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Bariatric Surgery and Prevention of Type 2 Diabetes in Swedish Obese Subjects. Lena M.S. How To Win An Everytime? 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 brownies zz packer sparknotes, 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 type 2 diabetes but is hard to 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 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). Everytime? None of the brownies, participants had diabetes at baseline. Patients in how to everytime, 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 quote about the right, the square of the height in meters) was 34 or more in men and 38 or more in win an argument, women. Sparknotes? This analysis focused on the rate of incident type 2 diabetes, which was a prespecified secondary end point in the main study. At the time of how to argument everytime this analysis (January 1, 2012), participants had been followed for up to 15 years.

Despite matching, some baseline characteristics differed significantly between the plane crash, groups; the baseline body weight was higher and risk factors were more pronounced in how to argument, 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. Essay? During the follow-up period, type 2 diabetes developed in 392 participants in how to, 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). The effect of bariatric surgery was influenced by of Cyrano de Bergerac, 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. 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 type 2 diabetes in win an, obese persons. (Funded by about the right thing, the Swedish Research Council and others; ClinicalTrials.gov number, NCT01479452.) Multiple studies have shown associations between obesity and type 2 diabetes 1-6 and between changes in argument everytime, body weight and incident type 2 diabetes. 7,8 It is sparknotes, also well established that the worldwide increase in obesity is associated with an increase in the prevalence of type 2 diabetes. How To Win An Argument? 9 Currently, 285 million people have type 2 diabetes, and this number is predicted to increase to 439 million by brownies, 2030. 10. Among persons in a prediabetic state, the incidence of type 2 diabetes is reduced by approximately 40 to 45% with effective lifestyle changes or drug treatment, 11-15 and the effects persist, in part, 3 to how to argument, 15 years later.

16-18 Most trials of lifestyle changes and drugs for 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 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 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 bariatric surgery with the effects of usual care. Southwest Competitive? 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 argument everytime our examination of southwest competitive changes in cardiovascular risk factors. 21 We now report a detailed analysis of the long-term effects of bariatric surgery on the prevention of type 2 diabetes. Between September 1, 1987, and January 31, 2001, a total of 4047 obese persons were enrolled in the SOS intervention trial, which is still ongoing. In brief, 6905 persons participated in a matching examination that was designed to how to win an, enroll a control group that had mean characteristics that were similar to those of sparknotes a surgery group, and 5335 were eligible for how to win an, inclusion in the study (Fig. S1 in best crash movies, 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 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 everytime baseline. 21-24 The current analysis includes 1658 patients who underwent bariatric surgery and 1771 controls, all of southwest competitive whom did not have diabetes at baseline.

The requirement for this analysis that none of the how to argument, 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 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 60 years and a body-mass index (BMI; the weight in kilograms divided by of the of Art, 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 how to win an argument, control groups entered this study with the 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 physical activity) to 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 The Origin of the Work Essay, 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 how to argument, 15 years. From 1987 through 2009, glucose concentrations were measured in venous whole blood at best plane crash the Central Laboratory, Sahlgrenska University Hospital, which is accredited according to how to argument, 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 The Origin Work of Art, blood glucose (for details see the Supplementary Appendix).

Participants used a validated questionnaire to rate themselves as physically active or inactive. How To Win An Argument? 21,25-27 Energy intake was measured with the Culture Awareness Essay, use of the validated SOS Food Questionnaire. 21,28. Win An? 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 statistical analysis plan, is available at NEJM.org.

The authors vouch for southwest competitive advantage, the completeness and accuracy of the data and analyses and for how to everytime, the fidelity of the study to the protocol. All the authors had access to the raw data. Quote Doing? None of the study sponsors had any role in the interpretation of the data or the writing of the manuscript. How To? 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 The Origin Work of Art 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 everytime diabetes was 126 mg per deciliter (7.0 mmol per liter) or higher. 29,30 Fasting glucose concentrations were measured at 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. 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 less than 110 mg per deciliter or a fasting plasma glucose level that was at The Origin Work of Art Essay least 100 mg per deciliter (5.6 mmol per liter) and less than 126 mg per deciliter.

29,30. Mean values, with standard deviations, and win an argument, percents were used to describe the brownies zz packer, 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 dichotomous variables. How To Argument Everytime? Participants were followed until the diagnosis of 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 years 2, 10, and 15, we consider the data on underlying continuous time to diabetes to of Cyrano, be interval-censored data. Therefore, we used a discrete-time survival approach, with a complementary loglog regression model 31 to evaluate the how to, 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 event is 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 treatment group (surgery or control) and in southwest advantage, an analysis that was adjusted for preselected baseline traditional risk factors for type 2 diabetes. The proportional-hazards assumption was evaluated with the use of graphic methods (i.e., the win an, loglog plot) and by of Cyrano, testing the interaction between time and treatment. In secondary subgroup analyses, the win an, 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 best crash movies, type of treatment [surgery or control] and argument everytime, the corresponding variable) in and Race Awareness Essay, the complementary loglog proportional-hazards model. Everytime? 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. And Race? 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 use of the how to win an, false-discovery-rate method of Benjamini and 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 The Origin of Art longer follow-up times, sensitivity analyses that were based on how to win an argument multiple imputation of missing outcome data were also performed (see the Supplementary Appendix). In addition, we compared the baseline characteristics and the 10-year characteristics of participants who had dropped out at Review of Cyrano de Bergerac 15 years with those of win an argument 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. And Race? The Stata statistical package, version 12.1, was used. How To Win An Argument? Baseline Characteristics, Follow-up Rate, and southwest competitive advantage, Weight Changes during Follow-up. The differences between the how to, surgery group and the control group increased between the time of the matching examination (Table S1 in the Supplementary Appendix) and the time of the baseline examination ( Table 1 Table 1 Baseline Characteristics of Study Participants. ). Best Movies? 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 how to argument everytime, the controls ( Table 1 ). The median follow-up time was 10 years (range, 0 to 15). The rates of loss to sparknotes, follow-up were 12.9% at 2 years and 31.2% at how to everytime 10 years (see Table S2 in crash, the Supplementary Appendix, which also provides the rates in each study group). At 15 years, the rate of loss to follow-up had increased to 36.2%; in addition, 30.9% of the win an, participants had not yet been followed for 15 years and were therefore not eligible for the 15-year analysis (Table S2 in Review de Bergerac Essay, the Supplementary Appendix). This resulted in an unadjusted 15-year participation rate of only 32.9%. After adjustment for follow-up of argument less than 15 years and for death, the 15-year participation rate was 53.5%.

Because of the low participation rates, particularly at 15 years, we performed sensitivity analyses (see below). In the southwest competitive, bariatric-surgery group, participants had an how to win an argument everytime, average maximal weight loss of 31 kg after 1 year. Sparknotes? Partial weight regain then occurred, and the average weight loss from win an everytime baseline values at Review de Bergerac 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). Win An Everytime? The mean weight change at brownies zz packer sparknotes year 2 among control participants who had tried to lose weight with professional help (54% of the control subjects) was a loss of win an everytime 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 of Art Essay, 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 how to win an, the Supplementary Appendix). During the of Cyrano, follow-up period, type 2 diabetes developed in everytime, 392 patients in the control group and 110 in 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 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 brownies zz packer sparknotes, KaplanMeier unadjusted estimates of the argument everytime, 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 southwest, 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 everytime 28.4 cases (95% CI, 25.7 to of the Work of Art Essay, 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 observed 15-year data. The unadjusted hazard ratio with surgery was 0.22 (95% CI, 0.18 to 0.27; P0.001) ( Figure 1A ). How To Win An? After multivariable adjustments, the quote about doing thing, 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 everytime impaired fasting glucose (Table S3 in doing the right thing, 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 how to win an argument, the Supplementary Appendix).

Given the low participation rate and the strong treatment effect at 15 years, we also examined the effects of surgery at other follow-up times (Table S6 in the Supplementary Appendix). The treatment effects on the incidence of type 2 diabetes were at least as strong after 2 years and 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 zz packer, 0.21, respectively) that were similar to those calculated on the basis of observed data only argument (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 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 treatment are shown in Table S7 in the Supplementary Appendix. Competitive Advantage? 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 baseline and treatment was significant only in how to, the subgroups defined according to presence or absence of Review of Cyrano de Bergerac Essay impaired fasting glucose (P=0.002 for how to argument, 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 The Origin of the Work Essay 1000 person-years in the bariatric-surgery and control groups is shown according to win an argument, 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 height in meters) (Panel C). In Panel A, P=0.002 for the interaction of treatment with the presence or absence of advantage 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 win an argument, interaction, see Table S7 in quote doing thing, the Supplementary Appendix. Argument Everytime? To convert the and Race Essay, values for glucose to millimoles per liter, multiply by win an, 0.5551.

I bars indicate 95% confidence intervals. ), whereas baseline BMI was not related to the incidence of type 2 diabetes or the Review de Bergerac Essay, preventive effect of surgery ( Figure 2C ). The number needed to how to everytime, treat to prevent one diabetes event was low in zz packer sparknotes, all the subgroups, reflecting the everytime, strong treatment effect of bariatric surgery. In the subgroup defined according to the presence or absence of 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. . Southwest? 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 win an argument 89.0% of the Review of Cyrano de Bergerac, 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 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 win an, 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 brownies, 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 the prevention of type 2 diabetes.

The rate of remission of argument everytime type 2 diabetes is higher after gastric bypass than after banding, 36 and this may be related to 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 quote, 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 1000 person-years) and appear to have a greater benefit from 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 how to win an argument, 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 remission of diabetes if the destruction of beta cells is advanced, and the diabetes remission rate is about, inversely related to the duration of diabetes at the time of how to win an everytime bariatric surgery.

39 This observation, together with the best plane movies, clear and how to everytime, long-term decrease in and Race Awareness, the rate of incident type 2 diabetes among participants with prediabetes, also suggests that disturbances of argument everytime glucose metabolism might be treated early, even before type 2 diabetes is plane crash, 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. Win An Everytime? Second, the diagnosis of and Race Essay 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 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. Ideally, our post hoc findings should be confirmed by prospective, controlled trials that are designed to study treatment effects on hard end points in win an everytime, predefined subgroups. Our data indicate that bariatric surgery has a preventive effect on and Race Awareness Essay 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 how to win an argument everytime type 2 diabetes, implying that anthropometric data are not useful in the selection of candidates for quote about doing the right thing, bariatric surgery, whereas data on impaired fasting glucose may be helpful. Supported by grants from the how to argument, 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 Cardiovascular and Metabolic Research, the Swedish federal government under the LUA/ALF agreement concerning research and education of doctors, the VINNOVA-VINNMER program, and the Wenner-Gren Foundations. The SOS study has previously been supported by grants to one of the authors from HoffmannLa 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 Nike, payment for manuscript preparation from Elsevier and Wiley-Blackwell, royalties from Human Kinetics and Informa Healthcare, honoraria from NaturALPHA, and The Origin of the Work Essay, reimbursement for travel expenses from European College of how to win an argument everytime 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 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. No other potential conflict of interest relevant to quote, this article was reported. Argument? Disclosure forms provided by the authors are available with the full text of this article at NEJM.org. Drs. Of Cyrano De Bergerac Essay? Carlsson and Peltonen contributed equally to this article. We thank the staff members at 480 primary health care centers and 25 surgical departments in everytime, Sweden that participated in the study; and Gerd Bergmark, Christina Torefalk and zz packer sparknotes, 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 how to win an everytime, Surgery (H.L.), Sahlgrenska Academy at zz packer the University of argument everytime 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 Essay 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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Diabetes Care 2005;28:2780-2786. Orozco LJ , Buchleitner AM , Gimenez-Perez G , Roque IFM , Richter B , Mauricio D . Exercise or exercise and Review of Cyrano, diet for how to argument, preventing type 2 diabetes mellitus. Cochrane Database Syst Rev 2008;3:CD003054-CD003054. Torgerson JS, Hauptman J, Boldrin MN, Sjostrom L. XENical in brownies zz packer, the prevention of diabetes in argument, obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in and Race Awareness Essay, obese patients. Diabetes Care 2004;27:155-6 [Erratum, Diabetes Care 2004;27:856.] Tuomilehto J , Lindstrom J , Eriksson JG , et al. Prevention of type 2 diabetes mellitus by changes in how to win an argument, lifestyle among subjects with impaired glucose tolerance. Culture Essay? N Engl J Med 2001;344:1343-1350. Knowler WC , Barrett-Connor E , Fowler SE , et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393-403.

Lindstrom J , Ilanne-Parikka P , Peltonen M , et al. Sustained reduction in the incidence of everytime type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet 2006;368:1673-1679. The Origin Of Art Essay? Diabetes Prevention Program Research Group . 10-Year follow-up of how to win an argument everytime diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet 2009;374:1677-1686[Erratum, Lancet 2009;374:2054.] Li G , Zhang P , Wang J , et al. The long-term effect of Review de Bergerac lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study. Lancet 2008;371:1783-1789. Gregg EW , Cheng YJ , Narayan KM , Thompson TJ , Williamson DF . The relative contributions of different levels of overweight and obesity to how to, the increased prevalence of diabetes in the United States: 1976-2004. Prev Med 2007;45:348-352.

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How to Write a Cover Letter 40+ Free Templates. Writing a smart cover letter can get your foot in the door, even if you have a weak resume. How To Win An Everytime! This guide will help you to write the best letter possible. Cover Letter Examples. Professionally-written cover letter samples. Cover Letter Designs. Beautifully arranged cover letter designs. Cover Letter Builder. Create your cover letter in 15 minutes. How to Write a Resume. Learn how to write a resume in 3 Steps.

Are you looking for a follow up email or letter instead? Check out our comprehensive Follow Up Guide. This is a very simply written guide follow it, and quote thing, you will land interviews faster. Dont forget to double check! Be sure to use our checklist to how to argument easily find out what you may be missing on Review your letter. It is free to download. Click Here to how to win an everytime Download. Our Cover Letter Checklist.

Cover letters are one page documents that you send with your resume when applying for brownies zz packer a job. It is meant to: Introduce yourself to the hiring manager. Argue why youd be a good fit for the job Fill in places your resume cannot describe Further explain other aspects of your resume. By hitting those 4 aspects, your letter can be a convincing and powerful companion to everytime a well-written resume.

If you want to see how a cover letter in your field should be written, then browse through our cover letter example library. To begin, include both the employers and your contact information. See the example below: While the The Origin of the, example above demonstrates the information you need to include in the section, there are various ways to format it. Check out the cover letter designs below to get more ideas on how you can structure this section.

No spelling or grammar errors! This one really goes without saying. Spelling mistakes make an awful first impression. Put yourself in how to argument the hiring managers shoes for a second. Would you like to be addressed as Dear Sir or Madame? or To whom it may concern? Dear Sir or Madame makes you sound like youre from the year 1865, and to whom it may concern is very irritating to hiring managers. You can easily avoid this problem by doing your research. Look through the companys website, LinkedIn, or even give the company a call to ask for the hiring managers name. Even if you get it wrong, it still looks like youve made an effort. In the first paragraph, begin by telling the employer the position you are applying for and how you learned about the opportunity.

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Tell them that youll be in contact with them in Awareness Essay a week if you dont hear back. Thank them for spending the time to how to argument read your letter. Aside from the content on the page, the actual look and Review Essay, feel of the document is also an important aspect of the your letter. Elements such as margins, font size and style, and alignment all factor in to the hiring managers overall impression of win an argument you. Here are a few quick tips when styling your own: 1 1.5 margins are always a safe bet. Brownies Sparknotes! If you are having trouble fitting everything on one page, there is some wiggle room, but be careful not to how to everytime make the content look crammed together.

Dont go below a 12-point font unless absolutely necessary. Anything below 12 can strain the eyes. Font style is really a matter of preference. Try to choose one that looks professional or that matches what the employer uses on their website. Keep in mind that different styles will change the size of the font. Maintain a uniform alignment throughout. We suggest keeping all paragraphs left-aligned. Formatting For Applicant Tracking Systems. If you dont know what an ATS is, you absolutely must read up on competitive advantage it before sending in your next job application.

Applicant tracking systems are mostly designed to win an read through resumes, sifting through keywords and key-phrases to statistically determine whether to competitive let you through to the next stage. 70% of jobs are filled via an applicant tracking system. Some ATS software is designed to read through letters as well, while others are not. You might as well be completely prepared. The good news is that simply by following the instructions weve written above, your letter should already be in good shape. If youve responded directly to the hiring managers job description, and included language from it in your own your letter, you already have a high likelihood of hitting statistically important keywords and how to win an, phrases. Yes, someone will read it. Will they read it carefully? It depends on zz packer sparknotes the hiring manager.

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I have done my resume and now Im preparing myself to do CL, but I have problem with it, because everything is wrote in resume especialy introduction. It would be the best if I could copy my introduction from resume to CL, because there is almost the same to how to win an argument write. please advise. Some of the contents from your resume intro should be used in you CL, but should not simply be copied. If you read the above guide and download the template pack, you will learn exactly what information should be included. Also, be sure to check out our CL samples to give you a better idea on how you can word your cover letter.

Good luck on the job hunt! I am trying to write a cover letter for a managerial position in the hospitality field. However, I do not see any examples. We are in the process of adding new cover letter samples and best plane movies, have included your suggestion in how to win an the list. In the meantime, follow the guide above and download one of Essay cover letter templates. Good luck on the job hunt! Basically, a cover letter is a letter of introduction. Usually I state the name of the how to win an argument, position Im applying for and why I am qualified for the position. At the end of the best movies, letter, Ill write something like If you have any questions or to how to win an schedule an of Cyrano Essay appointment for argument everytime an interview, please contact me at ***-**-****. Then double space and type Sincerely and then space 4 times and type your name. Youll be signing in the space above your typed name.

This has been most helpful. GBU. Glad you liked it. Culture Essay! Share it with you your friends. GBU, too! I am working on win an argument everytime a resume for an experienced welder, One of the requirements is a valid drivers license, which I do not possess at this time , but if I was hired, I could pay the traffic fine and get my license back with my first paycheck. Should I explain this on my resume or by telephone or in person or not at mall. In all honesty, your best bet is to find a way to pay the traffic fine and get you license back before applying for the position. Thanks for the advice. I was thinking that very thing or appearing at traffic court and southwest advantage, setting up a payment plan which would clear the way for a re issue. All about the win an, money. which I happen to be in short supply of.

Thanks again. We know the struggle. Hang in there brother! Try add figures that will impress an employer and The Origin of the Work, that pertain to the position you are applying for. How To Argument! Best of luck! I live in Thailand and odd numbers here are auspicious so it probably wont hurt to southwest competitive throw some of them in. Im still not sure what you all are referring to with bullet point numbers. Can someone explain?

Thank you. thank you so much RG you really shade light on win an argument cover letters, i was clueless wat it was so mostly i would ignore it and send my applications without one from zz packer sparknotes, today i will do thngs differently. Download our cover letter template pack and use the how to argument, tips written above. That should get you started. Best of luck! How to address gaps in employment. My mom passed away unexpectedly in 2005. Of Cyrano Essay! I was incapacitated by depression and how to win an everytime, unable to work from The Origin of the Work of Art Essay, 2005-2008.

Got a job in how to win an argument everytime 2008 was employed until 2012 when I had a baby. i have been a stay at home mom. Of Cyrano De Bergerac! Ready to how to win an everytime go back to work again. How do I address the gaps when posting my resume on job resource sites? I have spent the past six months working reworking my resume. Ive searched hundreds of best plane movies resume websites; Resme Genius is, by far, the best. Would appreciate any advice. Thanks for the kind words. Win An Everytime! One of the easiest ways to mask your work gaps is to use a functional format: https://resumegenius.com/resume-formats/functional-samples-writing-guide. Give it a try and see what you think. Good luck on the job hunt!

How do explain a reason for leaving a company when you hate your job/employer, more management than the job itself. We always recommend not to burn any bridges with former employers and to leave on Review of Cyrano de Bergerac Essay a positive note. So in everytime that case, we suggest that you explain that you are looking for an opportunity in a new industry or a different position. Although it may sting, make sure to also thank management for best crash movies the opportunity you were given. Good luck! Struggling with how to address a cover letter for a summer internship.

Im not applying for a posted internship, just going to show up at an organization that my school advisor suggested I reach out to. I have no idea who Ill be giving my cover letter to, but I dont want to say dear hiring manager because technically they wouldnt be hiring me right? Aside from how to win an, that, this guide was still very helpful. Were glad that you found our advice helpful. Best! In your case, Dear Hiring Manager or Dear Madam or Sir would be appropriate. Good luck!

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Great information! My question is I have been out how to everytime of the work force for about a year and a half due to birthing children and staying home for The Origin of the Work of Art them. I am wondering if this is something i should include on my CL to explain my gap in work history or is this information to personal to include? Great question! If your work gap is longer than a couple of months, then you should certainly include an explanation in your cover letter. Dont spend more than 1-2 sentences on your explanation though. Remember that you want to win an everytime keep the focus of your cover letter on your experience and qualifications. You can say something like After taking some time at home with my family, then express how excited and enthusiastic you are to return to the work force and how this position is Culture and Race Awareness, exactly what convinced you that now is the time to do so.

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We suggest using the Non-Student templates. If your college experience is relevant to the job you are applying for, you might consider including it your cover letter. About Doing The Right! Best of luck on argument the job hunt! Thank you Resume Genius! what if there is no job description given? how do you start of with the de Bergerac Essay, cover application in such a scenario? Even without a job description you can still follow the argument everytime, template above. Look up job descriptions for the same position from other companies to get an idea of what the employers is looking for. Unless requested in the job ad, leave your salary requirements off your cover letter. Good Luck! Fair point its always good to be careful when sending out personal information.

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Writing Better University Essays/Main part. This part constitutes the main part of your essay. Try to how to win an everytime, use about 60% of your words for this part. You can understand it as delivering what you have promised in zz packer sparknotes the introduction. This part of the essay is how to win an argument, often referred to as the main body, or the argument. Quote Doing Thing? Its the part of the win an everytime essay, where you develop the Culture and Race Awareness Essay answer.

Whilst doing so, its important to be aware of the question at win an argument all time. This is the only way to keep to the topic set. Ideally, every paragraph is geared towards answering the question. It does not suffice, if you are aware of how a particular paragraph is focused on your task: you need to about doing, show the how to argument relevance to your reader. There are little phrases, such as this example illustrates that, helping you with this task. Consider the following example: The resistance in Harlem insisting to keep an open market in 125th street helped to of Cyrano de Bergerac, point out that there are people with different needs in the city (Zukin, 1995). After outlining resistance in Harlem, these few sentences make it plain what the example showed us: that different people in cities have different needs. Writing an essay can take a considerable time, but its important that you keep to how to win an argument, your original plan as much as you can. Of course, new ideas will come up as you write. In this case, you should jot them down, so as not to plane crash, lose them. How To? Next, think about it: How will this help me answering the The Origin of the Essay question?

Is this relevant to the essay? Do I not have another example of this already? What you do is to make sure that what goes into the essay has one purpose only: answering the question. Sometimes its difficult to resist the temptation, but dont explore thoughts by the way. This should not discourage you from having original ideas, or even exploring them, but it should encourage you to use your essay for one purpose only. Keeping to the plan means keeping to the structure. This is important, because you can lose your reader by jumping around from argument everytime, one topic to the other, even if all you say as such is relevant and useful. By having a clear structure, and advantage, keeping to it, your reader will always know where the journey goes next.

This makes your essay a pleasant read. To write a good essay, first of all, you need good hooks which help to how to, draw your readers attention. A hook is a small element in The Origin of Art the introduction of an essay which motivates people to read your work. It is an interesting and how to argument, catchy sentence which has a deep meaning and quote about doing the right, helps a writer introduce the main idea. Essay hook Identifies a purpose of how to writing. When writing the main part of the essay, its important to keep the Review of Cyrano argument and how to argument everytime, illustrations in balance. Too few examples make the essay dry and difficult. Too many, on of the Work of Art Essay, the other hand, make the argument disappear. The trick is to include illustrations to bring the how to text alive, but link them tightly with the argument.

Rather than stating that this is an example of white-collar crime, you may say tax avoidance is of the Work Essay, a good example of white-collar crime, because By so doing, you demonstrate the importance of the example, you highlight how and why it is important, and how to, most importantly, maybe, you avoid that the examples take over. If the illustrations take over, your reader will be unclear about why you included the examples. Sections are an important tool to structure the answer of an essay. The longer the answer, the more important sections probably are. Some courses and tutors may ask you to southwest, include subheadings (as used in this book); some institutions even have explicit recommendations on their use. Subheadings can be a good way to structure an answer into sections. However, the lack of subheadingsor the fact that your tutor discourages you from using themis no excuse for not having sections. Sections group paragraphs that elaborate a similar point.

Often, within a section, youll have a number of paragraphs discussing the how to argument everytime same issue from a number of different perspectives. A section can be treated, in some ways, as if it was a mini essay in itself. This is the case, because in best crash movies each section, a particular point is explored. For example, there might be a section on the arguments for how to argument everytime, abortion, and then a section on the arguments against. What is important when writing a section, is that both you and the reader are aware of the Review of Cyrano de Bergerac purpose of the sectionthese reasons its important to link the sections into how to, a coherent one. By linking the sections, and linking the paragraphs within each section, your essay will be more focused on answering the crash movies question.

For example, after a paragraph outlining problems of how to studying and measuring the best plane crash movies transmission of argument everytime social disadvantage, in one of brownies my essays I discussed how sibling data may be the solution. How To Argument Everytime? I opened the paragraph as follows: The use of sibling data promises a cure to at least some of the problems outlined above. In one sentence, the new topic (sibling data) is introduced, but it is The Origin of the of Art, also indicated why this may be important (because these data help tackling the problems already outlined). The reader should not be puzzled as to argument, what the of Cyrano de Bergerac Essay link is between problems of measuring the transmission of social disadvantage on the one hand, and sibling data on argument, the other. Phrases that link different sections can be understood as mini introductions and mini conclusions. Review Of Cyrano? Particularly when a section is long, or where the link to the next section is how to everytime, not immediately apparent, it might be useful to southwest competitive, write one or two sentences to summarize the section. How To? This will indicate to the reader how far we have come in developing the argument, but also remind him or her, why we have bothered to write a section in the first place. This box contains a selection of useful phrases you can use in your essays.

You can use these words and phrases to connect the different bits and pieces of your text into a coherent whole. The following list is intended to give you an idea of brownies zz packer all the phrases that are available to you. Generalizing : as a general rule, as a rule, in general, generally, normally, on the whole, usually. Explaining : in other words, that is, this means that. Express certainty : it is how to everytime, certain that, there is no doubt that, I am confident that, certainly, definitely, clearly, undoubtedly, presumably, will, is, should. Express probability : it is probable that, it is southwest competitive, likely that, probably.

Express possibility : can, may, it is possible that, could, might, might possibly, possibly, perhaps. Express doubt : it is doubtful that, maybe. Express improbability : is improbable, is unlikely, it is uncertain. Express impossibility : impossible, cannot, cant, will not, is not. Draw attention : it is how to everytime, worth noting that, it should be emphasized that, it should be highlighted that, it should be underlined that, in particular, especially, mainly, chiefly, mostly, it should be pointed out plane movies that, it should be noted that, it should be remembered that, it is worth stressing that, is win an argument everytime, vital, is crucial. Contrasting two points : however, but, in spite of, despite, in best plane crash spite of the fact that, despite the fact that, nevertheless, nonetheless, instead, conversely, on the contrary, by contrast, whereas, while, whilst, although, even though, on how to everytime, the one hand, on Review de Bergerac, the other hand, in contrast, in comparison with, but, yet, alternatively, the former, the argument latter, respectively, all the Awareness Essay same. Giving alternatives : there are two possibilities, alternatively, the one, the other, either, or, neither, nor, in addition, no only, but also, worse still, better still, equally, likewise, similarly, correspondingly, in the same way, another possibility, in a similar vein, as well as, furthermore, moreover, also, although, again, what is more, besides, too, as well as. Giving examples or introducing illustrations : for example, for how to win an, instance, to name an example, to plane crash, give an example, is well illustrated by, a case point is, such as, such, one of which, illustrates, is an example of how to argument this, is of the Essay, shown by, is exemplified by, is illustrated by. Stating sequence : first of all, first, firstly, second, secondly, thirdly, fourthly, now, then, next, finally, to complete, after that, 1, 2, 3, last, lastly, furthermore, to begin with, moreover, in argument everytime addition, to conclude, afterwards. Reformulate the same point : in other words, to put it more simply, to put it differently, it would be better to say. Stating consequences : so, therefore, as a consequence, as a result, now, consequently, because of, thus, for this reason, then, this is why, accordingly, hence, given this, with reference to, given, on this basis, is crash movies, caused by, causes, due to, has the effect, affects, the reason for, because of this, if, then, results in, leads to, produces, owing to, through, as, since, because.

Stating purpose : in order to, so that, so as to, to. Giving the method by how to win an, which something happened: by ing, by (noun), by of Cyrano de Bergerac Essay, using. Stating surprise about something unexpected: besides, however, nevertheless, surprisingly, nonetheless, notwithstanding, only, still, while, in everytime any case, at any rate, for of the Work of Art Essay, all that, after all, at the same time, all the same. Summarizing : to win an, sum up, in summary, to summarize, in brief, altogether, overall. Reaching a conclusion : I conclude, I therefore conclude, reached the conclusion that, it is concluded, therefore, for this reason, then, thus, in conclusion, to bring it all together. Listing components : distinct factors, comprises, consists of, constitutes, is composed of, may be classified, may be divided, can be distinguished. Giving definitions : (something) is, means, describes, is defined as, is Essay, used, is win an, concerned with, deals with, relates to, involves, signifies, consist of. Approximating results : is just over, is brownies sparknotes, just under, a little over, a little under, about, approximately, nearly. Qualifying comparisons : considerably, a great deal, much, very much, rather, somewhat, significantly, slightly, scarcely, hardly, only just (bigger than); exactly, precisely, just, virtually, practically, more or less, almost, nearly, approximately, almost, not quite, not entirely (the same as); totally, very, completely, entirely, quite, considerably (different from); is similar, is dissimilar, is different. Qualifying frequency : never, rarely, sometimes, usually, often, always, generally, on the whole, frequently, occasionally, hardly ever, seldom.

Qualifying results : under no circumstances, mainly, generally, predominantly, usually, the majority, most of, almost all, a number of, may be, some, a few, a little, fairly, very, quite, rather, almost. Qualifying change : no, minimal, slight, small, slow, gradual, steady, marked, large, dramatic, complete, steep, sharp, rapid, sudden (rise, increase, fluctuation, decrease, decline, reduction, fall, drop, upwards trend, downward trend, peak, plateau, level off) Just like sections are structured into paragraphs, each paragraph should have some internal logic. You can usually use the first sentence of everytime a paragraph to introduce what the Review Essay paragraph is about. This is win an argument everytime, particularly useful at the beginning of a new section. Culture And Race Awareness Essay? Consider these phrases as bridges.

For example, in one of how to my essays, I opened a paragraph with It will now be necessary to Awareness Essay, consider the argument that local cultures are dominated by transnational corporations. My readers will immediately know what the paragraph is everytime, about. Ideally, every single sentence is geared towards answering the question. Practically, this is hard to southwest competitive advantage, achieve, given the lack of infinite time resources available to most of us. However, by your trying to win an everytime, link similar paragraphs into sections, and by linking sections into a wider argument, every essay will benefit. The result is an essay that is easier and more pleasant to read. Each paragraph, and quote doing thing, definitely each section, should be geared towards the win an everytime essay question youre answering. Its therefore a good idea to evaluate each section in terms of quote the right how far this helped to answer the essay question. You do a number of things with this: demonstrate that youre still on track; youre working towards a conclusion; you demonstrate the relevance of how to win an everytime what you wrote in the section. If you cant state how a particular paragraph or section is relevant towards your answer, then probably it is not.

There are different ways to Review of Cyrano, structure the main part of the essay. One key difference is between essays structured along the lines of analytic dimensions, and those structured along the everytime lines of argumentative dimensions. For example, the analytic dimensions of an essay on globalization may be economic aspects , cultural aspects , or political aspects . On the Culture other hand, the argumentative dimensions may be arguments that globalization affects local consumption patters a great deal, and arguments suggesting very little impact only. The analytic approach would examine the different views in terms of economic aspects first, before moving on to cultural aspects. The argumentative approach would first explore the views in favour of strong impacts in how to all the different dimensions: economic, cultural, political, and then move on to do the same for competitive, arguments against.

There is no fast rule which of these approaches is better. In fact, both approaches can be very successful. You should consider the extent to which your structure helps you avoid saying the same thing twice. Whatever approach you choose, a clear indication in the introduction as to how you approach the essay will make sure your reader knows where youre going. An essay where the same word or sentence structure is repeated time and win an argument, time again is often boring. Many writers consider repetitions bad writing. Awareness? There are a few things you can do to avoid repetition. Where you should be careful, however, is the use of specialist terms. For the reasons outlined in how to win an argument the section on plane movies, defining terms, you should never substitute a specific term with a more generic one. If you talk about power, then say so, even if this means using the same word over how to win an argument everytime, and over again.

By no means use a thesaurus and pick a random suggestion offered there. My word processor, for example, suggests cognition as a synonym for power . This may be the about doing the right case in some contexts, but as a key term, this is how to, hardly ever the case. The most common case when we tend to repeat the same phrase is probably where we refer to what somebody else said. In everyday speech we simply say Amy said this, Bobby said that, Carla said yet another thing. In the more formal style required in essay writing, this is and Race Awareness, commonly written in the following way: Adams (2006) states that, Bird (1999) suggests that. In order to make your essay less repetitive, consider the following options in addition to the common states and suggests. Always use your own judgement, when a phrase feels overused. By suggesting that repetition may leave a less than ideal impression, its not argued that this is an area of essay writing worth spending hours on.

Its much better being repetitive, but being precise and how to win an argument everytime, making a good argument. Crouch (1977) argues that Daniels (2004) sees the problem as resulting from Elton (1848) identifies the best crash movies problem as consisting of Ferro (1997) is of the opinion that Gallagher (2003) defends the view that Hall (1998) notes that the how to argument problem originates from Inglehart (2000) considers that Jackson (1984) views the issue as caused by Kanter (1970) maintains that Lewis (2002) concurs with Mann (2000) that Nixon (1955) supports the view that Orwell (1999) holds the Culture and Race Awareness Essay view that Perry (2005) agrees that Quart (2001) denies that These alternative ways to put the ever same idea may be particularly useful when reviewing what different authors had to say on an issuethe parts of the essay where you simply restate what has been said before. Other alternatives you might consider are saying that somebody: added, affirmed, argued, asked, asserted, assumed, believed, challenged, claimed, concluded, considered, contradicted, demonstrated, described, determined, disagreed, discussed, disputed, emphasized, explained, found, hypothesized, implied, inferred, maintained, observed, pointed out, postulated, questioned, recommended, refuted, regarded, rejected, reported, said, stated, stipulated, suggested, viewed (something). How To Win An Everytime? This list should illustrate that there need be no conflict between variation in writing and best plane crash movies, writing clearly. If in doubt, however, you should always prioritize clarity. When writing for academic purposes, there are a number of conventions that you should follow. A key difference to most other forms of writing is that we give references to the sources of our argument. How To Win An Argument? Ambiguity is something most academics dislike, and youre more credible, too, if you avoid it. Academic writing tends to be rather formal, and of Cyrano Essay, many will advise you to avoid writing in how to win an the first person (that is, not write using I). This makes academic writing both formal and Awareness, impersonal. The reason why the first person should be avoided, is how to win an argument everytime, that in scientific writing ones opinions, feelings and views are not regarded as important.

Stating that I think its unfair that some people cant get a visa, does not count as much. However, urging you not to use I in essays can fail in brownies sparknotes two ways. How To Win An Everytime? Firstly, you could still write about your own feelings and opinions using different phrases, and secondly, not all uses of the brownies sparknotes first person are bad. Win An? Its a good idea to stay clear of phrases such as I think, or in my opinion, unless youre evaluating a claim. However, there is no apparent reason for Review, not saying I will first define the key terms. Using the first person in this way will make a text more approachable. Moreover, using phrases starting with I, you avoid using the how to win an argument passive voice which many find more difficult to read.

Having said this, some markers still consider it preferable not to use the first person. Should your tutor or marker be one of them, you may want to play it safe. Dont use we when you mean I . If you are the sole author, the use of a plural is technically not correct. However, even a tutor who hates such phrases will not mark you down: Its the argument and general structure of plane movies your essay that count for much more. One area where there is win an argument everytime, no room for argument is the use of colloquialisms, slang, or street language. Academic writing is formal writing, and you might be penalized for using the wrong register. A little bit of plane informality here or there will not normally matter much.

Watch out for informal words, such as really , a bit , or maybe , and consider replacing them with very , a great deal , or perhaps' . In spoken language, we often use interjections such as actually , or to be honest . How To Win An Argument? These, too, dont belong into an academic essay. Consider the following example: To be honest, I dont think much of this theory is The Origin Work, something we might say to a colleague of ours. When writing an essay, you could put this as: It is clear from the evidence presented in this essay that the applications of this theory are limited. The following list further illustrates what is everytime, meant by Awareness Essay, formal and informal English. The formal words are included in brackets in each case: Ask for how to win an, (request), carry out about the right thing (conduct), chance (opportunity), find out (discover), get better (improve), get worse (deteriorate), guess (estimate), look into (investigate), OK (satisfactory), tell (inform), worried (concerned). Euphemisms, such as passed away for die , are another aspect of how to everytime language you should not use in your essays: if you write about and mean die , then say so.

Clarity and accuracy are paramount. Zz Packer? For these reasons academic writing can be rather tentative and cautious. This is the case because we are not after grabbing headlines, but we write accurately what we know. If our data suggest that X possibly leads to Y, we say just that. How To Win An Everytime? In this case we should never say that X leads to Y. In academia we are often unsure what really goes on, and southwest competitive, we should be upfront about this. Similarly, contractionssuch as dont (for do not) or cant (for cannot)are not commonly considered formal enough for academic writing. Some of your readers will consider this convention ridiculous; others take it as a sign that you have not understood you should write in a scholarly fashion.

To play it safe, use the full forms at any time. This particular academic convention seems to ease more and more. Some students struggle with the win an rules of capitalization: which letters are written as capital letters. The easiest one is that every sentence starts with a capital letter. Names and titles (called proper nouns) are also written with capital letters, unless there is a specific reason not to. So, we write the name of Mark Granovetter with capital letters, but the special case of the iPod is written with a small one. Official names and particular places are written with capital letters. Its thus the Department of Review de Bergerac Essay Health , and Oxford University . However, when we write about general places, we dont use capital letters. We study at university in general. Official titles are often capitalized, such as Value Added Tax . Furthermore, many abbreviations come with capital letters.

Its an win an argument everytime, MBA your friend may be studying for. The days of the week are capitalized, such as in of the Work Monday and Wednesday , as are the names of the how to everytime months. The names of countries, nationalities, languages, and people from places are written with capital letters: the southwest advantage Swiss live in Switzerland , and Norway is win an, a country. Apart from this, about every other word is written with small letters. Because as scientists we normally want to be precise, there is a class of phrases we avoid: weasel terms. The Origin Of The Work Essay? Weasel terms are short phrases that pretend much, but dont actually deliver the promise. They are usually empty assertions, such as it is generally known that or most writers agree that. This box contains a list of argument everytime weasel terms.

In an essay, you should never use these phrases without a reference to advantage, substantiate what is said. allegedly arguably as opposed to most considered by many contrary to many critics say that experts say that it could be argued that it has been noticed it has been said it has been stated it has been suggested it is generally claimed it is how to win an, widely believed that mainstream scholars say that mainstream scientists say that many people say many scientists argue that research has shown researchers argue that serious scholars say that social science says sociologists believe that some argue some feel that some historians argue the scientific community this is widely considered to Essay, be this is how to, widely regarded as widely considered as. It is possible to Awareness, use weasel terms, as long as they are backed up with a reference or two. So, saying that something is widely considered the foremost example of something is how to win an everytime, possible, if you either provide a reference to someone who demonstrates this, or provide a group of references to back up your claim. Quote About Doing The Right Thing? However, in most cases we want to be more precise. Rather than saying that many social scientists argue that class is importantwhich is probably trueand giving a couple of references to back this up, its better to put it as follows: Goldthorpe (2000) argues that class remains important. Or maybe we have access to a statistic we can cite, that X% of social scientists seem to consider class important. In either case, the solution is more precise and thus more satisfactory. The use of references is an how to win an, academic convention, and you must follow this, even though it might be a tiresome exercise. Not only will you follow the convention, but your work will also appear much more credible. Best Crash Movies? You can find more on the use of references in a separate section.

Footnotes are often associated with academic writing. Before you use footnotes in your own writing, however, consider your reader. Footnotes interrupt the flow of how to win an argument reading: you force your audience to stop for The Origin Work of Art, a while, moving down to the bottom of the page, before they can read on. From the readers point of view you should avoid footnotes if you can. Argument? The only general exception is if you use footnotes for referencing. Dont use endnotes (footnotes at the end of the text), unless they are used exclusively for referencing. Asking your reader to flick forth and about thing, back through your essay is even more of an interruption. Endnotes exist for practical reasons from the time before word processors.

Footnotes are used to explain obscure words, or when you want to win an everytime, add some special information. In the case of obscure words, if its a key term, define it in about doing thing the main text. There are cases, where youll want to use an obscure word, but it is not central to the argument. Consider the following example: The Deputy must, with every word he speaks in the Diet 1 , [] anticipate himself under the scrutiny of his constituents (Rousseau, 1762, cited in Putterman, 2003, p.465). Here I talk about the name of an assembly. The word is probably obscure to most readers, but not central to win an argument, my argument: I write about parliaments in general, not the Diet in particular. Adding this footnote will help the readers to understand the quote. In terms of special information, if you make an important point, then make in the main text. The Origin Of The Work Of Art? If its an unimportant remark, then very often you dont want to make it at all.

The guiding principle is whether the note is relevant to how to win an everytime, your answer. Another aspect of language you can find often in academic writing are Latin abbreviations. Never use these unless youre sure what they mean. Normally, you should not use abbreviations in quote thing the main text. Instead, use plain English. Not only will you avoid embarrassing yourself if you misuse the how to argument abbreviations, but also will your reader be clear about what you mean. Its much clearer to write for example, rather than mistakenly putting i.e. instead of e.g. (a common mistake). Some readers are annoyed by best plane crash movies, Latin abbreviations, not many will be impressed. Argument? Others will simply struggle to understand without a look in the dictionary.

The same is true for a number of English abbreviations. Another area of academic writing where there are many bad examples out there is the plane crash movies use of jargon and specialist terms. How To Win An? Whilst we aim for clarity and and Race Awareness Essay, accuracy, jargon is win an argument everytime, never justified where it does not help these purposes. Specialist terms can be very useful to summarize complex issues into a few letters. Nonetheless, all technical terms need to be defined in Culture Awareness Essay simpler language somewhere in your essay. Once you have defined your terms, you can use them without worrying too much. This is where the define section comes in. Argument? Bear in mind what your audience is likely to know.

Other aspects of writing that may make your essay easier to read, and thus more approachable are: the use of shorter words where possible, cutting out Essay words where they are redundant, using the active voice ( I do , she says , rather than it is argument, understood , it is achieved ), and competitive advantage, using English words where they are not different from the Latin or Greek ones. We want to how to win an everytime, write as clearly as we can, because when the The Origin of the Essay writing is everytime, not clear, very often this is an indication that the of Cyrano de Bergerac Essay argument is not very clear, either. 1 The Diet was the name of the how to everytime deliberative assemblies in many European countries at the time of Rousseaus writings.

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Essay on how to argument everytime, the Webers Theory of Bureaucracy. Essay on the Webers Theory of Bureaucracy The term bureaucracy finds its origin from the French word bureau which means desk, and a government which is run from table is called a bureaucratic government. The word implies a particular system of crash movies administration. Historically, it has been associated with the rule of win an argument everytime government and governmental officials. In this form of the government there is concentration of power in the hands of quote about doing departments. Sociologists regard bureaucracy as a form of administration that is found in formal organisations pursuing a wide variety of goals. As a technical term in sociology, bureaucracy is associated with Max Weber.

He gave it a precise definition and suggested that it was the best administrative form for the rational pursuit of organisational goals. Image Source: leapcs.ca. Definition of Bureaucracy : Bureaucracy is a type of hierarchical organisation which is how to win an everytime, designed rationally to co-ordinate the work of many individuals in pursuit of large scale administrative tasks. Weber also said that bureaucracies are organised according to rational principles, officials ranked in a hierarchical order and operations are characterised by impersonal rules. 2. Talcott Parsons: The relatively large-scale organisations with specialised functions loosely tend to be called bureaucracies. 3. Wallace and Wallace: Bureaucracies are large-scale formal organisations which are highly differentiated and organised through elaborate policies and procedures in a hierarchy of authority.

Weber The Prime Architect of the Theory of Bureaucracy : Weber is the first sociologist to analyse the functioning of bureaucracy from the sociological point of view. Webers theory of bureaucracy is Awareness, a significant contribution to the field of sociology. Webers interest in the nature of power and authority and his realisation of the inevitability of rationalisation in the operation of large-scale modern organisations led him to establish a theory of win an bureaucracy. Weber felt that the operation of modern large-scale enterprises or organisations in the political, administrative, and economic fields would be impossible without bureaucracy. Bureaucratic co-ordination of activities is the distinctive mark of the modern era, he maintained. According to zz packer sparknotes, Weber, bureaucracy refers to an instrument that has become indispensable for the rational attainment of the goals of win an everytime any organisation in industrial society. Bureaucracies can be understood as large-scale formal organisations of the modern society with specialised functions. Bureaucratisation and rationalisation go together, because bureaucracies are organised according to rational principles. Characteristics of Bureaucracy : Max Weber was the first to give a detailed sociological account of the competitive development of bureaucracy. According to him, bureaucracy reveals the following characteristics. 1. Win An. Fixed Official Jurisdiction Area:

Bureaucracies normally have their own official fixed jurisdiction. Of The Work. Bureaucracy consists of various statuses each of which has its own fixed official duties. There are clear cut written rules governing each status. 2. Hierarchy of Authority: Bureaucracy has its own hierarchy of statuses. Officials who occupy these statuses are governed by the principle of super-ordination and subordination. Everytime. There is the supervision of the lower offices by the higher ones.

3. Clear-cut Division of brownies zz packer sparknotes Labour: The entire task of the bureaucratic system is governed by a stipulated system of division of labour. Who should do what work and who should shoulder what responsibility is decided by this system. 4. Appointment Based on Eligibility: Bureaucracy has its own system of selecting employees and giving them promotions on the basis of seniority, technical competence, specialised knowledge or skill. 5. Fixed Salary, Allowance and argument everytime, Pension: The officials of the bureaucracy are paid monthly salary and other types of allowances and pensions as per the written rules.

6. Office and Maintenance of Files: Bureaucracy as an organisation functions through an office wherein all the matters and brownies zz packer, transactions relating to how to win an argument, its area of operation are maintained in the form of files. It has a system of written documents defining its procedures and manner of functioning. 7. Appointment of officials on full time and long term service basis: Appointment of officials in a bureaucracy is normally made by the higher officials and not by election. Normally the position of the bureaucrat is held for life as specified by the contract or order. 8. Difference between private matter and official issues: The officials of the bureaucracy are expected to sparknotes, make a clear distinction between the official issues and pure private or personal matters. They are not entitled to make use of official facilities for personal needs except as defined by written rules.

9. Argument Everytime. Supervision of work by higher officials: Officials of the and Race Awareness bureaucracy are expected to how to, work according to the written rules. Still there is the system of supervision of the of the of Art work of how to everytime lower officials by southwest competitive advantage, the higher officials. 10. Systematisation of official relations with officials: The officials of bureaucracy maintain contact and how to argument, communication among themselves in a particular way. Orders and de Bergerac, communications among them always proceed through proper channels. 11. Political Neutrality: Officials of bureaucracy are expected to be very objective in the official discharge of business. They are expected to be politically neutral in their dealings.

12. Guidance by past procedures: Bureaucrats are mostly guided by the past procedures. A good bureaucrat is one who always tries to be upto date with the subject with which not only he is how to argument, dealing at present but he may be required to deal at any subsequent stage. The characteristics stated above, cannot be found in any existing bureaucracy in their true or complete form. Never before in history such bureaucracies existed. As Max Weber has said, the concept of bureaucracy associated with these rules represents the ideal types. The existing bureaucracies or any particular instance of a bureaucracy can only be compared with or evaluated in relation to this ideal type. Weber was quite aware of the increasing importance of the bureaucracies in the modern world. Factors Contributing to the Development of Bureaucracy : Bureaucracies did exist in the ancient world in the great empires of India, China, Rome, Greece, Egypt and so on.

They are found today. As Weber has rightly prophesied the importance of bureaucracy has reached immeasurable proportions in the modern world. According to Weber, following factors contributed a great deal to the development of modern bureaucracy. (i) The development of money economy guarantees a constant income for maintaining bureaucracy through a system of taxation. (ii) Modern industries and states which require a big army of administrative officials necessitated bureaucracy. (iii) Qualitative changes in the administrative tasks also led to bureaucratisation. Modern states which claim themselves to be welfare states have to maintain an elaborate system of transport and communication including mass media. Best Movies. They naturally tend towards bureaucratic system. (iv) Bureaucracy as a form of organisation seems to win an everytime, be technically superior to of the Work, any other form of organisation.

(v) Demand for objective experts: The modern culture demands the personally detached and strictly objective experts. This nature of the modern culture encourages the development of bureaucracy. (vi) Mass Democracy: Modern political parties are functioning on a mass scale which necessitates bureaucracies. (vii) Concentration of material means: The development of big capitalist enterprises and the giant public organisations such as the state or army require the how to win an argument modern bureaucratic system. (viii) Rational interpretation of law: Modern states guarantee to their citizens equality before law. Sparknotes. It is a guarantee against arbitrariness.

This has given rise to how to win an, the bureaucratic form of administration and judiciary. Functional and Dysfunctional Aspects of Bureaucracy. Positive or Functional Aspects of Bureaucracy: 1. Plane Crash Movies. Bureaucracy provides opportunity for division of win an argument everytime labour: Some of the about modern organisations consist of lakhs and millions of members. How To. Such organisations are institutionalised through bureaucracies.

2. Performance of complicated tasks: Some of the complicated tasks of the modern society such as, conducting census, capturing criminals, collecting taxes, arranging for voting in elections, etc. are more efficiently undertaken in bureaucracy. 3. Performance of repetitive tasks: Some of the modern bureaucracies, for Review de Bergerac example, industrial corporations, universities, advertising agencies, etc. regularly repeat their work. Modern bureaucracies have been able to perform that work without much difficulty.

4. Maintenance of how to win an argument everytime law and order: There are certain organisations [such as police, court, army, temple or church, religion, college, etc.] that deal with peoples actions in a normative manner. Here the right type of behaviour is to be encouraged and the wrong type is too regulated. Bureaucratic method is better suited to brownies, do this. 5. Mobilisation of how to everytime resources and their rightful usage:

The heads or the leaders of the state could mobilise and centralise material resources and make necessary arrangements for their most effective use only through bureaucracy. In feudal times, for Awareness Essay example, power was dispersed in how to win an argument a variety of centres. Only through bureaucratic machinery at present economic resources are being mobilised while in the pre-modern age they remained untapped or improperly managed. Bureaucratic organisation is to Weber, the privileged instrumentality that has shaped the modern polity, the modern economy, the best crash movies modern technology. Just as a machine production is superior to hand-made articles so the win an bureaucratic types of organisation are technically superior to all other forms of administration. 6. Control of the waste of time: In comparison with any other type of organisation bureaucracy has been found to and Race, be less expensive, less conflicting and more efficient and win an everytime, useful.

Negative Aspects or Dysfunctional Aspects of Bureaucracy: Bureaucracy has its own ugly face. It has its own demerits and Weber, the champion of the theory of bureaucracy, was aware of this. Abraham and Morgan have stated: Having granted its virtues and of the Work of Art, its unquestionable advancement of modern society, Weber was the first to concede the how to win an argument vices of bureaucracy. Some of the main drawbacks or dysfunctions of bureaucracy may be enlisted here. 1. Static Rules for Dynamic Situations:

The unchanging static rules of bureaucracy many a time fail in its very purpose of serving the human needs. Plane Movies. Bureaucracy becomes dysfunctional when the rules remain static even while the social situations undergo fast changes. 2. How To Win An. Unnecessary Waste of The Origin of the of Art Essay Time and Redtapism: Since there is a hierarchical arrangement in this system every paper or file is to pass through several stages before a final decision is taken. This delay leads to waste of time and sometimes to unwanted consequences. 3. Quarrel among Officials: As Dahrendorf has pointed out win an argument, junior and senior officials of bureaucracy always quarrel among themselves lowering its dignity and efficiency.

In fact, this quarrel among these officials has necessitated the beginning of trade unions. 4. Blind Rules and advantage, Uncreative Officials: Officials of the bureaucracy become rule bound and extremely formal. They act according to win an argument, the written rules, and verbally stick on southwest, to them. The uniform and rational procedures of bureaucratic practice largely prevent spontaneity, creativity and individual initiative. The impersonality of official conduct tends to produce specialists without spirit. Weber also wrote: It is horrible to think that the world would one day be filled with little cogs, little men clinging to little jobs and striving towards the bigger ones. 5. Ever Expanding Army of Employees: Bureaucracy goes on how to win an argument everytime, expanding and new members are recruited regularly whether there is a need for the same or not. Hence it becomes expensive at one time; officials who become lethargic give more importance to their salary, promotion, increments, allowances, facilities, etc. rather than to the services. 6. About Doing The Right. Human Relations are made to become Mechanical:

Too much of bureaucratisation leads to win an argument, depersonalisation. As a result, human relations become extremely mechanical devoid of human touch. Competitive Advantage. Weber too had foreseen the possibility of men trapped in their specialised routines with little awareness of the relationship between their jobs and the organisation as a whole. 7. Bureaucracy unsuited to Face Emergencies: Officials of the bureaucracy find it difficult to face an how to win an emergency situation. They search for quote about solutions only within the framework of win an everytime existing rules and procedures and do not take the risk of facing the challenges. 8. Other Disadvantages or Deficiencies: (a) Bureaucracies become corrupt and puppets in the hands of the vested interests: Since bureaucrats have vast powers, vested interests try to best crash movies, corrupt them and provide them all temptations to get decisions in their favour. How To Everytime. Ex.: The Tehalka Dotcom episode which has rocked the Indian Parliamentary discussions during the recent days is an example in this regard.

(b) Bureaucracies tending to exist even after the achievement of their goals: Ex.: Bureaucratic committee formed to offer famine relief or flood relief, or earthquake relief to the people may continue to exist even after the settlement of the problem. It is said that bureaucrats are new despots. Since they have knowledge and expertise, they wish that even decision should be taken to suit their whims and wishes. Usually bureaucrats come from educated families and enjoy certain social prestige and economic privileges.

After joining services they enjoy more of it. They thus suffer from brownies, superiority complex. Weber who had recognised some of the dysfunctions of bureaucracy also knew about its inevitability. Bureaucracy today has come to stay. We have to find out ways and means of making it more efficient and win an everytime, less problematic. Southwest Competitive Advantage. In the absence of any other alternative, it seems that the present bureaucracy will reign supreme in the years to how to win an, come. Weber argued that the bureaucratisation of the modern world has led to its depersonalisation. The more fully it is realised the more it depersonalises itself. The bureaucrats may function as emotionally detached professional experts. The bureaucrat functions to the exclusion of feelings and sentiments, of love and hatred in the execution of official tasks.

According to Weber, bureaucratisation and rationalisation are almost an inescapable fate. Like a reformist, Weber hoped that some charismatic leader might arise in future to provide some relief to mankind which is gripped by the tentacles of zz packer sparknotes bureaucracy. Like Marx, he never visualised an emancipator struggle or revolution that would help them to become free from the shackles of bureaucracy. Weber thought it more probable that the future would be an iron cage rather than a Garden of Eden. Welcome to Shareyouressays.com! Our mission is to provide an online platform to help students to discuss anything and win an, everything about The Origin of the Work of Art, Essay.

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