Understanding Performance Management Essay Example for Free

Understanding Performance Management Essay The mandate to operate at an optimal performance level and meet financial and organizational expectations are transforming the way organizations do business. This evolution is driving higher standards of competence in day-to-day operations and adding new pressure to increase stakeholder value. In today’s rapid-paced business climate, the agility with which a company manages performance can determine market position and company profitability. Defining Performance Management Performance management is the integrated process of defining, assessing, and reinforcing employee work behaviors and outcomes (Cummings and Worley 2005). Performance management focuses on understanding, optimizing, and aligning action and decisions and ensuring the collaboration and empowerment of all individuals across the business network. It includes practices and methods for goal setting, performance appraisal, coaching, employee development and reward systems. More than ever, organizations need broader measures of employee performance to ensure that (1) deficiencies are address in a timely manner through employee development programs that meet the needs of the organisation and its market, (2) employee behaviours are being directed toward performance of specific objectives that are consistent with the work unit and the organization strategy, and (3) employees are provided with proper and timely feed back to assist with their career development. These practices jointly influence the performance of individuals and work group, and enables them to work across strategic, tactical, and operational levels to align actions to ensure optimal performance. In order for effective performance management to take place, the process must utilize information from three time periods to do so. It makes use of data from the past in order to gather information form past performance. This information is then utilized in the present for the establishment of work plans, goals and the setting of development opportunities. These objectives therefore allow for high levels of performance in the future. The Purpose of the Performance Management System The main purpose of performance management is to make sure that employee goals, employee behaviours used to achieve these goals and feedback information about employee performance are all linked to the corporate strategy. However there is no one way to manage performance. What ever system is adopted needs to be congruent with the culture and principles that pervade the organization. Most systems of performance management has three purposes- Strategic, Administrative, and Developmental. The strategic purpose- Defining Performance One of the ways in which strategies are implemented is by management defining the desired results, behaviours and employee characteristics necessary for carrying out strategy. They can then develop measurement and feedback mechanisms which will show hoe effectively results are being achieved and what to do to produce results. The organization can achieve this strategic purpose if it is flexible and amendable to changes in the goals and strategies which can occur, and also to recognise that if such changes occur, then there needs to be change in results, behaviours and characteristics of the employees, which must of necessity change to correspond with such organizational changes. The Administrative Purpose-Measuring Performance Performance appraisal information is one of the main instruments used by organizations for making administrative decisions, for example, salary administration, in terms of pay raises; promotions, retention or termination, recognition of individual performance and identification of poor performance. The Developmental Purpose- Feedback and coaching This aspect of performance management seeks to develop further, employees who are good at their jobs. In instances where employees are not performing up to standard, performance management also seeks to improve their performance through coaching. The feedback from the performance evaluation process indicates or identifies the areas of strengths and weakness in the employee performance. It is therefore critical to businesses that they recognise and fulfill the purpose of an effective performance management system as this is central to gaining a competitive advantage through the management of human resources. They also need to develop the measures by which performance can be evaluated. The discussion now turns to the development of the performance management system. It describes the major strategic decisions that must be put in place if the task force is to effectively design a performance management system. In order for a successful performance management to be established, the process must utilize five strategic decisions. 1. How the system will be used be used? 2. Who does the evaluation? 3. What areas are to be evaluated? 4. How should the evaluation be done? 5. What are the ways in which the evaluation can be done? How will the system be used Planned employee development should be one of the basic concepts of any organization’s performance management system. This is an attempt to state a broad policy which removes any option about people development by stipulating that developing people is a pillar of whatever system of management the organization espouses. This people development should be planned, not given mere lip service or expected to happen by itself. Adoption of this policy would guard against the simplistic way in which some supervisors consider themselves to be results oriented as opposed to people oriented, thus absolving themselves from people development. The major thrust of employee development will be to emphasize that the development of people as the best means available to achieve results for the organization. Three new thoughts are intended in this policy rec ¬ommendation. First, because development is different for everyone, there should be individual development plans. While there may always be areas of growth or development common to many at the same time, these ought not to be the sum total of the people develop ¬ing process taking place. It is often an easy excuse for supervisors point to plant–wide or company–wide â€Å"people† programs as a way of absolving themselves of their people developing responsibility. The second operable word in this policy state ¬ment is review. The supervisor is required to follow up on the people development plans. They are not to be spoken of enthusiastically for a brief period and then forgotten. If documented on company forms, they ought not to be forwarded to some staff office as though float ¬ing off into never–never land. They require monitoring so that progress can be checked periodically. Third, individual plans should be reviewed at least annually. This is an attempt to offer some time frame for periodic review, so as not to make the task too time–consuming. Furthermore, a lot can happen in twelve months, so that this time span is not too soon for considering new situations that might warrant chang ¬ing or updating the plan. Many practicing managers indicate a twelve month time frame as a practical one, especially when the development plan is discussed in the context of the annual performance evaluation. Each of my subordinates should work out a specific plan of personal development. Two thoughts are contained in this policy statement. First, each subordinate is to have a development plan. Again, we speak of the universality of develop ¬ment. This isn’t only for the weak, or only for those identified as shinning stars, or only for any select lucky or unlucky few. Everyone has developmental needs in order to help achieve the mission of the organization. Second, there is the question of who works out this plan for development. Some may immediately think of some subordinates who do not appear capable of working out their own personal development, hence this may prompt a negative vote (or â€Å"false† mark) on this state ¬ment. Clearly there will be some individuals less qualified than others to work out such a plan. But the intent is not to expect people to do it alone – quite the contrary. The real point of this statement is to fix on the subordinate a sharing of the development responsibility for which the supervisor is accountable. It becomes then a shared responsibility between the supervisor and the subordinate. I should require individual development plans from each of my subordinates Again many mangers can point to individuals who might state, or have stated, they are not interested in development. We’ve all encountered people like that. They readily assert that they have no interest in getting promoted; they know their job, they do it well, they simply want to work 9 to 5 and leave the jockeying for positions to someone else. This is precisely why the uni ¬versality of the need for development needs reinforcing. It ought not to be an option. The organization cannot afford to let people maintain that attitude. It is not what we want to people to think of promotion or becoming managers or anything they truly do not want to become, but in order to continue to perform well in the present areas of responsibility, people must keep pace with develop ¬ments in their field. Because no job stays the same, no jobholder can stay the same. â€Å"Future shock† is a concept with which we are all familiar. So much happens in the work developments around us that no job remains the same very long. Hence, if a worker is doing the job the same way he or she did a year ago, that person is less effective, if not completely wrong. Periodic on–the–job coaching is a major part of an individual’s development. The hope here is that the supervisor will feel at home with the statement and its implications. Periodic instruction or assistance on the job is an everyday occurrence. No one will deny the need for giving instruction or assistance on the job to those who need it, and some need it more that others. If we can begin to see this part of the warp and weft of individual development, then the universal change envisioned in these statements will not be so threatening to some. Who evaluates Performance appraisal of the employee should be done by immediate supervisor. The supervisor is the one who is usually in the best position to observe and evaluate his or her subordinates’ performance and he or she is responsible for that person’s performance. References I/O psych text Another approach that can be used is peer appraisals. According to kane and Lawler(1978), three techniques are usually used : (1) Peer nomination- each person nomoinates a specified number of group members as being highest in particular dimension of performance. (2) Peer rating- each group member rates the others on a set of performance dimensions using several kinds of rating scales. 3) Peer ranking- each member ranks all others from the best to worst on one or more performance dimensions. The Appraisal of an employee by his or her peers can be effective in predicting future management success. One problem however is log rolling; that is all the peers simply get together to rate each other highly. Also many group members donot like to evaluate one another, so part of the method hinges on impressing participants with its values. There is also the rating committee which is usually composed of the employees’ immediate supervisors and three or four other supervisors. This type of rating is useful and advantageous because while there may be discrepancies in the rating s made by individual supervisors, the composite ratings tend to be more reliable, fair and valid. Another advantage is that several raters can cancel out problems like bias and the halo effect on the part of the individual rater. Employee evaluation can also be done by employees assessing their own behaviour. This is known as the self assessment technique. The basic problem with this is that employees usually rate themselves higher than they are rated by their supervisors or their peers. Meyer(1980) reorted a study in which engineers rated their own performance against their views of the performance of other engineers in the company. On average, each engineer thought he or she was performing better than 75% of the rest of the engineers in the study. Statically, it is quite a trick to have a 100% of the workforce be in the top 25%b of job performers. This underscores the biggest problem with self- assessment: positive leniency. Most people have higher opinions of their own performance than others do. There is also the other form of appraisal which is appraisal by subordinates, otherwise known as upward feedback. In this situation, subordinates are anonymously asked to evaluate their supervisor’s performance. When this type of appraisal is conducted throughout the firm it really helps the top managers to diagnose management styles, identify potential people problems and take corrective action with individual managers as required. Appraisal may also be conducted through performance feedback from all the persons with whom the employee has to interact; this interaction is referred to as 360-degrwee feedback. The appraisal can take place between coworkers, subordinates, and internal and external customers. The Performance Appraisal Interview and the Coaching Process The appraisal interview is one in which the supervisor and subordinate review the appraisal and make plans to remedy deficiencies and reinforce strengths. For many supervisors the formal performance appraisal interview is one of the most dreaded activities of the role. Of course, supervisors often have no problem evaluating the outstanding performer. The problem is with everyone else. They are put in the position of providing information to a subordinate that often runs contrary to the subordinates own self-evaluation or self-image. This can lead to a number of outcomes that many managers would prefer avoiding. In conducting appraisal interviews effectively there are four major things that supervisors must do in preparation for interview: 1. Spend a lot of time preparing; go over the subordinates performance, your own interactions, the history of the employee; if the employee reports to a number of supervisors, make sure you have input from all relevant sources 2. They must assemble data, study the person’s job description, compare the employee’s performance standards that would be evaluated against, and review the files of the employee’s previous appraisals. 3. Supervisors should also prepare employees, that is , give them at least a week notice to review their work, read over job description, analyze problems and gather their questions and comments so that the interview can be a two-way conversation. 4. A mutually agreeable time should be choosen ofr the interview. Enough time time should also be scheduled for the intertview. Having prepared for the interview there are four important things that supervisors need to cognizant of: ? Supervisors should attempt to be direct and specific all times. They should speak in terms of objective work data such as absences, tardiness, qulit records, inspection reports, productivity records and cost reduction. This is done so that employee is aware of all the areas that he or she is being appraised on. ?The supervisor should also encourage the appraisee to talk. Stop and listen to what the person is saying. The supervisor should ask opened questions such as â€Å" what do you think we can do to improve the situation ? ? Do not get personal. Supervisors should try to compare employees’ performance to given standards and not to othe performance of other people. This can help to avoid confrontation or misunderstanding between the appraiser and appraisee. This also ensures that the person know what they are doing wrong and what they are doing right. The supervisor s hould ensure the persons understands , and get agreement before he or she leaves on how things will be improved and by a give n date . An action plan shoud also be developed showing steps and expected results. Coaching: Some General Guidelines be as specific as possible take advantage of critical incidents-for example after a major project, sit down and reflect with your subordinate about lessons learned identify specific developmental agendas identify resources available to subordinates adapt your coaching style to the individual Link to compensation Many people may argue that a performance appraisal is little more than a tool for managers to use in wringing as much work as possible from individuals without adequately rewarding them. This perception is difficult to deny if you have ever been the victim of such exploitation. Indeed, it must be recognized that a dishonest and secretive performance appraisal system will only exacerbate poor employee relations. However, if employees believe that the system can assist them in furthering their own careers and economic prospects, performance appraisals can actually boost employee morale. Performance appraisals are particularly useful in facilitating equitable decisions about salary if the agency uses a merit pay system as the basis for salary progression. A merit pay system requires a method for translating judgments about work quality into appropriate salary actions. Pay increases of varying sizes must be rationally explained if a merit pay system is not to seem arbitrary. If an organization has an automatic pay system, with scheduled salary increases, performance appraisals will help identify (and justify the termination of) unsatisfactory employees who demoralize others, since they receive the same salary increases as good workers. Recent research (Bannister Balkin, 1990) has reported that appraisees seem to have greater acceptance of the appraisal process, and feel more satisfied with it, when the process is directly linked to rewards. Such findings are a serious challenge to those who feel that appraisal results and reward outcomes must be strictly isolated from each other. Methods for performance appraisal

Probability lesson plan Essay Example for Free

Probability lesson plan Essay Probability the study of chance (Mathematics-sophomore) The purpose of this lesson aid is to help each student to know the basic principle of probability and to apply it to their everyday life. Probability or the study of chance is an important branch of mathematics that can be applied in other branch of sciences like biology, chemistry and physics. Example: What is the probability of getting a black queen from a standard deck of cards? We all know that there are 52 cards in a standard deck of cards and there are only two queens in it. So, the probability of drawing a queen is 2 out of 52 or 4. 16 %. Quiz: 1. What is the probability of getting a red card in a standard deck of card? 2. What is the chance of getting a face card in a deck of card? 3. In a game of poker, what is the chance of getting a straight? 4. Given a fair die, what is the probability of getting a 7 if you to toss the die two times? 5. Given the same die, what is the chance of drawing an even number? 6. Given a pair of dice, what is the chance of drawing an odd number? 7. Given a pair of dice, what is the chance of rolling a 7? 8. What is the probability of getting a flush in a deck of cards? 9. What is the probability of getting a royal flush in a game of poker? 10. Given a tetrahedron, what is the chance of rolling a 4? Lucky 9 The material needed in this game is a standard deck of playing cards. The rule of this game is obtaining a sum of nine from the two cards that will be given to you by the dealer. If none of the player has an exact card value of nine, the player with the highest card value wins. Instruction: 1. This game is for 2-4 persons. Each player is given two cards. 2. Each player will sum up their card using their respective value. The face card has a value of ten. 3. The player may opt to get another card if he/she is not satisfied with the sum of his/her card but it can be done only once. 4. If all the players are player are already satisfied with their cards, each will reveal their cards and add them up. 5. If the player obtains an exact value of nine, that player wins. 6. If the added card value is greater than nine, only the ones digit will be taken. Example, the total card values is equal to 14 then your score is 4. 7. If none of the players got an exact added value of nine, then the player with the highest score wins. If two or more player acquires the same added value, then it is a tie. For further explanation on probability, visit: http://www. betweenwaters. com/probab/probab. html. In this site, you will play a probability game. Just play this game and you will understand the concept of probability. Reference: Lemoine, Shirley (2001). Probability: the study of chance. Retrieved August 24, 2007 from http://www. col-ed. org/cur/math/math15. txt.

Anchorage in Orthodontics- A Review

Anchorage in Orthodontics- A Review Orthodontics is the branch of dentistry concerned with facial growth, the development of the dentition and occlusion, and the diagnosis, interception and treatment of occlusal anomalies. The goal of orthodontic treatment is to improve the persons life by enhancing dental and jaw function and dentofacial aesthetics. This is achieved by obtaining optimal proximal and occlusal contact of teeth (occlusion) within the framework of normal function and physiologic adaptation, acceptable dentofacial aesthetics and self-image and reasonable stability (Graber and Vanarsdal, 1994). Conventional orthodontic treatment is achieved using fixed and removable appliances to achieve a planned end point of treatment. Orthodontic anchorage is an important concept in orthodontic treatment, and can be reinforced by many types of appliances. Orthodontic headgear has traditionally been considered to be the gold standard appliance for reinforcing anchorage. However, an increasing awareness of the drawbacks of headgear, mainly poor patient compliance and serious eye injuries, has led to the development of appliances in which the evidence base supporting their use is incomplete. In addition, it has been suggested that functional appliances which are traditionally used for growth modification, can be used for   anchorage preparation. In this section, the concept of anchorage in orthodontic treatment is reviewed. The definition of anchorage is presented including its relationship to space requirements, extractions and certain appliances, including the potential of using functional appliances for anchorage. As the effectiveness of some of these appliances has been evaluated by randomized trial methodology (RCT), an account of the bias that can arise in RCTs is given and the potential effect this bias may have on the trial results. Finally, the important aspect of measurement of variables in orthodontic research is reviewed focusing on the reliability and validity of new measurement methods using computer software and digital models. 1.2.1 Definition and importance Anchorage in orthodontics can be defined as the resistance to unwanted tooth movement [1]. When an orthodontist/dentist plans treatment they evaluate the anchorage requirement by estimating the amount of space that is needed to correct the malocclusion. Anchorage   or space may be obtained by extracting teeth, moving teeth into certain position and/or the use of orthodontic appliances. Achieving anchorage can be obtained by one of the following methods: 1.2.2 Maximising the potential of available teeth: In this method a force is applied between two points (tooth or groups of teeth) and tooth movement is controlled by making one point more resistant to movement than the other. This is done by careful planning of the site of force application. Examples include: Active movement of one tooth versus several anchor teeth, for example correcting the centreline by moving one tooth at a time. Teeth of greater resistance to movement are utilized as anchorage for the translation of teeth that have less resistance to movement. A common example of this is closing space by pitting the posterior teeth (greater resistance) against the anterior teeth (less resistance). Increasing the number of teeth in the anchor unit, examples are: Adding the second molar to the fixed appliance. Adding the anterior teeth to reinforce posterior anchorage by bending loops mesial to the first molars. Adding teeth from the opposing arch to the anchor unit by utilizing inter-arch elastics. Making movement of anchor teeth more difficult, for example putting a tip- back bend in first molars. Using ankylosed teeth as anchors. 1.2.3 Providing an additional form of orthodontic appliance: The anchorage gained from the previous methods is limited. As a result, it is necessary to reinforce the anchorage with an additional appliance. The most commonly used orthodontic anchorage devices are: Extra oral anchorage (EOA) with headgear Intraoral anchorage with palatal and lingual arches. 1.2.4 Headgear Headgear is an orthodontic appliance that is used to apply forces to the teeth utilising structures outside the oral cavity. Headgear is usually applied to the first maxillary molar via a tube attached to the molar band. The force necessary to provide extra oral anchorage is 200 to 250 gm applied for 10-12 hours per day [2]. Headgear was first used for anchorage by Kingsley in 1866 to retract upper incisors in an upper premolar extraction case [3]. This was followed by Angle in 1888 and Case in 1907 [3]. In 1953, Kloehn developed the contemporary design of headgear that orthodontists   use today [3]. Since then, headgear has been used conventionally when maximum anchorage is required. As a result, it may be considered the gold standard for anchorage in orthodontic anchorage. 1.2.5 Disadvantages of headgear: The use of headgear has the following disadvantages or risks: Compliance: From the early days of headgear use, it was clear that substantial compliance was required and failure to wear headgear, for the prescribed amount   of time, was recognised [3]. Headgear compliance is measured as the discrepancy between actual hours of wear and reported hours of wear and has been evaluated in several studies. Results of these studies have been discouraging as the actual hours of wearing headgear appear to be much lower than that required [4-6]. For example, Brandao et al in 2006 suggested that patients who had been asked to wear their headgear for 14 hours a day, reported wearing their headgear an average of 13.6 hours a day while the actual hours of wear were only 5.6 hours [4]. Cole [6] and Cureton [5] also found that the reported hours of wear were much less than the actual hours of wearing headgear . Soft tissue injuries: Apart from minor injuries to the surrounding intraoral and   extra oral soft tissues, serious ocular injuries have been reported both in Europe and the United States. In some of these instances blindness has resulted as a final result of the injury. Ten eye injuries have been reported in the literature; 2 in the UK, 3 in France, 2 in Italy, 1 in Germany and 2 in the United States [7, 8]. These injuries resulted from one of several factors including dislodgement during sleep, improper removal of headgear or improperly playing with the headgear. Nickel Allergy: A small portion of the population will exhibit sensitivity to the Nickel alloy in facebows [9-11]. Nickel allergies in response to orthodontic appliances are not considered a major health risk. Exacerbation of pre-existing eczema: there has been a case reported in the literature in which an increase in the severity of a pre-existing atopic eczema was observed after headgear wear [12]. It is evident from the problems mentioned that the most significant drawbacks of headgear use are non-compliance and serious eye injuries. Several measures have been taken to overcome these two problems with varying amounts of success. 1.2.6 Improving headgear compliance: Suggestions have been made in the literature to encourage patients to increase the actual number of hours in which headgear is worn; these include the following: The use of a headgear calendar [13], The use of a headgear timer or electronic monitoring device and informing the patient of its presence [14], The use of conscious hypnosis for patient motivation during headgear wear [15], Treatment by a defined behavioural model which depends on a schedule for wearing headgear, in addition to parental observations and rewards based on patient compliance. This behavioural model is flexible and will evolve according   to the patients response and needs [16], Promoting headgear wear by considering gender differences, making patients more aware of their malocclusions and the effect of treatment [17]. 1.2.7 Headgear safety mechanisms: Several features have been added to headgear in an attempt to prevent elastic   recoil injuries or unintentional detachment of the headgear. These include: Lock mechanisms which prevent release of the facebows from the molar tubes [18], Snap-release headgears which prevent elastic recoil of the facebows when an excessive force is used [7], Plastic safety straps which attempt to limit the movement of the facebows [7], Intraoral elastics to attach the inner bow to the molar tube [7], Blunting and smoothening the ends of the facebows to reduce the potential for injury [7]. It has been recommended that at least two of these mechanisms are used simultaneously in addition to clear verbal and written instructions to the patients and parents [19]. In summary, headgear is considered the gold standard appliance for providing anchorage. However, in order for it to work effectively, it requires a significant amount of patient cooperation and compliance. There have been many attempts to improve headgear compliance, which is a reflection of the failure to overcome this problem. Finally, there   are several safety issues related to headgear, which may discourage patients and orthodontists from its use. The ideal solution would be to use an anchorage device that provides at least the same anchorage potential as headgear, but requires little or no compliance. This has led to the development of surgical anchorage devices. 1.2.3 Surgical anchorage In this thesis I will use the term surgical anchorage to denote all types of anchorage devices which are surgically placed in the maxilla or mandible. The use of implants for orthodontic anchorage is a rapidly developing field and appears to be very promising. It has evolved from using conventional restorative implants in the line of the arch to more specialized palatal implants and mini-plates, to mini-screw implants. Types of surgical anchorage include mini-screw implants, mini-plates and midpalatal implants. The mini-screw implant is a modification of screws used for fixation of maxillofacial fractures. Although they have varying lengths and diameters, they are generally smaller than maxillofacial fixation screws, hence the term mini. It is also important to distinguish mini-screw implants from midpalatal implants which can be used for orthodontic anchorage, as the latter are endosseous implants and a modification of prosthetic implants. Mini-plates are small surgical plates that must be surgically screwed to bone under the soft tissue. Mini-screw implants may provide anchorage reinforcement because of the combination of mechanical retention immediately after insertion (primary stability) and a degree of osseointegration. Mini-plates provide a stable structure fixed to bone for application of forces and midpalatal implants offer stability by osseointegration. Despite the widespread adoption of this type of technology, there is a dearth of high quality clinical research into their effectiveness. The literature concerning their use is referenced in section III as part of the systematic review. 1.2.4 Class II functional appliances Functional appliances are orthodontic appliances that utilize the facial and masticatory musculature to produce orthodontic forces. They are commonly used in the treatment of Class II malocclusions. They can either be removable, for example the Clarks Twin Block appliance, or fixed, for example, the Herbst appliance. In the UK, the most popular functional appliance for treating Class II malocclusions is the Twin Block [20]. Functional appliances were developed to treat malocclusions by growth modification,   by encouraging differential growth of the mandible and maxilla. In Class II malocclusions the objective is to encourage growth of the mandible and/or restrain growth of the maxilla. While this theoretical effect of functional appliances is often quoted, the evidence behind these concepts is lacking.   Recently, there have been a number of randomized clinical   trials evaluating the skeletal effect of functional appliances. These are summarised in a Cochrane systematic review published in 2013 which assessed and analysed outcomes of 17 studies [21]. These studies produce interesting results. When early two-phase treatment with a functional appliance was compared to adolescent one phase treatment (patients who did not receive a functional appliance), there was no difference in the final ANB (MD -0.02 °, 95% CI -0.47 to 0.43. P = 0.92). Similarly, when a comparison was made for early treatment between headgear and functional appliances, there was no difference in the final ANB (MD -0.17 °, 95% CI -0.67 to 0.34, P = 0.52). When functional appliance treatment was performed in adolescents and compared to untreated controls, there was a statistically significant difference in ANB (MD -2.37 °, 95% CI -3.01 to -1.74, P It was concluded from the results of these trials that the amount of skeletal change (growth modification), from the use of functional appliances is small and is unlikely to be   clinically significant. Nevertheless, it is clear that these appliances are very effective in the correction of Class II malocclusion primarily through dentoalveolar movements. The following effects of Twin Block treatment are clinically useful: Enhancing facial appearance [22, 23] Distalising upper molars and molar correction [24, 25] Reducing the overjet [24-30] Proclination of lower incisors [24-26, 28, 30, 31] Retroclination of upper incisors [24-26, 28, 30] A case report using Twin Blocks to treat a Class II division II case suggested that a Twin Block can be used instead of headgear derived anchorage [32]. When we consider the preparation of orthodontic anchorage it is common clinical experience that molar correction and the reduction of the overjet are major factors in reducing the anchorage requirements of a case. As a result, some clinicians use functional appliances in anchorage preparation with the aim of avoiding dental extractions or other forms of anchorage. A common method of achieving this is by utilizing a 2-phase treatment protocol during adolescence [33]. The first phase of treatment is achieved by using only a functional appliance. This phase usually continues until the overjet and/or molar relationship is corrected. The clinician may then choose to retain the correction obtained by the functional appliance by keeping the functional appliance in place or by using a simple removable appliance [34]. This is immediately foll owed by a second phase of active fixed orthodontic treatment. 1.2.5 Extraction As mentioned in the previous section, the anchorage requirements of a case are related to the space available in the upper and lower arches. It is common orthodontic practice to change anchorage requirement by the extraction of teeth [2]. The literature examining factors influencing the extraction decision can be divided into three different methodologies according to the method of study. These are: (i) the studies that directly ask clinicians their stated reasons for extraction, (ii) studies that measured the influence of the presence or absence of a cephalometric radiograph on the decision to extract, and (iii) studies that define some patient characteristic, such as cephalometric variables or orthodontic indices, and attempt to identify a correlation between these characteristics and whether or not extractions had been undertaken. I will discuss these studies in the following section: 1.2.5.1 Clinicians stated reasons influencing the extraction decision Only one study, Baumrind et al, directly asked orthodontists the factors that were related   to their decision to extract teeth as part of a course of treatment [35]. In this study full orthodontic records of 72 patients were given to 5 clinical instructors in a University setting in the USA. They were given a treatment planning form to complete for each patient; included in the form were questions about the extraction decision and the reasons for extraction. The clinicians stated that the most important reasons for extraction were crowding (49%), followed by incisor protrusion in 14% and profile improvement in 8%. Other, less frequent, reasons were Concern over Class II severity and concern for post- treatment stability (5%). No other single reason was stated as the most important reason in more than 2% of the forms. When considering all replies, crowding was cited in 72% of forms, incisor protrusion in 35%, profile improvement in 27% and Class II severity in 15%. No other si ngle reason was stated in more than 9% of forms. This was a simple cross-sectional study, in which the patient records and the participants were a convenience sample. It does, however, provide some relevant information on the reasons for extraction. 1.2.5.2 Cephalometric radiographs influencing the extraction decision: There have been several studies that have evaluated the effect of radiographs on the extraction decision. For example, Devereux et al [36] carried out a study in which a group of orthodontists were sent the orthodontic records of 6 patients on a CD, not containing lateral cephalometric radiographs or tracings, and were asked if they would extract teeth (T1). At this point, the orthodontists did not know that they were to be asked to examine the cases again after a washout period. After a period of 8 weeks (T2), the orthodontists were sent the records of the same 6 patients, but the lateral cephalometric radiographs and tracings were included in the records. They were asked again if they would extract teeth. The decisions made by this group (group A) were compared to another group of orthodontists (group B) who had full patient records, including lateral cephalometric radiographs and tracings, at both T1 and T2. It was found that the orthodontists in group A were 1.7 (95% CI, 1.0-2.8) times more likely to change their extraction decision than those in group B (odds ratio). In a similar investigation, Nijkamp et al investigated the influence of lateral cephalometric radiographs on the treatment planning decision [37]. This was a crossover design in which diagnostic records of 48 patients were given to 10 orthodontic postgraduates and 4 orthodontists. They were asked to formulate a treatment plan based around a dichotomous decision regarding three treatment options; (i) extraction, (ii) the use of a functional appliance and (iii) the use of rapid maxillary expansion. The diagnostic records at T1 included dental casts, but did not include a lateral cephalometric radiograph. T2 was 1 month later, and included both dental casts and lateral cephalometric radiographs and values. This design was repeated so that at T3, which was one month after T2, only dental casts were included; and at T4, which was one month after T3, dental casts and lateral cephalometric radiographs were included in the diagnostic records. Agreement between the treatment planning decision with and without the lateral cephalometric radiograph was assessed. In order for the treatment plans to agree, decisions about all three treatment options had to be the same. There was no statistically significant difference in the treatment plans between the use of only dental casts or with additional cephalometric information (P = 0.74). Another study by Han et al evaluated the effect of the incremental addition of diagnostic records on the extraction decision [38]. Five orthodontists provided a treatment plan for 57 patients. Orthodontic records were given to each of the five orthodontists in the following order: Session 1: study models only Session 2: study models and facial photographs Session 3: study models, facial photographs, and panoramic radiographs Session 4: study models, facial photographs, panoramic and lateral cephalometric radiographs. Session 5: all the previous records in addition to a lateral cephalometric tracing. The time interval between each session was 1 month, and the records were re-numbered between sessions. In each session, the orthodontists were asked to select a treatment pathway from a decision tree. The end point of each of the treatment pathway was a decision on whether or not to extract. The treatment planning decisions for each of the orthodontists in session 5 was considered the gold standard for that clinician. As a   result, the proportion of agreement between the treatment plan in each of the four sessions and the treatment plan in session 5 was obtained. The proportions of agreement between sessions 1, 2, 3, 4 and session 5 were 55%, 55%, 65% and 60% respectively. Therefore,] they concluded that study models alone are adequate for treatment planning, and that the addition of other types of diagnostic records made only a small difference. These three studies were good quality cross-sectional studies. The randomisation and method of washout were clear strengths of the studies. In addition sample size calculations were undertaken in two of these studies; Devereux et al and Nijkamp et al. 1.2.5.3 Patient characteristics influencing the extraction decision: The final type of studies evaluating the extraction decision are studies which attempt to identify a correlation between patient characteristics and whether or not extractions had been undertaken. Two studies, Xie et al and Takada et al, used a mathematical model to construct a decision-making Expert System (ES), which could formulate treatment decisions. [39, 40]. ES is a branch of artificial intelligence in which the computer programme simulates the decision-making and working processes of experts and solves clinical problems. They developed a model in which twenty-five patient characteristics were tested on 180 treated patients [39]. The rate of coincidence between the recommendations given by the optimized model and the actual treatments performed was found to be 100%. The characteristics that influenced the extraction decision were the anterior teeth uncovered by incompetent lips and IMPA (L1-MP). Another similar study was carried   out by Takada et   al whenÂà ‚   they selected   25 patient   characteristics   and 188 treated patients in their model [40]. The rate of coincidence between the recommendations given by the model and the actual treatment performed was 90.4%. The characteristics mostly influencing the extraction decision were incisor overjet and upper and lower arch length discrepancies. Heckmann et al investigated the influence of the angulations between the first and second lower molars on panoramic x-rays, on the extraction decision [41]. They used a sample of 30 patients treated by a premolar extraction approach, and a further matched sample of patients treated with a non-extraction approach. Pre- and post-treatment panoramic x-rays were scanned and computer software used to measure the angulations between lower first and second molars. Comparison between the mean angulation of the molars before treatment in the extraction and non-extraction group was not significant. Li et al compared mean cephalometric parameters and model analysis of Class II division 1 patients who were treated with either an extraction or non-extraction approach [42]. The sample consisted of 81 patients; 42 who had 4 premolar extractions and 39 who had non- extraction treatment. The extraction group had statistically significant greater values for the following parameters; arch length discrepancy, curve of spee, upper incisor tip, Frankfort-mandibular plane angle and lower anterior facial height. Bishara et al compared patient characteristics of Class II division 1 patients who were treated with either an extraction or non-extraction approach [43]. The sample consisted of 91 patients; 44 had first premolar extractions and 47 who had non-extraction treatment. A statistically significant difference was found between the extraction and non-extraction groups with regards to the following parameters; upper and lower arch length discrepancy, upper and lower lip protrusion in relation to the aesthetic plane in male patients, and the protrusion of the lower lip in female subjects. These studies were retrospective in nature. There were variations among the studies in the application of inclusion criteria in an attempt to control the characteristics of patients included in the study. Nevertheless, selection bias was inevitably present in these studies. Bias due to periodical changes may also be present due to the retrospective nature of the studies. In summary, studies evaluating the factors influencing the extraction decision are few in number. They have been carried out by gathering the opinion of clinicians in cross sectional studies or by conducting retrospective investigations on a sample of cases in which teeth were extracted as part of orthodontic treatment. The main deficiencies of the studies were due to inadequate selection and number of the study sample; and bias arising from their retrospective nature. References: 1.Roberts-Harry, D. and J. Sandy, Orthodontics. Part 9: Anchorage control and  distal movement. British Dental Journal, 2004. 196(5): p. 255-263.   2. Mitchell, L., An Introduction to Orthodontics. Second Edition ed. 2002, Oxford,  UK: Oxford University Press. 3. Charles T, P., Jr., Cervical headgear usage and thebioprogressive orthodontic  philosophy. Seminars in Orthodontics, 1998. 4(4): p. 219-230. 4. Brandao, M., H.S. Pinho, and D. Urias, Clinical and quantitative assessment of  headgear compliance: a pilot study. American Journal of Orthodontics Dentofacial Orthopedics, 2006. 129(2): p. 239-44. 5. Cureton, S.L., F.J. Regennitter, and J.M. Yancey, Clinical versus quantitative  assessment of headgear compliance. American Journal of Orthodontics   Dentofacial Orthopedics, 1993. 104(3): p. 277-84. 6. Cole, W.A., Accuracy of patient reporting as an indication of headgear  compliance. American Journal of Orthodontics Dentofacial Orthopedics, 2002.  121(4): p. 419-23. 7. Samuels, R.H.A. and N. Brezniak, Orthodontic facebows: safety issues and  current management. Journal of Orthodontics, 2002. 29(2): p. 101-7.   8. Samuels, R.H., A review of orthodontic face-bow injuries and safety equipment.  American Journal of Orthodontics and Dentofacial Orthopedics, 1996. 110(3): p.  269-272. 9. Burden, D.J. and D.J. Eedy, Orthodontic headgear related to allergic contact  dermatitis: a case report. British Dental Journal, 1991. 170(12): p. 447-8.   10. Lowey, M.N., Allergic contact dermatitis associated with the use of an Interlandi  headgear in a patient with a history of atopy. British Dental Journal, 1993. 175(2):  p. 67-72. 11. Kerosuo, H.M. and J.E. Dahl, Adverse patient reactions during orthodontic  treatment with fixed appliances. American Journal of Orthodontics Dentofacial  Orthopedics, 2007. 132(6): p. 789-95. 12. McComb, J.L. and C.M. King, Atopic eczema and orthodontic headgear. Dental  Update, 1992. 19(9): p. 396-7. 13. Cureton, S.L., F.J. Regennitter, and J.M. Yancey, The role of the headgear  calendar in headgear compliance. American Journal of Orthodontics   Dentofacial Orthopedics, 1993. 104(4): p. 387-94. 14. Doruk, C., U. Agar, and H. Babacan, The role of the headgear timer in extraoral  co-operation. European Journal of Orthodontics, 2004. 26(3): p. 289-91.   15. Trakyali, G., et al., Conscious hypnosis as a method for patient motivation in  cervical headgear weara pilot study. European Journal of Orthodontics, 2008.  30(2): p. 147-52. 16. Gross, A.M., G. Samson, and M. Dierkes, Patient cooperation in treatment with  removable appliances: A model of patient noncompliance with treatment implications. American Journal of Orthodontics, 1985. 87(5): p. 392-397.   17. Clemmer, E.J. and E.W. Hayes, Patient cooperation in wearing orthodontic  headgear. American Journal of Orthodontics, 1979. 75(5): p. 517-24.   18. Samuels, R., et al., A clinical evaluation of a locking orthodontic facebow.  American Journal of Orthodontics and Dentofacial Orthopedics, 2000. 117(3): p.  344-350. 19. ADVICE ON THE USE OF HEADGEAR, D.A.S.C. The British Orthodontic  Society (BOS), Editor. 20. Chadwick, S.M., P. Banks, and J.L. Wright, The use of myofunctional appliances  in the UK: a survey of British orthodontists. Dental Update, 1998. 25(7): p. 302-8.   21. Thiruvenkatachari, B., et al., Orthodontic treatment for prominent upper front  teeth (Class II malocclusion) in children. Cochrane Database of Systematic  Reviews 2013, Issue 11. Art. No.: CD003452. DOI:  10.1002/14651858.CD003452.pub3., 2013. 22. OBrien, K., et al., Early treatment for Class II malocclusion and perceived  improvements in facial profile. American Journal of Orthodontics Dentofacial  Orthopedics, 2009. 135(5): p. 580-5. 23. Singh, G.D. and W.J. Clark, Soft tissue changes in patients with Class II Division 1  malocclusions treated using Twin Block appliances: finite-element scaling  analysis. European Journal of Orthodontics, 2003. 25(3): p. 225-30. 24. OBrien, K., et al., Effectiveness of early orthodontic treatment with the Twin-block  appliance: a multicenter, randomized, controlled trial. Part 1: Dental and skeletal  effects. American Journal of Orthodontics Dentofacial Orthopedics, 2003.  124(3): p. 234-43; quiz 339. 25. Keeling, S.D., et al., Anteroposterior skeletal and dental changes after early Class  II treatment with bionators and headgear. American Journal of Orthodontics   Dentofacial Orthopedics, 1998. 113(1): p. 40-50. 26. Illing, H.M., D.O. Morris, and R.T. Lee, A prospective evaluation of Bass,  Bionator and Twin Block appliances. Part IThe hard tissues. European Journal of  Orthodontics, 1998. 20(5): p. 501-16. 27. Thiruvenkatachari, B., et al., Comparison of Twin-block and Dynamax appliances  for the treatment of Class II malocclusion in adolescents: a randomized controlled  trial. American Journal of Orthodontics Dentofacial Orthopedics, 2010. 138(2):  p. 144.e1-9; discussion 144-5. 28. OBrien, K., et al., Effectiveness of treatment for Class II malocclusion with the  Herbst or twin-block appliances: a randomized, controlled trial. American Journal  of Orthodontics Dentofacial Orthopedics, 2003. 124(2): p. 128-37. 29. OBrien, K., et al., Early treatment for Class II Division 1 malocclusion with the  Twin-block appliance: a multi-center, randomized, controlled trial. American  Journal of Orthodontics Dentofacial Orthopedics, 2009. 135(5): p. 573-9.   30. Tulloch, J.F.C., W.R. Proffit, and C. Phillips, Outcomes in a 2-phase randomized  clinical

Educational Goals and Philosophy :: Philosophy of Education Teaching Teachers Essays

Educational Goals and Philosophy There are several reasons why I want to be a teacher. One reason is that I love being around children. Another reason is that I love to see the look of amazement on child's face when they learn something new. I also love the look on their face when they discover that they can do what they just learned. During my observation, I met a little boy who had just moved back to West Virginia. This little boy is in the first grade and he has a learning disability. The class that I was observing was a special education class and I had the pleasure of helping the teacher with this little boy. The teacher thought that one of the best ways to help the little boy with his disability was to begin by playing games; we played games with flash cards, numbers, and the alphabet. The teacher asked him to spell his name with the alphabet cards, which he did, then she spread the cards out on the table and asked him to find the letter that she said. Each time he found the correct letter, his face would light up at the teachers praise. He was really excited when he found the "difficult letters". After watching the little boy I was just as excited as he was that he was doing a great job. Being a teacher would mean that I would have the opportunity to teach children new things everyday, and I would be able to share in their joy of learning. In my classroom I would use essentialism, the back to basics approach, I believe that all students should be taught the basic subjects. I would incorporate games into each subject so that the children will have fun while they learn. For example, we would play math bingo, and do crossword puzzles for reading. For science, I would have them bring leaves to class and then we could learn what type of leaf it is and what tree it came from. I think that if you make learning fun, a child will want to learn, they won't just look at it as something that they have to do. I also believe that the classroom environment contributes to the learning atmosphere.

Chinese and American Cultures Essay -- Culture Cultural Tan Jen Essays

Chinese and American Cultures Chinese-Americans authors Amy Tan and Gish Jen have both grappled with the idea of mixed identity in America. For them, a generational problem develops over time, and cultural displacement occurs as family lines expand. While this is not the problem in and of itself, indeed, it is natural for current culture to gain foothold over distant culture, it serves as the backdrop for the disorientation that occurs between generations. In their novels, Tan and Jen pinpoint the cause of this unbalance in the active dismissal of Chinese mothers by their Chinese-American children. In The Joy Luck Club, Amy Tan calls close attention to the idea of unrealization and forgetfulness. Through these two factors, Tan attempts to explain displacement on the pasts of both mothers and daughters. The daughters, we find, are lost and wandering, and the mothers themselves seem paralyzed by secret pasts of pain and sacrifice. For them, the past is a tenuous, ghostly thing that goes undigested for some time. For many of them, it is not ever talked about. The death of Suyuan Woo is attributed to this: â€Å" ‘ She had a new idea in her head,’ said my father. ‘But before it could come out of her mouth, the thought grew too big and burst. It must have been a very bad idea.’ â€Å"The doctor said she died of a cerebral aneurysm. And her friends at the Joy Luck Club said she died just like a rabbit: quickly and with unfinished business left behind† (Tan 19). Suyuan had a secret that she had kept from her daughter, Jing-Mei her entire life: two sisters that had been left behind while she fled from China. While it cannot be said that this was what caused her to have an aneurysm, the symbolism of having unfinished business, and ... ...er granddaughter eating the Chinese side. Addie in â€Å"Just Wait† is withdrawn from her entire family because she simply does not fit in and is placed, with a weak struggle, in the same category as her unwell brother. Duncan in â€Å"Duncan in China† cannot accept the China he visits because he only has images of the regal past in his head. Both novel and short story collection reflect the fear of a past being unexplored and left behind. They express deep concern about a lost generation of Chinese-Americans and look desperately for the ignored, shut out past as a result. Works Cited: Jen, Gish. Who’s Irish? New York: Alfred A Knopf, 1999. Tan, Amy. The Joy Luck Club. New York: G.P. Putnam’s Sons, 1989. Xu, Ben. â€Å"Memory and the Ethnic Self; Reading Amy Tan’s Joy Luck Club† in Memory, Narrative, and Identity: New Essays in Ethnic American Literatures. 261-77.

Ebay analysis Essay -- essays research papers

The name â€Å"eBay† (http://www.ebay.com) is synonymous with â€Å"online auctions†. Founded in September 1995, the company qualifies as a genuine cultural and economic phenomenon (Bunnell, 2000, p.vii). The site can be credited with creating and defining an entire industry and has remained the dominant force in the online auction world, with anywhere from 70 to 90 percent of the person-to-person online auction market. eBay is also the 15th most visited site (http://www.MediaMetrix.com) on the web. In the face of large competitors such as eBay, internet powerhouse, Amazon.com Auctions (http://www.amazon.com/auctions), is battling for online auction dominance over eBay. Amazon is not just a bookseller but also a genuine e-commerce platform for online merchants. With the addition of online auctions to its already colossal department store, Amazon is a major player for online auction supremacy. eBay is able to condense over four million items into thirteen main categories that are quite user friendly (ApnaGuide.com, 2000). They are easily navigated and buyers are able to find what they’re looking for without any troubles. Whereas Amazon.com Auctions can get a bit category crazy. Not only do some categories become needlessly rough (Jewellery), while others are just too general (Tools), but sometimes there is no clear division between subcategories. Take, for example, Home Accessories, Home Appliances, and Household Items in Home & Garden, where buyers have multiple places to look for the same type of item and might miss an auction in which they would have participated. Just to demonstrate the popularity of both sites, below are three searches that were conducted: Search Item: â€Å"Throwing Copper† eBay: 30 results, 7 of which had bids, highest number of bids: 2 Amazon.com Auctions: 1 result, of which 0 had bids Search Item: â€Å"the matrix dvd† eBay: 41 results, 28 of which had bids, highest number of bids: 14 Amazon.com Auctions: 38 results, of which 1 had bids, highest number of bids:1 Search Item: â€Å"the hobbit† eBay: 146 results, 65 of which had bids, highest number of bids: 10 Amazon.com Auctions: 21 results, of which 0 had bids From a buyers perspective, with inventory and selection, eBay stand in a league of their own. Browsing the site for items, you’ll find everything from baby strollers and rubble from the Berlin wall to cutting-edge mobile phones and talkin... ...  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Amazon.com Auctions: Inventory: 4/4  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Inventory: 4/4 Bidding: 4/4  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Bidding: 2/4 Functionality: 3/4  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Functionality: 4/4 Ease Of Use: 4/4  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ease Of Use: 3/4 Reference List Bunnell, D. (2000), The eBay Phenomenon, John Wiley & Sons, Inc., Canada Financial Review (2001), eBay the online top dog, http://afr.com/it/2001/01/23/FFXRNPT09IC.html ApnaGuide.com (2000), Review on ebay, http://www.apnaguide.com/review/12706 Altavista.com (1999), Amazon.com Auctions Review, http://auctionwatch.shopping.altavista.com/awdaily/reviews/amazon.html

The Return: Nightfall Chapter 6

â€Å"Isaid,get out ,† Meredith repeated to Caroline, still quietly. â€Å"You've said things that never should have been said in any civilized place. This happens to be Stefan's place – and, yes, it's hisplace to order you out, too. I'm doing it for him, though, because he never would ask a girl – and a former girlfriend, I might add – to get the hell out of his room.† Matt cleared his throat. He'd stepped back into a corner and everyone had forgotten about him. Now he said, â€Å"Caroline, I've known you way too long to be formal, and Meredith's right. You want to say the kind of things you've been saying about Elena, you do it somewhere faraway from Elena. But, look, there's one thing I know. No matter what Elena did when she was – was downhere before† – his voice dropped a little in wonder, and Bonnie knew that he meant, when Elena was here on Earth before – â€Å"she's as close to an angelnow as you can get. Right now she's†¦she's†¦completely†¦Ã¢â‚¬  He hesitated, stumbling for the right words. â€Å"Pure,† Meredith said easily, filling in the blank for him. â€Å"Yeah,† Matt agreed. â€Å"Yeah, pure. Everything she does is pure. And it's not like any of your nasty words could stain her, anyway, but the rest of us just don't like hearing you try.† There was a low â€Å"Thank you† from Stefan. â€Å"I was already going,† Caroline said, now through her teeth. â€Å"And don't youdare preach atme about purity ! Here, with all this going on! You probably just want to watch it going on yourself, two girls kissing. You probably – â€Å" â€Å"Enough.† Stefan said it almost expressionlessly, but Caroline was swept off her feet, up and out of the door, and deposited there by invisible hands. Her purse trailed after her. Then the door quietly shut. Fine hairs rose on the back of Bonnie's neck. This was Power, in such amounts that her psychic senses were stunned and temporarily paralyzed. Moving Caroline – and she wasn't a small girl – now that took Power . Maybe Stefan had changed just as much as Elena had. Bonnie glanced at Elena, whose pool of serenity was rippling because of Caroline. Might as well take her mind off it, and maybe make herself worthy of athank you from Stefan, Bonnie thought. She tapped Elena's knee, and when Elena turned, Bonnie kissed her. Elena broke the kiss very quickly, as if afraid to set off some holocaust again. But Bonnie saw at once what Meredith had said about it not being sexual. It was†¦more like being examined by someone who used all her senses to the fullest. When Elena moved away from Bonnie she beamed at her just as she had at Meredith, all the distress washed away by – yes, thepurity of the kiss. And Bonnie felt as if some of Elena's tranquility had soaked into her. â€Å"†¦should have known better than to bring Caroline,† Matt was saying to Stefan. â€Å"Sorry about butting in. But Iknow Caroline, and she could have gone on ranting for another half hour, never actually leaving.† â€Å"Stefan took care of that,† Meredith said, â€Å"or was that Elena, too?† â€Å"It was me,† Stefan said. â€Å"Matt had it right: she could keep on talking forever without actually leaving. And I'd just as lief nobody run Elena down like that in my hearing.† Why are they talking about those things? Bonnie wondered. Of all people, Meredith and Stefan were least inclined to chatter, but here they were, saying things that didn't really need to be said. Then she realized it was for Matt, who was moving slowly but with determination toward Elena. Bonnie got up as quickly and as lithely as if she could fly, and managed to pass Matt without looking at him. And then she was joining Meredith and Stefan in small talk – well, medium-small talk – about what had just happened. Caroline made a bad enemy, everyone agreed, and nothing seemed to teach her that her schemes against Elena always backfired. Bonnie would bet that she was hatching a new scheme right now against all of them. â€Å"She feels lonely all the time,† Stefan said, as if trying to make excuses for her. â€Å"She wants to be accepted, by anyone, on any terms – but she feels – apart. As if nobody who really got to know her would trust her.† â€Å"She's defensive,† Meredith agreed. â€Å"But you'd think she'd showsome gratitude. After all, we did rescue her and save her life just over a week ago.† There was more to it than that, Bonnie thought. Her intuition was trying to tell her something – something about what might have happenedbefore they had been able to rescue Caroline – but she was so angry on Elena's behalf that she ignored it. â€Å"Why should anybody trust her?† she said to Stefan. She sneaked a peek behind her. Elena was definitely going to know Matt anywhere, and Matt looked as if he were fainting. â€Å"Caroline's beautiful, sure, but that's it. She never has a good word to say about anybody. She plays games all the time – and – and Iknow we used to do some of that, too†¦but hers are always meant to make other people look bad. Sure, she can take mostguys in† – a sudden anxiety swept over her, and she spoke more loudly to try to push it away – â€Å"but if you're a girl she's just a pair of long legs and big – â€Å" Bonnie stopped because Meredith and Stefan had frozen, with identicalOh-God-not-again expressions on their faces. â€Å"And she also has very decent hearing,† said a shaking, threatening voice from somewhere behind Bonnie. Bonnie's heart leaped into her throat. That was what you got for ignoring premonitions. â€Å"Caroline – † Meredith and Stefan were both trying for damage control, but it was too late. Caroline stalked in on her long legs as if she didn't want her feet to touch Stefan's floorboards. Oddly, though, she was carrying her high heels. â€Å"I came back in to get my sunglasses,† she said, still in that trembling voice. â€Å"And I heard enough to know now what my so-called ;;friends' think of me.† â€Å"No, you didn't,† Meredith said, as rapidly eloquent as Bonnie was stunned mute. â€Å"You heard some very angry people letting off steam after you'd just insulted them.† â€Å"Besides,† Bonnie said, suddenly able to speak again, â€Å"admit it, Caroline – youhoped you'd hear something. That's why you took off your shoes. You were right behind the door, listening, weren't you?† Stefan shut his eyes. â€Å"This is my fault. I should have – â€Å" â€Å"No, you shouldn't,† Meredith said to him, and to Caroline she added, â€Å"And if you can tell me one word we said that isn't true, or was exaggerated – except maybe for what Bonnie said, and Bonnie is†¦just being Bonnie. Anyway, if you can point to one word of what the rest of us said that isn't true,I'll beg your pardon.† Caroline wasn't listening. Caroline was twitching. She had a facial tic, and her lovely face was convulsed, dark red, with fury. â€Å"Oh, you'regoing to beg my pardon all right,† she said, wheeling to point her long-nailed forefinger at each of them. â€Å"You'reall going to be sorry. And if you try that – that witchcraft-vampire type thing on me again,† she said to Stefan, â€Å"I have friends – real friends – who'd like to know about it.† â€Å"Caroline, just this afternoon you signed a contract – â€Å" â€Å"Oh, who gives a damn?† Stefan stood up. It was dark now inside the small room with its dusty window, and Stefan's shadow was thrown before him by the bedside lamp. Bonnie looked at it and then poked Meredith, as the hairs tingled on her arms and neck. The shadow was surprisingly dark and surprisingly tall. Caroline's shadow was weak, transparent, and short – an imitation shadow beside Stefan's very real one. The thunderstorm feeling was back. Bonnie was shaking now; trying not to, but unable to stop the shivering that had come on as if she had been thrown into icy water. It was a cold that had gotten directly into her bones and was ripping layer after layer of heat off them like some greedy giant, and now she was beginning to shakehard†¦. Something was happening to Caroline in the darkness – something was coming from her – or comingfor her – or maybe both. In any case, it was all around her now, and all around Bonnie, too, and the tension was so thick that Bonnie felt choked, her heart pounding. Beside her, Meredith – practical, level-headed Meredith – stirred uneasily. â€Å"What – ?† Meredith began in a whisper. Suddenly, as if it had all been exquisitely choreographed by the things in the dark – the door to Stefan's room slammed shut†¦the lamp, an ordinary electric one, went off†¦the ancient rolled-up shutter over the window came rattling down, dropping the room into sudden and complete darkness. And Caroline screamed. It was an awful sound – raw, as if it had been stripped like meat from Caroline's backbone and yanked out of her throat. Bonnie screamed, too. She couldn't help it, although her scream sounded too faint and too breathless, like an echo, not the coloratura job that Caroline had done. Thank God that at least Caroline wasn't screaming any longer. Bonnie was able to stop the new scream building in her own throat, even though her shaking was worse than ever. Meredith had an arm around her tightly, but then, as the darkness and the silence went on and Bonnie's shaking only continued, Meredith got up and heartlessly passed her to Matt, who seemed astonished and embarrassed, but tried awkwardly to hold her. â€Å"It's not as dark once your eyes get used to it,† he said. His voice was creaky, as if he needed a drink of water. But it was the best thing that he could have said, because of all things in the world to fear, Bonnie was most afraid of the dark. There werethings in it, things that only she saw. She managed, despite the terrible shaking, to stand with his support – and then she gasped, and heard Matt gasp, too. Elena was glowing. Not only that, but the glow extended out behind her and far to either side of her in a pair of what were beautifully defined, and undeniablythere†¦wings. â€Å"She h-has wings,† Bonnie whispered, the stutter caused by her shaking rather than by awe or fear. Matt was clinging toher now, like a child; he obviously couldn't answer. The wings moved with Elena's breathing. She was sitting on thin air, steady now, one hand held out with her fingers all spread in a gesture of denial. Elena spoke. It wasn't any language that Bonnie had heard before; she doubted it was any language people on Earth used. The words were sharp, thin-edged, like the splintering of myriad shards of crystal that had fallen from somewhere very high and very far away. The shape of the wordsalmost made sense in Bonnie's head as her own psychic abilities were sparked by Elena's tremendous Power. It was a Power that stood tall against the darkness and now was sweeping it aside†¦making the things in the dark scamper away before it, their claws scritching in all directions. Ice-sharp words followed them all the way, dismissive now†¦. And Elena†¦Elena was as heartbreakingly beautiful as when she'd been a vampire, and seemed almost as pale as one. But Caroline was shouting, too. She was using powerful words of Black Magic, and to Bonnie it was as if the shadows of all sorts of dark and horrible things were coming from her mouth: lizards and snakes and many-legged spiders. It was a duel, a face-off of magic. Only how had Caroline learned so much dark magic? She wasn't even a witch by lineage, like Bonnie. Outside Stefan's room, surrounding it, was a strange sound, almost like a helicopter. Whipwhipwhipwhipwhip†¦ It terrified Bonnie. But she had to do something. She was Celtic by heritage and psychic because she couldn't avoid it, and she had to help Elena. Slowly, as if making her way against gale-force winds, Bonnie stumbled to put her hand on Elena's hand, to offer Elena her power. When Elena clasped hands with her, Bonnie realized that Meredith was on her other side. The light grew. The scrabbling lizard things ran from it, screaming and tearing at each other to get away. The next thing Bonnie knew, Elena had slumped over. The wings were gone. The dark scrabbling things were gone, too. Elena had sent them away, using tremendous amounts of energy to overwhelm them with White Power. â€Å"She'll fall,† Bonnie whispered, looking at Stefan. â€Å"She's been using magic so strong – â€Å" Just then, as Stefan started to turn to Elena, several things happened very fast, as if the room was caught in the flashes of a strobe light. Flash. The window shade rolled back up, rattling furiously. Flash. The lamp went back on, revealing it was in Stefan's hands. He must have been trying to fix it. Flash. The door to Stefan's room opened slowly, creaking, as if to make up for slamming shut before. Flash. Caroline was now on the floor, on all fours, groveling, breathing hard. Elena had won†¦. Elena fell. Only inhumanly fast reflexes could have caught her, especially from across the room. But Stefan had tossed the lamp to Meredith and was across the distance faster than Bonnie's eyes could follow. Then he was holding Elena, encircling her protectively. â€Å"Oh,hell ,† said Caroline. Black trails of mascara ran down her face, making her look like something not quite human. She looked at Stefan with unconcealed hatred. He looked back soberly – no,sternly . â€Å"Don't call on Hell,† he said in a very low voice. â€Å"Not here. Not now. Because Hell might hear and call back.† â€Å"As if it already hadn't,† Caroline said, and in that moment, she was pitiful – broken and pathetic. As if she had started something she didn't know how to stop. â€Å"Caroline, what are you saying?† Stefan knelt. â€Å"Are you saying that you've already – made some bargain – ?† â€Å"Ouch,† Bonnie said, suddenly and involuntarily, shattering the ominous mood in Stefan's room. One of Caroline's broken nails had left a trail of blood on the floor. Caroline had knelt in it, too, making things pretty messy. Bonnie felt a sympathetic throb of pain in her own fingers until Caroline waved her bloody hand at Stefan. Then Bonnie's sympathy turned to nausea. â€Å"Want a lick?† she said. Her voice and face had changed entirely, and she wasn't even trying to hide it. â€Å"Oh, come on, Stefan,† she went on mockingly, â€Å"youdo drink human blood these days, don't you? Human or – whatever she is, whatever she's become. You two fly like bats together now, do you?† â€Å"Caroline,† Bonnie whispered, â€Å"didn't yousee them? Her wings – â€Å" â€Å"Just like a bat – or another vampire already. Stefan's made her – â€Å" â€Å"I saw them too,† Matt said flatly, behind Bonnie. â€Å"They weren't bat wings.† â€Å"Doesn't anybody have eyes?† Meredith said from where she stood by the lamp. â€Å"Look here.† She bent. When she stood again she was holding a long white feather. It shone in the light. â€Å"Maybe she's a white crow, then,† Caroline said. â€Å"That would be appropriate. And I can't believe how you're all – all – fawning on her as if she were some sort of princess. Always everybody's little darling, aren't you, Elena?† â€Å"Stop it,† Stefan said. â€Å"Everybody's, that's the key word,† Caroline spat. â€Å"Stop it.† â€Å"The way you were kissing people one after another.† She gave a theatrical shudder. â€Å"Everyone seems to have forgotten, but that was more like – â€Å" â€Å"Stop, Caroline.† â€Å"Thereal Elena.† Caroline's voice had become pretend-prissy, but she couldn't keep the venom out, Bonnie thought. â€Å"Because anyone who knows you knows what youreally were before Stefanblessed us with hisirresistible presence. You were – â€Å" â€Å"Caroline, stop right there – â€Å" â€Å"A slut! That's all! Just a cheap, anybody'sslut !†