text:
Relationships between compulsive exercise, quality of life, psychological distress and motivation to change in adults with anorexia nervosa
Sarah Young1,
Stephen Touyz2,
Caroline Meyer3,
Jon Arcelus4,5,
Paul Rhodes2,
Sloane Madden6,7,
Kathleen Pike8,
Evelyn Attia9,
Ross D. Crosby10,11 &
Phillipa Hay ORCID: orcid.org/0000-0003-0296-685612
Journal of Eating Disorders volume 6, Article number: 2 (2018) Cite this article
For people with anorexia nervosa (AN), compulsive exercise is characterized by extreme concerns about the perceived negative consequences of stopping/reducing exercise, dysregulation of affect, and inflexible exercise routines. It is associated with increased eating disorder psychopathology and poor clinical outcome. However, its relationships with two important clinical issues, quality of life (QoL) and motivation to change, are currently unknown. This study aimed to assess the cross-sectional relationships between compulsive exercise, QoL, psychological distress (anxiety and depressive symptoms, and obsessive-compulsive traits) and motivation to change in patients with AN.
A total of 78 adults with AN participated in this study, which was nested within a randomized controlled trial of psychological treatments for AN. At baseline (pre-treatment), participants completed questionnaires assessing compulsive exercise, eating disorder (ED) psychopathology, QoL, psychological distress and motivation to change.
Baseline correlational analyses demonstrated a moderate positive relationship between compulsive exercise and ED psychopathology, and a weak positive relationship between compulsive exercise and psychological distress. There was a moderate negative relationship between compulsive exercise and eating disorder QoL.
These results indicate compulsive exercise is moderately associated with poorer QoL and weakly associated with higher distress. Targeting compulsive exercise in the treatment of anorexia nervosa may help reduce the burden of illness and improve patients' engagement in treatment.
ACTRN12610000585022. Taking a LEAP forward in the treatment of anorexia nervosa: a randomized controlled trial. NHMRC grant: 634922.
Many people with anorexia nervosa (AN) engage in compulsive exercise as a part of their eating disorder. This type of exercise can be defined as very driven and rigid exercise behaviours and attitudes. Although compulsive exercise has been linked to poorer physical and mental health outcomes, little is known about how it impacts on an individual's quality of life, and their motivation to change their eating disorder. We conducted a study with 78 adults with AN (including 4 males) who were taking part in a larger eating disorder treatment study. Before they started treatment, participants completed questionnaires which asked about eating disorder symptoms, compulsive exercise, quality of life, symptoms of anxiety, depression and obsessive-compulsive features, and their motivation to change. Our results found that people who exercised compulsively experienced more severe eating disorder symptoms. They also demonstrated poorer quality of life relating to their eating disorder and more elevated symptoms of depression and anxiety. Focusing on compulsive exercise in treatment for AN may help patients to improve their quality of life and mood.
Anorexia nervosa (AN) is associated with a variety of negative physical, psychological and psychosocial effects [1], as well as functional impairment and reduced quality of life (QOL) [2, 3]. Adding to the illness burden are common co-morbidities such as obsessive-compulsive disorder (OCD) and/or obsessive-compulsive traits as well as low levels of treatment engagement [4, 5]. An important aspect of AN psychopathology, given scarce attention in the QoL and treatment engagement literature, is compulsive exercise. This is lacking despite the high prevalence of problematic exercise, its association with compulsivity, and detrimental effects on treatment and illness course [6,7,8].
Compulsive exercise can be described as an individual's extremely driven and inflexible exercise patterns, together with a perceived lack of capacity to stop exercising, despite awareness of its negative effects [9]. It has been associated with higher levels of psychological distress in AN, including greater depressive and anxious traits. A conceptual model of compulsive exercise [10] emphasizes both the positively and negatively reinforcing contributions of this type of exercise on affect regulation. Although patients exercise to improve their mood, compulsive exercise can also be maintained by the individual to reduce high levels of negative emotions, primarily anxiety [11, 12]. It is often performed to avoid withdrawal symptoms such as irritability and low mood. These symptoms can occur when an individual is unable to exercise due to treatment restrictions/recommendations [13, 14].
In community samples, two characteristics of exercise have been significantly associated with lower QoL and higher ED psychopathology: (1) feeling guilty when unable to exercise; and (2) exercising predominantly to change weight or shape [15,16,17]. These findings in the community underline the need to explore associations between compulsive exercise, QoL and ED psychopathology in patients with AN.
Another important facet of AN which can impact upon treatment is the presence of obsessive-compulsive traits. These are a common comorbidity of AN [18] and are closely related to the concept of compulsivity, a key maintaining factor in Meyer et al.'s cognitive-behavioural model of exercise [10]. A positive association between problematic exercise in AN and obsessive-compulsive personality disorder (OCPD) traits has been demonstrated [19]. In contrast, studies of the relationship between obsessive-compulsive disorder (OCD) and excessive exercise have been inconsistent [19]. It may be that examining obsessive-compulsive traits could be more relevant in patients with AN. An updated conceptualization of compulsive exercise and a corresponding self-report measure have since been developed [9] and this relationship can now be examined more closely.
Low motivation to change can also have a significant impact upon progress in treatment for AN, and has been associated with lower BMI [20], slower weight gain [21] and poorer overall QoL [22]. However, little is known about the relationship between compulsive exercise and motivation to change. As compulsive exercise has been associated with other indicators of eating disorder severity such as being a predictor of relapse [23] and having longer hospitalizations [24], it would be interesting to assess whether there is an association between exercise and motivation to change before treatment. Many patients with AN endorse compulsive exercise driven by shape and weight concerns, and as a method of affect regulation [10]. This is an area we wish to explore as it can be argued that these characteristics could contribute to reduced motivation to change. The trans-theoretical model of motivation to change [25] has been applied to patients with AN and posits that patients (with various illness diagnoses) can move between 6 stages of change ranging from pre-contemplation to maintenance and termination.
In summary, compulsive exercise is a core feature of AN, which can add great complexity to the course of the illness and have a negative impact upon treatment [6, 12]. Furthermore, exercise is associated with greater eating disorder psychopathology and higher levels of depression and anxiety. The relationship between compulsive exercise and QoL has been demonstrated in non-clinical studies but needs to be replicated in the clinical population. Little is known about the relationships between compulsive exercise and QOL, and between compulsive exercise and motivation to change in patients with AN. As obsessive-compulsive traits can compromise treatment outcome, the relationship between exercise in AN and these traits also requires further examination.
The current study thus aimed to assess the relationships between severity of compulsive exercise with subjective ratings of eating disorder psychopathology, QOL, psychological distress and motivation to change pre-treatment. It was hypothesized that compulsive exercise would be negatively related to QOL, but positively related to psychological distress. Given the paucity of previous research investigating compulsive exercise and motivation to change, no specific hypothesis was made for this relationship.
A total of 78 adults (including 4 males) participated in the current study, all of whom were enrolled in a multi-site randomized controlled trial (RCT) "Taking a LEAP forward in the treatment of anorexia nervosa" [26]. The trial took place in Leicester, United Kingdom; Sydney, Australia; and New York, United States of America. The main aim of the parent trial was to examine a novel cognitive-behavioural therapy module for compulsive exercise (compuLsive Exercise Activity theraPy or LEAP) [27], and to determine if it improved treatment outcomes for patients with AN who exercise. Participants were randomly allocated into one of two groups. The first group completed 34 sessions of mCBT-AN [28], a cognitive-behavioural therapy (CBT) which aims to normalize eating and help patients reach and maintain a healthy weight. The second group had eight sessions of LEAP treatment, and 26 sessions of mCBT-AN. LEAP aims to provide psychoeducation to patients about distinctions between healthy/balanced and compulsive exercise, utilizing CBT techniques to manage unhelpful exercise behaviours and beliefs [27]. A pilot study of LEAP for inpatients with AN has demonstrated its acceptability [29].
All participants were recruited for the trial through referral from an eating disorder clinic/service, or from public advertising. Potential participants had to be 18 years or older to enrol in the trial, have a DSM-5 primary diagnosis of AN [30] using the Eating Disorder Examination (EDE) interview [31], and have a Body Mass Index (BMI) between 14 and 18.5. Participants were assessed for medical stability and this was monitored regularly throughout the trial. To enrol in the trial, participants had to have participated in exercise in the previous month, as indicated on the Exercise Participation Screening Questionnaire (participated in an activity on at least one occasion in the previous 4 weeks) or scored at least one time in the past month on the Eating Disorder Examination Questionnaire, i.e. self-report that he/she participated in at least one occasion of exercise in the past 4 weeks (EDE-Q) [32]. This criterion was broad as the study aimed to recruit participants performing a range of exercise behaviour, but participants did not need to view their exercise as compulsive. Exclusion criteria were a diagnosis of psychosis or bipolar disorder, current substance dependence, high suicidality, medical instability and concurrent treatment for their eating disorder. There were 574 potential participants who expressed interest in the trial. However, 496 were deemed ineligible or did not wish to participate, hence there were 78 who were enrolled and randomized in the trial.
Ethics was approved at each site: the Western Sydney University Human Research Ethics Committee; National Health Service Research Ethics Committee in the UK, as part of the Health Research Authority; and the Institutional Review Board at Columbia University in New York, USA. Participants gave written informed consent for the treatment trial and for completion of research assessments.
The mean age of the participants at initial assessment in the current study was 27.38 years (SD: 9.22, median: 24.7, interquartile range: 20.1–31.0 years), their mean BMI was 16.52 (SD: 1.12, median: 16.8, interquartile range: 15.7–17.5) and the average duration of illness (from diagnosis of AN to enrolment in the trial) was 5.65 years (SD: 7.88, median:1.40; interquartile range: .6–8.5 years). 71.8% met criteria for AN-Restrictive subtype, whilst 28.2% met criteria for AN Binge-eating/Purging subtype. Of the participants, 32.1% were born in Australia, 50% were born in the UK, 11.5% in the USA, and the remaining 6.4% were born elsewhere. A total of 52.5% of the sample had completed university, whilst a further 35.9% had completed at least 10 years of schooling. At the time of the study, 57.7% worked full-time or part-time, 26.9% were students, 12.8% were unemployed and 2.6% completed full-time house duties. Most participants were single (69.3%), 26.9% were married or living in long-term relationships, and 3.8% were separated or divorced.
Participants completed self-report questionnaires assessing ED psychopathology, compulsive exercise, psychological distress, motivation to change and quality of life. These questionnaires were presented to participants in the order below.
Eating Disorder Examination-Questionnaire (EDE-Q) [32] is a 36-item questionnaire, comprised of the four subscales in the EDE interview [31]. It has demonstrated good psychometrics in clinical samples [33]. Participants completed the full EDE-Q, but only the EDE-Q global score was used in the analyses. Higher scores indicate greater eating disorder psychopathology. The Cronbach's α for the EDE-Q global score in the current study was .94.
Short Form-12 Health Status Questionnaire (SF-12) [34] assesses quality of life by investigating the functional limitations related to physical and mental health conditions. It consists of 12 Likert-style response items that examine a range of domains including Physical Functioning e.g. "Does your health now limit you in these activities? Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling or playing golf"; Bodily Pain e.g. "During the past four weeks, how much did pain interfere with your normal work, including both work outside the home and housework?"; and Social functioning e.g. "During the past four weeks, how much of the time has your physical health or emotional problems interfered with your social activities like visiting friends or relatives?" This study used two subscales, the Physical Health Component Summary Scale (PCS), and the Mental Health Component Summary Scale (MCS). Higher scores indicate a greater level of functioning. The SF-12 has previously demonstrated good psychometric properties [34] and the Cronbach's α for the overall scale was .89. The SF-12 can compare QoL across a variety of illness categories [35, 36].
Kessler-10 item distress scale (K-10) [37] is a measure of psychological distress (operationalized as anxiety and depression symptoms), originally developed as a screening tool for these symptoms in community samples. The 10-item questionnaire includes questions such as "Over the past four weeks (28 days), how often have you felt so nervous that nothing could calm you down?" and "Over the past four weeks (28 days), how often have you felt that everything was an effort?". Higher scores (maximum score of 50) indicate greater psychological distress, with large community surveys by the Australian Bureau of Statistics classifying scores of 30–50 to be in the Very High distress range [38]. It is a valid measure for patients with eating disorders [39]. The total score was used in the current study, and the Cronbach's α was .92.
Padua Inventory (Padua) [40] is a 39-item measure of psychological distress, specifically assessing obsessive-compulsive traits. It consists of six subscales: Contamination obsessions and washing compulsions e.g. "I feel my hands are dirty when I touch money"; Dressing/Grooming compulsions e.g. "I feel obliged to follow a particular order in dressing, undressing, and washing myself"; Checking compulsions e.g. "I have to do things several times before I think they are properly done"; Obsessional thoughts of harm to self/others e.g. "I think or worry at length about having hurt someone without knowing it"; and Obsessional impulses to harm self/others e.g. "When I see a train approaching, I sometimes think I could throw myself under its wheels". It has demonstrated good psychometric properties [41] and is valid for use in clinical samples. Higher scores indicate greater obsessive-compulsive traits. The mean total score was used in the current study and the Cronbach's α for the scale was .93.
Eating Disorder Quality of Life (EDQoL) [42] is a 25-item measure of eating disorders-specific quality of life with four subscales: Psychological "How often has your eating/weight made you feel worse about yourself?"; Physical/Cognitive "How often has your eating/weight affected your ability to pay attention when you wanted to?"; Work/School "How often has your eating/weight led to a leave of absence from work?"; and Financial "How often has your eating/weight led to the need to spend money from savings or use your credit card frequently?". These are summed for a mean total score, with higher scores representing lower quality of life. The EDQoL has been previously used in patients with eating disorders [36] and patients with chronic AN [35]. The Cronbach's α for the overall scale was .93. ED-specific QOL measures can be used to compare results of different treatment interventions [35, 36].
The Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) [43] is a validated measure of motivation to change in patients with AN. It consists of 20 items, assessing three factors of Weight Gain (readiness to achieve a minimum healthy body weight), Eating, shape and weight concerns (readiness to change shape and weight importance in defining achievement and satisfaction in life), and Ego-alien aspects (readiness to change interpersonal issues associated with AN). Each item has 5 answers representing the different stages of change: pre-contemplation; contemplation; preparation; action; and maintenance. The participant marks the response/s that is most in line with their current attitudes. Example items include Weight gain (pre-contemplation response) "As far as I am concerned I do not need to gain weight"; Eating, shape and weight concerns (action response) "I often try to challenge the importance that I place on my body shape or weight in determining my happiness and success"; and Ego-alien aspects (maintenance response) "The problems in my relationships with others have improved and I am trying to keep it this way". Higher scores indicate greater motivation to change. The following mean scores correspond to the different stages of change: < 1.5 = pre-contemplation; 1.5–2.4 = contemplation; 2.5–3.4 = preparation; 3.5–4.4 = action; > 4.5 = maintenance. Cronbach's α for the scale was .91.
Compulsive Exercise Test (CET) [9] is a 24-item self-report questionnaire examining the core maintaining factors of compulsive exercise for patients with eating disorders. It consists of 5 subscales: Avoidance and rule-driven behavior (CET-Avoidance, e.g. "I usually continue to exercise despite injury or illness, unless I am very ill or too injured"); Weight control exercise (CET-Weight control, e.g. "If I feel I have eaten too much, I will do more exercise"); Mood improvement (CET-Mood, e.g. "I feel less stressed and/or tense after I exercise"); Lack of exercise enjoyment (CET-Lack of enjoyment, e.g. "I find exercise a chore") and Exercise rigidity (CET-Rigidity, e.g. "I like my days to be organized and structured, of which exercise is just one part"). The CET-Total score is used in this study, calculated by summing the means for the five subscales. Higher scores reflect more compulsive exercise. It is psychometrically sound and has been validated for use in adult clinical samples [44, 45]. A clinical cut-off score of 15 is effective in differentiating between compulsive and non-compulsive exercise in patients with diagnosed eating disorders [44]. In the current study, only the CET-Total was used, and its Cronbach's α was .92.
The Shapiro-Wilk test demonstrated that the data were not normally distributed for the EDE-Q, Padua Inventory, ANSOCQ and CET, thus non-parametric tests (Spearman's rho) were used in the analyses. Due to hypotheses, one-tailed tests were used, except for the ANSOCQ which used a two-tailed test. The significance level was set at .05 and analyses were performed using SPSS, Version 22.
Correlations between compulsive exercise, QOL, distress and motivation to change
The aim of this study was to examine the relationships between compulsive exercise, QOL, psychological distress and motivation to change prior to treatment (see Table 1). CET-Total was positively and moderately associated with higher eating disorder psychopathology (EDE-Q). CET-Total was not significantly associated with the SF-12 Mental health Component score, but it showed a weak negative association with the SF-12 Physical health Component Score, meaning poorer physical health quality of life. CET-Total was moderately associated with higher EDQOL scores, indicating poorer quality of life.
Table 1 Spearman's correlations between compulsive exercise and variables of interest at baseline
Our results demonstrated a weak positive association between CET-Total and psychological distress, as measured by both the Kessler-10 and the Padua Inventory. There was no significant association between CET-total and motivation to change (ANSOCQ overall stage score).
The current study aimed to assess the relationships of compulsive exercise to QOL, psychological distress and motivation to change pre-treatment. Confirming the hypotheses, baseline correlations demonstrated weak positive associations between compulsive exercise (CET-Total) and psychological distress (anxiety and mood symptoms on the K-10), aligning with previous research [11, 46]. There was also a weak positive relationship between exercise and obsessive-compulsive traits, confirming previous results [8, 47, 48]. However, this contrasted Bewell-Weiss and Carter's study [49], which also used the Padua Inventory and found excessive exercise to be negatively associated with obsessive-compulsive symptomatology. Their study utilized a quantitative definition of compulsive exercise and categorized patients as excessive exercisers if they endorsed obligatory exercise for at least 1 h per day, on at least 6 days per week for 1 month. Our use of the CET examines the cognitive-behavioural characteristics of compulsive exercise, rather than the obligatory and quantitative aspects of compulsive exercise which may account for our different results.
A novel aspect of the current study was the examination of the relationships between compulsive exercise and quality of life. At baseline, compulsive exercise was moderately associated with poorer ED-related quality of life (EDQoL) and weakly associated with lower general physical-health quality of life (SF-12 PCS). There are few studies reporting upon these relationships in a clinical sample of outpatients, and our results emphasize the detrimental impact exercise can have upon patients' general functioning. Mond and Calogero [50] found that the two factors which differentiated between eating disorder patients and healthy women were the same as those associated with poorer quality of life in community samples, i.e. exercising for shape and weight reasons, and avoidance of guilt if exercise was missed [15,16,17]. However, they did not specifically investigate quality of life in this study. Other research examining an Australian sample of inpatients with EDs found a significant positive relationship between QOL and driven exercise [51]. Their study used the Quality of Life-Eating Disorders measure (QOL-ED) from the computer-generated Eating and Exercise Examination (EEE-C) [52] but looked only at the frequency of exercise and did not directly assess the compulsive qualities of exercise.
As compulsive exercise is associated with a wide range of physical health complaints [8], it was expected that there would be a significant relationship between compulsive exercise and poorer physical health QoL (measured by the PCS on the SF-12) prior to treatment. However, an unexpected finding was that the association between compulsive exercise and the mental-health component of the SF-12 (MCS) approached significance but was not significant (p = .05). The MCS measures the functional impairment from emotional issues upon work and social activities. Patients may experience their exercise to be adaptive, in that the behavior serves as both a way to improve their mood and to avoid/manage feelings of guilt and depression if they are unable to exercise. This could have impacted upon their ratings of functional impairment. Although the SF-12 has been evaluated as a sensitive measure of changes in ED pathology [35], it may also be that the MCS is not as sensitive to the positively and negatively reinforcing functions of compulsive exercise behavior.
Compulsive exercise was not significantly associated with lower motivation to change (ANSOCQ) in this pre-treatment sample (p = .055). However, we know that patients with a lower level of motivation for change demonstrate a greater rigidity of ED beliefs and are more ambivalent about reducing their ED behaviours. Given these negative characteristics of the illness are associated with poorer motivation to change, it is integral that therapists and medical specialists accurately assess patients' motivation to change. Future research should investigate this relationship longitudinally across treatment, as it may be that focusing on and addressing exercise in treatment [53] is more important for those who demonstrate lower motivation to change.
There were several strengths in the current study, namely that it incorporated both ED specific and general health QOL measures, as this has been recommended in recent reviews in the field [35, 36]. This study is novel in that no previous research has specifically investigated the relationships between compulsive exercise, quality of life and motivation to change in a clinical sample of outpatients with AN. It did include a small group of male patients with AN, but unfortunately it was not possible to conduct analyses based on gender due to our sample size. Men may experience more functional impairment than women from some ED symptoms e.g. objective binge eating [54], thus it would be beneficial for future studies to utilize larger samples of males with clinical EDs.
This study utilized a range of quality of life measures, however another eating disorder specific measure of HRQoL, e.g. Clinical Impairment Assessment (CIA) [55] may have been a useful addition. As our participants were medically stable and seen on a regular basis as outpatients, our results may not generalize to inpatients or day program patients. Although most of the correlations between compulsive exercise and variables of interest were significant, some of the correlations were weak in magnitude, e.g. K-10, Padua and SF-12 PCS. Finally, our patients were enrolled in an RCT addressing compulsive exercise and it was a criterion of entry that they had participated in at least one form of physical activity in the past month. These low exercise inclusion criteria were used to generalize as best as possible to patients with AN who engage in exercise (of any frequency), however it is important to acknowledge that these results may not generalize to all patients with AN. Despite having a low entry threshold for exercise, the mean CET score in this sample still fell above the clinical cut off score of 15 indicated for patients with AN who are compulsive exercisers [44].
This study demonstrated that greater compulsive exercise is moderately associated with poorer ED quality of life, and higher levels of ED psychopathology. Greater compulsive exercise is also weakly associated with higher levels of psychological distress. Addressing compulsive exercise is integral to reducing the burden of illness from AN and may be important in improving people's engagement in treatment. Further research is required to investigate the relationship between these variables, and to utilize longitudinal designs to assess if severity of compulsive exercise predicts these factors over time and throughout treatment.
ANSOCQ:
Anorexia Nervosa Stages of Change Questionnaire
CBT:
Cognitive-Behavioural Therapy
CE:
Compulsive Exercise
CET:
Compulsive Exercise Test
DSM-5:
Diagnostic and Statistical Manual of Mental Disorders 5th edition
EDE-Q:
Eating Disorder Examination-Questionnaire
EDQoL:
Eating Disorder Quality of Life scale
K-10:
Kessler 10-item Distress Scale
LEAP:
Loughborough Eating disorders Activity theraPy
MCS:
Mental Health Component Summary Scale
OCD:
OCPD:
PCS:
Physical Health Component Summary Scale
Padua Inventory
QOL:
RCT:
SF-12:
Short Form-12 Health Status Questionnaire
Zipfel S, Giel KE, Bulik CM, Hay P, Schmidt U. Anorexia nervosa: aetiology, assessment, and treatment. Lancet Psych. 2015;2:1099–111.
Winkler LA, Christiansen E, Lichtenstein MB, Hansen NB, Bilenberg N, Støving RK. Quality of life in eating disorders: a meta-analysis. Psych Res. 2014;219:1–9.
Mitchison D, Hay P, Mond J, Slewa-Younan S. Self-reported history of anorexia nervosa and current quality of life: findings from a community-based study. Qual Life Res. 2013;22:273–81.
Keski-Rahkonen A, Hoek HW, Susser ES, Linna MS, Sihvola E, Raevuori A, et al. Epidemiology and course of anorexia nervosa in the community. Am J Psych. 2007;164:1259–65.
Hart LM, Granillo MT, Jorm AF, Paxton SJ. Unmet need for treatment in the disorders: a systematic review of eating disorder specific treatment seeking among community cases. Clin Psych Rev. 2011;31:727–35.
Noetel M, Dawson L, Hay P, Touyz S. The assessment and treatment of unhealthy exercise in adolescents with anorexia nervosa: a Delphi study to synthesize clinical knowledge. Int J Eat Disord. 2017;50:378–88.
Dalle Grave R, Calugi S, Marchesini G. Compulsive exercise to control shape or weight in eating disorders: prevalence, associated features and treatment outcome. Comp Psych. 2008;49:346–52.
Shroff H, Reba L, Thornton LM, Tozzi F, Klump KL, Berrettini WH, et al. Features associated with excessive exercise in women with eating disorders. Int J Eat Disord. 2006;39:454–61.
Taranis L, Touyz S, Meyer C. Disordered eating and exercise: development and preliminary validation of the compulsive exercise test (CET). Eur Eat Dis Rev. 2011;19:256–68.
Meyer C, Taranis L, Goodwin H, Haycraft E. Compulsive exercise and eating disorders. Eur Eat Disord Rev. 2011;19:174–89.
Holtkamp K, Hebebrand J, Herpertz-Dahlmann B. The contribution of anxiety and food restriction on physical activity levels in acute anorexia nervosa. Int J Eat Disord. 2004;36:163–71.
Noetel M, Miskovic-Wheatley J, Costa D, Crosby RD, Hay P, Kohn M, et al. Exercise for the compulsive exercisers? An exploratory study in adolescent inpatients with anorexia nervosa. Adv Eat Disord. 2016;4:3.
Bamber D, Cockerill IM, Rodgers S, Carroll D. Diagnostic criteria for exercise dependence in women. Br J Sports Med. 2003;37:393–400.
Hausenblas HA, Symons DD. Exercise dependence: a systematic review. J Sport Exerc Psychol. 2002;3:89–123.
Mond JM, Rodgers B, Hay PJ, Owen C, Beumont PJV. Relationships between exercise behaviour, eating- disordered behaviour and quality of life in a community sample: when is exercise "excessive"? Eur Eat Disord Rev. 2004;12:265–72.
Mond JM, Hay PJ, Rodgers B, Owen C, Beumont PJV. An update on the definition of "excessive exercise" in eating disorders research. Int J Eat Disord. 2006;39:147–53.
Mond JM, Myers TC, Crosby RD, Hay P, Mitchell J. Excessive exercise and eating-disordered behaviour in young adult women: further evidence from a primary care sample. Eur Eat Disord Rev. 2008;16:215–21.
Swinbourne J, Touyz SW. The comorbidity of eating disorders and anxiety disorders: a review. Eur Eat Disord Rev. 2007;15:253–74.
Young S, Rhodes P, Touyz S, Hay P. The relationship between obsessive-compulsive personality disorder traits, obsessive-compulsive disorder and excessive exercise in patients with anorexia nervosa: a systematic review. J Eat Disord. 2013;1:16.
Geller J, Cassin SE, Brown KE, Srikameswaran S. Factors associated with improvements in readiness for change: low vs normal BMI eating disorders. Int J Eat Disord. 2004;42:40–6.
Schebendach JE, Mayer LE, Devlin MJ, Attia E, Contento IR, Wolf RL, Walsh BT. Dietary energy density and diet variety as predictors of outcome in anorexia nervosa. Am J Clin Nutrit. 2008;87:810–6.
Munoz PM, Quintana JM, Las Hayas C, Padierna A, Aguirre U, Gonzalez-Torres MA. Quality of life and motivation to change in eating disorders: perception of patient psychiatrist. Eat Behav. 2012;13:131–4.
Carter JC, Blackmore E, Sutander-Pinnock K, Woodside DB. Relapse in anorexia nervosa: a survival analysis. Psych Med. 2004;34:671–9.
Solenberger S. Exercise and eating disorders: a 3-year inpatient hospital record analysis. Eat Behav. 2001;2:151–68.
Prochaska JO, DiClemente CC, Norcross JC. In search of how people change: applications to addictive behaviors. Am Psych. 1992;47:1102–14.
Hay PJ, Touyz S, Meyer CM, Arcelus J, Crosby RD, Pike K, et al. A randomized controlled trial of the Loughborough eating disorders activity therapy (LEAP): a new approach to driven exercise in anorexia nervosa. Presented at the 21st annual meeting of the Eating Disorders Research Society 2016, New York, October 29.
Taranis L, Meyer C, Touyz S, Arcelus J, La Puma M. Loughborough eating disorders activity Programme "LEAP". Individual cognitive-behavioural therapy for compulsive exercise in the eating disorders: therapist manual. Loughborough: Loughborough University Centre for Research into Eating Disorders (LUCRED); 2011.
Pike KM, Walsh BT, Vitousek K, Wilson GT, Bauer J. Cognitive behavior therapy in the post-hospitalization treatment of anorexia nervosa. Am J Psych. 2003;160:2046–9.
La Puma M, Touyz S, Taranis L, Meyer C. Group cognitive-Behavioural therapy for excessive exercise in the eating disorders. Fremantle: Proceedings of the 6th annual Australian and New Zealand Academy for Eating Disorders (ANZAED) Conference; 2008.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). Washington: American Psychiatric Association; 2013.
Fairburn CG, Cooper Z, O'Connor M. The eating disorders examination. In: Fairburn CG, editor. Cognitive behavior therapy and eating disorders. New York: Guildford Press; 2008. p. 265–308.
Fairburn CG, Beglin SJ. Assessment of eating disorders: interview or self-report questionnaire? Int J Eat Disord. 1994;16:363–70.
Berg KC, Peterson CB, Frazier P, Crow SJ. Psychometric evaluation of the eating disorder examination and eating disorder examination-questionnaire: a systematic review of the literature. Int J Eat Disord. 2012;45:428–38.
Ware JE, Kosinski M, Keller SD. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–33.
Mitchison D, Hay P, Engel S, Crosby RD, Le Grange D, Lacey H, et al. Assessment of quality of life in people with severe and enduring anorexia nervosa: a comparison of generic and specific instruments. BMC Psych. 2013;13:284.
Ackard D, Richter S, Egan A, Engel S, Cronemeyer CL. The meaning of (quality of) life in patients with eating disorders: a comparison of generic and disease-specific measures across diagnosis and outcomes. Int J Eat Disord. 2014;47:259–67.
Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand SL, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psych Med. 2002;32:959–76.
Australian Bureau of Statistics (ABS). 4817.0.55.001 - Information Paper: Use of the Kessler-10 Psychological Distress Scale in ABS Health Surveys, Australia, 2007–08. Canberra: Author.
Mond JM, Hay PJ, Rodgers B, Owen C, Beumont PJV. Assessing quality of life in eating disorder patients. Qual Life Res. 2005;14:171–8.
Burns GL, Keortge S, Formea G, Sternberger L. Revision of the Padua inventory of obsessive- compulsive disorder symptoms: distinctions between worry, obsessions, and compulsions. Beh Res Ther. 1996;34:163–73.
Sternberger LG, Burns GL. Obsessions and compulsions: psychometric properties of the Padua inventory with an American college population. Beh Res Ther. 1990;28:341–5.
Engel SG, Wittrock DA, Crosby RD, Wonderlich SA, Mitchell JE, Kolotkin RL. Development and psychometric validation of an eating-disorder specific health-related quality of life instrument. Int J Eat Disord. 2006;39:62–71.
Rieger E, Touyz S, Schotte D, Beumont P, Russell J, Clarke S, et al. Development of an instrument to assess readiness to recover in anorexia nervosa. Int J Eat Disord. 2000;28:387–96.
Meyer C, Plateau CR, Taranis L, Brewin N, Wales J, Arcelus J. The compulsive exercise test: confirmatory factor analysis and links with eating psychopathology among women with clinical eating disorders. J Eat Disord. 2016;4:22.
Young S, Touyz S, Meyer C, Arcelus J, Rhodes P, Madden S, et al. Validity of exercise measures in adults with anorexia nervosa: the EDE, compulsive exercise test and other self-report scales. Int J Eat Disord. 2017;50:533–41.
Penas-Lledo E, Vaz Leal FJ, Waller G. Excessive exercise in anorexia nervosa and bulimia nervosa: relation to eating characteristics and general psychopathology. Int J Eat Disord. 2002;31:370–5.
Davis C, Kaptein S. Anorexia nervosa with excessive exercise: a phenotype with close links to obsessive-compulsive disorder. Psych Res. 2006;142:209–17.
Naylor H, Mountford V, Brown G. Beliefs about excessive exercise in eating disorders: the role of obsessions and compulsions. Eur Eat Disord Rev. 2011;19:226–36.
Bewell-Weiss CV, Carter JC. Predictors of excessive exercise in anorexia nervosa. Comp Psych. 2010;51:566–71.
Mond JM, Calogero R. Excessive exercise in eating disorder patients and in healthy women. ANZ J Psych. 2009;43:227–34.
Abraham SF, Brown T, Boyd C, Luscombe G, Russell J. Quality of life: eating disorders. ANZ J Psych. 2006;40:150–5.
Abraham SF, Lovell N. Research and clinical assessment of eating and exercise behaviour. Hosp Med. 1999;60:481–5.
Beumont PJV, Arthur B, Russell JD, Touyz SW. Excessive physical activity in dieting disorder patients: proposals for a supervised exercise program. Int J Eat Disord. 1994;15:21–36.
Mitchison D, Mond J, Slewa-Younan S, Hay P. Sex differences in health-related quality of life impairment associated with eating disorder features: a general population study. Int J Eat Disord. 2013;46:375–80.
Bohn K, Fairburn CG. Clinical Impairment Assessment questionnaire (CIA 3.0). In: Fairburn CG, editor. Cognitive behavior therapy and eating disorders. New York: Guildford Press; 2008. p. 315–7.
The authors would like to sincerely thank Andreea Heriseanu, Jackie Wales, Jessica Lerman and Lauren Belak for their work as research coordinators for the LEAP trial.
This study was supported by an NHMRC Project Grant no. 634922. HAY, Prof Phillipa; TOUYZ, Prof Stephen; MEYER, Dr. Caroline; ARCELUS, Dr. Jon; MADDEN, Dr. Sloane; CROSBY, Dr. Ross; PIKE, Dr. Kathleen. Taking a LEAP forward in the treatment of Anorexia Nervosa: A randomized controlled trial $557,100, 2010–2013. SY was supported by an Australian Postgraduate Award scholarship.
The datasets analysed during the current study are available from the corresponding author on reasonable request.
Griffith Taylor Building, School of Psychology, University of Sydney, Sydney, Australia
School of Psychology, University of Sydney, Sydney, Australia
Stephen Touyz & Paul Rhodes
WMG, University of Warwick, United Kingdom & University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
Caroline Meyer
Institute of Mental Health, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
Jon Arcelus
Leicestershire Adult Eating Disorders Service, Leicestershire Partnership NHS Trust, Bennion Centre, Glenfield Hospital, Leicester, UK
School of Medicine, University of Sydney, Sydney, Australia
Sloane Madden
Eating Disorders Service at the Sydney Children's Hospitals Network, Westmead, Australia
Division of Behavioral Health Services and Policy Research, Columbia University, New York, USA
Kathleen Pike
Department of Psychiatry, College of Physicians and Surgeons of Columbia University, Weill Cornell Medical College, New York, USA
Evelyn Attia
Neuropsychiatric Research Institute, Fargo, North Dakota, USA
Ross D. Crosby
University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, Australia
Phillipa Hay
Paul Rhodes
This study was nested within the RCT "Taking a LEAP forward in the treatment of anorexia nervosa". PH, ST, CM, JA, SM, RDC, KP and EA are chief investigators of this trial. SY developed the study idea and designed the study with PH and ST. RDC assisted SY with statistical analyses and interpretation of data. SY prepared the manuscript and all authors contributed to and approved the final manuscript.
Correspondence to Sarah Young.
Ethics approval was granted by the Western Sydney University Human Research Ethics Committee; the National Health Service Research Ethics Committee in the UK, as part of the Health Research Authority; and the Institutional Review Board at Columbia University in New York, USA.
Not applicable as the project did not report individual data.
ST and PH receive royalties from Routledge, Hogrefe, and Huber and McGraw-Hill publishers for printed contributions on eating disorders. SM and ST receive honoraria from Shire Pharmaceuticals. PH received royalties from Oxford University Press and receives sessional fees and lecture fees from the Australian Medical Council, Therapeutic Guidelines publication, and New South Wales Institute of Psychiatry. RDC is a statistical consultant to Health Outcome Solutions, in Winter Park, Florida. PH and ST are Editors-in-Chief of this journal, and CM, JA, SM, KP, JA, RDC and SY are on the editorial board. All authors have other published papers cited in this manuscript. SY submitted an alternate version of this manuscript as a part of her PhD thesis.
Young, S., Touyz, S., Meyer, C. et al. Relationships between compulsive exercise, quality of life, psychological distress and motivation to change in adults with anorexia nervosa. J Eat Disord 6, 2 (2018). https://doi.org/10.1186/s40337-018-0188-0
Obsessive-compulsive
Motivation to change
Exercise and Eating Disorders


text:
Women's Writing Circle
A place to share our stories ...
Books, Events and Services
Circle Read Arounds
So You Want To Write A Memoir
A PORTRAIT OF LOVE AND HONOR
Preview — Again In a Heartbeat
Reviews — Morning at Wellington Square
The Life Unexpected: An Anthology of Stories and Poems
Talks on Memoir
From Readers of Again In a Heartbeat
Critique Group
Workshops and Retreats
Living In An Age Of Digital Disruption
Are we living in an age of digital disruption? An ebooks LinkedIn discussion this past weekend centered on the Authors Guild meeting with the Department of Justice seeking an investigation of Amazon's business practices.
As I wrote on this blog last week, cries among "literary lions" and others with a vested and established interest in traditional publishing claim that Amazon borders on creating a monopoly in the ebook market.
Yesterday as I trolled The New York Times, I found the paper's public editor, Margaret Sullivan, putting the controversy into context in this article: Publishing Battle Should Be Covered Not Joined.
Sullivan writes: "It's important to remember that this is a tale of digital disruption, not good and evil."
Then I saw this article in SayDaily on the "democratization of content."
"The One Percent Rule of Internet culture goes something like this: One percent of users in any given community actively create new content, while the other 99% only view it. But on the new social-mobile Web, everyone is a creator."
Yes, anyone can create a book, publish a blog, "tell their brand stories and market their content." Thanks to pro-level digital tools like Smartphones and mobile apps, non-professionals have at their fingertips tools to make professional-looking visual content.
While I love blogging and was recently cited by bestselling author, Madeline Sharples as having one of her favorite blogs, I often feel the pressure to come up with a more digitally savvy blog.
This blog/website is set up much like the old-fashioned magazine. It offers written content in the form of an essay or journalistic Q and A. No videos here, no bells and whistles, nor have I hired a professional webmaster.
I'm comfortable and at home with the simplicity of the written word, and the photographs that enhance the commentary, not just my own, but the other wonderful bloggers and writers featured here.
That's not to disparage all the great new tools out there, but the learning curve, the investment in time and money, just isn't there for me, at least not now.
Interestingly, at a recent Constant Contact workshop I attended on email marketing, we heard that the fastest growing segment of people using Facebook and Twitter are over 60 years old.
My own sons, their friends and other Millennials I've talked to, deride Facebook. They don't have much interest in it or Twitter since they have no business to promote and no grandkids to show off. Or maybe they're just turned off by all of it.
Which gets back to the idea that Sullivan is right. We are living through an age of "digital disruption." It is changing and upending everything from how we go about branding and marketing ourselves "just as regular people" to publishing and selling ebooks. And for better or worse, it's here to stay.
It's a choice now whether to accept it and move forward or continue mourning over a way of life that is no more.
Are we living in an age of digital disruption? Your thoughts on the digital world and its impact on writing and publishing are most welcomed.
Posted by Susan G. Weidener at 9:25 AM
Labels: Amazon, apps, blogging, digital publishing, ebooks, New York Times
SUSAN G. WEIDENER
An experienced book editor, journalist and author, Susan received her BA in Literature from American University and her MS in Education from the University of Pennsylvania. Her memoirs, Again in a Heartbeat, and its sequel, Morning at Wellington Square, have received critical acclaim. Her novel, A Portrait of Love and Honor, is based on a true story. A former staff writer with The Philadelphia Inquirer, Susan started the Women's Writing Circle in suburban Philadelphia to empower women to write and find voice through memoir, fiction and poetry. The group offers critiques, read arounds, networking and book authorship opportunities. Susan also offers writing workshops and teaches memoir and fiction. She lives in Chester Springs, PA. She can be reached at sgweidener@comcast.net
2017 BLOGGING AWARD
BUY NOW (click on cover)
Membership and Session Fees
Full Membership $145.00 USD Half Membership $100.00 USD Writing Workshop $40.00 USD Critique $30.00 USD Single Read Around $25.00 USD Book purchase $15.00 USD
AUTHOR SUSAN G. WEIDENER
The Writer's Corner
Videotape: Interview With Susan About Memoir
Breaking the Rules of Writing
A Marriage of Fact and Fiction
Interview on How Memoir Changes Relationships
Interview - A Portrait of Love and Honor
Interview on Slants of Light
KIRKUS REVIEW - SLANTS OF LIGHT
Memoir Writer's Journey Interview With Susan
Memoir and Fiction - Choices
NAMW Guest Blog - Writing About My Mother
Susan's "Gutsy Story"
Susan's Interview On Honesty in Memoir
Susan's Radio Interview on the Avid Reader
Videotape: Slants of Light Author Panel
A Writer Waits to Find the Words: A Memoir Moment
Writing is my work, my pastime, my job. With writing, all the rest falls into place. Lately, though, finding words to describe what I feel r...
Writing and Wellness - A Guest Post By Randy Rolfe
This past month I met Randy Rolfe through Women's Business Connection , an empowering organization for women entrepreneurs in Cheste...
On Writing Book Discussion Questions
Should discussion questions be included in your new book? Do book discussion guides encourage book clubs to select a book? And, just a...
The "Sanctuary" That Is Writing
"H old fast to dreams For if dreams die Life is a broken-winged bird That cannot fly. Hold fast to dreams For when dreams g...
Family 'Myths' That Stymie the Memoir Writer
The memoir writer has the unenviable task of breaking through the family myths to get to the heart of her story and the people who populate...
Nicholas Sparks Evoking Emotion
"Love is like the wind, you can't see it but you can feel it." ~ A Walk to Remember by Nicholas Sparks. When I wrote my memoir abou...
Guest Blog - Journey Of The Heart
As we share our stories and journeys, I am pleased that Kathleen Pooler has written our first guest blog. I hope this is the beginning of ...
Slants of Light — A Collaboration
 "None of us is as smart as all of us." Japanese proverb Harriet, Susan and Edda A year to the date ...
Inner Monologue - Writing Prompt
June is here and with it comes the Circle read-around. As always, this is a chance to share our stories and become connected to our "...
A 'Gutsy' Indie Author's Adventure
This is the third in an occasional series featuring authors from around the world. I met Sonia Marsh through an independent author'...
Blog Archive January (1) December (2) November (2) October (3) September (3) August (1) July (4) June (1) May (4) April (2) March (1) February (1) January (1) December (3) November (2) October (2) September (2) August (3) July (4) June (3) May (2) April (2) March (4) February (3) January (3) December (3) November (4) October (4) September (4) August (3) July (4) June (4) May (3) April (3) March (4) February (1) January (4) December (3) November (4) October (4) September (4) August (4) July (4) June (5) May (2) April (4) March (4) February (5) January (5) December (4) November (4) October (5) September (2) August (5) July (3) June (4) May (5) April (3) March (3) February (4) January (4) December (3) November (5) October (4) September (4) August (6) July (5) June (6) May (5) April (4) March (5) February (4) January (4) December (5) November (2) October (4) September (5) August (4) July (4) June (5) May (5) April (5) March (5) February (4) January (2) December (5) November (4) October (4) September (5) August (3) July (7) June (5) May (4) April (6) March (7) February (7) January (6) December (3) November (6) October (2) September (5) August (3) July (2) June (3) May (4) April (4) March (4) February (5) January (5) December (6) November (3) October (4) September (4) August (3) July (3) June (5) May (5) April (8) March (6) February (6) January (6) December (6) November (4) October (3) September (5) August (8) July (9) June (8) May (3) April (3) March (8) February (4) January (3) August (2)
LIKE THE CIRCLE ON FACEBOOK
Leila Summers, author of "It Rains In February" - What Inspired My Memoir
This is the second in a series of occasional guest posts by authors and writers from around the world. I asked Leila Summers if she wou...
Crafting Memorable Scenes and Writing With Intent
Writing is no easy task, although sometimes it can flow, especially when a woman's voice and her life experience are encouraged in a s...
Every Writer Needs A Bit of "Paris"
For the past three and a half years my days have gone something like this: writing and publishing two memoirs, collaborating on an antholog...
About the Authors - Kimberly
"When we start at the center of ourselves, we discover something worthwhile extending toward the periphery of the circle." An...
2010-2020 Susan G.Weidener content copyrighted. All rights reserved. Awesome Inc. theme. Powered by Blogger.

redpajama_set_name: RedPajamaCommonCrawl


The Practice Advisory Group has built its reputation around the financial performance of its constituent practices. In order for the practice to be truly successful, it must fully understand its financial operations.
The firm provides not only comprehensive financial reporting, but also financial guidance. By establishing practice budgets and goals, The Practice Advisory Group provides the necessary financial leadership for the constituent practices. Many practices fail to plan in this critical area and, therefore, lose focus. By managing this financial process, the firm also manages cash flow for the practice, allowing for capital improvements, generating surplus and working capital reserves.


text:
Tempranillo Tips from the A-Team
Written by Danny Wood
Tempranillo is a Spanish grape best known as the main ingredient in that country's respected Rioja wines. It's also the basis of Vega Sicilia, arguably Spain's most famous vino. Tempranillo wines can have flavors you'd expect in a Cabernet, like dark fruit and mocha, the pepper you might find in a Syrah, and the savory notes and earthy tannins of some Sangioveses. The wines can be light and fruit-forward or fuller bodied and oaky. In recent decades, plantings of Tempranillo have increased dramatically. According to University of Adelaide researchers, Tempranillo was the world's fastest-expanding wine grape varietal between 2000 and 2010 with new plantings double that of Cabernet Sauvignon. About 346,000 more acres of the grape were planted worldwide, or about the same area as Australia's total vineyard coverage, bringing total acres up from about 222,000 to 568,000. Winemakers in countries including Australia, the United States, Argentina, Chile, and Mexico are now making top-notch Tempranillo wines. Spanish versions have also improved in quality, especially the wines coming out of Ribera del Duero and Toro, two regions a couple of hours
LaCrosse or La Crosse? True diversity in a grape
Elmer Swenson helped revolutionize the greater wine world with his cold-hardy grape breeding program. One such grape varietal that emerged from all his work was LaCrosse, with five species of grapes in its heritage. Learn about this grape made popular in colder climates — for good reasons.
Live Chat with Frank Musto
Live Chat with Frank Musto, which took place on August 12, 2020.
", "dateModified": "Aug-Sep 2020", "author": { "@type": "Person", "name": "Danny Wood", }, "publisher": { "name": "WineMaker", "@type": "Organization", "logo": { "@type": "ImageObject", "url": "http://winemakermag.wpengine.com/wp-content/uploads/WineMaker-Magazine-Logo-Leaf-245x120.png" } }, "description": "Tempranillo is a Spanish grape best known as the main ingredient in that country's respected Rioja wines. It's also the basis of Vega Sicilia, arguably Spain's most famous vino. Tempranillo wines can have flavors you'd expect in a Cabernet, like dark fruit and mocha, the pepper you might find in a Syrah, and the savory notes and earthy tannins of some Sangioveses. The wines can be light and fruit-forward or fuller bodied and oaky. In recent decades, plantings of Tempranillo have increased dramatically. According to University of Adelaide researchers, Tempranillo was the world's fastest-expanding wine grape varietal between 2000 and 2010 with new plantings double that of Cabernet Sauvignon. About 346,000 more acres of the grape were planted worldwide, or about the same area as Australia's total vineyard coverage, bringing total acres up from about 222,000 to 568,000. Winemakers in countries including Australia, the United States, Argentina, Chile, and Mexico are now making top-notch Tempranillo wines. Spanish versions have also improved in quality, especially the wines coming out of Ribera del Duero and Toro, two regions a couple of hours Already a member? Log In", "isAccessibleForFree": "False", "hasPart": { "@type": "WebPageElement", "isAccessibleForFree": "False", "cssSelector" : "#paywall" } }


You are here: Home / Blog / Cosmetic Dentistry / Take care of your smile on your vacation in Cancun!
While most of our patients come to get full dental treatments of affordable cosmetic dentistry in Cancun, we also have hundreds of walk-ins every year who have come to enjoy the beach but realized they could get some quick dental work during their stay. Several of these patients got recommendations from other guests staying at the same hotel they were and a few others decided to look up for dentists in Cancun on Google or Facebook. On the list of relatively quick services we can help you with are dental cleanings, teeth whitening and fillings. Obviously, we have a lot of patients most of the time so you should try to contact us in advance to reserve a appointment, as even though walk-ins are welcome, the waiting list might be long. We can also help you if you have a dental emergency.
In any case, here are some tips you can follow to keep your smile in the best condition even when you are away from home.
Dental brushing. Brushing is the basis of a healthy smile. After each meal it is recommended to wait about 20 minutes before cleaning. However, in case of not having much time, it is important to insist on areas susceptible to bacterial plaque accumulation.
Chew gum. Several studies have shown that chewing gum without sugar after a meal can help prevent cavities, because it stimulates the flow of saliva. Nonetheless, sugar-free chewing gum should never replace tooth brushing but might still be a good idea to bring with you some gum.
Hygiene kit. It is advisable to take an oral hygiene kit with brushes and portable toothpastes when you travel. For cleaning to be effective, it is necessary to transport the cleaning equipment in optimal conditions and keep the brush clean and dry, away from other products.
A dental vacation with your dog? Pet-Friendly hotels in Cancun!
Cancun Cosmetic Dentistry Rated Best for Service by WhatClinic 2018 The best prices for dental implants are in Cancun Cosmetic Dentistry!


text:
Selection of background colour for web view
If you select a dark background, the National Audit Office page will be displayed in dark tones and you won't have to choose a colour again the next time you visit – your choice will be remembered. You can change the background colour of the page later on in the header.
Select dark background
If you select a light background, the National Audit Office page will be displayed in light tones and you won't have to choose a colour again the next time you visit – your choice will be remembered. You can change the background colour of the page later on in the header.
Select light background
Riigikontroll
EST | RUS | ENG
Staff | Career in NAO | Contact information | Sitemap | Privacy Policy
WebView background: Light Dark
For auditee
NAO and public relations
About NAO
Co-operation with Parliament
About Auditor General
NAO and public relations » News
Address the National Audit Office
Subsidization of passenger trains is economically inefficient
10/2/2002 | 12:00 AM
Text size: [-A] [+A]
Language: EST | RUS | ENG
TALLINN, 2 October 2002 - The State Audit Office used the example of the subsidization of AS Edelaraudtee to investigate how the state has attempted to provide the population with optimum opportunities with public transport. The audit demonstrated that it is economically inefficient to go on supporting the passenger train traffic as it has been done up to now and there are no substantial arguments for preferring trains over other means of transport.
The State Audit Office assumed that the Ministry of Transport and Communications as the provider and planner of the services obtained for the subsidies has clarified the destinations and frequency of travel to be provided for the population with public transport subsidized at national level and therefore chosen the economically most efficient means for providing transport services.
The State Audit Office formed the following conclusions:
The state (Ministry of Transport and Communications) has not specified the minimum level of transport services or where to and how often people should be able to travel using the state support.
In most cases people prefer trains because of the price, convenience or speed. The State Audit Office's survey, carried out among the local governments, showed that train is the only possible mean of transport for approximately 400 people living in south-eastern part of Estonia. The state is going to spend approximately one billion kroons to subsidize passenger train traffic until 2009.
Ticket revenues only amount to approximately 10% of the transport costs on the railway. This means that the state will have to add up to 9 kroons to each kroon paid the passenger has paid for the ticket; in 2001 the state paid approximately 84 kroons extra for each time somebody traveled by train. The respective amounts are considerably smaller in case of carriage by bus. At the same time it would not be realistic to increase the prices of the tickets as in most cases the prices of the train and bus tickets are the same.
The calculations of the State Audit Office show that for the amount paid as the subsidies it would be possible to replace each train for 9 buses traveling free of charge, if we are not to consider the expenditures necessary for the construction of roads. The number of people traveling in each train amounts to the number of passengers carried by 1-3 buses. This means that if we were to allocate at least some part of the train subsidies between the other modes of transport it would be possible to provide the passengers with considerably better opportunities for mobility. Such a decision would call for additional costs for road construction but nevertheless we need to consider that in addition to buses there are other vehicles making use of the roads.
The main arguments given to justify the economically inefficient passenger transport on railway are mostly related to safety and environment protection requirements. The State Audit Office does not deny the importance of passenger safety and environment protection requirements. Nevertheless, these aspects are not sufficient to reason for the subsidization of railway transport being proportionally larger than the amounts of support allocated for other means of transport, as the relative share of railway transport in total passenger transport is very small. Therefore it is not plausible that the safety or environment friendliness of this mode of transport would have substantial impact on the status of environment or the passenger safety as a whole. If we were to spend the same amount of assets to solve the environment protection problems of other most common modes of transport it would be possible to achieve better results as we look at the picture as a whole while providing the passengers with traveling opportunities better than now.
The privatization of Edelaraudtee was the first attempt to involve private investments in provision of services subsidized by the state. This attempt was only successful to a certain extent. The volume of the transport services to be contracted for by the state was not clear until the end of the privatization. The tenderers were not asked to submit any binding bids concerning the price of the transport services, the quality of thereof, etc. therefore the competition between the tenderers did not include these issues. Therefore it is difficult to say whether the bid received by the state was economically the best. The contract in force also enables AS Edelaraudtee to increase the price charged for each transport kilometer on continuous basis while the state has no sufficient grounds to demand the maximum value of transport services from the provider of thereof.
The State Audit Office recommended the Minister of Transport and Communication to decide what should be the level of transport services provided to the citizen by the state resultant to the subsidization; the ministry should also complete the necessary calculations to decide whether to go on supporting Edelaraudtee or to replace the trains – at least in part – with buses. In case of transport between Tallinn-Tartu and Tallinn-Narva this should be done as soon as possible as the Parliament's decision to support these lines shall expire in 2003.
Pursuant to the decision endorsed by the Parliament the amounts to be paid to Edelaraudtee as subsidies total to 939.6 million kroons in 2001-2009.
Sven Soiver
Press Representative of State Audit Office
GSM: (372) 53 414464
Posted: 10/2/2002 12:00 AM
Last Update: 10/15/2015 9:46 AM
Last Review: 10/15/2015 9:46 AM
Payment of Food and Accommodation Subsidies to the Border Guard Officials
Activity Permits Granted by the Maritime Administration
State supervision over the payment of wage compensation should be strengthened
Review of the Problems Noted in the AIDS Prevention Program
The Problems with the Organization of Public Procurement Arise from Poor Planning
State Audit Office Disclosed Summary Report of the Work Performed Over the Year
Public Procurement Organized for the Maintenance of Road was Audited
The Quality of the Organization of Practical Training at Vocational Educational Institutions Fluctuates
Meeting of representatives of Supreme Audit Institutions of Nordic and Baltic countries
Food import could be made easier
Mr Jüri Kõrge started substitution for the Auditor General
Auditor General Juhan Parts submitted his letter of resignation to the President of the Republic
Major share of the regional loan funds has been spent on loan-related losses and administration costs
Performance Wages Paid at State Agencies Have Not Given the Expected Results
National Audit Office of Estonia | Kiriku 2/4, 15013 Tallinn, Estonia | Phone: +372 640 0700 | | E-mail: [email protected]
Site developed by AgileWorks. Designed by ADM Interactive. Technical solutions developed by NetGroup, Andmevara and Helmes.
The website of the National Audit Office uses cookies. You can opt out of these cookies at any time by changing the settings of the browser on the device you are using and deleting the cookies stored.
Learn more I understand


text:
Mandarin Oriental confirm data breach investigation
in Editor's News
Global hotel chain Mandarin Oriental has confirmed that its hotels have been affected by a credit card breach.
In a statement to security blogger Brian Krebs, it confirmed that is was "currently conducting a thorough investigation to identify and resolve the issue".
It said: "Unfortunately incidents of this nature are increasingly becoming an industry-wide concern. The Group takes the protection of customer information very seriously and is coordinating with credit card agencies and the necessary forensic specialists to ensure our guests are protected."
Detected after financial industry sources spotted a pattern of fraudulent charges on customer cards that had all recently been used at Mandarin hotels, Mandarin did not say how many of the company's locations worldwide may be impacted, but banking industry sources say the breach almost certainly impacted most if not all Mandarin hotels in the United States, including locations in Boston, Florida, Las Vegas, Miami, New York, and Washington, D.C. Sources also say the compromise likely dates back to just before Christmas 2014.
Mark James, security specialist at ESET, said: "With hotels in 27 countries reported to consist of over 10,000 rooms, there's a lot of information here that could generate lots of cash if full credit card data is included in the breach. The clientele at these establishments are worth a lot of money, therefore their credit cards will be a very big windfall for someone on the underground card market.
"Mandarin Oriental will need to limit the fallout of this breach as quickly and efficiently as they can. Information is key here and getting that out to the affected users as quickly and concisely as possible will help towards keeping their reputation and their customers.
"A lot of people these days accept the fact that their data online is not safe and will be subjected to theft at some point. It's how companies affected by data breaches react and recover that sets them apart from the others."
Tags: Credit carddata breachHotel
More than 700 cloud services are vulnerable to FREAK flaw
As we get FREAK out, was old code to blame again?


text:
Florence é uma cidade localizada no estado americano de Kentucky, no Condado de Boone.

Demografia
Segundo o censo americano de 2000, a sua população era de 23.551 habitantes.
Em 2006, foi estimada uma população de 26.929, um aumento de 3378 (14.3%).

Geografia
De acordo com o United States Census Bureau tem uma área de
25,7 km², dos quais 25,6 km² cobertos por terra e 0,1 km² cobertos por água.

Localidades na vizinhança
O diagrama seguinte representa as localidades num raio de 8 km ao redor de Florence.

Ligações externas

Cidades de Kentucky

redpajama_set_name: RedPajamaWikipedia


text:
A Maine church that's older than the state celebrated a milestone birthday
by Lincoln County News June 18, 2018
St. Denis Church, of Whitefield, is the second-oldest Catholic church in New England. The church celebrated its 200th anniversary June 10. Credit: Jessica Clifford | Lincoln County News
"It's not every day a church celebrates its 200th anniversary," said one fifth-generation parishioner present for the anniversary Mass at St. Denis Church in Whitefield on Sunday, June 10.
Anne Cough, of Gardiner, is one of many descendants of Irish farming families who can trace their families back several generations in the second-oldest Catholic Church in New England, said Fr. Frank Morin. Morin is the pastor of St. Michael Parish, which includes St. Denis.
Though a few of Cough's descendants immigrated to the Whitefield area just prior to 1840, St. Denis Church was founded in 1818.
The same year the church opened, 100 Catholic farming families immigrated to the Whitefield and Windsor area for its available farmland. The Keating family, of Whitefield, donated 18 acres of land in the hopes a church would be built on the property.
Fr. Dennis Patrick Ryan, an Irish immigrant serving St. Patrick Church in Newcastle, moved to Whitefield to serve the influx of Irish Catholics and soon founded the church.
Though St. Denis is referred to as the daughter church of St. Patrick, more churches began to sprout throughout the region after its inception.
"Fr. Ryan, of St. Denis, he was the one who nurtured these Catholic communities in Gardiner, Hallowell, and Augusta in the 1850s," Morin said. "He was the one promoting them to form themselves into separate parishes, along with the direction of the bishop."
In 1833, a new church was built in the place of the first, because of a rise in parishioners and the poor construction of the previous building. The church has undergone other renovations in the second half of the 19th century and in 1998.
St. Denis Church was placed on the National Register of Historic Places in 1976, and 11 years ago, St. Denis Church became part of St. Michael Parish. It is now one of six churches in the parish.
For the anniversary Mass, Bishop Robert P. Deeley, the 12th Bishop of the Diocese of Portland, was invited by the parish to say the homily.
After a reading of the gospel according to Mark, Deeley explained the history of St. Denis, saying the church opened two years before Maine became a state in 1820 and 35 years before the Roman Catholic Diocese of Portland was established in 1853.
He thanked the priests and deacons of the church, including Morin, and the parishioners for their support.
"It's a beautiful church; it's a beautiful community of faith," Deeley said after the mass. "It's amazing and gratifying that people have been gathering here … for 200 years."
Approximately 250 people attended the Mass. An average of 60 parishioners attend Mass each week, Morin said.
After the Mass, there was a reception in St. Denis Academy, now known as the parish hall, across the street from the church. The event was ticketed and had sold out before June 10.
In the hall, historical artifacts decorated the room. Parishioners ate food from local farms, highlighting the history of farming families who immigrated to Whitefield, while musicians from the parish played jazz music.
"I'm just happy to be part of this very, very historic moment, celebrating the roots of Catholic faith in this diocese, which covers the whole state of Maine," Morin said in an interview.
Moving into the third century of the church, descendants of the church's early parishioners are some of its most loyal today.
"The next generation after me also has good feelings about Whitefield and St. Denis Church," Cough said. "So it continues on."


October 22nd - Catching up.
I an having a day off today - a hectic yet rewarding weekend. Saturday saw one of the busiest coffee mornings in the village hall.
We always like to try out new ideas - well new to us anyway. We held a Baking Contest! From working with other village hall groups we have good relations with our local W.I. One of these days I'll join, but Cynthia and Anne agreed to act as judges and what an excellent job they did too. We had 5 entrants - all from the village. £2 per submission - some entered more than 1 category and winners received a tea for 2 voucher at our local tearoom, together with a wooden spoon and teatowel. They were all really excited - so next moth we will have another competition - savoury theme. Cheese scone.
The appleas have been prolific and as we were holding a cider festival on Saturday night we kept the apple theme running through the day. One neighbour baked some apple pies and another neighbour gave us some leeks he had grown. We took leeks, and apples to our butcher who made them into our very own Village sausages. They flew off the shelf and sold out. Definitely do this again next November's coffee morning.
In our local co-op one of the workers told me about his hobby of making cider! He was really keen to be involved - basically a couple of months ago i dropped off a few carriers of our apples which he and his pal turned into the most delicious cider I have ever tasted - it was so popular last night at the Festival!
Life slows down this next week and today my feet are certainly up!


Welcome! This blog was started informally by several people longing for an inclusive community of queer parenting. We'll talk about the challenges and victories of parenting as a queer person. Look for our posts each Monday, and follow us at @QueerDadsBlog. Check out our bios to get to know us a little better.
Please understand that QueerDads is a fledgling blog. We're trying to help shape a community of empowered, active, and wonderful queer parents and your feedback is crucial in this work. Contact us at QueerDadsBlog@gmail.com, @ us at @QueerDadsBlog, or leave us a comment here!
Thanks for starting this up!


text:
Q: Jquery : drop down menu causes page to jump to the top I've got a drop down menu on the 'more' link, but if you are scrolled down in the page at all when you click the fixed position menu 'more' the page jumps automaticaly to the top. Why is this? And can i change this? Thanks a lot
http://jsfiddle.net/rKaPN/61/
Edit: I've change the link from href="#" to href="www.google.com" because I'd like for a link to be there incase js does not load. Also adding return false cause all my links inside the ul to break. Any ideas?

A: Just remove the href="#" part from the link, that's what causes it and it's not needed as you've already got the onClick event.

A: In your code, add event.preventDefault(); after event.stopPropagation();
http://jsfiddle.net/AlienWebguy/rKaPN/52/
EDIT:
Per your comment, if you want to mix non-links with url-links in your nav, just give the active links a class="link". Then in your code, you'd use a condition to prevent the default event:
  if($(this).hasClass('link')){
      window.location = $(this).attr('href');
  }
  else {
      event.stopPropagation();
      event.preventDefault();
  }

A: To elaborate on RobinJ's answer:
The reason it jumps to the top here is that the hash is used for on page anchoring. That means locating the view at a particularly anchor's name. If you use a hash with no referenced anchor name, by default the screen will anchor to the top of the page.
When using javascript on anchors for actions that don't involve moving the screen or requesting a new URL, you generally won't need to enter an href attribute at all. A lot of people seem to think <a> requires this, but it really doesn't.

A: To elaborate on RobinJ's answer:
The reason it jumps to the top here is that the hash is used for on page anchoring. That means locating the view at a particularly anchor's name. If you use a hash with no referenced anchor name, by default the screen will anchor to the top of the page.
There are ways around this, but I personally skip adding the href attribute.

A: The page jumps, because the link is redirecting you to "#", you can add a return false; as the last statement of the code that handles the onclick event..., that should fix your problem.

A: for onclick events you can return value such as onclick="return someFunction()"
If someFunction returns a value of false it won't follow the link.
In this case it would ignore the #. If you had a URL there, it would likewise ignore that.
In your case since you're binding with jquery you can return false at the end of the function:
menu.find('ul li > a').bind('click',function (event) {
...
return false;
}

The method event.preventDefault() will also do this but it's good to know that you can return false to have a browser stop an event.

A: Replace href="#" with href="javascript:void(0);".

redpajama_set_name: RedPajamaStackExchange


text:
Many in Greater Vancouver surely remember known Manila-based talent manager Wyngard Tracy. The head of the panel of judges for the PNT Idol contest for two seasons and a close friend of the Fortaleza family, Tracy has been a regular visitor in the Lower Mainland.
On November 16 at 3:45 a.m., Tracy passed away at a Makati hospital. He was 58. According to reports, Tracy died from a stroke. It's the second time he had an attack. After his first heart attack, Tracy underwent brain and heart operation.
Tracy's career began as a television production assistant in the 1970s before becoming a radio disc jockey on DWWK. After a brief DJ-ing stint, he was referred to Vicor Entertainment Corporation and was tapped to manage its roster of recording artists, including Pinky de Leon, Maricris Vermont, and Leah Navarro.
As a talent manager, he also became one of the judges of 'Search for the Star in a Million' on ABS-CBN in 2005. Tracy even became one of the contestants in the Philippine version of 'Celebrity Duets' on GMA Network, where he was ranked fifth.
One of Tracy's most recent TV appearances in Manila was as judge on "Showtime" and "Magpasikat."
Talents managed Tracy, including Richard Gomez, Lucy Torres, John Estrada, and Maricel Soriano, remember him for his intelligence, kind heart, sincerity and sense of humor.
Gomez said: "Wyngard is one of the more intelligent people I have met in our industry. I truly enjoyed talking to him especially when it comes to analyzing situations and creating solutions. He's a gentle giant, sometimes aggressive but has a very kind heart. My family loves him so much and he will be missed dearly."
On her part, Torres could only wish that she spent more time with him.
"Gone too soon. I wish the time we spent together was much longer. It was short and sweet. He showed me and Richard nothing but kindness and love. We will never forget that," she said.
Torres also commended Tracy for the latter's "brilliant mind." "He was sturdy and steady the same way Tito Douglas was. In so short a time he was not just a manager, he became family. I will miss his honesty, his sincerity, which just became all the more obvious against the backdrop of the resident flimsiness that will never quite leave showbiz. I will miss his sense of humor and his wit. Tito Wyn had a brilliant mind. And that on top of a generous, kind heart that was driven to make people happy. He lived to love and even if he never verbalized it I knew that he also wanted to be loved."
Estrada remembers Tracy as "an amazing human being", while Soriano will always think of Tracy as her "gladiator."
"I will miss him dearly, but there are enough memories to keep me smiling until we are together again," Soriano said.
Tracy managed the likes of Pilita Corrales, Aiko Melendez, Jaya, Martin Nievera, Luis Manzano, Arnel Ignacio, Hans Montenegro, and Willie Revillame. He went on to manage the bands Side A and Freestyle.
In an interview with Manila Bulletin in 2005, he compared talent management to "parenthood".
"Para kang tatay. Managing is serious business because you are not only handling careers but to a certain extent, the lives of your talents," he said.
Tracy prides himself for honesty especially in dealing with the press.
"My policy is this: I would protect you but not to the extent na magsisinungaling ako," he explained.
"Sinasabi ko sa mga artista ko, 'Sorry ka kung may ginawa ka talagang kalokohan, di kita pagtatakpan. I won't deny it to press people. Siguro I'll just say, 'Wag na lang natin pag-usapan or off-the-record na lang.'
"Madalas kasi, the press knows the truth already. Pag dineny ko, I'd be insulting their intelligence. That's why I tell my talents, 'Wag kayong magkakamali. Be careful. You better behave.'"
Among Tracy's unfulfilled wishes was managing older talents.
"I want to manage veteran actors. Madami diyan na magagaling, pero walang trabaho kasi walang materials for them. Dito lang sa Pilipinas 'yan nangyayari. 'Ba't wala kang trabaho?' 'Kasi matanda na ako.' But in truth, they have become better with time," he said.
The only mass for Wyngard Tracy was at the La Salle Greenhills Chapel. No wake as per his dying wish.
"PATROL NG PILIPINO" EXPOSES THE LIFE OF A CELEBRITY ON
Imortal


text:
<#
.Synopsis
    Check Guest time drift with clock server after suspend
.Description
    Check Guest time drift with clock server after suspend

    <test>
    <testName>go_check_suspend_time_drift</testName>
    <testID>ESX-GO-010</testID>
    <testScript>testscripts\go_check_suspend_time_drift.ps1</testScript>
    <RevertDefaultSnapshot>True</RevertDefaultSnapshot>
    <timeout>480</timeout>
    <testParams>
        <param>TC_COVERED=RHEL6-38514,RHEL7-80223</param>
    </testParams>
    <onError>Continue</onError>
    <noReboot>False</noReboot>
    </test>

.Parameter vmName
    Name of the test VM.
.Parameter hvServer
    Name of the VIServer hosting the VM.
.Parameter testParams
    Semicolon separated list of test parameters.
#>

param([String] $vmName, [String] $hvServer, [String] $testParams)

#
# Checking the input arguments
#
if (-not $vmName)
{
    "FAIL: VM name cannot be null!"
    exit
}

if (-not $hvServer)
{
    "FAIL: hvServer cannot be null!"
    exit
}

if (-not $testParams)
{
    Throw "FAIL: No test parameters specified"
}

#
# Output test parameters so they are captured in log file
#
"TestParams : '${testParams}'"

#
# Parse test parameters
#
$rootDir = $null
$sshKey = $null
$ipv4 = $null
$logdir = $null

$params = $testParams.Split(";")
foreach ($p in $params)
{
	$fields = $p.Split("=")
	switch ($fields[0].Trim())
	{
		"rootDir"		{ $rootDir = $fields[1].Trim() }
		"sshKey"		{ $sshKey = $fields[1].Trim() }
		"ipv4"			{ $ipv4 = $fields[1].Trim() }
		"TestLogDir"	{ $logdir = $fields[1].Trim()}
		default			{}
    }
}

#
# Check all parameters are valid
#
if (-not $rootDir)
{
	"Warn : no rootdir was specified"
}
else
{
	if ( (Test-Path -Path "${rootDir}") )
	{
		cd $rootDir
	}
	else
	{
		"Warn : rootdir '${rootDir}' does not exist"
	}
}

if ($null -eq $sshKey)
{
	"FAIL: Test parameter sshKey was not specified"
	return $False
}

if ($null -eq $ipv4)
{
	"FAIL: Test parameter ipv4 was not specified"
	return $False
}

if ($null -eq $logdir)
{
	"FAIL: Test parameter logdir was not specified"
	return $False
}

#
# Source tcutils.ps1
#
. .\setupscripts\tcutils.ps1
PowerCLIImport
ConnectToVIServer $env:ENVVISIPADDR `
                  $env:ENVVISUSERNAME `
                  $env:ENVVISPASSWORD `
                  $env:ENVVISPROTOCOL

###############################################################################
#
# Main Body
#
###############################################################################

$retVal = $Failed
# Target offset as 1 sec, after ntpdate, offset should be less than $minOffset
$minOffset = 1

# Confirm the VM power state is PoweredOn
$vmObj = Get-VMHost -Name $hvServer | Get-VM -Name $vmName
$state = $vmObj.PowerState
if ($state -ne "PoweredOn")
{
    Write-Error -Message "ABORTED: $vmObj is not poweredOn, power state is $state" -Category ObjectNotFound -ErrorAction SilentlyContinue
    return $Aborted
}
Write-Host -F Gray "DONE. VM Power state is $state"
Write-Output "DONE. VM Power state is $state"

#
# Stop time rysnc service with different methods for RHEL 6 or RHEL7 / RHEL8
#
$linuxOS = GetLinuxDistro $ipv4 $sshKey
if ($linuxOS -eq "RedHat6")
{
    $ntpdDisable = bin\plink.exe -i ssh\${sshKey} root@${ipv4} "service ntpd stop"
    $ntpdStatus = bin\plink.exe -i ssh\${sshKey} root@${ipv4} "service ntpd status"
    if ($ntpdStatus -ne "ntpd is stopped")
    {
        Write-Host -F Yellow "ABORT: NTPD stopping failed"
        Write-Output "ABORT: NTPD stopping failed"
        DisconnectWithVIServer
        return $Aborted
    }
}
else
{
    # Stop ntpd / chronyd
    $ntpdStop = bin\plink.exe -i ssh\${sshKey} root@${ipv4} "systemctl stop ntpd"
    $ntpdDisable = bin\plink.exe -i ssh\${sshKey} root@${ipv4} "systemctl disable ntpd"
	$result = SendCommandToVM $ipv4 $sshKey "systemctl status ntpd | grep running"
    if ($result -ne $False)
    {
        Write-Host -F Yellow "ABORT: NTPD stopping failed"
        Write-Output "ABORT: NTPD stopping failed"
        DisconnectWithVIServer
        return $Aborted
    }

    $ntpdStop = bin\plink.exe -i ssh\${sshKey} root@${ipv4} "systemctl stop chronyd"
    $ntpdDisable = bin\plink.exe -i ssh\${sshKey} root@${ipv4} "systemctl disable chronyd"
	$result = SendCommandToVM $ipv4 $sshKey "systemctl status chronyd | grep running"
    if ($result -ne $False)
    {
        Write-Host -F Yellow "ABORT: Chronyd stopping failed"
        Write-Output "ABORT: Chronyd stopping failed"
        DisconnectWithVIServer
        return $Aborted
    }

    # Config ntp clock server and restart ntpdate
    $configNTP = bin\plink.exe -i ssh\${sshKey} root@${ipv4} "echo clock.redhat.com > /etc/ntp/step-tickers"
    $enableNtpdate = bin\plink.exe -i ssh\${sshKey} root@${ipv4} "systemctl enable ntpdate"
    $startNtpdate = bin\plink.exe -i ssh\${sshKey} root@${ipv4} "systemctl start ntpdate"
    $timedatectlResult = bin\plink.exe -i ssh\${sshKey} root@${ipv4} "timedatectl set-ntp 0"
}

#
# Before suspend, check offset which should be less than $minOffset
#
$offset_temp = bin\plink.exe -i ssh\${sshKey} root@${ipv4} "ntpdate -q clock.redhat.com | awk 'NR == 5 {print `$10`}'"
# Get offset_temp abs
$offset = [Math]::Abs($offset_temp)
Write-Host -F Gray "Before suspend, offset is $offset"
Write-Output "Before suspend, offset is $offset"
if ($offset -gt $minOffset)
{
    Write-Host -F Yellow "ABORT: Offset is wrong before suspend"
    Write-Output "ABORT: Offset is wrong before suspend"
    DisconnectWithVIServer
    return $Aborted
}

#
# Suspend the VM and confirm the power state
#
Write-Host -F Gray "Now, will Suspend the VM......."
Write-Output "Now, will Suspend the VM......."
$suspend = Suspend-VM -VM $vmObj -Confirm:$False
Start-Sleep -S 60
# Get the new VM power status
$vmObjSuspend = Get-VMHost -Name $hvServer | Get-VM -Name $vmName
$suspendState = $vmObjSuspend.PowerState
if ($suspendState -ne "Suspended")
{
    Write-Host -F Yellow "ABORT: $vmObj is not suspend, power state is $state"
    Write-Output "ABORT: $vmObj is not suspend, power state is $state"
    DisconnectWithVIServer
    return $Aborted
}
else
{
    Start-Sleep 300
}
Write-Host -F Gray "DONE. VM Power state is $suspendState......."
Write-Output "DONE. VM Power state is $suspendState"

#
# Power the VM, and confirm the power state
#
Write-Host -F Gray "Now, will Power On the VM......."
Write-Output "Now, will Power On the VM......."
$on = Start-VM -VM $vmObj -Confirm:$False

# WaitForVMSSHReady
$ret = WaitForVMSSHReady $vmName $hvServer ${sshKey} 300

# Get the new VM power status
$vmObjOn = Get-VMHost -Name $hvServer | Get-VM -Name $vmName
$onState = $vmObjOn.PowerState
if ($onState -ne "PoweredOn")
{
    Write-Host -F Yellow "ABORT: $vmObj is not poweredOn, power state is $state"
    Write-Output "ABORT: $vmObj is not poweredOn, power state is $state"
    DisconnectWithVIServer
    return $Aborted
}

#
# After power on, check offset which should be less than $minOffset
#
$offset_temp = bin\plink.exe -i ssh\${sshKey} root@${ipv4} "ntpdate -q clock.redhat.com | awk 'NR == 5 {print `$10`}'"
# Get offset_temp abs
$offset = [Math]::Abs($offset_temp)
Write-Host -F Gray "After suspend, offset is $offset"
Write-Output "After suspend, offset is $offset"
if ($offset -gt $minOffset)
{
    Write-Host -F Red "FAIL: After suspend, offset is incorrect"
    Write-Output "FAIL: After suspend, offset is incorrect"
}
else
{
    Write-Host -F Green "PASS: After suspend, offset is correct"
    Write-Output "PASS: After suspend, offset is correct"
    $retVal = $Passed
}

DisconnectWithVIServer

return $retVal

redpajama_set_name: RedPajamaGithub


The Walking Dead gained national attention as AMC's latest critically acclaimed drama, shattering the network's previous premiere ratings highs and earning a second season renewal after its very first episode. But before its television debut, Robert Kirkman's The Walking Dead was a comic phenomenon.
James Lowder, veteran editor and author in the horror genre and comics field, collects some of the biggest names in the zombie genre, along with other top horror and comics writers, to discuss the series on both page and screen.
James Lowder has worked extensively on both sides of the editorial blotter. His novels include Knight of the Black Rose and Prince of Lies, and his short fiction has appeared in such anthologies as Shadows Over Baker Street and The Repentant. As an editor he's helmed 10 anthologies, including two collections of superhero tales, and currently serves as consulting editor for the City of Heroes novel series from CDS Books. His nonfiction writing on film and comics has seen print in Amazing Stories, Sci-Fi Universe and the BenBella collection King Kong Is Back!


PSALMS 90 – I Am Not Ashamed Of The Gospel Of Christ!
1 (A Prayer of Moses the man of God.) Lord, thou hast been our dwelling place in all generations.
2 Before the mountains were brought forth, or ever thou hadst formed the earth and the world, even from everlasting to everlasting, thou art God.
3 Thou turnest man to destruction; and sayest, Return, ye children of men.
4 For a thousand years in thy sight are but as yesterday when it is past, and as a watch in the night.
5 Thou carriest them away as with a flood; they are as a sleep: in the morning they are like grass which groweth up.
6 In the morning it flourisheth, and groweth up; in the evening it is cut down, and withereth.
7 For we are consumed by thine anger, and by thy wrath are we troubled.
8 Thou hast set our iniquities before thee, our secret sins in the light of thy countenance.
9 For all our days are passed away in thy wrath: we spend our years as a tale that is told.
10 The days of our years are threescore years and ten; and if by reason of strength they be fourscore years, yet is their strength labour and sorrow; for it is soon cut off, and we fly away.
11 Who knoweth the power of thine anger? even according to thy fear, so is thy wrath.
12 So teach us to number our days, that we may apply our hearts unto wisdom.
13 Return, O LORD, how long? and let it repent thee concerning thy servants.
14 O satisfy us early with thy mercy; that we may rejoice and be glad all our days.
15 Make us glad according to the days wherein thou hast afflicted us, and the years wherein we have seen evil.
16 Let thy work appear unto thy servants, and thy glory unto their children.
17 And let the beauty of the LORD our God be upon us: and establish thou the work of our hands upon us; yea, the work of our hands establish thou it.
This site contains copyrighted material the use of which has not always been specifically authorized by the copyright owner. We are making such material available in our efforts to advance understanding & education in persecution, religious freedom, freedom of worship, human rights and social justice issues, etc. We believe this constitutes a 'fair use' of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C. Section 107, the material on this site is distributed without profit to those who have expressed a prior interest in receiving the included information for research and educational purposes. For more information go to: http://www.law.cornell.edu/uscode/17/107.shtml. If you wish to use copyrighted material from this site for purposes of your own that go beyond 'fair use', you must obtain permission from the copyright owner.
The views and opinions expressed in the media, articles or comments on this site are those of the speakers or authors and do not necessarily reflect or represent the views and opinions held by us.
The editorial staff oversee and administer the site pursuant to our editorial criteria. However, due to the social nature of this site, we cannot be held accountable for the content in the web community.
We strive to bring you truthful, accurate news reports and information. However, we do not warrant the accuracy, timeliness or completeness of the information obtained by outside links, authors, or comments added by our audience. If you have a complaint about something you have found on this web site, please Contact Us.
We welcome all comments, but any hateful, derogatory or foul language will be removed. We moderate all comments. We love feedback and debate, but do it in love.


November 19, 2008 | By Paul Mackenzie Ross | Filed in: finance, philosophy.
I come home to a news report on the TV, warning of the fear that because inflation is down today, there is a grave worry that it could go MUCH further with the economy threatened, unemployment to rise, doom and gloom could be upon us in the form of deflation, when everything "goes south" and even wages start going down.
In other news, a friend warns that Barack Obama is NOT a big fan of Internet privacy and that he will want to know more about you than it seems George W Bush ever did under the auspices of the Patriot Act.
OMG. Panic! What do we do?
The reallity of it all is that the Consumer Price Index was at its target 2% in October 2007 according to ONS stats and hit its peak of 5.2% in September 2008 before dropping back to 4.5% in October this year as oil and house prices have slumped, food prices have fallen too, along with that all important demand that drives inflation in the first place. Inflation could simply return to that magical 2% figure, and life could be as it was before. If not, inflation could fall to as little as 1%, but that's not headline news, so I suppose doom is a worthy accompaniment to your evening meal. Yes, inflation could go lower, but according to the Bank of England, it will probably stay above zero.
Your Internet privacy, such as your facebook rants and your multiple pseudonyms and anonymous blog commentary, are indeed very firmly in the sights of Barack Obama. You must declare your online identities and worry about every stupid thing you've ever said under your own name and made-up ones… if you're looking for a place on the Whitehouse staff, that is. Well why didn't you say that in the first place? I got all worried for a moment there.
And that leads on nicely to the great article I read today entitled The Myth of Record Debt. It would be so easy to twist figures to convey the point I need to make or to omit words or facts to suit a narrow agenda. But that's not the way I live my life nor conduct my business. There's a time and a place for using your imagination and unleashing your creativity but when reporting facts it is inappropriate for the use of either.