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I. Introduction: A. Welcome and Purpose of Training Welcome to the ABA Clinic Fire and Evacuation Safety Training. The purpose of this training is to ensure the safety and well-being of everyone in the clinic by preparing staff for effective response to fire emergencies and evacuation situations. B. Importance of Evacuation and Fire Safety Understanding the gravity of evacuation and fire safety is paramount. Compliance with safety standards not only meets regulatory requirements but also safeguards the lives of our clients, staff, and visitors. II. Overview of Fire Safety Standards: A. Explanation of Relevant Fire Safety Codes and Standards Our clinic strictly adheres to [Insert Relevant Fire Safety Codes and Standards], including guidelines from the National Fire Protection Association (NFPA) and local fire authorities. Familiarity with these standards is essential for maintaining a safe environment. B. Importance of Compliance Compliance with fire safety standards is a commitment to the well-being of our community. It sets the foundation for a secure and prepared clinic, ensuring a proactive approach to fire safety. III. Fire Prevention Measures: A. Identifying Fire Hazards in the Clinic Regular inspections, conducted quarterly, will identify potential fire hazards, including faulty wiring, overheating equipment, or improperly stored flammable materials. Staff is encouraged to report any potential hazards immediately. B. Proper Storage of Flammable Materials Flammable materials are stored in designated areas equipped with fire-resistant cabinets and safety measures. These areas are clearly marked, and staff is trained on proper storage procedures. C. Electrical Safety Tips Staff is trained to recognize and report any electrical issues promptly. Furthermore, electrical equipment undergoes regular maintenance checks to prevent electrical fires. D. Smoking Policy Smoking is strictly prohibited within the clinic premises. Designated smoking areas, equipped with fire-resistant receptacles, are provided outside the building, ensuring compliance with safety regulations. IV. Emergency Communication: A. Overview of Communication Systems Our clinic utilizes a robust communication system, including intercoms and a mass notification system, to relay emergency information promptly to all staff members. B. Designation of Emergency Contacts Emergency contact information for all staff members is regularly updated. Designated individuals are responsible for initiating emergency communication and ensuring all staff are informed. C. Internal Communication Protocols Clear internal communication protocols are established, outlining the chain of command and communication channels during emergency situations. Staff members are familiarized with these protocols during onboarding. V. Evacuation Procedures: A. Evacuation Routes Evacuation routes are clearly marked throughout the clinic, indicating the shortest and safest paths to exit points. These routes are reviewed annually and updated as needed. B. Emergency Exits and Assembly Points Staff is familiarized with the location of emergency exits and assembly points during regular drills. These drills, conducted quarterly, ensure that all staff are well-practiced in evacuation procedures. C. Evacuation Drills Evacuation drills are conducted quarterly, simulating various emergency scenarios. These drills include scenarios involving individuals with special needs, ensuring staff are equipped to assist everyone during evacuations. D. Assistance for Individuals with Special Needs Staff members receive specialized training on providing assistance to individuals with special needs during evacuations. This includes utilizing evacuation chairs, providing verbal guidance, and ensuring a calm and supportive approach. VI. Fire Extinguisher Training: A. Types of Fire Extinguishers Staff is trained on the different types of fire extinguishers available in the clinic, including ABC and CO2 extinguishers. Training includes recognizing the appropriate use for each type. B. Proper Use and Handling Hands-on demonstrations are provided to staff, allowing them to practice the proper use and handling of fire extinguishers. Emphasis is placed on safety precautions, including maintaining a safe distance and using the PASS method (Pull, Aim, Squeeze, Sweep). C. Location of Fire Extinguishers in the Clinic A map indicating the locations of all fire extinguishers is prominently displayed throughout the clinic. Staff is familiarized with these locations during training sessions. VII. Emergency Response Team: A. Designation of Emergency Response Team Members An Emergency Response Team is designated, comprising individuals from different departments. Team members receive specialized training and are identified by distinctive vests during emergencies. B. Roles and Responsibilities Clear roles and responsibilities for Emergency Response Team members are outlined in the Emergency Response Plan. This includes responsibilities such as assisting with evacuations, providing first aid, and coordinating with emergency services. C. Training for First Aid and CPR Emergency Response Team members receive regular training in first aid and CPR. Training sessions are conducted semi-annually to ensure team members are proficient in life- saving techniques. VIII. Mock Scenarios: A. Conducting Simulated Fire Drills Simulated fire drills are conducted quarterly, involving all staff members. These drills include various fire scenarios, such as small fires, smoke-filled areas, and evacuations of different areas within the clinic. B. Addressing Various Emergency Scenarios Staff members engage in discussions and practical exercises addressing various emergency scenarios, fostering a proactive mindset. Scenarios include power outages, medical emergencies, and coordination with external emergency services. C. Feedback and Improvement Strategies Feedback from drills is collected and analyzed to identify areas for improvement. Regular meetings are held to discuss feedback and implement necessary changes to enhance emergency response strategies. IX. Documentation and Record-Keeping: A. Importance of Documentation Accurate and detailed documentation of all safety-related activities is maintained, including inspection reports, drill records, and incident reports. This documentation is crucial for compliance and continuous improvement. B. Incident Reporting Procedures Staff is trained on the proper procedures for reporting incidents. Incident reports include details such as the nature of the incident, individuals involved, and actions taken. A designated individual reviews and addresses incident reports promptly. C. Regular Audits and Reviews Regular audits and reviews of safety procedures are conducted annually by an external safety consultant. This ensures that the clinic's safety protocols align with the latest standards and identifies areas for continuous improveme
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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BMC Womens Health. 2018;18(1):168-174. thereby an early onset of obesity. leptin can inhibit the production of testosterone in boys and subse- quently inhibit the development of secondary sex characteristics affecting spermatogenesis. for other adipokines, like resistin and omentin, are present in the testes and ovaries suggesting a role in puberty or reproduction; 58, 71 however, their plausible function is still unknown. that adipokines may be key regulators in an early onset of puberty in both girls and boys with obesity, specifically by affecting the HPG axis during gonadarche. Future research should focus on assessing puberty onset by measuring consistent puberty markers and determine the percentage of body fat and its distribution and adipokines and hormone serum levels particularly involved in the HPG axis. CONFLICTS OF INTEREST The authors declare no conflict of interest. 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. Selection criteria used were English language, longitudinal or cross-sectional studies assessing the onset of puberty, including menarche, thelarche, spermarche, or voice break, combined with high BMI or obesity/adiposity, and articles assessing or reviewing adipokines and its effects on the reproductive system. 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. 9 of 10 21. Lian Q, Mao Y, Luo S, et al. Puberty timing associated with obesity and central obesity in Chinese Han girls. BMC Pediatr. 2019; 19(1):1-7. 22. Deng Y, Liang J, Zong Y, et al. Timing of spermarche and menarche among urban students in Guangzhou, China: trends from 2005 to 2012 and association with Obesity. 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Circulating plasma leptin and IGF-1 levels in girls with premature adrenarche: potential implications of a preliminary study. Horm Metab Res. 2001;33(3):138-143. 34. Cousminer DL, Widén E, Palmert MR. The genetics of pubertal timing in the general population: recent advances and evidence for sex-spec- ificity. Curr Opin Endocrinol Diabetes Obes. 2016;23(1):57-65. 35. Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child. 1969;44(235):291-303. 36. Lacroix AE, Whitten R. Physiology. Treasure Island (FL): Menarche. StatPearls. StatPearls Publishing; 2018. 37. McDowell MA, Brody DJ, Hughes JP. Has Age at Menarche Chan- ged? Results from the National Health and Nutrition Examination Sur- vey (NHANES) 1999–2004. J Adolesc Health. 2007;40(3):227-231. 38. de Muinich Keizer SM, Mul D. Trends in pubertal development in Europe. Hum Reprod Update. 2001;7(3):287-291. 39. Talma H, Schönbeck Y, van Dommelen P, Bakker B, van Buuren S, Hirasing RA. Trends in menarcheal age between 1955 and 2009 in the Netherlands. PLoS ONE. 2013;8:e60056-e60056. 40. Kaplan HS, Lancaster JB. An evolutionary and ecological analysis of human fertility, mating patterns, and parental investment. Off- spring: Human fertility behavior in biodemographic perspective. 2003;1: 170-223. 41. Mitan LA. Menstrual dysfunction in anorexia nervosa. J Pediatr Adolesc Gynecol. 2004;17(2):81-85. 42. Xu H, Li P-H, Barrow TM, et al. Obesity as an effect modifier of the association between menstrual abnormalities and hypertension in young adult women: Results from Project ELEFANT. PLoS ONE. 2018; 13(11):e0207929-e0207929. 43. Tauqeer Z, Gomez G, Stanford FC. Obesity in women: insights for the clinician. J Womens Health (Larchmt). 2018;27(4):444-457. 44. de Ridder CM, Thijssen JH, Bruning PF, Van den Brande JL, Zonderland ML, Erich WB. Body fat mass, body fat distribution, and pubertal development: a longitudinal study of physical and hormonal sexual maturation of girls. J Clin Endocrinol Metab. 1992;75(2): 442-446. 45. Lassek W, Gaulin S. Brief communication: menarche is related to fat distribution. Am J Phys Anthropol. 2007;133(4):1147-1151. 46. Loomba-Albrecht LA, Styne DM. Effect of puberty on body composi- tion. Curr Opin Endocrinol Diabetes Obes. 2009;16:10-15. 47. Simonneaux V, Bahougne T. A multi-oscillatory circadian system times female reproduction. Front Endocrinol. 2015;6:1-15. 48. Marques P, Skorupskaite K, George JT, Anderson RA. Physiology of GNRH and gonadotropin secretion. In: Feingold KR, Anawalt B, Boyce A, et al., eds. Endotext. Endotext.org: South Dartmouth (MA); 2000. 49. Barcellos Gemelli IF, Farias EDS, Souza OF. Age at menarche and its association with excess weight and body fat percentage in girls in the Southwestern Region of the Brazilian Amazon. J Pediatr Adolesc Gynecol. 2016;29(5):482-488. 50. Aksglaede L, Juul A, Olsen LW, Sorensen TI. Age at puberty and the emerging obesity epidemic. PLoS ONE. 2009;4:1-6, e8450. 51. Ribeiro J, Santos P, Duarte J, Mota J. Association between over- weight and early sexual maturation in Portuguese boys and girls. Ann Hum Biol. 2006;33(1):55-63. 52. Budak E, Fernandez Sanchez M, Bellver J, Cervero A, Simon C, Pellicer A. Interactions of the hormones leptin, ghrelin, adiponectin, resistin, and PYY3-36 with the reproductive system. Fertil Steril. 2006;85(6):1563-1581. 53. Castellano JM, Tena-Sempere M. Metabolic control of female puberty: potential therapeutic targets. Expert Opin Ther Targets. 2016; 20(10):1181-1193. 54. Venancio JC, Margatho LO, Rorato R, et al. Short-term high-fat diet increases leptin activation of CART neurons and advances puberty in female mice. Endocrinology. 2017;158(11):3929-3942. 55. l'Allemand D, Schmidt S, Rousson V, Brabant G, Gasser T, Gruters A. Associations between body mass, leptin, IGF-I and circulating adrenal androgens in children with obesity and premature adrenarche. Eur J Endocrinol. 2002;146(4):537-543. 56. Böttner A, Jr K, Müller G, et al. Gender Differences of adiponectin levels develop during the progression of puberty and are related to serum androgen levels. J Clin Endocrinol Metabol. 2004;89(8):4053- 4061. 57. Unanue N, Bazaes R, Iñiguez G, Cortes F, Avila A, Mericq V. Adre- narche in Prader-Willi syndrome appears not related to insulin sensi- tivity and serum adiponectin. Horm Res. 2007;67(3):152-158. 58. Michalakis K, Mintziori G, Kaprara A, Tarlatzis BC, Goulis DG. The complex interaction between obesity, metabolic syndrome and repro- ductive axis: a narrative review. Metabolism: clinical and experimental. 2013;62(4):457-478. 59. Machinal-Quelin F, Dieudonne MN, Pecquery R, Leneveu MC, Giudicelli Y. 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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 gover
Q1. A teacher designs a lesson where students compute real-life percentages such as discounts and savings. 👉 A student calculates 15% of 200 to determine savings in a purchase. What is the correct result? A. 20 B. 25 C. 30 D. 35 Q2. In a classroom activity, learners compare numbers to find the highest common factor for grouping materials evenly. 👉 What is the GCF of 24 and 36? A. 6 B. 8 C. 12 D. 18 📘 FRACTIONS, DECIMALS, AND POWERS Q3. A learner converts fractions into percentages for data interpretation. 👉 What is 3/4 expressed as a percentage? A. 50% B. 60% C. 75% D. 80% Q4. A student models exponential growth using repeated multiplication. 👉 What is the value of 252^525? A. 25 B. 30 C. 32 D. 64 📘 ALGEBRA (EQUATIONS AND EXPRESSIONS) Q5. A teacher guides students to solve equations that represent real-life situations. 👉 Solve: 2x+8=202x + 8 = 202x+8=20 A. x = 4 B. x = 6 C. x = 8 D. x = 10 Q6. Students simplify expressions to understand relationships between quantities. 👉 Simplify: 3(x+4)−2x3(x + 4) - 2x3(x+4)−2x A. x + 12 B. x + 4 C. 5x + 4 D. 5x + 12 📘 FUNCTIONS AND GRAPHING Q7. A student analyzes a linear equation to determine its rate of change. 👉 What is the slope of y=3x−5y = 3x - 5y=3x−5? A. -5 B. -3 C. 3 D. 5 Q8. A learner evaluates functions to predict outcomes. 👉 If f(x)=2x+3f(x) = 2x + 3f(x)=2x+3, what is f(4)f(4)f(4)? A. 7 B. 9 C. 11 D. 14 📘 GEOMETRY Q9. Students explore geometric shapes and their properties through visual models. 👉 What is the sum of interior angles of a triangle? A. 90° B. 180° C. 270° D. 360° Q10. A student calculates the area of a classroom table with dimensions 8 cm by 5 cm. 👉 What is the area? A. 26 sq cm B. 30 sq cm C. 40 sq cm D. 48 sq cm 📘 MEASUREMENT AND FIGURES Q11. A learner determines the volume of a cube used in a science experiment. 👉 What is the volume of a cube with side 4 cm? A. 16 cubic cm B. 32 cubic cm C. 48 cubic cm D. 64 cubic cm Q12. Students identify shapes used in design projects. 👉 How many sides does a hexagon have? A. 5 B. 6 C. 7 D. 8 📘 STATISTICS AND PROBABILITY Q13. A teacher helps students interpret data sets using measures of central tendency. 👉 What is the mean of 4, 6, 8, 10, 12? A. 6 B. 8 C. 10 D. 12 Q14. A class experiment involves flipping a fair coin. 👉 What is the probability of getting heads? A. 1/4 B. 1/3 C. 1/2 D. 2/3 📘 WORD PROBLEMS (APPLICATION) Q15. A car travels 180 km in 3 hours during a learning task on speed. 👉 What is its average speed? A. 45 km/h B. 60 km/h C. 75 km/h D. 90 km/h Q16. Students analyze work efficiency in a project. 👉 If 5 workers complete a task in 12 days, how long will 10 workers take? A. 3 days B. 6 days C. 8 days D. 12 days Q17. A student solves a problem involving ratios in a classroom population. 👉 If the ratio of boys to girls is 3:2 and there are 30 students, how many boys are there? A. 12 B. 15 C. 18 D. 20 Q18. A learner determines the duration of a scheduled trip. 👉 A journey starts at 8:30 AM and ends at 11:15 AM. How long is the trip? A. 2 hrs 15 mins B. 2 hrs 30 mins C. 2 hrs 45 mins D. 3 hrs 15 mins Q19. A student computes simple interest for financial literacy. 👉 What is the simple interest on ₱1000 at 5% for 2 years? A. ₱50 B. ₱75 C. ₱100 D. ₱150 Q20. A learner solves a perimeter problem involving a rectangle. 👉 A rectangle has a length of 12 cm and perimeter of 34 cm. What is the width? A. 5 cm B. 7 cm C. 10 cm D. 11 cm ✅ ANSWER KEY (BASED ON YOUR REVIEWER) (All verified from your uploaded file) [ilide.info...002acd4e5a | PDF] QAnswer1C2C3C4C5B6A7C8C9B10C11D12B13B14C15B16B17C18C19C20A
IPC- From Bronze to Bioplastic -Reviewer for exam pt4.
Translator: Joseph Geni Reviewer: Morton Bast Before March, 2011, I was a photographic retoucher based in New York City. We're pale, gray creatures. We hide in dark, windowless rooms, and generally avoid sunlight. We make skinny models skinnier, perfect skin more perfect, and the impossible possible, and we get criticized in the press all the time, but some of us are actually talented artists with years of experience and a real appreciation for images and photography. On March 11, 2011, I watched from home, as the rest of the world did, as the tragic events unfolded in Japan. Soon after, an organization I volunteer with, All Hands Volunteers, were on the ground, within days, working as part of the response efforts. I, along with hundreds of other volunteers, knew we couldn't just sit at home, so I decided to join them for three weeks. On May the 13th, I made my way to the town of Ōfunato. It's a small fishing town in Iwate Prefecture, about 50,000 people, one of the first that was hit by the wave. The waters here have been recorded at reaching over 24 meters in height, and traveled over two miles inland. As you can imagine, the town had been devastated. We pulled debris from canals and ditches. We cleaned schools. We de-mudded and gutted homes ready for renovation and rehabilitation. We cleared tons and tons of stinking, rotting fish carcasses from the local fish processing plant. We got dirty, and we loved it. For weeks, all the volunteers and locals alike had been finding similar things. They'd been finding photos and photo albums and cameras and SD cards. And everyone was doing the same. They were collecting them up, and handing them in to various places around the different towns for safekeeping. Now, it wasn't until this point that I realized that these photos were such a huge part of the personal loss these people had felt. As they had run from the wave, and for their lives, absolutely everything they had, everything had to be left behind. At the end of my first week there, I found myself helping out in an evacuation center in the town. I was helping clean the onsen, the communal onsen, the huge giant bathtubs. This happened to also be a place in the town where the evacuation center was collecting the photos. This is where people were handing them in, and I was honored that day that they actually trusted me to help them start hand-cleaning them. Now, it was emotional and it was inspiring, and I've always heard about thinking outside the box, but it wasn't until I had actually gotten outside of my box that something happened. As I looked through the photos, there were some were over a hundred years old, some still in the envelope from the processing lab, I couldn't help but think as a retoucher that I could fix that tear and mend that scratch, and I knew hundreds of people who could do the same. So that evening, I just reached out on Facebook and asked a few of them, and by morning the response had been so overwhelming and so positive, I knew we had to give it a go. So we started retouching photos. This was the very first. Not terribly damaged, but where the water had caused that discoloration on the girl's face had to be repaired with such accuracy and delicacy. Otherwise, that little girl isn't going to look like that little girl anymore, and surely that's as tragic as having the photo damaged. (Applause) Over time, more photos came in, thankfully, and more retouchers were needed, and so I reached out again on Facebook and LinkedIn, and within five days, 80 people wanted to help from 12 different countries. Within two weeks, I had 150 people wanting to join in. Within Japan, by July, we'd branched out to the neighboring town of Rikuzentakata, further north to a town called Yamada. Once a week, we would set up our scanning equipment in the temporary photo libraries that had been set up, where people were reclaiming their photos. The older ladies sometimes hadn't seen a scanner before, but within 10 minutes of them finding their lost photo, they could give it to us, have it scanned, uploaded to a cloud server, it would be downloaded by a gaijin, a stranger, somewhere on the other side of the globe, and it'd start being fixed. The time it took, however, to get it back is a completely different story, and it depended obviously on the damage involved. It could take an hour. It could take weeks. It could take months. The kimono in this shot pretty much had to be hand-drawn, or pieced together, picking out the remaining parts of color and detail that the water hadn't damaged. It was very time-consuming. Now, all these photos had been damaged by water, submerged in salt water, covered in bacteria, in sewage, sometimes even in oil, all of which over time is going to continue to damage them, so hand-cleaning them was a huge part of the project. We couldn't retouch the photo unless it was cleaned, dry and reclaimed. Now, we were lucky with our hand-cleaning. We had an amazing local woman who guided us. It's very easy to do more damage to those damaged photos. As my team leader Wynne once said, it's like doing a tattoo on someone. You don't get a chance to mess it up. The lady who brought us these photos was lucky, as far as the photos go. She had started hand-cleaning them herself and stopped when she realized she was doing more damage. She also had duplicates. Areas like her husband and her face, which otherwise would have been completely impossible to fix, we could just put them together in one good photo, and remake the whole photo. When she collected the photos from us, she shared a bit of her story with us. Her photos were found by her husband's colleagues at a local fire department in the debris a long way from where the home had once stood, and they'd recognized him. The day of the tsunami, he'd actually been in charge of making sure the tsunami gates were closed. He had to go towards the water as the sirens sounded. Her two little boys, not so little anymore, but her two boys were both at school, separate schools. One of them got caught up in the water. It took her a week to find them all again and find out that they had all survived. The day I gave her the photos also happened to be her youngest son's 14th birthday. For her, despite all of this, those photos were the perfect gift back to him, something he could look at again, something he remembered from before that wasn't still scarred from that day in March when absolutely everything else in his life had changed or been destroyed. After six months in Japan, 1,100 volunteers had passed through All Hands, hundreds of whom had helped us hand-clean over 135,000 photographs, the large majority — (Applause) — a large majority of which did actually find their home again, importantly. Over five hundred volunteers around the globe helped us get 90 families hundreds of photographs back, fully restored and retouched. During this time, we hadn't really spent more than about a thousand dollars in equipment and materials, most of which was printer inks. We take photos constantly. A photo is a reminder of someone or something, a place, a relationship, a loved one. They're our memory-keepers and our histories, the last thing we would grab and the first thing you'd go back to look for. That's all this project was about, about restoring those little bits of humanity, giving someone that connection back. When a photo like this can be returned to someone like this, it makes a huge difference in the lives of the person receiving it. The project's also made a big difference in the lives of the retouchers. For some of them, it's given them a connection to something bigger, giving something back, using their talents on something other than skinny models and perfect skin. I would like to conclude by reading an email I got from one of them, Cindy, the day I finally got back from Japan after six months. "As I worked, I couldn't help but think about the individuals and the stories represented in the images. One in particular, a photo of women of all ages, from grandmother to little girl, gathered around a baby, struck a chord, because a similar photo from my family, my grandmother and mother, myself, and newborn daughter, hangs on our wall. Across the globe, throughout the ages, our basic needs are just the same, aren't they?" Thank you. (Applause) (Applause)
THAT'S ENTERTAINMENT Big movies on a small budget. Do you need millions of dollars to make a movie? No. Do you need millions of dollars to make a successful movie? Most people would answer 'Yes' to that question. But would they be right? We're used to hearing about really expensive Hollywood films. The 1997 Oscar-winner Titanic cost $200 million to make, and more recently, Spider Man 3, one of the most successful films of 2007, had a budget of more than $250 million. To be successful, however, a film doesn't need to be as expensive as the big Hollywood blockbusters. An example of this is the 2010 movie Monsters, which cost less than half a million dollars to make. Monsters is set in Mexico and is the story of two people trying to escape from aliens and get back to the USA. The film won several awards and got very good reviews from many film critics-for example, the website Moviefone put Monsters at number 3 in its list of the best sci-fi films for 2010. How did they make the film so cheaply? First of all, it only took three weeks to film, and the film crew was just seven people in a van. Secondly, the man who made the film, Gareth Edwards. decided to film it with digital video, which is cheaper than the usual 35mm film. (The film equipment cost only $15,000 altogether) There is also the fact that they used real locations, not a studio. And the cast of the film were Edwards himself and two friends of his all the extras in the film were people who were just there, and they weren't paid. Most importantly, Edwards did most of the production work himself. He spent eight months editing Monsters and then five months creating the special effects. And he did it all at home on his computer, using non-professional software. The amazing thing is that the final film looks nearly as professional as big, fancy Hollywood productions. Not everybody liked Monsters, of course. One person said: "That's 90 minutes of my life that I'll never get back. But overall, it was very well received. And at least it wasn't expensive to make.
What is an official invitation letter? The companies write a letter of invitation-business when they host business visitors from abroad or from the same region or country. The business visitors can be investors; potential buyers may be conference visitors, business partners, employees of any company, or mere individuals who come for training at the company’s facilities. If a company is inviting any visitor, a representative of that company must write the letter. Also, the firms must have some specific people who would sign the invitation letters. These letters are very much precise, only containing the necessary information. The invitation letter should state the name of the business organization they represent and their relationship to the host (e.g., distributor, regional sales reps, etc.). The letter should articulate the planned dates of travel, and must be formatted professionally. What is a personal invitation letter? A Personal invitation letter is a letter one writes to invite people to a party or a social gathering at a very personal level. It is a formal request asking for the person’s presence at the event that is going to take place. All the relevant details regarding the event like the reason, date, time and venue and the dress code, if any, must be provided in the invitation letters. This will keep the guests informed, and they will feel happy to attend the event. The style and tone of the letter would depend upon the relationship between the sender and receiver. Through the letter, you should be able to make the receiver feel that you highly value his/her presence at the party or the event. A personal invitation letter can be written to invite a person to a birthday party, wedding, conference, meeting, dinner, etc. Before writing the letter, make sure you have a list of people whom you would like to invite to the party or the event. How to Write an Invitation Letter Writing an invitation letter becomes easy and swift once you get through the tips and the format of the invitation letter provided below. Usually block, semi-block or a modified block format is used for official invitation letters. The important aspects of any invitation letters are date, time, salutations and closing. For more advice refer to the tips provided. Tips for Invitation Letter Writing ● Organize the Matter – Before you draft an invitation letter ensure that you have all the required material. This material refers to a list of the people to be invited, sequential order of the events, timings of the events, special guest, official documents, photocopies and any other required item. Some items may also need to be attached along with the letter, keep them alongside. Refer to these as and when required. All the relevant documents will help you in drafting the letter. ● Drafting – You don’t just write a letter straightway and post it. It has to be reviewed and finalized. One of these processes is drafting. Drafting ensures that your mistakes and their rectification aren’t passed on to the invitation itself. Make all the mistakes in the draft itself. Drafting an invitation letter is important as sometimes we may make mistakes that we are not able to see but they are visible to others. One may require a draft to be approved by seniors before it is finalized. A second opinion from a friend or peer etc. may be required as well to determine certain things. ● Politeness – You don’t need to be told that you have to use polite language while writing an invitation letter, why would you be rude when sending an invitation? True, but you have to remind yourself of certain manners and etiquettes required of an invitation. Your invitation is your initiative, not the recipients so you need to be gracious. Always begin the letter with a welcome note instead of straightforward information of the invitation. Words of respect and gratitude are symbols of courtesy and politeness, always expressing your gratitude in the beginning and the end of the letter. ● Positive Tone – The gesture of welcome and gratitude themselves are positive points of an invitation letter. Apart from these, gestures of appreciation and anticipation are other positive points which can persuade a guest to attend the event. When you show your appreciation and anticipation towards the recipient through your words, it is an acknowledgement of his importance and thereby a positive approach. Towards this effect two tenses are used within the invitation letter, the present and the future. The present tense conveys information about the event and the future tense conveys an anticipated presence of the guest. ● Offer Assistance – An invitation being the responsibility of the sender, the assistance to the recipient by default becomes a responsibility of the host. The more facilities you provide the better the chances of someone’s attendance. You can offer pick up and drop services, accommodation, meals, provide them contact numbers in case you are not present at the venue and other required assistance. Relevant facts like date, time and venue of the event in the beginning itself is itself assisting. These assistances encourage a positive response from the invitees. ● Special Instructions – Some occasions require special instructions for the guests. These instructions can be: 1. Dress code 2. Road or route map 3. Purpose of the occasion – birthday, honor, anniversary etc. 4. Return gift 5. Response or confirmation to the invitation 6. Attire and items required for the guest to bring 7. No eatables allowed 8. Entrance only by invitation 9. 2 people per pass 10. No weapons allowed ● Length of the Matter – A simple invitation letter will only contain only the relevant facts. A simple invitation letter features an introduction which allows the sender to introduce themselves and or the organization they represent. A simple background of the individual or company is enough. Though invitations are meant to be concise and straightforward, it isn’t necessary. You can vary the length as per your need and requirement. Wedding and party invitation letters are not lengthy as compared to visit and certain personal invitation letters. ● Using Letterhead – As a rule official Invitation letters require a letterhead. Letterhead represents the sender and its inclusion is authority established. If you have a pre printed letterhead then use that. Personal Invitation letters don’t require letterheads and one can use it as per one’s desire. ● Gesture of Appreciation – Next, the appreciation for the guest to attend an activity or event must be shown. This can be completed with a formal note, stating that you look forward to seeing the individual at the event. ● Don’t forget the Enclosure – Some requests require certain documents to be attached; these can be the photocopies of documents like agreements, hard copies of email received, earlier correspondence, receipts, warranty etc. Keep original copies of all your letters, faxes, e-mails, and other related documents. ● Closing the Letter – Start the letter with Gratitude and end it with the same. It is a professional and social courtesy. At the end of your last paragraph is written, a complimentary close of the likes of ‘Sincerely’, ‘Thank you’, ‘Truly’ is essential. Close the letter by restating your appreciation and gratitude. ● Proofreading – Check for - awkward phrases, grammatical errors, incomplete sentences and spelling mistakes. Fix them with appropriate punctuation and remove dull or lifeless sentences and replace them with clever phrasing, poetry or a themed approach. This is the final step; the draft will be reviewed and revised before it acquires a proper form. Read it aloud to yourself to figure out mistakes which are missed out in writing. ● Inform in Advance – Invitation letters need to be sent in advance. Try to send the invitation letter two weeks or more in advance. The recipient needs to know in advance so that they can adjust their schedules, book tickets or make other arrangements which are essential.
. Sports center manager / Leisure manager They conduct daily activities at sports complexes and recreational facilities with gyms, pools, and activity rooms. Individuals need a bachelor's degree in leisure and recreation, facility management, or hospitality. 3. Food truck manager They oversee the daily operations of food trucks at tourist attractions and unique event venues. They may be responsible for coordinating work schedules, obtaining food service licenses in different areas, and ordering food inventory as needed. Food truck managers need a minimum of a high school diploma but can also benefit from previous work experience. 4. Pastry chef They specialize in making various pastries and other desserts for bakeries, restaurants, and patisseries. They work closely with other kitchen staff and chefs to create dough mixtures, develop new recipes, decorate dessert items, and monitor the baking process to ensure a finished product. To become a pastry chef, individuals can either earn a high school diploma and develop their skills or attend a pastry arts program and earn an associate degree or bachelor’s degree. 5. Airport manager / Aviation manager They ensure efficient operations at an airport while ensuring that all airlines follow FAA (Federal Aviation Administration) guidelines. They hire and train airport personnel and monitor activities relating to They usually have a few years of work experience in a role at an airport, along with a bachelor's degree in airport management 6 security, customer service, and customer amenities, including onsite restaurants. and operations or aviation management. A professional certification can also be beneficial. 6. Spa manager They lead daily operations at spa facilities. Their duties include hiring and training spa employees and maintaining an up-to-date inventory of cosmetic products, sheets, towels, robes, and other items for skin treatments. Spa managers may also promote their spa by hiring freelance marketers or organizing advertisements for digital or print platforms. They also administer advanced therapies like facials and massages to customers. The education requirements include earning an associate's or bachelor's degree in hospitality or business management. Prospective spa managers also need a few years of work experience at a spa business. 7. Hotel assistant general manager They support the job duties of the hotel's general manager. They help the available manager interview job candidates, make hiring decisions, and coordinate training efforts for staff. Hotel assistant general managers may also cover shifts for general managers and act as temporary general managers when the manager is sick or on vacation. Individuals need a high school diploma and a few years of hotel experience. They may also benefit from earning an associate's degree or bachelor's degree in hospitality and tourism. 8. Tour manager They oversee tour bookers, tour guides, tour bus drivers, and marketing staff for a tour company. They schedule work shifts for tour guides, develop marketing Individuals can become tour managers by earning a high school diploma and working for a tour 7 strategies to increase tour bookings, and read tourist reviews to determine how they can improve their overall experience. They may also accompany clients when they travel and attend to their needs. company for a few years. They can also earn a bachelor's degree or master's degree in an area like hospitality and tourism management. 9. Cafe manager They oversee the daily operations of cafes in shopping centers, hotels, and other areas. They hire and train cafe staff, adjust coffee and bakery selections, handle complex customer questions, and ensure the cleanliness of their facilities. Cafe managers also create work schedules to provide enough staff during peak business hours. To become a cafe manager, individuals need a minimum of a high school diploma and previous experience working in a cafe as a barista or supervisor. 10. Activity manager They work for hotels and resorts, travel companies, and cruise liners to oversee guest activities and ensure guests have a pleasant experience. This may include planning guests' itineraries, offering guests tours of the local area, and developing fun activities within their facilities. Activity managers typically have bachelor's degrees in hospitality and tourism, event planning, or recreation. 11. Hotel sales coordinator They work for hotels and help create and manage their marketing and customer service strategies. They also work with a team of sales coordinators and hotel managers to research ways to increase bookings and retain customers. They may To become a hotel sales coordinator, individuals need a bachelor's degree in sales, marketing, hospitality, and tourism. 8 design special offers, create branding and promotional strategies, and follow up with guests after they check out. 12. Resort manager They oversee the daily activities at resort facilities. They typically monitor the resort's housekeeping activities, finances, and marketing materials. They manage different departments to assist with general maintenance and ensure a high guest satisfaction rate. To become a resort manager, individuals need experience working in the resort industry, either a bachelor's degree or master's degree in hotel management or hospitality and tourism. 13. Travel agent They work for travel agencies or as self-employed individuals to help clients book transport and hotel accommodations. Their duties may also involve creating a trip itinerary for their clients and helping them reschedule canceled flights or transfer accommodations. Prospective travel agents need a high school diploma and an interest in travel. They may also benefit from earning an associate's or bachelor's degree in hospitality and tourism management or applying for a professional travel agent certification. Travel agents often start as employees and become managers as their careers progress. 9 14. Catering manager They oversee a kitchen and server staff team for a catering company or event venue. They hire and train catering staff and work with one or more chefs to create an effective catering menu. They also design schedules for staff members, depending on the time required to set up and prepare food before an event. To become a catering manager, individuals can benefit from earning either an associate degree or a bachelor's degree in an area like hospitality or food service. 15. Entertainment manager They collaborate with resorts, cruise liners, hotels, and other accommodations to book singers, musicians, dance groups, comedians, and other entertainers to perform for guests. Their duties include holding auditions for potential talent, scheduling bookings, and negotiating with clients to determine price points. They oversee many aspects of events, including their production and financing. To become an entertainment manager, individuals can attend a four-year bachelor's degree program in hospitality, tourism management, event planning, or events and entertainment. 16. Guest services manager They assist hotel guests with their needs from when they check in to when they check out. They provide guests with room keys, organize baggage assistance, and delegate tasks to other staff like housekeepers, front desk employees, or room service personnel. They're also responsible for hiring and training the guest services staff. This position typically requires a minimum of a high school diploma and a few years of guest service experience. 10 17. Director of Housekeeping They work for a hotel, cruise line, or resort and manage its housekeeping staff. They maintain clean facilities for all guests by hiring and training housekeeping staff and monitoring inventory, including cleaning supplies, towels, bedsheets, and guest amenities. Housekeeping directors can benefit from earning a bachelor's degree in hospitality management and gaining several years of experience in the cleaning service industry. 18. Park manager They work at public and amusement parks and help develop marketing and promotional strategies to increase visitors. They may work with facilities managers to ensure the park remains clean and well-maintained. They also manage the park's budget, train managers in individual departments, and develop inclement weather or emergency policies. Prospective park managers need a bachelor's degree in leisure and recreation, management, or landscape design. 19. Food service director They work for hotels, cruises, and other accommodations to oversee food service operations for guests. Their job duties include developing a budget for food inventory and supplies, relaying information to food and beverage managers and kitchen staff, approving menu and drink ideas, and ensuring the quality of the food and dining operations. Directors at large hotels or other organizations may also To become a food service director, a bachelor's or master's degree in hospitality management, food service management, or culinary arts is necessary. 11 oversee the room service and catering from multiple restaurants. 20. Travel consultant They assist individuals, educational institutions, and corporations with their travel needs. They meet with clients to discuss their travel options to a destination and determine whether they need a passport, vaccinations, or weatherappropriate attire; they also help them find discounted hotels and airlines and arrange accommodations for clients with medical conditions and special needs. A high school diploma and a voluntary certification are typically necessary to become a travel consultant. An associate or bachelor's degree in tourism, international studies, or hospitality can also be beneficial.