text:
Attitudes of the General Public Toward Alternative Consent Models
Burns, Karen E A
Magyarody, Nora M
Duffett, Mark
Nisenbaum, Rosane
Cook, Deborah J
Bibliographic Citation
American journal of critical care : an official publication, American Association of Critical-Care Nurses 2011 Jan; 20(1): 75-83
To assess the general public's attitudes toward various consent models and data management strategies for critically ill adults eligible to participate in a low-risk randomized trial.
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Miller Bedroom Collection
From its legs to its trim, the Fur Elise Armoire feature elegant, stately details that impress.
Handcrafted with solid hardwood, with the utmost attention to fine details, the Amish Fur Elise Armoire promises to become an heirloom piece that will last generations! This elegant Armoire is perfect for those looking to bring sophistication into their bedroom. Treat yourself to the finest quality bedroom furniture with our Miller Fur Elise Collection.
Fully customizable and built to order, this Amish Fur Elise Armoire is available crafted from your choice of six different quality wood species and five different finishes. The Fur Elise Armoire features full extension side mounted slides, and two adjustable shelves.
This elegant piece of Amish bedroom furniture is also perfect for a subtle entertainment center in the bedroom with pocket doors, VCR shelf, TV swivel, and knockout back to accommodate for plug-ins.
Call us today with any questions on our elegant Fur Elise Collection at 1-866-272-6773. We have Amish Furniture Specialists waiting to help you. The Quality of our products is only matched by the quality of our customer service. Fur Elise - the bedroom you'll want to come home to.
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subset: commoncrawl


text:
Bunker Hill medley
Edison Military Band.
Issue Number:
Edison Gold Moulded Record: 9025
Release year:
This cylinder has not been digitized for online access. Learn more about our тАЬadopt-a-cylinderтАЭ program and to adopt this cylinder, use our credit card payment option or donate by check.
Edison Gold Moulded Record: 9025.
Year of release from "The Edison Phonograph Monthly," v.3 (1905/1906).
Introducing "Bunker Hill," "I've Got a Little Money and I Saved it All for You," "Tammany," "My Carolina Lady" and "The Preacher and the Bear."
Library's copy one not transferred due to poor condition.
Group Name:
Original Item Information:
Cylinder 11085тАФCopy 2тАФSpecial Coll., Performing Arts
Cylinder 6857тАФCopy 1тАФSpecial Coll., Performing Arts
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text: Bend Like a Branch by John Lithgoat published on 2012-11-19T03:44:50Z god i wish i could just break some hearts and never care about the damage i leave in my wake but i must be held in high regards all the time and i don't know why cause i just want to walk away from all the eyes and i know that i think bigger than i talk than i act and most days i'm thankful for my nature but today i'm thankful for my resolve and people change all the time i guess i'm the mother who lets her babies drown and at the last minute i pull them back up for air and regret it every time and then hate myself for thinking such awful things but you've gotta be a terrible person at least some of the time and most days i'm thankful for my nature but today i'm thankful for my resolve and people change all the time i guess but i'll get out of the habit of bending like a branch i'm not going to fold after every hand and i'll get you down and you'll get me down just like the way it's supposed to be get out of my house you can come back when i feel like it Genre Punk Comment by John Lithgoat @zoraofficial: glad you dig our tunes and stuff and junk. we have our album (with a dif. version of this song) at http://johnlithgoat.bandcamp.com/ 2013/03/17 05:35:57 +0000 Comment by Tristan B. Very passionate vocals, respect 2013/01/18 23:37:38 +0000 Comment by Tristan B. This is so good, I'm really impressed, if I was a record label guy I would sign you. 2013/01/18 23:37:17 +0000 Comment by Tristan B. Yep! I like your vocal style a lot too. Good taste. 2013/01/18 23:36:20 +0000 Comment by Tristan B. Dude, INSTANTLY loved this guitar sound. Pretty sure I'm following you. 2013/01/18 23:35:30 +0000 Comment by Rooster/ Oh dude, this is superb. The riff, the drums, and the vocals are all fantastic. Great vibe and rhythm. 9/10 2013/01/18 23:29:24 +0000 Comment by John Lithgoat @dominicsutton: lol yeah only realised that afterwards 2013/01/09 15:04:12 +0000 Comment by Dominic Sutton This is my new fav lithgoat song <3 2013/01/03 12:23:52 +0000 Comment by Dominic Sutton Was that ment to sound like paranod android? 2013/01/03 12:13:00 +0000 Comment by Dominic Sutton Dude this bit sounds exactly lke a radiohead song? 2013/01/03 12:12:42 +0000 Comment by METROPOLITAN INTENT LOVE THIS ONE!!!! 2012/12/15 22:32:52 +0000


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Paul SwifkaChico, California, US
My name is Paul Swifka, I am 30 years old I live in Chico, CA. I've worked in Radio and the Voiceover Business for many years, my delivery is announcer type, dramatic, Movie Trailers.... I do Imaging for Radio Stations, Concerts Spots, Documentaries and more.
English, English (North American), English (British), English (Australian), English (New Zealand)
Australian, British, New Zealand, North American
Middle Aged
Special Skills
Audiobooks, Business, Documentaries, Educational, Internet, Jingles, Movie Trailers, Radio, Telephone, Television
15 years in Radio on Air, and in production. Familiar with Adobe Audition, Digidesign Pro Tools and have voiced and produced thousands of commercials for radio and TV along with other voice over projects
Graduated from the Art Insitute of Seattle with a Communications degree and a major in Broadcasting. I am certified in using Pro Tools and Adobe Audition.
Audio Technica 3035
Computer & Software
Self Built PC Windows 7
Special Equipment
Adobe Audition, DBX Tub Pre amp, Tascam interface
Delivery Methods
email mp3, FTP, snail mail
Turnaround Time
Service Description
Money Order or Cashiers check
Voice Over Clients
Pepsi, Sprint, MGM, Paramount, Kellogs, Kraft, TDK, Engelbrecht, Robinson Rancheria, Gladiator Challenge, Burton, PBS, History Channel, Discovery, ect........
Payment Terms
Hire Paul as a voice actor. Payment is made through Voices.com SurePay, an escrow service that guarantees your work is done to your satisfaction. Send payment securely by Visa, Mastercard or PayPal through Voices.com then download your files from the website.
Watch a video to see how to make a payment
Next Steps
To contact Paul Swifka about your project, request a quote today. We'll walk you through the process step-by-step. It's fast and easy.
Hire Paul Swifka as a voice actor. Working with Paul Swifka is fast and easy. We'll walk you through the process step-by-step.
Request a quote for your project today.


text:
What ia eagle's effect of clindamycin??
What ia eagle's effect of clindamycin??
I've only heard of an eagle's effect of penicillin..
It refers to a paradoxical decrease in the efficacy of the drug at higher drug concentrations due to a large inoculum size. If you find a good explanation kindly share.
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text:
1. Stockton Spirit Festival
The Stockton Spirit Festival will be held on Saturday from 11 a.m. to 6 p.m. at Weber Point Events Center, 221 N. Center Street, Stockton. Set in a park-like setting, the third annual festival will include music, food and family-friendly activities. Admission is free. For more information, call 877-778-6258.
You must login to view the full content on this page.
Contact Pam Bauserman at 209-369-7035 or firstname.lastname@example.com


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by lisandra
(somerset nj)
I'm going through a very difficult time in my life. I don't know how I'm going to be able to provide for my 4 kids and be able to keep a roof over our heads.I'm out of work and its hard to get a job that will only be enough to pay for child care. Please pray for me and my family to be able to be financially stable. I know all things happen for a reason and i have all my trust in God.
Join in and write your own page! It's easy to do. How? Simply click here to return to Online Prayer Requests.
Click for Inspiration
50 Inspirational Bible Verse Pictures
See What Happens After A Single Act Of Kindness
By The End of This Video, Your Faith Will Be Stronger Than Ever
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text: This is the one you've been waiting for! This 3 bedroom + den is the largest available floorplan in Villagio at 1828 square feet under air. The view is incomparable to other units because of the expansive lake view with southern exposure. Diagonal tile floors, matching granite in the kitchen and baths, high end stainless steel refrigerator, upgraded washer/dryer, and 1 car attached garage are just some of the features that make this home stand out from the rest. This immaculate and well maintained home is located in the desirable community of Villagio in the heart of Estero. Multiple swimming pools, fitness center, onsite cafe, and movie theater are just some of amenities offered in this 24 hour man gated community.


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Jamie Clapp, 13, from Warmley was in the Cessna 150 when it crashed near a rural airstrip in Clutton, Somerset.
The teenager was a keen skateboarder and friends have posted a video on the internet showing him performing stunts.
Richard Badley, head of Mangotsfield School, said Jamie "was a popular, well-liked member of Year 9 and will be sorely missed by students and staff."
The head teacher added: "The school is doing all it can to support family and friends over the coming weeks."
The plane's 34-year-old pilot from Downend was also killed. He is not related to Jamie.
The aircraft has been moved from the crash site for examination and the Air Accidents Investigation Board (AAIB) is investigating the accident.
Ben Wills, from the AAIB, said: "I can confirm the incident took place and we are in the early stages of an investigation."
Most Popular Now | 56,514 people are reading stories on the site right now.";


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Property: Residence MiramasAddress: Angle Boulevard Khattabi et Rue Deraa | Gueliz, Marrakech 40000, Morocco
Location: Morocco > Marrakech-Tensift-El Haouz Region > Marrakech
Fitness Center with Gym / Workout Room Free High Speed Internet ( WiFi ) Free Parking Kitchenette Pets Allowed ( Dog / Pet Friendly ) Swimming Pool
Ranked #202 of 285 Specialty Lodging in Marrakech
Price Range (Based on Average Rates): $
Number of rooms: 12
- Official Description (provided by the hotel):
- Tastefully furnished & fully equipped apartments in fashionable "Gueliz", central Marrakech, within walking distance of restaurants, cafés & bustling nightlife. The mythical Jemaa El Fna Square is 5 min away by bus/taxi. Nightly rates are €60 for one-bedrooms, €105 for two-bedrooms and €140 for two-bedroom with private sunroof & pool. These rates include airport transfers, wifi internet and access to communal indoor pool & gym. ... more less


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Name:Human Intelligence Zealot
Aliases:HIZ, Hiz, Keven(Incognito)
Appearance:HIZ is 6"3' with a "perfect" build, combining top physical strength with the highest range of motion out of his joints. Keven also has shortish brown hair and blue-grey eyes
Personality:Keven is empathic towards humans and machines alike, and as such, he won't kill any being intentionally, but will rather incapacitate any threats physically or mentally through any means available to him. He also is very calm in every situation, whether in battle or in social situations, this allows him to coordinate strategies for nearly any situation
Though a bit outlandish in the way he does things, he will always put the well-being of others before himself, and hates it when others try to help him
- Flawless Coordination
- Peak Human Condition
- Accelerated Perception
- FemtoMechanical Body
- Regeneration
- Self-Power Bestowal(to an extent)
Story:Created by RIZ to be the perfect human, HIZ was designed to be the perfect representation of what a human should be (according to what RIZ believes). Sent out to teach others the err of their ways. Disallowed from killing anybody intentionally, he goes incognito under his alias of Keven (which he himself came up with). After several attempts in his own verse, he was sent out of dimension while simultaneously staying in his own dimension by an unknown force (for RP purposes :3). His current task is to incapacitate any who don't follow the rules set up by RIZ or any who would teach him the rules that are set up in other worlds


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Arugula Pesto Chicken Recipe
3 1 1
We had an abundance of arugula in our garden, so I turned it into pesto. The bold green color reminds my son of something The Incredible Hulk would eat. —Courtney Stultz, Weir, Kansas
Featured In: 33 Ways to Turn Rotisserie Chicken into Dinner
VERIFIED BY Taste of Home Test Kitchen
- 4 cups fresh arugula or spinach
- 1 cup fresh basil leaves
- 1/4 cup pine nuts
- 1 garlic clove, minced
- 1-1/2 teaspoons sea salt, divided
- 1/4 cup plus 1 tablespoon olive oil, divided
- 4 medium zucchini
- 1 rotisserie chicken, skin removed, shredded
- 2 plum tomatoes, chopped
- 1/4 teaspoon pepper
- Grated Parmesan cheese, optional
- Pulse arugula, basil, pine nuts, garlic and 1 teaspoon salt in a food processor until chopped. While processing, gradually add 1/4 cup oil in a steady stream until mixture is smooth. Using a shredder or spiralizer, shred zucchini lengthwise into long strands.
- In a large skillet, heat remaining oil over medium heat. Add zucchini strands and chicken. Cook and stir until zucchini is crisp-tender, about 4 minutes.
- Remove from heat. Add tomatoes, pesto, pepper and remaining salt; toss to coat. If desired, sprinkle with Parmesan cheese. Serve using a slotted spoon. Yield: 4 servings.
Originally published as Arugula Pesto Chicken in Taste of Home June/July 2016, p28
Reviews forArugula Pesto Chicken
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Reviewed May. 25, 2016


text:
Create a job
To keep your interviews organized and your candidates informed, you'll create a job description before you start inviting candidates.
1. Visit your Jobs page.
2. Click Create new job.
3. Add a job title, location, and description.
4. If you're on a Silver or Gold account, you have the ability to create a Custom Welcome Video. A Custom Welcome Video is a brief video that appears before your candidates do their interview for you. You can record one using a webcam by clicking Record New or embed a YouTube video by clicking Embed.
When you're satisfied with your job, click Save as Active and you're all set!
From there, you can set up user permissions to control which users on your account have access to information related to the job.


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Carnival Sensation
4 out of 5 stars
Download the FREE app and meet your ship mates!
It's not really bad. Most everything is free. Except alcohol and foo-foo coffees from coffee shop. Hot & Iced tea, regular coffee, juices, water are free. Pretty much all food is free. Room service free (except gratuity). Hubby and I typically get out with less than $700. Breakdown is typically $300 for spa day for the 2 of us, $200 bar bill for 5 days, $120 for gratuity, And the other $80 is gift shop, coffee specialty shop, casino.
Then just purchase by the drink. So much easier than carrying on and having to go back to your cabin every time you want a drink. You can carry 1 bottle of wine (per afult) to dining room and they will keep it for you there for dinners. But there is a corking fee. It's like $10 maybe $15. So your not really saving anything in the long run.
I know others have asked in the past, but I know things change. Anyone have recent experience with rental car at Fort Lauderdale airport and returning it to port with shuttle from car return to port? What companies did you use. Prices look like it would be cheaper or about same price as shuttle. Flying in day before so it would be nice to have set of wheels.
Read the best port reviews and tips for this cruise itinerary.
|Day 1
|Miami, Florida
|Day 2
|At Sea
|Day 3
|Ocho Rios, Jamaica
|Day 4
|At Sea
|Day 5
|At Sea
|Day 6
|Miami, Florida
A roll call is a space for members who are signed up for the same cruise (same ship & departure date) to connect.
Make friends BEFORE you sail, exchange tips on what to do onboard and in the ports and maybe even organize a shore excursion with your ship mates.


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Baseball's Hall of Fame seldom has lowered its standards for the sake of sentiment, and I'm hoping that record remains intact as the Veterans Committee scrutinizes a 12-man ballot that includes George Steinbrenner.
Judgment of Steinbrenner's credentials shouldn't get a boost because of the Yankee owner's death this year. If anything, voters should remember the honor will mean a lot more to the worthy candidates who are still alive, like Marvin Miller.
And without union boss Miller pioneering the way for the free-agent era Steinbrenner never would have been able to buy all those checkbook championships.
In terms of history and leadership, Miller is the best candidate on a slate that includes 288-game winner and operating-room icon Tommy John and one-time World Series-winning manager Billy Martin.
If Cooperstown is going to honor an owner, the next one in ought to be Charlie Finley, the irascible tightwad who was his own general manager and chief talent scout while the Oakland A's were winning three straight World Series.
Finley has never received the slightest whiff of approval from the Hall, because he rubbed so many people in baseball the wrong way. It will be a shame if that same fate befalls Miller.
Here's what else is on my lunchtime plate:
. . . Being loyal may be No. 2 on the list of Boy Scout laws, but isn't much of a priority in sports any longer. That's evidenced by Jimmie Johnson dumping the pit crew that helped him win four NASCAR crowns, and Jon Miller and Joe Morgan getting dumped from ESPN's Sunday night booth after 21 solid seasons.
. . . Worst place in the world to be a journalist right now is Russia, where reporters have been beaten and even killed recently. But they also aren't welcomed lately on the Auburn campus, where ESPN's Mark Schlabach was the target of angry hecklers because of his reporting on the Cameron Newton mess . . . But the War Eagle followers need to be honest, and admit that if archrival Alabama had a similar scandal brewing they'd be demanding that Woodward and Bernstein reunite to investigate.
. . . Tiger Woods finished last yesterday in that event in Thailand? You'd think the one thing he could still win is a skins tournament.
. . . Bud Selig is getting grief because he penned a letter recently saying he still believes the debunked fairy tale about Abner Doubleday inventing baseball. But I'm sure MLB's commissioner will clear this up, just as soon as he finishes this year's letter to Santa Claus.
. . . Shoutout to Gulf of Obama for taking a contrary view to yesterday's Halftime, with this comment about the NFL crackdown on helmet hits: "The NFL is turning into NASCAR with all these stupid new rules. Of course I don't want to see anyone get hurt, but things are starting to get really ridiculous."
. . . Oregon rightfully gets a lot of flak for its eye-jarring collection of football uniforms, but check out the school's new basketball court, which is as soothing as a walk in the woods.
. . . Bill Walton wrote a fine and touching eulogy for Maurice Lucas, the teammate that inspired the name of Luke Walton.
. . . Anyone who's a little too wobbly on their rollerblades lately might want to check whether they own one of the 29,000 pairs that are being recalled.
. . . Just when you think it can't get any worse for the Dallas Cowboys their website goes kablooey because somebody forgot to renew the registration. I'm guessing that before the season is over their artificial turf will get an incurable case of crabgrass.
. . . I have a tough time buying the belief that John Fox is No. 3 in line for the Cowboys job, after Bill Cowher and Jon Gruden. Dallas' fans are going to look at the defense-oriented Fox's 1-7 record with Carolina and see another Wade Phillips.
-- Tom Weir
Reid Cherner has been with USA TODAY since 1982 and written Game On! since March 2008.
He has covered everything from high schools to horse racing to the college and the pros. The only thing he likes more than his own voice is the sound of readers telling him when he's right and wrong.
Michael Hiestand has covered sports media and marketing for USA TODAY, tackling the sports biz ranging from what's behind mega-events such as the Olympics and Super Bowl to the sometimes-hidden numbers behind the sports world's bottom line.


text:
Reviewed By Steven G (Ketchum, ID) Reviewed for a 1986 Ford F-250 —5/10/2017 8:30 PM
This gate was all I expected. Installed in 2 min. Fits perfectly.
Reviewed By Judy S (Rawlings, MD) Reviewed for a 2015 Ford F-250 —12/30/2016 9:02 PM
I ordered the rack for my husband for Christmas. Was unsure what I was ordering and I used the chat option offered on the web site. It was extremely helpful ! Very happy overall with my experience on auto anything.
Know before you buy! Read customer reviews about Go Industries Truck Bed Accessories or ask our Product Experts.


text:
AU results 2016 Declared. AUCE B.Tech MS Result 2016. AU results 2016 AUCE Results step in au Results MS BE BTech November declared in official web page. Andhra University has regulated the BE/B.Tech, MS Exam. More number of candidates those who are pursuing their B.Tech MS in this University they all have attended for the Andhra University UG PG Exam 2016. The University has regulated the AU BE/B.Tech MS Exam in the month of November 2016. Huge number of aspirants has attended for the UG PG Exam. After the completion of Andhra University B.Tech Exam 2016. The attended aspirants are waiting for the release of AUCE Result 2016. Fabulous news for the attended candidates that the university has declared the AU B.Tech MS Exam Results 2016 in the official website on 10th January 2017 that is Today.
So the attended aspirants may check their AUCE Results 2016 by visiting the official web portal. In order to download the Andhra University B.Tech Results 2016 candidates need to approach the official web portal . Then look for the link of AU Result 2016 in that search for the Au B.Tech MS Result 2016 click on it. In that enter Hall Ticket Number and DOB details and finally click on submit button. The Andhra University Results 2016 B.Tech Exam will appear on screen download it and take a print out for further use. More data about AUCE MS Results 2016 candidates need to suggested to visit the official web portal.
AU results 2016 AUCE Results step in au Results MS BE BTech November
Organization Name : Andhra University
Name of The Exam: BE/B.Tech, MS Exam
Exam Date: In the month of November 2016
Category: Results
Website: www.andhrauniversity.edu.in
How To Download Andhra University B.Tech Result 2016
- Log on to the official web page www.andhrauniversity.edu.in
- Look for the link of Andhra University B.Tech MS Result 2016
- Enter Hall Ticket Number
- Finally press on submit button
- The AU Result 2016 will appear on screen
- Download it and take a print out for further use


text:
by Aaron
I was notified on 15 April 2013 from my sister who received a knock on the door from police that my father had passed away in the UK. All of his family live in Australia. Whilst overseas my father was working and unfortunately his health started to deteriorate but he was functional. I am shattered but I am grateful that my last conversation with him was on April 4 2013. I love him so much and miss him. I haven't been able to stop crying. I am trying not to blame myself for not getting over there sooner. He wouldn't want me to. His death was unexpected and was sudden. I have confronted going through our conversations on Facebook. Our last conversation related to bitterness and anger which my father was consumed with in his own family. It brings me some relief that some of his last written words were that he wished for my brother, sister and myself to not go down the path he did. My conversations with my father were meaningful and never trivial. Two years ago, when his father died, I asked my dad to write a eulogy and that even though he could not be here for the funeral, I would read what he would want to say, record it and upload it to Youtube so he didn't feel alone. I did this. It is incredibly painful to know that soon I will be doing the same. My father taught me to never give in when life kicks you down and I had the privilege of watching him getting up so many times and trying again. I will never give up but this is the hardest thing i'm ever going to have to deal with in my life.
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Healthy Eating for Wellbeing. A Nutrition Guide for Alcohol & Other Drug Agency Workers
- Basil Potter
- 2 years ago
- Views:
1 Healthy Eating for Wellbeing A Nutrition Guide for Alcohol & Other Drug Agency Workers
3 Welcome Through discussions with Alcohol and Other Drug (AOD) workers and consumers, it was found that nutrition information and education around AOD use was needed. There is a significant overlap between AOD use and physical and mental health and nutrition can play a major role in improving these. This guide aims to give AOD workers basic information about the overlap between nutrition and AOD use and rehabilitation to inform their work with consumers. The information in this booklet should not be substituted for the advice of a General Practitioner or Accredited Practising Dietitian (APD). Acknowledgements Thank you to the Foundation for Alcohol Research & Education (FARE) for providing funding for this resource. Thank you to those people in the AOD sector who contributed such useful information for this resource. Thanks to all WANADA staff for their ongoing encouragement and support, as well as the university practicum students for their contribution. Thanks must go to Bennett + Co for so kindly providing us with advice for this booklet. Thank you to Averil Eade from Melon Design for creating the design for this resource. Acknowledgement WANADA staff acknowledge Aboriginal and Torres Strait Islander people as the Traditional Custodians of this country and its waters. WANADA staff wish to pay their respect to Elders past and present and extend this to all Aboriginal people reading this message. Disclaimer: The Healthy Eating for Wellbeing: A nutrition guide for alcohol and other drug agency workers is intended to provide information and examples for working with alcohol and other drug consumers around nutrition, health and wellbeing. This information and examples are offered as a guide only. The guide is designed to assist workforce development and is based on information available at the date of publication. Copyright WANADA 2011 This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Western Australian Network of Alcohol and other Drug Agencies (WANADA). Requests and enquiries regarding reproduction and rights should be directed to WANADA. i
4 ii
5 What s in this booklet? Introduction 1 Nutrition and Alcohol or other Drug Use 1 Nutrition and AOD treatment 1 Nutrition care planning 1 Nutrients affected by AOD use 3 Side effects of undergoing AOD rehabilitation 4 Side effects of psychotropic medication 5 Tips to assist with side effects 6 Vomiting 6 Nausea 6 Dry mouth 6 Loss of appetite 6 Taste changes 6 Chewing and swallowing food 7 Diarrhoea 7 Constipation 7 Depression/anxiety/mood 7 Healthy weight gain 8 Healthy weight loss 9 Guide for serve sizes each day 10 What to look for on labels 11 Menu planning guide 12 Spending structure 12 Eating disorders 13 Introduction 13 Anorexia Nervosa 13 Some consequences of Anorexia Nervosa 13 Bulimia Nervosa 14 Some consequences of Bulimia Nervosa 14 Nutritional strategies for Bulimia Nervosa 14 Binge Eating Disorder 14 Some consequences of Binge Eating Disorder 14 Eating Disorders Not Otherwise Specified (EDNOS) 15 Useful websites 15 References 17 iii
6 Introduction Nutrition and Alcohol or Other Drug Use When using Alcohol or Other Drugs (AODs), appetite is often suppressed and eating can become a lower priority at the time of use. In addition, skipping meals and fasting may be used as a way of enhancing the effect of the AODs. Often food takes the form of quick, convenient snacks which are often high in fat and carbohydrates and low in protein. 1,2 In addition to changes in appetite and diet, AODs impact on the ingestion of nutrients. Alcohol is high in Kilojoules (Calories) yet has very low to non-existent nutrient content, and so can give the effect of feeling full without replenishing the body. 1,3 This can lead to an unhealthy weight. AOD use also damages the digestive tract which can lead to constipation, diarrhoea, indigestion and poor appetite as well as - reducing the activity of vitamins; reducing the ability of the body to break down food for energy; damaging the liver and impairing its ability to store nutrients; damaging the intestine resulting in poor nutrient absorption and utilisation as well as increased losses of nutrients; causing lean tissue (muscle and organs) to begin to break down; causing the immune system to become suppressed. 3,4 Nutrition and AOD treatment Nutrition is an important consideration during detoxification and rehabilitation. Among physical responses to detoxification are vomiting, nausea and diarrhoea which cause fluid and electrolyte loss as well as weight loss. 4 Further, starvation due to avoidance of eating is often seen in initial stages of treatment, creating an undernourished state with significant weight loss which can lead to binge eating and fluctuations in weight later. 4 In fact, weight gain is common following detoxification. It has been found that many factors influence eating patterns and behaviour in the early stages of rehabilitation. These include food being used as a drug substitute and mood regulator, to satisfy cravings, out of boredom and to provide structure to the day. Often high sugar and fat foods, caffeine and cigarettes are substituted for the AODs, perpetuating the behavioural cycle of dependence. Food has many roles in addition to satisfying hunger; it provides a basis for social interaction, comfort, identity and pleasure. In one study, some individuals undergoing AOD treatment believed that eating sweets would help them remain abstinent. 4,5 AOD workers can assist in preventing excessive weight gain by providing basic nutrition information to help individuals undergoing AOD treatment to make informed choices about their eating patterns. Excess weight gains may contribute to chronic diseases such as diabetes, cardiovascular diseases, joint and breathing problems as well as depression and relapse. 5 Nutrition care planning Nutrition care for this population includes an evaluation of nutrient status at detoxification, delivery of nutrient dense meals and encouraging normal eating patterns in conjunction with nutrition education. Nutrient rich foods are needed to repair damaged organs and tissues and enable them to function properly. Nutrition education is often received well in a group setting in 1
7 combination with other life skills. Educational content found to be most useful are: nutritional and health consequences of AOD use; food myths; food sources of nutrients; alternative ways to handle stress and cravings; integration of a healthy lifestyle into their recovery principles; weight management; signs of eating disorders; and consequences of substance substitution. 4 These topics can be accessed using the website list at the back of this resource. Ideally the aim of the nutrition care plan is to establish or re-establish normal eating patterns to nourish the body in the early stages of treatment. Encouraging the intake of complex carbohydrates, moderate amounts of protein and limited amounts of dietary fats combined with physical activity will assist with this. Food moderation, variety and energy balance is ideal. Food that is attractive and tasty will stimulate appetite and encourage regular meal consumption. Meal times in a group setting enable individuals to choose their foods while interacting socially. 4 As well as a nutrition care plan for the treatment process, after care plans involving at least one dietitian consultation to monitor body weight, signs of eating disorders and progress towards eating a healthy diet are helpful. 4 1 Emerson, M. H., Glovsky, E., Amaro, H., & Nieves, R. (2009). Unhealthy weight gain during treatment for alcohol and drug use in four residential programs for latina and african american women. Substance Use & Misuse, 44(11), Anonymous. (2000). Nutrition & addictions. Canadian Journal of Dietetic Practice and Research, 61(2), S8.Grotzkyj-Giorgi, M. (2009). Nutrition and addiction - can dietary changes assist with recovery? Drugs and Alcohol Today, 9(2), Grotzkyj-Giorgi, M. (2009). Nutrition and addiction - can dietary changes assist with recovery? Drugs and Alcohol Today, 9(2), The American Dietetic Association. (1990). Position of the American Dietetic Association: nutrition intervention in treatment and recovery from chemical dependency Journal of the American Dietetic Association, 90(9), Hodgkins, C., Cahill, K., Seraphine, A., Frostpineda, K., & Gold, M. (2004). Adolescent drug addiction treatment and weight gain. Journal of Addictive Diseases, 23(3),
8 Nutrients affected by AOD use Nutrient Affected Vitamin B1 (Thiamin) Vitamin B2 (Riboflavin) Vitamin B3 (Niacin) Vitamin B6 Folate Vitamin B12 Vitamin C Symptoms of Deficiency Mental confusion Weight loss Irritability Breakdown of muscles Mild confusion to coma 6 Itching, burning, watering of eyes Sore, burning lips Skin lesions with greasy scales Purple, swollen tongue 6 Dermatitis Dementia Diarrhoea Tremors Sore tongue Hair loss Red scaly rash around eyes, nose and mouth 6 Weakness Sleeplessness Cracking at corners of mouth Inflamed tongue Inflammation of inside lining of mouth 6 Large immature red blood cells General weakness Depression 6 Yellow tinted skin Smooth thick red tongue Numbness Tingling Burning feet Stiffness, weakness, fatigue 6 Impaired wound healing Swelling Bleeding Bone and teeth weakness Swollen bleeding gums Fatigue and lethargy 6 Foods Containing Nutrient Vegemite Wholegrain breads Pork Sunflower seeds Breads and cereals with thiamin (will say on label) Milk Yoghurt Eggs Cheese Mushrooms Organ meats (kidney, brain, liver etc) Rice bran & Wheat bran Breads (with niacin added) Meat (beef, lamb, pork, poultry, veal, fish) Peanuts Wheat germ/ wheat bran Fish Bananas Beef, veal, mutton, fish, chicken breast Legumes Vegemite Chinese cabbage Wheat germ/wheat bran Peanuts Chickpea flour Legumes Asparagus Raw strawberries Seafood Meat (rabbit, veal, beef, pork, fish) Milk and dairy products Mussels & oysters Sardines Red capsicum, onion, potato, brussels sprouts, watercress Oranges, lemons, pawpaw, mandarin, guava, blackcurrant juice Chicken & lamb liver 6 Stewart, R. (2009). Griffith Handbook of Clinical Nutrition and Dietetics (3rd ed.). 3
9 Side effects of undergoing AOD rehabilitation Focus groups conducted with previous AOD users in a rehabilitation setting provided an insight into the physical and mental health side effects of undergoing rehabilitation. The most common positive and negative effects mentioned are shown below. Positive Mental Health Effects Increase in memory gain / clearer thinking / increased concentration Increased motivation and will power Increased confidence / increased selfesteem / increased self-awareness Increased libido More emotionally stable Lower anxiety levels More energy Positive Physical Health Effects Better sleeping patterns Weight gain Weight loss More energy Healthier skin Regular bowel movements Increased self-care More physically fit Return of appetite and increase in appetite More hydrated Better and normal liver function Negative Mental Health Effects Less motivation Increased paranoia / increased anxiety / increased nervousness Negative Physical Health Effects Irregular and poor sleep Weight gain Many more positive effects were mentioned than negative ones and many negative aspects can be attributed to the change in environment. It was identified in consumer focus groups that this was an ideal time to introduce nutrition support. The majority of people stated that their food habits and physical health had begun to improve in the absence of AODs. Nutrition positively impacts on mental and physical health. 4
10 Side effects of psychotropic medication Anxiety, depression and other mental health issues are prevalent in the AOD using population. Medication is often prescribed for these ailments. Current and previous AOD users mentioned positive and negative impacts of these medications on their mental and physical health. Mental health side effects while using AODs General side effects Over and under medicate as medication wasn t having desired effect Stopped taking medication Loss of memory Blackouts Sleeping problems or constantly sleeping Increased concentration Amnesia Delusions Increased or decreased libido Specific medication side effects Tranquillisers mixed with Opiates increased effect of opiate Tranquillisers mixed with Amphetamines insomnia; mental paralysis Tranquillisers mixed with Alcohol lack of co-ordination; incoherence; memory loss Anxiolytics mixed with Methamphetamine memory loss Anxiolytics mixed with Alcohol increased effect of alcohol Antidepressants mixed with Amphetamines decreased paranoia/mania depending on when used; less effect of antidepressant Antidepressants mixed with Alcohol hallucinations; absentmindedness; more depressed; drowsiness/tiredness Physical health side effects while using AODs General side effects Sleeping problems or constantly sleeping Sweating/Shaking No appetite or taste Dry mouth Increased or decreased libido Specific medication side effects Tranquillisers mixed with Opiates increased effect of opiate Tranquillisers mixed with Amphetamines insomnia Anxiolytics mixed with Alcohol increased effect of alcohol Less depression Stable mood Tiredness Mood swings Disrupted sleep Numb Dissociated/Disoriented Low libido Unnatural highs and lows Mental health side effects in rehabilitation Physical health side effects in rehabilitation Irregular and poor sleep Weight gain Positively, consumers said that the effect of their medication was more noticeable in rehabilitation and their condition was now being effectively managed by taking the correct dosage. They were also clear about where the symptoms of their condition were coming from, whereas they were masked when they were using AODs. Again, many of these side effects can be assisted with appropriate nutrition. Some suggestions for managing side effects can be found in the next section. 5
11 Tips to assist with side effects Vomiting Vomiting can cause dehydration because large amounts of water are lost from the body. Repeated vomiting can irritate the throat, oesophagus and salivary glands and cause infection. It can also erode the teeth and gums. Long term vomiting can cause less food intake and lead to malnutrition and nutrient deficiencies. Some things to try are: Small, frequent snacks, rather than main meals; Fluids like clear soups, jelly, lemonade, dry ginger ale, ice cubes and icy poles or fruit juice to help with hydration; Eating cold meals; Plain or bland foods like crackers and pretzels; Avoid fatty, spicy or very sweet foods; If medication is causing vomiting, try taking it with food if able to; Eat and drink slowly so the stomach doesn t expand too much. 7,8 Nausea Try clear fluids first like lemonade, soups or ice cubes. When clear fluids are tolerated, try a half and half mixture of milk and soda water, diluted fruit juices, or weak tea. When a variety of fluids are tolerated try small amounts of food like: plain dry biscuits; thin crisp toast with a spread; boiled rice; soft, stewed fruit like apples, pears and peaches. 7,8 Dry mouth Rinse mouth with warm saltwater or alcohol-free mouth wash regularly. Drink small amounts of fluid frequently between meals. Chew gum to stimulate saliva. Add sauces, gravy or margarine to dry foods. Brush and floss teeth regularly to help prevent tooth decay and infections. 7,8 Loss of appetite Try small serves on a small plate. Snack between meals to keep food intake up without stretching the stomach too much. Avoid very sweet foods and foods high in fat. Eat the main meal when feeling the best. Avoid drinking a lot of fluid before or during a meal to allow more room for food in the stomach. Listen to music while eating. Take a walk or do some exercise before eating. 7,8 Taste changes If drinks are too sweet, flavour with something unsweetened such as lime juice, pureed fresh banana or strawberries. Instead of meat dishes, try other protein foods like cheese, egg or white meats such as chicken and turkey. Experiment with adding herbs, spices, sauces and seasonings to meals. 6
12 Brush teeth or use mouthwash before eating. Eat foods cold or at room temperature. Use plastic rather than metal eating utensils. 7,8 Chewing and swallowing food Try foods with different consistencies and see which one is easiest. Thin liquids, dry foods and sticky foods are often hard to swallow. Add sauces and gravy to dry foods. Drink fluid with meals. Try drinking through a straw. Reduce distractions to assist with concentrating on the actions of chewing and swallowing. Try different head positions like tilting forward or backward, to see if it makes swallowing easier. 7,8 Diarrhoea Have small meals instead of large ones. Rest and have clear fluids like juice or soup to help hydrate. Avoid caffeine as this may make diarrhoea worse. Lactose intolerance can be a cause of diarrhoea so avoid milk products if this is a problem. Lactase enzyme replacements (what is lacking in lactose intolerance) can be used. E.g. Lacteeze from chemists or choose lactose free products. See a GP or Dietitian before removing dairy foods from the diet. Avoid food and drinks that increase gas production like beans, onion, cabbage and carbonated drinks. 7,8 Constipation Go to the toilet when the urge is felt. Increase the amount of fibre in the diet (eat more fruit, vegetables, wholegrain breads and cereals and legumes) and increase water intake. Avoid refined products like white bread, white rice and pasta. Being more physically active helps the bowel muscles exercise and move food through the body. Try eating prunes. Try drinking a cup of warm fluids first thing in the morning. 7,8 Depression/anxiety/mood Be aware that: caffeine negatively impacts on mood and increases anxiety levels; sugar and refined carbohydrates create highs and lows in mood. Intake late in the day can also contribute to sleep problems; energy drinks contain caffeine or caffeine like products that also increase anxiety as well as often containing high sugar levels that produce poor moods. Instead encourage: wholegrain cereals, breads and pastas to help stabilise mood levels; small amounts of caffeine intake, if necessary, with only one teaspoon of coffee per cup to help reduce intake; oily fish intake 2-3 times a week, this includes canned tuna, herring, sardines and tuna (choose tuna in spring water for less fat intake); water intake throughout the day to keep hydrated. Even mild dehydration can affect mood and thinking. 7 7 Dietitians Association of Australia. (2009). Nutrition Manual (8th ed.). Deakin, ACT: Dietitians Association of Australia. 8 Rolfes, S.R., Pinna, K., & Whitney, E. (2009). Understanding normal and clinical nutrition (8th ed.). Belmont, CA : Wadsworth/Cengage Learning.
13 Healthy weight gain When a person eats too much for what their body needs, no matter what the source, metabolism favours fat formation and enlargement of fat cells. Dietary fat is most easily converted to body fat. Too much protein in the diet does not necessarily result in increased muscle mass, but can lead to an increase in body fat. In contrast, some AOD users may be underweight and malnourished when detoxing or entering treatment. They may need to gain weight but require assistance in doing so because their body and mind may be affected by AOD use. Following are some tips to assist with a healthy weight gain. Eat foods packed full of nutrients like: fruits and vegetables wholegrain breads, pastas and cereals lean meat (e.g., beef, lamb, chicken, turkey, fish) alternatives to meat like eggs, legumes (e.g. kidney beans, baked beans, chickpeas) and soy products some healthy fats (e.g., avocado, olives, olive oil, margarine and nuts) reduced fat dairy products (e.g., milk, yoghurt, cheese). Limit foods like lollies, soft drinks and takeaway foods with lots of energy (Calories). Check out What to look for on labels when discussing food choices with individuals. Drink only small amounts of fluid before and during meals. Try eating 5 to 6 times a day to stimulate appetite. When travelling keep some healthy snacks in a cooler bag (celery and carrot sticks, crackers and cheese, chopped apples and sultanas). Add healthy toppings to meals. Try adding reduced fat cheese to spaghetti, peanut butter or jam to toast or yoghurt to muesli. Add milk instead of water when cooking. For example, add milk to oats and add margarine and milk to mashed potato. Add powdered milk (skim milk powder), margarine, honey or dried fruits to cooking. Eat a little bit more than usual at each meal, but don t force eating. Add healthy oils to the top of salads like olive oil, olive oil dressings, whole olives, avocado, nuts and sunflower seeds. These are sources of good fats as well as other nutrients. Make up a bulk amount of milk smoothie each morning using full cream milk. Keep it in the fridge to drink throughout the day between meals. 9 8
14 Healthy weight loss Weight and health are connected. Being at an increased weight may make it more likely that a health condition is present, compared to a person of a healthy weight. There are other factors involved with disease risk like family history, cigarette smoking, physical activity level and dietary intake. Weight loss should be about a healthy lifestyle, not dieting so encourage small changes that can improve short and long term health and wellbeing. Below are some tips to get started. Be more physically active even if it s just taking the stairs instead of the lift, walking somewhere instead of driving or doing some housework. Reduce food portion size by using a smaller plate for meals. See Guide of serve sizes each day. Try different varieties of foods with different tastes and textures because tastes may have changed. Use hunger as a guide for eating. Eat when hungry and stop when full. Extra attention may need to be paid to hunger signals if the person is not used to recognising these signals. Eat slowly and pause between each bite, eating too quickly can lead to eating too much and feeling uncomfortably full. Drink some water while eating. Leave food on the plate. Pour food that comes in packages into a bowl to see how much is eaten American Dietetic Association. (2011a). Healthy Weight Gain Retrieved 20th January 2011, from aspx?id= American Dietetic Association. (2011b). Ways to Shave Calories Retrieved 20th January 2011, from aspx?id= Dietitians Association of Australia. (2008). Weight Management Retrieved 20th January 2010, from 9
15 Guide for serve sizes each day Food Type Serves Example Serve Sizes Fruit (Fresh OR Canned OR Stewed) 3 1 medium piece (e.g. apple, pear, orange, small banana) or 5 small prunes 2 small pieces (e.g. apricots, kiwi fruit, plums) 4 dried apricot halves, 1½ Tb sultanas (about the size of a golf ball) 1 cup diced pieces or canned fruit (about a fist sized amount) Fruit Juice 1 ½ cup juice (about the size of a tennis ball) Vegetables 5 90g of potato or 1 small potato (about the size of a household light bulb) 75g or ½ cup of cooked vegetables (about the size of a household light bulb) 1 cup of salad (about the size of a fist) 75g or ½ cup cooked dried beans, peas or lentils Breads, Cereals, Rice, Pasta, Noodles 5 2 slices of bread 1 medium bread roll 1 cup cooked rice, pasta or noodles 1 cup porridge, 1 1/3 cup breakfast cereal flakes, ½ cup muesli Meat, Poultry, Fish, Eggs, Legumes, Nuts, Seeds 1 Milk, Cheese & Yoghurt Fats & Spreads Max g cooked meat, chicken (e.g. ½ cup lean mince, 2 small chops, 2 slices roast meat) g cooked fish fillet (about the size of a man s palm) 2 small eggs 1/3 cup almonds or peanuts ¼ cup sunflower seeds or sesame seeds ½ cup cooked (dried) beans, lentils, chick peas, split peas 250mL or 1 cup of fresh, long-life or reconstituted dried milk ½ cup evaporated milk 40g or 2 slices of cheese (about the size of your 3 middle fingers together) 200g (1 small container) yoghurt 10g for 2 slices of bread (the size of a postage stamp and the thickness of your finger) Agency for Clinical Innovation. (2010). Nutrition Standards for adult inpatients in NSW Hospitals. NSW: Greater Metropolitan Clinical Taskforce. Kellet, E., Smith, A., & Schmerlaib, Y. (1998). The Australian Guide to Healthy Eating background information for consumers. Canberra: Australian Government Department of Health and Ageing. 10
16 What to look for on labels Energy Less than 1000kJ (239Cal) of energy per 100g Snack foods (lollies, chocolates, chips) - less than 600kJ per serve Fat Less than 5g of total fat per 100g Saturated Fat Less than 3g of saturated fat per 100g Fibre More than 3g of fibre per serve Sugar Less than 10g sugar per 100g Salt (Sodium) Less than 120mg of salt (sodium) per 100g Less than 400mg of salt per 100g if not possible to choose below 120mg Breakfast Cereals - Less than 350mg of salt (sodium) per 100g Cancer Council Western Australia. (2009). Healthy eating to reduce your risk of cancer [Brochure]. 11
17 Menu planning guide Below is a checklist for use specifically in residential settings to use when reviewing the weekly menu plan. This checklist will assist with ensuring a variety of main meal bases throughout the week. This checklist can be adapted for individual use. For the week commencing Monday and ending Sunday Main Meal Recommendations Per Week Check Beef/lamb/chicken/ pork/veal (aim for variety) Fish (Grilled, steamed or canned) Vegetarian Maximum 4-5 times per week Minimum 1-2 times per week (with chips maximum 1 per week) Minimum once per week Spending structure It is recommended to allocate 60% of the food budget to foods from the eat most group, 30% to the eat moderately group, and 10% to foods from the eat least section in accordance with the healthy eating pyramid. This idea is based on the 10-plan guide developed by the Department of Health under the Foodcents Program to help increase healthy dietary behaviours in the presence of a low income. Category Examples Recommended Spending Eat most Eat moderately Bread, cereals, rice, pasta, flour, fruit, vegetables, baked beans, lentils Lean meat, chicken, fish, eggs, nuts, milk, cheese, yoghurt 60% of budget 30% of budget Eat least Butter, margarine, oil, sugar, biscuits, cake, chocolate, crisps, cool drink, coffee, salad dressings, sauce 10% of budget 12
18 Eating disorders Introduction The issue of eating disorders and disordered eating patterns is prevalent in the AOD using population. Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder are the three eating disorders recognised by the Diagnostic Statistical Manual however, many more individuals are likely to experience Eating Disorders Not Otherwise Specified (EDNOS). EDNOS involves the presentation of some eating disorder criteria but not all criteria needed to diagnose one of the three recognised disorders. EDNOS should be approached as a serious condition as it endangers a person s health and wellbeing and can lead to serious complications. In a student research project conducted in two Western Australian AOD residential rehabilitation centres, it was found that 9% of the study population had a subclinical eating disorder and a further 25% indicated that they experienced EDNOS. In addition to this, 80% experienced repeated binge eating episodes. For more information on this research project, contact WANADA at An overview of eating disorders follows. To find out more information visit the websites listed under Eating Disorders Information in the Useful Websites section at the back of this resource. A list of Accredited Practising Dietitians can be found on the Dietitians Association of Australia website. Anorexia Nervosa Anorexia Nervosa (AN) is most common in females and central to this disorder is a distorted body image where the person sees themselves as being more fat than they are in reality. These people have a fear of gaining weight. Severe starvation and weight loss are characteristic of AN, resulting in malnutrition which can affect brain function and judgement, further impairing the individual s perception of themselves. Lethargy, confusion and delirium are also seen. 8 Some consequences of Anorexia Nervosa Digestion of food slows and the body becomes unable to absorb or digest food properly. Diarrhoea. Metabolism slows down. Insomnia. Overall the body loses body fat and protein. Body temperature falls. Heart becomes weak and beats irregularly. Blood pressure falls. Immune system stops working properly. Heart, kidneys and lungs stop functioning. Skin becomes dry and thin and fine hair develops on the body to keep warm. Nerves start to function abnormally. Bone density reduces (increased risk of fractures and falls). Loss of sex drive. Loss of menstruation for women. 8 13
19 Bulimia Nervosa Bulimia Nervosa (BN) is more prevalent than AN and more men suffer from BN than AN. Typically people suffering from BN engage in repeated episodes of binge eating followed by compensatory behaviours like vomiting, fasting, excessively exercising and/or using laxatives. Characteristic of these binges is the sense of lack of control. Binges usually occur at night and last an hour or more, usually including foods with lots of Calories, which are easy to eat and have little nutritional value. 8 Bulimics anticipate and plan the binge, become anxious and experience an urgency to begin, then rapidly and uncontrollably eat food which helps them feel relaxed and relieved. This is followed by feeling shame and disgust with themselves. Negative self-perception develops which perpetuates the bingeing cycle. A large proportion of people experiencing binge eating episodes accompanied by a lack of control were reported in the research project. Compensatory behaviours were also mentioned frequently. 8 Some consequences of Bulimia Nervosa Weight fluctuations that can make weight loss and maintenance more difficult. Swollen hands and feet, bloating, fatigue, headache, nausea and pain. If laxatives are used, they can injure the lower intestinal tract. Negative self-perceptions are developed and reinforced. Compromised immune system. Abnormal heart rhythms and kidney injury caused by fluid and mineral imbalance from vomiting and/or diarrhoea. Urinary tract infections. Irritation and infection of the oesophagus, pharynx and salivary glands, and dental problems. 8 Nutritional strategies for Bulimia Nervosa Plan meals and snacks that require eating at the table and using utensils. Limit availability of finger foods. Encourage lifestyle changes rather than dieting or skipping meals. Encourage people to eat a well-balanced diet and regularly timed meals with a variety of foods available. Include raw vegetables, salad or raw fruit at meals to extend eating times. Choose wholegrain, high-fibre breads, pasta, rice and cereals to increase fullness. Encourage people to drink water throughout the day. Soups and other water rich foods like fruit and vegetables can help people feel fuller. Include exercise into the daily regime, about 30 minutes each day. 8 Binge Eating Disorder Binge Eating Disorder (BED) is characterised by repeated episodes of binge eating without the compensatory measures mentioned in BN. Loss of control and guilt is often felt along with low selfesteem. 8 Some Consequences of Binge Eating Disorder Depression. Anxiety. Obesity. Panic attacks. Joint and muscle pain. Type 2 diabetes. High blood pressure. Digestive system problems. 8 14
20 Eating Disorders Not Otherwise Specified (EDNOS) This describes an individual presenting with some, but not all, of the criteria necessary to diagnose one of the three recognisable eating disorders. For example, someone may present with all of the criteria for AN, but be within a healthy weight range; or for someone with normal body weight taking part in compensatory behaviours like vomiting, laxative use or excessive exercising. Similarities exist between EDNOS and recognisable eating disorders like loss of control over behaviour, depression, anxiety, guilt or negative self-perception. 8 8 Rolfes, S. R., Pinna, K., & Whitney, E. (2009). Understanding normal and clinical nutrition (8th ed.). California, USA: Wadsworth. Useful websites Nutrition information and recipes American Dietetic Association Cancer Council of WA - Diabetes WA Dietitians Association of Australia Heart Foundation Nutrition Australia Eating disorders information Practice guidelines and resources: Fact sheets and workbooks: 15
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text:
I thought I would just write a quick post about a new film from the Méxican media production company, Nao.
The film is Bacalar. And before you ask, 'What has this to do with 'Mapmaker's?', the answer is "Nothing whatsoever", except, that the film is set within the State of Quintana Roo; which is located in Southeastern México, on the eastern part of the Yucatán Peninsula (the locale for the story of The Mapmaker's Opera) and the film's plot involves two young people's attempts in saving of one of the world's most endangered animal species! Continue Reading →


text:
What can I say? Another day, another review.
Book Review: The Big Burn
Timothy Egan. The Big Burn: Teddy Roosevelt and the Fire That Saved America. Boston: Houghton Mifflin Harcourt, 2009. 352 pages. Forest fires are a perennial concern, particularly in the American West, as is government stewardship of public lands. This was no less true in 1910, when the Forest Service was young and the worst fire … Read more


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