Cognitive and Physical Development of the Male Adolescent Essay

Cognitive and Physical Development of the Male Adolescent - Essay Example This is of course from a scientific perspective and from researchers who have studied the phases of adolescence in young people. The main difference that has been documented with girls and boys is the fact that physically they both develop at a similar pace but cognitively males seem to be slower in developing certain emotionally skills and rationalization skills in comparison to females. While the physical changes of puberty are important indicators which signal adolescent development to researchers, it is the cognitive aspects of adolescence that is the most detrimental to developing into a normal adult human being. There are many other changes that take place during this time that are varied from just physical and some of these are related to areas that are fundamental to life. Some of these are cognitive, self-concept, social / moral reasoning, and the ability to think abstractly. Although this developmental period of life needn't be an uncommonly stressful time, adolescents do encounter stresses, especially male adolescents because they have so many goals they feel that they must meet and they want to fit in with the popular male groups so desperately. Nevertheless, despite the struggles that male adolescents go through, most of them are well adjusted individuals who are not depressed nor mixed up people, which is commonly thought. Rather than them lacking in self-control and confidence they seem to have a great deal of abilities in rationalizing their personal circumstances and they deal with them far better than many psychologists give credit. At the same time it must be recognized some adolescents exhibit signs of disturbance and can suffer severe life crisis. The male adolescent is not looked closely enough at and therefore their physical and cognitive development is not as questioned as heavily as it is with the female gender. Male adolescents have many obstacles to overcome in their young lives and though some cope and make it through just fine with perfectly normal developmental progress in these two areas, as was stated others do struggle just as any young person can regardless of their gender. Early Adolescence and Beyond Kolaric & Galambos (1995) state that between boys and girls in the early adolescence period there is not much of a difference in their body language, verbal communication, and common gestures between the two in a social atmosphere. Boys exhibit a carefree during this period, which is quite normal. They appear to adapt in specific situations during this time period seemingly easy, especially when they exhibit self confidence and obviously have high self esteem as well. Blos's research (1965) from a few decades back clearly illustrates how although a large percentage of time has past his points are still remarkably close to what young males in the early stage of adolescence do experience. Time seemingly does not change how human beings develop, or in this case how the male figure develops cognitively and physically as well. In 1965, Blos stated clearly that the individual characteristics and the immediate environment had the most pull in a young male developing correctly from a cognitive perspective and from the physical concept as well. Even today this type of analytic theorization is quite common place as many researchers have proven that a child is directly affected by their environment and who they associate with. In

Sales Management Essay Example for Free

Sales Management Essay In order to find a solution to his situation, Evans and those suffering from similar problems have to explore the factors that depress their sales. Diagnosing weaknesses in sales performance is the first stage in improving the level of sales. Sales management is about achieving specified goals. The main aim is to raise sales volume through with the use of certain techniques and methods. Evans, on the contrary, seems preoccupied with achieving goals on his own personal agenda, with little interest in the company’s prospects or his own sales record. Therefore, in order to increase his aptitude as a salesperson, Evans needs to make it a priority. Individuals all come to the workplace for the purpose of achieving their personal goals, something a good boss will always recognize. However, when these goals are incompatible with the goals of the company, the organization should either part with the employee or force him or her to reconsider those goals and their relative importance as compared to the working experience. Evans seems preoccupied with asserting his superiority over people he is selling to. He may be so much impressed with his past record as a technician if there was any that he is willing to compromise the opportunity to sell an item for the pleasure of confirming his superior knowledge. Alternatively, he may be longing for a career of a farmer deep inside and thus wants to see many times more that he is no less knowledgeable than his clients that actually use the machines. While the above is a matter for detailed psychoanalysis, Evans must in the first place find a solution to his problem. To make it happen, he must first of all recognize that there is a problem and establish a list of priorities. The first thing is to question oneself what is more important: being a good salesman or finding additional proof of one’s technical expertise? If good sales skills are a priority, then Evans has to question himself: what are the qualities he is missing in order to improve his sales skills? It is the ability to build rapport with the customer? Or aptitude to convert this good relationship into sales numbers? If he answers â€Å"yes† to the first question, he may then probe further into understanding what exactly alienates his clients about his behavior. As a way to overcome the harmful trend, Evans can be put in a situation where he relives the whole incident, viewing it from the opposite side – that of the client. Thus, the company may pay a salesman to approach Evans with a proposition of purchasing some technological gadget. As the conversation develops, the fake salesman demonstrates that his understanding of the offered technology is way above that of Evans. Evans will have a chance to try out his reaction to this kind of behavior in salespeople – see whether he will be willing to purchase the item or not.   Most likely, being a competitively minded individual, Evans will be hurt to find out that someone with comparable background is more knowledgeable in the field than he is. As a result, he will have a chance to reassess his own line of behavior towards his customers. As another way to combat the harmful tendency, Evans can get a chance to assert his superiority in a way that will corroborate his expertise once and forever and release him of the need to compete with each prospective client he needs. To do this, he may need more interaction with qualified technicians so that he could impress them with his knowledge. The company in which Evans works can organize a competition on technical expertise among salespeople in which Evans would undoubtedly be the winner. He can then carry this title to publicize it to the farmers: the qualification would impress the farmers and make them think that they are indeed talking to an expert, while Evans will not be forced to assert his knowledge every time. In fact, he may simply need to find more qualified people than farmers to discuss technological side of his profession with. For this purpose he can visit various exhibitions and technological fairs and talk to professionals there. Evans can come up with new suggestions to make modifications of the current models, suggestions that can be useful since they are advanced by someone close to the actual users of agricultural machinery. If Evans shifts his focus from self-assertion to finding out about the needs of the farmers, he can score points with them and improve his relationships with prospective buyers of his product. However, getting rid of personal problems that inspire Evans to turn his sales process into a contest is only the first step. The second step is to learn the intricacies of results-oriented sales management. Evans has to realize that in his work his main ambition should be to provide an efficient interface between the company and its customers and to reveal to them the opportunities opened up by new agricultural machinery. If he chooses to make his approach to sales more customer-oriented, Evans can boost both his personal and corporate results. To produce better results, Evans should try to downplay his weaknesses as a salesman and build on his potential strengths. Building on one’s unique strengths will give Evans the desired competitive advantage. Expertise and thorough understanding of the equipment he is selling may be one such strength. Evans has to learn to exploit this strength by turning it into an asset. For instance, he may stress that with his vast knowledge, he may be more helpful than other salespeople in preparing the farmer for the efficient use of the machinery, pointing out its minute details and revealing ways to extend the working life of the equipment. Besides, with his vast knowledge, Evans is the one to select the most suitable piece of machinery to perform the necessary task. He should also pay attention to his weakness that seems to lie in the inability to build a long-lasting relationship with consumers. The value of mutually beneficial relationships cannot be overrated in today’s business environment. This is especially true for markets like that for agricultural machinery, where a restricted number of customers make repeated purchases, with the cost of each being rather sizeable. Salespeople are at the forefront of the company and are directly responsible for generating long-standing seller-buyer relationships that will provide benefits to both sides. In their role as boundary spanners, salespeople are â€Å"the business-to-business marketers primary source of communication with customers† (Shwepker 2003). Aiming to build long-lasting relationships with customers, Evans will improve his sales orientation that will over the long term reflect in increases in his sales volume. To improve his sales orientation, Evans should be more interested in the potential customer. He needs to demonstrate his interest in the customer needs and success through asking questions related to the farmer’s business. So far Evans’s primary focus has been himself and his knowledge. Shifting the balance towards the customer, his or her business and personality can improve the relationship dramatically. Only then will Evans be able to convince the customer that he is genuinely looking for a good match between the customer and the product. Sales orientation is not only about building wonderful relationships; it should include the ability to convert these relationships into sales numbers. Thus, Evans should understand that he is in this business for selling, and the consumer is of primary interest to him as a potential buyer of his agricultural machinery. Everything that can discourage the decision to buy is taboo. On the contrary, every ethical way to induce such a decision is welcome. This rule obviously excludes contests aimed at humiliating the consumer through pointing out deficiency in his or her knowledge. Although raising some ethical issues, Evans can try to capitalize on his past mistakes by offering to repeat the contest to knowledgeable farmers who previously lost to him. If he succeeds in making them believe they won this time, this exhilaration can spur them on to buy his machinery this time. Overall, Evans needs to discard or solve his personal problems that motivate him to see a customer as a potential competitor on knowledge rather than a potential buyer. Making boost in sales numbers a priority, he will be able to improve his performance. To do this, he needs to turn his superior knowledge from a liability into an asset. Bibliography Schwepker, Charles H., Jr. â€Å"Customer-oriented selling: a review, extension, and directions for future research.† Journal of Personal Selling Sales Management (March 22, 2003).

Essay About Family: Cutting Strings :: Personal Narrative essay about my family

Cutting Strings I’m in bed, scanning the ceiling for a light that isn’t there. There wasn’t one last night, or the night before, so I shouldn’t have expected anything different than the textured surface that my retinas now scratch across in a long diagonal. The same grey, dried-paint-sharp ceiling that they don’t show in the brochures. Always without a light. Sure, one of those fake-Southwestern lamps with a plastic lamp shade sits beside me on the coffee table, but it’ll just fall with everything else once this island of a motel room shrinks down to a pinpoint and these two beds, those dresser drawers, that mirror, Jessie, Bekah, and my own elusive existence tumble into the empty gap. â€Å"Are they still out there?† I don’t see her, but I imagine my 16-year-old sister Jessie gaping at the blank TV screen, hoping somebody will answer her question. â€Å"Yep,† Bekah rattles off too quickly. That’s right, I realize. Still outside. Probably in the car, pinned under the hard rain. It was raining when we got here. Some firefly of a town at the crossing of two faded freeways in northern Pennsylvania where it snows a lot in the wintertime for the skiers, my dad told me in a watery voice while our minivan hummed down the off-ramp. Watercolor black, I thought while I looked out the window, except for the yellow, splotchy Super-8 sign and the white motel lobby. My two sisters and I brought the luggage down and we’re still waiting for mom and dad like dead puppets, and I’m still wishing for a light fixture. Like the bubble-shaped one that hung in my bedroom about two thousand miles away, before I turned 18 on this family road trip. Before this second act, when my parents stopped flinching their puppet master wrists from above the stage, and so I finally cut my own strings, just to fall flat on my plastic face and deflate like a balloon. The door clicks open. What can I hang on to? The ceiling is blank. â€Å"Mom?† I hear my sister’s drawl and think desperately about a light fixture, this one big, with crystal chains and gold bars. I can feel the mattress slipping below my back. Take your things. Swinging from chandeliers? No, too much. I’d just hold on. â€Å"Take your things and get out,† Mom says. â€Å"You’re sleeping with your dad tonight.† My two sisters and my older brother and I never heard much, but my mother would sometimes tell us about how her parents beat her and did other things too.

Aging in Matthew Arnolds Growning Old and Robert Brownings Rabbi Ben Ezra :: Matthew Arnold Growning Old Essays

Aging in Matthew Arnold's Growning Old and Robert Browning's Rabbi Ben Ezra  Ã‚   Contemporaries of the Victorian Age, Matthew Arnold and Robert Browning wrote the poems, "Growning Old" and "Rabbi Ben Ezra," respectively, to express their views on aging. Arnold suffers tremendously, for he lives in melancholy solitude with his deteriorating body, helpless in his moral and physical pain. Browning, a happier man, finds much joy in his age and comfort in the moral and spiritual strength which God gives him. In effect, while Arnold pessimistically dwells on the physical pain accompanying the aging process and the inevitability of a cruel death, Browning devoutly expresses his optimistic outlook of old age and death as God's consummate end to the labors of life. Arnold's pessimism regarding aging leaves no room for optimism. The reader encounters this negativity right away, for in the first stanza Arnold ascertains, in answer to his question "What is it to grow old?", that aging involves "[losing] the glory of the form." The words "lose the glory" implicate a tragic and perhaps humiliating experience. Furthermore, Arnold describes the loss of "the glory of the form" as a time when "beauty [forgoes] her wreath," a phrase which presents the reader with the image of a queen abandoning her crown, as her time of glory ends forever. Arnold gives the reader another foreboding image of aging in line twenty-four, when he describes himself as being incarcerated by his age with the image of the "hot prison of the present, month to month with weary pain." The words "hot", "weary", "prison", and "pain" effectively portray Arnold's suffering and discomfort to the reader, simultaneously lending to his overall pessimistic standpoint. In addition, Arnold exp eriences an absense of feeling in accordance with his age. In the fourth stanza he declares that old age dies not imply gazing down on the world with "rapt prophetic eyes" and a "heart profoundly stirred/ to weep and feel the fullness of the past." Furthermore, he writes, "Deep in our hidden heart/ Festers the dull remembrance of a change/ But no emotion--none." One critic concurs, stating that Arnold's age induces an "emotional frigidity" (Madden 115). Another critic describes Arnold as having an "incapacity for feeling" (Bush 50). As to the "dull remembrance of a change" Madden adds, "There was always the memory of that 'different world' [which Arnold] had once known..." (115). Most probably, the "different world" of which Madden speaks is Arnold's youth, of which the poet only has a "dull remembrance" left, suggesting that Arnold finds no fulfillment or feeling in the memories of his youth.

Pros and cons Co-education Essay

Pros: 1. The mixing of both the two sexes in co-educational environment eradicates the inherent shyness in each student. On the other hand, by studying and working in a mixed-gender school, students will be given facilities for expressing and sharing their own ideas or opinions in the presence of the opposite sex. Therefore, it provides students a great incentive to overcome their shyness and enhance their confidence. 2. It is manifest that in the future students have to live in a mixed-sex world and hence they should be well- prepared to easily integrate into the real life. A co-educational environment is reflective of today’s society since it offers students a valuable opportunity to get exposed to a broad exchange of diverse ideas, opinions, values and lifestyles; to get accustomed to working and sharing with their peer of the opposite sex. As a result, students in co-educational schools are more likely to adapt themselves into any new surroundings and get ahead. 3. In the past, education open to women was really restricted due to moral and religious grounds as well as the society’s conception of sex-role and gender-appropriate forms of work. However, with the worldwide advance of the society, there has been an overwhelming shift in women’s roles providing them with greater opportunity for involvement in life beyond the domestic sphere. Consequently, the practice of co-education has made the growth of women’s rights and the expansion of the modern education system to serve all the segments of the population. 4. So girls and boys in the class tend to compete in a healthy manner with each other. It is also seen that the girls fare better than boys in most of the cases. This is because both the sexes are enhanced by the presence of the other. In the olden times it was believed that girls were incompetent to compete with the boys but this is not true. Cons: 1. When studying together in a school, male and female students are likely to suffer from some bad distraction. For instance, some teenage students may be fascinated by their peer of the opposite sex and spend much time attracting them instead of their studying. Many school girls can be bothered by the teasing and even the flirting of the boys. If such distraction is not kept in control, then the students will be certainly lured away from their study. 2. While the world is witnessing dramatic improvements in co-education, there is a public question and concern about the connection among co-education and sexual freedom; a rise in unmarried, particularly teenage-pregnancy; and the growth of sex harassment and sexually transmitted diseases in mixed-sex schools where boys and girls students spend much time together and the safe boundary between two sexes can be broken at any time.

RANDOMNESS

RANDOMNESS Nathan Bransford wrote recently about the randomness of bestsellers. In other words, there isnt some magical power that preordains the qualities of a story that breaks records and defies the odds. Sometimes a perfect storm just comes together. Like the mega waves he describes at sea, the ones that appear from nowhere and make a huge impression in that vast, monstrous water, they just happen and cant be fore casted. http://blog.nathanbransford.com/2012/06/randomness-of-bestsellers.html And yet, we keep trying to understand the process. Whats worse,in my opinion, and this is a BIG gripe with me, is that we also bash traditional publishers for producing books that do not do well. Thats talking out of both sides of our mouths. We try to think we can duplicate bestseller status, and really learn how to define the path to such a level, as if there was a manual somewhere. That logic should also mean that if we can predict great books, then we know enough to avoid a bad one. The deal is, people, is that we can only write our best.Publishers can only attempt to predict what will sell. eaders can only pretend to recognize a debut book as a bestseller. The fact is that nobody has mastered how to make a bestseller. There is no HOW TO WRITE A BESTSELLER FOR DUMMIES. Just spoke to someone this week who justified self-publishing Hes only trying to assuage his own conscience, the one thats attempting to rationalize into a hazy reality that he probably has no chance with traditional publishing. So he says theyve lost touch, can no longer produce quality material, thus leaving him no choice but to proceed with self-publishing since it has equal credibility. This is my reality . . . and my explanation of publishing: The more seasoned, experienced people who lay their eyes and hands on your manuscript, the better the book. Note, I did not say traditional or self-published. Multiple layers of review and decision making goes into traditional publishing. If you self-publish, make sure you put the same degree of attention into your manuscript as a traditional publishing house would put into it. Hire editors. Hire a cover designer. Hire a for matter. That is, unless you are experienced yourself. That doesnt mean read instructions and learn as you go. Sure, you CAN learn as you go, but do not go it alone. Youll never see the landmines, no matter how many blog posts you read about the business. This business isnt about randomness. Its about diligence and focus to detail. Nothing is fool-proof. Failure exists. Less than satisfactory happens. But your odds improve the more experience you put into your books development, writing,and promotion. Instead of trying to orchestrate a bestseller, just write your best. Then recognize what you should and should not do. Be daring in your writing. Be grounded in your publishing, no matter which route you take.

Wall Building

Wall Building A couple of comments in emails, on Facebook, and yes, even in person, made me sad this week. When a person was confronted with an opportunity, they spoke first about how they could not do it. Without flinching. Without a thought about trying to find a way to learn. They are building walls across a flat piece of ground that could lead to success. Examples: I am afraid to publish because I dont understand the difference between self-publishing and traditional. Darn, I dont know how to write a short story to enter that contest. Someone will tell me Im bragging if I tout my writing in public. Im afraid someone will steal my idea. I dont have enough money to publish. So many writers see the obstacles before they envision the opportunity. They feel the pain before they get injured. They flinch before they are pricked. As I told the Nebraska Writers Guild last week: Go ahead and be afraid. Go ahead and hold back, fearful of what to do next, because that just gives me and all these other people the chance to pass you Whatever you think, do, or hold back doing, takes energy. You can infuse your energy into being proactive and learning how to proceed, or you can expend your energy worrying about what might go wrong. With the first, you might gain headway. With the second, you get nowhere. Make a decision, then pursue the solution or march toward the goal. Read short stories and learn how to write them. Study the difference between publishing opportunities until you are comfortable in your choice. Decide if youre worried more about publishing or what people might say about you. Dare to submit, realizing the odds of someone stealing your work is miniscule. Save your money or start a crowdfunding project on Kickstarter.com and earn the money you need. There are options. There are opportunities. But you have to reach out for them. They do not come to you.

Biography of Clarence Darrow, Legendary Attorney

Biography of Clarence Darrow, Legendary Attorney Clarence Darrow became the most famous defense lawyer in early 20th century America by taking on cases considered hopeless and emerging as a leading voice for civil liberties. Among his celebrated cases was the defense of John Scopes, the Tennessee teacher prosecuted in 1925 for teaching about the theory of evolution, and the defense of Leopold and Loeb, two wealthy students who killed a neighbor boy for the thrill of it. Darrows legal career was utterly ordinary until he became involved in advocating for labor activists in the 1890s. Before long he would become nationally known as a crusader for justice, often speaking out against capital punishment. His obituary in the New York Time in 1938 noted that he had defended the accused in â€Å"a hundred or more murder trials, no client of his had ever died on the gallows or in the electric chair.† That was not entirely accurate, but it underscores Darrows legendary reputation. Fast Facts: Clarence Darrow Known For: Famous defense attorney who often won cases thought to be hopeless.Notable Cases: Leopold and Loeb, 1924; the Scopes Monkey Trial, 1925.Born: April 18, 1857, near Kinsman, OhioDied: March 13, 1938, age 80, Chicago, IllinoisSpouses: Jessie Ohl (m. 1880-1897) and Ruby Hammerstrom (m. 1903)Children: Paul Edward DarrowEducation: Allegheny College and University of Michigan Law SchoolInteresting Fact: Darrow claimed to believe in personal liberty, the abolition of capital punishment, and the improvement of labor conditions. Early Life Clarence Darrow was born April 18, 1857, in Farmdale, Ohio. After attending public schools in Ohio, young Darrow worked as a farm hand and decided the labor of the farm was not for him. He studied for a year Allegheny College in Pennsylvania before attending the University of Michigan law school for a year. His education was not impressive by modern standards, but it qualified him to read law for a year with a local lawyer in Ohio, which was a common method of becoming an attorney at the time. Darrow became a member of the Ohio bar in 1878, and for the next decade he embarked on a fairly typical career for a lawyer in small town America. In 1887, hoping to take on more interesting work, Darrow moved to Chicago. In the big city he worked as a civil lawyer, pursuing ordinary legal tasks. He took on work as a counsel for the city, and in the early 1890s he worked as a corporate counsel for the Chicago and Northwestern Railroad. In 1894 Darrow’s life took a significant turn when he began defending legendary labor activist Eugene V. Debs, who was fighting an injunction against him for leading a strike against the Pullman company. Darrow was ultimately not successful in his defense of Debs. But his exposure to Debs and the labor movement gave him new direction in life. Crusader for Justice Beginning in the mid-1890s, Darrow began taking on cases that appealed to his sense of justice. He was generally successful, for what he lacked in education and prestige he made up with his ability to speak plainly but dramatically in front of juries and judges. His courtroom suits were always rumpled, apparently by design. He portrayed himself as a common man seeking justice, though often armed with cunning legal strategies. Darrow became known for sharp cross-examinations of witnesses, and as he championed those he considered oppressed, he would often introduce novel concepts from the emerging field of criminology. In 1894 Darrow defended Eugene Prendergast, a drifter who killed the mayor of Chicago, Carter Harrison, and then walked into a police station and confessed. Darrow raised an insanity defense, but Prendergast was convicted and sentenced to death. He was the first and last of Darrows clients to be executed. The Haywood Case One of Darrows most notable cases came in 1907, when the former governor of Idaho, a supporter of the mining industry, was killed in a bombing. Detectives from the Pinkerton agency apprehended officials of the Western Federation of Miners (part of the Industrial Workers of the World) including the unions president, William Big Bill Haywood. Charged with conspiracy to commit murder, Haywood and others were to go on trial in Boise, Idaho. Darrow was retained for the defense and deftly destroyed the prosecutions case. Under Darrows cross-examination, the actual perpetrator of the bombing admitted he had acted alone as a matter of personal vengeance. He had been pressured to implicate the labor leaders by the prosecutors in the case. Darrow gave a summation which amounted to a profound defense of the labor movement. Haywood and the others were acquitted, and Darrows performance cemented his position as a defender of the common man against money interests. Leopold and Loeb Darrow was on the front pages of newspapers across American in 1924 when he defended Nathan Leopold and Richard Loeb. The two were college students from wealthy families who confessed to a shocking crime, the murder of a 14-year-old neighbor boy, Robert Franks. Leopold and Loeb became figures of public fascination as they told detectives they had committed the kidnapping and murder of a random boy for the adventure of perpetrating the perfect crime. Seated left to right, Nathan Leopold, Jr., attorney Clarence Darrow and Richard Loeb. The boys were found guilty of the murder and kidnapping and Bobby Franks.    The families of Leopold and Loeb approached Darrow, who at first resisted taking the case. He was certain they would be convicted, and he had no doubt they had committed the murder. But he took on the case as he was opposed to capital punishment, and his goal would be to save them from what seemed to be certain execution by hanging. Darrow requested that the case be heard by a judge without a jury. The judge in the case agreed. Darrow’s strategy was not to argue about their guilt, which was certain. And as they had been judged sane, he couldn’t argue an insanity defense. He tried something novel, which was to argue that the two young men were mentally diseased. Darrow called expert witnesses to advance psychiatric theories. The witness, known at the time as alienists, claimed the young men had mental problems related to their upbringings which were mitigating factors in the crime. The appeal for mercy posed by Darrow eventually succeeded. After deliberating for ten days, the judge sentenced Leopold and Loeb to sentences of life plus 99 years. (Loeb was killed in prison by another inmate in 1934. Leopold was eventually paroled in 1958 and died in Puerto Rico in 1971.) The judge in the case told the press that he was moved to show mercy by the age of the defendants and not by the psychiatric evidence. However, the case was considered by the public to be a triumph for Darrow. The Scopes Trial Darrow was a religious agnostic and was particularly opposed to religious fundamentalism. So the defense of John Scopes, the schoolteacher from Dayton, Tennessee, prosecuted for teaching about Darwin’s Theory of Evolution naturally appealed to him. American lawyers Clarence Darrow (1857-1938) and William Jennings Bryan (1860-1925) at the Scopes Trial. Heritage Images / Getty Images The case arose when the 24-year-old Scopes, teaching in a local public high school, included mentions of Darwin’s ideas in the curriculum. By doing so he violated a Tennessee law, the Butler Act, and he was charged. William Jennings Bryan, one of most prominent Americans in politics for decades, entered the case as the prosecuting attorney. On one level, the case was simply about whether Scopes had violated the local law. But when Darrow came into the case, the proceedings became nationally known, and the case was dubbed The Monkey Trial in the sensationalist press. A split in American society in the 1920s, between religious conservatives and progressives advocating science, became the focus of the courtroom drama. Newspaper reporters, including the legendary journalist and social critic H.L. Mencken, flooded into the town of Dayton, Tennessee, for the trial. News dispatches went out via telegraph, and even reporters in the new medium of radio relayed the proceedings to listeners around the country. The highlight of the trial occurred when Bryan, claiming to be an authority on Biblical teachings, took the witness stand. He was cross-examined by Darrow. Reports of the encounter stressed how Darrow had humbled Bryan by getting him to admit to a literal interpretation of the Bible. A headline in the Washington Evening Star proclaimed: Eve Made of Rib, Jonah Swallowed by Fish, Bryan Declares In Sensational Cross-Examination of Bible Beliefs By Darrow. The legal result of the trial was actually a loss for Darrow’s client. Scopes was found guilty and fined $100. However, to many observers, including H.L. Mencken, Darrow was considered to have won a victory in the sense of having shown to the nation at large the ludicrous nature of fundamentalism. Later Career Besides his busy legal practice, Darrow published a number of books, including Crime: Its Cause and Treatment, published in 1922, dealing with Darrows belief that crime was caused by factors impacting a persons life. He also wrote an autobiography published in 1932. In 1934, President Franklin Roosevelt appointed the elderly Darrow to a post in the federal government, assigned to correct legal problems with the National Recovery Act (a part of the New Deal). Darrows work was considered successful. One of his last jobs was to serve on a commission studying the threat arising in Europe, and he issued a warning about the danger of Hitler. Darrow died in Chicago on March 13, 1938. His funeral was attended by many members of the public, and he was eulogized as a tireless crusader for justice. Sources: Clarence Seward Darrow. Encyclopedia of World Biography, 2nd ed., vol. 4, Gale, 2004, pp. 396-397. Gale Virtual Reference Library.Scopes Monkey Trial. Gale Encyclopedia of American Law, edited by Donna Batten, 3rd ed., vol. 9, Gale, 2010, pp. 38-40. Gale Virtual Reference Library.Darrow, Clarence. Crime and Punishment in America Reference Library, edited by Richard C. Hanes, et al., vol. 4: Primary Sources, UXL, 2005, pp. 118-130. Gale Virtual Reference Library.

Corporate social responsibility Essay Example | Topics and Well Written Essays - 250 words

Corporate social responsibility - Essay Example As per discussion on the telephone, I am writing this letter to you to point out the positive aspects of implementing corporate social responsibility (CSR) at your organization and its impact on marketing for your organization. CSR refers to the "commitment to improving community well-being through discretionary business practices and contributions of corporate resources." CSR is no longer a trend or an obligation which companies set aside to show civil societies of their participation in the community. In fact today, CSR has a greater impact on corporate image, credibility, and involvement in the society which it serves. The basic premise is that corporations should give back to the community which makes the corporation what it is through acceptance, purchase of its products and appreciation.On the other hand, CSR from a corporate perspective can be seen as social marketing and corporate relations with its community. The focus of the practice, in fact, today is on developing strateg ies which reflect the corporate responsibility towards its community. It is the company's philanthropy through its business activities as well as public relations which are considered as CSR. This usually results in a positive image, public approval, indirect branding, and credibility for the organization. The result is increased profits, sustained profitability, and relations with the community. These aspects lead me to suggest that your organization shall benefit from implementing CSR in your business strategy.

Telecommuting Essay Example | Topics and Well Written Essays - 2500 words

Telecommuting - Essay Example While the new concept has many specific advantages and at the same time certain inherent limitations over conventional work places and can be implemented only in limited spheres of work, the concept is gaining immense popularity both among employers and employees due to tremendous flexibility available to them while working at home and also sufficiently meeting company deadlines. The aim of this paper is to study and bring out various advantages and disadvantages of telecommuting and their effects on organizational work culture and certain behavioral aspects in the present era. Hidden inside our advance to a new production system is a potential for social change so breathtaking in scope that few among us have been willing to face its meaning. For we are about to revolutionize our homes as well. Telecommuting is the trend which has grown fast since 1975 when just about 3% people worked from home and they were mostly farmers. Today, a much greater number of people are telecommuting and working from home. Telecommuting essentially implies that employees are using means of computers and telephones for work rather than using normal transportation channels. This has helped them save commuting time wasted on roads or rail, which in many cases can be up to 2-3 hours a day or 25-30% of time spent outside homes. This work culture saves money for employers as well in terms of reduced infrastructural requirements for employees and added benefits of improved productivity, better motivation for people in need as well as personal satisfaction for the employees who cannot move out of homes but want to work nevertheless. However, this aspect has had a considerable effect of lasting nature on the prevalent office culture. In succeeding paragraphs, we shall discuss the advantages and disadva ntages of telecommuting Telecommuting: Benefits Saved Time and Effort. As per a recent research, 10 minutes commuting time one-way amounts to two 40 hrs weeks a year. A similar 40 min one way commuting time consumes eight working weeks every year. (Telework, 2006) For those of us not understanding the gravity of the situation, this commuting time which is actually wasted doing nothing productive is actually equivalent to our whole entitlement of leave and holidays every year. Imagine having double number of off-duty days without any effect on your salary! Improved Productivity. Direct fallout of telecommuting has been improved productivity of an individual. While working from office, many good employees have serious reservations owing to their personal requirements at home. This is especially so in cases of working mothers, single parents or individuals with similar responsibilities. Such people, despite their good employability, cannot work and thus choose part time working or staying at homes. Even if they choose to work, they are pre-occupied with their personal requirements directly or indirectly affecting their work quality and as well as company's output. If such people have an opportunity to work from home than commute to office

SEXUAL OFFENCES AND OFFENDING Essay Example | Topics and Well Written Essays - 1500 words - 1

SEXUAL OFFENCES AND OFFENDING - Essay Example According to Lees (2000), law reform initiatives have expanded the definitions of rape, advocacy groups have become more widespread and established, and police officers have been exposed to better training and education programmes. However, it remains less clear how these changes have been accompanied by a significant shift in police officers’ attitudes towards rape complainants. This paper seeks to examine the response of police officers to rape allegations, the manner in which police investigate these allegations, and the challenges faced by the police when dealing with these allegations. According to Epstein and Langebahn (1994), offences if sexual violation and rape have notoriously low reporting rates. Few victims are willing to approach the police on their own accord. At the same time, of the cases that are reported, few of them proceed to the point of prosecution. While several studies have been conducted on rape cases which resulted in prosecution, little research has been conducted on complainant’s experiences of reporting rape to the police. This is despite the significant reforms to law and procedures taking effect in the mid 1980s. One of the first countries to attempt key reforms in its rape laws was New Zealand. It introduced an expanded and gender-neutral definition of rape in 1986. It also abolished married men’s right to spousal immunity from prosecution for rape. Similar reforms have been undertaken in England, the United States, and Australia. Jordan (2001) draws from a research conducted in the 1990s to determine the level to which women’s experiences of reporting rape to the police had improved since the reforms in New Zealand were initiated. In the study, 48 women were interviewed, with extensive information obtained regarding reporting and statement-taking, the medical examination, and support agency contacts. Throughout the study, there was a recurring issue. This is whether or not a woman

Michael Collins leadership Assignment Example | Topics and Well Written Essays - 750 words

Michael Collins leadership - Assignment Example Michael Collin’s approach to leading the region is task oriented.   This means he prioritize and values the task or job more than his relationship with his people.   In his visit to the region, the orientation of his leadership is revealed where he cared less about the people and is more concern about tasks related concern such as the length of service, what they like about the company, areas of improvement and corporate culture.   In addition, Michael Collins also described himself as a Renaissance man who could do a lot of things but gets impatient with people.   I thought of Michael Collin’s leadership orientation as task oriented because he perceive the importance of job in terms of tasks and not of people.     If Michael Collin is a people oriented leader, he would have enjoyed his visit and interaction with his workers.  Ã‚   He would have differed in his assessment of his people where he would find the engagement more fruitful when his people truste d him enough to share frank information about the company and their job.   He would have asked how his people are feeling not only about their job but also with their coworkers and their boss.   I did not think Michael Collins as people oriented leader because he did not value much their opinion and suspected their motive.3.  How might an understanding of individualized leadership be useful to Collins with respect to his relationship with marketing versus store personnel?   Individualized leadership is a leadership whereby the leader has a strong interpersonal relationship.

Physiology and Function Essay Example | Topics and Well Written Essays - 500 words - 2

Physiology and Function - Essay Example Peristalsis is the rhythmic segmental contraction and relaxation of the GI tract that helps in propulsion of food. Peristalsis is generally under autonomic control and is further mediated by myentric plexus located between the circular and longitudinal muscle layer. Contraction of these two muscles produces peristaltic waves, normally in a forward direction. Peristalsis plays a different role depending on the location of the GI tract. In the esophagus, it simply propels the food into the stomach. But in stomach, strong peristaltic contractions grind the food and mix it well with the acidic contents of the stomach. In the intestines the peristalsis is slow, providing sufficient time for digestion and absorption to take place (Guyton & Hall, 2000). Bile is produced and secreted by liver but is transported to gall bladder for storage. In the gall bladder it becomes concentrated and is released into the duodenum via common bile duct under the influence of cholecystokinin and vagal stimulation. Bile is composed of water, bile salts, bilirubin, cholesterol, fatty acids, lecithin and other common ions. Bile serves two important functions: assistance in fat digestions and removal of waste products. Bile does not contain any enzymes for digestion of fat but it causes emulsification of fat particles facilitating digestion and absorption in the intestinal mucosa. Bilirubin, a waste product of hemoglobin breakdown is also secreted in the feces via bile (Guyton & Hall, 2000). Saliva is secreted in the oral cavity by various glands such as parotid, submandibular, and sublingual glands. Every day these glands produce 800-1500ml of saliva. Saliva has two important components: ptyalin and mucus. Ptyalin is an amylase enzyme that helps in starch digestion, whereas mucus plays an important role in lubricating the food bolus and reducing mechanical friction. Saliva also has one important function of protecting oral cavity from invading

Michael Collins leadership Assignment Example | Topics and Well Written Essays - 750 words

Michael Collins leadership - Assignment Example Michael Collin’s approach to leading the region is task oriented.   This means he prioritize and values the task or job more than his relationship with his people.   In his visit to the region, the orientation of his leadership is revealed where he cared less about the people and is more concern about tasks related concern such as the length of service, what they like about the company, areas of improvement and corporate culture.   In addition, Michael Collins also described himself as a Renaissance man who could do a lot of things but gets impatient with people.   I thought of Michael Collin’s leadership orientation as task oriented because he perceive the importance of job in terms of tasks and not of people.     If Michael Collin is a people oriented leader, he would have enjoyed his visit and interaction with his workers.  Ã‚   He would have differed in his assessment of his people where he would find the engagement more fruitful when his people truste d him enough to share frank information about the company and their job.   He would have asked how his people are feeling not only about their job but also with their coworkers and their boss.   I did not think Michael Collins as people oriented leader because he did not value much their opinion and suspected their motive.3.  How might an understanding of individualized leadership be useful to Collins with respect to his relationship with marketing versus store personnel?   Individualized leadership is a leadership whereby the leader has a strong interpersonal relationship.

Labs 1,2,3,4,5,6,7 Lab Report Example | Topics and Well Written Essays - 2500 words

Labs 1,2,3,4,5,6,7 - Lab Report Example Label the Force Gravity (=mg), the Nor-mal Force (FN), and the Friction Force (Ff), but don’t use any specific numbers. What makes this a state of equilibrium? The cups are in a state of equilibrium just before it starts to slide. This is because the mg of each cup is made negligible by each normal force. Movement of the cups is being restricted by frictional force which acts on the cups. Only when an external force will be applied opposite to that of the frictional force will the cups begin to slide. If the co-efficient of friction is high then more force will be required since the opposing force also increases. However if the co-efficient of friction is low then the force required would also be low since lesser frictional force will be acting on the object. Lab 2 taught me the different forces that work on an object which is in state of motion of at rest. It gave me sound knowledge as to what forces are responsible for maintaining equilibrium of any body. Concepts about momentum of bodies and how mass has an effect on acceleration pr retardation became much clearer since we experience all of this in our day to day lives and getting to know about each thing from a scientific point of view made it fun. Each of the above observations explains the law of inertia. In the first observation since the water was still at one place at first and the bowl is accelerated, the water tries to stay behind while the bowl moves forwards immediately and the water spills back. However when I walk at steady speed nothing happens since no external force is there and the water tends to be at one place. When I walk straight the water tends to be in the forwards direction but since I turn rightly abruptly, the water spills since its motion was in the front and the sudden change in direction caused spilling. Inertia is also seen when I walk with the water bowl and the

“A Modest Proposal” by Jonathan Swift Essay Example for Free

â€Å"A Modest Proposal† by Jonathan Swift Essay The essay, â€Å"A Modest Proposal† by Jonathan Swift is a satirical piece that discussed, in great detail, the issues surrounding 18th century society as it pushed forward development as society progressed, both technologically and socially. The essay contained a ‘modest,’ albeit radical, proposal from Swift, wherein he tried to provide a rational solution to the problem of increasing population, scarcity, and poverty in his society under the British rule. Among Swift’s ‘modest proposals’ were the imposition of polygamy among humans, wherein â€Å"one Male [sic] will be sufficient to serve four Females,† and the practice of bearing children as Food, which he identified to be â€Å"very proper for Landlords. † These propositions provided a glimpse into the social problems Swift’s society experienced during his time, wherein poor governance, in order to be alleviated, was resolved through what Swift considered to be deviant and inhumane practices. Proposing these deviant and inhumane practices was a demonstration of the increased demoralization among the citizens of Swift’s society, a state which the author deemed to be too outrageous to be true but is actually occurring. Hence, in order to address these outrageous yet unconfronted social problems and issues, Swift’s essay generated the attention it deserved and warranted, therefore making the readers and the essay’s target audience aware of the social state at which their country found itself in. Swift’s essay, in effect, drove home the fact that in the midst of social progress and development, moral demoralization occurred as a consequence, defeating the purpose of development and progress in the society.

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