The fight for independence from Great Britain for Canada was much Research Paper

The fight for independence from Great Britain for Canada was much different than that of the United States of America - Research Paper Example Meanwhile, Canada and Great Britain, though once tainted with conflicts, now share some cultures and establish trade relationship. Under the colonization of Great Britain, its government system was controlled and the chief state is the British monarch (Hastedt 62). However, after the granting of independence, Canada, as mentioned earlier, was given more power over its legislature and enjoyed the ideals of democracy. Nowadays, the system of government in Canada is still with the essence of democracy but has adopted a parliamentary system--where the legislative and the executive department of the government are fused as far as their power and function are concerned (â€Å"Parliamentary Government,† n.pag.). In United States Great Britain has extended its collection of colonies over the territory of the Americans. During the early centuries at around eighteenth and nineteenth, United States of America was colonized and was in general, imposed with restrictions on economic matters . This was not what the American desired in contrast to Canada; United States took a measure to break the tie of colonization from Great Britain--to go into revolution. According to Thomas and Walker (163), U.S struggled and fought for independence even at war.

Analyse and evaluate the impact of volunteer tourism on host Essay

Analyse and evaluate the impact of volunteer tourism on host communities - Essay Example Volunteer tourism is thus aimed at serving for the welfare of the community and at the same time facing the challenges in touring new places of diverse language and culture. Generally mass tourism is viewed as an activity of excursion or entertainment trip that is aimed at refreshment for the people undertaking the tour. The visit to new places is aimed at getting to know the language, culture and heritage of the places. The activities of mass tourism involve leisure with food and lodging, luxurious transport, etc. These activities impact the host community as it leads to environmental pollution and degradation and accumulation of garbage and waste. With the rise in globalization and increase in activities of the tourism industry, the issues of environmental degradation and conservation of wildlife and awareness of pollution have become sensitive issues all over the world. Volunteer tourism is an activity undertaken the volunteer tourists in undertaking tours to different places with an objective to serve for the welfare of the tourist spots (Benson, 2010, p.39). Discussion The activities of volunteer tourism has shifted the objective of tourism from the welfare of tourist industry to the welfare of host community or the places which host the tourist for a being popular destinations. The members of the community view the activities of volunteer tourism as restoration of nature and environmental balance of the host community. As a result of this, the members of the host community engage themselves directly in activities undertaken as a part of volunteer tourism. The members of the host community act in collaboration of the volunteers tourists and extend full co-operation and support to the volunteers in order to accomplish the goals of volunteer tourism. As a result of the volunteer tourism, the tourists are also exposed to the culture, language and social heritage of the area and thus there is a healthy exchange of culture between the local people and the volun teer tourists. The overall purpose of volunteer tourism being aimed at welfare of the host community, the local area is positively impacted by the honest efforts of the volunteer tourists. The volunteer tourists also have the objective of providing assistance to the community development projects that have been planned for execution. In order to be fully effective, the community development projects should be supported with necessary funds along with the knowledge and skill for efficient execution (Bricker,  Black and  Cottrell, 2012, p.49). The community development programmes may be aimed at development of children and women in the region, provision of food and nourishment for the under privileged, conservation of trees and forests, environmental balance, etc. The volunteer tourists play a vital role in collecting the necessary funding and also share the knowledge and skill required for execution of the community development projects. The volunteer tourism activities provide a means for the host community to increase their income levels and also accumulation of wealth. The volunteer tourist activities put up in the target destination for a period of time. Thus the basic and essential needs of the volunteer tourists need to be fulfilled by the economy of the host country. The supply from the host community is purchased by the volunteer tourists due to which the income levels of the host commu

Open Research Paper Example | Topics and Well Written Essays - 1000 words

Open - Research Paper Example Qualifications wise the board is a mix of innovators and researchers. The board comprises two PhD holders and key personalities like Robert A. Iger the current CEO and president of The Walt Disney Company (Apple Inc., 2013b). The combination of innovation and research gives Apple’s Board the leadership qualities that are needed for consumer electronics business. Research provides Apple with access to the latest technology while innovation provides the company’s products with the competitive edge over its rivals. The board can take decisions based on both technology and innovation. 2. Committees the board sits on: The board at Apple Inc. sits on three committees: Audit and Finance, Compensation and Nominating and Corporate Governance. The Audit and Finance committee is responsible for maintaining the financial matters of the company. Moreover the committee looks after the audit system, performs risk management and also looks after the security of the data. Financial matt ers are of great importance to Apple Inc. and to make sure that the committee functions at optimum efficiency the members of the committee are some of the brilliant minds of the leading companies in the world (Apple Inc., 2011a). The second committee is Compensation committee whose main purpose is to design incentive plans for the company. In addition to designing the Committee can also review and modify any incentive plan as it sees fit. The committee has three members with Andrea Jung being the chairperson for the Committee (Apple Inc., 2013a). The third Committee is Nominating and Corporate Governance Committee whose sole responsibility is to nominate candidates for the Board of Directors at Apple Inc. In addition the committee can advise the Board of Directors regarding matters of governance. The committee comprises three members and William V. Campbell is appointed as the Chairperson of the Committee (Apple Inc., 2011). 3. Management at Apple Inc: Most of the individuals workin g for Apple have been working with the company since its formation. There are a few who joined shortly after Steve Jobs was made the CEO at Apple Inc. in 1997 (Apple Inc., 2013d). The management team is a relatively experienced one with people who have worked with some of the greatest companies in the world. One such example is Craig Federighi the Senior Vice President at the company. Federighi worked for NeXT Inc. and Ariba before working for Apple in 2009. NeXT Inc. and Ariba were one of the most popular IT companies of their time. Federighi is just one example of the many experienced individuals working for the management of Apple Inc. (Lowensohn, 2011). 4. Board’s Philosophy on Executive Compensation: Executive compensation at Apple Incorporation is determined by the Compensation Committee which comprises 4 non-employee directors of the company. As per the â€Å"Definitive Proxy Statement†, the executive compensation program of the company includes awarding Restric ted Stock Units (RSU) to all executive members of the company (Apple Inc., 2013d). However, the RSUs were not awarded to one executive member, Timothy Cook, who was promoted to the CEO of the company. In addition, the Compensation committee also has established a sound basis for determining the remuneration and bonuses for executive members of the company. As for instance, the Committee considers a number of factors while evaluating the remuneration and bonuses of the executive members, which include: Competitive Market

Summary Essay Example | Topics and Well Written Essays - 500 words - 5

Summary - Essay Example This research is aimed at exploring the most recent technologies of Physics like nano-identation, scanning electron microscopy, etc. which can be utilised to obtain a better understanding of tooth erosion and hence help in the improvement of the dental treatment techniques. The research will help the clinicians to solve dental problems better and thus help the affected population. B5 SUPPORTING STATEMENT Explain – in no more than half a page of 12-point Times New Roman font – why this project is of interest to you and why you believe you have the skills and knowledge necessary to undertake it successfully. Answer: Dental treatment is generally expensive. Therefore, people often prefer to leave their dental problems untreated. However, the dental problems become complicated due to this and serious heath hazards take place. As a result, more complicated medical procedures like oral and maxillofacial surgeries have to be performed which are riskier and costlier. In my opin ion, due to lack of consciousness and lifestyle issues are leading to more dental problems and this is becoming a serious public health issue. Hence, I want to conduct a research that would focus on the most innovative technologies to understand the dental problems like tooth erosion better and find out better treatment methods.

Turn On the People in Any Organization Essay Example for Free

Turn On the People in Any Organization Essay The pages of human history daubed in bloodshed on account t of World Wars I and II, war unleashed by Japan at Nanking, the Civil War of USA and many other small and big violent incidents ask the crying question. How to make this Planet Earth heaven-like? The answer is simple and direct. Eyes full of understanding, heart full of love and the life that refuses conflicts- these alone are enough! Most of the violence is for monetary gains, acquisition of territory, and to feed vanity. The materialistic civilization, the industrial and internet revolutions, have unleashed a new war, without actually declaring it. This relentless war is fought on day to day basis in the stock exchanges. Each Nation wants to become economically powerful and prevent others from becoming powerful! â€Å"Today, man is being destroyed by the inner conviction of uselessness and no amount of economic growth can compensate for this loss. † How long can we confront Nature to achieve better standards of living and better standards of life? Reconciliation with the eternal principles of Nature is the need of the hour to achieve genuine peace and prosperity and we need to learn a lot from the Plant and Animal Kingdom. If they can live in accordance with their own Nature in a peaceful manner, why can’t the human beings? Gung-ho is the Chinese language phrase. It is derived from gongye hezuoshe, which means industrial worker’s co-operative. Karl Marx must be shifting in his grave with the mention of this word. Such co-operatives were established for the benefit of workers by Rewi Alley and his team. State who the animal characters of the book are, and why they are important: The three animal characters mentioned refer to three Native American lessons. Champions of commerce and industrial magnates have accepted the supremacy of computer applications, and perhaps have come to the conclusion that this is the only path for economic ascendancy. For such individuals this book has something special and novel. The lessons for organizational turnaround are: The Spirit of the Squirrel, the lesson is one of the powers of worthwhile work. The Way of the Beaver, the lesson is accomplished through empowerment. The Gift of the Goose, the lesson is the exponential factor of motivation. Continuous application, relentless efforts is the key to success. They say, ‘have a will to grow and grow you will! ’ Apply each creature to a management situation; Any management situation, there is one permanent, irrevocable relationship. It is between one human being to another human being. Give respect and take respect—very simple! When you use the best adjectives you can form a wonderful sentence. Similarly, happy, motivated, empowered and encouraged members, who work with the sense of responsibility, can bring nothing but cheer to the financial results of a company. Leadership should score over management; the end-results will be precedent-shattering. â€Å"The Gift of the Goose† is the factor in motivation for an employee who finds himself in a discouraging situation and feels trapped. I know an instance of a bank accountant sending the recovery notice to a dairy unit owner who had lost his two cows that died under mysterious circumstances and he was unable to pay the loan installments. Selling milk of the cows was his only source income. From where would the poor man repay the loan? When this incident came to the notice of the Senior Manager of the Bank, he advised the accountant to give him further loan for buying four cows. He would maintain himself with the profit from the milk from two cows and with the other portion of the profit he would repay the loan amount of the bank! The right decision at the right time, saved the borrower from ruin, and the Banks loan was also repaid fully. Explain what you have learned from each character: Work is worship is not mere the spiritual quote; its practical utility is great. The beauty of the work done with sincerity and dedication is something special. For the best output, basic conditions need to be created for the employees to become basically sound and industrious. When there is a free working environment, when restrictions are less, and one has freedom to take decisions, the results would be encouraging. Those who work only commit mistakes. One who walks will at times stumble. Positive attitude and right frame of mind are the fundamentals to get the results. This is the sum and substance of the messages of the Squirrel, the Beaver and the Goose. Specifically, the principle involved in the example of Squirrel, is that even the small and insignificant looking beings make the difference in the world by their active presence. One needs to cultivate the habit of making the world a better place. We need to have common goals and shared ideals. The Beaver principle is, give the workers the long rope, within the well-defined boundaries. Let them work in a free atmosphere; let them not feel suffocated under the pressure of repeated orders, modifications and revised orders. Teach them to control themselves. The Goose principle, is let good work be appreciated, even the mild rebuke needs to be on an encouraging note. Trust them, and they will give better results. Console them, instead of questioning them. Congratulate them at the earliest opportunity. Choose one or more traits that you would like to emulate, and explain why you feel that way; The Spirit of the Squirrel, the lesson is one of the powers of worthwhile work. The three core ideas of Gung Ho are simple yet profound! : Worthwhile work guided by goals and values; putting workers in control of their production; and cheering one another on. What you do is no doubt important; but how you do, what you do is more important. I like this trait immensely, as it the only way to carry out duties and responsibilities in a peaceful manner. They say, â€Å"It is better to deserve without receiving, than to receive without deserving. † Participation in action is always better than renunciation of action. The modern combustible younger generation wishes to have proof for everything and will not accept anything, unless convinced about it scientifically. Well, here is the proof for the assured reward for productivity. –every action, has the reaction and the intensity of reaction is in proportion to the intensity of the action. Over which there is no dispute between the scientists and the spiritualists. One of the rare agreements between the two contending forces; the two opposing forces; the forces that do not see eye to eye with other! This is the solid foundation on which one needs to base one’s understanding, as one is bound to get rewards for one’s loyalty and hard work. Its timing is not the domain of the human being. Right things will happen at the right time and this need not be doubted at all. Gung-Ho approach solidifies such a belief. What changes would you like to see in your own life after reading this book? One of the important guidelines that I got from this book is about interaction with the people; how important it is in day to day disposition in life. Doing appropriate things at the appropriate time, gives positive results. How disciplined and regular are the animals in doing their duty ordained to them by Nature. They never falter. They never disobey the rules. Their food habit is disciplined. They won’t harm anyone without reason. Their traits are decided and certain. I need to learn much by observing the nature of the animals. I need to perform my duty to the best of my ability and judgment, not because someone is telling me, not because my boss is ordering, but because, but only because, to live by hard work is the correct way of life. Another important change in my life is that I begin to love animals and birds, take interest to study their nature, read books on them, and wonder what an important role Nature has provided for them in the beautification and maintenance of flora and fauna around us. Talk about what you liked or did not like about the book. The book is very helpful in creating a work and management culture of excellence. It provides elucidation of notable points to the leaders to increase their knowledge, skills and motivation. It tells that sharing of information is the road to prosperity. It assists in front-line decision making. Productivity is the top concern in any commercial or industrial establishment. And you have to create conditions for its willing acceptance of that expected productivity in the workplace. The employees can build an organization; just as sometimes it is claimed that the employees can break it. Every employer wishes to have the builder. An inspired employee is an asset to any organization in the ultra-competitive business world of the modern day. The traditional concept that the customer is king is assuming new dimensions. How to secure unflinching loyalty for products and how to retain the employees in top gear, as for productivity and the latent creative joy! Gung Ho has solid answers for such situations. This not the book to read and keep aside! It is the reference book, and as one faces different situations in life, the practical examples given will be beneficial to find an appropriate solution. The authors have developed a pleasant way of telling about the leadership qualities and management principles through the example of animals and birds. The principles elucidated in this book can be applied for small as well as big businesses. The book concretely tells how a business establishment on the verge of failure was converted into a success empire. References: Blanchard, Ken: Book: Gung Ho! Turn On the People in Any Organization. Hardcover: 256 pages Publisher: William Morrow; 1 edition (October 8, 1997) Language: English ISBN-10: 068815428X ISBN-13: 978-0688154288

Tudor Revolution in Henry Viii

Tudor Revolution in Henry Viii After the Tudor dynasty English government and kingship was never the same. The way the kings power switched from a Medieval system of hierarchy his control over his land was limited, to rule he needed support of the nobility and church and his parliament ineffective to an oligarchical government where the kings influenced penetrated his land, his nobility and within the government the power of the nobility shrank and the church became a secular concern. Government modernised through the centralisation of power and royal supremacy would rule. Parliaments importance would be re-invented and reforms to administration, law and justice, sovereignty and church power could be described as a revolution in government which under Henry VIIIs reformation of the church brought new opportunities for the consolidating of royal power. Cromwell reforms in the 1530s appear to be the turning point  [1]  . Although to say royal supremacy was an achievement, to say it occurred within the space of o ne decade seems restrictive and to say one man reformed a national government seems to simplistic, but looking at Henrys reign post-Cromwell Henry seemed more interested in his love life and war than gaining further reforms. Also Edward VI and Mary Is rules brought the return of factionalism, the return of power to the nobility and a decline in an effective government and Elizabeth, however, may have ruled stronger than her siblings the crown was never quite the same after Henry VIII died  [2]  , considering the damaged inflicted and the rising threat of the gentry and Puritanism which restricted her abilities to passstatueo prove that if there was a Tudor revolution, it must have happened under Cromwell. However, were Henrys and Cromwells reforms really a revolutionary? Hoak claims the rise of royal supremacy was emittable  [3]  but Elton, the theorist who invented the concept of the Tudor revolution believes although ideas may have been present, he remained the man who tur ned ideas into reality  [4]  , but surely this is admits if not him then someone else would have done it? Throughout this essay I will examine the areas of reforms instigated under Cromwell and Henry VIII as previous mentioned and examine whether they brought revolutionary change or were an obvious step towards secularisation. If there was a revolution in government it is necessary to look at the effects of the reformation on government control as the centralisation of the church was the first real break from Medieval tradition and ignited the want for royal supremacy. The church was the centre of life for the English population of all social rankings and therefore was the real center of power and whos alignments rested not with the king but with a foreigner power, the pope. The church had a separate court for which the kings power was exult  [5]  and bishops like Worsley had direct influence in the running of the government, and its law system and corruption within the church was greater than in government as Skeleton notes people did not come to court because there was better profit in attending cardinals rival court  [6]  . The church was a rival government within a government, it seems logical that to bring it under state control and historically, very much like the actions of Constantine the G reat, kingship has been restored to its full inheritance and endowed with the authority of the early Christian emperors  [7]  , however, although ironically it was a step back to go forward, how is learning from history revolutionary? The fact the backlash received from the nobility and populas was due to the feeling the church had too much land and power and disdain for the influence that a foreign body had within England  [8]  , suggest it was not such a radical idea as some made out to be, suggesting that others had contemplated it before. From this we can see a reformation of the church also caused a reformation of politics, but not necessarily a revolution. The break with the church inspired the idea of sovereignty and of commonwealth but where these new concepts? The idea of sovereignty of a unified self-governing free state, away from the authority of any sovereign potentates  [9]  appears certainly as a revolutionary in the history of English ruler-ship and as Elton suggests would have been the main driving forced spurring revolutionary change  [10]  as sovereignty consolidated Henrys land and government under Henrys control. Both Henry and Cromwell believed the House of Commons had to represent the whole nation  [11]  for the first time the entire nation would be under Westminsters control. The eliminated other small rivals courts those in Buckinghamshire and Sheffield  [12]  and brought Wales and northern counties under the kings rule for the first time, i.e. places like Durham  [13]  through Cromwell uses of councils and the influence of parliament in all the kingdom, i.e. even Calias had two seats in parliament  [14]  . Of course if under the control of parliament laws would be easier to enforce, regulate and to put the most loyal in control. On the other hand, this idea perhaps again is nothing but new, as Edward III during the Hundred Wars Year had created a national nobility and joined the country against the free of the French  [15]  , Henry and Cromwell likewise could have used the situation of the reformation to unite England using the same mentality against the Catholic church. The shifting use of power and effectiveness of parliament, however, does not seemed copied from the pages of history. Parliament Elton argues Henry VIIIs turning to parliament proved his supreme political genius; that his deliberate decision to take the nation â€Å"into partnership‚ was the most momentous step in the rise of parliament  [16]  , for Elton sovereignty created a duty and purpose for Parliament, however, it it seems Henry used parliament as a propaganda tool to promote the acceptance of change and show the link between the king and people  [17]  as Henrys supremacy was dependent on divine appointment and not parliament. However, from an administrative point of view Henry hereafter had a greater control over his kingdom, but parliament did not restrict Henrys decisions. This seems to point towards less of a governmental revolution and more towards a despotic government, historians like Gardiner have alleged Cromwell used his power more as an autocratic weapon  [18]  and Pollard portrays Cromwell especially like some Machveillian monster  [19]  , which both suggest the real intentions of Henry and Cromwells government. However, perhaps this could be interpreted as the Tudor revolution, considering other historic despotic governments, like Communist Russia, although a modern comparison, it was still a revolution of politics and considering politically, socially and economically almost resembled a Medieval state, it does become a fair comparison. Regardless of this parliament became an effective organ of government and brought reforms to the law and juridical system, the church and administration. Cromwells administration produced the largest body of statues seen before the 19th Century  [20]  , most centred on the church and many laws were to do with kings affairs i.e. Henry VIII passed 81 bills in his interest, though considering he was trying to legitimise a marriage to Ann Boleyn, its hardly surprising, but none the less a groundbreaking swift from Medieval politics. However, Roskel believes parliament developed from its Medieval roots and that by a natural process (the need for secularisation perhaps) and not the product of a Tudor revolution as the only change was a new theory of parliament and in the process drastically altered the practice  [21]  . The perfect example of this is the Privy council and demonstrates the need to remove the problems of factions and power which the nobility held. The Privy council had existed before Henry and Cromwell but the way it was used differed greater. The council would be an important link between parliament and the king and power came down only to those the king choose and old knightly elements were reduced to a few significant roles. The number of members decreased and meant those in power could not and made it easier to pass laws and to avoid factions, i.e. Henry VIIs council of 1472 included 72 men, whereas Henrys first had only 19  [22]  and members now had to have worked within the government before they could be in the council  [23]  , therefore this new system would exclude the majority of the nobility who might only serve their own interests. This can certainly be viewed as a revolutionary change, like the church the nobility was another thorn in the side of many English kings, although the council cut out the use of the nobility it was not a political instrument for assuaging opposition  [24]  , concessions still had to be made and therefore could not be completely revolutionary as the nobility were key important in keeping regional control. The most significant change perhaps was that the council could pass laws by proclamation and unlike its European counterparts in Spain and France who could only advise the king  [25]  , whereas the English privy council was able to influence and intervene the kings decisions, this reflects a comprising relationship where although Henry had royal supremacy he did not have a complete free reign over policy which shows policy being built on the existing governments foundations which lead to the improvement of the common law and the function of parliament  [26]  , but were these improvements revolutionary? Henrys reign was built on law and reforms to the common law and the judicial system from the 1530s onward they began to obey statue in a way they had never done before  [27]  , for the first time on a national level the process by which parliament made laws and court administrated them was enforced throughout the land. From 1532 for the first time the government conceived legalisation became the new focus in the houses, this was something which Elton says no one ever dreamt of establishing  [28]  changes in the law through Parliament, this was truly revolutionary. This shift towards the creating and then enforcing on law was something which had not happened under Medieval governments. Henry had control over both religious and regional courts, he had the ability to appoint judges and juries and unlike any other point made it seems a decision that was not emittable or the result of natural change as there had been no demand for a stricter enforcement of the law. Changes within the administration system also could be described as revolutionary. Administration benefited hugely from Cromwells policies and the outcome of the reformation. The change of law lands over church properties brought plenty of money into the The crowns new revenue courts showed the move towards the elimination of purely personal in favour of lasting bureaucratic control  [29]  . Henry said wherein we as head and you members are conjured and knit together into one body of politic  [30]   basically organic view of state in harmony and mutually dependent on its subjects. Although idea around since Dudleys Tree of Commonwealth (1509) and practised by Henry VII though Cromwell brought a renewed vigour in the practice.

Physical Exercise Reduce Symptoms Depression Health And Social Care Essay

Physical Exercise Reduce Symptoms Depression Health And Social Care Essay The aim of this essay will be to discuss and apply selected evidence related to nursing practice within a chosen field. Evidence based practice is an approach used by clinicians to deliver the highest quality care to meet the needs of patients and their families. By finding appraising and using the best evidence, health professionals are able to achieve optimum outcomes for all. (Melnyk Finout-Overholt 2005). However, an alternative view suggests that evidence exists to inform and guide practice rather than dictate it. (McKenna et Al 1999). When clinicians apply an evidence based model, the best available evidence, modified by patient circumstances and preferences, is applied to improve the quality of clinical judgements. (McMaster Clinical Epidemiology Group 1997) A recognised framework will be used to identify a question and then a systematic literature search will be carried out to assist in answering this question. A copy of this search will be provided and search parameters will be applied to gain the most relevant literature. After applying these parameters the search will be narrowed down to the five most relevant pieces of research. A table will be provided to show the key findings from each piece of literature, and one piece of research will then be critiqued in depth using a recognised framework. The question identified in this essay is Can physical exercise or activity help to reduce the symptoms of depression in older adults, compared to other forms of treatment? Background and Formulation of Question The question was devised using the PICO framework. This framework often is used to formulate clinical questions (Craig Smyth 2002), and it identifies and defines the essential components of a good clinical question. PICO is an acronym for patient population of interest, intervention, comparison intervention and outcome (National Institute for Health and Clinical Excellence 2007). Patient population of interest shall be older persons diagnosed with depression, intervention shall be physical exercise or activity, the comparison intervention shall be other forms of treatment for depression and the outcome will be a reduction in the symptoms of depression. A well thought out and formulated question maximises the potential for finding relevant evidence for a patient population (Craig Smyth 2002) Depression in older adults refers to depressive syndromes defined in the American Psychiatric Associations Diagnostic and Statistical Manual (DSM-IV) and in the International Classification of Diseases (ICD-10) that arise in people older than age 65 years. In old age, the symptoms of depression often affect people with chronic medical illnesses, cognitive impairment, or disability. (Alexopolous et al 2002). For a major depressive episode to be diagnosed, five of the following symptoms must be present: depressed mood, diminished interest, loss of pleasure in all or almost all activities, weight loss or gain (more than 5% of bodyweight), insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, feeling of worthlessness or inappropriate guilt, reduced ability to concentrate, recurrent thought of death or suicide. At least one of the symptoms must be either depressed mood or diminished interest or pleasure. The episode should last at least 2 weeks, lead to distress or functional impairment, and not be a direct effect of substance use, a medical condition, or bereavement. (Depression Today 2010). Two of the symptoms detailed above must be present for a minor depressive episode to be diagnosed. Between one and four percent of the general elderly population has major depression, and minor depression has a prevalence of between four and thirteen percent (Blazer 2003). Twice as many women as men are affected. Both the prevalence (Palsson et al 2001) and the incidence (Teresi et al 2001) of major depression double after age 70-85 years. Treatment for depression usually involves a combination of anti depressant drugs, talking therapies such as Cognitive Behaviour Therapy or Interpersonal Therapy and self help. (NHS Choices 2010). A recent review concluded that physical exercise programmes can obtain have a beneficial effect on depressive symptoms in older people. Although not appropriate for all older people exercise may improve mood in those undertaking it. (Blake et al 2009) Systematic Literature Search A systematic review of the literature was carried out using the CINAHL and PubMed databases and the search terms depression physical exercise and old* were used. CINAHL was found to be particularly useful as it possible to specify the age group required in the literature search. For the purposes of this search age 65+ was selected. PubMed is the public access version of Medline, a comprehensive database which indexes thousands of journals in the medical sciences field. (TVU 2010a). The Cumulative Index to Nursing and Allied Health Literature Indexes virtually all English language journals from 1983 onwards. This database covers midwifery, nursing and related disciplines (TVU 2010b). Initially the searches indicated a vast array of literature but by applying a systematic review this was reduced. By using a logical search strategy with Boolean techniques the number of documents was limited to thirty. These were then reviewed and five articles were then selected which addressed the ques tion of exercise as a form of treatment for older people diagnosed with depression. The search parameters were limited to studies written in the English language, the age and the subjects, and both sexes were to be included. Harvard (2007) suggests that by applying parameters such as these the most up to date and relevant literature can be sourced. A full record of this search history is attached in appendix 1 and 2. A summary of the findings in the five pieces of research selected is detailed in the table overleaf. This table follows a structure recommended by Timmins McCabe (2005). Author and Year Journal Type of Study Purpose Sample Design Data Collection Key Findings Blake et al 2009 Clinical Rehabilitation Qualitative To assess efficacy of physical exercise in 11 trials totalling 641 participants Varied Varied 1 Exercise not relevant 2009; 23: 873-887 systematic treating depression in older adults to all in group review 2 May improve mood 3 further research needed to establish medium to long term effects and cost effectiveness Mather et al 2002 British Journal of Quantitative To determine whether exercise is effective 86 participants split into RCT clinical 1 Modest improvement Psychiatry (2002) as an addition to anti depressants in reducing two groups interview in symptoms after 10 180:411-415 depressive symptoms in older adults weeks 2 older people should be encouraged to attend exercise classes Brenes et al 2007 Aging Mental Health Quantitative To test feasibility and efficacy of exercise and 37 participants, 32 completed RCT structured 1 Both exercise Jan 2007;11(1):61-68 anti depressants compared with usual the study clinical interview and medication were treatments for older adults with observed shown to be statistically minor depression self reporting more effective than current treatment 2 Exercise also aided physical functioning Kerse et al 2010 Annals of Family Quantitative To assess effectiveness of home based 193 participants, 187 completed RCT structured 1 exercise and social Medicine 8:214-223 (2010) physical exercise plan in treating older the study clinical interview visits showed similar adults with depressive symptoms compared effects in improving to social visits mood an quality of life 2 More research is required Blumenthal et al Archives of Internal Quantitative to assess effectiveness of exercise 156 participants RCT structured 1 after 16 weeks 1999 Medicine 159(19) (1999) compared to antidepressants for treatment clinical interview exercise equally effective of major depression in older as anti depressantsCritical Appraisal The following appraisal was structured by using an approved and recognised framework for completing such tasks. (Polit et al. 2001) The article selected for critical appraisal is Effects of exercise on depressive symptoms in older adults with poorly responsive depressive disorder. (Mather et al. 2002). A copy of the article is attached as appendix 2. The aim of the study was to determine whether exercise is effective as an adjunct to antidepressant therapy in reducing depressive symptoms in older people. This was clearly defined. In the introduction the authors stated that it is widely held that exercise is useful in depression, but that there were few studies on the potential effects that exercise may have as an addition to antidepressant therapies for older adults. The key finding of this study was that at ten weeks older people with poorly responsive depressive disorder showed a modest improvement in depressive symptoms and should therefore be encouraged to attend group exercise activities. The study conducted was a randomised controlled trial. Randomised controlled trials are the most rigorous way of determining whether a relation exists between treatment and outcome and for assessing the cost effectiveness of a treatment. (Sibbald Rowland 1998). Patients were randomly selected to attend either exercise classes or health education talks for ten weeks. Assessments were blind and were conducted at baseline, ten and thirty four weeks. The primary outcome was measured with the 17 item Hamilton Rating Scale for Depression (HRSD). HRSD is a multiple choice questionnaire used by clinicians to measure the severity of major depression in patients. (Hamilton 1960). The nature of both interventions is clearly described by the authors. All participants were outpatients recruited from primary care, psychiatric services and direct advertisement. 1885 patients were screened with a view to recruitment, and 86 were selected at random for the study. To be included patients were require d to have symptoms of depression, and to be older than fifty three years of age. In addition patients had to have been receiving antidepressant therapy for at least six weeks, without evidence of a sustained improvement in their condition. Patients were excluded if there was: alcohol or substance misuse, structured psychotherapy in place, or were already taking regular exercise. Patients with specific medical conditions preventing physical exercise were also excluded. Both groups were informed of the nature of the trial, and all patients gave written informed consent. The study was approved by a medical research ethics committee. There were two groups with 43 patients in each and were comparable in terms of age range and symptom presentation. There was however a heavy preponderance of women in the exercise group. The authors suggest that this may have introduced a bias into the results, and suggest a control group could be introduced in the future without either intervention. The outcomes for both groups were measured in the same way by the proportion of participants achieving a greater than thirty percent reduction in HRSD score from baseline. The results are shown in a statistical format and are recorded in a table. There are twenty four references in the report which support the evidence presented by the authors. The implications for the health service are that structured group exercise sessions can help to make a modest improvement in patients who are not responding to pharmacological treatment and that older people with depressive disorders should be encouraged to attend group exercise activities. It should be noted that one of the authors of the research is co-director of a company providing exercise classes for older people and whose profits support research into aging. Review of Literature This review of literature will show how the five main studies and all available literature assist in answering the set question. The first part of this review will concentrate on the five main studies and the second part will contain evidence from a wide range of sources and relate this combined information to government policy and guidelines. There will also be evidence of how all the information relates back to practice. It is well acknowledged that depression is widespread (Osborn et al 2003) and is the most prevalent mental health problem for older people (Age Concern 2007) The condition affects one in five people over 65 and rises to two in five in those over 85 (Mental Health Foundation 2008). The use of exercise to combat depression is well supported due to its effects on enhancing mood, improving cognitive function and reducing anxiety; it is also less expensive than medication (Louch 2008). A literature review was conducted to examine whether exercise could be an effective form of treatment for older adults with depressive symptoms. Article 1 (Blake, Mo, Malik and Thomas 2008) conducted a systematic review of eleven randomized control trials in order to establish whether physical activity interventions were successful in alleviating depressive symptoms in older people. Trials were included in the review when more than 80% of the participants were greater than sixty years old. In nine of the eleven studies short term positive outcomes were found, although the mode, intensity and duration of the exercise program differed across the studies. The medium to long term effects of exercise as an intervention were less clear. This outcome is backed up by Mead et al (2008) who concluded that exercise seems to improve depressive symptoms in people with a diagnosis of depression, but the effects are moderate and not statistically significant. However a randomized controlled trial conducted by Blumenthal et al (1999) (Article 2) had reached different conclusions. One hundred and fifty six men and women aged over fifty were split into groups randomly to a program of aerobic exercise, antidepressants (sertraline hydrochloride) or combined exercise and medication. After sixteen weeks of treatment the patients did not differ significantly statistically either on Hamilton Rating Scale for Depression or Beck Depression Inventory scores. The study concluded that antidepressant medication had the most rapid effect, but after sixteen weeks exercise was equally effective in reducing symptoms of major depressive disorder. Article 3 (Brenes et al 1999) conducted a pilot study designed as a randomized clinical trial to test the feasibility and efficacy of an exercise program and antidepressant treatment compared with usual care in improving emotional and physical functioning in older adults with minor depression. A total of thirty seven participants aged over sixty five were randomized to treatment: fourteen to exercise, eleven to sertraline and twelve to usual care. Patients who received either exercise or sertraline treatments demonstrated improvement both in clinician led and self reported measures of depressive symptoms. Those participants who received the usual package care experienced small or no improvement in mental state. There are some limitations to this study however. The sample size was small and thus the statistical power was weak. The diagnosis of minor depression was based on self diagnosis rather than clinical interview. It was also not stated in the report what the usual care was. Ther e were however significant trends to suggest that sertraline and exercise could be used as treatments for mild depression in older adults, and that a more in depth study should be undertaken. Article 4 (Kerse et al 2010) published a study comparing the effects of a home based exercise program with regular social contact in improving function, quality of life and mood in older people with depressive symptoms. A randomized controlled trial was conducted in which one hundred and ninety three people aged over seventy five with depressive symptoms received either an individualized physical activity program or social visits delivered over six months. The social visits were of the same time span as the exercise program. Outcome measures were obtained at three, six and twelve months. Both physical and mental well being was measured using a variety of techniques including a short function test, and the Nottingham Extended Activities of Daily Living Scale (Nouri Lincoln 1987). It was concluded that a structured activity program improved mood and quality of life for older people with depressive symptoms as much as the effect of social visits. There was however no control group bein g measured that was receiving usual care. Article 5 (Mather et al 2002) set out to determine whether exercise is effective as an adjunct to antidepressant therapy in reducing depressive symptoms in older people. A randomized controlled trial was conducted in which eighty six participants aged between fifty three and ninety one already receiving anti depressant therapy were given either exercise classes or health education talks over a ten week period. Assessments were made blind at baseline, ten and thirty four weeks using the Hamilton Rating Scale for Depression as the primary outcome. At ten weeks a significantly higher proportion of the exercise group (55% compared with 33%) experienced a greater than 30% decline in depression. In an article in The British Journal of Psychiatry in 2002, Jagadheesan et al critiqued this study and stated that it could have been more meaningful if a control group had been added which received no additional treatment other than continuing antidepressants. (Jagadheesan et al 2002). The majority of research above suggests that physical exercise reduces depression and depressive symptoms in the short term in older adults, but additional well controlled studies are required to determine the long term efficacy. A systematic review carried out by Sjosten Kivela supports these findings (Sjosten Kivela 2002). Direct comparisons between studies is difficult as they differ greatly in characteristics, nature of control comparison group, age of the participants, type and intensity of exercise and outcome measures used to follow up. National Institute for Clinical Excellence guidelines are set out to assist clinicians and patients in making decisions about appropriate treatment for specific conditions. The guidelines for depression suggest that for particularly for patients with mild or moderate depressive disorders, structured and supervised exercise can be an effective intervention that has a clinically significant impact on depressive symptoms. There is also evidence to suggest that individuals with low mood may also benefit from structured and supervised exercise. (NICE 2005). Conclusion Physical exercise is clinically beneficial in the short term for treatment of depressive symptoms in older people. Exercise, although not appropriate for all older persons with depression, may improve mood in this group. Evidence of the cost effectiveness of providing exercise interventions would be beneficial in helping decision making regarding service use and delivery. More well designed research studies are needed to examine the medium and long term benefits of exercise as a treatment for depressive symptoms in older adults, and to examine the types and duration of interventions that have the most positive effect. Word Count 3008 References Age Concern (2007) Mental Health Services Letting Down Older People. [On Line] Available at http://www.ageuk.org.uk/ [Accessed 12 May 2010] London: Age Concern. Alexopoulos, G.S., Buckwalter, K., Olin, J., Martinez, R., Wainscott, C., Krishnan, K.R. (2002) Comorbidity of late-life depression: an opportunity for research in mechanisms and treatment. Biol Psychiatry 2002; 52:543-58. Blake, H., Mo, P., Malik, S., Thomas, S. (2009) How Effective are Physical Activity Interventions for Alleviating Depressive Symptoms in Older People? A Systematic Review Clinical Rehabilitation 2009; 23: 873-887 Blazer, D.G. (2003) Depression in late life: review and commentary. J Gerontol Med Sci 2003; 56A: 249-65. Blumenthal, J.A., Babyak, M.A., Moore, K.A., Craighead, E., Herman, S., Khatri, P., Waugh, R., Napolitano, M.A., Forman, L.M., Appelbaum, M., Doraiswamy, P.M., Krishnan, K.R., (1999) Effects of Exercise Training on Older patients with Major Depression Archives Of Internal Medicine Vol. 159 No.19, October 25, 1999 Brenes, G.A., Williamson, J.D., Messier, S.P., Rejeski, W.J., Pahor, M., Ip, E., Penninx, J.H. (2007) Treatment of Minor Depression in Older Adults: A Pilot Study Comparing Sertraline and Exercise Aging Mental Health, January 2007; 11(1): 61-68 Craig, J.V. (2002). How to ask the right question. In J.V. Craig R.L. Smyth (Eds.), Evidence-based practice manual for nurses (pp. 21-44). Philadelphia: Churchill Livingstone. Depression Today (2010) DSM IV [Online] Available at http://www.mental-health-today.com/dep/dsm.htm [Accessed 8 May 2010] Hamilton, M (1960) A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry. 23: 56-62 Harvard, L. (2007) How to conduct an effective and valid literature search. Nursing Times 103, (45), 32-33 Jagadheesan, K., Chakraborty, S., Sinha, V.K., Nizamie, S.H. (2002) Effects of Exercise on Depression in Old Age The British Journal of Psychiatry (2002) 181: 532 Kerse, N., Hayman, K.J., Moyes, S.A., Peri, K., Robinson, E., Dowell, A., Kolt, G.S., Elley, C.R., Hatcher, S., Kiata, E., Wiles, J., Keeling, S., Parsons, J., Arroll B., (2010) Home-Based Activity Program for Older People With Depressive Symptoms: DeLLITE A Randomized Controlled Trial Annals of Family Medicine 8:214-223 (2010) Louch, P. (2008) Depression in Primary Care [On Line] Available at http://www.depression-primarycare.co.uk/ [Accessed 14 May 2010] Mather, A.S., Rodriguez, C., McMurdo, M.E.T. (2002) Effects of Exercise on Depressive Symptoms in Older Adults with Poorly Responsive Depressive Disorder The British Journal of Psychiatry (2002) 180: 411-415 McKenna, H., Cutliffe, J., McKenna, P., (1999) Evidence-based practice: demolishing some myths. Nursing Standard. 14, 16, 39-42. Date of acceptance: November 15 1999. McMaster Clinical Epidemiology Group (1997) Evidence Based Practice Resources [On Line] Available at http://hsl.mcmaster.ca/resources/topic/eb/nurse.html [Accessed 20 May 2010] Mead, G.E., Morley, W., Campbell, P., Greig, C.A., McMurdo, M., Lawlor, D.A. (2008) Exercise for depression. Cochrane Database of Systematic Reviews 2008. Issue 4. Art. No. CD004366.   Melnyk, B. M., Fineout-Overholt, E. (2005). Evidence-based practice in nursing healthcare: A guide to best practice. Philadelphia, PA: Lippincott Williams Wilkins. Mental Health Foundation (2007) Depression and Suicide in Later Life [On Line] Available at http://www.mentalhealth.org.uk/information/mental-health-a-z/depression-and-suicide-in-later-life/?locale=en [Accessed 12 May 2010] London: Mental Health Foundation National Institute for Health and Clinical Excellence (2005) Depression: Management of depression in primary and secondary care National Institute for Health and Clinical Excellence National Institute for Clinical Excellence (2007) Developing Clinical Questions [Online] Available at: http://www.nice.org.uk/niceMedia/pdf/GuidelinesManualChapter5.pdf [Accessed 8 May 2010] NHS Choices (2010) Treating Depression [On Line] Available at http://www.nhs.uk/conditions/depression/pages/treatment.aspx [Accessed 16 May 2010] Nouri, F.M. Lincoln, N.B. (1987) An Extended Activities of Daily Living Index for stroke patients. Clinical Rehabilitation 1987; 1:301-5. Osborn, P.J., Fletcher, A.E., Smeeth, L., Stirling, S., Bulpitt, C., Nunes, M., Breeze, E., Edmond, S.W.Ng., Jones, D., Tulloch, A. (2003) Performance of a single screening question for depression in a representative sample of 13,670 people aged 75 and over in the UK: Results from the MRC trial of assessment and management of older people in the community. Family Practice; 20: 6, 682-684 Palsson, S., Ostling, S., Skoog, I. (2001) The incidence of first onset depression in a population followed from the age of 70 to 85.Psychol Med 2001; 31: 1159-68. Polit, D.F., Beck, C.T., and Hungler, B.P. (2001) Essentials of nursing research methods, appraisal and utilisation. (5th Ed.) Philadelphia; Lippincott. Sibbald, B. Roland, M. (1998) Understanding controlled trials: Why are randomised controlled trials important? BMJ 1998; 316:201 (17  January) Sjosten, N., Kivela, S.L., (2006) The effects of physical exercise on depressive symptoms among the aged: a systematic review. Int J Geriatr Psychiatry. 2006 May; 21(5):410-8 Teresi, J., Abrams, R., Holmes, D., Ramirez, M., Eimicke, J. (2001) Prevalence of depression and depression recognition in nursing homes. Soc Psychiatry Psychiatr Epidemiol 2001; 36: 613-29. Thames Valley University (2010a) Library Services Databases A-Z [Online] Available at: http://lrs.tvu.ac.uk/eresources/atozlist.jsp?id= [Accessed 2nd May 2010] Thames Valley University (2010b) Library Services Databases A-Z [Online] Available at: http://lrs.tvu.ac.uk/eresources/atozlist.jsp?id= [Accessed 2nd May 2010] Timmins, F. McCabe, C. (2005) How to conduct an effective literature search Nursing Standard November 23: vol 20 no 11 Appendix 1 Copies of Search Strategies