Equal Opportunities and Diversity Case Study Example | Topics and Well Written Essays - 1500 words

Equal Opportunities and Diversity - Case Study Example The business case chosen for review is Tesco Ireland. This is one of the leading employers in Ireland and is also a classic example of an organisation that has to deal with diversity. Among its eleven thousand employees, the Company has a large percent of them coming from different parts of the world like America, Africa, Asia and other parts of Europe. The Company has a fair representation of people from various age groups that start from fifteen to eighty five. Besides this, the Company has also recruited and managed people with disability, different religious beliefs among others. Correspondence/similarities between equal opportunities and diversity have been demonstrated even in customer care by Tesco Ireland. The Company has made some changes that make shopping easier for persons with disabilities; first the Company has wide aisles that enable a person on a wheelchair or any device that helps in movement to use their stores easily. Secondly, Tesco has installed shelves that can easily be reached by children, undersized people or those on wheel chairs because those shelves are lower in height. Besides this, the Company has also incorporated wide ranges in its stores. All these changes were made after surveying Customers in a routine program managed by the Company called Customer Question Time Panels. (Mckillion, 1999) However, differences between equality and diversity were shown in the treatment of Polish Immigrant Workers during the year 2005. In the month of August, there were some agency workers of Polish origin who felt that they were not being granted equal opportunities in comparison to other workers. They engaged in a strike that highlighted the following discrepancies; Unequal salary payments between non-Polish workers and them Minimal chances of permanent employment for Polish Workers Poor working conditions These Polish workers were engaged in the distribution section of the Company. The Company tried to stand up for itself but their words to the press had already tarnished their image. In light of this strake, Tesco Ireland demonstrated that it did not treat its diverse workforce in an equal manner. (Berry, 2005) Equal opportunities and diversity in recruitment In the year 1999, Tesco Ireland worked hand in hand with North side Partnership to hire a number of employees perceived to be needy. These included; Travellers People with disability Recovered drug addicts Former prisoners (Thomas, 1990) These groups of people were hired to work in a new supermarket that would be opened five years from that time. The Company did not decide to hire these needy persons because there was lack of a better alternative; it did this because it wanted to grant equal opportunities to people in that area-Clare Hall. In actual sense, there were very many other people in need of employment in that area as unemployment was at a record high of sixteen percent in Clare Hall. By so doing, Tesco Ireland has shown that equal opportunities can be available to a diverse workforce thereby demonstrating that there are similarities in the latter two concepts. Similarities between equal opportunity and diversity have also been demonstrated by the Company by recruitment of people who have exceeded the official

Effect of School Based Obesity Interventions

Effect of School Based Obesity Interventions ABSTRACT Introduction Background 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, Prima testa et 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 â€Å"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 â€Å"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  £1b and between  £2.3b  £2.6b annually respectively, with the cost to the NHS projected to rise to  £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. â€Å"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, â€Å"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 MEDLINE ® (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 (http://catalogue.bl.uk/F/?func=filefile_name=login-bl-list) ISI index of Conference Proceedings (http://wok.mimas.ac.uk/) SCIRUS (http://www.scirus.com/) System for Information on Grey Literature (http://opensigle.inist.fr/) ZETOC (http://zetoc.mimas.ac.uk) Additionally, current control trials database at http://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 conta Effect of School Based Obesity Interventions Effect of School Based Obesity Interventions ABSTRACT Introduction Background 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, Prima testa et 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 â€Å"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 â€Å"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  £1b and between  £2.3b  £2.6b annually respectively, with the cost to the NHS projected to rise to  £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. â€Å"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, â€Å"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 MEDLINE ® (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 (http://catalogue.bl.uk/F/?func=filefile_name=login-bl-list) ISI index of Conference Proceedings (http://wok.mimas.ac.uk/) SCIRUS (http://www.scirus.com/) System for Information on Grey Literature (http://opensigle.inist.fr/) ZETOC (http://zetoc.mimas.ac.uk) Additionally, current control trials database at http://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 conta

Maud Martha, by Gwendolyn Brooks Essay -- Maud Martha Essays

  Ã‚  Ã‚  Ã‚   Black women's experiences and those of other women of color have never fit the private -public model.   Rather than trying to explain why Black women's work and family patterns deviate from the alleged norm, a more fruitful approach lies in challenging the very constructs of work and families themselves. ("Native") Maud Martha Brown had strong ideas regarding marriage.  Ã‚   She set out to conquer the role as wife, in spite of and because of her insecurities and personal hardships.   Unlike the rose-colored images that enveloped the minds of many traditional (white) women during that period of the 1940s and 50s, Maud Martha set her sights on being a bride under the simplest conditions.   Maud Martha was prepared to settle for being good enough to marry, rather than being a woman no man could refuse.   Her position in society, her relationships with her family, and her overall existence in society greatly influenced Maud Martha's ideas regarding the male-female union.   Though still influenced by her former roles, the final chapters of Gwendolyn Brooks' Maud Martha reveals an undeniably stronger and more mature heroine.      Ã‚  Ã‚  Ã‚   Pulitzer Prize- winning author, Gwendolyn Brooks has gained much attention, but not without comparable controversy and criticism (Appiah 313).   The Chicago-based author has built a sturdy reputation in both mainstream and African American literary circles.  Ã‚   Nonetheless, her more popular works has won most of the poet laureate's recognition.   "No white poet of her quality is so undervalued, so unpardonably unread.   She ought to be widely appreciated... as one of our most remarkable woman poets" ("Voices").   Brooks challenged the existing approach to romanticism, the fairy tale nature of the Amer... ...d Giola's Literature Web Site. <http://longman.awl.com/Kennedy/brooks/biography.html>. Modu, Anaezi and Andrea Walker. All the Man I Need: Black Woman's Loving Expressions on The Men They Desire. Newark: Gateway, 1999. 13-14. Parl, You-me and Galyle Wald. "Native Daughters in the Promised Land: Gender, Race, and Question of Separate Spheres". American Literature 70 (3) (1998) 14 Oct 2000 <http://newfirstsearch.oclc.org/webz/FSQER...:entityemailfullresultset=1%7.html>. Tresiddier, Jack. Dictionary of Symbols: An Illustrated Guide to Images, Icons, and Emblems. San Francisco: Chronicle, 1997. 120-6. Washington, Mary Helen. "The Darkened Eye Restored: Notes Toward a Literary History of Black Women". Angelyn Mitchell, ed. Within the Circle: An Anthology of African-American Literature, Criticism From the Present. Durham: Duke, 1994. 442-53.

Hunger Games Theme

What would we do if we were chosen at random to fight for our life? Would we just let it happen? Would we fight back and try our best to keep out dignity? Or would we do whatever it takes just to stay alive, even if it means losing site of who we really are? These are all decisions that Peeta and Katniss, two kids from a city called Panem had to make all by themselves. The novel The Hunger Games by Suzanne Collins has many themes, but the most important overall, is the importance of keeping dignity and humanity while fighting for our life. In the Hunger Games, a sixteen year old girl named Katniss and a sixteen year old boy named Peeta are chosen to go into the Hunger Games, where they will fight for their lives. During past years, competitors in the Hunger Games would do a number of unspeakable things in order to survive. Peeta however is the complete opposite. He wants to die with dignity. First off, in the novel The Hunger Games, by Suzanne Collins, many things go wrong in Panem, the society that the main characters Katniss and Peeta live in. For example, their society is filled with many things such as war, starvation, poverty, and violence. Peeta and Katnis have been taught since they were little that no matter what you are doing you have to keep your dignity while doing it. Even if it is fighting to the death. The way that both Peeta and Katniss have grown up comes in really handy during the Hunger Games. It makes it extremely easier for them to keep their dignity during the games. However, many competitors will do anything in order to survive, wouldn’t you? Peeta however, is very different; he believes that if he is going to die, he should at least go with his dignity. This means that while everyone else loses their minds, he will still think straight and won’t do anything outrageous in order to survive. For example, a girl from district 9 said â€Å"here’s some advice, just stay alive† (127). This quote shows that she believes the only thing that matters is staying alive. She will risk anything to live, even her humanity and dignity. Peeta however, would basically rather die with his dignity than live knowing he completely lost his dignity and humanity during the Hunger Games. To Peeta, his dignity is just as important as his own life. The competitors in the Hunger Games family and friends are also loosing spite of their humanity and dignity even though it may not seem like it to them. The family members show their loss of dignity when all of them just sit back and watch as their loved ones battle for their lives. It is just one big game to them. Celebrations are thrown if their loved one kills another person’s loved one. They don’t even comfort the other family at all. Everyone just parties while one family is having one of the worst possible days of their lives. Watching as somebody’s child is being killed isn’t right. Imagine if our society was like this. We wouldn’t just sit back and watch as our family and friends die before our eyes, would we? The novel The Hunger Games is similar to the novel Lord of the Flies by William Golding in a few ways. The most important however is the characters loss of humanity and dignity, which occurs in both novels. In Lord of the Flies, the large groups of boys that are stranded on the island lose sight of what is really important to them. They get caught up in trying to stay alive and doing whatever it takes to stay alive. Jack, from Lord of the Flies, ran around chanting â€Å"Kill the pig. Cut her throat. Spill her blood† (69). This quote shows us that the boys are starting to lose their dignity. This is exactly what happens in Suzanne Collins, Hunger Games. All of the competitors chosen to compete in the annual Hunger Games get caught up in killing people to stay alive that they forget who they really are inside. Ralph, the boy from the novel Lord of the Flies is very similar to Peeta, the boy from the novel Hunger Games in many ways. For example, both Ralph and Peeta are one of the only people to keep their humanity and dignity while they are stranded on an island or in this case fighting to the death in a huge arena. All of the boys in the novel Lord of the Flies lose their dignity and humanity except for Ralph and piggy who stay sane. This is very similar to the Hunger Games. Everyone in districts one through eleven go crazy and forget who they are except for two people. Only Peeta and katniss who are from District 12 keep their dignity while struggling to stay alive. Peeta says â€Å"at least let me die with my dignity† (167). This quote shows us that Peeta won’t lose his humanity and dignity no matter what. In conclusion, the novel The Hunger Games by Suzanne Collins shows us how society could end up if we lose sight of our dignity. She shows us that just because something bad could happen doesn’t mean that we have to forget what really matters to us, or even forget who we truly are behind all of the violent, or just plain old fake acts that we would have to put on just to live through the Hunger Games. She shows us through the eyes of Peeta that even when something gets tough, we just have to work through it and keep our head held high.

Commodification in Ilad

The Theme of commodification in the Iliad is highly important in the Iliad. Homer was against the idea of making the as a commodity. Homer's Iliad Is an excellent example of the suppressive role of women at this time. Women were treated merely as property and were used for producing material within the household. They are depicted as being inferior to men both physically and intellectually.The Iliad began with an argument between Achilles and Agamemnon over Brises, who was considered a war prizeThey brought back the spoils and dMded them equally among the warriors. Agamemnon's prize was Chryseis, the daughter of a riest of the god Apollo. Achilles' reward was a maiden named Brisels. Both women were taken against their will. unfortunately for Agamemnon, Chryseis' father begged for his daughter to be released and offered huge amounts of treasures as ransom.In return. Agamemnon took Brisels, Achilles prize, and that results a big disagreement between Agamemnon and Achilles. The example of Chrysels and Brisels was a critical reminder of what will become of the women of Troy should the Greeks succeed in taking Troy. Homer was successful in criticizing the social practices through this epic. Homer tried to shade a light on the mistreatment of women. He believes that any relationship between man and women out of the marriage is wrong.The relation between male and female in this epic Is a relation of maters and slave or a lover and a mistress. Homer was against the sub-human classification of women. Throughout the Iliad, women play a modest but important role that embodies their relative significance and the Impact they have on the affairs that take place. Their role is depicted wisely by homer in order to show the maltreatment of women. Homer was against using women as material objects and the Iliad represent a strong protest against this commodification of women. ton

My Successful Friend Idiom Story for ESL Students

My Successful Friend Idiom Story for ESL Students Here is a story about a successful friend who has had a fantastic career. Try reading the story one time to  understand the gist  without using the idiom definitions. On your second reading, use the definitions to help you understand the text while learning new idioms. Finally, youll find idiom definitions and a short quiz on some of the expressions at the end of the story.  Ã‚   My Successful Friend My friend Doug has really done well for himself in life. Im very proud of him and all of his achievements! We get together every year or so for a two or three-day hike in Oregon. Its a great time to reflect on how life is going, talk about old times and have new adventures. Let me tell you a little bit about Doug. It was clear from the very beginning that he was going places. He did very well in school, and everyone knew he was a smart cookie. Not only were his grades good, but he was also an outstanding athlete, as well as keeping his nose clean. Some accused him of being squeaky clean, but that didnt bother him. He wasnt going to let anyone rain on his parade!   After he graduated from college, he decided to go to New York. As the song goes: If you can make it there, you can make it anywhere! Back in those days, New York was a hotbed of innovation. Doug was a product design specialist and had some great designs on tap. Unfortunately, he didnt immediately succeed. Things werent easy in the beginning, and it took him a while to learn the ins and outs of the Big Apple. In any case, it soon became to clear to him that he needed to make some brownie points with his director. He decided he would volunteer to create the presentation for a new product at the companys yearly dog and pony show.   The boss wasnt so sure, but the decision about who would make the presentation wasnt carved in stone. In the end, the manager decided that Doug would do a good job. Doug gladly accepted the challenge and decided to make quite an impression. He wasnt exactly going to reinvent the wheel, but he knew he could improve on past presentations. He felt that giving a great presentation would improve his standing in the company. The day of the presentation arrived, and, no surprise, Doug did an outstanding job. His presentation was informative, and he didnt blow any smoke. Where there were problems, he pointed them out and made suggestions as to how to improve the situation. Long story short, because of his excellent presentation the director realized that he was the genuine article. Doug started taking more and more responsibility at the company. Within three years, he had sealed the deal on the development of two of his best ideas. As they say, the rest is history.   Idioms Used in the Story be on a roll to have one success after another have a string of successes  Big Apple New York New Yorkblow smoke to fake or provide false information in order to gain somethingbrownie points extra good will  carved in stone not changeable  dog and pony show a presentation during which a companys best products are showngenuine article real true not fakego places to become successfulhotbed of something an area that is famous for a certain type of industry or successins and outs the details and inside information about a place or situation  keep ones nose clean to not make any illegal or unethical mistakeson tap readyrain on someones parade to criticize the success of someonereinvent the wheel to remake or invent something that already exists  seal the deal to make an agreement sign a contractsmart cookie very intelligent personsqueaky clean without fault not having problems or mistakes Quiz I think were ___________. All of our products are selling very well.This bag looks like its ______________. It doesnt look fake.We ________________ with our partners and start the project in May.The contract isnt ________________. We can still negotiate the details.Work with Anna and shell show you the ____________ of the company.I dont want to _________ your _________, but there are still a few problems.I think shell ______________. Shes very intelligent AND competitive.  I wouldnt believe that. Hes known for ______________.   Quiz Answers on a rollgenuine article  sealed the dealcarved in stoneins and outsrain on your paradego placesblowing smoke More Idioms and Expressions in Context Stories Learn more expressions using stories with one or more of these further  idioms in context stories with quizzes. Its important to learn and use idioms in context. Of course, idioms are not always easy to understand. There are  idiom and expression resources  that can help with definitions, but reading them in short stories can also provide context that makes them come more alive.

Christmas Discount with Best Essay Education!

Christmas Discount with Best Essay Education! Christmas gifts arrive early this season! Happy Early Christmas - the gifts are already here! Not everybody has time to get all the presents for Christmas on the Black Friday sales. Due to large queues and exhausting trips to the mall - this experience might drive plenty of consumers crazy. God thing can seriously help you out in many ways. Firstly, our top academic help will provide some relieve before the Christmas boom! Make sure you have more time to dedicate to your personal business and family before and during holidays. Of course, we offer discounts this season. Another benefit is you do not have to queue to get the good writing assistance! Actually, you don’t have to do much at all! Order any type of writing from the professionals any time this month. Use code XMAS2017 and get 20% discount on any order in December. Happy holiday season!

Gold Alloys in Colored Gold Jewelry

Gold Alloys in Colored Gold Jewelry When you buy gold jewelry, it isnt pure gold. Your gold is really an alloy, or mixture of metals. The purity or fineness of gold in the jewelry is indicated by its karat number 24 karat (24K or 24 kt) gold is as pure as gold for jewelry gets. Gold that is 24K is also called fine gold and it is greater than 99.7% pure gold. Proof gold is even finer, with over 99.95% purity, but it is only used for standardization purposes and is not available for jewelry. So, what are the metals that are alloyed with gold? Gold will form alloys with most metals, but for jewelry, the most common alloying metals are silver, copper, and zinc. However, other metals may be added, especially to make colored gold. Heres a table of the compositions of some common gold alloys: Gold Alloys Color of Gold Alloy Composition Yellow Gold (22K) Gold 91.67%Silver 5%Copper 2%Zinc 1.33% Red Gold (18K) Gold 75%Copper 25% Rose Gold (18K) Gold 75%Copper 22.25%Silver 2.75% Pink Gold (18K) Gold 75%Copper 20%Silver 5% White Gold (18K) Gold 75%Platinum or Palladium 25% White Gold (18K) Gold 75%Palladium 10%Nickel 10%Zinc 5% Gray-White Gold (18K) Gold 75%Iron 17%Copper 8% Soft Green Gold (18K) Gold 75%Silver 25% Light Green Gold (18K) Gold 75%Copper 23%Cadmium 2% Green Gold (18K) Gold 75%Silver 20%Copper 5% Deep Green Gold (18K) Gold 75%Silver 15%Copper 6%Cadmium 4% Blue-White or Blue Gold (18K) Gold 75%Iron 25% Purple Gold Gold 80%Aluminum 20%

International Marketing Essay Example | Topics and Well Written Essays - 1500 words - 3

International Marketing - Essay Example Traditional thoughts and practices of limiting one company with in the geographical boundaries of the country are obsolete today. Companies, across the globe, are striving to get into newer markets in the form of newer countries. International marketing has become the very integral part of almost all companies of the present world. According to Doole and Lowe, â€Å"At its simplest level, international marketing involves the firm in making one or more marketing mix decisions across national boundaries. At its most complex level, it involves the firm in establishing manufacturing facilities overseas and coordinating marketing strategies across the globe†(Doole & Lowe, 2001). Established in 2000, Initial Fashions has been known for its unique and creative yet qualitative designs. The philosophy of the company states that fashion should ideally reflect latest art and design and is much more than just a consumption phenomena. The leading fashion house of Hong Kong also believes that the fashion should reflect one’s inner and the outer qualities. The company is credited for its rigorous support in the relevant happenings and events of art and culture. Initial Cafà © provides whole lot of beverages and food items and includes Espresso, Siphon Coffee, special drinks, cake, cookies, salad and sandwiches. Ice Moca, the food item which has cocoa flavour upon the taste of coffee is made by mixing coffee beans bought from various countries. Dark chocolate is then added to establish the cocoa flavour. The cafà © division of the Initial Fashion which uses antique furniture to slow down the pace of the citizen’s life at the ever-busy shopping centers and streets of Hong Kong has all the attributes to venture in the market of United Kingdom and be successful. As the cafà © belongs to the service industry, the most important condition to be successful is to maintain the quality. And with the reputation that Initial Cafà © has, there is little doubt about it’s

Absenteeism from School Essay Example | Topics and Well Written Essays - 1250 words

Absenteeism from School - Essay Example Thus, an individual's absenteeism is determined both by the information that he derives from the situation and by the set or expectation in terms of which he views the situation. The desirability of a situation is estimated in reference to internalized scales and norms of value which are determined by past experience (Burgess, 2003). That which conforms to these norms tends to be most readily perceived, and that which departs from the norms tends to be rejected. Since the absenteeism tends not only to confirm desirability estimates but also to strengthen other related expectations that are highly valued, the individual develops systems of more or less highly interrelated value expectations relative to his family, school, community, church, political party, nation, work group, and so on. These different systems may be mutually reinforcing or they may be in conflict with each other. Young people frequently experience conflict between the values acquired from their parents and those acq uired from their age peers. They may also perceive conflict between the values acquired at church and those acquired from their science teachers. Because of their high degree of independence of validating outcomes, they come to serve as stable reference points in terms of which experienced outcomes are evaluated as satisfying or unsatisfying. They also serve as comparing criteria and, as such, enable the individual to evaluate the values of other persons, groups, and subgroups. The student affected by absenteeism is one who makes evaluations in terms of his value systems without reference to the objective validity of his judgments (Byman and Burgess 2001). The value of the proposed research will be justified by increased number of drop outs from schools and low scores showed by many low class students in working areas. The concern has been validity: the truth value of research outcomes is stronger when both the data and the design are valid. Legitimating means that the research methods are consistent with the philosophical underpinnings of the question. For instance, the positivist assumes an objective reality; the postmodernist assumes no objective reality and no objective, truth. While a perfectly accurate portrayal of our notions of validity across the continuum is not possible, researchers can outline the major dimensions of thinking (Coffey and Atkinson 2003). Taking into account the nature of research, it is important to note that concerns about validity will include both external and internal validity, on the one hand, and measurement validity, on the other hand. Both these categories of concern are generated by the need to have confidence that our test, data, or design does indeed measure or reflect or produce what researchers intend it to measure, reflect, or produce. Without internal validity, one can only conclude that the approach being used to answer the question of interest is capable of estimating the relationship, and no statement about causation is possible. Even though there are those among the ranks of qualitative researchers who say they are not interested in internal validity, those who wish to infer causal relationships must be concerned with this aspect of their research. In fact, even some who dismiss this concern as being only a quantitative researcher's dilemma will admit to processes like triangulation and theoretical sampling, which are conceptual attempts and techniques to get at internal validity (Reid 1999). Absenteeism level is difficult to measure, so interview methods will help to collect required data and evaluate the level and causes of this problem. The research interview as a strategy to find out from people things

Study Skills Essay Example | Topics and Well Written Essays - 2000 words - 1

Study Skills - Essay Example Study skills are never attained fully formed, any more than a grown man pops out of his mother’s womb. According to Cottrell(2003 p3)They evolve and mature through repetition, trial and error, critique from others and continued reflection as you progress through your individual journey as a learner The purpose of this module is to provide the opportunity to acquire and develop the study skills that will be necessary to successfully complete this course to a standard that I am aiming for. Being a competent independent learner is derived from being self motivated, being able to manage personal learning processes, good time management skills and continually reflecting on what and how you learn best and tailoring your energies to suit. Within this portfolio I will examine the development of learner independence, time management, self evaluation of personal learning, production of an action plan and improving my essay writing skills. If as anticipated this is completed successfully it will add additional skills to my current ones and aide me in my current quest to secure a higher second grade result on this degree course. Learner independence or autonomy can be defined as â€Å"capacity to take responsibility for, and control of, your own learning, whether in an institutionalised context, or completely independent of a teacher or institution† (Thornbury, 2006). Learner independence is the ability of the learners to control their learning process (Holec, 1981). In the present age, when knowledge is growing at very fast pace because of the ongoing research work and rapid advancements in technology, the importance of independent learning cannot be overemphasized. Learners must understand that the education they are provided with at institutions is time-constrained, and what they need to learn is not limited to what they are taught in schools. Most learners used to learning in

Video response paper (writer's choice) Essay Example | Topics and Well Written Essays - 1500 words

Video response paper (writer's choice) - Essay Example It also forms part of the growing films on border-crossing as much as the Mexican migration became a dominant cinematic theme for both the US and Mexico. (Maciel and Garcia-Acevedo, p. 148) To say this, however, is tantamount to merely scratching the surface. The Syrian Bride is more than its obvious storyline. It is peppered with important themes and social issues that permeate in Israel today as well as its relations with its neighboring Arab countries. Plot The film depicted the story of Mona (Clara Khoury), a Druze woman living in Golan Heights, who in an arranged marriage, must travel to meet his groom, Tallel (Derar Sliman), in Syria. Everything was pretty straightforward, starting from the wedding festivities unto the wedding itself, which would take place at the border. Mona had to bid her family farewell and cross the border. It is at this point, however, wherein the story took an interesting turn. Israel and Syria do not maintain any diplomatic relations. In addition, both countries are claiming Golan Heights. Ebert (2006), in his review, expressed the dilemma in word best as he stated that Mona’s problem â€Å"is that Syria considers her to be already in Syria, and Israel considers her to be in Israel† and â€Å"how can she cross from a place one side says does not exist to a place the other side says does not exist?† The bureaucratic tangle was further complicated by the fact that Syria does not recognize Israeli passport, effectively barring Mona from entering the country. The entire caper was already comedic as the protagonist and the Salman family untangle their way to their destination. Symbolism Writing for the New York Times, Stephen Holden (2005) remarked that The Syrian Bride and its depiction of the impenetrable border symbolized all that’s wrong in the Middle East. This wrongness in bordered the ridiculous as complex norms and procedures applied at either side of the border defy logic, understanding and implemen tation. As has been shown by the film, everything was in fact insane. There are vague and conflicting security and political considerations resulting in a solid deadlock to which an Israeli border patrol officer could merely shrug in sympathy and perhaps in his own confusion as well. The entire caper disputed the opening claim of sadness for the whole film, making the film, in itself, hilarious with ridiculousness of Mona’s situation. The politics and the bureaucracy involved in the border defy reason and can actually victimize even the most fundamental and innocent needs and desires of people affected. In most respects, this situation is the same with the way relations between Israel and its neighboring countries are conducted – enforcing ridiculous legal norms and violating human rights in the process, just so security and political considerations could be satisfied. Apolitical More than anything, the film does not have a political agenda. It did not talk about which side of the fence – Israel or Syria – is correct, much less attack policymaking that would pit the two countries or their positions on several issues against each other. There was no suggestion of peace and/or some outright diplomatic resolution to the strained bi-partisan relationship or something to this effect. If there was some politics involved, it was, in the words of Ebert, just nibbling around the edges, â€Å"

Insurance Law Dissertation Example | Topics and Well Written Essays - 1500 words

Insurance Law - Dissertation Example Indeed in the current scenario of uncertainties and risks, both within and outside the home, insurance in various areas of business and personal domain has increasingly become critical part of improved lifestyle (Ward, 2000). But interestingly, while the concept of insurance is similar the format of insurance, especially the criteria of framework and regulation of insurance differs significantly in Islamic countries like Saudi Arabia and western countries like UK. In the recent times, Islamic insurance has rapidly emerged as one of the most popular and also a highly effective strategy to reduce financial risk of the individuals and the government as a whole (Anderson, 1976; Habshi & Othman, 1997; Ahmad, 1972). Indeed, the growth and penetration of Islamic insurance across the non Islamic countries has been seen as a positive trend in the insurance sector. The paper would therefore, be focusing on the question as to why should there be development of Islamic insurance in Saudi Arabia and UK? Meaning of Islamic Insurance Islamic insurance is mainly guided by Shariah or Islamic laws that forbid business based on unethical practices. Various products of insurance are strongly influenced by Shariah principles that prohibit gain through means like gambling, uncertainties or interest income (Mortuza, 1989; Ismail, 1997,98). Uncertainties are involved in life insurance as the outcome is unknown at the time of entering into contract and could vary. Gambling refers to gain of wealth under some defined conditions and interest income is unethical as it is not reward against hard work (Maysami, 1998; Sharif, 1997; Siddiqui, 1971). Thus, new concept of insurance emerged under ‘Takaful’ that worked within the precincts of Islamic laws. Islamic laws fundamentally rely on equitable distribution of wealth. Takaful is based on the ethical practices and is free from gambling, uncertainties and interest income (Ahmad, 2009: Anwar, 2008; and Saleh, 1986). It broadly ref ers to contributions made by individuals to be used in times of crisis or need. Rather than individuals, the family as a whole becomes the main beneficiary. Stagg-Massey (2007) state that Takaful has been taken from ‘kafal’ which is an Arabic word that means guaranteeing each other and taking care of each other’s needs. Thus, Takaful is a cooperative mechanism that promotes fair practice and spreads the risks and reduces financial loss suffered by an individual within the group. Need for Islamic insurance in Saudi Arabia and UK Middle East and African nations have lagged behind in insurance primarily because of the restraints imposed by religion and the prevalent poverty of the region. The development processes and growth have become major paradigms that necessitate insurance coverage. After 1970s, the discovery of oil and gases in the Gulf region has transformed the economy of the region. The large investment in the infrastructure and rapid growth in internation al trade has spurred the need for insurance amongst the working and non working population of the oil rich countries. Takaful not only facilitates the poor to survive with dignity under excruciating circumstances but also encourages ethical practices that are fair and justified (SAMA). Saudi Arabia being a leading Islamic nation is therefore morally bound to promote Takaful. In western countries like UK, insurance has fast transformed into major industry that is motivated by vested interests of making profit by exploiting the

Caterpillars Resilience for Strategic Change Management Process Essay

Caterpillars Resilience for Strategic Change Management Process - Essay Example 1) These above mentioned lines are not only mere scholarly jargon or illusion used by some well known academic scholars but the lines are truly reflecting the core essence of change management. In such context, Zajac, Kraatz & Bresser (2000) pointed out that the question is not about whether an organization is able to change or not rather the focus should be whether the mentioned organization is able to successfully implement the change management mechanism in competitive environment or not. Palaniswamy and Sushil (2003) argued that going for change for organizations is always directed by external factors because no organizations would want to change the existing system equilibrium without any bankable reason. Well, the argument has point because historical analysis of data shows that without the presence of certain reasons or the objective of achieving certain benefits, none of the organizations have invested its financial and non-financial resources to achieve change management (Za jac, Kraatz & Bresser, 2000). ... Caterpillar Inc- Business Dimension Caterpillar Inc or Cat is an American corporation which is global leader in manufacturing, construction and mining equipment, diesel-electric locomotive, industrial gas turbines and diesel and natural gas engines. The company was established in 1925 and at present, headquarter of the company is located in Peoria, Illinois, United States (Caterpillar, 2013a). The engineering giant offers wide range of products ranging from construction and mining equipment (the yellow equipment of the company has become symbolic icon for both industrial and retail consumers), customized industrial gas turbines which can lift heavy loads, natural gas engines which can work in low carbon emission state, remanufacturing services, end to end logistic services and even financial services (Gillett, Fink & Bevington, 2010). As of 2012, Caterpillar Inc has earned revenue of more than US $65 billion from its global business operation while the company has reported asset wort h around US$89 billion (Caterpillar, 2013a). As of 2008, the company has established presence in every continent while total employee base of the company exceeds 0.1 million (Gillett, Fink & Bevington, 2010). Now, the fact is that Caterpillar Inc never targeted retail customers or sell items to end users because from the starting days, the engineering targeted construction and mining companies or the dealers who sell construction equipment to both industrial and retail customers. In such business ideology, Caterpillar Inc has established global dealer distribution network crossing 185 partnerships across countries in Europe, South America, Africa, North