In the first part of this post I discussed the way successive administrations since Mrs Thatcher – those of john Major, Tony Blair, and now, possibly, the coalition, had planned to introduce ID cards. Privacy campaigners such as Simon Davies have opposed them, because of the immense potential they represent for human rights abuses, the mass surveillance of the population, and discrimination against immigrants and minorities. I posted it as a response to Mike's piece on Vox Political, which I reblogged, on Theresa May's latest campaign against illegal immigration, and the fears landlords and immigrants' rights groups have about the terrible effect this will have on them. The landlords in particular were concerned that this would lead to the introduction of 404 European document-style ID cards. In this part of the post I will discuss the dangers ID cards present, and their failure to do what is often claimed for them, such as to prevent crime and illegal immigration.
It looks like illegal immigration will be the platform by which ID cards will be introduced in this country. Mike and a number of other bloggers have commented on the way recent statements and policies by coalition ministers to combat illegal immigration suggest that they plan to introduce ID cards as part of their campaign. Illegal immigration has been the main issue driving their introduction in Europe, America and some developing nations. Davies book on the growth of the surveillance society in Britain notes that as the European Union dissolves borders in Europe, so the police were given greater power to check people's ID. As for fears that ID cards will somehow stop illegal immigrants from claiming benefits, this has been disproved in Australia. The Joint Parliamentary Committee on the Australia Card found that of 57,000 people, who overstayed their visa in New South Wales, on 22 were illegally claiming Unemployment Benefit.
Anti-racism campaigners are right to worry that ID will increase discrimination. ID cards carrying information on the bearer's ethnic groups or religious beliefs have been used to discriminate against minority groups in many countries. The Japanese were accused of racism when they passed legislation forcing all foreigners to carry ID cards. The French police were similarly accused of racism in demanding Blacks and Algerians carry and produce ID cards. This was one of the reasons behind the race riots in France in the 1990s. In Greece, the authorities were also accused of using the religious information on the card to discriminate against those, who were not Greek Orthodox. Down Under, Aboriginal and Jewish Australians joined the campaign against the Australia Card from fear that they would also suffer discrimination. A few thousand miles across the Pacific in New Zealand, Kiwi trade unions and civil liberties groups also feared ID cards would lead to discrimination against minorities and the poor.
Contrary to the frequent claims made by various Right-wing governments like Thatcher's, Major's and Blair's, ID cards don't actually stop welfare fraud. Says Davies 'the key area of interest lies in creating a single numbering system which would be used as a basis for employment eligibility, and which would reduce the size of the black market economy'. In Oz, the Department of Social Security stated that much less than 1 per cent of overpaid benefits came from identity fraud. The true figure for such crime is probably 0.6 per cent. Most fraudulent or overpaid benefit claims – 61 per cent – came from the non-reporting of variations in the claimant's income.
ID cards also don't stop crime. This is again contrary to the statements made by governments wishing to introducing them. The problem is not the identification of criminals, but in collecting sufficient evidence and successfully prosecuting them. The Association of Chief Police Officers in Britain concluded in 1993 report that burglaries, street crime and crimes committed by people impersonating officials could be reduced through ID cards. They did not, however, present any evidence for this. The Association did fear that the introduction of ID cards would make relations between the police and the general public worse. Davies considered that only a DNA or biometric database could possibly link perpetrators with their crimes.
The introduction of ID cards do, however, increase police powers. Police routinely ask for ID cards in all the countries that have them, and detain those, who don't possess them. In Britain the wartime ID cards were removed in 1953 after a High Court judge ruled that their routine demand by the police was contrary to the spirit of the National Registration Act, and adversely affected the good relations between police and the public.
In fact, instead of helping to combat crime, ID cards actually help it. ID cards provide a 'one-stop' proof of identity, and this can and is used by criminal gangs in their crimes. The technology used to manufacture the cards is now available and used by such organisations. As ordinary organisations, such as companies and the state civil service increasingly rely on ID cards as the unquestioned proof of an individual's identity, so they abandon the other systems used to check it that they have been using for decades. As a result, crimes using fake identities are actually easier with ID cards.
ID cards are a real danger to the privacy of personal information. About one per cent of the staff of companies involved in collecting the personal information used to construct the relational databases used in such cards are corrupt and prepared to trade confidential information. Each year, one per cent of all bank staff in Europe are dismissed for corruption. This is a minuscule percentage, it is true, but nevertheless it still presents a danger to the privacy and safety of the public. In Britain, computer crime amongst the civil services own ID staff massively increased in the 1980s and 1990s. The National Accounting Office estimated in March 1995 that hacking, theft and infection by viruses were all increasing on the IT network in Whitehall. In one year, for example, hacking rose by 140 per cent and viruses by a massive 300 per cent. Of the 655 cases of hacking in the Whitehall network identified by the NAO, most involved staff exceeding their authority to obtain the personal information of members of the public, which was they then passed on to outside individuals.
ID card schemes also tend to be much more expensive than governments' estimate and allow for. Once again, Australia provides a good example of this. When introducing the Australia Card scheme, the Ozzie government failed to take into account training costs, and the expenses coming from administrative supervision, staff turnover, holiday and sick leave, as well as compliance, the issue of the cards overseas and fraud. They also underestimated the costs of issuing and maintaining the cards and how expensive they would be to private industry. In the first part of this post I mentioned how leading Australian bankers and financiers, such as Sir Noel Foley, were openly hostile to the scheme. This is not surprising, as the Australian Bankers' Association estimated that the ID card their would cost Ozzie banks A$100 million over ten years. The total cost of the cards to the private sector was estimated at A$1 billion per year. At the time Davies was writing, the cost of the card system in the UK had not taken into account of administration and compliance costs. These could be as high as £2 – £3 billion. When Tony Blair launched his scheme to develop biometric ID cards, there was further embarrassment to the government when it was revealed by the papers that the scheme had also gone massively over its budget due to problems in developing the technology.
Another factor against the cards is the distress and inconvenience caused to the individual by their accidental loss or destruction. About five per cent of ID cards are either lost, damaged or stolen every year, and it can be several weeks before a replacement is received.
Governments have frequently insisted that ID cards will be voluntary. This was the stance taken by Tony Blair's government on them. It is misleading. There is a tendency for them to become compulsory. Even in nations where they are voluntary, there is considerable inconvenience if they are not carried, so that they are actually compulsory in practice if not in law.
ID cards also have a tendency to become internal passports as they acquire other uses through function creep. These will include all government and a significant number of important, private functions.
Finally, opponents of ID cards object to them because they feel that they damage national identity and personal integrity. The movements against ID cards in America, Australia, Canada and New Zealand called attention to the fears of ordinary people that the introduction of such cards would reduce them to mere numbers. They were a symbol of oppressive authority, and represented popular anxieties that their countries were ruled, not by elected officials, but by bureaucracies driven by technology.
Actually, reading through all the considerable negative aspects of ID cards and the list of the dangers and damage they represent to society and the safety and privacy of its members, I can see why the Coalition government would see no problem in introducing them. After all, such schemes are inefficient, corrupt and massively expensive. They expand the power of the state and the police at the expense of the individual, and are used to persecute and victimise minorities and the poor. Pretty much like all the Coalition's policies, then. And ID cards are exactly like IDS welfare schemes and workfare in that, undercover of eliminating welfare fraud, which they actually don't do anything about, they're really about controlling the movement of labour.
So, corrupt, authoritarian and discriminatory: just right for Theresa May and the rest of the Coalition then!
Shock! Horror! Cadaverous Author of Macabre Novels Calls Slumlords What They Are! Channel 4 Newsreaders Amazed!
It's been an interesting week for the Coalition and their supporters receiving a drubbing by journalists. Mike, over at Vox Political, has put up a good piece about the way Mehdi Hassan demolished Quentin Letts of the Daily Mail on Question Time. Hassan had rebutted Letts' arguments by asking who the person, who really hated Britain was: Miliband senior, a Jewish immigrant, who fought for his country, or the Daily Mail. This is the newspaper, he reminded us, that insinuated that Stephen Gately's death was somehow due to his homosexuality, attacked Danny Boyle for including a mixed race couple in the Olympic Games opening spectacle, called Olympic champion Mo Farah a 'plastic Brit', despises immigrants and Muslims, and seeks to undermine the NHS.
Last night, Have I Got News For You also laid into the Daily Heil. They covered the Mail's slander of Ralph Milliband. Ian Hislop, the editor of Private Eye naturally showed the Mail's hypocrisy by pointing out its pro-Nazi past, complete with its headlines screaming 'Hurrah for the Blackshirts' and opinion piece praising Nazi Germany and dismissing the allegations of Nazi atrocities. Hislop also pointed out that Paul Dacre, the Mail's editor, also showed a signal lack of patriotism, as he did not pay any tax to his country, avoiding it through a complex network of offshore companies based in the Bahamas. He also said that it was a bit rich for Dacre to accuse others of totalitarian sympathies, considering that Dacre's own staff call him 'Mugabe' because he's ancient, won't retire and despises the opposition.
The day before this, on Thursday, Channel 4 covered the brilliant state of the housing market under the Coalition in an investigatory feature entitled 'Generation Rent'. It showed that the present, younger generation have little chance of getting on the housing ladder due to the lack of properties being built. This was due to the recession. Mortgages on the properties that were available were exorbitantly high, so that most young people simply cannot afford them. They were thus forced to rent. This also was difficult and expensive, due to a lack of affordable properties. Many of the homes and flats were aimed at the affluent, not ordinary peeps wanting a roof over their head. The programme talked to a number of landlords, as well as tenants forced to rent due to property prices. Among the landlords interviewed was one, who bought properties simply to rent out to other landlords.
The programme's guest commentator for this section of the programme was Will Self, the cadaverous novelist, whose grisly works include Great Apes and How The Dead Live, as well as other tales of mayhem, mutilation, perversion and horror. Self's own private life has supplied much newspaper copy in its time. He was for years a drug addict, whose finals in philosophy while a student at Oxford were interrupted by his arrest for the chemicals. One newspaper also printed a long, spurious story in which it was alleged that the master of the modern macabre had found the company of John Major so insufferably dull while sat next to him on a plane trip, that he resorted to heroin to liven the journey up. Self's clean of drugs now, and like that other master of the extreme and transgressive, his friend, J.G. Ballard, Self lives in bourgeois domesticity with his wife and child.
But Self's description is accurate. It precisely describes the situation many young people now face, in which they cannot afford to buy, and the rents on those properties they can afford are raised so that they eat up a progressively larger proportion of their income.
What also was not remarked on the programme was that this situation had created a further potential for racial/ nationalist friction. One of the developers interviewed was Francis Liu, a Chinese businessman, who specialises in the construction of one-room apartments. These combine bathroom, living room and bedroom in the same space in a kind of even smaller bedsit. They look horrendous, like Bruce Willis' cramped home in the Fifth Element, but without Moebius' and Besson's visual flair and style. Channel 4's reporters interviewed some British people, who were forced to live in them now, because that's all they could afford. Liu's apartments weren't particularly cheap at £70 a week. They were also aimed at foreign investors from the Far East. This looks to me like a recipe for danger.
Globalisation and Neo-Liberal economics has succeeded in creating a trans-national elite that have more in common with each other, than with the citizens of their countries of origin. Hence all over the world there's a growing indifference to the plight of the poor by the super-rich. Mass immigration, as populations from the Developing World move to the developed West and North in search of jobs and better opportunities, is already a major political issue. It has led to the rise of far-Right movements across Europe, like the Golden Dawn in Greece, and increasingly harsh anti-immigrant measures in Italy and elsewhere. It is also not only Western culture that has racist elements. There is also racism in Chinese culture. I can remember finding in Waterstone's in Bath nearly two decades ago a large, hardback academic book on Chinese Racism. One of the Chinese students I knew at university told me a few years ago that he was horrified at the level of anti-Western prejudice and hatred in his country. Some of this hatred is due to the immense feeling of humiliation felt by the Chinese at their defeat in the Opium Wars, and the division and virtual colonisation of their great nation by the European powers.
The racist and nationalist Right in Britain and the rest of the world is motivated by resentment at the way foreigners are, or are perceived to be, given preferential treatment to the indigenous, host population. The Daily Mail and other right-wing tabloids have frequently attacked the government's immigration service for accommodating asylum-seekers in luxury housing. With Liu and developers like him building properties mainly or exclusively for rich foreigners from the Far East, then it's easy to see how this might enrage the existing, poorer local population, excluded from this luxury market. Liu was building his properties in Leeds, which I think may also have suffered from the effects of poverty and unemployment resulting from Thatcher's decimation of British industry. The local population likely to be priced out of properties like Liu's is not only White, but also Black and Asian, including families of Chinese descent, who've been British since coming here in the 19th century. Years ago I read a book on Japan by a Times journalist. He noted the resentment and controversy that had erupted in Australia when Japanese developers began building luxury beach complexes, which were to be owned solely by the Japanese. The construction of luxury rented properties, aimed at the Far Eastern rich, threatens to create similar tension and conflict over here.
Regardless of their ethnic origins, the landlords taking advantage of the current housing market to raise rents to ludicrous levels are Rackmans, has Self described them. It's another example of how the Coalition's policies are increasing the gap between rich and poor in the name of liberalisation.
One of the other arguments the American Right has used against the socialised medicine and the welfare state in America is the effect they believe it would have on the American birth rate. European birth rates are falling. Right-wing broadcasters and journalists, like Mark Steyn, have declared that this due to these nations' extensive welfare policy. With the state to care for them in sickness, unemployment and old age, Europeans are no longer bothering to have the children, who would otherwise support them. This contrasts markedly with the competing nations in the Developing World with their large families. As a result, Europe would face the problems of an aging population, with increased state expenditure on their care and tax burden on the contracting younger population that would be required to pay for it.
This argument has a number of major flaws, not least the fact that birth rates are falling throughout the Developed World, regardless of whether they have a welfare state or not. Japan has been governed more or less continually by the Liberal Democratic Party since the Second World War. This is a Conservative party and there has been little state welfare provision in Japan. Despite this, the Japanese birth rate is also falling, to the point where one of the major Japanese newspapers back in the 1990s declared that if this situation was not reversed, in a thousand years' time the Japanese people would be extinct. In some European countries this demographic decline appears to have begun long before the modern welfare state. The French and German birth rates appeared to have begun to fall some time around the First World War. The German writers Richard Korherr and Oswald Spengler also saw the declining European birth rate as part of its decadence, and these in turn inspired Mussolini to launch the 'demographic campaign' to raise the birth rate. Mussolini turned to the Fascist statistician and demographer, Corrado Gini, for information. Gini declared that the problem was symptomatic of the 'old age of nations', and due to the dominance of economics over patriotism. It was caused by the 'calculated egoism', 'sedentary character' and the growth in working class unrest. Mussolini himself went even further. He declared that it had been demographic decline that had caused the fall of the Roman Empire. Italy needed a high birth rate if it was to become a reinvigorated and dynamic nation. He argued that the low birth rate was the result of corrupt modern urban civilisation and its pernicious influences. This was contrasted with the countryside, where the virtues of peasant life resulted in large families. He therefore launched a campaign to depopulate the cities in favour of the countryside, and ban migration from it to the cities.
While Steyn and the rest of the American Right argue that state intervention and welfare policies are the cause of this decline, Mussolini demanded the exact opposite. The state launched a series of legislation to encourage its citizens to marry and have children. It also increased welfare provision to ensure the health of babies and their mothers. In 1925 it established the Opera Nazionale di Maternita ed Infanzia to ensure the health and welfare of women and their children. In 1929 it passed legislation granting maternity leave and birth insurance for working mothers, as well as a tax on unmarried men. From 1933 it passed further legislation providing for extra pay, and special loans, prizes and subsidies for families with a large number of children. Newlyweds were also to receive special loans from the state. The Italian population did rise during the Fascist period from 38,450,000 to 44,900,000. Historians of Fascist Italy, such as Philip V. Cannistraro, consider it very doubtful whether this was due to the government's policies, except, perhaps, that increased welfare provision may have lowered infant mortality.
Socialised medicine and the welfare state cannot be used to explain falling birth rates in Europe and the Developed World. Far more likely is the simple fact that living standards have risen since the 19th century. The more educated, affluent sections of the population tend to have fewer children than the poorer, less educated. Living standards have improved, and there are greater leisure opportunities than available than in the Victorian era. In the 19th century much of working class social life revolved around the pub, though participation and involvement in sport, music and popular educational facilities like museums and libraries were also growing. Since then a wider range of commercial goods have become available, along with leisure activities and venues from sports facilities to music, theatre and the cinema. Moreover infant mortality has fallen from the horrific levels of the 19th century, so there isn't the same necessity for parents to have large numbers of children in the hope that one, at least, might survive.
The converse of this is that the American Right, in their campaign against welfare benefits, Obamacare and decent working conditions are aiming to reduce their people to the kind of harsh poverty found in the modern Developing World and in the 19th century Europe and America, whose laissez-faire policies they idolise.
'Demographic Policy','Fasci Femminili' and'Gini, Corrado' in Philip V. Cannistraro, ed., Historical Dictionary of Fascist Italy (Westport, Connecticut: Greenwood 1982), pp. 162-4, 202-4, and 246.
Adrian Lyttelton, The Seizure of Power: Fascism in Italy 1919-1920, 2nde Edition (London: Weidenfeld and Nicolson 1987.


Raised on Neil, Joni & Leonard, Jenn weaned herself onto Phantom of the Paradise as one of the 10-year-old Winnipeg kids obsessed with repeated theatre viewings of that most brilliant rock opera horror comedy musical film, leaving Jenn with a genre-bending musical voraciousness still hungry to this day. Jenn became a Phantom Impresario at numerous venues thereafter: Stage West, The Sidetrack Cafe, Joe King Ball Park, The Winspear Centre and ultimately, her very own Paradise, Bluedog Guitars.
Having cut his teeth playing polkas in rural Alberta, Paul spent way too many years inventing PrimitiveSax and Wrangellianing on Hornby Island before falling off a boat in Shanghai where he played Mongolian Folk Fusion till his visa expired. Upon returning to Canada, he re-connected with his Phantom and thus, Bluedog was born.
At the age of three, Dylan gained notoriety on Hornby Island when he hitchhiked solo across the Island to visit a friend. He continued his peripatetic ways until he began songwriting at a Roma Circus and Squat Community in Barcelona, La Makabra, till his mother (coincidentally the Phantom) summoned him home to attend high school. His expulsion from The Dome in Roberts Creek and a hiatus from his pursuit of Permaculture landed Dylan squarely on the doorstep of Bluedog.


The St. Kitts & Nevis Patriots (SKN Patriots) are a franchise cricket team representing the Federation of St. Kitts & Nevis in the Caribbean Premier League (CPL). The franchise was established in January 2015 by Uday Nayak and Mohammed Ansari in partnership with the Government of St. Kitts & Nevis. Their love for cricket and the Federation of St.Kitts & Nevis made it a perfect opportunity to bring the Federation its first professional franchise team.
The Patriots home ground is the Warner Park Stadium in St. Kitts.
Uday is the quintessential entrepreneur with varied experience in banking and aviation, he co-founded the Veling Group in 2002. A true team builder, he successfully led Veling into various uncharted territories including aircraft leasing arranging JOLCO's and Sale & Leasebacks on its first A380 – he was the engine that powered the company.
He now brings with him his wealth of experience to Kayan which he intends to nurture along with his capable team. Uday is an alumnus of Harvard Business School and has an honorary doctorate from the University of Bolton for his contributions to philanthropy and aviation.
Over 17 years of experience in financial services and investment banking.Formerly of Salomon Brothers, where he worked in merger and acquisition advisory for major U.S. and Canadian corporations in the New York and Toronto offices.
Holds a Master of Philosophy Degree in Economics from Cambridge University and a B.S. in Economics and Business Finance from Brunel University, where he graduated with First Class Honors.
Richard joined the group in 2015 as the Chief Operating Officer and Team Manager of the St. Kitts & Nevis Patriots, a professional cricket franchise based in St. Kitts and who participates in the Caribbean Premier League. In the second year, he was elevated to Chief Executive Officer of the franchise. He has worked in the field of cricket for over 10 years with an 8 year stint with the West Indies Men's Cricket team as their Performance Analyst. He has served as a senior consultant to major cricket projects around the global.


text:
Clinical reasoning for acute dyspnoea: comparison between final-year medical students from discipline- and competency-based undergraduate programmes
Anja Czeskleba1,
Ylva Holzhausen1 &
Harm Peters ORCID: orcid.org/0000-0003-1441-75121
Clinical reasoning for acute dyspnoea: Comparison of final-year medical students from discipline- and competency-based undergraduate programmes.
The global shift to competency-based medical education aims to improve the performance of its trainees, including in the key competency domain of clinical reasoning. However, research on whether such education actually improves clinical reasoning is sparse. The purpose of this study is to compare assessed clinical reasoning performance in digitally presented cases of acute dyspnoea between final-year medical students from a traditional, discipline-based and those from an integrated, competency-based undergraduate programme.
A total of 60 medical students in their final-year clerkships participated in the study; 30 were from a discipline-based programme, and 30 were from a competency-based programme of the same faculty. The students completed a knowledge test consisting of 22 single choice items and a computer-based test of clinical reasoning with six video-based case scenarios with different underlying diseases leading to dyspnoea. The operationalized measures of clinical reasoning were the number and relevance of the diagnostic tests chosen, time to diagnosis and diagnostic accuracy.
The two groups did not differ in their knowledge of the acute dyspnoea content domain. With regard to clinical reasoning, the selection of relevant tests, time required to make a diagnosis and accuracy of the diagnosis varied across the six case scenarios in both groups. However, the results from the measures of the clinical reasoning process did not differ between the students from the two types of undergraduate medical programmes. No significant differences were found with regard to the selection of relevant diagnostic tests (M = 63.8% vs. M = 62.8%), the time to a diagnosis (M = 128.7 s vs. M = 136.4 s) or the accuracy of diagnosis (M = 82.2% vs. M = 77.0%).
Key indicators of the clinical reasoning process, when assessed with objectively measured parameters, did not differ between final-year medical students from a traditional, discipline-based and those from an integrated, competency-based undergraduate programme in the domain of acute dyspnoea. The results substantiate and expand those of previous studies based on subjective assessor ratings that showed limited change in the clinical reasoning performance of medical students with competency-based undergraduate education.
Undergraduate medical education, like the entire medical training continuum, is currently in a transition towards competency-based frameworks and curricula [1, 2]. Many medical faculties have reformed their undergraduate programmes from having traditional, discipline-based to integrated, competency-based curricula. Clinical reasoning represents a key competency for every physician and central outcome in competency-based training [3, 4] However, little empirical evidence exists on the extent to which competency-based education may improve the clinical reasoning ability of medical students. The purpose of the present study is to compare the clinical reasoning performance between final-year medical students from a discipline-based undergraduate programme and a competency-based undergraduate programme using a computer-based assessment instrument.
Clinical reasoning is an essential competency for every physician and serves as a foundation for the effective and safe execution of numerous medical tasks [3, 4]. It represents a complex cognitive process that commonly begins with patient presentation and results in a decision on an underlying diagnosis and/or the therapeutic approach to be taken. Early attempts to reform traditional discipline-based medical programmes placed the problem-based learning (PBL) teaching format at the centre of the curricular structure [5]. PBL is, to some degree, aligned with medical decision-making process, but it does not explicitly teach clinical reasoning in the decision-making process. Medical education reform has moved on, and the transition towards competency-based programmes currently represents the major direction for the entire medical education continuum, including undergraduate medical training [1, 2]. In today's frameworks for competency-based medical education, clinical reasoning represents a key competency to be conveyed during training. These frameworks include, e.g., CanMEDS in Canada [6], the Accreditation Council for Graduate Medical Education (ACGME) in the USA [7], Outcomes for Graduates in the UK [8] and the National Catalogue of Learning Outcomes in Medicine (NKLM) in Germany [9].
Competency-based programmes differ from traditional, discipline-based medical degree programmes in that they are usually horizontally and vertically integrated, and the approach to curriculum design is centred around predefined outcomes to be met by the programme [10]. Furthermore, they generally offer early patient-based learning in clinical workplaces, supported by structured training in communication skills with simulated patients. It is generally assumed that the competency-based reorientation of medical education will lead to better trained physicians and thus to better care of patients [6, 11]. However, the results presented in the literature are limited and inconsistent regarding overall improvement and sparse regarding changes in clinical reasoning ability. The limited results and research related to effects of curricular change contrast the large number of medical schools that have undergone major programme reform in recent decades. In general, a number of studies and overviews have compared discipline-based with problem-based programmes [6, 12,13,14,15,16,17], but there have been only a few comparative studies of competency-based curricula. The results on competency-based curricula are ambiguous. From a broad perspective, Kerijk et al. [18] found no overall differences in acquired knowledge, performance in a clinical setting or preparedness for working as a physician in students graduating from the two types of programmes of the same institution. In another study, Dutch students in their final year of an integrated curriculum were compared with German students with a discipline-based curriculum in a setting simulating tasks on their first day as physician in a clinical workplace [19, 20]. Medical supervisors subjectively rated the students on Likert-based scales and gave higher ratings to students from the integrated, competency-based programme for the "active professional development" competency and the "solving a management problem" professional activity. In contrast, students from the discipline-based course received higher ratings in the area of "breaking bad news". In the same study, when examining clinical decision-making more specifically, the educational researchers found no differences in supervisors' subjective, semi-quantitative ratings for "clinical reasoning under time-pressure" between the final-year students from the discipline-based and competency-based programmes [20]. These findings are consistent with those of another study by this group in which supervising physicians from Utrecht and Hamburg rated the competencies of their graduates semi-quantitatively on a Likert scale [21]. Their ratings showed no differences between the two groups in skills of "solving medical problems" and "ability to prioritize tasks", both of which can be attributed to the area of clinical reasoning.
With the advance of technology, new opportunities have emerged to assess the clinical reasoning performance of medical trainees. Technology-based testing allows objective and more differentiated measurements compared to the subjective Likert scale-based ratings that have been employed by supervisors. The Assessing Clinical Reasoning (ASCLIRE) test represents a feasible, effective and well-researched computer-based instrument for the assessment of clinical reasoning [4, 22,23,24]. The test is based on digitally presented cases of patients with acute dyspnoea and different underlying diagnoses. The test allows the evaluation of three partly correlated but distinct aspects of the clinical decision process: choice of relevant diagnostic information, time to a diagnostic decision and accuracy of the diagnostic decision. The ASCLIRE test mimics the clinical reasoning process to an appropriate degree with data acquisition, data interpretation, and data synthesis. Previous internal and external validation studies have shown that the test results i) have good psychometric properties; (ii) differentiate between trainees in different years of study; (iii) differentiate between experts and trainees; and (iv) have three separable latent factors in clinical reasoning, i.e., choice of relevant diagnostic information, decision time and diagnostic accuracy [4, 22,23,24].
The aim of this study is to compare the clinical reasoning performance of medical students in their final-year clerkships from a discipline-based or competency-based undergraduate medical programme. The clinical reasoning performance is assessed by using the ASCLIRE test and refers to the choice of relevant diagnostic information, decision time and diagnostic accuracy in digital cases of patients with various forms of acute dyspnoea. For this study, we took advantage of the brief opportunity at our medical faculty to have medical students in their final-year clerkships from both traditional, discipline-based and integrated, competency-based medical programmes.
The study was carried out in 2016 at the Charité – Universitätsmedizin Berlin (Charité). The study protocol was approved by the Charité data protection officer and the Charité ethics board (No. EA4–096-16).
Undergraduate medical programmes at the Charité
Approximately 300 new students are enrolled twice yearly in the first semester of the undergraduate medical programme at the Charité. Until the Summer 2010 term, students were enrolled in a traditional, discipline-based curriculum (TC), and beginning in the Winter 2010/11 term, they were enrolled in an integrated, competency-based curriculum (CC) [10]. Both programmes comprise twelve semesters and a total of 5500 teaching hours. In both programmes, students complete a final-year clerkship in the sixth year of study. This clerkship is divided into three trimesters with rotations in internal medicine, surgery and one elective discipline [10].
The traditional, discipline-based medical curriculum at the Charité (regular curriculum of medicine) is structured as a two-year pre-clinical section covering basic science subjects and a three-year clinical study section covering clinical science subjects [10]. The teaching formats in the pre-clinical section include lectures, seminars and practical sessions, while in the clinical section, there are lectures, seminars, simulations and bedside teaching. The symptoms and potential underlying diseases of dyspnoea are taught in semesters 5 to 10 through lectures, seminars, emergency simulations and bedside teaching.
The integrated, competency-based curriculum at the Charité (modular curriculum of medicine) was planned and implemented according to an outcome-oriented approach based on a framework for medical competencies developed at the Charité [10], which is comparable to the CanMEDS framework [6]. The programme is structured with 40 themed modules that integrate basic and clinical subjects throughout the programme. At the core of the longitudinal curriculum structure is clinical skills training bedside teaching with real patients, beginning in the first week of study, as well as the gradual increase in professional activities over the semester. Throughout the course, students are trained in communication skills for physicians and have weekly PBL sessions. The symptoms of dyspnoea and potential underlying diseases are taught in semesters 1 to 10 through lectures, seminars, PBL, emergency simulations and bedside teaching.
To compare the two undergraduate programmes, we purposively selected medical students in the final-year clerkship. Students in this phase of study were chosen because, first, this phase is close to the end of programme, thus allowing testing to assess overall programme outcomes. Second, the preceding, mostly theoretical and classroom-based phases of study, both in the discipline-based and competency-based programmes, can be seen as completed and self-contained. The study was carried out at a point when the two programmes were running in parallel and it was possible to recruit final-year medical students from both programmes [25]. The data were collected on two test dates (T1: June 2016, only TC participants; T2: December 2016, both TC and CC participants).
Recruitment procedure
To recruit the participants, medical students in the final-year clerkship at the Charité and connected teaching hospitals were invited via email to voluntarily participate in the study at the end of their second rotations. We purposely chose the end of the second rotation and omitted the third rotation because we expected an insufficient participation rate due to the final state examination, which is taken after the third rotation. To reduce the effects of a long-term study, only students from the regular curriculum of medicine who had completed up to the 14th semester of their studies were recruited. The number of participants was restricted beforehand to 60 (a goal of n = 30 from each programme) due to the availability of resources (cost for computer licences, research staff, etc.). Altogether, 256 students from the regular curriculum of medicine and 229 students from the modular curriculum of medicine were contacted. The inclusion of participants in the study was based on the order of their replies and the fulfilment of the study criteria. Study participation was financially compensated.
Control variables
The participants signed the consent form and provided socio-demographic information, such as age, gender and semester. Because context-specific prior knowledge played an important role in comparing competency development, all participants participated in a knowledge test on the acute dyspnoea content domain. This test consisted of 22 single choice items, each with four choices. The test was conducted on paper, took approximately 30 min to complete and was undertaken after the clinical decision-making test.
Administration of the ASCLIRE test
The ASLIRE test consists of altogether six digital patients' cases of acute dyspnea with different underlying disorder [4]. Each case begins with a short, video-based prototypical clinical presentation of a patient case. All clinical presentations are played by the same male standardized actor.
Following a general introduction and a training case, the participants worked individually on the randomly ordered cases of acute dyspnoea. For each case, the participants first watched the respective patient presentation video. Next, they were free to choose any type, order and number of diagnostic tests from a graphical interface of the computer screen. The test results were displayed via text (e.g., blood pressure), image (e.g., X-ray chest) or audio (e.g., heart rate) and had to be interpreted by the participants. For this part, the participants were instructed to work as quickly as possible to come to a decision regarding the underlying diagnosis without sacrificing accuracy. The participants could choose from 20 diagnoses available in a drop-down list on the computer screen. During the ASCLIRE testing, all selected diagnostic measures and the time required for all processes until a diagnosis was reached were recorded for each participant. The overall ASCLIRE test duration was approx. 60 min in total.
The clinical reasoning process was operationalized for each participant with three parameters: 1) relative proportion of the number and relevance of diagnostic measures (compared with those of the selections made by medical specialists in this field during the test validation); 2) diagnostic accuracy (correct or incorrect); and 3) time to diagnosis (in seconds from the end of the video presentation to the diagnostic decision).
The statistical analysis was carried out using SPSS 21 (IBM Deutschland GmbH, Ehningen, Germany). The data are presented as the mean and standard deviation. Results on correct or incorrect diagnostic accuracy are reported as the percentage of total answers given. Unpaired t-test were used to test for group differences in parametric variables. Chi-squared tests were applied to test for group differences in categorical variables. A p value lower than 0.05 was considered statistically significant. In the knowledge test, the number of correctly answered items was selected as the dependent variable. For the analysis of the ASCLIRE test, the following dependent variables were selected: 1) number and relevance of diagnostic measures; 2) time to diagnosis; and 3) diagnostic accuracy (correct or incorrect).
Socio-demographic variables
The comparison of the control variables revealed no significant difference in the age of participants (TC: M = 27.87 years, SD = 3.83; CC: M = 27.47 years, SD = 3.36 years). As expected, there was a small significant difference between the two groups in the number of semesters studied (t(37.33) = 3.33; p = 0.002 / TC: M = 12.87, SD = 1.28; CC: M = 12.03, SD = 0.49), which was mitigated as much as possible by limiting the number of semesters studied in the recruitment procedure.
Pre-existing knowledge variable
In the knowledge test on acute dyspnoea, there were no differences between the two groups in the number of correctly answered items (TC: M = 13.7 (62.1%), SD = 1.8; / CC: M = 13.6 (61.7%), SD = 2.1). On average, students answered 61.9% of items correctly, while the t-test showed no significant differences between the groups.
Overall, the distribution of the socio-demographic characteristics and domain-specific knowledge test scores indicated that the two cohorts were acceptably comparable and that we could continue to compare their clinical reasoning performance on the ASCLIRE test.
ASCLIRE test results for clinical reasoning
In the two study cohorts, the following results were obtained through the administration of the ASCLIRE test to the final-year clerkship students:
Selection of relevant diagnostic tests: The number of chosen relevant diagnostic tests varied across all students (Fig. 1), with the highest number of tests chosen for the case of pulmonary artery embolism and the lowest number chosen for the case of opioid intoxication in comparison to the expert standard. Overall, the TC students selected, on average, 63.8% of relevant diagnostic tests. The CC students did not show a significantly different result (62.8%) for any of the six cases (numeric details in appendix 1).
Time required to decide on a diagnosis: There was considerable variation in the time to diagnostic decision between the cases (Fig. 2). The mean time was longest for the case of lung oedema and shortest for the case of pneumonia. While TC students needed an average of 128.7 s across all cases to decide on a diagnosis, CC students needed 136.4 s. The difference was not significant for any of the six cases (numeric details in appendix 1).
Choice of the correct diagnosis: The accuracy of the chosen diagnosis varied across all students (Fig. 3), with the highest accuracy for the case of pneumonia and the lowest accuracy for the case of unstable ventricular tachycardia in comparison to the expert standard. Overall, the accuracy in choosing the correct diagnosis was an average of 82.2% for TC students and 77.0%. for CC students. The difference was not significant for any of the six cases (numeric details in appendix 1).
Number of relevant diagnostic tests chosen for six cases of acute dyspnoea with different underlying diseases by medical students in the final-year clerkship. Students were either from a traditional, discipline-based undergraduate medical programme (TC, n = 30) or an integrated, competency-based undergraduate medical programme (CC, n = 30) of the same medical faculty. The number of relevant diagnostic tests is based on a comparison with the selections made by medical specialists
Time required to decide on an underlying diagnosis for six cases of acute dyspnoea with different underlying diseases by medical students in the final-year clerkship. Students were either from a traditional, discipline-based programme (TC, n = 30) or an integrated, competency-based undergraduate medical programme (CC, n = 30) of the same medical faculty. The time required to decide on a diagnosis in seconds refers to the time from the end of the case video presentation to the time of the diagnostic decision
Choice of the correct diagnosis for six cases of acute dyspnoea with different underlying diseases by medical students in the final-year clerkship. Students were either from a traditional, discipline-based undergraduate medical programme (TC, n = 30) or an integrated, competency-based undergraduate medical programme (CC, n = 30) of the same medical faculty. Choice of the correct diagnosis was operationalized dichotomously as either correct or incorrect
Many medical schools have undergone major curriculum reform in recent decades, but little research comparing the performances of students from previous and new programmes is available. Those who have been managing themselves a major curriculum reform may not be surprised by this discrepancy. Similar to us, the authors of this articles, they likely have experienced that the implementation of a new programme and the parallel major organizational changes exhaust most if not all resources that can be mobilized to make the curricular change happen. In addition, they may have recognized that there are few opportunities to carry out such comparative studies in a feasible, reliable and valid manner. The following two examples may illustrate this difficulty. At our institution, we considered comparing the results of a large written final state exam with 320 multiple choice questions (MCQs) to potentially detect the differences in the medical knowledge acquired in the two programmes. However, we refrained from conducting this investigation, as most students of both study programmes learn specifically for the final state exam using the same commercially available platform that provides specific training based on the MCQs used in previous exams. Thus, the results on acquired knowledge would potentially be biased by the phenomenon of learning for the test using the same learning materials and MCQs. Next, we considered holding a comparative objective structured clinical examination (OSCE) to potentially detect differences in the practical skills acquired in the two programmes. However, again, we refrained from doing so, as the traditional curriculum does not include OSCE assessments, while OSCE assessments have a prominent role in the competency-based programme. Thus, the results for practical skills would have potentially been biased by the familiarity of the CC students with the test format [26]. In the following section, we will discuss the results of this study first in the context of research using the ASCLIRE test in general and second in the context of comparing clinical reasoning performance between different undergraduate medical programmes in particular.
The overall results we found with the ASCLIRE test for the final-year medical students in our study fit well and complemented the previous findings reported by Kunina-Habenicht et al. [4] on test participants with different levels of expertise. Across all six cases, the participants' results for choosing the correct diagnosis (TC students 82%, CC students 77%) ranked between those of medical experts (94%) and those of medical students before entering the final-year clerkship (56%, study years 1–5). The same finding was observed for the time to a diagnostic decision: the TC students (129 s) and CC students (136 s) ranked between medical experts (122 s) and medical students from years 1–5 (187 s). Thus, with increasing experience, the number of correct diagnoses increases, while the time to come to a diagnostic decision decreases. The consistent findings on student's rankings add further to the validity evidence for the ASCLIRE test in general but as well as to the validity evidence for the results of this study.
When examining the results of our study comparing the two study programmes, we were surprised to find no significant differences in the clinical reasoning performances between the final-year clerkship students from the traditional discipline-based and integrated, competency-based medical programmes of our medical faculty. We had expected that the students of the competency-based medical programme would perform better given the early patient exposure, longitudinal PBL, communication and skills training and explicit "medical decision-making" outcome in the new programme. However, with the objective assessment, we found no significant difference in the selection of relevant tests, the time to diagnosis or the choice of diagnosis in the acute dyspnoea domain. This finding was robustly demonstrated across all six cases of acute dyspnoea. Importantly, regarding the interpretation of our finding, the level of knowledge in the domain of acute dyspnoea did not differ between the two groups.
Overall, our study results complement the research on the influence of competency-based medical education on clinical decision-making ability. It expands and substantiates the of reports by Wijnen-Meijer et al. [19,20,21], who utilized subjective evaluations by employing objectively measurable parameters for clinical decision-making. Second, our study was conducted at one medical faculty in one country, which eliminates the potential impact of studying in different countries or medical schools due to context-specific practices and attitudes. On the other hand, the lack of differences in the acute dyspnoea content domain should not be generalized to assume that there are no differences in clinical reasoning in general or in other content domains. Clinical reasoning represents a complex problem-solving task that is strongly context-dependent [27]. The research in this area is limited by the availability of assessment instruments. The ASCLIRE test is available for this specific content domain but not for other domains that would allow a broader range of testing of clinical decision-making in other content domains. We considered the results of this study as a small but important piece in the puzzle of the overall picture of the impact of competency-based education on the clinical reasoning of medical students. With this report, we aim to make these so-called "negative results" available to the community to stimulate further research in this area and to make them accessible for potential future meta-analysis comparing the performance of medical students from competency-based programmes with that of medical students from other types of programmes.
Beyond these general considerations for the interpretation of our study results, the following particular conditions may have impacted the outcome of our study. First, the management of patients with acute dyspnoea was well covered in both types of undergraduate medical programmes, as it likely is in most, if not all, undergraduate medical programmes. Second, clinical decision-making was not explicitly taught and trained in either programme. It may be necessary to include formats that explicitly convey and train clinical decision-making to actually improve it.
This study has limitations beyond those discussed above. It was a single-centre study, which may limit the extent to which it is transferable to other contexts. Participants were not selected randomly. Due to the limited number of participants, it is not certain whether the sample represents the entire cohort. It would have been preferable to include whole annual cohorts from both undergraduate medical programmes and to test clinical decision-making in several content domains. This approach was prevented because it was not possible to implement new obligatory assessments for research purposes.
In conclusion, in the acute dyspnoea content domain, we found no differences in three objectively measurable parameters for clinical decision-making between medical students from a discipline-based and a competency-based programme. These results are consistent with subjective ratings by medical supervisors on clinical decision-making [19,20,21]. This study is intended to stimulate more and broader research on actual clinical reasoning performance in current competency-based undergraduate medical education programmes.
The dataset used and analysed during this study is available from the corresponding author on request where warranted.
ACGME:
Accreditation Council for Graduate Medical Education
ASCLIRE:
Computer-based test for assessing clinical reasoning
Integrated, competency-based curriculum
NKLM:
National Catalogue of Learning Outcomes in Medicine
OSCE:
Objective structured clinical exams
PBL:
TC:
Traditional, discipline-based curriculum
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The authors would like to thank Wolf Hautz and Fabian Stroben for providing the ASCLIRE test as well as for their support in carrying out the study. We further acknowledge support from the German Research Foundation (DFG) and the Open Access Publication Funds of Charité – Universitätsmedizin Berlin.
Anja Czeskleba, Dr. rer. Nat., research fellow and current PhD student at the Dieter Scheffner Center for Medical Education, Deans´ Office of Study Affairs, Charité - Universitätsmedizin Berlin, Germany.
Ylva Holzhausen, M.Sc., research fellow and current PhD student at the Dieter Scheffner Center for Medical Education, Deans´ Office of Study Affairs, Charité - Universitätsmedizin Berlin, Germany.
Harm Peters, MD, MHPE, is Director of the Dieter Scheffner Center for Medical Education, Deans´ Office of Study Affairs, Charité - Universitätsmedizin Berlin, Germany
The study was funded as part of the initiative "Hochschulpakt MSM 2.0" by the foundation "Bundesministerium für Bildung und Forschung". The researcher AC and YH were financed through this fund. The funding body had no influence on the design of the study and collection, analysis, and interpretation of data and on the preparation of the manuscript.
Dieter Scheffner Centre for Medical Education and Educational Research, Dean's Office of Study Affairs, Charité – Universitätsmedizin Berlin, Charité Platz 1, 10117, Berlin, Germany
Anja Czeskleba, Ylva Holzhausen & Harm Peters
Anja Czeskleba
Ylva Holzhausen
Harm Peters
AC and HP were responsible for conception and design of the study data collection, analysis and data interpretation. AC, YH and HP are responsible for drafting of the manuscript. All authors read and approved the final manuscript.
Correspondence to Harm Peters.
The data acquisition procedure was approved by the local data protection authorities and the local ethics board (No. EA4–096-16, Ethics Board, Charité – Universitätsmedizin Berlin, Campus Mitte). Written consent to participate was given by the study volunteers.
No details, images, or videos relating to an individual person are published in this paper.
The author HP is associated editor for BMC Medical Education.
Additional file 1.
Czeskleba, A., Holzhausen, Y. & Peters, H. Clinical reasoning for acute dyspnoea: comparison between final-year medical students from discipline- and competency-based undergraduate programmes. BMC Med Educ 20, 161 (2020). https://doi.org/10.1186/s12909-020-02055-y
DOI: https://doi.org/10.1186/s12909-020-02055-y
Final-year clerkship students
Discipline-based medical education
Competency-based medical education

redpajama_set_name: RedPajamaCommonCrawl


text:
\section{Introduction}

The classical theory of decision making is based on the expected utility
theory formalized by Von Neumann and Morgenstern [1]. In spite of its
normative appeal, researchers have uncovered several types of widespread
systematic violations of expected utility theory and of its underlying
assumptions, in experiments involving real human beings. Beginning with
the observations by Allais [2], Edwards [3], and Ellsberg [4] about fifty
years ago and continuing through the present, a growing body of clear
evidence has been accumulated, which shows that real-life decision makers
do not conform to many of the key assumptions and predictions of expected
utility theory. The deviations have been found to be systematic and
reproducible, and have been classified in so-called paradoxes and
fallacies, documented in a voluminous literature (see review articles
[5--7] and reference therein). While classical utility theory is perfectly
self-consistent, it is just that real human beings do not conform to its
predictions, leading to behaviors which appear paradoxical  {\it when
interpreted in the framework of classical utility theory}.

Here, we present an alternative ``Quantum decision theory'' (QDT) which,
while also being internally consistent as is classical utility theory,
provides correct predictions concerning the decisions made by real
humans under uncertainty. The behaviors of human beings, which appeared
paradoxical when interpreted with classical utility theory, find a simple
and unambiguous explanation, when interpreted through the lenses of QDT.
The underlying mechanisms at work to explain the characteristics of
decision making performed by real humans involve entanglement of actions,
the ordering of prospects with respect to the probabilities, the
interference between actions, and the mapping of the quantum interference
terms to human aversion towards loss and uncertainty.

The roots of our theory are found in quantum theory, based on the
mathematical techniques developed by Von Neumann [8] and Benioff [9,10].
Benioff [9,10] showed how the mathematical structure of quantum mechanics
provides a general description of quantum measurements [8] and of quantum
information processing [9,10]. Long before these works [8--10], Bohr himself
[11,12] mentioned that mental processes in many respects are similar
to those in quantum physics, and that quantum theory could serve
as a tool for attacking the problems associated with human thinking.

It is worth emphasizing that employing the mathematical techniques of
quantum theory for the description of human decision making does not
necessarily imply that psychological processes are truly quantum. This
simply means that such mathematical techniques are convenient tools for
formalizing the description of decision making, and provide novel testable
predictions.  The situation here could be compared with the following
well-known history of differential and integral calculi, which were
developed initially for describing the motion of planets under the
influence of gravity. But now, these calculi are used everywhere, for
problems having no relation to gravity. In the same way, the techniques
of quantum theory are nothing but the mathematical language of functional
analysis, which can be employed outside the quantum world, when
appropriate.

The aim of the present paper is to show that quantum decision theory
can be developed in such a way that it can be applicable not only to the
theory of measurements and to quantum information processing, but also to
some complex macroscopic problems, in particular by providing a coherent
structure to describe and predict decision making by real humans. For
this purpose, we reformulate the theory by accepting as its basic object,
not a manifold of simple actions but, a set of composite prospects. It
is the prospect compositeness that yields several nontrivial consequences,
such as decision interference, which reflects the presence of biases (with
respect to classical utility theory)  in the decision making process. The
developed QDT is shown to be mathematically self-consistent, and it can
explain the paradoxes of classical utility theory by accounting for the
empirical observations on decision making by real human beings. Its
usefulness is ultimately validated by its prediction of novel behaviors
that can be tested empirically. Our approach can also be applied to
quantum information processing on the manifold of composite prospects.
In order to show that QDT is mathematically justified, we present it
in a rigorous axiomatic way. Detailed calculations to explain the many
paradoxes reported in the framework of classical utility theory are given
in [7,16].

\section{Basic definitions}

The simplest elements in decision making theory are intended actions, or
just actions. We shall denote actions as $A_n$, enumerating them with the
index $n=1,2,\ldots$.

\vskip 2mm
{\bf Definition 1}.   {\it The action ring is a set ${\cal A}=\{ A_n: \;
n=1,2,\ldots\}$ of actions $A_n$, endowed with two binary operations,
the associative reversible addition, denoted as $A_m+A_n$, and the
distributive noncommutative multiplication, denoted as $A_mA_n$, which
possesses a zero element $0$, called the empty action, such that
$A_n0=0A_n=0$.}

\vskip 2mm
{\bf Definition 2}. {\it Two actions $A_m$ and $A_n$ from ${\cal A}$, with
$m\neq n$, are termed disjoint if and only if they are divisors of zero
with respect to each other, i.e., $A_mA_n=0$.}

\vskip 2mm
{\bf Definition 3}. {\it An action $A_n\in{\cal A}$ is composite, if and only
if it can be represented as a union}
\begin{equation}
\label{eq1}
A_n = \bigcup_{j=1}^{{\rm M}_n} A_{nj}
\end{equation}
{\it of ${\rm M}_n>1$ disjoint subactions $A_{nj}\in{\cal A}$, called action
modes, and $A_n$ is simple if it cannot be decomposed into a union of
form (\ref{eq1})}.

\vskip 2mm
{\bf Definition 4}.  {\it An action prospect $\pi_n$ is a conjunction}
\begin{equation}
\label{eq2}
\pi_n = \bigcap_j A_{n_j} \qquad ( A_{n_j}\in{\cal A}_n \subset {\cal A} )
\end{equation}
{\it of the actions $A_{n_j}$ taken from a subset ${\cal A}_n=\{ A_{n_j}:\;
n_j=1,2,\ldots\}$ of the action ring ${\cal A}$}.

\vskip 2mm
{\bf Definition 5}. {\it A prospect $\pi_n$ is composite if at least one
of the actions $A_{n_j}$ in conjunction (\ref{eq2}) is composite, and the
prospect $\pi_n$ is simple when all actions $A_{n_j}$ in conjunction
(\ref{eq2}) are simple}.

\vskip 2mm
{\bf Definition 6}. {\it Elementary prospects $e_\alpha$, with $\alpha=1,2,\ldots$,
are simple prospects}
\begin{equation}
\label{eq3}
e_\alpha = \bigcap_j A_{\alpha_j} \qquad
(A_{\alpha_j} \in {\cal A}_\alpha \subset {\cal A}) \; ,
\end{equation}
{\it such that any two elementary prospects $e_\alpha$ and $e_\beta$, with
$\alpha\neq\beta$, are mutually disjoint},
\begin{equation}
\label{eq4}
e_\alpha e_\beta = 0 \qquad (\alpha\neq \beta) \; .
\end{equation}

\vskip 2mm
{\bf Definition 7}. {\it The prospect lattice ${\cal L}$ is a set $\{\pi_n\}$
of partially ordered prospects $\pi_n$, such that any pair of prospects
can be ordered according to one of the linear transitive binary ordering
relations $\{ <,=,\leq\}$. Therefore, for any two prospects $\pi_1$ and
$\pi_2$, one has either $\pi_1<\pi_2$, or $\pi_1>\pi_2$, or $\pi_1=\pi_2$,
or $\pi_1\leq\pi_2$, or $\pi_1\geq\pi_2$. The minimal element is the empty
action $0$, and there exists a maximal element $\pi_*$, which makes the
lattice
\begin{equation}
\label{eq5}
{\cal L} = \{ \pi_n: \; 0 \leq \pi_n \leq \pi_* \}
\end{equation}
complete}.

\vskip 2mm
{\bf Remark}: The ordering operations are performed by using the
probabilities of the prospects introduced in Definition 18.

\vskip 2mm
{\bf Definition 8}. {\it For each mode $A_{nj}$ of an action $A_n$ there
corresponds a function ${\cal A}\rightarrow\mathbb{C}$, called the mode state $|A_{nj}>$,
such that it possesses a Hermitian conjugate state $<A_{nj}|$ and, for
any two mode states $|A_{ni}>$ and $|A_{nj}>$, a scalar product
\begin{equation}
\label{eq6}
< A_{ni} | A_{nj} > \; = \; \delta_{ij}
\end{equation}
is defined}.

\vskip 2mm
{\bf Definition 9}.  {\it The mode space is the Hilbert space}
\begin{equation}
\label{eq7}
{\cal M}_n \equiv {\rm Span} \; \{ | A_{nj} > : \;
j=1,2,\ldots,{\rm M}_n \} \; ,
\end{equation}
{\it which is the closed linear envelope spanning all mode states}.

\vskip 2mm
{\bf Definition 10}. {\it For each elementary prospect $e_\alpha$, there
corresponds a function ${\cal A}\times{\cal A}\times\ldots\times{\cal A}\rightarrow\mathbb{C}$,
called the basic state}
\begin{equation}
\label{eq8}
| e_\alpha>\; \equiv \; | A_{\alpha_1} A_{\alpha_2} \ldots > \;
\equiv \; \bigotimes_j | A_{\alpha_j} > \; ,
\end{equation}
{\it such that it has a Hermitian conjugate state $< e_\alpha|$ and, for any
two basic states $|e_\alpha>$ and $|e_\beta>$, there exists the scalar product}
\begin{equation}
\label{eq9}
< e_\alpha | e_\beta > \; \equiv \; \prod_j < A_{\alpha_j} A_{\beta_j} > \; =
\; \prod_j \delta_{\alpha_j \beta_j} \equiv \delta_{\alpha\beta} \; .
\end{equation}

\vskip 2mm
{\bf Definition 11}.  {\it The mind space is the Hilbert space}
\begin{equation}
\label{eq10}
{\cal M} \equiv {\rm Span} \; \{ | e_\alpha> \} = \bigotimes_n {\cal M}_n \; ,
\end{equation}
{\it which is the closed linear envelope spanning all basic states}.

\vskip 2mm
{\bf Definition 12}. {\it For each prospect $\pi_n$, there corresponds
a vector $|\pi_n>$ in the mind space ${\cal M}$, named the prospect
state $|\pi_n>\in{\cal M}$, possessing a Hermitian conjugate $<\pi_n|$}.

\vskip 2mm
{\bf Definition 13}.  {\it  The vacuum state is the vector $|0>\in{\cal M}$
corresponding to the empty prospect, for which}
\begin{equation}
\label{eq11}
< \pi_n | 0 > \; = \; < 0 |\pi_n> \; = \; 0 \; ,
\end{equation}
{\it for any $|\pi_n>\in{\cal M}$}.

\vskip 2mm
{\bf Definition 14}.  {\it A state of mind is a given specific vector
$|\psi>\in{\cal M}$ from the mind space, which is normalized, such that}
\begin{equation}
\label{eq12}
< \psi | \psi > \; = \; 1 \; .
\end{equation}

\vskip 2mm
{\bf Definition 15}. {\it The probability operator for a prospect
$\pi_n\in{\cal L}$ is the self-adjoint operator}
\begin{equation}
\label{eq13}
\hat P(\pi_n) \equiv | \pi_n > < \pi_n | \; ,
\end{equation}
{\it defined on ${\cal M}$ and satisfying the normalization condition}
\begin{equation}
\label{eq14}
\sum_n < \psi | \hat P(\pi_n) | \psi > \;  =  1 \; ,
\end{equation}
{\it in which the summation is over all $\pi_n\in{\cal L}$}.

\vskip 2mm
{\bf Definition 16}. {\it The algebra of probability operators is the
involutive bijective algebra}
\begin{equation}
\label{eq15}
{\cal P} \equiv \{ \hat P(\pi_n): \; \pi_n\in {\cal L} \} \; ,
\end{equation}
{\it with the bijective involution given by the Hermitian conjugation
${\cal P}^+={\cal P}$}.

\vskip 2mm
{\bf Definition 17}. {\it The expectation value of a probability operator
$\hat P(\pi_n)$, under the state of mind $|\psi>\in{\cal M}$, is the average
defined by}
\begin{equation}
\label{eq16}
< \hat P(\pi_n) > \; \equiv \; < \psi | \hat P(\pi_n) | \psi > \; .
\end{equation}

\vskip 2mm
{\bf Definition 18}. {\it The prospect probability $p(\pi_n)$ of a prospect
$\pi_n\in{\cal L}$, under the state of mind $|\psi>\in{\cal M}$, is the expectation
value}
\begin{equation}
\label{eq17}
p(\pi_n) \; \equiv < \hat P(\pi_n) > \; ,
\end{equation}
{\it with the normalization condition}
\begin{equation}
\label{eq18}
\sum_n p(\pi_n) = 1 \; ,
\end{equation}
{\it where the summation is over all $\pi_n\in{\cal L}$}.

\vskip 2mm
{\bf Definition 19}. {\it The probabilistic state is the set}
\begin{equation}
\label{eq19}
< {\cal P} > \; = \; \{ p(\pi_n) : \; \pi_n\in {\cal L} \}
\end{equation}
{\it of the prospect probabilities $p(\pi_n)$ for all $\pi_n\in{\cal L}$}.

\vskip 2mm
{\bf Definition 20}. {\it Two prospects, $\pi_1$ and $\pi_2$ from ${\cal L}$, are
indifferent if and only if}
\begin{equation}
\label{eq20}
p(\pi_1) = p(\pi_2) \qquad (\pi_1=\pi_2) \; .
\end{equation}

\vskip 2mm
{\bf Definition 21}. {\it Between two prospects, $\pi_1$ and $\pi_2$ from
${\cal L}$, the prospect $\pi_1$ is preferred to $\pi_2$ if and only if}
\begin{equation}
\label{eq21}
p(\pi_1) > p(\pi_2) \qquad (\pi_1 > \pi_2) \; .
\end{equation}

\vskip 2mm
{\bf Definition 22}. {\it The prospect $\pi_*$, which is the maximal
element of ${\cal L}$, is optimal if and only if the related prospect probability
is the largest among all $p(\pi_n)$, so that}
\begin{equation}
\label{eq22}
p(\pi_*) = \sup_n p(\pi_n) \qquad (\pi_* =\sup_n \pi_n ) \; .
\end{equation}

\vskip 2mm
{\bf Definition 23}. {\it The binary conjunction set}
\begin{equation}
\label{eq23}
{\cal B} \equiv \{ \pi_n e_\alpha : \;
\pi_n \in {\cal L} \; , e_\alpha\in {\cal A} \}
\end{equation}
{\it is the family of the conjunction actions $\pi_n e_\alpha\in{\cal A}$}.

\vskip 2mm
{\bf Definition 24}. {\it The probability operator for the conjunction action
$\pi_n e_\alpha\in {\cal B}$ is the self-adjoint operator}
\begin{equation}
\label{eq24}
\hat P(\pi_n e_\alpha) \equiv \hat P(e_\alpha) \hat P(\pi_n)
\hat P(e_\alpha) \; ,
\end{equation}
{\it defined on ${\cal M}$ and satisfying the normalization condition}
\begin{equation}
\label{eq25}
\sum_{n, \alpha} \hat P(\pi_n e_\alpha) = \hat 1 \; ,
\end{equation}
{\it in which $\hat 1$ is the identity operator on ${\cal M}$ and the summation
is over all $\pi_n\in{\cal L}$ and $e_\alpha\in{\cal A}$}.

\vskip 2mm
{\bf Definition 25}. {\it The probability $p(\pi_n e_\alpha)$ of the conjunction
action $\pi_n e_\alpha\in{\cal B}$, under the state of mind $|\psi>\in{\cal M}$,
is the expectation value}
\begin{equation}
\label{eq26}
p(\pi_n e_\alpha) \; \equiv \; < \hat P(\pi_n e_\alpha) > \; ,
\end{equation}
{\it with the normalization condition}
\begin{equation}
\label{eq27}
\sum_{n, \alpha} p(\pi_n e_\alpha) = 1 \; ,
\end{equation}
{\it where the summation is over all $\pi_n e_\alpha\in{\cal B}$.}

{\bf Remark}:
The probability $p(\pi_n e_\alpha)$ is the analog of the classical utility,
in the sense that, without additional effects, the conjunction action
which would be taken corresponds to the largest $p(\pi_n e_\alpha)$.
The next definition shows that there are additional interference terms,
which modify this classical picture.

\vskip 2mm
{\bf Definition 26}. {\it The quantum interference term for a prospect
$\pi_n\in{\cal L}$, under the state of mind $|\psi>\in{\cal M}$, is the average}
\begin{equation}
\label{eq28}
q(\pi_n) \equiv \sum_{\alpha\neq\beta} < \hat P(e_\alpha) \hat P(\pi_n)
\hat P(e_\beta) > \; ,
\end{equation}
{\it in which the summation is over all $e_\alpha\in{\cal A}$ and $e_\beta\in{\cal A}$}.

\vskip 2mm
{\bf Definition 27}. {\it Two prospects, $\pi_1$ and $\pi_2$ from ${\cal L}$,
are equally repulsive (equally attractive) if and only if}
\begin{equation}
\label{eq29}
q(\pi_1) =  q(\pi_2) \; .
\end{equation}

\vskip 2mm
{\bf Definition 28}. {\it Between two prospects, $\pi_1$ and $\pi_2$ from
${\cal L}$, the prospect $\pi_1$ is more repulsive (less attractive) if and only
if}
\begin{equation}
\label{eq30}
q(\pi_1) < q(\pi_2) \; .
\end{equation}

\vskip 2mm
{\bf Definition 29}. {\it A prospect $\pi_1\in{\cal L}$ is more repulsive (less
attractive) than $\pi_2\in{\cal L}$, in the sense of inequality (\ref{eq30}),
when one of the following is true:
\begin{itemize}
\item
$\pi_1$ leads to more uncertain gains than $\pi_2$ (less certain gain),

\item
$\pi_1$ gives a more certain loss than $\pi_2$  (less uncertain loss),
\end{itemize}
or $\pi_1$, as compared to $\pi_2$, requires to be:
\begin{itemize}
\item
more active under uncertainty (less passive under uncertainty),

\item
more passive under certainty (less active under certainty).
\end{itemize} }

{\bf Remark}: This classification is based on empirical evidence on human
decision making. To give a more complete and precize description, we formulate
in the definition below the counterpart of Definition 29.

\vskip 2mm
{\bf Definition 30}.  {\it A prospect $\pi_2\in{\cal L}$ is more attractive (less
repulsive) than $\pi_1\in{\cal L}$, in the sense of inequality (\ref{eq30}), when
one of the following is true:
\begin{itemize}
\item
$\pi_2$ leads to less uncertain gains than $\pi_1$ (more certain gain),

\item
$\pi_2$ gives a less certain loss than $\pi_1$  (more uncertain loss),
\end{itemize}
or $\pi_2$, as compared to $\pi_1$, requires to be:
\begin{itemize}
\item
less active under uncertainty (more passive under uncertainty),

\item
less passive under certainty (more active under certainty).
\end{itemize}   }

\section{Main results}

The above definitions make it possible to develop a self-consistent
quantum decision theory (QDT). This theory generalizes the quantum
theory of measurement developed by Von Neumann [8] and Benioff [9,10].
The principal innovation of our QDT is that it deals with composite
prospects, and not with simple actions. Also, the probability operator
(\ref{eq13}), generally, is an entangling operator [13--15]. These
features of our QDT result in the appearance of the quantum interference
term (\ref{eq28}) and, as a consequence, in the occurrence of interferences
between decisions. The latter serve as measures characterizing the prospects
as more or less repulsive (more or less attractive). The novel quantity,
the quantum interference term (\ref{eq28}), makes the QDT fundamentally
different from classical utility theory. In the frame of QDT, all known
paradoxes, plaguing classical utility theory, disappear. In other words,
QDT provides a coherent and realistic description of real human decision
making processes. Below, we present the main theorems of QDT, which make
clear that the theory is self-consistent and explain how the paradoxes
disappear within QDT. The detailed discussion and proofs of these theorems
will be given elsewhere [16].

\vskip 2mm
{\bf Proposition 1}. {\it The probability $p(\pi_n)$ of a prospect
$\pi_n\in{\cal L}$ is the sum}
\begin{equation}
\label{eq31}
p(\pi_n) = \sum_\alpha p(\pi_n e_\alpha) \; + \; q(\pi_n)
\end{equation}
{\it of the conjunction probabilities (\ref{eq26}) and the quantum
interference term (\ref{eq28})}.

\vskip 2mm
{\bf Proposition 2}. {\it The sum of the quantum interference terms
$q(\pi_n)$ over all $\pi_n\in{\cal L}$ is zero},
\begin{equation}
\label{eq32}
\sum_n q(\pi_n) = 0 \; .
\end{equation}

\vskip 2mm
{\bf Proposition 3}. {\it Between two prospects, $\pi_1$ and $\pi_2$ from
${\cal L}$, the prospect $\pi_1$ is preferred to $\pi_2$ if and only if}
\begin{equation}
\label{eq33}
\sum_\alpha \; [ p(\pi_1 e_\alpha) - p(\pi_2 e_\alpha) ] \; > \;
q(\pi_2) - q(\pi_1) \; .
\end{equation}

This proposition 3 shows that the preference of prospect $\pi_1$ over
prospect $\pi_2$ depends not merely on the relations between the
probabilities $p(\pi_1e_\alpha)$ and $p(\pi_2e_\alpha)$ but also on the relation
between the quantum interference terms $q(\pi_1)$ and $q(\pi_2)$. These
terms $q(\pi_1)$ and $q(\pi_2)$  influence the decision, by accounting for
such emotional feelings as the prospect attraction and prospect repulsion
which are involved in the process of decision making. The preferred prospect
$\pi_n$ is the one whose combined utility ($\sum_\alpha p(\pi_n e_\alpha)$) and
attraction ($q(\pi_n)$) are such that they satisfy the inequality
(\ref{eq33}).

The criterion (\ref{eq33}) is the basis for explaining a variety
of paradoxes typical of the application of classical utility theory
to real human decision making  [7]. In classical utility theory, the
interference terms $q(\pi_n)$ are absent, so that the preferred prospect
always corresponds to the largest utility. Real human beings do not follow
this specification, as exemplified by  the Allais paradox [2], the Ellsberg
paradox [4], the Rabin paradox [17], the Kahneman-Tversky paradox [18],
disjunction effect and the conjunction fallacy [5--7], which appear for
decisions made under uncertainty. The novel quantum terms $q(\pi_n)$ in
QDT makes it possible to resolve all these paradoxes.

The possibility of relating the disjunction effect with the interference
of actions was suggested earlier (see, e.g., [19,20]). However, the
principal advantage of our approach is that it is formulated  as a
self-consistent mathematical theory, which allows us to explain not
just one effect but actually all known paradoxes.

Our quantum decision theory is nothing but a general quantum theory of
measurement, endowed with an action ring, a prospect lattice  and a
probability operator measure. The algebra of probability operators plays
the role of the algebra of local observables. Because of the composite
nature of prospects and of the entangling properties of the probability
operators, quantum interference terms appear, which make actions
noncommutative and the prospect probabilities nonadditive. The developed
theory is self-consistent, containing no paradoxes, in contrast to those
that plague classical utility theory.

Our approach can be applied both to the description of human decision
making [7] as well as to quantum information processing. The tools for
realizing the latter can be of different physical nature. For example,
a convenient tool for quantum information processing can be constructed
on the basis of an optical lattice with multimode nonground-state
condensates of neutral atoms in each lattice site [21,22]. Then each
mode state $|A_{nj}>$ corresponds to a topological coherent mode of type
$j$, generated in a lattice site $n$. The mode space (\ref{eq7}) is a
Hilbert space of coherent modes of an $n$-site. Basic states (\ref{eq8})
form a basis for the states of the overall optical lattice. The mind space
(\ref{eq10}) is the Hilbert space for the coherent states of the whole
optical lattice. The prospect state $|\pi_n>$ is a state of ${\cal M}$, composed
of the superposition of the coherent modes generated in different sites.
The state of mind $|\psi>$ is a given reference state of ${\cal M}$.
Consequently, the prospect probability (\ref{eq17}) is the squared modulus
$$
p(\pi_n) = | < \pi_n |\psi> |^2
$$
of the transition amplitude $<\pi_n|\psi>$. The topological coherent modes
can be generated by applying an external resonant alternating field, either
modulating the trapping potential or varying atomic interactions [23,24].
The generation of the coherent modes can be well regulated, providing the
possibility of creating an atomic multimode register [21,22].

Another way of constructing a quantum register is by using molecular
magnets composed of nanomolecules with high spins. The spin states of
each molecule correspond to the mode states, forming the mode space
(\ref{eq7}). The states of the whole molecular magnet pertain to the mind
space (\ref{eq10}). The spin states can be governed by applying external
magnetic fields. An ultrafast spin regulation can be achieved by coupling
the molecular magnet to a resonant electric circuit [25].

We have here presented the general theory of  quantum information
processing devices, that applies to human decision makers, to atomic
multimode registers, or to molecular high-spin registers, or to other
condensed-matter registers. The common procedure for any quantum
register, playing the role of a decision maker, starts with the
classification of action prospects and ordering them through the
evaluation of their probabilities. Finding the optimal prospect
serves as a key for the subsequent functioning of the
information-processing device. Technical and experimental details of
such a quantum information-processing operation, requires separate
investigations, depending on the physical nature of a particular
system, chosen as a quantum register. But in any case, the operation
of these devices can be based on the mathematical scheme presented
in this Letter.

\vskip 5mm

{\bf Acknowledgement}: One of the authors (V.I.Y.) is grateful to
P.A. Benioff for useful correspondence and helpful remarks. Fruitful
discussions with E.P. Yukalova are appreciated.

\vskip 1cm

redpajama_set_name: RedPajamaArXiv


Come out and support Camp Liberty on April 27th at the American Spirit Centre in Brighton, Mi. Enjoy a dinner, bar, guest speakers and participate in the fundraising activities throughout the night. There will be many ways to show your support through the games, raffles and auctions. Follow the link at the bottom of the page to get registered today.
Our theme for this year is "The Rockin' 50's", so dress up if you want, and drive up in that classic restoration or hotrod vehicle to make it more interesting.
Rick Briggs has a 4th of July Veteran Talk Radio interview about Camp Liberty, the Eisenhower Center and how other sponsors and donors were involved.
The opening interview is 17 1/2 minutes long and discusses Camp Liberty programs and why it created. Then we cover how the Eisenhower Center, the DG Foundation and others helped with the building of our facilities and how Kroger sponsored ourr BBQs all year. Then we disucssed how the Operating Engineers and Michigan Cat helped with the pond, how ITC sponsored our Action Track Chairs, the up-coming "Open House" on July 29th and a new state wide project Rick is working on and hopes to announce in the near future.
Near the end of the broadcast is an old John Wayne recording of what America means to him, good to listen to also. Thanks to all that are trying to make a difference in our Veterans and service member family's quality of life. They are paid so little for what they are asked to do… enjoy, and "thanks" again.
Midwest Motorcyclist features Camp Liberty's Crusader Motorcycle and Raffle.
Fox 2 News Veteran's Day interview with Rick Briggs and other Veterans that help with CAMP LIBERTY.
Camp Liberty dedicates new lodge – Camp ready to help veterans in need!
Read about Camp Liberty's dedication of our new lodge at our open house in August.
Nearly 200 vets and their families enjoyed a great day of racing at the FireKeepers Casino 400 race at MIS Speedway in Jackson, MI. Good weather and a fun to watch race where the highlights of the day. This family sent Camp Liberty this picture and offered a big "Thank You" for the tickets that Camp Liberty got for them. A big thanks for serving the country!!
Camp Liberty received the following thank you letter from another Veteran who took her grandfather to the FireKeepers Casino 400 race. We are very pleased she and her grandfather enjoyed the day.
I wanted to thank whomever donated the tickets for the race! I took my grandpa and we had a blast! He's still telling everyone about it! We even got to see a friend of ours that works for NASCAR. We got to tour the garage, meet the crew chief of car he works on and the owner of the car! We got pictures with multi cars!
I will definitely remember it for the rest of my life!
Atlas Roofing from Grand Rapids, MI has become a major donor to Camp Liberty with multiple gifts of building suppliers for new Lodge. The plant manager of their insulation plant has been very supportive of the project, and different divisions of their company donated floor insulation, wall sheathing plus insulation, roof sheathing plus insulation, and all the roofing materials for the Lodge. We dared to ask them to donate again, and they stepped up and provided all of the roofing materials for the storage building as well. The value of their donation is about $35K. Their plant manager and PR team visited Camp Liberty and wrote this article and put it in their internal company newsletter. Camp Liberty is really appreciative for Atlas Roofing's support. Please review that article and read about several disabled vets who have experienced some of the resources offered by Camp Liberty.
Lori Lewis is a teacher at St. Pauls Lutheran School in Ann Arbor and has a son currently serving in the US military. During a late January service project that included her students, she chose Camp Liberty as the charity they wanted to support. They found our website and signed up through our donor registration portal. Camp Liberty was not sure what they had done, but was pleasantly surprised at their generosity and thoughtfulness. The kids and the teaching staff actually collected items that can be used as supplies for our new lodge or given to vets who needed some of the personal care items. There are many items that can be used at the lodge for when Camp Liberty holds organized events or when we have veterans spending the evening.
Besides the gifts, each child personally hand wrote a note to our veterans and they really tug at your heart. It is so refreshing that a group of kids appreciate what our veterans are doing for America. Our intent is to share the notes with veterans when they visit our lodge.
Thanks to Lori Lewis and her kids at St. Paul Lutheran School in Ann Arbor, Michigan.
Jeremy Briggs is interviewed by the internal magazine "Tomorrow" at the Chrysler Corporation and he discusses the hidden wounds that modern soldiers often carry when they come back home.
Please take a moment and listen to this 15 minute interview below (first half of show) and great plug for Camp Liberty and the After the Impact programs that was just on WHMI in late December. Also check out the link off their website.


text:
I Will Play For You
July 24, 2020 September 18, 2020 Priyanka Kanjilal Short Stories
A man playing the guitar secretly in his house hums happily with such joy that anyone would know that he is an ardent lover of music. As he leaves the house with the guitar on his back, a girl beams into him. He sees through her while he moves to the car. The car moves and as a sad song plays through. His moods were quite quickly modifiable, it seemed. By the time, he reached office, he had a very calculated and unfathomable expression. The guitar he carried was as if a part of him, always with him but was never played. He was a star performer in the confines of his mind and probably just his house. The girl who bumped into him that morning had been secretly stalking him and had noticed everything about him. She was his neighbour and wondered why should he play secretly and not share such a treasure he owns. And also that why does he leave the happiness in the room while going out. One day, she gathered courage and knocked at his door. She requested him to teach him as she admired the music coming from his house. He refused. She was surprised but did not lose hope.
She was quite patient and decided that no matter how long it took, she would learn from him and nobody else. She knocked every day until six months. The man finally agreed in response to the tears in her eyes.
She started coming to his place every third day for Music classes. These were the most beautiful moments in the day of the girl, though there was little or no communication between the reluctant tutor and the student except music notes. One day she got a diary on his table. Reading it, she smiled and shed her closest tear. As he entered the room, looked at her holding the diary, he was very angry with her and sent her away forever. The girl turns to him, says, "I will play for you", smiles with a resolute expression and walks off. She had learned some good music till then and was quite talented too. So, she started playing in her college fests and soon became insanely popular. As she attended bigger concerts and drew more fans to her, she once said in a Press conference. "Fredrick is the man who has made what I am today. Though he is not in my life he is in my music. I love him and my love for him lives in my music." Fredrick shed a tear as he watched the TV show though it was not clear whether the tear was from a memory or merely due to regret. On the TV screen, the Girl's smile was of a proud win.
In the house, Fredrick silently smiles and with an unreadable expression, opens his Diary which read, "I will never play for anyone, without you." This was for his girlfriend, her partner in playing music, who died and then he had promised to himself that he would never play music again for people. He tore off the page and wrote there -"I will play for you". He started playing, teaching and within days everyone knew his talent, loved his music. And his lost love was brought back to life; he started living her memories every time he played. He felt happy as he could feel her presence whenever he played.
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Priyanka Kanjilal
A computer graduate who is now a full-time writer, Priyanka feels that stories are a medium to narrate and share the various experiences of life.
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