Look Ahead 2: Student's Book (LOAH) (Bk. 2) [Andy Hopkins, Jocelyn Potter] on adirknesmala.gq *FREE* shipping on qualifying offers. Tape Script Look Ahead Xi - Free download as Word Doc .doc), PDF File .pdf), Unit 2. GETTING STARTED. Part B. Active Listening. Listen to Mike, talking. The Use of Textbook “Look Ahead 2”. As the Material for Improving the Students' Mastery in Narrative Text. Reading (The Case of Unit 2 to Teach the Year XI.

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FINAL THEORY OF DRIVING. 2. CONTENTS. Vertical Parking. 64 . always look far ahead for varying road conditions so that adjustments to. The LookAhead trial was a randomized controlled trial comparing an Intensive Keywords: Randomized controlled trial, type 2 diabetes, overweight, obese. ILI for overweight/obese patients with type 2 diabetes may reduce the risk of The Look AHEAD (Action for Health in Diabetes) trial provides a unique.

Thus there was a very low over-all rate of events in both groups. However, there were many other health benefits that occurred with ILI, including improved biomarkers of glucose and lipid control, less sleep apnea, lower liver fat, less depression, less urinary incontinence, less severe kidney disease, improved sexual dysfunction, reduced need of diabetes medications, maintenance of physical mobility, and improved quality of life.

This was achieved with less health care costs 8.

The randomization was one to one. Both groups received routine medical care from their own health care providers. All subjects were overweight or obese mean BMI Volunteers had to pass a maximum exercise test to participate in the study.


This was done so individuals could be given exercise goals to do throughout this long trial. As a result, patients with more severe cardiovascular disease were excluded. I The average duration of diabetes was 6.

A study goal was set for reduction of baseline body weight in ILI by 7. The ILI physical activity goal was to do minutes a week of unsupervised exercise. Most subjects walked, but some jogged, swam, and biked.

Some resistance exercise was encouraged. Sessions were 3 group and 1 individual session per month for the first 6 months.

For the next 6 months they came to 2 group and 1 individual session per month. In years 2—4, they were seen a minimum of once per month and an additional contact by group, phone, mail or e-mail The group sessions were with the same 10—20 participants and lasted 60 to 75 minutes.

These included a private weigh-in, group self-reports on weight, self-monitoring and goal setting, presentation of a new topic, discussion of topic and of barriers to success, action plans and homework for the next session The sessions dealt with setting goals for weight, activity, fat and calorie intake. Self-monitoring was stressed, with a fat and calorie counter booklet where food and portion sizes were recorded as well as food portions and physical activity in minutes.

These were reviewed with their lifestyle coaches.

Effort was placed on strategies to reduce fat and calories. Patients were offered structured menus and up to two meal replacements per day if they wished. The ILI volunteers could choose from four commercial liquid food replacements which were provided free of charge. A tool-box strategy was used. For subjects having trouble with their weight loss goals, problem solving, motivational interviewing and behavioral contracts were used.

These included frozen meals, community classes, exercise items, or use of weight loss medication. Only orlistat was offered. Very few opted to use orlistat and it was not successful in rescuing patients The characteristics of the patients at baseline were similar in the two groups and have been published 7. There was excellent randomization with risk factors comparable in the two groups.

Look Ahead (Loah), 2, Students Book

The results of weight, physical fitness, waist circumference, and glycated hemoglobin throughout the trial have been published 7 , as have the cumulative hazard curves for the primary composite end point 7. The event rate was 1. At 1 year of intervention, the ILI group lost 8. Fitness levels improved by As for meeting the 3 ADA goals for glycemic control, blood pressure, and lipids increased from At 4 years and 8 years of intervention, even though the weight loss maintenance was attenuated, there was still a significant difference in weight between the ILI and DSE groups 15 , This was continued in the weights at the end of intervention 7.

The ILI group showed improved biomarkers of glucose and lipid control 7 , 12 , improved blood pressure 7 , 14 , less sleep apnea 17 , 18 , lower liver fat 19 , less depression 20 , 21 , less urinary incontinence 22 , less severe kidney disease and retinopathy 23 , reduced need of diabetes medications 24 , maintenance of physical mobility 25 , improved quality of life 26 , less knee pain 27 , improved sexual function 28 , lowered inflammation 29 and reduced over-all health costs 8.

As stated previously, there was a much lower CVD event rate than was projected from available data at the time of the start of the trial 0. In fact, the event rate in DSE was so low that the investigators decided to revise the primary outcome so as to document more events by including hospitalized angina Why did this occur?

A number of possibilities could have had an impact.

In addition, these physicians were repeatedly reminded by LookAhead sites of the guidelines for treatment of DM2 patients promulgated by the American Diabetes Association. Also, they received results of the biomarkers being followed, so they were well aware if their patients were reaching guidelines or not. This could have affected their interactions with their patients for the better: Second, while patients were randomized to one of the two groups, all were free to do as they pleased with regard to how they led their life.

They could sign up for other weight loss programs or to exercise programs as they wished. These were health conscious individuals who had signed up for a very long study, so they may have been over-all much more careful about health risks than the average person with diabetes.

Thirdly, volunteers could only enter the study if they could perform a maximal exercise test. This was done because part of the intervention was to be increased physical activity and the investigators wanted to be sure that this could be prescribed to the ILI group. Thus, again, the cohort may have been healthier than the average diabetic patient.

Essentially the same diet was recommended, though somewhat more strict with regard to calories. It is impossible to say whether a different dietary approach would have given different event rates. The investigators opted for an approach that had been found to work.

The recommended increase in activity for ILI was to min per day at least 5 days per week. This was all the investigators felt they could ask from this extremely sedentary and aging population. All documentation of the activity was done by individual diaries, since the exercise was done at or near the home and not at the centers. That the ILI was compliant to an extent was shown by the increase in fitness that was found at 1 and 4 years The DSE also improved somewhat in year 1, suggesting that they also picked up their physical activity, though not as much.

Whether a more intensive exercise program in ILI would have had a greater impact is impossible to say. The ILI seems to have achieved a lowering of CV events by focusing on nutrition and physical activity. The ILI volunteers were successful in losing weight and maintaining a significant weight loss over the full median 9. They were also successful in increasing physical activity. The DSE was also successful in lowering of CV events to the same degree, and they achieved this by taking more medications: Is one approach superior to the other?

ILI had a great number of other positive effects that were enumerated and referenced above. It seems reasonable to suggest that invoking lifestyle change by health professionals and public health agencies is a constructive approach to prevent some of the side effects of DM2.

Individuals who were the most severely obese actually lost more weight than patients who were overweight. At 1 year, the severely obese lost 9. This may be because they were more compliant with diet and physical activity guidelines. They opted for more meal replacements and they came to meetings more regularly Clearly, older age is not a negative with regard to behavioral change.

All groups were able to lose weight and improve their risk factors. There was little difference among Caucasians, African-Americans, Hispanics. Native Americans did slightly less well.

Thus, a preventive approach seems reasonable for everyone. There was some regression of diabetes in the ILI group This did not occur in the DSE group. This occurred more in patients with a short duration of diabetes diagnosis and who had lost more weight and improved fitness better This is good news since DM2 leads to a host of complications that are costly in terms of quality of life and of dollars spent.

It suggests that if one intervenes forcefully early on as soon as diabetes in diagnosed, a chance for remission is there. It is possible that an earlier intervention would be successful in reducing cardiovascular risk. It is well-known that the atherogenic process begins long before DM2 is diagnosed It is possible that if only a very recently diagnosed group had been included that a positive effect on CVD events would have been shown.

A recent publication answers this question.

Use and costs of health-care services were recorded across an average of 10 years. So the intervention was carried out without incurring extra health care costs. B : Well, on the way home she met three drunken men. You know what? Okay, let me continue. These three men raped her brutally. Poor girl! B : And then, they killed the girl cruelly and threw her body into some bushes.

Oh, damn them! Look, the hair on my neck is standing up. At the end of the story, the ghost took revenge on them. A : Well, it served them right after all. Part A. Think about it. Listen to the following text. Why do mosquitoes buzz? To begin with the story, let me tell you that a long time ago, mosquitoes didn't buzz, they talked and talked. Then one day when one of them talked to an iguana and didn't let the iguana say one word.

After that, everything was in a mess. The snake was so angry that he made a rabbit, a monkey, a crow, and an owl get frightened. Finally, the whole jungle was mad at the mosquito and cried for the sun to come up and when it did, the mosquito lost his voice.

Part C. Second Challenge. Listen to the story of Antony and Cleopatra. Then, rearrange these sentences according to their sequence in the story and answer the questions. Cleopatra, Queen of Egypt, was known throughout the ancient world for her beauty and intelligence.

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Every man would fall in love with her. Antony, who with two others ruled Rome after the death of Julius Caesar, went to the East to meet Cleopatra and discover she was plotting against Rome. When Antony reached Egypt and saw Cleopatra for the first time, he was fascinated with her beauty and fell in love with her; he completely forgot his purpose there.

Antony stayed in Egypt enjoying the lazy and luxurious life with Cleopatra. Cleopatra was very happy.

She asked him to live in Egypt forever. So, he arranged a marriage between her sister, Octavia and Anthony for political reasons and restored the friendship.

Although Antony treated his wife with great kindness and respect, he longed for Cleopatra in Egypt.

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In fact, he knew that Octavius was ambitious and wanted to be a single ruler in Rome. At last Antony went back to Egypt and joined with Cleopatra against Rome. This time Octavius could not tolerate Antony so he sent his army to Actium to fight Antony and Cleopatra's army. The battle was so fierce that Antony and Cleopatra lost their armies. Feeling ashamed of being dishonored, Antony took his own life using his own sword. Cleopatra was speechless with grief.

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She told her servants to bring her two poisonous snakes. And so, dressed in a queen, she prepared for her death. On her throat and her arm she placed two snakes which bite and killed her instantly. Part D. Third Challenge. Listen to the following story. Complete the text and answer the questions. Why do Hawks Hunt Chicks? Situation: Ita saw a mother hen quickly gathering its chicks under its wings.


Then, Ita looked up and saw a hawk flying up in the sky. B : Hmm….. A : Oh, please, Mum, tell me. B : All right…. A : Okay.N Engl J Med ; Nice to see you again. I can't stand it. The current study found no significant difference between the treatment and comparison arms in changes in mean MCS scores over the course of the study, a finding consistent with that from several similar trials 20 , 22 , Superficially, the whale looks rather like a fish, but there are important differences in its external structure; its tail consists of a pair of broad, flat horizontal paddles the tail of a fish is vertical and it has a single nostril on top of its large, broad head.

Though two meta-analyses differed with respect to an effect of exercise in triglycerides in T2DM populations and neither found an effect on HDL cholesterol, 11 , 16 our findings agree with the established benefit of exercise training on lipid profile in normoglycemic individuals. Corresponding author. National Center for Biotechnology Information , U. A : Oh, why did she do that? Here is the story.

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