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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. Duchess Poetry Essay? 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 type 2 diabetes but is for research paper hard to maintain with behavioral modification alone. In an analysis of essay, data from a nonrandomized, prospective, controlled study, we examined the effects of bariatric surgery on the prevention of 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 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 change our future, age, and the body-mass index (BMI; the weight in my last duchess, kilograms divided by the square of the height in meters) was 34 or more in men and 38 or more in women. Head? This analysis focused on my last poetry 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 essay, 15 years.

Despite matching, some baseline characteristics differed significantly between the groups; the baseline body weight was higher and risk factors were more pronounced in the bariatric-surgery group than in the control group. 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 my last essay, 392 participants in the control group and in 110 in the bariatric-surgery group, corresponding to mis reporting resume, 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). 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 BMI (P=0.54). Sensitivity analyses, including end-point imputations, did not change the overall conclusions. My Last Poetry Essay? The postoperative mortality was 0.2%, and head for research, 2.8% of patients who underwent bariatric surgery required reoperation within 90 days owing to poetry essay, complications. Bariatric surgery appears to be markedly more efficient than usual care in the prevention of type 2 diabetes in obese persons. Resume? (Funded by the Swedish Research Council and my last poetry, 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 rubric 4th grade, worldwide increase in obesity is associated with an increase in the prevalence of my last duchess, type 2 diabetes. Write Introduction? 9 Currently, 285 million people have type 2 diabetes, and my last, this number is predicted to increase to 439 million by running head for research paper 2030. 10. Among persons in a prediabetic state, the duchess poetry, incidence of law cases studies, type 2 diabetes is reduced by duchess approximately 40 to 45% with effective lifestyle changes or drug treatment, 11-15 and the effects persist, in part, 3 to 15 years later.

16-18 Most trials of lifestyle changes and literary essay rubric 4th grade, drugs for poetry, the prevention of type 2 diabetes have included moderately obese patients. However, patients with severe obesity have the highest risk of type 2 diabetes, 1,2,19,20 and in this group, bariatric surgery is praxis essay currently the only treatment that typically results in my last, 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 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 long-term effects of running head, bariatric surgery with the my last essay, effects of usual care. We have previously shown that bariatric surgery results in long-term weight loss and reduces the incidence of science and technology change our future essay, 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 duchess essay, cardiovascular risk factors. 21 We now report a detailed analysis of the mis reporting resume, long-term effects of bariatric surgery on my last duchess poetry the prevention of how to write an admission essay, type 2 diabetes. Between September 1, 1987, and January 31, 2001, a total of my last essay, 4047 obese persons were enrolled in the SOS intervention trial, which is literary still ongoing. 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 my last poetry essay, 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 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 matching process unexpectedly resulted in the bariatric-surgery group having a higher mean body weight and more severe risk factors than the control group. Weight changes that occurred after matching made the study groups even more divergent with respect to these factors at baseline. Mis Reporting Resume? 21-24 The current analysis includes 1658 patients who underwent bariatric surgery and my last duchess essay, 1771 controls, all of essay help, whom did not have diabetes at baseline.

The requirement for this analysis that none of the patients have diabetes at my last poetry, baseline further reduced the similarity between the essay, two groups. The cutoff date for the analysis was January 1, 2012. The rate of duchess, incident type 2 diabetes was a prespecified secondary end point of the SOS intervention trial and was analyzed according to the SOS protocol. The study groups had identical inclusion and exclusion criteria. The inclusion criteria were an age of praxis essay, 37 to 60 years and a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of 34 or more in men and 38 or more in women before or at the time of the 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 essay, control groups entered this study with the intention of head, 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 my last duchess essay, 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 physical activity) to no treatment.

According to questionnaires administered at 6 months, 1 year, and 2 years, 54% of the praxis help, 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 15 years. From 1987 through 2009, glucose concentrations were measured in venous whole blood at the Central Laboratory, Sahlgrenska University Hospital, which is accredited according to my last duchess essay, 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 harvard studies, rate themselves as physically active or inactive. 21,25-27 Energy intake was measured with the use of the 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 all participants. The protocol, including the my last poetry, statistical analysis plan, is available at NEJM.org.

The authors vouch for literary essay, the completeness and my last duchess, accuracy of the literary, data and analyses and for the fidelity of the study to the protocol. All the authors had access to the raw data. None of the study sponsors had any role in 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 my last essay, use of diabetes medication or if there was documentation of resume, a fasting blood glucose level of 110 mg per my last duchess poetry, deciliter (6.1 mmol per literary essay, 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 duchess essay, 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 running head for research, type 2 diabetes; therefore, single fasting glucose determinations were used. Impaired fasting glucose was defined as a fasting blood glucose level that was at my last duchess poetry essay, least 90 mg per help, deciliter (5.0 mmol per liter) and less than 110 mg per deciliter or a fasting plasma glucose level that was at least 100 mg per my last duchess essay, deciliter (5.6 mmol per liter) and less than 126 mg per mis reporting resume, deciliter.

29,30. Mean values, with standard deviations, and percents were used to essay, describe the baseline characteristics. Differences between treatment groups were evaluated with the use of t-tests for continuous variables and with the use of a logistic-regression model for essay 4th grade, dichotomous variables. Participants were followed until the diagnosis of my last duchess, type 2 diabetes or until their last examination. Data from 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 how to write an admission, years 2, 10, and 15, we consider the data on duchess essay underlying continuous time to diabetes to be interval-censored data. Therefore, we used a discrete-time survival approach, with a complementary log–log regression model 31 to evaluate the cumulative incidence of type 2 diabetes and literary rubric 4th grade, the treatment effect of bariatric surgery.

This approach corresponds to my last poetry, the Cox proportional-hazards regression model when continuous time to event is observed in intervals, 31 and it provides relative-risk estimates as hazard ratios. And Technology Change Our Future? 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 treatment group (surgery or control) and in an analysis that was adjusted for my last poetry essay, preselected baseline traditional risk factors for type 2 diabetes. Law Cases? The proportional-hazards assumption was evaluated with the use of graphic methods (i.e., the log–log plot) and by testing the my last poetry essay, interaction between time and literary rubric 4th grade, treatment. My Last Poetry? 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 how will science our future including the my last poetry essay, corresponding interaction term (i.e., the product of the essay help, type of duchess poetry essay, treatment [surgery or control] and law cases, the corresponding variable) in the complementary log–log proportional-hazards model. Dichotomous variables could have one of two values (e.g., male or female sex). My Last Duchess Essay? For other variables, the mis reporting resume, interaction tests used the essay, original continuous variables. We performed 19 post hoc subgroup analyses, all of which are reported in the Supplementary Appendix. P values for interaction have been corrected for 19 multiple tests with the write an admission, use of the false-discovery-rate method of Benjamini and Hochberg. 32 The numbers needed to treat to prevent one diabetes event over the course of my last duchess poetry essay, 10 years was calculated as the reciprocal of the absolute difference in risk between the bariatric-surgery group and paper, the control group.

Since the rates of loss to follow-up were considerable at longer follow-up times, sensitivity analyses that were based on my last duchess poetry essay multiple imputation of missing outcome data were also performed (see the Supplementary Appendix). In addition, we compared the baseline characteristics and essay introduction, 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 my last duchess poetry, less than 0.05 were considered to for research, indicate statistical significance. The intention-to-treat principle was applied for all the my last poetry, calculations. Essay? The Stata statistical package, version 12.1, was used. Baseline Characteristics, Follow-up Rate, and Weight Changes during Follow-up. The differences between the surgery group and the control group increased between the poetry essay, time of the mis reporting resume, matching examination (Table S1 in the Supplementary Appendix) and the time of the baseline examination ( Table 1 Table 1 Baseline Characteristics of Study Participants. ). At baseline, patients in the bariatric-surgery group weighed, on average, 6 kg more, and most of the duchess poetry essay, risk factors we analyzed were more pronounced than were those in the controls ( Table 1 ). Literary Essay 4th Grade? The median follow-up time was 10 years (range, 0 to 15). The rates of 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 duchess, rates in each study group). At 15 years, the rate of loss to follow-up had increased to 36.2%; in praxis help, addition, 30.9% of the participants had not yet been followed for 15 years and were therefore not eligible for the 15-year analysis (Table S2 in the Supplementary Appendix). This resulted in an unadjusted 15-year participation rate of only 32.9%. After adjustment for duchess poetry essay, follow-up of paper, less than 15 years and for duchess, death, the how to write an admission, 15-year participation rate was 53.5%.

Because of the low participation rates, particularly at poetry, 15 years, we performed sensitivity analyses (see below). In the bariatric-surgery group, participants had an average maximal weight loss of 31 kg after 1 year. Partial weight regain then occurred, and mis reporting, 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 duchess, 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 introduction, 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 2.0) among participants who had not received help (P0.001). This difference in weight change disappeared after longer follow-up (Fig.

S3 in 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. S3 in the Supplementary Appendix). During the poetry, follow-up period, type 2 diabetes developed in science, 392 patients in duchess poetry essay, the control group and 110 in the bariatric-surgery group ( Figure 1A Figure 1 Cumulative Incidence of Type 2 Diabetes. Panel A shows the mis reporting, Kaplan–Meier unadjusted estimates of the cumulative incidence of type 2 diabetes in 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). Panel B shows the my last duchess poetry, Kaplan–Meier unadjusted estimates of the incidence of type 2 diabetes in subgroups defined in the control group according to receipt or no receipt of 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 1000 person-years and 6.8 (95% CI, 5.7 to 8.3) per 1000 person-years, respectively (P0.001), on the basis of how to, 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. ). Essay? 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 how will science change, impaired fasting glucose (Table S3 in 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 duchess poetry essay, S5 in the Supplementary Appendix).

Given the low participation rate and the strong treatment effect at law cases studies, 15 years, we also examined the my last, effects of harvard law cases, surgery at my last poetry essay, other follow-up times (Table S6 in head for research, the Supplementary Appendix). The treatment effects on my last duchess the incidence of type 2 diabetes were at least as strong after 2 years and 10 years of follow-up as after 15 years. Mis Reporting Resume? 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 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 ). Duchess? The hazard ratio with gastric bypass was 0.12 (95% CI, 0.05 to 0.27; P0.001), but the 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 0.31; P0.001) did not differ significantly from the hazard ratio with gastric bypass.

Interactions between risk factors and how will, treatment are shown in Table S7 in the Supplementary Appendix. The effect of bariatric surgery on the incidence of type 2 diabetes was highly significant in all subgroups, but the my last duchess essay, interaction between risk factors at baseline and treatment was significant only in the subgroups defined according to presence or absence of essay, impaired fasting glucose (P=0.002 for the interaction), fasting blood glucose level (P=0.007), fasting serum insulin concentration (P=0.007), and value for the homeostasis model assessment of insulin resistance (P=0.001). 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 type 2 diabetes per 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 duchess, kilograms divided by the square of the height in meters) (Panel C). In Panel A, P=0.002 for the interaction of essay, 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. For complete information on all calculated P values for interaction, see Table S7 in the Supplementary Appendix. To convert the values for my last essay, glucose to millimoles per literary essay 4th grade, liter, multiply by 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 duchess, surgery ( Figure 2C ). The number needed to treat to prevent one diabetes event was low in all the subgroups, reflecting the strong treatment effect of bariatric surgery. In the subgroup defined according to the presence or absence of essay rubric, impaired fasting glucose, the number needed to treat was 1.3 (Table S7 in the Supplementary Appendix). Postoperative mortality and 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 1658 Participants in the Bariatric-Surgery Group. . My Last Essay? 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 mis reporting resume, long-term incidence of 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. Duchess Poetry Essay? Among patients with impaired fasting glucose, bariatric surgery reduced the risk by 87%, and type 2 diabetes did not develop in approximately 10 of literary 4th grade, 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 other organizations 34,35 recognize bariatric surgery as an option for obese patients who have type 2 diabetes but have not suggested bariatric surgery for duchess poetry essay, the prevention of type 2 diabetes.

The rate of remission of type 2 diabetes is higher after gastric bypass than after banding, 36 and this may be related to and technology change our future, greater weight loss after gastric bypass or to 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 type 2 diabetes (incidence among patients receiving usual care, 91 cases per 1000 person-years vs. 20 cases per my last poetry essay, 1000 person-years) and appear to have a greater benefit from essay introduction, bariatric surgery (P=0.002 for duchess poetry, 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 a progressive disease, and the ability to produce insulin declines with time. 38 Improvement of insulin sensitivity by means of weight loss may not be enough to induce the running head for research, remission of diabetes if the destruction of 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 my last duchess, 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 studies, diagnosis of type 2 diabetes was based on fasting glucose levels and self-reported use of diabetes medication. Diagnosis of type 2 diabetes that was based on results of an oral glucose-tolerance test or on my last 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 diabetes. The low rate of participation at 15 years is also a limitation, but sensitivity analyses, including end-point imputations, indicate that our reported results are valid. How Will Science And Technology Change Essay? Ideally, our post hoc findings should be confirmed by my last poetry essay 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 literary, the selection of candidates for bariatric surgery, whereas data on impaired fasting glucose may be helpful. Supported by duchess poetry essay grants from the Swedish Research Council (K2012-55X-22082-01-3, K2010-55X-11285-13, K2008-65x-20753-01-4), the how will and technology our future essay, Swedish Foundation for Strategic Research to Sahlgrenska Center for Cardiovascular and Metabolic Research, the Swedish federal government under the LUA/ALF agreement concerning research and my last duchess essay, education of doctors, the VINNOVA-VINNMER program, and the Wenner-Gren Foundations. The SOS study has previously been supported by grants to how to introduction, one of the authors from Hoffmann–La Roche, AstraZeneca, Cederroth, Sanofi-Aventis, and Johnson Johnson.

Dr. Lena Carlsson reports receiving consulting fees from AstraZeneca and owning stock in Sahltech; Dr. Bouchard, receiving consulting fees from New York Obesity Nutrition Research Center, Pathway Genomics, Weight Watchers, and my last poetry, Nike, payment for head paper, 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. Bjorn Carlsson, being employed by and owning stock in AstraZeneca; Dr. Sjoholm, owning stock in Pfizer; Dr. Wedel, receiving consulting fees from AstraZeneca, Pfizer, Roche, and Novartis; and my last essay, 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 how will science our future essay drug effects and poetry essay, weight-loss effects on obesity for AstraZeneca. 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 harvard law cases, Peltonen contributed equally to this article. We thank the my last essay, staff members at 480 primary health care centers and 25 surgical departments in Sweden that participated in the study; and Gerd Bergmark, Christina Torefalk and Lisbeth Eriksson for administrative support. From the write introduction, 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 Public Health (H.W.), Gothenburg, and the Department of 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. 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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Bariatric surgery and long-term cardiovascular events. JAMA 2012;307:56-65. Wilhelmsen L , Tibblin G , Aurell M , Bjure J , Ekstrom-Jodal B , Grimby G . Running Head For Research Paper? Physical activity, physical fitness and risk of my last duchess essay, myocardial infarction. Adv Cardiol 1976;18:217-230. Thune I , Njolstad I , Lochen ML , Forde OH . Physical activity improves the metabolic risk profiles in men and women: the Tromso Study. Arch Intern Med 1998;158:1633-1640[Erratum, Arch Intern Med 1998;159:17.] Larsson I , Lissner L , Naslund I , Lindroos A . Leisure and occupational physical activity in resume, relation to poetry, body mass index in men and women. Scand J Food Nutr 2004;48:165-172. Lindroos AK , Lissner L , Sjostrom L . Validity and literary rubric, reproducibility of a self-administered dietary questionnaire in obese and non-obese subjects.

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Dixon JB , Zimmet P , Alberti KG , Rubino F . Bariatric surgery: an IDF statement for obese Type 2 diabetes. Diabet Med 2011;28:628-642. Runkel N , Colombo-Benkmann M , Huttl TP , et al. Evidence-based German guidelines for surgery for obesity. Int J Colorectal Dis 2011;26:397-404.

Rubino F , Kaplan LM , Schauer PR , Cummings DE . The Diabetes Surgery Summit consensus conference: recommendations for the evaluation and use of gastrointestinal surgery to treat type 2 diabetes mellitus. Ann Surg 2010;251:399-405. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and essay, meta-analysis. Am J Med 2009;122(3):248.e5-256.e5. Rubino F , Schauer PR , Kaplan LM , Cummings DE . Metabolic surgery to treat type 2 diabetes: clinical outcomes and mechanisms of action.

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My Last Duchess Poetry Explication …

Parrot For Kids Essays and essay Research Papers. ?Running Head: COMMUNICATION VIA “THE KID ” 1 Interpersonal Communication as lost . from the movie “The Kid ” COMMUNICATION VIA “THE KID ” 2 The interpersonal communication in the movie “The Kid ” is unique in some aspects. Russ, the middle aged character, has an indifference to harvard law cases everyone he communicates with at the beginning of the movie. As the movie progresses, you can see how Russ’s interpersonal communication. Communication , Graphic communication , Interpersonal communication 809 Words | 3 Pages. Duritz hides from his hurt and loneliness by working all the time, being thoughtless and insensitive to my last duchess poetry essay everyone he meets, and forgetting his feelings and . that he ever had them. But he can't escape his feelings. Mis Reporting. Duritz meets a pudgy, unhappy little kid named Rusty (Spencer Breslin) who turns out to be none other than Duritz himself, circa 1968.

At first, Duritz is poetry essay embarrassed by his younger self. He says, I look at head for research paper him and all I see is awful memories -- memories I've been spending most of my life. Amy Tong , Dog , Marriage 891 Words | 3 Pages. Kids or No Kids Candance Bacco March 3, 2013 The title of my paper is called Kids or No Kids . My Last. . Today married couples have a big decision on whether or not they want kids . I start out literary 4th grade, my paper by poetry talking about how important this decision is and how it effects other people. Then I start to talk about all the praxis help pros of having kids . After that I point out all the cons of having children. The next part of the paper is all about the duchess poetry pros and cons of not having kids . As you will see there are a lot. Child , Debut albums , Form of the Good 1027 Words | 3 Pages. want to share some information with people how to mis reporting tame a parrot to duchess poetry essay make a good friend Specific Purpose: . By the end of my speech you are going to be informed with some important steps how to studies teach a parrot to be tamed. Central Idea/Thesis: I am going to duchess essay teach you how to literary essay rubric 4th grade get the duchess poetry bird out of cage and tame to enjoy the abilities of the praxis help smartest bird in the world.

Introduction: You may be a first time parrot owner that just got home with a new bird wondering why. African Grey Parrot , Bird , Budgerigar 2100 Words | 5 Pages. Psittacosis ( parrot fever): Have you ever heard of the my last animal disease Parrot fever? Parrot fever is caused by . bacteria, but it also has the characteristics of a virus. The disease is caused by law cases studies airborne illness and something in the infected animals waste. Some of the symptoms of this disease in my last duchess essay, animals are discharge from their nose, weight loss, loss of balance and weakness. In humans they can get this disease by inhaling the infected waste or digesting the particles. Literary. One way to test for this. Animal , Bird , Infection 886 Words | 3 Pages.

The parrots are a broad order of poetry essay, more than 350 birds. Macaws, Amazons, lorikeets, lovebirds, cockatoos and many others are all considered . parrots . Though there is great diversity among these birds, there are similarities as well. Harvard Studies. All parrots have curved beaks and my last duchess poetry all are zygodactyls, meaning they have four toes on each foot, two pointing forward and two projecting backward. Most parrots eat fruit, flowers, buds, nuts, seeds, and mis reporting resume some small creatures such as insects. Parrots are found in warm climates. African Grey Parrot , Bird , Hyacinth Macaw 3215 Words | 9 Pages. Problem “ Kids will be kids .” Time and time again, this phrase has been used to dismiss the countless cases of bullying that take . place in schools across the country. Such a carefree attitude towards a violent and brutal problem like bullying is a disturbing trend to see. Every year thousands of kids fall victim to schoolyard and online bulling. A child who has suffered from bullying is “2 to 9 times more likely to commit or attempt suicide” (Teen Health) and more often then not, cruelty from peers.

Abuse , Aggression , Bullying 881 Words | 3 Pages. act, speak and my last poetry essay look a certain way. You are to be exactly like your parents, to say the least, holy like. Literary Rubric 4th Grade. “It is ok for poetry essay the members kids to running for research act . a certain way yet if the preachers kids act like that then suddenly the parents are horrible people. How many times has a preachers kid been told no you can't do that because people won't like it. My Last Duchess. How many preachers kids have missed out on a normal childhood because the parents wouldn't let them enjoy anything because people might talk.

You can't go. Christian terms , English-language films , Father 1065 Words | 3 Pages. Billy the Kid New Mexico has had many well-known legends throughout its history. Billy the Kid was arguably one of praxis essay, most . famous legends that New Mexico has ever had. Also known as William H. My Last Duchess. Bonney, Billy the Kid became a prominent and feared outlaw due to his violent nature. His life is still a heated topic throughout America, due to mis reporting resume his unnatural cruelness and pain. His disturbing acts of cruelty caused many tragedies captured many lives, including his own, making his life one to remember. Alexander McSween , Billy the Kid , Boy 2295 Words | 6 Pages. cast your mind back to the last time you stood your ground as your nine-year-old begged for yet another pair of duchess poetry, trainers, or your 14-year-old threatened to . fail his exams unless he could go out with his friends midweek ? bankrolled by you? Pampered kids can grow up to be dysfunctional within society Can you, hand on heart, say that you have never once given in to the petulant insistence that everyone else I know has one, even when you knew, deep down, that you shouldn't?

We all love our children. Child , Child discipline , CHILD syndrome 3138 Words | 6 Pages. Essay Narration and focalization in Flaubert’s Parrot I must admit. I had lost every sense of direction after five pages in Barnes' . book. There were no signs of a plot whatsoever and a mysterious narrator was being philosophical. What on for research, earth could he possibly mean by duchess “Did that burst of bubbles announce the gurgling death of another submerged reference?” I continued reading in praxis essay help, every free minute, determined to finish the book in time, avoiding having to write the essay on the eve of the. Bankruptcy in poetry essay, the United States , Gustave Flaubert , Julian Barnes 927 Words | 3 Pages. what children are doing, they are always surrounded by advertisements. Whether it is watching television, Reading a book/magazine, or browsing the internet; . Law Cases. advertisements are everywhere.

Eric Schlosser has a good point when he argues in his essay “ Kid Kustomers” that more advertisements are being directed towards children each day. It is not only directed toward children, but influencing children to beg their parents for my last duchess products they do not need or even want. As in, the rubric 4th grade stuff they see on television. Advertising , Burbank, California , Disney Channel 1468 Words | 4 Pages. Jealous Husband Returns as a Parrot. from danger or trouble. In the short story, “Jealous Husband Returns in Form of Parrot ”, Robert Olen Butler makes the point that cowardly . behavior can ultimately lead to ones demise through his use of plot, characterization, symbolism, and my last essay irony. In this story, Butler portrays a jealous husbands cowardly behavior when dealing with his supposedly cheating wife, which leads to his death. Mis Reporting. He then returns in the form of a parrot to endure the my last poetry pain of his decisions. As demonstrated by the husband, who is. Bird , Cowardice , Emotion 1563 Words | 4 Pages.

Adults feel less happy compared to kids A really enjoyable time for kids are when they are with their friends playing outside . How Will Science Our Future Essay. getting exercise rather than sitting down like an adult. My Last Duchess. Another enjoyable time that makes kids really happy is on rides or exploring where they see a world on a whole new perspective while adults do the same thing over and over again. Everyone must act more a like kid to have more enjoyable time. Kids seem much happier than adults do. Kids are so much more in essay introduction, happier when.

Force , Happiness , Personal life 1077 Words | 3 Pages. Swing Kids Before and during World War II was a tough time to live in Nazi Germany. Essay. The new laws and way of life during this period affected . Essay 4th Grade. society of my last, all ages in law cases, numerous different ways. New political and social groups were formed both to support and oppose the my last Nazi and praxis the Gestapo leaders. Essay. One of these groups was known as the Swing Kids who listened to Jewish and black swing music and danced at and technology change essay illegal clubs against the Nazis. The movie, “Swing Kids ”, explains this group of teenagers. The. Adolf Hitler , Germany , Hitler Youth 1076 Words | 3 Pages. “ Kid Kustomers” No matter where children are or what they are doing they’ll always find some sort of advertisements.

It can be when their . casually watching television, reading a magazine or just playing games on their computer. Poetry Essay. Advertisements are different forms of communication whose purpose is to make their product known to the public. Marketers aren’t partial to certain people; they target anyone and every age group, but recently there has been an law cases upsurge of advertisements aimed towards children. Advertising , Coca-Cola , Infomercial 1083 Words | 3 Pages. Swing Kids 1. Duchess Essay. Hamburg, Germany. Law Cases. 1939. The main character, a young, German man named Peter Muller, was very traumatized by what the Nazi's . and Gestapo (the terrorist political police of the my last essay Nazi regime founded by Hermann Goring, whose purpose was to praxis help persecute all political opponents of the Nazi regime) did to his father.

Over the course of the movie, Peter went through a change; he saw his father in a new light, and realized what really mattered in duchess, the world around him. Peter's father was a. Adolf Hitler , Aryan race , Fascism 2759 Words | 7 Pages. Psychic Kids : Attention Seeking Children In the television series, Psychic Kids : Children of the Paranormal, directed by . Praxis Help. Lisa Miller, psychic and medium Chip Coffey alongside Dr. My Last Duchess Poetry Essay. Lisa Miller, a clinical psychologist, help children and their families understand and cope with their child’s psychic abilities.

Within this documentary, a group of “psychic children” and their parents come together with Coffey and mis reporting resume Miller to grasp an understanding as to how to handle their psychic abilities. The children. Childhood , Clairvoyance , Family 990 Words | 3 Pages. Happy Marriages, Happy Kids On a sunny day, a father wants his family to go mountain climbing, but the mother prefers to go to duchess the . mall to buy shoes for the kids . Law Cases Studies. Even though it is a very normal conversation in a family, the way parents solve this conflict could make a big deal to duchess the kids . Siegel, author of “7 Essential Lessons Your Kids Learn from Your Marriage,” states that “how you and your husband talk to each other, how you listen, and how you work out your differences shape the beliefs. Alimony , Annulment , Divorce 1333 Words | 4 Pages. ? Marketing 310 September 11th, 2014 Parrot Heads Unite Research Paper How can we consider Jimmy Buffet as members of a reference . group? A brand community. For Research. The definition of a reference group is the people of duchess essay, whose attitudes, behavior, beliefs, opinions, preferences, and essay values are used by an individual as the basis for his or her judgment.

One does not have to be (or even aspire to be) a member of a reference group to be negatively or positively influenced by its characteristics. Jimmy Buffet. Brand , Brand management , Branding 708 Words | 4 Pages. Billy the Kid is poetry essay my kind of Cowboy This issue of Living in the West explores the how to write an admission essay love affair we have with the great American Cowboy. Call . them cowhands, cowpoke, cowpuncher or buckaroos, billions of dollars have been spent chronicling their storied history.

With his Stetson hat, sunburned face, weathered dungarees and boots of leather, the cowboy has gone from a ranch hand to a blue color icon. In fact, America’s love affair with the cowboy has been around longer than the name “cowboy” itself. American films , American Old West , Billy the Kid 1021 Words | 3 Pages. Nazi Germany declared war on my last duchess poetry essay, the freedom of its youth in Germany. But a group arose from the battlefields of war. They were called the “Swing . Kids ”. Science And Technology Change Our Future. This was a group of youth children that rebel toward the my last duchess poetry Nazi’s with their swing music that originated in America. With this new era of swing music extra punishment was put toward the youth from the how will science and technology change our future Nazi’s.

Kids all over the world rebelled against this Nazi stand. In this movie Peter Thomas are two friends whose views of Nazi Germany change. Before. Adolf Hitler , Aryan race , Fascism 906 Words | 3 Pages. Album Reviews Book Reviews Downloads Features Movie Reviews Music Video Reviews Single Reviews The Karate . Kid : Children’s own self-help Filed under: Movie Reviews — Leave a comment August 15, 2010 Starring Will Smith’s son, Jaden Smith, along Jackie Chan, bring to the big screen the remake of 1984’s The Karate Kid , a cross cultural adaptation depiction and a vivid stand-up towards school bullying. Dre is a 12 year old who just moved to China due to his. Bullying , Film , Jackie Chan 561 Words | 4 Pages. Allen Eckles Mrs. My Last Poetry. Konczakowski 12 CP LA period 1 23 August 2012 “Token kid ” In school social circles, I always find myself becoming “The . Token Black kid . 4th Grade. Most people just naturally assume by duchess the tan skin and write an admission introduction curly hair that I must be half black. They mistakenly assume that many of the accomplishments I have made are due to the fact that I am mixed. It is true that I am mixed, but not with African American, but with the Latino culture.

My mother was born in my last duchess, the Dominican Republic, and my. African American , Black Hispanic and Latino Americans , Black people 1337 Words | 4 Pages. ?Running head: 4MAT REVIEW, PARROT PARROT 1 4MAT Review . of, “The Complete Guide to Marriage Mentoring” By Les Parrot and Leslie Parrot Barbara Perry Liberty University 4MAT REVIEW, PARROT PARROT 2 “The Complete Guide to Marriage Mentoring” By Les Parrot and Leslie Parrot Summary In this book, Parrot Parrot (2005) present a resource. Alimony , Coaching , Divorce 1316 Words | 8 Pages. Analyzing a short story * Title: Kid Kill * Author: Ed McBain * Year: 1953 * Genre: Short story - crime story * . Description – a summary of the plot: The story takes place….. At the same time as it is written, It takes place on essay rubric 4th grade, a very cold day in a smaller town in a police station and in duchess essay, the home of the family. And Technology Change. In the beginning of the story….

We are at essay the police station where we meet the detective Art Willis and his partner Ed Daley. Studies. Then…… The detective arrives. Constable , Criminal Investigation Department , Detective 775 Words | 3 Pages. An Analysis of my last duchess poetry, Flaubert's Parrot by essay Julian Barnes. ?Book Review Flauberts Parrot by Julian Barnes By: Maureen Cutajar Published: December 18, 2009 Literary analysis: Flaubert's . Parrot , by duchess poetry essay Julian Barnes Julian Barnes’s ‘Flaubert’s Parrot ’ thematises the literary essay difficulties of interpreting the duchess poetry past and the elusiveness of literary essay rubric 4th grade, history. Geoffrey Braithwaite, the narrator, in his relentless pursuit of the relics and mementos of the nineteenth-century writer Gustave Flaubert poses the question: ‘How do we seize the past? Can we ever do so? When I was a medical.

Critic , Criticism , Gustave Flaubert 2059 Words | 5 Pages. Kids gain knowledge best by watching conducts of adults and my last duchess poetry essay replicating it is a contentious one. Many people think that this is the most . effective for the children to help learn. Duchess Essay. However the literary essay opposites are not few in numbers. In this essay I’ll discuss some argument for and against of the given topic. The behavior of the adults plays a significant role in duchess, shaping children’s inclination and character. After the baby is born the first and running head the nearest adults are his/her parents.

Then the little baby starts. Childhood , Developmental psychology , Educational psychology 550 Words | 2 Pages. Accounting For Kids AIU Online Abstract Many people hear accounting and think of an office full of my last duchess poetry, file cabinets and cubicles, thus its . far more complex. Accounting covers far more ground than the literary rubric average person may imagine. With a proper accounting process in place, a business will always be well informed of the company’s finances. Poetry Essay. Accounting is a business aspect that affects numerous corporation and running for research individuals all around the world. In the business world today, companies use the accounting. Accountancy , Accountant , Business 783 Words | 3 Pages. S Y M P O S I U M Arts Education from Past to Present Kant for Kids Editor’s note: This article is the ninth in an occasional series . on past treatments of major issues in poetry essay, arts education policy from antiquity through the twentieth century. Essay Rubric 4th Grade. Future essays will appear as occasion arises.

A esthetics, we could say, is the philosophy of my last, art (including poetry and literature), and philosophy can be defined as a way of reflecting and clarifying ordinary, everyday thoughts and praxis essay feelings that. Aesthetics , Art , Critique of Judgement 2419 Words | 7 Pages. Kids Having Kids: Teenage Pregnancy. Kids Having Kids : Teenage Pregnancy One of the most beautiful things in life that a person could experience is having a child. . There is an unspeakable bond between the duchess parent and the child, which starts as early as the time they first hear about being pregnant. This is true, but it is good to have everything in place when you have a child such as finding the how will and technology change our future right partner, having a good job, and stable finances.

The truth is that things don’t always go according to plan, and there are some consequences. Adolescence , Childbirth , Health 1272 Words | 4 Pages. Jealous Husband Returns in Form of Parrot Claim Paper. in Form of Parrot ” by my last essay Robert Butler which is written in first person narrator form. Writing this story in first person narrator form makes . Essay Rubric. this particular story very interesting and poetry much better of a story, and keeps the reader very interested in the story. When Butler writes this story he sets the story up from the beginning when he recognizes his wife, this places the reader in a zone to try and resume figure out how exactly the story is going to play out.

In the story Butler uses the parrot as the first. Academy Award for Best Actress , Academy Award for Best Picture , Fiction 1116 Words | 3 Pages. average weight of textbooks in my last, History, Mathematics, Science, and head for research paper Reading/Language Arts exceeds this percentage at nearly all grade levels from 1-12. . According to the US Consumer Product Safety Commission, during the 2011-12 school year more than 13,700 kids , aged 5 to 18, were treated for poetry essay backpack-related injuries. | A broken tablet requires an experienced technician to running for research fix, which can be costly and my last poetry time-consuming. How To Essay Introduction. Textbooks can usually be repaired with basic supplies such as glue or tape.Print textbooks. Digital , Education , High school 2139 Words | 6 Pages. learning disability.

Some educators may feel that inclusion may not work in all cases due to the fact that the child may be disruptive and prohibit . others from learning. Gaining knowledge of essay, inclusion has given me the how will change our future essay opportunity to relate to duchess poetry essay the kids I educate at work that have various learning disabilities. I was able to interview some of the students to see what actually got involved in alternative school setting. One student told me that he was there for gang activity. Shelby County. Education , Educational stages , Gang 2038 Words | 6 Pages. In the article “what’s the Matter with kids today?” Amy Goldwasser discusses the paper issues this generation of kids . Goldwasser makes . some logical arguments of the benefits of my last duchess poetry essay, technology in the lives of kids . She touches on the emotional aspect of kids and how social technology plays a part in resume, their lives. Goldwasser started her article talking about some studies and quotes on some of the my last duchess poetry essay problems with this generation’s children. She also talks a bit about the fact that this is the how will essay first generation in. Adolescence , Generation Y , Instant messaging 1007 Words | 3 Pages. Third Culture Kids Research Questions: 1. What is the my last duchess essay socio-demographic profile of the research participants?

2. What are the . Praxis Help. factors that influence identity crisis among these third culture kids ? 3. What are the experiences of third Culture kids who are having identity crisis? (THIS CAN BE CHANGED. WE NEED TO FIND THE CONNECTION BETWEEN 2 and 4.) 4. What are the difficulties for the Third Culture kids associated identity crisis? 5. How do Third Culture Kids cope with these. Adjusted Gross Income , Conceptual framework , Exploratory research 491 Words | 3 Pages. phenomenon of Hong Kong Kids I The Phenomenon of my last poetry, Hong Kong Kids . THE PHENOMENON OF HONG KONG KIDS II Abstract In recent years, children who born after 1990s are labeled “Hong Kong kids ”. The comments towards “Hong Kong kids ” are mostly negative. This paper is aimed to discover “Hong Kong kids ” characteristic, and essay rubric 4th grade the cause of this phenomenon. My Last Essay. Throughout examining “Hong Kong kids ”, it can show out. Economy of the People's Republic of China , Emotional intelligence , Hong Kong 1067 Words | 3 Pages. PROBLEM/OPPORTUNITY The most pressing issue facing Casablanca kids is a declining net income which has resulted from supply chain and harvard law cases . production issues. Namely, manufacturing costs have remained stagnant while retailers such as WalMart have been forcing prices down.

Casablanca Kids is confronted with the poetry essay interesting opportunity of redesigning their distribution channels. Effective distribution channel restructuring will allow the how to an admission essay introduction company to my last poetry overcome their issue of mis reporting, declining net sales and therefore. Big-box store , Competition , Distribution 1389 Words | 5 Pages. going to discuss whether it’s a good idea to poetry essay give kids an allowance? First of all, I’m a kid and 4th grade secondly, I love money. . My answer is absolutely yes – it’s a great idea to duchess essay give kids an allowance. What is an allowance? It’s money given to a child on essay, a regular basis by a parent or a guardian. The money can be used to go towards something specific or left to my last duchess the child to decide how they want to spend it. Research has shown that kids who learn about money management at an early age tend.

Concept , I Love Money , Idea 612 Words | 3 Pages. from the University of Pittsburgh found that “harsh verbal discipline”—cursing, insults, and shouting—can be as harmful to kids as hitting or . spanking. The scientists tracked 967 middle-schoolers for two years. Change. The students attended 10 public schools in my last poetry, eastern Pennsylvania and help came from middle-class families that were not considered “high risk.” Sifting through surveys these kids and their families completed on my last duchess essay, “their mental health, child-rearing practices, the quality of the parent-child relationship. Death growl , Father , Lisa Simpson 855 Words | 3 Pages. Developing Coherent Paragraphs ______________________________________________________________ Paragraph structures provide a map for praxis help your ideas, guiding . readers through your reasoning.

Keep this simple set of principles in mind while you write, and use it as a checklist when you're revising. Use Topic Sentences State the central idea of each paragraph explicitly in a topic sentence. That's one way to show that you have thought through your material. In academic writing, the duchess poetry topic sentence. Logic , Marshall McLuhan , Paragraph 637 Words | 4 Pages. Life and times of thunderbolt kids. ? Life and Times of Thunderbolt kid - Chapter Two Analysis (3a) Institution Life and running paper Times of . Thunderbolt kid - Writing from a youngster's perspective is duchess poetry essay not simple. Done well however, it can be viable and influencing, so its value an attempt. Most stories of this sort utilize a third-individual fortunate perspective; however, a first-individual conduct is possible. Some individuals infrequently deliver child focused stories, which is odd - truth be told.

Bill Bryson , Child , Childhood 1448 Words | 7 Pages. Are Sports Hurting Kids ? Organized sports have a lot of effects on children, whether they be positive or negative. Children are still . And Technology Change Our Future. finding out who they are and what the world is like. Duchess Essay. I chose this topic because I wanted to essay know childrens’ motives to do organized sports, and what effects the sports have on the them. I wanted to know the reasons kids start playing sports and, while it may be different for every child, they all had to have had some say in it. Every sport has skills that benefit. Baseball , Child , Childhood 2477 Words | 6 Pages. ?Weston Miller Miller1 Mr. S. Torok CHC2D1 Friday, April 19, 2013 Swing Kids The 1993 drama “Swing Kids ” . starring Robert Sean Leonard and Christian Bale is my last duchess poetry overall a very good movie.

The film is essay set in duchess essay, Nazi ruled Germany in mis reporting resume, the year 1939 and tells the incredible story of three boys and their love and fight for swing music. Swing Kids is a remarkable display of directing and poetry essay acting talent. Thomas Carter's eye for camera technique lends the feeling of actually being alongside the. Adolf Hitler , Germany , Hitler Youth 911 Words | 3 Pages. ?Katie Luther English 118, Instructor Griffin 7/9/2013 Essay#1 Audience: Class Mates and teacher Caution! Kids At Play! I . loved growing up in my neighborhood. I lived on a street called Hemming Way and mis reporting resume it was a beautiful street where each house seemed to stand on its own hill, almost like royalty. My house was a deep dark red and my last duchess poetry essay it had bright green grass out front and a beautiful garden that consisted of roses, dandelions, and essay help jasmines.

There were trees and mountains everywhere. English-language films , Jump , Play 865 Words | 3 Pages. parents use spanking as a discipline, what messages parents try to get across to their kids , why people view spanking as abuse, and many more. . Duchess Essay. Participants in this essay are going to be reporters on this topic all over the US. Parents that have used spanking as discipline will as well be participants. Methods of spanking will be discussed. Write Essay Introduction. I believe that spanking is a good way to show that you care and love your kid (s) and duchess are trying to get them going in law cases studies, the right direction, instead of poetry, doing illegal. Aggression , Anger , Corporal punishment 1304 Words | 4 Pages. So Yesterday, I was out on head, my regular shopping and I came across this kid who looked like she was 6 or 7 years old and her mother in duchess poetry essay, the same . aisle. I was looking at essay stuff and all of a sudden the kid sees something she likes, and duchess then all of studies, a sudden she says Mommy can I have this? The mother said no you cannot have that, the kid started to make a huge fuss and ask why? I want it now, and treating the my last poetry essay mother terribly, then the help mother said no again and the child started to cry and scream out, I was.

Cellular network , Childhood , Developmental psychology 1014 Words | 3 Pages. Kids Need Sports Kids these days are stuck inside doors just playing video games, doing homework, watching television, and . that’s just wrong. My Last Essay. Kids should be outside playing sports, getting some exercise while having fun. There are many reasons nowadays why kids aren’t playing or end up quitting sports, such as their parents don’t want them to running for research play and get hurt, kids feel that they can’t do the sport or won’t be any good at it. A other reason kids end up quitting sports because they don’t like to. A Great Way to Care , Behavior , EBSCO Industries 981 Words | 3 Pages. Is Billy The Kid a Tragic Hero? William H. My Last. Bonney (born William Henry McCarty, Jr.) was known for how will and technology our future his sulky smooth character, his enigmatic . hero/outlaw image, and most importantly his treacherous rumored 21 murders. Most commonly and historically known as Billy the Kid , Bonney was born November 1859 in New York City, having moved around numerous times as a young child, and ultimately settling down in the Old American West. Orphaned as a young boy, “The Kid ” began hanging around the wrong crowd.

American Old West , Aristotle , Billy the Kid 1214 Words | 3 Pages. Effect On Kids Video games have a positive and my last poetry negative effect on kids . Video games affect the kids health, for mis reporting . example lead to cardiovascular implication. Also affect their education when affecting their cognition. Duchess Poetry Essay. Others video games effects on harvard law cases, kids are when affecting their social and behaviors. Parents need to involve and regulate their children‘s gaming habit. My Last Duchess. Video games attribute in big portion in kids behavior. Video game affect kids negatively could be a good reason to make a kid violent. Console game , Entertainment Software Rating Board , Game 1508 Words | 4 Pages.

arm every man, woman and child in resume, America. With more guns showing up in America, the more likely your child will be to find one. While most people think that . children will not do anything with a gun if they find one, there are still going to be those kids that will play around with it and wind up doing something that they will regret. Gun safety is a bigger issue than most people would like to believe. Duchess Essay. They usually just turn a blind eye to resume accidental gun accidents involving children, but what are they. Accident , Breech-loading weapon , Cannon 1317 Words | 3 Pages. COnsuming kids comparison and contrast. In the duchess film Consuming Kids , it really shows the change our future dark side of marketing to kids . Essay. Marketing to kids gives them bad . study habits because they will always want to literary essay 4th grade play with their cool new toy that they saw on TV instead of doing their schoolwork. When I was young, I know that’s all I would want to do is play with my cool new toy. I would just keep putting off doing my work and my last I would tell myself that “oh I’ll get to it later” and mis reporting later came and essay I never ended up getting to doing my work, because why. Advertising , Anno Domini , Marketing 1177 Words | 3 Pages.

? Autism Spectrum Disorder Felix Maymi Nova Southeastern University Life-Span Human Development PSYC 2350 Roberta Arrigo Autism Spectrum . Disorder Key Findings: Population Attributable Fractions for Three Perinatal Risk Factors for Autism Spectrum Disorders, 2002 and 2008 Autism and an admission introduction Developmental Disabilities Monitoring Network Autism is a developmental disability that affects a person’s verbal and my last duchess non-verbal communication, understanding of language, and resume socialization. Asperger syndrome , Attributable risk , Autism 614 Words | 3 Pages. ? Diary of Wimpy Kid Evaluative Essay San Diego Christian College Children’s Literature Abstract The Diary of duchess, a Wimpy . kid is a book about adolescence who have dealt with emotional struggles and social acceptance in middle school. Mis Reporting. The book highlighted areas of struggle which included: bullies, emotional responses in my last duchess essay, both positive and negative ways, friendship, and science change our future essay family dynamics. The book was intended was readers of age seven and older but could be used a discussion book with children. Diary of a Wimpy Kid , Emotion , Friendship 1690 Words | 8 Pages. schoolers at stores like HM, Forever21, and PacSun. It has just now become “normal” seeing little kids dress up in my last, clothes that are not age . appropriate. Sex is an write essay uprising problem we have within the my last duchess poetry essay youth today, and how can it not be if it is literally all they are exposed to.

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Christmas Day Essay Essays and Research Papers. Valentines Day | New Year | Rio de Janeiro Carnival | Oktoberfest | Christmas | Diwali Christmas . Festival» Christmas Festival- The Origin of Christmas - The History of Christmas - Christmas Story- Christmas Tradition- The Religious Aspect of Xmas- 12 days of Christmas - Significance of Christmas - Christmas Day in the Morning- Jesus Christ- Mary Mother of Jesus- About Santa Claus- The Christmas Tree» Christmas Celebrations- Christmas Eve Celebration- Christmas Day - The Tradition of Gifting- Christmas. Christmas , Christmas carol , Christmas Eve 729 Words | 3 Pages. spanish christmas they don't belive in santa claus .They belive that the 3 wiseman.Kids leave there shoes out side and believe that the 3 . wiseman will come and fill there shoes up with presents.Most people in Spain go to Midnight Mass or 'La Misa Del Gallo' (The Mass of the Rooster). It is called this because a rooster is supposed to my last duchess, have crowed the night that Jesus was born. Most families eat their main Christmas meal on for research Christmas Eve before the service. The traditional Spanish Christmas dinner. Biblical Magi , Christmas , Christmas Eve 943 Words | 3 Pages. Lang. Arts Holiday Research Project Christmas in Spain Many countries celebrate their holidays in many different ways compared to essay, . us. What they do may be weird or out of the normal to us.

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A Christmas Carol , Bob Cratchit , Charles Dickens 846 Words | 4 Pages. Very often when a popular novel published it is turned into a movie a little later. A Christmas Carol by Charles Dickens is a very popular . Harvard Studies! original story about a man named Scrooge who is flooded with greed. It’s around Christmas time and Scrooge is told by the spirit of his old partner, Jacob Marley, that he will be visited by my last duchess poetry essay, three ghosts. These ghosts are the how to write an admission Ghosts of Christmas Past, Present, and duchess poetry Yet to how will science and technology change, Come.

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First of all, let me thank you all for coming here today. I’m . happy that so many of you could make it today. For those of you who don’t know me, my name is My. I’m a student of English 1 intake 6. This afternoon, I’m going to be introducing about Christmas Day in England. This information I give you today should help you understand and have a basic knowledge of Christmas Day . I divided my presentation into 3 part. I’ll be gin. Armenian Apostolic Church , Christmas , Christmas controversy 645 Words | 2 Pages. Christmas Day The morning of mis reporting Christmas is just wonderful.

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?Brooke Boyd English/Comp Mrs. Goslin 31 March 2014 Childhood Christmas to Adulthood Christmas Christmas . as a child for me was very fun. I got many presents from Santa as well as many from relatives. Christmas was probably my favorite holiday of the year, to me it meant that if I was good enough Santa would bring me presents. Most of the time I was very good and my last never got into trouble. In my family when you go from childhood to adulthood it becomes a big deal. For starters you open presents. Adult , Adulthood , Basement 992 Words | 3 Pages. An essay discussing the christian holidays Christmas and holy sunday. Compare/contrast the two and how they effect the religion and modern american society. Christianity Essay Christianity as a whole has many different holidays and days of obligation, from The Sabbath, which occurs . How Will Essay! every seven days , to holidays like Christmas and Easter which are observed only duchess essay, once a year.

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Anzac Day , Australia , Australian and my last duchess poetry essay New Zealand Army Corps 1015 Words | 3 Pages. Philippine Christmas The Philippines is studies known as the Land of Fiestas, and at Christmas time, this is especially true. . Filipinos are proud to proclaim their Christmas celebration to be the my last poetry longest and studies merriest in the world. It begins formally on my last duchess essay December 16 with attendance at the first of nine pre-dawn or early morning masses and running for research continues on nonstop until the duchess poetry essay first Sunday of harvard law cases studies January, Feast of the Three Kings, the essay official end of the harvard law cases season. The Philippines is the only Asian country where. Christmas , Christmas carol , Christmas Eve 1593 Words | 5 Pages. The celebration of Christmas in the Philippines begins on the 16th of December and ends on the first Sunday of January which is the Feast of . the Epiphany (The Three Kings). It is my last duchess essay quite different from the other countries of the world, it is the longest of the Philippine festivities stretching for over 3 weeks. This makes the Filipino Christmas celebration one of the longest Christmas season in the world. Mis Reporting Resume! A rich tradition which dates back to the Spanish period. Christmas or Pasko is the my last essay most awaited.

Christmas , Christmas carol , Christmas Eve 937 Words | 3 Pages. Elijah and Xavier were always the best of friends. From the science and technology our future essay day they met at Residential School, they started to bond, and my last duchess poetry essay had a connection as . Literary Rubric 4th Grade! strong as two brothers. However, they were eventually split apart, as Xavier had decided to my last poetry essay, fulfill his role as a bush Indian, and left with his Aunt Niska to live in the wilderness. When years had passed, Xavier got lonely, and the only harvard law cases studies, person he wanted to have by his side was Elijah; thus, their friendship was rekindled. Now, many years later, they still. Eye color , Grey , KILL 1072 Words | 3 Pages. English Coursework - a Christmas Carol. Coursework - A Christmas Carol Question: How does the personality of Ebenezer Scrooge develop during the novel “A Christmas . Carol”? In this essay I am going to duchess essay, distinguish the personality changes of Ebenezer Scrooge in the novel, “A Christmas Carol”; who was once a miserly, lonely businessman but became a generous, respected, kind man. I will divide the changes into stages providing evidences shown throughout the story. (From the first meeting with Jacob Marley to the three Christmas spirits) Charles.

A Christmas Carol , Bob Cratchit , Charles Dickens 2113 Words | 5 Pages. Outline First days frustration I Introduction A. Hook: 80 % of international students feel frustrated in their first . days outside of their country. Harvard Law Cases! B. My Last Poetry! Connecting Information: The first day outside your country are hard, frustrating and sometimes scary and praxis help sad. Duchess Poetry! C. Thesis Statement: that’s how some students and that’s how I felt in my first days in the United States. II Body A. Pa 2 topic sentence: this was the first time for me in harvard law cases studies, a place that I don’t know anyone. Debut albums , Frustration , Help 759 Words | 3 Pages. How Becoming an Adult Has Changed Christmas. and I love having every memorial moment with them.

We still do the same things at Grandmas every year nothing has changed except for the fact that I’m a . Mother now. I can distinctively remember the Christmas of 2006; it was the my last essay year my son (Jaylen) was born. It’s the year I realized that my spoiled days were over and it was not only about me any more. It was the first time I actually realized that I’m Mommy now! It was a very fearful and joyful moment at how to essay the same time; my family didn’t pay as much. Christmas , Christmas tree , English-language films 1501 Words | 4 Pages.

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