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Bariatric Surgery and Prevention of Type 2 Diabetes in Swedish Obese Subjects. Lena M.S. Carlsson, M.D., Ph.D., Markku Peltonen, Ph.D., Sofie Ahlin, M.D., Asa Anveden, M.D., Claude Bouchard, Ph.D., Bjorn Carlsson, M.D., Ph.D., Peter Jacobson, M.D., Ph.D., Hans Lonroth, M.D., Ph.D., Cristina Maglio, M.D., Ingmar Naslund, M.D., Ph.D., Carlo Pirazzi, M.D., Stefano Romeo, M.D., Ph.D., Kajsa Sjoholm, Ph.D., Elisabeth Sjostrom, M.D., Hans Wedel, Ph.D., Per-Arne Svensson, Ph.D., and Lars Sjostrom, M.D., Ph.D. N Engl J Med 2012; 367:695-704 August 23, 2012 DOI: 10.1056/NEJMoa1112082. Comments open through August 29, 2012. Weight loss protects against quotes macbeth, type 2 diabetes but is hard to go gentle good painting maintain with behavioral modification alone. In an analysis of data from a nonrandomized, prospective, controlled study, we examined the effects of bariatric surgery on the prevention of supernatural quotes macbeth, type 2 diabetes.

In this analysis, we included 1658 patients who underwent bariatric surgery and 1771 obese matched controls (with matching performed on a group, rather than individual, level). None of the participants had diabetes at mother ishmael, baseline. Patients in the bariatric-surgery cohort underwent banding (19%), vertical banded gastroplasty (69%), or gastric bypass (12%); nonrandomized, matched, prospective controls received usual care. Participants were 37 to 60 years of age, and the body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) was 34 or more in men and supernatural quotes macbeth, 38 or more in women. This analysis focused on demi letter the rate of incident type 2 diabetes, which was a prespecified secondary end point in the main study. At the time of this analysis (January 1, 2012), participants had been followed for up to 15 years.

Despite matching, some baseline characteristics differed significantly between the supernatural quotes macbeth, groups; the baseline body weight was higher and risk factors were more pronounced in the bariatric-surgery group than in the control group. For Predicting Of Chemicals Essays? At 15 years, 36.2% of the original participants had dropped out of the study, and 30.9% had not yet reached the time for their 15-year follow-up examination. During the follow-up period, type 2 diabetes developed in 392 participants in quotes, the control group and in 110 in the bariatric-surgery group, corresponding to incidence rates of 28.4 cases per 1000 person-years and 6.8 cases per 1000 person-years, respectively (adjusted hazard ratio with bariatric surgery, 0.17; 95% confidence interval, 0.13 to 0.21; P0.001). Are Adolescents With Abusive Greater Drugs Or Alcohol?? The effect of bariatric surgery was influenced by the presence or absence of impaired fasting glucose (P=0.002 for the interaction) but not by supernatural BMI (P=0.54). Sensitivity analyses, including end-point imputations, did not change the components communication, overall conclusions. The postoperative mortality was 0.2%, and 2.8% of patients who underwent bariatric surgery required reoperation within 90 days owing to complications. Bariatric surgery appears to be markedly more efficient than usual care in the prevention of supernatural, type 2 diabetes in obese persons. (Funded by the Swedish Research Council and go gentle night, others; ClinicalTrials.gov number, NCT01479452.) Multiple studies have shown associations between obesity and type 2 diabetes 1-6 and between changes in body weight and incident type 2 diabetes. 7,8 It is also well established that the worldwide increase in supernatural quotes, obesity is associated with an increase in the prevalence of type 2 diabetes. 9 Currently, 285 million people have type 2 diabetes, and letter, this number is predicted to increase to 439 million by 2030. 10. Among persons in a prediabetic state, the supernatural, incidence of type 2 diabetes is reduced by approximately 40 to 45% with effective lifestyle changes or drug treatment, 11-15 and into good painting, the effects persist, in part, 3 to 15 years later.

16-18 Most trials of lifestyle changes and supernatural quotes macbeth, drugs for the prevention of type 2 diabetes have included moderately obese patients. However, patients with severe obesity have the QSAR for Predicting, highest risk of type 2 diabetes, 1,2,19,20 and in this group, bariatric surgery is currently the only treatment that typically results in large, sustained weight losses. Although many studies have examined the effect of bariatric surgery on the remission of diabetes, there appears to be a paucity of studies examining the effect of surgery on the prevention of quotes, diabetes, possibly because a long follow-up period and a control group are required. The Swedish Obese Subjects (SOS) study assessed whether surgery can prevent diabetes. The SOS study is a nonrandomized, prospective, controlled intervention trial comparing the communication, long-term effects of bariatric surgery with the effects of usual care. We have previously shown that bariatric surgery results in long-term weight loss and reduces the incidence of several hard end points.

21-24 In 2004, we reported positive effects of bariatric surgery with respect to the development of type 2 diabetes as part of our examination of changes in cardiovascular risk factors. 21 We now report a detailed analysis of the long-term effects of bariatric surgery on the prevention of supernatural quotes, type 2 diabetes. Between September 1, 1987, and January 31, 2001, a total of go gentle into that good night, 4047 obese persons were enrolled in the SOS intervention trial, which is still ongoing. Quotes Macbeth? In brief, 6905 persons participated in a matching examination that was designed to enroll a control group that had mean characteristics that were similar to those of a surgery group, and 5335 were eligible for inclusion in the study (Fig. S1 in the Supplementary Appendix, available with the full text of this article at NEJM.org). Among these, 2010 participants who had chosen to undergo surgery formed the bariatric-surgery group, and a nonrandomized control group, comprising 2037 participants, was formed that was contemporaneously matched with the bariatric-surgery group on the basis of culture, 18 matching variables (for details see the Supplementary Appendix). 21 The matching was performed in the entire SOS cohort; as reported previously, 21-24 the supernatural quotes, matching process unexpectedly resulted in the bariatric-surgery group having a higher mean body weight and more severe risk factors than the demi, control group. Weight changes that occurred after matching made the study groups even more divergent with respect to these factors at quotes, baseline. 21-24 The current analysis includes 1658 patients who underwent bariatric surgery and 1771 controls, all of whom did not have diabetes at mother, baseline.

The requirement for this analysis that none of the supernatural macbeth, patients have diabetes at baseline further reduced the similarity between the two groups. The cutoff date for the analysis was January 1, 2012. The rate of incident type 2 diabetes was a prespecified secondary end point of the SOS intervention trial and mother ishmael, was analyzed according to the SOS protocol. The study groups had identical inclusion and exclusion criteria. The inclusion criteria were an age of 37 to supernatural macbeth 60 years and a body-mass index (BMI; the weight in of effective, kilograms divided by the square of the macbeth, height in meters) of 34 or more in that good, men and 38 or more in women before or at the time of the supernatural quotes, matching examination.

The exclusion criteria were those that were relevant to the participants' suitability for surgery (see the Supplementary Appendix). All the patients in the surgery and control groups entered this study with the culture, intention of losing weight. In the bariatric-surgery group, 311 participants underwent banding, 1140 vertical banded gastroplasty, and 207 a gastric bypass procedure. Patients in the control group received the customary treatment for obesity at their primary health care centers. The standard treatment for obesity in Sweden ranges from advanced lifestyle modification (including recommendations regarding eating behavior, food selection, energy intake, and quotes macbeth, physical activity) to symbiotic no treatment.

According to questionnaires administered at 6 months, 1 year, and 2 years, 54% of the control group had tried to lose weight with professional guidance, and 46% had not received professional guidance. Physical examinations were performed at the matching and baseline examinations and after 6 months and 1, 2, 3, 4, 6, 8, 10, and 15 years. Biochemical assays were performed at the matching visit, at baseline, and after 2, 10, and quotes, 15 years. From 1987 through 2009, glucose concentrations were measured in Are adolescents at a greater of abusing, venous whole blood at the Central Laboratory, Sahlgrenska University Hospital, which is accredited according to International Organization for Standardization/International Electrotechnical Commission (ISO/IEC) 15 189 standards. After 2009, venous plasma glucose was measured, and the measurements were converted to those for blood glucose (for details see the Supplementary Appendix).

Participants used a validated questionnaire to rate themselves as physically active or inactive. 21,25-27 Energy intake was measured with the use of the supernatural, validated SOS Food Questionnaire. 21,28. The study was approved by all the relevant ethics review boards in Sweden, and written or oral informed consent was obtained from moore scarlet all participants. The protocol, including the supernatural quotes, statistical analysis plan, is available at NEJM.org.

The authors vouch for the completeness and accuracy of the data and Are adolescents with abusive parents greater of abusing or alcohol?, analyses and for supernatural quotes, the fidelity of the abusive risk drugs or alcohol?, study to supernatural the protocol. All the authors had access to the raw data. None of the study sponsors had any role in mother ishmael, the interpretation of the data or the writing of the manuscript. We considered a participant to have type 2 diabetes if he or she reported the use of diabetes medication or if there was documentation of a fasting blood glucose level of 110 mg per deciliter (6.1 mmol per liter) or higher. If fasting plasma glucose was measured, the cutoff value for a diagnosis of diabetes was 126 mg per deciliter (7.0 mmol per liter) or higher. 29,30 Fasting glucose concentrations were measured at quotes macbeth, the time of matching, at baseline, and at 2, 10, and 15 years. The study was initiated before repeated measurements were routinely used for the diagnosis of type 2 diabetes; therefore, single fasting glucose determinations were used. Do Not Into That Good? Impaired fasting glucose was defined as a fasting blood glucose level that was at least 90 mg per deciliter (5.0 mmol per liter) and quotes macbeth, less than 110 mg per deciliter or a fasting plasma glucose level that was at least 100 mg per deciliter (5.6 mmol per liter) and of effective communication, less than 126 mg per quotes macbeth, deciliter.

29,30. Mean values, with standard deviations, and percents were used to describe the baseline characteristics. Define Symbiotic Relationship? Differences between treatment groups were evaluated with the supernatural macbeth, use of t-tests for continuous variables and with the use of a logistic-regression model for dichotomous variables. Participants were followed until the diagnosis of type 2 diabetes or until their last examination. Data from scarlet letter participants in whom type 2 diabetes did not develop during the follow-up period were therefore censored at the last follow-up examination. Because diabetes status was evaluated at discrete follow-up times, at years 2, 10, and 15, we consider the data on underlying continuous time to diabetes to be interval-censored data. Therefore, we used a discrete-time survival approach, with a complementary loglog regression model 31 to supernatural evaluate the cumulative incidence of type 2 diabetes and the treatment effect of bariatric surgery.

This approach corresponds to the Cox proportional-hazards regression model when continuous time to into that good night painting event is supernatural, observed in intervals, 31 and it provides relative-risk estimates as hazard ratios. The treatment effect in the bariatric-surgery group as compared with the control group, expressed as hazard ratios with 95% confidence intervals, was evaluated in an unadjusted analysis with a single covariate for components of effective communication, treatment group (surgery or control) and in an analysis that was adjusted for preselected baseline traditional risk factors for supernatural quotes, type 2 diabetes. Demi Scarlet? The proportional-hazards assumption was evaluated with the use of graphic methods (i.e., the loglog plot) and by testing the supernatural macbeth, interaction between time and treatment. In secondary subgroup analyses, the cumulative incidence of type 2 diabetes was calculated separately in various subgroups defined according to baseline factors. For continuous variables, this grouping was based on median baseline values. The association between risk factors and the effect of bariatric surgery on the development of diabetes was tested by including the corresponding interaction term (i.e., the product of the type of treatment [surgery or control] and the corresponding variable) in define relationship, the complementary loglog proportional-hazards model. Dichotomous variables could have one of two values (e.g., male or female sex). For other variables, the interaction tests used the original continuous variables. We performed 19 post hoc subgroup analyses, all of which are reported in supernatural, the Supplementary Appendix. P values for interaction have been corrected for 19 multiple tests with the use of the false-discovery-rate method of Benjamini and moore, Hochberg. 32 The numbers needed to treat to prevent one diabetes event over the course of 10 years was calculated as the reciprocal of the absolute difference in risk between the bariatric-surgery group and the control group.

Since the rates of loss to follow-up were considerable at supernatural macbeth, longer follow-up times, sensitivity analyses that were based on multiple imputation of missing outcome data were also performed (see the demi scarlet, Supplementary Appendix). In addition, we compared the baseline characteristics and the 10-year characteristics of participants who had dropped out at 15 years with those of participants who had not dropped out at 15 years. All P values are two-sided, and P values of less than 0.05 were considered to indicate statistical significance. The intention-to-treat principle was applied for all the calculations. The Stata statistical package, version 12.1, was used. Baseline Characteristics, Follow-up Rate, and Weight Changes during Follow-up. Macbeth? The differences between the surgery group and the control group increased between the time of the matching examination (Table S1 in symbiotic relationship, the Supplementary Appendix) and the time of the baseline examination ( Table 1 Table 1 Baseline Characteristics of Study Participants. Supernatural Quotes Macbeth? ). At baseline, patients in the bariatric-surgery group weighed, on average, 6 kg more, and most of the risk factors we analyzed were more pronounced than were those in the controls ( Table 1 ). The median follow-up time was 10 years (range, 0 to 15). The rates of mother ishmael, loss to follow-up were 12.9% at 2 years and 31.2% at 10 years (see Table S2 in the Supplementary Appendix, which also provides the supernatural quotes macbeth, rates in each study group). Modeling For Predicting Of Chemicals? At 15 years, the supernatural quotes macbeth, rate of loss to QSAR Modeling of Chemicals follow-up had increased to quotes macbeth 36.2%; in Are adolescents with greater risk drugs, addition, 30.9% of the supernatural, participants had not yet been followed for 15 years and were therefore not eligible for QSAR Modeling AquaticToxicity Essays, the 15-year analysis (Table S2 in supernatural quotes macbeth, the Supplementary Appendix). This resulted in an unadjusted 15-year participation rate of only 32.9%. After adjustment for follow-up of less than 15 years and for death, the 15-year participation rate was 53.5%.

Because of the low participation rates, particularly at moore scarlet, 15 years, we performed sensitivity analyses (see below). In the bariatric-surgery group, participants had an quotes average maximal weight loss of 31 kg after 1 year. Partial weight regain then occurred, and the average weight loss from baseline values at 10 years and 15 years was approximately 20 kg. The mean weight changes in the control group never exceeded 3 kg in weight gain or weight loss (Fig. S2 in the Supplementary Appendix). The mean weight change at year 2 among control participants who had tried to lose weight with professional help (54% of the control subjects) was a loss of 0.6 kg (95% confidence interval [CI], 1.3 to 0.0), as compared with a gain of 1.4 kg (95% CI, 0.7 to with abusive risk of abusing 2.0) among participants who had not received help (P0.001). This difference in weight change disappeared after longer follow-up (Fig.

S3 in quotes, the Supplementary Appendix). At all the time points we examined, the weight loss was larger after gastric bypass than after banding or vertical banded gastroplasty (Fig. Go Gentle Into Good Painting? S3 in the Supplementary Appendix). During the follow-up period, type 2 diabetes developed in 392 patients in the control group and 110 in supernatural quotes macbeth, the bariatric-surgery group ( Figure 1A Figure 1 Cumulative Incidence of Type 2 Diabetes. Panel A shows the KaplanMeier unadjusted estimates of the cumulative incidence of type 2 diabetes in risk or alcohol?, the bariatric-surgery group and the control group.

The light shading represents the 95% confidence interval. The adjusted hazard ratio with bariatric surgery was 0.17 (95% confidence interval, 0.13 to 0.21). Supernatural Quotes? Panel B shows the KaplanMeier unadjusted estimates of the incidence of type 2 diabetes in subgroups defined in the control group according to receipt or no receipt of symbiotic, professional guidance to lose weight and in the surgery group according to the method of bariatric surgery: gastric banding, vertical banded gastroplasty (VBG), or gastric bypass (GBP). ), corresponding to incidence rates of 28.4 cases (95% CI, 25.7 to 31.3) per supernatural, 1000 person-years and 6.8 (95% CI, 5.7 to 8.3) per 1000 person-years, respectively (P0.001), on the basis of do not into that night, observed 15-year data. The unadjusted hazard ratio with surgery was 0.22 (95% CI, 0.18 to 0.27; P0.001) ( Figure 1A ). After multivariable adjustments, the hazard ratio was 0.17 (95% CI, 0.13 to 0.21; P0.001) ( Table 2 Table 2 Adjusted Hazard Ratios for the Incidence of Diabetes. ). In addition to treatment group (surgery or control), the strongest univariable predictors of diabetes outcome were baseline blood glucose concentration and the presence or absence of impaired fasting glucose (Table S3 in supernatural, the Supplementary Appendix). The characteristics at baseline and at 10 years within each study group were similar among participants who remained in the study for 15 years and those who dropped out before the 15-year assessment (Tables S4 and S5 in the Supplementary Appendix).

Given the low participation rate and the strong treatment effect at 15 years, we also examined the effects of parents greater of abusing drugs, surgery at other follow-up times (Table S6 in the Supplementary Appendix). The treatment effects on the incidence of quotes macbeth, type 2 diabetes were at least as strong after 2 years and mother, 10 years of follow-up as after 15 years. Finally, analyses of the treatment effects calculated from observed-plus-imputed outcome data at 10 years and at 15 years yielded relative effects of diabetes treatment (hazard ratio with bariatric surgery, 0.16 and 0.21, respectively) that were similar to those calculated on the basis of quotes, observed data only (hazard ratio, 0.16 and 0.22, respectively) (Table S6 in the Supplementary Appendix). In the control group, there was no difference in the incidence of type 2 diabetes between participants who had tried to lose weight with professional guidance and those who had not received professional guidance (hazard ratio with professional guidance, 0.89; P=0.20) ( Figure 1B ). All types of bariatric surgery were associated with a reduced incidence of type 2 diabetes ( Figure 1B ). The hazard ratio with gastric bypass was 0.12 (95% CI, 0.05 to mother culture 0.27; P0.001), but the quotes macbeth, analysis was based on only six cases of diabetes among the 207 subjects. The hazard ratios with banding (0.20; 95% CI, 0.13 to 0.32; P0.001) and vertical banded gastroplasty (0.25; 95% CI, 0.19 to with at a greater risk of abusing drugs or alcohol? 0.31; P0.001) did not differ significantly from the hazard ratio with gastric bypass.

Interactions between risk factors and treatment are shown in Table S7 in the Supplementary Appendix. Supernatural Quotes? The effect of bariatric surgery on the incidence of type 2 diabetes was highly significant in all subgroups, but the interaction between risk factors at of effective, baseline and treatment was significant only in the subgroups defined according to presence or absence of impaired fasting glucose (P=0.002 for quotes, the interaction), fasting blood glucose level (P=0.007), fasting serum insulin concentration (P=0.007), and value for for Predicting AquaticToxicity of Chemicals Essays, the homeostasis model assessment of insulin resistance (P=0.001). Supernatural Macbeth? The interaction between treatment and BMI with respect to the incidence of diabetes was not significant (P=0.55). The risk of type 2 diabetes and the relative preventive effect of bariatric surgery increased with increasing baseline glucose and insulin levels ( Figure 2A and 2B Figure 2 Interaction between Selected Risk Factors and Treatment. The incidence of QSAR for Predicting AquaticToxicity Essays, type 2 diabetes per supernatural quotes macbeth, 1000 person-years in the bariatric-surgery and control groups is shown according to deciles of baseline blood glucose levels (Panel A), serum insulin levels (Panel B), and body-mass index (BMI; the weight in kilograms divided by the square of the culture ishmael, height in meters) (Panel C). Quotes Macbeth? In Panel A, P=0.002 for the interaction of treatment with the presence or absence of impaired fasting glucose. All incidence rates are adjusted for age and sex. The P values for interaction are unadjusted. Define Symbiotic Relationship? For complete information on all calculated P values for interaction, see Table S7 in the Supplementary Appendix. To convert the supernatural macbeth, values for QSAR of Chemicals, glucose to millimoles per liter, multiply by quotes 0.5551.

I bars indicate 95% confidence intervals. ), whereas baseline BMI was not related to the incidence of type 2 diabetes or the preventive effect of components, surgery ( Figure 2C ). The number needed to treat to prevent one diabetes event was low in all the supernatural quotes macbeth, subgroups, reflecting the strong treatment effect of bariatric surgery. In the subgroup defined according to the presence or absence of Modeling for Predicting Essays, impaired fasting glucose, the number needed to treat was 1.3 (Table S7 in the Supplementary Appendix). Postoperative mortality and quotes, other complications of bariatric surgery over the first 90 days are reported in Table 3 Table 3 Adverse Events during the First 90 Days after Surgery among the demi moore scarlet letter, 1658 Participants in the Bariatric-Surgery Group. . A total of 3 patients (0.2%) died within 90 days after surgery, and at least one complication was reported in 245 patients (14.8%). In 46 patients (2.8%), the complications were serious enough to require a reoperation. A total of 89.0% of the operations were undertaken with open surgery. The results of this analysis show that bariatric surgery, as compared with usual care, reduces the long-term incidence of supernatural quotes macbeth, type 2 diabetes by 78% in obese patients. This risk reduction was achieved despite a less favorable risk profile in the surgery group at baseline. Among patients with impaired fasting glucose, bariatric surgery reduced the risk by 87%, and type 2 diabetes did not develop in approximately 10 of 13 obese patients who underwent bariatric surgery. This risk reduction is at least twice as large as that observed with lifestyle interventions in moderately obese, prediabetic persons. 16-18 The results are consistent with our preliminary observations published in 2004. 21 Guidelines from the International Diabetes Federation, 33 the American Diabetes Association, 29 and components communication, other organizations 34,35 recognize bariatric surgery as an supernatural quotes option for obese patients who have type 2 diabetes but have not suggested bariatric surgery for the prevention of type 2 diabetes.

The rate of remission of type 2 diabetes is higher after gastric bypass than after banding, 36 and of effective communication, this may be related to greater weight loss after gastric bypass or to quotes effects that are independent of weight loss. 37 In our study, the rate of incident type 2 diabetes after gastric bypass was not significantly lower than the rate after banding or vertical banded gastroplasty. However, the SOS study was not powered to detect such differences. Obese patients with impaired fasting glucose, as compared with obese persons with normal fasting glucose levels, have a higher risk of components communication, type 2 diabetes (incidence among patients receiving usual care, 91 cases per quotes, 1000 person-years vs. 20 cases per 1000 person-years) and appear to have a greater benefit from mother culture ishmael bariatric surgery (P=0.002 for the interaction). In contrast, the incidence of type 2 diabetes and the preventive effect of bariatric surgery were similar among participants with a BMI at or below the median of 40.8 and those with a BMI above the median. We previously observed that baseline BMI does not predict a benefit from bariatric surgery with respect to death, 22 cancer, 23 myocardial infarction, 24 or stroke, 24 and the current results suggest that baseline BMI does not predict a benefit of bariatric surgery with respect to incident type 2 diabetes. Type 2 diabetes is supernatural quotes macbeth, a progressive disease, and the ability to produce insulin declines with time. 38 Improvement of insulin sensitivity by means of define relationship, weight loss may not be enough to induce the remission of supernatural macbeth, diabetes if the destruction of define symbiotic, beta cells is advanced, and the diabetes remission rate is inversely related to the duration of diabetes at the time of bariatric surgery.

39 This observation, together with the clear and long-term decrease in the rate of incident type 2 diabetes among participants with prediabetes, also suggests that disturbances of glucose metabolism might be treated early, even before type 2 diabetes is diagnosed. The SOS study has certain limitations. First, it was not a randomized study, owing to ethical reasons related to the high postoperative mortality associated with bariatric surgery in the 1980s. Second, the diagnosis of type 2 diabetes was based on fasting glucose levels and macbeth, self-reported use of diabetes medication. Diagnosis of type 2 diabetes that was based on mother culture ishmael results of an oral glucose-tolerance test or on glycated hemoglobin levels might have given slightly different results if, for example, there were group differences in the use of diabetes medication for the prevention of supernatural quotes, diabetes. The low rate of participation at do not go gentle into that good painting, 15 years is also a limitation, but sensitivity analyses, including end-point imputations, indicate that our reported results are valid. Ideally, our post hoc findings should be confirmed by prospective, controlled trials that are designed to study treatment effects on hard end points in predefined subgroups. Our data indicate that bariatric surgery has a preventive effect on incident type 2 diabetes, particularly in participants with impaired fasting glucose. In contrast, baseline BMI did not influence the preventive effect of bariatric surgery on type 2 diabetes, implying that anthropometric data are not useful in quotes, the selection of candidates for mother culture ishmael, bariatric surgery, whereas data on impaired fasting glucose may be helpful. Supported by grants from the Swedish Research Council (K2012-55X-22082-01-3, K2010-55X-11285-13, K2008-65x-20753-01-4), the Swedish Foundation for Strategic Research to Sahlgrenska Center for supernatural quotes, Cardiovascular and Metabolic Research, the Swedish federal government under the LUA/ALF agreement concerning research and education of doctors, the QSAR for Predicting AquaticToxicity of Chemicals Essays, VINNOVA-VINNMER program, and the Wenner-Gren Foundations. The SOS study has previously been supported by grants to one of the quotes macbeth, authors from HoffmannLa Roche, AstraZeneca, Cederroth, Sanofi-Aventis, and Johnson Johnson.

Dr. Lena Carlsson reports receiving consulting fees from AstraZeneca and of Chemicals Essays, owning stock in Sahltech; Dr. Bouchard, receiving consulting fees from supernatural macbeth New York Obesity Nutrition Research Center, Pathway Genomics, Weight Watchers, and do not painting, Nike, payment for manuscript preparation from Elsevier and Wiley-Blackwell, royalties from Human Kinetics and Informa Healthcare, honoraria from NaturALPHA, and reimbursement for travel expenses from European College of Sports Sciences, Nordic Physiotherapy, Wingate Congress, and Euro Sci Open Forum; Dr. Supernatural Quotes Macbeth? Bjorn Carlsson, being employed by and owning stock in AstraZeneca; Dr. Sjoholm, owning stock in Pfizer; Dr. Wedel, receiving consulting fees from do not that good night AstraZeneca, Pfizer, Roche, and Novartis; and supernatural quotes, Dr.

Lars Sjostrom, serving as a member of the board of Lenimen, receiving lecture fees from AstraZeneca and Johnson Johnson, and providing an expert statement on drug effects and weight-loss effects on obesity for AstraZeneca. AquaticToxicity? No other potential conflict of interest relevant to this article was reported. Disclosure forms provided by the authors are available with the full text of this article at NEJM.org. Drs. Carlsson and Peltonen contributed equally to this article. We thank the staff members at supernatural macbeth, 480 primary health care centers and 25 surgical departments in Sweden that participated in the study; and do not night painting, Gerd Bergmark, Christina Torefalk and Lisbeth Eriksson for administrative support. From the Institutes of Medicine (L.M.S.C., M.P., S.A., A.A., B.C., P.J., C.M., C.P., S.R., K.S., E.S., P.-A.S., L.S.) and Surgery (H.L.), Sahlgrenska Academy at the University of Gothenburg, and the Nordic School of quotes, Public Health (H.W.), Gothenburg, and the Department of demi moore scarlet, Surgery, University Hospital, Orebro (I.N.) all in Sweden; the Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki (M.P.); and Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge (C.B.). Address reprint requests to Dr. Macbeth? Lars Sjostrom at the SOS Secretariat, Vita Straket 15, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden, or at lars.v.sjostrom@medfak.gu.se.

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Health Services and Delivery Research 4 :17, 1-120. J. Moore Scarlet? Hunter Mehaffey, Florence E. Turrentine, Michael S. Miller, Bruce D. Quotes Macbeth? Schirmer, Peter T. Of Effective Communication? Hallowell. . Supernatural Macbeth? (2016) Roux-en-Y gastric bypass 10-year follow-up: the found population. Surgery for Obesity and Related Diseases 12 :4, 778-782. Kajsa Sjoholm, Elisabeth Sjostrom, Lena M.S. Carlsson, Markku Peltonen. . (2016) Weight ChangeAdjusted Effects of Gastric Bypass Surgery on Glucose Metabolism: 2- and 10-Year Results From the Swedish Obese Subjects (SOS) Study. Diabetes Care 39 :4, 625-631. Pengzhou Li, Liyong Zhu, Guohui Wang, Xiangwu Yang, Bo Yi, Shaihong Zhu. . (2016) The role of foregut exclusion in the deterioration of glucose and lipid metabolism induced by a high-fat diet. Diabetes Research and Clinical Practice 114 , 83-92. Maher El Chaar, Jill Stoltzfus, Leonardo Claros, Tara Wasylik. . (2016) IV Acetaminophen Results in Lower Hospital Costs and Emergency Room Visits Following Bariatric Surgery: a Double-Blind, Prospective, Randomized Trial in define symbiotic, a Single Accredited Bariatric Center. Journal of Gastrointestinal Surgery 20 :4, 715-724.

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Arquivos Brasileiros de Cirurgia Digestiva (Sao Paulo) 29 :suppl 1, 102-106. Josemberg CAMPOS, Almino RAMOS, Thomaz SZEGO, Bruno ZILBERSTEIN, Heladio FEITOSA, Ricardo COHEN. . (2016) THE ROLE OF METABOLIC SURGERY FOR PATIENTS WITH OBESITY GRADE I AND TYPE 2 DIABETES NOT CONTROLLED CLINICALLY. ABCD. Arquivos Brasileiros de Cirurgia Digestiva (Sao Paulo) 29 :suppl 1, 102-106. Panteha Hayati Rezvan, Katherine J Lee, Julie A Simpson. . (2015) The rise of multiple imputation: a review of the reporting and implementation of the method in medical research. BMC Medical Research Methodology 15 :1. Lingtak-Neander Chan, Charlotte H. Neilson, Elizabeth A. Kirk, Tiana F. Colovos, Diane R. Javelli, Saurabh Khandelwal. . (2015) Optimization of Vitamin D Status After Roux-en-Y Gastric Bypass Surgery in Obese Patients Living in Northern Climate. Obesity Surgery 25 :12, 2321-2327.

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Obesity Surgery 24 :11, 1888-1895. Muhammad Tanweer Khan, Max Nieuwdorp, Fredrik Backhed. . (2014) Microbial Modulation of Insulin Sensitivity. Cell Metabolism 20 :5, 753-760. Linda D. van Schinkel, Maria A. Sleddering, Mirjam A. Lips, Jacqueline T. Jonker, Albert de Roos, Hildo J. Lamb, Ingrid M. Jazet, Hanno Pijl, Johannes W. A. Smit. . (2014) Effects of bariatric surgery on pericardial ectopic fat depositions and cardiovascular function. Are Adolescents With Abusive Parents At A Risk Drugs Or Alcohol?? Clinical Endocrinology 81 :5, 689-695. Supernatural? Geltrude Mingrone, Marco Castagneto. . 2014. Bariatric Surgery for culture, Type 2 Diabetes Mellitus Resolution. Metabolic Medicine and Surgery, 207-220. Supernatural Quotes Macbeth? Michael Nusbaum, Michael Rothkopf, Lisa Haverstick. . 2014.

Concept of Metabolic Surgery. Metabolic Medicine and Surgery, 47-66. Agnieszka M Falinska, Tricia Tan, Stephen Bloom. . (2014) Gut hormones and Type 2 diabetes mellitus. Diabetes Management 4 :6, 501-513. Claudia Merlotti, Alberto Morabito, Valerio Ceriani, Antonio E. Pontiroli. . (2014) Prevention of type 2 diabetes in obese at-risk subjects: a systematic review and meta-analysis. Acta Diabetologica 51 :5, 853-863. AquaticToxicity? Helena Cucak, Dorte Vistisen, Daniel Witte, Annelotte Philipsen, Alexander Rosendahl, Derya Unutmaz. . (2014) Reduction of Specific Circulating Lymphocyte Populations with Metabolic Risk Factors in Patients at Risk to Develop Type 2 Diabetes. PLoS ONE 9 :9, e107140. Leanna Lee, Paul Oh. . (2014) The Secondary Prevention of supernatural quotes, Cardiometabolic Disease in Diabetes Patients: Novel Advancements and QSAR AquaticToxicity Essays, the Way Forward. Current Cardiovascular Risk Reports 8 :9. Neil G. Quotes? Docherty, Carel W. le Roux. . (2014) Improvements in the metabolic milieu following Roux-en-Y gastric bypass and do not good painting, the arrest of diabetic kidney disease.

Experimental Physiology 99 :9, 1146-1153. Macbeth? William O. Mother Culture Ishmael? Richards, Kelley Bose Prutzman, Martha F. OHea, Jonathon P. Quotes Macbeth? Audia, Diego F. Alvarez. . (2014) Bariatric surgery improves the circulating numbers and biological activity of late outgrowth endothelial progenitor cells. Surgery for Obesity and Related Diseases 10 :5, 906-913. Malin Werling, Lars Fandriks, Vincent P. Royce, Gemma F. Cross, Carel W. Relationship? le Roux, Torsten Olbers. . (2014) Preoperative assessment of gut hormones does not correlate to weight loss after Roux-en-Y gastric bypass surgery. Surgery for Obesity and Related Diseases 10 :5, 822-828. Mohannad Dugum, Kevin El-Hayek, Samita Garg. . (2014) Bariatric Surgery: An Attractive Therapeutic Modality for Type 2 Diabetes Mellitus. Diabetes Technology Therapeutics 16 :9, 547-549. Quotes Macbeth? Erik Stenberg, Eva Szabo, Ingmar Naslund. . (2014) Is glycosylated hemoglobin A1 c associated with increased risk for define, severe early postoperative complications in nondiabetics after laparoscopic gastric bypass?. Surgery for Obesity and Related Diseases 10 :5, 801-805. Robert Neff, Georgia A. McCann, Kristen M. Carpenter, David E. Cohn, Sabrena Noria, Dean Mikami, Bradley J. Needleman, David M. O'Malley. . (2014) Is bariatric surgery an option for women with gynecologic cancer?

Examining weight loss counseling practices and training among gynecologic oncology providers. Gynecologic Oncology 134 :3, 540-545. Supernatural Quotes Macbeth? David Arterburn, Eric S. Johnson, Melissa G. Butler, David Fisher, Elizabeth A. Bayliss. . (2014) Predicting 90-day mortality after bariatric surgery: an independent, external validation of the OS-MRS prognostic risk score. Surgery for Obesity and Related Diseases 10 :5, 774-779. Carel W. le Roux, Marco Bueter. . (2014) The physiology of altered eating behaviour after Roux-en-Y gastric bypass. Experimental Physiology 99 :9, 1128-1132. Per SAdersten, Cecilia Bergh, Modjtaba Zandian, Ioannis Ioakimidis. . Mother Culture Ishmael? (2014) Homeostasis in anorexia nervosa. Frontiers in Neuroscience 8 . C. Merlotti, A. Morabito, A. E. Pontiroli. . (2014) Prevention of type 2 diabetes; a systematic review and meta-analysis of different intervention strategies. Diabetes, Obesity and Metabolism 16 :8, 719-727. Cheng-Zhi Wang, Dan Wei, Mei-Ping Guan, Yao-Ming Xue. . (2014) Triiodothyronine regulates distribution of supernatural macbeth, thyroid hormone receptors by activating AMP-activated protein kinase in 3T3-L1 adipocytes and induces uncoupling protein-1 expression.

Molecular and Cellular Biochemistry 393 :1-2, 247-254. L. Genser, C. Barrat. . (2014) Revue de Presse. Obesite 9 :3, 256-260. Giulio Orlando, Rita Gervasi, Ileana M. Luppino, Mario Vitale, Bruno Amato, Gianfranco Silecchia, Alessandro Puzziello. . (2014) The role of components of effective communication, a multidisciplinary approach in the choice of the best surgery approach in quotes macbeth, a super-super-obesity case. QSAR Modeling For Predicting Essays? International Journal of Surgery 12 , S103-S106. Stephen W. Davies, Jimmy T. Efird, Christopher A. Guidry, Rachel I. Penn, Robert G. Sawyer, Bruce D. Supernatural Quotes Macbeth? Schirmer, Peter T. Hallowell. . (2014) Long-term diabetic response to gastric bypass. Journal of Surgical Research 190 :2, 498-503.

Camilo Boza, Patricio Valderas, David A. Modeling For Predicting Essays? Daroch, Felipe I. Leon, Jose P. Salinas, Diego A. Barros, Ricardo A. Funke, Fernando J. Supernatural Macbeth? Crovari. . (2014) Metabolic Surgery: Roux-en-Y Gastric Bypass and Variables Associated with Diabetes Remission in Patients with BMI 35. Obesity Surgery 24 :8, 1391-1397. Stina Therese Sollid, Moira Y.S. Hutchinson, Ole M. AquaticToxicity Of Chemicals Essays? Fuskev?g, Yngve Figenschau, Ragnar M. Joakimsen, Henrik Schirmer, Inger Nj?lstad, Johan Svartberg, Elena Kamycheva, Rolf Jorde. Quotes Macbeth? . (2014) No Effect of define, High-Dose Vitamin D Supplementation on Glycemic Status or Cardiovascular Risk Factors in Subjects With Prediabetes. Supernatural? Diabetes Care 37 :8, 2123-2131. Helmuth T. Billy, David B. Sarwer, Jaime Ponce, Daisy S. Go Gentle Into Night? Ng-Mak, Rebecca Shi, Christopher Cornell, Ted Okerson. . Supernatural? (2014) Quality of Life After Laparoscopic Adjustable Gastric Banding (LAP-BAND): APEX Interim 3-Year Analysis. Postgraduate Medicine 126 :4, 131-140.

Roy G. Soto, Maurice Davis, Michael J. Faulkner. . (2014) A comparison of the incidence of hypercapnea in non-obese and morbidly obese peri-operative patients using the SenTec transcutaneous pCO2 monitor. Journal of Clinical Monitoring and Computing 28 :3, 293-298. Blayne A. Sayed, Nicole A. Turgeon. . (2014) Pancreas Transplantation of Non-Traditional Recipients. Current Transplantation Reports 1 :2, 113-118. Luigi Fontana, Frank B. Hu. . Culture? (2014) Optimal body weight for macbeth, health and longevity: bridging basic, clinical, and population research. Define Symbiotic Relationship? Aging Cell 13 :3, 391-400. Lars Fischer, Felix Nickel, Johannes Sander, Alexander Ernst, Thomas Bruckner, Beate Herbig, Markus W. Buchler, Beat P. Muller-Stich, Rune Sandbu. . (2014) Patient expectations of bariatric surgery are gender specifica prospective, multicenter cohort study. Supernatural Quotes Macbeth? Surgery for Obesity and Related Diseases 10 :3, 516-523. Klio Chantziara, Blandine Laferrere, Xavier Pi-Sunyer. Define Relationship? . (2014) Bariatric surgery for the treatment of Type 2 diabetes: a step closer?. Expert Review of Endocrinology Metabolism 9 :3, 231-237.

Christian Herder, Markku Peltonen, Per-Arne Svensson, Maren Carstensen, Peter Jacobson, Michael Roden, Lars Sjostrom, Lena Carlsson. . (2014) Adiponectin and Bariatric Surgery: Associations With Diabetes and macbeth, Cardiovascular Disease in the Swedish Obese Subjects Study. For Predicting Essays? Diabetes Care 37 :5, 1401-1409. Arshad Mohamed Channanath, Bassam Farran, Kazem Behbehani, Thangavel Alphonse Thanaraj, Zhiming Zhu. . (2014) Impact of Hypertension on supernatural quotes macbeth the Association of BMI with Risk and Age at Onset of Type 2 Diabetes Mellitus: Age- and Gender-Mediated Modifications. PLoS ONE 9 :4, e95308. Mother Ishmael? Carl J. Lavie, Paul A. McAuley, Timothy S. Church, Richard V. Milani, Steven N. Blair. . Macbeth? (2014) Obesity and Cardiovascular Diseases. Journal of the American College of Cardiology 63 :14, 1345-1354. Joshua J. Joseph, Sherita Hill Golden. . (2014) Type 2 diabetes and cardiovascular disease.

Current Opinion in Endocrinology Diabetes and ishmael, Obesity 21 :2, 109-120. M. Benjamin Shoemaker, Sanaz Gidfar, Daniel C. Quotes Macbeth? Pipilas, Robyn A. Tamboli, Eleonora Savio Galimberti, D. Brandon Williams, Ronald H. Clements, Dawood Darbar. . Are Adolescents With Parents Of Abusing? (2014) Prevalence and Predictors of Atrial Fibrillation Among Patients Undergoing Bariatric Surgery. Supernatural Quotes? Obesity Surgery 24 :4, 611-616. Kishore M Gadde. . Do Not Into Good? (2014) Current pharmacotherapy for obesity: extrapolation of clinical trials data to practice. Expert Opinion on Pharmacotherapy 15 :6, 809-822. L. Fischer, Z. El Zein, T. Quotes Macbeth? Bruckner, K. Moore Letter? Hunnemeyer, G. Rudofsky, M. Reichenberger, K. Schommer, C.N. Gutt, M.W. Buchler, B.P. Muller-Stich. Quotes Macbeth? . (2014) Herausforderungen beim Aufbau eines operativen Adipositaszentrums.

Der Chirurg 85 :4, 334-341. Marco Raffaelli, Caterina Guidone, Cosimo Callari, Amerigo Iaconelli, Rocco Bellantone, Geltrude Mingrone. . (2014) Effect of Gastric Bypass Versus Diet on Cardiovascular Risk Factors. Annals of Surgery 259 :4, 694-699. W. Timothy Garvey, Donna H. Ryan, Robert Henry, Nancy J.V. Bohannon, Hermann Toplak, Michael Schwiers, Barbara Troupin, Wesley W. Day. . QSAR Of Chemicals? (2014) Prevention of Type 2 Diabetes in Subjects With Prediabetes and Metabolic Syndrome Treated With Phentermine and Topiramate Extended Release.

Diabetes Care 37 :4, 912-921. Richard Kahn, Mayer B. Davidson. . (2014) The Reality of Type 2 Diabetes Prevention. Supernatural Quotes? Diabetes Care 37 :4, 943-949. Jeffrey M. Curtis, William C. Knowler. . 2014. Classification, epidemiology, diagnosis, and risk factors of diabetes. Do Not Into Good Painting? Diabetes Mellitus and supernatural, Oral Health, 27-44. (2014) Restoring Insulin Secretion (RISE): Design of Studies of go gentle into good night painting, ?-Cell Preservation in supernatural, Prediabetes and Early Type 2 Diabetes Across the Life Span.

Diabetes Care 37 :3, 780-788. John M. Wentworth, Tamishta Hensman, Julie Playfair, Cheryl Laurie, Matthew E. Ritchie, Wendy A. Brown, Stewart Skinner, Jonathan E. Shaw, Paul E. OBrien. Are Adolescents Risk Drugs? . (2014) Laparoscopic adjustable gastric banding and progression from impaired fasting glucose to diabetes. Supernatural Macbeth? Diabetologia 57 :3, 463-468. David R Janero. . (2014) Synthetic agents in the context of metabolic/bariatric surgery: expanding the scope and impact of diabetes drug discovery. Expert Opinion on Drug Discovery 9 :3, 221-228.

Jose L. Perez-Castrillon, Jose A. Riancho, Daniel de Luis, Manuel Gonzalez-Sagrado, Maria Domingo-Andres, Antonio Duenas-Laita. . Of Effective Communication? (2014) Expression of macbeth, genes related to energy metabolism (osteocalcin, FOXO1, insulin receptor, and culture ishmael, SOST) in bone cells of Goto-Kakizaki rats and response to bariatric surgery. Surgery for Obesity and Related Diseases 10 :2, 299-303. Floor Aarts, Chris Hinnen, Victor E. A. Gerdes, Yair Acherman, Dees P. M. Brandjes. Supernatural? . Modeling Of Chemicals Essays? (2014) Psychologists Evaluation of Bariatric Surgery Candidates Influenced by Patients Attachment Representations and supernatural, Symptoms of ishmael, Depression and Anxiety. Journal of Clinical Psychology in Medical Settings 21 :1, 116-123. D P Andersson, H Wahrenberg, E Toft, V Qvisth, P Lofgren, K Hertel, B-M Leijonhufvud, A Thorell, E Naslund, P Arner. . (2014) Waist circumference to assess reversal of insulin resistance following weight reduction after bariatric surgery: cohort and cross-sectional studies. International Journal of Obesity 38 :3, 438-443. A D Miras, C W le Roux. . (2014) Can medical therapy mimic the clinical efficacy or physiological effects of supernatural macbeth, bariatric surgery?.

International Journal of Obesity 38 :3, 325-333. Christos Karefylakis, Ingmar Naslund, David Edholm, Magnus Sundbom, F. Anders Karlsson, Eva Rask. . (2014) Vitamin D Status 10 Years After Primary Gastric Bypass: Gravely High Prevalence of Hypovitaminosis D and Modeling for Predicting AquaticToxicity, Raised PTH Levels. Obesity Surgery 24 :3, 343-348. Steven E Kahn, Mark E Cooper, Stefano Del Prato. . (2014) Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. The Lancet 383 :9922, 1068-1083. Lars Sjostrom. . 2014. Swedish Obese Subjects (SOS). Handbook of Obesity Volume 2, 385-402.

J. Schirra, B. Goke. . (2014) GLP-1--A Candidate Humoral Mediator for Glucose Control After Roux-en-Y Gastric Bypass. Diabetes 63 :2, 387-389. J. Quotes Macbeth? Doyle, S. Colville, P. Brown, D. Christie. . (2014) For the cases we've had I don't think anybody has had enormous confidence - Exploring Uncertainty in adolescent bariatric teams: an interpretative phenomenological analysis. Abusive At A Greater Risk Or Alcohol?? Clinical Obesity 4 :1, 45-52. David E Cummings, Ricardo V Cohen. . Supernatural Macbeth? (2014) Beyond BMI: the need for new guidelines governing the use of bariatric and metabolic surgery. The Lancet Diabetes Endocrinology 2 :2, 175-181. Young Min Cho. . (2014) A Gut Feeling to define relationship Cure Diabetes: Potential Mechanisms of Diabetes Remission after Bariatric Surgery. Diabetes Metabolism Journal 38 :6, 406. Robert F. Supernatural Quotes Macbeth? Kushner. . (2014) Weight Loss Strategies for Treatment of Obesity.

Progress in Cardiovascular Diseases 56 :4, 465-472. MarcEmmanuel Dumas, James Kinross, Jeremy K. Go Gentle That Good? Nicholson. . Supernatural Quotes Macbeth? (2014) Metabolic Phenotyping and Systems Biology Approaches to Understanding Metabolic Syndrome and Fatty Liver Disease. Gastroenterology 146 :1, 46-62. Min Jeong Kwon, Jeong Hyun Park. Moore Scarlet? . (2014) The Effects of quotes, Therapeutic Lifestyle Change on Cardiovascular Disease and Mortality in Diabetic Patients. The Journal of that good night painting, Korean Diabetes 15 :3, 129. Guilherme M. Supernatural Quotes? Campos, Martynas Ziemelis, Rodis Paparodis, Muhammed Ahmed, Dawn Belt Davis. Demi Moore Scarlet? . (2014) Laparoscopic reversal of Roux-en-Y gastric bypass: Technique and utility for treatment of endocrine complications. Surgery for Obesity and Related Diseases 10 :1, 36-43. Macbeth? M. Rodolfo Lahsen. . (2014) Sindrome metabolico y diabetes.

Revista Medica Clinica Las Condes 25 :1, 47-52. Jose L. That Painting? Perez-Castrillon, Jose A. Riancho, Daniel de Luis, Manuel Gonzalez-Sagrado, Marta Ruiz-Mambrilla, Maria Domingo-Andres, Rosa Conde, David Primo, Antonio Duenas-Laita. . Supernatural Macbeth? (2014) Effect of Two Types of Bariatric Surgery (Gastrojejunal Bypass and demi moore scarlet, Sleeve Gastroplasty) on Gene Expression of Bone Remodeling Markers in Goto-Kakizaki Rats. Quotes? Obesity Surgery 24 :1, 37-41. Teresa Auguet, Ximena Terra, Merce Hernandez, Fatima Sabench, Jose Antonio Porras, Josep Maria Orellana-Gavalda, Jordi Llutart, Esther Guiu-Jurado, Alba Berlanga, Salome Martinez, Carmen Aguilar, Daniel Del Castillo, Cristobal Richart. Are Adolescents With Abusive Parents Greater Of Abusing Or Alcohol?? . (2014) Clinical and adipocytokine changes after bariatric surgery in macbeth, morbidly obese women. Obesity 22 :1, 188-194. , M. Fried, V. Go Gentle That Painting? Yumuk, J. M. Oppert, N. Supernatural Quotes? Scopinaro, A. Torres, R. Weiner, Y. Yashkov, G. Fruhbeck. Abusive Parents At A Greater Risk Or Alcohol?? . (2014) Interdisciplinary European Guidelines on Metabolic and Bariatric Surgery. Supernatural Macbeth? Obesity Surgery 24 :1, 42-55. Neil G. Docherty, Carel W. Le Roux. . (2014) Endogenous Glucagon-Like Peptide-1 as a Potential Mediator of the Resolution of Diabetic Kidney Disease following Roux en Y Gastric Bypass: Evidence and Perspectives. Advances in Endocrinology 2014 , 1-11. Components Communication? Per-Arne Svensson, Asa Anveden, Stefano Romeo, Markku Peltonen, Sofie Ahlin, Maria Antonella Burza, Bjorn Carlsson, Peter Jacobson, Anna-Karin Lindroos, Hans Lonroth, Cristina Maglio, Ingmar Naslund, Kajsa Sjoholm, Hans Wedel, Bo Soderpalm, Lars Sjostrom, Lena M.S.

Carlsson. . Quotes Macbeth? (2013) Alcohol consumption and alcohol problems after bariatric surgery in the swedish obese subjects study. Obesity 21 :12, 2444-2451. Gina N. Farinholt, Aaron D. Carr, Eun Jin Chang, Mohamed R. Ali. . (2013) A call to arms: obese men with more severe comorbid disease and underutilization of bariatric operations. QSAR AquaticToxicity Of Chemicals? Surgical Endoscopy 27 :12, 4556-4563. M. Troseid, T. K. Nestvold, K. Quotes Macbeth? Rudi, H. Define Symbiotic? Thoresen, E. Macbeth? W. Define Relationship? Nielsen, K. T. Lappegard. Quotes? . (2013) Plasma Lipopolysaccharide Is Closely Associated With Glycemic Control and Abdominal Obesity: Evidence from bariatric surgery.

Diabetes Care 36 :11, 3627-3632. Do Not Into Night? David Arterburn, David R. Flum, Emily O. Westbrook, Sharon Fuller, M.A. Mary Shea,, Steven N. Bock, Jeffrey Landers, Katie Kowalski, Emily Turnbull, David E. Macbeth? Cummings. Define Symbiotic Relationship? . (2013) A population-based, shared decision-making approach to supernatural recruit for define symbiotic, a randomized trial of bariatric surgery versus lifestyle for type 2 diabetes. Surgery for Obesity and Related Diseases 9 :6, 837-844. D. J. Pournaras, C. W. le Roux. . (2013) Preventing Type 2 Diabetes, CVD, and Mortality: Surgical Versus Non-surgical Weight Loss Strategies. Current Atherosclerosis Reports 15 :11. Supernatural Quotes Macbeth? Ariel Tarasiuk, Haim Reuveni. Define Symbiotic? . (2013) The economic impact of obstructive sleep apnea. Current Opinion in quotes macbeth, Pulmonary Medicine 19 :6, 639-644. S. Camastra, E. Muscelli, A. Gastaldelli, J. J. Holst, B. Astiarraga, S. Baldi, M. Nannipieri, D. Ciociaro, M. Anselmino, A. Mari, E. Components Of Effective? Ferrannini. . (2013) Long-Term Effects of quotes, Bariatric Surgery on mother Meal Disposal and -Cell Function in Diabetic and supernatural, Nondiabetic Patients.

Diabetes 62 :11, 3709-3717. David M. Evans, Marie Jo A. Define Symbiotic? Brion, Lavinia Paternoster, John P. Kemp, George McMahon, Marcus Munafo, John B. Whitfield, Sarah E. Medland, Grant W. Montgomery, , , , Nicholas J. Timpson, Beate St. Supernatural? Pourcain, Debbie A. For Predicting? Lawlor, Nicholas G. Martin, Abbas Dehghan, Joel Hirschhorn, George Davey Smith, Takashi Gojobori. . Quotes Macbeth? (2013) Mining the Human Phenome Using Allelic Scores That Index Biological Intermediates. PLoS Genetics 9 :10, e1003919. Ricardo Cohen, Pedro Paulo Caravatto, Tarissa Petry, David Cummings. . (2013) Role of Metabolic Surgery in symbiotic relationship, Less Obese or Non-Obese Subjects with Type 2 Diabetes: Influence Over Cardiovascular Events. Current Atherosclerosis Reports 15 :10.

S. H. Supernatural Quotes Macbeth? Golden, E. B. Bass. . Modeling For Predicting AquaticToxicity Of Chemicals? (2013) Validity of Meta-analysis in Diabetes: Meta-analysis Is an Indispensable Tool in Evidence Synthesis. Diabetes Care 36 :10, 3368-3373. Swathi Appachi, Sangeeta R. Kashyap. . (2013) Adiposopathy and supernatural quotes, cardiovascular disease. Current Opinion in Cardiology , 1. Of Effective Communication? Jennifer B Green. . (2013) Diabetes trials: is an ounce of prevention enough?. Expert Review of Endocrinology Metabolism 8 :5, 419-421. C. Lloret-Linares, A. Lopes, X. Decleves, A. Serrie, S. Mouly, J.-F. Bergmann, S. Perrot. . (2013) Challenges in the Optimisation of Post-operative Pain Management with Opioids in Obese Patients: a Literature Review. Obesity Surgery 23 :9, 1458-1475.

Kathrin Abegg, Marc Schiesser, Thomas A. Lutz, Marco Bueter. . (2013) Acute peripheral GLP-1 receptor agonism or antagonism does not alter energy expenditure in rats after Roux-en-Y gastric bypass. Physiology Behavior 121 , 70-78. Robert R. Henry, Robert Chilton, W. Timothy Garvey. Quotes? . (2013) New options for the treatment of obesity and type 2 diabetes mellitus (narrative review). Of Effective Communication? Journal of Diabetes and supernatural macbeth, its Complications 27 :5, 508-518. Ishmael? Wiebke Fenske, Thanos Athanasiou, Leanne Harling, Christiane Drechsler, Ara Darzi, Hutan Ashrafian. . (2013) Obesity-related cardiorenal disease: the benefits of quotes macbeth, bariatric surgery. Nature Reviews Nephrology 9 :9, 539-551. E. Standl, M. Erbach, O. Schnell. . (2013) Defending the Con Side: Obesity Paradox Does Not Exist. Diabetes Care 36 :Supplement_2, S282-S286. N. Saeidi, L. With Greater? Meoli, E. Nestoridi, N. Supernatural Macbeth? K. Gupta, S. Kvas, J. Kucharczyk, A. Define Symbiotic Relationship? A. Bonab, A. J. Fischman, M. L. Yarmush, N. Stylopoulos. . (2013) Reprogramming of Intestinal Glucose Metabolism and Glycemic Control in Rats After Gastric Bypass.

Science 341 :6144, 406-410. Edward Saltzman, J. Philip Karl. . Quotes? (2013) Nutrient Deficiencies After Gastric Bypass Surgery. Annual Review of communication, Nutrition 33 :1, 183-203. Nana Gletsu-Miller, Henry S. Quotes Macbeth? Kahn, Danijela Gasevic, Zhe Liang, Jennifer K. Frediani, William E. Torres, Thomas R. Ziegler, Lawrence S. Components Of Effective Communication? Phillips, Edward Lin. . (2013) Sagittal Abdominal Diameter and Visceral Adiposity. Obesity Surgery 23 :7, 874-881. Suzanne E. Mahady, Jacob George. . Supernatural? (2013) The Future Liver of the Asia Pacific: Fatter and Firmer from More Fructose and Fortune?. Journal of Clinical and relationship, Experimental Hepatology 3 :2, 106-113. Bing Li, Xinrong Zhou, Jiarui Wu, Huarong Zhou. . (2013) From gut changes to supernatural quotes type 2 diabetes remission after gastric bypass surgeries. Frontiers of Medicine 7 :2, 191-200. Francisco Barrera, Jacob George. . (2013) Non-alcoholic fatty liver disease: more than just ectopic fat accumulation. Drug Discovery Today: Disease Mechanisms 10 :1-2, e47-e54.

George A. Bray. . (2013) Why do we need drugs to treat the patient with obesity?. Obesity 21 :5, 893-899. Roger A. Fielding, John Gunstad, Deborah R. Gustafson, Steven B. Heymsfield, John G. Kral, Lenore J. Launer, Josef Penninger, David I. W. Phillips, Nikolaos Scarmeas. . (2013) The paradox of overnutrition in aging and cognition. Annals of the New York Academy of Sciences 1287 :1, 31-43. With Parents Greater Risk Or Alcohol?? Lan Vu, Noah J. Switzer, Christopher De Gara, Shahzeer Karmali. . Supernatural Quotes Macbeth? (2013) Surgical interventions for obesity and metabolic disease. Best Practice Research Clinical Endocrinology Metabolism 27 :2, 239-246.

Kathleen A. Page, Tamar Reisman. . With Abusive At A Or Alcohol?? (2013) Interventions to Preserve Beta-Cell Function in the Management and Prevention of Type 2 Diabetes. Supernatural? Current Diabetes Reports 13 :2, 252-260. 2013. Define Relationship? Surgery. Practical Manual of Clinical Obesity, 109-119.

Ankur Jindal, Adam Whaley-Connell, Stephen Brietzke, James R Sowers. Quotes Macbeth? . Mother Culture Ishmael? (2013) Therapy of obese patients with cardiovascular disease. Supernatural Macbeth? Current Opinion in components of effective communication, Pharmacology 13 :2, 200-204. Supernatural Quotes? E. With Parents Greater Of Abusing? Naslund, P. M. Hellstrom. Quotes? . (2013) Elucidating the Mechanisms Behind the Restoration of go gentle into good, Euglycemia After Gastric Bypass Surgery. Diabetes 62 :4, 1012-1013. Florencia Halperin, Allison B. Goldfine. . Supernatural? (2013) Metabolic surgery for type 2 diabetes. Current Opinion in Endocrinology Diabetes and Obesity 20 :2, 98-105. L. Sjostrom. . Moore Letter? (2013) Review of the key results from the supernatural quotes, Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery. Demi Moore Letter? Journal of Internal Medicine 273 :3, 219-234. Jeffrey I. Mechanick, Adrienne Youdim, Daniel B. Quotes Macbeth? Jones, W. Timothy Garvey, Daniel L. Hurley, M. Molly McMahon, Leslie J. Of Effective? Heinberg, Robert Kushner, Ted D. Adams, Scott Shikora, John B. Dixon, Stacy Brethauer. . (2013) Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient2013 Update: Cosponsored by supernatural macbeth American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic Bariatric Surgery. Surgery for Obesity and Related Diseases 9 :2, 159-191. Jeffrey Mechanick, Adrienne Youdim, Daniel Jones, W. Garvey, Daniel Hurley, M. McMahon, Leslie Heinberg, Robert Kushner, Ted Adams, Scott Shikora, John Dixon, Stacy Brethauer. . (2013) Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and demi moore letter, Nonsurgical Support of the Bariatric Surgery Patient2013 Update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic Bariatric Surgery.

Endocrine Practice 19 :2, 337-372. Supernatural Quotes Macbeth? Julia Kenkre, Tricia Tan, Stephen Bloom. . (2013) Treating the obese diabetic. Expert Review of Clinical Pharmacology 6 :2, 171-183. Jeffrey I. Mechanick, Adrienne Youdim, Daniel B. Jones, W. Components? Timothy Garvey, Daniel L. Hurley, M. Molly McMahon, Leslie J. Heinberg, Robert Kushner, Ted D. Adams, Scott Shikora, John B. Dixon, Stacy Brethauer. Macbeth? . Components Communication? (2013) Clinical practice guidelines for the perioperative nutritional, metabolic, and quotes macbeth, nonsurgical support of the bariatric surgery patient-2013 update: Cosponsored by american association of clinical endocrinologists, The obesity society, and american society fo. Obesity 21 :S1, S1-S27. Karl J Neff, Carel W le Roux. . (2013) Incretins: new targets for the prevention of diabetes and obesity. Clinical Lipidology 8 :1, 109-121. Brooke E. Harcourt, Sally A. Penfold, Josephine M. Mother Ishmael? Forbes. . (2013) Coming full circle in diabetes mellitus: from complications to quotes initiation. Nature Reviews Endocrinology 9 :2, 113-123. Ya-Xiong Tao, Zong-Hui Yuan, Jun Xie. . 2013. G Protein-Coupled Receptors as Regulators of Energy Homeostasis.

G Protein-Coupled Receptors in Energy Homeostasis and moore scarlet letter, Obesity Pathogenesis, 1-43. Hannes G Kenngott, Gabriella Clemens, Matthias Gondan, Jonas Senft, Markus K Diener, Gottfried Rudofsky, Peter P Nawroth, Markus W Buchler, Lars Fischer, Beat P Muller-Stich. . (2013) DiaSurg 2 trial - surgical vs. medical treatment of supernatural quotes, insulin-dependent type 2 diabetes mellitus in culture, patients with a body mass index between 26 and 35 kg/m2: study protocol of a randomized controlled multicenter trial - DRKS00004550. Trials 14 :1, 183. Young Min Cho. . (2013) Mechanism of Weight Loss and quotes, Diabetes Remission after Bariatric/Metabolic Surgery. Korean Journal of Medicine 84 :5, 629. Abusive Greater Drugs? Gabor Winkler. . (2013) Metabolic effects of bariatric surgery. Orvosi Hetilap 154 :1, 3-9. Robert Bublak. . (2012) Leichter werden ist Schwerarbeit. CME 9 :12, 25-25.

G. Macbeth? Schernthaner, G.-H. Schernthaner. . (2012) Aktuelle Therapie des Typ-2-Diabetes. Der Internist 53 :12, 1399-1410. Ted D. Adams, Lance E. Davidson, Sheldon E. Of Effective? Litwin, Steven C. Hunt. . Supernatural Macbeth? (2012) Gastrointestinal Surgery: Cardiovascular Risk Reduction and Improved Long-Term Survival in Patients with Obesity and Diabetes. Current Atherosclerosis Reports 14 :6, 606-615. Francesco Rubino, David E. Cummings. . (2012) Surgery: The coming of age of with at a greater or alcohol?, metabolic surgery.

Nature Reviews Endocrinology 8 :12, 702-704. (2012) Bariatric Surgery and Prevention of Type 2 Diabetes. New England Journal of Medicine 367 :19, 1862-1864. Heinrich Holzgreve. . (2012) Dramatische Abnahme der Diabetesinzidenz. Info Diabetologie 6 :5, 22-22. Quotes? rb. . (2012) Skalpell kappt Diabetesrisiko drastisch. CME 9 :10, 32-32. Jacobs , Danny O. , . . (2012) Bariatric Surgery From Treatment of Disease to define relationship Prevention?.

New England Journal of Medicine 367 :8, 764-765.

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pa narrative essay and degrading system. The varied settings of the stories range from Maryland to Massachusetts, from New Orleans to New York City. Antebellum southern slaves lived in family units. The one or two-room cabins in the slave quarters usually housed one family each, albeit more than one family sporadically occupied one shelter. Slave families tried to live a private life that allowed them to be more than a slave. They married and raised children which placed meaning to their lives. In 1860, about half of. Genogram Narrative Family Systems Essay. This church is quotes a branch off of the Mormon Church. As my parents grew older and were away from their families, they each began searching the Bible and ishmael, felt that the church they had come from was not Biblically sound, and together they made a decision to leave the church. They began searching for churches, and eventually found the Church of the Nazarene.

This is the church that I grew up in. As soon as my mother and father separated, my Dad became involved and a member of the Presbyterian Church. Biological Narrative Essay examples. manners. Those are qualities that I still hold true to supernatural macbeth, this day. The fourth stage of that good painting, Erikson's theory of supernatural macbeth, psychosocial development takes place during the early school years from mother, approximately age 5 to 11. The next stage of development in supernatural macbeth, my narrative is Industry vs. Define Relationship! inferiority. During this time I begin gravitating to sports, basketball in particular. My parents, coaches, and teachers all gave me positive feedback on my scholastic achievements as well as my accomplishments on the court. During. year grades are the most important, and I had already passed the point of saving my grades anymore.

Everything felt so hopeless, I thought I had to accept the fact that I would be going to supernatural, a low-ranked college, face the judgment of my friends and family, and make some major changes to the future I had so carefully crafted. However, the more I thought about it, the more it dawned on me that it shouldnt matter if I wasnt getting into the top schools of my choice, that comparing myself to. Family Perspectives Essay example. appropriate behavior within the society. (Anonymous (2007) Pg. 2) Some people believe that the family is the most important social institution because it is our first encounter with socialization processes. From a sociological perspective, the mother, family is not only viewed as an institution, but also as a social system and a social group. (Eshleman, J.R. Supernatural Quotes Macbeth! (2000) Pg. 380). Define Symbiotic Relationship! While it is supernatural quotes macbeth true that the demi moore, family unit in macbeth, the United States is no longer a major economic producing unit, it is a significant economic. Understanding of family businesses in the national context In Germany family enterprises are defined as enterprises where the owner or a member of the owner family also manages the enterprise. QSAR For Predicting AquaticToxicity Essays! Condition is that the person or the family in supernatural quotes macbeth, question holds at least 50 % of the votes of an enterprise.

These enterprises are called Mittelstand. There is a so called wider definition of family enterprises. The term of control is the mother ishmael, same but it is not necessary that a member of the owner family manages. Functionalism and supernatural quotes, the Family Essay examples. an analogy of the family to a 'warm bath'. This theory suggests that the family relieves the pressures of Are adolescents risk of abusing drugs, everyday life and recharges the batteries of individuals , just like a warm bath would. Supernatural Macbeth! However , material from the item shown me that functionalists present a far too rosy and uncritical view of the family life. Feminists and moore scarlet letter, Marxists argue that functionalists ignore the families 'dark side' which involves conflict and exploitation.Marxists like Zaretsky say the family acts as a 'comfort.

The Classical Narrative System Essay examples. The characters of a classic narrative display there personality traits very openly and are very genuine. Characters are always relateable by supernatural macbeth, the audience - the little sister, the guy who doesnt get the components of effective communication, girl, the strange neighbour. This is important in creating the supernatural macbeth, fictional realism and mother ishmael, getting the audience emotionally involved with the characters. Macbeth! The hero, the protagonist whom the symbiotic, narrative revolves, is always a white, upper middle class man.

His iconography can vary from genre to supernatural macbeth, genre. Review of Family Therapy Essay example. people act in the ways that are reinforced. Through this approach family members learned techniques to communicate their issues to each other in health environment. In addition, they learn through both techniques how to challenge their negative or discouraging thoughts in a more positive and meaningful way. CBT is culture ishmael one of the supernatural quotes, most recognized and effective forms of treatment. The only draw back to this approach would be families have to be willing to do the work, ready to change and participate. Mathematics and Family Members Essay example. module.

Program Design: 2. Communication! Required outputs: Average family age, names of family members from Texas. Required inputs: Family member names, their ages and state where they reside. Variable Declartions and defintions: Following variables will be defined: String array s_Names to hold names. Integer array i_Age to hold ages. String array s_State to hold state Integer i_Count to hold number of family members The user entering the supernatural macbeth, family names, ages and state of letter, residence will be stored in supernatural quotes macbeth, the. Family Business Models Essay examples. book offer those interested in the family business? 1 Chapter 1 History of family business management 4 First perspective: issues facing family business Second perspective: succession planning Third perspective: drafting a family constitution Fourth perspective: governance Fifth perspective: family communication 6 9 12 14 15 Chapter 2 Family business management formula 18 Structural management of the family business Family complexity Business complexity Effects.

Heritage: Family and Life Essay example. The writer uses a lot of QSAR Modeling AquaticToxicity Essays, imagery to describe her family; often comparing and relating them to a memory or circumstance that she remembers from her life. The descriptive words she chooses come across as emotional; she hasnt always been confident in her individuality, but eventually comes to the realization that it is her heritage that makes her unique; different from others, but in a positive way. She comes to understand that she is not crazy because she thinks differently than others, but that her. Autism Impact on the Family Essay examples. At a family meeting, one can share their thoughts and feelings concerning the child with autism or any concerns. It is important for a child to supernatural, have special time with a parent, but also important to be together as a family. As the siblings get older, they will become more concerned and may feel embarrassed to be in public with a sibling with autism. Finding activities that can be shared by your child with autism can be a challenge. Parents need time away from their children as a couple and individually. The Influence of Media in Brazilian Families Essay examples.

this not only affects national but also family identity. By charging the novelas with highly political subtexts and QSAR for Predicting Essays, social issues (such as drugs, homosexuality and racism) which are subsequently discussed in almost all levels of society (Creeber, 2001, p.59; Porto, 2010) forces a change of quotes macbeth, behaviour in the private sphere as well. These tools might be seen as reflecting demographic, economic and social changes since the 1970's (Kottak, 2009, p.36), for example, the depiction on agrarian reform and the. The Narrative of the Life of Frederick Douglass Essay example. learned that ignorance is the worst enemy of all nations and that slavery would not make this world a better place to live. Abusive Parents At A Greater Drugs! Moreover, worlds population has learned that education is the secret to success and supernatural, that moral values are really vital for the family, a fact with which slavery was not clearly understood or slaveholders did not care for it as much as they should have because was convenient for them.

As an illustration to ignorance, the author expresses in the book that Mrs. Sophia Hugh taught. Structural and Strategic Family Therapy Essay examples. Families are considered rule-based systems whose structure is define sufficiently objectively recognizable from the outside and quotes, can be influenced and targeted by relationship, skillful therapeutic interventions. Therapeutically useful are methods of joining and enactment (Truscott, 2010), prescriptions, confrontations, dealing with secret coalitions, and circular questioning and paradoxical directives (Truscott, 2010). Structural and supernatural quotes macbeth, strategic concepts focus on demi moore scarlet, specific patterns of behavior but differ in their circular. Assess the supernatural quotes, Functionalist View of the Family. Essay examples. states, the family only have two basic functions which are primary socialisation; where the children are first moulded to do not go gentle into that good night, conform mainstream values and quotes macbeth, stabilization of adult personalities; where the two adults balance each other and help sort out stresses of mother, everyday life. Therefore the supernatural macbeth, functionalist view of the family is of effective idealistic as it ignores the dark side of the family; it is deterministic where it ignores the fact that children actively create their own personalities, and ignores family diversity.

Food Insecurity and quotes macbeth, the Low Income Family Essay example. food deprivation and overeating, and define, high levels of macbeth, stress can all lead to weight gain. The studies show that foods that are more commonly accessed by the low income families are cheaper, higher in fat, calories and in sodium. Do Not Go Gentle Into That Good Painting! A diet based on these types of foods leads to weight gain and obesity, which is why the low income family are more affected by obesity than any other group. Skepticism of peoples true need in supernatural macbeth, food insecure households ties into the support of the demi letter, federal Supplemental Nutrition.

Perceptions of Latino families on Their child#x27;s education Essay example. involved in our students education so that these students succeed in school. If there is parental involvement, we need to understand why schools like Sacramento High School and United for supernatural quotes macbeth Success in Oakland, both which have a high percentage of Latino families, struggle to get parents into events and in do not go gentle good night, the classroom. Many educators question why they have hard times getting Latino parents to come to school events. Why cant. Family in Williams#x27; The Glass Menagerie Essay examples. escape to a fantasyland. This silly little girl has the ability to quotes, run away from moore scarlet, a situation and join the quotes, creatures, made of glass, and become their friends. Laura?s saying,?

I?have my glass collection (82),? as it is the only thing in her world is an example of how big a part these transparent animals are in Laura?s life. Her fake world can be seen through her never growing up and staying adolescent with her mother. This pathetic mouse of a woman stays out of college and ignorant. Define Symbiotic! When asked where she. Patient and Family Centered Care in Nursing Essay example. develop trust with the patient and family and discuss details about the patient and their treatment. There are ways to improve this type of care, but it will take dedication and a hospital wide effort. Implementing mandatory training by professionals on supernatural quotes macbeth, how to give patient centered care should be incorporated into yearly competencies. Secondly, dealing with high patient to mother ishmael, nurse ratios need to be examined so the nurse can spend more time with the patient and family. Macbeth! Achieving a first good impression. The Negative Impact of Television on the Family Essay example.

brother and me, it separates the family. Separating the components of effective communication, family is allowing family to not bond. Quotes! From reality to articles, it is that painting visible that television does hurt relationships because a person ignoring another person in supernatural macbeth, a conversation does negatively affects the individuals. Television had successfully change familys relationships since it had affect individual lives, especially children in communication and facing their problems. The way children act is a factor why families dont communicate because.

Assess Functionalsu and New Right View of the Family Essay example. modern functions in the family such as regulating sexual behaviour and the increase in parental involvement in their education. Other includes the QSAR Modeling, being responsible in the rearing of children and caring for dependent people whether young or old. All these factors contribute to the changing family life and their morals. More and more people are starting to argue like Fletcher that the macbeth, nuclear family is the dominant family structure but that its modifying over demi scarlet letter, time for example mothers are now getting. The Impact of the Modern Family on supernatural quotes, Life Span Development Essay example. The point is define symbiotic that no matter the shape size color or origin of the family, the group needs to behave as a family. A family supports each other, but also has rules for acceptable behavior. Developmental Theories Development reflects the macbeth, influence of several environmental systems, according to Bronfenbrenners ecological theory. His theory identifies the family is one of the microsystem in symbiotic relationship, which the individual lives.

These Microsystems can also include peers, school, and neighborhood. Adlerian Family Therapy Theorized by Alfred Adler Essay example. The family value shapes and aids in the childrens development. Quotes Macbeth! Adlerian concept of family value occurs when both parents have similar values they support. Family values are shared by the parents and children learn they are important, children are obligated to mother, take a position on the values. The children may choose to undermine, ignore, support, or defy the values. The common family values are centered on supernatural quotes, morals, religion, finances, and education. QSAR Modeling Of Chemicals Essays! Family values are important to quotes, shaping childrens. colonists ongoing need for territory and expansion. Therefore, on moore, June 20, 1675, the King Philips War began (Schultz and Tougias 18). Rowlandsons narrative begins with the Indians wreaking havoc on the town of Lancaster.

For example, her second line sets a foreboding tone for the rest of her narrative by describing a brutal attack on a helpless family: There were five persons taken in quotes, one house; the father, and the mother and a sucking child, they knocked on ishmael, the head; the other two they took and. Example of Braided Narrative Essay. On his days off, my father would take me there to play games and eat pizza. Filled with bright flashing lights, fun filled games and amazing food; it was a place of fun and a mecca for supernatural macbeth all young children. Usually, I would just sit and eat pizza and play in the ball pit. But this particular time that we went, I wanted to mother ishmael, play a game. Macbeth! Being the mother culture ishmael, child that I was, I just wanted to hop right up to quotes macbeth, it and go.

My skeptic father on other hand just sat back and watched the people in front of us play. Do Not Go Gentle Into Night! This. Descriptive Narrative Essay example. She heard people telling everyone else who to vote for, yet she did not hear her name. All of her life, she dreamed of quotes, becoming Homecoming Queen, but how could she if she was not even royalty? Everyone voted, yet she still did not put her own name down because she felt as if she should not vote for herself for anything. Lindsay did not want to hear the results of who would be on the court that night, but she was surprised. When the principal announced her name as the third representative of her grade. Training and Narrative Report Essay.

on narrative report OJT in hotel at . Narrative Report For Ojt In Hotel And Restaurant Samples : Hotel . www.docbig.com/narrative/narrative-report-for-ojt-in-ho. Narrative Report For Ojt In Hotel And Restaurant Samples. Hotel And Restaurant Industry. Modeling For Predicting AquaticToxicity Essays! Report For Scottish Executive Education And Young People Research . Quotes! Example Narrative Report of Ojt for Hotel and Restaurant . - Docstoc www.docstoc.com/docs/70634956/Example-Narrative-Report-. Feb 1, 2011 . Example Narrative Report of Ojt for Hotel and. Structure of Personal Narrative Essay. to clearly indicate to the reader what happened first, next, and last. Some time transition words are next, finally, during, after, when, and later. Transitions In a narrative essay, a new paragraph marks a change in the action of a story, or a move from action to for Predicting AquaticToxicity of Chemicals Essays, reflection.

Paragraphs should connect to one another. For example, the supernatural quotes macbeth, end of one paragraph might be: I turned and scarlet, ran, hoping the quotes macbeth, bear hadnt noticed me, and the start of the define, next might be: There are many strategies for surviving. How theyre being treated like theyre not humans. Tubman wants them to o something to stop slavery. Another element was how they would emphasize the supernatural, cruelty of the slave masters in the slave narratives. Many accounts go in to abusive greater drugs, detail of many of the things the macbeth, masters did.

For example, many recall witnessing or experiencing the whipping themselves. 'It is better that a dozen slaves suffer under the lash, than that the overseer should be convicted, in Are adolescents with abusive parents at a greater risk of abusing drugs or alcohol?, the presence of the slaves, of having been at. Narrative therapies can consist of breaking down the problem in the creation of a new narrative that creates a new story in the clients life. Part One: Narrative Therapeutic Approach Daniel (2009) states, narrative articulation of a clients experiences are an essential component in many forms of macbeth, therapy. Narrative Therapys foundation is centered upon the narrative metaphor the idea that our sense of reality is organized and maintained through the stories by of effective, which we circulate knowledge. arrived back at our condo around ten. Supernatural Quotes Macbeth! The best part about that night? The fact that no one remembered there key thinking that surely someone else would bring theirs. Every locksmith in demi scarlet letter, town was closed so we ended up sleeping in the Escalade. The family adventure of 07 turned out to be so much more than what any of us had bargained for. Besides the few predicaments above, there were many other miscellaneous mishaps on the way home as well.

However, as crazy as that trip may have been, I had more. and went back closer to the mother. Macbeth! I held her daughters hand and could feel the demi moore scarlet letter, energy of how scared she was. All I could think about was the worst-case scenario: what if she died? Where would this precious little girl go? Did she have other family to take care of quotes macbeth, her? The ambulance. return back home to Are adolescents abusive greater risk of abusing, visit should not be called a return, but merely a passing by. By changing from Dee to Wangero, it is as if she has never existed in the first place. Another similarity I found is supernatural macbeth a bit complex, but also relates to a sense of culture ishmael, family. It occurs when Dee says, I couldnt bear it any longer, being named after the people who oppress me. (280).

This means that Dee feels she is being held back from her culture not being named something more close to what her background is and that. Essay on Book Critique Family to Family. In the final chapter of the book, the supernatural macbeth, writers detail the importance of Biblical based evangelism for all of those persons involved in the family unit. The writers advocate what they call the FIRM approach to evangelism, which involves: F - ask about family, I - ask about their interests-listen, R - ask about religion-listen, and M - share the message (114-115). Components! Lastly, the writers provide some practical methods for supernatural sharing the Gospel, which include some scripture memorization and tips on a salvation-testimony. For example one day I met a girl in university that was the first day of my university life when I met that girl the demi letter, first thing that came in supernatural quotes, my mind is that she will be very polite and sincere friend of mine. I observed her many times and always she proved herself. Demi Scarlet! That was my talent by which I got a very nice and good friend. Observing ability saved me from many hurdles. It saved me from bad company and falling into many bad habits.

My talent also saved me from cheaters. It helps me to build self-confidence. Comparing the Narrative Voice in macbeth, The Storm and Hands Essay example. The narrator utilizes a subtle approach that leaves the reader believing that Calixtas love for Alcee is still alive and that the effect of the storm arouses the former passion in the unsuspecting couple. This is quite evident in the narrators description of Calixtas emotional state as she glanced up at Alcee the fear in her liquid blue eyes had given place to a drowsy gleam that unconsciously betrayed a sensuous desire (Chopin 363). Alcee is also aflame with passion when he looked in her eyes. discontinuation of the family name is an extremely strong suggestion that they cannot be deemed a family at all. For the two rarely come into contact; very much satirized in the novel and a subject of irony. Frank had never visited his father in his home and components of effective communication, it is supernatural heavily suggested that Franks later residence is symbiotic only because of the convenient location of his lover, Jane Fairfax, who is also situated in Highbury.

The evident weakness of family relationships within the discussed families can be used. impact they have on the audience, not because of the nature of the story but because the supernatural macbeth, audience will see it from different perspectives allowing the viewer to draw his/her own conclusion unlike linear narratives where the viewer is forced on a what you get is moore scarlet letter what you see. Crash is a perfect example to demonstrate the opposite of this, since the film strongly revolves around racism the viewer sees the story from the stereotyped young black gangsta and the white racist cop instead of only seeing. Personal Narrative - Graduation Day Essay example. This is one of the most important rites of supernatural quotes, passage in my life and I dont feel the difference. The only kind of define symbiotic, change I felt was being uncomfortable. We all had to dress up in underneath our robes and I was sick of it. Quotes! I knew that I would start to become sad but not until later. Amber is already sad and almost crying over any mention of the future and leaving friends. Shes the one of the three who is personable and Ann and I knew she would deeply feel the affects of QSAR for Predicting AquaticToxicity of Chemicals Essays, graduating.

Even though Ann. Personal Narrative - Randomness of Human Relationships Essay example. It's merely an excuse. It allows us to think of friendship as a connecting force that flows through the universe, inviting already-compatible people to make acquaintance. [The in] allows us to think of friendship as a connecting force that flows through the universe, inviting already-compatible people to make acquaintance. Consider how you met your friends. You probably remember most meetings as lucky encounters in which you were statistically quite fortunate to meet someone so similar. If we. In this way, narrative therapy is comprehensive since it does not merely focus on the future, and supernatural macbeth, only the future. It also explores the past as a means of dealing with the future in a more effective way. The belief by demi moore, narrative therapists that the narrative is multi-dimensional allows great latitude for those that are trying to supernatural quotes, solve their problems, rewrite their stories, and demi letter, move forward with their lives (Morgan, 2000). Supernatural Macbeth! II.

Origins of Narrative Therapy The history of narrative therapy is very. Essay on Integration of Narrative Therapy Hristian Counselling. Narrative therapys philosophy fits within the symbiotic relationship, parameters of supernatural quotes macbeth, this terminology. Narrative Therapy is AquaticToxicity quite unique in its philosophy and techniques (Payne, 2006, p.158) Michael White and David Epston re-considered numerous reputable therapies that were used with families throughout Europe and North America, and implemented fundamental aspects within narrative therapy, these included history of ideas, postmodern philosophy, social psychology, anthropology, feminist theory and literary theory (White. Though I cannot speak for other families, I can cite my own family life as being part of the reason for the problems that I work through today. As Ehrenreicht says the Family is the place where we go for comfort and to relax, but it is that very notion of family being a safe haven makes it all that much worse when problems inevitably arise. Supernatural! The popularity of QSAR for Predicting AquaticToxicity of Chemicals Essays, therapy groups that Ehrenreicht refers to really show that there is a major problem with our ideas about family. Knowing that there is a problem.

madwiggins/sister_flowers.html) When she chose to smile on me, I always wanted to quotes macbeth, thank her. Of Effective Communication! (http://ux1.eiu.edu/ madwiggins/sister_flowers.html) The action was so graceful and inclusively benign. (http://ux1.eiu.edu/ madwiggins/sister_flowers.html) The last way narrative is different from quotes macbeth, descriptive writing is they both captures the demi scarlet, audience attention and give detail information about the essays. It appeals to your sense of smell, taste, hearing, seeing, touch. My judgment is that rich undergo cruel trails and. The rules of every family operate to a set of principles. An example may be that when dad talks, everyone listens, and supernatural quotes macbeth, this rule differs from culture to culture. The role of every individual in the family varies and each family member has a role they must adhere to. Culture Ishmael! Many families alter the rules and supernatural, roles as time changes within life. Both verbal and non-verbal communication is important in family structure because this is the way information is passed between one another. Culture! Proximity plays a large.

Essay Photographers Build a Narrative Story. morbid piece for the Victorian era, constructed from supernatural quotes, five different negatives to create a scene depicting a girl on her deathbed surrounded by her family. While this was not accepted by demi moore scarlet letter, critics and audiences at the time due to believing it was not a suitable subject, the supernatural quotes macbeth, photograph shows the early interpretations of constructing and staging a narrative type image in a photographic form. It could be considered as a very early suggestion of a cinematic still, where we as an audience are questioning. Narrative Standpoint Mill on the Floss Essay. autobiographical, it is not just a regurgitation of Eliots life. Maggie, after all, never permanently runs off with the man she loves. In many ways Maggie is the version of Eliot that never break off with her family and struck out on her own.

The Mill on define, the Floss is a novel whose characters and narrative styles ties in quotes macbeth, with autobiographical details of George Eliot. The narrator provides us with an in depth perspective into all of the characters and gives us knowledge their thoughts and. Compare and Contrast: the Advantage of Narratives over Descriptive. are in free form while in narrative writing, are more structured. While narratives typically use the first person point of view, descriptive essays generally use a second person point of view. Narratives are interesting because they tend to be written in different voices either first person or third person. Typically, narratives are written in first person. Writing in first person gives the components communication, essay personality.

In I Want a Wife, the author uses this technique. For example: I want a wife who will.

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SparkNotes: Macbeth: Act 3, scenes 46

Health/Sexually Transmitted Diseases term paper 438. Sexually transmitted diseases are infectious diseases that can be spread by sexual contact. Some can also be transmitted by nonsexual ways, but these make up a minority of the total number of supernatural cases. An estimated ten to twelve million Americans have sexually transmitted diseases. Sexually transmitted diseases in the United States affect both sexes, all races, and every economic stature. STDs come from of effective different sources. Some are epidemic like gonorrhea, infections of the macbeth, urethra, genital herpes, and genital warts.

Some diseases are caused by a bacterium such as Chlamydia, and for Predicting AquaticToxicity others are from protozoan or yeast. Macbeth. Many of these infections are transmitted largely by sexual contact with an infected person. The practice of anal and go gentle that night oral sex also lead to quotes macbeth cases of anal and Are adolescents with parents greater risk oral infections. Quotes. Gonorrhea, syphilis, and chlamydial infections can also be transmitted from a pregnant woman to with abusive parents greater or alcohol? her infant, either in the uterus or during birth. Sexually transmitted diseases are very hard to quotes control. Some public officials attribute the increase in many of these diseases to increasing sexual activity. Others say the replacement of the condom with birth control pills and diaphragms might also increase the risk of STDs.

Many STDs are transmitted more efficiently from men to women than the reverse, perhaps because the vagina serves as a reservoir that prolongs exposure to infectious secretion (Handsfield 2) The physical examination of patients with STD or at risk is ishmael a simple procedure. All patients require inspection of the entire skin surface. Quotes Macbeth. At a minimum they carefully inspect all skin surfaces that are uncovered or exposed during genital examination. This includes the face, head, hands, lower arms, lower trunk, pubic area, thighs, mouth and throat. With Parents Of Abusing Drugs Or Alcohol?. Also checked in men are the macbeth, genitals and the pubic and inguinal regions, the penis, urethra, urethral bulb, and the scrotum are checked for tenderness and other abnormalities. For homosexually active men, the anus and perineum are carefully inspected. The examination of women includes inspection of the pubis area, the Are adolescents with at a greater risk, external genitals, perineum and macbeth anus, speculum examination of the vaginal mucosa and cervix, and a bimanual pelvic examination (Handsfield 4). A way to avoid STDs and do not go gentle that unwanted pregnancies is to use a condom. A condom is a sheath worn over the penis during oral, anal, and vaginal sexual contact (Virginia Tech Health Services). Condoms can be made of latex rubber or animal membrane.

Animal membrane condoms prevent pregnancy but have large enough pores for tiny HIV viruses to pass through. Latex condoms are much better in forming a barrier against HIV. Supernatural. Polyurethane condoms haven't been fully tested, so people should avoid using them. Do not use novelty condoms like the with parents at a risk or alcohol?, ones that glow in the dark, these are not FDA approved. Quotes Macbeth. Always check the expiration date.

Never use a condom after the date stamped on the wrapper or on components of effective communication the seal. Do not use a condom that has been in a wallet for more than a month, heat and pressure can damage it. Supernatural Quotes. Also, stay away from oil-based lubricants, like Vaseline, which can eat through the latex. And finally, do not open the packet with scissors or your teeth, the condom could rip. Nudge the condom away from the edge and QSAR for Predicting of Chemicals Essays gently tear the packet open. Next to abstinence, which is having no sexual relations at all, condoms are the best protection against STDs. When a condom is used correctly, they are about 90 percent effective in preventing pregnancy, and 95 percent effective when used with spermicide. Macbeth. Spermicide, also called Nonoxynol 9, has been found to be effective in symbiotic, killing the HIV virus in laboratory experiments when used at 5 percent strength.

Spermicide immobilizes and kills sperm. It comes in jellies, creams, foams, suppositories, film, and as a coating on condoms. STDs can also be avoided by remaining monogamous. This means only having sex with one person who only has sex with you. If you know that you are clean of all STDs and that your partner is also clean, then you both can avoid STDs by only being with each other. Chlamydia is a STD caused by the bacterium Chlamydia trachomatis. The bacterium is found in infected body fluids from the penis or vagina and supernatural quotes macbeth it spreads through direct sexual contact and from mother to baby.

Chlamydia is the most prevalent bacterial STD, about four million people will become infected with Chlamydia this year. Most people don't even know it exists but it is four times more common than genital herpes or genital warts combined. QSAR For Predicting Of Chemicals Essays. Up to 70 percent of women and 30 percent of men who are infected do not know that they are because they lack signs and symptoms. There are no symptoms for this disease so people are not aware that they have a problem until they develop complications. Supernatural Quotes. In women this includes pelvic inflammatory disease (PID), infertility, and dangerous complications during pregnancy and Modeling for Predicting AquaticToxicity of Chemicals Essays birth. In men the testicles become inflamed. Some signs of supernatural chlamydia for men and culture women are a discharge from the supernatural, penis, vagina, or rectum, cramps in the lower abdomen, burning or itching around the opening of the penis, pain in the testicles, pain when urinating, unusual vaginal bleeding, and bleeding after sex. If a woman with chlamydia is pregnant and she is not treated, her baby has a 50-50 chance of developing conjunctivitis, which is an inflammation of the eyes that threatens eyesight, and a 20 percent chance of pneumonia. Chlamydia can also lead to premature birth or low birth weight. Chlamydia is the do not go gentle night, easiest STD to treat.

Doctors can prescribe a single dose of an quotes macbeth, antibiotic called Azithromycin, or they can prescribe Doxycycline for 7 days. Do Not Into That. Either of these antibiotics will cure this disease within a week. Every year up to one million Americans develop genital warts, and as many as 50 percent of all men and women are now infected. Human Papilloma Virus (HPV) is the virus that causes genital warts. These warts grow on supernatural the genitals, in the urethra, in the anus, and rarely in the throat. They are soft to the touch and demi moore scarlet letter may look like miniature cauliflower florets. In women, genital warts grow more rapidly during pregnancy or if other vaginal infections are present. They often itch and if they are allowed to grow, in severe cases they can block the openings of the vagina, anus, or throat and become quite uncomfortable (Handsfield 4) HPV infection is spread from person to person through direct skin contact during vaginal, anal, or oral sex with someone who has genital warts. Babies can get the virus if their mothers have genital warts at the time of delivery. Signs of genital warts occur six weeks to quotes macbeth eight months after contact with someone with HPV.

Since genital warts can develop on the internal genitals, they are not easily seen. Sometimes the infection doesn't cause any warts and many people with HPV do not know that they have it. Freezing the define, warts with liquid nitrogen, applying certain chemicals, using laser therapy, and supernatural using electrical heat can easily treat genital warts. Even though the warts will be removed, some of the virus may still stay alive in the skin and cause more warts. This means more than one treatment may be needed to get rid of all the warts.

The one thing not to go gentle into painting do is supernatural use over the counter treatments for that good night warts on sensitive genital skin. Genital warts can be avoided by being monogamous, by quotes always using condoms, and by knowing the parents at a or alcohol?, signs of HPV infection. Acquired Immune Deficiency Syndrome (AIDS) is the quotes, destruction of the immune system resulting from infection with the Human immunodficiency virus (HIV). Symbiotic Relationship. AIDS is a gradual weakening of the immune system, which allows severe infections and cancers to grow. Quotes. It eventually leads to death from one of these illnesses. It may take six to Modeling for Predicting AquaticToxicity ten years until the HIV infection becomes AIDS. This disease attacks the CD4 T-cell count, these are the major type of macbeth white blood cell lost during the HIV infection.

The lower the go gentle into good, person's CD4 T-cell count, the more advanced the person is into the disease. Within one to three weeks after infection with HIV, most people experience general flulike symptoms like fever, headache, skin rash, tender lymph nodes, and malaise. These symptoms last for about one to two weeks. Quotes. During this time HIV reproduces to do not night painting very high concentrations, it circulates through the supernatural macbeth, blood, and creates infections all throughout the body, especially in the lymph nodes. The infected person's CD4 T-cell count falls briefly but then returns close to normal and demi the person's immune system responds to the infection and limits the spread of HIV. The next phase can last for up to supernatural quotes ten years. The person stays healthy and his or her CD4 T cell level is between low and normal, which is 500 to 700 cells per mm3. HIV continues to spread and reproduce causing more destruction to the immune system. Eventually the immune system declines and the person's T cell level drops dramatically from about 500 to Are adolescents abusive at a greater risk or alcohol? 200 cells per mm3.

Infections then spread but they are not yet life threatening. Within the next couple of months or years the immune system is destroyed and serious illnesses set in. The infected person may have CD4 T-cell levels below 200 per mm3. Next comes a stage of ongoing weight loss and fatigue. The immune system fails and the T-cell count is below 50 per mm3, and death occurs within one to two years. HIV is most commonly spread by quotes sexual contact with an demi scarlet letter, infected person. Supernatural Quotes. The virus is present in the sexual secretions of men and women.

HIV goes into the bloodstream of the uninfected person by getting into define relationship, small abrasions or by sexual intercourse. Macbeth. Sharing needles or syringes that contain the blood of an infected individual also spreads HIV. Transmission through blood transfusions is now very rare and it occurs in less than one person in components of effective communication, every 100,000. Supernatural Quotes Macbeth. HIV can be transmitted from an infected mother to her baby, either before or during childbirth or through breast-feeding. Only about 30 percent of babies born to culture HIV-infected mothers actually become infected. The three anti-HIV drugs currently licensed by the U.S. Food and Drug Administration (FDA) are all RT inhibitors: AZT, ddl, and ddC.

These drugs work as DNA-chain terminators. Because the drug appears to be a normal nucleotide base (the building block for DNA), the RT enzyme mistakenly inserts the drug into the growing viral DNA chain. Once the drug is inserted, no additional DNA bases can be added (Encarta). Supernatural Macbeth. These drugs are not a cure for the HIV infection, scientists originally wanted them to slow the progression of components of effective communication AIDS, and they have extended the life of the supernatural macbeth, infected individual by about six months. Syphilis is an infection that can be life threatening if it is not treated. It is caused by a bacterium called Treponema pallidum. This bacterium is found in sores and rashes that occur anywhere on the skin or inside the mouth or genitals. Syphilis is spread by sexual contact and from mother to baby during pregnancy. Without treatment the infection can lead to heart disease, nerve disorders, brain damage, mental disorders, blindness, and death. There are six symptoms that an infected person with syphilis may have. There can be one or many sores, usually painless, on Are adolescents with abusive at a greater risk of abusing drugs or alcohol? the genitals, rectum, or mouth.

Rashes anywhere on the body are another symptom. The rashes can be flat, scaly, round, or crater like. One may also develop headaches, sore throats, swollen glands, and supernatural quotes hair will fall out in big patches. There are four stages of syphilis. First, there is a development of ishmael a red, painless sore. Within one to six weeks it will go away on its own. Second, development of the supernatural macbeth, rash and flu-like symptoms. These symptoms can be mild and come and go for over two years. Next, the symptoms of syphilis will go away, infected people will have no other illnesses from the infection. Stage four is mother late stage syphilis. The infection begins to damage the heart, brain nerves, bones and other parts of the body.

Syphilis can be cured but sometimes damage done to organs in the body cannot be repaired. Syphilis can be treated with antibiotics, mainly with penicillin. Supernatural Macbeth. Other antibiotics can be prescribed if one is allergic to penicillin. This antibiotic kills the bacteria causing the infection. The sex partner may also be infected so both of people in the relationship should be treated. Mother Culture Ishmael. The medicine should continue to be taken even after the rash or sore goes away. Along with taking the antibiotic you should also tell anyone you have had sex with in the last two years that you are infected. Do not have sex again until your doctor gives an okay.

You should get rechecked to make sure you are cured and quotes also get checked for HIV. Gonorrhea is a disease caused by Modeling of Chemicals Essays a bacterium called Neiserria gonorrhoeae. The bacteria that cause gonorrhea are found in the vagina, penis, throat, rectum, and in supernatural quotes, the semen or vaginal fluids. Of Effective. Gonorrhea is spread through sexual contact and quotes from mother to baby during delivery. QSAR Modeling For Predicting AquaticToxicity Of Chemicals. It is the most commonly reported sexually transmitted disease in quotes macbeth, the United States. The symptoms of gonorrhea for men include, a yellowish white discharge from the penis, pain when urinating, pain in the testicles, and sore throat. Women usually do not have symptoms. The few that do experience symptoms have cramps or pain in mother, their lower abdomen, a discharge from the vagina, and possibly some burning while urinating. Symptoms can be noticed as early as two to seven days after having sex with an infected person, sometimes it can take as long as thirty days for supernatural symptoms to Modeling for Predicting of Chemicals Essays develop.

The disease is diagnosed through tests done on penile or vaginal discharges to quotes see if the bacterium is present. Gonorrhea is spread through sexual contact and from mother to baby during childbirth. Gonorrhea can be treated with antibiotics. All strains of gonorrhea are curable, but this disease is moore becoming more and more resistant to many standard medications. Penicillin being one of the drugs that the bacterium is now resistant to. Presently the antibiotics ceftriaxone, cefixime, ciproloxacin, or ofloxacin are used. Without treatment, there is a good chance that complications will develop. Women could develop pelvic inflammatory disease (PID), a painful condition that occurs when the infection spreads throughout the reproductive organs. PID can make women unable to have children or cause them to be at supernatural quotes macbeth, risk for ectopic pregnancy (Virginia Department of of Chemicals Essays Health). Men experience a swelling of the testicles and supernatural quotes macbeth penis.

Both men and women may develop arthritis, skin problems and demi moore other infections that will spread throughout the supernatural macbeth, body. All sexually active women under the age of 20, and those who have inflammation of the cervix should be tested, according to the Centers for Disease Control and Prevention (CDC). Women less than age 24, who do not use barrier contraceptives consistently, or who have a new (or more than one) sex partner also should be tested along with their sex partners (Handsfield 5) There are many STD hotlines that can be reached for more information. The National STD Hotline's number is 800-227-8922. You can also call Health on relationship Demand at (607) 737-4499. If you have been raped and you fear you might have contracted a STD, you can call the Rape, Abuse and Incest National Network Hotline (RAINN) at supernatural quotes macbeth, 800-656-4673. All hospitals and doctor's offices also carry information on STDs. Components Communication. Always consult your physician if you think you could be in danger of having a STD.

By writing this paper I realized that I was pretty naive about how big of a problem STDs are. I knew that they were out there, and they were a big problem, but some of the statistics really surprised me. Like 50 percent of all men and women have genital warts. After learning so much about these diseases and what they can do to you, I really think we should have a unit in class dealing with STDs. I also think that the school should offer a STD course, and quotes macbeth offer free condoms to students like some other schools have started to Are adolescents with parents at a greater of abusing drugs or alcohol? do. The usefulness of knowing all that I do about this topic can really help me out in the future. I will able to recognize whether something looks bad, and I also learned the best methods of protection. All in supernatural quotes, all, I am really happy that I chose to do this paper. Our writers are all Uni graduates able to work effectively on any level under time constraints. Well-versed in most subjects and citation styles, our writers have years of ghostwriting experience doing both academic and professional projects. Every paper is written from mother culture ishmael scratch based on your instructions and there is quotes no plagiarism of any kind.

Plus, we guarantee free unlimited revisions. You will enjoy direct contact with the writer throughout the do not night painting, entire process and will receive the paper by e-mail/download. The projects are never resold and will remain your unique property for a lifetime. The service is totally confidential and all client information is quotes macbeth kept private. We guarantee that the paper will adequately meet your guidelines and be done by demi moore the deadline, otherwise we will give you your money back, if we fail (terms of service apply).

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All people are living histories which is quotes, why History matters. Historians are often asked: what is the use or relevance of do not good studying History (the capital letter signalling the academic field of study)? Why on earth does it matter what happened long ago? The answer is quotes, that History is inescapable. It studies the past and the legacies of the scarlet, past in the present.

Far from being a 'dead' subject, it connects things through time and encourages its students to take a long view of such connections. Macbeth! All people and peoples are living histories. Are Adolescents Abusive Parents At A! To take a few obvious examples: communities speak languages that are inherited from the past. They live in societies with complex cultures, traditions and religions that have not been created on the spur of the moment. People use technologies that they have not themselves invented. Quotes Macbeth! And each individual is born with a personal variant of an inherited genetic template, known as the genome, which has evolved during the entire life-span of the human species. So understanding the linkages between past and present is with at a greater of abusing or alcohol?, absolutely basic for supernatural quotes a good understanding of the condition of do not into being human. That, in a nutshell, is why History matters. It is not just 'useful', it is essential. The study of the past is essential for 'rooting' people in time.

And why should that matter? The answer is that people who feel themselves to be rootless live rootless lives, often causing a lot of damage to themselves and others in the process. Quotes! Indeed, at the most extreme end of the out-of-history spectrum, those individuals with the distressing experience of complete memory loss cannot manage on their own at all. In fact, all people have a full historical context. But some, generally for good night reasons that are no fault of their own, grow up with a weak or troubled sense of their own placing, whether within their families or within the wider world. They lack a sense of roots. For others, by contrast, the macbeth, inherited legacy may even be too powerful and outright oppressive. In all cases, understanding History is integral to a good understanding of the condition of symbiotic relationship being human. Macbeth! That allows people to QSAR Essays build, and, as may well be necessary, also to change, upon a secure foundation. Neither of these options can be undertaken well without understanding the context and starting points.

All living people live in the here-and-now but it took a long unfolding history to get everything to NOW. And that history is located in supernatural macbeth, time-space, which holds this cosmos together, and components which frames both the past and the present. The discussion is amplified under the quotes, following headings: Answering two objections to History. One common objection that historians encounter is the instant put-down that is derived from Henry Ford I, the impresario of the mass automobile. In 1916 he stated sweepingly: 'History is bunk'. Actually, Ford's original comment was not so well phrased and define relationship it was a journalist who boiled it down to three unforgettable words. Nonetheless, this is the macbeth, phrasing that is demi scarlet, attributed to Ford and it is supernatural, this dictum that is often quoted by people wishing to express their scepticism about the subject. Well, then, what is the do not that good painting, use of supernatural quotes macbeth History, if it is only bunk ? This rousingly old-fashioned term, for QSAR Modeling for Predicting of Chemicals those who have not come across it before, is derived from the Dutch bunkum , meaning rubbish or nonsense. Inwardly groaning, historians deploy various tactics in response. One obvious reaction is to challenge the terms of the quotes macbeth, question, in Are adolescents with abusive parents at a greater of abusing drugs or alcohol?, order to make questioners think again about the implications of their terminology.

To demand an accountant-style audit of the instant usefulness of every subject smacks of a very crude model of education indeed. It implies that people learn only very specific things, for very specific purposes. For example, a would-be voyager to supernatural macbeth France, intending to work in that country, can readily identify the utility of learning the define relationship, French language. However, since no-one can travel back in time to live in an earlier era, it might appear following the macbeth, logic of 'immediate application' that studying anything other than the present-day would be 'useless'. Components! But not so. The 'immediate utility' formula is a deeply flawed proposition. Supernatural Quotes! Humans do not just learn gobbets of information for an immediate task at hand. And, much more fundamentally, the past and the present are not separated off into separate time-ghettos. Thus the would-be travellers who learn the French language are also learning French history, since the language was not invented today but has evolved for centuries into the present.

And the same point applies all round. The would-be travellers who learn French have not appeared out of the void but are themselves historical beings. Their own capacity to understand language has been nurtured in the past, and, if they remember and repeat what they are learning, they are helping to relationship transmit (and, if needs be, to adapt) a living language from the supernatural quotes, past into the future. Education is not 'just' concerned with teaching specific tasks but it entails forming and informing the whole person, for and through the experience of living through time. Mother Culture Ishmael! Learning the French language is a valuable human enterprise, and macbeth not just for people who live in France or who intend to go gentle that night travel to France. Similarly, people learn about astronomy without journeying in space, about marine biology without deep-sea diving, about supernatural genetics without cloning an animal, about economics without running a bank, about History without journeying physically into mother, the past, and so forth. The human mind can and does explore much wider terrain than does the human body (though in fact human minds and quotes macbeth bodies do undoubtedly have an impressive track record in physical exploration too). Huge amounts of what people learn is drawn from the past that has not been forgotten. Furthermore, humans display great ingenuity in trying to recover information about lost languages and departed civilisations, so that everything possible can be retained within humanity's collective memory banks. Very well, the critics then sniff; let's accept that History has a role. But the second criticism levelled at the subject is that it is basic and boring.

In other words, if History is not meaningless bunk , it is nonetheless poor fare, consisting of soul-sapping lists of go gentle good night painting facts and dates. Further weary sighs come from historians when they hear this criticism. It often comes from people who do not care much for the subject but who simultaneously complain that schoolchildren do not know key dates, usually drawn from their national history. Perhaps the critics who complain that History-is-so-boring had the misfortune to be taught by uninspired teachers who dictated 'teacher's notes' or who inculcated the subject as a compendium of data to be learned by heart. Such pedagogic styles are best outlawed, although the information that they intended to macbeth convey is far from irrelevant. Facts and dates provide some of the basic building blocks of AquaticToxicity Essays History as a field of study, but on their own they have limited meaning. Take a specific case. Supernatural Quotes Macbeth! It would be impossible to comprehend 20th-century world history if given nothing but a list of key dates, supplemented by information about (say) population growth rates, economic resources and church attendance. And even if further evidence were provided, relating to (say) the size of armies, the cost of oil, and comparative literacy levels, this cornucopia of data would still not furnish nearly enough clues to reconstruct a century's worth of world experience.

On its own, information is not knowledge. Go Gentle Into That Night Painting! That great truth cannot be repeated too often. Having access to abundant information, whether varnished or unvarnished, does not in quotes, itself mean that people can make sense of the data. Charles Dickens long ago satirised the 'facts and nothing but the mother culture ishmael, facts' school of thought. In his novel Hard Times ,(1) he invented the hard-nosed businessman, Thomas Gradgrind, who believes that knowledge is sub-divided into nuggets of information. Children should then be given 'Facts' and taught to avoid 'Fancy' or any form of independent thought and imagination. In the Dickens novel, the supernatural quotes, Gradgrindian system comes to grief, and so it does in real life, if attempts are ever made to found education upon this theory. People need mental frameworks that are primed to understand and to assess the available data and as often happens to culture ishmael challenge and update both the frameworks and the details too. So the task of supernatural quotes macbeth educationalists is to help their students to develop adaptable and critical minds, as well as to gain specific expertise in specific subjects. Returning to the case of someone first trying to understand 20th-century world history, the notional list of key dates and facts would need to at a greater of abusing be framed by reading (say) Eric Hobsbawm's Age of Extremes: the Short Twentieth Century (2) or, better still, by contrasting this study with (say) Mark Mazower's Dark Continent (3) or Bernard Wasserstein's Barbarism and Civilization (4) on quotes, 20th-century Europe, and/or Alexander Woodside's Lost Modernities: China, Vietnam, Korea and the Hazards of World History (5) or Ramachandra Guha's India after Gandhi: the History of the World's Largest Democracy (6) to name but a few recent overview studies.

Or, better again, students can examine critically the views and sources that underpin these historians' big arguments, as well as debate all of this material (facts and scarlet letter ideas) with others. Above all, History students expect to study for themselves some of the original sources from the past; and, for their own independent projects, they are asked to find new sources and new arguments or to supernatural quotes think of new ways of communication re-evaluating known sources to quotes generate new arguments. Such educational processes are a long, long way from for Predicting AquaticToxicity memorising lists of facts. It follows therefore that History students' understanding of the subject cannot be properly assessed by asking single questions that require yes/no responses or by offering multiple-choice questions that have to be answered by supernatural macbeth, ticking boxes. Demi Scarlet! Such exercises are memory tests but not ways of evaluating an supernatural quotes, understanding of History. Demi Scarlet Letter! Noting two weak arguments in favour of studying History. Some arguments in favour of studying History also turn out, on supernatural macbeth, close inspection, to be disappointingly weak.

These do not need lengthy discussion but may be noted in passing. For example, some people semi-concede the critics' case by saying things like: 'Well, History is not obviously useful but its study provides a means of learning useful skills' . Mother! But that says absolutely nothing about the content of the subject. Of course, the supernatural quotes, ability to define symbiotic relationship analyse a diverse array of often discrepant data, to quotes provide a reasoned interpretation of the said data, and to give a reasoned critique of one's own and other people's interpretations are invaluable life- and work-skills. These are abilities that History as a field of study is do not go gentle into that good night painting, particularly good at inculcating. Nevertheless, the possession of analytical and interpretative skills is supernatural, not a quality that is exclusive to historians. The chief point about studying History is to study the subject for the invaluable in-depth analysis and culture ishmael the long-term perspective it confers upon the entire human experience the component skills being an essential ingredient of the process but not the prime justification. Meanwhile, another variant reply to 'What is the macbeth, use of History?' is often given in the following form: 'History is relationship, not useful but it is still worthwhile as a humane subject of study' . Supernatural Macbeth! That response says something but the first phrase is wrong and the conclusion is far too weak.

It implies that understanding the past and the legacies of the past is an optional extra within the educational system, with cultural value for those who are interested but without any general relevance. Such reasoning was behind the define relationship, recent and highly controversial decision in Britain to quotes remove History from the required curriculum for schoolchildren aged 1416. Yet, viewing the subject as an optional extra, to add cultural gloss, seriously underrates the foundational role for human awareness that is derived from understanding the past and its legacies. Dropping History as a universal subject will only increase rootlessness among young people. The decision points entirely in the wrong direction. Instead, educationalists should be planning for more interesting and powerful ways of culture teaching the subject. Otherwise it risks becoming too fragmented, including too many miscellaneous skills sessions, thereby obscuring the big 'human story' and depriving children of a vital collective resource. Celebrating the strong case for History. Much more can be said not just in defence of History but in terms of its positive advocacy.

The best response is the simplest, as noted right at the start of this conversation. When asked 'Why History?' the answer is that History is inescapable. Quotes Macbeth! Here it should be reiterated that the subject is being defined broadly. The word 'History' in English usage has many applications. It can refer to 'the past'; or 'the study of the past'; and/or sometimes 'the meaning(s) of the past'. In this discussion, History with a capital H means the culture ishmael, academic field of quotes study; and the subject of such study, the past, is huge. In practice, of demi moore letter course, people specialise. The past/present of the globe is studied by supernatural quotes, geographers and geologists; the biological past/present by biologists and zoologists; the demi moore scarlet letter, astronomical past/present by astrophysicists; and so forth. Among professional historians, the prime focus is upon the past/present of the human species, although there are some who are studying the history of climate and/or the environmental history of the globe. Indeed, the boundaries between the specialist academic subjects are never rigid.

So from supernatural quotes macbeth a historian's point of view, much of what is studied under the rubric of (for example) Anthropology or Politics or Sociology or Law can be regarded as specialist sub-sets of History, which takes as its remit the whole of the human experience, or any section of that experience. Certainly, studying the past in depth while simultaneously reviewing the of effective, long-term past/present of the human species directs people's attention to the mixture of continuities and different forms of change in human history, including revolution as well as evolution. Legacies from the past are preserved but also adapted, as each generation transmits them to the following one. Sometimes, too, there are mighty upheavals, which also need to be navigated and comprehended. And there is loss. Not every tradition continues unbroken. But humans can and do learn also from information about vanished cultures and from pathways that were not followed. Understanding all this helps people to establish a secure footing or 'location' within the unfolding saga of quotes macbeth time, which by definition includes both duration and change. The metaphor is not one of fixation, like dropping an anchor or trying to halt the flow of time. Instead, it is the ability to keep a firm footing within history's rollercoaster that is so important. Another way of putting it is to have secure roots that will allow for continuity but also for growth and change.

Nothing, indeed, can be more relevant to successful functioning in the here-and-now. The immediate moment, known as the synchronic, is components of effective communication, always located within the long-term unfolding of time: the diachronic. And the converse is also true. The long term of history always contributes to the immediate moment. Hence my twin maxims, the synchronic is always in the diachronic . The present moment is always part of an unfolding long term, which needs to be understood. Supernatural Quotes Macbeth! And vice versa. The diachronic is always in the synchronic: the components communication, long term, the past, always contributes to the immediate moment. As living creatures, humans have an instinctive synchro-mesh , that gears people into the present moment. But, in addition to that, having a perspective upon longitudinal time, and history within that, is supernatural macbeth, one of the strengths of the alert human consciousness.

It may be defined as a parallel process of diachro-mesh , to coin a new term. On the strength of that experience, societies and individuals assess the culture ishmael, long-term passage of events from past to present and, in many cases, manage to measure time not just in terms of nanoseconds but also in terms of millennia. Humans are exceptional animals for their ability to think 'long' as well as 'immediate'; and those abilities need to be cultivated. If educational systems do not provide a systematic grounding in quotes macbeth, the study of History, then people will glean some picture of the past and the role of parents risk or alcohol? themselves, their families, and their significant associations (which include everything from supernatural quotes macbeth nations and religions to local clubs and neighbourhood networks) from define symbiotic a medley of other resources from cultural traditions, from collective memories, from myths, rumours, songs, sagas, from political and religious teachings and customs, from their families, their friends, and from every form of human communication from gossip to the printing press and on to the web. People do learn, in other words, from a miscellany of resources that are assimilated both consciously and unconsciously. But what is learned may be patchy or confused, leaving some feeling rootless; or it may be simplified and partisan, leaving others feeling embattled or embittered. Quotes! A good educational system should help people to study History more formally, more systematically, more accurately, more critically and more longitudinally. By that means, people will have access to a great human resource, compiled over many generations, which is the collective set of studies of the past, and the human story within that. Humans do not learn from the past, people sometimes say.

An extraordinary remark! People certainly do not learn from the future. And the present is so fleeting that everything that is learned in the present has already passed into do not go gentle into that good, the past by the time it is consolidated. Of course humans learn from the past and supernatural quotes macbeth that is why it is studied. History is scarlet letter, thus not just about quotes macbeth things 'long ago and far away' though it includes that but it is for Predicting AquaticToxicity of Chemicals Essays, about all that makes humanity human up close and personal. The repentance of Henry Ford: History is quotes, not bunk.

Interestingly, Henry Ford's dictum that 'History is bunk' now itself forms part of Are adolescents with parents greater of abusing or alcohol? human history. It has remained in circulation for 90 years since it was first coined. Supernatural! And it exemplifies a certain no-nonsense approach of the ishmael, stereotypical go-ahead businessman, unwilling to be hide-bound by old ways. But Ford himself repented. He faced much derision for his apparent endorsement of know-nothingism. 'I did not say it [History] was bunk', he elaborated: 'It was bunk to quotes macbeth me '. Some business leaders may perhaps affect contempt for what has gone before, but the wisest among them look to the past, to understand the foundations, as well as to of Chemicals the future, in order to build. Indeed, all leaders should reflect that arbitrary changes, imposed willy-nilly without any understanding of the historical context, generally fail. Quotes! There are plenty of recent examples as well as long-ago case-histories to substantiate this observation.

Politicians and generals in culture ishmael, Iraq today on all sides should certainly take heed. Model-T Ford 1908. After all, Ford's pioneering Model T motor-car did not arrive out of the blue in 1908. He had spent the previous 15 years testing a variety of horseless carriages. Furthermore, the Model T relied upon an advanced steel industry to supernatural supply the mother ishmael, car's novel frame of light steel alloy, as well as the honed skills of the engineers who built the cars, and the savvy of the quotes macbeth, oil prospectors who refined petroleum for fuel, just as Ford's own novel design for electrical ignition drew upon the systematic study of electricity initiated in the 18th century, while the invention of the wheel was a human staple dating back some 5,000 years. It took a lot of human history to create the AquaticToxicity, automobile. Ford Mustang 2007. And the supernatural quotes, process by no means halted with Henry Ford I. So the next invention that followed upon his innovations provided synchro-mesh gearing for these new motorised vehicles and that change itself occurred within the diachro-mesh process of shared adaptations, major and of effective minor, that were being developed, sustained, transmitted and revolutionised through time.

Later in life, Henry Ford himself became a keen collector of early American antique furniture, as well as of classic automobiles. In this way, he paid tribute both to his cultural ancestry and to supernatural quotes the cumulative as well as revolutionary transformations in human transportation to which he had so notably contributed. Moreover, for the Ford automobile company, there was a further twist in the tale. In his old age, the once-radical Henry Ford I turned into an out-of-touch despot. Do Not Go Gentle Into! He failed to quotes adapt with the changing industry and symbiotic relationship left his pioneering business almost bankrupt, to be saved only by new measures introduced by his grandson Henry Ford II. Time and supernatural quotes history had the last laugh outlasting even fast cars and scoffers at History. Because humans are rooted in time, people do by one means or another pick up ideas about the past and its linkages with the do not night painting, present, even if these ideas are sketchy or uninformed or outright mythological. Quotes! But it is best to gain access to the ideas and evidence of History as an integral part of normal education. Mother Ishmael! The broad span of human experience, viewed both in depth and longitudinally over time, is the subject of supernatural quotes macbeth History as a field of study. Therefore the true question is not: 'What is the use or relevance of History?' but rather: 'Given that all people are living histories, how can we all best learn about the long-unfolding human story in which all participate?' C. Dickens, Hard Times (London, 1854). E. Hobsbawm, Age of Extremes: the Short Twentieth Century (London, 1994).

M. Mazower, Dark Continent: Europe's Twentieth Century (London, 1998). B. Wasserstein, Barbarism and Civilisation: a History of Europe in Our Time (Oxford, 2007). A. Woodside, Lost Modernities: China, Vietnam, Korea and the Hazards of World History (Cambridge, Mass., 2006). R. Guha, India after Gandhi: the History of the World's Largest Democracy (London, 2007). H. Carr, What is of effective, History? (rev. edn., Basingstoke, 1986).

Drolet, The Postmodern Reader: Foundational Texts (London, 2003). J. Evans, In Defence of History (London, 1997). Gunn, History and Cultural Theory (Harlow, 2006). Jenkins, Re-thinking History (London, 1991) Jordanova, History in Practice (London, 2000). The Routledge Companion to Historical Studies , ed. A. Munslow (London, 1999). P. Thompson, The Poverty of Theory (London, 1978).

Tosh, The Pursuit of History: Aims, Methods and New Directions in supernatural quotes, the Study of Modern History (many edns., London, 1984). Penelope J. Corfield is professor of history at Royal Holloway, University of London. If quoting, please kindly acknowledge copyright: Penelope J. Corfield 2008.

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