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Anorexia nervosa, often referred to simply as anorexia,[11] is an eating disorder characterized by low weight, fear of gaining weight, and a strong desire to be thin, resulting in food restriction.[1] Many people with anorexia see themselves as overweight even though they are in fact underweight.[1][2] If asked they usually deny they have a problem with low weight.[3] Often they weigh themselves frequently, eat only small amounts, and only eat certain foods.[1] Some will exercise excessively, force themselves to vomit, or use laxatives to produce weight loss.[1] Complications may include osteoporosis, infertility and heart damage, among others.[1] Women will often stop having menstrual periods.[3]
The cause is not known.[2] There appear to be some genetic components with identical twins more often affected than non-identical twins.[2] Cultural factors also appear to play a role with societies that value thinness having higher rates of disease.[3] Additionally, it occurs more commonly among those involved in activities that value thinness such as high-level athletics, modelling, and dancing.[3][4] Anorexia often begins following a major life-change or stress-inducing event.[3] The diagnosis requires a significantly low weight.[3] The severity of disease is based on body mass index (BMI) in adults with mild disease having a BMI of greater than 17, moderate a BMI of 16 to 17, severe a BMI of 15 to 16, and extreme a BMI less than 15.[3] In children a BMI for age percentile of less than the 5th percentile is often used.[3]
Treatment of anorexia involves restoring a healthy weight, treating the underlying psychological problems, and addressing behaviors that promote the problem.[1] While medications do not help with weight gain, they may be used to help with associated anxiety or depression.[1] A number of types of therapy may be useful including an approach where parents assume responsibility for feeding their child, known as Maudsley family therapy and cognitive behavioral therapy.[1][12] Sometimes people require admission to hospital to restore weight.[7] Evidence for benefit from nasogastric tube feeding, however, is unclear.[13] Some people will just have a single episode and recover while others may have many episodes over years.[7] Many complications improve or resolve with regaining of weight.[7]
Globally, anorexia is estimated to affect 2.9 million people as of 2015.[9] It is estimated to occur in 0.9% to 4.3% of women and 0.2% to 0.3% of men in Western countries at some point in their life.[14] About 0.4% of young women are affected in a given year and it is estimated to occur ten times less commonly in men.[3][14] Rates in most of the developing world are unclear.[3] Often it begins during the teen years or young adulthood.[1] While anorexia became more commonly diagnosed during the 20th century it is unclear if this was due to an increase in its frequency or simply better diagnosis.[2] In 2013 it directly resulted in about 600 deaths globally, up from 400 deaths in 1990.[15] Eating disorders also increase a person's risk of death from a wide range of other causes, including suicide.[1][14] About 5% of people with anorexia die from complications over a ten-year period, a nearly 6 times increased risk.[3][8] The term anorexia nervosa was first used in 1873 by William Gull to describe this condition.[16]
Anorexia nervosa is an eating disorder characterized by attempts to lose weight, to the point of starvation. A person with anorexia nervosa may exhibit a number of signs and symptoms, the type and severity of which may vary and may be present but not readily apparent.[17]
Anorexia nervosa, and the associated malnutrition that results from self-imposed starvation, can cause complications in every major organ system in the body.[18] Hypokalaemia, a drop in the level of potassium in the blood, is a sign of anorexia nervosa.[19][20] A significant drop in potassium can cause abnormal heart rhythms, constipation, fatigue, muscle damage and paralysis.[21]
Symptoms may include:
Interoception has an important role in homeostasis and regulation of emotions and motivation. Anorexia has been associated with disturbances to interoception. People with anorexia concentrate on distorted perceptions of their body exterior due to fear of looking overweight. Aside from outer appearance, they also report abnormal bodily functions such as indistinct feelings of fullness.[27] This provides an example of miscommunication between body and brain. Further, people with anorexia experience abnormally intense cardiorespiratory sensations, particularly of the breath, most prevalent before they consume a meal. People with anorexia also report inability to distinguish emotions from bodily sensations in general, called alexithymia.[27] In addition to metacognition, people with anorexia also have difficultly with social cognition including interpreting other's emotions, and demonstrating empathy.[28] Abnormal interoceptive awareness like these examples have been observed so frequently in anorexia that they have become key characteristics of the illness.[27]
Other psychological issues may factor into anorexia nervosa; some fulfill the criteria for a separate Axis I diagnosis or a personality disorder which is coded Axis II and thus are considered comorbid to the diagnosed eating disorder. Some people have a previous disorder which may increase their vulnerability to developing an eating disorder and some develop them afterwards.[medical citation needed] The presence of Axis I or Axis II psychiatric comorbidity has been shown to affect the severity and type of anorexia nervosa symptoms in both adolescents and adults.[medical citation needed]
Obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) are highly comorbid with AN, particularly the restrictive subtype.[29] Obsessive-compulsive personality disorder is linked with more severe symptomatology and worse prognosis.[30] The causality between personality disorders and eating disorders has yet to be fully established.[medical citation needed] Other comorbid conditions include depression,[31] alcoholism,[32] borderline and other personality disorders,[33][34] anxiety disorders,[35] attention deficit hyperactivity disorder,[36] and body dysmorphic disorder (BDD).[37] Depression and anxiety are the most common comorbidities,[38] and depression is associated with a worse outcome.[38]
Autism spectrum disorders occur more commonly among people with eating disorders than in the general population.[39] Zucker et al. (2007) proposed that conditions on the autism spectrum make up the cognitive endophenotype underlying anorexia nervosa and appealed for increased interdisciplinary collaboration.[40]
There is evidence for biological, psychological, developmental, and sociocultural risk factors, but the exact cause of eating disorders is unknown.[41]
Anorexia nervosa is highly heritable.[41] Twin studies have shown a heritability rate of between 28 and 58%.[42] First degree relative of those with anorexia have roughly 12 times the risk of developing anorexia.[43] Association studies have been performed, studying 128 different polymorphisms related to 43 genes including genes involved in regulation of eating behavior, motivation and reward mechanics, personality traits and emotion. Consistent associations have been identified for polymorphisms associated with agouti-related peptide, brain derived neurotrophic factor, catechol-o-methyl transferase, SK3 and opioid receptor delta-1.[44] Epigenetic modifications, such as DNA methylation, may contribute to the development or maintenance of anorexia nervosa, though clinical research in this area is in its infancy.[45]
Obstetric complications: prenatal and perinatal complications may factor into the development of anorexia nervosa, such as maternal anemia, diabetes mellitus, preeclampsia, placental infarction, and neonatal cardiac abnormalities. Neonatal complications may also have an influence on harm avoidance, one of the personality traits associated with the development of AN.[medical citation needed]
Neuroendocrine dysregulation: altered signalling of peptides that facilitate communication between the gut, brain and adipose tissue, such as ghrelin, leptin, neuropeptide Y and orexin, may contribute to the pathogenesis of anorexia nervosa by disrupting regulation of hunger and satiety.[46][47]
Gastrointestinal diseases: people with gastrointestinal disorders may be more risk of developing disorders eating practices than the general population, principally restrictive eating disturbances.[48] An association of anorexia nervosa with celiac disease has been found.[49] The role that gastrointestinal symptoms play in the development of eating disorders seems rather complex. Some authors report that unresolved symptoms prior to gastrointestinal disease diagnosis may create a food aversion in these persons, causing alterations to their eating patterns. Other authors report that greater symptoms throughout their diagnosis led to greater risk. It has been documented that some people with celiac disease, irritable bowel syndrome or inflammatory bowel disease who are not conscious about the importance of strictly following their diet, choose to consume their trigger foods to promote weight loss. On the other hand, individuals with good dietary management may develop anxiety, food aversion and eating disorders because of concerns around cross contamination of their foods.[48] Some authors suggest that medical professionals should evaluate the presence of an unrecognized celiac disease in all people with eating disorder, especially if they present any gastrointestinal symptom (such as decreased appetite, abdominal pain, bloating, distension, vomiting, diarrhea or constipation), weight loss, or growth failure; and also routinely ask celiac patients about weight or body shape concerns, dieting or vomiting for weight control, to evaluate the possible presence of eating disorders,[49] especially in women.[50]
Studies have hypothesized the continuance of disordered eating patterns may be epiphenomena of starvation. The results of the Minnesota Starvation Experiment showed normal controls exhibit many of the behavioral patterns of anorexia nervosa (AN) when subjected to starvation. This may be due to the numerous changes in the neuroendocrine system, which results in a self-perpetuating cycle.[51][52][53]
Another hypothesis is that anorexia nervosa is more likely to occur in populations in which obesity is more prevalent, and results from a sexually selected evolutionary drive to appear youthful in populations in which size becomes the primary indicator of age.[54][unreliable medical source?]
Anorexia nervosa is more likely to occur in a person's pubertal years. Some explanatory hypotheses for the rising prevalence of eating disorders in adolescence are "increase of adipose tissue in girls, hormonal changes of puberty, societal expectations of increased independence and autonomy that are particularly difficult for anorexic adolescents to meet; [and] increased influence of the peer group and its values." [55]
Early theories of the cause of anorexia linked it to childhood sexual abuse or dysfunctional families;[56][57] evidence is conflicting, and well-designed research is needed.[41] The fear of food is known as sitiophobia,[58] cibophobia,[59] or sitophobia and is part of the differential diagnosis.[60][61] Other psychological causes of anorexia include low self-esteem, feeling like there is lack of control, depression, anxiety, and loneliness.[62]
Anorexia nervosa has been increasingly diagnosed since 1950;[63] the increase has been linked to vulnerability and internalization of body ideals.[55] People in professions where there is a particular social pressure to be thin (such as models and dancers) were more likely to develop anorexia,[medical citation needed] and those with anorexia have much higher contact with cultural sources that promote weight loss.[medical citation needed] This trend can also be observed for people who partake in certain sports, such as jockeys and wrestlers.[64] There is a higher incidence and prevalence of anorexia nervosa in sports with an emphasis on aesthetics, where low body fat is advantageous, and sports in which one has to make weight for competition.[65] Family dynamics can play big part in the cause of anorexia.[66] When there is a constant pressure from people to be thin, teasing, bullying can cause low self-esteem and other psychological symptoms.[62]
Constant exposure to media that presents body ideals may constitute a risk factor for body dissatisfaction and anorexia nervosa. The cultural ideal for body shape for men versus women continues to favor slender women and athletic, V-shaped muscular men. A 2002 review found that, of the magazines most popular among people aged 18 to 24 years, those read by men, unlike those read by women, were more likely to feature ads and articles on shape than on diet.[unreliable medical source?][67] Body dissatisfaction and internalization of body ideals are risk factors for anorexia nervosa that threaten the health of both male and female populations.[medical citation needed]
Websites that stress the importance of attainment of body ideals extol and promote anorexia nervosa through the use of religious metaphors, lifestyle descriptions, "thinspiration" or "fitspiration" (inspirational photo galleries and quotes that aim to serve as motivators for attainment of body ideals).[68] Pro-anorexia websites reinforce internalization of body ideals and the importance of their attainment.[68]
The media give men and women a false view of what people truly look like. In magazines, movies and even on billboards most of the actors/models are photoshopped in multiple ways. People then strive to look like these "perfect" role models when in reality they aren't any where near perfection themselves.[69]
Evidence from physiological, pharmacological and neuroimaging studies suggest serotonin may play a role in anorexia. While acutely ill, metabolic changes may produce a number of biological findings in people with anorexia that are not necessarily causative of the anorexic behavior. For example, abnormal hormonal responses to challenges with serotonergic agents have been observed during acute illness, but not recovery. Nevertheless, increased cerebrospinal fluid concentrations of 5-Hydroxyindoleacetic acid (a metabolite of serotonin), and changes in anorectic behavior in response to tryptophan depletion(a metabolic precursor to serotonin) support a role in anorexia. The binding potential of 5-HT2A receptors and 5-HT1A receptors have been reportedly decreased and increased respectively in a number of cortical regions. While these findings may be confounded by comorbid psychiatric disorders, taken as a whole they indicate serotonin in anorexia.[70][71] These alterations in serotonin have been linked to traits characteristic of anorexia such as obsessiveness, anxiety, and appetite dysregulation.[72]
Neuroimaging studies investigating the functional connectivity between brain regions have observed a number of alterations in networks related to cognitive control, introspection, and sensory function. Alterations in networks related to the dorsal anterior cingulate cortex may be related to excessive cognitive control of eating related behaviors. Similarly, altered somatosensory integration and introspection may relate to abnormal body image.[73] A review of functional neuroimaging studies reported reduced activations in "bottom up" limbic region and increased activations in "top down" cortical regions which may play a role in restrictive eating.[74]
Compared to controls, recovered anorexics show reduced activation in the reward system in response to food, and reduced correlation between self reported liking of a sugary drink and activity in the striatum and ACC. Increased binding potential of [11C]raclopride in the striatum, interpreted as reflecting decreased endogenous dopamine due to competitive displacement, has also been observed.[75]
Structural neuroimaging studies have found global reductions in both gray matter and white matter, as well as increased cerebrospinal fluid volumes. Regional decreases in the left hypothalamus, left inferior parietal lobe, right lentiform nucleus and right caudate have also been reported.[76], in acutely ill patients. However, these alterations seem to be associated with acute malnutrition and largely reversible with weight restoration, at least in nonchronic cases in younger people.[77] In contrast, some studies have reported increased orbitofrontal cortex volume in currently ill and in recovered patients, although findings are inconsistent. Reduced white matter integrity in the fornix has also been reported.[78]
A diagnostic assessment includes the person's current circumstances, biographical history, current symptoms, and family history. The assessment also includes a mental state examination, which is an assessment of the person's current mood and thought content, focusing on views on weight and patterns of eating.
Anorexia nervosa is classified under the Feeding and Eating Disorders in the latest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5).
Relative to the previous version of the DSM (DSM-IV-TR), the 2013 revision (DSM5) reflects changes in the criteria for anorexia nervosa, most notably that of the amenorrhea criterion being removed.[7][79] Amenorrhea was removed for several reasons: it does not apply to males, it is not applicable for females before or after the age of menstruation or taking birth control pills, and some women who meet the other criteria for AN still report some menstrual activity.[7]
There are two subtypes of AN:[18][80]
Body mass index (BMI) is used by the DSM-5 as an indicator of the level of severity of anorexia nervosa. The DSM-5 states these as follows:[81]
Medical tests to check for signs of physical deterioration in anorexia nervosa may be performed by a general physician or psychiatrist, including:
A variety of medical and psychological conditions have been misdiagnosed as anorexia nervosa; in some cases the correct diagnosis was not made for more than ten years.
The distinction between the diagnoses of anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified (EDNOS) is often difficult to make as there is considerable overlap between people diagnosed with these conditions. Seemingly minor changes in people's overall behavior or attitude can change a diagnosis from anorexia: binge-eating type to bulimia nervosa. A main factor differentiating binge-purge anorexia from bulimia is the gap in physical weight. Someone with bulimia nervosa is ordinarily at a healthy weight, or slightly overweight. Someone with binge-purge anorexia is commonly underweight.[95] People with the binge-purging subtype of AN may be significantly underweight and typically do not binge-eat large amounts of food, yet they purge the small amount of food they eat.[95] In contrast, those with bulimia nervosa tend to be at normal weight or overweight and binge large amounts of food.[95] It is not unusual for a person with an eating disorder to "move through" various diagnoses as their behavior and beliefs change over time.[40]
There is no conclusive evidence that any particular treatment for anorexia nervosa works better than others; however, there is enough evidence to suggest that early intervention and treatment are more effective.[96] Treatment for anorexia nervosa tries to address three main areas.
Although restoring the person's weight is the primary task at hand, optimal treatment also includes and monitors behavioral change in the individual as well.[98] There is some evidence that hospitalisation might adversely affect long term outcome.[99]
Psychotherapy for individuals with AN is challenging as they may value being thin and may seek to maintain control and resist change.[100] Some studies demonstrate that family based therapy in adolescents with AN is superior to individual therapy.[101]
Treatment of people with AN is difficult because they are afraid of gaining weight. Initially developing a desire to change may be important.[102]
Diet is the most essential factor to work on in people with anorexia nervosa, and must be tailored to each person's needs. Food variety is important when establishing meal plans as well as foods that are higher in energy density.[103] People must consume adequate calories, starting slowly, and increasing at a measured pace.[24] Evidence of a role for zinc supplementation during refeeding is unclear.[13]
Family-based treatment (FBT) has been shown to be more successful than individual therapy for adolescents with AN.[8][104] Various forms of family-based treatment have been proven to work in the treatment of adolescent AN including conjoint family therapy (CFT), in which the parents and child are seen together by the same therapist, and separated family therapy (SFT) in which the parents and child attend therapy separately with different therapists.[8] Proponents of family therapy for adolescents with AN assert that it is important to include parents in the adolescent's treatment.[8]
A four- to five-year follow up study of the Maudsley family therapy, an evidence-based manualized model, showed full recovery at rates up to 90%.[105] Although this model is recommended by the NIMH,[106] critics claim that it has the potential to create power struggles in an intimate relationship and may disrupt equal partnerships.[medical citation needed]
Cognitive behavioral therapy (CBT) is useful in adolescents and adults with anorexia nervosa;[107] acceptance and commitment therapy is a type of CBT, which has shown promise in the treatment of AN.[108] Cognitive remediation therapy (CRT) is used in treating anorexia nervosa.[109]
Pharmaceuticals have limited benefit for anorexia itself.[110]
AN has a high mortality[111] and patients admitted in a severely ill state to medical units are at particularly high risk. Diagnosis can be challenging, risk assessment may not be performed accurately, consent and the need for compulsion may not be assessed appropriately, refeeding syndrome may be missed or poorly treated and the behavioural and family problems in AN may be missed or poorly managed.[112] The MARSIPAN guidelines recommend that medical and psychiatric experts work together in managing severely ill people with AN.[113]
The rate of refeeding can be difficult to establish, because the fear of refeeding syndrome (RFS) can lead to underfeeding. It is thought that RFS, with falling phosphate and potassium levels, is more likely to occur when BMI is very low, and when medical comorbidities such as infection or cardiac failure, are present. In those circumstances, it is recommended to start refeeding slowly but to build up rapidly as long as RFS does not occur. Recommendations on energy requirements vary, from 5–10 kcal/kg/day in the most medically compromised patients, who appear to have the highest risk of RFS to 1900 kcal/day[114][115]
AN has the highest mortality rate of any psychological disorder.[8] The mortality rate is 11 to 12 times greater than in the general population, and the suicide risk is 56 times higher.[19] Half of women with AN achieve a full recovery, while an additional 20–30% may partially recover.[8][19] Not all people with anorexia recover completely: about 20% develop anorexia nervosa as a chronic disorder.[96] If anorexia nervosa is not treated, serious complications such as heart conditions[17] and kidney failure can arise and eventually lead to death.[116] The average number of years from onset to remission of AN is seven for women and three for men. After ten to fifteen years, 70% of people no longer meet the diagnostic criteria, but many still continue to have eating-related problems.[117]
Alexithymia influences treatment outcome.[110] Recovery is also viewed on a spectrum rather than black and white. According to the Morgan-Russell criteria, individuals can have a good, intermediate, or poor outcome. Even when a person is classified as having a "good" outcome, weight only has to be within 15% of average, and normal menstruation must be present in females. The good outcome also excludes psychological health. Recovery for people with anorexia nervosa is undeniably positive, but recovery does not mean a return to normal.[medical citation needed]
Anorexia nervosa can have serious implications if its duration and severity are significant and if onset occurs before the completion of growth, pubertal maturation, or the attainment of peak bone mass.[medical citation needed] Complications specific to adolescents and children with anorexia nervosa can include the following: Growth retardation may occur, as height gain may slow and can stop completely with severe weight loss or chronic malnutrition. In such cases, provided that growth potential is preserved, height increase can resume and reach full potential after normal intake is resumed.[medical citation needed] Height potential is normally preserved if the duration and severity of illness are not significant or if the illness is accompanied by delayed bone age (especially prior to a bone age of approximately 15 years), as hypogonadism may partially counteract the effects of undernutrition on height by allowing for a longer duration of growth compared to controls.[medical citation needed] Appropriate early treatment can preserve height potential, and may even help to increase it in some post-anorexic subjects, due to factors such as long-term reduced estrogen-producing adipose tissue levels compared to premorbid levels.[medical citation needed] In some cases, especially where onset is before puberty, complications such as stunted growth and pubertal delay are usually reversible.[118]
Anorexia nervosa causes alterations in the female reproductive system; significant weight loss, as well as psychological stress and intense exercise, typically results in a cessation of menstruation in women who are past puberty. In patients with anorexia nervosa, there is a reduction of the secretion of gonadotropin releasing hormone in the central nervous system, preventing ovulation.[119] Anorexia nervosa can also result in pubertal delay or arrest. Both height gain and pubertal development are dependent on the release of growth hormone and gonadotrophins (LH and FSH) from the pituitary gland. Suppression of gonadotrophins in people with anorexia nervosa has been documented.[120] Typically, growth hormone (GH) levels are high, but levels of IGF-1, the downstream hormone that should be released in response to GH are low; this indicates a state of "resistance" to GH due to chronic starvation.[121] IGF-1 is necessary for bone formation, and decreased levels in anorexia nervosa contribute to a loss of bone density and potentially contribute to osteopenia or osteoporosis.[121] Anorexia nervosa can also result in reduction of peak bone mass. Buildup of bone is greatest during adolescence, and if onset of anorexia nervosa occurs during this time and stalls puberty, low bone mass may be permanent.[122]
Hepatic steatosis, or fatty infiltration of the liver, can also occur, and is an indicator of malnutrition in children.[123] Neurological disorders that may occur as complications include seizures and tremors. Wernicke encephalopathy, which results from vitamin B1 deficiency, has been reported in patients who are extremely malnourished; symptoms include confusion, problems with the muscles responsible for eye movements and abnormalities in walking gait.
The most common gastrointestinal complications of anorexia nervosa are delayed stomach emptying and constipation, but also include elevated liver function tests, diarrhea, acute pancreatitis, heartburn, difficulty swallowing, and, rarely, superior mesenteric artery syndrome.[124] Delayed stomach emptying, or gastroparesis, often develops following food restriction and weight loss; the most common symptom is bloating with gas and abdominal distension, and often occurs after eating. Other symptoms of gastroparesis include early satiety, fullness, nausea, and vomiting. The symptoms may inhibit efforts at eating and recovery, but can be managed by limiting high-fiber foods, using liquid nutritional supplements, or using metoclopramide to increase emptying of food from the stomach.[124] Gastroparesis generally resolves when weight is regained.
Anorexia nervosa increases the risk of sudden cardiac death, though the precise cause is unknown. Cardiac complications include structural and functional changes to the heart.[125] Some of these cardiovascular changes are mild and are reversible with treatment, while others may be life-threatening. Cardiac complications can include arrhythmias, abnormally slow heart beat, low blood pressure, decreased size of the heart muscle, reduced heart volume, mitral valve prolapse, myocardial fibrosis, and pericardial effusion.[125]
Abnormalities in conduction and repolarization of the heart that can result from anorexia nervosa include QT prolongation, increased QT dispersion, conduction delays, and junctional escape rhythms.[125] Electrolyte abnormalities, particularly hypokalemia and hypomagnesemia, can cause anomalies in the electrical activity of the heart, and result in life-threatening arrhythmias. Hypokalemia most commonly results in anorexic patients when restricting is accompanied by purging (induced vomiting or laxative use). Hypotension (low blood pressure) is common, and symptoms include fatigue and weakness. Orthostatic hypotension, a marked decrease in blood pressure when standing from a supine position, may also occur. Symptoms include lightheadedness upon standing, weakness, and cognitive impairment, and may result in fainting or near-fainting.[125] Orthostasis in anorexia nervosa indicates worsening cardiac function and may indicate a need for hospitalization.[125] Hypotension and orthostasis generally resolve upon recovery to a normal weight. The weight loss in anorexia nervosa also causes atrophy of cardiac muscle. This leads to decreased ability to pump blood, a reduction in the ability to sustain exercise, a diminished ability to increase blood pressure in response to exercise, and a subjective feeling of fatigue.[126]
Some individuals may also have a decrease in cardiac contractility. Cardiac complications can be life-threatening, but the heart muscle generally improves with weight gain, and the heart normalizes in size over weeks to months, with recovery.[126] Atrophy of the heart muscle is a marker of the severity of the disease, and while it is reversible with treatment and refeeding, it is possible that it may cause permanent, microscopic changes to the heart muscle that increase the risk of sudden cardiac death.[125] Individuals with anorexia nervosa may experience chest pain or palpitations; these can be a result of mitral valve prolapse. Mitral valve prolapse occurs because the size of the heart muscle decreases while the tissue of the mitral valve remains the same size. Studies have shown rates of mitral valve prolapse of around 20 percent in those with anorexia nervosa, while the rate in the general population is estimated at 2–4 percent.[127] It has been suggested that there is an association between mitral valve prolapse and sudden cardiac death, but it has not been proven to be causative, either in patients with anorexia nervosa or in the general population.[125]
Relapse occurs in approximately a third of people in hospital, and is greatest in the first six to eighteen months after release from an institution.[128]
Anorexia is estimated to occur in 0.9% to 4.3% of women and 0.2% to 0.3% of men in Western countries at some point in their life.[14] About 0.4% of young females are affected in a given year and it is estimated to occur three to ten times less commonly in males.[3][14][128] Rates in most of the developing world are unclear.[3] Often it begins during the teen years or young adulthood.[1]
The lifetime rate of atypical anorexia nervosa, a form of ED-NOS in which not all of the diagnostic criteria for AN are met, is much higher, at 5–12%.[129]
While anorexia became more commonly diagnosed during the 20th century it is unclear if this was due to an increase in its frequency or simply better diagnosis.[2] Most studies show that since at least 1970 the incidence of AN in adult women is fairly constant, while there is some indication that the incidence may have been increasing for girls aged between 14 and 20.[130]
Eating disorders are less reported in preindustrial, non-westernized countries than in Western countries. In Africa, not including South Africa, the only data presenting information about eating disorders occurs in case reports and isolated studies, not studies investigating prevalence. Data shows in research that in westernized civilizations, ethnic minorities have very similar rates of eating disorders, contrary to the belief that eating disorders predominantly occur in Caucasian people.[medical citation needed]
Men (and women) who might otherwise be diagnosed with anorexia may not meet the DSM IV criteria for BMI since they have muscle weight, but have very little fat.[131] Men and women athletes are often overlooked as anorexic.[131] Research emphasizes the importance to take athletes' diet, weight and symptoms into account when diagnosing anorexia, instead of just looking at weight and BMI. For athletes, ritualized activities such as weigh-ins place emphasis on weight, which may promote the development of eating disorders among them.[citation needed] While women use diet pills, which is an indicator of unhealthy behavior and an eating disorder, men use steroids, which contextualizes the beauty ideals for genders.[41] In a Canadian study, 4% of boys in grade nine used anabolic steroids.[41] Anorexic men are sometimes referred to as manorexic.[132]
The term anorexia nervosa was coined in 1873 by Sir William Gull, one of Queen Victoria's personal physicians.[133] The history of anorexia nervosa begins with descriptions of religious fasting dating from the Hellenistic era[134] and continuing into the medieval period. The medieval practice of self-starvation by women, including some young women, in the name of religious piety and purity also concerns anorexia nervosa; it is sometimes referred to as anorexia mirabilis.[135][136]
The earliest medical descriptions of anorexic illnesses are generally credited to English physician Richard Morton in 1689.[134] Case descriptions fitting anorexic illnesses continued throughout the 17th, 18th and 19th centuries.[137]
In the late 19th century anorexia nervosa became widely accepted by the medical profession as a recognized condition. In 1873, Sir William Gull, one of Queen Victoria's personal physicians, published a seminal paper which coined the term anorexia nervosa and provided a number of detailed case descriptions and treatments.[137] In the same year, French physician Ernest-Charles Lasègue similarly published details of a number of cases in a paper entitled De l'Anorexie hystérique.[138]
Awareness of the condition was largely limited to the medical profession until the latter part of the 20th century, when German-American psychoanalyst Hilde Bruch published The Golden Cage: the Enigma of Anorexia Nervosa in 1978. Despite major advances in neuroscience,[139] Bruch's theories tend to dominate popular thinking. A further important event was the death of the popular singer and drummer Karen Carpenter in 1983, which prompted widespread ongoing media coverage of eating disorders.[140]
The term is of Greek origin: an- (ἀν-, prefix denoting negation) and orexis (ὄρεξις, "appetite"), translating literally to a nervous loss of appetite.[141]
Several case reports brought attention to the association of anorexia nervosa and celiac disease.(...) Some patients present with the eating disorder prior to diagnosis of celiac disease and others developed anorexia nervosa after the diagnosis of celiac disease. Healthcare professionals should screen for celiac disease with eating disorder symptoms especially with gastrointestinal symptoms, weight loss, or growth failure.(...) Celiac disease patients may present with gastrointestinal symptoms such as diarrhea, steatorrhea, weight loss, vomiting, abdominal pain, anorexia, constipation, bloating, and distension due to malabsorption. Extraintestinal presentations include anemia, osteoporosis, dermatitis herpetiformis, short stature, delayed puberty, fatigue, aphthous stomatitis, elevated transaminases, neurologic problems, or dental enamel hypoplasia.(...) it has become clear that symptomatic and diagnosed celiac disease is the tip of the iceberg; the remaining 90% or more of children are asymptomatic and undiagnosed.
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Emperor Tetra – Fin Rips? Likely Culprits?
Home › Forums › Fresh and Brackish Water Fishes › Emperor Tetra – Fin Rips? Likely Culprits?
- This topic has 0 replies, 1 voice, and was last updated 6 years, 1 month ago by mikev.
August 8, 2014 at 11:53 am #303355
Hey guys.
Tonight whilst looking at my tank, I realised some of my Emperor Tetras have damaged fins.
My stock list is:
6 x Congo Tetra
5 x Emperor
6 x Glow light
9 x Neon
2 x Plec
2 x Guppy
I would imagine that the congos are most likely to be the culprits for this? The one guppy seems scared to death of them so I will be transferring both of them to a different tank tomorrow.
I've had the congos and most of the emperors about a month now.
Also the one male emperor has a slight pale patch near his head on his side which can be seen in the photo below. Do you think this is anything to worry about?
Here are some photos. Do you think my stocking of congos could be making the other fish stressed? Are their fins likely to grow back?August 8, 2014 at 5:05 pm #353416
Byron HoskingParticipant
I cannot see the white patch issue from these photos as the lighting is bright and the fish are thus not clearly defined. I'll just comment on your fin nipping possibilities.
This is very unlikely to be the Congo Tetra. It is more likely the Emperor themselves, but the glowlights are not entirely ruled out. Tetra are shoaling fish by nature, which means they have an inherent need to be kept in groups. A scientific study a year or so back showed that below six caused shoaling fish to feel insecure and aggression was often heightened, even within otherwise peaceful species. Tank size (and the environment) also plays into this, and you haven't mentioned the tank size here. With six glowlights, and given the traits of this species, I would suspect the Emperors first if nipping is involved. I would certainly add more of them, up to 7-9 if tank space permits.
One cannot rule out a bacterial issue, which might involve the white patch and fin damage, but without clearer photos it may be impossible to say. And I am not the one to help with disease, but other members undoubtedly can.
Byron.August 9, 2014 at 8:48 pm #353421
Hey Byron!
Thanks for your reply. I had a 6th emperor but unfortunately she contracted a disease last week that all but killed her and I had to euthanase her Here is a photo of what she had:
I am keeping a close eye on the others to make sure I cant see it on them.
The slightly white spot on the male emperor can be seen just behind his gills in the first photo of the last post. (the rightmost fish).
The tank is a 200L Fluval Roma 200. The fin issue is definitely nips rather than rot.August 11, 2014 at 5:26 pm #353424
Byron HoskingParticipant
On the reddish growth/ulcer in the latest photo (the dead fish), I had this only a couple weeks ago on a Black Phantom. When I see this, I try to net the fish out and euthanize it. The fish slowly weakens to the point it is easy to net. I've no idea what this actually is, but I have read that euthanizing the fish is likely best. I have never known it to spread after doing this, and the affected fish never recovers.
To the whitish spots, which I seem to see on both fish, I am wondering if it is just normal colouration? It seems to be highlighted by the light. I would keep an eye on this. Without knowing exactly what a disease is, using any medication can be dangerous. I have killed fish without curing the disease in the past, which is why I am now so cautious and prefer euthanizing a single fish.
If there is fin nipping, I would suspect the Emperors. I gave away my group of Emperors because they terrorized the other fish. A few weeks later, fry appeared in the tank, so obviously they had spawned prior to my removing them. The fry grew, twelve in all, and I watched to see how they would behave. Once or twice they sort of looked a bit sneaky, but over a period of several months they behaved themselves. It may have been that growing up in this tank with other fish from the start was the difference.
Byron.August 12, 2014 at 2:04 pm #353426
Emperor Tets are very nippy wth one another, but I've never (I've been keeping and breeding them continuously for over 20yrs) seen damage to that extent, so I'm going to disagree and suggest that the finnage of the Emperors may be triggering a response from the Congos (which really can knock lumps of each other, especially breeding males).
I can't see a whitish patch either, but many Emperor Tets are wild imports and so may come in with encysted fluke larvae and the like which might result in a pale patch under the skin, or it could be a healing injury. If the fish is active and feeding I wouldn't worry.August 14, 2014 at 1:54 am #353430
The red lesions look like Piscine Tuberculosis (always fatal once it breaks out). Many aquarium fish seem to carry this infection but do not show symptoms unless they are stressed. Humans can contract it as well . If you have cuts/abrasions on your hands and put them in an aquarium containing infected fish. It's easily cured apparently. Your other Emperors look fine apart from the nipped fins.August 14, 2014 at 2:32 am #353431
I agree that the red lesions could be due to fish TB (mycobacteriosis). However, I don't know how susceptible this species of fish is to mycobacteria. A definitive diagnosis would usually require histology or a DNA test.
Humans can contract it as well. If you have cuts/abrasions on your hands and put them in an aquarium containing infected fish. It's easily cured apparently.
Unfortunately, it is not easily cured in humans. I have known several people who have caught this.
Here is a link to an on-line disease book (specifically written for zebrafish, but also generally applicable to other fish) written by fish vets who actually do research on this disease.
Gloves and washing hands with alcohol and considered possible preventatives.
Also of interest about this disease: it is NOT an obligate pathogen. This means that it can make a living hanging out in a tank with out requiring fish to infect and then infect them later.
Among the many possible sources of fish, few sources produce that are not contaminated with this pathogen (this would be fish from a handful of labs and very few fish farms (the 5-D fish farm in Florida is one). Fish going through pet or fish stores have probably be exposed to the pathogen left be previous fish going through the store.August 14, 2014 at 3:29 am #353432
I was also thinking myco but didn't want to be the one to say it. Adrian Tappan has written an excellent pamphlet on the subject and has most generously offered it freely online.August 14, 2014 at 6:06 am #353434
Yes, looks like Myco is a strong possibility. ASAIK, tetras are quite susceptible to it. Some of the fin problems may be caused by myco as well (secondary infections develop in fish that has been weakened by Myco).
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subset: commoncrawl


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Contact Us
The Office 365 Launch Program is a multi-faceted slate of end-user training designed to increase adoption and activation of Office 365. The 90 day program equips new users with the necessary tools to make a successful transition to Office 365. The main components of the program are OnDemand video with NHGO NOW, New Horizons Quick Reference Cards, and Instructor-Led training sessions with Power Hour.
The Office 365 Launch Program is a 90 day program.
Yes. The program can be applied to standard versions of Office as well.
Up to four, one-hour sessions per user. Two mandatory (Getting Started with Office 365 & Getting Started with Outlook Online), and two additional elective titles selected by the customer. Choose from: Getting Started with Delve, Getting Started with Office 365 Video, Getting Started with OneDrive, Getting Started with OneNote Online, Getting Started with SharePoint Sites, Getting Started with Skype for Business, Getting Started with Sway, Getting Started with Yammer, Skype for Business: Collaborating with Meetings, and Skype for Business: Team Collaboration with OneNote. View full course descriptions here.
There will be two scheduled webinars. The first will cover the fundamental features of Office 365, and the second will introduce more advanced features.
There will be seven emails distributed on a one-per-week basis beginning during the Launch phase of the program.
90 days.
You will receive our full eight-page Office 365 QRC along with the accompanying QRC for each of your Power Hour sessions.
All Quick Reference Cards are delivered digitally and will be accessible for 90 days.


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Mona's Monkey
From the Super Mario Wiki, the Mario encyclopedia
Jump to:navigation, search
Mona's Monkey (sometimes known as Mona's Chimp) is a small monkey with special goggles, and a blue shirt with a red "3" printed on. It is one of the animals owned by Mona. It first appeared, just as Mona's Elephant and Mona's Pig, in WarioWare, Inc.: Mega Microgame$!. The monkey can throw Banana Peels, and it has saved her twice in a row.
WarioWare, Inc.: Mega Microgame$![edit]
In WarioWare, Inc.: Mega Microgame$!, the Diamond Police followed Mona because of speeding. Since Mona has to be on work at the Gelateria as fast as possible, she hasn't any time for a speeding ticket, and put her first three animals in defense. The first one was her Elephant. It shot sludge at the police cars, but more came. Next was her pig. It kicked numerous of Soccer Balls to the cars. Still, more came. Finally, her monkey came on, throwing banana peels to the police cars. After a long time, the chimp has overcome the police force, and Mona came just in time.
All three animals cheered her when Mona dismounted her scooter.
WarioWare: Twisted![edit]
In WarioWare: Twisted!, Mona needs again help of her animals, this time to get away the Dinosaurs. To hinder her, one of the Dinosaurs had a gray T-Rex on his shoulder. The one who brought Mona's animals was Pizza Joe in an airplane. He set the animals up on Mona's cap at all in once. Mona's Monkey was at top. However, Mona's Elephant and Mona's Pig attacked first. The elephant created a soccer ball and the pig kicked the ball. The T-Rex was defeated in one hit. The Dinosaurs then appeared again with a blue dinosaur robot on wheels. The attack of Mona's two animals didn't affect the robot. Mona's Pig became angry, and put its mechanical goggles on. A long time later, the attack still didn't affect the big robot, and the goggles wore off. Then the monkey ate its banana, and threw the peel to the robot. it slipped, and was simply defeated. Again, the monkey saved her.
WarioWare: Touched![edit]
In WarioWare: Touched!, Mona is chased by Vanessa and the Dinosaurs. Her three animals tried to help her with Manager Joe, but has been kicked away by Vanessa's falcon-like robot. Then her newer animals, 4.1 and 4.2 appeared in a flying vehicle, and shot soccer balls to the robot.
WarioWare: Smooth Moves[edit]
In WarioWare: Smooth Moves, the three animals made a cameo appearance in Young Cricket's story, along Mona's Bear. They stand next to Mona, who served dumplings together with Joe, Art and Deco.
Names in other languages[edit]


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Gastech Exhibition & Conference
EAGE collaborates with Gastech 2018
The European Association of Geoscientists & Engineers (EAGE) is collaborating with the Gastech 2018 Exhibition and Conference in Barcelona, Spain. The goal of this collaboration is to highlight new technologies and industry developments across the upstream sector. For over 45 years, the Gastech exhibition and conference has been at the forefront of the international gas, LNG and energy industries.
This world-renowned event is regarded as the most significant meeting place for upstream, midstream and downstream gas and LNG professionals, where they convene to do business. As an EAGE member there are 3 ways you can share your upstream expertise and meet with the global energy value chain at Gastech 2018. See here all possibilities.
Speak at the Conference
The Gastech 2018 Conference is currently calling for papers on the Strategic and the Technical Conferences. There are more than 90 sessions you can submit a paper for.
EAGE will be holding a separate upstream focused conference stream during Gastech; for information on the topics and how to submit, please visit the Technical Programme pages. The deadline for this call for papers has been extended until 3 April 2018!


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What do the stars have in store for you this week?
Follow @astrotherapist on Twitter and email firstname.lastname@example.com to schedule a reading over the phone or Skype. Available in-person in NYC! $125 for 60 minutes, $150 for 90 minutes.
April 20–May 20
The sun in Taurus forms an alliance with Pluto in your exploration zone this week, giving you a push out of your comfort zone and into the big wide world. Any experience of newness—whether with a person, place or thing—is likely to be powerful, and it may even change you in a lasting way. If you want to grow, the familiar is verboten. You can also learn from your own subconscious, since Mercury in your subliminal corner is linked with eye-opening Uranus and schooled Saturn. Pay close attention to your dreams and face what's going on in the back of your head with objectivity and acceptance. Plumb the depths of your psyche for buried wisdom. These transits want you to come to terms with yourself and with your past. The full moon rises in your others angle, which could bring about a turning point in a relationship and cause emotions to run high among the people you encounter. You might opt to evaluate your connections and ask yourself if there are shared ideals, mutual support, potential for growth and a truly organic bond between you. This is a good time to consider taking things to the next level or parting ways amicably. Mars in your worth sector is at odds with Neptune, so your friends may not agree with how you're handling your money or possessions or acting on your priorities, and you could feel confused or even deceived. But Mars is playing nice with Jupiter, enabling you to use your resources well and get tons done. You can acquire new skills by jumping in with confidence and making the most of your talents. A strong work ethic will do wonders for you.
May 21–June 20
With Mercury—your ruling planet—skipping through your network zone and meeting up with Uranus there this week, spur-of-the-moment interactions with friends will be extra stimulating and group brainstorming can generate original ideas. Avoid jumping to conclusions about people, though. Merc is also vibing with Saturn in your one-on-one angle, setting the stage for a serious conversation with another individual. If you had a misunderstanding with someone during the recent Mercury retrograde, this planetary confab makes it easier to hash out your differences and repair the damage. A full moon in your efficiency corner offers the perfect excuse to kick a bad habit or drop something from your schedule. A work project might come to fruition, but you may also need to watch out for emotional meltdowns on the job. A health crisis can put you on notice, signaling that it's time to ease up and take better care of yourself. If you're not content with your job or everyday life, contemplate how you can devote more time to work that fulfills you deeply and makes your soul sing. With Mars in your sign going up against Neptune in your ambition house, you're driven to pursue your agenda, but you're still unsure about where all your efforts are going to get you. Don't let authority or bureaucracy discourage you, and don't let anyone tell you that you're on the wrong course. Evaluate whether your actions are advancing your dream as you define it. A Mars-Jupiter collaboration gives you the courage to go all out in expressing yourself, enjoying life, showing off your creative side and pursuing what—or whom—you love.
June 21–July 22
Don't fly solo this week because the sun-Pluto conference in your network and partnership houses can help you to forge a powerful connection. You need to let people know who you truly are in order to have meaningful relationships. If you meet someone new, he or she is liable to make a strong impression on you—and it's also quite possible that you'll deepen an already existing bond. If a friendship changes now, it's almost certainly for the best. When Mercury and Uranus meet up at the top of your chart, your mind may jump from one idea to another, especially when you're thinking about goals or speaking to authority figures. You might run with something new in your head and balk at answering to another person. But Mercury is also joining forces with Saturn in your productivity corner, helping you to back up your talk with solid work and a sharp critical faculty. With Mars hiding out in the last house of your chart, you should be willing to work behind the scenes without a lot of commendation. A Mars-Neptune squabble suggests that a yearning to escape could lure you off track, and you may find a change of scene will replenish your inspiration. Examine your behavior and consider possible subconscious motives rooted in your belief system. A Mars-Jupiter summit favors bold self-confrontation that enhances your understanding of yourself. You should also be able to accomplish a great deal around the house during this transit. The full moon, however, gives you permission to also get out and play. Indulge your inner child, creative streak, wanderlust or romantic side at some point during the week.
July 23–August 22
Your ruling planet is shining at the top of your chart and harmonizing with Pluto in your productivity corner this week, which bodes well for your ability to prove yourself in your profession or in public. You're focused on goals and capable of shouldering a lot of responsibility with composure and confidence now. Seek to align your heightened ambition with the gradual evolution of your job situation or day-to-day life, factoring in what you want to be known for and what you're good at. The full moon at the bottom of your chart nudges you to strike a balance between your outer life and your inner life, and it may use a domestic or family matter to get your attention. Spending time alone to process private emotions will be cathartic. On the other hand, with Mercury and Uranus coming together in your expansion zone, you're inclined to take a trip, learn something new and shift your perspective. Opening your mind to the new and unfamiliar will feel exciting. And since Merc is also gelling with Saturn, a planned adventure should go well—plus you'll find it fairly easy to express your views and creativity with an effective combination of self-assurance and knowledgeability. Most importantly, in the process of learning more about life and the world, you'll learn about yourself. Mars and Neptune are quarreling in your group and closeness houses, implying that friendship and intimacy will be a confusing mix. Trying to coordinate your agenda with that of someone else could leave you bewildered. But a Mars-Jupiter connection encourages you to actively network with a wide range of people. You'll have no trouble making advantageous contacts.
August 23–September 22
This week's Mercury-Uranus rendezvous takes place in your depth sector, which could mean a few different things. You might have a surprising conversation with someone close to you, uncover a secret or make a breakthrough in your psyche or in an investigation. In any case, revelations are fairly likely. Your ruler is also vibing with Saturn in your foundation angle, reinforcing the theme that probing beneath the surface will be worth it. Introspection can enable you to come to grips with the past; talking to a family member can settle matters; and confiding in someone you trust will help you sort out your emotions. Meanwhile, the sun in your exploration zone is clicking with Pluto in your joy house, underscoring the value of getting beyond the familiar and exposing yourself to new people, places, ideas and experiences. Personal growth and profound pleasure go hand-in-hand now. The full moon could bring new information to light or trigger a development involving a sibling or your community, and a flurry of communication or activity in your surroundings might overwhelm you. Your words will carry a lot of feeling, and you may be moved to pour your heart out to someone, particularly since this lunation is connected with romantic Neptune and intense Pluto. Mars is arguing with Neptune, hinting that you feel like someone isn't supporting your ambition and is perhaps even causing you to doubt yourself. If you know where you're headed, stay the course. Mars is gelling with Jupiter in your worth house, meaning your efforts are apt to pay off financially, boost your confidence or make you more hopeful about being able to take care of your own needs.
September 23–October 22
Thanks to a sun-Pluto hookup in your depth and feelings zones this week, an intimate encounter is likely to evoke powerful emotions, while shining a light on something in your psyche can facilitate profound transformation. Your relationship with a parent could shift perceptibly if you have a heart-to-heart, and delving into the past or your family history can change your feelings for the better. Mercury's meeting with Uranus in your one-on-one angle will rev up your encounters with other individuals, and someone could be the bearer of startling news. You never know what people will say under this transit, but that's not necessarily a bad thing. Another strong possibility is that you'll run into a person quite unexpectedly. Merc is teaming up with Saturn in your cognition-and-communication house, paving the way for a serious conversation if there's something on your mind. Do engage in dialogue because it will help you to make sense of your thoughts. Watch your spending when a full moon lands in your worth sector, intertwining your mood and your material needs. Thankfully, the moon is forming a beneficial angle with Neptune in your productivity corner, which suggests an influx of income tied to creative work. Decluttering your workspace would be a good use of this transit. Mars isn't getting along with Neptune, so your drive to broaden your horizons and fight for what you believe in could be slowed if you're not feeling well; you need to do something for others; or you're unclear on details. Luckily, Mars is forming a partnership with Jupiter in Libra, so learning experiences are within reach. Standing up for what's right, exploring new places and expanding your mind will all stimulate personal growth.
October 23–November 21
Due to the sun and Pluto syncing this week, you might get into an intense discussion, change your mind about a person, express yourself with significant force and make a big impression on others. And someone could have a very strong impact on your thinking as well. A Mercury-Uranus meetup in your productivity corner invites you to take a different mental approach to a task, problem or time management, and it also encourages innovative thinking on the job. Try not to make quick assumptions about colleagues—or your health—or criticize others before stopping to consider what you're saying. Mercury's link with Saturn favors detailed financial planning and a thorough inventory of your assets and resources, including your natural talents and acquired skills. Aim to figure out how to align your work with your core values and how to improve your security along the way. The Scorpio full moon is bound to make you more conscious of your needs and could bring out very strong emotions in you. Put yourself first without infringing on anyone else's rights. Ponder what (or who) in your life is past its expiration date. This lunation symbolizes a healthy letting go. Its ties to Pluto and Neptune can help you to express what you're feeling, so don't silence yourself. A Mars-Neptune feud makes sex and love an even more complicated mix than usual, and you could notice a disconnect between your romantic ideals and the effort required to make a relationship work. And fyi, this planetary argument means you should steer clear of financial gambles. A Mars-Jupiter alliance suggests being brave enough to get close to someone or to confront something in your psyche will allow you to understand yourself better and will also promote universal empathy.
November 22–December 21
With the sun in your productivity corner, you're determined to get things done, and his conference with Pluto in your worth house this week hints that your hard work can generate a shift in your finances or your self-esteem. The power of your priorities can fuel you to make significant headway now. A Mercury-Uranus rendezvous is likely to bring out your sense of humor and your creativity, and if you're enjoying reading or writing, the time will fly by. You might blurt out your feelings impulsively or take a spontaneous trip. Any pleasurable mental exercise or creative writing will be helped along by Merc's connection with Saturn in Sagittarius. Clever ideas should come to you quickly, and you'll have the patience to organize them. This would be a good time to hatch a plan for future fun or have a substantial conversation with someone you care about. Mars in your one-on-one angle is tussling with Neptune, though, so an interpersonal conflict is apt to involve confusing emotions and could make you feel insecure or uncomfortable. In addition, your home life might be draining, and you could get into a disagreement over a domestic issue or taking care of a family member. Thankfully, Mars is harmonizing with Jupiter in your network sector, favoring teamwork, socializing and shared adventures. If you're going through relationship trouble, you can lean on your friends for support and wisdom, and they'll come through for you. The full moon may trigger a need to be alone to catch up on your sleep, unwind, daydream and reflect. Releasing something from the past will be a relief, so let it go.
December 22–January 19
Pluto in Capricorn forms a major connection with the sun in your fulfillment house this week, giving you permission to show the world the real you. Don't hide your light; express your whole self without apology. Pleasurable experiences can change you, so get out and enjoy life. Love is likely to be felt very deeply, and revealing the person you're becoming could attract someone who's right for you. The full moon in your humanity zone is also vibing with Pluto, and this might entail being there for a friend who's in crisis. A link with Neptune suggests you'll be able to feel—and convey—empathy for others in need, so don't hesitate to be supportive. If a group is no longer a natural fit for you, though, this is a good time to walk away. A Mercury-Uranus rendezvous at the bottom of your chart might signify unexpected communication with family or roomies or a burst of insight into your private emotions, childhood or roots. And Merc's partnership with Saturn—your ruler—encourages you to reflect on the past and listen to the wise voice in your head telling you to close a certain chapter of your life with no regrets or guilt and move on. Mars and Neptune aren't seeing eye-to-eye, so although you're driven to accomplish a ton, daydreams could lure you off-track or you might have a hard time conceptualizing exactly how you'll attack certain tasks or problems. The Mars-Jupiter confab will reward your hard work with greater recognition or responsibility. You'll have the energy to get a lot done and should note that a willingness to learn and to be of service will serve you very well.
January 20–February 18
Uranus is convening with Mercury this week, prompting quick trips, interesting conversations, brilliant brainstorms and lots of ad-libbing. The fast pace could generate nervous energy or hasty assumptions, so take a breath and count to 10 before you say something out of left field. Merc is teaming up with Saturn in your network house, enabling you to bounce ideas off people and get constructive feedback, and you can also network very effectively. If you need to have an important conversation with a friend, this transit gives you the green light. The sun is nestled at the bottom of your chart and syncing up with Pluto, implying that introspection and reflection on the past are powerful tools for achieving psychological transformation, so seek peace and quiet to look back and look within. Carve out alone time to tap into your deepest emotions and create a shift. If you're tempted to skim the surface of your subconscious and take short cuts to meaningful, healing change, remind yourself how strong you are. The full moon draws your attention to your outer life and could spell a change in your career path or life direction or bring drama with authority figures. Self-promotion is favored, particularly if you capitalize on your range of talents—and perhaps factor in your spiritual values as well. And be willing to bring a hidden side of yourself out; it can work for you now! A Mars-Neptune skirmish hints that iffy funds or confidence can mess with your pursuit of love, fun or fulfillment, but Mars's connection with Jupiter pushes you to go for it. Taking a risk to expand your horizons will pay off, so don't play it safe; go out on a limb!
February 19–March 20
This week's full moon is in cahoots with Neptune, and it falls in your perspective zone, signaling that a change of outlook may be just what you need. Explore your beliefs—including subconscious ones you absorbed growing up—and look at how they influence your self-identity and the image you project. Now is the time to water positive beliefs to grow a total self-affirming philosophy and cull negative ones that keep you from becoming the person you were meant to be. Your mind and soul are closely tied now, so learning and spiritual fulfillment are, too. You might complete a course of study or publishing endeavor or let your wanderlust inspire an adventure. A sun-Pluto summit nudges you to network, express yourself to a group and reach out to friends who have your back. Mercury's meetup with Uranus could trigger quick decisions and perceptions involving money, possessions or priorities, so while this is one of those weeks to watch out for impulse splurges, you might suddenly figure out a financial problem or finally choose to get rid of something you don't want. Merc's alliance with Saturn lays the groundwork for you to ask for a promotion, get your business plan together or plot your career path. You can also get a lot done at home, given that mobilizing Mars is surging through your foundation angle, but his spat with Neptune hints that a conflict with family or someone you live with could take the wind out of your sails. Try to understand your underlying motivations and how your behavior might be sending unintended signals. A Mars-Jupiter tête-à-tête tells you that unearthing buried anger can lead to greater self-awareness. And intimacy in the privacy of your home is also favored!
March 21–April 19
When Mercury aligns with Uranus this week, your brain may go into overdrive, bringing lightning-fast revelations and outside-the-box ideas—along with some nervous energy. Your communication could also speed up, resulting in hasty words or unexpected interactions. Try to relax if you get too wound up. Luckily, Merc is also allying itself with Saturn, preventing you from getting ahead of yourself. Test your insights against what you've already learned, trying to incorporate experimental thinking with know-how and convention to get the best out of exhilarating originality and established systems. Shape your vision of the future, fitting new pieces into the big picture. A sun-Pluto conference indicates that you're able to use the resources you have—including your talents and confidence—to continue your gradual progress in a different career (or life) direction. You can make a strong impression on authority figures, especially if you're clear on what you have going for you and what's most important to you. The full moon coaxes you to also consider the needs of people close to you and strive to get better at navigating the complexities of give-and-take. This lunation's links with Neptune and Pluto imply that the transformation of something within yourself or within a close relationship will work in tandem with embracing the spiritual dimension of your life; releasing the past; trusting your intuition; accepting that some changes won't happen overnight; and empowering yourself to achieve your goals. Your ruler is quibbling with Neptune, so your proactive mindset might be hampered by lingering uncertainty. But a Mars-Jupiter link encourages you to assert yourself in conversations, make an effort to learn from others and to learn about relationships, pitch your ideas to someone, and reach out to many people in order to make beneficial contacts.
Follow @astrotherapist on Twitter and email email@example.com to schedule a reading over phone or Skype. Available in-person in NYC! $125 for 60 minutes, $150 for 90 minutes.


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In our final episode of Season 1, we're recapping what the last year has looked like for our content – and looking towards the future.
We're so grateful for this first year – for our guests, their stories, YOU (our listeners), your feedback and engagement, the Young&BosSHE community, our BosSHEs (all around the world) and the ways in which our entire BosSHE world has impacted the lives of so many over the last 12 months and throughout Season 1.
12 months – 12 episodes – 15 guests – and so many essential topics, topics that matter to SHEs everywhere.
Our team is so grateful for the stories we've had the chance to share and for you, the SHEs who continue to listen to us.
In January, we'll launch Season 2, and we're SO excited. We'll follow our same interview format based on our monthly content themes, and you'll have the chance to continue hearing from powerful SHEs as we celebrate their stories.
In the first quarter alone, we'll speak with a sex educator who is passionate about preparing parents for their miniSHEs' tough, but essential questions, we'll talk with a successful business owner who is dedicated to weaving service and mission through the strands of her day to day and we'll sit down with a graduate student and LGBT advocate whose journey has been watched by many. And those are just the episodes we'll record before the year of this year.
We're excited, we're ready and we're dedicated to bringing these stories to you in the ways you want to hear them. So let's chat. Let us know what you like, what you don't like, what we're missing and where we're winning. SHEspeaks is for you, all the SHEs, and we want to give you what you're looking for. Send me an email at email@example.com. I want to hear from you.
Finally, let me thank you for your dedication to this work. When YBShe began, as a happy hour dream between a group of big-dreaming-grad-school-young-professional-SHEs, we weren't sure where we'd find ourselves. And now, we couldn't be happier with where that is. So, for the final time this Season, let me continue to remind you, in a world that needs so much love and kindness and warmth and peace and goodness and light and comfort –
SHEs everywhere, this one's for you.
Want to catch up on the rest of Season 1? Head to our podcast homepage to listen to all eleven episodes!


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Is there a way to determine the default ordering when viewing a feature's related records in an ArcGIS Online web map?
The case is that when in Collector viewing a feature's related table, we want to sort the related records by a date field. In the web map pop-up configuration it has a setting to sort based on a field, but when opening this setting for the table, the resulting sort field options are from the feature class and not the table itself.


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All information contained within this site is for reference purposes only and not intended to substitute for the advice given by a pharmacist, physician, or other licensed health-care professional. sammysoap products are for external use only, and as such, effects of ingredients vary. sammysoap products have not been evaluated by the FDA and are not intended to diagnose, treat, cure, or prevent any health condition or disease. Before using any essential oil product, read our page Essential Oil Safety located in the footer section of the homepage. Contraindications are also listed in Essential Oil Safety. Even pure, natural ingredients cause some individuals to develop an allergic reaction. As with any product, discontinue use if you experience discomfort or other indications that the product may not be appropriate for your individual body chemistry.
$ 23.95
Pure Therapeutic Grade Organic Sweet Almond Oil All Natural Face and Body Oil, Aromatherapy Base, and Carrier Emollient Botanical Name: Prunus amygdalus var. dulcia Method of Extraction: cold pressed from ripe...
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Pure Therapeutic Grade Virgin Organic Argan OilAll Natural Face & Body Moisturizing Oil Aromatherapy Base and Carrier Oil Botanical Name: Argania spinosa Method of Extraction: cold pressed and unrefined Plant...
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Pure Therapeutic Grade Organic Avocado Oil - Unrefined All Natural Face and Body Oil, Aromatherapy Base, and Carrier Emollient Botanical Name: Persea americana Method of Extraction: cold pressed Cultivation Method:...
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100% Pure Organic Unrefined Cocoa Butter All Natural Face and Body Oil, Carrier Oil, Body Emollient Botanical Name: Theobroma cacao Method of Extraction: expeller pressed & unrefined Cultivation Method: organic...


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The Most Epic Beaches in the World
White and soft sand, palm trees, impressive size cliffs, and the ocean. At least a few vacation days in one of the seven most beautiful beaches in the world would make a tourist trip just as good as a fairytale. Of course, it is easy to be biased about it, but all of these beaches and places we are going to talk about today are


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KS KitSound iD On-Ear Headphones with Microphone and Multi Function Button for Smartphone/Tablet
Introducing the KitSound™ iD Headphones
Not only do the KitSound iD headphones look great, but with their 40 mm drivers and super-soft ear cups they sound and feel great too.
Be Unique
The KitSound iD headphones come in a range of bold colours so you can express your individuality and make a statement with the design that suits you best.
Not Just About Looks
As well as giving a balanced sound to your music, the KS iD headphones give you complete control with a multi-function button and in-line mic, and they even fold up to a compact size for easier transportation. What's more, their swivel ear cups give flexibility and the 3.5 mm jack means they're compatible with most smartphones, MP3 players and tablets.
Ultra Comfortable
Their exterior may be tough and robust, but the soft ear cups and adjustable headband make these headphones really comfortable to wear.
The KitSound iD Headphones
In the same way that rave did in the 1980s, EDM is taking over clubs and festivals all around the world, provoking the return of neon body paint, fluffy boots and glow sticks - and now you have the KitSound iD Headphones to match.
About KitSound
We are craftspeople. We are musicians. We are KitSound™ and we all commit ourselves to achieving one shared goal: Bringing people closer to their music. By understanding music we stay true to its craft. Pure, rich, incredible sound. We settle for nothing less.
Frequency response: 20 Hz - 20 kHz
Sensitivity: 105 dB
Drivers: 40 mm
Cable length: 1.2 m
Speaker magnet: NdFeb
Jack plug: 3.5 mm
Avoid using headphones with the volume turned up for an extended period of time. Doing so can damage your hearing. It is advisable to keep the volume at a moderate level at all times. For your own safety, please do not use when driving or cycling.


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Image editing issues with Fireworks - What am I doing wrong?
All I am trying to do is make a 600x450 image that has text on it. I want to use it for Craigslist. I downloaded Fireworks 8 because I have some familiarity with it, created a white canvas that is 600x450, clicked the text button, added the text, adjusted it accordingly, optimized it, and then exported it.
I go to upload it to Craigslist, and it will not accept it. Just to make sure that it wasn't a CL issue, I tried uploading another image, and it worked fine.
What am I missing here?
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Maguey Pon Pon bag
Precio: $110.00
Me llamo: Maguey Pon Pon bag
Soy de: Aldama, Chiapas
Descripción: José and other men in his village laboriously hand weave these beautiful bags from the maguey plant, the same plant used in the making of mezcal. The leaves of this spiny plant in the agave family are cut, then pounded to extract the fibers. The fibers are repeatedly washed until they are a pale straw color, then spun into a sturdy cord that is then woven into a sturdy bag. Each bag takes two months to create.
Note: Each bag is unique and varies slightly. Please indicate in a note if you have preference for tassel color, we will try to match, but cannot guarantee.


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We have a new team member in training and last night I started him on the path to craft beer excellence by introducing him to the myriad of aromas and flavors that are craft beer. He indicated in college he did not have the funds to enjoy much craft beer and so Blue Moon and Sweetwater 420 were about as adventurous as he ever got. I decided to start him off on training wheels with the Mother Earth Weeping Willow Witbier, but followed that up with Noda Coco Loco and finally hit him with Big Boss High Roller. Time will tell if I've created a monster or not, but he was ready for that fourth beer when I told him I needed to call it a night. I hope I taught the 22-year-old tot at least a few things about beer and it will at least whet his appetite for more craft beers in the future.
PS: Don't give beer to babies or in the US those under 21. 😉


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Amy's Art Journal
My sketches, drawings, and paintings as I learn new skills.
Tuesday, August 28, 2012
Ewe & Lamb, Ottoman
6" x 8" watercolor paper, mechanical pencil, August 13, 2012
6" x 8" drawing paper, graphite pencils 4B - 6H, Au. 16, 2012
The ewe and lamb were a quick sketch from the cover of the Dharma Trading catalog, there were four lambs but I only drew the two. Animals take a lot of care, proportional and texturally, but I think I did pretty well. I got the wide open eyes expression on the lamb, and the sleepy guarded look on the ewe. I got a set of charcoal sticks, pencils and graphite pencils. "Trying to get a feel for the artists pencils 6B - 6H and the charcoal pencils, soft, medium and hard. I did not like the charcoal pencils, too soft. The harder pencils were nice, still smudged and gave me detail, but they were all very hard to sharpen. The metal sharpener that came with them was awful, but my Mary Kay one was great, a much finer cutting edge. I'm sure I will just need to get used to the softer pencils and not trying to get too much detail from them. Broad strokes, and they'll be great for rubbings." The old ottoman and the oriental rug are in my living room, maybe someday I'll do a bit of the rug in color.
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Amy Art Quilter & Fyber Cafe
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A consultant is sought, with a deadline of 26 August 2020, to work with the Secretariat's Scientific and Technical Assistance Branch on chemicals and waste management during public health emergencies, conflicts and disasters.
Now available online: Overview of concept notes for voluntary contributions for implementing the Basel, Rotterdam, and Stockholm conventions, as approved by COPs in 2019.
The English advance version of the report of the twelfth meeting of the Open-ended Working Group (online segment), held on 1-3 September 2020, is now available.
Children and exposure to hazardous pesticides: risk reduction strategies and the human rights-based approach" is the title of this Spanish-language webinar, on 29 September 2020.
Representatives from the Barcelona Convention, CITES, Climate Change Convention, Convention on Biological Diversity, Minamata Convention, Montreal Protocol, and the Rotterdam and Stockholm conventions, join the Basel Convention's Implementation and Compliance Committee online to discuss ways to better prevent and combat illegal traffic.
Back to school, back to university, back to the office? Snap the plastic waste you encounter and you could win the Plastic Waste Partnership's photo contest, deadline 30 September.
The 16th meeting of the Chemicals Review Committee concludes successfully online with two chemicals recommended for listing in Annex III of the Rotterdam Convention at the next COP.
The Basel and Rotterdam conventions continue to grow as Tuvalu becomes the 188th, and 163rd Party respectively, with into force on 19 November 2020.
The new call for proposals will be presented and discussed during these Basel Convention online meetings.
Having recently deposited its instrument of accession WITH the UN Depositary in New York, the convention will ENTER INTO FORCE for Algeria on 19 October 2020.


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New mobile web app from Affygility Solutions provides a simple, affordable way to access EHS compliance and corrective action information from the convenience of your touch-screen smartphone. Works with iPhone, iPod touch, Android, Blackberry.
Tag Archives: mobile phone
Get the latest potent compound safety news on your smartphone!
At Affygility Solutions we know how busy your schedule can be, that's why you can now access the latest...


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The Cayman Islands has announced its selected athletes set to compete the 2018 Commonwealth Games. this April. Of the 22 athletes selected across 7 sports, 4 swimmers will be headed to the Gold Coast.
Both David Ebanks and Lauren Hew competed at the 2014 edition of the Games, with Ebanks' highest finish coming in the 50m breaststroke where he wound up 19th. He is slated to compete in the 50m and 100m breaststroke again this year. Hew finished 14th in the 50m back and 15th in the 200m back, while also getting on the board in18th position in the 100m back at the 2014 Commonwealth Games. She is expected to compete in the 50m free, 200m free, 50m back and 100m backstroke this time around.
Iain McCallum and Alison Jackson are joining the aforementioned in the Gold Coast as well.
Per The Cayman Compass the Cayman Islands first competed in the Commonwealth Games in 1978 in Edmonton, Alberta, Canada, and have competed in every edition of the competition since then. Cayman's Cydonie Mothersill of track and field won the nation's lone gold medal in the 200 meters in Delhi 2010.


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Behind-The-Scenes Jobs Of The Academy Awards
For most people Oscar night is a time to kick back and relax, to place bets on the winners and debate which of the losers was robbed, to take in the elaborate dresses, and to cringe internally as the orchestra cuts off acceptance speeches with cheerful abandon. But for a small army of professionals working in the entertainment industry, Oscar night is a job like any other, with the same slip-ups and technical issues that are common occurrences in the world of live television.
Sure, you have your directors and screenwriters, the creative masterminds celebrated by the show itself. But then you have the other, less glamorous but equally important jobs, the ones without which there would be no show at all. And while there will probably never be an award for Best Teleprompter Operator, well, maybe there should be. We've rounded up some of the essential jobs of the Oscars, so that they too can get their moment in the spotlight.
1. Script Coordinator
Average salary: $43,000
Everyone knows what a screenwriter is (unless you're one of those people who think the actors make up the words as they go along), but their role is sometimes insulated from the logistical demands of the production process. That's why events like the Oscars hire a script coordinator to run point between the writing department and production team. The tasks can range from rote (printing out dozens of copies of the script) to highly specialized (annotating it as it evolves over numerous revisions). So when you hear the words coming out of a presenter's mouth, don't just think of the person who wrote them--think of the script coordinator who brought them off the page and onto the airwaves.
> Find a writing job
2. Audio Mixer
Average salary: $35,000
If you're a regular concertgoer, audio mixers are a familiar sight. You know, the guy standing at the back of the house, bending studiously over a mixing console that looks like it's been lifted from the bridge of the Starship Enterprise. The Oscars have audio mixers too; from the orchestra to the audience to the lavaliere microphones pinned to the presenters' lapels, there's a lot of sound to process and render coherent for viewers at home.
> Find a job in audio production
3. Seat Filler
Average salary: $0
Ever notice how the auditorium where the Oscars are filmed is always packed to the gills? A casual viewer could easily get the impression that the entire population of California consists of celebrities and hotshot directors. In fact, though, producers hire "seat fillers" to do exactly what the name implies. No, it's not a paid position, but it's still a chance for non-industry types to attend the ceremony and get a hit of stardust. But unless you're a career extra, it's probably not worth adding to your resume.
4. Lighting Designer
Average salary: $49,000
Good lighting can mean the difference between someone looking like a movie star and a pitted, washed-out prune. It's up to the lighting designer to plot out the lighting plan for the show, a process as intensely choreographed as any ballet. It requires technical know-how along with a keen sense of the aesthetic, not to mention personalized knowledge of what kind of lighting the presenters prefer. You don't want Judi Dench complaining that her forehead looks too bright.
> Find a job in the lighting department
5. Producer
Average salary: $65,000
When we think of a director, we get a clear image in our heads: the megaphone, the folding chair, "lights, camera, action!" But what about producers? Despite filling an essential role, they remain somewhat mysterious in terms of what they actually do. Here's a primer: they hire the director and other key members of the crew. They handle the budget. They serve as the logistical brain for the entire project. There are many different kinds of producers, from finance-oriented line producers to deal-making executives, and a show as complicated as the Oscars is bound to have a whole slew of them.
> Find a job as a producer
6. Set Designer
Average salary: $58,000
Don't get us wrong, the Emmys and the Grammys have their share of spectacle, but the Oscars are on a whole different plane of glittery pomp and circumstance. Maybe it's the sense of heritage--the first Oscars were presented in 1929, and they remain a distinctly American endeavor. But the show's set designers are also responsible for preserving some of that old Hollywood glamour, with decor that echoes the shiny, art deco past while edging the broadcast into the clean, digital present. You didn't just think that giant Oscar head behind the podium got there all by itself, did you?
> Find a job in the set department
7. Security Consultant
Average salary: $44,000
In the world of security, the Oscars rank somewhere between Disney World and a heavily traveled airport--in other words, they're pretty freakin' secure. With so many celebrities and industry heads in one place, it's up to the production's security team to make sure everyone gets where they're going safely, and that the sketchy dude hanging around the red carpet doesn't try to lob a banana at Ryan Gosling's head. And most importantly, they make sure those little white envelopes remain sealed until the big moment.
> Find a job as a security consultant
8. Production Assistant
Average salary: $36,000
Production assistants are the up-and-comers of the television world. They're usually kids, fresh out of college, with a microphone headset and dreams of working in the entertainment industry. PAs typically help set up and break down equipment, but their job requires them to assist wherever they're need (which could be anywhere from the electrical department to making sure everyone's walkie talkies are functioning properly). It's a job for the eager-to-learn, but on the Oscars, even production assistants need to be experienced and highly disciplined.
> Find a job as a production assistant
9. Camera Operator
Average salary: $37,000
Saturday Night Live's camera crew ranges between eight and ten people. The Oscars, in comparison, have more than 20 working behind the lens. Whether they're using traditional cameras, Steadicams, or looming crane arms (responsible for that distinctive swoop from ceiling to stage), the show's camera crew is responsible for capturing the ceremony with flair, as the director cuts between their individual feeds on the fly. Even with dozens of cameras pointed at the stage, you need to be absolutely focused--in every sense of the word.
> Find a job as a camera operator
Photos: Flickr; Getty Images; Shutterstock; Shutterstock; Getty Images; Flickr; Flickr; Flickr; Flickr


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Shoulders and arms, bones carved from hickory, rawed by fire. I sleep between three and four hours a night. I don't know, because time is mud. I sit at the kitchen table until Connie comes down, and she complains when the coffee pot is dry. She taught me how to make a fresh pot. Everything is on the counter: the filter, the Folgers, the measuring spoon. I make a second pot for her when I hear the creaking floorboards. I am mostly neat, but it takes all my concentration, and my hands are still clumsy. But I do it. She growls when there are grounds in her cup or when the floor is splashed. Then do it yourself, I growl back. Do siblings ever stop being children towards each other?
The hours between pots of coffee are long.
My fingers roam the plastic tablecloth, drawing circles and lines, etching a shape from what I know is now mine. Fingernails unfurl a flourish of shapes, an open sky cluttered with dust. It's playful, and I am playing. The pain falls behind the bones and I become a boy drawing in the dirt with a stick.
The canvas. The real thing. A thing to be dressed with real paint and real strokes. It calls me and it terrifies me. This big canvas that smells like linen. I can't see it, but I know what it is. An emptiness to be filled, demanding purity. If not of talent, of intent. The canvas knows the difference, even before the eyes.
Oh, but this doubt. I cry into my hands, afraid of this empty space I need to fill. What if my hands won't work, or the pads of my fingers lose their touch? Blankness stares at me and I stare back, besieged, all hesitation and fear. Focused and focused and focused on filling the blankness. I am a child, beginning with nothing and wanting everything. My eyes are mostly dry when I hear the floorboards creak.


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Back in 1986, Mat Warren recorded and released The Way To My Heart on Sunset Records. The Way To My Heart which features legendary Chicago house diva Pepper Gomez who wrote the lyrics to this classic.
Despite being regarded as a classic, Matt Warren decided to remake The Way To My Heart when he signed to Wake Up! Music and began work on his comeback album Music is My Life. It was released by Wake Up! Music on the '19th' October 2018 and featured a brand new remake of The Way To My Heart.
Just like the original, the remake of The Way To My Heart was featured Pepper Gomez who co-produced the Music Is My Life with Matt Warren using her MyMy Lady G moniker. One of the album's highlights is the anthemic sounding The Way To My Heart, which features a very special video.
The video to The Way To My Heart was produced by Marcus Mixx Shannon and features the incredible visual arts of thirteen year old Frankie Wolfe. She's a member of Wake Up! Music's Youth Arts Support Initiative (YASI) which is dedicated to Nu, You and Youth and has a bright future ahead of her.
Speaking of Nu, what's your favourite version of The Way To My Heart? is it the old or Nu?


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It's true! Your friends and family do play an important role in your oral health. An assistant professor of health policy and health services research at Boston University came to this conclusion after researchers conducted a study on oral health among residents of a particular area of Boston. The purpose of the study was not only to determine how best to distribute information to people about their oral health but about their overall health as well.
Although you don't want to give up on family dental care at your Amherst dentist, it's interesting to consider how your social network might influence the way you take care of your teeth and gums. Read on!
How Your Friends and Family Provide Influence
The study pointed out that although women can be motivated by doctors on how to care for their children's physical and oral health, changes were usually short-lived. But when the advice came from those people close to these mothers—friends, family members, and others within their social circle—the advice tended to be followed. What's more, the advice actually made a difference in how the mothers cared for their children.
The conclusion is that for the most part, people are more inclined to listen to and follow the advice of people they know—and know well.
The Basics of Dental Health
Your friends and family might have great advice on keeping your mouth healthy, but nothing replaces visiting your dentist twice each year for examinations and cleanings. Good home care—brushing and flossing regularly—is also important. Prevention is always better when it comes to dentistry, and it means you can often avoid extensive—and sometimes expensive—treatment!
If you have questions about taking care of your oral health, be sure to ask your Amherst dentist Dr. Kenneth Edwards about family dental care. Give us a call today!


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Kristen and Mike share insights and stories on how they create personal awareness to improve the quality of their personal and professional lives.
Kristen Prinz & Mike Lauesen
Mike Lauesen, business coach, former Founder and CEO of Nicoat, and author of Getting off the Treadmill discusses a few tools from his novel on how to shift your life in the right direction to embrace the joys of life
In this episode of "Tales from Around the Water Cooler":
Mike's Toolkit:
- Pay attention to what is going on in your life and find balance.
- Slow down.
- Show gratitude.
- Take risks, but first take the time to evaluate and study the risks.
Check out Mike's website and book, Getting off the Treadmill.


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Whether you are celebrating with a big party or enjoying time with family and friends at Christmas, Beyond the Barn can supply beautiful festive arrangements for your home or party venue – or why not make a gift of flowers this Christmas?
We create a wonderful selection of Christmas door wreaths made with fresh flowers and foliage. We also hold wreath workshops so that you can come and learn how to make a bespoke decoration for your door. Our Christmas workshops are a much enjoyed morning where you can be as creative as you dare. This year we will be at West Stoke Farm, Stoke Charity on 11th and 12th December 2018 from 10am – 12 noon. We provide everything you will need to create a gorgeous wreath for your door as well as plenty of refreshments to keep you going. The cost is £55 per person and booking is essential. Call 07957112806.
We are very excited to be demonstrating our wreaths at Hotel du Vin, Winchester if you'd like to join our workshop there on the evening of 11th December from 6.30pm then please call the hotel on 01962 896329
We also make up table centres with candles, flowers and festive foliage, we hang fir garlands and decorate Christmas trees. Give us a call to chat through your ideas for Christmas and the festive season.
A few ideas…
… any further questions