The Queens Maries Maids of Honor to a Queen Mary

Evaluation Of The Medical Patient Records - 944 Words

Documentation in the healthcare setting is the materials that provides official information or evidence that serves has a record. (Merriam-Webster Dictionary) Yesterday healthcare organizations depended on verbal and written reporting to serve as a tool for continuity of care for patients. The first standard of nursing that is taught in Nursing School is in Fundamentals of Nursing which is one standard of nursing practice, superb assessment having the ability to evaluate, gather and analysis a patient’s health status. A good assessment directly influences the nurses’ plan of care (Taylor, 2001) which is a necessity to provide good patient care. This is why nurses’ assessment should be conveying accurately. In Nursing the main factor is being the patients’ advocate, this will determine if the patient is receiving standard of care. Charting is essential for many reasons such as ensuring continuity of care, treatment plans for the patient, substantiate billing, and most important is to recollect memory or to justify care that was provided. Medical patient records are also organized documents that to obtain patient medical history and as well as previous care. Medical records are personal documents stored by his or her health care provider. Each medical record has enough information to distinguish each patient. It contains their first and last name with gender and age. This method of medical record is still in use by many physicians; however, there has been a faster andShow MoreRelatedWill The Ehr Increase Clinical Utility By Providing The Patients With Easy Data Accessibility?978 Words   |  4 Pagesproviding the patients with easy data accessibility? 2. Will the EHR allow users to see the course of disease in terms of activities and responsibilities? 3. Will the EHR allow users to monitor compliance in daily basis? 4. Will the EHR help in adjusting the course of chronic disease in a standardized program? These questions needs to be verified in order to establish the usefulness of the system. In short, when clinical simulation is to be carried out, the following steps can help in evaluation. VerbalRead MoreThe Importance Of The Cardiac System Of Care, The Healthcare And Evaluation Professionals From The State Of South Dakota1548 Words   |  7 Pagessystem of care and provide assistance to the emergency medical services (EMS) by equipping them with medical devices such as Automatic External Defibrillator’s (AED), mechanical CPR device LUCAS 2 and Simulation training support. To understand the scope of the cardiac system of care, the healthcare and evaluation professionals from the state of South Dakota conducted full scale mock exercises during Summer 2014 to understand the flow of patient information, which directly affects the quality of careRead MoreCvcu Case Study1213 Words   |  5 PagesThis study focused on patients cared for in the adult CVICU who were supported by mechanical ventilation. Moreover, the target population was patients who had undergone cardiothoracic surgery, were supported by mechanical ventilation on postoperative days 1–5, and had no pre-existing cognitive dysfunction. Accordingly, this population was studied because patients who are supported by mechanical ventilation represent the largest population of patients at risk for the development of delirium (JarmanRead MoreThe American Health Information Management Association1383 Words   |  6 Pagesrespected authority for professional education and training in the effecti ve management of health data and medical records needed to deliver quality healthcare to the public. Throughout AHIMA’s history back to 1928, the American College of Surgeons established the Association of Record Librarians of North America (ARNLA) to â€Å"elevate the standards of clinical records in hospitals and other medical institutions† (www.ahima.org, 2015). Since its formation, the Association has undergone several name changesRead MoreThe Electronic Health Record And Clinical Decision Support824 Words   |  4 PagesEvaluation Project: Part 1 Arcandrice Richardson Walden University System Design, Planning, and Evaluation NURS 6431 Dayna Herrera September 24, 2015 Evaluation Project: Part 1 The scenario selected for this evaluation project focuses on the electronic health record. The scenario involves patient documentation, clinical decision support, and performing nursing notes. The project involves evaluation and implementation of EHR. The electronic health record and clinical decision support are notRead MoreRole Of General Practitioners And Primary Care Providers1681 Words   |  7 Pagesdiagnosing dementia Primary care physicians (PCP) play a crucial role in dementia diagnosis. Older patients receive healthcare primarily from their general practitioners (GPs). [51, 52] Most patients and carers prefer their GPs to be the first source of professional help when dealing with dementia. [53-55] The Australian guidelines advocate early diagnosis by timely exploration of symptoms raised by patients and carers. [14] It would be reasonable for GPs to initiate the diagnostic process for suspectedRead MoreEffective Communication Within A Workplace854 Words   |  4 PagesUnderstanding effective communication in a medical setting helps hospitals and doctor offices develop a work environment that is able to communicate effectively with coworker, patients and doctors in order to take of the patients needs. Listening, clarity and Patience are three main keys to effective communication within a workplace. In this paper, the author will describe an experience within the medical field work place where communication was effective. In a medical workplace environment, having effectiveRead MoreMedical Practice Initiative785 Words   |  3 PagesMedical Practice Initiative. One of the main drivers of the Medical Practice Initiative (MPI), aside from patient safety, is the acquisition, maintenance, and minimization of cognitive and psychomotor skill decay of healthcare personnel. A primary focus is maintenance of military and medical skills throughout a caregiver’s career (7). There is some crossover between the CCTI and the MPI as both apply to healthcare providers, but the MPI is more closely tied to Role 3 through Role 5 skills and proceduresRead MoreElectronic Medical Records and the Nurse Informatics Specialist914 Words   |  4 PagesElectronic medical records and the nurse informatics specialist Over the years, with the technological development and digitalization of almost all the processes, there have been calls for the healthcare technology to be adopted in a wider sense of it. This has been mainly on the development of the appropriate chip and other electronic storage systems that can hold the information about each Americans medical information and any other relevant data like the physical address and the migration trendRead MoreFederal Qualified Public Health Clinic1223 Words   |  5 PagesMany of FQPH patients are recipients of Medicaid and SCHIP, or uninsured self-pay clients as it is located in a large Northwestern City. The physicians are frustrated with current conditions. As a last-ditch effort, they inform Administrator of their complaints that need immediate attention or they will terminate employment. Those complaints include inadequate paper medical records; inefficient patient registration practices; mean and slow employees; mistreatment of patients and medical staff; inadequate

Anna Karenina Free Essays

The novel opened up to an implication of the strife in the Oblonsky household. There was an atmosphere of confusion as everyone was concerned about the discovered sexual affair of the Master of the house with the French governess. The wife of Prince Arkadyevitch Oblonsky (Stiva) did not leave her room and it showed how the situation evident with how everything has been going wrong. We will write a custom essay sample on Anna Karenina or any similar topic only for you Order Now Examples were given to prove establish the confusion and the mess of the situation like the children going wild all over the house, how the house helpers were quarrelling, the man-cook quitting his job and others who were threatening to do so. Stiva woke up on the leather-covered sofa in his study without having to realize that he was not sleeping with his wife until he reached for his dressing gown that was not where it should have been, within arm’s reach of their bed. After which, he remembered his current predicament. The setting in this scene how a marital dispute can affect so many people and how more marital disputes can stir the course of the following events in the novel. Kitty’s big night, the ball, was narrated to be a dream-like event where she was to go down a â€Å"great staircase, flooded with light and lined with flowers and footmen in powder and red coats (Tolstoy Part 1, Chapter 9).† The sound of the orchestra can be heard. Women and men were wonderfully dressed, expensive fabrics and vibrant colors filled the ballroom as people started to waltz on the dance floor. This shows how Kitty, at the start of the novel was naà ¯ve in a way as she saw so much romance in the night and how she loved social gatherings like that night’s ball. The setting described the vibrancy and excitement Kitty felt before she found out that Vronsky, the man she loved, fell in love with Anna, the woman she adored. The description of the ballroom and the atmosphere was further elaborated with describing how perfect everything was with Kitty, from her hair, to her dress to her shoes, only to come to a huge turning point wherein she sees Vronsky’s affection for another woman.   The description of how exquisite Anna looked that night, added much weight to the twist that was about to take place, it made Vronsky’s admiration for Anna like a harder slap on Kitty’s face. Theme The major theme in the novel was about society and family. The second part of the novel gave much emphasis to solidifying this theme through different instances wherein Anna was reprimanded or placed in a bad light because of a foreseen case of infidelity.   It was important for families to stay together, more so during their time as women who are divorced loose a lot of ground in society, while the men do not loose as much. There was one instance wherein the text showed how Anna had three sets of friends in the Petersburg society.   There are those who belonged to the circle of her husband’s colleagues that seems to serve merely as acquaintances with the family. Another set was concerning the friends in Countess Lydia Ivanovna’s circle that Anna soon disliked greatly and the last set was one with Princess Betsy Tverskaya who was the wife of her cousin.   Each set of friend offered much of their opinions about how Anna changed and often gossiped about her and her husband Karenin. Alexey Alexandrovitch, Anna’s husband, only saw fit to talk to her wife about her behavior with another man upon realizing that others are already gossiping about them. The confrontation was indifferent for both of them and their relationship changed but they stayed together to avoid any societal conflicts. When Anna and Vronsky made love, it was obvious that Anna was distraught as to the consequences of her actions with society and how it will affect his family, even her son. When Vronsky fell of his horse during a race, Anna could not contain her emotions in public. This had shown her improper affection for Vronsky.   She cried as she was so worried about him. Instead of being jealous about Anna’s obvious feelings for another man, Karenin simply warned her to be careful about how she reacts in public and showed how he valued his social stature more than he did his actual relationship with his wife. Even after Anna admitted his relationship with Vronsky, Karenin was more preoccupied with protecting his honor. During that time, it has established how people were more concerned about the opinions of society and how they maintain a clean image in public.    How to cite Anna Karenina, Papers

Creativity free essay sample

Innovation brings change to organizations, individual lives and the society. So, the most important part of innovation is to convince people that the new ideas are useful and will be helpful in adding value to their lives (Bingham Spiraling 2011). This Is because many people are resistant to change. In a business context, Innovation Is defined as the process of introducing new products Into the market, or the action of bringing changes to something already existing In the market by Introducing new methods, ideas, or products (Allendale Banks 2007). Trucker (1985) provides thatInnovation Is the act that gives resources a new capacity to create wealth. On the other hand, J Brown-Kahn (1984) defines It as the process of generating new Ideas and making appropriate decision about them to create something useful. Overall, Innovation Is about creating new things that fulfill specific goals, or Improve the value of life. Innovation Introduces change to organizations, the society and the lives of individuals. We will write a custom essay sample on Creativity or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page So the most important aspect of innovation is persuading people that new ideas are beneficial and will be supportive in adding values to an individuals life (Bingham Spiraling 2011).

Heart Of Darkness By Joseph Conrad Essays (1071 words) -

Heart Of Darkness By Joseph Conrad In the novel Heart of Darkness by Joseph Conrad one of the major themes is the perversity of the Congo. What is good and evil in the European world becomes distorted and hazy in the heart of Africa. To the outside world white is good and black is evil; it is as simple as that. This philosophy is embodied in Marlow's aunt, who believes that his job is to bring light into the land of darkness and to enlighten the savages. This idea, however, becomes corrupted when white objects symbolize suffering and greed instead of good, and light images hide the presence of darkness. Symbols such as, a white rag, white imperialists and ivory, no longer represent the good will of the imperialists, on the other hand they represent the exploitation and chaos that the Europeans have brought to the Congo. The main character Marlow is faced with this confusion as he voyages through the jungle, and he must reevaluate his former opinions, which no longer hold true. The European philosophy is shown through the conversation that Marlow has with his aunt before commencing his adventure. According to her, his job seems clear: to bring civilization and light to the"heart of darkness." Instead of focusing on the horrors of imperialism she is disillusioned to believe that it is all for the better. The Europeans, especially the British have no respect for other cultures or other ways of life, and they truly believe that they are helping the Africans. Not by choice but because of the "white man's burden" they feel the need to "[wean] those ignorant millions from their horrid ways"(28). To the outside this seems like an earnest motive; however, once inside Marlow begins to see new forms of corruption. Are the imperialists their to help, or are they there to make money to fulfill their greed? He begins to realize that it is not the black savages who represent evil, but rather the selfish whites. This corruption is further shown through the novel with symbols that reveal that perversity of the jungle. None of Marlow's previous beliefs hold true in the Congo and he must reevaluate what is light and what is dark. He is confronted with the distortion of images and confusion at the first station. He sees a group of natives in the shade and immediately compares it to hell. As he states: "Black shapes crouched, lay, sat between the trees, leaning against the trunks, clinging to the earth, half coming out, half effaced within the dim light, in all the attitudes of pain, abandonment, and despair"(35). He notices one figure in particular, one with a white rag around his neck. Is it the natives who create this feeling of suffering or is it the whites? These people are in the shade because they have nothing to live for anymore. The imperialists have destroyed their way of life and now they are eagerly awaiting death. The corruption is not in the black boy, rather in the white rag. What it symbolizes is not clear. Marlow asks, "Where did he get it? Was it a badge ? an ornament ? a charm ? a propitiatory act...It looked startling round his black neck, this bit of white thread from beyond the seas"(35). Marlow does not know why exactly the boy is wearing the rag; however, he does know that the Europeans brought it - along with suffering and corruption. Rather than bringing light to the natives, they have brought nothing but pain and chaos. This confusion in appearances is show again with the alternative motives of the whites. They are not humanitarians helping a civilization out of good will. They are there out of greed and corruption. Without the presence of society, the inner core of humans is revealed and what is white on the outside is sometimes black on the inside. This reversal of appearances is displayed in all the imperialists that Marlow comes across. One is the manager at the first station. He gives the allusion of being a gentleman with his European clothing and manners, yet inside he is filled with crookedness. In order to maintain this image he must train a native to follow his orders. He makes another suffer to keep the allusion of being white. This distortion of appearances is revealed again in the uncle of the manager of the second station. His skin color hides the presence of evil. Marlow remarks that he "seemed to beckon with a dishonoring flourish before

A day in Buna (holocaust) essays

A day in Buna (holocaust) essays During the years of 1933-1939, the German Nazis party began the invasion of the Jewish people. Prior to the outbreak of World War II, Hitler had addressed that the Jews would have to be destroyed if war should come. The will to kill the Jews was embedded in their beliefs not infused by external conditions. Hitlers actions were carried out in many concentration camps. In 1939, Adolf Hitler began to move the Jews into ghettos as the war start. A ghetto, in Europe, is like a China Town or a Little Italy. Something where people of one race or one religion get together to live. Now, lets imagine what ghetto life was like. We are humans who only want to be treated like humans not animals. We have been here for a few weeks already, and the bad condition of living here is unbearable, which I interpret it as the following example. Suppose youre here, and in the next two hours, while youre looking and reading, it snows six inches and hour. So in two hours, the snow out there is going to be a good foot deep, which leads to great difficulty of getting home. Now there isnt enough food for you. Although there are enough restrooms, but we all have to stand in line in order to fit approximately ten families. Also, there arent any beds. Therefore, there arent any comforts. There are some water provided, but its a limited amount, which is about six gallons a day. The health and welfare of all who are here is extremely poor. They are depriving us of basic needs to survive. We hardly get any food as they only feed us bread, water and soup called gruel. It doesnt have much in it, it is only enough to keep us alive to work for them. The people who are running this place (S.S officers) are killing hundreds of us weekly for no reason. The Nazis are treating us inhumanely, torturing and killing us, using execution, poisonous gasses, forced labor, star ...

Corporate Ethics in the Post-Enron Era from the Role of a Policy Essay

Corporate Ethics in the Post-Enron Era from the Role of a Policy Analyst - Essay Example It evident that for those companies that collapsed, most of them exhibited symptoms like conflict of interest in dealings, exaggerated compensation packages, manipulation of voting rights etc. All these issues have renewed the need to strengthen corporate governance by inculcating business ethics in corporate dealings. Accordingly for us to tackle the issue of corporate governance, the basic principles and concepts in corporate governance need to be discussed (McDonald, 2007). Ethics as a concept refers to concepts or maxims of right or wrong behavior in the society. Ethics can be equated to morality. The critical question to be asked on ethics with regard to corporate governance is whether ethics has a place in this profit centered capitalist economy. The answer lies in the experiences highlighted above on business malpractices whose consequences have not only affected the shareholders only but also the general public at large. Corporate governance involves the assignment of duties and rights amongst all the participants in a corporation from the board of governors all the way to the stakeholders. It also provides for structures for achieving set objectives and decision making. At the same time the corporation exists within a society, thus societal ideals such as fair dealing, transparency, accountability and responsible citizenship must be upheld by the corporate entity. All these societal values have to be incorporated into the concept of corporate governance. This is to say that the corporation has to consider both the legal and social values in its pursuit of better corporate governance. Encompassing the aspect of societal values and norms dictates that the participants in the running of modern day corporations ascribe to the principle of corporate citizenship. The principle of corporate citizenship entails the commitment of individuals to unquestionable ethical behavior in corporate affairs (Cross & Miller, 2012). This principle sits well from the strateg ic and the operational levels of an organization as it is usually tied up with board leadership and corporate image. It is therefore imperative that for any business to be sustainable in these globalized and interconnected world all the corporate players have to recognize that the operating environmental, social obligations, and governance responsibilities are integral to corporate performance and sustenance (Cross & Miller, 2012). All these factors will determine company profits. The case of companies like Enron reflects a new dimension of corporate governance. This dimension entails strategic thinking by the board of directors in providing leadership beyond short term financial performance. The corporate leadership, boards of directors, shareholders, and the modern role of the CEO, must be prepared to provide strategic leadership and oversight on issues to do with the environment as this presents substantial reputation risk. They must also commit to creating shareholder value thro ugh engaging in activities which will increase access to markets while at the same time mitigating against immediate tangible and anticipated future risk (Bernstein, 2004). General Policy recommendations Several policies and strategic thinking

Eassy Essay Example | Topics and Well Written Essays - 500 words - 1

Eassy - Essay Example Globalization has significantly changed the dynamics of social structure and provided it with socio-cultural diversity that is indeed diverse in its application of ideas, ideologies and competencies across people coming from different race, culture, color and nationality. In such conditions, the role of HRM is crucial in creating a diverse workforce whose competencies are judiciously exploited for increasing organizational productivity (Gillham, Wood & Somerville, 2007). Indeed, in the transforming societal norms, cultural competencies can provide the organizations with unique competitive advantage that would be difficult to imitate. Thus, treating workforce as human capital is not only desirable but also essential in the changing environment of high competition. Moreover, environmental changes like globalization and technology are also intrinsically linked to other paradigms of business which have considerable impact on the overall performance of the firm. Computer and internet have redefined communication and provided people with huge entrepreneurial opportunities to expand their business across globe. They have diminished the geographical distances and increased the challenges for HRM. The job specifications have become more stringent and jobs less secure due to new trends of outsourcing in non-core areas of business. HR’s contribution to the human capabilities through training and development become vital facilitator of motivated workforce that generates job security and inculcates higher sense of self-worth (Zapata-Cantu et al., 2007). HRM is also responsible for creating an organizational culture that highlights cross cultural understanding, mutual respect, shared goals and strong teamwork. This is important in current times as diversity in workforce necessitates understanding of cross cultural values to inculcate mutual respect and strengthen teamwork

Intermediate macroeconomics Assignment Example | Topics and Well Written Essays - 250 words

Intermediate macroeconomics - Assignment Example The cycle can be illustrated graphically as shown below. Potential output is the total production of output that is possible when all the factors of production are fully and efficiently employed. For example when the unemployment rate is about 5% since a 0% unemployment rate cannot be achieved in real economic conditions. Actual output is the real physical output that has actually been produced in the economy. Output gap is therefore expressed as the difference between the potential output and the real output. Large output gap is an indication of increased unemployment rate. The neo-classical theory uses output gap to explain business cycle. Y=c[y-t(y)]+i(r)+g dy=c’(dy-I’dy)+I’dr =c’dy-c’I’dy+I’dr dy-c’(1-i’)dy=I’dr dy(1-c’(1-i’)d=I’dr dy=I’dr/1-c’(1-i’) dy/dr=I’/1-c’(1-i’) The expenditure multiplier explains the amount o change in output due to a unit change in government expenditure while tax multiplier explains the amount of change in output due to a unit change in tax rate. m/p=l(r)+k(y)

Biochemical and Hormonal Changes in Childhood Obesity

Biochemical and Hormonal Changes in Childhood Obesity The prevalence of chronic or non communicable disease is escalating much more rapidly in developing countries than in industrialized countries. According to World Health Organization (WHO) estimates, by the 2020, non communicable diseases will account for approximately three quarter of all deaths in the developing countries (WHO. Global Strategy for non communicable disease prevention, 1997). In this regard, a potential emerging public health issue for the developing countries may be increasing incidence of childhood obesity with associated complications, which in turn is likely to create public health burden for poorer nations in the near future (Freedman et al, 2001). Lower to middle income nations face the double burden of having both malnourished and over nourished population, with most overweight and obese children being concentrated in urban areas. Rapid urbanization is associated with unhealthy lifestyle or New World Syndrome. In addition, in such communities, childhood obesit y is still considered a sign of healthiness and high social class. There is no universal consensus on a cut off points for defining overweight and obesity in children and adolescents, usually, for clinical practice and epidemiological studies, child overweight and obesity are assessed by means of indicators based on weight and height measurements, such as weight for height measures or body mass index (weight (kg)/height (m2))(WHO. Report series no.847, 1995).The US Centers for Disease Control and Prevention (CDC) defines obese as being at or above 95th percentile of body mass index for age (Kuczmarsk RJ et al, 2000). History of obesity is both interesting and gives details of its progression. Obesity is an age-old health condition. Through out the history of obesity, its reputation varies from appreciation and opposite among cultures and in time. Ancient Egyptians are said to consider obesity as disease. Perhaps the most famous and earliest evidence of obesity is the Venus figurines, Statuettes of an obese female torso that probably had a major role in rituals. Ancient China has also been aware of obesity and dangers that come with it. They always were a believer of prevention as a key to longevity. The Aztecs believed that obesity was supernatural, an affliction of the gods. Hippocrates, the father of medicines was aware of sudden deaths being more common among obese men than lean ones as stated in his writings. In certain cultures and areas where food is scarce and poverty is prevalent, is viewed as symbol of wealth and social status. To date, an African tribe purposely plumps up a bride to pre pare her for child bearing. Before a wedding can be set, a slim bride is pampered to gain weight until she reaches the suitable weight. Through out the history of obesity, the publics view and status of obesity changed considerably in the 1900s. It was regarded as unfashionable by the French designer, Paul Poi ret who designed skin-revealing clothes for women. About the same time, the incidence of obesity began to increase and become wide spread. Later in 1940s, Metropolitan life insurance published a chart of ideal weight for various heights. They also advocated that weight gain parallel to age is unhealthy. The government and medical society become more hands-on with obesity by imitating campaign against it. This was preceded by a study of risk factors for cardiovascular disease revealing obesity in the high ranks. Since then various diets and exercise programs have emerged. In 1996, the Body Mass Index (BMI) was published. This statistical calculation and index determined that a person is obese or not. At this time ,obesity incidence have soared, led by children and adolescent obesity, tripling in just a few short years, greater than any number in the history of obesity. This increase in the incidence of childhood obesity with associated cardiovascular risks, type 2 diabetes mellitus and stroke is supported by a considerable body of evidence. The prevalence of overweight and obesity in childhood and adolescents has been increasing throughout much of the developed and developing world for the past few decades. It has become increasingly clear that excess adiposity in childhood predisposes individual not only to increased risk of adiposity and its sequaele as adults (Freedman et al, 2001), but also to increased risk of multiple chronic diseases in childhood and adolescence (Rosen bloom et al, 1999). Though mechanism not clearly delineated, excess body weight and adiposity is associated with type 2 diabetes mellitus and its complications, cardiovascular disease risk factors, non alcoholic fatty liver disease and asthma in youth. Childhood Obesity 1930 1972 Risk factors for coronary heart disease (CHD) such as hypertension, dyslipidemia, impaired glucose tolerance and vascular abnormalities were present in overweight children. CHD is likely to be increased in overweight children when they become adults as a result of established risk factors. This study investigated whether excess weight in childhood was associated with CHD in adulthood among a very large cohort of persons born in Denmark in 1930 through 1972. They underwent mandatory annual health examination at public or private schools in Copenhagen. Each child was examined by school doctors or nurses and was assigned a health card bearing childs name, date of birth, birth weight reported by parents. 10,235 men and 4,318 women, for whom childhood BMI data were available, received a diagnosis of CHD or died of CHD as adults. The risk of CHD event, a non fatal event, and a fatal event among adults was positively associated with BMI at 7-13 years of age for boys and 10 to 13 years of ag e as girls. The associations were linear for each age and risk increased across the entire BMI distribution. Childhood Obesity 1930 1972 Risk factors for coronary heart disease (CHD) such as hypertension, dyslipidemia, impaired glucose tolerance and vascular abnormalities were present in overweight children. CHD is likely to be increased in overweight children when they become adults as a result of established risk factors. This study investigated whether excess weight in childhood was associated with CHD in adulthood among a very large cohort of persons born in Denmark in 1930 through 1972. They underwent mandatory annual health examination at public or private schools in Copenhagen. Each child was examined by school doctors or nurses and was assigned a health card bearing childs name, date of birth, birth weight reported by parents. 10,235 men and 4,318 women, for whom childhood BMI data were available, received a diagnosis of CHD or died of CHD as adults. The risk of CHD event, a non fatal event, and a fatal event among adults was positively associated with BMI at 7-13 years of age for boys and 10 to 13 years of ag e as girls. The associations were linear for each age and risk increased across the entire BMI distribution. Childhood Obesity and Economic Growth 1930-1983 Childhood obesity was related to the economic growth during the 50 years of economic growth in the industrialized world especially in Denmark. Annual measurements of height and weight were available for all children born between 1930 and 1983 attending primary schools in Copenhagen Municipality. 165,389 boys and 163,609 girls from the age of 7 through 13 years were included in this study. After computerization SBMI (kg/m2) were calculated and the prevalence of overweight and obesity according to international age and gender–specific criteria. Economics growth was indicated by the Gross National Product and the overall consumption per capita, adjusted for inflation. Prevalence of overweight and obesity among Danish children rose in phases, which were not paralleled by trends in economic growth. The microeconomics growth indicators seem inappropriate as proxies for the environmental exposures that have elicited the obesity epidemic. Childhood obesity and television viewing Children spend a substantial portion of their lives watching television (TV). Investigators have hypothesized that TV viewing causes obesity by one or more than three mechanisms: Displacement of physical activity. Increased calorie consumption while watching or caused by the effects of advertising. Reduced resting metabolism. The relationship between TV viewing and obesity has been examined in a relatively large number of cross sectional epidemiological but few longitudinal studies. Many of them have found relatively weak, positive association or mixed results. Many experimental studies have found that reducing TV viewing may help to reduce the risk of obesity. One school based experimental study was designed specifically to test directly the casual relationship between TV viewing behaviors and body fatness. The results of this randomized controlled trial provide evidence that TV viewing is a cause of increased body fatness and that reducing the TV viewing is a promising strategy for preventing childhood obesity (Robinson; 2001). The objective of another study (Utter J et al, 2006), was to explore how time spent watching television (TV) is associated with the dietary behavior of New Zealand children and young adolescents. Total number of participants was 3275 children aged 5-17 years. The findings suggest that longer duration of TV watching (thus more frequent exposure to advertising) influences the frequency of consumption of soft drinks, some sweets and snacks and some fast foods among children and young adolescents. Efforts to control the time spent watching TV may result in better dietary habits and weight control for children and adolescents. Childhood Obesity US- A decade of progress, 1990-1999 Current data suggest that 20% of US children are overweight .An analysis of the secular trends suggest that 20% of US children are overweight, and a clear up ward trend in body weight in children of 0.2 Kg between 1973 and 1994. In addition, childhood obesity is more prevalent among minority sub groups such as African Americans. Obesity that begins early in life persists into adulthood and increases the risk of obesity related conditions later in life. There has been tremendous increase in the number of studies examining the etiology and health effects of obesity in children (Goran MI, 1990-1999).1980 (boys 0.2% girls 0.5%) and 1997 (boys 1.2%, girls 2.0%). Ten years trends of childhood obesity in Israel 1990-2000 Cross sectional data was collected from 13284 second and fifth class school; children between 1990-2000. Prevalence of obesity was determined using Israeli and US reference values. BMI values at 95th percentile increased overtime in all ages and sex categories. Between 1990 and 2000, 95th centile values were increased by 12.7%and 11.8% among second grade boys and girls respectively. Among fifth graders in 2000, 10.7% of boys and 11.1% of girls exceeded the 1990 BMI reference values. The proportion of obese children increased over time using both Israeli and US reference values (Huerta Michael et al, 2008). Netherlands. Overweight, Obesity in 2003: V.1980-97. Data on 90,071 children, aged 4-16 years were routinely collected by 11 Community Heath Services during 2002-2004. International cut -off points for BMI to determine overweight and obesity. On average, 14.5% of boys and 17.5% of the girls were overweight (including obesity), which is a substantial increase since 1980 (boys 3.9% and girls 6.9%) and 1997 (boys 9.7% and girls 13%). Similarly 2.6% of the boys and 3.3% 0f the girls aged 4-16 years were obese, which is much higher than in 1980 (boys 0.2% and girls 0.5%) and 1997 (boys 1.2% and girls 2.0%), (KatjaVan Den Husk, 2007). Obesity trends in US. 2003-2006 Height and weight measurements were obtained from 8164 children and adolescents as apart of the 2003-2004 and 2005-2006 National Health and Nutrition Examination Survey (NHANES). Because no statistically significant differences in the prevalence of high BMI for age were found between the estimates for 2003-2004 and 2005-2006, data for four years were combined to provide more stable estimates for the most recent time period. Over all, in 2003-2006, 11.3% of children and adolescents aged 2 through years were at or above 97th percentile of the 2000 BMI- for- age growth charts, 16.3% were at or above 95th percentile. Prevalence estimates vary by age and by racial/ethnic group. Analysis of the trends in high BMI for age showed no statistically significant trend over the four time periods (1999-2000, 2001-2002, 2003-2004, and 2005-2006) for either boys or girls (Cynthia l.Ogden et al, 2008). 11-March 2005. Public Release Date: Consensus on Childhood Obesity, Recommends classification as disease A common statement on childhood obesity was published to day in the journal of Chemical Endocrinology and Metabolism (one of the journals of Endocrine Society). The consensus statement reflects the conclusions from an international summit held in Israel last year (2004) and includes a controversial recommendation to classify obesity as a disease. This decision was based upon the available research on the diagnosis, prevalence, causes (including endocrine disorders), risks, prevention and treatment of childhood obesity. Pediatric obesity is now recognized as a major health problem all over the world. Researcher have found that children who are obese have a higher risks adult obesity, which is strongly associated with many serious medical complications that impair quality of life and lead to additional increased risks. The statement also noted the prevalence of overweight/obesity among children 6-11 years (in the US) doubled between the years 1980-2000. By classifying obesity as legiti mate disease, public funding and in user sreimbursement for obesity treatment becomes legalized (consensus on childhood obesity, 2005). Serious health risks will likely to begin to appear in obese children and adolescents as they grow older. These may include diabetes mellitus, metabolic syndrome, hyperandrogenism, heart disease, hypertension, respiratory factors, and sleep disorders. Obese children are also at greater risk of anxiety and depression. It also recommended a number of measures that can be implemented by parents; schools, health providers and government and regulatory agencies to help to prevent the onset of childhood obesity Endocrine Regulation of Energy Metabolism Adipocytokines and Obesity The mechanism underlying obesity was further explained by the discovery of adipocytokines, the role of peripheral thyroid hormones (T4, T3), thyroid stimulating hormone and insulin the regulation of energy metabolism. The levels of some of the adipocytokines were shown to be related to visceral obesity, type 2 diabetes mellitus and coronary artery disease. Plasma levels of all the adipocytokines increase with the obesity except adiponectin (Yuji Matsuzawa et al, 2003). Recent studies point out to the adipose tissue as a highly active organ secreting a range of hormones, Leptin, Adiponectin, and Resistin. They are considered to take part in the regulation of energy metabolism. Leptin, Adiponectin and Resistin are produced by the adipose tissue. Leptin and Adiponectin are insulin sensitizing while Resistin increase the insulin resistance. Leptin The notion that genetic abnormalities contribute to obesity gained important support with the identification of the Ob gene and its protein product in 1994 (Zhangy et al, 1996). The Ob gene termed Leptin from the Greek Leptos, meaning thin, is produced in adipose tissue and is thought to act as an afferent satiety signal in a feed back loop that affects the appetite and satiety centre in the hypothalamus of brain. The ultimate effect of this loop is to regulate body-fat mass. In human, as noted by Considine et al, 1996; caloric restriction reduces leptin concentrations and Ob mRNA levels in adipose tissue, and refeeding increases these levels. One fundamental mechanism of obesity is insensitivity to the action of Leptin, presumably in the hypothalamus. The Leptins primary physiological function is to provide a signal to suppress body fat by decreasing food intake or increasing energy expenditure. Serum leptin concentrations change more during weight loss than during weight gain (Rose nbaum M et al, 1997). Adiponectin Adiponectin or Adipo Q, an adipocyte specific secreted protein with roles in glucose and lipid homeostasis (Insulin stimulates the secretion of adiponectin). Circulating adiponectin concentrations are high 500-30,000 Â µg/l (5-30mg/ml) accounting for 0.01% of total plasma proteins (Berget et al, 2002). Adiponectin was discovered in the mid 1990s by four different groups of researchers (Hu E et al, 1996). Adiponectin has various biological functions including insulin sensitizing (Hotta K et al, 2000), antiatherogenic (Yamauchi T et al, 2003), anti-inflammatory (Ouchi N et al, 2003), antiangiogenic and anti tumor functions (Brakenhielm E et al, 2004). Adiponectin acts through Adiponectin receptors, Adipo R1 and Adipo R2. Adipo R1 is mostly expressed in skeletal muscles and Adipo R2 is abundant in liver. These receptors are also expressed by the pancreatic ß cells (Kharroubi et al, 2003), macrophages and atherosclerotic lesions (Chinetti et al, 2004) as well as in brain (Yamauchi et al, 2003). Circulating Adiponectin levels display diurnal variation with a nocturnal decline and maximum levels in the late morning (Gavrila et al, 2003). Adiponectin is also found in breast milk, which in turn is implicated in childhood obesity prevention (Savino et al, 2008). Among the various adipocytokines, adiponectin, which is an abundant circulating protein (247 amino acids) synthesized purely in adipose tissue, appears to play a very important role in carbohydrates, lipid metabolism and vascular biology. Adiponectin appears to be a major modulator of insulin action and its levels are reduced in type 2 diabetes mellitus, which could contribute to peripheral insulin resistance in this condition. It has significant insulin sensitizing as well as anti inflammatory properties that include suppression of macrophage phagocytosis and TNF-a secretion and blockage of monocytes adhesion to endothelial cells in vitro. Although further investigations are required, Adiponectin administration, as well as regulation of the pathway controlling its production, represents a promising target for managing obesity, hyperlipidemia, insulin resistance, type 2 diabetes mellitus, and vascular inflammation (Manju Chandran et al, 2003). Resistin Human resistin is 108 amino acids prepeptide and is cleaved before its secretion from the Adipose tissue. Resistin circulates in the blood as dimeric protein consisting of 92 amino acids polypeptides that are linked by a disulfide bridge. Holcomb et al, 2000 first described the gene family and its tissue specific distribution. Originally described as lung specific, is also produced by the adipose tissue and peripheral blood monocytes. It is also present in dividing epithelia of the intestine. Resistin increase blood glucose and insulin concentration in the mice and impairs hypoglycemic response to insulin infusion. In addition, anti resistin antibodies decrease blood glucose and insulin sensitivity in obese mice (Ukkalo O, 2002). The physiological role of resistin in human remains controversial. There more resistin protein in obese than lean individuals, with a significant positive correlation between resistin and BMI. BMI is a significant predictor of insulin resistance, but resisti n adjusted for BMI is not. These data demonstrate that resistin protein is present in human adipose tissue and blood and that there is significantly more resistin in serum of obese individuals. Serum resistin is not a significant predictor of insulin resistance in human (Youn et al, 2003, Rear R and Donnelly R, 2004). Tumor Necrosis Factor-a It will be unreasonable not to mention the Tumor Necrosis Factor a and its role in vascular inflammation related to atherosclerosis especially in obesity. It is a cytokine involved in systemic inflammation and is a member of a group of cytokines that stimulate the acute phase reaction. The primary role of TNF is in the regulation of immune cells. TNF is able to induce apoptotic cell death, to induce inflammation and to inhibit tumourgenesis and viral replication. Dysregulation and, in particular, over production of TNF have been implicated in a variety of human diseases, as well as cancer (Locksley et al, 2001). The theory of antitumoural response of the immune system in vivo was recognized by the physician William B in 1968. Dr A Granger reported a cytotoxic factor produced by lymphocytes and named it Lymphotoxin (Kalli WB and Granger GA, 1968). Dr L Loyal old, in 1975 reported another cytotoxic factor produced by macrophages and named it Tumor Necrosis Factor (TNF) (Cars well et al, 1975). Interleukin – 6 (IL-6) Chronic inflammation is linked to endothelial dysfunction, atherosclerosis, and insulin resistance (Fernandez-Real JM and Ricart W, 2003 and Fernandez-Real JM, Ricart W, 2005). Plasma concentrations of proinflammatory cytokines, such as interleukin (IL) 18, IL-6, and tumor necrosis factor (TNF)-a, and of several other inflammatory markers are increased in patients with ischemic heart disease (Fernandez-Real JM and Ricart W, 2003, Ridker PM et al, 2002, Engstrom G et al, 2004, Ridker PM et al, 1997, Pradham AD et al, 2002). Circulating cytokines also are elevated in type 2 diabetes, obesity, and insulin resistance syndrome and play a central role in the pathogenesis of these disorders (Fernandez-Real JM and Ricart W, 2003). IL-6 is a mediator of the inflammatory response, and it is linked to dyslipidemia, type 2 diabetes, and risk of myocardial infarction (Fernandez-Real JM and Ricart W, 2003, Ridker PM et al, 2000, Esteve E et al, 2005, Yudkin JS et al, 2000). IL-6 is secreted by a variety of different cell types, including lymphoid and endothelial cells, fibroblasts, skeletal muscle, and adipose tissue. Circulating IL-6 levels correlate with obesity and insulin resistance and may predict the development of type 2 diabetes mellitus (Yudkin JS et al, 2000, Pradhan AD et al, 2001, Akira S et al, 1993, Mohamed-Ali V et al, 1997). Endothelial dysfunction is regarded as a causal factor in the development of atherosclerosis (Hansson GK, 2005). It is one of the earliest abnormalities that can be detected in people at risk for cardiovascular events, and it is linked to insulin resistance and type 2 diabetes (Steinberg HO and Baron AD, 2002, Natali A et al, 2006). Cytokines have an important role in the endothelial injury induced by inflammation. The vascular endothelium is involved in the inflammatory response to atherosclerosis (Hansson GK, 2005, Steinberg HO and Baron AD, 2002, Natali A et al, 2006, Widlansky ME et al, 2003), and changes in endothelium function could underlie the association between cardiovascular disease and inflammation. Obesity Related Insulin Resistance: Definition and Pathogenesis Insulin resistance is a state in which a given amount of insulin produces a subnormal biological response (Kahn CR, 1978). In particular, it is characterized by a decrease in the ability of insulin to stimulate the use of glucose by muscles and adipose tissue and to suppress hepatic glucose production and output (Matthaei et al, 2000). Furthermore, it accounts a resistance to insulin action on protein and lipid metabolism and on vascular endothelial function and genes expression (Bajaj M and Defronzo RA, 2003). Several defects in the insulin signaling cascade have been implicated in the pathogenesis of insulin resistance, Insulin resistance is believed to have both genetic and environmental factors implicated in its etiology (Matthaei et al, 2000 and Liu et al, 2004). The genetic component seems to be polygenic in nature, and several genes have been suggested as potential candidates (Matthaei et al, 2000). However, several other factors can influence insulin sensitivity, such as obesity, ethnicity, gender, perinatal factors, puberty, sedentary lifestyle and diet (Liu et al, 2004). The Role of Fatty Acids and Adipocytokines Obesity represents the major risk factor for the development of insulin resistance in children and adolescents (Caprio S, 2002), and insulin resistance/hyperinsulinemia is believed to be an important link between obesity and the associated metabolic abnormalities and cardiovascular risk (Weiss R and Kaufman FR, 2008). Approximately, 55% of the variance in insulin sensitivity in children can be explained by total adiposity, after adjusting for other confounders, such as age, gender, ethnicity and pubertal stage (Caprio S, 2002). Obese children have hyperinsulinemia and peripheral insulin resistance with an ~40% lower insulin-stimulated glucose metabolism than non-obese children (Caprio S et al, 19996). Adipose tissue seems to play a key role in the pathogenesis of insulin resistance through several released metabolites, hormones and adipocytokines that can affect different steps in insulin action (Matsuzawa Y, 2005) (Fig. 1). Adipocytes produce non-esterified fatty acids, which inhibit carbohydrate metabolism via substrate competition and impaired intracellular insulin signaling (Matsuzawa Y, 2005, Griffin ME et al 1999 and Randle PJ, 1998). In children, as in adults, several adipocytokines have been related to adiposity indexes as well as to insulin resistance. Adiponectin is one of the most common cytokines produced by adipose tissue, with an important insulin sensitizing effect associated with anti-atherogenetic properties (Despres JP, 2006 and Gil-Campos M et al, 2004). Whereas obesity is generally associated with an increased release of metabolites by adipose tissue, levels of Adiponectin are inversely related to adiposity (Matsuzawa Y, 2005). Therefore, reduced levels of this adipocytokine have been implicated in the pathogenesis of insulin resistance and metabolic syndrome (Matsuzawa Y, 2005). Decreased levels of Adiponectin have been detected across tertiles of insulin resistance in children and adolescents (Weiss R et al, 2004), where it is a good predictor of insulin sensitivity, independently of adiposity (Lee S et al, 2006). Adipose tissue also produces tumour necrosis factor-a, an inflammatory factor, which can alter insulin action at different levels in the intracellular pathway (Matsuzawa Y, 2005). Interleukin-6 (IL-6) is ano ther inflammatory cytokine released by adipose tissue and its levels are increased in obesity (Matsuzawa Y, 2005). IL-6 stimulates the hepatic production of C-reactive protein and this can explain the state of inflammation associated with obesity, and could mediate, at least partially, obesity-related insulin resistance (Matsuzawa Y, 2005). Data based mainly on animal studies also suggest that increased levels of resistin, another molecule produced by adipose tissue, could impair insulin sensitivity (Matsuzawa Y, 2005). The close relationship between Leptin levels and insulin resistance in children has also been suggested by the data (Chu NF et al, 2000). Serum levels of retinol-binding protein 4 (RBP4) correlate with insulin resistance in subjects with obesity as well as in those with impaired glucose tolerance (IGT) or type 2 diabetes mellitus, therefore suggesting that it could be useful in assessing insulin resistance and the associated risk for complications (Graham TE et al, 2006). Serum RBP4 is independently related to obesity as well as to components of the metabolic syndrome in normal weight and overweight children (Aeberli I et al, 2007). Diet composition in obese children might be an additional factor promoting and/or worsening insulin resistance. Animal and human studies suggest that a high energy intake as well as a diet rich in fat and carbohydrates and low in fiber could increase the risk of developing insulin resistance (Canete R et al, 2007). The Role of Fat Distribution An altered partitioning of fat between subcutaneous and visceral or ectopic sites has been associated with insulin resistance (Weiss R and Kaufman FR, 2008). Visceral fat has a better correlation with insulin sensitivity than subcutaneous or total body fat (Caprio S et al, 1995), in both obese adults and children. Visceral fat has higher lipolytic activity compared with subcutaneous fat, therefore a greater amount of free fatty acids and glycerol gain entry or carried out to the liver (Matthaei et al, 2000). Visceral fat in girls is directly correlated to the glucose-stimulated insulin levels and inversely correlated with insulin sensitivity and the rate of glucose uptake. No correlation was found between abdominal subcutaneous fat (Caprio S et al, 1995). Ectopic deposition of fat in the liver or muscle can also be responsible for insulin resistance in obese subjects, as the accumulation of fat in these sites impairs insulin signaling, with a reduced glucose uptake in the muscle and a decreased insulin-mediated suppression of hepatic glucose production (Weiss R and Kaufman FR, 2008). Intramyocellular lipid (IMCL) accumulation has been shown as a factor related to decreased insulin sensitivity (Jacob S et al, 1999 and Thamer C et al, 2003). Obese insulin sensitive children and adolescents present lower levels of visceral fat and IMCL when compared with obese insulin resistant children (Weiss R et al, 2005). Accumulation of fat in the liver has also been associated with insulin resistance, independently of adiposity (Kelley DE et al, 2003). It has also been suggested that deposits of fat around blood vessels can produce several cytokines and therefore contribute to the development of insulin resistance, through a so-called vasocrine effect (Yudkin JS et al, 2005). Insulin Resistance and Associated Complications Insulin resistance in obesity is strictly related to the development of hypertension (Marcovecchio ML et al, 2006 and Cruz ML et al, 2002), dyslipidemia (Howard BV and Howard WJ, 1994), impaired glucose tolerance (IGT) (Sinha R et al, 2002), hepatic steatosis (DAdamo E et al, 2008), as well as to the combination of these factors, also known as metabolic syndrome (Eckel RH et al, 2005). Furthermore, insulin resistance is associated with systemic inflammation, endothelial dysfunction, early atherosclerosis and disordered fibrinolysis (Dan Dona P et al, 2002). It is alarming that these metabolic and cardiovascular complications are already found in obese children and adolescents (Dietz WH, 2004). The presence of these alterations in prepubertal children is then particularly worrying, as insulin resistance and related complications might be further exacerbated by the influence of puberty, due to the physiological decrease in insulin sensitivity associated with normal pubertal development (Caprio S et al, 1989). Insulin resistance in childhood can track in adult life (Sinaiko AR et al, 2006). Insulin resistance at the age of 13 years predicts insulin resistance at age 19 years, independently of BMI, and is also associated with cardiovascular risk in adulthood (Sinaiko AR et al, 2006). The fundamental role of insulin resistance in human disease was already recognized in 1988 by Reaven (Reaven GM, 1988) who emphasized its role in the development of a grouping of metabolic abnormalities, which he defined as syndrome X. Later studies strengthened the concept of insulin resistance as a key component of the metabolic syndrome, a cluster of impaired glucose tolerance (IGT), dyslipidemia, hypertension, hyperinsulinemia, associated with an increased risk of type 2 diabetes mellitus and cardiovascular disease (Eckel RH et al, 2005). Insulin resistance represents a serious and common complication of obesity during childhood and adolescence. A timely diagnosis and an appropriated prevention and treatment of obesity and insulin resistance are required in order to reduce the Biochemical and Hormonal Changes in Childhood Obesity Biochemical and Hormonal Changes in Childhood Obesity The prevalence of chronic or non communicable disease is escalating much more rapidly in developing countries than in industrialized countries. According to World Health Organization (WHO) estimates, by the 2020, non communicable diseases will account for approximately three quarter of all deaths in the developing countries (WHO. Global Strategy for non communicable disease prevention, 1997). In this regard, a potential emerging public health issue for the developing countries may be increasing incidence of childhood obesity with associated complications, which in turn is likely to create public health burden for poorer nations in the near future (Freedman et al, 2001). Lower to middle income nations face the double burden of having both malnourished and over nourished population, with most overweight and obese children being concentrated in urban areas. Rapid urbanization is associated with unhealthy lifestyle or New World Syndrome. In addition, in such communities, childhood obesit y is still considered a sign of healthiness and high social class. There is no universal consensus on a cut off points for defining overweight and obesity in children and adolescents, usually, for clinical practice and epidemiological studies, child overweight and obesity are assessed by means of indicators based on weight and height measurements, such as weight for height measures or body mass index (weight (kg)/height (m2))(WHO. Report series no.847, 1995).The US Centers for Disease Control and Prevention (CDC) defines obese as being at or above 95th percentile of body mass index for age (Kuczmarsk RJ et al, 2000). History of obesity is both interesting and gives details of its progression. Obesity is an age-old health condition. Through out the history of obesity, its reputation varies from appreciation and opposite among cultures and in time. Ancient Egyptians are said to consider obesity as disease. Perhaps the most famous and earliest evidence of obesity is the Venus figurines, Statuettes of an obese female torso that probably had a major role in rituals. Ancient China has also been aware of obesity and dangers that come with it. They always were a believer of prevention as a key to longevity. The Aztecs believed that obesity was supernatural, an affliction of the gods. Hippocrates, the father of medicines was aware of sudden deaths being more common among obese men than lean ones as stated in his writings. In certain cultures and areas where food is scarce and poverty is prevalent, is viewed as symbol of wealth and social status. To date, an African tribe purposely plumps up a bride to pre pare her for child bearing. Before a wedding can be set, a slim bride is pampered to gain weight until she reaches the suitable weight. Through out the history of obesity, the publics view and status of obesity changed considerably in the 1900s. It was regarded as unfashionable by the French designer, Paul Poi ret who designed skin-revealing clothes for women. About the same time, the incidence of obesity began to increase and become wide spread. Later in 1940s, Metropolitan life insurance published a chart of ideal weight for various heights. They also advocated that weight gain parallel to age is unhealthy. The government and medical society become more hands-on with obesity by imitating campaign against it. This was preceded by a study of risk factors for cardiovascular disease revealing obesity in the high ranks. Since then various diets and exercise programs have emerged. In 1996, the Body Mass Index (BMI) was published. This statistical calculation and index determined that a person is obese or not. At this time ,obesity incidence have soared, led by children and adolescent obesity, tripling in just a few short years, greater than any number in the history of obesity. This increase in the incidence of childhood obesity with associated cardiovascular risks, type 2 diabetes mellitus and stroke is supported by a considerable body of evidence. The prevalence of overweight and obesity in childhood and adolescents has been increasing throughout much of the developed and developing world for the past few decades. It has become increasingly clear that excess adiposity in childhood predisposes individual not only to increased risk of adiposity and its sequaele as adults (Freedman et al, 2001), but also to increased risk of multiple chronic diseases in childhood and adolescence (Rosen bloom et al, 1999). Though mechanism not clearly delineated, excess body weight and adiposity is associated with type 2 diabetes mellitus and its complications, cardiovascular disease risk factors, non alcoholic fatty liver disease and asthma in youth. Childhood Obesity 1930 1972 Risk factors for coronary heart disease (CHD) such as hypertension, dyslipidemia, impaired glucose tolerance and vascular abnormalities were present in overweight children. CHD is likely to be increased in overweight children when they become adults as a result of established risk factors. This study investigated whether excess weight in childhood was associated with CHD in adulthood among a very large cohort of persons born in Denmark in 1930 through 1972. They underwent mandatory annual health examination at public or private schools in Copenhagen. Each child was examined by school doctors or nurses and was assigned a health card bearing childs name, date of birth, birth weight reported by parents. 10,235 men and 4,318 women, for whom childhood BMI data were available, received a diagnosis of CHD or died of CHD as adults. The risk of CHD event, a non fatal event, and a fatal event among adults was positively associated with BMI at 7-13 years of age for boys and 10 to 13 years of ag e as girls. The associations were linear for each age and risk increased across the entire BMI distribution. Childhood Obesity 1930 1972 Risk factors for coronary heart disease (CHD) such as hypertension, dyslipidemia, impaired glucose tolerance and vascular abnormalities were present in overweight children. CHD is likely to be increased in overweight children when they become adults as a result of established risk factors. This study investigated whether excess weight in childhood was associated with CHD in adulthood among a very large cohort of persons born in Denmark in 1930 through 1972. They underwent mandatory annual health examination at public or private schools in Copenhagen. Each child was examined by school doctors or nurses and was assigned a health card bearing childs name, date of birth, birth weight reported by parents. 10,235 men and 4,318 women, for whom childhood BMI data were available, received a diagnosis of CHD or died of CHD as adults. The risk of CHD event, a non fatal event, and a fatal event among adults was positively associated with BMI at 7-13 years of age for boys and 10 to 13 years of ag e as girls. The associations were linear for each age and risk increased across the entire BMI distribution. Childhood Obesity and Economic Growth 1930-1983 Childhood obesity was related to the economic growth during the 50 years of economic growth in the industrialized world especially in Denmark. Annual measurements of height and weight were available for all children born between 1930 and 1983 attending primary schools in Copenhagen Municipality. 165,389 boys and 163,609 girls from the age of 7 through 13 years were included in this study. After computerization SBMI (kg/m2) were calculated and the prevalence of overweight and obesity according to international age and gender–specific criteria. Economics growth was indicated by the Gross National Product and the overall consumption per capita, adjusted for inflation. Prevalence of overweight and obesity among Danish children rose in phases, which were not paralleled by trends in economic growth. The microeconomics growth indicators seem inappropriate as proxies for the environmental exposures that have elicited the obesity epidemic. Childhood obesity and television viewing Children spend a substantial portion of their lives watching television (TV). Investigators have hypothesized that TV viewing causes obesity by one or more than three mechanisms: Displacement of physical activity. Increased calorie consumption while watching or caused by the effects of advertising. Reduced resting metabolism. The relationship between TV viewing and obesity has been examined in a relatively large number of cross sectional epidemiological but few longitudinal studies. Many of them have found relatively weak, positive association or mixed results. Many experimental studies have found that reducing TV viewing may help to reduce the risk of obesity. One school based experimental study was designed specifically to test directly the casual relationship between TV viewing behaviors and body fatness. The results of this randomized controlled trial provide evidence that TV viewing is a cause of increased body fatness and that reducing the TV viewing is a promising strategy for preventing childhood obesity (Robinson; 2001). The objective of another study (Utter J et al, 2006), was to explore how time spent watching television (TV) is associated with the dietary behavior of New Zealand children and young adolescents. Total number of participants was 3275 children aged 5-17 years. The findings suggest that longer duration of TV watching (thus more frequent exposure to advertising) influences the frequency of consumption of soft drinks, some sweets and snacks and some fast foods among children and young adolescents. Efforts to control the time spent watching TV may result in better dietary habits and weight control for children and adolescents. Childhood Obesity US- A decade of progress, 1990-1999 Current data suggest that 20% of US children are overweight .An analysis of the secular trends suggest that 20% of US children are overweight, and a clear up ward trend in body weight in children of 0.2 Kg between 1973 and 1994. In addition, childhood obesity is more prevalent among minority sub groups such as African Americans. Obesity that begins early in life persists into adulthood and increases the risk of obesity related conditions later in life. There has been tremendous increase in the number of studies examining the etiology and health effects of obesity in children (Goran MI, 1990-1999).1980 (boys 0.2% girls 0.5%) and 1997 (boys 1.2%, girls 2.0%). Ten years trends of childhood obesity in Israel 1990-2000 Cross sectional data was collected from 13284 second and fifth class school; children between 1990-2000. Prevalence of obesity was determined using Israeli and US reference values. BMI values at 95th percentile increased overtime in all ages and sex categories. Between 1990 and 2000, 95th centile values were increased by 12.7%and 11.8% among second grade boys and girls respectively. Among fifth graders in 2000, 10.7% of boys and 11.1% of girls exceeded the 1990 BMI reference values. The proportion of obese children increased over time using both Israeli and US reference values (Huerta Michael et al, 2008). Netherlands. Overweight, Obesity in 2003: V.1980-97. Data on 90,071 children, aged 4-16 years were routinely collected by 11 Community Heath Services during 2002-2004. International cut -off points for BMI to determine overweight and obesity. On average, 14.5% of boys and 17.5% of the girls were overweight (including obesity), which is a substantial increase since 1980 (boys 3.9% and girls 6.9%) and 1997 (boys 9.7% and girls 13%). Similarly 2.6% of the boys and 3.3% 0f the girls aged 4-16 years were obese, which is much higher than in 1980 (boys 0.2% and girls 0.5%) and 1997 (boys 1.2% and girls 2.0%), (KatjaVan Den Husk, 2007). Obesity trends in US. 2003-2006 Height and weight measurements were obtained from 8164 children and adolescents as apart of the 2003-2004 and 2005-2006 National Health and Nutrition Examination Survey (NHANES). Because no statistically significant differences in the prevalence of high BMI for age were found between the estimates for 2003-2004 and 2005-2006, data for four years were combined to provide more stable estimates for the most recent time period. Over all, in 2003-2006, 11.3% of children and adolescents aged 2 through years were at or above 97th percentile of the 2000 BMI- for- age growth charts, 16.3% were at or above 95th percentile. Prevalence estimates vary by age and by racial/ethnic group. Analysis of the trends in high BMI for age showed no statistically significant trend over the four time periods (1999-2000, 2001-2002, 2003-2004, and 2005-2006) for either boys or girls (Cynthia l.Ogden et al, 2008). 11-March 2005. Public Release Date: Consensus on Childhood Obesity, Recommends classification as disease A common statement on childhood obesity was published to day in the journal of Chemical Endocrinology and Metabolism (one of the journals of Endocrine Society). The consensus statement reflects the conclusions from an international summit held in Israel last year (2004) and includes a controversial recommendation to classify obesity as a disease. This decision was based upon the available research on the diagnosis, prevalence, causes (including endocrine disorders), risks, prevention and treatment of childhood obesity. Pediatric obesity is now recognized as a major health problem all over the world. Researcher have found that children who are obese have a higher risks adult obesity, which is strongly associated with many serious medical complications that impair quality of life and lead to additional increased risks. The statement also noted the prevalence of overweight/obesity among children 6-11 years (in the US) doubled between the years 1980-2000. By classifying obesity as legiti mate disease, public funding and in user sreimbursement for obesity treatment becomes legalized (consensus on childhood obesity, 2005). Serious health risks will likely to begin to appear in obese children and adolescents as they grow older. These may include diabetes mellitus, metabolic syndrome, hyperandrogenism, heart disease, hypertension, respiratory factors, and sleep disorders. Obese children are also at greater risk of anxiety and depression. It also recommended a number of measures that can be implemented by parents; schools, health providers and government and regulatory agencies to help to prevent the onset of childhood obesity Endocrine Regulation of Energy Metabolism Adipocytokines and Obesity The mechanism underlying obesity was further explained by the discovery of adipocytokines, the role of peripheral thyroid hormones (T4, T3), thyroid stimulating hormone and insulin the regulation of energy metabolism. The levels of some of the adipocytokines were shown to be related to visceral obesity, type 2 diabetes mellitus and coronary artery disease. Plasma levels of all the adipocytokines increase with the obesity except adiponectin (Yuji Matsuzawa et al, 2003). Recent studies point out to the adipose tissue as a highly active organ secreting a range of hormones, Leptin, Adiponectin, and Resistin. They are considered to take part in the regulation of energy metabolism. Leptin, Adiponectin and Resistin are produced by the adipose tissue. Leptin and Adiponectin are insulin sensitizing while Resistin increase the insulin resistance. Leptin The notion that genetic abnormalities contribute to obesity gained important support with the identification of the Ob gene and its protein product in 1994 (Zhangy et al, 1996). The Ob gene termed Leptin from the Greek Leptos, meaning thin, is produced in adipose tissue and is thought to act as an afferent satiety signal in a feed back loop that affects the appetite and satiety centre in the hypothalamus of brain. The ultimate effect of this loop is to regulate body-fat mass. In human, as noted by Considine et al, 1996; caloric restriction reduces leptin concentrations and Ob mRNA levels in adipose tissue, and refeeding increases these levels. One fundamental mechanism of obesity is insensitivity to the action of Leptin, presumably in the hypothalamus. The Leptins primary physiological function is to provide a signal to suppress body fat by decreasing food intake or increasing energy expenditure. Serum leptin concentrations change more during weight loss than during weight gain (Rose nbaum M et al, 1997). Adiponectin Adiponectin or Adipo Q, an adipocyte specific secreted protein with roles in glucose and lipid homeostasis (Insulin stimulates the secretion of adiponectin). Circulating adiponectin concentrations are high 500-30,000 Â µg/l (5-30mg/ml) accounting for 0.01% of total plasma proteins (Berget et al, 2002). Adiponectin was discovered in the mid 1990s by four different groups of researchers (Hu E et al, 1996). Adiponectin has various biological functions including insulin sensitizing (Hotta K et al, 2000), antiatherogenic (Yamauchi T et al, 2003), anti-inflammatory (Ouchi N et al, 2003), antiangiogenic and anti tumor functions (Brakenhielm E et al, 2004). Adiponectin acts through Adiponectin receptors, Adipo R1 and Adipo R2. Adipo R1 is mostly expressed in skeletal muscles and Adipo R2 is abundant in liver. These receptors are also expressed by the pancreatic ß cells (Kharroubi et al, 2003), macrophages and atherosclerotic lesions (Chinetti et al, 2004) as well as in brain (Yamauchi et al, 2003). Circulating Adiponectin levels display diurnal variation with a nocturnal decline and maximum levels in the late morning (Gavrila et al, 2003). Adiponectin is also found in breast milk, which in turn is implicated in childhood obesity prevention (Savino et al, 2008). Among the various adipocytokines, adiponectin, which is an abundant circulating protein (247 amino acids) synthesized purely in adipose tissue, appears to play a very important role in carbohydrates, lipid metabolism and vascular biology. Adiponectin appears to be a major modulator of insulin action and its levels are reduced in type 2 diabetes mellitus, which could contribute to peripheral insulin resistance in this condition. It has significant insulin sensitizing as well as anti inflammatory properties that include suppression of macrophage phagocytosis and TNF-a secretion and blockage of monocytes adhesion to endothelial cells in vitro. Although further investigations are required, Adiponectin administration, as well as regulation of the pathway controlling its production, represents a promising target for managing obesity, hyperlipidemia, insulin resistance, type 2 diabetes mellitus, and vascular inflammation (Manju Chandran et al, 2003). Resistin Human resistin is 108 amino acids prepeptide and is cleaved before its secretion from the Adipose tissue. Resistin circulates in the blood as dimeric protein consisting of 92 amino acids polypeptides that are linked by a disulfide bridge. Holcomb et al, 2000 first described the gene family and its tissue specific distribution. Originally described as lung specific, is also produced by the adipose tissue and peripheral blood monocytes. It is also present in dividing epithelia of the intestine. Resistin increase blood glucose and insulin concentration in the mice and impairs hypoglycemic response to insulin infusion. In addition, anti resistin antibodies decrease blood glucose and insulin sensitivity in obese mice (Ukkalo O, 2002). The physiological role of resistin in human remains controversial. There more resistin protein in obese than lean individuals, with a significant positive correlation between resistin and BMI. BMI is a significant predictor of insulin resistance, but resisti n adjusted for BMI is not. These data demonstrate that resistin protein is present in human adipose tissue and blood and that there is significantly more resistin in serum of obese individuals. Serum resistin is not a significant predictor of insulin resistance in human (Youn et al, 2003, Rear R and Donnelly R, 2004). Tumor Necrosis Factor-a It will be unreasonable not to mention the Tumor Necrosis Factor a and its role in vascular inflammation related to atherosclerosis especially in obesity. It is a cytokine involved in systemic inflammation and is a member of a group of cytokines that stimulate the acute phase reaction. The primary role of TNF is in the regulation of immune cells. TNF is able to induce apoptotic cell death, to induce inflammation and to inhibit tumourgenesis and viral replication. Dysregulation and, in particular, over production of TNF have been implicated in a variety of human diseases, as well as cancer (Locksley et al, 2001). The theory of antitumoural response of the immune system in vivo was recognized by the physician William B in 1968. Dr A Granger reported a cytotoxic factor produced by lymphocytes and named it Lymphotoxin (Kalli WB and Granger GA, 1968). Dr L Loyal old, in 1975 reported another cytotoxic factor produced by macrophages and named it Tumor Necrosis Factor (TNF) (Cars well et al, 1975). Interleukin – 6 (IL-6) Chronic inflammation is linked to endothelial dysfunction, atherosclerosis, and insulin resistance (Fernandez-Real JM and Ricart W, 2003 and Fernandez-Real JM, Ricart W, 2005). Plasma concentrations of proinflammatory cytokines, such as interleukin (IL) 18, IL-6, and tumor necrosis factor (TNF)-a, and of several other inflammatory markers are increased in patients with ischemic heart disease (Fernandez-Real JM and Ricart W, 2003, Ridker PM et al, 2002, Engstrom G et al, 2004, Ridker PM et al, 1997, Pradham AD et al, 2002). Circulating cytokines also are elevated in type 2 diabetes, obesity, and insulin resistance syndrome and play a central role in the pathogenesis of these disorders (Fernandez-Real JM and Ricart W, 2003). IL-6 is a mediator of the inflammatory response, and it is linked to dyslipidemia, type 2 diabetes, and risk of myocardial infarction (Fernandez-Real JM and Ricart W, 2003, Ridker PM et al, 2000, Esteve E et al, 2005, Yudkin JS et al, 2000). IL-6 is secreted by a variety of different cell types, including lymphoid and endothelial cells, fibroblasts, skeletal muscle, and adipose tissue. Circulating IL-6 levels correlate with obesity and insulin resistance and may predict the development of type 2 diabetes mellitus (Yudkin JS et al, 2000, Pradhan AD et al, 2001, Akira S et al, 1993, Mohamed-Ali V et al, 1997). Endothelial dysfunction is regarded as a causal factor in the development of atherosclerosis (Hansson GK, 2005). It is one of the earliest abnormalities that can be detected in people at risk for cardiovascular events, and it is linked to insulin resistance and type 2 diabetes (Steinberg HO and Baron AD, 2002, Natali A et al, 2006). Cytokines have an important role in the endothelial injury induced by inflammation. The vascular endothelium is involved in the inflammatory response to atherosclerosis (Hansson GK, 2005, Steinberg HO and Baron AD, 2002, Natali A et al, 2006, Widlansky ME et al, 2003), and changes in endothelium function could underlie the association between cardiovascular disease and inflammation. Obesity Related Insulin Resistance: Definition and Pathogenesis Insulin resistance is a state in which a given amount of insulin produces a subnormal biological response (Kahn CR, 1978). In particular, it is characterized by a decrease in the ability of insulin to stimulate the use of glucose by muscles and adipose tissue and to suppress hepatic glucose production and output (Matthaei et al, 2000). Furthermore, it accounts a resistance to insulin action on protein and lipid metabolism and on vascular endothelial function and genes expression (Bajaj M and Defronzo RA, 2003). Several defects in the insulin signaling cascade have been implicated in the pathogenesis of insulin resistance, Insulin resistance is believed to have both genetic and environmental factors implicated in its etiology (Matthaei et al, 2000 and Liu et al, 2004). The genetic component seems to be polygenic in nature, and several genes have been suggested as potential candidates (Matthaei et al, 2000). However, several other factors can influence insulin sensitivity, such as obesity, ethnicity, gender, perinatal factors, puberty, sedentary lifestyle and diet (Liu et al, 2004). The Role of Fatty Acids and Adipocytokines Obesity represents the major risk factor for the development of insulin resistance in children and adolescents (Caprio S, 2002), and insulin resistance/hyperinsulinemia is believed to be an important link between obesity and the associated metabolic abnormalities and cardiovascular risk (Weiss R and Kaufman FR, 2008). Approximately, 55% of the variance in insulin sensitivity in children can be explained by total adiposity, after adjusting for other confounders, such as age, gender, ethnicity and pubertal stage (Caprio S, 2002). Obese children have hyperinsulinemia and peripheral insulin resistance with an ~40% lower insulin-stimulated glucose metabolism than non-obese children (Caprio S et al, 19996). Adipose tissue seems to play a key role in the pathogenesis of insulin resistance through several released metabolites, hormones and adipocytokines that can affect different steps in insulin action (Matsuzawa Y, 2005) (Fig. 1). Adipocytes produce non-esterified fatty acids, which inhibit carbohydrate metabolism via substrate competition and impaired intracellular insulin signaling (Matsuzawa Y, 2005, Griffin ME et al 1999 and Randle PJ, 1998). In children, as in adults, several adipocytokines have been related to adiposity indexes as well as to insulin resistance. Adiponectin is one of the most common cytokines produced by adipose tissue, with an important insulin sensitizing effect associated with anti-atherogenetic properties (Despres JP, 2006 and Gil-Campos M et al, 2004). Whereas obesity is generally associated with an increased release of metabolites by adipose tissue, levels of Adiponectin are inversely related to adiposity (Matsuzawa Y, 2005). Therefore, reduced levels of this adipocytokine have been implicated in the pathogenesis of insulin resistance and metabolic syndrome (Matsuzawa Y, 2005). Decreased levels of Adiponectin have been detected across tertiles of insulin resistance in children and adolescents (Weiss R et al, 2004), where it is a good predictor of insulin sensitivity, independently of adiposity (Lee S et al, 2006). Adipose tissue also produces tumour necrosis factor-a, an inflammatory factor, which can alter insulin action at different levels in the intracellular pathway (Matsuzawa Y, 2005). Interleukin-6 (IL-6) is ano ther inflammatory cytokine released by adipose tissue and its levels are increased in obesity (Matsuzawa Y, 2005). IL-6 stimulates the hepatic production of C-reactive protein and this can explain the state of inflammation associated with obesity, and could mediate, at least partially, obesity-related insulin resistance (Matsuzawa Y, 2005). Data based mainly on animal studies also suggest that increased levels of resistin, another molecule produced by adipose tissue, could impair insulin sensitivity (Matsuzawa Y, 2005). The close relationship between Leptin levels and insulin resistance in children has also been suggested by the data (Chu NF et al, 2000). Serum levels of retinol-binding protein 4 (RBP4) correlate with insulin resistance in subjects with obesity as well as in those with impaired glucose tolerance (IGT) or type 2 diabetes mellitus, therefore suggesting that it could be useful in assessing insulin resistance and the associated risk for complications (Graham TE et al, 2006). Serum RBP4 is independently related to obesity as well as to components of the metabolic syndrome in normal weight and overweight children (Aeberli I et al, 2007). Diet composition in obese children might be an additional factor promoting and/or worsening insulin resistance. Animal and human studies suggest that a high energy intake as well as a diet rich in fat and carbohydrates and low in fiber could increase the risk of developing insulin resistance (Canete R et al, 2007). The Role of Fat Distribution An altered partitioning of fat between subcutaneous and visceral or ectopic sites has been associated with insulin resistance (Weiss R and Kaufman FR, 2008). Visceral fat has a better correlation with insulin sensitivity than subcutaneous or total body fat (Caprio S et al, 1995), in both obese adults and children. Visceral fat has higher lipolytic activity compared with subcutaneous fat, therefore a greater amount of free fatty acids and glycerol gain entry or carried out to the liver (Matthaei et al, 2000). Visceral fat in girls is directly correlated to the glucose-stimulated insulin levels and inversely correlated with insulin sensitivity and the rate of glucose uptake. No correlation was found between abdominal subcutaneous fat (Caprio S et al, 1995). Ectopic deposition of fat in the liver or muscle can also be responsible for insulin resistance in obese subjects, as the accumulation of fat in these sites impairs insulin signaling, with a reduced glucose uptake in the muscle and a decreased insulin-mediated suppression of hepatic glucose production (Weiss R and Kaufman FR, 2008). Intramyocellular lipid (IMCL) accumulation has been shown as a factor related to decreased insulin sensitivity (Jacob S et al, 1999 and Thamer C et al, 2003). Obese insulin sensitive children and adolescents present lower levels of visceral fat and IMCL when compared with obese insulin resistant children (Weiss R et al, 2005). Accumulation of fat in the liver has also been associated with insulin resistance, independently of adiposity (Kelley DE et al, 2003). It has also been suggested that deposits of fat around blood vessels can produce several cytokines and therefore contribute to the development of insulin resistance, through a so-called vasocrine effect (Yudkin JS et al, 2005). Insulin Resistance and Associated Complications Insulin resistance in obesity is strictly related to the development of hypertension (Marcovecchio ML et al, 2006 and Cruz ML et al, 2002), dyslipidemia (Howard BV and Howard WJ, 1994), impaired glucose tolerance (IGT) (Sinha R et al, 2002), hepatic steatosis (DAdamo E et al, 2008), as well as to the combination of these factors, also known as metabolic syndrome (Eckel RH et al, 2005). Furthermore, insulin resistance is associated with systemic inflammation, endothelial dysfunction, early atherosclerosis and disordered fibrinolysis (Dan Dona P et al, 2002). It is alarming that these metabolic and cardiovascular complications are already found in obese children and adolescents (Dietz WH, 2004). The presence of these alterations in prepubertal children is then particularly worrying, as insulin resistance and related complications might be further exacerbated by the influence of puberty, due to the physiological decrease in insulin sensitivity associated with normal pubertal development (Caprio S et al, 1989). Insulin resistance in childhood can track in adult life (Sinaiko AR et al, 2006). Insulin resistance at the age of 13 years predicts insulin resistance at age 19 years, independently of BMI, and is also associated with cardiovascular risk in adulthood (Sinaiko AR et al, 2006). The fundamental role of insulin resistance in human disease was already recognized in 1988 by Reaven (Reaven GM, 1988) who emphasized its role in the development of a grouping of metabolic abnormalities, which he defined as syndrome X. Later studies strengthened the concept of insulin resistance as a key component of the metabolic syndrome, a cluster of impaired glucose tolerance (IGT), dyslipidemia, hypertension, hyperinsulinemia, associated with an increased risk of type 2 diabetes mellitus and cardiovascular disease (Eckel RH et al, 2005). Insulin resistance represents a serious and common complication of obesity during childhood and adolescence. A timely diagnosis and an appropriated prevention and treatment of obesity and insulin resistance are required in order to reduce the

Roberto Goizueta and Jack Welch are two of the best leaders in American

Roberto Goizueta and Jack Welch are two of the best leaders in American companies. Welch and Goizueta Leadership Assignment Introduction ============ Roberto Goizueta and Jack Welch are two of the best leaders in American companies. They have created much value and wealth for their shareholders. Goizueta was born in a wealthy family and is an aristocratic, formal gentleman who likes a nice predictable schedule. He has a deep respect of tradition. Being the chairman and chief executive of Coca-Cola, he essentially runs a one-product company. Whereas Welch was born in a poor family and grown in an environment that was full of competition. Welch is impulsive and charming. Being the chairman and chief executive of General Electric, he runs a conglomerate with a dozen businesses. He puts almost every aspect of GE management a heavy element of competition. Though there are many differences in their style of working, both of them do have good wealth-building skills and share some common characteristics to become successful leaders. In the following, an analysis of these common characteristics will be discussed. Common characteristics ====================== First of all, both of Goizueta and Welch have the vision and the ability to sort out the noise from the signal and then to drive just for essence of what’s important. Good leaders need to direct the employees to do things that will be beneficial to the companies, and discourage them from doing thin...

Growing Up In The 1990s Vs Growing Up In The 2010s Essay

Throughout history every generation has been different from the next, and every child is raised knowing the media and social acceptances of their own generation. Two generations that are very close to each other but are very different are the 1990s and the 2010s. The 1990s was revolutionary for its rise in multiculturalism, and also started to introduce technology in the forms of cable TV, internet, and videogames. The 2010s continues this rise in technology and multiculturalism, and has also become a decade of reality TV, online shopping, cell phones, tablets, and more inappropriate movies and music. Some comparable aspects of both generations include technology, TV shows, and music. In my opinion the 90’s comes out on top as a better time to grow up in. The technology of the 90’s was much more simpler and not as relied upon as in the 2010s. Cell phones were introduced in the 90’s and were very big and clunky, only a few percent of people used them so you wouldn’t see people glued to their phones all day. The World Wide Web had only just been invented and was a huge curiosity to the people discovering it. People of all ages in the 90’s use to walk to stores and by a new CD to play on their walkmans, and digital cameras were just becoming commercially available. As for video games, the Super Nintendo Entertainment system (1990), Gameboy (1990), Nintendo 64 (1996), Playstation (1994), Sega Saturn (1994), and the Sega Dreamcast (1999), all of which had innovative, creative, educational, and fun games to play. technology was more of a casual fun thing, and not a dominant force, so kids played outside a lot more as well. On the other hand, the 2010s also had a huge leap in technological advances. In 2012 Google Chrome became the world’s top web browser, the tablet was invented, everyone has a cell phone (and kids are given them at too young an age), YouTube became very popular, and FaceBook and Twitter rule social media. While some of this technology is a huge achievement, it is used in mainly the wrong ways. Parents give their children tablets and cell phones at too young of an age, too substitute a babysitter, and this ends up being the only thing the kid does. Social media sites have led to many suicides because of cyber bullying, and is filled with drama, which is why I believe FaceBook should have an age limit. If it had an age limit then it would only  be adults on it, and they would use it to find long lost friends, and cyber bullying would go down a lot. As for video games, 2010s released the Wii, Xbox 360, Ps3, Nintendo Dsi/Dsi xl, Nintendo 3ds/3ds xl/ 2ds, Wii U, Xbox One, Ps4, and also customizable gaming pc’s have become very popular. Although all of these systems are great and have many fun games, yet the gaming consoles have become filled with too many FPS games (First-person shooters), and I mean way too many to the point that games are focusing more on graphics and less on innovation and fun. M rated games (M for mature) are being bought by children’s parents and given to the child as a gift. Now I never realize any big issues by M rated games, and know that the violence is just in the game and doesn’t need to happen in real life. However when these games are given to young kids, it will affect their minds as they grow and are glued to mature rated videogames all day. The 1990s and 2010s technology have both taken huge leaps, but it appears to me that the 1990s was more casual fun, and there was no cyber bullying. The 1990s TV shows were more family friendly orientated and did not consist of thousands of reality shows. Sit-coms such as Seinfeld, Friends, Full House, The Fresh Prince of Bel-Air, Everybody Loves Raymond, and Boy Meets World were mainly family friendly although some may have contained some slight sexual innuendo. TV commercials were much better, as there wasn’t as much insulting of your intellect, really bad comedy, and sex in them during the 1990s. Nickelodeon and other such cartoon networks were very popular for kids and they did not act like you were stupid. Some memorable cartoon and kid shows from the 90’s include Rug rats, Double Dare, GUTS, Pokà ©mon, Powerpuff Girls, Dragon Ball Z, Power Rangers, Teenage Mutant Ninja Turtles, Batman the Animated Show, Captain Planet & The Planeteers, Ren and Stimpy, and Sailor Moon. However, 2010s TV shows have been corrupted by fake drama reality TV, sex, over violence, and drugs. Even while watching commercials you come a cross sexual innuendos, tampon commercials, and condom commercials. If I was still a little kid and this stuff was appearing on my TV I would be asking my parents some questions, and It would probably feel quite awkward seeing stuff like that on TV at such a young age. Cartoons and kid shows such as Pokà ©mon, Hannah Montana, Phineas and Ferb, Teen Titans Go, can still be entertaining, but they have truly toned down the  vocabulary, life lessons, and humour which makes for an experience that feels like your being treated as if you were an infant. Anime has become extremely popular in the 2010s, and for good reason. Anime holds on to things from old cartoons such as good vocabulary, humour, life lessons, emotional experiences, intense battles, and good voice acting. Sadly most anime has been taken off TV around America and Canada and the only way to watch it is to find it online or buy them at stores. Music in the 1990s consisted of a large variety, the most popular being Grunge, teen-pop, Hip-Hop, Rap (nothing like today’s rap), alternative rock, punk rock, Rock and Roll, trance, and techno. People had they’re on musical taste and did not just try and fit in with the media’s favorites. Conversely, if you look at the music of the 2010’s, they still have a big variety but there are some obvious leaders of the pack. Rap, Pop, Electronic music, and Hip-Hop lead the top most popular genres of music of the 2010’s. The rap, hip-hop, and pop music is nothing like it use to be, it now is mainly focused on sex, money, gangsters, drugs, getting drunk, and pleasure in any form. Me, as a seventeen year old boy, is still surprised on how fast the acceptance of music like this has reached the media, and I feel that it truly is not good for the minds of the youth growing up in this age, while the 1990’s still did have some of these flaws, but it was much less. Through discussing technology, TV shows, and music of the 1990’s and 2010’s, I can safely say that even though I was only born in 1996, the 90’s had less bullies, was more family friendly, and was generally more fun than it would be, being born in the 2010s. However each generation has their own positives and negatives, and not one could ever be perfect. The important thing is to make the best of it, and to not be afraid of being yourself.

The concept of Happiness according to Kant ( with the categorical imperative) and Mill (with the utilitarianism).

The concept of Happiness according to Kant ( with the categorical imperative) and Mill (with the utilitarianism). Kant vs. MIll"Happiness"In two words the concept of happiness exemplifies the "American dream". People go to any means by which to obtain the many varied materials and issues that induce pleasures in each individual, and ultimately in the end, the emotion remains the ultimate goal. John Stewart Mills, a nineteenth century philosopher, correctly supported the pursuit of happiness, and maintained the concept that above all other values, pleasure existed as the utmost objective. Mills promoted his views of natural human tendency and his arguments supporting his theory that above all else, happiness was the most important dream to be fulfilled. Although Mills believed so strongly in his idea of happiness, another philosopher, by the name of Immanuel Kant, proposes a counter argument based on the principles of metaphysics. Immanuel Kant, in " Groundwork of the Metaphysics of Morals," defends his strong beliefs in the issue of a good will.Mill Street, WarwickIn my paper I will discuss the different claims made by each Mills and Kant on happiness's role in moral life, and present the issue that diminishes to a clash between emotions and pleasures verses rationality and logic.Kant's moral theory and Utilitarianism are similar in the respect that they both attempt to explain how one can go about acting ethically, however they differ in areas of measuring morality and their usage of rules. Both Kant and Mills measure morality in different ways. Kant says that an act is deemed moral for two reasons: if it's done for the sake of duty and if its maxim can be willed as a universal law. If one completes an action based on their duty to perform, they do the right thing because it is what they feel they ought to do as their duty. Therefore, this act would...