World Cultures North And South America And Europe

Noah Weisman 10 May 2016 World Cultures 1: North and South America and Europe Project 2; Investigating Another Region An Analysis of Jamaica If I would visit anywhere in the world, it would probably be the proud and independent island nation of Jamaica. The island-nation of Jamaica is the third largest island of the â€Å"Greater Antilles,† a collection of larger islands in the Caribbean Sea, which is a specific section of the North Atlantic Ocean of the Western Hemisphere, specifically off the east coast of the continent of North America. To the north, lie the countries of Cuba, the Bahamas, Crooked Island, Cat Island, Great Inagua, Nassau, Andrea, Key West, and the southern coast of Florida (which is part of the United States of†¦show more content†¦Like many other Caribbean islands, the island of Jamaica was formed by vast and tall underwater volcanoes that, after erupting, their lava cooled to form the land mass of Jamaica. The center of this island-nation contains many of these ancient and long-dormant volcanoes and, as a result, they are mostly composed of igneous rock. This occurrence has creat ed the significant and gorgeous mountainous landforms that compose both the central and eastern regions of Jamaica. Most tourists tend to visit the Blue Mountains, Dry Harbor Mountains, and the Moncho Mountains. Over time, however, these mountains have slowly eroded due to various forms of weathering, such as rainwater, chemicals in the air, and the assorted varieties of plants and animals that burrow within. One can see significant evidence of this weathering process in the mountainous landforms of central Jamaica by the many flowing rivers and waterfalls, as well as the many coves, caves and sinkholes all throughout the valleys between the Dry Harbor Mountains in the northeast and the Moncho Mountains in the southwest. The three major rivers of Jamaica are the Black River, Minho River, and the Kingston River. As well, the erosion explains for the geological differences between central and eastern Jamaica. Central Jamaica has more valleys, flat plateaus, and mid-latitude hills. By contrast, the mountains of eastern Jamaica are more steep and reach

Religion And Peer Pressure Religion - 1973 Words

Religion and Peer Pressure Religion throughout history has been a complicated subject. Some people try to oppress it, some want to hide it away and never speak of it again, while others simply want to embrace it and all its glory. There are some who look down upon others for having a different religion or view from their own, along with those who have killed others in the name of religion. There are some who bring religion to others who have never heard and just want to lead them to salvation. Countries such as America have always been considered to be religiously tolerant. Religion was first addressed when George Washington became president, but there were some problems with others judging people based on their religion (America’s True History). Religion throughout the world has been pressured, hated and loved, but still serves as a way to bring people closer together. Langston’s Hughes â€Å"Salvation† it talks about how a boy experiences his first lie about religion. In the story, Hughes states as a boy, there was a special meeting for the children who had not yet been brought to Jesus. He was told that when a person is saved, he or she will see a light and feel something inside meaning Jesus had come into their life. Langston sat there and waited for Jesus to come to him, but all he heard were the loud moans and shouts at him because he hadn’t seen Jesus. Hughes was all by himself when Westley said that he was tired of waiting, got up, and pretended to be saved. LangstonShow MoreRelatedIdentity And Identity Essay712 Words   |  3 PagesThe purpose of this report is to create a greater knowledge and understanding of the different values and beliefs that shapes and individuals decision. This report is also going to investigate the impact that Peers, Media, family, culture and religion has on your identity. For this report, I will be analyzing one of two different scenarios that show the factors that influence the identities, relationships and the decisions that teenager has to make. Throughout the scenario above, the female studentRead MoreInt Task 1 Essay767 Words   |  4 PagesLearning Environments For Homeschooling: EzineArticles.com Retrieved July 25, 2013 from http://ezinearticles.com/?Learning-Environments-For-Homeschoolingid=2286248 Wenner, M. (2008). Study: Religion is Good for Kids: Live Science Retrieved July 25, 2013 from http://www.livescience.com/1465-study-religion-good-kids.html Skurchak, G.( 2010). Homeschooling Effects on Children. Livestrong.com Retrieved May 2, 2013 from http://www.livestrong.com/article/178461-homeschooling-effects-on-children/Read MoreTeenage Girls in Society Essay example1274 Words   |  6 Pageshigh school girl who struggles with everyday Teenage issues impacted by Society. Although she is from Australia, these issues are universal. Issues like drinking, smoking, peer pressure and body image are just a few that her friends in the novel, â€Å"Does my Head Look big in this, face too. However she stays true to her religion even in the midst of society’s influence especially on teenage girls. In this book she is a Muslim and struggles with the fallacies that come with the idea of the Islamic traditionRead MoreReligion and Public school Essay1652 Words   |  7 Pagesestablished religion. To prevent this from happening in America, the Framers of the constitution banished the ability for the state to interfere with religion, and vice versa. Yet over time this mixture of government and religion has been tested, especially i n cases involving school and religion. Like any argument, there is a party which agrees and another which disagrees. When looking at schools and practices of religion, there is a side that believe the mixture of school and religion is just andRead MoreSalvation Essay617 Words   |  3 PagesSalvation Living in a country where we are entitled to freedom of religion, many of us have grown to have our own beliefs and ways of viewing religion on a whole. There are others who have been pressured by family or friends to believe in God and him alone. Sometimes with the pressure of others, we can begin to believe in something that we truly do not feel is right. In the essay â€Å"Salvation† by Langston Hughes, the main character faces a struggle of wanting to be saved by God. Does he want to beRead MoreNature vs Nurture: Do Genes Or Environment Matter More? Essay778 Words   |  4 Pagesis how nurture changes us over time. Nurture is the environment that we live in and is the dominant factor of one’s personality. Through the changes from nurture, we change our views on different situations and behaviours from family influence, peer pressure, and culture. To begin with, family influence has several things to do with our nurture and it is also how we got your personality in the first place. Families are seen everyday in life for most. Since they are seen the most, what they do theRead MoreReligion, Religion And Religion1189 Words   |  5 PagesReligion is a concept that is passed down from generation to generation. Thankfully, because someone decided to write the religious values down, same of religions core concepts haven’t changed much. But people typically don’t learn their religion by growing up and finding a bible or Quran and reading it. People form religious identities from their culture and how a person is shaped by the world. Religion will forever refuse to die because it gives people a purpose in this world. The people thatRead MoreEssay On The Relationship Between Religion And Children Health1292 Words   |  6 Pagesit has been shown that religious adults are, in general, healthier than non-religious adults (Koenig et al. 2001; Lee and Newberg 2005). However, little is known about the relationship between religion and children’s health. In this peer reviewed study, the relationship between different aspects of religion (i.e. affiliation, importance, and attendance) and overall health status, including psychological health, of adolescents between the ages of six and nineteen are explored. Data pertaining toRead MoreAgents And Stages Of Socialization971 Words   |  4 PagesThere are many agents and stages of socialization throughout the world. Agents are the things that influence people throughout all of their stages. Family, church, media, schools, and peers are all agents. The stages of socialization are peoples stages of life, but all cultures have fewer or more stages th an others. Childhood, adolescence, adulthood, and old age are the stages in the United States culture. Adolescence can be a very odd stage in and of itself, but some cultures do not even have anRead MoreAnalysis Of George Wilson s God Freaking Idiots 915 Words   |  4 PagesThose three horrendous breeding grounds of conformity are as follows, organized religion, patriarchal society, and the educational system. Organized religion is the end all be all source of the plague that is conformity. Ever since the dawn of the first organized religion man has felt the pressure of his traitor’s brothers to not think for himself and just take what this new religion is telling him to do. This new religion and could tell this man to kill his first born for his god, and without thinking

Religion And Peer Pressure Religion - 1973 Words

Religion and Peer Pressure Religion throughout history has been a complicated subject. Some people try to oppress it, some want to hide it away and never speak of it again, while others simply want to embrace it and all its glory. There are some who look down upon others for having a different religion or view from their own, along with those who have killed others in the name of religion. There are some who bring religion to others who have never heard and just want to lead them to salvation. Countries such as America have always been considered to be religiously tolerant. Religion was first addressed when George Washington became president, but there were some problems with others judging people based on their religion (America’s True History). Religion throughout the world has been pressured, hated and loved, but still serves as a way to bring people closer together. Langston’s Hughes â€Å"Salvation† it talks about how a boy experiences his first lie about religion. In the story, Hughes states as a boy, there was a special meeting for the children who had not yet been brought to Jesus. He was told that when a person is saved, he or she will see a light and feel something inside meaning Jesus had come into their life. Langston sat there and waited for Jesus to come to him, but all he heard were the loud moans and shouts at him because he hadn’t seen Jesus. Hughes was all by himself when Westley said that he was tired of waiting, got up, and pretended to be saved. LangstonShow MoreRelatedIdentity And Identity Essay712 Words   |  3 PagesThe purpose of this report is to create a greater knowledge and understanding of the different values and beliefs that shapes and individuals decision. This report is also going to investigate the impact that Peers, Media, family, culture and religion has on your identity. For this report, I will be analyzing one of two different scenarios that show the factors that influence the identities, relationships and the decisions that teenager has to make. Throughout the scenario above, the female studentRead MoreInt Task 1 Essay767 Words   |  4 PagesLearning Environments For Homeschooling: EzineArticles.com Retrieved July 25, 2013 from http://ezinearticles.com/?Learning-Environments-For-Homeschoolingid=2286248 Wenner, M. (2008). Study: Religion is Good for Kids: Live Science Retrieved July 25, 2013 from http://www.livescience.com/1465-study-religion-good-kids.html Skurchak, G.( 2010). Homeschooling Effects on Children. Livestrong.com Retrieved May 2, 2013 from http://www.livestrong.com/article/178461-homeschooling-effects-on-children/Read MoreTeenage Girls in Society Essay example1274 Words   |  6 Pageshigh school girl who struggles with everyday Teenage issues impacted by Society. Although she is from Australia, these issues are universal. Issues like drinking, smoking, peer pressure and body image are just a few that her friends in the novel, â€Å"Does my Head Look big in this, face too. However she stays true to her religion even in the midst of society’s influence especially on teenage girls. In this book she is a Muslim and struggles with the fallacies that come with the idea of the Islamic traditionRead MoreReligion and Public school Essay1652 Words   |  7 Pagesestablished religion. To prevent this from happening in America, the Framers of the constitution banished the ability for the state to interfere with religion, and vice versa. Yet over time this mixture of government and religion has been tested, especially i n cases involving school and religion. Like any argument, there is a party which agrees and another which disagrees. When looking at schools and practices of religion, there is a side that believe the mixture of school and religion is just andRead MoreSalvation Essay617 Words   |  3 PagesSalvation Living in a country where we are entitled to freedom of religion, many of us have grown to have our own beliefs and ways of viewing religion on a whole. There are others who have been pressured by family or friends to believe in God and him alone. Sometimes with the pressure of others, we can begin to believe in something that we truly do not feel is right. In the essay â€Å"Salvation† by Langston Hughes, the main character faces a struggle of wanting to be saved by God. Does he want to beRead MoreNature vs Nurture: Do Genes Or Environment Matter More? Essay778 Words   |  4 Pagesis how nurture changes us over time. Nurture is the environment that we live in and is the dominant factor of one’s personality. Through the changes from nurture, we change our views on different situations and behaviours from family influence, peer pressure, and culture. To begin with, family influence has several things to do with our nurture and it is also how we got your personality in the first place. Families are seen everyday in life for most. Since they are seen the most, what they do theRead MoreReligion, Religion And Religion1189 Words   |  5 PagesReligion is a concept that is passed down from generation to generation. Thankfully, because someone decided to write the religious values down, same of religions core concepts haven’t changed much. But people typically don’t learn their religion by growing up and finding a bible or Quran and reading it. People form religious identities from their culture and how a person is shaped by the world. Religion will forever refuse to die because it gives people a purpose in this world. The people thatRead MoreEssay On The Relationship Between Religion And Children Health1292 Words   |  6 Pagesit has been shown that religious adults are, in general, healthier than non-religious adults (Koenig et al. 2001; Lee and Newberg 2005). However, little is known about the relationship between religion and children’s health. In this peer reviewed study, the relationship between different aspects of religion (i.e. affiliation, importance, and attendance) and overall health status, including psychological health, of adolescents between the ages of six and nineteen are explored. Data pertaining toRead MoreAgents And Stages Of Socialization971 Words   |  4 PagesThere are many agents and stages of socialization throughout the world. Agents are the things that influence people throughout all of their stages. Family, church, media, schools, and peers are all agents. The stages of socialization are peoples stages of life, but all cultures have fewer or more stages th an others. Childhood, adolescence, adulthood, and old age are the stages in the United States culture. Adolescence can be a very odd stage in and of itself, but some cultures do not even have anRead MoreAnalysis Of George Wilson s God Freaking Idiots 915 Words   |  4 PagesThose three horrendous breeding grounds of conformity are as follows, organized religion, patriarchal society, and the educational system. Organized religion is the end all be all source of the plague that is conformity. Ever since the dawn of the first organized religion man has felt the pressure of his traitor’s brothers to not think for himself and just take what this new religion is telling him to do. This new religion and could tell this man to kill his first born for his god, and without thinking

Religion And Peer Pressure Religion - 1973 Words

Religion and Peer Pressure Religion throughout history has been a complicated subject. Some people try to oppress it, some want to hide it away and never speak of it again, while others simply want to embrace it and all its glory. There are some who look down upon others for having a different religion or view from their own, along with those who have killed others in the name of religion. There are some who bring religion to others who have never heard and just want to lead them to salvation. Countries such as America have always been considered to be religiously tolerant. Religion was first addressed when George Washington became president, but there were some problems with others judging people based on their religion (America’s True History). Religion throughout the world has been pressured, hated and loved, but still serves as a way to bring people closer together. Langston’s Hughes â€Å"Salvation† it talks about how a boy experiences his first lie about religion. In the story, Hughes states as a boy, there was a special meeting for the children who had not yet been brought to Jesus. He was told that when a person is saved, he or she will see a light and feel something inside meaning Jesus had come into their life. Langston sat there and waited for Jesus to come to him, but all he heard were the loud moans and shouts at him because he hadn’t seen Jesus. Hughes was all by himself when Westley said that he was tired of waiting, got up, and pretended to be saved. LangstonShow MoreRelatedIdentity And Identity Essay712 Words   |  3 PagesThe purpose of this report is to create a greater knowledge and understanding of the different values and beliefs that shapes and individuals decision. This report is also going to investigate the impact that Peers, Media, family, culture and religion has on your identity. For this report, I will be analyzing one of two different scenarios that show the factors that influence the identities, relationships and the decisions that teenager has to make. Throughout the scenario above, the female studentRead MoreInt Task 1 Essay767 Words   |  4 PagesLearning Environments For Homeschooling: EzineArticles.com Retrieved July 25, 2013 from http://ezinearticles.com/?Learning-Environments-For-Homeschoolingid=2286248 Wenner, M. (2008). Study: Religion is Good for Kids: Live Science Retrieved July 25, 2013 from http://www.livescience.com/1465-study-religion-good-kids.html Skurchak, G.( 2010). Homeschooling Effects on Children. Livestrong.com Retrieved May 2, 2013 from http://www.livestrong.com/article/178461-homeschooling-effects-on-children/Read MoreTeenage Girls in Society Essay example1274 Words   |  6 Pageshigh school girl who struggles with everyday Teenage issues impacted by Society. Although she is from Australia, these issues are universal. Issues like drinking, smoking, peer pressure and body image are just a few that her friends in the novel, â€Å"Does my Head Look big in this, face too. However she stays true to her religion even in the midst of society’s influence especially on teenage girls. In this book she is a Muslim and struggles with the fallacies that come with the idea of the Islamic traditionRead MoreReligion and Public school Essay1652 Words   |  7 Pagesestablished religion. To prevent this from happening in America, the Framers of the constitution banished the ability for the state to interfere with religion, and vice versa. Yet over time this mixture of government and religion has been tested, especially i n cases involving school and religion. Like any argument, there is a party which agrees and another which disagrees. When looking at schools and practices of religion, there is a side that believe the mixture of school and religion is just andRead MoreSalvation Essay617 Words   |  3 PagesSalvation Living in a country where we are entitled to freedom of religion, many of us have grown to have our own beliefs and ways of viewing religion on a whole. There are others who have been pressured by family or friends to believe in God and him alone. Sometimes with the pressure of others, we can begin to believe in something that we truly do not feel is right. In the essay â€Å"Salvation† by Langston Hughes, the main character faces a struggle of wanting to be saved by God. Does he want to beRead MoreNature vs Nurture: Do Genes Or Environment Matter More? Essay778 Words   |  4 Pagesis how nurture changes us over time. Nurture is the environment that we live in and is the dominant factor of one’s personality. Through the changes from nurture, we change our views on different situations and behaviours from family influence, peer pressure, and culture. To begin with, family influence has several things to do with our nurture and it is also how we got your personality in the first place. Families are seen everyday in life for most. Since they are seen the most, what they do theRead MoreReligion, Religion And Religion1189 Words   |  5 PagesReligion is a concept that is passed down from generation to generation. Thankfully, because someone decided to write the religious values down, same of religions core concepts haven’t changed much. But people typically don’t learn their religion by growing up and finding a bible or Quran and reading it. People form religious identities from their culture and how a person is shaped by the world. Religion will forever refuse to die because it gives people a purpose in this world. The people thatRead MoreEssay On The Relationship Between Religion And Children Health1292 Words   |  6 Pagesit has been shown that religious adults are, in general, healthier than non-religious adults (Koenig et al. 2001; Lee and Newberg 2005). However, little is known about the relationship between religion and children’s health. In this peer reviewed study, the relationship between different aspects of religion (i.e. affiliation, importance, and attendance) and overall health status, including psychological health, of adolescents between the ages of six and nineteen are explored. Data pertaining toRead MoreAgents And Stages Of Socialization971 Words   |  4 PagesThere are many agents and stages of socialization throughout the world. Agents are the things that influence people throughout all of their stages. Family, church, media, schools, and peers are all agents. The stages of socialization are peoples stages of life, but all cultures have fewer or more stages th an others. Childhood, adolescence, adulthood, and old age are the stages in the United States culture. Adolescence can be a very odd stage in and of itself, but some cultures do not even have anRead MoreAnalysis Of George Wilson s God Freaking Idiots 915 Words   |  4 PagesThose three horrendous breeding grounds of conformity are as follows, organized religion, patriarchal society, and the educational system. Organized religion is the end all be all source of the plague that is conformity. Ever since the dawn of the first organized religion man has felt the pressure of his traitor’s brothers to not think for himself and just take what this new religion is telling him to do. This new religion and could tell this man to kill his first born for his god, and without thinking

Ben Carson Essay Free Essays

English 52 3:00pm class Faith Ben Carson today is a neurosurgeon that once was just a young black kid from the ghetto with no knowledge of anything the world. Today he is one of the most inspiring person in the world, he was the first neurosurgeon to separate conjoined twins from the head, without bleeding to death. He had no dad, and a mom with psychiatric problems. We will write a custom essay sample on Ben Carson Essay or any similar topic only for you Order Now He faced a hard teenage and childhood, in his life he faced problems from racism, anger management, and poverty. This book shows us how having faith with no fear of the unknown, this book ould lead anyone to have a successful spiritual life and career. His faith led him to go through all the struggles and come out successful. Ben Carson had different experiences throughout his childhood, and having faith led him to go through struggles. When he was just a boy, his father left him, his brother, and mother, because of another family he had. As a child Ben tried to figure out why his father had left them for another family, Ben used church as a way to escape his problems. He began to really have faith, when he heard the preacher talk about a missionary doctor; from then on, his faith set him on a path to become a doctor. There also came a time where his faith was put to the test. At 14 years old he struggled with a bad temper. All the hate he felt from his dad leaving him was in his heart, and he had never let it go. One day at school, he sat listening to classical music when one of his friends made fun of him and was going to change the music. Carson, with all the hate he had, he pulled out a pocket knife he had bought and aimed for his stomach, he hit his friend’s belt buckle. He ran home and thought to himself he was crazy. He got home and locked himself in the bathroom and prayed to God to take his temper away and he prayed and sang, â€Å"Jesus is All the World to Me. † From then on his faith only became stronger, and whenever he felt anything negative, going back to this moment made him feel better. God gave him a second chance to life and make more of it. From then on, he knew he was going to be an instrument of God to save people. When he went on a job for the university to recruit students with his current wife, he almost had an accident while falling asleep on the wheel; he felt relieved and thanked God for helping and giving him yet another chance to life. His struggle through Yale University, when he couldn’t find a job, his faith and willingness helped him find one. Even in his junior year, when he had no money, he walked through the university, thinking and asking God how he was going to make it through, and, just like that, he found 10 dollars in the ground. He knew God was guiding him through and watching over him. In another school year, when he also went through rough economic times, he then again walked through his campus to see if he would find money again, but, no luck, his university did a test of honesty and said that all of the test the class had taken, had been burned in a fire his whole class, there were notices posted some of the students just said, that they will just say they did not see the post. Carson was the only one left and the teacher and a photographer came to take the picture of the only honest student in class and right then and there the teacher handed him a 10 dollar bill. As he grew older and became a doctor during surgeries and he felt lost his faith helped him and believed God would guide his hands and even though he did have times, he failed, his surgeries he had faith, that made him strong to overcome it. At the end without faith he wouldn’t be where he is at today. In my life, without faith I wouldn’t be where I am right now. Ever since I read this book, it has inspired my faith in a spiritual and professional way. I have gone to church more often and found the peace I was looking for. I no longer have temper issues, either. I have been more successful in my job and will soon be getting another job. I have been dedicated more, and I don’t make sudden decisions, which only benefits me. My faith has also made me outgoing in my career. I never give up finding a solution to a problem. There’s a saying that says â€Å"faith can move mountains. † I believe that Ben Carson is a perfect example of this, and it’s an example that I am following step by step in school and work. When I feel frustrated and ngry, I let my faith intervene and help me get through my own struggles, My marriage has also gotten much better. I have set my life goals based on this book and I know I could achieve them. There is a saying that says faith is the last to die, and that’s the difference between hope and faith. I believe those who hope wait around for things to come out good or wait for things to be handed to them are the ones who never step to the world of t he unknown because of fear and like of faith. But with faith you have to put in your work and not give up on your goals. Ben Carson made it from the ghetto to being a successful, respected Neurosurgeon; because of his faith, he never once stopped believing in himself. His mom’s faith in him also helped; she knew he was going to be special. I believe we all have our destiny this life and that God has set a path for us, our choices, decisions and faith are the ones that decide our path. I will follow my own path just as Ben Carson did; I do not where it will take me, but I know that faith will keep me on the right path. Because faith is the last thing to die. How to cite Ben Carson Essay, Essays

Technology Has Changed the Live of Teen Agers Essay Example

Technology Has Changed the Live of Teen Agers Essay DOI: 10. 1111/j. 1464-5491. 2006. 01868. x Glycaemic control Review Article 23 0742-3071Publishing, alcohol Diabetic Medicine and2006 consumption D. Ismail et al. DME UK Oxford, article Blackwell Publishing Ltd Social consumption of alcohol in adolescents with Type 1 diabetes is associated with increased glucose lability, but not hypoglycaemia D. Ismail, R. Gebert, P. J. Vuillermin, L. Fraser*, C. M. McDonnell, S. M. Donath†  and F. J. Cameron Abstract Department of Endocrinology and Diabetes, Royal Children’s Hospital, Melbourne, *Wimmera Base Hospital*, Horsham and † Clinical Epidemiology and Biostatistics Unit, Royal Children’s Hospital, Melbourne, Australia Accepted 10 June 2005 Aims To determine the effects of social consumption of alcohol by diabetic adolescents on glycaemic control. Methods Fourteen (five male) patients aged 16 years were recruited from the diabetes clinic at the Royal Children’s Hospital. The continuous glucose monitoring system (CGMS) was attached at a weekend when alcohol consumption was planned for one night only. For each patient, the 12-h period from 18. 00 h to 06. 00 h for the night with alcohol consumption (study period) was compared with the same period with non-alcohol consumption (control period) either 24 h before or after the alcohol study night. Thus, each subject was his /her own control. Glycaemic outcomes calculated from continuous glucose monitoring included mean blood glucose (MBG), percentage of time spent at low glucose levels (CGMS 4. 0 mmol/l), normal glucose levels (CGMS 4. 0–10. 0 mmol/ l) and high glucose levels ( 10. mmol/ l) and continuous overall net glycaemic action (CONGA). Results The mean number of standard alcohol drinks consumed during the study period was 9. 0 for males and 6. 3 for females. There was no difference in percentage of time at high and normal glucose levels in the study and control periods. During the control period, there was a higher percentage of time with low glucose levels compared with the study period (P 0. 05). There was an increas ed level of glycaemic variation during the study time when compared with the control period. We will write a custom essay sample on Technology Has Changed the Live of Teen Agers specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Technology Has Changed the Live of Teen Agers specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Technology Has Changed the Live of Teen Agers specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Conclusions In an uncontrolled, social context, moderately heavy alcohol consumption by adolescents with Type 1 diabetes appears to be associated with increased glycaemic variation, but not with low glucose levels. Diabet. Med. 23, 830–833 (2006) Keywords adolescence, alcohol, glycaemic control Abbreviations CGMS, continuous glucose monitoring system; CONGA, continuous overall net glycaemic action; MBG, mean blood glucose; RCH, Royal Children’s Hospital Introduction Adolescents with Type 1 diabetes frequently engage in risk-taking activities [1]. Amongst these activities is the social Correspondence to: Dr Fergus Cameron, Deputy Director, Department of Endocrinology and Diabetes, Royal Children’s Hospital, Flemington Road, Parkville, Victoria 3052, Australia. E-mail: fergus. [emailprotected] org. au consumption of alcohol, frequently as underage drinkers [2]. Whilst the effects of alcohol consumption upon glycaemia have been well described in a controlled setting [3– 6], little is known about the impact on glucose levels of alcohol consumption by adolescents within an ambulant, social context. The purpose of this project was to utilize continuous glucose monitoring to study the impact of social alcohol consumption on glycaemic control in a group of alcohol-using adolescents.  © 2006 The Authors. 830 Journal compilation  © 2006 Diabetes UK. Diabetic Medicine, 23, 830–833 Review article 831 Patients and methods This study was approved by the Human Ethics Research Committee of the Royal Children’s Hospital (RCH). That approval was contingent upon the fact that the investigators should not be seen to encourage underage drinking in adolescents. Consequently, we only approached adolescents who we knew were drinking socially and, despite our previous counselling, elected to continue to drink alcohol on a semi-regular basis. We recruited 22 adolescents with Type 1 diabetes from the RCH diabetes clinic. The adolescents were considered eligible only if 16 years old and parental/patient consent was obtained. HbA 1c (Bayer DCA 2000 immunoagglutination method, Calabria, Barcelona, Spain) was measured, and diabetes duration and insulin doses were recorded. The MiniMed continuous glucose monitoring system (CGMS) was attached to the study patients over a weekend period. Patients were required to have an alcohol-free period for at least 24 continuous hours during the weekend trace period. A diary was kept of activities during the trace period (insulin injections, meal, snacks, dancing, alcohol consumption, sport). There was no change in insulin doses between study and control periods. In the evening when alcohol was consumed, patients were asked to recall how many and what type of drinks were consumed and how inebriated they became. Patients recall of alcohol consumption was converted to ‘standard drinks’ (one standard drink contains the equivalent of 12. ml 100% alcohol) using The Australian Alcohol Guidelines [7]. CGMS data was recorded between 18. 00 and 06. 00 h on the evening when alcohol was consumed (the study period) and between 18. 00 and 06. 00 h on the evening when no alcohol was consumed (the control period). CGMS data were only analysed if there had been regular calibrations with intermittent capillary blood glucose readings at a maximum of 8-h intervals. Each CGMS trace was qualitatively and quantitatively analysed using mean glucose values, per cent time in glycaemic ranges and ontinuous overlapping net glycaemic action (CONGA) [8]. CONGA values were calculated to assess glycaemic variation over 1-, 2- and 4-h intervals. Low glucose values were defined as CGMS values 4 mmol/ l, normal glucose values when CGMS values were 4– 10 mmo/ l and high glucose values when CGMS values were 10 mmol/ l. Each patient acted as their own control with study periods and control periods being compared. Inter-individual values were grouped for comparison. Differences between study and control periods were analysed using paired t-tests. Analyses were done in Stata [9]. ales and nine females. The mean age was 18. 5 years (range: 17. 4 – 19. 5). The mean duration of diabetes was 9. 4 years (range: 3 – 16. 3). Six of our subjects took four insulin injections per day and eight took two injections daily . The mean insulin dose was 1. 1 units /kg/day (range: 0. 7 –1. 8), and the mean HbA1c was 9. 6% (range: 8. 2 – 10. 8). Activities during the study period Thirteen subjects had dinner before drinking and only one subject did not consume any food before going out. Three subjects ‘danced a lot’ and six subjects went dancing but did not dance a lot. Ten subjects had something to eat after drinking. Alcohol consumption during the study period The mean number of alcohol drinks consumed on the study night was 9. 0 (range 3–16) for males and 6. 3 (range 3–14) for females. All the females consumed pre-mixed sweetened alcohol drinks (5% alcohol), with only one consuming beer and one consuming wine. Four of the males consumed mixed spirits, one mixed spirits and beer and one beer only. Forty per cent of the males had more than seven standard drinks during the study and 67% of the females had more than five drinks. In total, 80% of the subjects had pre-mixed sweetened alcohol drinks at some point during the study period. Forty-three per cent of the subjects reported that they became inebriated and 14. 3% consumed alcohol to the point where they became physically sick. None of the subjects lost consciousness or took recreational drugs during the study period. Comparative CGMS data between study and control periods Results Patients There was no significant difference between the overall mean glucose levels of patients when comparing study and control periods (Table 1; P = 0. 43). Similarly, there were no significant differences in the amount of time spent with either normal or high glucose values between study and control periods (Table 1). A larger proportion of time was spent with low glucose values during the control period when compared with the study period (1. 9 vs. 16. 8%, P = 0. 03). A significantly larger degree of glycaemic variation was seen in the CONGA values in the study period when compared with the control period (Table 1). The difference in CONGA values were consistent and independent of whether glycaemic variation was assessed over 1-, 2- or 4-h intervals. Of the 22 subjects recruited, eight were excluded because their CGMS traces did not have sufficiently frequent calibration points with intermittent capillary measures of blood glucose. Of the 14 subjects remaining, we were able to obtain study period data on 14 patients and matched control period data on only 12 patients. The study period occurred on the night prior to the control period in nine subjects. There were five Discussion It has long been recognized that a prohibitionist approach is usually ineffective when counselling adolescents who engage in risk-taking behaviours [10]. Many centres today, ourselves included, have instead adopted a harm minimization approach in dealing with such behaviours. An important component  © 2006 The Authors. Journal compilation  © 2006 Diabetes UK. Diabetic Medicine, 23, 830–833 832 Glycaemic control and alcohol consumption †¢ D. Ismail et al. Outcome measure Mean difference between Study period Control period study period and mean value mean value control period (95%CI) P-value 10. 6 16. 8 58. 6 24. 6 2. 1 3. 2 3. 7 1. 2 (? 2. 1, 4. 4) ? 14. 9 (? 28. 1, ? 1. 8) ? 0. 8 (? 27. 3, 25. 8) 15. 7 (? 4. 5, 35. 8) 0. 6 (0. 2, 1. 0) 1. 1 (0. , 1. 9) 1. 8 (0. 4, 3. 1) 0. 43 0. 03 0. 95 0. 12 0. 006 0. 01 0. 01 Table 1 CGMS outcomes, study and control periods Blood glucose levels (mmol/l) 11. 8 Per cent time low glucose 1. 9 Per cent time high glucose 57. 8 Per cent time normal glucose 40. 3 CONGA1* 2. 7 CONGA2* 4. 3 CONGA4* 5. 5 *CONGA calculated at 1-, 2- and 4-h intervals. CONGAn is the standard deviation of differ ent glucose measures n hours apart for the duration of the CGMS trace. of counselling using a harm minimization approach is that the information provided be credible and reflective of ‘real’ or ‘lived’ circumstances. Continuous glucose monitoring provides a technique whereby the glycaemic consequences of various behaviours can be documented in an ambulant or non-artificial setting. Adolescents with Type 1 diabetes frequently consume alcohol in a social context [11]. Alcohol is known to inhibit the gluconeogenic pathway, to inhibit lipolysis, impair glucose counter-regulation and blunt hypoglycaemia awareness [3,4]. Previous studies in young adults with Type 1 diabetes have shown that moderate consumption of alcohol in the evenings without concomitant food intake may cause hypoglycaemia the following morning [5]. Consumption of alcohol after a meal, however, has shown no similar adverse effects on glucose [6]. It is reasonable to assume, therefore, that alcohol consumption may be a significant risk factor for hypoglycaemia in adolescents with Type 1 diabetes [5]. Studies of the glycaemic effects of alcohol consumption in an ambulant adolescent/young adult population can be difficult. This is because such behaviours are uncontrolled, often spontaneous and usually in the context of other social activities (parties, dancing, etc. ). In order to ensure that we only reported accurate CGMS data during these activities, capillary blood glucose calibration was considered vital and those patients who failed in this regard were excluded from analysis. Just over 60% of the patients recruited were able to successfully wear and calibrate a CGMS unit during these activities. Given that patients who experience hypoglycaemic symptoms are more likely to perform capillary self measures of blood glucose, we feel that it is unlikely that those patients excluded from the analysis had a greater frequency of hypoglycaemia than those patients reported. We were unable to record our subjects’ alcohol consumption in a contemporaneous fashion and hence were reliant upon their recall. It is possible that their remembered patterns of consumption were not entirely accurate. This potential inaccuracy should not be seen as a weakness of this study, as we only set out to determine patterns of glycaemia in adolescents engaging in spontaneous and uncontrolled alcohol consumption. We neither specified the type nor the amount of alcohol to be consumed (our ethical approval was contingent on this not occurring). The data as to amount of alcohol consumed have been included for descriptive purposes only. The results of this study show that alcohol consumption by adolescents in a social context is associated with a greater degree of glycaemic variation and less time spent with low glucose values than evenings where no alcohol is consumed. Whilst the second of these findings appears counter-intuitive, there may be several possible explanations. Firstly, the vast majority of our study group ate a meal prior to going out and ate upon their return before going to bed. These are practices that we have instilled as harm minimization strategies to avoid alcohol-induced hypoglycaemia in our clinic. Secondly, most of the alcohol consumed was as pre-mixed spirit and sweetened, carbonated beverages. Finally, alcohol consumption was only associated with vigorous exercise (dancing) in a minority of our study group. All of these factors could have combined to negate the hypoglycaemic effects of alcohol. In a previous study of glycaemia during alcohol consumption in adult men [5], hypoglycaemia occurred most often 10–12 h after wine consumption when the evening before ended at 23. 0 h. We analysed our data to see if a similar phenomenon occurred in this study and found that the per cent of time spent with CGMS readings 4 mmol/l between 06. 00 and 12. 00 h on the morning after the study period (i. e. the morning after the drinking night) was only 1. 1%. Notwithstanding the fact that our cohort frequently consumed alcohol later than 23. 00 h, the facto rs that impacted upon glycaemic control during the study night appear to have carried over to the ‘morning after’. The findings in this study highlight the importance of ambulant testing. It is important to note that the findings of the group studied here may not be seen in adolescents who drink non-sweetened alcoholic drinks or in those adolescents with better underlying metabolic control. Whilst alcohol consumption in isolation may reasonably be thought to cause hypoglycaemia, alcohol consumption by adolescents in the context of meals, sweetened mixers and little activity did not result in more hypoglycaemia than an alcohol-free evening. Whether the increase in glycaemic variation seen on an evening  © 2006 The Authors. Journal compilation  © 2006 Diabetes UK. Diabetic Medicine, 23, 830–833 Review article 833 of alcohol consumption has negative clinical outcomes remains an area for further investigation. Competing interests CMM was a Novo Nordisk research fellow. FJC received fees for speaking at conferences and funds for research from Novo Nordisk. References 1 Cameron F, Werther G. Adolescents with diabetes mellitus. In: Menon, RK, Sperling, MA, eds. Pediatric Diabetes. Boston: Kluwer Academic Publishers, 2003: 319–335. 2 Frey MA, Guthrie B, Lovelandcherry C, Park PS, Foster CM. Risky behaviours and risk in adolescents with IDDM. J Adol Health 1997; 20: 38–45. 3 Avogaro A, Beltramello P, Gnudi L, Maran A, Valerio A, Miola M et al. Alcohol intake impairs glucose counterregulation during acute insulin-induced hypoglycaemia in IDDM patients. Diabetes 1993; 42: 1626–1634. 4 Kerr D, Macdonald IA, Heller SR, Tattersal RB. Alcohol causes hypoglycaemic unawareness in healthy volunteers and patients with type 1 diabetes. Diabetologia 1990; 33: 216–221. 5 Turner BC, Jenkins E, Kerr D, Sherwin RS, Cavan DA. The effect of evening alcohol consumption on next morning glucose control in type 1 diabetes. Diabetes Care 2001; 24: 1888–1893. 6 Koivisto VA, Tulokas S, Toivonen M, Haapa E, Pelkonen R. Alcohol with a meal has no adverse effects on postprandial glucose homeostasis in diabetic patients. Diabetes Care 1993; 16: 1612–1614. 7 National Health and Medical Research Council. Australian Alcohol Guidelines: Health Risks and Benefits. DS9. Available from: http://www7. health. gov. au/nhmrc/publications/synopses/ds9syn. htm. 8 McDonnell CM, Donath SM, Vidmar SI, Werther GA, Cameron FJ. A novel approach to continuous glucose analysis utilising glycaemic variation. Diab Tech Therap 2005; 7: 253–263. 9 StataCorp. Stata statistical software. Release 8. 0. College Station, TX: Stata Corporation, 2003. 10 Kyngas H, Hentinen M, Barlow JH. Adolescents perceptions of physicians, nurses, parents and friends: help or hindrance in compliance with diabetes self-care? J Adv Nurs 1998; 27: 760–769. 11 Patterson JM, Garwick AW. Coping with chronic illness. In: Werther, GA, Court, JM, eds. Diabetes and the Adolescent. Melbourne: Miranova Publishers 1998, 3–34.  © 2006 The Authors. Journal compilation  © 2006 Diabetes UK. Diabetic Medicine, 23, 830–833 Technology Has Changed the Live of Teen Agers Essay Example Technology Has Changed the Live of Teen Agers Essay DOI: 10. 1111/j. 1464-5491. 2006. 01868. x Glycaemic control Review Article 23 0742-3071Publishing, alcohol Diabetic Medicine and2006 consumption D. Ismail et al. DME UK Oxford, article Blackwell Publishing Ltd Social consumption of alcohol in adolescents with Type 1 diabetes is associated with increased glucose lability, but not hypoglycaemia D. Ismail, R. Gebert, P. J. Vuillermin, L. Fraser*, C. M. McDonnell, S. M. Donath†  and F. J. Cameron Abstract Department of Endocrinology and Diabetes, Royal Children’s Hospital, Melbourne, *Wimmera Base Hospital*, Horsham and † Clinical Epidemiology and Biostatistics Unit, Royal Children’s Hospital, Melbourne, Australia Accepted 10 June 2005 Aims To determine the effects of social consumption of alcohol by diabetic adolescents on glycaemic control. Methods Fourteen (five male) patients aged 16 years were recruited from the diabetes clinic at the Royal Children’s Hospital. The continuous glucose monitoring system (CGMS) was attached at a weekend when alcohol consumption was planned for one night only. For each patient, the 12-h period from 18. 00 h to 06. 00 h for the night with alcohol consumption (study period) was compared with the same period with non-alcohol consumption (control period) either 24 h before or after the alcohol study night. Thus, each subject was his /her own control. Glycaemic outcomes calculated from continuous glucose monitoring included mean blood glucose (MBG), percentage of time spent at low glucose levels (CGMS 4. 0 mmol/l), normal glucose levels (CGMS 4. 0–10. 0 mmol/ l) and high glucose levels ( 10. mmol/ l) and continuous overall net glycaemic action (CONGA). Results The mean number of standard alcohol drinks consumed during the study period was 9. 0 for males and 6. 3 for females. There was no difference in percentage of time at high and normal glucose levels in the study and control periods. During the control period, there was a higher percentage of time with low glucose levels compared with the study period (P 0. 05). There was an increas ed level of glycaemic variation during the study time when compared with the control period. We will write a custom essay sample on Technology Has Changed the Live of Teen Agers specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Technology Has Changed the Live of Teen Agers specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Technology Has Changed the Live of Teen Agers specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Conclusions In an uncontrolled, social context, moderately heavy alcohol consumption by adolescents with Type 1 diabetes appears to be associated with increased glycaemic variation, but not with low glucose levels. Diabet. Med. 23, 830–833 (2006) Keywords adolescence, alcohol, glycaemic control Abbreviations CGMS, continuous glucose monitoring system; CONGA, continuous overall net glycaemic action; MBG, mean blood glucose; RCH, Royal Children’s Hospital Introduction Adolescents with Type 1 diabetes frequently engage in risk-taking activities [1]. Amongst these activities is the social Correspondence to: Dr Fergus Cameron, Deputy Director, Department of Endocrinology and Diabetes, Royal Children’s Hospital, Flemington Road, Parkville, Victoria 3052, Australia. E-mail: fergus. [emailprotected] org. au consumption of alcohol, frequently as underage drinkers [2]. Whilst the effects of alcohol consumption upon glycaemia have been well described in a controlled setting [3– 6], little is known about the impact on glucose levels of alcohol consumption by adolescents within an ambulant, social context. The purpose of this project was to utilize continuous glucose monitoring to study the impact of social alcohol consumption on glycaemic control in a group of alcohol-using adolescents.  © 2006 The Authors. 830 Journal compilation  © 2006 Diabetes UK. Diabetic Medicine, 23, 830–833 Review article 831 Patients and methods This study was approved by the Human Ethics Research Committee of the Royal Children’s Hospital (RCH). That approval was contingent upon the fact that the investigators should not be seen to encourage underage drinking in adolescents. Consequently, we only approached adolescents who we knew were drinking socially and, despite our previous counselling, elected to continue to drink alcohol on a semi-regular basis. We recruited 22 adolescents with Type 1 diabetes from the RCH diabetes clinic. The adolescents were considered eligible only if 16 years old and parental/patient consent was obtained. HbA 1c (Bayer DCA 2000 immunoagglutination method, Calabria, Barcelona, Spain) was measured, and diabetes duration and insulin doses were recorded. The MiniMed continuous glucose monitoring system (CGMS) was attached to the study patients over a weekend period. Patients were required to have an alcohol-free period for at least 24 continuous hours during the weekend trace period. A diary was kept of activities during the trace period (insulin injections, meal, snacks, dancing, alcohol consumption, sport). There was no change in insulin doses between study and control periods. In the evening when alcohol was consumed, patients were asked to recall how many and what type of drinks were consumed and how inebriated they became. Patients recall of alcohol consumption was converted to ‘standard drinks’ (one standard drink contains the equivalent of 12. ml 100% alcohol) using The Australian Alcohol Guidelines [7]. CGMS data was recorded between 18. 00 and 06. 00 h on the evening when alcohol was consumed (the study period) and between 18. 00 and 06. 00 h on the evening when no alcohol was consumed (the control period). CGMS data were only analysed if there had been regular calibrations with intermittent capillary blood glucose readings at a maximum of 8-h intervals. Each CGMS trace was qualitatively and quantitatively analysed using mean glucose values, per cent time in glycaemic ranges and ontinuous overlapping net glycaemic action (CONGA) [8]. CONGA values were calculated to assess glycaemic variation over 1-, 2- and 4-h intervals. Low glucose values were defined as CGMS values 4 mmol/ l, normal glucose values when CGMS values were 4– 10 mmo/ l and high glucose values when CGMS values were 10 mmol/ l. Each patient acted as their own control with study periods and control periods being compared. Inter-individual values were grouped for comparison. Differences between study and control periods were analysed using paired t-tests. Analyses were done in Stata [9]. ales and nine females. The mean age was 18. 5 years (range: 17. 4 – 19. 5). The mean duration of diabetes was 9. 4 years (range: 3 – 16. 3). Six of our subjects took four insulin injections per day and eight took two injections daily . The mean insulin dose was 1. 1 units /kg/day (range: 0. 7 –1. 8), and the mean HbA1c was 9. 6% (range: 8. 2 – 10. 8). Activities during the study period Thirteen subjects had dinner before drinking and only one subject did not consume any food before going out. Three subjects ‘danced a lot’ and six subjects went dancing but did not dance a lot. Ten subjects had something to eat after drinking. Alcohol consumption during the study period The mean number of alcohol drinks consumed on the study night was 9. 0 (range 3–16) for males and 6. 3 (range 3–14) for females. All the females consumed pre-mixed sweetened alcohol drinks (5% alcohol), with only one consuming beer and one consuming wine. Four of the males consumed mixed spirits, one mixed spirits and beer and one beer only. Forty per cent of the males had more than seven standard drinks during the study and 67% of the females had more than five drinks. In total, 80% of the subjects had pre-mixed sweetened alcohol drinks at some point during the study period. Forty-three per cent of the subjects reported that they became inebriated and 14. 3% consumed alcohol to the point where they became physically sick. None of the subjects lost consciousness or took recreational drugs during the study period. Comparative CGMS data between study and control periods Results Patients There was no significant difference between the overall mean glucose levels of patients when comparing study and control periods (Table 1; P = 0. 43). Similarly, there were no significant differences in the amount of time spent with either normal or high glucose values between study and control periods (Table 1). A larger proportion of time was spent with low glucose values during the control period when compared with the study period (1. 9 vs. 16. 8%, P = 0. 03). A significantly larger degree of glycaemic variation was seen in the CONGA values in the study period when compared with the control period (Table 1). The difference in CONGA values were consistent and independent of whether glycaemic variation was assessed over 1-, 2- or 4-h intervals. Of the 22 subjects recruited, eight were excluded because their CGMS traces did not have sufficiently frequent calibration points with intermittent capillary measures of blood glucose. Of the 14 subjects remaining, we were able to obtain study period data on 14 patients and matched control period data on only 12 patients. The study period occurred on the night prior to the control period in nine subjects. There were five Discussion It has long been recognized that a prohibitionist approach is usually ineffective when counselling adolescents who engage in risk-taking behaviours [10]. Many centres today, ourselves included, have instead adopted a harm minimization approach in dealing with such behaviours. An important component  © 2006 The Authors. Journal compilation  © 2006 Diabetes UK. Diabetic Medicine, 23, 830–833 832 Glycaemic control and alcohol consumption †¢ D. Ismail et al. Outcome measure Mean difference between Study period Control period study period and mean value mean value control period (95%CI) P-value 10. 6 16. 8 58. 6 24. 6 2. 1 3. 2 3. 7 1. 2 (? 2. 1, 4. 4) ? 14. 9 (? 28. 1, ? 1. 8) ? 0. 8 (? 27. 3, 25. 8) 15. 7 (? 4. 5, 35. 8) 0. 6 (0. 2, 1. 0) 1. 1 (0. , 1. 9) 1. 8 (0. 4, 3. 1) 0. 43 0. 03 0. 95 0. 12 0. 006 0. 01 0. 01 Table 1 CGMS outcomes, study and control periods Blood glucose levels (mmol/l) 11. 8 Per cent time low glucose 1. 9 Per cent time high glucose 57. 8 Per cent time normal glucose 40. 3 CONGA1* 2. 7 CONGA2* 4. 3 CONGA4* 5. 5 *CONGA calculated at 1-, 2- and 4-h intervals. CONGAn is the standard deviation of differ ent glucose measures n hours apart for the duration of the CGMS trace. of counselling using a harm minimization approach is that the information provided be credible and reflective of ‘real’ or ‘lived’ circumstances. Continuous glucose monitoring provides a technique whereby the glycaemic consequences of various behaviours can be documented in an ambulant or non-artificial setting. Adolescents with Type 1 diabetes frequently consume alcohol in a social context [11]. Alcohol is known to inhibit the gluconeogenic pathway, to inhibit lipolysis, impair glucose counter-regulation and blunt hypoglycaemia awareness [3,4]. Previous studies in young adults with Type 1 diabetes have shown that moderate consumption of alcohol in the evenings without concomitant food intake may cause hypoglycaemia the following morning [5]. Consumption of alcohol after a meal, however, has shown no similar adverse effects on glucose [6]. It is reasonable to assume, therefore, that alcohol consumption may be a significant risk factor for hypoglycaemia in adolescents with Type 1 diabetes [5]. Studies of the glycaemic effects of alcohol consumption in an ambulant adolescent/young adult population can be difficult. This is because such behaviours are uncontrolled, often spontaneous and usually in the context of other social activities (parties, dancing, etc. ). In order to ensure that we only reported accurate CGMS data during these activities, capillary blood glucose calibration was considered vital and those patients who failed in this regard were excluded from analysis. Just over 60% of the patients recruited were able to successfully wear and calibrate a CGMS unit during these activities. Given that patients who experience hypoglycaemic symptoms are more likely to perform capillary self measures of blood glucose, we feel that it is unlikely that those patients excluded from the analysis had a greater frequency of hypoglycaemia than those patients reported. We were unable to record our subjects’ alcohol consumption in a contemporaneous fashion and hence were reliant upon their recall. It is possible that their remembered patterns of consumption were not entirely accurate. This potential inaccuracy should not be seen as a weakness of this study, as we only set out to determine patterns of glycaemia in adolescents engaging in spontaneous and uncontrolled alcohol consumption. We neither specified the type nor the amount of alcohol to be consumed (our ethical approval was contingent on this not occurring). The data as to amount of alcohol consumed have been included for descriptive purposes only. The results of this study show that alcohol consumption by adolescents in a social context is associated with a greater degree of glycaemic variation and less time spent with low glucose values than evenings where no alcohol is consumed. Whilst the second of these findings appears counter-intuitive, there may be several possible explanations. Firstly, the vast majority of our study group ate a meal prior to going out and ate upon their return before going to bed. These are practices that we have instilled as harm minimization strategies to avoid alcohol-induced hypoglycaemia in our clinic. Secondly, most of the alcohol consumed was as pre-mixed spirit and sweetened, carbonated beverages. Finally, alcohol consumption was only associated with vigorous exercise (dancing) in a minority of our study group. All of these factors could have combined to negate the hypoglycaemic effects of alcohol. In a previous study of glycaemia during alcohol consumption in adult men [5], hypoglycaemia occurred most often 10–12 h after wine consumption when the evening before ended at 23. 0 h. We analysed our data to see if a similar phenomenon occurred in this study and found that the per cent of time spent with CGMS readings 4 mmol/l between 06. 00 and 12. 00 h on the morning after the study period (i. e. the morning after the drinking night) was only 1. 1%. Notwithstanding the fact that our cohort frequently consumed alcohol later than 23. 00 h, the facto rs that impacted upon glycaemic control during the study night appear to have carried over to the ‘morning after’. The findings in this study highlight the importance of ambulant testing. It is important to note that the findings of the group studied here may not be seen in adolescents who drink non-sweetened alcoholic drinks or in those adolescents with better underlying metabolic control. Whilst alcohol consumption in isolation may reasonably be thought to cause hypoglycaemia, alcohol consumption by adolescents in the context of meals, sweetened mixers and little activity did not result in more hypoglycaemia than an alcohol-free evening. Whether the increase in glycaemic variation seen on an evening  © 2006 The Authors. Journal compilation  © 2006 Diabetes UK. Diabetic Medicine, 23, 830–833 Review article 833 of alcohol consumption has negative clinical outcomes remains an area for further investigation. Competing interests CMM was a Novo Nordisk research fellow. FJC received fees for speaking at conferences and funds for research from Novo Nordisk. References 1 Cameron F, Werther G. Adolescents with diabetes mellitus. In: Menon, RK, Sperling, MA, eds. Pediatric Diabetes. Boston: Kluwer Academic Publishers, 2003: 319–335. 2 Frey MA, Guthrie B, Lovelandcherry C, Park PS, Foster CM. Risky behaviours and risk in adolescents with IDDM. J Adol Health 1997; 20: 38–45. 3 Avogaro A, Beltramello P, Gnudi L, Maran A, Valerio A, Miola M et al. Alcohol intake impairs glucose counterregulation during acute insulin-induced hypoglycaemia in IDDM patients. Diabetes 1993; 42: 1626–1634. 4 Kerr D, Macdonald IA, Heller SR, Tattersal RB. Alcohol causes hypoglycaemic unawareness in healthy volunteers and patients with type 1 diabetes. Diabetologia 1990; 33: 216–221. 5 Turner BC, Jenkins E, Kerr D, Sherwin RS, Cavan DA. The effect of evening alcohol consumption on next morning glucose control in type 1 diabetes. Diabetes Care 2001; 24: 1888–1893. 6 Koivisto VA, Tulokas S, Toivonen M, Haapa E, Pelkonen R. Alcohol with a meal has no adverse effects on postprandial glucose homeostasis in diabetic patients. Diabetes Care 1993; 16: 1612–1614. 7 National Health and Medical Research Council. Australian Alcohol Guidelines: Health Risks and Benefits. DS9. Available from: http://www7. health. gov. au/nhmrc/publications/synopses/ds9syn. htm. 8 McDonnell CM, Donath SM, Vidmar SI, Werther GA, Cameron FJ. A novel approach to continuous glucose analysis utilising glycaemic variation. Diab Tech Therap 2005; 7: 253–263. 9 StataCorp. Stata statistical software. Release 8. 0. College Station, TX: Stata Corporation, 2003. 10 Kyngas H, Hentinen M, Barlow JH. Adolescents perceptions of physicians, nurses, parents and friends: help or hindrance in compliance with diabetes self-care? J Adv Nurs 1998; 27: 760–769. 11 Patterson JM, Garwick AW. Coping with chronic illness. In: Werther, GA, Court, JM, eds. Diabetes and the Adolescent. Melbourne: Miranova Publishers 1998, 3–34.  © 2006 The Authors. Journal compilation  © 2006 Diabetes UK. Diabetic Medicine, 23, 830–833

Essay on The Civil War in the United States in 1861-1865 part 2

Essay on The Civil War in the United States in 1861-1865 part 2 Essay on The Civil War in the United States in 1861-1865 part 2 Essay on The Civil War in the United States in 1861-1865 part 2Essay on The Civil War in the United States in 1861-1865 part  1South was lack of basic necessities. Its small industry worked for the war effort, and sea blockade prevented export of cotton to Europe and getting food and medication. Although the human and material resources of the South were at the limit, its military power has not yet been broken.In the spring of 1863, under the command of Lee, southerners again dealt a severe blow to the federal army on the Virginia portion, but it was the last major victory of the rebels. Human resources of the North were huge, former slaves appeared to be good soldiers. Industry of the North, which ended the industrial revolution, worked at full capacity, farmers expanded supply of agricultural products (they purchased cotton in England or replaced with wool), thousands of immigrants came to the states.The army of Lee was stopped at Gettysburg (PA) and dropped back to Virginia in J uly 1863, and the Grant troops took Confederate stronghold on the river Mississippi. This marked a turning point in the war. In the spring of 1864, federal troops began an offensive in the west in the heart of the Confederacy Georgia. In the fall, General William Sherman took the largest industrial center of the South, Atlanta, and began famous march to the sea. On April 9, 28,000 army of Lee was surrendered, as well as troops of the other generals of the South (175 thousand people). Thus ended the civil war, which killed over 600 thousand people from both sides (Mousseau, 2012).Lincoln’s deathOn April 14, 1865, in the theater Lincoln was shot by the actor Booth, fanatic killers. It was the revenge of the slaveholders. Lincolns death plunged America into mourning. He gained respect and love of people of different political views and beliefs. Consistently following the universal values in politics and in life, unselfish and friendly, a great American, was one of the few polit ical figures of his time, who impressed even the supporters of revolutionary class struggle.Lincoln did not sought to the dictatorship in relation to the South. He wanted to restore the US on the same, equal to all states constitutional basis, with the only condition the recognition of the abolition of slavery. He considered magnanimity to the defeated, restoration of their political rights the most appropriate course of promoting civil peace. Life has shown, however, that solving problems of post-war reconstruction of the South was not so easy, and events have gone in a different direction than Lincoln relied.Reconstruction Era (18651877)   Slavery was abolished in the country irrevocably by the 13th Amendment to the Constitution, which was approved in April by the Senate, and by 3/4 of the states in December, 1865. There remained unresolved specific questions of the further existence of the South the conditions of admission of the former Confederate states into the Union, posi tion of former slave owners and freed slaves, device power and others. In the US, there was no consensus in ruling circles in this respect. A group of influential congressional Republicans headed by Thaddeus Stevens and Charles Sumner insisted on a military dictatorship over the South, deprivation of active participants of the rebellion of civil rights and providing them to blacks.After the death of Lincoln, disagreement between the President and Congress worsened. The new President Andrew Johnson, a former vice president, continued Lincoln’s course. He had neither fame nor the authority of his predecessor, and the practical results of the first peacekeeping policy turned against him. He adopted the decree of amnesty in May 1865, which restored the planters in civil, political and proprietary rights (except the right to have slaves).Confiscated during the war plantations were returned to former owners, who forced and threatened black population to work for former owner. There branched terrorist organizations, including the famous Ku Klux Klan. Having power, they adopted black codes laws that deprived former slaves land property rights, freedom of movement, freedom of speech, assembly and meetings, right to marry whites, and so on (Harvey, 2012).In July 1866, Congress passed the 14th Amendment to the US Constitution. It deprived the leaders of the Confederation of the right to hold public office, and equalized the rights of blacks with whites. Radical Reconstruction meant the forced democratization of life in the South, with the support of the army, which entered southern states, but without unleashing terror and dictatorship.The agrarian question was decided by a resolution to buy property. By 1880, almost total illiteracy among blacks reduced to 70%. By the end of the 60s, in the southern states they actively used their political rights and were elected even to Congress. Constitution of the southern states was revised, which was a decisive factor in i ts acceptance to union on a new basis.A booming capitalism in a natural, evolutionary way leveled the differences between the North and the South, and in the 70s Radical Reconstruction gradually diminished. As the Democratic Party stepped up its mass base, including the expense of the farmers and poor whites of the South, the Republican lost its former influence over the masses. In 1876, presidential candidate of the Democrats, Samuel J. Tilden (NY) received more votes than Republican Rutherford B. Hayes of Ohio. However, the election results were reviewed and majority was given to Hayes. Leaders of both parties made a deal: the US president was a Republican in exchange for a commitment to withdraw federal troops from the territory of the South.Meaning of the Civil War and Reconstruction Era   Both events were a single entity, and went far beyond the military victory of the North over the South. Conflict of free enterprise and plantation slavery can be seen as a conflict between t wo forms of ownership and diametrically opposed types of work organization of capital: slavery excludes wage labor, and vice versa.The main outcome of the Civil War was the abolishment of slavery. The remaining components of the US economy industry, commerce, agriculture farm developed before the war. In the northeast United States, the industrial revolution ended before the 60s. The Civil War temporarily reduced the rate of economic growth, but ultimately it prepared the development of capitalism on a much broader basis. Adopted in 1862 Homestead Act was the most progressive solution of the agrarian question, and the Republican Party, staying in power from 1861 to 1884, held a series of activities for the benefit of entrepreneurs.As for the South, after the Civil War it still was behind the North and West of the USA. Part of plantations were transferred to new owners, a part was divided into small plots and leased. Still mostly blacks worked on plantations, but as farm laborers or tenant sharecroppers, giving part of the harvest to the owner.The abolition of slavery created a crucial prerequisite for the formation of the labor market in the South, but it was not fully formed even in the years of radical Reconstruction. The main obstacle was the fact of racial discrimination black Americans usually could get only the most difficult and dirty work. Black people in general remained at the position of lower class, although a small portion of them became educated people, owners and even entrepreneurs.Reconstruction could not solve all the problems of turning the South into the same region of the US, as free north and west. However, it pushed the events follow the evolutionary path.ConclusionIt took almost a century the struggle of black Americans for their civil rights to culminate in the actual, real success. This occurred not only under the influence of their own struggle, which took sometimes violent forms, but also because of the evolution of American societ y on the way of recognition of human values and respect for human rights, which for the first time were proclaimed in America in 1776. The first step in this direction was made by the great document abolishing slavery, signed by Abraham Lincoln.The civil war between northern and southern states was the inevitable consequence of the contradictions between the two social systems in the country. The question of slavery, which was entirely determined by the economic and political interests of the planters, was the key issue. Maximum program of the most aggressive circles of the South was turning the US into a single slave power, but they were quite satisfied with separation from the Union as an independent state (Carroll, 2011).In the winter-spring 1861, Confederation of 11 southern states was formed. On April 13, southerners unleashed hostilities with shelling federal Fort Sumter in Charleston bay (South Carolina), whose small garrison capitulated and lowered the American flag. Thus be gan a four-year Civil War the most bloody and destructive of all that took place on the territory of the United States. The turning point in the war in favor of the free states was achieved through conducting it in a revolutionary way. Homestead Acts from May 20, and the act of freeing the slaves from September 22, 1862 had a crucial meaning. While South was lack of basic necessities, the north finished industrial revolution. On April 9, 1864 the victory was taken by the north and there started Reconstruction Era (1865-1877). The main outcome of the Civil War was the abolishment of slavery.