Effect of Simulation Based Education on Medical Knowledge

Effect of Simulation Based Education on Medical Knowledge EFFECT OF SIMULATION BASED EDUCATION ON KNOWLEDGE OF MEDICAL STUDENTS IN CONTEXT OF COMMUNITY MEDICINE Bogam Rahul R. Corresponding Author Dr Rahul Ramesh Bogam ABSTRACT Simulations are being increasingly used to train medical students in diverse clinical skills. Simulation is arguably the most prominent innovation in medical education over the past 15 years. Role play is a simulation technique which can potentially strengthen knowledge that will lead to improved expertise. The present study was undertaken to assess an effectiveness of simple intervention in the form of ‘Role Play Simulation’ on the knowledge of undergraduate MBBS medical students of one of randomly selected medical colleges in Maharashtra regarding ‘Epidemics Investigations.’ Methods: A cross-sectional study consisting of pre and post test intervention was conducted at one of the randomly selected medical colleges in Western Maharashtra. A structured pretested self administered questionnaire consisting of 15 close ended questions was distributed to all 144 participants. The present study attempted to incorporate simulation based role play which was based on epidemic/outbreak investigations for food poisoning. Immediately after this intervention, same questionnaire was distributed to participants as a post test and responses were collected. ‘Paired t-test’ was used to assess pre and post intervention knowledge of participants. Results: Present study revealed significant improvement in knowledge of participants about epidemic investigations from pre to post intervention as a result of ‘Role Play Simulation Based Education’ (t = 42.87, p Conclusion: A simple simulation form like role play can make significant change in knowledge of medical students about very important topic i.e. ‘Epidemic Investigation’ in Community Medicine subject. Key words: Simulations, Community Medicine, Knowledge, Medical students, Role play INTRODUCTION There have been burgeoning developments and changes in medical education.[1] The information and communication technology has revolutionized the teaching and learning process.[1] Various new teaching methodogies are being used to impart medical education to the students in more effective way. The basic reason to look for these methodologies is the dis-satisfaction with conventional mode of education, which is losing it’s relevance in this era of information explosion. [1] Simulations are being increasingly used to train medical students in diverse clinical skills. Simulation is arguably the most prominent innovation in medical education over the past 15 years. [2] They help us to replicate situations which may not possible to get in real settings or where it may be logistically difficult to work on real patients. [1] Role play is a simulation technique which can potentially strengthen knowledge that will lead to improved expertise. Despite of an effectiveness of role play in providing medical education, it’s use in educating medical students is limited. [3] ‘Epidemic Investigation’ is not only an essential aspect in Community Medicine subject but also it has public health relevance. Even though very few studies have been conducted so far in India to evaluate the knowledge of medical students pertaining to investigations of epidemic, some evidences have shown that ‘Simulation Based Education’ can be an effective teaching tool to educate medical students about emergency situation like epidemics. Clinical situations for teaching and learning purposes are created using various forms of simulation like mannequins, part-task trainers, simulated patients or computer-generated simulations. The present study was undertaken to assess an effectiveness of simple intervention in the form of ‘Role Play Simulation’ on the knowledge of undergraduate MBBS medical students of one of randomly selected medical colleges in Maharashtra regarding ‘Epidemics Investigations.’ OBJECTIVE To assess an effectiveness of ‘Role Play Simulation’ on knowledge of undergraduate MBBS medical students about ‘Epidemics Investigations.’ MATERIAL AND METHODS A cross-sectional study consisting of pre and post test intervention was conducted at one of the randomly selected medical colleges in Western Maharashtra. The inclusion criteria were all 144 undergraduate medical students from 7th semester who were present on the day of an intervention. Those who did not attend the class on the day of an intervention were excluded from the study. Written permission was also obtained from participants after explaining the purpose of study to them. A structured pretested self administered questionnaire consisting of 15 close ended questions was distributed to all participants. They were allowed 15 minutes to complete questionnaire under strict supervision. A questionnaire consisted of questions based on various aspects of epidemic investigations like essential criteria for confirmation of existence of an epidemic, spot map, epidemiological case sheet etc. The present study attempted to incorporate simulation based role play which was based on epidemic/outbreak investigations for food poisoning. Few volunteer medical students were selected and trained to participate in simulation based role play. They were asked to focus on ten important steps in investigation of an epidemic i.e. verification of diagnosis, confirmation of an existence of an epidemic, defining the population at risk, rapid search for all cases and their characteristics, data analysis, formulation of hypothesis, testing of hypothesis, evaluation of ecological factors, further investigation of population at risk and writing the report (Table 1). Remaining students were asked to watch this simulation based role play. Total duration of role play was about 20 minutes. Immediately after this intervention, same questionnaire was distributed to participants as a post test and responses were collected. Data Analysis The scoring system for each complete question was assigned for pre and post intervention. Statistical analysis was done using Microsoft Office Excel Sheet. ‘Paired t-test’ was used to assess pre and post intervention knowledge of participants. RESULTS AND DISCUSSION In present study, of 144 participants 78(54.16%) were males and 66 (45.83%) were females. All (100%) participants were in age bracket of 20-23 years. In contemporary medical education, there is strong emphasis on the use of innovative teaching methods like Problem Based Learning, One Minute Preceptor (OMP), Computer Assisted Learning, Flipped Teaching etc. Uses of these types of methods help students to learn various clinical skills in more effective way. The present study attempted to impart knowledge to undergraduate medical students about investigations of an epidemic by using ‘Role Play Method’ rather than using traditional teaching method. The present study showed that simple simulation form like role play made improvement in the knowledge of participants about ‘Epidemic Investigations.’ Similarly other Studies also reported that the use of simulations as a teaching tool increases student’s comprehension of complex theoretical concepts in relation to modules that are taught solely with the traditional lecture/seminar format. [4] Jennifer M Weller et al. [5] also recommended that ‘Simulation Based Education’ needs to be integrated into medical curricula at the development stage, with careful attention paid to transfer of skills learnt to the real clinical environment. In a Malaysian medical school, role plays have been used to teach communication skills in primary care medicine. [6] Table. 1. Pre and Post intervention questions with correct response (n = 144) Table. 2. Mean marks of participants (n = 144) Present study revealed significant improvement in knowledge of participants about epidemic investigations from pre to post intervention as a result of ‘Role Play Simulation Based Education’ (t = 42.87, p However prior to an intervention, poor level of knowledge was found amongst participants regarding certain aspects of epidemic investigations like Spot Map, criteria for confirmation of epidemic, period of investigation of an epidemic etc.( Table 2). The present study reiterates the need for incorporation of innovative methodologies like simulations along with traditional methods for better learning of students. At some places, methodology like ‘Role Play’ has been regular teaching method in medical colleges.[7]At the University of Heidelberg, Germany, introducing role plays augmented the realism of technical training and improved doctor-patient communication and to teach students to obtain a sexual history and discuss sexual health issues. [8] Role-play is simple form of simulation which can be a valuable teaching tool for medical education, requiring few resources and allowing students to look at the material they are learning in a new light. CONCLUSIONS Present study reported significant improvement in knowledge of undergraduate medical students pertaining to epidemic investigation from pre to post-intervention as a result of role play method. It shows that even a simple simulation form like role play can make significant change in knowledge of medical students about very important topic i.e. ‘Epidemic Investigation’ in Community Medicine subject. ACKNOWLEDGEMENT We heartily acknowledge the cooperation and support of Dr. Shekhar M. Kumbhar for conduction of this study. DECLARATION OF INTEREST The author reports no conflicts of interest. The author alone is responsible for the content and writing of the article. REFERENCES Tejinder Singh, Piyush Gupta, Daljit Singh. Principles of Medical Education. Jaypee Brothers Medical Publishers (P) Ltd. 2013; 4th Edn, 1-14. Morgan Passiment Heather Sacks Grace Huang. Medical Simulation in Medical Education: Results of an AAMC Survey. 2011, Association of American Medical Colleges: 1-42. P.Ravi Shankar, Rano M.Piryani, Kundan K.Singh and Bal Man Karki. Student feedback about the use of role plays in Sparshanam, a medical humanities module. F 1000 research. 2012; 1 (65): 1-10. Govinda Clayton and Theodora-Ismene Gizelis. Learning through Simulation or Simulated Learning? An Investigation into the Effectiveness of Simulations as a Teaching Tool in Higher Education.1-25. Jennifer M Weller, Debra Nestel,Stuart D Marshall, Peter M Brooks, Jennifer J Conn. Simulation in clinical teaching and learning.MJA.2012; 196 (9):1-5. Sherina HN and Chia YC: Communication skills teaching in primary care medicine. Medical Journal of Malaysia. 2002; 57(Suppl E): 74–77. Manzoor I, Mukhtar F and Hashmi NR: Medical students’ perspective about role plays as a teaching strategy in community medicine. Journal of the College of Physicians and Surgeons, Pakistan. 2012; 22(4): 222–5. Nikendei C, Kraus B, Schrauth M, P.Weyrich, S.Zipfel, W.Herzogi et al.: Integration of role-playing into technical skills training: a randomized controlled trial. Medical Teacher. 2007; 29(9): 956–960. 1

Beauty and Genetic Enhancement :: Creative Writing Essays

Beauty and Genetic Enhancement      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Nausea.   To describe the whole situation in one word I would have to choose nausea.   The Expo center was packed with societies elite,   eagerly waiting the announcement of what the rumor mill had told them to be the most important invention of the decade.   The air was cold and damp, like that of a hospital.   Barley audible was the most annoying Michael Bolton song that I could imagine.   As I got entranced by the dullness of the situation I noticed that the lights were slowly getting dimmer.   As Michael Bolton's voice became silent, Dr. Zimmerman spherical body came waddling out.      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Dr. Zimmerman was a very large, gluttonous man.   I had worked with him many times, and I had lost more than one of my ideas to his fat hands.   He was ruthless, unemotional, and conscienceless; the perfect scientist.   He painstakingly climbed onto the two foot platform in front of the podium, making a little grunt that accidentally found its way into the microphone.   "Hello? Can you guys hear me in the back?"   He gurgled in his natural grotesque voice. With the acknowledgment of the audience, he sipped the glass of ice water which stood on the podium and cleared his throat.   "Ladies and Gentlemen, I am here to inform you of a discovery that my team of genetic scientist and I have discovered."   The more he said the more I wanted to hear. I wanted to shout to make him blurt it out, but it was impossible to speed him up, attention was the reason why he became a scientist.   He didn't care about the effects of his discoveries, as long as he packed the expo center the next weekend.  Ã‚   "The quest toward perfection is finally over.   Your unborn children now have the opportunity to be everything you ever wanted them to be!"   A large blue vein slowly became visible through his cherry red forehead. "Birth defects are a thing of the past."   Suddenly the severity of the situation slammed into me like a subway train.  Ã‚   "There will be no such thing as an imperfect child!"   The sound of flapping mucus in his throat was almost unbearable.  Ã‚   The applause began, I knew it wouldn't stop for at least ten minutes because Dr. Zimmerman wouldn't let it.   I ran to the bathroom to think about what had just happened.      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Dr. Zimmerman was referring to the G.A.M.   project, Genetic Alterations for Mankind.   The team of four was lead by him.   The goal was to alter DNA of freshly fertilized embryos, to control every one of their physical and mental

Bloodlines Chapter Twenty-Three

â€Å"WHAT DID YOU DO?† I was sitting on the end of a row of seats at Jill's fashion show almost a week later, in downtown Palm Springs, waiting for things to start. I hadn't even known Trey was at the show and was startled to suddenly find him kneeling beside me. â€Å"What exactly are you referring to?† I asked him. â€Å"There are about a million things I can take credit for.† He scoffed and kept his voice pitched low, which wasn't too necessary with the dull roar of conversation around us. Several hundred had turned out to see the show. â€Å"I'm talking about Slade and friends, and you know it,† Trey said. â€Å"They've been really upset about something this week. They keep complaining about those stupid tattoos.† He looked at me meaningfully. â€Å"What?† I asked, putting on a face of innocence. â€Å"Why do you think this has anything to do with me?† â€Å"Are you saying it doesn't?† he asked, not fooled in the least. I could feel a traitorous smile playing over my lips. After raiding Keith's apartment, the Alchemists had made sure his tattooist partners no longer had the means to administer illicit tattoos. There'd also been no more talk of Zoe replacing me. It had taken days before Slade and his friends had realized their connection to performance-enhancing ink was gone. I'd been observing their furtive conversations with amusement this week but hadn't realized Trey had noticed as well. â€Å"Let's just say that Slade may soon no longer be the superstar he's been,† I said. â€Å"Hope you're ready to step up and take his place.† Trey studied me a few moments more, apparently hoping I'd add something else. When I didn't, he simply shook his head and chuckled. â€Å"Anytime you need coffee, Melbourne, you come see me.† â€Å"Noted,† I said. I gestured toward the still-growing crowd. â€Å"What are you doing here anyway? I didn't realize you were interested in today's hottest fashions.† â€Å"I'm not,† he agreed. â€Å"But I've got a couple of friends working on the show.† â€Å"Girlfriends?† I asked slyly. He rolled his eyes. â€Å"Friends who are girls. I have no time for silly female distractions.† â€Å"Really? I figured that's why you got your tattoo. I hear women go for that kind of thing.† Trey stiffened. â€Å"What are you talking about?† I remembered that Kristin and Julia had mentioned how strange it was that Trey had a tattoo of his own and Eddie had later mentioned seeing it on Trey's lower back in the locker room. Eddie had said it looked like a multi-rayed sun made of very ordinary ink. I'd been waiting for a chance to tease Trey about it. â€Å"Don't play coy. I know about your sunshine. How come you always give me such a hard time, huh?† â€Å"I†¦Ã¢â‚¬  He was truly at a loss. More than that. He looked uncomfortable, worried – like this was something he hadn't wanted me to know about. That was weird. It wasn't that big a deal. I was about to question him more when Adrian suddenly made his way to us through the crowd. Trey took one look at Adrian's stormy face and immediately got to his feet. I could understand his reaction. Adrian's expression would've intimidated me too. â€Å"Well,† said Trey uneasily. â€Å"Thanks again. I'll catch you later.† I murmured a goodbye and watched as Adrian slipped past me. Micah sat beside me, then Eddie, and then two empty seats we'd saved. Adrian sat down in one of them, ignoring Eddie's greeting. Moments later, Lee came hurrying in and took the other seat. He looked troubled about something but still managed to be friendlier than Adrian. Adrian stared stonily ahead, and my good mood plummeted. Somehow, without knowing why, I had a feeling I was the reason for his dark mood. We had no time to pursue it, though. The lights went down and the show began. It was emceed by a local newscaster, who introduced the five designers showing tonight. Jill's designer was third, and watching the others go before her made the anticipation that much more intense. This was worlds away from the practice sessions I'd seen before. The lights and the music took everything to a more professional level, and the other models seemed so much older and seasoned. I began to share Jill's earlier anxiety, that maybe she was out of her league. Then Lia DiStefano's turn came. Jill was one of her first models and emerged wearing a flowing, silvery evening gown made of some fabric that seemed to defy gravity. A half mask of pearls and silver covered up her part of her face, obscuring her identity to those who didn't know better. I would've expected them to tone down her vampire features a little, to possibly give her a little more humanlike color. Instead, they'd played up her unusual looks, putting a luminescent powder on her skin that enhanced her paleness in a way that made her look otherworldly. Every single curl had been arranged into place, artfully falling around her and bedecked with tiny glittering jewels. Her walk had improved vastly since that first practice. She'd practically slept in those high heels and had gone beyond simply not trying to fall over. There was a new confidence and purpose that hadn't been there before. Every once in a while, I'd catch a faint glimpse of nervousness in her eyes or an adjustment in her stride as she managed the tall silver heels. I doubted anyone else noticed those things, however. Anyone who didn't know Jill and her traits well would see nothing but a strong, ethereal woman striding down the catwalk. Amazing. If she could transform this much with only a little encouragement, what more was to come? Glancing at the guys beside me, I saw similar feelings mirrored in their faces. Adrian's was filled with that brotherly pride he often had for her, all traces of his earlier bad mood vanished. Micah and Lee both displayed pure, unfiltered adoration. To my surprise, Eddie's expression was adoring too, along with something else. It was almost†¦ worshipful. This was it, I realized. In coming out as this beautiful, larger-than-life goddess-like creature, Jill was giving flesh to all of Eddie's idealistic, protective fantasies. She was the perfect princess now, with her dutiful knight waiting to serve. She appeared two more times in Lia's line, stunning each time, though never quite matching that initial debut in the silver dress. I watched the rest of the show with only half an eye. My pride and affection for Jill were too distracting, and honestly, most of the clothes I saw tonight were way too flashy for my tastes. There was a reception after the show, where guests, designers, and models could mingle over refreshments. My little group found a corner near the hors d'oeuvres to wait for Jill, who had yet to make an appearance. Lee carried an enormous bouquet of white lilies. Adrian watched a waitress go by with a tray full of champagne glasses. His eyes were filled with longing, but he made no moves to stop her. I was proud and relieved. Jill, balance, and alcohol were not things we wanted to mix. When the waitress was gone, Adrian turned to me, and I finally saw that earlier anger return. And, as I'd suspected, it was directed toward me. â€Å"When were you going to tell me?† he asked. It was as enigmatic as Trey's earlier opening line. â€Å"Tell you what?† â€Å"That the financial aid isn't going to come through! I talked to the registrar's office, and they said you knew.† I sighed. â€Å"I wasn't keeping it from you, exactly. I just didn't have a chance to tell you yet. There were kind of a lot of other things going on.† Okay, I actually had been putting it off, for exactly this reason. Well, not exactly. I hadn't anticipated he would get so worked up about it. â€Å"You apparently had enough time to pay the auditing fee, though. And enough money. But not enough to fund new lodging.† I think what was more upsetting about this than the topic was the insinuation that I had somehow chosen to act in a way that would inconvenience him. Like I'd purposely subject myself to this if there'd been some way to avoid it. â€Å"A onetime payment was easy to slip in,† I told him. â€Å"Month-to-month rent? Not so much.† â€Å"Then why bother at all?† he exclaimed. â€Å"The whole point of this was to get me money to get out of Clarence's! I wouldn't be taking these stupid classes otherwise. You think I want to ride the bus for hours each day?† â€Å"Those classes are good for you,† I countered, feeling my own temper rise. I hadn't wanted to lose control, not here and certainly not with our friends witnessing everything. Yet I was appalled at Adrian's reaction. Couldn't he see how good it was for him to do something useful? I'd seen his face when he showed me his paintings. They'd given him a healthy channel to deal with Rose, not to mention a sense of purpose for him. And besides, it killed me to see how casually he could just toss aside those â€Å"stupid† classes. It was another reminder of the unfairness of the world, how I couldn't have what others took for granted. He scowled. â€Å"‘Good for me?' Come on, stop being my mom again! It isn't your job to tell me how to live my life. If I want your advice, I'll ask for it.† â€Å"Right,† I said, putting my hands on my hips. â€Å"It's not my job to tell you how to live your life – just my job to make it as easy as possible for you. Because God knows you can't suffer through anything that's a little inconvenient. What happened to all those things you told me? About being serious about improving your life? When you asked me to believe in you?† â€Å"Come on, you guys,† said Eddie uneasily. â€Å"This isn't the time or place.† Adrian ignored him. â€Å"You have no problem making Jill's life as easy as possible.† â€Å"That is my job,† I growled back. â€Å"And she's still a girl. I wouldn't think an adult like you would need taking care of the same way!† Adrian's eyes were filled with emerald fire as he glared down at me, and then his gaze focused on something behind me. I turned and saw Jill approaching. She was back in the silver gown, her expression full of radiant happiness – happiness that plummeted as she got closer and realized there was an altercation going on. By the time she was standing next to me, all her excitement from a moment ago had been replaced by worry and concern. â€Å"What's happening?† she asked, looking between Adrian and me. Of course, she had to already know because of the bond. It was a wonder his dark feelings hadn't messed up her performance. â€Å"Nothing,† I said flatly. â€Å"Well,† said Adrian. â€Å"It depends how you define ‘nothing.' I mean, if you consider lying and – â€Å" â€Å"Stop it!† I cried, raising my voice in spite of my best effort. The room was too noisy for most to notice, but a couple people standing nearby glanced at us curiously. â€Å"Just stop it, Adrian. Can you please not ruin this for her? Can't you just for one night pretend there are other people in the world who matter besides you?† â€Å"Ruin it for her?† he exclaimed. â€Å"How the hell can you say that? You know what I've done for her! I've done everything for her! I've given up everything for her!† â€Å"Really?† I asked. â€Å"Because from what I can tell, it doesn't seem like – â€Å" I caught sight of Jill's face and promptly cut myself off. Behind the mask, her eyes had gone wide with dismay at the accusations Adrian and I were slinging back and forth. I'd just told Adrian he was selfish and not thinking of Jill, yet here I was, continuing to engage with him on her big night, in front of her and our friends. It didn't matter if I was right – and I felt certain I was. This was no time to be having this discussion. I shouldn't have let Adrian bait me into this, and if he didn't have the sense to stop things before they got worse, then I would. â€Å"I'm leaving,† I said. I forced as sincere a smile as I could for Jill, who now looked on the verge of tears. â€Å"You were amazing tonight. Really.† â€Å"Sydney – â€Å" â€Å"It's okay,† I told her. â€Å"I've got some things to do.† I groped for what they would actually be. â€Å"I need to, um, clean up the stuff Keith left behind. Can you get her and Eddie back to Amberwood?† This was directed to Micah and Lee. I knew one of them would step up. I felt no need to make any such provisions for Adrian. I honestly didn't care what became of him tonight. â€Å"Of course,† said Lee and Micah in unison. After a moment, though, Lee frowned. â€Å"Why do you need to clean up Keith's stuff?† â€Å"Long story,† I muttered. â€Å"Let's just say he left town and won't be back anytime soon. Maybe never.† Inexplicably, Lee seemed bothered by this. Maybe during all the time Keith had spent at Clarence's, the two guys had become friends. If so, Lee owed me. Jill still looked upset. â€Å"I thought we were all going out to celebrate?† â€Å"You can if you want,† I said. â€Å"As long as Eddie's with you, I really don't care.† I reached awkwardly to Jill. I almost wanted to hug her, but she was so elaborate and magnificent in her clothing and makeup that I was afraid of ruining her. I settled for a halfhearted pat on the shoulder. â€Å"I meant it. You were breathtaking.† I hurried away, half-afraid that either Adrian or I would crack and say something stupid to the other. I had to get myself out of there. My hope now was that Adrian would have enough sense to let the topic go and not make this night any worse for Jill. I didn't know why the fight with him upset me so much. He and I had been bickering nearly since we'd met. What was one more quarrel? It's because we'd been getting along, I realized. I still didn't think of him in human terms, but somewhere along the way, I'd come to regard him as a little less of a monster. â€Å"Sydney?† I was stopped by an unexpected source: Laurel. She had touched my arm as I passed by a group of girls from Amberwood. I must have looked really mad because when I fixed my gaze on her, she actually flinched. That had to be a first. â€Å"What?† I asked. She swallowed and stepped away from her friends, eyes wide and desperate. A fedora covered most of her hair, which – I'd heard – she still hadn't been able to restore to normal. â€Å"I heard†¦ I heard you might be able to help me. With my hair,† she said. That was another favor Kristin had done me. After letting Laurel suffer for a few days, I'd had Kristin put out the word that Sydney Melrose – with her dorm room pharmacy – might be able to fix what was wrong. I'd also made sure, however, that it was understood that Laurel wasn't my favorite person and that it would take a lot to convince me. â€Å"Maybe,† I said. I tried to keep my face hard, which wasn't difficult since I was still so upset over Adrian. â€Å"Please,† she said. â€Å"I'll do whatever you want if you can help me! I've tried everything on my hair, and nothing works.† To my astonishment, she shoved some yearbooks at me. â€Å"Here. You wanted these, right? Take them. Take whatever you want.† Another five days of scrubbing with heavy detergent would actually fix her, but I certainly wasn't going to tell her. I took the yearbooks. â€Å"If I help you,† I said, â€Å"you need to leave my sister alone. Do you understand?† â€Å"Yes,† she said quickly. â€Å"I don't think you do. No more stunts, bullying, or talking about her behind her back. You don't have to be her best friend, but I don't want you interfering with her anymore. Stay out of her life.† I paused. â€Å"Well, except to offer an apology.† Laurel was nodding along with everything I said. â€Å"Yes, yes! I'll apologize right now!† I lifted my eyes to where Jill was standing with her admirers, Lee's flowers in her arms. â€Å"No. Don't make this night any weirder for her. Tomorrow's soon enough.† â€Å"I will,† said Laurel. â€Å"I promise. Just tell me what to do. How to fix this.† I hadn't expected Laurel to approach me tonight, but I had been expecting her one of these days. So, I already had the small bottle of antidote ready in my purse. I retrieved it, and her eyes nearly popped out of her head as I held it in front of her. â€Å"One dose is all you need. Use it just like shampoo. Then you'll have to re-dye it.† She reached for the bottle, and I jerked it back. â€Å"I mean it. Your harassment of Jill ends now. If I give this to you, I will not hear one more word about you giving her a hard time. No more grief if she talks to Micah. No more vampire jokes. No more calling Nevermore and asking about tall, pale people.† She gaped. â€Å"No more what? I never called anyone!† I hesitated. When the tattooist had mentioned someone calling and asking about people who looked like vampires, I'd assumed it was Laurel running with the vampire joke. From the baffled look on her face now, I no longer thought that was true. â€Å"Well, if I hear about any of the other stuff continuing, then what happened to your hair will be nothing in comparison to what happens next. Nothing. Do you understand me?† She nodded shakily. â€Å"P-perfectly.† I handed her the bottle. â€Å"Don't forget.† Laurel started to turn away and then cast another uneasy glance at me. â€Å"You know, you can be scary as hell sometimes.† I wondered if the Alchemists had had any idea what I'd be doing when it came to this job. At least this settled one thing. Laurel's desperation convinced me the vampire jokes had only been a tactic. She didn't really believe any of them were true. It did, however, raise the unnerving question about who had asked about vampires at Nevermore. When I was finally out of the building and heading toward my car, I decided I really would go to Keith's. Someone needed to sort through his belongings, and it seemed like a safe way to avoid the others. I still had a couple of hours before curfew at Amberwood. Keith's apartment hadn't been disturbed since the Alchemists had raided it. The telltale signs from before were there, where we'd discovered his stash of Clarence's blood and silver supplies. The Alchemists had done little more than retrieve the essentials they needed and had left the rest of his belongings behind. My hope in coming tonight had been to get ahold of his other ingredients, the ones not used to manufacture illicit tattoos. It was always handy to have extra amounts of those chemicals on hand, be it for destroying Strigoi bodies or making dorm room chemistry experiments. No such luck. Even if his other supplies hadn't been illegal, the Alchemists had apparently decided to confiscate all chemicals and ingredients. Since I was here, though, I decided to see if any of his other possessions were items that would be of use to me. Keith certainly hadn't held back in using his illicit funds to furnish the apartment with every comfort of home. Scratch that. I doubted his home had anything like this: a California-king-sized bed, giant flatscreen TV, a theater-worthy sound system, and enough food to throw parties every night for the next month. I peered through cupboard after cupboard, appalled at how much of that food was junk food. Still, maybe it'd be worth taking some of it back for Jill and Eddie, so I bagged up the more portable sweets for them, organizing by color and size. I wondered also about the practicality of hauling the TV back to Amberwood. It seemed like a waste to leave it for the Alchemists' repo crew, though I could already imagine Mrs. Weathers's expression if she saw us dragging it up the stairs. I wasn't even sure Jill and I had a wall big enough to hold it. I sat down in Keith's recliner to ponder the TV issue. Even the recliner was top of the line. The luxurious leather felt like butter, and I practically sank into the cushions. Too bad there was no room for it in Ms. Terwilliger's room. I could see her relaxing back in it while drinking cappuccino and reading old documents. Well, whatever became of the rest of Keith's stuff, it was going to require the rental of a moving truck because Latte certainly couldn't handle the TV, chair, or most of the other things. Once this was decided, there was no reason for me to stay any longer tonight, but I hated to go back. I was afraid of seeing Jill. There was no reaction of hers I welcomed. If she was still sad from the argument, that would make me feel guilty. If she tried to defend Adrian, that would upset me too. I sighed. This chair was so ridiculously comfortable, I might as well enjoy it a little longer. I dug into my messenger bag, looking for homework, and remembered the yearbooks. Kelly Hayes. I'd had almost no time to think about her or the murders, not with all the drama surrounding Keith and the tattoos. Kelly had been a junior when she died, and I had a yearbook for each of her years at Amberwood. Even as a freshman, Kelly took lots of space in the yearbook. I remembered Mrs. Weathers saying Kelly was a good athlete. No kidding. Kelly had participated in nearly every sport Amberwood offered and been exceptional at all of them. She'd made varsity teams during her first year and won all sorts of awards. One thing I also immediately discovered was that Kelly was definitely not a Moroi. That much was obvious, even in black and white, and confirmed in the sophomore-year color spread in the middle. She had a very human build and tanned skin that clearly loved the sun. I was skimming the index of the junior yearbook when I heard a knock at the door. For a moment, I didn't want to answer. For all I knew, it was some loser friend Keith had made while here, looking to eat his food and watch TV. Then I worried it could be something Alchemist related. I found the Kelly tribute section I'd been seeking and set the yearbook down before tentatively approaching the door. Looking out the peephole, I caught sight of a familiar face. â€Å"Lee?† I asked, opening the door. He gave me a sheepish smile. â€Å"Hey. Sorry to bug you here.† â€Å"What are you doing here?† I exclaimed, beckoning him inside. â€Å"Why aren't you back with the others?† He followed me into the living room. â€Å"I – I needed to talk to you. When you said you were coming here, it made me wonder if what my father had said was true. That Keith isn't here anymore?† I sat back down on the recliner. Lee took a spot on the nearby loveseat. â€Å"Yup. Keith's gone. He was, uh, reassigned.† Keith was off being punished somewhere, and I said good riddance. Lee glanced around, taking in the expensive furnishings. â€Å"This is a nice place.† His eyes fell on the cabinet that had held the alchemy supplies. Its door still hung precariously from its hinges, and I hadn't bothered tidying up where the Alchemists had cleaned out its other contents. â€Å"Was this†¦Ã¢â‚¬  Lee frowned. â€Å"Was this place broken into?† â€Å"Not exactly,† I said. â€Å"Keith, um, just needed to find something in a hurry before he left.† Lee wrung his hands and looked around some more before turning back to me. â€Å"And he's not coming back?† â€Å"Probably not.† Lee's face fell, which surprised me. I'd always gotten the impression he didn't like Keith. â€Å"Will another Alchemist be replacing him?† â€Å"I don't know,† I said. There was still some debate on that. Turning Keith in had stopped me from being replaced by Zoe, and Stanton was now considering just having me fill in as the local Alchemist since the duties were light. â€Å"If someone does, it may be a while.† â€Å"So you're the only Alchemist in the area,† he repeated, sounding sadder still. I shrugged. â€Å"There are some in Los Angeles.† That inexplicably perked him up a little. â€Å"Really? Could you tell me their – â€Å" Lee stopped as his focus dropped to the open yearbook lying at my feet. â€Å"Oh,† I said, scooping it up. â€Å"Just a research project I'm doing on – â€Å" â€Å"Kelly Hayes.† The cheerful look was gone. â€Å"Yeah. Have you heard of her?† I reached for a nearby piece of scrap paper, intending to use it as a bookmark for the tribute section. â€Å"You might say that,† he replied. I started to ask what he meant, and that's when I saw it. The spread they'd done in honor of Kelly had pictures from all parts of her high school life. Unsurprisingly, most of them were pictures of her playing sports. There were a few from other areas of her social and academic worlds, including one of her at the prom. She wore a stunning blue satin dress that made the most of her athletic figure and was giving the camera a big grin as she wrapped an arm around her dashing, tuxedo-clad date. Lee. I jerked my head up and looked at Lee, who was now regarding me with an unreadable expression. I turned back to the picture, scrutinizing it carefully. What was remarkable wasn't that Lee was in the picture – though, believe me, I hadn't figured out what was going on with that yet. What had me hung up was the timing. This yearbook was five years old. Lee would've been fourteen at the time, and the guy looking back at me with Kelly was certainly not that young. The Lee in the picture looked exactly like the nineteen-year-old sitting across from me, which was impossible. Moroi had no special immortality. They aged like humans. I looked back up, wondering if I should be asking if he had a brother. Lee saved me from questioning, though. He simply regarded me with a sad look and shook his head. â€Å"Shit. I hadn't wanted it to happen like this.† And then, he took out a knife.

The Site Formation Processes in Archaeology

Site Formation Processes refers to the events that created and affected an archaeological site before, during, and after its occupation by humans. To gain the best possible understanding of an archaeological site, researchers collect evidence of the natural and cultural events that happened there. A good metaphor for an archaeological site is a palimpsest, a medieval manuscript that has been written on, erased and written over, again and again, and again. Archaeological sites are the remains of human behaviors, stone tools, house foundations, and garbage piles, left behind after the occupants leave. However, each site was created in a specific environment; lakeshore, mountainside, cave, grassy plain. Each site was used and modified by the occupants. Fires, houses, roads, cemeteries were built; farm fields were manured and plowed; feasts were held. Each site was eventually abandoned; as a result of climate change, flooding, disease. By the time the archaeologist arrives, the sites have lain abandoned for years or millennia, exposed to weather, animal burrowing, and human borrowing of the materials left behind. Site formation processes include all of that and quite a bit more. Natural Transforms As you might imagine, the nature and intensity of events that occurred at a site are highly variable. Archaeologist Michael B. Schiffer was the first to clearly articulate the concept in the 1980s, and he broadly divided site formations into the two major categories at work, natural and cultural transforms. Natural transforms are ongoing, and can be assigned to one of several broad categories; cultural ones can end, at abandonment or burial, but are infinite or close to it in their variety. Changes to a site caused by nature (Schiffer abbreviated them as N-Transforms) depend on the age of the site, the local climate (past and present), the location and setting, and the type and complexity of occupation. At prehistoric hunter-gatherer occupations, nature is the primary complicating element: mobile hunter-gatherers modify less of their local environment than do villagers or city dwellers. Types of Natural Transforms View of Point of Arches on the Ozette Reservation North of Cape Alava. John Fowler Pedogenesis, or the modification of mineral soils to incorporate organic elements, is an ongoing natural process. Soils constantly form and reform on exposed natural sediments, on human-made deposits, or on previously formed soils. Pedogenesis causes changes in color, texture, composition, and structure: in some cases, it creates immensely fertile soils such as terra preta, and Roman and medieval urban dark earth. Bioturbation, disturbance by plant, animal and insect life, is particularly difficult to account for, as shown by a number of experimental studies, most memorably with Barbara Boceks study of pocket gophers. She discovered that pocket gophers can repopulate the artifacts in a 1x2 meter pit backfilled by clean sand in the space of seven years. Site burial, the burial of a site by any number of natural forces, can have a positive effect on site preservation. Only a handful of cases are as well-preserved as the Roman site Pompeii: the Makah village of Ozette in Washington state in the US was buried by a mudflow about 1500 AD; the Maya site Joya de Ceren in El Salvador by ash deposits about 595 AD. More commonly, the flow of high- or low-energy water sources, lakes, rivers, streams, washes, disturb and/or bury archaeological sites. Chemical modifications are also a factor in site preservation. These include cementation of deposits by carbonate from groundwater, or iron precipitation/dissolution or diagenetic destruction of bone and organic materials; and the creation of secondary materials such as phosphates, carbonates, sulfates, and nitrates. Anthropogenic or Cultural Transforms The Pompeii of North America, Joya de Ceren, was buried in a volcanic eruption in August 595 CE. Ed Nellis Cultural transforms (C-Transforms) are far more complicated than natural transforms because they consist of a potentially infinite variety of activities. People build up (walls, plazas, kilns), dig down (trenches, wells, privies), set fires, plow and manure fields, and, worst of all (from an archaeological point of view) clean up after themselves. Investigating Site Formation To get a handle on all of these natural and cultural activities in the past that have blurred the site, archaeologists rely on an ever-growing group of research tools: the primary one is geoarchaeology. Geoarchaeology is a science allied with both physical geography and archaeology: it is concerned with understanding the physical setting of a site, including its position in the landscape, types of bedrock and Quaternary deposits, and the types of soils and sediments within and outside of the site. Geoarchaeological techniques are often carried out with the aid of satellite and aerial photography, maps (topographic, geological, soil survey, historical), as well as the suite of geophysical techniques such as magnetometry. Geoarchaeological Field Methods In the field, the geoarchaeologist conducts a systematic description of cross-sections and profiles, to reconstruct stratigraphic events, their vertical and lateral variations, in and outside of the context of archaeological remains. Sometimes, geoarchaeological field units are placed off-site, in locations where lithostratigraphic and pedological evidence can be collected. The geoarchaeologist studies the site surroundings, description and stratigraphic correlation of the natural and cultural units, as well as sampling in the field for later micromorphological analysis and dating. Some studies collect blocks of intact soils, vertical and horizontal samples from their investigations, to take back to the laboratory where more controlled processing can be conducted than in the field. Grain size analysis and more recently soil micromorphological techniques, including thin section analysis of undisturbed sediments, are conducted using a petrological microscope, scanning electron microscopy, x-ray analyses such as microprobe and x-ray diffraction, and Fourier Transform infrared (FTIR) spectrometry. Bulk chemical (organic matter, phosphate, trace elements) and physical (density, magnetic susceptibility) analyses are used to incorporate or determine individual processes. Formation Process Studies Restudy of Mesolithic sites in Sudan excavated in the 1940s was conducted using modern techniques. The 1940s archaeologists commented that aridity had affected the sites so badly that there was no evidence of hearths or buildings or even post-holes of buildings. The new study applied micromorphological techniques and they were able to discern evidence of all of these types of features at the sites (Salvatori and colleagues). Deep-water shipwreck (defined as shipwrecks more than 60 meters deep) site formation processes have shown that the deposit of a shipwreck is a function of heading, speed, time, and water depth and can be predicted and measured using a set basic of equations (Church). Formation process studies at the 2nd century BC Sardinian site of Pauli Stincus revealed evidence of agricultural methods, including the use of a sodbuster and slash and burn farming (Nicosia and colleagues). The microenvironments of Neolithic lake dwellings in northern Greece were studied, revealing a previously unidentified response to rising and falling lake levels, with the residents building on platforms on stilts or directly on the ground as needed (Karkanas and colleagues). Sources Aubry, Thierry, et al. Palaeoenvironmental Forcing During the Middle-Upper Palaeolithic Transition in Central-Western Portugal. Quaternary Research 75.1 (2011): 66-79. Print.Bertran, Pascal, et al. Experimental Archaeology in a Mid-Latitude Periglacial Context: Insight into Site Formation and Taphonomic Processes. Journal of Archaeological Science 57 (2015): 283-301. Print.Bocek, Barbara. The Jasper Ridge . American Antiquity 57.2 (1992): 261-69. Print.Reexcavation Experiment:  Rates of Artifact Mixing by RodentsChurch, Robert A. Deep-Water Shipwreck Initial Site Formation: The Equation of Site Distribution. Journal of Maritime Archaeology 9.1 (2014): 27-40. Print.Ismail-Meyer, Kristin, Philippe Rentzel, and Philipp Wiemann. Neolithic Lakeshore Settlements in Switzerland: New Insights on Site Formation Processes from Micromorphology. Geoarchaeology 28.4 (2013): 317-39. Print.Linstà ¤dter, J., et al. Chronostratigraphy, Site Formation Processes and Pollen Record of Ifri Netsedda, N e Morocco. Quaternary International 410, Part A (2016): 6-29. Print.Nicosia, Cristiano, et al. Land Use History and Site Formation Processes at the Punic Site of Pauli Stincus in West Central Sardinia. Geoarchaeology 28.4 (2013): 373-93. Print.