Explain the Rationale for the Existence of Supplier Induced Demand in Health Care

EXPLAIN THE RATIONALE FOR THE EXISTENCE OF SUPPLIER INDUCED DEMAND IN HEALTH CARE AND EXPLORE THE EXTENT TO WHICH EMPIRICAL WORK HAS BEEN ABLE TO ESTABLISH ITS EXISTENCE Introduction: In the traditional market, consumers decide how much to consume and suppliers decide how much to supply and prices coordinate the decisions. For perfect competition it is assumed inter alia that there is: perfect information so that individuals are fully informed about prices, qualities etc; a lot of buyers and sellers; no single buyer or seller that has influence on the price. But health care market falls short of the perfect market paradigm as it is dogged by many phenomena that cause it to fail (Arrow 1963). One such phenomenon is supplier-induced demand (SID), whereby health care providers, usually physicians, exploit their information advantage over patients in order to induce patients to utilize more healthcare services than they would if they were accurately informed. The phenomenon of SID tends to take an important place within social debates because it has an impact on health care expenditures, health status and the allocation of income between patients and physicians (Labelle et al 1994). Therefore, it has attracted considerable attention in the health economics literature since Roemer (1961), who observed a positive correlation between the number of hospital beds available and their use leading to the observation, ‘a bed built is a bed filled’, sometimes referred to as Roemer’s Law. Although a variety of empirical tests of SID have been reported in literature, researchers disagree on the definition of and tests for SID. The validity of the results from the tests is controversial. Therefore there is no consensus on the development and implementation of public policy based on these results (Labelle et al 1994, p349). Indeed, Doessel (1995, p. 58) observed that this area of research can be described as a theoretical and empirical quagmire. After defining the terms, this essay is going to explore and explain the theoretical rationale, the empirical evidence and policy implications for the existence of SID. The argument will be summed up in the conclusion. Health Care Market and SID A market is a shorthand expression for the process by which households’ decisions about consumption of alternative goods, firms’ decisions about what and how to produce, and workers’ decisions about how much and for whom to work are all reconciled by adjustment of prices. Health care comprises services of health care professionals, which are addressed at health promotion, prevention of illnesses and injury, monitoring of health, maintenance of health, and treatment of disease, disorders, and injuries in order to obtain cure or, failing that, optimum comfort and function (quality of life) (Worldbank website). In health care market there is: a few buyers and sellers; asymmetry of information therefore violation of consumer sovereignty; allocation of resources by physicians and not price mechanism etc. Therefore patients face a dilemma in translating their desire for good health into a demand for medical care. This requires both information and medical knowledge, which they usually do not have. There is no definitive and widely accepted definition of SID. In literature, the definitions range from positive and value free (Fuchs 1978) to normative with negative connotations (Folland et al 2001, p. 04). McGuire (2000, p504) says that SID ‘exists when the physician influences a patient’s demand for care against the physician’s interpretation of the best interest of the patient’. Labelle et al (1994, p. 363) point out the need to incorporate in the definition of SID both the effectiveness of the agency relationship and the effectiveness of the induced services. This me ans that inducement can give rise to ‘good’ or ‘bad’ outcomes for patients depending on its clinical effectiveness, e. g. f a doctor persuades a patient to undertake more treatment where the patient would otherwise have opted for a less than clinically effective package of care. Rationale for the existence of SID: The theoretical analysis of SID is based upon the assumption that doctors maximise their utility subject to income and inducement. Dranove (1988, p 281) argues that under certain conditions the physician will have an incentive to recommend treatments whose costs outweigh their medical benefits. SID involves a shift of the demand curve, such that as supply ncreases, demand also increases (Fig. 1). In practice the exact demand curves themselves cannot be measured. Only the equilibrium points (A, B, C and D) of the overall market can be observed. If the supply of doctors increases from Q1 to Q2 (Fig. 1a), then the fee payable decreases from P1 to P2. But if SID exists (Fig. 1b), as the number of doctors increases from Q1 to Q2 the doctor would keep shifting the demand curve from D through to D3 in order to maintain or increase income. Fig. 1: Graphical representation of competing hypotheses The potential for SID to arise is shaped but not guaranteed by a number of characteristics of the health care market including: information gaps and asymmetries which encourage patients to seek medical advice and delegate decision-making to doctors; potential weaknesses in the agency relationship and the impact of clinical uncertainty on the decision making processes of doctors. Systems for financing, organising and paying for medical services also influence doctor and patient behaviour. The asymmetry of information between user and provider is the most fundamental peculiarity of health care, and the source of the most serious failures of market processes during resource allocation. Informational asymmetries may also invalidate the assumption of â€Å"consumer sovereignty† which underlies evaluative policy assessment in much of economics. Patients will often be relatively poorly informed compared with their doctor about their condition, treatment options, expected outcomes and likely costs. Unlike other professional services, information asymmetry is most pronounced in health care markets. Many researchers have tested the hypothesis that more knowledgeable patients should be resistant to SID and that they should therefore make less use of medical care. Surprisingly these studies have consistently found that knowledgeable patients frequently use more care [Bunker and Brown (1974); Hay and Leahy (1982) and Kenkel (1990)]. The institutional responses to information asymmetry are professionalisation, self-regulation, and the development of an agency relation between individual transactors and between the professions and society collectively. Agency relationship is formed whenever a principal (patient) delegates decision-making authority to another party, the agent (doctor). Ill-informed consumers are protected, by provider advice, from consumption of unnecessary or harmful services (inappropriate or poor quality) and also from failure to consume needed services. If this agency relationship were perfect, doctor would take on entirely the patient’s point of view and act as if he/she were the patient. All consumption choices made for the patient by the provider would be made so as to maximize the patient’s (and ultimately society’s) utility function. Health care providers do not always act as perfect agents for their patients. Their recommendations are sometimes influenced by self-interest, or the interest of the organization for which they work. This imperfect agency arises because the doctor (agent) performs a dual role — the same person who provides advice about a treatment usually provides and receives payment for that treatment. Hence, demand is no longer independent of supply; the agent can shift the demand curve to any position (Fig. 1b). The demand curve (Figure 1a), assumes that independent consumers of care are not directly influenced by suppliers in their decisions to use care, or alternatively that if such direct influence exists, its level is determined external to the market process itself. On the other hand, it has been shown that in spite of the presumed physician influence over the patient, the physician cannot predict the level of patient compliance (Goldberg et al 1998). Therefore it is doubtful how much influence the physician wields over the patient when it comes to SID. Traditionally doctors’ behaviour is controlled by a professional code- â€Å"Hippocratic oath†. Financial self-interest on the part of the physicians is only one of the causes of imperfect agency. Another very important cause is the failure of physicians to understand or accept patients’ preferences regarding the impact of health status on utility and provide this information to the patient (Labelle et al 1994). The target income theory posits that as the number of physicians has increased, they have induced additional demand to get a particular income, e. g. y increasing the volume and variety of tests and procedures. This is in contrast with conventional economics where increasing supply lowers the price for the consumer. The target income is determined by the local income distribution (Rizzo and Blumenthal, 1996). A professional service like Health care is inherently heterogeneous and nonretradable. A monopolistic competitor selling a nonretradable service set s a quantity to maximize profit and unless there is some cost to inducement, a physician or dental practitioner pursuing net income would induce demand to an infinite extent (Gaynor 1994). However, physicians prefer not to induce demand and only do so if they are compensated by adequate gains in income. The utility maximisation of physicians is limited by disutility of discretion, i. e. either the physician’s internal conscience (Evans 1974; Mcguire and Pauly 1991) or as a result of a reputation process by which doctors who excessively induce demand are punished through future reductions in true patient demand (Dranove 1988). SID can arise when clinical uncertainty causes provision of ‘unnecessary’ or ‘wasteful’ medical services even if doctors act in the perceived interests of their patients. If a doctor inadvertently underestimates a patient’s ability to pay for the cost of medical procedures, the level of care recommended might exceed that which the patient would have nominated. However, some analysts maintain that doctors’ responses to clinical uncertainty can give rise to SID fully consistent with the patient’s interests rather than self-interest (Richardson and Peacock 1999, p. 9) e. g. use of diagnostics in excess of ‘standard’ levels in the event of diagnostic uncertainty. Institutional and regulatory arrangements influence how medical markets work. They create incentives or disincentives for doctors (and patients) to behave in ways that could engender SID. For example, the cost-bearing and financing aspects of the doctor’s service are largely borne by third parties (i. e. governments and private insurers). As a consequence, typically neither the consumer nor the provider carefully considers the price or cost of the service supplied. This can influence the extent and form of SID. Other arrangements that can promote SID include: the system of payment for doctors (i. e. ee-for-service, capitation or salaried); the effect of medical indemnity arrangements on the adoption of ‘defensive medical practices’ by doctors; and the form of monitoring of doctor treatment practices. The link between physicians and pharmaceutical companies can also promote SID. Big pharmaceutical companies approach physicians and â€Å"ask† them to prescribe specific drugs to patients in exchange for a reward, such as free holidays. For example, in 2002 drug firms spent nearly $9. 4 billion on marketing to American doctors (The Economist 15th Feb. 2003). As a result, physicians are illing to prescribe extra medicines that are unnecessary and provide no benefit to the patient. Moreover, these drugs favoured by the physicians and produced by big companies might be more expensive than others with equivalent effectiveness However, one major criticism of the SID model is that it focuses on only one price– the nominal fee level–while ignoring access costs. If increased supply reduces travel time and office waits, the total cost of care has fallen even if fees remain constant. Secondly, the SID theory carries an implicit assumption that the extra services are unnecessary. An alternative view is that few situations in medicine are clear-cut and a broad range of indications is consistent with generally acceptable practice. Empirical evidence of SID Several indirect hypotheses and empirical tests have been carried out but due to the lack of a rigorous theoretical model and the presence of econometric and measurement problems, results concerning the existence of SID still remain controversial and inconclusive. SID is not easy to measure and interpret because of the difficulty of separating out induced from un-induced demand, supply changes from demand changes and SID from other factors influencing demand (e. . income, insurance coverage, health status). However, there is clear evidence that physicians who are paid on fee-for-service basis can adjust the number of services in response to limitations on the levels of fees (Rice, 1983), but such responses are not automatic and health economists don't have a good understanding of what contextual factors are i mportant in predicting such responses. Nevertheless, the potential for such responses means that inducement is an important factor to consider in policy development. To test for SID early studies looked at changes in utilisation compared to increases in physician/population ratio. The hypothesis underlying the tests is that, in response to an increase in the doctor/population ratio (i. e. competition), doctors will seek to induce demand or raise their fees so as to maintain their incomes. Cromwell and Mitchell (1986) demonstrated a significant demand inducement for surgical procedures with overall rates of surgery increase by about 0. 08% for each 1% increase in surgeon supply. Rice’s (1984) found that 10% decline in physician reimbursement led to a 6. 1% increase in intensity of medical services and a 2. 7% increase in intensity in surgical services. However, a similar study found mixed responses to fee changes across procedures (Labelle et al 1990). Another technique used for testing SID is to examine the effect of changes in doctor supply on doctor compared with patient initiated visits. Assumption here is that if SID exists, increases in doctor numbers would lead to an increase in doctor-initiated visits (that is, an income maintenance response test). Tussing and Wojtowycz (1986), using this technique, found that areas with more GPs were associated with much larger proportion of return visits arranged by doctor, i. e. a strong relationship to support SID. On the other hand, doing a similar experiment, Rossiter and Wilensky (1983) found only very small inducement effect. This approach to investigating the presence of SID effects (increasing physicians and increasing utilisation) fell somewhat out of favour when Dranove and Wehner (1994) found that, according to the standard methodology among SID theorists, an increase in the number of physicians resulted in an increase in childbirths. Recent studies have looked at physician behaviour in response to fee reduction, e. g. Yip (1998) found that physicians compensate for income losses due to public price reduction by increasing volume. Medicare fee cuts lead to increased amounts of heart surgery enabling physicians to recoup 70% of lost revenue. Gruber and Owings (1996) found that a 13% reduction in fertility rate in the US in 1970-1982 led to an increase in caesarean sections and reduction in the less profitable vaginal births. Between 1971-1981, the number of GPs per capita in Winnipeg, Canada increased by 56%. Remarkably, however, real gross income per physician remained virtually unchanged during the period. GPs simply increased the number of contacts with existing patients – so much so that their average revenue actually increased (Roch et al 1985). On the other hand, in Norway, Grytten and Sorensen (2001) compared a salaried group of physicians with another one that was compensated by fee for service. Neither of the two groups of physicians increased their output as a response to an increase in physician density. In UK, dentists are paid on a fixed fee-for-service basis. Supplier income can only be increased by increasing utilisation. Therefore, testing for the existence of SID in dentistry has involved looking for a positive correlation between dentist density and utilisation of dental care. Birch (1988) concluded that a positive correlation between the number of dentists per capita and the treatment content per visit provides sufficient (but not necessary) evidence for the existence of SID, in a fee-regulated market environment. Other researchers [Manning and Phelps (1979); Grytten et al (1990)]  found similar correlations. Sintonen and Maljanen (1995) found that individual and general inducement appeared to have considerable effect on utilisation, but no systematic connection with supply conditions (dentist/population ratio). This was interpreted to indicate that some dentists, regardless of the market situation, have adopted individual inducement. However, there are alternative explanations for a positive correlation between dentist density and the utilisation of medical services: permanent access demand on the market for medical services due to price regulation; demand decisions by rational patients (the opening of new practices, particularly in rural areas, reduces the average time and transport costs, and the average time spent in the waiting room also falls); reversed causality where physicians set up shop in high demand regions (Zweifel 1981 p216). Policy Implications of SID: SID is of great importance to the policy maker because it threatens the basic market paradigm and severely undermines economic recommendations about market policy. There are differing interpretations of policy significance of SID. According to Carlsen and Grytten (2000), policy makers can compute the socially optimal density of physicians without knowledge of SID. Yet most analysts look at SID from the perspective of manpower and reimbursement policy for purposes of cost containment. They do not consider its contribution to the health status of patients. The impact of SID on equity, distributional issues and the net social benefits is usually ignored (Labelle et al 1994). The issue of SID raises another major controversy of whether adequate control over resource allocation to and within healthcare is best achieved through the demand side or through regulatory controls on the supply side (Reinhardt 1989, p. 339). Indeed, due to problems with moral hazard and SID, insurers use demand-side incentives (e. g. co-insurance and deductibles), as well as supply-side incentives aimed at providers (e. g. aying physicians through salary or capitation). An example of policy implications of SID to manpower planning is when a government wishes to attract physicians to rural areas, and it does so by paying rural doctors more than those in urban areas. This could precipitate SID within urban practices, hence nullifying the government’s intention. Direct regulation of the supply of physicians—by mandating that all new graduates spend a c ertain number of years in rural communities, for example —might have some advantages, although this may well affect the number and quality of medical students. For facility planning purposes, Roemer’s Law has the fundamental implication that there is no external â€Å"demand† standard, based on observed utilisation, from which â€Å"needed† levels can be inferred. Providers will themselves determine use on the basis of available capacity inter alia. SID means increased demand by patients, which raises costs of care. If it exists, then the policy maker may wish to provide for control of supplier behaviour by mandating evidence-based medicine: cost-effectiveness evaluation of new interventions, medical audits etc, all of which encroach on clinical freedom. Use of provider payment mechanisms like salaries for doctors, global budgets, and case payments could help. However, Ferguson (2002) argues that overall, demand curve for medical care slopes downward, and that supplier-induced demand is overrated as a policy concern. Conclusion: This essay has explained the rationale for the existence of SID and has explored its policy implications and empirical evidence of its existence. There is arguably sufficient evidence to accept that SID can occur. Even Hippocrates himself realised that as in all things mercenary (in health care it is â€Å"fee-for-service†) there is no such thing as pure altruism. Indeed, the Hippocratic oath is an admission to the potential for pecuniary self-interest and abuse of sacred trust. Imperfect agency and clinical uncertainty are the main causes of SID. If SID is pervasive, there could be a variety of economy-wide impacts, e. g. it could increase health expenditure without a commensurate improvement in health outcomes. Therefore, it has important implications for the health policy process. Strong support for SID hypothesis was found in the UK dentistry. Otherwise, there is no robust evidence on the likely magnitude of SID. Although inconclusive, most studies suggest that where SID arises, it is small both in absolute terms and relative to other influences. However, it is still worth considering SID-attenuating arrangements say in the case of physician reimbursement policy. As there are a number of fundamental and seemingly irresolvable methodological and data problems associated with trying to assess SID, definitive evidence of its existence most likely will remain illusive. References: 1. Arrow, K. J. (1963). Uncertainty and the Welfare Economics of Medical Care. American Economic Review 53: 941-973. 2. Birch, S. (1988). The identification of supplier-inducement in a fixed price system of health care provision: The case of dentistry in the United Kingdom. Journal of Health Economics. 7:129–150. 3. Bunker, J. P. and Brown, B. W. (1974). The physician patient as an informed consumer of surgical services. New England Journal of Medicine 290: 1051-1055 4. Carlsen, F. and Grytten, J. (2000). Consumer satisfaction and supplier induced demand. Journal of Health Economics 19:731-753 5. Cromwell, J. and Mitchell J. (1986). Physician-Induced Demand for Surgery. Journal of Health Economics 5: 293-313. 6. Doessel, D. P. (1995). Commentary. In Harris, A. (ed), Economics and Health: 1994, Proceedings of the Sixteenth Australian Conference of Health Economists, School of Health Services Management, University of New South Wales, NSW. 7. Dranove, D. (1988). Demand inducement and the physician/patient relationship. Economic Inquiry 26:281-298 8. Dranove, D. and P. Wehner (1994): Physician-induced demand for childbirths Journal of Health Economics 13:61-73 9. Evans, R. G. (1974). Supplier induced demand; some empirical evidence & implications. In Perlman, M. (ed). The economics of health & medical care. London: Macmillan 10. Ferguson, B. S. (2002). Issues in the demand for medical care: can consumers and doctors be trusted to make the right choices? AIMS Health Care Reform Background Paper #5. Halifax: AIMS http://www. aims. ca/Publications/Demand/demand. pdf (accessed: 26th April 2004). 11. Folland, S. , Goodman, A. and Stano, M. (2001). The Economics of Health and Health Care. 3rd ed, Upper Saddle River, New Jersey. Prentice Hall 12. Fuchs, V. (1978). The supply of surgeons and the demand for operations. Journal of Human Resources, 13(supplement): 35–56. 13. Gaynor, M. (1994). Issues in the Industrial Organization of the Market for Physician Services. The Journal of Economics and Management Strategy 3(1): 211-255. 14. Goldberg, A. I. Cohen, G. and Rubin, A-H E. (1998). Physician Assessments of Patient Compliance with Medical Treatment. Social Science and Medicine 47(11): 1873-6) 15. Gruber, J. and Owings, M. (1996). Physician financial incentives and caesarean section delivery, RAND Journal of Economics 27(1): 99-123. 6. Grytten, J. and Sorensen, R. (2001). Type of contract and supplier-induced demand for primary physicians in Norway. Journal of Health Economics 20: 379-393. 17. Grytten, J. , Holst, D. and Laakf, P. (1990). Supplier Inducement: Its Effect on Dental Services in Norway; Journal of Health Economics 9: 483-491 18. Hay, J. and Leahy, M. (1982): Physician-induced demand: An empirical analysis of the consumer info rmation gap. Journal of Health Economics 1: 231-244. 19. Kenkel, D. (1990): Consumer health information and the demand for medical care. Review of Economics and Statistics 52: 587-595 20. Labelle, R. , Hurley, J. and Rice, T. (1990). Financial Incentives and Medical Practice: Evidence from Ontario on the Effect of Changes in Physician Fees on Medical Care Utilisation, Working Paper 90-4 Centre for Health Economics and Policy Analysis, MacMaster University, Hamilton, Ontario 21. Labelle, R. , Stoddart, G. and Rice, T. (1994), A Re-examination of the Meaning and Importance of Supplier-Induced Demand. Journal of Health Economics 13(3): 347-368. 22. Manning, W. G. , Jr. and Phelps, C. E. (1979). The demand for dental care. Bell Journal of Economics 10(2): 503–525. 23. McGuire, T. (2000 chapter 9). Physician agency. In Culyer, A. J. and Newhouse, J. P. (eds). Handbook of Health Economics, 1A, Elsevier: North Holland. 24. McGuire, T. G. , and Pauly, M. V. (1991). Physician Response to Fee Changes with Multiple Payers. Journal of Health Economics 10: 385-410. 25. Reinhardt, U. (1989). Economists in health care: saviours, or elephants in a porcelain shop? American Economic Review 79: 337-342. 26. Rice, T. (1983). The Impact of Changing Medicare Reimbursement Rates on Physician-induced Demand. Medical Care. 21(8): 803-815. 27. Rice, T. (1984). Physician-induced demand: New evidence from the Medicare program. Advances in Health Economics and Health Services Research 6:129-160 28. Richardson, J. and Peacock, S. (1999). Supplier-induced demand reconsidered. Working Paper 81, CHPE, Monash University. http://chpe. buseco. monash. edu. au/pubs/wp81. pdf (accessed: 27th April 2004). 29. Rizzo, J. A. and Blumenthal, D. A. (1996). Is the Target-Income Hypothesis an Economic Heresy? Medical Care Research and Review 53(3): 243–266. 30. Roch, D. Evans, R. G. and Pascoe, D. (1985). Manitoba and Medicare: 1971 to Present. Winnipeg, Manitoba: Manitoba Health. 31. Roemer, M. I. (1961). Bed supply and hospital utilisation: A national experiment, Hospitals. Journal of American Health Affairs 35:988–993 32. Rossiter, L. and Wilensky, G. , (1983). The Relative Importance of Physician-Induced Demand for Medical Care. Milbank Memorial Fund Quarterly 61(2): 252-277. 33. Sintonen, H . and Maljanen, T. (1995). Explaining the Utilisation of Dental Care: Experiences from the Finnish Dental Market. Health Economics 4(6): 453-466. 34. Tussing, A. D. and Wojtowycz, M. (1986). Physician-induced Demand by Irish General Practitioners’. Economic and Social Review 14(3): 225-247 35. Worldbank website: http://www1. worldbank. org/hnp/hsd/HEGlossary. asp (accessed: 27th April 2004). 36. Yip, W. (1998). Physician Responses to Medical Fee Reductions: Changes in the Volume and Intensity of Supply of Coronary, Artery Bypass Graft (CABG) Surgeries in the Medicare and Private Sectors, Journal of Health Economics 17(6): 675-699 37. Zweifel, P. (1981 p245-267). Supplier Induced Demand in a Model of Physician Behaviour. In van der Gaag, J. and Perlman, M. (eds), Health, Economics and Health Economics. Amsterdam: North-Holland ———————– P- fees for ServiceQ- supply of doctors S- supply curve of servicesD- demand curve for services P2 P1 Q1 Q2 D C A S1 S P3 P1 P2 Q1 Q2 Q3 Q4 D D2 D1 D3 S1 S B (a) No SID(b) With SID D

Application of Background Methodology Essay

In addition, childhood obesity can adversely affect social and economic development and lead to adult obesity causing more adverse health conditions. The costs of treating obesity in the United States are steadily increasing. Estimates show the direct and indirect costs associated with treating obesity was near $139 billion in 2003 (Li, & Hooker, 2010). The focus of this paper is to examine a peer-reviewed research article conducted by Ji Li, PhD. and Neal Hooker PhD published in the Journal of School Health, to show how the application of background and methodology of the research process can be applied to problems in health care. By examining the purpose of the study, the hypothesis, the variables employed, and the framework used to guide the study, a better understanding of the research process will be gained. Study Purpose Schools have been the subject of many research studies regarding childhood obesity. Surveys have examined issues such as race, ethnicity, and gender-specific differences relating to issues such as how television viewing affects weight gain and how physical activity effects academic achievement. The National School Lunch Program (NSLP) School Breakfast Program (SBP) and have been the subject of many studies (Li, & Hooker, 2010). The studies examined food choices; comparing the nutritional content of program meals to other competitive food choices available in the cafeteria. A different study observed the effect of NSLP eligibility and food insecurities on child welfare. The results of the study indicated no evidence of benefit associated with participation in the NSLP and child well-being (Li, & Hooker, 2010). Past research, associating childhood obesity and school-related programs and activities have been limited. The research did not differentiate between either public or private school types or were only composed of public school findings. Moreover, past research studies have employed only limited perspectives on the issue. The purpose of this article’s study is to delve further into the effects family, school, and community play on childhood obesity in hopes of understanding better the correlation (Li, & Hooker, 2010). By doing so administrators of health care will be better equipped to advise parents, educators, and policies makers of the importance of wellness and nutrition among school-aged children. Research Questions Many questions are posed in this study. The main question asked is, what is the correlation, if any, between school type, physical activity, participation in the NSLP, and other independent variables on body mass index (BMI) of children living in the United States? In addition, does the type of school, public or private, make a difference in the BMI of children? Last, does the physical activity level of the parents have an effect on a child’s BMI (Li, & Hooker, 2010)? Hypotheses This hypothesis of the study is not clearly stated within the article although the reading suggests there are several. The study suggests that children living in lower socioeconomic households and qualifying for the NSLP have greater chance of becoming obese. Children who attend public schools are more at risk of becoming overweight than those who attend private schools. In addition, children whose parents are physically active have less chance of becoming overweight. Last, parental education levels, smoking habits, and employment status can affect a child’s weight (Li, & Hooker, 2010). Study Variables To analyze how various factors effect childhood obesity, information was gathered about the children’s schools, families, communities, and daily activities from the National Survey of Children’s Health (NSCH). These sociodemographic independent variables include such information as the child’s age, gender, race, primary spoken language, physical activity level, television use, time spend playing computer games, extracurricular ctivities, and participation in the free or reduced lunch program (Li, & Hooker, 2010). Information about parental activities such as smoking practices, employment status, and education, economic, and activity levels were also included. The dependent variable body BMI was used as the measure of obesity. BMI can be defined as weight in kilograms divided by height in meters squared. This method of mea surement is widely used by health providers to determine physical development (Li, & Hooker, 2010). Conceptual Model or Theoretical Framework The conceptual model used to understand the results of the study and to determine its empirical and scientific effectiveness, studies the relationships between childhood obesity and factors that contribute to the problem. By considering the multidimensional perspectives surrounding the lives of children in the United States, the effects on BMI as a measure of obesity can prove probable correlations. This study first applied a nonlinear regression model to survey data to examine important relationships. Next, the study constructed three model specifications to investigate the effects of the NSLP (Li, & Hooker, 2010). Last, discoveries were analyzed regarding the factors influencing the child’s probability for becoming overweight (Li, & Hooker, 2010). The conceptual model of the study provides correlations between socioeconomic status (SES) and other factors and childhood obesity by providing supporting facts. Review of Related Literature A review of the literature cited supports the need for this study. Research by Ogden, Carroll, and Flegal (2008) proves the BMI of children and adolescents in the United States are increasing steadily. A related study by Bouchard (1997) shows the relationship between childhood and adult obesity. In addition, the reference to Dietz (2004) shows that obesity can cause serious illness in children such as type 2 diabetes and heart disease. The high cost associated with treating obesity in the United States proves the need for further study into the problems associated to childhood obesity (Finkelstein, Ruhm, & Kosa, 2005). Study Design The study design employed was quantitative, consisting of data gathered by the Centers for Disease Control and Prevention’s (CDC) 2003 and 2004 NSCH. The State and Local Area Integrated Telephone Survey Program was used to survey and investigate the physical and psychological health status of children age birth to 17 (Li, & Hooker, 2010). The households were randomly selected with the screening question of the presence of children under age 18 in the household was used. Observations of 62,880 children from different households living in the United States were studied through the value of BMI (Li, & Hooker, 2010). Conclusion The article from the Journal of School Health contains research collected from the NSCH conducted by the CDC to investigate the associations between children attending public and private schools, student eligibility for the free or reduced-cost meal programs, and family SES on children’s BMI (Li, & Hooker, 2010). Issues such as parent education and activity level in addition to child television and video game use are noted as possible associative factors that may lead to childhood obesity. The research further illustrates the implications for school health policy and its need for wellness curricula to promote healthy eating and physical exercise (Li, & Hooker, 2010). By examining the background and methodology used in the creation of this study, one can see how the data was used to help formulate and prove the hypotheses giving a greater understanding of the research process.

Aztec Calendar Stone Essay Example for Free

Aztec Calendar Stone Essay Obtaining the knowledge that was passed down to them from earlier Mesoamerican cultures, the Aztecs carved the calendar stone in 1479 (Smith 253). At the time, the Aztecs lived in a very civilized world filled with amazing architecture, an impressively complex government system, and they also employed intricate systems of writing and calendric systems (Taube 7). The Calendar Stone was made by basalt stone. For the Aztecs, everything was pictorial in nature around this era. The calendar stone depicted different pictograms or Codex Magliabechianoand, which was primarily written on religious documents (Aztec-History). Art was centered around religion in this era. So the pictograms of the gods on the calendar stone would correlate with that subject matter. The Aztecs were a highly ritualistic civilization devoted to divination and their Gods. The Aztec calendar stone was created as a divinatory tool which was used for rituals, to forecast the future, and to determine which days were lucky and which days not for the outcome of various actions and events (Smith 254). The calendar had two systems. It had the sacred Tonalpohualli, which was based on the 260-day cycle and the Iuhpohualli, which was a 365-day cycle (Palfrey). Seen by the count, there is a five day difference between these two calendars. The five day differences were thought to be the most unholy, unlucky days of the year (Smith 257). The world was thought to be coming to an end. On the Aztec Calendar, the year was divided into 13-day periods. Each group of 13 days had a different deity ruling over the unit. This is because these units were thought to have a special symbolic influence and the deities were to ensure a positive outcome (Smith 256). In the middle of the Sun Stone, is the sun god Tonatuih. His tongue protruding between his teeth resembles a sacrificial flint knife. In his claw like hands he clutches human hearts (Palfrey). ‘Many scholars have debated on the stone’s meaning and purpose. Some suggest that, fixed horizontally; it served as a sacrificial altar, which would make sense because the stone was dedicated to the sun deity. Most agree though, that it offers a graphic representation of the Mexica cosmos’ (Palfrey). In The Aztecs, Smith sums up what is to be believed the thought of the Aztecs when they carved the calendar stone â€Å"The Aztec calendar stone conveyed the message that the Aztec empire covered the whole earth (territory in all four directions), and that it was founded upon the sacred principles of time, directionality, divine warfare, and the sanction of the gods† (Smith 270). Keeping the Aztec calendar is proof of ancient cultures mathematical and scientific achievements without the aid of modern technology. The study of the sun stone could lead to further advances in mathematics and acts as a road map to our celestial bodies from that era of our history. The Aztecs believe they felt justified in believing in this calendar because of numerous events that changed the course of history for them. Because Aztec Indians were fervent astronomers, they tracked the stars and correlated that between the days to create this sun calendar. Examples of events happening within the timeline of the calendar stone being built are these: Between 1452 and 1454, their capital city Tenochtitlan suffered from flood and famine, the following year on 4/16/1445 (Julian calendar) there was an eclipse of the sun. From 1473-1479, there were 4 more solar eclipses within a five year time frame (Aveni, Calnek). During this time the Aztec nation conquered and sacrificed many of the neighboring towns. Their leaders were wounded or killed, followed by violent earthquakes (Aveni, Calnek). There may have been even more visible eclipses seen by the Aztecs that have not been discovered because they were lost, or destroyed, or even confused with other natural events (Aveni, Calnek). If one were to take into consideration the Aztecs being a society with strong beliefs in deities, the Aztecs constant state of turmoil from wars and death and then couple that with a constant flow of solar eclipses; it wouldn’t take much to consider that the Aztecs might have thought there Gods were planning on ending their world†¦. again. The Aztecs might have carved this massive calendar from stone to give their future generations a chance to do things right, where they did not. Many other artifacts of the same caliber and craftsmanship were excavated around the time the calendar stone was. This was an amazing find, because in the early colonial period of the sixteenth century, pre-Hispanic stone sculptures were considered potent satanic threats to successful conversion (Taube 25). With the Spaniards thinking this, this lead to the destruction of many great pieces of art, manuscripts, and other forms of architecture. Thankfully, with the Aztecs foreseeing this frame of mind being a possibility and other circumstances occurring, many artifacts survived by being hidden in caves, on mountain tops, and even buried under Mexico City (Taube 25). After the artifacts were excavated, rather than being destroyed, they were treated as objects of curiosity and to be studied (Taube 25-26). I account for any differences between reception then and today by knowing people today have so many different religions and beliefs. Whereas the Aztecs were ignorant of the different beliefs we have today. They just had knowledge of what was taught to them by their elders as we do ours. There were not that many differences and very many similarities between American Indians of this era. In the way they did things to their architecture and sculptures. As a matter of fact, the Aztecs calendar was based of the earlier Mayan cultures. The Aztec calendar stone and Mayan calendar share many similarities. Both calendars have ritual days. The Aztec ritual day that was formed is the Tonalpohualli and the Maya ritual day is the Tzolkin. The day names on both calendars are also very similar. Both calendars used 18 months with 20 day counts along with other counts. The Aztec and Maya calendar stone is believed to have both mythological and astronomical significance. Both Native American cultures regarded their calendars as religious. Using the calendars, the Aztec and Maya priests dictated when to grow crops, when the dry and rainy seasons were, when to go to war, etc. (World Mysteries). The main way the Aztec calendar differed was in their more primitive number system and less precise way of recording dates. The year also started with different months. The Maya calendar tracked the movements of the planets and the moon. From this came their reckoning of time, and a calendar that accurately measures the solar year to within minutes. The Aztecs also kept the two different aspects of time, the Tonalpohualli, which was counting the days and the Xiuhpohualli which was counting the years (World Mysteries). The Aztecs believed they were living in the fifth and final stage of life. Because the Maya used a 360 day long cycle, they could tell that there were time periods way longer than the age of our universe (World Mysteries). It helped me figure out what some of the major celestial events where during the time the Aztec Sun Calendar was created. Palfrey, Dale. Mysteries of the Fifth Sun: The Aztec Calendar. n. p. Web. 8 January 1999. http://www. mexconnect. com/articles/199-mysteries-of-the-fifth-sun-the-aztec-calendar This is a website with basic information about the Aztec Sun Calendar. It gave me more insight into what the calendar looked like. Aztec-History. N. p. , nd. Web. 1996-2012 http://www. aztec-history. com This website has an enormous amount of information about Aztec Indians, from clothing to their demise and pretty much everything in between. The website gave me most of the information about the calendar stone I have so far. Smith, Michael. The Aztecs. Blackwell Publishers Inc. , 1996. Print. The book is Aztec Indians and their culture. This book helped me to understand the calendar stone more and why it was just a big part of Aztec life. Taube, Karl. Aztec and Maya Myths. British Museum Press, 1993. Print. This book detailed facts and myths about Aztec and Mayan Indians. This book helped me find what the Aztecs art and idols were see as in the early colonial period. Aztec Calendar Stone. (2018, Oct 26).

Case Study Essay Example | Topics and Well Written Essays - 1000 words - 8

Case Study - Essay Example In this session we would be reviewing the leadership skills displayed by Navy commander D. Michael Abrashoff, in order to define and learn different theories of leadership. This review would be well backed by the statement of impact of these theories on the work force relating them to the leadership model of Navy commander D. Michael Abrashoff who captioned the three hundred highly skilled sailors of USS Benfold. This case study was selected, as the leadership skills which are being reviewed would fit into the improvisation methodology of any management scenario. The trait theory suggests that there are some identifiable qualities or characteristics that should be possessed by the leaders and the degree of efficacy of a leader would be directly proportional to the extent of these qualities or characteristics held by them. Some of the qualities which fall under the trait theory are as following A leader should be able to understand the context and content of his designation and assigned responsibilities. The dynamics of internal and external environmental variables which would affect the activities of the enterprise should be grasped well by the leader. It also implies to the technical competence and sound general education of the leader. The leadership quality of intelligence was reflected a number of times in the leadership model set by D. Michael Abrashoff while captioning the three hundred highly skilled sailors of USS Benfold, the U.S. Navys warship. His technical competence was proved as he had an excellent service record, combat experience, and had held prestigious posts in Washington, DC. Moreover his technical expertise had provided Benfold the reputation of being the best ship in the Pacific fleet. He could analyze the smartness and talent of his crew within no time and he viewed the internal and external environmental variables through the eyes of the crew. It was his ability to grasp the work situation realities,

How does Raising Arizona (movie) use symbolism to help explore its Essay

How does Raising Arizona (movie) use symbolism to help explore its theme - Essay Example The film derives much of its language from the disparity between the level of speech expected from the characters and the level of language that is actually spoken. This disparity is there not just for comic effect, but also to contribute fully to the movie’s theme about American self-improvement through upward mobility. H.I. and Ed’s pursuit of a child is symptom of the pursuit of the larger aspect of the American Dream and another aspect is the desire to rise from one strata to the next. The film satirizes the effect of lofty language utilized by those living within a higher class by revealing the truth that that the more sophisticated speech becomes, the more likely it is to become confusing. H.I.’s entire narration is populated by haughtily descriptive phrasing to describe simple concepts: â€Å"Edwinas insides were a rocky place where my seed could find no purchase.† One doubts that the average petty criminal with little education would describe the i nability of a woman to get pregnant in such a way, but it works both for comedic effect and to further the theme of language can barring communication. In addition to H.I.’s narration, the dialogue also works to reveal how terminology works as a symbolic obstruction to simple communication. One of the most hilarious yet satirically incisive scenes in the film reveals the manner in which professional jargon almost seems to be intentionally utilized to create a firewall of misunderstanding. When H.I. appears before parole board language becomes a direct symbol of the way in which law is exploited to support social distinction between the haves and have-nots. The entire conversation about recidivism leads to the actually quite profound joke about the misunderstanding about H.I. â€Å"not just telling us what we want to hear.† The language game taking place in this scene is painfully

The Prevalence of Diabetes Mellitus in the Middle East Essay

The Prevalence of Diabetes Mellitus in the Middle East - Essay Example Non-insulin-dependent diabetes mellitus (NIDDM) increases considerably the risk for all manifestations of atherosclerotic vascular disease, coronary heart disease, cerebrovascular disease, and peripheral vascular disease(Payorala, 1987) The underlying mechanisms for accelerated atherogenesis in NIDDM are poorly understood. Although NIDDM is associated with a clustering of risk factors favoring atherogenesis (high total triglyceride and low high-density lipoprotein cholesterol levels and a high prevalence of hypertension and obesity), population-based, prospective studies have repeatedly shown that only a small proportion of the excess risk for coronary heart disease in NIDDM can be explained by the effects of NIDDM on the levels of cardiovascular risk factors(Payorala, 1987) Therefore, the excessive occurrence of coronary heart disease and other cardiovascular complications in NIDDM must be mainly caused by diabetes itself or factors related to it. Type 2 diabetes is the most prevale nt form of diabetes and is due to the combination of insulin resistance and defective secretion of insulin by pancreatic b-cells. (Grundy, Benjamin, Burke, Chait, Eckel , Howard, Mitch, Smith , & Sowers.,1999)Diabetes mellitus is a major risk factor for morbidity and mortality due to coronary heart disease (CHD), cerebrovascular disease, and peripheral vascular disease. Metabolic control and duration of type 2 diabetes are important predictors of coronary heart disease (ischaemic heart disease. (Kuusisto J, Mykkanen L, Pyorala K, & Laakso M.,1994) Introduction/Background to the issue: During the past 20 years, major socio-demographic changes have occurred in the Eastern Mediterranean Region (Alwan A, King H , 1992) The total population of the Region has almost doubled. The birth rate has remained high but infant and childhood mortality rates and the crude death rate have decreased. Life expectancy has improved dramatically, urbanization has occurred and per capita income has increased. The

Emergency Nursing Essay Example | Topics and Well Written Essays - 1250 words

Emergency Nursing - Essay Example experience in critical care. Some nurses have a Baccalaureate degree, others have diplomas and associate degrees as their base education. Some hold Masters degrees as well. PALS- Pediatric Advanced Life Support and ACLS- Advanced Care Life Support are other certifications that can be obtained in specialized areas (NHT, 2008) A minimum of one year work experience is preferred and critical care skills.The nurse must be an independent thinker, be comfortable with and capable of using nursing skills and procedures and be able to make a decision in a timely manner. Assertive and non- emotional nurses are preferred, with excellent communication and critical thinking skills. An excellent understanding of Anatomy, Physiology and Pathophysiology is also required (NENA, 2003) Emergency nursing requires expertise in several core competencies. The emergency nurse must be able to interpret data, perform objective assessments, interpret diagnostic results and select nursing interventions to manage the following areas of competencies. 1. Triage 2. Respiratory 3. Cardiovascular 4. Neurological 5. Maxillofacial/ eye/ear/nose/throat 6. Gastrointestinal 7. Genitourinary 8. Obstetrical client 9. Musculoskeletal/ Integumentary 10. Multi-system traumas Emergency Nurse Role 4 11. Environmental Emergencies 12. Immunological/Hematological/Endocrine systems 13. Knowledgeable in Domestic Violence/Sexual Assault 14. Toxicology 15. Mental Health 16. Infectious Disease 17. Psychosocial 18. Discharge Planning/ Client Education 19. Professional Practice Issues/ Legal & Ethical Issues Triage refers to the practice of grouping patients from the most critically ill/injured to the least. This is to ensure that... Patient Care-Emergency nurses care for patients and families in hospital emergency departments, ambulances, helicopters, urgent care centers, cruise ships, sports arenas, industry, government, prisons, military, poison control centers

Education Essay Example | Topics and Well Written Essays - 1000 words - 16

Education - Essay Example Much has been discussed about the interest of students and their learning experience in the school level. Many experiments have been done on the same and several critics have given the drawbacks and necessary steps that need to overcome them to have a better learning experience. On keeping this as a starting note, it is high time that equal importance is given to students and their learning experience at a higher education level. The primary factor that determines the scale of learning experience of every student is their boredom factor. So, in order to identify the extent to which the students and teachers are responsible for the learning experience in higher education, an analysis have to be made with boredom as a critical factor.( Mann & Robinson 2009) To give a brief explanation of what boredom is, it can be attributed to person’s state of mind when he has nothing to do that he likes. On an analysis on what causes boredom among students which in turn leads them to have a bad learning experience, it was found out that the teaching techniques of the lectures and the methods they follow to be the primary reason. Some of the teaching methods followed by teachers evoke a passive environment of learning. Also, a one way relationship between teachers and students could also lead to a dip in their learning curve. On the other side, a student’s individual interest also plays a part on the grade one earns in learning. (Gjesne 1977) If the student is not open towards learning new things, irrespective of whatever the teacher presents. Then, the student is at the receiving end for all the blames of having a lean learning experience. Hence a cognitive analysis is required on both sides to determine the extent of impact on learnin g experience. ( Mann & Robinson 2009) The main teaching method that is followed in most of the universities is converting text to computer PowerPoint presentations and presenting them. Although studies have

Andrew Ryan at VC Brakes Assignment Example | Topics and Well Written Essays - 750 words

Andrew Ryan at VC Brakes - Assignment Example The dictatorial tendencies, poor rapport in the various levels of management and mistrust from the workforce constitute the confounding issues the faces the implementations of the total management program. The paper utilizes the strengths, weaknesses, opportunities and threats as a management tool in order to analyze the case study effectively VC Brakes faced numerous issues emanating from its autocratic culture that dominated the firm’s operations (Cespedes and Yong, 2013, Pg. 2). In addition, VC Brakes had a reputation of poor top- down managerial skills and lack of trust from the production to the professional workforce who felt that the firm was unresponsive to their queries. The introduction of total quality management program by Crossroads Corporation was intended to improve the product quality, management practices and more so, to develop a consistent operational strategy that would be utilized across all sectors in the various subsidiaries found under VC Brakes.Questio n 1The major situation that faced Ryan involved the implementation of total quality management program that would raise the ailing quality productivity at VC Brakes. The autocratic culture evident in VC Brakes is depicted in various situations in the case study of instance, the emphatic condensation of the training sessions. (Cespedes and Yong, 2013, Pg. 6).   The notion would have amassed numerous achievements if it had gone through the initially specified time since it could have provided ample time.

Wireless Electricity Assignment Example | Topics and Well Written Essays - 500 words

Wireless Electricity - Assignment Example International Journal Of Computational Engineering Research (ijceronline.com), Volume 2 Issue 7, pp. 48-51. This is a research paper which was published in the international journal. This paper presents a detailed analysis of wireless transmission and various associated concepts. This paper is a good source for developing the base for the research. This paper also discusses some of issues with wireless transmission. In the start, authors differentiate between wireless and wired medium of energy transmission. This is a detailed project report presented by four students. This report presents a detailed analysis of wireless energy transmission. In this report, authors discuss different applications of wireless energy transmission. In this scenario, they analyze these applications on the basis on certain parameters such as user-friendliness, sustainability, economical and technological feasibility and health and safety. This paper discusses a wide variety of methods and technologies exist up to now for wireless transmission of electricity and the need for a Wireless System of Energy Transmission. They also discuss their advantages, disadvantages and economical consideration. This paper also discusses the history of wireless transmission. Mohammed, S. S., Ramasamy, K., & Shanmuganantham, T. (2010). Wireless Power Transmission – A Next Generation Power Transmission System. International Journal of Computer Applications, Volume 1 Issue 13, pp. 100-103. This paper discusses a detailed analysis of technologies available for wireless energy transmission. The paper is based on finding a solution to deal with energy losses that occur in case of wireless transmission due to the wireless nature of this energy transmission. This is a thesis that is presented by a graduate student for the completion of his graduation in electrical engineering. This thesis is a complete guide for wireless

Two Career Versus Single Career Families Essay Example for Free

Two Career Versus Single Career Families Essay Families with two working parents are more common today than in years past.   The percentage of stay at home parents has been dwindling since WWII when women started entering the job force at a rapid rate.   While there are plenty of working families, many families still have a stay at home parent, especially with very young children in the home.   The differences between two career and single career families can be noticed in their economical situation, in their involvement with their children, and in their recreational activities.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The financial situations of families with two working parents and families with one working parent vary.   Two career households typically bring in more revenue.   They also spend less on utilities on average because there are less household members in the family during the day.   Two career families often have daycare expenses, however, but these dwindle as children age and attend school. Depending on the career of the breadwinner, single career families typically make less money on average than families with two working parents.   Utilities and food costs could run a bit higher because more people are in the home more often than families where both parents work.   A bonus to having a stay at home parent is that there are relatively little or no costs associated with day care expenses. Overall, a family with two working parents will have a better financial situation than a single career family.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Another difference between a two career family and a one career family is the amount of and degree of involvement with the children.   Two career families often have a difficult time finding opportunities to volunteer in schools or take their children special places during the week due to their work schedules.   They are restricted by their employers on the amount of time that they can take off of work as well, so they may have to rely on babysitters or family members to do things such as take the children to scheduled appointments such as the doctor or dentist. Single career families, on the other hand, rarely have these issues.   A stay at home parent has more time and opportunity to do things like volunteer in the community or join groups where they have interaction with other parents and children.   If school age children are in the home, a stay at home parent can volunteer in the school, get the children from school if necessary and even do nice things like take them out to lunch once in awhile.   A stay at home parent also does not need to find alternate care for doctor and dentist appointments.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Another noticeable difference between two career families and single career families is the type of recreation that they engage in.   Often, when both parents work during the day, they fill their evenings catching up on their children’s activities and lives in between cooking dinner and catching up on household chores.   They often restrict their children’s’ extracurricular activities because there simply is not enough time to do everything.   Two career families can save up for family vacations when both parents can take time off. Single career families seem to have more children involved in more activities.   These families don’t restrict activities as much because there is someone at home during the day taking care of the chores; there is no catch up in the evening, so it is easier for everyone to do more things.   Single career families often do not take vacation because they cannot afford it and their schedules are full already with all of the extracurricular activities that the children are involved in.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   There are advantages to both two career and single career families.   Two career families generally have more revenue and can save up for vacation time, but miss out on other valuable time with their children.   Single career homes have someone at home taking care of all of the necessary chores, so the family can enjoy more activities, but on average, they have less revenue to do things like take long vacations.   Either way, a family is a family, and the most important thing they can share is love.

Mesopotamia and Egypt Essay Example for Free

Mesopotamia and Egypt Essay The early civilizations of Mesopotamia and Egypt were very similar, but they were also different in some ways. Both Mesopotamia and Egypt developed their civilizations centered on rivers, but these rivers were polar opposites. Mesopotamia was between two rivers called the Tigris and Euphrates rivers. Egypt’s civilization developed around the Nile River. The Tigris and Euphrates rivers differed from the Nile River. The Nile River was calm, and the Tigris and Euphrates Rivers were wild and very unpredictable. Since these rivers had opposite behaviors, Mesopotamia’s specialty was in irrigation, while Egypt was a more agricultural society. Mesopotamia and Egypt were very similar in their roots, but they also had distinctive forms of social organization and religious observance that developed because of the rivers that surrounded them. Mesopotamia’s social organization was a way to differentiate between rulers and those who were commoners. Each city-state in Mesopotamia had elders and young men that made decisions for the community. Rulers protected their access to both political and economic resources by creating systems of bureaucracies, priesthoods, and laws. Priests and bureaucrats served their leaders well, defending and advocating rules and norms that validated the political leadership. Lists of professions were passed around so each person could know his or her place in the social order. The king and priest were at the top of the social structure followed by bureaucrats who were scribes, supervisors, and craft workers. The craft workers were jewelers, gardeners, potters, metal smiths, and traders; this was the largest group of the social structure. The craft workers were not slaves but they depended on their employer’s households. People rarely moved from one social level to another. Not only was there organization between society in general, but there was also specific organization between families. In families, the senior male became the patriarch. A family was made up of a husband and a wife who was bound by a contract that stated that the wife would provide children, preferably male, and the husband would provide support an d protection. If there was no male child, a second wife or slave could bear children to serve as the couple’s offspring. In families, sons would inherit the family’s property and the daughters would receive dowries. Priests were at the top of the social organization with the king because they lived in temples, which represented  the cities’ power. Bureaucrats were at the top of the social structure underneath the main people of power because they were scribes. Mesopotamia was the world’s first city to keep records and read, developing a writing system. Writing became important to the development of cities and enabled people to share information across greater distances and over longer periods of time. Scribes played a significant role in developing a writing system that people anywhere and in the future could decipherer. The Tigris and Euphrates Rivers served as major communication and transportation routes for Mesopotamia. The need for a system of record keeping developed because farmers and officials needed a way to keep track of the distribution of goods and services. It was important to keep track of goods and services because long-distance trade was very important to Mesopot amia since it lacked many raw materials that were crucial to developing the city. On the other hand, in Egypt, the social organization was similar to Mesopotamia, but differed just slightly. At the top was a Pharaoh or also called a king was the center of Egyptian life followed by priests, scribes, craftsmen, and lastly farmers and slaves. The Pharaoh was at the center of life and had the responsibility to ensure that flooding of the Nile River continued without interruption and had the responsibility to develop a vibrant economy. Egyptians believed that the Pharaoh was a descendant from the gods. Egypt had one advantage that Mesopotamia did not have, the Nile River. The Nile River was navigable and provided annual floods. These annual floods allowed for regular moisture. Even though the Nile River did not fertilize the fields as wells as the Tigris and Euphrates Rivers in Mesopotamia, the yearly floods meant that the topsoil was renewed every year, making the soil easy to plant in. Egypt also had the sun that allowed a bountiful agriculture. Egypt, similarly to Mesopotamia, was a scribe nation. Since little people were literate in both Mesopotamia and Egypt, a scribesâ €™ social status was increased automatically. However, even though both Mesopotamia and Egypt were scribal cultures, Egypt appeared to be more literate. This could be because Egypt developed later than Mesopotamia, and they may have used it more since Egypt had the Nile River. The Nile provided for good harvest allowing Egypt’s economy to flourish. Since Egypt had good harvest, they may have needed to keep better track of goods and services because they had more goods to keep track of since they had better harvest than  Mesopotamia. Social structure in Egypt and Mesopotamia was not the only thing that was affected by the rivers. Another aspect of early civilization that was affected by the Tigris and Euphrates rivers in Mesopotamia was religion. Mesopotamians had beliefs in gods that molded their political organizations and controlled everything. They believed the gods controlled weather, fertility, harvests, and the underworld. They had to respect their gods, but they also feared them because they were powerful. A major way for Mesopotamians to worship their gods was through the temples. Temples were gods’ homes and were the cities’ identity. To demonstrate cities’ power, rulers would elaborately decorate temples. The priests and other officials lived in the temples and worked to serve gods, the most pow erful immortal beings to the Mesopotamians. Temples ran productive and commercial activities and those that were close to the river would hire workers to hunt, fish, and collect. The temples were a way for people to worship their gods and show their faithfulness to them. Therefore, since the Mesopotamians believed that the gods controlled everything including weather and harvest, two important aspects in Mesopotamia civilization, it was important that they stay faithful to their gods since they did not have the best rivers. The Tigris and Euphrates Rivers would flood if there was heavy rainfall during the height of the agricultural season. Thus, if they worshiped their gods frequently, the Mesopotamians may believe that the gods will bestow good weather eliminating floods more often, creating a better year of harvest. Like Mesopotamia, each region in Egypt had its own god. In addition, Egypt also had temples to worship their gods. In Egypt, gods were inactive and the kings, or pharaohs, were active. The pharaoh had responsibility to uphold cults while the priests were to uphold regular rituals. The pharaoh acted as a mediator between the gods and the people o f the city. He supported the gods through rituals held in temples, which the Egyptians contributed many resources to. Since trade from the Nile River allowed the city of Egypt to prosper economically, they had more resources to build more elaborate temples and later on pyramids. Pyramids were unique to Egyptian culture. The pyramids became a place for state rituals and were very important to Egyptian culture. Since Egypt prospered because of its location next to the Nile, they had an abundance of resources that was necessary to build the intricate temples. Both Mesopotamia and Egypt were  riverine cultures. Each city had its own unique social organization and religious beliefs, but they had similar roots. Both civilizations were scribal cultures, but since Egypt had the Nile River, the two civilizations differed. Since both civilizations were scribal, scribes attained great social status under the king and priests. Egypt prospered greatly from the resources that the predictable Nile River offered. Mesopotamia had the Tigris and Euphrates rivers that were unpredictable, but still provided for irrigation and allowed the city to advance in irrigation technology and opened the city up to the surrounding cities. Mesopotamia and Egypt both had polytheism and worshiped their gods in temples. Instead of referring to the king like in Mesopotamia, Egypt refers to the pharaoh. Egypt believed that the pharaoh communicated with the gods. The rivers in both Mesopotamia and Egypt opened these areas up to the rest of the world and allowed for great economic growth.

Caring For Children

Caring For Children Firstly, the part of the practitioner in caring for children contains the practitioner meeting the single necessities of children. Examples are, that providing food and drinks to the children which meets their dietary necessities. Furthermore, care plans are formed by the early years practitioner to help to see the childs necessities which are unsimilar from all other toddlers. Refer to appendix one which is a care plan of a child, within a child care setting formed by an early years practitioner. As when referring to the Early Years Foundation Stage, under Food and drink Before a child is admitted to the setting the provider must also obtain information about any special dietary requirements, preferences and food allergies that the child has, and any special health requirements. (Statutory Framework for the Early Years Foundation Stage) (pg.22). In addition, these care plans will help the practitioner to confirm that the childs individual necessities are seen through this care plan. Refer to Appendix 1 which is an example of a care plan which a setting in Wales uses which is produced for the ages of 0-2. These care plans aids the practitioners to give out a day-to-day arrangement for childrens and their respective families. Examples from my placement are that, child I is not allowed normal milk as they have an allergy to it. In turn, for the childs dietary and nutriential necessities, soya milk is replaced and used within the setting, when the rest of the children have normal milk according to their individual necessities or parents necessities which have been set out. Furthermore, the practitioners within my placement e.g. childcare practitioners have met the childs individual necessities of not being given the normal milk to child I, and giving the child soya milk which is permitted. Lastly, the Childrens Act 2004 legislation aids promote the necessities of children to be established at all times to help a childs well being. This is as, under the Childrens Act 2004, a childs well-being has to be seen and the food necessities which is a part of their care necessities has to be obeyed too. In turn, this includes a childs food necessities such as dietary necessities being seen within any child care setting. In conclusion, this legislation aids to develop childrens necessities and any special necessities, as childrens individual dietary necessities to be accurately met. Secondly, ensuring the rights of the children are being established which its a statutory responsibility for the practitioner to follow whilst working with early aged children. This right is the Childrens Act 2004 which is the highly regarded legislation which has been set out within the UK that supports the single rights of early aged children. This act provides the national Framework for all childrens services and is identified in the Every Child Matters five outcomes for early aged people and children which all Professionals regarding to any child care job would need to follow. Refer to Appendix 2, which is the copy of information about the Childrens Act 2004. Examples are, such as the childcare practitioners at my placement, school teacher, after school club teachers, early years practitioner. The Government aim for every child regardless of their upbringing or situation, in which they have been brought up to, is to have the support they require. Also, a significant policy change in relation to the Green paper is the introduction of the five outcomes that are considered key to childrens on-going progression and well-being. Furthermore, Refer to Appendix two which is a document of the Every Child Matters act which the practitioner practices during their development practice. Inturn, from the every Child Matters act under Being healthy Evidence will include ways in which providers promote the following: physical, mental, emotional and sexual health; participation in sport and exercise; healthy eating and the drinking of water;. (Every Child Matters (2012) In conclusion, practitioners would be compulsory to offer food which is strong for the children and at the same time meets their single special dietary necessities. Examples from my placement is that, children are provided with healthy meals daily which are different from each day. As one day the cook would prepare tuna pasta, and at another day the cook would prepare rice with curry. In conclusion, the staff e.g. childcare practitioners at my placement are ensuring that children are getting all the fuels from the nutrients from the healthy balanced diet sheet chart to benefit majorly with their improvement of development. Thirdly, working with their families and obeying their wishes. Examples are that a parent for any reason would not want their child to eat biscuits within the setting. Furthermore, the early years practitioner would be essential to ensure that parents necessities which have been set out to the child care provision type of setting are obeyed too and the child does not be given any biscuits. As when referring to the Early Years Foundation stage, under Food and drink Providers must record and act on information from parents and carers about a childs dietary needs. (Statutory Framework for the Early Years Foundation Stage) (pg.22). In conclusion, listening to parents requirements and responding on them is vital as the statutory piece of framework states that. Refer to appendix 3 which has nutrition information for early years practitioners to obey and know. Examples from my placement is that, child S is not allowed chocolates or biscuits according to their parents requirements for any of their snack or as a part of their dinner meal. In addition, my placement listens to child S parents and ensured child S does not be provided with that food. In addition, when the rest of the children have a chocolate treat or a biscuit, child S is given another food to swap the chocolate treat, such as crackers. This ensures that the parents necessities are being obeyed, and the snack replacement is a healthy type of food which child S likes which is highly important and is according to child Ss parents necessities which has been set out, which allows child S to have. Fourthly, working in a team and with other professionals is vital for the early year practitioner to do when caring for children. This is as, each child has unsimilar individual necessities and own unique weaknesses and strengths. Furthermore, it is the duty of the early year practitioner to ensure that they work with other professionals to help overcome the difficulties which could alter their learning or improvement of development and boost it in whenever possible. As when referring to the Early Years Foundation Stage under Progress check at age two If there are significant emerging concerns, or an identified special educational need or disability, practitioners should develop a targeted plan to support the childs future learning and development involving other professionals (for example, the providers Special Educational Needs Co-ordination) as appropriate. (Statutory Framework for the Early Years Foundation Stage, (pg.10). In addition, refer to Appendix 4 which is a copy of the D isability Act 2001 Acts Information which early years practitioners could be compulsory to follow and accurately use when it is vital, whilst working with children. Examples from my placement is that, child K has special needs in which they have difficulty speaking. Furthermore, my placement referred him to a speech therapist that visits them daily and my placement and helps to enhance child Js speaking skills. This involves the whole family and the setting, in which the setting has to build up on it from the tips being given by the speech therapist. In conclusion, by working with other professionals early years practitioners can get effective help to help stop any obstacles on the childs learning and improvement of development. Fifthly, compliance with legal requirements which a must for early years practitioners to follow whilst caring for children. The EYFS is a statutory framework meaning its a legislation that provides the standards for the care, learning and development of children from the small birth of a child to the growing age of toddlers of five years old. Furthermore, as its a statutory framework all providers/practitioners must use the EYFS to make sure that which ever type of setting a Parent decides to choose for their child, they can be assured that their child will receive a satisfactory experience that will help and support them in their learning, development and care. In conclusion, practitioners and registered providers in childcare in the UK who are caring for children under the age of five years old are required to use the EYFS, which are then dealt in two processes. In turn, they are registered and then are inspected to see if they match the standards of requirements of the EYFS by th e Ofsted. EYFS framework provides the standards for the care, development and learning of children which are from small birth of a child to the last stage of foundation stage of a childs learning. The purpose of the EYFS is to help each child to achieve the five Every Child Matters outcomes which are the follows; Early Years Foundation Stage ( birth to five years old ) Early Years Foundation Stage ( birth to five years old ) Early Years Foundation Stage ( birth to five years old ) Early Years Foundation Stage ( birth to five years old ) Early Years Foundation Stage ( birth to five years old ) EYFS has 4 themes which are the follows; A unique child = Early Years Foundation Stage ( birth to five years old) Positive relationships = Early Years Foundation Stage ( birth to five years old) Enabling environments = Early Years Foundation Stage ( birth to five years old) Learning and development = Early Years Foundation Stage ( birth to five years old) The EYFS applies to: Every Child Matters is also another legislation which supports the rights of children to a healthy way of life. Its a programme which is a statutory framework which is essential to be obeyed. EYFS applies to Early Years Foundation Stage (birth to five years old) Early Years Foundation Stage ( birth to five years old) Refer to Appendix five, which is a job description of an Early Years practitioner which has all the abilities and approvals stated an early years practitioner would need within themselves such as their abilities, and approvals which they have took before to work with early aged children. Examples from my placement is that, the setting at the staff room has a poster of the Early Years foundation stage with each of the five outcomes on it. This shows how important this document is for any child care setting and my placement. Also every nursery nurse, whilst doing observations or planning any education progress activity for the children practices it. Examples are, child care practitioner H did an observation on child L, which they then sat down and looked through the EYFS. By looking through the EYFS, it helps them see what period a child is at. Examples are, a child care practitioner would look and establish their observation around it, such as a toddler and do an observation on their fine motor skills which is a development of their major stage of physical development, which could not be very good. In turn, it shows the nursery nurse how the period of a child is improving on development as they are growing up. Furthermore then produce more activities around it, which involves practising different strategies and doing one to one support with the childs respective families, for them to encourage their knowledge of how to help support their childs progress of development and the different ways they can aid it, this why working with families is vital. E2: There are many different ways in which how care for children may be provided within families and society. Firstly, a child could be cared for within families and society by a Day nursery type of setting. This is as a, child is cared throughout the day within a day nursery. Inturn, a child is cared in a day nursery as all of their care necessities are met. This includes the main basic care needs of children which are Play, Food, Care and access to pure water which is a childs right. Furthermore, examples of care necessities of children being met, such as play would be met by having set routines such as free play for babies such as mornings and set times for outdoor play and indoor play for pre-schoolers. This is important as, by ensuring that children have set times of play will allow to promote childrens social development and independence skills which is an obligation for an early years practitioner to do. In turn, when children play together, theyre communicating with each other which helps with their social development as theyre communicating with other children and other different ch ildren, by doing different types of activities such as playing cars with each other, or another example could be an activity which could help develop childrens physical development of an running game, such as tag rugby with pre-schoolers. Inturn, it would encourage their gross motor skills, which is the childs body increasing correctly as when children run, their body metabolism is working and putting their body into the correct type of practise which helps a child with their overall bodys development growing. In conclusion, a day nursery cares and helps promote childrens development such as social and physical development of children, as using the milestones of development for children as a guide and basing correct types of different activities around it. As when referring to the Early Years Foundation Stage Providers must provide access to an outdoor play area or, if that is not possible, ensure that outdoor activities are planned and taken on a daily basis (unless circumstances make this inappropriate, for example unsafe weather conditions). (Statutory Framework for the Early Years Foundation Stage, pg.24). In conclusion, by children participating in activities which helps promote their physical and social development, its a Head Managers and a duty of a statutory setting, such as a Day Nursery. Examples from my placement, is that my placement ensures that every childs care necessities are seen. As, my placement has a set routine of how to meet childrens care necessities such as foods. This is shown and understood by parents, as its placed within the main room. In turn, my placement provides snacktime in the morning, which is a selection of milk and biscuits. Secondly, my placement provides lunch to food which meets each childs dietary necessities and a tea time. Also, outdoor play for children, which aids childrens physical progress of motor and gross skills. In conclusion, my placement ensures that childrens care necessities are being seen through a certain structure of a days timetable of small snacks, big meals such as lunch, and play provided to children at all times or when it is required. Secondly, a child could be cared for within families and society by an After-School clubs. This is as After school clubs; offer care to early children. Examples are, when a child finishes any child care setting, e.g. Private day nurseries, schools periods, they could join straight to an after school club location. In turn, by having after school clubs ensures that children are being cared for the rest of the remaining day, by proper staff members of child care practitioners. This rest assures parents, who jobs are all day long, that their child are in safe hands and are being observed and meeting their necessitys properly after such as always being kept a watch that theyre safe and carefree. In conclusion, after school clubs offers good care to children throughout the extent of time period a child is at. Also, after school clubs help build childrens social and emotional development. This is as, a child would be taking parts in a wide range of varied events which is placed infront of them and which interests them. Furthermore, this would promote a childs self-esteem, as they are being given an selection of different choices as to what they like and would like to do, which they can choose from, without any one else telling them what activity they think should the child participate and give a try according to them, such as staff members which could be teachers. In turn, this is self-reliance abilities and qualities being established within early childrens. Also, a childs social and emotional development is occurring as when a child is contributing in activities they like, they would meet and began to communicate with other children which could be new to them. Furthermore, by doing an activity of their choice would help build their friends circle to get huge, as they would meet new different children with the same taste alike to them. In turn, friendships could occur, which would help promote a childs self-confidence and ability to begin communicating with different children, with different personalities. As when referring to childrens Development Milestones, Encourage children to choose to play with a variety of friends from all backgrounds, so that everybody in the group experiences being included. (Development Matters in the Early Years Foundation Stage (EYFS) Positive Relationships: what adults could do, (pg.9). In conclusion, childrens social development and confidence should be encouraged all times, within any types of child care settings meeting single childrens rights, of meeting single childrens care necessities. Examples from my placement, is that the setting has an Afterschool club which is delivered for children to join and share, which could be a child attending an statutory school type of setting and Tea time lunch is already provided for them with an range of activities to do such as free times, this includes drawing, paintings, writing, computer time. In conclusion, after school clubs are delivered within my placement, and appeals to majority of all age ranges. Thirdly, a child could be cared for within families and society by Preschools. Firstly, as child care practitioners provide intense care throughout the day meaning a Parent can leave their Child there and be assured their Child is going to be in safe hands as theyre in the hands of a qualified child care practitioners who know what and how to do their job rightly and properly. Secondly, same as a statutory school setting which offers care for children; it provides meals to children which are adjusted to a childs single dietary necessities or parents necessities being given out to the setting. Examples are, a parent might not like their child to eat certain foods, which could be provided within a Preschool, e.g. Chocolate/Cheese. Therefore, the Preschools makes sure that that certain child does not eat that type of food and swaps it with another piece of which is not a related food, an example would be mini cheddars instead of Chocolate in which the child does not feel left out and the Parents voice is listened too. It develops to care childrens improvement as some Pre-schoolers have a daily learning plan, however on the other hand the early years practitioners use learning plan and plan activities such as hand painting which means the child can go and try-out and progress their skills such as some Pre-schoolers have play normally throughout the day or at a specific time meaning that play would help the childs cognitive development to increase. Also, it keeps the parents updated with their childs progress throughout the day as some Pre-schoolers have a board in which they could write each childs name and tick against if they ate some, or full or none of their dinners and writing what they had against the dinner which lets the parents know what exactly their child ate throughout the day. Therefore if the parents not happy with it, they can talk about it to the child care practitioners. Each Child has a designed Key Worker in which has a job of keeping an eye and developing a certain child Development therefore each child needs are being met and are tried through observations meaning the childs progress is being monitored and discusses with parents through one to one tutorial sort of meeting. Lastly, it helps the childs physical development as for children/babies use play to work all their vital body parts such as hard inside muscles therefore when they play it helps develop their gross motor skills. As controlling their larg e muscles. (Tassoni, P, (2007), pg. ) and their fine motor skills, controlling their smaller muscles of their hands and feet. (Tassoni, P, (2007), pg ). In conclusion, it helps practice a childs physical development which includes their hands in fine motor skills, and their body, gross motor skills. Examples from my placement is that, they keep parents updated about their childs health and well-being throughout the day, through post it notes which includes their Lunch/Snacks/Nappies information on it. This includes how much or how little their child has eaten and what exactly they ate. As child T, was not feeling well and ate very little for their lunch which was Tuna pasta. In conclusion, the post it notes was given to Parents and explained to the parents when coming to collect, child T that their child has had not ate enough and theyre ill. In conclusion, by settings having an policy of post it notes will ensure and prove, how the child got cared throughout that one day and if there was any accidents, parents can fill an accident form, and be aware of how and where exactly their child has an accident within the setting. Lastly, such as a signing in policy meaning all Visitors will sign in and sign out. My placement also has a signing in policy in which I always have to make sure I do also. The signing in policy is a sheet of register paper with all the staffs name and the date written. It also has a space for students and volunteers in which I sign in. As Im not a member of staff I have to write my names unlike the permanent member of staff who already have their names printed. This helps a lot as if an serious emergency happens then the building has to be evacuated immediately therefore the visitor safety will be ensured, as a whole the students, volunteers, staffs and for example an electrician came to my placement the other day, he also had to sign in. This ensures if a crisis happens or fire, their safety will also be ensured in this way, no one will be missed in numbers and so will be mine as I am working as a student there. The attendance of any visitor, student, staff, of which time they came in and out of the building will be recorded therefore my setting will have the correct date and time for their own assurance. Therefore for example, if a crime crops up or if the college requires seeing if the student really went to their placement for example me. I could say that day I was at placement, when I might not truly have been therefore, the placement could show their record as a proof. E3: Statutory, private, voluntary and independent settings, all have different roles when caring for children. Firstly, statutory types of settings are those types of settings in which the Legal Law is involved with and confirming its provided to all early children and early aged people. A popular example of an statutory service would be a School. Schools is necessity for all parents to join and make sure, that a parent ensures that their child goes to school as its a statutory type of legislation which has to be listened too. In turn, all children are obliged to attend school. Refer to Appendix six, an plan of promoting the well-being of children within a within a statutory place of a school which delivers education to different abilities and aged groups of children, such as a plan which meets the individual necessities as when giving out or meeting parents wishes of providing medicines to their child. These guide plans are for settings to use properly and consider if a child requires any type of medical help which could be in a form of medicines, pumps, tablets according to a childs group o f age. In turn, these care plans are based on what a child requires according to their necessities and how they could aid them. Furthermore, these guide plans of health would be within the statutory type of setting with the Head Manager within the office, as its necessary for them to know any kind of medical problems which have occurred or are being occurred recently and, if there was an issue to arise, the office would know immediately know what action to take or who should be the first and utmost priority to contact when an emergency arises. In conclusion, these guide care action plans are vital for a setting to have, and know beforehand about a child, this could also include staff members being aware of also beforehand, as this helps them as an Head manager within an office, as to what action or what allergys a child has and the immediate action plan for that. As when referring to the Early Years Foundation Stage, under Health-Medicines, They must have a procedure, discussed with parents and or/carers, for responding to children who are ill or infectious, take necessary steps to prevent the spread of infection, and take appropriate action if children are ill. (Statutory Framework for the Early Years Foundation Stage), (pg.21/22). In conclusion, as its legal for schools and vital staff members, such as Teachers,Head Manager, Head Teacher to be aware of, and organised a way of dealing with giving medicines to children who are poorly. Examples from my placement, is that Child O has an allergy to many different types of foods. Furthermore, a guided plan of his medicines and care within a setting, e.g. class is placed on the board which is completed. This ensures, that Teacher W knows when how to prevent any issues from occurring. As once, a child was giving chocolate with nuts on, which Child O is not allowed. Immediately, Teacher W did not allow Child O to have it. In conclusion, its vital for the setting, and staff members to have a guided plan of health for the child as it benefits, the staff members and Head manager majorly. Secondly, private types of settings are those types of settings which earn money at all times. An example, of a private service would be Private Day Nurseries. Private Day Nurseries are places for Parents who normally work full time to leave their child in a safe environment in the hands of a skilled Nursery Nurses who help the development of the Children and provide them with regular requirements with the Parents agreements on food/sleep time or other kind of similar activitys. Refer to Appendix seven, which is a Policy of Behaviour within a Private Day Nurseries. A policy of behaviour is very important within all categories of child care settings who look after small age types of children. A policy of behaviour is different within each child care settings, however it is essential as it inboards instructions and guidelines within the child care settings of what is accepted through behaviour and what is not accepted. As when referring to the Early Years Foundation Stage, Managing beh aviour, Providers must have and implement a behaviour management policy, and procedures. A named practitioner should be responsible for behaviour management in every setting. (Statutory Framework for the Early Years Foundation Stage, pg.23). In conclusion, a policy which stresses the importance of accurate behaviour, and inappropriate behaviour amongst childrens is vital. Examples from my placement, is that my placement has a policy of what behaviour should be and how children should meet that criteria. Furthermore, this includes the classroom as well, as when a child is not behaving well or disturbing the class, Teacher R writes the child name on the board, amongst the sad face. This is a type of a warning for the child, for the child to calm down and relax, however if it continues another tick would go amongst the childs name. In turn, if its continues, it could go serious and the child misses their break and lunch time. In conclusion, a policy of a behaviour structure will enforce and promote good understanding amongst childrens of what a right, accurate behaviour is. Lastly, Human Rights Act 2000 is a development of the importance of meeting childrens care necessities, as it gave single obligatory rights to early children which includes that whenever any conclusions on early aged children and grown-ups are built around using the Human Rights Act 2000 guidelines. In turn, this Act provided children with having general basics rights, such as being treated alike with each and as single human being in a positive way which resulted that, children are required to be respected and being objectively treated when child care practitioners communicate with early children. Thirdly, voluntary types of settings are those types of settings which contain certain types of charities behind the voluntary types of settings, which include major kinds of organisations. Playgroups help childrens with their cognitive development as cognitive skills are based on learning and thinking and play is a form of way in children research the world, playing allows children to test and develop these skills. (Tassoni, P, 2007, pg.) as whilst they are learning as theyre discovering new things by playing with differ