JD Power Essay Example | Topics and Well Written Essays - 750 words - 1

JD Power - Essay Example Now, how does one define the specific market segments of JD Power consumers? Basically, the company provides pertinent market research to its clients spanning a myriad of different industries, including automotives, real estate, insurance, and telecommunications. If it is to be broken down, the company has two main target markets – everyday consumers and corporate business entities. Everyday consumers utilize the customer satisfaction ratings and market research studies of the company in order to make better- informed decisions regarding their purchases and transactions, using the culled consumer information data as a reference point. They make use of the service by simply going to the company’s consumer website, where they can look for the specific industry that concerns them at the moment. From there, the market research data and research surveys would be readily available for instant viewing. Consumers in all likelihood use the product every time they are in need of a figure-backed opinion concerning an upcoming purchase. They could compare how the product or service stacked up in the court of public opinion, and could use it as an additional tool towards making an informed and well-researched decision. Corporations and businesses make up the other major market segment of the company. They seek the consumer data culled by JD Power for their own internal use. The companies buy the comprehensive research provided by JD Power and utilize it in accordance with their own business interests.2 This is a process that occurs every time a new product or service is launched; the companies would want to know how it is received in the marketplace. Armed with this information , these client companies would be well-informed as to what their succeeding strategies would be. Now, why did JD Power and Associates choose to concentrate on these two main target markets? Obviously the consumers do not pay anything for the research that is

Benefits of Nonverbal Communication Essay Example for Free

Benefits of Nonverbal Communication Essay Certain things are not conveyed by words or verbal means because individuals are not simply skilled to deliver or are not trained to explain in appropriate means or symbols. An officer can definitely learn from an understanding of nonverbal communication as he/she will be able to gain the nuances of an offender or parolee’s responses whether these are in consonance with the gaze in his eyes, the confidence of gait, or the studied looks that he may portray during the sessions that might transpire with the officer (Messina, Training in Nonverbal Communication). An officer who has spent a lengthy time studying people in this kind of profession, the difficulty usually lies in studying those who are mentally deranged, or the offenders who are so evil that they are capable to manipulate even the most intelligent officers, when possible. Their eyes convey differently where their talk or smiles carry them to a different level (Carrick, 2006). Art in any form conveys the reality that a human’s world is enriched by the kind of communication inherent in being human. Even one’s attire may speak a million things about the person or his intentions. People communicate both through verbal and nonverbal modes. Though we mistake verbal communication is clearer, yet often the reverse is truer (Messina, Training in Nonverbal Communication). People frequently understand our gestures more than our words. Hence, the adage â€Å"Actions speak louder than words. † Nonverbal communication is taught and performed frequently on an almost instinctive level. People get attention by using nonverbal signals and every so often the attention is usually due to an unpleasant manner by which these signals were conveyed. Most people who employ body language utilize such behavior to conceal the self for fear of rejection. The result would mean no real deep connections and deters other people to develop such deep and beneficial relationships. Many of those who realize their need try to unlearn years of covering up and attempt to make themselves known to avoid (Messina, Training in Nonverbal Communication). Every individual has inadequate stock of body language and utilizes the same manners to show specific emotionality. Body language and/or gestures, and a host of physical and psychological signals take place in clusters. This means that when a particular body language is used, it may not mean much as when it is used alongside many other forms of communication (Messina, Training in Nonverbal Communication). The officer then must continually make use of every opportunity as a learning experience as people are dynamic and continually changing. Reference: Carrick, Damien. 31 January 2006. The Law Report. Parole Boards. Messina, James D. Training in Nonverbal Communication. Accessed from Analysis of Cultural Communication and Proxemics http://www. unl. edu/casetudy/456/traci. htm

Biochemical and Hormonal Changes in Childhood Obesity

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

Cinema in Toni Morrisons The Bluest Eye Essay -- Toni Morrison Bluest

Cinema in Toni Morrison's The Bluest Eye In Toni Morrison’s novel, The Bluest Eye, characters learn how to perform social roles though film. Pauline goes to the movies in search of a more glamorous identity. Instead, the unattainable beauty she sees onscreen reaffirms her low place in society. Laura Mulvey’s article, Visual and Other Pleasures, explains film’s ability to indoctrinate patriarchal social order. This ability is certainly applicable to Morrison’s novel. Film reinforces the Breedloves’ place in society, teaches Claudia to love Shirley Temple and constructs women as sexual objects for pleasure. Mulvey’s article also examines the powerful, active male gaze. In The Bluest Eye the female gaze is constructed as dirty, unnatural and wrong. Women and children in this novel are relegated to the role of passive sexual objects. Little girls are subjected to the gaze of Cholly and Soaphead Church. Mulvey defines this type of gaze as fetishistic scopophilia. In both Mulve y’s article and Morrison’s novel film is used as an instructional tool to create identity and reinforce social and gender roles. Film’s power to enforce social order is revealed in Pauline’s trips to the movies. She is drawn to the physical beauty and therefore taught to value beauty above anything else in society. Pauline receives an â€Å"education† from the movies. â€Å"It was really a simple pleasure, but she learned all there was to love and all there was to hate† (Morrison 122). Pauline learns how to order her world though film. She is taught to love beauty and hate ugliness. Film, however, also teaches her to hate herself because of her ugliness. At first Pauline identifies with the beautiful white women she sees in the movies. ... ...so presents the idea of scopophilia and active male gaze. Morrison further examines these ideas by constructing an active female gaze. When Pecola and Claudia experience this type of gaze they do not feel powerful, but sinful. Morrison also depicts women in the role of passive sexual objects. These women are forced to submit to the male gaze and are powerless to control it. In The Bluest Eye Morrison examines Mulvey’s assertions about the role of cinema, the active male gaze and the passive female. She proves cinema’s ability to assign social scripts and the total domination of the active male gaze over little girls. Works Cited Morrison, Toni. The Bluest Eye. New York, New York: Penguin Group, 1994. Mulvey, Laura. â€Å"Visual Pleasure & Narrative Cinema.† Visual and Other Pleasures. Bloomington, IN: Indiana University Press, 1989. 14-26.

The Meaning of Abstract Art Essays -- essays research papers

There are generally two types of paintings- representational and abstract. While representational painting portrays recognizable objects, abstract painting does not look like a particular object. Instead, abstract art is made up of designs, shapes and colors. (http://www.harley.com/art/abstract-art/ ) The meaning of abstract art is, in its most simplified form, art that relies on the emotions of the artist and the elements of design rather than exact representation. This broad definition allows artists almost unlimited freedom of expression. Some abstract artists create compositions that have no precedent in nature. Other abstract artists work from nature and then interpret their subjects in a nonrepresentational manner. In other words, as found on Wikipedia by Answers.com, when abstract art represents the natural world, it â€Å"does so by capturing something of its immutable intrinsic qualities rather than by imitating its external appearance.† (http://www.answers.com/topic /abstract-art)   Ã‚  Ã‚  Ã‚  Ã‚  Historically, abstract art has existed for centuries, as Jewish and Islamic traditional forbids the use of representational art. (http://www.artelino.com/articles/abstract_art.asp) However, the roots of what we generally term â€Å"abstract art† can be traced to the Impressionism movement of the 1880s-1890s. Impressionism disregarded the notion that art was supposed to portray images. Post Impressionism continued this trend and placed more emphasis on the artist’s emotions and expression. Wassily Kandinsky and Kasimir Malevich were the first to really create works that were pure abstraction. Kandinsky was the founder of the Abstraction movement and even published a book detailing his theories on art and spirituality, On the Spiritual in Art. (http://www.artelino.com/articles/abstract_art.asp) Kandinsky created a series of pieces with numbered titles beginning with, â€Å"Improvisation† and â€Å"Composition.† (http://www.ibiblio.org/wm/ paint/auth/kandinsky/) These works were studies in color and line, without an emphasis on representation. While Kandinsky worked in Germany, Malevich spent much of his time in the Russian city of Vitebsk where he taught and founded the UNOVIS, which stood for â€Å"Affirmers of the New Art† and was founded to promote â€Å"collectivity in the creative process† and create a new way of teaching and creating art. (http://www.russianavantgard... ...tational designs and elements, his work can be considered some of the greatest examples of abstract art to date.   Ã‚  Ã‚  Ã‚  Ã‚  Leger, Boccioni and Rothko were all expressing their inner vision. Art is a form of creative expression. Abstract art allowed artists to push the boundaries of creative freedom by favoring design and emotion over representation. But, as the question is posed at paintings.name, â€Å"How free can art be?† (http://paintings.name/) The answer is clear. The only constraint placed by abstract art is that the works are generally nonrepresentational. The artists are free to explore their subjects from various perspectives, geometries and situations. Movement can be show like never before. Merely by adding abstract elements to their works, artists can increase their range. As paintings.name states, â€Å"Contemporary paintings no longer reflect a contraposition between abstract art and figurative art, but these styles either flow together in paintings by contemporary artists, or exist side by side in pure abstract paintings or pure figurative paintings.† (ht tp://paintings.name/) The meaning of abstract art is found in this freedom of choice and expression.

The Puppet Master of Rome: the Mother-Son Relationship in Shakespeare’s Coriolanus

There is one thing in the world that everyone has: a mother. Some people never knew their mothers, some have bad relationships with their mothers, and some love their mothers more than anything else. In William Shakespeare’s Coriolanus, Caius Martius, or Coriolanus, has a very intense relationship with his mother, Volumnia. He loves, respects, fears, and is controlled by her. This is made very evident throughout the play. Everything she asks for is done promptly after a simple proclamation of her need for it.This includes anything from fetching a drink for her to calling off an attack on a city. Coriolanus has his mother’s voice in his ear throughout the play. Sometimes, it saves him, but it also gives him a lack of identity and ultimately causes his demise. The first time we are introduced to Volumnia is in Act 1, Scene iii of the play. She is sitting and sewing with Virgilia, Coriolanus’ wife, and Valeria, Virgillia’s friend. At this point in the play, C oriolanus is in battle, fighting the Volsces in the city of Corioles.Virgilia worries for the safety of her husband and prays that he comes back unharmed. Volumnia responds to her and lets the audience see what kind of mother she really is. As Virgilia expresses her concern for her husband’s well being, Volumnia proceeds to tell her that she would rather have her son die in battle than come back uninjured. She makes a short speech about how his injuries and his involvement in battle enforce his manhood. When he was but tender-bodied and the only son of my womb, when youth with comeliness plucked all gaze his way, when for a day of kings’ entreaties a mother should not sell him an hour from her beholding, I, considering how honor would become such a person – that it was no better than picturelike to hang by th’ wall, if renown made it not stir – was pleased to let him seek danger where he was like to find fame.To a cruel war I sent him, from whence he returned, his brows bound with oak, I tell thee, daughter, I sprang not more in joy at first hearing he was a man-child than now in first seeing he had proved himself a man. (I, iii, 5-17) In this speech, Volumnia makes it clear that she had always planned for Coriolanus to be a warrior and she would not be proud of him for any other reason. As their talk continues, Virgilia asks her how she would feel if her son died in battle. Volumnia responds to her by saying that is she had twelve sons, she would have rather â€Å"had eleven die nobly for their country than one voluptuously surfeit out of action. † (I, iii, 22-25) This statement reveals the to audience Volumnia’s obsession of gaining fame vicariously through her acclaimed war-hero son and her influence on her son becomes blatantly apparent.This demonstrated Volumnia’s gender role in her society, as well. Volumnia â€Å"manages to be heard in spite of [traditional gender roles]; nevertheless, there are s trict codes of conduct and societal expectations for the behavior of women, which Virgilia follows to the letter, although Volumnia cannot help but rebel. Coriolanus seems restricted by these same ideas [and] forced to act like a hardened man, and stung when he has to admit weakness, or show any emotion. † (Coriolanus Themes) This view is further enforced in the following act’s first scene, when Coriolanus returns.Volumnia and the others stand watching him and his army approach. Volumnia proclaims â€Å"O, he is wounded; I thank the gods for‘t. † (II, i, 118) She basks in the glory of his wounds and announces them to the crowd as he approaches. A darker side of Volumnia comes out in this scene. As trumpets sound, she looks upon her nearing son and says aloud â€Å"Before him he carries noise, and behind him he leaves tears. Death, that dark spirit, in’s nervy arms doth lie; which, being advanced, declines, and then men die. (II, i, 154-157) She also makes it known that she has faith in his position in the Consul, which has yet to be confirmed. This overbearing attitude of Volumnia’s has a huge influence on Coriolanus, but we don’t see the true extent of his dependence and commitment to her until act III, when Volumnia berates him for his actions in front of the citizens of the town and for the Senators, therefore, costing him his position as Consul member. Coriolanus had let his temper and disdain for the citizens and government overcome him and he insulted them all in various ways, including calling the Senators â€Å"barbarians† (III, i, 239).She enters by saying, â€Å"O, sir, sir, sir, I would have had you put your power well on, before you had worn it out. † (III, ii, 16-18) After berating him, she encourages him to go make amends with the people of the town and regain his popularity; she won’t give up her dreams quite yet. She also lets him know that she will guide him and he can  "go to them, with this bonnet in thy hand; and thus having far stretched it – here be with them – thy knee bussing the stones – for in such business action is eloquence [†¦]. (III, ii, 72-76) She later follows this statement with, â€Å"Prithee now, go and be ruled [†¦]†(III, ii, 89-90) This statement presents a sort of double entendre, seeing as she presently rules him and has for his entire life. She is not only telling him to hand himself over to the approval of the public, but to let her take him by the hand in doing so. Volumnia makes it known that she has everything to lose from Coriolanus’ failure. She even bluntly states, â€Å"[†¦] it is my more dishonor than thou to them. Come all to ruin!Let thy mother rather feel thy pride than thy dangerous stoutness, for I mock at death with as big heart as thou. Do as thou list. Thy valiantness was mine, thou suck’st it from me, but owe thy pride thyself. † (III, ii, 124- 130) To this, Coriolanus responds with compliance and goes immediately to the market place, asking of his mother, â€Å"chide me no more. † (III, ii, 132) Coriolanus cannot take much chastisement or reprimanding from his mother without caving in and doing exactly as she asks, for that is all he knows.Towards the end of the play, Coriolanus finally defies his mother and leaves Rome to side with the Volces. This is the first time he ever left her or did not follow her word in the entire play. However, before his attack on Rome, Volumnia uses the most epic of motherly guilt trips when she, Virgilia, and Valeria travel to the Volsces’ city to convince Coriolanus to stop the attack. She attempts to break his icy exterior to attack his heart and change his position on the coming war.She first attempts to stoke his ego and confirm his greatness, asking how he could make this decision. When that fails to reach him, she pushes the argument that they will have no place to go whe n their home is destroyed. When that also fails, she then pulls on his heartstrings and tells him that they will all die by the hands of the Volsces because of his commands. When she notices him beginning to doubt his position, she lays on the line â€Å"so, we will home to Rome, and die among our neighbors. [†¦] Yet give us our dispatch.I am hushed until our city be afire, and then I’ll speak a little. † (V, iii, 172-182) This finally reaches him. He breaks down to Aufidius and makes peace, refusing to continue the war. In the end, Vomumnia was praised by Rome for convincing her son to make peace and preventing the attack. He gained the hero status she wanted for her son. He did not resent her for it, but he did die to defend the honor of Rome. â€Å"Volumnia's reputation as the noblest Roman matron of them all is apparently the product of outmoded idealization of motherhood.Hofling, undoubtedly the best informed of the recent commentators, writes: ‘Volumn ia thus is seen to be an extremely unfeminine, non-maternal person, one who sought to mold her son to fit a preconceived image gratifying her own masculine (actually pseudo-masculine) strivings. Her method, we learn from the above and other speeches, was to withhold praise and the scant affection she had to give from any achievements except aggressive and exhibitionistic ones† (Putney) Coriolanus’ lack of independence from his mother created a lack of identity for himself.He did not know how to go about life without his mother, even at his age and having his own family. â€Å"Coriolanus' lack of identity is due to a controlling mother in a fatherless environment. According to the Freudian model for establishing male identity, Coriolanus is doomed. Nowhere is this more evident that at the end of the play, when Volumnia, his mother convinces him to spare Rome. He is wholly controlled by his mother, and has no voice of his own. He says, â€Å"Like a dull actor now,/ I ha ve forgot my part and I am out,/Even to full disgrace† (V, iii, 40-42).Following his mother's demands, he spares Rome, which leads directly to his demise. Thus, his controlling mother coupled with the absence of a father figure leads to his lack of identity, which leads to his death. † (Freudian Interpretation) Coriolanus even follows his mother’s desire for honor in death in battle during his final hour. He proclaims, â€Å"cut me to pieces, Volsces. Men and lads, stain all your edges on me. † (V, vi, 110-111) In the end, if it were not for Volumnia’s influence, her son may have lived a full life and been able to care for his family.In the same respect, there may have not been peace between Rome and the Volsces. Volumnia truly is the strength of Rome. Throughout the play, Volumnia never lost her courage or backed down from the challenges that could have prevented her and her son from achieving her status. She made it seem as though she would do anyt hing for the people she loved and the city that was her home, but she always had ulterior motives and clawed her way to the top, sacrificing her son along the way. Works Cited â€Å"Coriolanus Themes.† GradeSaver.com. 14 Mar. 2011. GradeSaver LLC.. 1999 . â€Å"Freudian Interpretation.† New York University.edu. 14 Mar. 2011. New York University. . Putney, Rufus. â€Å"Coriolanus | Mother-Son Relationship.† eNotes.com. 14 Mar. 2011. eNotes.com. 2011 .

Film Techniques against the Theme of “Change” Essay

How are we made aware of the filmmaker’s attitude towards change? Refer to three specific episodes from the film. (excl. concl. stages)In Pleasantville, the filmmaker, Gary Ross, conveys his attitude towards change through the characters of David and Jennifer who are transported into the 1950s sitcom â€Å"Pleasantville†. He doesn’t necessarily demonstrate change to bear a positive result; rather, he addresses that change is essential to the development of society and self and that it is important to understand and accept change. Ross contrasts the ignorance and mindlessness of the unchanged people of Pleasantville with the hunger for knowledge that the changed (or coloured) people possess, communicating to the viewer that change and knowledge go hand in hand. Ross also portrays and somewhat satirises an unchanged society’s people to be ruled by their own mindlessness, and in their epiphany, translates to the viewer that change can come from within or from outside one’s self but is different for everyone. Dark overtones are used to parallel the Pleasantville to a society under fascist rule. However, in the end, change will always affect everyone and this new understanding will help to overcome the changes encountered in the future that may seek to detriment the society. The three scenes which will be discussed in relation to the filmmaker’s attitude towards change are the breakfast scene, the classroom scene, and the rain scene. The breakfast scene is the scene where Betty is piling food on other food and topping it off with maple syrup for Mary-Sue’s breakfast. The audience is overwhelmed at the ridiculous amount of food that is being placed on her plate, which is shown by extreme close-up and cuts of the shots of every time another food item is slapped onto the plate, and is accompanied by an upbeat music. The audience knows that the person under the guise of Mary-Sue is Jennifer, stereotypical of an American teenage girl, so she is naturally concerned about her weight and watches the food she eats. The scene is ironic because such a big breakfast is the exact type of meal she would be trying to avoid. The scene is also hyperbolic as even in the 1950s, it would be considered  ridiculous to eat such a variety of foods for just one morning meal. The ‘jumpy’ non-diegetic music timed with the quick shots of food being placed on the plate, and the jump-cuts showing the reactions of a horrified Jennifer when seeing all this food, assist create situational humour. The reason that all these techniques have been used to create humour is to present a sitcom-style situation. In doing this, Gary Ross satirises the mindlessness of the unchanged people and this becomes important as the storyline progresses. The breakfast scene is also a place which symbolically informs the audience of the current circumstances of Pleasantville. Betty is piling food which would normally be considered tasteful by the audience once in a while and individually: pancakes, salami, bacon and eggs. This is what could be represented in the saying: â€Å"Too much of a good thing is never good.† The incongruous mix of foods is intentionally used by the filmmaker to make the audience feel uncomfortable. It is symbolically stating that there are too many good things in Pleasantville. There is also a sense that this is the situation everyday, meaning there is no change. This can be inferred from the ease and comfort with which Betty is placing the food on Mary-Sue’s plate. It is as if she has been doing this her whole life. The final food item is the syrup being slowly poured onto all the other foods, which is shown for a longer amount of time than the other foods and with the music becoming slower, almost as if poison. This symbolises the ‘sickly sweet’ mannerism which has consumed the people of Pleasantville. Ross is effectively trying to convey the bitterness of a sickly sweet society who has never seen anything other than the norm and has never experienced any change. This suggestion can be furthered in the discussion of the film’s â€Å"black-and-white technique†. The black-and-white technique is not just important in the distinguishing of changed people from unchanged people. It was conventionally used in Noir films to represent the dark overtones of the society. It is used as a motif in Pleasantville for the majority of the beginning of Jennifer and David’s adventure (until things start to change, that is). This is especially significant with all the subtle implications  and allusions to a Nazi-style dictatorship. For example, the burning of books is reminiscent of that in 1936 when the German government burnt all books which would oppose its rule, in fear that the society it governed would think of rebelling. Big Bob is the obvious ruler, as he is almost always seen with a low shot, making him look big and powerful to the audience. Bob’s situation is similar, burning books to stop changes occurring. Books are seen as works of art which are derived from the imagination of thinking people. Bob’s censorship practices extend to the prohibition of Mr Johnson from using colours to paint (that is, from using the full extent of his imagination) in his Code of Conduct. In this way, he is much like the German government in the 30s. However, he wants to continue his rule without any violent opposition; only ‘pleasantness’. There is irony however, as there is vandalism and disruption when the Milk Bar is broken into and sabotaged because of his encouragement, which is the exact opposite of ‘pleasant’. The fact that people submitted to this way of life (where everything is sickly sweet) without opposition before (before changes were introduced) shows that they were not ruled by Bob, but really by the restrictions they placed on themselves. Bob is only used to embody the fears and restrictions and ignorance that the Pleasantville society possesses. The filmmaker is trying to convey through these situations and allusions that those who resist change are irrational and are ruled by their own ignorance. The classroom scene when the students are learning about the geography of Pleasantville encapsulates the nature of the whole Pleasantville society. The students are used to learning the same thing everyday (since they already know the answers to the questions). The mise en scene of the students’ positions is incongruous. They are high school students but have their backs straight and behaving as if they are in kindergarten. They seem very comfortable, though, but when Jennifer confronts the teacher with the question â€Å"What’s outside of Pleasantville?† they are shocked. A panning shot from the point of view of Jennifer shows the reaction of the class, and the silence adds to the tension. After the teacher assures the students that there is nothing outside of Pleasantville, and that the roads begin where  they end, a sigh of relief ripples uniformly throughout the class. This reaction illustrates how fearful the students are of change and questioning the norm, since it is unknown and unfamiliar. The fact that the students have no appetite for knowledge is related to their inexperience of change. Thus, Ross is effectually demonstrating that change and knowledge go hand in hand. Later, in the Milk Bar, when everyone is questioning David about the fire, the same students show a thirst for knowledge. The way they keep pressing David to tell them about places outside Pleasantville is contrasted to the classroom scene. Again, the technique of silence is employed, but this time in a freer atmosphere with curiosity instead of fear and with non-diegetic music which depicts a ‘cheeky’ mood. It depicts the way David is about to break the rules by allowing people to know information that he thinks they shouldn’t because it will â€Å"throw their whole universe out of whack.† In this way, Ross illustrates to the audience that change is about development rather than the results produced (whether positive or negative). The classroom scene creates an interesting contrast to the classroom scene in ‘the real world’. At school, students are assured their futures are crystal clear: both predictable and wonderful. In the real world, David and Jennifer were being constantly reminded of the negative things in the future by the teachers: â€Å"Employment will go down thirty percent in the next five years†¦Greenhouse emissions†¦Ã¢â‚¬  This gave a very bleak outlook of the future, and the zooming and simultaneous cutting of shots of different classrooms added to the feeling of impending doom. In Pleasantville however, everyone’s futures are predictably wonderful. The characters, without having developed an understanding of change, are at a loss when they find themselves feeling emotions and thinking for themselves. For instance, when Mr Johnson’s artworks are exposed, people become enraged and frightened and consequently violence occurs. This symbolises how these unchanged and undeveloped people don’t know what to do when circumstances change. Ross is trying to show the audience that it is important to develop and understand change, because it will help in the handling of future problems. The rain scene is the scene where, after the emergence of the storm, it suddenly starts raining and very important events are taking place. One of these events involve the time when David and Margaret are kissing at Lover’s Lane. When rain suddenly starts pouring, David placates everyone’s fears by going out into the rain and holds his arms up to the sky, as if embracing the weather. The scene is a cinematic homage to the film Shawshank Redemption, depicting the part after Andy Dufresne has escaped from the prison and is now a free man. It is definitely a turning point in the film Pleasantville and is seen as a revelation. The allusion is symbolic because, just like Andy Dufresne, the kids at Lover’s Lane have escaped the grey walls that once held their thoughts and are now free to think and feel emotions. The next morning they all wake up coloured (except for David). Ross here is suggesting that change sets people free, and resistance to change is resistance to thought and passion. This assertion is further developed near the end of the movie in the courtroom scene. Gary Ross assumes the voice of David to speak to the audience. Here, the technique of monologue/speech is cleverly used: â€Å"It’s all inside you†¦And you can’t stop something that’s inside of you!† Ross is saying that these people restricted themselves from thinking and feeling emotions but they have always had the potential to be different, feel passionately and think independently. He directly states that change comes from within; Jennifer and David were merely triggering the changes to happen. Ross also implies that change is different for everyone. The aftermath of the storm shows David is still in monochrome. The shot of his reflection in the lake up to him contrasts to the coloured environment. The reflection is symbolic in that it shows David’s silent desperation while searching deep within himself to find a change. Jennifer experiences a similar problem. The dialogue between her and David is important. â€Å"I’ve had like ten times as much sex as these girls and I’m still [in black and white].† David’s reply is that maybe it is not about sex. The audience later finds that Jennifer finally changes colour when she starts reading books and puts on her glasses. The symbolism of the glasses is that her perception of the world changes and hence she changes. A panning shot around her room shows the new  colour, and finally a photograph of her alter ego, Mary-Sue, is in colour, meaning she has changed. David’s physical and individual transformation is completed when he finally starts standing up for what’s right and takes actions against what’s wrong. When he punched Whitey, he took action to fight for Betty, and the audience witnessed the first drop of blood in the whole film, showing David’s furious passion. Soft music depicting a ‘revelation’ accompanies this shot, demonstrating that he has found what he was seeking: change in himself. The over-the-shoulder shot of his back and the mirror is reminiscent of the lake scene and symbolic: not only has he found himself; but he has left his other self behind him. Ross here asserts that people change for different reasons and that change inevitably affects everyone so they can have a better understanding of themselves and the world around them. In conclusion, the filmmaker Gary Ross conveys his attitude towards change through David and Jennifer and the effect of their presence on the town. He stresses that change is essential to understanding the world, but most of all, understanding and accepting ourselves. Ross uses various allusions to show the control the citizens of Pleasantville were once under, and then to show that they have broken free, and that in the end, everyone is inevitably affected by change. He employs satire to compel the audience to have a negative view of those who are resistant to change, and to take a liking to the characters who embrace change. Ross asserts that everyone must change in order to live their lives to the fullest extent. â€Å"Pleasantville† (1998) directed by Gary Ross