsteen creates is actually very relevant to other people wherein individuals who only have little knowledge or none at all about Springsteen can still relate with his music. Springsteen emphasizes the world of highways and factories, loners and underdogs, and many others. As such, the themes of the songs of Springsteen actually embody the ideals and struggles of most ordinary Americans.Being the case, Springsteen was able to substantially influence the American pop cultu re and also different societal debates. Springsteen has the ability to not only speak for his fans but actually to them with directness and sincerity, which actually touches the lives of his followers. Cavicchi uses three years of ethnographic research and his own experiences and impressions as a fan in writing his book. He provides an interdisciplinary study of the ways by which ordinary individuals who have special and sustained attachments to their idols actually were able to change and affect their lives because of fandom.Furthermore, it challenges the negative perception about the term â€Å"fan†, specifically the stereotypes of fans as being obsessive, delusional, and to the point of having mental problems. Cavicchi strongly emphasizes that fandom is a normal socio-cultural activity that aids in shaping the identity of individuals. Object of Fandom Destiny Hope Cyrus also popularly known as Miley Cyrus is an American pop singer, songwriter, and actress. Her rose to fame started when she stars in the Disney Channel as Hannah Montana.After the success of her television series, she released a soundtrack CD of the songs that she sang in the Hannah Montana Show. The popularity of the soundtrack CD in the American market, especially for teenagers enables her to create a solo music career with her debut album, Meet Miley Cyrus. In her first album, Miley Cyrus was able to create her first top single entitled â€Å"See You Again†. The increasing popularity of Miley Cyrus paved the way for her to launch her second album called Breakout. Both the albums of Miley Cyrus top number 1 on the Billboard 200.In addition, the single of Miley Cyrus entitled â€Å"Party in the U. S. A. † was recognized as the highest charting and fastest selling single that reach number 2 in the Billboard Hot 100. The influence of Miley Cyrus reaches different nations, which is proven by the record-breaking sales of her albums that reach more than 15 million records. Mil ey Cyrus also shines in the field of acting. Miley Cyrus first extended play was The Time of Our Lives. Miley Cyrus also performed in the concert/film Hannah Montana and Miley Cyrus: Best of Both Worlds Concert.In relation to this, Miley Cyrus also starred in Bolt wherein she recorded the soundtrack for the movie, which enables her to be nominated in the Golden Globe Awards. The hit show Hannah Montana was later produced in the film with Miley Cyrus as the lead star of the movie. Moreover, the prominence of Miley Cyrus in the society is recognized by Time magazine when she is included in the â€Å"100 Most Influential People in the World and she also ranked 35 on the â€Å"Celebrity 100† list of Forbes magazine for earning $25 million in 2008. Interviewee # 1The first interviewee is Zoe, a 16 years old girl that describes herself as an avid fan of Miley Cyrus. Zoe is a Caucasian American, who is currently studying in a public school. The interview was conducted through phone wherein the queries in the questionnaires were asked and were substantially answered by the respondent. The main interest of Zoe mostly deals with normal young adult hobbies like shopping and hanging out friends. In addition, Zoe also stated that she is very much interested in music, especially from modern pop artist. As previously mentioned, Zoe is a self-proclaimed Miley Cyrus fan.She said that she first get acquainted with the pop star through her series in the Disney Channel, Hannah Montana. Zoe immediately likes the character of Miley in the series and she also took notice of her exceptional singing abilities. Zoe said â€Å"Miley has an exceptional and unique singing voice that can really attract its listeners, once I heard her voice she already mesmerized me. † Zoe opted to have the complete albums of Miley Cyrus instead of just downloading it from the Internet, which she said is a way for her to actually give worth to the singing ability of her idol buy adding to her CD sales.In addition to this, Zoe is also a fan of Miley Cyrus in Facebook and she also follows her in Tweeter. The influence of Miley Cyrus on Zoe affects her fashion sense because Zoe admitted she is actually imitating the fashion sense of Miley. â€Å"I always look carefully at the outfits that she wear, as I really admire her unique fashion sense†, stated Zoe. Zoe explains in the interview that she has not really done anything outrageous as a fan of Miley, the only thing that she did is make a scrapbook of her idol, which other people finds weird.Moreover, Zoe strongly believes that Miley Cyrus exemplifies the normal life of a teenager that has to go through the awkward stage of adolescence, which Zoe can relate to. Zoe expressed in the interview that Miley Cyrus affected her life by making her believe in her dreams and do more things in her life, as Zoe said, â€Å"I can have the best of both worlds just like Miley†. Interviewee # 2 The second interviewee is Sama ntha, a 13-years old teenage girl who is a die-hard fan of Miley Cyrus. She is an African-American that is studying in a public school.Samantha’s interests usually involve watching television, playing computer games, and the occasional going out with her friends. Samantha exclaimed â€Å"I love Miley Cyrus so much! † when asked in the interview on who is her idol. She explains in the interview that she was introduced to the pop star sensation while watching Hannah Montana because her parents only allow her to watch limited channels and this include the Disney Channel. At first, she likes the comic banter between Miley Cyrus and her dad because Samantha can actually relate to it because she said that she has the same relationship with her father.Later on, Samantha is really entertained by the singing capabilities of Miley Cyrus. In relation to this, Samantha can actually relate to the lyrics of Miley Cyrus’ songs that talks about related issues about being a teen ager. Samantha keeps a collection of different Miley Cyrus memorabilia like bags, school supplies, and others. She even said that â€Å"almost all my things are Miley Cyrus inspired†. In addition, Samantha also applauds the acting capability of Miley Cyrus, especially when it comes to comedy that is why she even created her own fan page for Miley.Samantha informed me in the interview that she has not done any outrageous thing as a fan of Miley Cyrus because she believes that becoming a fan does not necessarily mean doing something â€Å"stupid†. Moreover, Samantha points out that Miley Cyrus is an inspiration to her and also to her friends because she represents teenager everywhere who are following their dreams despite the set-backs of the teenage life. Interviewee # 3 The last interviewee is an 18 years old Asia who is actually on her way of going to college.She requested that I do not state her name in the paper, as she is afraid that someone might know that she is a fan of Miley Cyrus. The hesitation of this girl in admitting that she is a fan of Miley Cyrus comes from the fact that most of her peers perceived Miley Cyrus as a loser. As a result, this girl does not have any Miley Cyrus memorabilia and she does not join any networking site about Miley Cyrus. The main reason of this girl for idolizing Miley Cyrus is because she can relate with the life of the pop star.She states that â€Å"Miley Cyrus is just a typical teenager who commits mistakes like her photo scandal and other boyfriend troubles . . . she is being real to herself and to her public. † The girl idolizes Miley Cyrus because of her courage to be true to herself and to others even if she is already popular. In relation to this, she also thinks that Miley Cyrus is a strong individual that can properly handle all the criticisms that come her way. Being the case, Miley Cyrus influences this girl to also be true to herself and never give up. AnalysisBased on the answers of th e three interviewees it is quite observable that most of Miley Cyrus fans are teenage girls who are undergoing the difficult and confusing stage of adolescence. Their main reasons for idolizing Miley Cyrus are due to her singing and acting talents as well as the way she handles herself. The interviewed fans of Miley Cyrus have not done any outrageous or stupid things for their idol because of the reason that they have other outlets in order to express their enthusiasm and support for Miley Cyrus such as buying her albums, patronizing her products, and joining/creating networking sites.However, in the situation of one girl, she cannot freely express that Miley Cyrus is her idol because of the negative perception of her friends when it comes to the pop star. From the answers of the interviewee it is clearly proven that Miley Cyrus becomes an influential and powerful personality in the society because she represents the life of most teenagers.Miley Cyrus’ songs, television serie s, and even her life exemplify the issues and problems of an average American teenager. Miley Cyrus has substantially contributed to the American pop culture because most of her fans can actually relate with her life. Moreover, Miley Cyrus has her way of actually inspiring the lives of teenagers through her songs and the characters that she portrays, which embody a strong woman that will not give up amidst the challenges of life.

Personal Health Records Essay

Abstract A personal health record (PHR) is a universal tool that consists of a comprehensive database of an individuals health documents. Personal health records are available in a variety of platforms, such as paper, the internet, personal computers, and portable devices. This paper describes the contents included in a personal health record as well as the steps to putting together a personal heath record. The advantages of having a personal health record can be a life saver. Patients can control their own health records and play a proactive role in better managing their personal health care information. Several concerns remain an issue with personal health records, issues such as security and privacy, costs, and lack of standardization. Have you ever wondered what to do with all your immunization records or old medical records you collected over the years and have stuffed away in a multiple places throughout your home? That is because until recently, individuals didn’t have a place to properly store their personal medical records. Everyone has a different system of how they maintain their personal health records, from an old shoe box, to â€Å"the special drawer† or the over stuffed file folder. There are several problems associated with these kind of record keeping practices. First of all, they are not safe or secure in the event of theft or fire. Secondly, it is difficult to manage your health from a file folder. Papers documents collected over a persons lifetime can be enormous, especially in the event of a long term illness. It is a daunting task to gather up all your paper documents saved over the past several years and present them in one big disorganized pile to a health care worker and expect them to sort it out. Because of the demands in healthcare and on healthcare workers, there has been an recent surge in the area of personal health records development. Several companies and researchers have developed simple and creative ways for individuals to maintain their personal health records, in addition to easily integrating their records into clinical healthcare systems. A personal health record is a way that individuals can gather all there medical information and place it into one safe and secure place. Personal health records are a gathering of an individuals medical data from several different sources and making them readily accessible in one or another format when needed. Sources where one might collect medical information are: clinics, multiple doctors offices, laboratories, pharmacies, radiology departments, hospitals, insurance companies, and the military, etc. Not to confuse anyone, but a personal health record or a electronic personal health record is not the same as a electronic health record. A personal health record is used by an individual and they control who can see or use the information in it. Other people, such as their doctor, may be able to add information to it. An electronic health record is used and controlled by health care providers. Electronic health records may be stored at a doctor’s office, a hospital, an insurance company, or an employer. (â€Å"NIH Medicine Plus,† pgs. 16-17) Electronic health records are legally mandated notes on the care provided by clinicians to patients. There is no legal mandate on personal health records.(Wikipedia, n.d) Creating an comprehensive personal health record can be life saving for several reasons. One reason being, in the case of an emergency, medical personal need accurate up to date data in order to provide an individual with the most proficient care available. For example, for the first time in history at any mass gathering, many of the people’s personal electronic health records were instantly, securely available to medical personnel at the world-famous Indy 500 motor race. The Indianapolis Motor Speedway’s Clarian Emergency Medical Center ha d access to those records, thanks to the Indiana Network for Patient Care (INPC). The data include admission and discharge notes, lab test results, and other critical information. A personal electronic health record is medical information about an individual that is stored in secure digital form on a computer or a network of computers. The goal of many in the health-care field is to have that information available instantly to health professionals wherever you are—even at The 500. (â€Å"NIH Medicine Plus,† pgs. 16-17) Putting together a personal health record is a great way to take control of your health. A Personal health record is initiated and maintained by an individual. From using something as simple as a notebook, a file folder, or buying a program or using a password protected website, creating a personal health record is becoming more readily available than ever before. Web sites such a Google Health or Microsoft Health Vault are just a few of the many web based companies cashing in on the personal health record market. Most of these web sites provide secure password protected access to some health insurers, pharmacies, and providers so you can request and upload your records, saving yourself some work. Some of the tools found on these web sites can help track and record your progress towards your health goals, such as weight loss and nutrition. Keeps track of doctor visits and information to share with your doctor, such as blood sugars, cholesterol, and blood pressure since your last appo intment. Electronic personal heath record websites help to diminish the hassle of scheduling appointments, submitting insurance claims, ordering prescriptions or refills by automatically doing it for you. Additional tools include monitoring devices such as a pacemaker check or blood sugar/insulin calculator to ordering prescriptions. Flags recent medication or discharge instructions from your last visit. Costs may vary depending on the type of personal health record being used. Using a computer based personal health record can be as easy as checking your e-mail. Personal health records are offered by a variety of sources—employers, insurers, healthcare organizations, and companies that aren’t in the healthcare arena. Kaiser Permanente said in April that more than 3 million of its 8.6 million members use its My Health Manager system to access their records, make appointments, look at lab results, and order prescriptions.(Hobson, 2009) PHRs can contain a diverse range of data and may include information such as: 1.Name, birth date, blood type 2.Emergency contact(s) 3.Primary caregiver(s)/phone number 4.Medicines, dosages, and how long taken, including over the counter and herbal remedies 5.Allergies/adverse drug reactions 6.Date of last physical 7.Dates/results of tests and screenings 8.Major illnesses/surgeries/procedures and their dates/hospitalizations 9.Chronic diseases 10.Family illness history 11.vaccinations/immunization records 12.laboratory test results 13.imaging reports 14.Activities of daily living 15.Health insurance information 16.Spiritual or Religious Preferences 17.Advance Directives What not to include in your personal health record: 1. your social security number 2. home address 3. telephone number Use caution when placing your personal information on the internet. Using information that identifies you too closely can lead to identity theft, even medical identity theft. Medical identity theft is when someone steals your insurance information and makes medical appointments in your name and orders prescription medications. Reports cite 200,000 cases of medical identity theft each year. (Torrey, 2010) One advantage to using a web-site for posting your PHR is having the ability to access your medical records from almost anywhere, anytime, as well as helping keep your records updated and current. Using a PHR helps to eliminate duplicate tests, which saves both time and money. In addition, instead of waiting for the usual 7-10 days for lab results to be mailed to you, systems can automatically upload the information to the PHR once they become available. Not only does this help with patient satisfaction, but is an enormous savings on mailing and handling costs. One of the obstacles and concerns of creating a personal health record is security and privacy of individuals records. Many consumers wonder whether their health information is kept private and secure in an electronic health record system. There are several PHR web providers that would love nothing better than to sell your information to advertisers. Although there are several good programs, consumers need to use caution when selecting an online program. Most companies use encrypted programs to protect unwanted and unauthorized access to an individuals personal health records. Many individuals continue to use paper records for their personal health records. However, with the invention of modern computer record keeping programs, paper records may not be as effective for the care of individuals with chronic illnesses. Some individuals have a long history of medical problems and have accumulated volumes of paper medical records. Paper records are not readily available at multiple locations at once and often present with an inconsistently of information. An individual with a chronic illness may benefit from transferring their paper records into an electronic personal health records program, which will aid in improving their continuity of care and efficiency. Many personal health care programs offer services that will help guide individuals on the how to of scanning and uploading their paper records into the program. Another benefit to using an electronic program is having your personal information formatted into a standard reporting structures for charting and sharing information and making it easier and faster for healthcare workers to review medical history and treat an individual. For example, a doctor can order a test for a patient and have the results transmitted to a their PDA and in turn can review the patients medical information and order further tests, medications and treatments at their convenience. This not only saves time for the patient, but frees the doctor from making frequent trips to the various locations to see patients or review results of tests. The results are then immediately uploaded into the patients personal health records. (Mohammod, 2009) For example, a newly diagnosed insulin dependent diabetic may have concerns with the dosages of their insulin and sliding scales plus managing their diet. Tools included in some of the personal health record programs will smooth the progress of mapping out a diabetics progress as well as offering a plethora of educational sites and suggestions and feedback, including alerts being sent to the physician or nurse if their blood sugar enters into a dangerous zone.(SentinelNewsService, 2009) Nursing related issues and Personal health records are becoming more challenging then ever before. As progress towards digitizing healthcare evolves, nurses are caught in between the paper documentation to electronic documentation chaos. Nurses must play an proactive role in educating themselves to the variety of personal health record information that is readily available for their patients. Many patients are unaware of the services available to them and a healthcare provider must often help inspire their patients along their personal journey of creating a personal health record. Moreover, a nurse that is proactive with helping patients with their personal health records, will also encourage a patient to healthy behaviors, by teaching patients how to use tools to keep track of their health progress, such as weight loss and diet control. Encouraging a patient to keep better track of their healthcare records will be invaluable for patients with chronic illnesses. Providing up to date information in one document to a health care provider not only saves time and money, but assists the health care provider in providing safer and improved quality of care as well as a better way of communicating with their providers. As a nurse, it can be very frustrating taking a health history on a patient with a chronic illness with a long list of medications. Often, patients are poor historians or don’t remember the name of a drug or dosage. Nurses can spend well over an hour just gathering information about the patients history before they can begin to treat the patients problem. It is always a welcoming sign of relief when a patient produces an itemized list of all their medications and dosages as well as their past medical history. The time spent gathering all the patients information could be better spent on giving more personal care to the patient as well as the other patients in the nurses care.(Sensmeier, 2010, p. 47-50) Physicians have their own issues and concerns related to personal health records. First of all, most physicians are mostly interested in providing safe, resourceful and revenue producing care. Physicians are slow to adapt to change and it is difficult to convince a physician to use a service for something that may not produce results for many years. Personal health records are in their infancy stages and are only a hand full of individuals are utilizing the services. Physicians as well other medical personal may not be educated on personal health records and are not obligated to review or edit or manage these type of records. However, once a document from a patients personal health record is imported into an Electronic medical record, the physician is then responsible for reviewing such data. Physicians are then responsible for maintaining the accuracy of the data exported to the patients personal health record. Another concern is the issue of compensation. How are physicians going t o be compensated for their time spent on training, implementation, updating and creating documents for PHR? Also, covering the costs associated with the hiring of new staff that will be needed to head such a plan, as well as purchasing the required equipment and software that will be used to interface with larger networks?(â€Å"American College for Physicians,† 2006, p. 1-2) Personal health records have a direct impact on the role of the nursing informatics specialist. One of the roles of a nursing informatics specialist is reviewing, analyzing and coordinating new applications across departments and determine how the new applications will best fit into a healthcare system effectively. One of the biggest concerns of any healthcare system is cost, the cost of a new program or application must be carefully scrutinized by the nursing informatics specialist as well as other personal within the healthcare system before being accepted into the system. Several questions that arise from the nursing informatics specialist may include: 1.Revenue enhancement 2.Cost containment 3.Broad-spectrum cohesiveness throughout the system 4.Better workflow processes 5.Government regulations 6.Patient safety/satisfaction 7.Implementation and Development 8.Data interfaces 9.Troubleshooting and training 10.Software/equipment issues 11.Standardization development A key concern to most healthcare systems is the inevitability of employing such systems. Healthcare systems will eventually be forced into implementing such programs. The future of healthcare is rapidly becoming more digitalized and will be dictated by the consumers demands and systems that can better accommodate such demands. The next generation of computer savvy consumers and evolving healthcare technologies is on the forefront of nursing informatics specialists agendas. Nursing informatics specialists are scrambling to keep up with technology and developing savvy ways of keeping up with current trends in healthcare. Currently, there is very little data related to the purchasing costs of commercial PHR applications which presents a problem to the NIS. Not only is PHR a cost concern problem, but anytime a new product as enormous as PHR applications are lingering over a health care systems head, it becomes a system wide concern because the future is so unpredictable and health care systems can’t afford to spend millions of dollars on the implementation of such systems and then the system becomes obsolete within a year after implementation. A nursing information specialist’s input is critical in healthcare systems decision making process. Every day you hear of a new process or a new policy related to healthcare. Nursing information specialists are fairly new to the healthcare scene and are instantaneously being propelled into unfamiliar and never heard of areas of healthcare. A NIS must hold on tight to their game hat and be prepared to handle the roller coaster ride of the unpredicted future of healthcare technology. (Shah, Kaelber, Adam, Pan, Middleton & Johnston, 2008) The standardization of personal health records is an ongoing concern among consumers and the healthcare industry. There are many standards, open specifications, and efforts toward standardization of PHR information, and services. Many organizations are actively working to improve and support the exchange of medical record information.(â€Å"Records for Living,† 2010) Because there is not set standard among PHR vendors and health care organizations, the present recommendation is to adopt data content and exchange standards that are based upon standards accepted for EHRs, as a way of improving the interoperability of the systems. In addition, it is important for consumers to understand the privacy policies and practices of PHR vendors and health care organizations and who may have secondary access to their personal information. Also, these agencies should address any language barrier issues preventing the consumer from fully understanding the agencies practices related to security and privacy. Since HIPPA does not cover all PHR systems, consumers should be provided a complete outline of the uses of their PHR data and not covered entities should voluntarily adopt to strict privacy policies and practices. No health information provided to a PHR agency should be used without the expressed consent or authorization of the consumer. (US dept. of Health a nd Human Services, 2010) President Bush and Secretary Leavitt have put forward a vision that, in the Secretary’s words, â€Å"would create a personal health record that patients, doctors and other health care providers could securely access through the Internet no matter where a patient is seeking medical care.† (US dept. of Health and Human Services, 2010) Before those famous words can be put into effect, there first, must be a global standardization and recognized language. Currently, there is no uniform definition of â€Å"personal health records†, therefore making collaboration and policy-making difficult. The following aspects of PHRs can vary: 1.what information is allowed on a PHR 2.secure and reliable sources of the information 3.features and functions offered 4.custodian of the record 5.storage location of the contents 6.authorized access to records and security standards Additionally, organizations will continue to discover gaps during the development phases of PHR, by collecting data and information, agencies can make recommendations and respond with appropriate action. Providing readily accessible, safe and reliable data through secure systems of communication will help to better serve consumers, patients, healthcare workers and federal and public agencies, and others far more effectively. However, there is a general concern for the underserved populations. There are several areas of the country that do not have access to such systems or have the resources or funds to purchase such systems. Also, there are educational barriers to consider in relation to health literacy issues which could limit the use of PHR systems in these underserved populations. With so many people out of work and living on welfare, there are far greater concerns than having a PHR. Many people are only concerned with their basic survival and having enough resources to provide a meal or heat to their families. The government would need to provide assistance to the underserved if this was required of them. In conclusion, as a nurse and a potential consumer, I am in favor of a electronic personal heath record and do think the pros of such systems outweigh the cons, especially in the case of the chronically ill. I do, however have many concerns with PHRs. As a nurse, it would be difficult to rely on data presented in a electronic personal health record unless I was able to verify the information with a physician treating the individual or a family member. I can see how easily an individual may inadvertently enter the wrong medication into their personal health record. A simple slip of the key may change a medication entered as a diabetes drug Amaryl instead of an Alzheimer’s medication called Reminyl. Pharmaceutical companies are working hard to prevent medications from being named something similar to other drugs currently on the market, but there have been several reported deaths due to medication errors. It should be required that a government monitoring agency be in charge of overseeing the content being entered into PHRs as well as protecting consumers from becoming the victim of targeted marketing scams or identity theft. Too often we hear of these things happening to unknowing victims and unfortunately most of these victims are the elderly, which will more than likely be one of the biggest consumers of this kind of service. The government will also need to set standards for protecting consumers, otherwise, if consumers are being victimized on these kind of systems, PHR could potentially suffer harm and loose the trust of consumers. The widespread adoption of PHRs will not happen until consumers are confident with their personal records being adequately protected. I think it is important to get consumers and patients more involved in their own healthcare. And one of the first steps is learning how to create their own personal health record. Not only can they learn to create their own PHR, but they could get there family and friends involved as well. Using an Internet-based PHR system allows for multiple individuals, such as family members and caregivers to contribute patient information from multiple locations. For example, a sibling that lives out of town may have the access to update their parents health information and also share the information with another sibling who lives out of town and both collaborate on the information provided. This allows for continuity of care in the event of an illness and the sibling is not directly available to be at their parents bedside. The personal health record will play a key role in motivating the consumer or patient to a safer, more efficient form of healthcare. Because personal health records are still in their infancy stages, there remains a great deal of concern for the safety and security for the users personal information. Once these concerns are addressed and â€Å"idiot- proofed†, consumers and health care facilities may buy into it. Personal health care records are designed to help individuals better organize their health care records by placing all their documents into one easily accessible format. This kind of application can be a life saver. Having all of a patients up to date information available for healthcare personal to review in one easy to read format may make the difference between life and death in some cases. Quickly identifying drug allergies, medications, health history is all a part of the vital information needed in the case of any emergency. There is a myth among most consumers, most consumers believe that emergency rooms should have access to their medical records in the event of a crisis and the truth is, they don’t. Many patients see several doctors from a variety of locations and emergency rooms don’t have immediate access to all of a patients medical information. A personal health record not only allows you to share information with health care providers at multiple locations , it also empowers the consumer or patient to better manage their own health goals. Building a health record takes a considerable amount of time and effort. You have to collect all your past medical documents and manually enter them into a PHR platform of your choice. After that, it is as simple as scanning or faxing in a document or entering the information manually into a system after each visit to the doctor, or test, which keeps your medical records current and updated. Term Paper References EHR/PHR Basics. (pgs. 16-17). Retrieved March 12th, 2011, from www.nlm.nih.gov Hobson, K. (2009). Time to switch to an online personal health record? Retrieved March 11th, 2011, from www.usanews.com Mohammod (2009). Encyclopedia of Personal Health Records – Paper Records. Retrieved March 12th, 2011, from wiki.patientsknowbest.com Personal Health Records Policy Statements Adopted by the American College of Physicians. (2006). Retrieved March 10th, 2011, from www.acponline.org Personal Health Records Standards. (2010). Retrieved March 13th, 2011, from www.recordsforliving.com Sensmeier, J. E. (2010). Tech update:the journey toward a personal health record. Retrieved March 11th, 2011, from www.nursingcenter.com SentinelNewsService. (2009). Nurses Engineer lead efforts to radically change personal health records. Retrieved March 11th, 2011, from www.lasentinel.net Shah, S., Kaelber, D., Adam, V., Pan, E., & Johnston, D. (2008). A Cost Model for Personal Health Records. Retrieved March 13th, 2011, from www.ncbi.nlm.hin.gov Torrey, T. (2010). Avoiding the consequences of medical identity theft. Retrieved March 11th, 2011, from www.patients.about.com US dept. of Health and Human Services. (2010). Personal Health Records and Personal Health Records Systems. Retrieved March 13th, 2011, from www.nchs.hhs.gov Wikipedia. (n.d). Personal Health Records. Retrieved March 12th, 2011, from www.wikipedia.org

About Shakespeare Essay Example for Free

About Shakespeare Essay Essay Topic: Literature , William Shakespeare Choose cite format: APA MLA Harvard Chicago ASA IEEE AMA Hamlet (634) , Claudius (325) , Ophelia (231) , Polonius (224) , Gertrude (208) , Laertes (186) , Horatio (118) , Fortinbras (82) Haven't found the essay you want? Get your custom sample essay for only $13.90/page ? Hamlet is Shakespeare’s longest and most tragic play. It was first published in 1603, from a draft published several years earlier. The play begins two months after the death of King Hamlet of Denmark. The country is in a state of unrest. Young Fortinbras of Norway is preparing for war. After the King’s death, his brother Claudius takes over the throne, and marries the widowed Queen Gertrude. Young Hamlet, the late king’s son is incensed. He is told by the ghost of his father, that Claudius had poisoned him, to become the King of Denmark. Hamlet starts acting like a madman rousing concern. Polonius, an advisor to King Claudius is also worried by Hamlet’s strange â€Å"transformation. † The two, along with Queen Gertrude instruct Rosencrantz and Guildenstern, Hamlet’s childhood friends to spy on him. Hamlet is also increasingly hostile towards his love, Ophelia, Polonius’ daughter. Out of fear, the King orders Hamlet to be sent to England. King Claudius and Polonius both feel that Hamlet is dangerous. To ensure who the culprit was, Hamlet cleverly changes the lines in a play which is performed before the king and the queen. The King’s reaction convinces Hamlet that it was indeed he who poisoned his father. Alone, King Claudius reveals his crime, and confesses that he cannot escape divine judgment. After the play, Queen Gertrude scolds her son, but he instead scolds his mother for her wrong actions. Polonius is spying on the two, from behind a curtain. Hamlet hears Polonius, and kills him thinking he is Claudius. Anxious and scared, the king orders Hamlet to be sent to England, along with Rosencrantz and Guildenstern. The King wants Hamlet killed as soon as he arrives in England. Hamlet had the spies Rosencrantz and Guildenstern put to death instead. Meanwhile, Young Fortinbras has brought his army to Denmark. Hamlet admires Young Fortinbras, for his courage to fight for honor. The death of Polonius has a profound impact on Ophelia, who in her depression and apathy kills herself by drowning. Laertes, Polonius’ son is enraged. The king tells him that it was Hamlet who murdered Polonius. The two decide to get rid of Hamlet, their common enemy. Claudius and Laertes arrange a duel, in which Laertes will fight Hamlet. To ensure Hamlet’s death, Laertes poisons the tip of his sword. In the course of the duel, Laertes, Hamlet and the King are poisoned by the same sword. Queen Gertrude drinks a poisoned drink meant for Hamlet, and is killed. Dying, Hamlet tells Horatio to tell the world of his story and recommends Young Fortinbras the next king of Denmark. Hamlet – Prince of Denmark is a play that deals with the main subjects of honor, revenge and suicide. Hamlet is not our typical hero. Born in a royal family, he is a refined young man with noble attributes, but he has his weaknesses. After his father’s murder, he is driven mad by anger when his mother marries Claudius. His love for Ophelia too turned into a strange confusion and mix of emotions. He distrusts all those around him, and starts dwelling in a melancholy state of mind. Even those he thought were his friends turn out to be spies sent by the king and queen. This also explain Hamlets â€Å"insanity† to a great extent. But even so, Hamlet is a disturbed individual. The way he treats Ophelia is obvious evidence. He is cruel to her, in spite of her efforts to try and understand him. He is also impulsive – he kills Polonius without thinking twice. Justice and revenge form major themes of the play, with Claudius, at the Head of a country, having killed his own brother, and Hamlet, avenging his father’s death. Suicide also forms an essential theme in the play. Ophelia kills herself by drowning. Hamlet too is prompted to kill himself. † But should he, or not; â€Å"To be or not to be, that is the question. † Shakespeare portrays all the characters with great ingenuity. He analyses human psyche, and how eventually, everyone’s destiny is controlled by fate. About Shakespeare, Hamlet Study Guide, http://absoluteshakespeare. com/guides/hamlet/hamlet. htm About Shakespeare. (2017, Mar 16).

Medicare, Medicaid Billing and Equipment Fraud Essay

Medicare, Medicaid Billing and Equipment Fraud - Essay Example However, according to anonymous (3), the Congressional Budget Office estimated total Medicare spending in 2010 to be $528 billion, giving a rough estimate of approximately 9% waste. The Medicare and medic aid are fraud targets as they are founded on the billing system of â€Å"honor†. They were initially set-up as an aid to honest doctors who could help the needy access medical services. Medicare fraud is evident in phantom billing, patient billing, and upcoding unbundling scheme. Durable medical equipment is also pruned to medical fraud. Examples of this equipment include oxygen supplies and wheelchairs. In equipment fraud, scammers charge Medicare for a similar wheelchair for many times without actually giving the chair to actual persons. The most recent cases of Medicare fraud focuses on infusion injections on HIV/AIDS. These injections are very expensive but patients are normally injected with common liquids or saline solutions (Anonymous 5). However, Medicare is billed in such way that shows that the expensive injection was really given. With current trends in such frauds, only law and ethical issues can stop the practice.

Learning Theories Paper Essay Example | Topics and Well Written Essays - 500 words

Learning Theories Paper - Essay Example he constructivist theory allows for a more dynamic role on the part of the learner by engaging him/her actively to analyze, conceptualize and synthesize the current objective in light of the previous knowledge by forming constructs. A constructivist classroom is a dynamic and ‘happening’ place where most of the learning process is carried out by the students themselves, with the teacher merely facilitating by putting forth queries that keep up a healthy classroom discussion. The teacher always makes the students recall any previous knowledge they might have, and shares the learning objective to be achieved. Student input is invited as to how the object might be achieved by following certain success criteria. The query put across to the class is ‘This is what we’ll learn today; how do you think we might go about learning it?’ Active participation from all members of the class, individually as well as in groups, enables the class to reach a conclusive construct regarding the learning objective at hand. Group formation not only instils the value of teamwork in the class, it also reinforces respect for a differentiated working environment having students belonging to various academic, social and cultural backgrounds. The teacher always bears in mind that individual student’s faith and background has a significant effect on the extent of their learning capability and subtly tries to maximize it. He encourages each student to give their response and ask questions, however insignificant they might seem, hence facilitating the emotional fulfilment of the class The constructivist theory impacts the students positively. Repeated application of constructivism enables the student to acquire knowledge that is multidimensional while transforming them into confident, original, responsible and creative individuals. The teacher looks out for misconceptions which are evident as a result of discussion and guides the students in the right direction of questioning. In

History of the development of the Apple Newton Case Study

History of the development of the Apple Newton - Case Study Example It was believed that the invention of Newton would be of great significance to the users. Unlike the traditional desktop, it would be much portable and easier to carry wherever one goes. This would be possible due to the fact that it was to be smaller with a size 8.27† X 11.7†. In other words, it would be the size of a folded A4 sheet which is fairly efficient and can be handled by an individual much easily. Besides, it would be more preferable as it was to be equipped with a special user interface along side a cursive handwriting. These are features that were believed to make Newton be the only gadget of choice for everyone who would be interested in having a taste of personal computer. With enough resources, the management of Apple Inc would support its engineers and programmers to conduct an extensive research as they developed this product. Because of such a support, the development of the product began in a high speed. At first, they introduced a brand called Figaro which was having the size of A4. After its launching, it was valued to be worth $6,000. It was a very admirable product with a large format screen, object-oriented graphics and a well-developed internal memory. Because of such developments, the company managed to realize large volumes of sales and increased profit gins up to the later years. However, as fate would have it, the development of Newton would be discontinued in 1987 when the company realized that it would not be viable at all. Despite realizing a profit of $2 billion between 1987 and 1989, the company did not realize any success thereafter up to 1990. The other reason for the death of this product was the rise of Sakoman and Macintosh Classic, rival commodities which posed a very great challenge to its progress. Moreover, the company faced a stiff competition from other established firms such as Dell, Compaq and Gateway which introduced complementary products

Mamagement of information technology Case Study

Mamagement of information technology - Case Study Example Is MIS a failed discipline Have we gone on for almost three decades without making progress" (Briggs, Robert O., Nunamaker, Jay & Sprague, Ralph, 2000:5-10) In the beginning of twentieth century, revolution began in knowledge and information then accelerated gradually thereafter. It became now the foundation for many new services and products where in 1974 applications pushed the limits of human ability. As information system, research advanced so did user expectations. And the question raised is how individuals, organization can adjust in order to leverage the delivery of information technology. The infrastructure of the information technology (IT) affords the base for an organization to construct its information system needed to complete the work and provide the employee with all the necessary information. However, management decisions regarding IT are very critical because it affects employees' productivity and performance and therefore, it may affect the organization's overall success(Gareth R.Jones, 2000). "Across all industries nevertheless, developing countries are increasingly deploying IT to solve their development problems. Lending by the World Bank for[ information technology] (IT) has been growing at six times the growth rate of total Bank lending, and is present 90% of Bank's lending operations. However, while the provision of the technology is a necessary condition for achievement of the benefit which IT can bring, there is mounting evidence to suggest that this itself is not sufficient. Changes are required in the behaviour of individuals and organization also)." (Al-Gahtani, 2003, p57, 13p) Information system plays a very essential role in the banking industry particularity. It relies heavily on information technology. In this fast-paced world, no bank can function without highly sophisticated information system. In addition to that, it limits the demand for labour in general. Purpose and Scope "Management information system is essential for creating competitive firms, managing global corporations, and providing useful products and services to customers." (Laudon, 2002,P1) It provides information figure of reports and exhibit to managers. For instance, sales managers may use their computer workstations to obtain sales outcome of their products and to access weekly sales study reports, and then assess sales made by every salesperson. "Management information systems arose in the 1970s to focus on computer-based information systems aimed at managers." (Laudon, 2002, P15). since of the growths of the Internet, globalisations of deal, and the increase of information financial system, have to get better the position of information systems in business and management. And then it wants pays concentration to organisation management information that subject rose by sociology, finances, environment and psychology. "An organization is a stable, formal social structure that takes resour ces from the environment and processes them to produce outputs." (Laudon, 2002,P87) This essay will be evaluating the contribution of Management Information System to

Globalization Annotated Bibliography Example | Topics and Well Written Essays - 750 words

Globalization - Annotated Bibliography Example th and early twentieth centuries due to European imperialism and colonialism but it continues in todays global environment due to new information and communication technologies. A firm aspiring today to be successful must be adaptable and flexible in a globalized environment. Most businesses today place globalization as one of their top concerns. This is because globalization is the future of any successful business; it is a rapidly-growing challenge as the world economy gets more integrated due to the accelerating trend of globalization. Any firm that aspires to be successful must tackle the issue of globalization, in particular the cultural or local characteristics of a foreign national market. This means management must consider the local context when making vital decisions such as on strategy, hiring or marketing. Although global markets can be considered as borderless, there are local issues that need to be solved or considered when entering or penetrating a new market (OMeara, Mehlinger, & Krain 101). It may be incorrect to adapt a one-size fits-all global strategy when it comes to national markets because countries can differ significantly on cultural practices and beliefs. There is truth to an old adage when it concerns globalization and is a goo d warning: Think global but act local. Perhaps the most challenging part of globalization is the management of people who belong to various ethnic groups. Cultural diversity presents special challenges to management with the main task of bringing out the best in people coming from various backgrounds. It is a difficult task of unifying people towards a common corporate objective. Modern globalization is evolving and the new paradigm today is â€Å"Think local, act global† (Park & Hirowatari 238). Understanding foreign cultures is essential to everything. It is the key to successfully entering a new market or introducing a new product or service to existing markets. It is easy to adapt a general global strategy

Autobiography on how my life led to the decision of becoming a nurse Essay

Autobiography on how my life led to the decision of becoming a nurse - Essay Example I have overcome many obstacles and have made many difficult decisions to get where I am in life. The journey that I was meant to take has recently become clear. Ultimately, this decision was there all along; however I did not recognize it or realize that the calling of a nurse was one that was right for me. After having spent what seemed like forever wandering and searching for my life’s purpose, I reached the lowest point in my life. After much thought, I decided I needed to go back to school; yet my options were limited as the only thing I could afford was a technical school. I enrolled in a Medical Assistant School and instantly fell in love with the subject matter. For the first time in my life, I felt like a part of something greater than just the information that was being presented to me. I got a job the week I graduated and became a Medical Assistant in a large Allergy and Asthma practice. I went above and beyond my job and felt like this was finally the path I was meant to be on. My motivation kicked in and I knew this was what I needed to do; moreover, rather than it merely being a job, I craved more. I tried to figure out a way to go back to school in order to realize my dream of becoming a nurse, and there was no way I was going to settle for anything else. I wanted to go all the way and pursue my degree; however, the biggest obstacle at this point was purely financial. It just so happened that my older cousin moved in with my family at this time; because he too was feeling a little lost. The only thing that made him happy was looking back at memories he made while he was in the military. He kept talking about how much he needed motivation so that he could go to college and get a degree and how the military would now pay for it. This is when it all started to click for me. I finally realized this was what I needed to do to get where I wanted to go in life. I decided that I was

DQ Assignment Example | Topics and Well Written Essays - 250 words

DQ - Assignment Example e process , why is engagement important for successful implementation and lastly how might engagement with management differ from techniques that you might use to engage staff employees. A consultant can engage others in the change process through various ways. A consultant can use a survey by use of questionnaire or conduct a research on the change he wants to bring. He can also use total quality management tool by accessing the current and expected performance. Through the various studies and engaging various stakeholders, you could bring constructive engagement through it (Seneque & Bond, 2012). Engagement is important for successful implementation because the consultant is able to determine the weakest and strongest area on the implementation of change. Understanding this enables those intending to bring the change address the weaknesses and strengths and bring about change successfully (Kettinger, Teng, & Guha, 1997). Engagement with top management and lower management differs as a result of various factors. Usually the needs of the executive and the employees are different. In most cases, the fear of change creates tension among employees because they fear they would be laid off. The top management greatest fear is on how they would continue asserting their powers in the organization (Aladwani, 2001). Seneque, M., & Bond, C. (2012). Working with the complexities of transformational change in a society in transition.European Business Review,  24(5), 425-443.

Three Accomplishments Essay Example for Free

Three Accomplishments Essay Describe your three most important accomplishments to date. You may address Civic Services, Community Services, and Volunteer work, if applicable, as well as work related experience: Three accomplishments: Coming to united States – Career Accomplishment Fulfilling the Family Responsibilities Starting a Charity – Social Accomplishment My childhood dream was to go to United States and study. So, I worked hard to get good grades. Unfortunately, in my second of college, June 1986, I met with a bus accident, which critically damaged my right hand. Subsequently, I completely lost my wrist movement. I could regain the arm movement by going though one year of physical therapy, however. The doctors informed me that I had to take a break from my studies if need be. I was upset, to say the least, though I did not lose my entire self-confidence. I began to practice writing with my left hand instead. Within three months, I was able to accomplish this. I wrote my second year exams and got distinction. Simultaneously attending college and physical therapy, I ultimately graduated without losing a year. Few years later, for the first time, when my feet touched the soil of USA, my joy knew no bounds. As a matter of fact, the feeling of triumph that I regained enabled me to see through any problem whatsoever. During my final year of college, July 1988, my father passed away. At that time, my younger brother and younger sister had not completed their studies, and so I felt that it was my responsibility to provide support to them. Therefore, I began to look for work, putting on hold my dream to go for higher studies. Financially supporting my family until my siblings were old enough to look after themselves; I did not regret my decision at all, despite the fact that many of my friends had obtained their postgraduate degrees from USA by that time. What I had gained was priceless, too: the pleasure of acting responsibly. One of my friends lost his eyes in an accident in Aug 2002. Seeing his misery, I decided to do something useful for blind people. So I actively participated in organizing charities and leading awareness programs for organ donation. I was also fortunate to start a charity in Vizag in Andharapradesh, India, on behalf of my mother in July 2006. At present, I am in talks with Shankar Eye Foundation in India to increase the number of eye surgeries. So long as I am helping myself and society, I believe I am accomplishing something.

Timothy Treadwell Behavior Essay Example for Free

Timothy Treadwell Behavior Essay There’s a lot of awareness toward animal rights and animal cruelty in the United States, there are plenty of animal rights organizations that help us the public learn about what happens to animals when we don’t know or see. But some activist make the safety of animals their priority in life, even to the point to put them in danger to do what they think is correct. Timothy Treadwell, also known as Grizzly Man, did just that. Being a hardcore activist living with grizzlies in order to protect them from what he called â€Å"the evils of men†. According to Anthrozoologist like Hal Herzog, the author of â€Å"Some We Love, Some We Hate, Some We Eat†, Timothy Treadwell’s behavior can be explained by his past life struggles, his over love for bears, and his eagerness to take action. How does someone go from being an actor to a bear enthusiast? Treadwell’s occupation is stated as being an actor because that’s what he studied for, but it was something that he didn’t get lucky in and therefor became a frustrated actor. The truth about Treadwell is that before you found his â€Å"calling† he was a very lost and unhappy person, in some of his footage saying â€Å"Nobody friggin’ knew that there are times when my life has been on the precipice of death†. Treadwell after becoming alcoholic survived a near-fatal heroin overdose making him realize that he had to do something in his life that was meaningful and that’s where the grizzlies changed his life. Hal Herzog says â€Å"animal activism can give meaning and purpose to a person’s life† (Herzog 242), after hiding bottom Treadwell needed to figure out what else he had to do where he wouldn’t be judged, rejected, and ashamed by anyone. When Treadwell met his first bear, he found his calling, he found his meaning in life, he now knew what his purpose was and that was to live among the brown bears. Because of his past situations and disappointments, being alone in the wild with creatures that wouldn’t mind having him around and where curious about him made him feel safe. In the film Treadwell shares how he can’t wait to return to Alaska when he leaves, he enjoyed being out there because that was his safe zone in life away from all ‘evil’. That safe zone with the bears kept Treadwell at piece and gave him an identity, Hal Herzog giving an example of activist that are lost in the world and once they find something worth fighting for they find themselves and gain an identity. Treadwell’s identity was Grizzly Man, his identity gave him power and strength that helped him throughout the ears with living with bears for 13 summers. There’s a saying that states â€Å"love kills† and you could say that about Timothy Treadwell’s death, being attacked and eaten by the very animal that he love the most makes you wonder why anyone could pass logic and follow their heart. Throughout Werner Herzog’s film Treadwell shouts, cries, and expresses how much he loves grizzly bears, â€Å"I will die for these animals! I will die for these animals! I will die for these animals! † he said. Hal Herzog explains in a chapter that sometimes instead of following our heads we believe we should follow our hearts because that will lead us to happiness, â€Å"Our hearts are even more prone to error than our heads†(Herzog 260). Treadwell’s heart was bears and helping the bears, but because of the obsessive love he had turned into the willingness to go against his logic of living with wild animals. He believed that bears were his friends; he told them he loved them and even petted them, Treadwell didn’t care about anything else besides his friends in the wild whom he loved and was willing to die for them and did die because of one. His powering love that he had for these animals, the living things that had saved his life and brought so much happiness, was a reason why he decided to leave humans and life in solitude with bears. â€Å"I am the Lord’s humble servant. I am Allah’s disciple there has been an absolute miracle. It has rained 1. 65 inches of rain today† Treadwell said after a long drought affecting the animals. Treadwell’s love drove him to take action but his eagerness to go every summer and spend months alone, his ambition, desire, and anxiousness to be with bears was from his passion to return the favor. â€Å"The moral commitment of activists shows up in many different ways Sometimes the burden just gets too heavy† (Herzog 245), Treadwell felt like he owned his life to the bears that he had a commitment to them and was never to break it. After saving his internal and physical self he needed to protect them and he did as much as he could, he looked after the animals as if they were his family and when it got hard he just took it out on himself and never on the animals because Treadwell believed humans were the problem not the bears. Treadwell wanted to accomplish what no other person could do and that was to live within wild animals that had the strength to kill anyone, and his ambition drove him to take action, his love and commitment to the grizzly bears. Timothy Treadwell’s death was horrific and not shocking at all because most people did except that to happen, if you asked anyone what they thought of Treadwell decision to live with grizzlies they’d probably say he was crazy. But the truth is that he was crazy but crazy in love, in love with the animals that had given him a purpose in life and had saved him from his past. Timothy Treadwell didn’t want harm for anyone or for anything, he just wanted to express his gratitude and love to the animals that had changed his life forever.

Reliability of Speaking Proficiency Tests

Reliability of Speaking Proficiency Tests Introduction Testing, as a part of English teaching, is a very important procedure, not just because it can be a valuable source of information about the effectiveness of learning and teaching but also because it can improve teaching, and arouse the students motivation to learn. Testing oral proficiency has become one of the most important issues in language testing since the role of speaking ability has become more central in language teaching with the advent of communicative language teaching (Nakamura, 1993). However, assessing speaking is challenging (Luoma, 2004). Validity and reliability, as fundamental concerns and essential measurement qualities of the speaking test (Bachman, 1990; Bachman Palmer, 1996; Alderson et al, 1995), have aroused widespread attention. The validation of the speaking test is an important area of research in language testing. Test of oral proficiency just started in China 15 years ago, and there are a few very dominant tests. An increasing number of Chinese linguists are putting their attention and efforts on analysis of their validity and reliability. Institutions began to introduce speaking tests into English exams in recent years with the widespread promotion of communicative language teaching (CLT). Publications that deal with speaking tests within institutions provide some qualitative assessments (Cai, 2002). But there is relatively little research literature relating to the reliability and validity of such measures within a university context. (Wen, 2001). The College English Department at Dalian Nationalities University (DLNU) has been selected as one of thirty-one institutions of the College English Reform Demonstration Project in the Peoples republic of China. In College English (CE) course of DLNU, the speaking test is one of the four subtests of the final examination of English assessment. The examination uses two different formats. One is a semi-direct speaking test, in which examinees talk to microphones connected to computers, and have their speeches recorded for the teachers to rate afterwards. The other is a face-to-face interview. This research in this paper aims to ascertain the degree of the reliability and validity of the speaking tests. By analyzing the results of the research, teachers will become more aware of the validity and reliability of oral assessments, including how to improve the reliability and validity of speaking tests. I, as a language teacher, will gain insight into the operation of language proficiency te st, In order to better degree of reliability and validity of a particular test, I will also take other qualities of test usefulness into account when designing the language proficiency test., such as practicality and authenticity. Research questions: This study mainly addresses the questions of validity and reliability of the speaking test administered at DLNU. They are comprehensive concepts that involve analysis of test tasks, administration, rating criteria, examinee and testers attitudes towards the test, the effect of the test on teaching and teacher or learner attitudes towards learning the tests (Luoma, 2004). Therefore, the purpose of this study is to answer the following research questions: 1. Is the speaking test administered at DLNU a valid and reliable test? This question can involve the following two sub-questions: 1) To what extent is the speaking test administered at DLNU reliable? 2) To what extent is the speaking test administered at DLNU valid? 2. In what aspects and to what extent may the validity and reliability of the speaking test administered at DLNU be improved? Literature Review This chapter presents a theoretical framework of speaking construct, ways of testing speaking, marking of speaking test and the reliability and validity of speaking test, also introduces the situation of speaking test in China. Analyzing Speaking And Speaking Test The Nature Of Speaking Speaking, as a social and situation-based activity, is an integral part of peoples daily lives (Luoma, 2004). Testing second language speaking is often claimed to be a much more difficult undertaking than testing other second language abilities, capacities or competencies, skills ¼Ã‹â€ Underhill, 1987). Assessment is difficult not only because speaking is fleeting, temporal and ephemeral, but also because of the comprehensibility of pronunciation, the special nature of spoken grammar and spoken vocabulary, as well as the interactive and social features of speaking (Luoma, 2004), because of the â€Å"unpredictability and dynamic nature† of language itself (Brown, 2003). To have a clear understanding of what it means to be able to speak a language, we must understand that the nature and characteristics of the spoken language differ from those of the written form (Luoma, 2004; McCarthy OKeefe, 2004; Bygate, 2001) in its grammar, syntax, lexis and discourse patterns due to the nature of spoken language. Spoken English involves reduced grammatical elements arranged into formulaic chunk expressions or utterances with less complex sentences than written texts. Spoken English breaks the standard word order because the omitted information can be restored from the instantaneous context (McCarthy OKeefe, 2004; Luoma, 2004; Bygate, 2001; Fulcher, 2003). Spoken English contains frequent use of the vernacular, interrogatives, tails, adjacency pairs, fillers and question tags which have been interpreted as dialogue facilitators (Luoma, 2004; Carter McCarthy, 1995). The speech also contains a fair number of slips and errors such as mispronounced words, mixed sounds, and wrong words due to inattention, which is often pardoned and allowed by native speakers (Luoma, 2004). Conversations are also negotiable, unpredictable, and susceptible to social and situational context in which the talks happen (Luoma, 2004). The Importance Of Speaking Test Testing oral proficiency has become one of the most important issues in language testing since the role of speaking ability has become more central in language teaching with the advent of CLA (Nakamura, 1993). Of the four language skills (listening, speaking, reading, writing), listening and reading occur in the receptive mode, while speaking and writing exist in the productive mode. Understanding and absorption of received information are foundational while expression and use of acquired information demonstrate an improvement and a more advanced test of knowledge. A lot of interests now in oral testing is partly because second language teaching is more than ever directed towards the speaking and listening skills ¼Ã‹â€ Underhill, 1987). Language teachers are engaged in â€Å"teaching a language through speaking† (Hughes, 2002:7). On one hand, spoken language is the focus of classroom activity. There are often other aims which the teacher might have: for instance, helping the student gain awareness of practice in some aspect of linguistic knowledge (ibid). On the other hand, speaking test, as a device for assessing the learners language proficiency also functions to motivate students and reinforce their learning of language. This represents what Bachman (1991) has called an â€Å"interface† between second language acquisition (SLA) and language testing research. However, assessing speaking is challenging, â€Å"because there are many factors that influence our impression of how well someone can speak a language† (Luoma, 2004:1) as well as unpredictable or impromptu nature of the speaking interaction. The testing of speaking is difficult due to practical obstacles and theoretical challenges. Much attention has been given to how to perfect the assessment system of oral English and how to improve its validity and reliability. The communicative nature of the testing environment also remains to be considered (Hughes, 2002). The Construct Of Speaking Introduction To Communicative Language Ability (CLA) A clear and explicit definition of language ability is essential to language test development and use (Bachman,1990). The theory on which a language test is based determines which kind of language ability the test can measure, This type of validity is called construct validity. According to Bachman (1990:84), CLA can be described as â€Å"consisting of both knowledge or competence and the capacity for implementing or executing that competence in appropriate, contextualized communicative language use†. CLA includes three components: language competence, strategic competence and pyschophysiological mechanisms. The following framework (figure 2.1) shows components of communicative language ability in communicative language use (Bachman,1990:85). Knowledge Structures Language Competence Knowledge of the world Knowledge Of Language Strategic Competence Psychophysiological Mechanisms Context Of Situation This framework has been widely accepted in the field of language testing. Bachman (1990:84) proposes that â€Å"language competence† essentially refers to a set of specific knowledge components that are utilized in communication via language. It comprises organizational and pragmatic competence. Two areas of organizational knowledge that Bachman (1990) distinguishes are grammatical knowledge and textual knowledge. Grammatical knowledge comprises vocabulary, syntax, phonology and graphology, and textual knowledge, comprises cohesion and rhetorical or conversational organization. Pragmatic competence shows how utterances or sentences and texts are related to the communicative goals of language users and to the features of the langue-use setting. It includes illocutionary acts ¼Ã…’or language functions, and sociolinguistic competence, or the knowledge of the sociolinguistic conventions that govern appropriate language use in a particular culture and in varying situations in t hat culture (Bachman, 1987). Strategic competence refers to mastery of verbal and nonverbal strategies in facilitating communication and implementing the components of language competence. Strategic competence is demonstrated in contextualized communicative language use, such as socialcultural knowledge, real-world knowledge and mapping this onto the maximally efficient use of existing language abilities. Psychophysiological competence refers to the visual and auditory skill used to gain access to the information in the administrators instructions. Among other things, psychophysiological competence includes things like sound and light. Fulchers Construct Definition To know what to assess in a speaking test is a prime concern. Fulcher (1997b) points out that the construct of speaking proficiency is incomplete. Nevertheless, there have been various attempts to reflect the underlying construct of speaking ability and to develop theoretical frameworks for defining the speaking construct. Fulchers framework (figure 2.2) (Fulcher, 2003: 48) describes the speaking construct. As Fulcher (2003) points out that there are many factors that could be included in the definition of the construct: Phonology: the speaker must be able to articulate the words, have an understanding of the phonetic structure of the language at the level of the individual word, have an understanding of intonation, and create the physical sounds that carry meaning. Fluency and accuracy: these concepts are associated with automaticity of performance and the impact on the ability of the listener to understand. Accuracy refers to the correct use of grammatical rules, structure and vocabulary in speech. Fluency has to do with the ‘normal speed of delivery to mobilise ones language knowledge in the service of communication at relatively normal speed. The quality of speech needs to be judged in terms of the gravity of the errors made or the distance from the target forms or sounds. Strategic competence: this is generally thought to refer to an ability to achieve ones communicative purpose through the deployment of a range of coping strategies. Strategic competence includes both achievement strategies and avoidance strategies. Achievement strategies contain overgeneralization/morphological creativity. Learners transfer knowledge of the language system onto lexical items that they do not know, for example, saying â€Å"buyed† instead of â€Å"bought†, Speakers also learn approximation: learners replace an unknown word with one that is more general or they use exemplification, paraphrasing (use a synonym for the word needed), word coinage (invent a new word for an unknown word), restructuring (use different words to communicate the same message), cooperative strategies (ask for help from the listener) , code switching (take a word or phrase from the common language with the listener in order to be understood) and non-linguistic strategies (use gestur es or mime, or point to objects in the surroundings to help to communicate). Avoidance or reduction strategies consist of formal avoidance (avoiding using part of the language system) and functional avoidance (avoiding topical conversation). Strategic competence includes selecting communicative goals and planning and structuring oral production so as to fulfill them. Textual knowledge: competent oral interaction involves some knowledge of how to manage and structure discourse, for example, through appropriate turn-taking, opening and closing strategies, maintaining coherence in ones contributions and employing appropriate interactional routines such as adjacency pairs. Pragmatic and sociolinguistic knowledge: effective communication requires appropriateness and the knowledge of the rules of speaking. A range of speech acts, politeness and indirectness can be used to avoid causing offence. Ways Of Testing Speaking Clark (1979) puts forward a theoretical basis to discriminate three types of speaking tests: direct, semi-direct and indirect tests. Indirect tests belong to â€Å"procommunicative† era in language testing, in which the test takers are not actually required to speak. It has been regarded as having the least validity and reliability, while the other two formats are more widely used (OLoughlin, 2001). In this section, the characteristics, advantages and disadvantages of the direct and semi-direct test are presented, The Oral Proficiency Interview Format One of the earliest and most popular direct speaking test formats, and one that continues to exert a strong influence, is the oral proficiency interview (OPI) –developed originally by the FSI (Foreign Service Institute) in the United States in the 1950s and later adopted by other government agencies. It is conducted with individual test-taker by a trained interviewer, who assesses the candidate using a global band scale (OLoughlin, 2001). It typically begins with a warm-up discussion of a few easy questions, such as getting to know each other or talking about the days events. Then the main interaction contains the pre-planned tasks, such as describing or comparing pictures, narrating from a picture series, talking about a pre-announced or examiner-selected topic, or possibly a role-play task or a reverse interview where the examinee asks question of the interviewer (Luoma. 2004). An important example of this type of test is the speaking component of the International English L anguage Testing System (IELTS), which is adopted in 105 different countries around the world each year. The Advantage Of An Interview Format The oral interview was recognized as the most commonly used speaking test format. Fulcher (2003) suggests that it is partly because the questions used can be standardized, making comparison between test takers easier than when other task types are used. Using this method, the instructor can get a sense of the oral communicative competence of students and can overcome weakness of written exams, because the interview, unlike written exams, â€Å"is flexible in that the questions can be adapted to each examinees performance, and thus the testers have more controls over what happens in the interaction† (Luoma, 2004:35). It is also relatively easy to train raters and obtain high inter-rater reliability (Fulcher, 2003). The Disadvantage Of An Interview Format However, concern and skepticism exist about whether it is possible to test other competencies or knowledge because of the nature of the discourse that the interview produces (van Lier, 1989). a. Issue of time For the instructor, time management can be quite an issue. For instance, using a two-hour period for exams for 20 students means each student is allowed only six minutes for testing. This includes the time needed to enter the room and adjust to the setting. With such a time limit the student and instructor can hardly have any kind of normal real-world conversation. b. Issue of asymmetrical relationship The asymmetrical relationship between examiners and candidates elicits a form of inauthentic and limited socio-cultural contexts (van Lier, 1989; Savignon, 1985; Yoffe, 1997). Yoffe (1997) commented on ACTFL (American Council on the Teaching of Foreign Languages) OPI that the tester and the test-taker are â€Å"clearly not in equal positions† (Yofee, 1997). The asymmetry is not specific to the OPI but is inherent in the notion of an interview as an exchange wherein one person solicits information in order to arrive at a decision while the interlocutor produces what he or she perceives as most valued. The interviewee is, in most cases, acutely aware of the ramifications of the OPI rating and is, consequently, under a great deal of stress. Van Lier (1989) also challenges the validity of OPI in terms of the asymmetry between them because â€Å"the candidate speaks as to a superior and is unwilling to take the initiative† (van Lier, 1989). Under the unequal relationship, the speech discourse, such as turn –taking, topic nomination and development, and repair strategies are all substantially different from normal conversational exchanges (see van Lier 1989). c. Issue of interviewer variation Given the fact that the interviewer has considerable power over the examinee in an interview, concerns have been aroused about the effect of the interlocutor (examiner) on the candidates oral performance. Different interviewers vary in their approaches and attitudes toward the interview. Brown (2003) warns the danger of such variation to fairness. OSullivan (2000) conducts an empirical study that indicated learners perform better when interviewed by a woman, regardless of the sex of the learner. Underhill (1987:31) expresses his concern on the unscripted â€Å"flexibility†¦ means that there will be a considerable divergence between what different learners say, which makes a test more difficult to assess with consistency and reliability.† Testing Speaking In Pairs There has been a shift toward a paired speakers format: two assessors examine two candidates at a time. One assessor interacts with the two candidates and rates them on a global scale, while the other does not take part in the interaction and just assessesusing an analytic scale. The paired oral test has been used as part of large-scale, international, standardized oral proficiency tests since the late 1980s (Ildikà ³, 2001). Key English Test (KET), Preliminary English Test (PET), First Certificate in English (FCE) and Certificate in Advanced English (CAE) make use of the paired format. In a typical test, the interaction begins with a warm-up, in which the examinees introduce themselves to the interlocutor, followed by two pair interaction task. The talk may involves comparing two photographs by each candidate at first, such as in Cambridge First Certificate (Luoma, 2004), then a two-way collaborative task between the two candidates based on more photographs, artwork or computer gra phics, and ends up with a three-way discussion with the two examinees and the interlocutor about a general theme that is related to the earlier discussion. The advantages of the paired interview format Many researchers claim that the paired format is preferable to OPI. The reasons are: a. The changed role of the interviewer frees up the instructors in order to pay closer attention to the production of each candidate than if they are participants themselves (Luoma, 2004). b. The reduced asymmetry allows more varied interaction patterns, which elicits a broader sample of discourse and increased turn-takings than were possible in the highly asymmetrical traditional interview (Taylor, 2000). c. The task type based on pair-work will generate a positive washback effect on classroom teaching and learning (Ildiko, 2001). In the case of the instructor following Communicative Language Teaching (CLT) methodology, where pair work may take up a significant portion of a class, it would be appropriate to incorporate similar activities in the exam. In that way the exam itself is much better integrated into the fabric of the course. Students can be tested for performance related to activities done in class. There may also be benefits in regards to student motivation. If students are aware that they will be tested on activities similar to the ones done in class, they may have more incentive to be attentive and use class time effectively. The disadvantages of the paired interview format There are, however, also concerns voiced regarding the paired format. a. Mismatches between peer interactants The most frequently raised criticisms against the paired speaking test relate to various forms of mismatches between peer interactants (Fulcher, 2003). Ildiko (2001) points out that when a candidate has to work with an incomprehensible or uncomprehending peer partner, it may negatively influence the candidates performance. As a consequence, in such cases it is quite impossible to make a valid assessment of candidates abilities. b. Lack of familiarity between peer interactants The extent to which this testing format actually reduces the level of anxiety of test-takers compared to other test formats remains doubtful (Fulcher, 2003). OSullivan (2002) suggests that the spontaneous support offered by a friend positively reduces anxiety and task performance under experimental conditions. However, the chances are quite high that the examinee will meet with strangers as his or her peer interactant. It is hard to imagine how these strangers can carry out some naturally flowing conversations. Estrangement, misinterpretation and even breakdown may occur during their talk. c. Lack of control of the discussion Problems are generated if the examiner loses control of the oral task (Luoma, 2004). When the instructions and task materials are not clear enough to facilitate the discussion, the examinees conversation may go astray. Luoma (2004) points out that testers often feel uncertain about what amount of responsibility that they should give to the examinees. Furthermore, examinees do not know what kind of performance will earn them good results without the elicitation of the examiner. When one of the examinees has said too little, the examiner ought to monitor and jump in to give help when necessary. Semi-Direct Speaking Tests The term â€Å"semi-direct† is employed by Clark (1979:36) to describe those tests that are characterized â€Å"by means of tape recordings, printed test booklets, or other ‘non-human elicitation procedures, rather than through face-to-face conversation with a live interlocutor.† Appearing during 1970s, and being an innovative adaptation of the traditional OPI, the semi-direct method normally follows the general structure of the OPI and makes an audio-recording of the test takers performance which is later rated by one or more trained assessors (Malone, 2000). Examples of the semi-direct type used in the U.S.A. are the simulated oral proficiency interviews (SOPI) and the Test of Spoken English 2000 (TSE) (Ferguson, 2009). Examples in U.K. include the Test in English for Education Purpose (TEEP) and the Oxford-ARELS Examinations (OLoughlin, 2001). Another mode of delivery is testing by telephone as in the PhonePass test (the test mainly consists of reading sentenc es aloud or repeating sentences), or even video-conferencing (Ferguson, 2009). The Advantages Of The Semi-Direct Test Type First, the semi-direct test is more cost efficient than direct tests, because many candidates can be tested simultaneously in large laboratories and administered by any teacher, language lab technician or aide in a language laboratory where the candidate hears taped questions and has their responses recorded (Malone, 2000). Second, the mode of testing is quite flexible. It provides a practical solution in situations where it is not possible to deliver a direct test (OLoughlin, 2001), and it can be adapted to the desired level of examinee proficiency and to specific examinee age groups, backgrounds, and professions (Malone, 2000). Third, semi-direct testing represents an attempt to standardize the assessment of speaking while retaining the communicative basis of the OPI (Shohamy, 1994). It offers the same quality of interview to all examinees, and all examinees respond to the same questions so as to remove the effect that the human interlocutor will have on the candidate (Malone, 2000). The uniformity of the elicitation procedure greatly increases the reliability of the test. Some empirical studies (Stansfield, 1991) show high correlations (0. 89- 0. 95) between the direct and semi-direct tests, indicating the two formats can measure the same language abilities and the SOPI can be the equivalent and surrogate of the OPI. However, there are also disadvantages. The Disadvantages Of The Semi-Direct Test Type First, the speaking task in semi-direct oral test is less realistic and more artificial than OPI (Clark, 1979; Underhill, 1987). Examinees use artificial language to â€Å"respond to tape-recorded questions situations the examinee is not likely to encounter in a real-life setting† (Clark, 1979:38). They may feel stressful while speaking to a microphone rather than to another person, especially if they are not accustomed to the laboratory setting (OLoughlin, 2001). Second, the communicative strategy and speech discourse elicited in these semi-direct SOPIs is quite different from that found in typical face-face interaction – being more formal, less conversation-like (Shohamy, 1994). Candidates tend to use written language in tape-mediated test, more of a report or narration; while, they focus more on interaction and on delivery of meanings in OPI. Third, there are often technical problems that can result in poor quality recordings or even no recording in the SOPI format (Underhill, 1987). In conclusion, one cannot assume any equivalence between a face-to face test and a semi-direct test (Shohamy, 1994). It may be that they are measuring different things, different constructs, so the mode of test delivery should be adopted on the basis of test purpose, accuracy requirement, practicability, and impartiality (Shohamy, 1994). Stansfield (1991) proposes the OPI is more applicable to the placement test and evaluation test of the curriculum, while SOPI is more appropriate for large-scale test with requirement of high reliability. Marking Of Speaking Test Marking and scoring is a challenge in assessing second language oral proficiency.. Since only a few elements of the speaking skill can be scored objectively, human judgments play major roles in assessment. How to establish the valid, reliable, effective marking criteria scales and high quality scoring instruments have always been central to the performance testing of speaking (Luoma, 2004). It is important to have clear, explicit criteria to describe the performance, as it is important for raters to understand and apply these criteria, making it possible to score them consistently and reliably. For these reasons, rating and rating scales have been a central focus of research in the testing of speaking (Ferguson, 2009). Definition Of Rating Scales A rating scale, also referred to as a â€Å"scoring rubric† or â€Å"proficiency scale† is defined by Davies et al as following (see Fulcher, 2003):  ·consisting of a series of band or levels to which descriptions are attached  ·providing an operational definition of the constructs to be measured in the test  ·requiring training for its effective operation Holistic And Analytic Rating Scales There are different types of rating scales used for scoring speech samples. One of the traditional and commonly used distinctions is between holistic and analytic rating scales. Holistic rating scales also are referred to as global rating. With these scales, the rater attempts to match the speech sample with a particular band whose descriptors specify a range of defining characteristics of speech at that level. A single score is given to each speech sample either impressionistically or by being guided by a rating scale to encapsulate all the features of the sample (Bachman Palmer, 1996). Analytic rating scales: They consist of separate scales for different aspects of speaking ability (e.g. grammar / vocabulary; pronunciation, fluency, interactional management, etc). A score is given for each aspect (or dimension), and the resulting scores may be combined in a variety of ways to produce a composite single overall score. They include detailed guidance to raters, and rich information that they provide on specific strengths and weakness in examinee performance (Fulcher, 2003). Analytic scales are particularly useful for diagnostic purposes and for providing a profile of competence in the different aspects of speaking ability (Ferguson, 2009). The type of scale that is selected for a particular test of speaking will depend upon the purpose of the test Validity And Reliability Of Speaking Test Bachman And Palmers Theories On Test Usefulness The primary purpose of a language test is to provide a measure that can be interpreted as an indicator of an individuals language ability (Bachman, 1990; Bachman and Palmer, 1996). Bachman and Palmer (1996) propose that test usefulness including six test qualities—reliability, construct validity, authenticity, interactiveness, impact (washback) and practicality. Their notion of usefulness can be expressed as in Figure2.3: Usefulness=Reliability + Construct validity + Authenticity + Interactiveness + Impact +Practicality These qualities are the main criteria used to evaluate a test. â€Å"Two of the qualities reliability and validity are critical for tests and are sometimes referred to as essential measurement qualities† (Bachman Palmer, 1996:19), because they are the â€Å"major justification for using test scores as a basis for making inferences or decisions† (ibid). The definitions of types of validity and reliability will be presented in this section. Validity And Reliability Defining Validity The quotation from AERA (American Educational Research Association ) indicates: â€Å"Validity is the most important consideration in test evaluation. The concept refers to the appropriateness, meaningfulness, and usefulness of the specific inferences made from test scores. Test validation is the process of accu ­mulating evidence to support such inferences. A variety of inferences may be made from scores produced by a given test, and there are many ways of accumulating evidence to support any particular inference. Validity, however, is a unitary concept. Although evidence may be accumulated in many ways, validity always refers to the degree to which that evidence supports the inferences that are made from the score. The inferences regarding specific uses of a test are validated, not the test itself.† (AERA et al., 1985: 9) Messick stresses that â€Å"it is important to note that validity is a matter of degree, not all or none (Mess Reliability of Speaking Proficiency Tests Reliability of Speaking Proficiency Tests Introduction Testing, as a part of English teaching, is a very important procedure, not just because it can be a valuable source of information about the effectiveness of learning and teaching but also because it can improve teaching, and arouse the students motivation to learn. Testing oral proficiency has become one of the most important issues in language testing since the role of speaking ability has become more central in language teaching with the advent of communicative language teaching (Nakamura, 1993). However, assessing speaking is challenging (Luoma, 2004). Validity and reliability, as fundamental concerns and essential measurement qualities of the speaking test (Bachman, 1990; Bachman Palmer, 1996; Alderson et al, 1995), have aroused widespread attention. The validation of the speaking test is an important area of research in language testing. Test of oral proficiency just started in China 15 years ago, and there are a few very dominant tests. An increasing number of Chinese linguists are putting their attention and efforts on analysis of their validity and reliability. Institutions began to introduce speaking tests into English exams in recent years with the widespread promotion of communicative language teaching (CLT). Publications that deal with speaking tests within institutions provide some qualitative assessments (Cai, 2002). But there is relatively little research literature relating to the reliability and validity of such measures within a university context. (Wen, 2001). The College English Department at Dalian Nationalities University (DLNU) has been selected as one of thirty-one institutions of the College English Reform Demonstration Project in the Peoples republic of China. In College English (CE) course of DLNU, the speaking test is one of the four subtests of the final examination of English assessment. The examination uses two different formats. One is a semi-direct speaking test, in which examinees talk to microphones connected to computers, and have their speeches recorded for the teachers to rate afterwards. The other is a face-to-face interview. This research in this paper aims to ascertain the degree of the reliability and validity of the speaking tests. By analyzing the results of the research, teachers will become more aware of the validity and reliability of oral assessments, including how to improve the reliability and validity of speaking tests. I, as a language teacher, will gain insight into the operation of language proficiency te st, In order to better degree of reliability and validity of a particular test, I will also take other qualities of test usefulness into account when designing the language proficiency test., such as practicality and authenticity. Research questions: This study mainly addresses the questions of validity and reliability of the speaking test administered at DLNU. They are comprehensive concepts that involve analysis of test tasks, administration, rating criteria, examinee and testers attitudes towards the test, the effect of the test on teaching and teacher or learner attitudes towards learning the tests (Luoma, 2004). Therefore, the purpose of this study is to answer the following research questions: 1. Is the speaking test administered at DLNU a valid and reliable test? This question can involve the following two sub-questions: 1) To what extent is the speaking test administered at DLNU reliable? 2) To what extent is the speaking test administered at DLNU valid? 2. In what aspects and to what extent may the validity and reliability of the speaking test administered at DLNU be improved? Literature Review This chapter presents a theoretical framework of speaking construct, ways of testing speaking, marking of speaking test and the reliability and validity of speaking test, also introduces the situation of speaking test in China. Analyzing Speaking And Speaking Test The Nature Of Speaking Speaking, as a social and situation-based activity, is an integral part of peoples daily lives (Luoma, 2004). Testing second language speaking is often claimed to be a much more difficult undertaking than testing other second language abilities, capacities or competencies, skills ¼Ã‹â€ Underhill, 1987). Assessment is difficult not only because speaking is fleeting, temporal and ephemeral, but also because of the comprehensibility of pronunciation, the special nature of spoken grammar and spoken vocabulary, as well as the interactive and social features of speaking (Luoma, 2004), because of the â€Å"unpredictability and dynamic nature† of language itself (Brown, 2003). To have a clear understanding of what it means to be able to speak a language, we must understand that the nature and characteristics of the spoken language differ from those of the written form (Luoma, 2004; McCarthy OKeefe, 2004; Bygate, 2001) in its grammar, syntax, lexis and discourse patterns due to the nature of spoken language. Spoken English involves reduced grammatical elements arranged into formulaic chunk expressions or utterances with less complex sentences than written texts. Spoken English breaks the standard word order because the omitted information can be restored from the instantaneous context (McCarthy OKeefe, 2004; Luoma, 2004; Bygate, 2001; Fulcher, 2003). Spoken English contains frequent use of the vernacular, interrogatives, tails, adjacency pairs, fillers and question tags which have been interpreted as dialogue facilitators (Luoma, 2004; Carter McCarthy, 1995). The speech also contains a fair number of slips and errors such as mispronounced words, mixed sounds, and wrong words due to inattention, which is often pardoned and allowed by native speakers (Luoma, 2004). Conversations are also negotiable, unpredictable, and susceptible to social and situational context in which the talks happen (Luoma, 2004). The Importance Of Speaking Test Testing oral proficiency has become one of the most important issues in language testing since the role of speaking ability has become more central in language teaching with the advent of CLA (Nakamura, 1993). Of the four language skills (listening, speaking, reading, writing), listening and reading occur in the receptive mode, while speaking and writing exist in the productive mode. Understanding and absorption of received information are foundational while expression and use of acquired information demonstrate an improvement and a more advanced test of knowledge. A lot of interests now in oral testing is partly because second language teaching is more than ever directed towards the speaking and listening skills ¼Ã‹â€ Underhill, 1987). Language teachers are engaged in â€Å"teaching a language through speaking† (Hughes, 2002:7). On one hand, spoken language is the focus of classroom activity. There are often other aims which the teacher might have: for instance, helping the student gain awareness of practice in some aspect of linguistic knowledge (ibid). On the other hand, speaking test, as a device for assessing the learners language proficiency also functions to motivate students and reinforce their learning of language. This represents what Bachman (1991) has called an â€Å"interface† between second language acquisition (SLA) and language testing research. However, assessing speaking is challenging, â€Å"because there are many factors that influence our impression of how well someone can speak a language† (Luoma, 2004:1) as well as unpredictable or impromptu nature of the speaking interaction. The testing of speaking is difficult due to practical obstacles and theoretical challenges. Much attention has been given to how to perfect the assessment system of oral English and how to improve its validity and reliability. The communicative nature of the testing environment also remains to be considered (Hughes, 2002). The Construct Of Speaking Introduction To Communicative Language Ability (CLA) A clear and explicit definition of language ability is essential to language test development and use (Bachman,1990). The theory on which a language test is based determines which kind of language ability the test can measure, This type of validity is called construct validity. According to Bachman (1990:84), CLA can be described as â€Å"consisting of both knowledge or competence and the capacity for implementing or executing that competence in appropriate, contextualized communicative language use†. CLA includes three components: language competence, strategic competence and pyschophysiological mechanisms. The following framework (figure 2.1) shows components of communicative language ability in communicative language use (Bachman,1990:85). Knowledge Structures Language Competence Knowledge of the world Knowledge Of Language Strategic Competence Psychophysiological Mechanisms Context Of Situation This framework has been widely accepted in the field of language testing. Bachman (1990:84) proposes that â€Å"language competence† essentially refers to a set of specific knowledge components that are utilized in communication via language. It comprises organizational and pragmatic competence. Two areas of organizational knowledge that Bachman (1990) distinguishes are grammatical knowledge and textual knowledge. Grammatical knowledge comprises vocabulary, syntax, phonology and graphology, and textual knowledge, comprises cohesion and rhetorical or conversational organization. Pragmatic competence shows how utterances or sentences and texts are related to the communicative goals of language users and to the features of the langue-use setting. It includes illocutionary acts ¼Ã…’or language functions, and sociolinguistic competence, or the knowledge of the sociolinguistic conventions that govern appropriate language use in a particular culture and in varying situations in t hat culture (Bachman, 1987). Strategic competence refers to mastery of verbal and nonverbal strategies in facilitating communication and implementing the components of language competence. Strategic competence is demonstrated in contextualized communicative language use, such as socialcultural knowledge, real-world knowledge and mapping this onto the maximally efficient use of existing language abilities. Psychophysiological competence refers to the visual and auditory skill used to gain access to the information in the administrators instructions. Among other things, psychophysiological competence includes things like sound and light. Fulchers Construct Definition To know what to assess in a speaking test is a prime concern. Fulcher (1997b) points out that the construct of speaking proficiency is incomplete. Nevertheless, there have been various attempts to reflect the underlying construct of speaking ability and to develop theoretical frameworks for defining the speaking construct. Fulchers framework (figure 2.2) (Fulcher, 2003: 48) describes the speaking construct. As Fulcher (2003) points out that there are many factors that could be included in the definition of the construct: Phonology: the speaker must be able to articulate the words, have an understanding of the phonetic structure of the language at the level of the individual word, have an understanding of intonation, and create the physical sounds that carry meaning. Fluency and accuracy: these concepts are associated with automaticity of performance and the impact on the ability of the listener to understand. Accuracy refers to the correct use of grammatical rules, structure and vocabulary in speech. Fluency has to do with the ‘normal speed of delivery to mobilise ones language knowledge in the service of communication at relatively normal speed. The quality of speech needs to be judged in terms of the gravity of the errors made or the distance from the target forms or sounds. Strategic competence: this is generally thought to refer to an ability to achieve ones communicative purpose through the deployment of a range of coping strategies. Strategic competence includes both achievement strategies and avoidance strategies. Achievement strategies contain overgeneralization/morphological creativity. Learners transfer knowledge of the language system onto lexical items that they do not know, for example, saying â€Å"buyed† instead of â€Å"bought†, Speakers also learn approximation: learners replace an unknown word with one that is more general or they use exemplification, paraphrasing (use a synonym for the word needed), word coinage (invent a new word for an unknown word), restructuring (use different words to communicate the same message), cooperative strategies (ask for help from the listener) , code switching (take a word or phrase from the common language with the listener in order to be understood) and non-linguistic strategies (use gestur es or mime, or point to objects in the surroundings to help to communicate). Avoidance or reduction strategies consist of formal avoidance (avoiding using part of the language system) and functional avoidance (avoiding topical conversation). Strategic competence includes selecting communicative goals and planning and structuring oral production so as to fulfill them. Textual knowledge: competent oral interaction involves some knowledge of how to manage and structure discourse, for example, through appropriate turn-taking, opening and closing strategies, maintaining coherence in ones contributions and employing appropriate interactional routines such as adjacency pairs. Pragmatic and sociolinguistic knowledge: effective communication requires appropriateness and the knowledge of the rules of speaking. A range of speech acts, politeness and indirectness can be used to avoid causing offence. Ways Of Testing Speaking Clark (1979) puts forward a theoretical basis to discriminate three types of speaking tests: direct, semi-direct and indirect tests. Indirect tests belong to â€Å"procommunicative† era in language testing, in which the test takers are not actually required to speak. It has been regarded as having the least validity and reliability, while the other two formats are more widely used (OLoughlin, 2001). In this section, the characteristics, advantages and disadvantages of the direct and semi-direct test are presented, The Oral Proficiency Interview Format One of the earliest and most popular direct speaking test formats, and one that continues to exert a strong influence, is the oral proficiency interview (OPI) –developed originally by the FSI (Foreign Service Institute) in the United States in the 1950s and later adopted by other government agencies. It is conducted with individual test-taker by a trained interviewer, who assesses the candidate using a global band scale (OLoughlin, 2001). It typically begins with a warm-up discussion of a few easy questions, such as getting to know each other or talking about the days events. Then the main interaction contains the pre-planned tasks, such as describing or comparing pictures, narrating from a picture series, talking about a pre-announced or examiner-selected topic, or possibly a role-play task or a reverse interview where the examinee asks question of the interviewer (Luoma. 2004). An important example of this type of test is the speaking component of the International English L anguage Testing System (IELTS), which is adopted in 105 different countries around the world each year. The Advantage Of An Interview Format The oral interview was recognized as the most commonly used speaking test format. Fulcher (2003) suggests that it is partly because the questions used can be standardized, making comparison between test takers easier than when other task types are used. Using this method, the instructor can get a sense of the oral communicative competence of students and can overcome weakness of written exams, because the interview, unlike written exams, â€Å"is flexible in that the questions can be adapted to each examinees performance, and thus the testers have more controls over what happens in the interaction† (Luoma, 2004:35). It is also relatively easy to train raters and obtain high inter-rater reliability (Fulcher, 2003). The Disadvantage Of An Interview Format However, concern and skepticism exist about whether it is possible to test other competencies or knowledge because of the nature of the discourse that the interview produces (van Lier, 1989). a. Issue of time For the instructor, time management can be quite an issue. For instance, using a two-hour period for exams for 20 students means each student is allowed only six minutes for testing. This includes the time needed to enter the room and adjust to the setting. With such a time limit the student and instructor can hardly have any kind of normal real-world conversation. b. Issue of asymmetrical relationship The asymmetrical relationship between examiners and candidates elicits a form of inauthentic and limited socio-cultural contexts (van Lier, 1989; Savignon, 1985; Yoffe, 1997). Yoffe (1997) commented on ACTFL (American Council on the Teaching of Foreign Languages) OPI that the tester and the test-taker are â€Å"clearly not in equal positions† (Yofee, 1997). The asymmetry is not specific to the OPI but is inherent in the notion of an interview as an exchange wherein one person solicits information in order to arrive at a decision while the interlocutor produces what he or she perceives as most valued. The interviewee is, in most cases, acutely aware of the ramifications of the OPI rating and is, consequently, under a great deal of stress. Van Lier (1989) also challenges the validity of OPI in terms of the asymmetry between them because â€Å"the candidate speaks as to a superior and is unwilling to take the initiative† (van Lier, 1989). Under the unequal relationship, the speech discourse, such as turn –taking, topic nomination and development, and repair strategies are all substantially different from normal conversational exchanges (see van Lier 1989). c. Issue of interviewer variation Given the fact that the interviewer has considerable power over the examinee in an interview, concerns have been aroused about the effect of the interlocutor (examiner) on the candidates oral performance. Different interviewers vary in their approaches and attitudes toward the interview. Brown (2003) warns the danger of such variation to fairness. OSullivan (2000) conducts an empirical study that indicated learners perform better when interviewed by a woman, regardless of the sex of the learner. Underhill (1987:31) expresses his concern on the unscripted â€Å"flexibility†¦ means that there will be a considerable divergence between what different learners say, which makes a test more difficult to assess with consistency and reliability.† Testing Speaking In Pairs There has been a shift toward a paired speakers format: two assessors examine two candidates at a time. One assessor interacts with the two candidates and rates them on a global scale, while the other does not take part in the interaction and just assessesusing an analytic scale. The paired oral test has been used as part of large-scale, international, standardized oral proficiency tests since the late 1980s (Ildikà ³, 2001). Key English Test (KET), Preliminary English Test (PET), First Certificate in English (FCE) and Certificate in Advanced English (CAE) make use of the paired format. In a typical test, the interaction begins with a warm-up, in which the examinees introduce themselves to the interlocutor, followed by two pair interaction task. The talk may involves comparing two photographs by each candidate at first, such as in Cambridge First Certificate (Luoma, 2004), then a two-way collaborative task between the two candidates based on more photographs, artwork or computer gra phics, and ends up with a three-way discussion with the two examinees and the interlocutor about a general theme that is related to the earlier discussion. The advantages of the paired interview format Many researchers claim that the paired format is preferable to OPI. The reasons are: a. The changed role of the interviewer frees up the instructors in order to pay closer attention to the production of each candidate than if they are participants themselves (Luoma, 2004). b. The reduced asymmetry allows more varied interaction patterns, which elicits a broader sample of discourse and increased turn-takings than were possible in the highly asymmetrical traditional interview (Taylor, 2000). c. The task type based on pair-work will generate a positive washback effect on classroom teaching and learning (Ildiko, 2001). In the case of the instructor following Communicative Language Teaching (CLT) methodology, where pair work may take up a significant portion of a class, it would be appropriate to incorporate similar activities in the exam. In that way the exam itself is much better integrated into the fabric of the course. Students can be tested for performance related to activities done in class. There may also be benefits in regards to student motivation. If students are aware that they will be tested on activities similar to the ones done in class, they may have more incentive to be attentive and use class time effectively. The disadvantages of the paired interview format There are, however, also concerns voiced regarding the paired format. a. Mismatches between peer interactants The most frequently raised criticisms against the paired speaking test relate to various forms of mismatches between peer interactants (Fulcher, 2003). Ildiko (2001) points out that when a candidate has to work with an incomprehensible or uncomprehending peer partner, it may negatively influence the candidates performance. As a consequence, in such cases it is quite impossible to make a valid assessment of candidates abilities. b. Lack of familiarity between peer interactants The extent to which this testing format actually reduces the level of anxiety of test-takers compared to other test formats remains doubtful (Fulcher, 2003). OSullivan (2002) suggests that the spontaneous support offered by a friend positively reduces anxiety and task performance under experimental conditions. However, the chances are quite high that the examinee will meet with strangers as his or her peer interactant. It is hard to imagine how these strangers can carry out some naturally flowing conversations. Estrangement, misinterpretation and even breakdown may occur during their talk. c. Lack of control of the discussion Problems are generated if the examiner loses control of the oral task (Luoma, 2004). When the instructions and task materials are not clear enough to facilitate the discussion, the examinees conversation may go astray. Luoma (2004) points out that testers often feel uncertain about what amount of responsibility that they should give to the examinees. Furthermore, examinees do not know what kind of performance will earn them good results without the elicitation of the examiner. When one of the examinees has said too little, the examiner ought to monitor and jump in to give help when necessary. Semi-Direct Speaking Tests The term â€Å"semi-direct† is employed by Clark (1979:36) to describe those tests that are characterized â€Å"by means of tape recordings, printed test booklets, or other ‘non-human elicitation procedures, rather than through face-to-face conversation with a live interlocutor.† Appearing during 1970s, and being an innovative adaptation of the traditional OPI, the semi-direct method normally follows the general structure of the OPI and makes an audio-recording of the test takers performance which is later rated by one or more trained assessors (Malone, 2000). Examples of the semi-direct type used in the U.S.A. are the simulated oral proficiency interviews (SOPI) and the Test of Spoken English 2000 (TSE) (Ferguson, 2009). Examples in U.K. include the Test in English for Education Purpose (TEEP) and the Oxford-ARELS Examinations (OLoughlin, 2001). Another mode of delivery is testing by telephone as in the PhonePass test (the test mainly consists of reading sentenc es aloud or repeating sentences), or even video-conferencing (Ferguson, 2009). The Advantages Of The Semi-Direct Test Type First, the semi-direct test is more cost efficient than direct tests, because many candidates can be tested simultaneously in large laboratories and administered by any teacher, language lab technician or aide in a language laboratory where the candidate hears taped questions and has their responses recorded (Malone, 2000). Second, the mode of testing is quite flexible. It provides a practical solution in situations where it is not possible to deliver a direct test (OLoughlin, 2001), and it can be adapted to the desired level of examinee proficiency and to specific examinee age groups, backgrounds, and professions (Malone, 2000). Third, semi-direct testing represents an attempt to standardize the assessment of speaking while retaining the communicative basis of the OPI (Shohamy, 1994). It offers the same quality of interview to all examinees, and all examinees respond to the same questions so as to remove the effect that the human interlocutor will have on the candidate (Malone, 2000). The uniformity of the elicitation procedure greatly increases the reliability of the test. Some empirical studies (Stansfield, 1991) show high correlations (0. 89- 0. 95) between the direct and semi-direct tests, indicating the two formats can measure the same language abilities and the SOPI can be the equivalent and surrogate of the OPI. However, there are also disadvantages. The Disadvantages Of The Semi-Direct Test Type First, the speaking task in semi-direct oral test is less realistic and more artificial than OPI (Clark, 1979; Underhill, 1987). Examinees use artificial language to â€Å"respond to tape-recorded questions situations the examinee is not likely to encounter in a real-life setting† (Clark, 1979:38). They may feel stressful while speaking to a microphone rather than to another person, especially if they are not accustomed to the laboratory setting (OLoughlin, 2001). Second, the communicative strategy and speech discourse elicited in these semi-direct SOPIs is quite different from that found in typical face-face interaction – being more formal, less conversation-like (Shohamy, 1994). Candidates tend to use written language in tape-mediated test, more of a report or narration; while, they focus more on interaction and on delivery of meanings in OPI. Third, there are often technical problems that can result in poor quality recordings or even no recording in the SOPI format (Underhill, 1987). In conclusion, one cannot assume any equivalence between a face-to face test and a semi-direct test (Shohamy, 1994). It may be that they are measuring different things, different constructs, so the mode of test delivery should be adopted on the basis of test purpose, accuracy requirement, practicability, and impartiality (Shohamy, 1994). Stansfield (1991) proposes the OPI is more applicable to the placement test and evaluation test of the curriculum, while SOPI is more appropriate for large-scale test with requirement of high reliability. Marking Of Speaking Test Marking and scoring is a challenge in assessing second language oral proficiency.. Since only a few elements of the speaking skill can be scored objectively, human judgments play major roles in assessment. How to establish the valid, reliable, effective marking criteria scales and high quality scoring instruments have always been central to the performance testing of speaking (Luoma, 2004). It is important to have clear, explicit criteria to describe the performance, as it is important for raters to understand and apply these criteria, making it possible to score them consistently and reliably. For these reasons, rating and rating scales have been a central focus of research in the testing of speaking (Ferguson, 2009). Definition Of Rating Scales A rating scale, also referred to as a â€Å"scoring rubric† or â€Å"proficiency scale† is defined by Davies et al as following (see Fulcher, 2003):  ·consisting of a series of band or levels to which descriptions are attached  ·providing an operational definition of the constructs to be measured in the test  ·requiring training for its effective operation Holistic And Analytic Rating Scales There are different types of rating scales used for scoring speech samples. One of the traditional and commonly used distinctions is between holistic and analytic rating scales. Holistic rating scales also are referred to as global rating. With these scales, the rater attempts to match the speech sample with a particular band whose descriptors specify a range of defining characteristics of speech at that level. A single score is given to each speech sample either impressionistically or by being guided by a rating scale to encapsulate all the features of the sample (Bachman Palmer, 1996). Analytic rating scales: They consist of separate scales for different aspects of speaking ability (e.g. grammar / vocabulary; pronunciation, fluency, interactional management, etc). A score is given for each aspect (or dimension), and the resulting scores may be combined in a variety of ways to produce a composite single overall score. They include detailed guidance to raters, and rich information that they provide on specific strengths and weakness in examinee performance (Fulcher, 2003). Analytic scales are particularly useful for diagnostic purposes and for providing a profile of competence in the different aspects of speaking ability (Ferguson, 2009). The type of scale that is selected for a particular test of speaking will depend upon the purpose of the test Validity And Reliability Of Speaking Test Bachman And Palmers Theories On Test Usefulness The primary purpose of a language test is to provide a measure that can be interpreted as an indicator of an individuals language ability (Bachman, 1990; Bachman and Palmer, 1996). Bachman and Palmer (1996) propose that test usefulness including six test qualities—reliability, construct validity, authenticity, interactiveness, impact (washback) and practicality. Their notion of usefulness can be expressed as in Figure2.3: Usefulness=Reliability + Construct validity + Authenticity + Interactiveness + Impact +Practicality These qualities are the main criteria used to evaluate a test. â€Å"Two of the qualities reliability and validity are critical for tests and are sometimes referred to as essential measurement qualities† (Bachman Palmer, 1996:19), because they are the â€Å"major justification for using test scores as a basis for making inferences or decisions† (ibid). The definitions of types of validity and reliability will be presented in this section. Validity And Reliability Defining Validity The quotation from AERA (American Educational Research Association ) indicates: â€Å"Validity is the most important consideration in test evaluation. The concept refers to the appropriateness, meaningfulness, and usefulness of the specific inferences made from test scores. Test validation is the process of accu ­mulating evidence to support such inferences. A variety of inferences may be made from scores produced by a given test, and there are many ways of accumulating evidence to support any particular inference. Validity, however, is a unitary concept. Although evidence may be accumulated in many ways, validity always refers to the degree to which that evidence supports the inferences that are made from the score. The inferences regarding specific uses of a test are validated, not the test itself.† (AERA et al., 1985: 9) Messick stresses that â€Å"it is important to note that validity is a matter of degree, not all or none (Mess