Population Growth in Perspective Essay -- Argumentative Persuasive Pap

Populace Growth in Perspective Presentation To anybody even remotely familiar with the circumstance, the ever-extending total populace can without much of a stretch be a reason for grave concern. In fact, the straightforward acknowledgment that the absolute total populace will in all probability be multiplying inside the following century may appear to suggest calamity. Considering the strain our present gigantic populace puts on the world, is it not regular to assume that multiple times our number will spell catastrophe? While this is the view held by numerous unmistakable voices, there additionally is a less-saw gathering of individuals who fight that the strength of the earth and the creativity of its kin will keep the planet a nice spot to live. In this paper, I endeavor to fundamentally look at different speculations on the size of future populace development and think about what as some of the potential aftereffects of this development may be. At long last, I presume that in spite of the fact that there are noteworthy advancement issues confronting the world because of the growing populace, the world is most likely not set out toward ruin. Current Population Awareness The emotional increments in total populace in the course of the most recent decades have not gone unnoticed. The media every now and again covers issues identified with populace development and control, making a great many people mindful of probably a portion of the conversations encompassing total populace. Numerous cultural issues, for example, ecological demolition, the spread of harmful infection, and starvation are conjecture because of the planet's expanding populace. Actually, overpopulation is regularly seen as the main danger to the world due to its wide going impacts. Here at Goshen, overpopulation is a well known point for Senior Seminar papers. Basically consistently, in any event one individual I... ...93 Bailey, Ronald. Ed. The True State of the Planet. Free Press, New York. 1995 Earthy colored, Lester and Kane, Hal. Full House. W.W. Norton and Company, New York. 1994 Cassen, Robert. Populace and Development: Old Debates, New Conclusions. Exchange Publishers, New Brunswick. 1994 Cohen, Joel. What number of People Can the Earth Support?. W.W. Norton and Company, New York. 1995 Ehrlich, Paul. The Population Bomb. Ballantine Books, New York. 1968 Holland, 1993, as cited in How Many People Can the Earth Support? Lutz, Wolfgang. The Future of World Population. Populace Reference Bureau, June, 1994 Spengler, J.J., as cited in Population: A Clash of Prophets, ed. Edward Pohlman. Guide Books, New York, 1973 That Population Explosion, TIME magazine, January 11, 1960 Internet webpage: Web 1: http://www.carnell.com.overpopulation.html

Capital Structure Theory Essay Essays

Capital Structure Theory Essay Essays Capital Structure Theory Essay Paper Capital Structure Theory Essay Paper At the point when an organizations obligation to-value proportion augments its worth and limits the organizations weighted normal expense of UAPITA (WAC), it is supposed to be at the objective or ideal capital structure. Obligation ordinarily offers a lower cost of capital in light of the capacity to deduct charge from Interest, however the companys chance Increases as obligation Increases. Part b. (Business Risk) Business chance alludes to the hazard brought upon the firm by its activities. This can be affected by numerous elements, for example, cost of creation, deals volume, unit value, rivalry, request, government guidelines, and so on. An organization with higher business hazard ought to work with a capital structure that has a lower obligation apportion to defend TTS investors by ensuring that it can meet the entirety of its money related commitments. A high business hazard implies a low obligation proportion while a low business chance implies that a firm may have the option to work with a high obligation proportion. Part c. (Activity Leverage) A firm that makes hardly any deals with deals giving a high gross edge is said to have high activity influence. Working influence is reliant on an organizations fixed and variable expenses. On the off chance that a firm has a high extent of fixed costs it has high activity influence instead of a firm with low fixed expenses and high factor throws which are unconsidered to have a low activity influence. A top of the line vehicle sales center has high working influence while a supermarket has low working influence. In a high working influence firm or Industry, determining Is Incredibly Important. A little mistake in determining could significantly harm the organizations BIT. The inverse can be said for a firm with a low working influence. A little blunder in estimating is acknowledged and anticipated. The mistake will have little impact on the organizations BIT. A Company with high activity influence should fund its tasks with a low measure of obligation to safeguard, n the instance of a misinterpretation, to ensure Its Investors. Business hazard and activity influence regularly go connected at the hip and are utilized to ascertain the organizations complete hazard on ROE. Part d. (Exchange Off Theory) The exchange off hypothesis expresses that there are advantages to obligation inside a capital structure up until the ideal, or target, capital structure. The hypothesis produces into results the expense shield made by intrigue installments. Intrigue installments on obligation are charge deductible making a tax reduction for obligation financing. A firm arrives at ideal capital structure when the minimal duty shield rises to the negligible liquidation costs. Chapter 11 expenses are ten Increased expenses AT Talking Witt EOT Instead AT Witt similarly which bring about a higher likelihood of insolvency. Hence, there is where the minor tax reductions equivalent the expense of financing with more obligation. Now, we see the organizations ideal capital structure. Part e. Hilter kilter Information and Signaling) Asymmetric data alludes to the acknowledgment that administrators have more and better data that outside financial specialists do. Flagging depends on an organizations activities and how it is safeguarded by its speculators. Self assured person lopsided data could lead gracious firm abruptly assuming more obligation or expanding thei r profit strategy. This would flag that the organization is going to encounter development or is at an experienced and stable state. Cynic topsy-turvy data could lead a firm to give increasingly stock since they perceive an up and coming misfortune. By giving increasingly stock, the misfortune could be spread over a bigger number of investors bringing about a littler misfortune for every offer. Financial specialists know this nonetheless and are vigilant when a firm issues progressively stock. In view of flagging, when a firm attempts to change their capital structure their financial specialists carry on in path coordinated by the sign given, regardless of whether that sign is exact or not. Part f. (WAC) WAC or weighted normal expense of capital is the organizations cost of capital with every class of capital weighted proportionately. The more obligation that organization utilizes, the higher the WAC. The higher the WAC, the higher the companys chance. When utilizing obligation, the WAC starts to fall, yet in the long run, the expenses of obligation and value will make WAC increment which will thusly make the estimation of the organization drop. This takes us back to the ideal or target capital structure, where the obligation to value Asia expands the organizations esteem. Part g. (Save Borrowing Capacity) Firms ought to be that as it may, utilize a lower obligation to value proportion than ideal capital structure proposes. The explanation being, that an open door may emerge where more assets are required. As recently talked about, the issue of progressively stock imparts a negative sign whether the sign is exact or not, however to give more obligation past the ideal capital structure proportion would diminish the organizations esteem which would likewise impart a negative sign. In this way, a firm ought to have a hold acquiring limit on account of such a chance. Part h. (Lucky chances) A fateful opening is a timeframe where a regularly inaccessible opening exists. A model is todays loan fees. The glimpses of daylight hypothesis recommend that since loan costs are so unusually low, presently is a decent time for organizations to give obligation. Despite what might be expected, when securities exchange costs are incredibly high, firms should give greater value. Part I. (Individual Application) It is absolutely critical that chiefs know and comprehend their organizations hazard and how it separates into activity influence and business chance. This may be dialed exclusively down their specific firm or off their industry all in all. Directors ought to likewise consider the advantage of deducting enthusiasm on obligation to use as an assessment shield. Supervisors should take the awry data hypothesis and motioning into thought. They ought to know about what certain activities sign and how they can abstain from imparting an inappropriate sign and use motioning furthering their potential benefit. The WAC ought to likewise be viewed as while deciding the organizations obligation to value proportion. They should realize that at one point, WAC will start to increment as now ten Tall Is Klan on an excess of EOT IT a company needs to make the most of AT a chance however doesn't have the assets important, they should give more obligation to take advantage. Hence administrators ought to have a hold acquiring limit and have a lower introductory obligation to value proportion than the ideal capital structure proposes. Administrators ought to likewise be vigilant and mindful of windows of chances in which they can expand the partnerships development. As should be obvious, there are numerous angles one needs to consider while deciding an organizations capital structure and this article just marginally starts to start to expose capital structure hypothesis.

Argument Essay Topics For Kids - Where to Find the Best Arguing Essay Topics For Kids

Argument Essay Topics For Kids - Where to Find the Best Arguing Essay Topics For KidsArguing Essay Topics for Kids - Where to Find the Best Arguing Essay Topics For Kids? When you're in college and you want to go about writing an essay about a controversial issue, the last thing you want to do is write in generalities.You'll be sure to lose points on this one. However, you may be able to win some by adding words and arguments to the debate. To help you decide where to get these ideas, here are some ideas that will help you select the best argument topics for kids.First, you can use the children's games as an example. You might be thinking about writing a paper on a life lesson in the old-time board games, but you might be a bit shy to write about an actual game. So, look at games and examples like monopoly, dominoes, or memory.Also, check out the subjects of things that have been used in past debates and find the arguement topic for that one. You could take a basic subject like the i ssue surrounding the American flag and turn it into a topic for argument. Take some issues surrounding the Bible and turn them into topics.For instance, taking the issue of whether animals should be considered humans and turning it into a topic would make a good argument topic for kids. You could talk about animals and how they are related to humans.Kids love to argue. You can give them a topic, and they'll have so much fun arguing about it that they'll forget that it's a real topic and you're not just making up arguments on the spot.Whenyou are selecting a subject for the argument topic, make sure that it's something that you can talk about well. They'll see this as an opportunity to debate, and they'll be learning at the same time.Using the subjects of board games or other hobbies to the advantages of kids and give them good arguments is something that is very helpful when it comes to essay topics for kids. Check out some board games and kids' hobbies, and you can easily get the s ubjects that are going to help your child out with an argument.

Effectiveness of school-based interventions - Free Essay Example

Sample details Pages: 26 Words: 7949 Downloads: 4 Date added: 2017/06/26 Category Statistics Essay Tags: School Essay Did you like this example? ABSTRACT Introduction Background Don’t waste time! Our writers will create an original "Effectiveness of school-based interventions" essay for you Create order Obesity in both adult and children is fast becoming one of the most serious public health problems of the 21st century in developed and developing countries alike. It is estimated that approximately 10% of school age children. The prevalence of childhood overweight and obesity is ever on the increase in the UK as in the rest of the world. It is estimated that the prevalence of overweight and obesity among 2 10 year old children in the UK rose from 22.7%-27.7% and 9.9%-13.7% respectively between 1995 and 2003; these figures are set to increase unless something is done. School-based interventions offer a possible solution in halting obesity prevalence, because the school setting provides an avenue for reaching out to a high percentage of children (especially in the western world), opportunity for constant monitoring of children and the resources for anti-obesity interventions. Objectives To systematically review the evidence of the impact of school-based interventions to prevent childhood obesity on: Adiposity (primary objective) Knowledge, physical activity levels and diet (secondary objectives) Methods The review was done following the Cochrane collaboration guidelines. In addition to searching electronic databases, first authors of all included studies were contacted. A recognised critical appraisal tool was used to assess the quality of included studies. Results Three RCTs and one CCT met the inclusion criteria for the review. All four studies had a control and intervention group; with various study limitations. While none of the studies found statistically significant BMI changes in intervention groups when compared with control group post-intervention, all of them recorded either a significant change in diet, or an increase in physical activity levels. INTRODUCTION BACKGROUND Obesity is generally understood as abnormal accumulation of fat to the extent that presents health risk (Kiess, Marcus et al. 2004), and was added to the international classification of diseases for the first time in 1948 (Kipping, Jago et al. 2008). The worldwide clinical definition of adult obesity by the WHO is body mass index (BMI) 30kg/m2 (WHO 2006). In children however, because of the significant changes in their BMI with age (Cole, Bellizzi et al. 2000), there is no universally accepted definition of obesity (Parizkova and Hills 2004; Bessesen 2008) and it therefore varies from country-to-country. The most commonly used definition of childhood obesity is the US definition which measures overweight and obesity in a reference population using the cut off points of 85th and 95th centiles of BMI for age (Ogden, Yanovski et al. 2007). In the UK, overweight and obesity are diagnosed using a national reference data from a 1990 BMI survey of British children (Stamatakis, Primatesta e t al. 2005). Children whose weights are above the 85th centile are classed as overweight and over the 95th centile are considered obese (Reilly, Wilson et al. 2002). Recent estimates suggest that obesity has reached epidemic proportions globally with about 400 million adults being clinically obese, a figure projected to rise to about 700 million by 2015 (WHO 2006). In children, the current WHO estimates are that about 22 million children globally under age 5 are overweight (WHO 2008). In the UK, evidence suggests that obesity is set to be the number one preventable cause of disease in a matter of time (Simon, Everitt et al. 2005). In the last three decades, the scale as well as the prevalence of obesity have grown rapidly amongst all age, social and ethnic groups in the UK, as well as globally (Table 1)(Kipping, Jago et al. 2008). Estimates suggest that in the UK, between 1984 and 2002/2003, the prevalence of obesity in boys aged 5-10 rose by 4.16%, and by 4.8% in girls (Stamatakis, Primatesta et al. 2005). There is therefore there is an urgent need for the development and implementation of effective intervention strategies to halt the ever increasing obesity prevalence (Summerbell Carolyn, Waters et al. 2005). OBESITY CAUSATION The primary risk factors associated with the increase in prevalence of childhood obesity are ever increasing involvement in sedentary lifestyles and an increase also in the consumption of high energy dense food and drink (Ebbeling, Pawlak et al. 2002; Sekine, Yamagami et al. 2002; Speiser, Rudolf et al. 2005; Topp, Jacks et al. 2009). The underlying mechanism of obesity formation is an imbalance between energy input and expenditure (Moran 1999; Kipping, Jago et al. 2008) Genetic and environmental factors greatly influence the bodys energy balance. Nevertheless, genetic conditions which either cause production of excessive fat in the body or reduce the rate at which it is broken down, of which Prader-Willi syndrome is an example account for less than 5% of obese individuals (Speiser, Rudolf et al. 2005), with environmental factors accounting for a very high percentage (French, Story et al. 2001). The major cause of the rising obesity problem is arguably changes in physical and social environments (French, Story et al. 2001). In recent times, there has been a remarkable shift towards activities that do not promote energy expenditure, for example, most children would travel to school in cars rather walk, in contrast to what obtained in the 1970s (Popkin, Duffey et al. 2005; Anderson and Butcher 2006). There is evidence to suggest that obese children are less active than their non-obese counterparts, hence promoting physical activity such as walking or exercising will help prevent obesity in children (Hughes, Henderson et al. 2006). Media time (television viewing, playing video games and using the computer) has been identified as one of the significant environmental changes responsible for the surge in childhood obesity. Besides promoting physical inactivity, it encourages energy input via excessive snacking and inappropriate food choices as a result of television advertisements (Ebbeling, Pawlak et al. 2002; Speiser, Rudolf et al. 2005). Robinson in his study reveals that between ages 2 and 17, children spend an average of 3 years of their waking lifetime watching television alone (Robinson 1998). Parents play a significant role in where, what and how much their children eat and to an extent, how physically active their children are. In most homes, children make their food choices based on the options they are presented with by their parents, and they characteristically would go for wrong option, more so if they have an obese parent (Strauss and Knight 1999). Other changes within the family such as physical inactivity and working patterns of parents have contributed somewhat to the obesity epidemic. In a family where the parents work full-time, there tends to be very little time for them to prepare wholesome home-made meals and this could possibly explain the increasing demand for eating out (Anderson and Butcher 2006) thereby increasing intake of high energy dense food. Childrens attitude to and participation in physical activities depends largely on how physically active their parents are. Thus children of sporty parents embrace exercise heartily and are therefore less prone to becoming obese.(Sallis, Prochaska et al. 2000). In addition to these family factors, societal factors such as high crime rate, access to safe sports/recreational facilities, transportation and fewer physical education programs in schools significantly impact on energy balance (Koplan, Liverman et al. 2005; Popkin, Duffey et al. 2005; Topp, Jacks et al. 2009). French summarizes the environmental influence on obesity by opining that The current epidemic of obesity is caused largely by an environment that promotes excessive food intake and discourages physical activity (French, Story et al. 2001) CONSEQUENCES OF OBESITY Evidence suggests that childhood obesity and/or overweight has a great impact on both physical and psychological health; causing effects such as behavioral problems and low self esteem, with a higher risk in girls than in boys (Reilly, Methven et al. 2003). Although most of the serious consequences do not become evident until adulthood, research has shown childhood obesity to be linked to metabolic disorders such as insulin resistance and type 2 diabetes, stroke and heart attacks, sleep apnea, nonalchoholic fatty liver disease, higher incidence of cancers, depression, dyslipidaemia, increased blood clotting tendency, etc (Ebbeling, Pawlak et al. 2002; Reilly, Methven et al. 2003; Kiess, Marcus et al. 2004; D. A. Lawlor, C. J. Riddoch et al. 2005; Daniels 2006; WHO 2006). One of the long-term serious consequences of childhood obesity is that obese children are twice more likely to grow into obese adults than their non-obese counterparts (Moran 1999); however, this largely depends on factors such as age of onset, severity of the disease and the presence of the disease in one parent (Moran 1999; Campbell, Waters et al. 2001; Kiess, Marcus et al. 2004; WHO 2006). Other long term consequences include early death and adverse socio-economic consequences such as poor educational attainment and low/no income in adulthood (Reilly, Methven et al. 2003; Fowler-Brown and Kahwati 2004; Kiess, Marcus et al. 2004). Obesity-related morbidity places a huge and growing financial demand on governments. In the UK alone, the Department of Health has reported that obesity costs the NHS and the UK economy as a whole about ÂÂ £1b and between ÂÂ £2.3b ÂÂ £2.6b annually respectively, with the cost to the NHS projected to rise to ÂÂ £3.6b by 2010 (DH 2007). TREATMENT AND PREVENTION The treatment of obesity requires a multidisciplinary approach due to the multi-faceted nature of the condition (Parizkova and Hills 2004). This is aimed at reducing caloric intake and increasing energy expenditure through physical activity (Ebbeling, Pawlak et al. 2002). These interventions are more likely to be successful if the patients family is involved and the treatment tailored to individual needs and circumstances (Fowler-Brown and Kahwati 2004). In extreme cases, options such as surgical and pharmacological treatments could be exploited. These options are very unpopular and usually not recommended because the associated health risks outweigh the benefits by far (Epstein, Myers et al. 1998; Ebbeling, Pawlak et al. 2002). Considering the huge costs and high levels of treatment failure associated with obesity treatment (Stewart, Chapple et al. 2008), the axiom by Benjamin Franklin cannot describe any other condition better than it describes obesity management. An ounce of prevention is worth a pound of cure Dietz et al confirm this by saying that prevention remains the best and most effective management of obesity (Dietz and Gortmaker 2001). Obesity prevention interventions are usually set either in the home or at school with an objective of eliminating peer pressure and, by so doing effect behavioral change (Ebbeling, Pawlak et al. 2002). Literature suggests that the school has so far remained the choice setting for these preventive interventions despite the very limited evidence on its effectiveness (Birch and Ventura 2009). Why is the school setting a good focus of intervention? Approximately 90% of children are enrolled in schools in developed countries (Baranowsk, Cullen et al. 2002) Children spend a substantial amount of time in school and therefore consume a considerable proportion of their daily calories at school (Katz, OConnell et al. 2005) School related activities present an opportunity to educate children on the concept of energy balance, healthy living and how to make appropriate food choices (Ebbeling, Pawlak et al. 2002; Koplan, Liverman et al. 2005) It offers opportunity for continuity and constant monitoring via frequent contact (Baranowski T 2002) Schools have an availability of existing manpower and facilities needed for anti-obesity interventions (Kropski, Keckley et al. 2008) In a nut shell, Schools offer many other opportunities for learning and practicing healthful eating and physical activity behaviors. Coordinated changes in the curriculum, the in-school advertising environment, school health services, and after-school programs all offer the potential to advance obesity prevention (Koplan, Liverman et al. 2005). PREVIOUS SYSTEMATIC REVIEWS Systematic reviews have been conducted on the effectiveness of school-based interventions in the prevention of childhood obesity. Campbell et al (2001), conducted a systematic review of 7 randomised control trials (RCTs) (6 were school-based, varying in length of time, target population, quality of study and intervention approach). The review found that dietary and physical education interventions have an effect on childhood obesity prevalence. However, success varied with different interventions amongst different age groups. Two of the three long term studies that focused on a combination of dietary education and physical activity, and dietary education respectively reported an effect on obesity prevalence reduction. Similarly, 1 out of the 3 school based short-term interventions that focused only on reducing sedentary activity also found an effect on obesity prevalence. While this review shows that dietary and physical activity interventions based at school are effective against th e risk factors of obesity, the question of generalisability and reproducibility arises as the review reports the majority of the included primary studies were carried out in the US. Most of the studies used BMI as a measure of adiposity, and BMI as has been documented varies across ethnic and racial groups (Rush, Goedecke et al. 2007), thus, it will be inappropriate to apply the findings of US-based obesity prevention interventions to children in middle and low income countries where conditions are different. There are also concerns about the methodology and study design. For example the school-based study by Gotmaker et al (1999) had limitations such as low participation rate (65%) and the researchers were unable to adjust for maturity in boys and there was also poor assessment of dietary intake. All these limitations could have been responsible for a high percentage of the reported intervention effect thus affecting the validity of the results of the study (Gortmaker, Peterson et al. 1999). The authors of the review however concluded that there is currently very limited high quality evidence on which to draw conclusions on the effectiveness of anti-obesity programmes. A Cochrane review which is an update of the Campbell et al (2001) study by Summerbell et al (2005) has examined the impact of diet, physical activity and/or lifestyle and social support on childhood obesity prevention. Their review examined the effectiveness of childhood obesity prevention interventions which included school based interventions. Their study included 10 long-term (a minimum duration of 12 months) and 12 short-term (12weeks 12 months) clinical trials (randomised and controlled). 19 out of the 22 studies that met their inclusion criteria were school/pre-school based. The study chose the appropriate study type; more than one reviewer was involved in the entire process of data collection, extraction and selection of included studies. In general, the study found that most of the school-based interventions (dietary and/or physical activity) reported some positive changes in targeted behaviours, but however had very little or no statistically significant impact on BMI. The reviewers stated that none of the 22 studies fulfilled the quality criteria because of some form of methodological weakness which includes measurement errors. For instance, the study by Jenner et al (1989) had no valid method of measuring food intake. The studies by Crawford et al (1994), Lannotti et al (1994) and Sallis et al (2000) had similar measurement errors. Reporting error was identified in studies by Little et al (1999) and Macdiarmid et al (1998). There were also reliability concerns about the secondary outcomes measurement in some of the included studies. The reviewers therefore expressed the need for further high quality research on effectiveness. Kropski et al (2008) reviewed 14 school-based studies that were designed to effect a life style change, a change in BMI, decrease overweight prevalence through a change in nutrition, physical activity or a combination of both. Of the 14 studies, three were done in the UK, one in Germany and 10 in the US. The right type of studies were chosen for this review and the whole process was done by more than one reviewer, however they were unable to draw strong conclusions on the efficacy of school-based interventions because of the limited number of primary studies available and methodological or design concerns which include: small sample size (Luepker, Perry et al. 1996; Mo-suwan, Pongprapai et al. 1998; Nader, Stone et al. 1999; Warren, Henry et al. 2003), no intention-to treat analysis (Danielzik, Pust et al.; Sallis, McKenzie et al. 1993; Sahota, Rudolf et al. 2001; Warren, Henry et al. 2003), possibility of type I (Coleman, Tiller et al. 2005) and type II errors (Warren, Henry et al. 2003), unit of analysis errors (Sallis, McKenzie et al. 1993) and inconsistent results (Mo-suwan, Pongprapai et al. 1998; Caballero, Clay et al. 2003; Coleman, Tiller et al. 2005). Despite their inability to draw a conclusion on effectiveness, overall, the review found that a combination of nutritional and physical activity interventions had the most effect on BMI and prevalence of overweight, with the result largely varying from community-to-community. The nutrition only and physical activity only interventions appeared to have had a change on lifestyles of participants but either had no significant effect on the measures of overweight or no BMI outcomes were measured. Another systematic review on the effectiveness of school-based interventions among Chinese school children was carried out by M.Li et al (2008). The authors included 22 primary studies in their review. The review reported that the primary studies showed that there are some beneficial effects of school-based interventions for obesity prevention; the reviewers however expressed their concerns that most of the studies included in the review had what they considered to be serious to moderate methodological weaknesses. Sixteen of the 22 studies included studies were cluster control trials, and there was no mention by any of the researchers that cluster analysis was applied to any of the 16 studies. In addition to lack of cluster analysis, no process evaluation was conducted in any of the studies. Only one study performed an intention to treat analysis. Twelve studies experienced dropouts, but there was incomplete information on the study population at the end of the trial and the reason f or the dropouts. Additionally, none of the studies explained the theory upon which they based their intervention. There was also potential recruitment and selection bias in all the primary studies as identified by the reviewers. They stated that none of the studies reported the number of subjects that were approached for recruitment into the study. As none of the RCTs included described the method they used in randomization, neither did they state if the studies were blinded or not. The methodological flaws in a high percentage of the included primary studies could impact on the validity of the findings of the review. Again, the authors failed to reach a conclusion on the effectiveness of the interventions because of the intrinsic weaknesses found in the primary studies, and as a result state the need for more primary studies that would address the methodological weaknesses that is highly present in nearly all existing primary studies conducted on this topic so far. The study of the efficacy of school-based interventions aimed at preventing childhood obesity or reducing the risk factors is a rather complex one. Pertinent issues on effectiveness of school-based interventions to prevent the risk factors of obesity remain that there is very limited/weak evidence on which to base policies on. Heterogeneity of primary research (in terms if age of study population, duration of intervention, measurement of outcomes and outcomes measured) makes further statistical analysis nearly impossible. BMI is currently the most widely used measure of overweight and obesity in children. However, BMI has no way of distinguishing between fat mass and muscle mass in the body and might therefore misdiagnose children with bigger muscles as obese. Another disadvantage of using BMI in overweight measurement is its inability of depicting the body fat composition (Committee on Nutrition 2003), other surrogate indicators of adiposity may be needed. Most authors that have carried out a review on this topic so far have expressed the need for further research on this topic to add to the existing body of evidence. RATIONALE FOR THIS STUDY All the systematic reviews on this subject so far have focused mainly on the United States. Lifestyle differences such as eating habits between American and British children possibly affect generalisability and reproducibility of US findings to the UK. For example, in the US, research has shown that 0.5% of all television advertisements promote food, and that about 72% of these food advertisements promote unhealthy food such as candy and fast food (Darwin 2009). In the UK paradoxically, the government in 2007 enforced regulations banning television advertisement of unhealthy foods (foods with high fat, salt, and sugar content) during television programmes aimed at children below 16 years of age (Darwin 2009). Thus US children are at a higher risk of becoming obese than their UK counterparts as a result of higher rate of exposure to TV junk food advertisements. Another lifestyle difference between American and British children is physical activity. In the UK, a high percentage of children aged 2 to 15 achieve at least 60 minutes of physical activity daily (about 70% of males and 60% of females) (DoH 2004), as opposed to the US where only about 34% of school pupils achieve the daily recommended levels of physical activity daily (CDC 2008). These differences highlight the importance of public health policies being based on the local population characteristics rather than on imported overseas figures. There is therefore need to review the evidence of UK school-based obesity interventions to inform policy relevant to the UK population. To the best of my knowledge following an extensive literature search, no systematic review has been conducted on the effectiveness of school-based intervention in preventing childhood obesity in the UK, despite the high prevalence of the condition and its public health significance in this country. This research aims to bridge this gap in knowledge by focusing on UK based studies to evaluate the efficacy of school-based interventions in the UK population. This study therefore stands out insofar as it will be assessing the effectiveness of school-based interventions in the reducing the risk factors of obesity in the UK, with a hope of providing specific local recommendations based on UK evidence. This type of review is long overdue in the UK, considering that the governments target to reduce childhood obesity to its pre-2000 levels by the year 2020 (DoH 2007) will require local evidence of effective interventions to succeed. The next stage of this review will describe in detail the research methodology to be used to conduct the proposed systematic review. Also included will be research strategy details to be adopted, study selection criteria, data collection and analysis. AIMS AND OBJECTIVES The aim of this research is to: Systematically review school-based intervention studies in the UK aimed at reducing the risk factors of childhood obesity among school children. Objectives are: To assess the efficacy of school-based anti-obesity interventions in the UK. To identify the most effective form of school-based interventions in the prevention of childhood obesity amongst school children in the UK. CRITERIA FOR INCLUDING STUDIES IN THIS REVIEW METHODS This review was performed as a Cochrane review. The Cochrane guidance on systematic reviews and reporting format were as far as possible adhered to by the author (Green, Higgins et al. 2008). The entire review process was guided by a tool for assessing the quality of systematic reviews, alongside the accompanying guidance (health-evidence.ca 2007a; health-evidence.ca 2007b). TYPES OF STUDY In the search for the effectiveness of an intervention, well conducted randomised control trials (which are the best and most credible sources of evidence) will be the preferred source of studies for this review. However, because of the limited number of RCTs conducted on this topic so far, this study will include controlled clinical trials if there is insufficient availability of RCTs. TYPES OF PARTICIPANTS School children under 18 years of age TYPES OF INTERVENTIONS Interventions being evaluated are those that aim to: Reduce sedentary lifestyle Effect nutritional change Combine the two outcomes above Reduce obesity prevalence Effect an attitude change towards physical activity and diet Studies that present a baseline and post intervention measure of primary outcome. Interventions not included in this study are: Those with no specified weight-related outcomes Those that involved school-age children but were delivered outside of the school setting, as our focus is based on school-based interventions aimed at obesity prevention. Studies done outside the UK Studies with no specified interventions Non-RCTs or CCTs For each intervention, the control group will be school children not receiving the intervention(s). TYPES OF OUTCOMES MEASURED Primary outcomes Change in adiposity measured as BMI and/or skin fold thickness Secondary outcomes Knowledge Physical activity levels Diet SEARCH METHODS FOR IDENTIFICATION OF STUDIES Electronic searches The electronic databases OVID MEDLINEÂÂ ® (1950-2009), PsycINFO (1982-2009), EMBASE (1980-2009) and the British Nursing Index (1994-2009) were all searched using the OVID SP interface. The Wiley Interscience interface was used to search the following databases: Cochrane Central Register of Controlled Trials and Database of Abstracts of Reviews of Effects. There was also a general search of internet using Google search engine, in an attempt to identify any ongoing studies or unpublished reports before proceeding to search grey literature sources. Grey literature For references to childhood obesity prevention in schools, the following grey literature sources were searched: British Library Integrated Catalogue (https://catalogue.bl.uk/F/?func=filefile_name=login-bl-list) ISI index of Conference Proceedings (https://wok.mimas.ac.uk/) SCIRUS (https://www.scirus.com/) System for Information on Grey Literature (https://opensigle.inist.fr/) ZETOC (https://zetoc.mimas.ac.uk) Additionally, current control trials database at https://www.controlled-trials.com/ was searched for any ongoing research. The UK national research register was also searched at https://portal.nihr.ac.uk/Pages/NRRArchive.aspx. All the links to the grey literature databases were tested at the time of this review and found to be working. Hand searches It was not possible to conduct a hand search of journals due to pragmatic reasons. Reference lists Reference lists of retrieved studies were searched for other potential relevant studies that might have been omitted in the earlier search. Correspondence First author of all included studies were contacted with a view to seeking more references. DATA COLLECTION AND ANALYSIS Selection of studies The abstracts and titles of the hits from the electronic databases searched were screened for relevance by a single assessor. Those that were thought to be potentially relevant were retrieved and downloaded unto EndnoteTM to make the results manageable and also avoid loss of data. At the end of the search, all databases were merged into one single database and duplicated records of the same study were removed. Subsequently, the assessor then sought and obtained the full text of, and reviewed the relevant studies that were considered eligible for inclusion. Multiple reports of same study were linked together. No further data were sought for studies not included in the review. Data extraction Data extraction from included studies was done by a single reviewer and the data recorded on a data extraction form. A summary of each included study was described according to these characteristics: Participants (age, ethnicity etc.), study design, description of school-based interventions, study quality and details such as follow-ups and date, location, outcomes measured, theoretical framework, baseline comparability and results Assessment of methodological quality of included studies A number of researchers (Jackson, Waters et al. 2005) and the Cochrane guidelines for systematic reviews of health promotion and public health interventions (Rebecca Armstrong, Waters et al. 2007) strongly advise using the Quality Assessment Tool for Quantitative Studies (2008a) developed by the Effective Public Health Practice Project in Canada and the accompanying dictionary (to act as a guideline) (2008b) in assessing methodological quality. Based on criteria such as selection bias, study design, blinding, cofounders, data collection methods, withdrawals and drop-outs and intervention integrity, the tool which is designed to cover any quantitative study employs the use of a scale (strong, moderate or weak) to assess the quality of each study included in the review. Analysis Considering the small number of studies included in the review and heterogeneity in terms of interventions, delivery methods, intensity of interventions, age of participants, duration of intervention and outcomes measured, it was not statistically appropriate to undertake a Meta analysis, which admittedly would have been the preferred method of analysing and summarising the results of the studies. A narrative synthesis of the results was done instead. RESULT DESCRIPTION OF STUDIES Results of the search The search of electronic sources identified 811 citations out of which 97 potential studies were retrieved. A reference management software EndnoteTM was used to search for and remove duplicate citations. Further screening of title and abstract reduced the number of citations to 17 potential studies. Full texts of the 17 studies were sought, 13 were excluded, and four met the inclusion criteria and were therefore included in the review. Authors of the four studies were then contacted in view to obtaining additional references. No relevant papers were retrieved through the grey literature search. There were no ongoing studies at the time of this review Included studies Four school based intervention studies carried out in the UK were included in the review. Intervention The aim of the Active Programme Promoting Lifestyle Education in Schools (APPLES) project in Leeds (Sahota, Rudolf et al. 2001), a multidisciplinary and multiagency programme was to reduce risk factors of obesity in primary schools by influencing dietary and physical activity behaviour, by promoting lifestyle education. The intervention was underpinned by the Health Promoting Schools philosophy and involved the whole school community including parents. In the Southwest of England, the Christ Church Obesity Prevention Programme (CHOPPS) (James, Thomas et al. 2004) aimed to prevent excess weight gain by discouraging the consumption of carbonated drinks amongst school children. On the other hand, a pilot study, the Active for life year 5 project in the South Gloucestershire aimed to examine the effects of lessons on physical activity, nutrition and screen viewing on time spent involving in sedentary activities. It also evaluated the feasibility of adapting lessons from a US intervention (Eat well and keep moving) for use in the UK. Fourthly, the aims of the Be Smart intervention in Oxford were to promote healthy diet and/or physical activity in school children and prevent childhood obesity. The development of this intervention was based on the Social Learning Theory. The four intervention programmes employed various media for the delivery of the interventions. The APPLES intervention, over one academic year in September 1996 to July 1997 targeted obesity by promoting healthy eating and physical activity via the school curriculum. The intervention was a multidisciplinary and multiagency programme that embarked on teacher training sessions, modification of school meals to exclude unhealthy foods, and the development of school action plans. Whilst the intervention group received this intervention, the comparison received no intervention. One of the two school based intervention project to involve parents was conducted in Oxford. The Be Smart intervention began in January 2000 and lasted for 20 weeks over four school terms. The intervention involved delivering a 25-minuite interactive and age-appropriate lesson to each intervention group at lunch-time clubs and targeted behavioural change. Four of the authors were involved in the delivery of the lessons, which was delivered weekly in term one and fortnightly in subsequent terms. To ensure continuity, the same author taught the same intervention to the same intervention group for the entire duration of the project. In South Gloucestershire, the Active for life year 5 intervention was conducted over a five-month period from February 2006 to June 2006. This intervention was a multi-component one which was adapted from the Eat Well Keep Moving project in the US. It involved delivering of interactive lessons on nutrition, physical activity and screen viewing by trained primary school teachers. Lastly, the CHOPPS intervention lasted for one school year from August 2001 to October 2002. The intervention was delivered by one of the authors, and was targeted at behavioural change by discouraging the consumption of carbonated drinks. Each class received a one-hour session each term. The first session focused on balance of good health and the ill-effects of carbonated drinks. The subsequent sessions comprised of music competition, presentation of art and a quiz based on a popular television game show. Study design All the four studies had RCT designs. However, the Be smart project (Warren, Henry et al. 2003) did not specify how randomisation was done. All programmes had an intervention and a control group for baseline and post-intervention comparison. The APPLES project (Sahota, Rudolf et al. 2001) was single-blinded and compared outcomes in primary school children aged 7-11 years in Leeds (intervention: n = 314, and control group: n = 322, Boys: 51% and girls: 49%) at baseline and at the end of the intervention. Evaluating outcomes in a slightly similar age group, the Active for Life Year 5 project, a double-blinded cluster RCT compared outcomes in 9-10 year old primary school children in SW England [Intervention schools = 10 clusters (n = 331), control = 9 clusters (n = 348)]. In Oxford, the Be Smart project (Warren, Henry et al. 2003) evaluated its intervention in 5-7 year old school children via a group RCT. There were 3 intervention groups (Eat smart: n = 56, Play smart: n = 54 and Play/E at Smart: n = 54) and a control group (Be Smart: n = 54). Finally, the CHOPPS (James, Thomas et al. 2004) project in SW England was a cluster RCT that assessed its intervention in 7-11 year old school children. There were a total of 19 clusters in the study [Intervention: 15 clusters (n=325); Boys: 169, Girls: 156, and control: 14 clusters (n = 319); Boys: 155, Girls: 164. Outcomes In all the four studies, the effect of the intervention was assessed by collecting the data on growth, measured in terms of BMI (height and weight). There was repeat measure of height and weight in all four studies at baseline, and at the end of the study for Active for life year 5 (Kipping, Payne et al. 2008), APPLES (Sahota, Rudolf et al. 2001) and CHOPPS interventions (James, Thomas et al. 2004). For the Be smart intervention, the repeat measure was taken a month post-intervention (Warren, Henry et al. 2003). Besides weight and height, the individual studies assessed other different outcomes. The Active for life year 5 intervention assessed time spent doing screen-viewing activities (Watching DVDs, television, Videos and playing computer games) and mode of transport to school using questionnaires completed by the children (at baseline and at the end of the study). The APPLES interventions additionally assessed the childrens diet (using a 24hour recall and 3-day food diaries), their knowledge on nutrition and physical activity (via focus group), their psychological state and how physical activity they are (both using questionnaires). In SW England, the CHOPPS project in addition to height and weight assessment, consumption of carbonated drink and water were also assessed (using 3-day diaries completed by the children). Nutrition knowledge, physical activity and diets were also assessed using questionnaires in the Be smart intervention in Oxford. Excluded studies Thirteen published studies were excluded from this review. The reasons for excluding these studies are provided in Appendix 5 and include location (studies carried out outside the UK) and study design (non-RCTs or CCTs). Methodological quality of included studies In terms of overall quality, one of the four included studies has been rated as strong (James, Thomas et al. 2004), two as moderate (Sahota, Rudolf et al. 2001; Kipping, Payne et al. 2008) and one as weak (Warren, Henry et al. 2003). Three of the four studies had cluster RCT study designs (Sahota, Rudolf et al. 2001; James, Thomas et al. 2004; Kipping, Payne et al. 2008) whilst one had a CCT design (Warren, Henry et al. 2003). Of the three RCTs, only one reported blinding of both participants and assessors (Kipping, Payne et al. 2008). Number of participants in all four studies ranged from 213 to 679 school children, and all studies reported follow-up of up to at least 80% of participants. In terms of cofounding, all four included studies reported that there were no significant baseline differences between the intervention and control groups, and as such rated were rated as strong (Sahota, Rudolf et al. 2001; Warren, Henry et al. 2003; James, Thomas et al. 2004; Kipping, Payne et al. 2008). Validity and reliability of data collection tools were addressed by all four studies, with a few of them identifying issues with validity. Collection tools used for height and weight in all four studies were reliable and valid. However, there were a few validity issues with the questionnaires used for assessing other outcomes such as physical activity and dietary intake. For example, the Active for Life Year 5 project expressed concerns that the questionnaires used for assessing physical activity though reliable, might not have been sufficiently valid (Kipping, Payne et al. 2008). Similarly, in the CHOPPS intervention, there were issues around validity of self collected diary data owing to the possibility of under-reporting by the children (James, Thomas et al. 2004). Again in the APPLES intervention project, problems with dietary and behaviour change assessments were reported (Sahota, Rudolf et al. 2001) Effects of interventions Only one of the four studies compared effectiveness of different types of school based interventions (Warren, Henry et al. 2003). Adiposity Only two of the four studies measured adiposity using indices other than BMI. The Be smart programme (Warren, Henry et al. 2003) measured skin-fold thickness at five sites using a Holtain skinfold calipers. Waist circumferences were also measured at four sites using a standard tape measure. However, there was no comparison either at baseline or post intervention of adiposity between the intervention and control groups using these measures. Similarly, the CHOPPS programme (James, Thomas et al. 2004) measured waist circumference at the point of flexure as the child bends to one side (deducting 1cm to account for clothing). The scores were converted to z scores and comparisons were made between the intervention and control groups. However, no significant changes were observed. BMI All four studies reported results for BMI in terms of height and weight, and found no significant differences between control and intervention groups at the end of the studies (Sahota, Rudolf et al. 2001; Warren, Henry et al. 2003; James, Thomas et al. 2004; Kipping, Payne et al. 2008). Height and weight measurements were taken using standardised measurement tools in all four studies. Although all the studies reported no significant BMI differences, in terms of the number of overweight children, the CHOPPS intervention (James, Thomas et al. 2004) recorded a 7.5% increase in number of overweight children in the control clusters, compared with a 0.2% decrease in the intervention group (Mean difference 7.7%, 95% CI: 2.2% to 13.1%) at 12 months. At three-year follow-up however, the prevalence of overweight had increased in all the groups (intervention and control), which meant that the significant difference previously recorded at the end of the study was no longer evident. Knowledge Two of the four studies assessed the childrens knowledge about physical and nutritional education at baseline and post intervention. The Be smart intervention(Warren, Henry et al. 2003) assessed nutrition knowledge using a questionnaire where children were shown pictorial representations of different kinds of food and asked to choose the one they thought was healthiest. The end of study analysis showed an increase in nutrition knowledge in both control and intervention groups when compared to the initial stages (p0.01, p0.001). Although unquantifiable, the APPLES programme (Sahota, Rudolf et al. 2001) through a focus group discussion found that when compared to the control group, children in the intervention group had a greater understanding of the health benefits of staying active and healthy eating and were also more able to recall all most of the lessons they were taught during the intervention. Diet Dietary intake was assessed by three of the four studies (Sahota, Rudolf et al. 2001; Warren, Henry et al. 2003; James, Thomas et al. 2004). Sahota 2001, assessed dietary intake using a 24hour recall (using a checklist, where children were required to tick the foods eaten from a list of possible foods) and a free form three day food diary. At the end of the study, an analysis of the 24hour recall showed a 50% increase in vegetable consumption amongst intervention children when compared to the control group (weighted mean difference of 0.3, 95% CI 0.2 to 0.4). However, the three day diary did not show any significant difference; possibly because of the low completion rate of the food diaries. The Be smart intervention (Warren, Henry et al. 2003) similarly reported an overall increase in vegetable (p0.05) and fruit (p0.01) consumption, with no significant differences between the control and intervention groups or genders at baseline or final stage. Intervention group analysis showed that the Eat smart and Be smart groups recorded a significant increase (p0.05) in fruit and vegetable consumption when compared to the other intervention groups. A significant increase in fresh fruit consumption was recorded amongst males (p0.01) when compared to females. No significant changes in consumption of foods high in fat were observed amongst the groups. The CHOPPS intervention (James, Thomas et al. 2004) measured change in diet by assessing the childrens consumption of carbonated drinks using a three day diary. The children were required to record their carbonated drink consumption over two weekdays and one weekend day in a diary. At the end of the study, an analysis of the carbonated drink diaries showed a reduction in the consumption of carbonated drinks in the intervention group compared with the control group (mean difference 0.7 95% CI: 0.1 to 1.3). There was also an increase in water consumption in both the control and intervention groups, but no significant difference between the two groups was recorded. Physical activity levels The Active for life year 5 programme measured physical activity levels by assessing mode of transportation to school and time spent on screen-viewing activities (Kipping, Payne et al. 2008). A questionnaire about the length of time spent of screen-viewing activities (watching televisions, DVDs or playing computer games) was given to the children to complete. The end of study analysis revealed that although the children from intervention groups spent less time on screen- viewing activities when compared to children from the control group, however, the differences between the two groups did not reach a statistically significant level (mean difference at the end of intervention between the two groups adjusted for clustering and baseline: -11.6 minutes, 95% CI: -42.7 to 19.4 for weekday and -15.4 minutes 95% CI: -57.5 to 26.8 for Saturday). The study also found that at the end of the study, children from the control school had higher odds of walking/cycling to school (after adjusting for baseline difference). Similarly, the Be smart intervention (Warren, Henry et al. 2003) assessed physical activity patterns rather than levels by asking the children questions about their mode of transport to school, and activities they undertake a break times. Questionnaires about how physically active the children are after official school hours were issued to their parents to complete. Information on the parental questionnaire included the frequency and duration of their childs habitual attendance of after-school clubs, screen-viewing activities and outdoor play. The post intervention analysis of the questionnaires revealed a slight increase in the number of children that walked to and fro school in both intervention and control groups. For playground activity, an increase was also recorded in all groups, with a higher increase in all intervention groups when compared with the control groups. Overall, there was no significant gender difference in playground activities at either baseline or post interven tion. Similarly, the parental questionnaires reported no intervention effect on activity levels after school hours. The APPLES intervention (Sahota, Rudolf et al. 2001) used a questionnaire to measure physical activity levels and sedentary behaviour in the children. The questionnaire was categorised by how frequent the children were involved in outdoor sporting activities such as swimming and frequency of sedentary activity such as watching television, in the past 24 hours. An analysis of the questionnaires showed no significant difference in physical activity levels in the intervention and control groups. What it however showed, was a 33.3% increase in sedentary activity in overweight children in the intervention group. DISCUSSION Summary and discussion of main results None of the four included studies reported significant short-term changes in BMI at baseline and post intervention. The fact that no significant BMI changes were detected does not in any way imply evidence of ineffectiveness. Possibilities are that small sample/unit sizes and short intervention duration (in all included studies) might have resulted in the inability to detect any weight/height changes. Previous school based intervention studies that have reported significant anthropometric changes in school children both lasted for a minimum duration of two years (Dwyer, Coonan et al. 1983; Gortmaker, Peterson et al. 1999); which is a reasonable time frame to expect any anthropometric changes. Despite the lack of significant anthropometric changes, changes were reported for some other outcomes measured in the primary studies. There was a modest increase in vegetable and fruit consumption in two of the studies (Sahota, Rudolf et al. 2001; James, Thomas et al. 2004). Also a significant reduction in the consumption of carbonated drinks and an increase in water consumption were reported in the CHOPPS project. Although the changes did not reach significant levels, the Active for life year 5 intervention reported a reduction in the time spent on screen viewing activities in the intervention group when compared to the control group. Quality of the evidence Given that this study is a review of intervention effects, the study designs of the included studies were the appropriate types to answer the study question. In terms of global rating, one study was rated as strong, two as moderate and one as weak. However, some caution is required in interpreting findings from this review as all of the studies had some limitations such as small sample/unit sizes and issues around concealment. All these may have introduced a possible systematic measurement bias. Another major issue with all the studies was the short intervention duration. Considering that all the studies measured change in adiposity in terms of weight and height, realistically, it takes a considerable length of time to actually notice a change in either weight or height following an intervention. This shortcoming may have possibly made statistically significant changes difficult to detect. Potential biases in the review process The guidance in Cochrane Handbook for Systematic Reviews of interventions (Higgins and Green 2008) was followed throughout the review process as far as possible. A quality assessment tool for assessing methodological quality of systematic reviews (health-evidence.ca 2007a; health-evidence.ca 2007b) was used in this review to assess the quality of included studies. Judging by the principles set in these resources, a number of potential limitations have been identified in this review. Firstly, in order to minimise errors, limit bias and improve reliability of findings, the Cochrane guidance recommends that key steps of a systematic reviews such as selection of studies and data extraction should be undertaken by more than one reviewer. This was however not possible due to the nature of this piece of work. Although there is strong evidence that RCT is the least bias estimate of effect size (Campbell, Waters et al. 2001) and the preferred method for estimating the effectiveness of interventions (Stephenson and Imrie 1998), there is still a lot of debate around its usefulness in assessing the effectiveness of lifestyle and behavioural interventions (Campbell, Waters et al. 2001). Nevertheless, a majority of the studies included in the review have Randomised controlled trial designs. During the search for studies, efforts were made to comprehensively search all relevant sources such as RCT register and social science databases. Additionally, firs authors of all included studies were contacted. Grey literature sources were also searched. Despite these efforts, it is possible that hand searching of key journals may have identified additional potentially relevant studies. No language restriction was imposed during the search, and as such, no potentially relevant studies were excluded on a language basis. Agreements and disagreements with other studies or reviews AUTHORSS CONCLUSION Implications for practice Despite the need for more research identified by this review, some evidence that school based interventions could have some positive impact on lifestyle behaviours that places children at risk of becoming obese was also found. Although positive effects in terms of adiposity were not shown, no harmful effects of the interventions were shown either. School based anti-obesity interventions should therefore be promoted by local public health authorities and encouraged by schools for long term prevention of obesity and its associated adverse health effects. Considering that children do not have any say at home in terms of purchasing food, involving parents actively in school based interventions could produce a sustained positive effect on children outside of the school setting. Although the study concludes that there is insufficient evidence on the efficacy of school based intervention in preventing childhood obesity, this does not mean evidence of ineffectiveness of these interventions. Given that some positive changes were reported in all the included studies, promotion of school based anti-obesity interventions is greatly encouraged at this time, as these interventions have demonstrated the potential to be beneficial on the long run. Implications for research

The Suicide Act - Free Essay Example

Sample details Pages: 11 Words: 3170 Downloads: 7 Date added: 2017/06/26 Category Law Essay Type Analytical essay Tags: Act Essay Suicide Essay Did you like this example? Critically assess whether the Suicide Act 1961 should be amended to permit physician assisted suicide. The Suicide Act 1961 amended the law of England and wales and professed that the act of suicide is not a criminal offence. However, section 2(1) of the current legislation makes it a statutory offence to â€Å"aid, abet or counsel or procure the suicide of another.†[1] Thus the criminal act carries a sentence of up to fourteen years imprisonment for assisting another to commit suicide. This subsection of the legislation commonly relates and incorporates to all cases of assisted suicide including Physician assisted suicide (PAS). Don’t waste time! Our writers will create an original "The Suicide Act" essay for you Create order Nevertheless there has been a myriad of efforts to legalise PAS; commonly, by means of private members’ bill in the House of Lords however none have been successful yet. Lord Joffe, a prominent supporter of PAS, proposed the ‘Assisted Dying for the Terminally Ill Bill’ three times, in order to provide the opportunity of PAS to individuals who were critically ill, however the possibility for the current legislation to be amended was opposed in 2006 by 148 votes to 100[2]. However, whether the Suicide Act should be reformed to permit PAS has proven to be somewhat stimulating to many legal theorists and contemporary academics for decades. The term ‘Physician Assisted Suicide’ relates to a circumstance by which a physician intentionally provides a treatment to a knowledgeable and capable patient on her or his request. Even though in the case of such an event, the means to the death of the individual is self-administered, the physician’s role as an agent is in breach of s.2 of the Suicide Act 1961.[3] Nevertheless the American and European jurisdictions share common principles regarding such instances, which insinuate that PAS is considered to be a moral wrong and an offence of criminal nature on a universal scale.[4] Currently, there have been prominent legal proceedings in America and Canada in pursuit of challenging the ‘universal belief’ that PAS is a criminal offence. According to the factual and moral assessments of PAS alongside further cases in the medical field, the patient’s death has a correlation with the Actus Reus or omission executed by the physician. In cases as such, it is clear that the position of human rights’ jurisprudence[5] in regards to medical law is somewhat controversial, thus prompting the need for the current legislation of PAS in the UK to reform. Prior to legalising PAS, some would argue that ethical and religious grounds should be taken into account. For instance a common ethical concept whereby many emphasise moral significance to PAS, is the fact that it does not directly kill the patient and the patient is simply assisted. However, In Williams’ ‘Intention and Causation in Medical Non-Killing’[6], Williams argues that in both instances physicians are inducing the means to death. Furthermore, she puts forward an oblique alternative; the formation of an identifiable offence in which she calls a ‘medical mercy- killing’ whereby the particular circumstance, intention and the patient’s consent should be considered equally. Williams draws attention to the differences between an omission and an act in relation to the execution of PAS. Nevertheless she maintains that such terms should not be manipulated because it could â€Å"absolve medical professionals from criminal liability.†[7] According to Williams, the law makers are culpable of interpreting a physician’s withdrawal of an effective tre atment from the patient as â€Å"falling outside the general legal prohibition against deliberate active killing†[8]; therefore the withdrawal of the beneficial treatment is not merely an omission but could be perceived as a criminal offence as death is an immediate result. Thus Williams is concerned that the classification and depiction of an ‘omission’ and an ‘act’, â€Å"rules out the signià ¯Ã‚ ¬Ãƒâ€šÃ‚ cance of intention and causation from those activities perceived to be omissions.†[9] Albeit an omission is a concept in criminal law which concerns the Actus Reus of a crime and not the ‘intention’, In the case of Airedale Trust v Bland[10] the House of Lords did acknowledge that the physician intended to withdraw the feeding tube to end the life of his suffering patient. However in regards to the case, It is worthy of note that the law permits an omission leading to the patient’s death whereby the patient has given c onsent to discontinue the treatment. Furthermore, the law also enforces upon the fact that the court’s approval is needed if the patient is in a ‘Permanent Vegetative State’. Therefore one could culminate that if a physician can in fact omit to giving treatment then in this specific context, the Suicide Act should be amended to permit PAS. However, the amendment of the Suicide Act could possibly undermine some ethical and religious principles. The sanctity of human life is a fundamental moral argument against PAS which upholds ethical principles. The notion that life is sacred is indeed an issue raised in the Assisted Dying for the Terminally Ill Bill; â€Å"life is God-given and cannot in consequence be terminated by others, even on request.†[11] Hence this ethical concept puts forward the argument that every individual deserves to be valued irrespective of the pain or experience that they are going through, as the human life is an indispensable good a nd not to be treated as a means to an end. Thus this concept forbids the killing of a patient since it’s not a legitimate defence. Nevertheless, atheists and other non-classical theists maintain that there is also a secularist approach of the concept of sanctity of life. For instance, Professor Glover defined the principle as â€Å"an absolute barrier, an absolute ban, not derived from a religious source on the intentional taking of innocent human life†[12] in which he understood to be similar to the religious and moral concept. Indeed the sanctity of human life seems to be a universal concept, therefore it highlights the possibility of a wide scale opposition if PAS is legalised. Furthermore in the Bill, Rev Gill supported the idea that the amendment of the act could result in a national upheaval, he maintained that â€Å"to secular people life is still given, it is given by the people; you did not invent your life. Human life is in that sense special and to be treat ed with carewhether we are religious or not.†[13] Indeed, the sanctity of human life seems to be a polemic issue in regards to the moral and religious sphere within society. Therefore if the majority of the population consider that there is a moral duty to uphold the sacredness of life, then the legalisation of PAS could possibly lead to a social upheaval. Nonetheless, it can be perceived that the sanctity of human life affects the underlying choices that concern the human autonomy. The fundamental concept of autonomy is the right for an individual to define the boundaries that define his life. To the dogma of justice, the value for the patient’s autonomy is regarded as essential to those would like the Suicide Act to be amended to permit PAS. In some instances an individual is incapable of taking their own life; therefore the need for medical expertise of a physician in order to die painlessly is necessary. In the case of Pretty[14], it was maintained that Pretty ha d the ‘right to life’ due to the fact that in Article 2 of the ECHR[15], â€Å"Everyones right to life shall be protected by law. No one shall be deprived of his life intentionally†. [16] Thus she argued that the Courts should not repudiate her husband’s assistance in her pursuit to die as the Article protects her liberties but also the ‘right to life’. The Article seemed to recognise that individuals like Pretty could choose whether to end their life. In regards to this case, it can be argued that a consenting patient should have the freedom to choose whether a physician shall assist them to die. Nonetheless, Richard Posner takes a pragmatic view in relation to the human autonomy; he maintains that â€Å"A prohibition against assisting suicide cannot be justified on this ground in cases in which the person who wants to end his life is incapable of doing so without assistance†.[17] Hence, in exceptional situations, the sanctity of human life seems to act as an impediment to individuals like Pretty because her autonomy is somewhat appropriated.[18] Therefore, by legalising PAS individuals’ are treated as autonomous persons, thus the freedom of choice to die in dignity is valued and respected. However, without strict guidelines and safeguards, legalising PAS could lead to many complicated problems. In some instances, the principle of autonomy undermines the sanctity of human life as autonomy is not regarded as a moral absolute. It is significant to measure the individual’s freedom against what is rational because the principle of autonomy has no universal grounds due to its subjectivity. For instance, Kant maintains that rational agents should be treated as an end to themselves due to religious beliefs that the human body belongs to a divine being, therefore a â€Å"Man cannot have the power to dispose of his life.†[19] Hence, Kant lays great importance on rationality over prima facie obligat ions. However, according to the Utilitarian theory, an outcome or motive should benefit the majority without the interference of one’s beliefs or moral standards because every action should apply to â€Å"the greatest good for the greatest number of people†.[20] Even though Kant highly values the human autonomy he considers the duty to be a rational act because an individual should be well informed about the medical procedure in order to be able to base a decision on a universal principle (‘thou shalt not kill’) and not on their self-interest. It is worthy of note that human life is also a fundamental good as opposed to an instrumental good, hence being a value in itself than a means to an end. Albeit the concept of sanctity of life values human life and reinforces a physician’s duty of care to the patient, the Law makers should focus on a moral concept whereby the majority will be able to relate to and comprehend. Indeed, if the principle of autono my is a universally accepted concept amongst members of this society then PAS should be permitted because the theory respects the notion that every individual deserves the right to life and the right to die. Nevertheless there are practical arguments which expose the complication which could arise if the act is to be amended to permit PAS. The concept of slippery slope suggests that by permitting PAS, physicians will gradually move away from the standards and principles which they are supposed to uphold, thus inevitably leading to involuntary PAS. For instance, in places where PAS is legal, such as in the Netherlands, it has been documented that â€Å"†¦only 53 percent of these cases did the patient ever express interest in receiving euthanasia.† [21] Certainly, it is clear that if PAS is legalised, the chances of involuntary PAS is far more than likely. In support of this contention, in Dr Ezekiel’s critical essay he reports that in â€Å"15 percent of euthan asia cases, patients were not involved in the decision to end their lives, sometimes even when they were competent†. [22] As a result, it is empirical that PAS could be practised regardless of the patients consent. It is even more deplorable that such instances occur when the action is illegal and the penalties are of such severity in the Netherlands, with persistent claims of â€Å"explicit and established safeguards† [23] exempting involuntary PAS. To an extent, the slippery slope argument highlights prevalent problems that society would have to deal with if the suicide act is amended to legalise PAS. However, many have criticised the slippery slope as a fallacy because it makes an assumptive leap to an irrational conclusion. Almagore suggests that if specific guidelines and safeguards are set in place then PAS would benefit those who are in palliative care and terminally ill.[24] Nonetheless, in his discussion he outlines the dangers of permitting PAS. Almagore eluci dates that PAS should be practised by experienced physicians who have known the patient for a long period of time otherwise physician’s will be guilty of making irrational judgements on cases ; he uses the example of Dr Kevorkian who assisted; â€Å"44 people in one state; 15 who were terminally ill and 29 who suffered from chronic conditions†.[25] From this study, one can easily draw attention to the dangerous consequences of PAS if the law is amended to permit it without any effective safeguards. Not only does the slippery slope argument highlight the correlation of voluntary and involuntary PAS, but it also accentuates the degree of risk to vulnerable patients. Such lives could inevitably be ended against their autonomy and when there are alternative methods to relieve suffering, it could be more expensive than the administration of the drug. For instance, according to Almagore, Kevorkian was â€Å"unqualified and was disinterested in examining patients and exam ining their cause of illness and assisted those who were misdiagnosed.†[26] Permitting PAS would therefore result in some Physicians favouring other pain relieving and cost effective factors. In addition to the slippery slope argument, as well as addressing issues such as the disrespect, degradation and contempt of the value of human life, it also focuses on concerns surrounding the efficiency on both cost and time. In relation to the economic analysis regarding the creation of such legislation, the Kaldor-Hicks efficiency[27] illustrates that PAS maximises wealth as it releases beds in hospitals and reduces the government’s spending on palliative care and medication for terminally ill patients, thus generating greater net benefits. However, the Pareto efficiency theory insinuates that PAS does not necessarily make one party better off[28] as there is a ‘Pareto optimal’ allocation of recourses. The outcome of the action executed by the physician is sufficie nt as there is an equally sufficient compensation and also improves the welfare of the state without the deprivation of the other. These theories of efficiency are certainly hard to apply since involuntary PAS would not be Pareto efficient or moral as there is an exclusive focus on generating greater net benefits for the majority. Therefore, the slippery slope argument is indubitably sound because if the legislatures take a Kaldor-Hicks approach then surely involuntary PAS would to some length become a reasonable means. Indeed the Assisted Dying for the Terminally Ill Bill was determined on permitting assisted suicide only with the facilitation of a Physician, it was somewhat clear based on evidence that other states carried out involuntary assisted suicide after the legislation was passed for PAS. Nevertheless, according to the Attorney-General it was apparent that, â€Å"the traditional attitude of the common law was to condemn suicide until the law was changed by the Suicide Act 1961†.[29] It seems to the majority that though the assisted suicide Laws in the Netherlands and Belgium specify that physicians alone are permitted to assist with suicide, the documented ill-practises executed by these Doctors creates a prodigious challenge to the legislatures in England and Wales. Nonetheless when legislations as such are amended many would argue that simply providing treatment with the consent of the patient does not abuse an individual’s autonomy. However implementing safeguards for PAS would be complicated as explored in the slippery slope. Even so, the principle of autonomy takes into consideration the very matter of an individual’s freedom of choice a profoundly serious virtue and right and one that necessitates a remarkable deal of justification. Bibliography Cases Airedale Trust v.Bland [1993] 1 All ER 821 [HL] R. (on the application of Pretty) v DPP [2001] UKHL 61 Legislations European Convention on Human Rights Suicide Act 1961 Books and Reports ‘The Concept of Pareto Efficiency’, lt;https://pages.uoregon.edu/cjellis/441/441notes.pdfgt;last accessed 15 December 2013, 2007) Almagor R C, â€Å"A Circumscribed Plea for Voluntary Physician- Assisted Suicide†, (2000) 913 Annals of the New York Academy of Sciences 127 Elliott and Quinn ‘English Legal System’ (14th edition, Pearson 2013) Emanuel E J, ‘What is the Great Benefit of Legalizing Euthanasia of Physician-Assisted Suicide?’ (1999) 109 Ethics |lt;https://philosophyfaculty.ucsd.edu/faculty/rarneson/Courses/EMANUELwhatisthebenefit.pdfgt; last accessed 12 December 2013 Gorsuch N M, ‘The Future of Assisted Suicide and Euthanasia’ (Princeton University Press 2006), Ch. 7 Kant I, ‘The issue of Suicide’- lt;https://philosophia.uncg.edu/sites/default/files/PHI301metivier/pdf/Kant-Suicide.pdf gt;pp. 147-154 last accessed 12 December 2013 Kennedy and Grubb A, ‘Medical Law’ (2nd edition, Butterworths 1994) Posner R, â€Å"The Tanner lectures on Human Values- Euthanasia and Health Care: Two Essays on the Policy Dilemmas of Aging and Old Age† lt;https://tannerlectures.utah.edu/_documents/a-to-z/p/Posner96.pdfgt;last accessed 14 December 2013, (Yale university 1994) The Select Committee| ‘Assisted Dying for the Terminally Ill Bill’ |HL|(2004-05)| HL Paper 86I |lt;https://www.publications.parliament.uk/pa/ld200405/ldselect/ldasdy/86/8604.htmgt; Last accessed 15 December 2013 Williams G, ‘Intention and Causation in Medical Non-Killing: The Impact of Criminal Law Concepts on Euthanasia and Assisted Suicide’ (Routledge-Cavendish 2007) Stone R, ‘Textbook on Civil Liberties and Human Rights’ ( 6th edition, Oxford University Press 2006) Jackson E, ‘Medical Law Text, Cases and Materials’ (3rd edition, oxford university press 2013) Stauch M and Wheat K with Tingle J, ‘Text, Cases and Materials on Medical Law’ (3rd Edition, Routledge Cavendish 2006) Slapper G and Kelly D, ‘English Legal System’ -2013-2014 (Routledge 2013) Molenaar J C, ‘A Report from the Netherlands’ [1987] Bioethics [1] Kennedy and A. Grubb, ‘Medical Law’ (2nd edition, Butterworths 1994) page; 1282 [2] Emily Jackson, ‘Medical Law Text, Cases and Materials’ (3rd edition) (oxford university press 2013) page; 929 [3] Suicide Act 1961, s 3 [4] Jan C. Molenaar, ‘A Report from the Netherlands’ [1987] Bioethics page 156 [5] Kennedy and A. Grubb, ‘Medical Law’ (2nd edition, Butterworths 1994) page;1241 [6] Glenys Williams, ‘Intention and Causation in Medical Non-Killing: The Impact of Criminal Law Concepts on Euthanasia and Assisted Suicide’ (Routledge-Cavendish 2007) [7] Ibid 87 [8] Ibid [9] Ibid [10]Airedale Trust v.Bland [1993] 1 All ER 821 (HL) [11] The Select Committee| ‘Assisted Dying for the Terminally Ill Bill’ |HL|(2004-05)| HL Paper 86I |page 24/paragraph 53 [12] Ibid [13] Ibid [14] R. (on the application of Pretty) v DPP [2001] UKHL 61 [15] European Convention on Human Rights [16] European Convention on Human Rights, Article 2 [17] Richard Posner, â€Å"The Tanner lectures on Human Values- Euthanasia and Health Care: Two Essays on the Policy Dilemmas of Aging and Old Age† lt;https://tannerlectures.utah.edu/_documents/a-to-z/p/Posner96.pdfgt;last accessed 14 December 2013, (Yale university 1994) [18] Neil M. Gorsuch, ‘The Future of Assisted Suicide and Euthanasia’ (Princeton University Press 2006), Ch. 7 [19] Immanuel Kant, ‘The issue of Suicide’- lt;https://philosophia.uncg.edu/sites/default/files/PHI301metivier/pdf/Kant-Suicide.pdf gt;pp. 147-154 last accessed 12 December 2013 [20] Elliott and Quinn ‘English Legal System’ (14th edition, Pearson 2013) page: 678 [21] E J Emanuel, ‘What is the Great Benefit of Legalizing Euthanasia of Physician-Assisted Suicide?’ Vol.109 No.3. (1999) 109 Ethics 640-1 [22] Ibid 640 [23] Ibid [24] R Cohen-Almagor, â€Å"A Circumscribed Plea for Voluntary Physician- Assisted Suicide†, (2000) 913 Annals of the New York Academy of Sciences 127 [25] Ibid [26] Ibid [27] A method used in economic analysis for legal scenarios for cost effectiveness. [28] ‘The Concept of Pareto Efficiency’, lt;https://pages.uoregon.edu/cjellis/441/441notes.pdfgt;last accessed 15 December 2013, Page; 1 [29] The Select Committee| ‘Assisted Dying for the Terminally Ill Bill’ |HL|(2004-05)| HL Paper 86I | paragraph 11

Roles Of Leadership And Management - 1466 Words

In every organization, individuals are faced with the task of fitting into a role, and functioning in the role that they possess. This role can be seen in the simple organization of the family, and in more complicated organizations, such as national government. One pivotal role in any organization is that of the leader who provides a framework and advises those under his direction. A manager not only leads those under his direction, but is also efficiently utilizes the available resources and time. Leadership and management are critical in the healthcare setting, and more specifically in nursing. According to Ellis and Abbot (2013) â€Å"the role of the leaders is to inspire, facilitate and direct rather than to dictate the way in which†¦show more content†¦Strict authority is often needed when working with employees who need a large amount of direction and who do not have the educational background or initiative to act on their own. According to Frandsen (2015)  "This style works best in a true emergency, when split-second decision-making is needed; however, if employed as the leader’s primary style, it is demoralizing and can result in increased turnover, as staff feel undervalued.† The person in the leadership role makes the decision with little to no regard for the ideas of subordinates. This type of leadership may be viewed as dictatorial. While some people may follow the dictates of the leader without question, others will find this to be an intolerable work environment. Nurses are educated to be self-reliant, critical thinkers. Those who possess these skills would feel suppressed in an environment where their ideas that could improve the work environment or patient care were of little to no importance. Also, this leadership style does little to acknowledge the efforts and accomplishments of those working. Without positive feedback, self-confidence and motivation may be compromised. According to Giltinane (2013) â €Å"followers of an autocratic leader can rely heavily on their team leader and may underperform in the leader’s absence.† Without someone directing actions, those under the supervision of an authoritative leader no longer have the capacity to self-motivate and

Lost in Time free essay sample

I began the painstaking process of lifting the seal, trying to ignore the bold printed label reading ‘DO NOT OPEN UNTIL 2010’. For seven years this time capsule had sat on a shelf collecting dust. I had forgotten both this cardboard cylinder and the memories it contained. It was as much of a mystery to me as my plans for the future, plans my parents wanted desperately to know. I had no idea what had been important to me at the age of ten, or what was important enough to me to be my future career path now. I wished I could open a book of clear, concise words about my self. I was Ancient Egyptian Hieroglyphs to Cleopatra, indecipherable and mysterious. I was Mayan civilization; my dreams, and all I had hoped for, had disappeared for reasons I could not name. I wanted a codex, or a Rosetta stone dedicated to the enigma of my own desires and plans. We will write a custom essay sample on Lost in Time or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page I tore at the label with a sudden ferocity. It remained the only thing between me and, what I hoped would be, a revelation. I felt as though a tangible piece of my childhood ideals, an object sanctified in simplicity, would connect me to the person I had once been. As children we often dream of our future, and I have always been of the opinion that the future can be found rooted in the times we have forgotten. I was not however, prepared for the epiphany the time capsule contained. The information I had sealed away, among the Pokemon cards, to share with myself proved indispensable, something I could never have predicted. I could not have done better than writing six words on a sheet of paper; words that were the answer to the age old question ‘What do you want to be when you grow up?’. I had flawlessly spelled out my reply, ‘I want to be an archaeologist’ the ten-year-old demanded trough the simple scrawl. It was as if the child within myself was ordering me to recognize our dream, the way only a self-centered child can. The path I wanted to take began to become clear. I knew what it was I had always wanted, above all else. I have always known an insatiable desire to whet my appetite for puzzles of the past. It became instantaneously clear that I had a simple goal all along, to learn the facts contained deep within history. It had always given me satisfaction to learn obscure information about ancient civilizations, to know them like neighbors. In my head there began to form an understanding of why I cried every time my sister deleted my Discovery Channel specials from the recorded programs. I knew suddenly that I had, throughout my life, had a desire to be in the company of others who shared my thirst for knowledge. My mother had found little excitement in my thorough list the accuracies and fictional assumptions of Michelle Moran’s novel, â€Å"Nefertiti†. I recognized my longing for a chance to learn and discover the history that will teach others, and myself, as something I have wanted all my life. Throughout our lives we will meet countless people, out of the blue, people who have the ability to leave just as swiftly as they came. The only person you are guaranteed to always have is your own self. Every person you meet can influence you in some way or another, but it should truly be your own self that holds the most sway over each choice you make. It’s unfortunate that what you want can become clouded and your ambitions can go astray. Human nature allows each of us to lose focus. We put our dreams, what we want for our future, aside and dedicate all of our attention to the present. When we allow ourselves to neglect the past, when we put that box of dreams away, we allow what is important to become irreversibly lost in time.