text:
A little disclaimer first... sorry about the format, or the length. This was originally an idea I had at school, then I wrote it as a short story in many parts through facebook chat for an awesome person I know. As such the style may change, or there is an unnatural jump. Either way I hope you enjoy it.

The great theatre of the world

The stage manager stands there and surveys his work. It wa sgood. He particularly liked the way the light went through the leaves of the trees. The land was luscious and green, th people happy and all was good.

Soon he would meet the director and show him what he has done but for now he could relax in this perfect world he had created.

Soon the director turned up and boy was he pleased with the stage managers work.

"This is perfect, it is amazing. How did you get the light to go through the trees like that? Seriously my friend you have earned this."

With that the director handed the stage manager a small bag tied at the top.

"What's this?" Asked the stage manager

"Money. You know? To pay you for work you have done?"

"But i didint put money in this world, whats it for?"

"It represents worth, one thing could cost more money than another. you can sell your work, goods, anything really and in exchange you can buy stuff."

"Stuff?"

"Yeah, food, entertainment, land... people"

"People?! Buy people?!"

"Well only those that can afford to anyway"

"This is not how I built this place!"

"Yeah but audiences dont like perfect. They get bored. I need a story. I need to make this place more interesting."

"This will end in tears, and not just mind mark you"

"Grow up man! Things will be fine, a little story never hurt"

"Mark my words this will be bad"

With that the stage manager left, throwing the money onto the ground.

the director continued to survey the land. this will do. qquite nicely I believe.

The director is at a table, staring intently at something. In walks the stage manager.

"Ah, stage manager. Come have a look at this"

"This isnt another change is it? You have made so many. I created perfection, it didnt need changes"

"Hush your mouth, perfection is boring. And yes it is another change -"

"It'll end in tears you know"

"Stop moping and have a look at this"

The stage manager moves closer to the table and as he gets closer he sees that a map of the world is on the table, next to it lies some felt pens and the director has enthusiastically been adding colour to the map.

"Its a map of the world which you have scribbled on. so what?"

"It's what the scribbles mean thats important. They are borders" The director beamed proudly

"Borders? What do they need borders for, they are all already bordered by the ocean"

"Ah well its more of a seperation from the other countries nearby... You know generate some community spirit and the such"

"But they were one big community?"

"Ah see what I've done as well is in the process given them a few diffferent languages, colours and beliefs. I tell you what it was quite tough to think up all the ridiculous things for them to believe, however they accepted it"

"Things to believe... are we talking god again? Must you make a cameo for your friend everytime? He cant even act. What you done this time?"

"Well the Christians believe he built the world."

"HE DIDNT I DID!"

"Calm down, I know that and he knows that. What does it matter if they dont?"

"I cant believe you. Stop making changes, someone is going to get hurt."

The stage manager walks off in anger.

"Perfection is boring!" shouts the director after him.

The director turns back to his map and picks up a pen. "Maybe I'll add platypus to Australia... That will really fuck them up."

"Hello?" the stage manager's voice travelled into the void. the director's lab was empty. this is unusual, normally he is here tinkering, interferring.

"Hello?" the stage manager tried again. The same void swallowed his voice and it faded off into the distance.

"Up here!" the director cried, "come look at this! you'll have to hurry!"

The stage manager climbed through the laboratory, discarded thoughts littering the floor where they had taken root with a life of their own.

The stage manager climbed the ladder to the roof where the director was stood, in a rain coat, with the wind tearing through his hair.

"You wont want to miss this"

The stage manager curious inspite of himself joined the director and looked out over the land in the general direction that he was.

After a couple of moments the skies grew darker and darker and clouds formed. As the clouds met a funnel emerged and and gradually saught its way downwards. As it touched the floor it seemed to rip the earth around it. Everything flew through the air, landing in heaps of rubbish.

"What on earth is that?!"

"I call it a tornado. Beautiful isnt it?"

"Deadly more like"

"Well yeah, whats the point in it if its not? the best stories come out of tragedy. You should see what else I have done, earth quakes, tsunamis, hurricanes, volcanoes, the works. I am going to call them natural disasters."

"They look horrid. Why would you do this to people?"

"Its entertainment my dear friend, its all just entertainment."

"I dont want any part of this."

"What are you talking about?! its your world. You are part of this. Without you there would not be any of this. We owe our thanks to you. You built the stage, all I have done is make the stries happen. and boy are they happening."

"You are sick"

"You should see it, the horror people will put each other through, it shows the best in others. Every criminal has a story which makes you yearn for him to be brought back into society. Every act of hardship is followed up by resilience."

"Only in the stories that you show. What about where they dont get back to normal? or they dont rehabilitate? what happens to those people?"

"Well, of course there will be fallout. There is always fallout. Can't make an ommlette without breaking some eggs."

"You arent breaking eggs, you are smashing them and rolling in delight in the mess. Thats it. Im through. I am not indulging you any more. I am going down into that place and I am going to correct what you have done. I am going to tell people the truth"

"They will think you are crazy..."

"I dont care. I cant stand here playing with people for entertainment. I created perfection and you have destroyed it in favour of this horrorshow. Good luck with your endeavors as I am gone"

the stage manager stormed off fuming. As he walked down the hill into the world he threw his mobile phone and only contact with the director into a pond. He ditched his creators bag and with every step became more human. At the bottom of the hill he entered the world as a human to do what he could...

The director grabbed his phone and dialled for the stage manger.

*ring ring*

shit

*ring ring*

Fuck pick up

*ring ring*

Come on! Pick up

*You have reached the answering machine of-"

""Fuck fuck fuck shit shit"

"Please leave a message after the tone"

*Beep*

"Hey. It's me. uhh. I need your help. I think you were right. The world cant handle it anymore. Things are getting bad down there. I dont know what to do.

I gave them entertainment but they just wanted more. More sex, more violence, more horror. I dont have anything left to give.

Shit! what was that?

I think there may be someone outside. our someones. It's getting noiser...

I dont have anything left to give, and I cant watch the horribleness that they gleefully inflict on one another. Have you seen Auschwitz yet? I didnt make that. They did. Well maybe I gave them the tools to do it.

No i gave them the tols to build civilisation, not evil. Perhaps they no longer want t obe civil?

It's getting louder outside... I think they are coming for me.

What I am trying to say is although perfection is boring it is safe. Remember how beautiful that world looked when you built it? They have shit all over it now?

Crap! I think they are in the labratory!

Anyway what I'm saying is undo it all. Only you know what I have done and what can be undone. Ignore God, he is a prick, he just wants to stay God. Did you see his commandments? What a turd.

*Shouting grows loud*

Ithink they are right outside. Promise me you will do this?

*Crash as door breakss down*

You've got to fix this. Fix it-"

*Line goes dead*

****************************************************************

Two kids are laughing and joking as they walk down an alleyway. They see a homeless man passed out, stinking of piss and alcohol. They move over to him and start going through his stuff.

They pull out a small bag which contains coins, but no currency they have ever heard off.

They see a map with scribbles all over it, notes about religions.

They unfold a photo of a tornado.

"What a fucking freak"

With that on of the heftier teenagers swings his foot back and punts the homeless man in the stomach. The homeless guy wakes with a start as the teenagers run off down the alleyway.

The homeless man coughs and splutters up phlegm and blood. And there sat the saviour of the world, everyday becoming more human, and every day the world taking another part of him.

The End

title: The Great Theater of the world

question: What does the story say about the director?

answer: It seems like he has the final say on what goes on the Earth, in a cosmic sense. The State Manager creates a perfect world with humanity living in harmony and peace. The Director adds lots of divisive elements to humanity like religions, races, and cultures as well as lots of natural disasters so that a better story comes about. As time goes on, the properties he gave to humanity result in lots of horrible outcomes. He's regretful by the end and begs the State Manager to revert it all back, but the State Manager is long gone by then.

question: What does the story say about the State Manager?

answer: He's the creator of the world, but he's not God. He creates a perfect world where humans live in harmony and peace. However, the Director wants to have a more exciting story and incorporates lots of divisive features like religions, borders, races, etc. The State Manager is against all that but can't persuade the Director otherwise. After the Director adds natural disasters, the State Manager can't take it anymore and decides to go to Earth and tell the truth to humans. The Director warns that humans will think he's crazy, but he goes anyway. By the time the Director regrets the changes, he's long gone, turning more human every day. On Earth, he lives as a homeless, sick man who stinks of piss and alcohol. Two kids see him, look at the contents of his bag, call him a freak, and kick him before running away.

question: What does the text say about peaceful religions like Buddhism?


split: test

text:
Showrunning director and executive producer Mimi Leder breaks down what changed between seasons of "The Leftovers."

“Mimi Leder can direct the shit out of anything.”

That’s Justin Theroux describing his showrunning director on “The Leftovers,” but it’s also as close as an opinion can come to being factual — and one supported by this critic. A helmer of giant blockbusters (like “Deep Impact”) and intimate dramas (like “The West Wing”), Leder expertly transformed Damon Lindelof’s wild words — “He has a lot of huevos,” Leder said — into a unique vision that brought them to life like no one else could. And she did it with incredible insight into everything from what makes each character tick to what the audience needed to see in order to access those characters.

Speaking to Indiewire shortly before starting production on Season 3, Leder dug into how the series developed over its first two seasons, what she brought to the table as a director and why one big scene didn’t make the cut for the brilliant — and nearly feature-length — finale.

READ MORE: ‘The Leftovers’: An Oral History of the Finale’s Karaoke Scene, from Damon Lindelof & Justin Theroux

YOU CAME ONBOARD “THE LEFTOVERS” AS A DIRECTOR AND THEN YOU MOVED INTO THE ROLE OF CO-EP, CORRECT?

Damon asked me to come direct an episode, and I directed “Gladys” how I thought the show should be. It was a brand new show, so — when I came on — I felt very close to it. I felt like I somehow understood it on a much deeper level. Then, while I was editing it, they asked me to stay. There were some growing pains in the beginnings of “The Leftovers.” That’s no secret.

THERE’S BEEN A LOT OF TALK ABOUT WHAT CHANGED AND WHAT DIDN’T CHANGE BETWEEN SEASON 1 AND SEASON 2.

My perspective is that Damon and Tom Perrotta were really discovering what the show was about. You write a story and then your story starts to speak to you, and I believe that they had some growing pains in the beginning. “Who’s point of view is this?” They started doing point of view stories, which they discovered were very successful — which it always is because it’s from your character’s point of view. You immediately, as an audience, get sucked in.

[Damon Lindelof & Mimi Leder on the set of "The Leftovers" Season 3]
I think that these point of views became stronger. The visual language — that maybe I brought to it, especially in the second season — helped to define what that was. The first season was very muted, very claustrophobic. And in the second season, we were moving to Austin, Texas, to this little town called Miracle. And I thought it was really important to expand the color palette, to find rich, deep colors to help express our characters’ emotions. I also thought opening up the show visually was important: wider shots, showing the environment more because the environment was very pertinent to the story. So, that’s what I think I helped bring to the show.

IT’S THOSE DETAILS THAT ELEVATE THINGS IN SUCH A BIG WAY, BUT IT’S HARD TO JUST POINT TO IT AND SAY, “WELL HEY, THIS IS WHAT REALLY HELPED IT EVOLVE.”

You know, it ultimately is a show about family and what it’s like to lose your family — to lose everything in your life that is special to you. And so, how do you visually explore that? How do you dive deep into someone’s soul? We use close-ups very regularly. We get in there, but we also drop back to see the body language. For me, it’s really important to really dig deep into a character’s heart and try and find what’s between those lines. What are those moments when the actor isn’t speaking? What are those moments that help express and take you to the next level? It’s a real privilege to work on this show because of Damon’s writing, and his team of writers are an extraordinary group of thinkers who attach meaning to everything. I am on the continual search for the right look, the right light, the right environment to express that.

DIRECTING THE SEASON 2 PREMIERE, DID YOU FEEL IT WAS IMPORTANT FOR YOU TO BE THE ONE TO SET THAT TONE WHEN YOU’RE STARTING OVER, IN A WAY, FOR SEASON 2?

Oh, absolutely. I mean, I started to open up the show at the end of the first season. I didn’t want it to look like a whole new show. I just wanted it to breathe more, and I think we did that. We had the camera breathe more. We did bigger and bolder things. The most successful shots are ones that you feel and not ones that you are watching. It’s better when you just feel them, and they speak to you.

WHEN YOU WERE GETTING READY TO SHOOT OR WHEN YOU WERE ON SET SHOOTING “I LIVE HERE NOW,” THE SEASON 2 FINALE, WERE YOU AT ALL CONSIDERING THAT THIS COULD BE THE SERIES FINALE? THAT THIS COULD BE THE END?

You know, I personally did not think it would be the end, but if it was the end, I felt it was very satisfactory in terms of a man’s journey — Kevin’s journey home to his family. And it certainly could’ve been the end, but I never felt like it was resolved. Personally, I felt there were so many great moments in the finale — I’m sounding egotistical, I don’t mean to — and so many heartbreaking moments.

That one scene, for example, when Kevin is in the infirmary and John Murphy comes in and finds him and he looks at him and he goes, “I killed you.” And he goes, “Nope.” That scene, to me, was so much about how we live and get through life. Oftentimes, we never know what’s happening. We just don’t know how we’re going to get through life’s challenges.

[THE LEFTOVERS SEASON 2 MIMI LEDER & CAST JUSTIN THEROUX]
THE FINALE IS JUST PACKED FULL OF VITAL SCENES. THERE’S NOTHING EXTRANEOUS. THERE’S NO FAT ON IT WHATSOEVER. AND YET, IT’S ALMOST FEATURE LENGTH. IT’S ABOUT 73 MINUTES LONG.

And I shot it in 13 days.

THAT’S CRAZY.

It was so challenging, but we were so organized and so in tune with each other. Just that bridge sequence — the charging of the bridge was obviously emotional, but it was a physically difficult scene to do. That was one of the most heartbreaking scenes to film with hundreds of extras around you, but was that really what is was about? The scene was about Nora saving her baby’s life and holding onto the only thing that felt real to her. So, the scenes for me are always about what the characters are feeling and what they’re expressing.

DID YOU HAVE TO CUT ANYTHING FROM THE FINALE?

There was one scene we cut, but I knew we were going to cut it before I even shot the scene. [laughs] I don’t know if I’m supposed to tell you these things.

I’LL MAKE SURE HBO IS COOL WITH IT. [THEY ARE.]

After that scene in the infirmary, Kevin and John come out and we had a scene where people had tied the pillar to a truck and were trying to pull it down. And so basically, it was John and Kevin saving the pillar-man from fighting those guys — kind of saving him together.

Emotionally, it just didn’t feel right. I knew it on the page. They need to go from the infirmary to walking up the street [as they do at the end of the episode]. And that’s how I presented it. I mean, I shot the scene, but I presented my cut to Damon without the fight scene in it. He saw the fight scene and he agreed. But rarely does that happen. We do not do reshoots. We never did a reshoot on this second season, and not much is ever cut.

And you know, by the way, when we’re filming, we are crying! We are so into it. I look next to me, to my director of photography, Michael Grady — who’s this beautiful big burly guy, tough as can be — and he has tears coming out of his eyes. It’s the most gratifying show to work on because it’s really about something. It really is about something that matters. It’s been a privilege to be a part of it.

_[Editor’s Note: Indiewire’s Consider This campaign is an ongoing series meant to raise awareness for Emmy contenders our editorial staff and readership find compelling, fascinating and deserving. Running throughout awards season, Consider This contenders may be underdogs, frontrunners or somewhere in between. More importantly, they’re making damn good television we all should be watching, whether they’re nominated or not.]_

_Stay on top of the latest TV news! Sign up for our TV email newsletter here._

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question: What does the story say about the changes Mimi Leder made?

answer: She contributed to the visual language of the show, which made the point of view episodes stronger. She expanded the color palette to express the characters' emotions, established wider shots that showed the environment since that was important to the story. She says she wanted the show to breathe more, do bigger and bolder things. She wanted both close-ups and wide shots to show the characters' emotions and body language. Apart from the larger changes, she also took out a scene from the final episode, which was rare, but it was the correct decision.

question: What does the article say about Mimi Leder's relationship with the rest of the team?

answer: She was brought in to direct an episode and then asked to continue, eventually becoming a co-executive producer. Justin Theroux thinks she has the ability to direct anything. She thinks Damon and Tom Perrotta were discovering what their story should be like in the first season, and she helped them achieve their vision with her visual language. The final episode, which lasts for 73 minutes, was shot in just 13 days because the entire team was in tune with each other. When she had to cut a scene from it, which is rare for the show, her intuition was in line with Damon's.

question: What does the article say about Matt Damon?


text:
_Quick Response Manufacturing (QRM) is touted as the answer to Lean for hi-mix, lo-volume environments typically encountered in SMEs like job shops or machine builders. Personally, after having read the book and some papers about QRM, I got interested in QRM for the management of make-to-order products along make-to-stock fast movers, typically managed with the more traditional, anonymous or product-specific kanban (see also an earlier post on pull upstream and downstream op the order penetration point). So when Rajan Suri, Mr. QRM himself, was in the Netherlands last week, I took the opportunity and enrolled in a two-day workshop on QRM with him. Expectations were high, but although QRM does propose some interesting tools, overall it was somewhat disappointing. A post on what to expect and what not to expect from QRM._

QRM: Time as a Competitive Weapon

In times where low-cost countries like China and India have proven to be massive economic powers, SMEs in many countries are looking for ways to compete. Suri proposes time as the key to their competitiveness. This is at the core of his approach called Quick Response Manufacturing or QRM. QRM is about lead time reduction. And it focuses on SMEs characterized by low volume and a high variety of (possibly) custom-engineered products. Because of the lead time reduction, so Suri argues, a lot of waste and therefore overhead and indirect cost typically attributed to the product cost are reduced, thereby reducing the standard cost of a product.

In this respect, QRM does not propose anything new. Time based approaches already existed well before QRM. Lean as well as TOC in general have lead time as a main target. Just remember Taiichi Ohno saying: “All we are doing is looking at the time line, from the moment the customer gives us an order to the point when we collect the cash. And we are reducing the time line by reducing the non-value adding wastes” as recorded in the 1988 book on the Toyota Production System. And in this respect, I also strongly recommend Goldratt’s “The Race” from 1986 that very well explains the power of time, as QRM calls it. So QRM and Lean share this common target through which waste can be eliminated and avoided.

The thing less to like in the way Suri positions QRM is that he states that Lean doesn’t work in the typical job shop environment. This is somewhat simplistic I think. Just remember that Toyota in fact exactly developed their production system to cope with lower volumes and a more proliferated product portfolio compared to US car manufacturers. I think it is important to note that Suri in fact speaks about the traditional kanban system not being applicable rather than Lean as a whole. By speaking of Lean as a whole he fails to recognize that Lean is far more than kanban and that even JIT involves a lot more than kanban (think of heijunka, the full work system and the work order sequence system). But we’ll come back to that.

MCT: Visualizing Lead Time

As part of QRM’s approach, Suri proposes to focus primarily on one key indicator of performance and progress: time. This measure is operationalized using a metric called Manufacturing Critical-path Time or MCT. The good thing about MCT is the fact that it includes the administrative process preceding the actual production process so often encountered in make-to-order or even engineer- or configure-to-order environments.

Another thing I liked about it was the way lead time is visualized. Unlike time in a VSM, the MCT shows waiting time proportionally to the time in which the part is actually touched. For Lean initiatives focused on reducing lead time this proportionality aspect in fact helps teams better focus on the problem of waiting time. Furthermore, it allows you to visualize multiple feeder lines, which isn’t that easy in a VSM. But then again, a VSM isn’t always focused on just the time aspect either. From the example shown here, you can maybe see that the MCT map looks a bit like an inverted Gantt chart.

[QRM MCT Map]

_Example of an MCT map (from the QRM Management Center)_

The funny thing is that this MCT map made me think about the kind of time-based process maps we used to make in the Business Process Re-engineering (BPR) era. I even found a nice one from one of the projects I was involved in, in the mid-90’s, focusing on administrative lead times (sorry, this one is in Dutch).

[Time-based Process Map]

_Example of a time-based process map (by the author, 1997)_

As you may have noticed, I mentioned the MCT approach distinguishes between waiting time (what it refers to as white space) and touch time (so called grey space, in which someone works on the job). It is important to note that this isn’t the same as value-add and non value-add as for instance setup and material handling are seen as touch time in the MCT. The reason Suri mentioned for this were related to managing change: because these times are typically relatively short compared to the white space, calling them non value-add may put off employees to further work on lead time reduction.

The thing which again is a pity, is that although Suri mentioned that the MCT map can be complimentary to the VSM, he also introduced the MCT metric as being simpler and superior to Lean’s measurement of the seven wastes. This is silly, as I never even have seen anyone proposing the seven waste categories as actual indicators. In fact, Lean’s process efficiency indicator is very similar to the MCT metric comparing grey space to white space.

Cells: the Product Family Approach

The next thing proposed by QRM, is to structure your organization around so-called Focused Target Market Segments (FTMS) that are at the basis of the creation of QRM cells. To be honest, this is almost identical to the analysis you typically perform when preparing for a Value Stream Analysis, preparing the implementation of kanban loops and developing a Value Stream based organization.

[Lean Value Stream Analysis]

_Example of a product family and cell analysis (by the author, 2014)_

Furthermore, the additional elements required to form QRM cells are comparable to the Lean approach to organizing your plant, i.e., develop autonomy and team ownership for decision-making in the cell, multi-skilling and focus on continuous improvement, particularly focused on lead time reduction.

But is everything interpreted in exactly the same way? No. Suri provided an example of team ownership whereby an operator from a cell went out to collect his own parts from a paternoster system. Now although this might be interpreted as team ownership, when your focus is on reducing the lead time of your products, I personally don’t think having operators go out of the line to collect their parts is such a good idea…

Also here, Suri tried to differentiate Lean and QRM by stating the Lean cells only know unidirectional flows and are inflexible. I think this view is based upon a simplified view of a Lean organizational structure. Not everything in a Lean organization is (yet) organized into the well-known U-cells with dedicated, right-sized machines focusing on only a small product family. But this doesn’t mean Lean doesn’t consider any other form of organizing yourself around flows. Again, a pity, as QRM’s second core concept is extremely similar to the approaches promoted in Lean thinking.

When discussing this topic, I also asked my main question for the workshop: what does QRM propose as an approach when a cell includes both a small set of make-to-stock fast movers and a larger set of make-to-order slow movers and more exotic parts? To my disappointment, the answer was to split these cells into two cells and to dedicate different resources to them. Now although I agree on the principle in the long run, not all companies can simply duplicate their resources and dedicate their work centers to different families just like that.

System Dynamics: Good Ole’ Queuing Theory

QRM’s third core concept is referred to as “System Dynamics”. Nice wording maybe, but nothing more than queuing theory with a new label. Suri thereby does reference John Little and his well-known Little’s law (from 1961), however, he unfortunately does not give credit to John Kingman and his Kingman formula (also from 1961) upon which QRM builds heavily.

Coincidentally, I recently published a blog post on Kingman and his formula from queuing theory that you can find here: http://dumontis.com/2016/07/muri-mura-kingman/

So unfortunately, also here, QRM doesn’t really propose anything new, other than a new vocabulary for already existing theory. The thing which is good though, is that Suri brings Little, but also Kingman in particular, back into focus. As the literature on Lean doesn’t do a good job in explicitly referencing queuing theory in its writings and concepts.

POLCA: Generic Kanban for Managing FIFO Lanes

A larger part of the workshop was dedicated to the POLCA system. POLCA stands for Paired-cell Overlapping Loops of Cards with Authorization. Without going into too much detail here, POLCA is a card based system (like the kanban system is), that links two cells by a number of cards in a loop. A POLCA card is returned to its origin cell when the destination cell has finished work, in order to signal that is has free capacity. To contrast this with the traditional, anonymous and part-specific kanban card, a POLCA card therefore is a capacity signal.

[QRM POLCA Cards]

_Example of POLCA cards at Bosch Hinges (via http://www.procesverbeteren.nl)_

By having POLCA cards in a loop between two cells, you in fact keep the work content between the two cells constant. POLCA therefore is a way to implement the same thing as kanban tries to do, viz., keeping work-in-process (WIP) stable and thereby lead times in control (the Constant WIP or CONWIP principle also known from factory physics and even Goldratt’s Drum-Buffer-Rope approach, based upon Little’s Law from 1961). Furthermore, by releasing constant work packages (in terms of required capacity) instead of just work orders, QRM just as much applies the principles behind levelling (_heijunka_) as Lean tries to do.

With POLCA as a release signal based upon available capacity and with the purpose of keeping WIP in control in a certain part of your value stream, you of course still need a sequenced list of work orders that can then be released. In QRM, such lists are called authorization lists and each cell needs one that is regularly updated when changes in priorities occur. To create such lists, QRM proposes the use of MRP at the value stream level (so cells are seen as “black boxes”) which is similar to the hi-level use of MRP together with flat bill-of-material (BOM) structures in Lean. As QRM combines pull for execution with MRP for the authorization lists, Suri speaks of POLCA as a push-pull system, to differentiate it from pure schedule-driven push and anonymous, part-specific pull systems. I think this is not a correct way to represent POLCA, as to me it still is a pull system focusing on keeping WIP in control by tying the release decision to the actual WIP in the value stream.

So the underlying concept is not really new, but is the technique? I am sorry to say that even the technique proposed by POLCA isn’t really new. As early as 1982, Masuyama of Toyota’s production control department already described Toyota’s work order sequence system, and in the same year Hayashida described the sequenced pull and broadcasting system in use with Toyota’s suppliers. Hall described Yamaha’s PYMAC system, also known as Synchro-MRP in 1986, using kanban to pull from a sequence list generated by MRP. Later, Sandras (1989) used the term “generic kanban” to do the same as the POLCA cards. And Hopp and Spearman called it the “job kanban card” (1996). Although the exact details of each of these techniques sometimes differ, their purpose and even their elements are fairly similar: a card that is used as a release signal upstream and a sequenced list based upon which the operation then subsequently actually releases the next work order into the flow.

In its most simple form we know this as visual management of FIFO-lanes, whereby the preceding operation monitors its outgoing FIFO-lane per destination and when a position is free, he can take the next work order from upstream with that same destination (looking at the routing on the order sheet typically accompanying the parts in the FIFO-lane). The maximum size of the FIFO-lane in fact also keeps WIP between two cells in control, just like the POLCA or generic kanban cards. Now I do think working with cards is somewhat more robust than only working with visual management of the FIFO-lanes, particularly when the layout doesn’t really facilitate visual management of your queues. But when possible, visual management is of course far more simple than cards.

QRM: Not New, But Some Nice Additions

Coming back to my initial question: what’s new about Quick Response Manufacturing or QRM? As you have seen, not that much really. The focus on lead time reduction, the cell approach to organizational structure, the use of queuing theory (or system dynamics) and even POLCA are not new concepts or even totally new techniques.

The main thing which is a nice addition, I personally think, is the visual representation of lead time using the MCT map. That can help teams and companies be more conscious about the waiting time in their system, even beyond the shop floor. Another thing is the POLCA system. Although not really new, it does represent a very practical way, and described in detail, to actually implement the CONWIP principle in a lo-volume, hi-mix environment.

Overall, QRM has taken a subset of Lean elements, relabeled them under the umbrella of QRM and targeted SMEs characterized by a lo-volume and hi-mix of (possibly customized) products. Can these companies benefit from QRM? Sure they can, as the core concepts of QRM as well as its tools are effective ways to improve the operations of these companies, no doubt. But to position it as different from Lean to me is just a marketing fad. There is nothing really new under the sun, but hey, in the end it doesn’t need to be new to be effective. But let’s not create the illusion QRM is different from Lean. It isn’t.

And as for my question on mixing make-to-order with make-to-stock items in the same cell: QRM doesn’t have an answer for this. So back to the _gemba_ it is, working with the teams to discover new territory and continually improving the ways that we currently already apply in mixing and effectively managing these types of products in our cells, with the aim to control and reduce our lead times and reliably serve our customers.

question: What books does the text mention?

answer: The author references Taiichi Ohno from the 1988 book on the Toyota Production System, and recommends Goldratt’s “The Race” from 1986.

question: What does the text say about employee productivity?


text:
A Boy and His Gun

It was loaded. They didn’t know that though. They didn’t even know the gun was in his backpack

It gave Jacob a sense of security. He had been nervous before he finally walked out the door with it. But now he knew what he was capable of, he didn’t pity anyone that doubted him. That piece of black steel at the bottom of his bag, hidden beneath his math worksheets, was confidence. It was like having God on his side.

At school, nothing else was different about today. The cliques all noticed their members. Friends noticed each other while teachers noticed their favorite students. No one noticed Jacob though.

In class he sat in the back. A little straighter than normal, his face was a little more sure, but no one paid enough attention to notice any change in him.

The day went how it always does. Jocks mocked the geeks, while cool kids planned parties and nerds worked on homework. Jacob prowled the hallways by himself, like a lone wolf. He stalked the halls like a shadow. He sat in class like a statue. He was a ghost.

Jacob was there, but no one even tried to interact with him, luckily for them. No one knew how close he was to a breaking point, he wanted to find out though. He wanted to show them. Jacob wanted to be pushed, to see if he would fall or explode. He wanted to know what he was made of.

On break he eyed the cold steel. In the bathroom, behind the doors of a stall, Jacob felt the weight of it against his hands. He pressed the muzzle against his cheek. He felt so hot compared to how cold it was. He wanted to be that cold. He wanted his heart to feel like that icy piece of metal. He wanted to know that he could simply take a life, destroy someone’s world, change the universe and do it stoically over and over.

The day passed. Hour by hour, minute by minute, slowly seconds ticked, like the fuse on a bomb. Jacob felt a thrill deep inside, wondering if he would go off like a firework. He waited for someone, anyone to press his buttons.

title: A Boy and His Gun (380 Words)

question: Who is Jacob?

answer: A school boy with a gun.

question: Where is the story set?

answer: A school, presumably high school.

question: What happens with the gun?

answer: Jacob presses it to his cheek in the bathroom but ultimately does not shoot it or reveal it to anyone else.

question: Who mocks who?

answer: Jocks mock the geeks.

question: Write a ~1 sentence summary.

answer: Jacob takes a gun to school, and the day goes on as usual without incident, only with Jacob feeling newly sure of himself knowing that he could snap at any time.


text:
_Directions:_ Please indicate the best answer to the fallacies in the following passages.  Not all passages necessarily contain fallacies. Fallacies present here include those of relevance, presumption, and ambiguity.

1. Old man Brown claims that he saw a flying saucer in his farm, but he never got beyond the fourth grade in school and can hardly read or write. He is completely ignorant of what scientists have written on the subject, so his report cannot possibly be true.

2. My client is an integral part of this community. If he is sent to prison not only will this city suffer but also he will be most missed by his family. You surely cannot find it in your hearts to reach any other verdict than "not guilty."

3. You ought to try to study harder in school this year, Samuel, because it will spare your parents the embarrassment of a letter from the instructor telling them you're not taking your school work seriously..

4. You will back up my story and tell the committee I am reasoning logically; because if you don't I will do everything in my power to see that you are fired.

5. I believe in the Bible because it is the written word of God through his prophets. Obviously, God would not lie to his prophets. After all, the Bible says so.

6. Congress shouldn't bother to consult major universities about educational appropriations. As members of educational establishment, they will naturally want as much money for education as they think they can get.

7. In recent studies researchers have show that women have more accurate intuition than men do. The reason cited is that men's intuition is more often mistaken.

8. I can see that you are in the market for a new car. We're having a sale on Pintos this month. Do you want to pay cash or do you want the installment plan?

9. John has really worked hard on his term project, and he will really be depressed if he does not make an _A_. For these reasons, you just have to give him an _A_ on his project.

10. What is right is what is morally obligatory. What is morally obligatory is what you should do. Of course, you should do something because it is the right thing to do.

11. I can see that the efficiency with which the Tornado Home Vacuum System works and the marvelous way in which it saves on toil and drudgery in the home impresses you. Therefore, shall I charge it to your account or do you want to pay cash?

12. If we wish to determine which of a person's motives determine his actions, we need only examine which of the alternative courses of action he chooses to perform. Therefore, a person's motives are determined by the actions he chooses to perform.

13. A prosecutor states to the jury: "You cannot let this man go free because our society is not safe with him at large. Who knows who his next victim will be?"

14. It should be no surprise to you that if a Democrat is elected in the next presidential election that we will have one of the worst recessions in years. Recessions always seem to be created by Democratic administrations.

15. As I walked to the library from the Learning Center not one person spoke to me. Lander University is not as friendly as I was led to believe.

16. How can we save our country from the bureaucratic dictatorship, the corruption, and the creeping socialism of the present administration? Only one way vote Independent.

17. I don't care what your arguments are; you are using Mickey Mouse tactics. The arguments you give are simply tacky.

18. Officer, please excuse my going over the speed limit, but my mother is ill and I'm being audited by the IRS, and I don't know how I can meet all my bills.

19. Why haven't you been studying, as you should? You would feel a lot better if you would take you school work more seriously.

20. Those who say that extra-sensory perception is not reliable are mistaken. The police, Hollywood stars, and politicians have all relied on it.

21. But Doctor, surely your advice that I should not drink coffee is not sound advice since you yourself often drink coffee.

22. The late Ely Culbertson, one of the world's outstanding bridge players, once declared that the United Nations as presently constituted has serious defects. He must be right because I don't think the opinion of a man of his caliber should be taken lightly.

23. The General Assembly of the United Nations keeps voting for radical issues. Therefore, the U. S. will be forced to reduce its financial contribution to the U. N. unless there is a demonstrated change soon.

24. During the Gulf war many Americans made immense profits. That is an indisputable fact. Therefore, there can be no doubt that American business interests instigated the war.

25. No mathematician has ever been able to demonstrate the truth of the variants of the Goldberg conjecture, so they cannot all be true..

26. Everyone says that a logic course is easier than a math course, so it must be.

27. Unless you back up my story and tell the committee I am reasoning logically, I'll do everything in my power to see that you are fired.

28. The best students make the best grades. Therefore, getting high grades will undoubtedly cause you to be a better student.

29. Everyone believes that men write the best novels; therefore, there is little doubt that they do so.

30. Since the Bible says, "Thou shall not kill," it would be wrong to exterminate the termites in City Hall.

31. But Mom I don't see why I have to wear socks; Einstein never did wear socks.

32. I once knew a philosophy student who went crazy and another one who was not that well balanced. You can see what the study of philosophy did to them.

33. A great many charges of graft and corruption have been brought against Senator Anderson over the past several years, and he has had numerous opportunities to refute them, but he has never done so. Therefore, I think, the evidence indicates he is not to be trusted.

34. The present U.S. administration has not yet developed an energy policy. Nonetheless, almost every other developed nation in the world has an energy policy, except us. Therefore, the United States should have a unified energy policy.

35. The welfare program is totally unnecessary. Why, I know a guy who runs a very lucrative illegal gambling operation and drives his new Cadillac down every week to collect his welfare check.

36. It was his fault, Officer. You can tell by the kind of car I'm driving and by my clothes that I am a good citizen and would not lie. Look at the rattletrap he is driving, and look at how he is dressed. You can't believe anything that a dirty, longhaired hippie like that might tell you. Search his car; he probably has pot in it.

37. General Jed M. Lamgetter believes that it is absolutely essential to our future security that we immediately upgrading our computing systems to Linux from Microsoft NT. But his arguments are hardly deserving of careful consideration, for in a couple of weeks General Lamgetter will retire from the Army and become CEO and be given large stock options in Red Hat, one of the main linux producers.

38. The real reason you favor the draft is that you're too old to be drafted.

39. Richard Nixon: "Mr. Sparkman and Mr. Stevenson should come before the American people, as I have and make a complete financial statement as to their financial history, and if they don't, it will be an admission that they have something to hide.

40. Stanford produces the best graduates in the United States. Therefore, any every Ph.D. from Stanford is better than any other Ph.D. in the country.

41. Water extinguishes fire. Oxygen is part of water. Therefore, oxygen will extinguish fire.

42. Priests take a vow of poverty. The Church is a corporate body composed of priests. Therefore, the Church should not own property.

43. Since the average life-span of an individual in developing countries is thirty years, the leaders in those countries grow old before they have time to learn the rudiments of good government.

44. As the convener of the ninth annual Women's Freedom Movement, let me remind you once again that women have been discriminated against for centuries, and they have suffered as second-rate people for centuries. I, for one, refuse to submit to this discrimination and second-rate treatment any longer.

45. I ought always to do what is right. I have a right to say what I think. Therefore, I ought always to say what I think.

46. As a result of a poll of 28 adults interviewed on Main Street in Greenwood, S.C. on Friday night, we can conclude that all people in Greenwood prefer going downtown to watching TV.

47. According to the law, a man is innocent until proved guilty. So Mr. Ratskeller must be innocent of the charge of bribery, since he has not yet been proved guilty. Therefore, since Mr. Ratskeller is innocent, it would be wrong to convict him.

48. Although you have said you will give me no more of your time, I'll not ask for any _more_ of your time; I'll just ask for the amount of time you have already given once more.

49. A description of a candidate who is woefully inept: "I most enthusiastically recommend this candidate with no qualifications whatsoever."

50. Nothing would be better than a high score on this test, but a poor grade would be better than nothing, so conclude that a bad grade would be better than a high score.

question: What could the flying saucer possibly be?

answer: This information can't be found.

question: Why doesn't Samuel study more seriously?

answer: This information can't be found.

question: List a few of the defects that Culbertson thought the UN had.

answer: This information can't be found.


text:
“Tell us Roger, what do you think you will sound like?”
“My song….hmm…”
Roger closed his eyes, and began to drift between his memories.

Flashback.

A young Roger was staring up at a T.V. screen. There was an interview with a man dressed in a crisp suit regarding his latest invention, the life song. Life songs were a strange concept. A song formulated by the memories of a person. It was an one hour soundtrack of a person’s life and by listening to it, one could hear the entire collection of memories stored in a person’s brain. All the ups and downs of a person’s life converted to major and minor keys, and peacetime and turbulence into tempo. By listening to one’s song, you would be able to feel every experience ever felt by that person. However, process only worked on dead bodies, after all neural activity had stopped.  It had hardly been released worldwide a month ago and it was already being called the greatest trend of the 22nd century. As Roger watched the man talk about the complexities involving scanning the brain for prominent memories, Roger felt a calling. What an idea! A person’s whole life nested into one clean hour of universal expression!

Back to the present.

“You know, I’ve never really thought about it. I prefer not to over think these things, sometimes it’s just better to let them happen.”

“Words of wisdom from a wise man. Now, we’ve all heard of your career, but where and how did it begin? Do you have any advice for people who’re also heading in this direction?”

Flashback.

Roger was 17 now. He was in a crowded room with white walls. There was a large tube like structure near the back, almost like an MRI scanner. It was hooked up to a computer and what appeared to be a confusing series of switches and dials. Roger was interning at a small local company that produced life songs. Roger stepped up to the dials for the first time in his life. He watched an old man’s body being loaded into the scanner and fidgeted as he prepared to debut into his desired career. As he put on the headphones and scanned the memories of the person, he realized how difficult it was. Finding the right memories to represent the person’s life, adjusting the pitch and rhythm to correct the flow of the song, censoring out unnecessary details, everything had to be perfect. After six grueling hours, it was complete. As Roger listened to it, he was severely disappointed. It sounded all wrong. He wiped the disk clean and started over. Day after day, Roger tried again and again. At last, four days after he started, it was complete to perfection. Roger put on the headphones to listen to his masterpiece, featuring the life of the old man. He pressed play. The beats pounded in his ears. The soothing melodies blended into the harsh instrumentals and the tempo shifted and danced with the mood. Roger took off the headphones and stood in stunned silence. He had witnessed something sacred and understood the importance of it, and he wanted more.

Back to the present.

“My career huh? Well, my career started out when I was just 17 years old, interning at a now extinct company started by a few family friends. It was hard at first and I wasn’t very good at it-“

“THE Roger not being good at life-composing?”

“Well, even the great have to learn. Over time we get better at whatever we do, we develop skills which we didn’t have, skills which we now take for granted. And, if there was any advice I wanted to give, this is it. Just work hard, keep trying and you’ll make it there one day.”

“Words of inspiration. Now, Roger, we all know that you’ve been around since before the first life song was produced. What all of us are wondering is, how, in your opinion, has the world changed as a result of this technology?”

Flashback.

Roger was now a successful young man. Working in one of the most prestigious record labels, Roger had it all. Money, success, fame. His face appeared on magazines. People would ask for his autograph. He had his pick of women and lifestyle. Despite all this, Roger felt a deep seated uneasiness and dissatisfaction. Roger felt as though by extracting the memories of a person, he could see who those people really were on the inside. He saw the sanctity of people’s lives being violated. For example, he had once met an elderly woman who had signed a document requesting that her life song be never extracted, and her mind untouched after death. However, her family members countersigned it minutes after her death, hoping to know what she truly sounded like. Roger was introduced to the true face of disillusionment that day, as he saw the faces of the woman’s family shift uneasily. The woman’s song was a cacophony of confusion and depression, the few relaxing melodies spread out across large intervals, lasting only a few seconds. There was also a movie star (a former particular favorite of Roger’s) who’s song revealed the actor’s true personality, shallow and callous.  These sort of events tended to distress Roger. He had seen people for whom their song had become an obsession. They lived their lives just to make it sound good. Everywhere he turned he saw mothers who disciplined their screaming children by telling them that their life songs would sound terrible if they didn’t comply with their parent’s demands. There was even an artist, who led his life specifically to make it sound in a certain way, without giving regard to any human aspects of life. While all this lead to good songs, it was only superficially good. Like popular music on the radio, it sounded good just to sound good. There was no depth to the sound. Roger felt as though people had forgotten how to appreciate reality without thinking about how it would influence their songs. As a result, Roger wasn’t entirely sure about he felt regarding the “22nd century’s greatest achievement”.

Back to the present.

“Well, the world is always changing, so it’s hard to tell. But I’d like to think that for some people, they take it too far, they forget what life is and only remember what their song might be.”

“There’s some food for thought! Now, before we wrap up here tonight, do you have any final comments?”

Flashback.

The alarm clock rang loudly as the sun shone in through the curtains. Roger slowly sat up and rubbed the sleep from his eyes. Roger got up and threw the curtains back. He threw the curtains back and marveled at the beauty of the sunrise. Slowly he walked to the bathroom and looked in the mirror. Roger was by no means a member of the youth. His hair had finished graying, his skin had become wrinkly like a raisin, and he lacked the energy he once had. However, in exchange for age, he gained wisdom. Upon finishing his morning rituals, he went to his closet and sifted through his collection of clothing, looking for the appropriate articles. He finally settled on a simple yet comfortable monochrome shirt, and inconspicuous pants. He got into his car and entered the destination into the autodrive. As he sat back he began to reflect upon his life. Roger remembered staring up into a bright T.V. screen and watching an interview with a man who had invented the life song. Roger remembered that awe and hoped that some people would be inspired with the interview which he was scheduled for today. He stared absent-mindedly out the window musing over his life. Outside he saw many people with headphones on, ignoring the world around them, drowning themselves in their own plastic fantasies. Roger wondered if they had even noticed the perfection in the world around them. Roger was drawn out of his thoughts as he arrived at the front gate of the T.V. station. He opened the door and walked outside towards the building where he was enthusiastically welcomed by a young man waiting for him.

Back to the present.

“Final thoughts? Well, there’s just one thing that’s been bothering me these days.”

Roger paused and cleared his throat.

“It might sound  ironic coming from a man of my profession, but, I believe that with all this technology around us, Silence is a…a, truly forgotten art”

The interview ended uneventfully and the audience was left to reflect upon Roger’s statement. The following year after that passed rather quietly. Roger announced his retirement though, due to his experience his advice was still greatly sought after. Unfortunately, all  living things must come to an end. Roger, being a living thing, had run out of time, and died peacefully and content.
After his death, Roger was carried to the neural noise controller. The machine booted up slowly. Roger, being a man who had listened to the life songs of various people every day for over a decade, was having his life song being broadcasted internationally, by people who eagerly wanted to know what he would sound like after absorbing so many different sounds. Finally the machine booted up. Roger was reverently loaded into it. The lights flashed and the machine let out a soft glow. Roger’s successor worked carefully as he converted Roger’s mind into sound. At last, it was done. A buzz of excitement could be heard as it began to play.

It started out with a crescendo, building up to a symphony of violins and drums all in the exposition. However as the song progressed, it quieted down. Gradually, the sound became a hush. The distant hum of life passing by in the background was heard. Eventually even that disappeared and all that could be heard was the faint sound of birds chirping and leaves cracking. The faint gush of a waterfall could be discerned from the peaceful sounds of nature. If you closed your eyes, you could see sunlight beaming down from the gaps in the trees as nature grew and continued, without anyone influencing it in any direction. There was a melody, but it was not made of instruments. It was pure nature.

Roger’s song reflected his inner peace and tranquility. His ability to live life without worrying about how it may sound, without forcing it in any direction, and letting things flow. There was a subtle beauty in the tranquility of his song, but it was lost among the noise of the masses, who strove to best each other and to attain “beauty” without once stopping to realize why they did so.

title: In Requiem

question: What was the greatest trend of the 22nd century

answer: The greatest trend of the 22nd century was the practice of making life songs. A life song is a one-hour soundtrack formulated from the memories of people after they have died. The ups and downs are converted to major and minor keys and peacetime and turbulence make the tempo.

question: What is the moral of the story?

answer: The moral is that we get so caught up in our lives that we forget to notice the beauty around us. The people in the story are all wired up to sound. They are so deep in thought, striving for the perfect life song that they don't notice how quiet and perfect their surroundings are.


text:
NEW DELHI — In October 2008, Henry Konczak went to get a blood test.

“I was getting short of breath,” says Konczak, a 65-year-old musician and video producer from Ohio. “All of a sudden they said, ‘Get to the hospital immediately.’”

Konczak had a blood infection and spent the next month receiving intravenous antibiotics, but his misfortune didn’t stop there. A doctor discovered that he had a heart murmur and would need surgery to replace his mitral valve. He called the nearby Cleveland Clinic to inquire about costs. The quote? A whopping $130,000, not including the surgeon’s fees.

Konczak says his insurance had been abruptly terminated when he turned 50 and he could not afford a replacement. When he heard the procedure price, he was shocked.

“I said, ‘I’ll send you my financials. I don’t make that kind of money,’” he recalls. “She said, ‘Well, good luck with that.’”

Facing a choice between bankruptcy and death, Konczak chose a third option: India. On Dec. 23, 2008, Konczak successfully underwent surgery at Indraprastha Apollo Hospital, a prominent private facility in New Delhi. The entire three-week trip — from flights to lodging to medical fees — cost $10,000.

“I saved my life, and I saved my business,” he says.

Konczak’s story may seem unorthodox, but he’s hardly alone. For Americans struggling to meet health care costs, medical tourism has become a surprisingly common choice. Estimating the number of medical tourists is tricky, but according to a government survey, more than 300,000 U.S. residents may go abroad each year for health care. There are many reasons why Americans travel for treatment, but the main one is money.

India is a particularly attractive choice for American patients, since it has a number of hospitals offering quality care from English-speaking professionals at affordable rates. Vinayak Shourie, the international marketing director at Fortis Healthcare, estimated that 20 percent of his company’s business comes from foreigners — and that figure is growing. India introduced medical visas in June 2005 to promote the industry, and it recently began allowing citizens of nearly 150 countries to apply entirely online. The tourism ministry issued more than 170,000 medical visas in 2016, a 45 percent increase over the previous year. It’s become a big business for the country, and business is booming.

But India also has one of the world’s most unequal health care systems. The gap between the services available to the wealthy and the poor is yawning, and roughly 86 percent of the rural population lacks health insurance.

“If you have a lot of money, you can access a lot of medical care,” says George Thomas, an orthopedic surgeon from Chennai, India. “On the other hand, very large numbers of people in India cannot access even basic health care.”

Medical tourism thus presents both opportunities and risks. At its best, the industry can help India grow its health care system, using the revenues generated from international patients to improve local care. At its worst, it risks shifting resources to private hospitals catering to elites at the expense of public institutions serving the poor.

“What’s the effect on health care for Indians? Here, the answer is the story is kind of messy,” says Glenn Cohen, a professor at Harvard Law School and an expert on medical tourism. “But there’s some reason to be concerned.”

***

I am a poster child for the quality of India’s top medical facilities. One month after moving to New Delhi, I started to feel lightheaded and dizzy while walking back from my Hindi class. Shortly after reaching my home, I collapsed, had a seizure, and was rushed by my roommate to the nearest emergency room.

After being discharged, I went to see a neurologist my friend recommended at Max Super Specialty Hospital, a well-regarded private institution. I was admitted for three days and underwent a battery of tests, none of which revealed anything serious. My stay — in a hotel-like private room with free meals and Wi-Fi — was comfortable. My total costs, before insurance, were $2,892.

This was a small fraction of the approximately $25,000 bill I could have been saddled with in the United States. Yet the average annual income in India is only about $1,600, meaning that for many, my medical expenses would have been more than a year’s worth of pay. That stays true if you subtract the roughly $250 extra the hospital charged me as an international patient. Eventually, my health care plan reimbursed me for the majority of my expenses. But most Indians don’t have any medical insurance.

The average Indian hospital, of course, is not nearly as pricey as the top-tier private institutions frequented by wealthy locals and medical tourists. The country’s central and state governments operate hospital networks, and they have enacted various programs to try to ensure that India’s poorer residents don’t have to pay at government facilities.

Public hospitals are overburdened and deficient, frequently producing stories about patients who suffer from medical malpractice. Recently, a government hospital in Uttar Pradesh — India’s most populous state — made international headlines after 63 people died in two days when the facility ran out of oxygen.

It’s therefore no surprise that Indians prefer private health care. A 2016 government report found that the country’s public facilities treated less than 30 percent of people’s illnesses. The preference is particularly stark in cities, where most of India’s high-quality private hospitals are located. Between 2004 and 2014, the public-to-private distribution of urban hospitalization cases shifted toward the latter by roughly 6 percent. But private health care is more expensive, and during the same period of time, the average amount spent on each urban hospital visit increased by approximately 176 percent.

***

For the industry’s proponents, medical tourism’s promise is this: My experience (and payments) can be channeled, redirected, and perhaps ultimately replicated for India’s less affluent, nonexpat communities. Some, for example, argue that medical tourism inspires Indian doctors to return home — reversing brain drain. Others say it improves services nationwide. Apollo Hospitals executive Preetha Reddy recently wrote that medical tourism helps “contribute to the objective of health for all.”

Josef Woodman, the CEO of Patients Beyond Borders, says the industry is pushing hospitals to seek international accreditation.

“When you get a JCI [Joint Commission International] that comes in and makes certain demands of the hospital, that’s a benchmark for the rest of the health care system,” he says.

But many academics are skeptical that the industry will improve things overall. Valorie Crooks, a health geographer at Simon Fraser University, says medical tourism’s potential spillover benefits were “mostly pie-in-the-sky things” for which there’s little evidence.

Crooks is determinedly nonpartisan in debates about whether medical tourism is, on the whole, good or bad. But she does maintain that any benefits for the local population require well-enforced redistribution.

“Where the benefit can be is in relation to the revenue and ensuring that the revenues that are brought in have some benefit, not just to that private institution but back into the public sector,” she says.

Deepanshu Mohan, a professor at the Jindal School of International Affairs who researches Indian health care, agrees.

“The distribution of the revenue that has accumulated in the private sector has to be worked out,” he says.

Mohan argues that after India’s economy opened up in the early 1990s, the amount of private health care spending shot up while public expenditures languished. The result, he says, is a staggering gap between the nation’s private hospitals and its government facilities.

***

To see what he meant, I visited the All India Institute of Medical Sciences (AIIMS), New Delhi’s most prominent public hospital. Constructed in 1956, the AIIMS campus is a collection of mostly brown, white, and green buildings packed with doctors, nurses, and medical students. Hundreds of patients and their families camp out on the surrounding lawns and walkways, waiting for treatment. Many have traveled hundreds of miles in hopes of receiving quality, affordable care.

Some are lucky to have reached AIIMS at all. Emergency medical services in India are far more fractured than in the United States or Europe, especially outside cities. Residents of rural regions may not know that ambulance systems exist, and those in need often have to wait long periods and travel substantial distances to find suitable doctors. It’s therefore no surprise that trauma victims in India are more than twice as likely to die as their counterparts in wealthy states.

Among those gathered outside AIIMS is Vishnu Dayal, a 32-year-old farmer who arrived at the hospital two days ago with his mother. She was suffering from bile duct stones — a painful condition that often requires surgery. Dayal had come from Pilibhit, a district roughly 150 miles away.

“Our district hospital is very bad,” he says, explaining why they chose an eight-hour bus ride over receiving local treatment. His criticism is indicative of Indian health care’s structural flaws. According to the Organisation of Pharmaceutical Producers of India, nearly 80 percent of Indian doctors work in urban areas, serving only 28 percent of the country’s population. Those who do practice outside cities are often dismally unqualified. A World Health Organization report released in 2016 found that only 18.8 percent of people working as doctors in rural India had medical credentials.

Like many of the other patients and attendants sprawled about the site, Dayal was living outside. He spent most of his waking hours sitting on a makeshift mat near the hospital’s central buildings. At 8 p.m., when the AIIMS grounds closed to nonpatients, Dayal packed up, left, and went to sleep on a nearby road.

Despite this, Dayal says he felt _santusht_ (“satisfied”) with his experience. He had good reason. Dayal’s mother had to wait only one day before being admitted, a comparatively short period of time. There are reports of some AIIMS patients waiting months before starting treatment, even when suffering from potentially fatal ailments. Additionally, AIIMS doctors are highly regarded. There was a big gap between AIIMS and the smooth, five-star experience at top private facilities — but an even bigger one between the nation’s flagship public hospital and its desolate rural counterparts.

“It tells you a lot about the quality of medical resources in the area that he is coming from,” Mohan says. “You have a proliferating demand for medical services in cities because there’s a huge amount of migration coming from rural areas.”

Most of these deficiencies are related to low government spending. In 2014, roughly 1.4 percent of India’s public GDP expenditures went to health care, the 15th lowest in the world, and less than half the 3.3 percent of private GDP that was spent. The lack of financing shows. Many government hospitals — especially outside the biggest metropolises — lack critical technology such as ventilators, leading to needless deaths. Rural regions depend more heavily on government facilities and are therefore especially impacted by the lack of public resources.

This scarcity extends to doctors. The country has only one government physician for every 10,189 residents, and these practitioners work more but are paid less than their counterparts in the private sector. As a result, most doctors try to move into the lucrative private hospitals located in large cities. Some states are trying to make rural service compulsory for recent graduates of government medical schools. But the idea has received strong pushback from students, and these requirements can be poorly enforced. Physicians serving in public hospitals, for example, are known to open better-paying, time-consuming private practices on the side.

“Without an effective redistribution mechanism … doctors trained within India are more and more likely to migrate from the public health care system to the private health care system,” Mohan says. “The medical tourism industry may lead to an exacerbation.”

The government’s support for the private hospitals that take international patients is also worrying. India’s central government provides financial support to these institutions as part of its Marketing Development Assistance Scheme. Forty-three of New Delhi’s private hospitals received city land at concessional rates. The government made these discounts contingent on each hospital reserving 10 percent of inpatient and 25 percent of outpatient services for low-income individuals, free of cost.

Unfortunately, private hospitals often flout these rules. Last year, New Delhi’s government fined five of the largest institutions roughly $100 million for failing to treat the poor, including Max — the hospital where I received care. It wasn’t the first time the judiciary found that private medical facilities were ignoring state requirements. In 2009, the Delhi High Court fined Indraprastha Apollo Hospital — where Konczak was treated — for violating the terms of its land agreement.

In theory, these penalties may be significant enough to deter future violations (Max Healthcare reported approximately $400 million in gross revenue last year). But Rupa Chanda — an economist and health care expert at the Indian Institute of Management Bangalore — says between judicial delays and corruption, major hospitals could find ways to avoid the full cost.

“The influential will pay their money and get out of it,” she says. “These requirements are not working.”

***

An incomplete system that leaves millions of people uninsured. An enormous urban-rural divide. A government that indirectly subsidizes high-quality private facilities that many cannot afford. The more one looks at India’s medical system, the more it starts to look like the American one.

Even the stories of these countries’ underserved populations overlap. Dayal’s mother and Konczak were treated in dramatically different situations. But despite poor health, both spent hours traveling to New Delhi because the hospitals near their homes could or would not provide them with adequate care.

The comparison might be even more apt were it not for the Affordable Care Act (ACA), which extended health insurance to nearly 20 million people in the United States. According to experts like Cohen, that’s already leading to a decline in medical tourism, as more people find themselves with adequate coverage at home.

The tax bill that recently passed Congress, however, eliminates the ACA’s individual mandate, and the Congressional Budget Office estimates that the change will increase the number of uninsured Americans by 13 million. Experts say the rising number of uninsured people will, in turn, produce an upsurge in foreign health care travel.

Konczak is a good example of the ACA’s impact. After returning to the United Stats, he eventually managed to purchase “a little bit of insurance” — a $600-a-month major medical plan. Once the ACA was implemented, however, he used Ohio’s marketplace to buy more substantive and affordable insurance that he imagines would have enabled him to do valve replacement surgery much closer to home.

“My health insurance cost monthly went down to $130,” he says. “I almost cried.”

India has no ACA analogue, but its public hospital system was partially designed to provide less affluent residents with affordable and accessible treatment. Like the United States but unlike, say, Belgium or Slovenia, India’s constitution does not list health care as a fundamental right. But it does declare that the government shall regard raising “the standard of living of its people and the improvement of public health as among its primary duties.”

The medical tourism industry highlights these countries’ flaws, and it showcases some of the shortcomings of health care worldwide. Releasing the stress on fractured systems could help ensure a fairer distribution of resources. But it’s hard to see how moving patients to India’s overburdened system makes global health care any more just.

Issues of fairness weighed on Konczak during his trip. It’s nearly impossible to visit India without witnessing stark poverty, and even as he was lying in the ICU, Konczak says he was perturbed by what he saw.

But he didn’t go to India to save the world. He went to save his life.

“It bothered me,” Konczak says. “But also, I’m dying.”

question: What does the text say about the American insurance system?

question: What is the common choice for American patients?

answer: India is an attractive choice for American patients because of the quality of healthcare and the price point.

question: What does the text say about the author?

answer: The narrator is a poster child for the quality of India's top medical facilities. A month after moving into New Delhi the narrator felt lightheaded and dizzy while walking home. Soon after, they collapsed and was rushed to the nearest emergency room. Nothing serious happened to them but their total cost before insurance for their private healthcare was $2,892. This would have costed over $25,000 in the United States.


text:
A Debt to Be Paid

Chapter One
Second Chances
Shaun turned his head, looking down the long road he knew he had to travel, dropping the wet ended cigarette onto the floor he raised his foot and stood on the cigarette on the ground turning his foot from left to right, the scraping was very irritating but satisfying at knowing he had smoked his last cigarette.
Shaun took hold of the bag, raising the handle of the duffle bag to slide over his shoulder, he then reached for his rifle that was leaning against an old oak tree. Shaun started to make his way down the highway.
He had been travelling for a very long time, he made his way out of Atlanta in the early days of the apocalypse and had passed through many towns and cities to make his way to the BLR radio station where the tower was still active to communicate with other survivors,  Shaun never really trusted anybody since the first few days of the apocalypse, in the first few days his fellow man became monsters, they were no longer his neighbours or his friends or even just strangers, they were savage beings who would stab your heart out for just a can of beans or even something simple as a plaster.
Shaun had made met many fellow survivors before, somewhere just looking for hope and others.. Well hope for these other people was the satisfying taste of fresh undead blood.
Shaun had been walking down the highway for quite a while, he would hum to himself such a simple tune “Cats and the cradle and the silver spoo..”  His humming would come to a halt.  Before Shaun knew he was surrounded by masked greasy looking man, they were each wielding an automatic gun of some kind, before he even reached for his rifle a man shouted “Drop all yer equipment! HANDS WHERE I CAN SEE EM” Shaun slowly letting the duffle bag slip from his shoulders to land at his feet, whilst his rifle was thrown towards the ground, He had hoped it would have been like one of his favourite movie scenes from Hot Fuzz where the rifle would go off when it made contact with the ground but alas it just skidded for half a second along the concrete floor.
A man with a scrap made mask that looked something like a welders mask, made his way towards Shaun, this man looked filthy like he hadn't washed for days, all sweat running down his body and dirt marks took over most of the visible skin. This man slightly chuckled as he took hold of both his rifle and his bag and dragged it back towards the four men he was with.
Shaun was little worried it had be silent for at least seven minutes, he had already come to terms with the situation and knew for sure he was going to die, but still Shaun tried to think of a solution where these men would die or how he would run.
As Shaun counted to the ten minute mark after he watched these savages loot through his personal items, the same man with the mask stepped forward, and raised his rifle towards Shaun’s head, Shaun looked this man right in the face and spoke “Well? What are you waiting for, this is what you want isn't it?” The masked man moved his finger to the trigger, and responded with “It’s a Dog eat dog world son,” Shaun closed his eyes and prepare for what was coming, Shaun wasn't afraid anymore, His body flinched as he heard a shot, his eyes still closed Shaun wondered if this man had missed or that he was just playing a game with him.
Shaun slowly opened his eyes to see the man with a bullet sized crack to the left of his skull, blood would be pouring out as this large masked man fell to his knees. As Shaun looked towards the other men at the back two of them had already started running from the highway, the other two men still waiting where looking around aiming there rifles screaming “COME ON OUT WHERE ARE YE?”  Another shot was heard in the distance as these men tried to pin point the shot, it was already too late one of the men had already been impacted before they could even begin to find this mysterious murder. The last man was standing in front of Shaun, he looked Shaun right in his eyes, Shaun was confused, and he didn't know if this was his lucky day or his day had been prolonged for five more minutes. The last man turned to the woods, and began sprinting as fast as he could, until he was nothing but a medium sized figure in Shaun’s eyes. Shaun stood up, his head looking back and forth looking for the person who had taken the shots, after just a few seconds Shaun took a few steps forward to his duffle bag and rifle, These man had thrown not only his essentials but his personal belongings all over the floor, as Shaun was cleaning up he heard a rustling coming from a thick group of bushes, Shaun reached for his rifle immediately facing it towards the group of bushes, his hands where very steady, and he dared not say a word he did nothing that would put him off his concentration, suddenly a man appeared from the bushes with his sniper rifle strapped around his back and both hands in the air, the man was wearing some sort of cloak and face mask, he had also a large duffle bag hung from his shoulders,  At this point Shaun didn't know what to do.

Chapter Two
Hitch Hiker
Shaun, with his rifle still aimed towards the man, they both made eye contact with each other, even threw this man’s mask he knew he had nowhere else to look. Shaun slightly lowered his rifle from the aim of the man’s head and spoke, “Was it you?” he asked “Was that you back there” This man slowly raised his hands towards his head, Shaun returned his aim to the man’s head, this gentleman didn’t looked scared of Shaun, even though the rifle was aimed at him he still continued to remove the hood from his head, has the hood was slowly lifted and the masked pulled down to reveal his face, there stood a man who looked like he could use  good shave and a haircut , the man finally replied to Shaun and said “Aye, that was me, are you alright?” Shaun looked to him, and without responding to his question asked “Why, why did you save a stranger, why save somebody who could hurt you” The man’s eyes scanned Shaun thoroughly and said “The world isn't how it used to be, sometimes you got to remember that where still human, and this is how humanity should be, not like those lost sheep over their” as the man pointed to the remains of the dead group. Shaun looked to his man carefully lowering his rifle but his guard was still high, Shaun turned to the man and said “Thank you, but you really didn’t have to stop” The man finally lowering his arms, one to his side the other resting on his bag like a portable arm rest, the man looked to Shaun and said “My names Jack, but everybody calls me TK or well used too..” Shaun gave the man a little smirk, he had forgotten what is was like to have a conversation without it being a hostage situation or having your face eaten off Shaun replied to the man “My names Shaun, Pleasure to meet you” Jack seemed impatient to Shaun, after only a few moments of meeting jack looked like he wanted to get on his way pretty fast, Jack looked to Shaun again and said “I am glad I could at least save one life today, but I got to find my friend, he made radio contact about two hours ago, He’s supposed to be meeting me at Roads end, do you know where it is?” Shaun looked to the man and said “Roads end? Is that the bridge that was never completed?” jack replied swiftly “Yes! That’s it, that’s where I need to meet him but I have no idea how to get there” Shaun knew of roads end, but he didn’t know the route at all from where he was, Shaun’s face went blank as he went into a deep few seconds thought “He wondered if he pretended to know, he would make it off the highway to the rural areas safely, Shaun wasn’t really known as a liar, and didn’t trust people very much, but if he created his own little persona with this man, he would be able to bare the thought of travelling with a stranger without having to have real trust” As Shaun snapped out of his deep thought, he looked to Jack and said “ I’ll show you the way, I’ve been on the road to long alone and it would be nice to have some company and maybe even get us out of here alive” Jack was already grinning like he knew Shaun would make the offer, Jack responded to Shaun with a cheerful tone of voice and said “We have a deal my friend, I’d be more than happy to accept the generous offer”  Both the men walked up to each other, both moving their hands towards each other, as they both tightly gripped each other’s hands and shook on the deal.

Chapter Three
False Shepard
Shaun and jack had set off on a long journey to roads end, both the men had been travelling for an hour and a half, even though the world was at its end Shaun always liked to keep the time and date it always gave him peace at mind to know the hours and the days of this new life he had started as a survivor. Shaun and Jacked had talked about many things, they went on to talked about the good old days of going to a bar just to a have a sweet sip of an ice cold beer after a long day’s work and how it always tasted better when it was worked for. Other conversations went on about their hobbies and What few weird things they did to keep themselves entertained, all the while Shaun had pointing out wrong routes and making up small stories about them to convince jack he knew where he was heading. Shaun and Jack finally came across some buildings after a long journey, it was a rundown gas station surrounded by wrecked vehicles, on the opposite side of the gas station was a diner, which looked like it had not been raided by bandits or other survivors yet, and Shaun looked to jack and said “Can you keep watch for a minute? Ill check and see if there is anything we can use inside” Jack nodded to Shaun as he made his way to the door of the gas station Shaun pushed the door gently as the bell above the door made a ringing noise he quickly stopped in his tracks to see if he had alerted anyone or anything that may have been waiting inside. He waited a few moments before making his way to the counter, there he rested down his rifle and his bag, he moved his hand to the zipper on the duffle bag pulling it towards himself to open the top compartment of the bag when he had completed this action he made his way to the back to check to see if the store had any unused cans or still sealed packs of water. Shaun was looking through all the shelves he could find nothing, at this point he was very stressed at the idea he would have to walk out empty handed, he turned to his right to kick a pile of empty boxes to release some of his anger, and behind these boxes revealed to be a box full of twelve unused cans of beans and rice and a Jug used for willing up water machines, that was half empty his anger soon became settled when the stress was relieved, suddenly he heard the bell on the door ring Shaun slowly walked to the door and started talking to what he believed was jack “Can’t wait for you to see this, maybe would could have a feast tonight!” Shaun suddenly paused as he made it back to the counter, he looked towards the door to see a half-eaten rotting corpse leaning over where he had placed his gun and his bag, The undead creature suddenly turned towards Shaun and started charging, He had nothing to defend himself with, as the creature made contact with him they were both locked in arms pushing against each other, Shaun was slowly being over whelmed by this surprisingly strong undead man, and he quickly moved his hand to hold the zombie back by his neck he quickly scanned the room with his eyes for some kind of weapon to defend himself, the undead creature pushing himself on Shaun only inches away from his neck, and there it was he finally found a weapon to try to fend off this creature a rusty fork lay under the table covered in dust. Shaun reached out as hard as he could to try and grab the item from under the table, A smash was heard as an arrow made its way through the window to connect with the side of the zombies skull, this arrow was instantly fatal as the undead creature fell back and landed on the floor twisted like a pretzel, Shaun’s eyes focused to the smashed window and there stood jack wielding a compound bow Shaun walked towards the door, grabbing the handy firmly and pulling the door wide open, he looked at jack and said “What the hell man?! Where did you go, I asked you to keep watch” Jack looked at him knowing he was angry about it, and he knew he had the right to be jack replied “I’m sorry, I didn't know I thought I’d take a little wander myself, I thought maybe we could each be searching, the area was clear when I left I only found this cross bow and some sachets of ibuprofen powder” Shaun looked to jack and instead of an angry response Shaun smiled and said “When do I get to owe you one” Jack looked to Shaun and never questioned his change of heart, Shaun didn't know either I guess he just wanted to stay on good terms with Jack to get where he was going, Jack smiled and asked “Did you find anything?” With a big grin on Shaun’s face he replied “12 can of rice and beans, Half a jug of water” Jack smiled and replied with “I guess we get to eat for another night”  That night Shaun and Jack had traveled not to deep into the woods close by, deep enough not to be seen but also for them to be able to keep track of the road, they smiled and laughed as they had a belly full of warm meal, That night it felt they were already  the best of friends, Shaun questioned himself in his thoughts that if what he was doing could be classed as being what the bandits do, But still Shaun never changed his mind he kept with the idea of misleading the man but the guilt was slowly starting to brew inside of him.

title: [HF] H1Z1 - "A Debt To Be Paid" - Part One

question: How does Shaun survive the attack by the Highwaymen?

answer: Though the men surround Shaun with guns, a shot from the surrounding bush kills one of their number. The others aren't sure where the shot came from. When more shots are fired the robbers flee in terror.

question: Where is Jack going when he shoots the robber?

answer: Jack is looking for his friend. The friend made radio contact and they had agreed to meet at road's end


text:
[islip new york flood]REUTERS/Lucas Jackson

-   A GOLDMAN SACHS REPORT ON THE EFFECTS OF CLIMATE CHANGE ON CITIES ACROSS THE WORLD MAKES FOR GRIM READING.
-   THE REPORT, RELEASED EARLIER THIS MONTH, SAID RISING TEMPERATURES WOULD LEAD TO "CHANGING DISEASE PATTERNS," "MORE INTENSE AND LONGER-LASTING HEATWAVES," "MORE DESTRUCTIVE WEATHER EVENTS," AND "PRESSURE ON THE AVAILABILITY AND QUALITY OF WATER FOR DRINKING AND AGRICULTURE."
-   MAJOR CITIES SUCH AS NEW YORK, TOKYO, AND LAGOS WERE ALSO HIGHLIGHTED AS BEING AT RISK OF FLOODING.
-   MARKETS INSIDER ALSO SPOKE TO GOLDMAN SACHS, UBS AND JPMORGAN ABOUT WHY BANKS ARE NOW FOCUSING ON CLIMATE CHANGE.
-   VIEW MARKETS INSIDER FOR MORE STORIES.

------------------------------------------------------------------------

Goldman Sachs this month released a report on the effects of climate change on cities around the world, and it makes for grim reading.

The bank's Global Markets Institute, led by Amanda Hindlian, warned of significant risks to the world's largest cities, which are especially vulnerable to more frequent storms, higher temperatures, rising sea levels, and storm surges.

"Cities generate roughly 80% of global GDP and are home to more than half of the world's population today, a share that the United Nations projects will reach two-thirds by 2050," the report said. About 40% of the population lives within 100 kilometers of a coast, and one in 10 people live in areas less than 10 meters above sea level, it said.

Goldman highlighted three cities that could be subject to storm surges and could face harmful flooding: New York, Tokyo, and Lagos. It said several others that are less than 11 meters above sea level — including Miami, Florida; Alexandria, Egypt; Dhaka, Bangladesh; and Shanghai, China — also faced major flood risks.

SEE MORE: _Here's why JPMorgan and Goldman Sachs say 2019 is the year climate change is at the top of investors' minds_

[New york]Goldman Sachs

Goldman's researchers said they started with the scientific consensus that "human activity — principally the emission of greenhouse gases — is causing the earth to warm in ways that are affecting the climate."

They said that natural ecosystems would be damaged, human health would be threatened, and food and drinking-water systems would be pressured. For example, agriculture would be massively affected, as "warmer temperatures and shifting precipitation patterns could reduce yields and nutritional quality as well change growing seasons and agricultural zones around the world."

Goldman gave some fairly stark warnings about potential outcomes:

-   "MORE FREQUENT, MORE INTENSE AND LONGER-LASTING HEATWAVES" that affect human health, productivity, economic activity, and agriculture. "Higher surface temperatures could exacerbate the warming process by causing permafrost to melt, releasing further methane and CO2 into the atmosphere."
-   "DESTRUCTIVE WEATHER EVENTS, INCLUDING STORMS, WINDS, FLOODING AND FIRES." It's not just New York, Tokyo, and Lagos; "other major low-lying coastal or already flood-prone cities include Shanghai, Dhaka, Mumbai and Karachi — each of which has a population of 15 million people or more."
-   "CHANGING DISEASE PATTERNS." The researchers said that "warmer temperatures could cause disease vectors to migrate from the tropics to regions where people have less immunity; this is true not only for viruses like malaria and dengue fever but also for water-borne and food-borne diseases."
-   "SHIFTING AGRICULTURAL PATTERNS" AND FOOD SHORTAGES. "Livestock could be affected by higher temperatures and reduced water supplies. Ocean acidification is likely to put stress on aquatic populations and affect current fishing patterns. Some of these changes are already underway. Some climate scientists, for example, estimate that coral reefs will be all but extinct over the course of the century due to ocean acidification."
-   WATER. "Half of the world's population will live in water-stressed areas as soon as 2025," Goldman said, citing the World Health Organization. "Even in non-stressed areas, the quality of surface water could deteriorate as more rain and storms drive erosion and the release of toxins. These dynamics could affect everything from the availability of drinking water for people to a shortage of water for livestock and crops (with negative effects for the food supply) to decreases in hydroelectric power generation."

[Lagos and Tokyo]Goldman Sachs

The bank said those things would "affect economic activity, damage infrastructure — from buildings to transportation to water and waste-management systems — and disproportionately harm vulnerable residents."

"Despite the uncertainty around the timing and scale of the impact, it may be prudent for some cities to start investing in adaptation now," Goldman said, adding that "urban adaptation could drive one of the largest infrastructure build-outs in history."

"Given the scale of the task, urban adaptation will likely need to draw on innovative sources of financing," the report said.

[Global populations]Goldman Sachs

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question: What does the text say about Global Markets Institute?

question: What does the text say about climate change?

answer: The report released by Global Markets Institute warned of significant risks to the world's largest cities especially the ones with more frequent storms, higher temperatures, rising sea levels, and storm surges.

question: What does the text say about Goldman Sachs?

answer: Goldman Sachs released a report highlighting three cities that could be subject to storm surges and could face harmful flooding: New York, Tokyo, and Lagos. Their researchers started with the scientific consensus that "human activity - principally the  emission of greenhouse gases — is causing the earth to warm in ways that are affecting the climate." They said that natural ecosystems would be damaged, human health would be threatened, and food and drinking-water systems would be pressured.

question: What does the text say about JPMorgan and Goldman Sachs?

answer: JPMorgan and Goldman Sachs say 2019 is the year climate change is at the top of investors' minds.