Literature Review on Childhood Obesity and Treatment

Literature Review on Childhood Obesity and Treatment Obesity has become a huge problem within the Western World over recent years. (34% of the adult population in the US in 2007 (Barness (1986: 75)). It is known from the general media that the incidences of childhood obesity are also on the increase. This review aims to evaluate the ideas and concepts from two Journals. Barness, L.A. (2007) Obesity in Children. Ells et al, (2005) Prevention of Childhood Obesity. Childhood Obesity According to Barness (1986: 75-76), there are a number of tools used to define the obese child. weight for height is the most common used as it uses a chart and the skinfold thickness becomes very erroneous in the obese child due to errors in measurement. The BMI uses charts to which take into account the gender and age of the child which then encompasses more of the variables within children (not apparent in adults) resulting in increased accuracy. There is some debate as to causes of obesity. Some causes are thought to be (Ells et al. (2005: 443)) gender, race, socioeconomic status, special educational needs, environmental factors and genetics (although Ells et al. (2005: 442) states that fewer than 1% of childhood obesity cases are directly caused by a genetic disorder). There are also a number of disease states causing secondary obesity which need to be ruled out prior to attributing the unexplained weight gain to the above causes. These include neurological lesions, endocrinopathies and congenital syndromes (Barness (1986: 82)). There are various factors affecting the obese child including psychological as Obese children often suffer from low self esteem and some can go on to develop depression (10% become clinically depressed Barness (1986: 77)) whereas others comfort eat leading to obesity. There are a number of risk factors which can result from an obese child which include hypertension, diabetes mellitus and dyslipidemia. (Chu et al. (1998: 1141) Dyslipidaemia includes hyperlipidaemia, elevated low-density lipoproteins, and decreased high density lipoproteins (Barness (1986: 81)). Sleep apnoea a common cause of pulmonary insufficiency Barness (1986: 77). The child can wake up many times a night resulting in constant sleep deprivation. This can be life limiting as it puts a strain on the heart also. It has been reported that some children can benefit from tonsillectomy and adenoidectomy Barness (1986: 77). However, Zafer et al. (1999: 33) have concluded that this treatment is associated with an increase in weight, height and BMI. Obesity Treatment As the causes of obesity are varied, so the treatment also needs to be varied. As well as dealing with the causes of obesity there maybe other health issues to be dealt with also. (see above) . The major treatment options involve diet, exercise and behaviour modification (Barness (1986: 83). The dietary requirements need to be under strict medical supervisions as the child is still growing and requires essential nutrients for growth. Barness (1986: 83) states that a protein-sparing modified fast (PSMF) diet has been used and appears safe and can stimulate the respiratory system and blunt the appetite due to ketones being released as the diet is also low in carbohydrates. Barnes does not, however, go into details of behaviour modification or exercise programmes. Obesity Prevention There a number of factors which cause obesity, as stated above. A holistic approach is required to ensure obesity does not occur in the child. According to Ells et al. (2005: 441) evidence supports measures which ensure physical activity and a healthy diet as well as adequate behavioural support for the child to reduce the risk of obesity. Interventions which will aid children to live and grow healthily can come from a number of different sources. School Intervention Schools can influence a childs behaviour and therefore help in the health prevention of obesity. Ells et al. (2005: 444) that a review highlighted a number of health prevention programmes. One of these was based on children being taught via a national curriculum to reduce their sedendatory behaviour. This showed a reduction in obesity. Another two were based on physical activity programmes which showed that there was no significant reduction in obesity over a control group. The multi-faceted approach of nutrition, education, behavioural therapy and physical activity showed that this may help to reduce obesity, especially in girls. Ells et al. (2005: 444) concluded that much more research is needed in this area. Research carried out by Nauta, Byrne and Wesley (2009: 16-17) concluded that school nurses had an awareness of childhood obesity but were unable to set up treatment programmes. Family Intervention There are a number of different behavioural causes within the family environment, including the mothers knowledge of nutrition and opportunities to share family meals. Ells et al. (2005: 445 446) also cited studies undertaken to examine the efficiency of family based behaviour modification programmes and health promotion which did not support any significant decrease in weight in the obese child. Goodfellow and Northstone (2008: 117) found out that children from the Isle of Man were more likely to be obese than in Avon, showing that external influences will have a bearing on the family and individuals health. Preschool / Anti-Natal Intervention A significant number of children are obese at pre-school age. However there is little evidence to support the need for intervention within the pre-school age chilidren. Ells et al. (2005: 446 447) questions whether obesity prevention should begin during the ante-natal period and cited a study finding maternal weight to correlate to preschool obesity but another found that breast feeding had a protective effect on childhood obesity. A study by Rossem et al. (2010: 7) supports the link between breast feeding and reduced obesity in the child. Morgan (1986: 34)) cited that expectant parents should be alerted to the dangers of childhood obesity as there is a strong link with a parent and childs body weight. Government Policies Ells et al. (2005: 449) indicates that in order to prevent the growing trend of obesity Governments must have a key role. For instance Ells et al. (2005: 449) a number of UK police documents including the Health Select Committee Report on Obesity (2004). Monitoring To Ensure Prevention is Working It is vital that preventative measures in place are monitored to ensure that they are reducing both the incidence and severity of childhood obesity so that resources can go to the appropriate measures. Ells et al. (2005: 449) stated that monitoring in most countries consists of only occasional surveys. The UK Essential Core Database for child health have recommended that monitoring (BMI) be carried out on children at entry and exit from both primary and secondary schools. Research carried out by Levine et al. (2008: 255), however, showed that monitoring of primary school children was achievable but that of secondary schools was not. Conclusion It can be concluded that childhood obesity is a large, increasing problem within the western world which will follow on into adulthood. This essay has aimed to give an overview of the theories and evidence surrounding childhood obesity including associated diseases, treatments, preventative measures and people involved in supporting the obese child as well as those factors thought to cause the obesity in the first place. This is a complex issue with evidence currently emerging. This review was mainly focussing on the use of two articles Obesity in Childhood and Prevention of Childhood Obesity which between then cover all the issues surrounding childhood obesity. Where there is further supporting or refuting evidence I have added this. The literature included here is by no means comprehensive and the reader may wish to research an aspect of childhood obesity in greater depth.

Rough Water Ahead

Required: 1. How should Smooth Sailings’ management perform the recoverability test for the cruise ship as of December 31, 2010? The following are the required steps to identify, recognize and measure the impairment of a long-lived asset (group) to be held and used: * Indicators of impairment — consider whether indicators of impairment are present. Test for recoverability — If indicators are present, perform a recoverability test by comparing the sum of the estimated undiscounted future cash flows attributable to the asset (group) in question to their carrying amounts (as a reminder, entities cannot record an impairment for a held and used asset unless the asset first fails this recoverability test). Measurement of an impairment — If the undiscounted cash flows used in the test for recoverability are less than the long-lived asset’s (group’s) carrying amount, determine the fair value of the long-lived asset (group) and recognize an impairment loss if the carrying amount of the long-lived asset (group) exceeds its fair value. What assets and liabilities should be included in the â€Å"asset group† as defined by ASC 360-10 for purposes of performing the recoverability test?For purposes of recognition and measurement of an impairment loss, a long-lived asset or assets shall be grouped with other assets and liabilities at the lowest level for which identifiable cash flows are largely independent of the cash flows of other assets and liabilities. Asset groups may include assets and liabilities outside the scope of ASC 360-10 (for example, goodwill — if certain conditions, discussed later, are met — and other non-amortizing intangible assets).In general, assets should be grouped when they are used together, that is, when they are part of the same group of assets and are used together to generate joint cash flows. If assets and/or liabilities are grouped for purposes of a test for recoverability, they are referred to as an ? asset group. How should the multiple operating scenarios impact the recoverability test? ASC 360-10 allows entities to use either a single-most-likely estimate of expected future cash flows (often referred to as a traditional or best-estimate approach) or a range of possible future outcomes (often referred to as a probability-weighted approach).However, if alternative courses of action to recover the long-lived asset (group) are under consideration or if a range is estimated for the amount of possible cash flows, the likelihood of possible outcomes should be considered. An entity is not required to use the probability-weighted approach, but it may be useful in considering the likelihood of possible outcomes. If the probability-weighted approach is used, the likelihood of possible outcomes should be considered in determining the best estimate of future cash flows. What impact should the potential foreclosure and extinguishment of debt have on the cash flows used t o perform the recoverability test? Generally, debt should not be included in an asset group because the lowest level of identifiable cash flows will typically not include cash flows associated with debt (i. e. , the principal payments associated with the debt). Further, the cash flows associated with debt principal payments are typically easy to identify; therefore, most entities will be able to eliminate the cash flows associated with debt from the cash flows of other assets and liabilities.However, in rare instances, if the lowest level of identifiable cash flows includes cash flows associated with debt principal payments and it is not practical to eliminate those cash flows (which would be more likely to occur when the asset group is a business or reporting unit), then the debt should be included in the asset group (i. e. , netted with the carrying amounts of the assets of the group) so as to maintain an appropriate comparison. This basis adjustment provides the same result as if the debt principal payments have been excluded (e. g. debt with a carrying value of $100 would have undiscounted cash flows of $100). As a reminder, the guidance in ASC 360-10 prohibits the inclusion of interest expense in assessing the recoverability of long-lived assets. When the FASB originally deliberated Statement 144, it considered and rejected requests for a limited exception to the fair value measurement for impaired long-lived assets that are subject to nonrecourse debt. Some constituents believed that the impairment loss on an asset subject entirely to nonrecourse debt should be limited to the loss that would occur if the asset were put back to the lender.The FASB decided not to provide an exception for assets subject to nonrecourse debt. In its basis for conclusions, the FASB explained that the â€Å"Recognition of an impairment loss and the recognition of a gain on the extinguishment of debt are separate events, and each event should be recognized in the period in whic h it occurs. The Board believes that the recognition of an impairment loss should be based on the measurement of the asset at its fair value and that the existence of nonrecourse debt should not influence that measurement. † (Statement 144, paragraph B34) 2.What impairment loss, if any, should be recorded as of December 31, 2010? As discussed above, if indicators of impairment exist for an asset (group) to be held and used, an entity determines whether the sum of the estimated undiscounted future cash flows attributable to the asset (group) in question is less than its carrying amount. If those undiscounted cash flows are less than the carrying amount, then an entity will recognize an impairment loss based on the excess of the carrying amount of the asset (group) over its respective fair value.However, under ASC 820 cash flows used to determine fair value (using a present value technique) when determining the impairment loss (Step 3) must include assumptions that market partic ipants would use in their estimates of fair value. As a result, entities are not able to simply apply a discount rate to the cash flows used in Step 2 to determine fair value without first determining whether they reflect the expectations of market participants.Entities may use their own assumptions as a starting point in developing market participant assumptions and apply reasonable judgment in analyzing whether such assumptions are representative of market participant assumptions. The determination of market participant assumptions and their effect on fair value estimates are particularly subjective considering that the evaluation is being made for assets to be held and used. When multiple valuation techniques are used, the merits of each valuation technique and the underlying assumptions embedded in each of the techniques should be considered in evaluating and assessing the results.In this case, we do not know the assumptions for the estimated fair value of $3. 0 million and we c onsider the discounted cash flow is more reliable. The first step is to check impairment indicator. Because of an increased presence of pirate in the area which Smooth Sailing cruises, the cruise ship’s operating performance has significantly declined which has directly contributed to a decline in its overall fair value, and may indicate a potential impairment. In the second step, we did the recoverability test.The undiscounted cash flow is the sum of expected operating cash flow and the cash flow from the net working capital. Calculation is shown below: We use the probability-weighted approach to get the estimated future cash flow ($2. 30) which is smaller than the net book value. As a result, the cruise is not recoverable. In the third step, we calculated the impairment loss. We calculated the discounted cash flow as follow: So an impairment of 2. 44 million should be recorded, which is the difference between the net book value of 4. million and the discounted cash flow of 2. 16 million. The detailed calculation is included in the attachment â€Å"rough water ahead. xlsx† Alternate Facts: Would the outcome of the recoverability and impairment tests change if the probability assessment was revised such that there was a 50 percent, 40 percent, and 10 percent probability of scenarios A, B, and C occurring, respectively? If so, how? An impairment of 0. 62 million should be recorded. The calculation is included in the attachment â€Å"rough water ahead. xlsx†

Building a Houseâ€Advice From an Architect

Congratulations on your (soon-to-be) home! While building a new house is an exciting—and possibly mind-boggling—experience for you, it is important to stay involved in every step of the process. Generally speaking, building your new house should not be a passive exercise. A myriad of decisions must be made, and they should be made by you. When you are unable or unwilling to make decisions, you force the builder to make them, and the result may waver from what you were hoping for. To make sure your new home fulfills your own vision, follow the following guidelines for staying involved when building a house. Understand Your Contract No matter what type of contract you sign, you become a party in a legal document involving a massive amount of money for the construction of your new house. Therefore, it is essential that you know your rights—and exercise them. Start by reading the contract thoroughly and understanding it. Remember: You are paying for the knowledge, experience, and abilities of the builders. Youre also paying them a profit above their expenses. So, what do you expect in return? How do you ensure that you get what you expect? Expectations of all parties should be laid out in the contract. Watch Building Costs The average house contains approximately 1,500 to 2,000 square feet. Do you need more space than that? Why? How much more? You pay for each and every square foot of space in your house, whether its occupied, usable, or otherwise. You also want to keep costs in perspective. For example, say the brick you really like costs $10 more per thousand than the standard brick. When a typical amount of 10,000 bricks is involved, thats a total extra expense is $100. Its up to you to decide if the special brick is worth the extra cost, but doing the math yourself in the first place will help you make informed decisions about your home. Overall, be smart. Take care that glitz and gadgets suggested by friends, the builder, or magazines do not get in the way of good basic construction. Bouncy floors where joists are stretched to the maximum are not remedied by a hot tub, flocked wallcovering, skylights, or jazzy door hardware. Comply With Building Codes No, you should not expect to control the number of nails used in your home. However, you should expect a substantially built house that is free of defects and in accord with all applicable codes and regulations. Require proof of such compliance at the closing of your mortgage. Many jurisdictions issue Certificates of Occupancy, which would indicate accord with the minimum code and safety standards. Realize that some details are virtually unchangeable because they need to be done correctly. This includes a properly sized and constructed foundation system, a properly designed and installed structural system, and so on. Changeable items such as finishes and coverings should not distract you from requiring good basic construction. At the same time, watch for things that are not necessarily what you want and that you will not be able to change easily or cheaply. It may be able to be corrected. Question things that just dont look or seem right. Most of the time they indeed are not. Seek some reliable outside, impartial advice—other than your father, even if he is a builder! Be Flexible Be ready and prepared to compromise in order to resolve situations and problems. Be aware, however, of what you may be giving up in this process;  examine and understand both sides. Is the situation worth what you are losing? The builder is fully capable of doing anything or finding someone who can do anything you wish, but anything always comes with a price. Be careful and wary of unique, inordinate, or far-out requests, new technology, and untested materials and equipment. Understand that construction is an imperfect science. Combine that understanding with natural elements (e.g., site conditions, weather, wood members, human foibles), and you might face situations where things could change, must be changed, or simply exceed capabilities. Flat-out errors do happen. Absolute perfection or your idea of perfection may not—and more than likely, will not—be achieved. Drastic imperfections, however, can be corrected, and they should be. It is within your rights to require this. Keep Records Issues not clearly and specifically noted, written, described, or shown will be left up for interpretation by both sides in the future. Therefore, be redundant in your record-keeping,  leaving nothing to chance. Follow up verbal discussions and instructions with written verification. Keep receipts; records of phone calls and other correspondence; samples you approve; sales slips; model, type, and style numbers; and the like. Knowing the exact details of all aspects of the building process can help you immensely. If an issue arises somewhere down the road, there will be no room for doubt or argument, and a resolution can be found quickly and without dispute. Keep It Professional Be pragmatic and absolutely businesslike in all of your dealings with the builders. They are working for you; you are not seeking them as new friends. If a friend or relative performs part of the work, treat that person in exactly the same manner:  Have a contract and demand adherence to your schedule. Dont let a gift or a good price disrupt the project overall. Questions to Ask When Building a House What is a good design for my needs?What is a building code? Does it affect me? How does it work?Overall, who is responsible for my building project?What are good sizes and proportions for rooms? What style do I want?What am I really getting from the builder?What problems do I have in my current home that I dont want to repeat?Where can I find answers and help? How do I make my desires known?What does that line on the drawing mean?What is a dispute? What is a lien?What are specifications? Does the builder write and provide them?What if my builder does something in a way I dont like?When will the house be finished?What is a contract? What does it say? What is my part in it?What is an extra?Is that a good material? Ive never heard of it.What can I change?Who picks the color of the paint, wall coverings, tile, type of wood, siding, etc?Is landscaping included? Are any landscape features guaranteed?What if I disagree with the builder? Can I stop the work?Am I allowed on the job site? Can I inspect the work as it goes up? Can I bring someone with me?If I buy an element of the house myself, who will install it?I have several items that I dont like. Do I have to close on the mortgage right now? About the Author, Ralph Liebing Ralph W. Liebing (1935–2014) was a registered architect, a lifelong teacher of code compliance, and the author of 11 books on architectural drawings, codes and regulations, contract administration, and the construction industry.  A 1959 graduate from the University of Cincinnati, Liebing taught at the University of Cincinnati School of Architecture and the College of Applied Science Technology at Illinois State University. In addition, he trained carpenters union apprentices, directed classes at community education programs, and taught architectural technology for Daytons ITT Technical Institute. He practiced architecture in both Ohio and Kentucky. Liebing published many textbooks, articles, papers, and commentaries. He was a fierce advocate for not only enforcing specifications and codes but for design firms to engage owners in the process.  His publications include Construction of Architecture: From Design to Built, Architectural Working Drawings, and The Construction Industry. In addition to being a Registered Architect (RA), Liebing was a Certified Professional Code Administrator (CPCA), Chief Building Official (CBO), and a Professional Code Administrator. Ralph Liebing was a pioneer in creating useful, professional web content of lasting quality.