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LEVEL 2 QUIZ 3 A-D 2021 superlatives, future forms, adverbs, verbs + infinitives
Quiz by Julio Cesar de Santos
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Do you know which one is _________________________ building in the world?
the most tallest
the most tall
the tallest
Alexei is _____________________ student in my class.
the goodest
the best
the better
Do you know which one is _________________________ building in the world?
Alexei is _____________________ student in my class.
Some people say the Nile is _________________________ river in the world. Some otheres say it is the Amazon.
_________________________________ road is in China, many people have died trying to cross it.
Which one is ___________________ planet from the sun in the solar system.
Look!!! The old woman ____________________ down, there is a hole on the street and she is not paying attention
One day I ____________________, but I don't know, being single has its advantages.
Mum, please let me go out with my friends, I promise I _______________________ early.
A: It is really hot in here. B: _________________ the windows for you .
A: Do you have any plan for next weekend? B: Yes, I ____________________________ home so I finish my science project.
Aisha and Jhon ________________________ to Cuba next holidays. They are planning to leave on December 21st.
Oh my God, Ben sings ___________________________.
All these atheletes run really ______________. I don't have any idea who will win.
All my students did really _________ in their exams. I guess they studied this time.
I really ___________________ all my subjects this time, last semester I failed three subjects
I ______________________ a car one day, a small one is ok, I don't mind.
The teacher said he _______________________ taller, he is only 1.65 cm tall.
Hurry up, We really _____________ by 11:oo, otherwise We won't be able to go to the movies.
You know what??!!! I __________________ to Mary, she is the one, I love her tons.
Experts predict humans ______________ insects in the future. Really, insects are ____________________________ source of protein. I _________________ believe we need ________________ a solution for food supply world wide.
I'm wanting to make a vocab quiz using the following 1. Supply chain a) The sequence of activities involved in the production and distribution of a product (Correct) b) The sequence of activities involved in marketing a product (Incorrect - refers to a different aspect of business operations) c) The sequence of activities involved in hiring employees (Incorrect - unrelated to product production) d) The sequence of activities involved in customer service (Incorrect - unrelated to product production) 2. Intermediaries a) Middlemen or brokers who facilitate transactions between two parties (Correct) b) The final consumers of a product (Incorrect - refers to end-users, not intermediaries) c) The employees working at a company's headquarters (Incorrect - unrelated to transaction facilitation) d) The shareholders of a company (Incorrect - unrelated to transaction facilitation) 3. Specialization a) Focusing on a specific task or aspect of production to achieve expertise and efficiency (Correct) b) Expanding business operations to new markets (Incorrect - refers to a different concept) c) Maximizing profits through cost-cutting measures (Incorrect - unrelated to specialization) d) The process of developing new products (Incorrect - unrelated to specialization) 4. Coordination a) Organizing and harmonizing different elements or activities to work together effectively and efficiently (Correct) b) Maintaining independence and autonomy among different departments (Incorrect - opposite meaning of coordination) c) Creating a hierarchical structure within an organization (Incorrect - unrelated to coordination) d) Maximizing competition among employees (Incorrect - unrelated to coordination) 5. Outsourcing a) Hiring external companies or individuals to perform specific tasks or functions (Correct) b) Expanding business operations to international markets (Incorrect - refers to a different concept) c) Merging with other companies to form a larger entity (Incorrect - unrelated to outsourcing) d) Expanding the scope of in-house operations (Incorrect - opposite meaning of outsourcing) 6. Inspection a) Examining and evaluating suppliers, products, or processes to ensure compliance with quality standards (Correct) b) Promoting new products through advertising campaigns (Incorrect - unrelated to inspection) c) Conducting market research to understand customer preferences (Incorrect - unrelated to inspection) d) Developing prototypes for new products (Incorrect - unrelated to inspection) 7. Efficiency a) Accomplishing tasks or goals with minimum waste of time, effort, or resources (Correct) b) Maximizing profits through aggressive pricing strategies (Incorrect - unrelated to efficiency) c) Expanding business operations to new markets (Incorrect - refers to a different concept) d) Streamlining organizational hierarchy through downsizing (Incorrect - unrelated to efficiency) 8. Expertise a) Specialized knowledge or skill in a particular field or area (Correct) b) Broad knowledge across multiple disciplines (Incorrect - opposite meaning of expertise) c) Entry-level knowledge and skills (Incorrect - unrelated to expertise) d) General knowledge applicable to various industries (Incorrect - opposite meaning of expertise) 9. Trend a) General direction or pattern of change or development over time (Correct) b) A one-time occurrence or isolated event (Incorrect - opposite meaning of trend) c) A static and unchanging state (Incorrect - opposite meaning of trend) d) A minor fluctuation in a stable market (Incorrect - unrelated to trend) 10. Demand a) Desire or need for a particular product or service (Correct) b) The quantity of a product produced by a company (Incorrect - refers to supply, not demand) c) The pricing strategy employed by a company (Incorrect - unrelated to demand) d) The promotional activities carried out by a company (Incorrect - unrelated to demand)RPMS Quiz: Quality vs. Efficiency 1. A teacher spends five hours creating a highly interactive digital game for a single 40-minute lesson. This is an example of prioritizing: • A) Quality over Efficiency • B) Efficiency over Quality • C) Administrative Competence • D) Resource Management • Hint: The focus is on high-level engagement, but the time investment is very high. 2. Which of the following best describes "Efficiency" in the context of the RPMS? • A) Submitting all MOVs and reports on or before the deadline with minimal errors. • B) Ensuring 100% of students pass the quarterly examination. • C) Creating the most aesthetically pleasing portfolio in the department. • D) Conducting home visits for every single student in a class of 50. • Hint: Look for the option that emphasizes timeliness and resource use. 3. Using a "template" or a "reusable slide deck" for lesson planning is a strategy to improve: • A) Efficiency • B) Instructional Diversity • C) Subject Matter Mastery • D) Classroom Discipline • Hint: Templates reduce the time spent on repetitive formatting. 4. If a teacher provides detailed, personalized feedback to every student but submits the grades two weeks late, they have achieved: • A) High Quality, Low Efficiency • B) Low Quality, High Efficiency • C) High Quality, High Efficiency • D) Low Quality, Low Efficiency • Hint: The work itself is excellent, but the timing is poor. 5. Which tool improves Efficiency without sacrificing the Quality of assessment data? • A) Automated Google Forms for multiple-choice quizzes. • B) Giving everyone a passing grade to save time on checking. • C) Writing long paragraphs of feedback on 200 paper-based essays. • D) Skipping assessments entirely to finish the syllabus faster. • Hint: Look for a balance where technology handles the "busy work." 6. When discussing Quality in your RPMS portfolio, which "Means of Verification" (MOV) is most appropriate? • A) Sample of student work with constructive teacher comments. • B) A logbook showing you arrived at school at 7:00 AM daily. • C) A certificate for attending a 1-hour webinar. • D) A photo of your organized teacher's cabinet. • Hint: Quality is evidenced by the impact on student learning. 7. The concept of "Doing the right things" (Effectiveness) represents: • A) Quality • B) Efficiency • C) Speed • D) Compliance • Hint: "Doing the right things" is about results; "Doing things right" is about process. 8. How does "Efficiency" help a teacher maintain "Quality" in the long run? • A) It prevents burnout by optimizing workload, leaving energy for creative teaching. • B) It allows the teacher to take more side jobs. • C) It ensures the teacher never has to talk to parents. • D) It proves that the teacher is smarter than their peers. • Hint: Consider the relationship between teacher well-being and performance. 9. If a teacher's RPMS rating for Quality is 5 (Outstanding) but Efficiency is 2 (Fair), what is the most likely reason? • A) The teacher produces excellent work but often misses deadlines. • B) The teacher is very fast but makes many mistakes in their reports. • C) The teacher is both slow and produces poor results. • D) The students are failing despite the teacher being very organized. • Hint: Check the gap between the high-standard output and the slow delivery. 10. What is the ultimate goal of balancing Quality and Efficiency in the PPST-RPMS? • A) To achieve sustainable professional excellence that benefits the learners. • B) To get a higher salary increase only. • C) To impress the School Head during the observation. • D) To finish the school year with the least amount of work possible. • Hint: It's about long-term growth for both teacher and student. ________________________________________ Answer Key: 1. A | 2. A | 3. A | 4. A | 5. A | 6. A | 7. A | 8. A | 9. A | 10. A ________________________________________*MCQ Quiz: Understanding Good Practices in Writing AI Prompts** 1. **Q:** What is the first step in crafting an effective AI prompt? - a) Define the objective - b) Select the AI tool - c) Provide examples - d) Choose the target audience 2. **Q:** Why is it important to specify the target audience in a prompt? - a) It helps in choosing the right AI tool. - b) It ensures the output is tailored to the right level. - c) It determines the length of the prompt. - d) It makes the prompt more creative. 3. **Q:** Which of the following is a good practice when writing a prompt? - a) Keep the prompt vague to allow AI flexibility. - b) Include clear and specific instructions. - c) Write a very long and detailed prompt. - d) Start with examples before stating the objective. 4. **Q:** What is the role of examples in a well-structured prompt? - a) To confuse the AI with multiple possibilities. - b) To provide context and clarify expectations. - c) To make the prompt longer. - d) To show off knowledge of the subject. 5. **Q:** When should you select the AI tool in the prompt-writing process? - a) After defining the objective and specifying the audience. - b) Before defining the objective. - c) At the very end. - d) Before writing anything else. 6. **Q:** What is a common mistake to avoid when writing prompts? - a) Being too specific in instructions. - b) Including irrelevant information. - c) Mentioning the target audience. - d) Defining the objective clearly. 7. **Q:** How should the tone of a prompt be set? - a) It should be casual and open-ended. - b) It should be formal and precise. - c) It should change depending on the day. - d) It should be vague to encourage creativity. 8. **Q:** What is the final step in crafting a well-structured prompt? - a) Review and refine the prompt. - b) Select the target audience. - c) Provide examples. - d) Choose the AI tool. https://www.revisely.com/quiz/oEkaoMake a multiple choice quiz for my year 8 science students based on the science in this transcript from a video: 3°C 0:04 It can be the difference between snow and sleet 0:08 Wearing a jacket or not 0:11 In your day-to-day life, it may not seem significant 0:15 But 3°C of global warming would be catastrophic 0:20 Heatwaves, droughts, extreme precipitation, even fire 0:25 3°C of warming is really disastrous 0:28 The scary thing is, the world is well on its way there 0:32 Since the industrial revolution, the Earth has warmed between 1.1°C and 1.3°C 0:40 This is a problem that babies you pass in the street will have to live with 0:46 Children born today... 0:47 ...are up to seven times more likely to face extreme weather than their grandparents 0:52 If global temperatures do rise by 3°C... 0:55 ...what would their world look like? Climate change is already having devastating effects 1:03 Rising sea levels 1:05 Desertification 1:07 Hollywood has always enjoyed imagining the end of the world 1:11 While blockbusters like this are clearly fiction... 1:14 ...this film will show the scenario we all face... 1:17 ...unless more drastic measures are taken to stop burning fossil fuels 1:30 In some parts of the world the effects of inaction are already clear 1:35 The slums of Bangladesh’s capital are filling up with climate migrants 1:41 Minara comes from Bhola District, an area in southern Bangladesh 1:46 There, like many other parts of the country... 1:49 ...rivers swollen by heavier rain and melting Himalayan glaciers... 1:53 ...are washing away people’s homes 1:56 Many, like her, have lost everything 2:00 Our home in Bhola had endless amounts of land 2:03 There was lots of space for farming, we had a spacious house 2:08 There were different types of fruits, vegetation and trees growing at home 2:12 We used to eat the fruit from our own trees 2:18 I can’t eat them now because they don't exist anymore 2:21 Since the river flooded for the third time, I had to flee to Dhaka 2:26 Life was much better back home 2:29 It was unbearable to live through, truly intolerable 2:33 We didn’t have the time to save anything at all 2:38 1.1°C to 1.3°C of global warming has already transformed Minara’s life 2:45 It’s one of the reasons why so many migrants like her... 2:47 ...are moving to the city each year... 2:50 ...nearly 400,000 according to the last estimate 2:53 And climate models show there could be much worse to come How climate modelling works 3:02 Climate scientist Joeri Rogelj... 3:04 ...has spent the last ten years modelling future climate scenarios... 3:08 ...for the United Nations 3:10 The models we use to carry out this exercise... 3:13 ...really represent the state of the art... 3:15 ...of our current knowledge of climate change and where we are heading 3:19 Joeri’s projections use data collected by hundreds of scientists around the world 3:26 Here this is the 3°C level... 3:28 ...and so there is at least a one-in-four chance that under current policies... 3:32 ...we would hit 3°C by the end of the century 3:36 This is just one of the scenarios Joeri looks at 3:40 Another one imagines that all policy promises are kept 3:44 The most optimistic assumes that all promises have been kept... 3:47 ...and net-zero targets are met 3:50 Where our best estimate ends up around 2°C at the end of the century... 3:54 ...there is still a one-in-20 chance that we end up with 3°C instead 3:59 One would not be entering a plane if there is a one-in-20 chance... 4:03 ...that the plane will crash Nowhere is safe from global warming 4:07 A rise of 3°C would affect everyone 4:10 Even wealthy cities in rich countries wouldn’t be immune to the consequences 4:15 European capitals like Paris and Berlin... 4:18 ...would bake under more extreme heatwaves 4:22 Frequent storm-surges in New York could turn parts of the city desolate 4:27 In many ways, cities magnify, intensify climate events 4:33 Cities are hotter than the places around them... 4:36 ...they tend to be more vulnerable to flooding 4:39 And you can get a really bad event in a city in a way that you can’t in the countryside 4:46 And because of their denser populations... 4:49 ...disasters in a city affect far more people 4:52 Some cities might be badly prepared for the changes coming 4:56 But they have the means to adapt 4:59 Cities tend to be wealthier than surrounding places 5:03 They have a lot of amenities 5:05 A city that has taken seriously the risks of a 3°C world... 5:08 …wouldn’t necessarily be a worse place to be in a 3°C world 5:12 But a city that hasn’t prepared for these sort of eventualities... 5:16 ...that might be a really nasty place The impact of prolonged droughts 5:20 So far, many developed cities have got off lightly... 5:24 ...but some rural parts of the world are suffering disproportionately 5:29 Smallholders—small-scale farmers—are particularly vulnerable to climate change 5:35 And there are over 600 million around the world 5:38 Smallholders with farms under two hectares... 5:40 ...produce around a third of the global food supply 5:46 Central America’s “Dry Corridor”... 5:48 ...supports a mix of smallholdings and medium-sized farms 5:53 Sandwiched between the Pacific Ocean and the Caribbean Sea... 5:56 ...the area is prone to droughts 6:08 Israel Ramírez Rivera is a smallholder in Guatemala 6:12 Here, climate change is making the dry seasons longer, and more severe 6:18 This is the biggest ear of maize that this plot could deliver 6:23 He depends on his crops of corn and beans 6:26 But they’re getting harder to grow 6:30 The surrounding mountains... 6:32 ...used to provide us with native food... 6:38 ...and now that isn’t an option anymore... 6:41 ...due to climate change and its effects 6:46 Nearly two-thirds of the smallholders in the Dry Corridor now live in poverty 6:52 The impact of all of this for us... 6:59 ...malnutrition among children 7:03 We’ve lost a few 7:07 For my crops especially, the midsummer heat is harder than before 7:16 The plant dries up and can’t provide us... 7:19 ...with the necessary food provision 7:24 Severe droughts in Central America... 7:26 ...are now four times more likely than they were last century 7:30 Many families from here have gone to the States 7:37 The economic despair and debts... 7:44 ...have pushed many people from this community to do this journey 7:53 Migration from Guatemala to the United States has quadrupled since 1990 7:59 Not all of this has been due to climate change 8:02 But longer droughts would force even more to move 8:05 In a 3°C world, annual rainfall in this region... 8:09 ...could drop by up to 14% 8:12 At 3°C, over a quarter of the world’s population... 8:16 ...could endure extreme droughts for at least a month of the year 8:19 Northern Africa could see droughts that last for years at a time Rising sea levels, storm surges and flooding 8:24 But for some, too much water will be the problem 8:29 10% of the world’s population lives on a coastline... 8:32 ...that’s less than 10 metres above sea level 8:35 For these coastal inhabitants, a 3°C world would spell disaster 8:40 By 2100, global sea levels could have climbed by half a metre from 2005 levels 8:46 Low-lying cities like Lagos would be especially vulnerable... 8:49 ...with up to up to a third of the population displaced 8:54 And in Fiji, rising waters are already upending lives 9:04 You can see the graveyard there, it’s all under water now... 9:08 ...due to this rising sea level and climate change 9:15 The village of Togoru in Fiji is being swallowed by the sea 9:19 Barney Dunn, the village headman, has seen over half the village disappear 9:24 Relatives’ houses have been abandoned, and family graves are now under water 9:29 We have been asked by the government to relocate... 9:32 ...but no one wants to relocate... 9:34 ...because we have our great-great-grandparents down there in the sea 9:39 This is the place we’ve been brought up in 9:41 ...it’s not easy to leave 9:44 Past attempts to build a seawall haven’t worked 9:48 But Barney sees building a new one as the village’s only hope 9:52 If they do that, maybe we can save whatever is left 9:56 But if we don’t have the seawall, then it will be keep eroding and time will come... 10:01 ...maybe in ten,15 years, Togoru will be all eroded 10:05 Rising seas also mean storms cause more floods 10:11 And many more countries could suffer 10:14 The Philippines and Myanmar are just two countries... 10:17 ...that will also see an increase in storm surges in a 3°C world 10:21 To escape, many will move… 10:24 …often, to urban areas Extreme heat and wet-bulb temperatures 10:27 Half the world’s population already lives in cities... 10:31 ...almost a third in slums 10:36 For them, a 3°C world could be deadly 10:40 Minara has moved to Dhaka to escape the impact of climate change 10:44 But life could get even worse for her 10:47 I’m struggling a lot nowadays 10:49 The heat during the day is unbearable 10:52 Even late at night it doesn’t cool down 10:57 The heat is getting more intense every day 10:59 I mean, it’s going to get much worse 11:03 I can barely survive it now, how will I live through it in the future? 11:08 Dhaka is getting hotter 11:11 In the last 20 years the average daytime temperature... 11:13 ...has crept up by nearly half a degree 11:17 Days that approach 40°C are now being reported 11:20 And high so-called wet-bulb temperatures are on the rise 11:26 A wet-bulb temperature is a measure of heat and humidity 11:30 Humans cool themselves by sweating… 11:32 But in these conditions, when relative humidity is near 100%... 11:36 ...sweat doesn’t evaporate well 11:38 So people can’t cool down… 11:41 ...even if given unlimited shade and water 11:45 At a high wet-bulb temperature, the body can’t lose heat... 11:49 ...and so it gets hotter and hotter... 11:51 ...and the body is designed to work at a given temperature 11:53 And if it gets too hot inside, you will die 11:58 The human limit for wet-bulb temperatures is 35°C... 12:02 ...around skin temperature 12:04 Dhaka will have a much higher chance... 12:05 ...of reaching dangerous wet-bulb temperatures... 12:07 ...if global warming reaches 3°C 12:12 You can’t really adapt to that 12:14 You have to get out. If the temperature is so high that you can’t work... 12:20 ...can’t do hard manual labour outside for significant parts of the year... 12:25 ...then many places will become functionally no longer part of the economy 12:33 Jacobabad in Pakistan, and Ras al Khaimah, in the United Arab Emirates... 12:37 ...have already recorded deadly wet-bulb temperatures 12:40 More of the tropics and the Persian Gulf... 12:43 ...as well as parts of Mexico and the south-eastern United States... 12:47 ...could all get to this threshold by the end of the century 12:50 Climate modelling might show us the weather Increased migration and conflict 12:52 But it doesn’t show us its other effects on society 12:56 Established migration patterns could change 12:59 Climate disasters may exacerbate reasons people cross borders 13:03 Within countries, more people will move to cities 13:07 In a 3°C world, tens of millions of people a year... 13:10 ...could be displaced by disasters made worse by climate change 13:15 When people are displaced by climate... 13:18 …they may well go to cities... 13:19 ...because cities are the places that attract people from the countryside already 13:25 A lot of people who can get to the developed world... 13:28 ...not least because the developed world tends to be less hot, will give that a go 13:35 As migration around the world increases... 13:38 ...there could be more competition for fewer resources 13:42 Water—already a highly contested resource—will be a focal point 13:47 Turkey’s new Ilisu dam has reduced the flow of water into Iraq 13:53 China lays claim to rivers vital to India and Pakistan 13:57 The prospect of a water-conflict makes people very uneasy 14:03 How national tensions would exacerbate those sorts of reactions... 14:08 ...in a 3°C world... 14:09 ...is the sort of thing that no one should really want to find out 14:14 I think you’d have to be incredibly sanguine... 14:16 ...not to think that the sort of climate extremes that we talk about... 14:19 ...in a 3°C world wouldn’t lead some places... 14:22 ...to the brink of societal collapse 14:25 Those lucky enough to escape unrest... Adaptation and mitigation are crucial 14:28 ...would still have to adapt to a radically different world 14:32 People can adapt to climate change in all sorts of ways, one of the most obvious ones... 14:37 ...is air conditioning 14:39 But other ways to adapt at a local or regional level... 14:42 ...I mean, one of the most obvious is diversifying agriculture 14:47 There are physical things you can do, like seawalls 14:52 The fact that people can adapt and that adaptation will reduce suffering... 14:57 ...doesn’t mean that it will eliminate suffering 15:00 Suffering is built into this whole process of heating up the planet 15:06 Adaptation will only get the world so far 15:09 The best way to deal with a 3°C world... 15:12 ...is not to go to a 3°C world 15:14 And that’s why increasing efforts on mitigation are important 15:17 It’s why working towards negative emissions... 15:20 ...that could bring down the temperature after it peaks are important 15:25 Once you get to a 3°C world, you are in real bad global trouble 15:33 The scale of change needed... 15:35 ...and the slow progress of governments so far... 15:38 ...means 3°C of warming is uncomfortably likely unless more is done 15:44 Despite existing pledges, greenhouse-gas emissions... 15:48 ...are still set to rise by 16% from 2010 levels by 2030 15:54 The need to act has never been clearer 15:57 There’s still time to reduce emissions, so that a 3°C world remains fiction... 16:02 ...rather than becoming fact Received: 26 November 2019 Revised: 10 January 2020 Accepted: 19 January 2020 DOI: 10.1111/obr.13005 PEDIATRICS/PHYSIOLOGY Adipokines: A gear shift in puberty Desirée Nieuwenhuis | Natàlia Pujol-Gualdo Amanda J. Kiliaan Department of Anatomy, Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Preclinical Imaging Center PRIME, Nijmegen, The Netherlands Correspondence Amanda J. Kiliaan, PhD, Associate Professor, Department of Anatomy, Donders Institute for Brain, Cognition, and Behaviour, Preclinical Imaging Center PRIME, Radboud university medical center, 6500 HB Nijmegen, Geert Grooteplein 21N 6525 EZ Nijmegen, The Netherlands. Email: amanda.kiliaan@radboudumc.nl Funding information Europees Fonds voor Regionale Ontwikkeling (EFRO), Grant/Award Number: BriteN 2016 1 | INTRODUCTION The prevalence of obesity in adolescents and children is increasing in | Ilse A.C. Arnoldussen | Summary In this review, we discuss the role of adipokines in the onset of puberty in children with obesity during adrenarche and gonadarche and provide a clear and detailed overview of the biological processes of two major players, leptin and adiponectin. Adipokines, especially leptin and adiponectin, seem to induce an early onset of puberty in girls and boys with obesity by affecting the hypothalamic-pituitary- gonadal (HPG) axis. Moreover, adipokines and their receptors are expressed in the gonads, suggesting a role in sexual maturation and reproduction. All in all, adipokines may be a clue in understanding mechanisms underlying the onset of puberty in child- hood obesity and puberty onset variability. KEYWORDS adipokines, obesity, puberty 1,2 the age of 5 years were overweight or were with obesity in 2016, and 3 Obesity is defined by an excessive accumulation of white adipose tissue (WAT), and it is often indicated by a body mass index (BMI) 4 above 30. Two main types of adipose tissue were described: WAT and brown adipose tissue (BAT), which differ in morphology and func- 5-7 Ilse A.C. Arnoldussen and Amanda J. Kiliaan contributed equally to this work. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2020 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation Obesity Reviews. 2020;21:e13005. wileyonlinelibrary.com/journal/obr 1 of 10 https://doi.org/10.1111/obr.13005 alarming rates. Specifically, worldwide, 41 million children below this number is expected to increase to 70 million in 2025. obesity is associated with various severe health complications, includ- ing increased risk of diabetes mellitus type 2, hypertension, heart dis- eases, and disturbances in sex hormone levels. 5,6 and mitochondria and plays a role in thermogenesis. Adipocytes in tion. BAT consists of adipocytes containing multiple lipid droplets WAT contain only a few mitochondria and a single lipid droplet. Adipose tissue has several functions including the storage of energy, thermogenesis, and the production and secretion of adipokines Generally, two physiological processes, adrenarche and gonadarche, 11,24 Childhood 5,7,8 a key role in puberty onset. Puberty is known as a period through which the body changes physically, being a physiological process resulting in the maturation of children, i.e. they develop sexual characteristics and obtain reproduc- 9,11 Adipokines are involved in a number of physiological processes including blood pressure, metabo- lism, glucose, and vascular homeostasis and may play amongst others 8-10 (hormones, cytokines, and peptides). tive functions. between obesity and puberty,2,12-23 the biological mechanisms under- lying obesity and puberty onset remain unclear. Hereafter, we review in detail the role of adipokines in the onset of puberty in childhood obesity. Although many studies have shown associations 2 | INITIATION OF PUBERTY PHYSIOLOGICAL PROCESSES IN THE interact to regulate the onset of puberty. During adrenarche, the adrenal cortex secretes steroid hormones (including 2 of 10 NIEUWENHUIS ET AL. androstenedione, dehydroepiandrosterone, dehydroepiandrosterone sulfate (DHEAS), androstenedione, and cortisol), insulin-like growth factor, and growth hormone, which contribute to the pubertal insights on new genetic loci (e.g. melanocortin-4 receptor, mitochon- drial carrier 2, and mitogen-activated protein kinase 13) and on sev- eral pathways that regulate the timing of puberty; however, it partly 34 9,24,25 Both adrenarche and gonadarche are involved in the development growth spurt, body odor, skin oiliness, and skeletal maturation. explains puberty timing variation. Thereby, defining the role of 25 adipokines is of importance in elucidating the variability in puberty as the expression of adipokines is sex-specific and is altered with body composition, adiposity, and during growth spurts. Moreover, adipokines and their receptors are expressed in gonads and several brain regions suggesting involvement in the onset of puberty and sex- ual maturation. Lastly, adipokines interfere in processes regulating timing and duration of puberty, for instance in the HPA and HPG axes which are both key players during adrenarche and gonadarche. Involvement of adipokines in the onset of puberty and specifically in individuals with obesity will be further reviewed in the next 2,24 3 | Puberty onset in girls is assessed using different markers, such as thelarche (breast development), menarche (the start of of pubic hair. pituitary-gonadal (HPG) axis is activated,2,26 and several hormones have been identified to participate in the activation of the HPG axis During gonadarche (Figure 1), the hypothalamic- 2,27 Kisspeptin, neurokinin B, and dynorphin are released by specialized including kisspeptin, neurokinin B, dynorphin, leptin, and ghrelin. 28 key regulator of the pulsatile secretion of gonadotropin releasing neurons, the KNDy neurons in the hypothalamus. Kisspeptin is a 29,30 B stimulates, and dynorphin inhibits the release of kisspeptin, which hormone (GnRH) from the hypothalamus. In addition, neurokinin implies that both coordinate a pulsatile release of kisspeptin. 31 Sub- sections. sequently, the activated HPG axis induces the pituitary gland to secrete luteinising hormone (LH) and follicle stimulating hormone (FSH). As a result, gametogenesis occurs, and the gonads will release sex hormones. Consequently, secondary sex characteristics develop including breast development in girls and an increased testicular vol- 2,26,32 is possibly due to differences in levels of body fat, hypothalamic-pitui- THE ONSET OF PUBERTY IN GIRLS ume in boys. The age at puberty onset varies greatly among individuals, which 19 35 menstruation), and pubic hair development. 33 genome-wide association studies have provided important new tary-adrenal (HPA) axis activity, and genetic background. Recent The average age of However, this age differs between cultures and ethnicities, and since 1980, age at menarche is girls at start of menarche is 12.4 years. 36 significantly decreasing. 36-39 F I G U R E 1 Hormonal regulation in the initiation of puberty in boys and girls. The secretion of kisspeptin, neurokinin B, and dynorphin from KNDy neurons initiate the release of gonadotropin releasing hormone (GnRH) from the hypothalamus. This activates the pituitary gland to produce and secrete luteinising hormone (LH) and follicle stimulating hormone (FSH), which in turn stimulate the gonads to produce estrogen and testosterone in girls and boys, respectively 1467789x, 2020, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13005, Wiley Online Library on [10/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License NIEUWENHUIS ET AL. 3 of 10 T A B L E 1 Summary of included studies Authors Year Country Study Design Primary Outcome Sex Sample Size (n) Age (y) Data Collection Lian et al21 2019 China Cross-sectional Puberty starts earlier in Chinese Han girls with obesity compared with Chinese Han girls with normal weight. Girls 2996 9-19 2012 and 2013 Biro et al12 Lazzeri et al20 2018 USA 2018 Italy Longitudinal Cross-sectional Body mass index had a greater effect on age at menarche than did race and ethnicity. Girls 946 6-16 2004-2014 Li et al23 2018 China Longitudinal For both, boys and girls, a higher BMI (ie, overweight and obese) is associated with earlier onset of puberty Girls Girls Boys Girls 542 Deng et al22 Flom et al15 2017 China Cross-sectional Increased BMI is associated with early timing spermarche and menarche. Boys Girls Girls 1278258 9-15 2005-2012 He et al24 Holmgren et al17 2017 China 2017 Sweden Cross-sectional Longitudinal Onset of puberty is not related to obesity in boys. Boys Boys Girls Girls 782 7-17 972 929 5839 Kelly et al19 2017 UK 2016 Brazil 2016 USA Longitudinal prospective cohort Higher BMI in girls is associated with the onset of menstruation at an earlier age. 11 10-18 11-17 Barcellos Gemelli et al25 Cross-sectional Longitudinal Excess weight is associated with early age of menarche. Girls 727 2014 2003-2009 Glass et al16 Lee et al26 In girls, but not in boys, greater adiposity is associated with the earlier onset of puberty. Boys Girls 135 Cabrera et al27 Leonibus et al14 2014 USA 2013 Italy Cross-sectional Longitudinal Thelarche occurred earlier than recently reported, while age of menarche remained unchanged. Girls 610 3-17.9 2007 2005-2012 Currie et al13 2012 Europe, USA, Canada Cross-sectional Overweight/obesity during childhood predicts the early onset of puberty in girls. Girls 20410 11, 13, 15 2005-2006 2017 USA Prospective birth cohort Overweight/obese status at the age of 7 ye was associated with increased risk of early menarche 788 From birth to menarche occurred Pregnancies 1959-1966 2016 USA Cross-sectional Boys with overweight enter puberty earlier compared with boys with normal weight or obesity, while puberty starts later in boys with obesity compared with boys with normal weight and overweight. Boys 3872 6-16 2005-2010 Overweight during childhood shows a relation with the early onset of puberty in girls. 6535 4259 695 11 15 5.8-12.2 2009/2010 2013/2014 2014-2017 Higher BMI during childhood is associated with early puberty. 2008 and 2009 2000-2002 Obesity during childhood is related to the earlier onset of puberty. Boys Girls 84 123 71 (Continues) 1467789x, 2020, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13005, Wiley Online Library on [10/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 4 of 10 NIEUWENHUIS ET AL. 3.1 | Fat storage For the initiation of puberty, the timing of stimulation and/or inhibi- tion of different hormones is important, and additionally, a certain amount and distribution of body fat is needed in order to start menar- che, which emphasizes the importance of body fat. From an evolution- ary point of view, body fat increases in mammalian females during puberty onset, and it highlights the need to guarantee a healthy preg- 40 women with anorexia nervosa. particularly body fat localized predominantly on the gluteofemoral fat depots, is profoundly associated with start of menarche, more than nancy, offspring, and maternal survival. fat, sex-hormones, and neuroendocrine alterations can evolve in men- strual dysfunction, for instance, in women with severe obesity or in 41-43 44-46 to gluteofemoral fat depots suggesting that leptin may convey infor- amount of total body fat. mation on body fat distribution to the hypothalamus during puberty. An improper level of body Importantly, body fat distribution, Blood leptin levels are strongly related 45 3.2 | HPG axis The HPG axis is activated by the release of kisspeptin resulting in the release of GnRH from the hypothalamus, and LH and FSH from the pituitary gland. In girls, FSH is involved in the development of the folli- cles in the ovaries, and it promotes the secretion of estrogen. LH stim- ulates the production of androgen hormones and induces ovulation 48 9,47 the release of kisspeptin and neurokinin B, and kisspeptin thereby (Figure 1). The secretion of estrogen has an inhibitory effect on inhibits the GnRH release from the hypothalamus. pattern of GnRH is important for the regulation of the menstrual cycle. This roughly 28-day-cycle comprises several phases, including the follicular phase and luteal phase. During the follicular phase, increasing levels of FSH stimulate the maturation of follicles and the production of estrogen from the ovaries. This in turn inhibits the release of FSH from the pituitary gland. A high level of estrogen will induce the production of LH by the pituitary gland, resulting in ovula- tion. The matured follicle secretes progesterone thereby inhibiting the release of GnRH. When the corpus luteum is demolished, there is less 48 3.3 | Adipokines According to results from studies reported in Table 1, girls with obe- sity enter puberty earlier compared with girls with normal higher leptin concentrations inhibit the intake of food and increases inhibition of GnRH. As a consequence, the cycle will start again. whole process, starting from the activated HPG axis, results in the development of the secondary sex characteristics in girls including 9,47 thelarche and menarche. 13,14,16-23,49-51 weight. these girls might be found in the secretion of adipokines. For instance, leptin is positively associated with the amount of body fat. Generally, energy expenditure. 9,52-54 An explanation for the early onset of puberty in The expression This TABLE 1 (Continued) Authors Year Country Study Design Primary Outcome Sample Sex Size (n) Age (y) Data Collection Herman-Giddens et al28 2012 USA Cross-sectional Observed mean ages of beginning genital and pubic hair growth and early testicular volumes were earlier than in past studies, depending on the characteristic and race/ethnicity. Boys 4131 6-16 2005-2010 Sorensen et al29 Aksglaede et al30 2010 2009 Denmark Denmark Cross-sectional/longitudinal Longitudinal Puberty onset at earlier ages was associated with an increased BMI in boys. Boys 1528 5.8-19.9 1991-1993/2006-2008 1930-1969 Juul et al31 Ribeiro et al32 2007 2006 Denmark Portugal Retrospective cohort Cross-sectional Higher BMI is associated with early voice break. 11-15 10-15 1990-1999 Kaplowitz et al18 Abbreviation: BMI, body mass USA Cross-sectional The early onset of puberty in Caucasian girls is likely related to an increased BMI. 5-12 1992-1993 2001 index. The higher BMI in boys and girls at 7 y of age, the earlier they enter puberty. Boys 21 612 Girls 135 223 Boys 463 Boys 382 Girls 437 Girls 10 750 Early sexual maturation in boys and girls is associated with overweight. 1467789x, 2020, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13005, Wiley Online Library on [10/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License NIEUWENHUIS ET AL. 5 of 10 Leptin may possibly play a role in adrenarche as its plasma level increases with higher levels of body fat and as it can modulate both girls. 33 ing adrenarche. In coherence, in children with obesity, the androgen These findings suggested that lower reproductive status was associated with higher total adiponectin concentrations and that a higher reproductive status was related to higher HMW adiponectin the HPA and HPG axes. These axes are functionally integrated dur- DHEAS was positively associated with leptin levels. Nevertheless, concentrations in girls. In addition, individuals with obesity often another study showed that enhanced adrenal androgen secretion in girls with premature adrenarche was not explained by leptin or BMI 55 ated with androgen levels in girls ; however, it was not related to levels. and IL-6. TNF-α alters, and IL-6 inhibits the expression of 56 8 In addition, the adipokine adiponectin was negatively associ- 57 differences of adiponectin seem to develop during the progression of 56 adiponectin (Figure 2). Thereby, a low level of total adiponectin and/or high levels of inflammatory cytokines in individuals with obe- sity can promote the onset of puberty. Many more adipokines are secreted by WAT including omentin, 52,65-67 9,36,62,68 adrenarche in girls with Prader-Willi syndrome. Interestingly, sex puberty. adrenarche; however, both are not required factors. Thus, leptin and adiponectin might be able to influence In gonadarche, leptin can stimulate the secretion of kisspeptin, and subsequently activation of the HPG axis, which eventually increases the expression of estrogen and androstenedione in the ova- 58 2,60 65-67 The expression of these ries (Figure 2). Ob gene in WAT, resulting in the synthesis and secretion of leptin. Thus, high levels of leptin promote onset of puberty in girls via secre- tion of kisspeptin, and estrogen stimulates leptin secretion addition- ally. Moreover, adiponectin can affect the HPG axis due to the expression of adiponectin receptors in the hypothalamus, pituitary In return, estrogen stimulates the expression of the 59 gland, and gonads. onset as it inhibits the secretion of kisspeptin and GnRH in the hypo- thalamus and the release of GH and LH in the pituitary gland, and 2,60-62 52,60 63 girls with central precocious puberty (CPP). Moreover, total adiponectin had negative correlations with progression of puberty in girls (defined by Tanner stages), whereas HMW adiponectin had FIGURE 2 Adipokinesaffectingthe initiation of puberty in girls. Leptin stimulates the release of kisspeptin in KNDy neurons, which activates the hypothalamus to produce gonadotropin releasing hormone (GnRH). In response to the release of GnRH, the pituitary gland secretes follicle stimulating hormone (FSH) and luteinising hormone (LH), which stimulates the ovaries to release estrogen resulting in the formation of secondary sex characteristics in girls. Estrogen stimulates the production of leptin. Adiponectin inhibits GnRH release resulting in reduced levels of GnRH and thereby a delayed onset of puberty. TNF- α and IL-6 inhibit the production of adiponectin and therefore stimulate the onset of puberty In detail, adiponectin is a regulator of puberty thereby inhibiting the onset of puberty (Figure 2). with obesity often have low levels of adiponectin. et al. showed that total adiponectin was significantly lower, whereas high molecular weight (HMW) adiponectin was significantly higher in ment. 55 63 develop a chronic low-grade inflammatory state, which can be indi- cated by a high level of circulating inflammatory cytokines like TNF-α 64 Individuals Sitticharoon positive associations with LH levels and the progression of puberty in 63 visfatin, resistin, and chemerin. and visfatin are expressed in the ovaries. adipokines in the ovaries suggests a role within the reproductive sys- tem; however, the exact biological processes have to be examined. Thus, specifically leptin, adiponectin, and inflammatory cytokines pro- duced by WAT could be permissive key players during an early onset of puberty in girls with obesity. As an exception, HMW adiponectin seems to have a stimulatory effect on peripheral repro- ductive function as HMW is not able to cross the blood brain 63 barrier. 4 | Markers that are used to assess puberty onset in boys are THE ONSET OF PUBERTY IN BOYS spermarche, voice break, testicular volume, and pubic hair develop- 35 spermarche develop in the early stages of puberty onset, voice In women, omentin, chemerin, While pubic hair development, larger testicular volume, and 69 testicular volume increases, which occurs at an average age of break usually appears in later stages of puberty. Generally, first 1467789x, 2020, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13005, Wiley Online Library on [10/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 6 of 10 NIEUWENHUIS ET AL. 11.9 years, followed by the development of pubic hair at 12.2 years of average, and lastly, boys experience spermarche around an aver- 55 related with leptin levels. Thereby, leptin plausibly has a minor impact in adrenarche in boys. Since leptin receptors are found in the hypothalamus, pituitary gland, and testes, they might be involved in the onset of puberty by affecting the HPG axis during gonadarche. Leptin stimulates the release of kisspeptin and GnRH, and as a consequence, it accelerates the onset of puberty (Table 1, Figure 3). In contrast, adiponectin inhibits the secretion of GnRH, GH, LH, and FSH therewith delaying the onset of puberty. However, adiponectin levels are generally lower in men compared with women and even lower in men with obe- age age of 13.4 years. 70 4.1 | Fat storage Many aspects of the reproductive physiology are energetically demanding,71 and therefore, an adequate energy level is necessary. In boys, a dynamic change in body composition occurs around the age of 10 to 13 years, in which they gain approximately 40% of sity. culating inflammatory cytokines. levels can stimulate the HPG axis and therewith an early onset of puberty in boys. Nevertheless, leptin can inhibit the production of tes- 72 mostly consisting of lean mass, which causes exhaustion of most of fat. Subsequently, a growth spurt follows in which they gain tissue 72 in boys, an adequate amount of body fat is important in the onset of their body fat. These alterations in amount of body fat indicate that 4.2 | Puberty in boys is initiated by the release of kisspeptin. As mentioned before, this activates the HPG axis, resulting in the release of GnRH from the hypothalamus, and consequently the release of LH and FSH 9,74 puberty. tosterone from the testes, to estrogen (Figure 3). of the development of secondary sex characteristics in boys. Additionally, leptin can affect fertility in men as it can modulate the nutritional support of spermatogenesis, and moreover, dysfunction of spermatogenesis is associated with an increased leptin level and 73 58 2,60-62 HPG axis from the pituitary gland (Figure 1). and LH stimulates the secretion of testosterone from the testes, which inhibits the release of kisspeptin from the KNDy neurons and 9,48 in men, the release of kisspeptin is more consistent, causing a con- 29,48 subsequently GnRH from the hypothalamus. receptors expressed on KNDy neurons. In humans, KNDy neurons Contrarily to women, LH-induced testosterone levels lead to the stant release of LH. development of secondary sex characteristics in boys. differences between sexes in kisspeptin release are related to a sex- specific and sex steroid-dependent kisspeptin system as estrogen and progesterone modulate kisspeptin activity through the sex-steroid 48 in the infundibular nucleus are involved in negative and positive sex- 48 tal exposure to sex steroids and result in sex-specific differences in steroid feedbacks. kisspeptin release. These sexual dimorphisms are induced by perina- 75,76 4.3 | Adipokines The association between obesity and puberty onset in boys is rather controversial compared with findings in girls. Most studies reported an early onset of puberty in boys associated with increased ate adipose tissue from actual breast tissue. stages are more difficult to assess than female stages as boys lack a more determined marker such as menarche. Thirdly, puberty onset can be indicated by the activation of the HPG axis, and the presence of these secondary sex characteristics is the result of hormonal 2 14,17,22,23,50,51,77,78 BMI, 20,49 all while others reported no associations at Current markers used 79 16,80 or a delayed onset of puberty (Table 1). The presence of excessive adipose tissue can be involved in puberty onset in boys as the secretion of adipokines can modulate both adrenarche and gonadarche. Leptin can affect adrenarche by modulating both the HPG and HPA axes,33 and moreover, androgen levels were positively 55 nal androgen secretion in boys with premature adrenarche was not associated with plasma leptin levels. Nevertheless, enhanced adre- 9 In more detail, 61,62 adiponectin, and individuals with obesity often have high levels of cir- Moreover, inflammatory cytokines, TNF-α, and IL-6, inhibit expression of the leptin receptor in the testis. FSH induces spermatogenesis, too. function and role still have to be examined. 64 High leptin and low adiponectin and fat tissue can convert testosterone Both processes might result in the delay 29,61,79 81,82 In men, other adipokines like chemerin are found in the gonads 65 Thus, particularly high leptin and low adiponectin levels stimulate the HPG axis and thereby accelerate the onset of puberty in boys. Additionally, leptin can dysregulate the development of secondary sex characteristics and spermatogenesis by affecting testosterone levels and nutritional sup- port of spermatogenesis. 5 | LIMITATIONS AND FUTURE RESEARCH DIRECTIONS Even though multiple epidemiological studies have shown the link between puberty onset and obesity, there are some important limita- tions. Firstly, determining both the onset and stage of puberty is rather difficult. For instance, assessing the stage of breast develop- ment in girls with obesity is complicated as clinicians should differenti- 2 changes in response to the activated HPG axis. to determine the onset of puberty refer to secondary sex characteris- tics, such as testicular volume in boys and breast development in girls. A more accurate measurement of puberty onset would be to combine secondary sex characteristics with plasma or serum hormone level measurements such as LH, FSH, adipokines, e.g. leptin. Thereby, differences in puberty measurements could explain variations in the age of puberty onset between boys and girls within different Thereby, resistin is expressed in the testes of rats, but its exact 83 Secondly, male pubertal 1467789x, 2020, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13005, Wiley Online Library on [10/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License NIEUWENHUIS ET AL. 7 of 10 FIGURE 3 Adipokines affecting the initiation of puberty in boys. Leptin activates kisspeptin secretion in KNDy neurons, this activates the production of gonadotropin releasing hormone (GnRH) from the hypothalamus. GnRH stimulates the pituitary gland to secrete follicle stimulating hormone (FSH) and luteinising hormone (LH), activating the production of testosterone from the testes allowing the development of secondary sex characteristics. Leptin also inhibits the production of testosterone, which may cause a delayed onset of puberty. Adiponectin inhibits GnRH release. Low levels of adiponectin, as a result of TNF-α and IL-6 expression, lead to a reduced inhibition of GnRH. In response to GnRH release, the pituitary gland will secrete FSH and LH, and the testes will produce testosterone resulting in the development of secondary sex characteristics in boys countries, and In addition, the inclusion of a of puberty. ferent time points is complicated, as subjects examined several decades ago presented pronounced differences concerning lifestyle patterns such as nutrition and exercise habits. Lastly, obesity or over- weight is often determined by BMI, a classification based on weight and height measurements. Additionally, it is important that all studies studies or across continents, ethnicities proper age range (8-16 years) is important when assessing the onset (Figure 4). 12-15,17,20-23,49,77-79,84,85 30,47 Furthermore, comparison between studies from dif- 86 Specifically in children, BMI is often dependent on age and growth use the same anthropometric standards and sex-specific cut-offs. 13,14,16-23,49-51,77-80 fat and would represent a more accurate measurement in its regard. Based on this review, several suggestions can be made for further research. Firstly, the roles of adipokines like resistin, chemerin, visfatin, and omentin in puberty onset, fertility, and sexual maturation should be examined in detail. Secondly, future research examining the onset of puberty should combine indicators of puberty onset (e.g. breast development or testicular volume) with plasma or serum hor- mone measurements such as LH, FSH, sex-steroids, adipokines (e.g. spurts. ment in case of growth spurts. distribution of body fat should be taken into account in determining puberty and obesity in children. For instance, the body adiposity index (BAI), which was introduced in 2011 by Bergman et al.,87 uses hip cir- cumference and height in order to estimate the percentage of body 87 Thereby, BMI is a less accurate measure- F I G U R E 4 87,88 Therefore, both percentage and Average age of puberty onset in Europe, China, and the United States according to several studies from Table 1. Age of puberty onset ranges from 8.47 to 13.33 years in girls and from 8.63 leptin), and body fat distribution (e.g. BAI,87 waist-hip ratio's and/or dual-energy X-ray absorptiometry (DXA)2). Additionally, defining con- sistent and general measurements of puberty in both boys and girls, combined with a proper age range (8-16 years), would facilitate the comparisons between different studies and their results. 12-15, 17, 20-23, 25-29, 31 to 13.7 years in boys. included if average age of markers used to assess puberty was not reported. Pink: girls. Blue: boys Studies (Table 1) were not 39, 56 1467789x, 2020, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13005, Wiley Online Library on [10/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 8 of 10 NIEUWENHUIS ET AL. 6 | CONCLUSION In conclusion, epidemiological data regarding obesity and puberty onset in girls show similar outcomes as adiposity results in the early onset of puberty in girls. The majority of the studies examining boys with obesity indicate an early onset of puberty, while not all reported an earlier onset of puberty. In detail, high leptin, TNF-α, and IL-6 levels combined with low adiponectin levels stimulate the activation of the HPG axis in girls and boys with obesity, and 5, 45, 50, 51 REFERENCES 1. Kumar S, Kelly AS. Review of childhood obesity: from epidemiology, etiology, and comorbidities to clinical assessment and treatment. May- o Clin Proc. 2017;92(2):251-265. 2. Reinehr T, Roth CL. Is there a causal relationship between obesity and puberty? The Lancet Child & adolescent health. 2019;3(1):44-54. 3. WorldHealthOrganization. Facts and figures on childhood obesity. 2017. 4. Guglielmi V, Sbraccia P. Obesity phenotypes: depot-differences in adipose tissue and their clinical implications. Eat Weight Disord. 2018; 23(1):3-14. 5. Gomez-Hernandez A, Beneit N, Diaz-Castroverde S. Escribano O. 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FUNDING INFORMATION This research was funded by Europees Fonds voor Regionale Ontwikkeling (EFRO), project BriteN 2016. ORCID Ilse A.C. Arnoldussen Amanda J. Kiliaan https://orcid.org/0000-0002-7395-5284 https://orcid.org/0000-0002-2158-6210 13, 14, 16-26, 29-32 Furthermore, several receptors Nevertheless, We conclude Search strategy We searched PubMed for articles published before Novem- ber 15th, 2019 using relevant keywords, including ‘onset of puberty and adiposity/obesity’, ‘onset of puberty’, ‘children with obesity’, ‘adipose tissue’, ‘childhood obesity’, ‘adiposity’, ‘obesity’, ‘adipokine(s)’, ‘HPG axis’, ‘adipokines ovary/ova- ries’, or ‘adipokines testes’, either alone or in combination. 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Secondary sexual characteristics in boys: data from the Pediatric Research in Office Settings Network. Pediatrics. 2012;130(5):e1058-e1068. 86. WHO. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser. 1995;854:1-452. 87. Akin I, Tolg R, Hochadel M, et al. No evidence of “obesity paradox” after treatment with drug-eluting stents in a routine clinical practice: results from the prospective multicenter German DES.DE (German Drug-Eluting Stent) Registry. JACC Cardiovasc Interv. 2012;5(2): 162-169. 88. Marcovecchio ML, Chiarelli F. Obesity and growth during childhood and puberty. World Rev Nutr Diet. 2013;106:135-141. How to cite this article: Nieuwenhuis D, Pujol-Gualdo N, Arnoldussen IAC, Kiliaan AJ. Adipokines: A gear shift in puberty. Obesity Reviews. 2020;21:e13005. https://doi.org/ 10.1111/obr.13005 1467789x, 2020, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13005, Wiley Online Library on [10/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are goverCreate a vocabulary quiz for 10th grade EFL students at CEFR B1 level. For example: adequate means: 1. sufficient 2. more and more 3. not enough. Use all the vocabulary below and provide accompanying definitions per the example to create this vocabulary quiz. The vocabulary quiz must contain at least 226 questions including the following vocabulary: addition advance advanced advertising among other things analysis appear approach as at least average be responsible for something be responsible for doing something before besides can challenge chance change characteristic claim come after come first come last common complicated concern conditions conduct consequence considerable cope critic current decrease delayed deliberately demonstrate design destruction development disagreement disaster discovery dislike do doubt drop educate efficient emphasis enjoyable essay essentially even if even though event exactly except that exist extraordinary feature feedback figure financial finding findings flexible flood flu focus on somebody or something focus frequent fresh frighten from gain generate guidance hopefully ideal illness illustrate image in terms of something in actual fact in connection with something in that case in the meantime initial instruction intelligence interest introduce invest investigate just about just about keep on doing something kind of knowledge lack landscape likely limited little look at something low material mean means measure mention miss misunderstand more or less must naturally nature necessarily nevertheless not at all not only notice objective occasional official on the one hand on the other hand once others otherwise out of date participate particular past perform personality personally planet planning plant point of view policy pollution popular population prevent priority private probable produce profession professor proof proposed protest provided (that) psychology public purpose quality question question questionnaire react reasonable recommend recycle regard region regular relevant reliable rely on/upon sb/sth request research result review revise risk run out of rural salary sample seldom sense set up sth or set sth up significant skilled slight specialist specific still structure study supposed surface take advantage of sth thanks to somebody or something theory throw away throw out something throw something away throw out transport trash treatment unfortunately unhealthy unique united universe unknown unlike unlikely urban vary view visible vision volume whom wildlife within worthwhile would additional analyze analyst appearance on average change characterize complicate concerned concerning concerned with something consequently cope with something criticize criticism currently deliberate demonstration designer developing developed educated educator efficiency efficiently emphasize enjoyment existence existing figure out something finance flexibility frequency hopeful illustration initially intelligent interested in something investor investment investigation investigator limitation meaning occasionally old-fashioned participant participation particularly performance planned pollute prevention producer professional psychological psychologist publicly reaction reasonably recommendation regardless regarding regional relevance researcher resulting revision sensible set out something set something out significantly significance skillful slightly specialize specifically specify theoretical transportation unfortunate unity unite universal variation viewerMake quiz to this sentences Here are some simple A1-level sentences using your words: 1. **Afternoon** – I like to drink tea in the afternoon. 2. **Pick up** – Can you pick up the book from the floor? 3. **River** – The river is very long and beautiful. 4. **Sport** – My favorite sport is basketball. 5. **Thanks** – Thanks for your help! 6. **Town** – I live in a small town. 7. **Work** – She goes to work every day. We found you were making a quiz on the subject of "What is a rubric? A tool comprising a set of criteria (with possible levels of performance quality on the criteria) developed to assess learners’ work, from written to oral to visual. It is used tomeasureperformance,suchastheprocess of doing something (e.g.,playing a musical instrument, making a speech) or products of the learners’ work (e.g., concept map, laboratory report, bookshelf) (Brookhart, 2013). BENEFITS OF USING RUBRICS Support authentic assessment Reflects how well learners are able to apply knowledge inthe real-world context. Communicate expectations Gives learners an idea of what is expected of them. It is especially useful when the rubrics are communicated to the learners before they are assessed. Improve performance Explicit criteria and performance level descriptions allow learners to understand the desired performance. Learners are able to assess themselves by referring to the specific criteria and performance-level descriptions. Provide informative feedback Instructors are able to provide constructive feedback to learners on their weaknesses and strengths. Promote thinking andlearning 4 Provide informative feedback Instructors are able to provide constructive feedback to learners on their weaknesses and strengths. Learners are able to review and revise their work,thus reflecting on their learning experiences. Ensure fairness Learner performance assessed fairly given its objectivity. It helps avoid disputes between learners and instructors about the scores/grades achieved. TYPES OF RUBRIC ANALYTIC It consists of individual criterion with corresponding descriptor of performance. HOLISTIC It consists of performance descriptors that are placed together to refeclet to overalll performance. ANATOMY OF ANANALYTIC RUBRIC Rating scales with corresponding scores or weights The row represents the criteria for the desired performance, while the column represents the evaluation score. Under the rating scale (corresponding weights orscorescanbeassigned),theperformance descriptors are explicitly stated ANATOMYOF AHOLISTICRUBRIC Descriptions: It comprises the rating scale (corresponding weights or scores can be assigned) in the row while the combined desired performance descriptors are placed in the column. Description of the task The purpose of the assignment is to assess learner’s cognitive and analytic skills in applying knowledge gained and constructed throughout the course Diffusion of Innovation,bywatching the Surrogates movieand writing ananalytical review of the movie in the context of innovation diffusion.Iwant to provide learners with informative feedback on their cognitive and analytic skills such as the following: applying the concepts of innovation diffusion,making judgmentson the scenes related to innovation diffusion identified from the movie,selecting and critiquing theories of innovation diffusion and making connections between the theories,aswell asarguingand proposing necessary solutions to the problemss hown in the movie. ESTABLISHING ALTERNATIVEASSESSMENTINHIGHEREDUCATION VALIDITYAND RELIABILITYOF RUBRICS. Validity Measuring what is supossedto be measured. Reability Yielding consists results. Instruments that are used in the alternative assessment must be aligned to the learning outcomes and measure well what it intends to measure (valid) and produce consistent scores (reliable). The valid instrument will manifest the true ability (latent trait) of learners and permit appropriate inferences to be made about a specific group of people for specific purposes. TYPES OF VALIDITY FACE VALIDITY Simple form of validity thatapplies a superficial and subjective assessment whether the instrument measures what it is supposed to measure. CONTENT VALIDITY Refers to the extent to which the items on a measure assess the same content or how wellthe content material was sampled inthe measure. CONSTRUCT VALIDITY Refers to the extent to which the test may be said to measure a theoretical construct or trait. CONCURRENT VALIDITY Refers to the extent to which scores onanewmeasure are related to scores from a criterion measure administered at the same time. PREDICTIVE VALIDITY Refers to the uses of the scores from the new measure to predict performance on a criterion measure administered ata later time. STEPS TO CONSIDER WHEN ESTABLISHING CONTENT VALIDITY Calculate the level of expert agreeement for the content validity, get expert to verfy. Interview the expert ,make meta contentdata análisis from literatura. STEPS TO CONSIDER WHEN ESTABLISHING CONSTRUCCT VALIDITY Administer the instrument for alll learners, revise any item necccesay, run an apropriates statistical analiysis, administerthe instrument to learners as a pilot test . CONSTRUCTMAP Morepreciseconceptthan construct. Ranges from one extreme to another(fromhightolow,small tolarge,positivetonegative,or strongtoweak). Identifiesthepositionofthe respondentsinthisrange. Representativenessofsampling (questions and ability of respondents). EXAMPLEO FACONSTRUCTMAP:AFFECTIVE LEVELOF AFFECTIVE VARIABLES EXAMPLESOFITEMSIN MEASURINGTEAM WORKING SKILLS 5. Characterisation Learnersvolunteerstodothe groupworks. 4. Organisation Learners are willing to help others,althoughitisnottheir scopeoftask. 3. Valuing Learners respect other team members’opinionwhendoing thediscussion. 2. Responding Learnergivescooperationwhen neededingroupworks. 1. Receiving Learneracceptsthediversityof races and nationalities among groupmembers. EXAMPLEOFACONSTRUCTMAP:PSYCHOMOTOR LEVELOF PSYCHOMOTOR VARIABLES EXAMPLESOFITEMSIN MEASURING DIGITAL SKILLS 7.Origination Learnerscanmodifytheirowndevicesto performbetter. 6.Adaptation Learnerscansolveandtroubleshootthe problemwhileusingthecomputer. 5.ComplexOvertResponse Learnerscanusethecomputercompetently. 4.Mechanism Learners can use the computer independently,butstillmakeminorerrors. 3.GuidedResponses Learnerscanusethecomputer,butstill needguidance. 2.Set Learnersarereadytousethecomputer. 1.Perception Learnerscanobservehowtousecomputer. EXAMPLEOFACONSTRUCTMAP:COGNITIVE LEVELOF COGNITIV E VARIABLES EXAMPLESOFITEMS IN MEASURING THINKINGSKILLS 6. Creating Learners are able to suggest anewmodelorframeworkof learningdigitalcommunity. 5. Evaluating Learners are able to judge the impactofthescenariotowards educationperspective. 4. Analysing Learnerscandifferentiate the factsusingafew theories. 3. Applying Learnerscansolveproblems usingthefactsgiven. 2. Understanding Learnersareabletoexplainthe factsusingtheirownwords. 1. Remembering Learnersonlymemorisethe. Direction of Increasing “X” Learners Learners with high “X” Learners with mid range “X” Learners with low “X” Responses to Item Item response indicate highest level of X Item response indicate higher level of X Item response indicate lower level of X The construct map shows the lower ability students are in line with the lower level of items. This shows that when educators plan to develop an instrument, it Item response indicate lowest level of X Direction of Decreasing “X” is crucial to create an item difficulty thatrepresents learners’ ability. Learners’ ability Learners who engage in level characterisation Learners who engage in level organisation Learners who engage in level valuing Learners who engage in level responding Learners who engage in level receiving Direction of Decreasing“X” MEASURINGCONSTRUCTVALIDITY Unlike content validity, this construct validity can be analysed using statistical analysis. Use Exploratory FactorAnalysis [EFA], Confirmatory FactorAnalysis [CFA] or Unidimensionality to confirm all items are measuring the right construct and the raw variance explained for the latent variables is sufficient. Gap initem map also can show accuracy in construct validity. RELIABILITY The degree to which test scores are consistent over repeated administrations of the same/ equivalent test and therefore considered dependable and repeatable for an individual learner.A test thatproduces highly consistent and stable results (i.e. relative free from random error) is said to be highly reliable. TYPESOFRELIABILITY Test-retest demonstrates the stability of a measure over time 01 Internal consistency most of the items within a rating scale of a concept show consistency of scoring. Inter-rater the extent to which two or more independent raters are consistent in observing, recording and scoring data (should be 70% or higher agreement) 04 Intra-rater relies on one rater to rate an object or event twice (70% or higher of agreement) FACTORSAFFECTING VALIDITYANDHOWTO INCREASEVALIDITY? FACTORS AFFECTING VALIDITY HOWTO INCREASE VALIDITY? 1. Inaccuracy of items in measuringtheoutcomes 1. Vetting session to get reviewsfromtheexpert. 2. Pooritemsdevelopment 2. Followtheformatandtips indevelopinggooditems. 3. Unclearinstructions 3. Do pilot testing to measuretheusabilityof thetest. 4. Interveningevents 4. Controltheinternalthreats validityfactors. 5. Itemsdifficultyisnot suitableforthelearners 5. Create a construct map toensurethereisanitem thatrepresentslearners ability. FACTORS AFFECTING RELIABILIT Y HOWTOINCREASERELIABILITY? 1. TestLength 1. Thetestlengthshouldbeappropriate withtestdifficulty. 2. Test retest interval 2. Suggesteddurationisbetween3 weeksto2months. 3. Variability of scores 3. Doconstructmaptoensuretheitems aresuitablewithlearners’ability. 4. Guessing 4. Penalisetheguessinganswers.You alsocandetecteitherthelearnersare guessing or not using the statistical analysis named guessing analysis andpersonfitanalysis. 5. Inconsistency score from different raters 5. Appointtheratertomarkcertain questionsforalllearners(Thisalways happen when you have more than onesectionandhavemorethanone lecturer). CONCLUSION Coming back to the issue of validity and reliability in assessment, there is a need for educators to put an effort to ensurethattheitemsintheformofquestionsorinstructions arenotonlyclearbutalsoabletomeasurewhatitisintended tomeasurebasedontherelatedlearningoutcomes. Establishingvalidityandreliabilityofinstrumentscan provide educators with some indications of the quality of the measuring tools being used. Valid and reliable instruments enabletheeducatorstocontinuouslyusethemeasuringtools withoutreservation. Reliablenot valid Precisenot Accurate Reliableand valid Preciseand Accurate NotReliable butvalid NotPrecisebut Accurate NotReliable butNotvalid NotPrecisebut NotAccurate 94 ". Would you like to continue making it or start afresh?