43 results
Estimation of Clay Proportions in Mixtures by X-Ray Diffraction and Computerized Chemical Mass Balance
- Mark Hodgson, A. William L. Dudeney
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- Journal:
- Clays and Clay Minerals / Volume 32 / Issue 1 / February 1984
- Published online by Cambridge University Press:
- 02 April 2024, pp. 19-28
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As part of a laboratory study of the hydrothermal alteration of kimberlite, a mass balance procedure has been developed for estimating the relative proportions of synthetic phyllosilicate phases— chlorite, vermiculite, smectite, kaolinite and serpentine—present in reaction products. The procedure is based on a combination of X-ray powder diffraction (XRD) measurements (for phase identification), atomic absorption determinations (for total Si, Al, Fe, and Mg) and published analyses of clay minerals (for stoichiometric deductions). It centers on the computer inversion of a 4 × 4 matrix form of four simultaneous equations representing the mass balance of Si, Al, Fe, and Mg in four chosen minerals and incorporates a systematic routine for selecting from all possible permutations of high and low estimates of the mineral chemical analyses acceptable sets of product stoichiometries and phase proportions consistent with the total metal analyses. To minimize uncertainties and computing time, the program takes account of elemental relationships and water mass balances associated with phyllosilicates. It also accommodates data relevant to poorly crystalline phases for which a range of theoretical type-analyses modeled on aluminum oxyhydroxides and 9–11-Å, 2:1 layered aluminosilicates are employed.
The procedure produces reliable trends in phase proportions consistent with the intensities of characteristic XRD peaks of clay minerals present in the analyzed mixture; for example, increases in estimated kaolinite proportions correspond with larger 7-Å (and other) peaks in analyzed samples. A precision of 7–25% has been routinely achievable.
P102: Supporting Informal Carers to Undertake Regular Physical Activity from Home: a Co-design and Prototype Development Study of a novel app, “CareFit”
- Kieren J Egan, William Hodgson, Bradley MacDonald, Barbara Fawcett, Mark D Dunlop, Alison Kirk, Roma Maguire
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- Journal:
- International Psychogeriatrics / Volume 35 / Issue S1 / December 2023
- Published online by Cambridge University Press:
- 02 February 2024, p. 251
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Background:
Informal carers (unpaid family members and friends), are critical to millions worldwide for the ongoing delivery of health and well-being needs. However, the physical and mental wellbeing of caregivers is often poor including low levels of physical activity, frequently owed to contributing factors such as lack of time, lack of support and motivation. Thus, accessible evidence-based tools to facilitate physical activity for carers are urgently needed.
Objective:The aim of this study was to co-design and develop a novel mobile app to educate and support carers in the undertaking of regular physical activity. This is achieved via integration of the transtheoretical model of behaviour change and UK physical activity guidelines across 8 weeks of use.
Methods:We co-designed a mobile app, “CareFit,” by directly involving caregivers, health care professionals, and social care professionals in the requirements, capturing, and evaluation phases across a number of Agile Scrum development sprints. Requirements for CareFit were grounded in a combination of behavioural change science and UK government physical activity guidelines.
Results:Participants identified different barriers and enablers to physical activity, such as a lack of time, recognition of existing activities, and concerns regarding safely undertaking physical activity. Requirements analysis highlighted the importance of simplicity in design and a need to anchor development around the everyday needs of caregivers (eg, easy-to-use video instructions, reducing text). Our final prototype app integrated guidance for undertaking physical activity at home through educational, physical activity, and communication components.
Conclusions:Integrating government guidelines with models of behavioural change into a mobile app to support the physical activity of carers is novel and holds future promise. Integrating core physical activity guidelines into a co-designed smartphone app with functionality such as a weekly planner and educational material for users is feasible acceptable and usable. Here we will document the latest developments on the project including an ongoing national study currently taking place in Scotland to test the prototype with 50 carers.
Three-dimensional food printing: its readiness for a food and nutrition insecure world
- Liezhou Zhong, Joshua R. Lewis, Marc Sim, Catherine P. Bondonno, Mark L. Wahlqvist, Amin Mugera, Sharon Purchase, Kadambot H. M. Siddique, Michael J. Considine, Stuart K. Johnson, Amanda Devine, Jonathan M. Hodgson
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- Journal:
- Proceedings of the Nutrition Society / Volume 82 / Issue 4 / December 2023
- Published online by Cambridge University Press:
- 15 May 2023, pp. 468-477
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Three-dimensional (3D) food printing is a rapidly emerging technology offering unprecedented potential for customised food design and personalised nutrition. Here, we evaluate the technological advances in extrusion-based 3D food printing and its possibilities to promote healthy and sustainable eating. We consider the challenges in implementing the technology in real-world applications. We propose viable applications for 3D food printing in health care, health promotion and food waste upcycling. Finally, we outline future work on 3D food printing in food safety, acceptability and economics, ethics and regulations.
Contributors
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- By Janice Capel Anderson, S. Wesley Ariarajah, Constantine Belezos, Ian Boxall, Marc Zvi Brettler, Edward Breuer, Daniel Bruno, Mark Chapman, W. T. Dickens, Mark W. Elliott, Eldon Epp, Tassilo Erhardt, Timothy Gorringe, Harriet Harris, Peter C. Hodgson, Leslie Howsam, Werner G. Jeanrond, Scott McLaren, Wayne A. Meeks, Néstor Míguez, Stephen D. Moore, Robert Morgan, Halvor Moxnes, Peter Neuner, Mark Noll, Jorunn Økland, Gaye Ortiz, John Riches, Christopher Rowland, Nicolaas A. Rupke, Edmund J. Rybarczyk, Lamin Sanneh, Constantine Scouteris, R. S. Sugirtharajah, Willard M. Swartley, William R. Telford, David Thompson, Elena Volkova, J. R. Watson, Gerald West, Michael Wheeler, Keith Whitelam
- Edited by John Riches, University of Glasgow
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- The New Cambridge History of the Bible
- Published online:
- 09 June 2015
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- 13 April 2015, pp xi-xii
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Principal contributors
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- By Edward Copley, Anna Pierson, Richard Pierson, Michael Allan, Natish Bindal, Catriona Bentley, Hannah Church, Michael B Clarke, Lloyd Craker, Nicholas Crombie, Neil H Crooks, Hozefa Ebrahim, Ian Ewington, James Geoghegan, Au-Chyun Nicole Goh, Andrew G Haldane, Khalid Hasan, Max Simon Hodges, Eric Hodgson, Asim Iqbal, Paul Jeanrenaud, Emily Johnson, Deepak Joseph, Michael McAlindon, Craig McGrath, Randeep Mullhi, Rebecca Paris, Sachin Rastogi, Simon Smart, Insiya Susnerwalla, Alifia Tameem, Mark Tindall, Laura Tulloch
- Edited by Hozefa Ebrahim, Khalid Hasan, Mark Tindall, Michael Clarke, Natish Bindal
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- Practice Single Best Answer Questions for the Final FRCA
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- 05 November 2012
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- 11 October 2012, pp vi-vii
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Introduction to the Special Issue on the Evolution of Institutions
- MARK BLYTH, GEOFFREY M. HODGSON, ORION LEWIS, SVEN STEINMO
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- Journal of Institutional Economics / Volume 7 / Issue 3 / September 2011
- Published online by Cambridge University Press:
- 19 May 2011, pp. 299-315
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How can evolutionary ideas be applied to the study of social and political institutions? Charles Darwin identified the mechanisms of variation, selection and retention. He emphasized that evolutionary change depends on the uniqueness of every individual and its interactions within a population and with its environment. While introducing the contributions to this special issue, we examine some of the ontological positions underlying evolutionary theory, showing why they are appropriate for studying issues in economics, political science and sociology. We consider how these ideas might help us understand both institutional change and the formation of individual preferences.
Numbers-needed-to-treat analysis: an explanation using antipsychotic trials in schizophrenia
- Richard Hodgson, John Cookson, Mark Taylor
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- Advances in Psychiatric Treatment / Volume 17 / Issue 1 / January 2011
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- 02 January 2018, pp. 63-71
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- January 2011
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The evaluation of treatment effects is important to both the clinician and the patient. However, outcomes in randomised trials are often difficult to apply to the clinic. The number needed to treat (NNT) is one method that facilitates the interpretation of clinical trials in a meaningful way. When combined with the number needed to harm (NNH), the balance between the risks and benefits of a particular treatment can be appreciated. We illustrate the use of these concepts by focusing on recent large pragmatic studies of antipsychotics, including CATIE, EUFEST and CUtLASS.
Contributors
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- By Derek Barrett, Mark C. Bellamy, Andrew R. Bodenham, Pieter A.J. Borg, Ian Calder, Tim Cook, Joy E. Curran, Philippa Evans, Andrew D. Farmery, Chris Frerk, Priya Gauthama, Ankie E.W. Hamaekers, John Henderson, Eric Hodgson, Jeremy A. Langton, Andrew D.M. McLeod, Abhiram Mallick, Viki Mitchell, James Nicholson, Anil Patel, Adrian Pearce, Will Peat, John Picard, Mansukh Popat, Brian Prater, Mridula Rai, Om Sanehi, Jane Stanford, Richard Vanner, Peter J.H. Venn, Steven M. Yentis
- Edited by Ian Calder, Adrian Pearce
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- Core Topics in Airway Management
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- 10 January 2011
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- 16 December 2010, pp vii-viii
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. Flowers, Carole Fontaine, David Ford, Mary Ford, Stephanie A. Ford, Jim Forest, William Franke, Robert M. Franklin, Ruth Franzén, Edward H. Friedman, Samuel Frouisou, Lorelei F. Fuchs, Jojo M. Fung, Inger Furseth, Richard R. Gaillardetz, Brandon Gallaher, China Galland, Mark Galli, Ismael García, Tharscisse Gatwa, Jean-Marie Gaudeul, Luis María Gavilanes del Castillo, Pavel L. Gavrilyuk, Volney P. Gay, Metropolitan Athanasios Geevargis, Kondothra M. George, Mary Gerhart, Simon Gikandi, Maurice Gilbert, Michael J. Gillgannon, Verónica Giménez Beliveau, Terryl Givens, Beth Glazier-McDonald, Philip Gleason, Menghun Goh, Brian Golding, Bishop Hilario M. Gomez, Michelle A. Gonzalez, Donald K. Gorrell, Roy Gottfried, Tamara Grdzelidze, Joel B. Green, Niels Henrik Gregersen, Cristina Grenholm, Herbert Griffiths, Eric W. Gritsch, Erich S. Gruen, Christoffer H. Grundmann, Paul H. Gundani, Jon P. Gunnemann, Petre Guran, Vidar L. Haanes, Jeremiah M. Hackett, Getatchew Haile, Douglas John Hall, Nicholas Hammond, Daphne Hampson, Jehu J. Hanciles, Barry Hankins, Jennifer Haraguchi, Stanley S. Harakas, Anthony John Harding, Conrad L. Harkins, J. William Harmless, Marjory Harper, Amir Harrak, Joel F. Harrington, Mark W. Harris, Susan Ashbrook Harvey, Van A. Harvey, R. Chris Hassel, Jione Havea, Daniel Hawk, Diana L. Hayes, Leslie Hayes, Priscilla Hayner, S. Mark Heim, Simo Heininen, Richard P. Heitzenrater, Eila Helander, David Hempton, Scott H. Hendrix, Jan-Olav Henriksen, Gina Hens-Piazza, Carter Heyward, Nicholas J. Higham, David Hilliard, Norman A. Hjelm, Peter C. Hodgson, Arthur Holder, M. Jan Holton, Dwight N. Hopkins, Ronnie Po-chia Hsia, Po-Ho Huang, James Hudnut-Beumler, Jennifer S. Hughes, Leonard M. Hummel, Mary E. Hunt, Laennec Hurbon, Mark Hutchinson, Susan E. Hylen, Mary Beth Ingham, H. Larry Ingle, Dale T. Irvin, Jon Isaak, Paul John Isaak, Ada María Isasi-Díaz, Hans Raun Iversen, Margaret C. Jacob, Arthur James, Maria Jansdotter-Samuelsson, David Jasper, Werner G. Jeanrond, Renée Jeffery, David Lyle Jeffrey, Theodore W. Jennings, David H. Jensen, Robin Margaret Jensen, David Jobling, Dale A. Johnson, Elizabeth A. Johnson, Maxwell E. Johnson, Sarah Johnson, Mark D. Johnston, F. Stanley Jones, James William Jones, John R. Jones, Alissa Jones Nelson, Inge Jonsson, Jan Joosten, Elizabeth Judd, Mulambya Peggy Kabonde, Robert Kaggwa, Sylvester Kahakwa, Isaac Kalimi, Ogbu U. Kalu, Eunice Kamaara, Wayne C. Kannaday, Musimbi Kanyoro, Veli-Matti Kärkkäinen, Frank Kaufmann, Léon Nguapitshi Kayongo, Richard Kearney, Alice A. Keefe, Ralph Keen, Catherine Keller, Anthony J. Kelly, Karen Kennelly, Kathi Lynn Kern, Fergus Kerr, Edward Kessler, George Kilcourse, Heup Young Kim, Kim Sung-Hae, Kim Yong-Bock, Kim Yung Suk, Richard King, Thomas M. King, Robert M. Kingdon, Ross Kinsler, Hans G. Kippenberg, Cheryl A. Kirk-Duggan, Clifton Kirkpatrick, Leonid Kishkovsky, Nadieszda Kizenko, Jeffrey Klaiber, Hans-Josef Klauck, Sidney Knight, Samuel Kobia, Robert Kolb, Karla Ann Koll, Heikki Kotila, Donald Kraybill, Philip D. W. Krey, Yves Krumenacker, Jeffrey Kah-Jin Kuan, Simanga R. Kumalo, Peter Kuzmic, Simon Shui-Man Kwan, Kwok Pui-lan, André LaCocque, Stephen E. Lahey, John Tsz Pang Lai, Emiel Lamberts, Armando Lampe, Craig Lampe, Beverly J. Lanzetta, Eve LaPlante, Lizette Larson-Miller, Ariel Bybee Laughton, Leonard Lawlor, Bentley Layton, Robin A. Leaver, Karen Lebacqz, Archie Chi Chung Lee, Marilyn J. Legge, Hervé LeGrand, D. L. LeMahieu, Raymond Lemieux, Bill J. Leonard, Ellen M. Leonard, Outi Leppä, Jean Lesaulnier, Nantawan Boonprasat Lewis, Henrietta Leyser, Alexei Lidov, Bernard Lightman, Paul Chang-Ha Lim, Carter Lindberg, Mark R. Lindsay, James R. Linville, James C. Livingston, Ann Loades, David Loades, Jean-Claude Loba-Mkole, Lo Lung Kwong, Wati Longchar, Eleazar López, David W. Lotz, Andrew Louth, Robin W. Lovin, William Luis, Frank D. Macchia, Diarmaid N. J. MacCulloch, Kirk R. MacGregor, Marjory A. MacLean, Donald MacLeod, Tomas S. Maddela, Inge Mager, Laurenti Magesa, David G. Maillu, Fortunato Mallimaci, Philip Mamalakis, Kä Mana, Ukachukwu Chris Manus, Herbert Robinson Marbury, Reuel Norman Marigza, Jacqueline Mariña, Antti Marjanen, Luiz C. L. Marques, Madipoane Masenya (ngwan'a Mphahlele), Caleb J. D. Maskell, Steve Mason, Thomas Massaro, Fernando Matamoros Ponce, András Máté-Tóth, Odair Pedroso Mateus, Dinis Matsolo, Fumitaka Matsuoka, John D'Arcy May, Yelena Mazour-Matusevich, Theodore Mbazumutima, John S. McClure, Christian McConnell, Lee Martin McDonald, Gary B. McGee, Thomas McGowan, Alister E. McGrath, Richard J. McGregor, John A. McGuckin, Maud Burnett McInerney, Elsie Anne McKee, Mary B. McKinley, James F. McMillan, Ernan McMullin, Kathleen E. McVey, M. Douglas Meeks, Monica Jyotsna Melanchthon, Ilie Melniciuc-Puica, Everett Mendoza, Raymond A. Mentzer, William W. Menzies, Ina Merdjanova, Franziska Metzger, Constant J. Mews, Marvin Meyer, Carol Meyers, Vasile Mihoc, Gunner Bjerg Mikkelsen, Maria Inêz de Castro Millen, Clyde Lee Miller, Bonnie J. Miller-McLemore, Alexander Mirkovic, Paul Misner, Nozomu Miyahira, R. W. L. Moberly, Gerald Moede, Aloo Osotsi Mojola, Sunanda Mongia, Rebeca Montemayor, James Moore, Roger E. Moore, Craig E. Morrison O.Carm, Jeffry H. Morrison, Keith Morrison, Wilson J. Moses, Tefetso Henry Mothibe, Mokgethi Motlhabi, Fulata Moyo, Henry Mugabe, Jesse Ndwiga Kanyua Mugambi, Peggy Mulambya-Kabonde, Robert Bruce Mullin, Pamela Mullins Reaves, Saskia Murk Jansen, Heleen L. Murre-Van den Berg, Augustine Musopole, Isaac M. T. Mwase, Philomena Mwaura, Cecilia Nahnfeldt, Anne Nasimiyu Wasike, Carmiña Navia Velasco, Thulani Ndlazi, Alexander Negrov, James B. Nelson, David G. Newcombe, Carol Newsom, Helen J. Nicholson, George W. E. Nickelsburg, Tatyana Nikolskaya, Damayanthi M. A. Niles, Bertil Nilsson, Nyambura Njoroge, Fidelis Nkomazana, Mary Beth Norton, Christian Nottmeier, Sonene Nyawo, Anthère Nzabatsinda, Edward T. Oakes, Gerald O'Collins, Daniel O'Connell, David W. Odell-Scott, Mercy Amba Oduyoye, Kathleen O'Grady, Oyeronke Olajubu, Thomas O'Loughlin, Dennis T. Olson, J. Steven O'Malley, Cephas N. Omenyo, Muriel Orevillo-Montenegro, César Augusto Ornellas Ramos, Agbonkhianmeghe E. Orobator, Kenan B. Osborne, Carolyn Osiek, Javier Otaola Montagne, Douglas F. Ottati, Anna May Say Pa, Irina Paert, Jerry G. Pankhurst, Aristotle Papanikolaou, Samuele F. Pardini, Stefano Parenti, Peter Paris, Sung Bae Park, Cristián G. Parker, Raquel Pastor, Joseph Pathrapankal, Daniel Patte, W. Brown Patterson, Clive Pearson, Keith F. Pecklers, Nancy Cardoso Pereira, David Horace Perkins, Pheme Perkins, Edward N. Peters, Rebecca Todd Peters, Bishop Yeznik Petrossian, Raymond Pfister, Peter C. Phan, Isabel Apawo Phiri, William S. F. Pickering, Derrick G. Pitard, William Elvis Plata, Zlatko Plese, John Plummer, James Newton Poling, Ronald Popivchak, Andrew Porter, Ute Possekel, James M. Powell, Enos Das Pradhan, Devadasan Premnath, Jaime Adrían Prieto Valladares, Anne Primavesi, Randall Prior, María Alicia Puente Lutteroth, Eduardo Guzmão Quadros, Albert Rabil, Laurent William Ramambason, Apolonio M. Ranche, Vololona Randriamanantena Andriamitandrina, Lawrence R. Rast, Paul L. Redditt, Adele Reinhartz, Rolf Rendtorff, Pål Repstad, James N. Rhodes, John K. Riches, Joerg Rieger, Sharon H. Ringe, Sandra Rios, Tyler Roberts, David M. Robinson, James M. Robinson, Joanne Maguire Robinson, Richard A. H. Robinson, Roy R. Robson, Jack B. Rogers, Maria Roginska, Sidney Rooy, Rev. Garnett Roper, Maria José Fontelas Rosado-Nunes, Andrew C. Ross, Stefan Rossbach, François Rossier, John D. Roth, John K. Roth, Phillip Rothwell, Richard E. Rubenstein, Rosemary Radford Ruether, Markku Ruotsila, John E. Rybolt, Risto Saarinen, John Saillant, Juan Sanchez, Wagner Lopes Sanchez, Hugo N. Santos, Gerhard Sauter, Gloria L. Schaab, Sandra M. Schneiders, Quentin J. Schultze, Fernando F. Segovia, Turid Karlsen Seim, Carsten Selch Jensen, Alan P. F. Sell, Frank C. Senn, Kent Davis Sensenig, Damían Setton, Bal Krishna Sharma, Carolyn J. Sharp, Thomas Sheehan, N. Gerald Shenk, Christian Sheppard, Charles Sherlock, Tabona Shoko, Walter B. Shurden, Marguerite Shuster, B. Mark Sietsema, Batara Sihombing, Neil Silberman, Clodomiro Siller, Samuel Silva-Gotay, Heikki Silvet, John K. Simmons, Hagith Sivan, James C. Skedros, Abraham Smith, Ashley A. Smith, Ted A. Smith, Daud Soesilo, Pia Søltoft, Choan-Seng (C. S.) Song, Kathryn Spink, Bryan Spinks, Eric O. Springsted, Nicolas Standaert, Brian Stanley, Glen H. Stassen, Karel Steenbrink, Stephen J. Stein, Andrea Sterk, Gregory E. Sterling, Columba Stewart, Jacques Stewart, Robert B. Stewart, Cynthia Stokes Brown, Ken Stone, Anne Stott, Elizabeth Stuart, Monya Stubbs, Marjorie Hewitt Suchocki, David Kwang-sun Suh, Scott W. Sunquist, Keith Suter, Douglas Sweeney, Charles H. Talbert, Shawqi N. Talia, Elsa Tamez, Joseph B. Tamney, Jonathan Y. Tan, Yak-Hwee Tan, Kathryn Tanner, Feiya Tao, Elizabeth S. Tapia, Aquiline Tarimo, Claire Taylor, Mark Lewis Taylor, Bishop Abba Samuel Wolde Tekestebirhan, Eugene TeSelle, M. Thomas Thangaraj, David R. Thomas, Andrew Thornley, Scott Thumma, Marcelo Timotheo da Costa, George E. “Tink” Tinker, Ola Tjørhom, Karen Jo Torjesen, Iain R. Torrance, Fernando Torres-Londoño, Archbishop Demetrios [Trakatellis], Marit Trelstad, Christine Trevett, Phyllis Trible, Johannes Tromp, Paul Turner, Robert G. Tuttle, Archbishop Desmond Tutu, Peter Tyler, Anders Tyrberg, Justin Ukpong, Javier Ulloa, Camillus Umoh, Kristi Upson-Saia, Martina Urban, Monica Uribe, Elochukwu Eugene Uzukwu, Richard Vaggione, Gabriel Vahanian, Paul Valliere, T. J. Van Bavel, Steven Vanderputten, Peter Van der Veer, Huub Van de Sandt, Louis Van Tongeren, Luke A. Veronis, Noel Villalba, Ramón Vinke, Tim Vivian, David Voas, Elena Volkova, Katharina von Kellenbach, Elina Vuola, Timothy Wadkins, Elaine M. Wainwright, Randi Jones Walker, Dewey D. Wallace, Jerry Walls, Michael J. Walsh, Philip Walters, Janet Walton, Jonathan L. Walton, Wang Xiaochao, Patricia A. Ward, David Harrington Watt, Herold D. Weiss, Laurence L. Welborn, Sharon D. Welch, Timothy Wengert, Traci C. West, Merold Westphal, David Wetherell, Barbara Wheeler, Carolinne White, Jean-Paul Wiest, Frans Wijsen, Terry L. Wilder, Felix Wilfred, Rebecca Wilkin, Daniel H. Williams, D. Newell Williams, Michael A. Williams, Vincent L. Wimbush, Gabriele Winkler, Anders Winroth, Lauri Emílio Wirth, James A. Wiseman, Ebba Witt-Brattström, Teofil Wojciechowski, John Wolffe, Kenman L. Wong, Wong Wai Ching, Linda Woodhead, Wendy M. Wright, Rose Wu, Keith E. Yandell, Gale A. Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- The Cambridge Dictionary of Christianity
- Published online:
- 05 August 2012
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- 20 September 2010, pp xi-xliv
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Plate section
- C. Laird Birmingham, University of British Columbia, Vancouver, Pierre J. V. Beumont, University of Sydney
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- Medical Management of Eating Disorders
- Published online:
- 18 December 2009
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- 23 September 2004, pp -
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17 - Information for family and friends
- C. Laird Birmingham, University of British Columbia, Vancouver, Pierre J. V. Beumont, University of Sydney
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- Medical Management of Eating Disorders
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- 18 December 2009
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- 23 September 2004, pp 257-259
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Summary
AN is a disease, like asthma is a disease. It is not dieting, a strong wish to be thin, or malingering. People afflicted with AN have within their minds two realities. One reality is a normal and healthy one. Just like you and I, those who suffer from AN want to be happy, healthy, and normal. The other reality is best understood as a phobia, a state of immense fear and concern. In AN, the phobia is that of loss of control, leading to obesity. Just like a phobia of going outside, AN has far-reaching implications. The phobia of personal obesity leads to changes in exercise, eating, unusual behaviors, and AN almost constant state of fear, anxiety, and inability to cope with life. The weight loss that results from this phobic state can be life-threatening.
What causes anorexia nervosa?
Anorexia is a disease that occurs in about one in 100–200 women and about two in 1000 men. The onset of AN is preceded by weight loss. The weight loss may have occurred for any reason, e.g. dieting, travel, diarrhea, or after surgery. AN also requires a certain genetic make-up. AN cannot occur in those who do not have a genetic predisposition to the disease. Even with a genetic predisposition and weight loss, other factors, such as social, environmental, family, or psychological stressors, may be necessary for the disease to manifest itself.
3 - History, examination, and investigations
- C. Laird Birmingham, University of British Columbia, Vancouver, Pierre J. V. Beumont, University of Sydney
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- Medical Management of Eating Disorders
- Published online:
- 18 December 2009
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- 23 September 2004, pp 24-47
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Summary
Special considerations for history taking in eating disorder patients
Leave your office to meet the patient and observe their behavior with those who have accompanied them. Note their state of affect and ability to walk, then gait, weakness, and unsteadiness.
Certain elements of the history, such as those related to abuse or sexual issues, may best be left to a subsequent interview when rapport has been developed.
Instruct the patient to change in a private area, to keep on their underwear, and to wear the gown open to the back. Examining the patient while fully dressed may lead to failure to observe the degree of emaciation and other physical signs. It is preferable to perform the physical examination in the presence of a female trusted by the patient. Do not do rectal, pelvic, or breast examination as part of an eating disorder assessment physical examination.
Mental status examination
General appearance and behavior
Does the patient appear physically unwell, anxious, or depressed? Is he or she emaciated, or are they wearing clothes that obscure their figure? Is the patient restless? Many anorexic patients are unable to sit still or even sit, even when asked to do so, and continually jiggle their feet.
Speech
Is the patient communicative, or do they answer only briefly and reluctantly. Does the patient set out to justify their reasons for dieting? Do they avoid eye contact when asked potentially confrontational questions about eating, exercise, vomiting, or laxative abuse?
4 - Medical manifestations by system
- C. Laird Birmingham, University of British Columbia, Vancouver, Pierre J. V. Beumont, University of Sydney
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- Medical Management of Eating Disorders
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Summary
The medical symptoms and signs of AN and, although less serious, of other eating disorders are part of the illness, and hence it is more appropriate to think of them as medical manifestations rather than merely complications. Although the disorder usually starts in adolescence, its course is often prolonged; AN patients may be ill for many years, and the majority of severely ill AN patients are in early or mid adult life. Hence, AN is a matter of concern for adult physicians as well as for pediatricians and adolescent medicine specialists. Figure 4.1 shows a mnemonic that is useful for remembering the physical signs of eating disorders.
Manifestations result from starvation or from the behaviors adopted to induce it. They are not indicative of underlying pathology. The inexperienced clinician who undertakes unnecessary investigations to exclude all possible causes for each abnormal finding is doing the patient a disservice by delaying appropriate treatment. Rather, all clinicians should be aware of the wide range of physical abnormalities that are commonly found in anorexic patients (Table 4.1). Many of these abnormalities, such as decreased serum concentrations of gonadotropins and steroid sex hormones, alterations to the peripheral metabolism of thyroid hormone, and raised circulating concentrations of cortisol and growth hormone, are best regarded as physiological adaptations to the state of starvation and do not require treatment. However, some medical complications are not only clinically important but are also life-threatening; these require special attention.
7 - Medical and nutritional therapy
- C. Laird Birmingham, University of British Columbia, Vancouver, Pierre J. V. Beumont, University of Sydney
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- Medical Management of Eating Disorders
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- 23 September 2004, pp 128-170
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15 - Nursing patients with anorexia nervosa
- C. Laird Birmingham, University of British Columbia, Vancouver, Pierre J. V. Beumont, University of Sydney
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- Medical Management of Eating Disorders
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Summary
Introduction
Caring for patients with dieting disorders can be one of the most challenging and rewarding roles for nurses. However, even for the most experienced clinician, it can also be frustrating, anxiety-provoking, and emotionally draining, and nurses must be aware of the potential for burnout and emotional over- or underinvolvement.
Nurses become many things to a patient with AN, most essentially someone who is familiar with the patient's feelings, ideas, emotions, routines, rituals, and behaviors. Nurses need to be skilled in recognizing and interpreting the physiological and psychological signs, symptoms, and complications of the disorder. It is imperative that they develop AN empathic, non-judgmental approach, and that they maintain clear professional boundaries — yet a nurse's job is to challenge fixed and unrealistic beliefs and to assist in the development of motivation to change, so it is necessary to form a strong and trusting bond. As well, nurses provide information, act as role models, and support the patient and their family through the recovery process.
In order to fulfill this challenging and difficult role, nurses need education, clinical supervision, support from management and administration, collaboration and communication with other nursing colleagues, and recognition from other members of the treatment team that the nurse's role is valuable and vital.
16 - The role of the dietitian
- C. Laird Birmingham, University of British Columbia, Vancouver, Pierre J. V. Beumont, University of Sydney
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- Medical Management of Eating Disorders
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Summary
A team approach is vital for effective treatment of eating disorders. The specialist clinical dietitian, as part of the team, is the most qualified person to provide accurate education about nutrition, weight gain, weight maintenance, the resumption of normal eating, and the nutritional methods of avoiding the refeeding syndrome.
Nutrition treatment is not as simple as applying AN educational formula and handing out a diet sheet. Nutrition intervention is complex, and eating disorder patients are resistant to nutritional treatment. Compliance may be reduced by perceived coercion, psychiatric comorbidities such as borderline personality disorders, self-harm, and suicidality, and ethical issues such as the need to report at-risk children to the law. Dietary change may be dependent on the patient's psychological progress.
The objectives of this chapter are to:
Review the range of dietetic interventions that are professionally acceptable to dietitians.
List some methods of dealing with the emotional issues that are likely to occur during treatment.
Promote self-care (supervision) for all dietitians working with eating disordered patients.
Discuss distinctions between specialist and non-specialist dietitians.
Clinical boundaries
Discuss the therapeutic limitations of nutrition counseling and make clear the need for concurrent psychotherapy at the first interview.
Professional boundaries
Work as a member of a team: before initiating any nutrition intervention, make certain that a doctor is following the patient medically on a regular basis and that psychological therapy is being carried out by a qualified practitioner. Emphasize the link between the patient's eating disorder and their emotional health in the dietetic sessions. Set AN upper limit of six dietetic sessions with a patient who is not engaged in a psychological intervention. This is to avoid clouding the dietetic intervention with emotional issues, to encourage psychological treatment, and to protect the patient against inadequate treatment.
[…]
5 - The clinician's response to common physical complaints
- C. Laird Birmingham, University of British Columbia, Vancouver, Pierre J. V. Beumont, University of Sydney
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- Medical Management of Eating Disorders
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Summary
Many of the physical symptoms of AN arerelated directly to the effects of semi-starvation, while other physical symptoms areassociated mainly with behavioral problems such as excessive exercising, vomiting, and purging. Table 5.1 lists the most common physical manifestations in AN. Table 5.2 lists the physical manifestations most commonly found in BN.
Edema
Case
A 25-year-old female gains 10 kg in seven days. She is extremely anxious and agitated and threatens to discharge herself against medical advice. The nurse asks you why she has gained so much weight.
Comment
During feeding, edema occurs due to volume depletion, low metabolic rate, behaviors such as vomiting and laxative, enema, and diuretic use, which cause the body to have high circulating hormones that promote the retention of fluid. Antidiuretic hormone is secreted by the pituitary, renin is secreted by the kidney, angiotension is formed in the blood, and aldosterone is produced by the adrenal gland. The amount of fluid that might be retained in a patient is impossible to predict, but it is often 3—5 kg of water. The fluid retention is much greater in patients with a history of binge—purge behavior or diuretic use.
If the patient is suspected of having edema, apply steady, firm pressure with the pad of your thumb over the skin covering the lower tibia, just about the ankle. After 15 seconds, a small pit will appear if edema is present.
PART V - AREAS OF SPECIAL INTEREST
- C. Laird Birmingham, University of British Columbia, Vancouver, Pierre J. V. Beumont, University of Sydney
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- Medical Management of Eating Disorders
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Summary
Introduction
This section of the book is directed at a more selective audience than Parts I–IV. First, it deals with the specific roles that general practitioners, nurses, and dietitians play in the management of patients with AN and other eating disorders. Second, it provides a brief section on the essential information that should be given to patients, their families, and their friends. Third, it draws conclusions about the possible future direction of clinical work in eating disorders and to the possibility of prevention programs with AN appraisal of risk factors.
2 - The behavioral disorders
- C. Laird Birmingham, University of British Columbia, Vancouver, Pierre J. V. Beumont, University of Sydney
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- Medical Management of Eating Disorders
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Summary
Dieting (restricting) and purging forms of anorexia nervosa
The diagnostic criteria that have been prescribed for AN and the other eating disorders have varied only slightly over the years, and the present form (see Tables 1.3–1.6) is essentially similar to when the disorders were first described. It is important to stress that these descriptions are simply lists of symptoms and signs that are commonly associated and that point to a similarity of course of others. They are not true definitions of an illness entity as is found in many instances elsewhere in medicine, i.e. an explanatory portrayal of etiological factors, pathology and physiopathology, derived manifestations, and a course of progression. Instead, they merely note physical, psychological, and behavioral features without a clear appreciation of their interrelationship. The most characteristic of the features of an eating disorder are the behavioral disturbances that the patient displays; it is these features that will be described here.
Anorexic behaviors, although all directed at either decreasing energy intake or increasing energy expenditure, are not uniform (Table 2.1). Some patients employ only the restrictive behaviors commonly associated with “normal” dieting, such as undereating, refusal of high-energy foods, and strenuous exercise. This is the “dieting” or “restricting” form of the illness; these patients differ from normal mainly in the extent of these behaviors and their inability to desist. Other patients also use vomiting and laxative or diuretic abuse. The presentation, then, is of the “purging” form of AN.
14 - The role of the general practitioner
- C. Laird Birmingham, University of British Columbia, Vancouver, Pierre J. V. Beumont, University of Sydney
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- Medical Management of Eating Disorders
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- 18 December 2009
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- 23 September 2004, pp 239-244
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Summary
With the current shift in focus from tertiary services to primary and secondary services, and with estimates that up to 5% of women presenting to (or registered with) a general practitioner have AN eating disorder, the general practitioner's (GP) role in identifying, treating, and managing people with eating disorders is becoming increasingly important. In addition, it is particularly concerning that, because eating disorders are frequently concealed or denied, up to 50% of cases go unrecognized in a clinical setting. On a practical level, secondary prevention has been associated with improved outcome and reduced chronicity.
For patients with partial- and full-syndrome disorders, the most effective role that a GP can take is the role of care coordinator or case manager. As Keks notes, “There is no consensus as to what constitutes case management; [however] on AN individual patient level it means the coordination of care for patients who require a number of services from different providers.”
In some cases, the GP's main goal will be to build rapport and motivation for change before arranging referral to other health professionals for treatment. In other instances, where additional training has been undertaken, the GP may feel comfortable with taking on AN extended role. Alternatively, the GP may wish to limit actual practice to medical management but to take responsibility for coordinating associated services. AN essential component of every GP's role is the identification of the disorder as it presents in various developmental or formative stages.