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ap prose essays AP Literature Prose Essay Prompts (1970–2012) 1970 Meredith’s “Ferdinand and mt homework Miranda” from The Ordeal of Richard Feveral: Show how the. Essay Tale Of Two! young woman and the young man in the passage are made to dog ate seem naturally suited for one. 1971 Orwell’s “Some Thoughts on the Common Toad”: Demonstrate how the speaker. establishes his attitude toward the coming of spring. 1972 Joyce’s “Eveline” from Dubliners: Explain how the resume writing boise author prepares his reader for. Eveline’s final inability or unwillingness to sail to South America with Frank. Consider at. least two elements of fictions such as theme, symbol, setting, image, characterization, or. any other aspects of the narrative artist’s craft. Mt Homework! 1973 Dickens’ Hard Times: Explain how the author’s presentation of details is intended to shape. the reader’s attitudes toward the place he describes — Coketown and writing boise the caves.
Give. specific attention to the function of word choice, imagery, phrasing, and sentence structure. 1974 Henry James’s What Maisie Knew: In the opening lines of the passage we are told the. “new arrangement was inevitably confounding” to Maisie. Write a descriptive or narrative. piece which presents a person who is undergoing a new experience that is confounding. 1975 Lagerkvist’s The Marriage Feast: Define and discuss the subject of the story. Direct your. remarks to the significance of the events described.
1976 Work/author unknown: Characterize briefly the world and way of life described in the. passage, discuss the effect of the passage as a whole, and mt homework analyze those elements that. achieve this effect. 1977 No prose selection (instead, had the following prompt: A character’s attempt to recapture. Writing! or reject the past is important in many plays, novels, and dog ate poems. Choose a work in which a. character views the past with such feelings as reverence, bitterness, or longing. Show with. clear evidence how the character’s view of the past is used to develop a theme in the work.) 1978 Johnson’s “Review of ‘A Free Enquiry Into The Nature and Origin of Evil’”: Analyze. Samuel Johnson’s attitude toward writer Soame Jenyns and treatment of Jenyns’ argument. 1979 Quentin Bell on the Woolf family: Show how style reveals feelings about family.
1980 Two funerals: Compare the questions of two different authors’ attitudes by examining diction and choice of. detail; also discuss their effect on dog ate mt homework, the reader. 1981 George Bernard Shaw on his mother’s cremation: Analyze how diction and detail convey. Essays! 1982 Stevenson’s “Cat Bill”: Analyze strategies that make the argument effective for mt homework his. Resume Boise! 1983 Thomas Carlyle’s “Work”: Examine how he uses language to convince the dog ate reader of the. rightness of his position. 1984 Austen’s Emma: Explain how passage characterizes Emma more than Harriet. Mailer’s “Death of Benny Paret”: Explain and sociological perspective help analyze effect on reader and how diction, syntax, imagery, and dog ate mt homework tone produce that effect. (Two prose prompts; no poem) 1985 Hemingway’s A Farewell to Arms: Compare two drafts of a passage from A Farewell to. Arms and analyze the effect of revisions. 1986 Dickens’ Dombey and Son: Define narrator’s attitude toward characters through imagery, diction, narrative structure, choice of detail. 1987 George Eliot’s “Leisure” from Adam Bede: Describe her two views of leisure and discuss. stylistic devices she uses to concise leadership statement convey those views.
1988 Updike’s “Reunion”: Analyze blend of humor, pathos, and grotesque in their story. 1989 Conrad’s “Captain MacWhirr” from Typhoon: Define attitude of speaker toward Captain. and analyze techniques he uses to define Captain’s character. 1990 Didion’s “Self-deception - Self-respect”: Show how style and tone help convey attitude. 1991 Boswell’s The Life of Samuel Johnson: Discuss the ways Boswell differentiates between. the writing of dog ate, Addison and essay Johnson. 1992 Beginning and ending of dog ate mt homework, Tillie Olsen’s “I Stand Here Ironing”: Analyze the narrative. Resume! techniques and dog ate mt homework other resources of resume boise, language Olsen uses to characterize the mother and mt homework her.
1993 Lytton Strachey’s conception of american essays, Florence Nightingale: Define Strachey’s view and analyze. Dog Ate! how he conveys it. 1994 Sarah Jewett’s “A White Heron”: Show how the author dramatizes the young heroine’s. adventure using diction, imagery, narrative pace, and point of view. 1995 Sandra Cisneros’ “Eleven”: Show how the author uses literary techniques to bni referral resume characterize. 1996 Hawthorne’s “Judge Pyncheon” from dog ate, House of the Seven Gables: Analyze how the. narrator reveals the character of Judge Pyncheon. Resume! Emphasize such devices as tone, selection of detail, syntax, point of view. 1997 Joy Kogawa’s Obasan: Analyze how changes in perspective and style reflect the narrator’s. complex attitude toward the past. Consider elements such as point of view, structure, selection of detail, and figurative language.
1998 George Eliot’s Middlemarch: Write an dog ate, essay in which you characterize the narrator’s. attitude toward Dorothea Brooke and analyze the literary techniques used to convey this. 1999 Cormac McCarthy’s The Crossing: Show how the perspective help author’s techniques convey the dog ate impact. of the experience on resume writing services, the main character. 2000 Joseph Addison’s The Spectator (March 4, 1712): Analyze how the language of dog ate, the. passage characterizes the diarist and his society and how the characterization serves. Addison’s satiric purpose. Consider such elements as selection of detail, repetition, and. 2001 Henry Fielding’s Tom Jones (1749): Analyze the techniques that Fielding employs in this. scene to characterize Mr. Allworthy and Mrs. Deborah Wilkins. 2002 Alain de Botton’s Kiss and Tell: Write an essay in which you analyze how the author. produces a comic effect. 2002B Annie Proulx’s The Shipping News: Note the author’s use of such elements as diction, syntax, imagery, and figurative language.
Analyze how the author’s use of language. generates a vivid impression of Quoyle as a character. 2003 Mavis Gallant’s “The Other Paris”: Explain how the author uses narrative voice and. characterization to provide social commentary. 2003B Joyce Carol Oates’s We Were the Mulvaneys (1996): Analyze the literary techniques Oates. uses to characterize the speaker, Judd Mulvaney. Support with specific references to the. 2004 Henry James’s “The Pupil” (1891): Analyze the author’s depiction of the three characters. and american essays the relationships among them. Mt Homework! Pay particular attention to tone and point of view. 2004B Elizabeth Gaskell’s Mary Barton (1848): This is from a novel about mill workers living in. Manchester, England, in the 1840’s. Analyze how Gaskell uses elements such as point of.
view, selection of detail, dialogue, and characterization to make a social commentary. 2005 Katharine Brush’s “Birthday Party” (1946): Write an sociological perspective, essay in which you show how the. author uses literary devices to achieve her purpose. 2005B Norris’ McTeague: A Story of San Francisco: Discuss how the characterization in the. passage reflects the narrator’s attitude toward McTeague. Consider such elements as. diction, tone, detail, and syntax. 2006 Oscar Wilde’s Lady Windermere’s Fan (1892): Analyze how the dog ate mt homework playwright reveals the. values of the characters and the nature of their society. 2006B From “a nineteenth-century novel”: Discuss how the bni referral narrator’s style reveals his attitudes. toward the people he describes. 2007 Dalton Trumbo’s Johnny Got His Gun: Analyze how Trumbo uses such techniques as point. of view, selection of detail, and syntax to characterize the relationship between the young. man and his father. 2007B Seamus Deane reflecting on his childhood experiences with books and writing: Analyze. how Deane conveys the impact those early experiences had on him. 2008 Aran from Anita Desai’s Fasting, Feasting (1999): Analyze how the dog ate author uses such. literary devices as speech and point of view to characterize Aran’s experience. 2008B Jane Austen’s Northanger Abbey (1818): Analyze the literary techniques Austen uses to. characterize Catherine Morland. 2009 Ann Petry’s The Street (1946): Analyze how Petry establishes Lutie Johnson’s relationship. to the urban setting through the use of poets society todd essay, literary devices such as imagery, personification, selection of detail, and figurative language.
2009B Zorah Neale Hurston’s Seraph on the Suwanee (1948): Analyze the literary techniques. Hurston uses to describe Sawley and to characterize the people who live there. 2010 Maria Edgeworth’s Belinda (1801): The narrator provides a description of Clarence. Harvey, one of the suitors of the novel’s protagonist, Belinda Portman. Read the passage. carefully. Then write an essay in which you analyze Clarence Hervey’s complex character. as Edgeworth develops it through such literary techniques as tone, point of view, and. 2010B Maxine Clair’s “Cherry Bomb”: Write an essay in which you analyze how Clair uses. literary techniques to characterize the mt homework adult narrator’s memories of her fifth-grade summer. 2011 George Eliot’s Middlemarch (1874): In the passage, Rosamond and Tertius Lydgate, a. Dead Poets Anderson Essay! recently married couple, confront financial difficulties. Read the dog ate mt homework passage carefully. Then. write a well-developed essay in which you analyze how Eliot portrays these two characters.
and their complex relationship as husband and wife. You may wish to consider such. literary devices as narrative perspective and dead poets selection of detail. 2011B Tomson Highway’s Kiss of the Fur Queen (1998): The following passage is the opening of. the novel by the Cree novelist and playwright Tomson Highway. Read the passage. Dog Ate! carefully. Then write a well-organized essay in which you analyze how Highway uses. literary devices to cities dramatize Okimasis’ experience. 2012 Carefully read the dog ate following excerpt from the renaissance novel Under the dog ate mt homework Feet of Jesus by Helena Maria Viromentes.
Then write a well-organized essay in which you analyze the development of Estrella's character. In your analysis, you may wish to consider such literary elements as selection of detail, figurative language, and tone.
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Adolescent Addiction and STD/HIV essay. Adolescence is considered to be a unique period in life cycle, which represents various challenges and opportunities to the individuals. In fact, it is mt homework a time of essay help, constant search and experimentation, which increasingly includes risky sex and drug use. Today, young people are largely disoriented: parents and teachers assert, for example, that one should abstain from early sexual activities, smoking or alcohol consumption, but television, movies and magazines propagandize a disreputable lifestyle full of mt homework, unsafe sexual practices, smoking, and alcohol consumption. Therefore, adolescence is understood as one of the most difficult periods of human development.
Despite its relative brevity, it largely determines the entire life of the bni referral resume, individual. Sure, the formation of character and other personal basics occur in this period of life cycle. These circumstances make adolescents particularly vulnerable and malleable to the negative influences of environment. In addition, it is necessary to take into account an adolescent’s tendency to be free from parental guardianship and control that often leads to dog ate mt homework the denial of american, spiritual values ??and standards of living of the older generation. Dramatically, young people aged less than 25 years are more heavily affected by STD/HIV-AIDS. Most sexually transmitted infections occur more frequently in adolescents than in adults. Parents and teachers often do not know what, how and when to talk to adolescents. The talks about sexuality and remedies are tabooed in society, particularly with regard to young people. In this case, young people, not having access to accurate information, rely on dog ate rumors and stereotypes learned from peers and the media. In such a case, young people need adequate support and reliable information to help them protect themselves.
Key words: adolescence, STD/HIV-AIDS, risky sex, drug use. Background on HIV/AIDS. HIV/AIDS and other STDs are one of the most important and tragic issues facing humanity at services the end of XX century. Today, HIV/AIDS is “recognized as a global emergency demanding the attention on the international health agenda and one of the most important public health issues” (Wasti, Simkhada, Randall, van Teijlingen, 2009, p. Mt Homework. 62). In fact, STDs and HIV infection have spread to all the sectors of the population, including happy families. Hence, it is a quite relevant problem that affects all aspects of resume writing services boise, our society, and thus, needs much attention to deal with. Mt Homework. The first cases of infection were observed in Africa in 1959. In 1981, a new syndrome was first identified among homosexual men in personal leadership statement, the United States of America.
Since 1987, the spread of a new infectious disease has reached epidemic proportions. Nowadays, the disease is registered in mt homework, 152 countries around the world (UNAIDS WHO, 2003). The highest prevalence of reported infections can be found in all African countries. In fact, HIV prevalence among young people (10–19 years) is 2.1 million adolescents, who live with HIV in services boise, 2012 (Joint United Nations Programme on HIV/AIDS [UNAIDS], 2013). Generally speaking, AIDS is a chronic condition caused by the human immunodeficiency virus, abbreviated as HIV. There is no doubt that AIDS is a complex scientific problem. However, the dog ate mt homework, fight against HIV/AIDS and other STDs is largely complicated by the lack of questions tale of two cities, effective therapeutic drugs, and because of the inability to be vaccinated. Mt Homework. That is services why, health education programs, full and objective information about the urgency of the problem and effective ways to prevent infections are crucial in the fight against the AIDS epidemic.
Sure, HIV/AIDS and other STDs are difficult to control due to dog ate mt homework the following significant issues: 1) lack of effective treatment; 2) lack of resources for primary prevention (vaccination); 3) difficulties in contacts with the population most severely affected by HIV/AIDS. How HIV is Transmitted. The main routes of HIV transmission include as follows: A. Unsafe anal, vaginal, or oral sex (i.e. sex without a condom). Currently, the dead poets society todd anderson, lion’s share of cases of HIV infection falls on mt homework unprotected sex. In order to protect themselves from HIV and other sexually transmitted infections, it is bni referral resume important to abstain from sexual intercourse or even it happens make sure to dog ate mt homework use a quality condom. B. Through blood products. The vast majority of HIV infections are among people who use or have used drugs intravenously.
Furthermore, HIV can be transmitted when using non-sterile, untreated medical instruments or during blood transfusions. C. From mother to writing child. Child transmission is possible: during pregnancy (when HIV penetrates through the placenta to the fetus) during childbirth and breast feeding. Dog Ate Mt Homework. Now let us talk about the personal leadership, factors that contribute to the spread of HIV infection: 1) the dog ate mt homework, growing number of children and concise leadership statement adolescents, who have dropped out of the dog ate mt homework, sphere of social control; 2) the essays, proliferation of different forms of deviant behavior among children, adolescents and young people:increase in dog ate, the number of injecting drug users; increase in sociological perspective essay, alcohol abuse among minors; increase in juvenile delinquency; involvement of youth and minors in commercial sex. 3) reducing educational potential of families; 4) preventive work is not up to teenagers dropped out of the area of social control; 5) the imperfection of social monitoring (allowing to assess the effectiveness of preventive measures to track changes in the behavior of #8220;at risk#8221; groups, and to identify new areas of risk) as well as medical control over the representatives of #8220;at risk#8221; groups; 6) the lack of legal protection and psychosocial assistance to drug addicts and their families during the rehabilitation period;
7) low effectiveness of drug treatment, the high cost of removing the mt homework, psychological dependence that makes it unaffordable for most addicts; 8) relative effectiveness of law enforcement agencies to combat drug trafficking; 9) low coordination of prevention activities by resume writing different agencies and dog ate organizations; 10) poor sexual health knowledge; 11) limited condom use since parents do not talk to their children about sexual matters (Wasti, Simkhada, Randall, van Teijlingen, 2009). HIV Signs and Symptoms. Now let us focus our specific attention on the fundamental criteria for recognition of HIV infection. Personal. The recognition of HIV infection, especially in the early stages, is very difficult. The doctor must first of all be alert to dog ate this infection, mindful of its inexorable spread in our society.
The diagnostic program for HIV infection should include three main fragments. Anamnesis – information about a person’s belonging to risk groups, sexual contact with persons from these groups, especially with the large number of partners. In addition, it is important to consider the indications of the subject for a long stay abroad, especially in endemic regions. Analysis of clinical symptoms. Multifaceted, abundant and diverse clinical manifestations of HIV infection have the common features: relentless flow, increasing severity, combination of todd, a variety of dog ate mt homework, pathological conditions, resistance to therapy, etc.
The physician must especially pay attention to generalized lymphadenopathy, weight loss, persistent diarrhea, severe pneumonia, progressive damage to the central nervous system and, of course, Kaposi’s sarcoma. Laboratory tests. The diagnosis of HIV infection should always be confirmed by the laboratory. Thus, HIV signs and symptoms include: 1) enlarged liver or spleen; 2) fever; 3) diarrhea; 4) chills; 5) headache; 6) muscle aches; 7) sore throat; 8) rash; 9) night sweats; 10) neurologic symptoms; 11) ulcers in personal leadership, the mouth; 12) nausea and vomiting; 13) thrush; and 14) swollen lymph nodes (“Signs and Symptoms,” n.d.). However, it is possible to remember that the above-mentioned symptoms and signs usually disappear in a week to a month and can be easily mistaken for any other virus infections. HIV/AIDS Prevention and Treatment. There is no doubt that successful fight against HIV / AIDS largely depends on the targeted prevention efforts of different government and non-governmental organizations and efficient attempts to deal with the problem that include political, societal, and treatment approaches. Since the mt homework, recognition of HIV, many government and non-governmental organizations took all the services boise, possible to measures to deal with the problem. HIV/AIDS treatment and prevention took place in different areas, including education programs, public information, strategies to dog ate minimize the risks of being affected with HIV, and more.
In fact, HIV / AIDS treatment pursues a comprehensive goal: to bni referral resume reduce the amount of virus in the body, to keep the replication (reproduction) of the dog ate mt homework, virus, to backup or restore the immune system and to prevent or treat opportunistic infections that occur due to immune deficiency. As for the treatment options for dealing with the problem, it is important to introduce free voluntary HIV testing, qualified counseling for infected people to raise their awareness about the disease and safe sex behavior, appropriate and adequate antiretroviral therapies, training sessions, specialized diagnostic and treatment centers to improve the social and material conditions of dead poets todd anderson essay, life for all. Thus, HIV / AIDS treatment is currently being conducted in mt homework, three areas: Etiotropic therapy aimed at help eliminating or suppressing a retrovirus. Pathogenetic therapy aimed at restoring the immune system. Symptomatic therapy aimed at dog ate mt homework the treatment of major clinical manifestations of AIDS. Standard antiretroviral therapy that is considered to be today’s most efficient and effective way to treat HIV infection. It blocks the HIV virus in the patients’ blood with antiretroviral drugs, which does not allow the virus to multiply further. Nowadays, medicine does not have the means that would completely cure a person infected with HIV. However, various medicine products that can delay disease progression are designed and essay questions tale of two manufactured by different organizations. WHO reports about the evidence-based programs for dealing with the problem, arguing that as of the end of 2012, 9.7 million individuals, including children and adolescents, had access to antiretroviral therapy (ART) in different countries worldwide.
In fact, WHO provides various countries with treatment options, evidence-based programs, ongoing guidance and support in delivering standard antiretroviral therapy within a public health approach (World Health Organization [WHO], 2013). Mt Homework. In addition to this, WHO along with UNAIDS launched an evidence-based prevention program known as the Treatment 2.0 strategy. Essay. This program is aimed at encouraging adults and adolescents to adopt appropriate behaviors that decrease their risk of dog ate mt homework, HIV infection. Also, the program is designed to assist HIV-positive individuals in reducing their risk of transmitting HIV. In fact, the Treatment 2.0 strategy promotes drastic simplification of essay help, standard antiretroviral therapy (ART) and full integration with treatment and prevention in order to ensure Universal Access (WHO, 2013). Here are some preventive measures to cope with the HIV / AIDS issue. One of the dog ate, most important ways to prevent HIV / AIDS is to have sex with only one partner, do not have contact with prostitutes, casual acquaintances, drug addicts who use intravenous needles, etc. Moreover, it is essential to use condoms to protect against HIV. Make sure to utilize only your own hypodermic needles, toothbrushes, and razors.
Insist on using only sterile disposable instruments during surgeries (including dental ones), acupuncture, tattooing or body piercing. In addition, the most important policy actions include: 1. Ensuring promotion, protection and respect of human rights and taking measures to eliminate discrimination and combat stigma. 2. Essay Questions Of Two. Cooperative work of all sectors of society, including governments, non-governmental organizations, religious organizations, education sectors, private sectors, trade unions, and the media. 3. Involvement of individuals living with HIV in the implementation and evaluation of preventive strategies that address the mt homework, distinct prevention needs. 4. Taking into bni referral, account cultural norms and beliefs, recognizing the key role they can play in supporting prevention efforts and their potential impact on the spread of HIV. 5. Dog Ate Mt Homework. Wide dissemination of knowledge of statement, how HIV infection is transmitted and how to prevent it. 6. Promoting the links between HIV prevention and protection of dog ate mt homework, sexual and reproductive health.
7. Promoting programs to resume writing boise meet the HIV prevention needs of key groups and populations affected by dog ate HIV. 8. Mobilizing and strengthening financial, human and institutional capacities in all sectors, particularly in health and education. 9. Leadership. Ensuring adequate investment in areas of research, development and promotion of new prevention technologies. 10. Ensuring “safer sex behavior, condom promotion, identifying and treating STIs, harm reduction, voluntary counselling and testing services, sexual health and HIV/AIDS to youth, preventing mother to child transmission” (Wasti, Simkhada, Randall, van Teijlingen, 2009, p. 63). Thus, taking the above-mentioned information into consideration, it is possible to draw a conclusion that HIV/AIDS and mt homework other STDs are truly one of the most important and tragic issues facing humanity at the end of bni referral, XX century. Anyone at any age, regardless of gender, place of residence, religion and social status can become infected with HIV. However, the fact is that young people are most at risk of HIV infection.
This is dog ate due to the fact that adolescence is viewed as one of the most difficult periods of human development. Today, young people are largely disoriented: the media, movies and magazines propagandize a disreputable lifestyle full of unsafe sexual practices, smoking, and alcohol consumption. As a result, not having access to accurate information, they begin to rely on rumors and stereotypes learned from peers and TVs. Sociological Essay. In this connection, young people need adequate support and help to protect themselves from being infected. Mt Homework. Sure, HIV/AIDS is an important issue, which requires much attention to personal leadership deal with.
It is critical to take all the possible measures to cope with the problem at the national and international levels. Our research presents a solution to the HIV issue, provides the information on HIV transmission routes, HIV symptoms and signs and HIV/AIDS treatment and preventive measures to deal with the issue. Undoubtedly, only the knowledge about HIV transmission and prevention is able to protect each of us from being affected by this viral infection.
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Pathophysiology, diagnosis, and dog ate mt homework management of polycystic ovary syndrome. Polycystic ovary syndrome (PCOS) was first reported in 1935 by Stein and Leventhal who described seven women dealing with amenorrhea, hirsutism, and enlarged ovaries with multiple cysts (Stein and american renaissance essays Leventhal, 1935). This syndrome was given the name Stein–Leventhal syndrome after these two physicians for sometime. In the 1960s, however, the term polycystic ovary syndrome (PCOS) was first introduced and gradually started to dog ate mt homework, replace its former name. It is now recognized as a common complex heterogeneous endocrine disorder in reproductive-age women associated with reproductive, metabolic and psychological features. This syndrome is primarily characterized by irregular menses, hyperandrogenism, and polycystic ovaries (Azziz et al., 2004). Given the fact that one out of five women of reproductive age is affected by this syndrome, and studies which suggest that 5% to 10% of females 18 to 44 years of age are affected by PCOS, it is deemed to be the most common endocrine abnormality among women of reproductive age in the US. In Saudi Arabia, the resume, prevalence of PCOS is mt homework still unknown although it is believed to be similar to the other studies. In addition, it is a chronic disease with manifestations across the lifespan of women and resume writing represents a major health and economic burden.
Therefore, the aim of this research is to review this subject in mt homework, depth taking in consideration the pathogenesis, clinical features, diagnosis, complications and resume writing management. Material and Methods. This study was performed by a literature search of English-language studies which was conducted on PubMed (from 1994 to 2016) and CENTRAL (Cochrane Central Register of Controlled Trials) using the dog ate, terms, ‘PCOS’, ‘polycystic ovary syndrome’, and ‘polycystic ovary disease’. Polycystic ovary syndrome is the most common endocrine disease in women of child-bearing age. Dead Society Todd! Additionally, World Health Organization (WHO) has declared PCOS to be the leading cause of type 2 anovulatory infertility.
Based on studies performed in Greece, Spain and the USA, the prevalence of PCOS using the National Institutes of Health and National Institute of Child Health and Human Development (NIH/NICHD) criteria indicate that PCOS affects 4%–8% of women of reproductive age. That percentage increases up to even 18% according to the guidelines of the Rotterdam consensus (Azziz et al., 2004) (Asuncion, 2000) (Diamanti-Kandarakis, 1999) (Knochenhauer, 1998). Recently, there has been variations of the prevalence of PCOS depending on the diagnostic criteria used. Normally, females of dog ate reproductive age experience cycles of hormonal activity that repeat at about one-month intervals. With every cycle, a woman’s body prepares for a potential pregnancy, whether or not that is the sociological help, woman’s intention. The term menstruation refers to dog ate mt homework, the periodic shedding of the uterine lining. Averagely, the menstrual cycle takes about 28 days and occurs in phases: the sociological essay help, follicular phase, the dog ate, ovulatory phase (ovulation), and the luteal phase. There are four major hormones (chemicals that stimulate or regulate the activity of cells or organs) involved in the menstrual cycle: follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen, and progesterone. Services! During the mt homework, follicular phase of the resume writing services, menstrual cycle, which starts on the first day of a woman’s period, two hormones; follicle stimulating hormone (FSH) and dog ate mt homework luteinizing hormone (LH), are released from the brain, specifically the pituitary gland, and travel in the bloodstream to the ovaries. These hormones stimulate the primary maturation of around 15 to 20 eggs in the ovaries, each in its own “shell,” called a follicle. As well as triggering an concise personal leadership, increase in mt homework, the production of the female hormone estrogen.
As this follicular phase progresses, one follicle in one ovary becomes dominant and produces estrogen while continuing to mature suppressing all of the dead poets anderson essay, other follicles in the group. The second phase, or ovulation, begins on the 14th day after the follicular phase started. The rise in estrogen from the dominant follicle triggers a surge in the amount of luteinizing hormone that is produced, which causes the dominant follicle to release its egg from the dog ate, ovary into the fallopian tube. During the last phase, known as luteal phase, the empty follicle, once harboring the egg, develops into a structure called the corpus luteum, which secretes the hormone progesterone. Progesterone prepares the uterus for the implantation of a fertilized egg. If the egg is writing boise not fertilized, it passes through the uterus, and dog ate mt homework the lining covering it breaks down and concise leadership statement sheds, and the next menstrual period begins. The pathophysiology of PCOS results from dog ate mt homework, a primary defect in society todd anderson essay, the pituitary function, as well as, defects in insulin secretion and action, and ovarian function. Increased luteinizing hormone (LH) and dog ate gonadotropin–releasing hormone (GnRH) levels relative to follicle-stimulating hormone (FSH) was the resume, first laboratory abnormality identified in classic PCOS. Raised LH levels will lead to an increase of androgen production and dog ate secretion by society todd essay ovarian theca cells. The increase in LH seems to be the dog ate mt homework, result of abnormal sex steroid feedback rather than the cause of androgen excess.
Patients with PCOS are less susceptible to resume writing services boise, suppression of LH by luteal phase hormones, where the modest rise in androgen levels in patients with PCOS absurdly stimulates LH pulsatility. Moreover, use of antiandrogen treatment lowers the elevated LH pulse frequency of PCOS to a normal level, suggesting that androgen excess interferes with the hypothalamic inhibitory feedback of female hormones, principally progesterone (Rosenfield and dog ate Bordini, 2010). In spite of tale of two this, about dog ate, half of the patients with PCOS, especially obese patient, do not have elevated LH levels or abnormal gonadotropin response to GnRH agonist testing. Furthermore, around half of PCOS patients with a verified ovarian source of hyperandrogenism were revealed to have normal LH levels and LH responses to a GnRH agonist test, also suggesting that their ovarian dysfunction is independent of LH excess. Another major influence in the pathophysiology of PCOS is the association with insulin and its function; In the ovary, insulin helps to regulate ovarian function, and american acts in dog ate mt homework, conjunction with LH to enhance androgen production which can lead to writing services boise, anovulation (Gonzalez, 2012). Etiology and risk factors. A detailed pathogenesis of PCOS has not been clarified yet.
Which is one of the reasons for defining it as a syndrome rather than a disease whereas a syndrome is mt homework a cluster of symptoms which cannot be explained under a common etiologic factor. American! However, the individual susceptibility probably depends on prenatal androgen exposure, genetic factors, ethnic origin and environmental risk factors (Zhang et al., 2012). The interaction of dog ate a number of genetic and environmental factors determine the heterogeneous, clinical, and questions of two cities biochemical phenotype, which is why PCOS is described as an oligogenic disorder (Barber and Franks, 2010). Although the genetic etiology of PCOS is dog ate yet undetermined, a family history of PCOS is relatively common; however, familial links to PCOS are unclear. Nonetheless, based on the aggregation of cases in families, PCOS is considered a heritable disorder and resembles an autosomal dominant pattern (Diamanti-Kandarakis, Kandarakis and Legro, 2006). Hence, a family history of PCOS is considered a risk factor. As for ethnic factors, hirsutism is more rarely observed in individuals of Asian origin (approximately 10%) compared with the Caucasian race (approximately 70%). Environmental risk factors, such as obesity, seem to amplify genetic predispositions (Zhang et al., 2012). Obesity is a prevalent characteristic of resume PCOS (Shannon and Wang, 2012), ranging from 12.5% to 100% (Mirzaei and Kazemi, 2008), with a collective estimated prevalence of 49% (Graff et al., 2013). These environmental factors implicated in dog ate mt homework, PCOS (e.g., obesity) can be aggravated by essay tale cities poor dietary choices and physical inactivity; infectious agents and toxins may also play a role (Diamanti-Kandarakis, Kandarakis and Legro, 2006). Dog Ate! The reproductive and metabolic features of PCOS are sometimes reversible with lifestyle modifications such as weight loss and exercise (Shannon and Wang, 2012).
Clinical features of PCOS. The clinical presentation of PCOS varies widely. These considerably distinctive features, displaying a varying degree of expression in each individual, emphasize the essay tale, phenotypic variability of PCOS, and is in dog ate mt homework, fact another reason why it is considered as a syndrome. Women with PCOS may present with an array of serious clinical implications including reproductive manifestations (hirsutism, infertility and pregnancy complications) (Boomsma et al., 2006), psychological problems (reduced quality of life, poor self-esteem, depression, anxiety) (Deeks, Gibson-Helm and Teede, 2010), and metabolic implications (insulin resistance, metabolic syndrome, impaired glucose tolerance (IGT), diabetes mellitus type 2 (DM2) and potentially cardiovascular disease (CVD)) (Sir-Petermann et al., 2013) (Meikle, 2006). Presentation of concise personal statement PCOS may vary across the mt homework, life cycle of the patient due to essay questions tale of two, the heterogeneous nature of PCOS and the wide spectrum of mt homework clinical features. Generally, PCOS is a chronic condition that usually begins in adolescence then transitions to dead poets society anderson essay, include infertility and increase metabolic complications over time. However, when combined with obesity, metabolic implications of PCOS such as IGT, DM2 and the metabolic syndrome can present in mt homework, adolescence (Coviello, Legro and Dunaif, 2006). Reproductive features of PCOS. Clinical hyperandrogenism primarily includes hirsutism, acne and male pattern alopecia. Poets Todd Essay! PCOS is dog ate a common cause of hirsutism occurring in approximately 60% of cases. Hirsutism is defined in females as male type terminal hair growth and distribution (Norman et al., 2007).
Acne affects one third of cases and personal statement is not particularly specific for PCOS (Norman et al., 2007). Studies have shown that androgen levels are elevated in woman with acne, although the severity of acne has not been positively correlated with any particular hormone with the exception of the adrenal androgen, dehydroepianandrosterone sulfate (DHEA-S) (Karrer-Voegeli et al., 2009). Conversely, in many PCOS women hirsutism is not associated with acne, which might be due to variable local androgen bioactivity. An enzyme called 5-?-reductase controls the androgen activity in the hair follicle by converting free testosterone to dog ate, the more potent dihydrotestosterone (DHT). This enzyme has two isoforms: type 1 is bni referral located in the sebaceous glands and pubic skin and type 2 is present primarily in the hair follicle, genital skin, and adult scalp. This explains the different clinical manifestations seen in hyperandrogenic women when the degree of hirsutism is not well-matched with the severity of the acne (Archer and Chang, 2004). Male pattern hair loss (androgenic alopecia) is a genetically determined disorder characterized by the gradual conversion of terminal hairs into indeterminate, and finally into vellus hairs. The incidence of androgenic alopecia in PCOS is not clearly defined, but several reports vary from a prevalence of 40-70%. It is less frequently seen in PCOS cases, as it generally requires a familial predisposition. Ovarian abnormalities and Infertility. Most of the women suffering from PCOS will seek gynecological counseling due to menstrual irregularity, with 70% to 80% of women presenting with oligomenorrhoea or amenorrhoea.
Oligomenorrhoea occurs usually in adolescence, with onset later in life often associated with weight gain (Brassard, AinMelk and Baillargeon, 2008). Furthermore, these ovarian abnormalities have been thought to increase the risk for infertility. Infertility was one of the main symptoms originally attributed to PCOS according to the understanding of Stein and Leventhal (Stein and Leventhal, 1935). The consequent epidemiologic studies implied that about 90% to 95% of dog ate women attending infertility clinics with anovulation, have been diagnosed with PCOS, which is the sociological essay, most common cause of anovulatory infertility. (Hull, 1987) In a large population of dog ate 1,741 women affected by PCOS, primary infertility was reported in 50% of women, while secondary infertility was reported in 25% of women (Dungan, 2008). On the other hand, there is currently a debate on the legitimacy of the relationship between PCOS and infertility. Research has concluded that 60% of women with PCOS are fertile (defined as the ability to conceive within 12 months), although time to conceive is often increased. Psychological features of leadership statement PCOS.
There are very few studies to date that have explored the psychological aspect of dog ate mt homework PCOS, since most research has focused primarily on the biological and physiological features of the syndrome. Questions Tale Cities! However, these psychological features do, in fact, compromise quality of life and dog ate adversely impact on mood and psychological well-being. (31) Some of these concerns include the negative body image due to obesity, acne and excess hair. Moreover, women with PCOS deal with low self-esteem, anxiety and poets society todd it may even lead to depression. The other challenge for dog ate mt homework, patients is dealing with psychosocial impact of mood disturbance and reduced psychological well-being on motivation and the ability to implement and sustain successful lifestyle changes that are critical in cities, this condition. Dog Ate Mt Homework! (32) Metabolic features of PCOS. Actually, obesity is considered a serious growing epidemic disorder in writing services boise, the world population, especially in the childhood and teenage years. Women with PCOS represent a cohort of people with a high prevalence of overweight (BMI .25 kg/m2) and obesity (BMI .30 kg/m2) compared to mt homework, healthy women, up to 61% of bni referral prevalence,93 with a typical central distribution of adipose tissue, although there is a wide variability in dog ate, the estimates of obesity in PCOS women across different countries and ethnicities.13 In the Western countries, such as Australia, USA, and UK, the PCOS women have the essay of two, highest prevalence of overweight and obesity,94,95 compared to dog ate mt homework, Chinese PCOS women (only 20% has a BMI of essay tale of two 25 kg/m2 or greater).96 The causal role in the association between obesity and PCOS has yet to be determined but cultural, lifestyle, and dog ate mt homework ethnic factors take part in these conditions.
Recent literature has found that greater adiposity was described in more severe reproductive phenotypes (characterized by hyperandrogenism associated with chronic anovulation),49 and concise lean women had milder reproductive phenotype compared with those who were overweight;97 so obesity can exacerbate the dog ate, PCOS reproductive phenotypes. It also appears that obesity could have a bidirectional relationship with PCOS, as women with PCOS are more inclined to weight gain and excessive weight gain increases PCOS prevalence, unmasking a latent PCOS condition, but this yet remains to tale of two, be clarified. Insulin is a hormone produced by the pancreas to control the amount of sugar in the blood. It helps to move glucose from dog ate, blood into cells, where it’s broken down to produce energy. Insulin resistance (IR) is a physiological condition where the sociological help, body’s cells are resistant to the effects of insulin. As a result, the body therefore has to produce extra insulin to compensate. High levels of insulin stimulate the dog ate mt homework, ovaries to cities, produce too much testosterone, which interferes with the development of the follicles i.e. the dog ate, sacs in the ovaries where eggs develop, which in turn prevents normal ovulation.
Insulin resistance have also been found in some cases to concise personal, lead to weight gain, which may exacerbate many of PCOS symptoms, because having excess fat causes the body to produce even more insulin. Insulin Resistance, considered an essential etiological factor of PCOS, was traditionally attributed primarily to obesity. Although the demonstration of insulin resistance is not required to make the mt homework, diagnosis of PCOS, it is clear that hyperinsulinemic insulin resistance plays a prominent role in PCOS. The prevalence of insulin resistance in PCOS ranges from 50%–70%57–60 and occurs independently of obesity. Metabolic syndrome is not a disease, but rather a clustering or “constellation” of abnormal conditions. Although there are several definitions of what is essays required to be diagnosed with metabolic syndrome, most health care professionals use criteria from the dog ate mt homework, National Heart, Lung, and Blood Institute (NHLBI) and questions of two cities the American Heart Association. Consistent with the increased prevalence of mt homework insulin resistance, metabolic syndrome is also more common in women with PCOS. A meta-analysis (32) has shown that women with PCOS have higher levels of triglycerides (TG), LDL cholesterol and total cholesterol (TC), and lower HDL cholesterol.
levels compared with control women, regardless of body mass index (BMI). Lean women with PCOS were also more likely to have metabolic syndrome than lean women without PCOS (OR 3.00, 95% CI 1.24–6.78).62 The components of metabolic syndrome are associated with insulin resistance and dead society are summarized in Table 3.63. A specific abnormal pattern of insulin receptor phosphorylation, namely increased serine phosphorylation and reduced tyrosine phosphorylation, appears to be responsible for insulin resistance observed in PCOS. As reported by dog ate the main scientific societies,13,15,49 women with PCOS present an increased prevalence of classic risk factors for cardiovascular disease (CVD) such as hypertension, dyslipidemia, diabetes, and essay obesity and nonclassic risk factors such as C-reactive protein (CRP), homocysteine, and tumor necrosis factor-?.50 PCOS at any age is characterized by greater odds for elevated CVD risk markers and these elevated makers can occur without obesity but are magnified with obesity.13. In 2004, a worldwide case-control study of patients from 52 countries was published, the dog ate mt homework, INTERHEART study,51 that found nine potentially modifiable risk factors, accounted for over 94% of the population-attributable risk of a first myocardial infarction in women; the nine factors included smoking, hypertension, dyslipidemia, diabetes, visceral obesity, psychosocial factors, decreased consumption of poets todd anderson fruits and vegetables, regular consumption of alcohol, and regular physical activity. The majority of these occur in the PCOS woman. It is estimated that the prevalence of dog ate mt homework each risk factor is approximately double for women with PCOS when compared with controls, while it is 1.5 times higher in BMI-matched studies beginning in adolescence and it is found in e. Since PCOS is society todd anderson essay considered as a lifelong multisystemic and multifaceted disorder, the dog ate mt homework, reproductive and metabolic alterations characterizing the syndrome may be also associated with an increased risk of the development of statement cancers, such as the endometrial, ovarian, and breast cancer, which recognize potential hormonal and/or metabolic pathogenetic mechanisms. The potential mechanisms which could promote the mt homework, onset of neoplastic diseases in these women, particularly endometrial cancer, include the chronic anovulatory state, resulting in an unopposed estrogen action, associated with hyperandrogenism.117.
At present, based on poets society todd anderson the most recent meta-analysis,118 women with PCOS of all ages seem to mt homework, be at an increased risk of endometrial cancer. In particular, the risk of endometrial cancer may be even higher in the premenopausal subgroup of women with PCOS, while overall the risk of ovarian and breast cancer was not significantly increased.118 These current results are consistent with previous reviews published on cancer in PCOS116,119,120. Unfortunately, as with studies of cardiovascular risk, the assessment of cancer risk in PCOS women is complicated by the presence of various potential confounding factors such as obesity, T2DM, inflammation, and metabolic syndrome, which are highly represented in PCOS populations. Obesity is a recognized risk factor for endometrial cancer and the authors of the resume writing services, most recent meta-analysis118 acknowledge that the increased risk of this cancer could be attributed, at least in part, to increased prevalence of obesity in mt homework, PCOS women. The same issue applies to T2DM, another possible confounding factor that is most representative in PCOS women and associated with an higher risk of endometrial cancer, possibly secondary to help, hyperinsulinemia, hyperglycemia, and inflammation.122 Therefore, there is uncertainty as to whether increased endometrial cancer risk is due to different metabolic risk factors or PCOS itself, which is mt homework characterized by american essays many metabolic and reproductive complications that could be responsible for dog ate mt homework, an increased oncology risk on endometrium. Nonetheless, it is generally accepted that PCOS women with amenorrhea are at greater risk for endometrial hyperplasia and cancer;13 therefore, ESHRE/ASRM Consensus Workshop Group has established a proper endometrial surveillance with ultrasound and/or biopsy to assess endometrial thickening in women which experience extended period of amenorrhea, based on clinical suspicion and presentation, and in questions, these women periodic progestogen withdrawal is dog ate also recommended, at least four episodes per year.13 There is resume services boise limited and contradictory evidence regarding the risk of ovarian131 and breast cancer121 in women with PCOS; so currently, the ESHRE/ASRM consensus statement13 does not recommend routine surveillance strategy and/or clinical care to dog ate, detect ovarian and breast cancer in essay questions tale, women with PCOS. There is also insufficient evidence to evaluate any association of PCOS with vaginal, vulvar, and cervical cancer. Diagnostic criteria outlined in Table 1 have been modified on four occasions since the National Institute of Health first defined the syndrome in 1990 (2), highlighting the dog ate mt homework, complex nature of the disorder. In 2003, the Rotterdam criteria were published and further revised in bni referral resume, 2004 (3), followed by the Androgen Excess Society criteria in 2006 (4), subsequently modified by the Androgen Excess and PCOS Society (AE-PCOS) in 2009 (5). Today, the Rotterdamcriteria are the most widely utilized guideline requiring any two of the following three features: androgen excess –identified clinically or biochemically; chronic anovulation; or polycystic ovarian morphology (3). Despite frequent amendments to diagnostic criteria, the features first described by dog ate mt homework Stein and Leventhal continue to be recognized in the various classification systems.
In particular, ovarian dysfunction manifesting as either oligomenorrhoea amenorrhoea and hyperandrogenism can be considered the. hallmarks of the concise leadership statement, syndrome (6), having been consistently recognized throughout the literature. Importantly, all diagnostic criteria have similarly identified PCOS as a diagnosis of exclusion with the need to rule out various differentials as identified in Table 2. Three tools can be used to diagnose PCOS (Table 2). In 1990, the National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health (NIH) hosted a panel of experts who developed the first known criteria for PCOS.8,13 Over the next decade, it was discovered that ovarian morphology was a key component in the diagnosis. The European Society Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) sponsored a workshop in Rotterdam. During the workshop, polycystic ovarian morphology on pelvic ultrasound was added to the NICHD/NIH criteria. It was then decided that only two of the dog ate mt homework, three criteria had to be met for a diagnosis of PCOS. 8,13 In 2006, the Androgen Excess Society (AES) suggested that the NICHD/NIHS criteria could be used with modifications that included the Rotterdam tool.
The AES defines PCOS as a disorder primarily involving androgen excess, along with various combinations of phenotypic features (e.g., hyperandrogenemia, hirsutism, oligo-ovulation/anovulation, and/or polycystic ovaries) that may promote a more accurate diagnosis.8,13 In 2012, the NIH sponsored an evidence-based methodology on perspective essay polycystic ovary disease. Dog Ate! The expert panel concluded that each criterion has its own strengths and of two cities weaknesses; however, the use of multiple criteria was considered confusing, impeding progress in understanding PCOS.14 If PCOS is dog ate suspected, a complete medical history, physical examination, blood tests, and a pelvic ultrasound should be performed.5 A medical history and physical examination provide the physician with information about unexplained weight gain, menstrual cycle abnormalities, male-pattern hair growth, skin changes, and elevated blood pressure (BP). Blood is drawn to assess hormone, glucose, and lipid levels, and a pelvic ultrasound is performed to scan for ovarian cysts.5,13,15 During the assessment period, other potential causes associated with reproductive, endocrine, and metabolic dysfunction should. be excluded. Physicians should rule out adrenal hyperplasia, Cushing’s syndrome, and resume boise hyperprolactinemia before a PCOS diagnosis is confirmed.5,13 After PCOS is diagnosed, studies show that more than 50% of patients develop prediabetes or diabetes, and there is an increased risk of myocardial infarction (MI), dyslipidemia, hypertension, anxiety, depression, endometrial cancer, and sleep apnea.4 Moreover, pregnant women with PCOS should be informed of the dog ate mt homework, increased rates of miscarriage, gestational diabetes, pre-eclampsia, and premature delivery.4. The treatment of PCOS in adolescent girls should aim to essay questions, achieve ovulation, normalize the menstrual cycle, reduce and if possible eliminate hirsutism and acne, achieve weight loss, as well as to treat hyperlipidemia and hyperglycaemia in order to lower the risk of cardiovascular disease. Most protocols in puberty also aim to dog ate mt homework, reduce the resume boise, androgen excess. However, most importantly, a healthy diet combined with exercise should be proposed as the dog ate mt homework, number one priority, especially in overweight adolescent women. Obesity was closely related to IR; for this reason, weight loss represented a fundamental preliminary approach in the treatment of bni referral obese/overweight PCOS women. In fact, weight loss resulted in the restoration of spontaneous ovulation and higher fertility rate.145 Losing weight not only contributes to dog ate mt homework, the prevention of the clinical manifestations of the PCOS, but also improves the young girl’s self-esteem . Similarly, the use of cosmetics as well as hair removal, used in resume, conjunction with androgen suppression therapy, could be effective in the treatment of hirsutism.
However, lifestyle modification programs are related to a low compliance and a high dropout rate. To overcome this problem, the feasibility and the efficacy of a structured exercise training program was evaluated in obese anovulatory PCOS patients.146 The structured exercise training resulted in a higher menses frequency and the ovulation in comparison with diet. Successively, lifestyle modifications resulted more efficacious than clomiphene cictrate (CC) and metformin in terms of pregnancy rate, resulting in 12.2%, 14.4%, 14.8% and 20% of dog ate pregnancies after CC, metformin, CC plus metformin, and society anderson essay lifestyle modification, respectively.147. Available guidelines recommended CC as the first-line treatment of anovulatory infertility in women with PCOS.16 CC is an estrogen modulator, efficacious, simple to mt homework, administer and to manage, safe and cheap. Specifically, CC was effective in increasing pregnancy rate compared to placebo (OR 5.8, 95% CI 1.6–21.5).148. According to the standard protocol, CC is administered for bni referral, 5 days from second or third day of the menstrual cycle, starting from mt homework, 50 mg/day and increasing up to 250 mg/day. Bni Referral! “Managed care” studies showed that the most effective dosage is 100–150 mg/day and over 75% of ovulations occur already within a dosage of 100 mg/day.149 Alternative protocols for CC administration were proposed in patients with known CC resistance. Extended CC regimen resulted in higher ovulation and pregnancy rates in comparison with gonadotropins ovulation induction, suggesting that in CC-resistant PCOS patients a further period of mt homework CC administration might be preferable.149 In our practice, CC (at a dosage of 100 mg/day, and for not more than six cycles) remains a valid therapy for inducing ovulation in infertile PCOS patients. Aromatase inhibitors (AIs), such as estrogen modulators, were approved by bni referral resume the Food and Drug Administration as first-line adjuvant therapies for estrogen-receptor–positive breast cancer.150 Several data150 evaluated the mt homework, efficacy of essays AIs, and in dog ate mt homework, particular of letrozole, as first-line therapy for inducing ovulation in infertile patients affected by PCOS. Letrozole was usually administered at a dose of bni referral resume 2.5 mg/day, for 5 days from the third to the seventh day of the menstrual cycle. More recently, a meta-analysis of RCTs showed that letrozole is dog ate related to leadership statement, significantly higher live-birth rates than CC (OR 1.64, 95% CI 1.32–2.04).151 Furthermore, the quality of the evidence was considered low due to the poor study transparency in reporting methods and in dog ate mt homework, consideration of the resume, more favorable results in the trials reporting live birth as primary end point. Excellent results of AIs in terms of cumulative live-birth rate and singleton pregnancy was reported in mt homework, the largest multicenter randomized double-blind parallel controlled trial (Pregnancy in PCOS trial II, PPCOS II) comparing letrozole to CC.152.
To date, letrozole remains an off-label drug.153 Studies are needed to validate the efficacy/safety of AIs over CC in further settings and to resume, clarify its role in well-codified strategies and algorithms for ovulation induction in PCOS.150 Thus, the use of dog ate mt homework AIs in clinical and nonexperimental settings should be probably avoided. Metformin belongs to insulin-sensitizing drugs commonly used in treating T2DM. Because IR is a common condition in PCOS women, metformin was introduced in clinical practice in the treatment of these patients.154. Metformin is writing boise available in dog ate, two formulations: immediate- and extended-release, which are administered orally. Even if no dose-finding study is statement available, metformin administration at dog ate, incremental doses from 500 to sociological essay help, 2,500 mg/day was proposed to treat women with PCOS.154 Several systemic and local effects were demonstrated to explain the dog ate, reproductive benefits due to metformin administration.154. In practice, metformin seemed to restore the ovulatory function after almost 3 months of treatment; thus it could be recommended in PCOS patients who absolutely wish to avoid multiple gestations and/or in patients who do not tolerate CC and/or in those who do not have an sociological, imminent reproductive need.154 On the basis of literature data and on our experience, metformin (at a dosage of dog ate mt homework 1,700–2,000 mg/day, and for at least three cycles) should be used in selected cases of oligoanovulatory PCOS patients who wish to questions tale of two, avoid multiple gestation and/or in dog ate mt homework, patients who do not tolerate CC, are CC-resistant and/or in those who do not have an imminent reproductive need and/or in those undergoing IVF. Oral contraceptives are the basis of hormone therapy, as they contribute to the reduction of hyperandrogenemia, hirsutism and acne [34-36]. A combination of 35mg ethinyl estradiol and 2 mg cyproterone acetate is usually administered. The latter is an antiandrogen, particularly effective in the reduction of testosterone and poets society todd anderson D4-androstendione and the normalization of the LH/ FSH ratio. However, it seems to have a negative effect on the lipid profile, causing a significant increase of triglyceride levels .
Newer combinations of contraceptives are now available containing progestogens (e.g. desogestrel), which are as effective as antiandrogens without impairing the lipid profile. Finally, a combination of 30mg ethinyl estradiol and dog ate drospirenone is also advisable. Its main advantage is that it does not cause weight gain due to essay tale of two, its mild diuretic effects. With the focus on menstrual disorders in the absence of hirsutism, adolescent girls can also use progestogens for a limited number of days each month. Dog Ate! While other substances with hormonal or antiandrogenic effect, such as spironolactone, flutamide, finasteride and GnRH agonists, are also effective, their use, however, not being indicated during adolescence. Metformin, aimed to manage insulin resistance, is concise leadership statement widely used in the treatment of PCOS, in daily doses ranging from 500 mg to mt homework, 2000 mg.
It has been shown to reduce hyperandrogenemia by increasing the resume, levels of SHBG. Dog Ate Mt Homework! In obese women with PCOS, it can also induce weight loss by reducing insulin resistance. Lastly, metformin is beneficial in adolescent girls with PCOS with regard to ovulation, the normalization of the menstrual cycle and boise even loss of dog ate mt homework weight [38,39]. Thiazolidinediones have been associated with a reduction in the levels of androgens and insulin resistance and the reappearance of ovulation in patients with PCOS. In a number of studies, rosiglitazone and pioglitazone are reported to be effective in restoring normal menstrual cycles and reducing insulin levels in women with PCOS [40,41]. More recently, a new agent, myo-inositol (MYO) has been added as a crucial treatment for the PCOS women with infertility, increasing the possibilities to conceive. Myo-inositol is a vitamin B-like substance that can function as the basis of a number of signalling and secondary messenger molecules in american renaissance, insulin signalling pathways. Mt Homework! Myo-inositol seems to of two, correct the mal-functioning insulin pathways and reduce the mt homework, signs and symptoms of insulin resistance .
If diet and exercise are not effective, additional weight reducing medication can be discussed. Orlistat inhibits the intestinal absorption of fat and sibutramine acts directly on the appetite center of the brain. Both cause additional weight loss of 3% and 8.5%, respectively [43,44]. However, there is not yet sufficient evidence regarding the safety of these drugs in adolescence . Management of the long-term complications. The long-term risks observed in women with PCOS are not the same in all PCOS patients but they vary according to different phenotypes and results were negatively affected by obesity and lifestyle factors.
When Rotterdam criteria are applied, almost uniformly accepted by the main scientific societies,13,15,16 the prevalence of society anderson essay PCOS in mt homework, the population increases to over 20%,160 with a large majority, approximately 75%, of referred PCOS women having “classic” PCOS (according to NIH criteria) and the remaining 25% equally divided between ovulatory and non-hyperandrogenic PCOS phenotypes.161 Several studies13,162 suggest that women with PCOS, based on the classic-NIH criteria, exhibit a more detrimental metabolic and cardiovascular profile compared to milder phenotypes. In line with these considerations, the main scientific societies dealing with PCOS,13,15,16,49 have recently proposed guidelines and consensus statements, suggesting a correct diagnostic approach to PCOS patients and bni referral resume an effort to properly identify the phenotype of each patient, with the aim to target specific treatments and to mt homework, prevent these severe long-term risks. In consideration of the increasing prevalence of obesity, particularly abdominal, and the important bearing on the phenotype of PCOS, it is recommended that BMI and waist circumference be determined at every visit,167 considering the presence of abdominal obesity in European women with a waist circumference of at dead society todd essay, least 80 cm.167. Regarding the cardiovascular risk in dog ate, PCOS women, AE-PCOS Society49 proposed, according to CVD risk classification provided by American Heart Association,168 to categorize the PCOS-related CVD risk as: “at risk” for PCOS women with any following risk factors: obesity, cigarette smoking, hypertension, dyslipidemia, subclinical vascular disease, IGT, and/or family history of premature CVD (,55 years of essay help age in male relative, ,65 years of age in female relative); and “at high risk” for PCOS women with metabolic syndrome and/or T2DM and/or overt vascular or renal disease. There is an overall consensus about the increased cardiovascular risk in the PCOS patients, due to relevant metabolic dysfunctions. Therefore, all societes13,15,16,49 agree to recommend a CVD risk assessment at dog ate mt homework, any age, for blood pressure, complete lipid profile (including total, LDL, HDL, non-HDL cholesterol, and triglycerides), waist circumference, BMI, glucose profile, cigarette smoking, and a family history of early CVD. Moreover, depression and anxiety disorders are recognized as risk factors for CVD and they are common in PCOS women; so it is statement suggested that PCOS patients be assessed also for depression, anxiety, and mt homework QoL.15,16,49 Because cardiovascular risk increases with age and it can be exacerbated by obesity and worsened by environmental insults, periodic reassessment for CVD risk is suggested but there is perspective essay no agreement how often the CVD risk assessment should be repeated.
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Installation Technician - Meter Reader - Electrical. Salina , KS 67402. Installation Technician Electrical, Gas Water Meters. Net2Source has immediate opportunities available for mt homework, experienced electrical installation technicians. Were hiring over 50 Installers for bni referral resume, Gas/Water/Electric meter installation in the Wichita Kansas area. Hourly Contract Employee. Duration: Minimum 1 year with potential of 2 years of mt homework work. Wichita Kansas and surrounding areas. Required Skills and Job Summary. Applicant will be trained and expected to follow all SAFETY policies and procedures without exception.
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Meter Reading training will be provided. Ability to work in a confined space when needed. Must pass post training our meter reading meter exam with a score of 95% or higher. Background, Requirements Education. Prior Electrical, Gas or Plumbing experience required.
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Great! You'll now receive job alerts for Installation Technician - Meter Reader - Electrical at Salina, KS. Create a job alert for Installation Technician - Meter Reader - Electrical at Salina, KS. Posted 2 days ago. VIEW JOBS 10/1/2017 12:00:00 AM 2017-12-30T00:00 **Overview** Self-starter with excellent problem solving, communication, teamwork, safety, Lockout/Tagout, and project management skills. Mt Homework! Must be capable to effectively troubleshoot plant and concise statement, facility power from 480V three phase down to 5 volts DC.
Complete electrical installations as required to dog ate mt homework, properly and safely complete assigned tasks, to include running conduit and poets society, pulling wire. **Responsibilities** + Create and sustain zero injury in dog ate mt homework workplace, minimize Pb blood level exposure levels + Coordinate and implement maintenance training programs related to essays, electrical and dog ate, control systems + Must be able to troubleshoot and repair electrical and controls systems, to include PLCs, VFDs, motor starters, PID loop tuning, digital and analog I/O, etc + Identify best practices that ultimately reduce equipment downtime, i.e. reduce recurring equipment issues, reduced setup, quick-change modules, and equipment efficiency + Must be able to services boise, identify opportunities that ultimately reduce maintenance costs + Seeks out unsolicited automation and control projects and mt homework, improvements that contribute to resume, the plant performance + Use Work Order software system and other computer programs as required + Support new installations, improvements, and mt homework, optimization projects in all areas of the plant + Provide programming, debug, and troubleshooting support for all factory automation systems, plc’s, hmi’s, vfd’s, robots, PID loop tuning, motor control, electrical power distribution, etc + Develop and implement programming modifications to the factory automation systems that will facilitate plant performance standards and simplify operator intervention. Bni Referral! + Provide hardware and software support to the plant automation network + Assist in developing documentation for new and dog ate, existing plant automation and control systems + Maintain current program versions for american renaissance essays, all plant automation equipment on the central controls computer drive, or document management system + Develop, initiate, and dog ate mt homework, support plans to optimize and simplify existing plant automation and control systems + Develop, initiate, and support plans to modernize existing obsolete plant control systems + Provide operational support and implement modifications to todd essay, items, such as, plant robot, machine vision, machine automations, data collection + Proficient in data collection to SQL server platform, provide platform to display required information on specified platforms + Ability to run conduit and pull wire as required for mt homework, power distribution and controls integration + Involved in plant shutdown activities relating to skills and tasks assigned + Responsible for continuous improvement in american renaissance essays all areas of Maintenance department + Comply with current Quality Systems requirements + Understand marketplace and update systems as needed and capable to work effectively with plant engineering and all related departments. + Follow Toyota Production Systems (TPS) objectives and guidelines, to include support of Kaizen events. + Follow Lean Manufacturing procedures. + Perform other work as assigned by the supervisor or management personnel. **Qualifications** **Education, Experience, Skills Required:** Candidate must have a 2 year degree from vocational school in industrial electronics and controls or 10 years of industrial electrical and dog ate, controls experience with at least 5 years of sociological perspective help experience with Allen Bradley Programmed Logic Control related products and dog ate, ladder diagram logic. Must possess above average troubleshooting skills in order to sustain plant production. **Equipment Used:** Knowledge of all electrical tools, i.e. oscilloscope, multimeters, amp-meters, megohmmeters, power meters, process meters, etc. Person must possess above average computer skills that relate to report writing, presentations, spreadsheets, and project management, to include most Microsoft products and must be able to writing services, computer knowledge for access to, modification of, and upload/download PLC and mt homework, panelview programs. Familiar with common hand tool usage including power tools. **Physical Requirements:** Sitting, standing, bending, twisting, and walking as necessary. Resume! Wearing of PPE is mt homework required. Employee is required to repetitiously lift and handle equipment and parts weighing from sociological grams to 100 pounds. **EEO Statement** Exide Technologies is an equal opportunity employer where an mt homework, applicant's qualifications are considered without regard to dead society todd anderson, race, color, religion, sex, national origin, age, disability, veteran status, genetic information, sexual orientation, gender identity or expression, or any other basis prohibited by law. **About Exide** Exide Technologies () is a global provider of stored electrical energy solutions—batteries and associated equipment and services for transportation and industrial markets.
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VIEW JOBS 10/1/2017 12:00:00 AM 2017-12-30T00:00 Description At Schwan's Company, we are driven to bring our customers delicious foods and dog ate mt homework, reliable services. In addition to our home delivery service, we offer well-known retail brands such as Red Baron®, Freschetta®, and renaissance, Tony's® pizzas, Pagoda® snacks and appetizers, and dog ate, Mrs. Smith's® and Edwards® desserts. To learn more, visit us at http://www.schwanscompany.com. This position is primarily responsible for properly maintaining and repairing production machinery, mechanical equipment and property in a generalist capacity to ensure continuous and effective operation.
If you meet our job qualifications and become a member of resume our team, we will further train you on the following job duties and provide you with an excellent benefits package. Mt Homework! Company Benefits We offer a comprehensive benefits package designed to services, assist our employees and their families with their financial security, health and well-being. In addition to a competitive base pay, we offer a variety of benefit programs. + Health, Life, Dental and Vision Plans + 401(k) Program with a Company Match + Profit Sharing based on company results + Two weeks paid vacation for new hires + Employee discounts on company products Job Duties and Responsibilities + Setup and tear down equipment; may assist with major repairs, construction, fabrication, and installation of mt homework new plant equipment + Ensure operation of american machinery and mechanical equipment by completing preventive maintenance requirements on conveyor systems and production machines; troubleshoot malfunctions + Locate sources of problems by dog ate, observing mechanical devices in operation, listening for problems, and using precision measuring and testing instruments + Remove defective parts by dismantling components using hoists and hand and bni referral resume, power tools + Help control downtime by dog ate mt homework, informing production workers of routine preventive maintenance techniques; monitoring compliance + Use SAP to document and resume, communicate with operations + Work in a safe manner with a sense of urgency while maintaining a safe and dog ate, orderly work area + Participate in and successfully complete management-assigned training directed at increasing job-related trade skills Qualifications Education: High School Diploma or equivalent required. Two-year degree in specialized maintenance trade preferred. Years of Related Experience: 0-2 years of related experience Knowledge/Skills/Abilities: + Basic mechanical knowledge + Ability to read and interpret safety documents, maintenance instructions and essay tale of two cities, procedure manuals + Ability to complete work orders and enter the required paperwork into a computer + Ability to add subtract multiply and divide in all units of measure + Demonstrated interpersonal skills sufficient to communicate in dog ate mt homework a professional manner with co-workers and supervisors + Ability to pass a standardized hands-on mechanical aptitude assessment. Concise Leadership Statement! + Must be able to lift up to ninety (90) lbs. + Some basic electrical skills preferred The employing subsidiaries of Schwan's Company are Equal Employment Opportunity Employers. All qualified applicants will receive consideration for mt homework, employment without regard to disability, age, race, color, religion, gender, vet status, national origin or other protected class. Job Type: Maintenance-Plant Business Unit: SFC Global Supply Chain, Inc.
Req #: 17004477 Schwan's Company Salina KS. Wastewater Treatment Technician II 3Rd Shift. Posted 2 days ago. VIEW JOBS 10/1/2017 12:00:00 AM 2017-12-30T00:00 Description This position under general supervision is responsible for performing maintenance work to bni referral, ensure the proper and efficient running of equipment designed to handle wastewater. Dog Ate! Mixes and administers chemicals at appropriate dosages and rates. Receives stores and dispenses bulk chemicals and absorbents. Todd! Cleans and services wet-wells catch basins and septic tank traps. Inspects and dog ate mt homework, maintains plugs in all designated floor drains in plant. Collects stores and properly disposes of waste products such as aerosol cans paint used brushes and rollers drums used absorbents and statement, oil filters.
Drains cleans and dog ate, inspects all tanks and pits. Services and resume, operates electronic sampler. Catches and tests pH samples. Maintains appropriate records and dog ate, logs. Dead Poets! Calibrates and dog ate mt homework, operates hazardous gas detector.
Diagnoses hydraulic electrical mechanical plumbing or related problems and american renaissance essays, applies appropriate corrective action. Repairs gearboxes and electrical motors and mt homework, adjusts/programs electronic equipment. Participates in and successfully completes training directed at increasing job-related trade skills as mandated by management/supervisor. Assists with the training of maintenance employees in keeping all equipment in good repair and regularly serviced. Performs all duties in compliance with company policies and procedures and in a safe manner according to State Federal and company regulations. Keeps all areas clean neat orderly and ensures areas are returned to their safe condition according to policy and procedure. Responsible to conduct yourself and poets anderson, ensure your subordinates (if applicable) conduct themselves in a manner consistent with company mission values code of ethics policies and other standards of dog ate mt homework conduct Qualifications Education: High School Diploma or equivalent required. Two-year degree in concise statement specialized maintenance trade preferred.
Years of Related Experience: 1-3 years of dog ate mt homework related experience. Knowledge/Skills/Abilities: Ability to perform all Maintenance Mechanic 1 duties. Completion of Hazardous Materials/Hazardous Waste Certification Training if part of the hazardous materials clean-up crew. Knowledge and ability to properly handle and process EPA DOT and perspective essay help, OSHA hazardous waste shipping regulations. Knowledge of mt homework Area Wastewater Ordinance EPA regulations OSHA regulations DOT Hazmat regulations and SPCC plan. Ability to read and interpret documents such as safety rules operating and maintenance instructions and procedure manuals.
Ability to complete work orders carry out instructions furnished in written oral or diagram form and complete required paperwork. Ability to add subtract multiply divide in all units of measure using whole numbers common fractions and decimals and calculate figures and amounts such as proportions percentages area circumference and volume. Mechanical knowledge and ability to expand knowledge and skills via on-the-job and concise statement, formal training directed at mt homework increasing job-related skills as mandated by management/Supervisor including all required OSHA training. Perspective Help! Ability to obtain a valid forklift license. Ability to learn basic computer skills including SAP Maintenance Module. Good problem solving skills. Demonstrated interpersonal skills sufficient to communicate in a professional manner with co-workers and supervisors. Mt Homework! Exhibit desirable and appropriate professional behavior including dependability integrity ability to essay questions tale of two, learn results orientation ability to interact effectively with others team playing sense of urgency and a quality focus to provide for dog ate, a cohesive productive unit dedicated to the achievement of essay company and department goals.
Must be able to lift ninety (90) lbs The employing subsidiaries of The Schwan Food Company are Equal Employment Opportunity Employers. Dog Ate Mt Homework! All qualified applicants will receive consideration for employment without regard to disability, age, race, color, religion, gender, vet status, national origin or other protected class. Job Type: Maintenance-Plant Business Unit: SFC Global Supply Chain, Inc. Req #: 17006485 Schwan's Company Salina KS. Installation Technician - Meter Reader - Electrical.
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