The Human Microbiota Essay Example | Topics and Well Written Essays - 500 words

The Human Microbiota - Essay Example The gut microbiome takes part in broad range host related processes and has remarkable effect on human health (Greenblum, Peter and Elhanan 1). The gut microbiome has been straightforwardly caught up in the etiopathogenesis of a number of pathological conditions. These include: inflammatory bowel diseases (IBD’s), Autism, Circulatory disease and Obesity. In addition to that, gut microbiome also influence: immune system response as well as conditioning, dietary calorific availability, post-surgical recovery and drug toxicity plus metabolism. Gut Microbiome as well conducts significant physiological roles that define the host, such as: intestinal response, immune system maturation, xenobiotic as well as energy metabolism and epithelial cell injury repair (Kinross, Ara and Jeremy 1). The gut microbiome, in most mammals, mainly consists of 4 bacterial phyla that execute most of the various physiological processes in the host, these include: Actino-bacteria, Fermicutes, Proteobacteria as well as Bacteriodetes. Every host has a characteristic biological association with its gut microbiome plus by definition this controls individual threat of disease. Recent advances in systems biology founded on the next generation ‘omics’ techniques have been able to explain the gut microbiome comprehensively at a functional (proteomic, metabolic as well as transcriptomic) and genetic level. Consequently, these studies have generated new knowledge about the gut microbiome’s genetic variability among individuals, species as well as populations. Furthermore, the studies have highlighted the significance of gut microbiome to human health (Kinross, Ara and Jeremy 1). Being aware of the genetic variation of gut microbiomes, within as well as among hosts, would assist in gaining insight into the evolutionary forces that shape these communities. Furthermore, studying the genetic variation of human gut microbiome may well provide insight into budding relations

Encouraging Children to Join Dance Physical Activities

Encouraging Children to Join Dance Physical Activities ABSTRACT Objective: The objective of the study was to encourage young primary 4/ 5 school children to participate in skill based physical activity like dance which has better health benefits then the regular physical education sessions. Methods: An epidemiological cohort study was conducted in randomly selected three schools in Glasgow. 95 children participated out of which 64 underwent 16 weeks of dance training as an additional physical education session in schools by a trained dance professional. Control group (N=31) children attended the regular physical education session of the school. For both the groups measurements were taken at baseline, post 8 weeks and post 16 weeks of the intervention. The aerobic fitness and body fat percentage were the major criteria to assess the effectiveness of the study. Aerobic fitness was measured by 20 m shuttle run test and body fat was assesses by Tanita body composition analyser. Results: A significant improvement in aerobic capacity was reported in the intervention group with mean -1.71  ± SD 1.77; p value Conclusion: The 16 week dance intervention has enhanced the aerobic fitness in children. The study suggests that a well planned entertaining skill based PE session can have positive influence upon increasing physical activity levels in young children. INTRODUCTION Physical inactivity is estimated to cause 2 million deaths worldwide annually. Furthermore it contributes largely to medical costs [1]. Engaging in regular physical activity is an essential element in preventing chronic diseases [2]. It is presupposed that improved physical activity in childhood can reduce the health risks associated with inactivity and benefit health both during childhood and adulthood [3]. However in recent years the inflating physical inactivity in children around the world has gathered considerable attention [4, 5, 6]. The increasing prevalence of overweight and obesity in children has been attributed in part, to decrease in physical activity. The imbalance in energy intake and energy expenditure is a major root for epidemic of child obesity [7]. A large proportion of children in Scotland are insufficiently active in order to gain subsequent health benefits, hence promotion of health enhancing physical activity to children has become a public health priority. Gui delines for Appropriate Physical Activity for Elementary School Children states that children should accumulate at least sixty minutes of moderate to vigorous physical activity (MVPA) in a day [8]. To a certain limit, a linear dose-response relationship between physical activity and health can be seen [9]. Researches suggest that habitual physical activity levels decreases over the lifespan, hence children are more active than adolescents and further more than adults. Hence it can be proposed that children who do not develop patterns of regular physical activity are at risk of being sedentary adults. The adequate fitness in childhood is likely to carry beneficial biological and behavioural effects into adulthood. Physically active children are more likely to become physically active adults [10]. The declined physical activity in young children today is widely noticeable; computer games and television shows are attracting childs attention and are preferred over play [11]. Children from sedentary parents are found to be comparatively more inactive then their other counter parts. The triad between physical inactivity, obesity and unhealthiness can be presumed seeing the correlation between the three. Obesity can be relate as a unforeseen trait in a number of chronic diseases and conditions in early and later life like cardiovascular and respiratory problems, insulin resistance (type II diabetes), osteoarthritis, endocrine and metabolic disorders, psychological imbalance etc [12,13]. While evidence proves that physical activity in children improves the bone strength, benefits cardiovascular system, improve glycemic control, improves metabolism, reduce the risk of specific cancers, induce positive state of well-being like self- esteem, self-efficacy, and positive mood states [14,15,16,17,18]. Studies report positive effect of exercise training on cognition in elementary school children [19]. Churchill et al., (2002) suggest improvements in cognition due to exercise is mainly on executive function [20]. The inclusion of a healthy dose of vigorous physical activity in schools as a part of the Educational curriculum can improve the overall development of the child. The school has emerged as a critical setting for promoting health enhancing physical activity in children [21, 22, 23, 24]. School is a universal place where every child around the world spends most of his or her time, hence is a key factor in improving physical activity in children. Studies reviewing the effect of school based interventions propose an improved level of health-related knowledge and fitness in children. But in terms of obesity prevention not much effect has been detected. However, some measure of obesity has found to be downsized. Physical education in schools is not sufficient enough to provide notable health benefits. It appears that when children are given free choice, many of them seem to be less active. In order to get the health related effects it is important to offer skill based physical education sessions like dance, football, rugby etc where children can engage in moderate-to-vigorous physical activity. There are evidence that proves the effect of moderate- vigorous physical activity (MVPA) in weight stability and cardiovascular health [25]. In order to improve physical activity trends in Scottish schools, a school based intervention involving primary school children was developed. The intervention was designed to encourage children to participate in physical activity like dance which is more likely to be welcomed by children of younger age group and to continue it throughout their school career. To upgrade aerobic fitness and to downgrade the fat percentile in children were among the components of the study plan. METHODOLOGY The intervention Dance Yourself Fit focuses on improving the physical activity trends in primary 4-5 school children. Since it has been presupposed that notion of play starts declining by this age. By choosing dance as the mode of exercise, the intervention aims toward enhancing the skill based physical activity in schools along with an increase in the number of physical education (PE) sessions per week. Study design and sampling The Glasgow City Council has randomly selected three primary schools from the same socioeconomic area for the study. 95 healthy 8-9 years old volunteers including 54 girls and 41 boys participated from primary 4-5 classes. The mean weight and height of the participants before the initiation of the study was 30.09 kg with 95% CI (28.428- 131.769) and 132.24 cm with 95% CI (130.75- 133.73) respectively. Each school was visited prior to the start of the study to ensure all potential volunteers, teachers and parents are fully aware of the aims of the study. The method of monitoring and assessment was explained to the students. Adjustment was made by the school to include two physical education sessions per week in their timetable. A qualified dance professional was recruited as a coach to train the students with dance. Normal and healthy is defined as those without any medical condition which can hamper their ability to participate in aerobic exercise. Physical activity and medical questionnaire were given to the students and those considered unsuitable by the test results were excluded from the participation. Children were instructed to cease exercise if they feel any discomfort. Subjects Intervention group consists of 64 students from all the three primary schools. Control group comprise of 31 students, from one of the three randomly selected intervention schools. Children in the control group follow their normal PE sessions and physical activity and they are monitored followed by the intervention group every time the assessment is taken. The flow chart (figure: 1) represents the availability of children for measurements at each level. Consent for participation in the study was taken from the parents/guardians and the participants. Ethical approval of the study was obtained from the ethical community of the University of Glasgow. Exercise Plan Dance sessions were planned for 16 weeks, twice every week for a period of an hour/session. As per Serbescu C et. al two extra sessions of physical education per week were sufficient to obtain improvement in fitness level of the children [26]. Each dance session has a structured format commencing with 5 minutes of warm up followed by 45 minutes of moderate to high intensity dance moves with target intensity reaching up to 65-80% of maximum heart rate and a short cool down period. Measures All the measurements were taken at the baseline, intermediate (i.e. at the end of 8th week) and final levels by the well trained research staff. Comparison between the three levels was done for both the groups to judge the effectiveness of the intervention. In the intervention group, 44 children were present for baseline and final measurements, 41 for baseline and intermediate and 31 for intermediate and final measurements. Heart rate: Exercise intensity was monitored by Polar Heart Rate Monitor. Heart rate monitoring has been used successfully as a means of estimating the stress placed on the cardiopulmonary system and provides an indication of the intensity, duration and frequency of activity [27]. Heart rate monitoring belts were made to worn during the dance sessions. Data was stored in Polar performance software and analysed. Height: A portable stadiometer was used to measure height in centimeters (cm) to the nearest 0.1 cm. Weight: Tanita body composition analyser was used to measure weight in kilograms (kg) to the nearest 0.1 kg. Both weight and height were measured in light clothing like track pants or shorts with shoe off. Body Fat Percentage: Bioelectrical impedence, a non invasive validated procedure used for measuring body fat [28]. Tanita body composition analyser was used for the same. Houtkooper LB et al suggest that bioelectric impedence is a better test specifically for grading average adiposity in groups [29]. Cardio-respiratory Fitness: The multistage 20-meter shuttle run (MST) / bleep test / beep test was used to assess the maximal aerobic capacity (VO2max). Since (VO2max) is considered as a gold standard to assess cardiovascular fitness and MST is a validated test to measure the maximal oxygen uptake [30]. Maximum oxygen carrying capacity (VO2max) and aerobic fitness are directly proportional to each other; a higher (VO2max) value indicates a better cardio respiratory fitness. The test protocol consists of 23 levels. Each level last for 1 minute and comprise of a series of laps that were ran back to forth between two lines set 20 metres apart, with a starting speed of 8.5 km/hr and increases by 0.5 km/hr at each level using a pre-recorded audio tape. A single beep indicates end of a level and three beeps indicate start of the next level. Students can walk, jog or run keeping in time with the beeps until they cannot keep in time with the speed set by the tape which is students maximal ef fort. MST table was used to assess the (VO2max) values [31, 32]. Statistical Analysis Paired t test was used to compare the aerobic fitness (MST score), weight, height and body fat percentile values at baseline, intermediate and final level of both the control and intervention group. Descriptive data are mean  ± SD and statistical significance was analysed at p RESULTS Completed baseline, intermediate and final data were collected from students at the beginning, post 8 weeks and post 16 weeks respectively. Out of 95, 10 students were not present on the day of baseline measurements, 13 for the intermediate and 34 for the final measurements. Height, weight, age, sex, body fat percentage, and MST score were calculated for each child. Some students had incomplete data because of absence on more than 1 day of measurement. These data were excluded from the analysis. Body Fat Percentage Final results showed an overall reduction in fat percentage. At baseline, relative to the control group, children in the intervention group had significantly higher body fat percentage (4.17% higher). Comparing the baseline and final data of body fat percentage in the intervention group, a reduction in fat mass with mean of 2.57  ± SD 18.04, p value 0.35 was observed. While baseline and intermediate showed a mean difference of 3.26  ± SD 19.85, p value 0.30. An increase in fat percentile was reported from intermediate to the final results with mean -1.34  ± SD 4.75, p value 0.126. The readings of mean and SD of body fat percentage at all the three levels is given in table1. Aerobic Fitness An improvement in the Multistage Shuttle Run Test (MST) score has been observed in both the groups. At baseline, relative to the control group, children in the intervention group had significantly lower aerobic capacity, but by the end of the study intervention group showed better improvement in the aerobic capacity compare to the control group. A significant improvement with p value Heart rate Heart rate was monitored in all the dance sessions for the intervention group as well as the control group during their regular physical activity sessions. Comparing the results of boys from the intervention and control group a higher value of resting heart rate (HR), maximum heart rate (MHR) and average heart rate ( AHR) was reported in the pupil of the intervention group ( 126 bpm, 166 bpm, 132 bpm respectively). For the detailed report of the heart rate during the dance session refer figure: 2. Heart rate monitoring of one of the boy from the control group during the regular PE session showed following results. HR: 87 bpm, MHR: 157 bpm, AHR: 106 bpm . Refer figure: 3 for detailed picture of the heart rate during a regular physical activity session. The heart rate monitor of a girl from the intervention group showed following results. HR: 136 bpm, MHR: 193 bpm and AHR: 156 bpm. A complete range of heart rate during the dance session is given in figure: 4. Gender Difference In the intervention group at the baseline girls had significantly higher estimated body fat percentage (about 4.2 % higher) than boys. This difference in body fat % at the end of intervention went down to 2.24 %. Girls reported significant improvement in the aerobic capacity during the intervention period. Table 3 describes the individual readings of mean and SD of body fat percentage, MST and weight of boys and girls in the intervention group at baseline and final levels. Girls touched approximately 190 bpm of heart rate during the dance session which is much better then the boys MHR range during the dance session. DISCUSSION The unhealthy life style is the major risk factor for many preventive chronic diseases. Therefore the elevating sedentary behaviour in children has become a public health concern around the globe. It has been documented that improved level of exercise capacity in children confers protection against many chronic diseases with underlying risk factors like obesity [33]. Number of studies has confirmed the significance of school based intervention in promoting physical activity in children [21, 22, 23, 24]. Most of these studies involve multiple component procedure like physical activity, time spent in physical activity, dietary intake, class room education, parents involvement etc [34, 35, 36].Though, these studies were designed intensively and most of them had a long follow up period but still were not able to discover the precise factor (physical activity or dietary habits) that has the prime potential in improving the health status of the children. Further more most of these studies are self reporting and hence the results of such interventions can not be considered as significant. In the present study we focused on a novel school-based approach to boost the involvement of children in physical activity which can have health benefits as well as have rejoicing effect on children so that an attempt is made to gain their interest in being active. Our aim was to make the sessions so exciting that children do not find them stereotyped. Health benefits of the intervention Physical activity The intervention Dance Yourself Fit was designed to test the hypothesis that children who participated in 16 weeks of dance sessions conducted by the professional coach would report significant improvement in aerobic capacity and reduction in body fat in contrast to a control group who engaged in the regular PE sessions. In accordance with the hypothesis, the results revealed that scores of MST for children in the intervention group increased significantly following 16 weeks of training. The findings indicate reduced body fat compare to the control group at the end of the intervention as per the bioelectric impedence measurements. In this respect, the study support previously conducted study on physical activity and fitness in elementary school children (Sallis JF, McKenzie TL et al., 1997) [24] and research by Dwyer T et al in South Australia on the effect of daily physical activity in primary school children [37]. Results also support the study by Baquet G et al. (2004) that report ed improved aerobic capacity in children following high-intensity, intermittent-running aerobic exercises [38]. In addition the methodology of the current study does not agree with the design of Wilma J et al. (2008) which has used multiple components to improve physical activity in children. The study has described a lot about the minor aspects of the intervention but has lagged behind in demonstrating the information regarding PE sessions which is an important aspect in assessing the significance of the study. However standard parameters were used to assess the results (Euro Fit test) but the outcome of the study does not transmit any statistical significance. Also the study has not reported any gender comparison on the effect of intervention which is more likely to be seen in any objectively based study [39]. Supposedly there is only handful of studies that has worked on improving the health related physical activity in children. Study by Fairclough S. J et al. (2008) is an educational based intervention on improving the health related exercise in children [40]. The study had 5 classroom sessions, were knowledge of health related benefits of exercise were given to the children. Pre and post questionnaire were given to the children and assessment was made according to the marks scored by the children. The current study does not agree with this education based intervention because it seems unconvincing that children of age group 9-10 will voluntarily engage themselves in health enhancing exercises just by the effect of 5 class room sessions.- The present study showed an overall higher aerobic fitness in boys than girls at the baseline. However, unlike other studies girls showed comparatively better improvement in fitness at the end of the intervention. Maximum Heart Rate Maximum Heart Rate (MHR) measurement was used to judge the intensity of the dance session to elicit aerobic fitness in children. The standard formula of calculating MHR is 220-age but is not preferred for pre pubertal children because their MHR generally range from 195 to 205 beats per minute and is independent of age [41]. As per the ACSM (American College Of Sports Medicine) guidelines the exercise intensity should reach 80 to 85 % of MHR to elicit cardio vascular response. The children in the intervention group reported MHR in the range of 160 to 190 bpm (approximately) which is in the range to have health benefits. In contrast to most of the studies girls surpass boys in MHR range during the intervention sessions. Body Fat Percentage Results suggested a significant increase in the weight of children in both the groups. This can be merely due to the children being at the age of pre pubertal growth spurt which leads to an increase in weight and height. Although the weight gain in children in the intervention group is comparatively lower then the control group. In respect to the measure of body fat percentage used in the current study, the findings indicate that the intervention also had positive impact on fat percentage compared to the control group. Future research is needed to understand the impact of exercise interventions on the relationship between weight status and body fat. Strength The intervention included a large study sample and the duration of the study was long enough to analyse the effectiveness of the intervention. The children were from the age group of 8-9 years (age from which decline in physical activity begins). Since the range is not vast the results are less prone to be biased. The availability of comparable data at baseline, mid and final level of the intervention was an advantage to assess the results of the intervention. Strength of this study also includes the direct measurement of VO2 max, body fat% and aerobic capacity using standard methods of assessment. Involvement of the professional coach for physical education session other then the regular PE teacher has worked as an asset for the study. The result of the study has proved the significance of MVPA in enhancing the health status of children. Limitations When interpreting our results the following limitations should be considered. In total 95 children participated in the study but only a third were present for all the three measurements. This has affected the comparative results between baseline, intermediate and final data. Least number of students was present for the final measurement which might have affected the overall outcome of the study. In the mid of the study children went for Easter vacation and no home based program was given to maintain the effect of the intervention which has shown reverse results. Our scenario here supports the study by Aaron L et al which suggested a reversed intervention effects of the school based interventions during the summer vacations [42]. The physical activity hall in most of these schools were not big enough to have one 20 m running lap as required for 20 meter shuttle run test. A to and fro of 20 m were used to assess the aerobic capacity. Therefore some variation in the readings might be possible. Future Research Despite finding that a 16 week dance intervention enhanced the aerobic fitness in children, future research is required which can prove the long term benefit of physical activity at early age. Studies are required to understand the exercise physiology of girls and boys at the pre pubertal age. Importantly effect of skill based physical education in school system need to be established. Studies are required to establish more effective strategies for encouraging health related physical activity in young children. Is concentrating on overweight or obese children for planning exercise program can be beneficial for better results? Are multiple short sessions of physical activity would be sufficient to get health related benefits compare to one long session of exercise. There are many hypotheses which need to be confirmed through more intense future researches. CONCLUSION Scotland urgently needs more research into physical inactivity and obesity along with useful data on trends in the epidemic of child obesity. The current study suggests the importance of skill based PE session along with the beneficial effect of additional physical education sessions on the health status of the children. A well planned entertaining PE session can have positive influence upon increasing physical activity levels in young children. The study also suggests that government should take steps to improve and increase the physical education in primary schools to combat physical inactivity and obesity in growing children. 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Overweight status and psychological well-being in adolescent boys and girls: a multilevel analysis, Eur J Public Health. 2008 December; 18(6): 616–621. Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, Allen K, Lopes M, Savoye M, Morrison J, Sherwin RS, Caprio S. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med.2004;350:2362–2374. Nader PR, OBrien M, Houts R, Bradley R, Belsky J, Crosnoe R, Friedman S, Mei Z, Susman EJ: Identifying risk for obesity in early childhood. Pediatrics 2006, 118:e594-601. Freedman DS, Khan LK, Serdula MK, Dietz WH, Srinivasan SR, Berenson GS. The relation of childhood BMI to adult adiposity: the Bogalusa Heart Study. Pediatrics. 2005 Jan;115(1):22-7 Froberg K, Andersen LB., Mini review: physical activity and fitness and its relations to cardiovascular disease risk factors in children, Int J Obes (Lond). 2005 Sep;29 Suppl 2:S34-9. Lee IM. Physical activity and cancer prevention — data from epidemiologic studies. Med Sci Sports Exerc 2003; 35:1823-7. Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence. CMAJ. 2006 Mar 14; 174(6):801-9. Darla M. Castelli, Charles H. Hillman, arah M. Buck, and Heather E. Erwin. Physical Fitness and Academic Achievement in Third- and Fifth-Grade Students, Journal of Sport Exercise Psychology, 2007, 29, 239-252. Churchill JD, Galvez R, Colcombe S, Swain RA, Kramer AF, Greenough WT. Exercise, experience and the aging brain. Neurobiology of Aging. 2002; 23(5):941–955. Trish Gorely, Mary E Nevill, John G Morris, David J Stensel, Alan Nevill. Effect of a school-based intervention to promote healthy lifestyles in 7–11 year old children, Int J Behav Nutr Phys Act. 2009; 6: 5. Danielzik S, Pust S, Muller MJ: School-based interventions to prevent overweight and obesity in prepubertal children: process and 4-years outcome evaluation of the Kiel Obesity Prevention Study (KOPS). Acta Paediatr Suppl 2007, 96:19-25. Manios Y, Moschandreas J, Hatzis C, Kafatos A: Health and nutrition education in primary schools of Crete: changes in chronic disease risk factors following a 6-year intervention programme. Br J Nutr 2002, 88:315-324. Sallis JF, McKenzie TL, Alcaraz JE, Kolody B, Faucette N, Hovell MF: The effects of a 2-year physical education program (SPARK) on physical activity and fitness in elementary school students. Sports, Play and Active Recreation for Kids. Am J Public Health 1997, 87:1328-1334. Nakeeb Y., Duncan M., Lyons M, Woodfield L. Body fatness and physical activity levels of young children, Annals of Human Biology, January–February 2007; 34(1): 1–12. Serbescu C, Flora D, Hantiu I, Greene D, Laurent Benhamou C, Courteix D. Effect of a six-month training programme on the physical capacities of Romanian schoolchildren, Acta Paediatr. 2006 Oct; 95(10):1258-65. Armstrong N. 1998. Young peoples physical activity patterns as assessed by heart rate monitoring. J Sport Sci 16:S9–S16. 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Harrell JS, McMurray RG, Bangdiwala SI, Frauman AC, Gansky SA, Bradley CB: Effects of a school-based intervention to reduce cardiovascular disease risk factors in elementary-school children: the Cardiovascular Health in Children (CHIC) study. J Pediatr 1996, 128:797-805. SL Gortmaker, K Peterson and J Wiecha et al., Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health, Arch Pediatr Adolesc Med 153 (1999), pp. 409–418. P Sahota, MCJ Rudolf, R Dixey, AJ Hill, JH Barth and J Cade. Evaluation of implementation and effect of primary school based intervention to reduce risk factors for obesity, BMJ 323 (2001), pp. 1027–1029. M Story, M Evans, RR Fabsitz, TE Clay, BH Rock and B Broussard. The epidemic of obesity in American Indian communities and the need for childhood obesity-prevention programs, Am J Clin Nutr 69 (1999) (suppl), pp. 747S–844S. Dwyer T, Coonan WE, Leitch DR, Hetzel BS, Baghurst RA, An investigation of the effects of daily physical activity on the health of primary school students in South Australia, Int J Epidemiol. 1983 Sep;12(3):308-13. Baquet G, Guinhouya C, Dupont G, Nourry C, Berthoin S. Eff Encouraging Children to Join Dance Physical Activities Encouraging Children to Join Dance Physical Activities ABSTRACT Objective: The objective of the study was to encourage young primary 4/ 5 school children to participate in skill based physical activity like dance which has better health benefits then the regular physical education sessions. Methods: An epidemiological cohort study was conducted in randomly selected three schools in Glasgow. 95 children participated out of which 64 underwent 16 weeks of dance training as an additional physical education session in schools by a trained dance professional. Control group (N=31) children attended the regular physical education session of the school. For both the groups measurements were taken at baseline, post 8 weeks and post 16 weeks of the intervention. The aerobic fitness and body fat percentage were the major criteria to assess the effectiveness of the study. Aerobic fitness was measured by 20 m shuttle run test and body fat was assesses by Tanita body composition analyser. Results: A significant improvement in aerobic capacity was reported in the intervention group with mean -1.71  ± SD 1.77; p value Conclusion: The 16 week dance intervention has enhanced the aerobic fitness in children. The study suggests that a well planned entertaining skill based PE session can have positive influence upon increasing physical activity levels in young children. INTRODUCTION Physical inactivity is estimated to cause 2 million deaths worldwide annually. Furthermore it contributes largely to medical costs [1]. Engaging in regular physical activity is an essential element in preventing chronic diseases [2]. It is presupposed that improved physical activity in childhood can reduce the health risks associated with inactivity and benefit health both during childhood and adulthood [3]. However in recent years the inflating physical inactivity in children around the world has gathered considerable attention [4, 5, 6]. The increasing prevalence of overweight and obesity in children has been attributed in part, to decrease in physical activity. The imbalance in energy intake and energy expenditure is a major root for epidemic of child obesity [7]. A large proportion of children in Scotland are insufficiently active in order to gain subsequent health benefits, hence promotion of health enhancing physical activity to children has become a public health priority. Gui delines for Appropriate Physical Activity for Elementary School Children states that children should accumulate at least sixty minutes of moderate to vigorous physical activity (MVPA) in a day [8]. To a certain limit, a linear dose-response relationship between physical activity and health can be seen [9]. Researches suggest that habitual physical activity levels decreases over the lifespan, hence children are more active than adolescents and further more than adults. Hence it can be proposed that children who do not develop patterns of regular physical activity are at risk of being sedentary adults. The adequate fitness in childhood is likely to carry beneficial biological and behavioural effects into adulthood. Physically active children are more likely to become physically active adults [10]. The declined physical activity in young children today is widely noticeable; computer games and television shows are attracting childs attention and are preferred over play [11]. Children from sedentary parents are found to be comparatively more inactive then their other counter parts. The triad between physical inactivity, obesity and unhealthiness can be presumed seeing the correlation between the three. Obesity can be relate as a unforeseen trait in a number of chronic diseases and conditions in early and later life like cardiovascular and respiratory problems, insulin resistance (type II diabetes), osteoarthritis, endocrine and metabolic disorders, psychological imbalance etc [12,13]. While evidence proves that physical activity in children improves the bone strength, benefits cardiovascular system, improve glycemic control, improves metabolism, reduce the risk of specific cancers, induce positive state of well-being like self- esteem, self-efficacy, and positive mood states [14,15,16,17,18]. Studies report positive effect of exercise training on cognition in elementary school children [19]. Churchill et al., (2002) suggest improvements in cognition due to exercise is mainly on executive function [20]. The inclusion of a healthy dose of vigorous physical activity in schools as a part of the Educational curriculum can improve the overall development of the child. The school has emerged as a critical setting for promoting health enhancing physical activity in children [21, 22, 23, 24]. School is a universal place where every child around the world spends most of his or her time, hence is a key factor in improving physical activity in children. Studies reviewing the effect of school based interventions propose an improved level of health-related knowledge and fitness in children. But in terms of obesity prevention not much effect has been detected. However, some measure of obesity has found to be downsized. Physical education in schools is not sufficient enough to provide notable health benefits. It appears that when children are given free choice, many of them seem to be less active. In order to get the health related effects it is important to offer skill based physical education sessions like dance, football, rugby etc where children can engage in moderate-to-vigorous physical activity. There are evidence that proves the effect of moderate- vigorous physical activity (MVPA) in weight stability and cardiovascular health [25]. In order to improve physical activity trends in Scottish schools, a school based intervention involving primary school children was developed. The intervention was designed to encourage children to participate in physical activity like dance which is more likely to be welcomed by children of younger age group and to continue it throughout their school career. To upgrade aerobic fitness and to downgrade the fat percentile in children were among the components of the study plan. METHODOLOGY The intervention Dance Yourself Fit focuses on improving the physical activity trends in primary 4-5 school children. Since it has been presupposed that notion of play starts declining by this age. By choosing dance as the mode of exercise, the intervention aims toward enhancing the skill based physical activity in schools along with an increase in the number of physical education (PE) sessions per week. Study design and sampling The Glasgow City Council has randomly selected three primary schools from the same socioeconomic area for the study. 95 healthy 8-9 years old volunteers including 54 girls and 41 boys participated from primary 4-5 classes. The mean weight and height of the participants before the initiation of the study was 30.09 kg with 95% CI (28.428- 131.769) and 132.24 cm with 95% CI (130.75- 133.73) respectively. Each school was visited prior to the start of the study to ensure all potential volunteers, teachers and parents are fully aware of the aims of the study. The method of monitoring and assessment was explained to the students. Adjustment was made by the school to include two physical education sessions per week in their timetable. A qualified dance professional was recruited as a coach to train the students with dance. Normal and healthy is defined as those without any medical condition which can hamper their ability to participate in aerobic exercise. Physical activity and medical questionnaire were given to the students and those considered unsuitable by the test results were excluded from the participation. Children were instructed to cease exercise if they feel any discomfort. Subjects Intervention group consists of 64 students from all the three primary schools. Control group comprise of 31 students, from one of the three randomly selected intervention schools. Children in the control group follow their normal PE sessions and physical activity and they are monitored followed by the intervention group every time the assessment is taken. The flow chart (figure: 1) represents the availability of children for measurements at each level. Consent for participation in the study was taken from the parents/guardians and the participants. Ethical approval of the study was obtained from the ethical community of the University of Glasgow. Exercise Plan Dance sessions were planned for 16 weeks, twice every week for a period of an hour/session. As per Serbescu C et. al two extra sessions of physical education per week were sufficient to obtain improvement in fitness level of the children [26]. Each dance session has a structured format commencing with 5 minutes of warm up followed by 45 minutes of moderate to high intensity dance moves with target intensity reaching up to 65-80% of maximum heart rate and a short cool down period. Measures All the measurements were taken at the baseline, intermediate (i.e. at the end of 8th week) and final levels by the well trained research staff. Comparison between the three levels was done for both the groups to judge the effectiveness of the intervention. In the intervention group, 44 children were present for baseline and final measurements, 41 for baseline and intermediate and 31 for intermediate and final measurements. Heart rate: Exercise intensity was monitored by Polar Heart Rate Monitor. Heart rate monitoring has been used successfully as a means of estimating the stress placed on the cardiopulmonary system and provides an indication of the intensity, duration and frequency of activity [27]. Heart rate monitoring belts were made to worn during the dance sessions. Data was stored in Polar performance software and analysed. Height: A portable stadiometer was used to measure height in centimeters (cm) to the nearest 0.1 cm. Weight: Tanita body composition analyser was used to measure weight in kilograms (kg) to the nearest 0.1 kg. Both weight and height were measured in light clothing like track pants or shorts with shoe off. Body Fat Percentage: Bioelectrical impedence, a non invasive validated procedure used for measuring body fat [28]. Tanita body composition analyser was used for the same. Houtkooper LB et al suggest that bioelectric impedence is a better test specifically for grading average adiposity in groups [29]. Cardio-respiratory Fitness: The multistage 20-meter shuttle run (MST) / bleep test / beep test was used to assess the maximal aerobic capacity (VO2max). Since (VO2max) is considered as a gold standard to assess cardiovascular fitness and MST is a validated test to measure the maximal oxygen uptake [30]. Maximum oxygen carrying capacity (VO2max) and aerobic fitness are directly proportional to each other; a higher (VO2max) value indicates a better cardio respiratory fitness. The test protocol consists of 23 levels. Each level last for 1 minute and comprise of a series of laps that were ran back to forth between two lines set 20 metres apart, with a starting speed of 8.5 km/hr and increases by 0.5 km/hr at each level using a pre-recorded audio tape. A single beep indicates end of a level and three beeps indicate start of the next level. Students can walk, jog or run keeping in time with the beeps until they cannot keep in time with the speed set by the tape which is students maximal ef fort. MST table was used to assess the (VO2max) values [31, 32]. Statistical Analysis Paired t test was used to compare the aerobic fitness (MST score), weight, height and body fat percentile values at baseline, intermediate and final level of both the control and intervention group. Descriptive data are mean  ± SD and statistical significance was analysed at p RESULTS Completed baseline, intermediate and final data were collected from students at the beginning, post 8 weeks and post 16 weeks respectively. Out of 95, 10 students were not present on the day of baseline measurements, 13 for the intermediate and 34 for the final measurements. Height, weight, age, sex, body fat percentage, and MST score were calculated for each child. Some students had incomplete data because of absence on more than 1 day of measurement. These data were excluded from the analysis. Body Fat Percentage Final results showed an overall reduction in fat percentage. At baseline, relative to the control group, children in the intervention group had significantly higher body fat percentage (4.17% higher). Comparing the baseline and final data of body fat percentage in the intervention group, a reduction in fat mass with mean of 2.57  ± SD 18.04, p value 0.35 was observed. While baseline and intermediate showed a mean difference of 3.26  ± SD 19.85, p value 0.30. An increase in fat percentile was reported from intermediate to the final results with mean -1.34  ± SD 4.75, p value 0.126. The readings of mean and SD of body fat percentage at all the three levels is given in table1. Aerobic Fitness An improvement in the Multistage Shuttle Run Test (MST) score has been observed in both the groups. At baseline, relative to the control group, children in the intervention group had significantly lower aerobic capacity, but by the end of the study intervention group showed better improvement in the aerobic capacity compare to the control group. A significant improvement with p value Heart rate Heart rate was monitored in all the dance sessions for the intervention group as well as the control group during their regular physical activity sessions. Comparing the results of boys from the intervention and control group a higher value of resting heart rate (HR), maximum heart rate (MHR) and average heart rate ( AHR) was reported in the pupil of the intervention group ( 126 bpm, 166 bpm, 132 bpm respectively). For the detailed report of the heart rate during the dance session refer figure: 2. Heart rate monitoring of one of the boy from the control group during the regular PE session showed following results. HR: 87 bpm, MHR: 157 bpm, AHR: 106 bpm . Refer figure: 3 for detailed picture of the heart rate during a regular physical activity session. The heart rate monitor of a girl from the intervention group showed following results. HR: 136 bpm, MHR: 193 bpm and AHR: 156 bpm. A complete range of heart rate during the dance session is given in figure: 4. Gender Difference In the intervention group at the baseline girls had significantly higher estimated body fat percentage (about 4.2 % higher) than boys. This difference in body fat % at the end of intervention went down to 2.24 %. Girls reported significant improvement in the aerobic capacity during the intervention period. Table 3 describes the individual readings of mean and SD of body fat percentage, MST and weight of boys and girls in the intervention group at baseline and final levels. Girls touched approximately 190 bpm of heart rate during the dance session which is much better then the boys MHR range during the dance session. DISCUSSION The unhealthy life style is the major risk factor for many preventive chronic diseases. Therefore the elevating sedentary behaviour in children has become a public health concern around the globe. It has been documented that improved level of exercise capacity in children confers protection against many chronic diseases with underlying risk factors like obesity [33]. Number of studies has confirmed the significance of school based intervention in promoting physical activity in children [21, 22, 23, 24]. Most of these studies involve multiple component procedure like physical activity, time spent in physical activity, dietary intake, class room education, parents involvement etc [34, 35, 36].Though, these studies were designed intensively and most of them had a long follow up period but still were not able to discover the precise factor (physical activity or dietary habits) that has the prime potential in improving the health status of the children. Further more most of these studies are self reporting and hence the results of such interventions can not be considered as significant. In the present study we focused on a novel school-based approach to boost the involvement of children in physical activity which can have health benefits as well as have rejoicing effect on children so that an attempt is made to gain their interest in being active. Our aim was to make the sessions so exciting that children do not find them stereotyped. Health benefits of the intervention Physical activity The intervention Dance Yourself Fit was designed to test the hypothesis that children who participated in 16 weeks of dance sessions conducted by the professional coach would report significant improvement in aerobic capacity and reduction in body fat in contrast to a control group who engaged in the regular PE sessions. In accordance with the hypothesis, the results revealed that scores of MST for children in the intervention group increased significantly following 16 weeks of training. The findings indicate reduced body fat compare to the control group at the end of the intervention as per the bioelectric impedence measurements. In this respect, the study support previously conducted study on physical activity and fitness in elementary school children (Sallis JF, McKenzie TL et al., 1997) [24] and research by Dwyer T et al in South Australia on the effect of daily physical activity in primary school children [37]. Results also support the study by Baquet G et al. (2004) that report ed improved aerobic capacity in children following high-intensity, intermittent-running aerobic exercises [38]. In addition the methodology of the current study does not agree with the design of Wilma J et al. (2008) which has used multiple components to improve physical activity in children. The study has described a lot about the minor aspects of the intervention but has lagged behind in demonstrating the information regarding PE sessions which is an important aspect in assessing the significance of the study. However standard parameters were used to assess the results (Euro Fit test) but the outcome of the study does not transmit any statistical significance. Also the study has not reported any gender comparison on the effect of intervention which is more likely to be seen in any objectively based study [39]. Supposedly there is only handful of studies that has worked on improving the health related physical activity in children. Study by Fairclough S. J et al. (2008) is an educational based intervention on improving the health related exercise in children [40]. The study had 5 classroom sessions, were knowledge of health related benefits of exercise were given to the children. Pre and post questionnaire were given to the children and assessment was made according to the marks scored by the children. The current study does not agree with this education based intervention because it seems unconvincing that children of age group 9-10 will voluntarily engage themselves in health enhancing exercises just by the effect of 5 class room sessions.- The present study showed an overall higher aerobic fitness in boys than girls at the baseline. However, unlike other studies girls showed comparatively better improvement in fitness at the end of the intervention. Maximum Heart Rate Maximum Heart Rate (MHR) measurement was used to judge the intensity of the dance session to elicit aerobic fitness in children. The standard formula of calculating MHR is 220-age but is not preferred for pre pubertal children because their MHR generally range from 195 to 205 beats per minute and is independent of age [41]. As per the ACSM (American College Of Sports Medicine) guidelines the exercise intensity should reach 80 to 85 % of MHR to elicit cardio vascular response. The children in the intervention group reported MHR in the range of 160 to 190 bpm (approximately) which is in the range to have health benefits. In contrast to most of the studies girls surpass boys in MHR range during the intervention sessions. Body Fat Percentage Results suggested a significant increase in the weight of children in both the groups. This can be merely due to the children being at the age of pre pubertal growth spurt which leads to an increase in weight and height. Although the weight gain in children in the intervention group is comparatively lower then the control group. In respect to the measure of body fat percentage used in the current study, the findings indicate that the intervention also had positive impact on fat percentage compared to the control group. Future research is needed to understand the impact of exercise interventions on the relationship between weight status and body fat. Strength The intervention included a large study sample and the duration of the study was long enough to analyse the effectiveness of the intervention. The children were from the age group of 8-9 years (age from which decline in physical activity begins). Since the range is not vast the results are less prone to be biased. The availability of comparable data at baseline, mid and final level of the intervention was an advantage to assess the results of the intervention. Strength of this study also includes the direct measurement of VO2 max, body fat% and aerobic capacity using standard methods of assessment. Involvement of the professional coach for physical education session other then the regular PE teacher has worked as an asset for the study. The result of the study has proved the significance of MVPA in enhancing the health status of children. Limitations When interpreting our results the following limitations should be considered. In total 95 children participated in the study but only a third were present for all the three measurements. This has affected the comparative results between baseline, intermediate and final data. Least number of students was present for the final measurement which might have affected the overall outcome of the study. In the mid of the study children went for Easter vacation and no home based program was given to maintain the effect of the intervention which has shown reverse results. Our scenario here supports the study by Aaron L et al which suggested a reversed intervention effects of the school based interventions during the summer vacations [42]. The physical activity hall in most of these schools were not big enough to have one 20 m running lap as required for 20 meter shuttle run test. A to and fro of 20 m were used to assess the aerobic capacity. Therefore some variation in the readings might be possible. Future Research Despite finding that a 16 week dance intervention enhanced the aerobic fitness in children, future research is required which can prove the long term benefit of physical activity at early age. Studies are required to understand the exercise physiology of girls and boys at the pre pubertal age. Importantly effect of skill based physical education in school system need to be established. Studies are required to establish more effective strategies for encouraging health related physical activity in young children. Is concentrating on overweight or obese children for planning exercise program can be beneficial for better results? Are multiple short sessions of physical activity would be sufficient to get health related benefits compare to one long session of exercise. There are many hypotheses which need to be confirmed through more intense future researches. CONCLUSION Scotland urgently needs more research into physical inactivity and obesity along with useful data on trends in the epidemic of child obesity. The current study suggests the importance of skill based PE session along with the beneficial effect of additional physical education sessions on the health status of the children. A well planned entertaining PE session can have positive influence upon increasing physical activity levels in young children. The study also suggests that government should take steps to improve and increase the physical education in primary schools to combat physical inactivity and obesity in growing children. 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Placebo Effect :: essays research papers

The Placebo Effect   Ã‚  Ã‚  Ã‚  Ã‚  The activity I chose to write about was on Dr. Walter A. Brown’s article in Scientific American about placebos and their effect on the patients. His article described what a placebo is and if it is ethical for doctors to prescribe this “treatment'; to their patients.   Ã‚  Ã‚  Ã‚  Ã‚  Dr. Brown, who is a psychologist at Brown University, decided to do a study on the effects of a placebo. A placebo is any treatment or drug with no medicinal value that is given to a patient to relieve symptoms of an ailment. His hypothesis in the article focused on if the placebos had any effect on the patients who took them.   Ã‚  Ã‚  Ã‚  Ã‚  To test his hypothesis, Dr. Brown and his colleagues performed experiments on patients who had depression. To test his idea, he employed what is known as the “double blind technique.'; This type of experimentation involves that neither the doctors nor the patients know if they are receiving the real “stuff'; or simply sugar pills (placebos). Only the experimenters know who gets what. What this supposedly does is that the patient will mentally think that the doctor is giving him/her the real drug and they will soon be feeling better. When in reality, it is themselves, not the medicine, which makes them feel better. These are the findings of Dr. Brown.   Ã‚  Ã‚  Ã‚  Ã‚  In his experiments on the placebos, he found that the placebo can make a person feel better, but it can also have no effect what-so-ever. In his study of the depressed patients, about 50% of the subjects with normal levels of cortisone benefited from the placebo, whereas, only about 35% of the depressed patients benefited from the drug. This led Dr. Brown to realize that there are other factors in treating depression. He found that the persons with short-term depression responded more favorably to the placebo than those with long-term depression.   Ã‚  Ã‚  Ã‚  Ã‚  Other doctors also performed “placebo experiments'; to realize if it really works. One example would be of the experiments led by Edmunds G. Diamond of the University of Kansas Medical Center in the 1950’s. His research involved the surgery to treat angina pectoris. He had a set of 18 patients suffering from this ailment have common surgery to relieve this symptom. In 13 of the patients, the doctors actually performed the operation, however in the other five, all they did was make an incision in the chest and sew it back up.

Oklahoma Bombing Speech Analysis

One of the top 100 speeches of all time was said by Bill Clinton, when he was addressing the memorial of the Oklahoma Bombing. This was said In 1995 when tragedy struck the lives of hundreds. Innocent women, men, and children were murdered for no apparent reason, and people needed someone to turn to. This person was Bill Clinton, he responded In ways of composure and emotion that just added to his already powerful speech; he addressed the Issues the correct way. He was given the almost Impossible task to piece the nation back together after this ragged.HIS goal was to mourn with the audience, but not to dwell on It, he wanted to try and help them to move on. HIS use of pathos, logos, and ethos added to the effectiveness of the speech. He began his speech by addressing the ones that were most effected, and then by addressing the rest of the world. He establishes himself and his credibility by not only being the president, but also being a father, a husband, a person. When he says â₠¬Å"Hillary and I also come as parents, as husband and wife, as people who were your neighbors for some of the best years of our lives.This builds his pathos and ethos and allows the audience to connect with him on a more personal, deeper level, knowing that he is just like the rest of them, that they share a common ground. This allows Clinton to talk to them, not above them. Immediately after this he uses the emotions of the audience to his advantage, through the use of pathos. He grieves and mourns with the audience; this is shown when he says â€Å"You have lost too much, but you have not lost everything,† everything being America. Clinton uses a quotation from a widowed mother that only helped the rhetorical sense of the speech.He quotes her by saying, â€Å"The anger you feel is valid, but you must not allow yourselves to be consumed by it. The hurt you feel must not be allowed to turn into hate, but instead into the search for Justice. † These words are powerful a s is, but the fact that they were spoken by someone who has experienced what they are going through cause the words to mean so much more. They listen to her words more the Clinton in my opinion, because she has been In their shoes. Another use of quotations Is when he quotes Mr†¦ Keating â€Å"If anybody thinks that Americans are mostly mean and selfish, they ought to come to Oklahoma.If anybody thinks Americans have lost the capacity for love and caring and courage, they ought to come to Oklahoma†. This helps the audience feel closer to the situation, they may grieve together, but they will also fight together, for Justice. He also fortifies his speech by the use of parallel structure and repetition In order to add to the aspect of persuasion. His use of repetition is seen when he says â€Å"We mourn.. We share†¦ We thank.. We pledge. † The use of we signifies that Clinton, as the president and as a friend will mourn with them. It means that in these times o re than ever we must come together as a nation.He uses repetition and parallel inspirational kind of tone to it, because of this the audience feels the need to stand up to evil and hatred, because good trumps evil any day. Another time we see this is through the â€Å"Who worked† sequence. This plays to the emotion of the audience and puts what has occurred into a reality. Lastly when he talks about planting the tree in honor of the children, this makes the audience believe and understand that he does care. Bill Clinton brought the nation together, and helped them move on when it was thought impossible.

Le Ly Hayslip: Between East and West

The West has always been generally regarded as a negative force upon Asian cultures in the sense that the introduction of Western ways brings irrevocable changes that stains the purity Oriental cultures. On the other side of the fence, the West has always regarded the East as a land of exotic people, stubbornly clinging to their old ways, refusing to change with the times. Indeed it is a clash between the immovable rock and the irresistible force, and people in the crossroads get caught and get lost in the maelstrom, with a few coming out unscathed. Le Ly Hayslip’s book When Heaven and Earth Changed Places chronicles such a struggle. It is a poignant book that captures the rending of one’s soul, when one is caught between the need to change and the desire to cling to the old and the familiar. The encroachment of the West first took place within the context of the Vietnam War, when the United States allied itself with South Vietnam against the communist North. More than a book about how war changes a life, the book is about how Le Ly Hayslip straddled the East and the West and how she managed to keep herself whole and survived. The book captures the epic life of Le Ly Hayslip, from her childhood, to her life as a young woman escaping to the United States, to her return to her native land, some twenty years after. This paper seeks to take a look at Le Ly’s life at three important milestones and understand how the West has imposed itself upon her world and how it changed her life as well as those of the people she loved. The West first came into Le Ly’s life when she was still very young. Perhaps in an uncanny prediction of her destiny, her village straddles the border between the conflicting South and North Vietnam. Their lives were constantly being pulled by soldiers from each side and their loyalties were constantly shifting and the people were under constant threat of violence and threat to their lives. Le Ly captures the simplicity of their life as well as the suffering they endured at the crossroads, â€Å"Although the land remained fertile, farming was often interrupted and the whole village came close to destruction.† (5) While the influence of the West is not so direct in this case, it can actually be seen in the civil war that is going on in her country. For a long time, Vietnam has been a colony of France, and it was only after World War did Vietnam finally gain its independence. However, the fledgling country soon fell under the shadow of communism through the influence of China, which in turn was being controlled by the Soviet Union. In light of this, it might be said Western imperialism has been affecting Le Ly’s life from the day she was born. The desire of the Soviet Union to spread the communist ideology is the reason why South and North Vietnam are at war. When Le Ly was 14 years old, Le Ly and her friends worked as lookouts for North Vietcongs. The South discovered what she was doing and she is arrested and tortured. When she is released from prison, the Vietcongs regard her with suspicion and sentence her to death, charging her with espionage. However, instead of killing her, the two soldiers tasked with carrying out her sentence raped Le Ly instead. It was at this juncture that Le Ly left her village to work in the town of Saigon. In Da Nang, she took on several jobs, working as a maid, a black-market vendor, and a prostitute. It was at this stage of her life that Le Ly met several Americans. Her bad experiences in the hands of the Vietcongs as well as the relatively good treatment she received from the Americans have changed Le Ly’s values and allegiances. This relatively pleasant encounter with the West has planted in Le Ly the desire to leave Vietnam and start a new life in the United States. She saw the West as a land of promise, where she can escape from all the violence and war in the East. She saw a chance when Ed, asks her hand in marriage, after which, they immediately left Vietnam with her son in tow. When Le Ly left for the United States, she longed to someday return to her home land, but she was also unsure if she will ever have that chance. In the United States, she gets down to settling to a new life, resolved to leave the past behind. Of course that is easier said than done, and her love for her family and the longing to return to Vietnam never left Le Ly. This desire became stronger when Le Ly found prosperity and success in the United State. After so many years of living as an American, Le Ly returned to Vietnam. In all her years living in the United States, she managed to stay true to her eastern roots. The Buddhist ways that Le Ly’s father taught her served as the anchor of her identity, and she never gave up this part of her that she held sacred. Between the East and the West, Le Ly found a haven in the love and respect that she had for the two countries that she calls home. And that perhaps is the reason why Le Ly was able to reconcile the conflict and rage that was tearing her soul apart. She soon comes to an understanding and by her own words Le Ly thus describes the freedom and wisdom in living a life of compassion, Vietnam already had too many people who were ready to die for their beliefs. What it needed was men and women – brothers and sisters – who refused to accept either death or death-dealing as a solution to their problems. If you keep compassion in your heart, I discovered, I discovered, you never long for death yourself. From my father’s death, I had finally learned how to live. (383) References Hayslip, L. L. (1993). When Heaven and Earth Changed Places: Tie-In Edi