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Laxative

Laxatives, purgatives, or aperients are substances that loosen stools and increase bowel movements. They are used to treat and prevent constipation.

Laxatives vary as to how they work and the side effects they may have. Certain stimulant, lubricant, and saline laxatives are used to evacuate the colon for rectal and bowel examinations, and may be supplemented by enemas under certain circumstances. Sufficiently high doses of laxatives may cause diarrhea. Some laxatives combine more than one active ingredient, and may be administered orally or rectally.

Bulk-forming agents
Bulk-forming laxatives, also known as roughage, are substances, such as fiber in food and hydrophilic agents in over-the-counter drugs, that add bulk and water to stools so they can pass more easily through the intestines (lower part of the digestive tract).

Properties Bulk-forming agents generally have the gentlest of effects among laxatives, making them ideal for long-term maintenance of regular bowel movements.
 * Site of action: small and large intestines
 * Onset of action: 12–72 hours
 * Examples: dietary fiber, Metamucil, Citrucel, FiberCon

Dietary fiber
Foods that help with laxation include fiber-rich foods. Dietary fiber includes insoluble fiber and soluble fiber, such as:
 * Fruits, such as bananas, though this depends on their ripeness, kiwifruits, prunes, apples (with skin), pears (with skin), and raspberries
 * Vegetables, such as broccoli, string beans, kale, spinach, cooked winter squash, cooked taro and poi, cooked peas, and baked potatoes (with skin)
 * Whole grains
 * Bran products
 * Nuts
 * Legumes, such as beans, peas, and lentils

Emollient agents (stool softeners)
Emollient laxatives, also known as stool softeners, are anionic surfactants that enable additional water and fats to be incorporated in the stool, making movement through the bowels easier.

Properties
 * Site of action: small and large intestines
 * Onset of action: 12–72 hours
 * Examples: Docusate (Colace, Diocto), Gibs-Eze

Emollient agents prevent constipation rather than treating long-term constipation.

Lubricant agents
Lubricant laxatives are substances that coat the stool with slippery lipids and decrease colonic absorption of water so the stool slides through the colon more easily. Lubricant laxatives also increase the weight of stool and decrease intestinal transit time.

Properties

 * Site of action: colon
 * Onset of action: 6–8 hours
 * Example: mineral oil

Mineral oils, such as liquid paraffin, are generally the only nonprescription lubricant laxative available, but due to the risk of lipid pneumonia resulting from accidental aspiration, mineral oil is not recommended, especially in children and infants. Mineral oil may decrease the absorption of fat-soluble vitamins and some minerals.

Hyperosmotic agents
Hyperosmotic laxatives cause the intestines to hold more water, creating an osmotic gradient, which adds more pressure and stimulates bowel movement.

Properties

 * Site of action: colon
 * Onset of action: 12–72 hours (oral), 0.25–1 hour (rectal)
 * Examples: glycerin suppositories (Hallens), sorbitol, lactulose, and PEG (Colyte, MiraLax)

Lactulose works by the osmotic effect, which retains water in the colon; lowering the pH through bacterial fermentation to lactic, formic, and acetic acids; and increasing colonic peristalsis. Lactulose is also indicated in portal-systemic encephalopathy. Glycerin suppositories work mostly by hyperosmotic action, but the sodium stearate in the preparation also causes local irritation to the colon.

Solutions of polyethylene glycol and electrolytes (sodium chloride, sodium bicarbonate, potassium chloride, and sometimes sodium sulfate) are used for whole bowel irrigation, a process designed to prepare the bowel for surgery or colonoscopy and to treat certain types of poisoning. Brand names for these solutions include GoLytely, GlycoLax, Cosmocol, CoLyte, Miralax, Movicol, NuLytely, Suprep, and Fortrans. Solutions of sorbitol (SoftLax) have similar effects.

Saline laxative agents
Saline laxatives are nonabsorbable, osmotically active substances that attract and retain water in the intestinal lumen, increasing intraluminal pressure that mechanically stimulates evacuation of the bowel. Magnesium-containing agents also cause the release of cholecystokinin, which increases intestinal motility and fluid secretion. Saline laxatives may alter a patient's fluid and electrolyte balance.

Properties
 * Site of action: small and large intestines
 * Onset of action: 0.5–3 hours (oral), 2–15 minutes (rectal)
 * Examples: sodium phosphate (and variants), magnesium citrate, magnesium hydroxide (milk of magnesia), and magnesium sulfate (Epsom salt)

Stimulant agents
Stimulant laxatives are substances that act on the intestinal mucosa or nerve plexus, altering water and electrolyte secretion. They also stimulate peristaltic action and can be dangerous under certain circumstances. Properties
 * Site of action: colon
 * Onset of action: 6–10 hours
 * Examples: senna, bisacodyl

Prolonged use of stimulant laxatives can create drug dependence by damaging the colon's haustral folds, making users less able to move feces through their colon on their own. A study of patients with chronic constipation found that 28% of chronic stimulant laxative users lost haustral folds over the course of one year, while none of the control group did.

Miscellaneous
Castor oil is a glyceride that is hydrolyzed by pancreatic lipase to ricinoleic acid, which produces laxative action by an unknown mechanism.

Properties
 * Site of action: colon, small intestine (see below)
 * Onset of action: 2–6 hours
 * Examples: castor oil

Long-term use of castor oil may result in loss of fluid, electrolytes, and nutrients.

Serotonin agonist
These are motility stimulants that work through activation of 5-HT4 receptors of the enteric nervous system in the gastrointestinal tract. However, some have been discontinued or restricted due to potentially harmful cardiovascular side effects.

Tegaserod (brand name Zelnorm) was removed from the general U.S. and Canadian markets in 2007, due to reports of increased risks of heart attack or stroke. It is still available to physicians for patients in emergency situations that are life-threatening or require hospitalization.

Prucalopride (brand name Resolor) is a current drug approved for use in the EU since October 15, 2009, in Canada (brand name Resotran) since December 7, 2011, and in the United States since December 2018.

Chloride channel activators
Lubiprostone is used in the management of chronic idiopathic constipation and irritable bowel syndrome. It causes the intestines to produce a chloride-rich fluid secretion that softens the stool, increases motility, and promotes spontaneous bowel movements.

Effectiveness
For adults, a randomized controlled trial found PEG (MiraLax or GlycoLax) 17 grams once per day to be superior to tegaserod at 6 mg twice per day. A randomized controlled trial found greater improvement from two sachets (26 g) of PEG versus two sachets (20 g) of lactulose. 17 g per day of PEG has been effective and safe in a randomized, controlled trial for six months. Another randomized, controlled trial found no difference between sorbitol and lactulose.

For children, PEG was found to be more effective than lactulose.

Laxative abuse
Some of the less significant adverse effects of laxative abuse include dehydration (which causes tremors, weakness, fainting, blurred vision, kidney damage), low blood pressure, fast heart rate, postural dizziness and fainting; however, laxative abuse can lead to potentially fatal acid-base, and electrolyte imbalances. For example, severe hypokalaemia has been associated with distal renal tubular acidosis from laxative abuse. Metabolic alkalosis is the most common acid-base imbalance observed. Other significant adverse effects include rhabdomyolysis, steatorrhoea, inflammation and ulceration of colonic mucosa, pancreatitis, kidney failure, factitious diarrhea and other problems. The colon will need more quantities of laxatives to keep functioning, this will result in a lazy colon, infections, irritable bowel syndrome, and potential liver damage.

Although some patients with eating disorders such as anorexia nervosa and bulimia nervosa abuse laxatives in an attempt to lose weight, laxatives act to speed up the transit of feces through the large intestine, which occurs after the absorption of nutrients in the small intestine is already complete. Thus, studies of laxative abuse have found that effects on body weight reflect primarily temporary losses of body water rather than energy (calorie) loss.

Laxative gut
Physicians warn against the chronic use of stimulant laxatives due to concern that chronic use could cause the colonic tissues to get worn out over time and not be able to expel feces due to long-term overstimulation. A common finding in patients having used stimulant laxatives is a brown pigment deposited in the intestinal tissue, known as melanosis coli.

Historical and health fraud uses
Laxatives, once called "physicks" or "purgatives", were used extensively in historic medicine to treat many conditions for which they are now generally regarded as ineffective in evidence-based medicine. Likewise, laxatives (often termed colon cleanses) may be promoted in alternative medicine for various conditions of quackery, such as "mucoid plaque".

title: Laxative


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Halloumi

Halloumi or haloumi is a cheese that is thought to have originated from Cyprus, though some contest that it originated in Egypt. It is made from a mixture of goat's and sheep's milk, and sometimes also cow's milk. Its texture is described as squeaky. It has a high melting point and so can easily be fried or grilled, a property that makes it a popular meat substitute. Rennet (mostly vegetarian or microbial) is used to curdle the milk in halloumi production, although no acid-producing bacteria are used in its preparation.

Halloumi is popular throughout the Eastern Mediterranean. By 2013, demand in the United Kingdom had surpassed that in every other European country except Cyprus.

In the United States, Halloumi is a registered trademark owned by the government of Cyprus, while in the UK it is owned by the Foundation for the Protection of the Traditional Cheese of Cyprus named Halloumi. It is also protected as a geographical indication in the EU, as a Protected Designation of Origin (PDO), which means within the EU only products made in certain parts of Cyprus can be called "halloumi". PDO protection for Halloumi was delayed largely by disagreements among farmers of cattle, sheep, and goats regarding the inclusion of cows' milk, and (if cows' milk were included) the proportion of it.

Etymology
The English name halloumi is derived from Modern χαλλούμι, khalloúmi, from Cypriot Maronite Arabic xallúm, ultimately from Egyptian حلوم.

The Egyptian Arabic word is itself a loanword from Coptic  (Sahidic) and   (Bohairic), and was used for cheese eaten in medieval Egypt. The name of the cheese likely goes back to the Demotic word ḥlm "cheese" attested in manuscripts and ostraca from 2nd-century Roman Egypt.

The Cypriot Turkish name hellim derives from this source, as does the name of the different modern Egyptian cheese.

History
A recipe for enhancing ḥalūm ('cheese') by brining is found in the 14th-century Egyptian cookbook كنز الفوائد في تنويع الموائد : Kanz al-Fawāʾid fī Tanwīʿ al-Mawāʾid.

The earliest known surviving descriptions of halloumi in Cyprus were recorded in the mid-16th century by Italian visitors to Cyprus, where it is often said to have originated. However, the question of whether the recipe for the quintessential halloumi was born in Cyprus and then travelled to Lebanon and the rest of the Levant, or whether the basic techniques of making cheese that resists melting evolved over time in various parts of the eastern Mediterranean—or both—does not have a definitive answer.

Traditionally, Cypriot halloumi was made from sheep and/or goat's milk, since there were few cows on the island until they were brought over by the British in the 20th century. But as demand grew, industrial cheese-makers began using more of the cheaper and more plentiful cow's milk.

Overview and preparation
Although it can be consumed raw, halloumi is often used in cooking and can be fried until brown (without melting) due to its higher-than-typical melting point. This makes it an excellent cheese for frying or grilling (as in saganaki) and serving either as is, or with vegetables, or as an ingredient in salads or sandwiches. There are many recipes that use halloumi beyond simple grilling.

Traditional halloumi is a semicircular shape, weighing 220 –. The fat content is approximately 25% wet weight, 47% dry weight with about 17% protein. Its firm texture when cooked causes it to squeak on the teeth when being chewed. Traditional halloumi is typically made from fresh, unpasteurised sheep and/or goat's milk. However, for its commercial production a mixture of pasteurized sheep, goat and occasionally cow's milk is used (with the cow's milk making up the lowest proportion of the milk used, if used at all).

Two main types of halloumi exist: fresh and mature. Fresh halloumi has a semi-hard, elastic texture and a milder, less salty flavor compared to the aged version. As mature halloumi is stored in brine it has a harder, drier texture, as well as a saltier flavor. Both versions have a slight minty flavor, due to the addition of spearmint during the production of the cheese.

Sealed, halloumi (both fresh and mature) can last in a refrigerator for as long as a year.

Production
Production of halloumi cheese involves several key steps.

The first step of halloumi production involves the coagulation of the milk in order to make curds. This occurs by stirring rennet into the milk mixture while keeping it at a temperature of 30–34 °C until the milk coagulates (a process which takes approximately 30–45 minutes). Once the curd is formed it is then cut, reheated and stirred in order to increase its firmness. The curds are then added to special molds and pressed until a sufficient amount of whey has been removed.

The next step of production involves the boiling of the pressed curds in hot whey (collected during the pressing of the curds) for at least 30 minutes, during a process known as scalding. This is the most crucial step in the halloumi production as it contributes to the characteristic texture of the cheese. The cooked pieces are then removed from the whey and are salted and garnished with fresh or dried mint (Mentha viridis) leaves. They are then folded and stored in salted whey for 1–3 days before being packed in airtight containers, ready to be sold and consumed.

For the production of mature halloumi, the cheese needs to be kept in the brine whey for at least 40 days.

Nutritional facts
100 g of commercially produced packaged halloumi typically contains:

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/

title: Halloumi


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Talk:Van der Waerden's theorem

Dummy header for very old comments
In the statement of the theorem, we use {1,...,N}, but in the proof we use {0,...,N-1}. Should we use the same convention throughout? AxelBoldt 03:59 Jan 13, 2003 (UTC)

I've incremented the numbers in the proof by 1 to make it consistent. Terry 17:58, 6 Sep 2004 (UTC)

 * You cannot just increment all the numbers in a proof with no understanding of what is going on; the "consistent" proof was completely wrong. For example, you had

 * That is, there are two integers b1 and b2, both in {1,...,33},  such that c(b1·5 + k) = c(b2·5 + k) for all k in {1,...,5}.

 * which makes no sense, because if b1 is 33 then later on b3 will be larger than 325.

 * I have reverted the page. Please feel free to add back the remarks you put in about upper bounds, or to revert the page again and then correct the damage you did to the proof.  -- Dominus 13:40, 7 Sep 2004 (UTC)

 * Sorry about that. I went through the proof again; the error you pointed out was the only error I made in the proof, as far as I can tell.  I'm pretty sure it's correct now. Terry 05:59, 8 Sep 2004 (UTC)

 * Yes, you're right. I'm sorry I said you had no understanding of what was going on; it looked to me like you had just done a global replace of each number n with n-1. Thanks for correcting the proof and adding back your remarks about the upper bounds.  -- Dominus 13:39, 8 Sep 2004 (UTC)

Proof
A very simple way to prove the Van der Wareden's theorem is to derive it as a corollary of Gallai's Theorem which in turn is a corollary of the Hales–Jewett theorem. The proof runs like this:
 * Apply Gallai's Theorem for V = {0,...k}. Now {b, b+c,...b+kc} is monochromatic. Q.E.D.

Note->Here we were looking for an AP of length k. c and b are the positive integers existing by Gallai's so that cV + b is monochromatic.

This should be included in the article. Any comments?--Shahab 10:16, 17 May 2007 (UTC)

 * While that does seem to work (although I'm not entirely familiar with Gallai's Theorem), I would say that it doesn't make sense to prove things "backwards" - although these generalized versions of each can be proven subsequently and independently, I think it makes more sense to prove them from the ground-up, as opposed to using the most general theorem at any given time to plainly and uninsightfully assert the more specific cases. Cheeser1 15:20, 17 May 2007 (UTC)

 * I am only talking about adding the fact that Van der Waerden's theorem is a corollary of Gallai's theorem (or of the Hales-Jewett Theorem) because it is a point worth realizing that all these theorems are a part of general geometric picture. You are right Cheeser1 when you say that it makes sense to give an insightful picture but there is no reason why the Hales Jewett bit can't be included in the article. Adding some info won't hurt the insight. BTW although the Hales Jewett Theorem is a generalization, it and the Van der Waerden's theorem have very similar colour focussing proofs, so HJ is really not that far advanced then VDW. Cheers--Shahab 13:01, 18 May 2007 (UTC)

 * I'm not sure when it was added, but I just noticed there is mention of both Szemeredi's theorem and Hales-Jewett as stronger theorems. I also noticed that this article's a bit of a mess, I think. Maybe I'll tidy it up. --Cheeser1 22:21, 17 June 2007 (UTC)

importan nitpicking
Is there anyone who can look at the expression

 * $$V(r,k) \leq 2^{2^{r^{2^{2^{k + 9}}}}}$$,

without instantly see why the comma really needs to be INSIDE the "displayed" TeX? On the browser I'm using, it is positioned ridiculously. Michael Hardy 01:43, 21 June 2007 (UTC)

request explanation of bound
What is the point in the sentence "The best-known lower bound for V(2,k) is that V(2,k) > 2k / kε for all positive ε.[4]"? It seems to mean that V(2,k) is at least equal to 2k. —Preceding unsigned comment added by 193.50.42.4 (talk) 09:31, 22 May 2008 (UTC)

 * The statement is that $$V(2, k) > 2^k/k^\epsilon$$ for all positive ε.  This means that although $$V(2, k)$$ is not known to exceed $$2^k$$ in general, it is known to come very, very close: it exceeds $$2^k / k^{0.000001}$$ and other quantities that are just a hair smaller than $$2^k$$. -- Dominus (talk) 17:10, 22 May 2008 (UTC)

 * In the reference, the statement is exactly " given ε>0 $$V(2, k) > 2^k/k^\epsilon$$ for all sufficiently large k" which I personally find more illuminating. I was disappointed to find that the reference does not provide a proof of this statement though. If someone knows a source which provides a proof, I think that would be a better thing to reference.76.193.189.206 (talk) 17:33, 8 May 2011 (UTC)

After a bit of googling, it appears that this bound is due to Z. Szabo in  "An application of Lov´asz Local Lemma— a new lower bound on the van der Waerden numbers". Random Structures and Algorithms, 1, 1990. Personally I think that this is a better citation. 76.193.189.206 (talk) 17:37, 8 May 2011 (UTC)

proof overly complicated
The proof that W(2, 3) ≤ 325 seems unnecessary complicated to me.

Consider the following proof that W(2, 3) ≤ 13:

In 5 consecutive two-colored integers two have the same color and have an odd number of integers between them (call them a and b a<b). Consider the integer in the middle of these two. If it has the same color we are done. Now consider the two integers to the left of a and the right of b each of which forms an arithmetic progression of length three with a and b. If one of these shares the color of a and b we are done. If this is not the case the three considered integers to the right, left and in the middle of a and b suffice. For this proof 4 additional integers to the right and left of the 5 integer are needes which sums up to 13. —Preceding unsigned comment added by 160.45.6.96 (talk) 12:58, 21 April 2010 (UTC)

typesetting in the proof
The proof is a bit awkward to read. If MinN is to be a function, it should be coded as \operatorname{MinN} or \mathop{\rm MinN} or at least {\rm MinN} [I removed the tags on purpose in a subsequent edit]. I don't understand why a central star $$*$$ appears in various places. (I did not read the text in detail but don't think any convolution is involved, and it probably just means multiplication which is traditionally denoted by \times or \cdot.) Also the line breaking and the u=1,...,L(?) in the line after the equation, rather than directly at the end of (but inside) the equation, is confusing. All in all, it gives the impression that a person not very familiar with mathematical writing was at work here, which make the whole section lose a lot its credibility. — MFH:Talk 20:53, 31 March 2013 (UTC)

Opening sentences describing the statement of vdW
The 2nd sentence reads at the moment as follows: Van der Waerden's theorem states that for any given positive integers r and k, there is some number N such that if the integers {1, 2, ..., N} are colored, each with one of r different colors, then there are at least k integers in arithmetic progression whose elements are of the same color.

The opening of the article would a little more clear and make the connection to Ramsey Theory more clear if it read as follows: Van der Waerden's theorem states that for any given positive integers r and k, there is some number N such that if the integers {1, 2, ..., N} are colored in an arbitrary manner using r different colors, then there exist at least k integers of {1, 2, ..., N} in an arithmetic progression whose elements are of the same color. Odahviing (talk) 08:07, 31 August 2019 (UTC)

Example and Open problem sections
In order to link the first example given of the statement of vdW properly with the fact that there are an infinite number of van der Waerden numbers yet to be given reasonable bounds for, it would make more sense if the heading read 'First example' instead of just 'Example'. Further, the writing in the sections 'Example' and 'Open Problem', altough they contain a lot of useful information that is certainly valuable, is a little rough and could use some polishing.

I propose that the Example and Open problem sections should read:

First example
The first non-trivial example to consider from van der Waerden's theorem is when r = 2, say red and blue. The van der Waerden number W(2, 3) is bigger than 8, since one can color the integers from {1, ..., 8} like this:

No three integers of the same color form an arithmetic progression in the segment {1, ..., 8}. However, it is impossible to add either a blue 9 or a red 9 without forming a monochromatic arithmetic progression of length three: If you add a red 9, then the red 3 , 6 , and 9 are in arithmetic progression. Alternatively, if you add a blue 9, then the blue 1 , 5 , and 9 are in arithmetic progression.

Using an exhaustive search of all possible two color assignments of the first nine integers, which would run through 29 = 512 examples, one can show that it is unavoidable to create monochromatic arithmetic progression of length three in the first nine integers. By the above example of colors assigned to {1, ..., 8}, we then conclude that nine is the least integer that guarantees the existence of length three progressions in two colors, hence, we have proved that W(2,3) = 9.

Open Problem
The following table summarizes the known values or lower estimates of the first few van der Waerden numbers.

Indeed, the explicit value of the van der Waerden number W(r,k) is not known for almost all ordered pairs (r,k). The standard combinatorial proof of van der Waerden's theorem only employs the establishment of upper bounds to van der Waerden numbers, and in most cases, these upper bounds are exceedingly weak. For the case r = 2 and k = 3 considered above, a combinatorial argument given below shows that it is sufficient to color the integers {1, ..., 325} with two colors to guarantee there will be a monochromatic arithmetic progression of length three.

For r = 3 and k = 3, the bound given by the standard combinatorial approach is is 7(2·37 + 1)(2·37·(2·3 7 + 1) + 1), or approximately 4.22·1014616. Employing exhuastive search on 327 = 7.62·1012 candidates, in principle, one could show that any coloring the first twenty seven integers with the colors red, blue and yellow will inevitably lead to at least one monochromatic arithmetic progression of length three. Additionally, it is possible to color {1, ..., 26} with three colors so that there is no monochromatic arithmetic progression of length three arises; for example:

This proves that W(3,3) =27.

The best upper bound currently known is due to Timothy Gowers, who establishes

 * $$W(r,k) \leq 2^{2^{r^{2^{2^{k + 9}}}}},$$

by first establishing a similar result for Szemerédi's theorem, which is a stronger version of Van der Waerden's theorem. The previously best-known bound was due to Saharon Shelah and proceeded via first proving a result for the Hales–Jewett theorem, which is another strengthening of Van der Waerden's theorem.

The American mathematician Ronald Graham has offered a prize of US$1000 for a proof of the specific upper bound

 * $$W(2,k) \leq 2^{k^2}.$$

The best lower bound currently known for $$W(2, k)$$ is that for all positive $$\varepsilon$$ we have $$W(2, k) > 2^k/k^\varepsilon$$, for all sufficiently large $$k$$. Odahviing (talk) 10:02, 31 August 2019 (UTC)

title: Talk:Van der Waerden's theorem


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The Age of Plastic

The Age of Plastic is the debut album by the English new wave duo the Buggles, first released on 10 January 1980 on Island Records. It is a concept album about the possible repercussions of modern technology. The title was conceived from the group's intention of being a "plastic group" and the album was produced in the wake of the success of their debut record, "Video Killed the Radio Star" (1979), which topped the UK Singles Chart. Most of the album's other tracks were written during promotion of the single.

The album was recorded on a budget of £60,000. Bassist Trevor Horn was chiefly inspired by Kraftwerk's 1978 album The Man-Machine and sought unconventional recording methods for The Age of Plastic. Keyboardist Geoff Downes characterised the album as "science fiction music ... like modern psychedelic music ... very futuristic." Several tracks also featured contributions from vocalist Bruce Woolley, who left the group mid-production. The backing tracks were recorded at Virgin's Town House in West London, while the vocals were recorded and mixed at Sarm East Studios. Mixing was completed before Christmas 1979.

The Age of Plastic reached number 27 on the UK Albums Chart amid a mixed critical reception. Its three subsequent singles, "The Plastic Age", "Clean, Clean" and "Elstree", charted in the UK, reaching number 16, 38 and 55 respectively. Classic Pop magazine called it the 99th best album of the 1980s, Paste magazine the 45th-best new wave album of all-time. A September 2010 performance at the Ladbroke Grove's Supperclub in Notting Hill, London marked the first time that the group performed the album in its entirety.

Background
Geoff Downes formed the Buggles in 1977 in Wimbledon, South West London with Trevor Horn and Bruce Woolley. The trio had recorded rough demos of early compositions such as "Video Killed the Radio Star", "Clean, Clean" and "On TV", a track later included on their second album, Adventures in Modern Recording. Talking about the formation of the Buggles, Downes said about the demos: "We’d sort out the songs at my place and do all the arrangements together. Later we’d kick the artist out of the studio and spent most of the studio time just doing different things of our own, using every moment to our best advantage. It was a big experience for both of us and after a couple of years of doing that, we had quite a few songs together... It was at that stage that we decided to become artists. We felt that it was about time that somebody started making good, well-produced pop records again. We wanted to give people something more than they already had."

The Buggles were signed to Island Records, who gave Horn and Downes recording and publishing contracts. The group started recording their first studio album in the first half of 1979. Although Woolley was originally intended to be the band's lead vocalist, he left the group during the sessions to form his own band, the Camera Club, who also recorded versions of "Clean, Clean" and "Video Killed the Radio Star", songs that appeared on their 1979 album English Garden. When "Video Killed the Radio Star" became a huge commercial success, Horn and Downes realized that they needed to record more material to fill out a full album, so they wrote additional songs, during the promotion of the single, while in airport lounges, dressing rooms, rehearsal rooms and studios.

Production
The Age of Plastic was afforded a budget of £60,000 (equivalent to £0 in ). Engineer Hugh Padgham recorded the backing tracks at Virgin's Town House in West London, as Sarm East Studios was very small and Horn wanted to record real drums. The Buggles went to London's Wardour Street to recruit two women to appear on the album. The mixing and Horn's vocal recording were later performed at Sarm East Studios, and mixing was finished before Christmas 1979 for a 1980 album release. Sarm East mixer Gary Langan used a 40-input Trident TSM console to record and mix the album, which was housed inside the same control room as were two Studer A80 24-track machines and outboard gear that included an EMT 140 echo plate, Eventide digital delay, Eventide phaser, Marshall Time Modulator, Kepex noise gates, Urei and Orban equalizers, and Urei 1176, Dbx 160 and UA LA2 and LA3 compressors.

Vocals were recorded at Sarm East to a click track using a Roland TR-808 drum machine and other various machines and boxes that were synced to the tracks. As Langan recalls: "In those days of relatively limited technology we again had to push what we had to the limit... If, for instance, something required an effect, whether it be tape delay or phasing or some big, delayed reverb, the art was to get that effect right and record it... It all had to be done and then, as I said, it would influence the next process." Langan has noted that balancing the backing vocals in the songs was an issue because of the limited storage capacities of the time: "We'd make it as clean as we possibly could, bounce that down to two tracks and then we'd erase."

Style and composition
Unable to make the album sound similar to others of the late 1970s, Horn "figured that if I couldn't get records to sound like Elton John, which I couldn't because I couldn't figure out how they did it, then whatever I could do, I'd better exaggerate it." He had also wanted to "perverse things with sound, except that in 1978 and 1979, none of the equipment which would later allow me to do that was available. So I had to pre-date that technology by finding my own ways of achieving certain sounds." Audio noted that the album's sound was reminiscent of duo Godley & Creme's debut album Consequences.

Some music reviewers have labeled The Age of Plastic as the first landmark of another electropop era. In his book Are We Not New Wave?: Modern Pop at the Turn of the 1980s, Theo Cateforis writes that the album's title and the songs "I Love You (Miss Robot)" and "Astroboy" "picture the arrival of the 1980s as a novelty era of playful futurism." In a 1979 interview, Downes defined the album as "science fiction music. It's like modern psychedelic music. It's very futuristic." Multiple music journalists have described it as a mixture of synthpop and new wave music, with elements of disco, punk, progressive rock and pop music from the 1960s. The album was also influenced by groups such as 10cc, ELO and Kraftwerk.

Downes and Krinein Magazine noted the tracks' instrumentations of guitars, bass guitar, drums, vocoded, robotic and female vocals, and synthesizers used to emulate orchestral instruments, and well as compositional elements of a variety of complex builds. Downes has said that he used five synthesizers in making The Age of Plastic, which were used to "fake up things and to provide effects we won't use them in the manner that somebody like John Foxx does." According to Horn: "We used about three different drummers including one [ Richard James Burgess ] from Landscape and Johnny Richardson from the Rubettes, who's really good. We also used the occasional session guitarist to play various bits and there were three or four girl singers involved. Apart from that, we did everything ourselves." Downes claimed to have used George Shearing's trick of doubling melody lines in block chords very heavily on some of the songs.

Themes
The Age of Plastic is a tragicomic concept album with lyrical themes of intense nostalgia and anxiety about the possible effects of modern technology. The lyrics, which were written by Trevor Horn, were inspired by the works of J. G. Ballard. The Buggles have claimed that they were necessarily a "plastic group" to meet the needs of a "plastic age", explaining the album's title, The Age of Plastic. Downes has said that the lyrics were "trying to make cynical comments on a number of issues." Eight tracks are included on The Age of Plastic: "Living in the Plastic Age", "Video Killed the Radio Star", "Kid Dynamo", "I Love You (Miss Robot)", "Clean, Clean", "Elstree", "Astroboy (And the Proles on Parade)" and "Johnny (on the Monorail)". The album's lyrical concept was compared by Orange Coast magazine to that of the works of Canadian progressive rock band Klaatu.

"Video Killed the Radio Star," the second track, refers to a period of technological change in the 1960s, the desire to remember the past and the disappointment that children of the current generation would not appreciate the past. The fast-paced third song, "Kid Dynamo," is about the effects of media on a futuristic kid of the 1980s. Of the album's fourth track, "I Love You (Miss Robot)", Downes has said it is about "being on the road and making love to someone you don't really like, while all the time you're wanting to phone someone who's a long way off." Wave Maker magazine viewed the song as "a darkly soothing, bass guitar-driven ballad which brings us back into cyberpunk country."

"Clean, Clean" is the album's fifth track, and follows the story of a young boy who grows out of being a gangster, and, despite not willing to do so, will at least try to keep the fighting clean. Wave Maker found "Elstree," the album's sixth song, as lyrically similar to "Video Killed the Radio Star," as it follows "a failed actor taking up a more regular position behind the scenes and looking back at his life in regret." The slow-tempo ballad "Astroboy (And the Proles on Parade)", according to Wave Maker, "once again revisits cyberpunk with a much lighter vibe, although the keyboards do occasionally border darker realms, expecially [sic] with the post-chorus hook," and the album closer "Johnny on the Monorail" has a "pop atmosphere" that "better suits the flow of the rest of the album."

Release
The Age of Plastic was first released in Australia on 10 January 1980, and in the United Kingdom on 4 February the same year. Initially, songs from The Age of Plastic were played on English radio stations from 31 December 1979, and two advertisements for the album were also released. On 1 February 1980, Hans Zimmer filed an injunction to the High Court of Justice threatening to take the album off store shelves for not being credited, but was it rejected; Zimmer didn't play any instrument and only programmed the sequencer and a few Prophet V sounds. The Age of Plastic appeared on the UK Albums Chart for six weeks, reaching number 27 on the chart. The album debuted at number 32 in Norway, eventually reaching number 23, and peaked at number 24 in Sweden. It also reached the number 15 spot on the French Albums Chart and number 35 in Japan.

Lead single "Video Killed the Radio Star", released months earlier, was commercially successful, topping the record charts in 16 countries, including the UK Singles Chart. From January to October 1980, three more singles were issued in support of the album: "Living in the Plastic Age", "Clean, Clean" and "Elstree". All of the singles had chart success in the UK, with "The Plastic Age" and "Clean, Clean" gaining chart success on an international level.

A Trouser Press writer recalled that "The Age of Plastic was a disappointment to fans of the Buggles' cogent 45s ... technically stunning, reasonably catchy and crashingly hollow." Upon release, Betty Page from Sounds commented that the group "stretches uncomfortably out into the long playing medium like a skein of well-chewed bubblegum." Dave Marsh and John Swenson, writing for The Rolling Stone Record Guide (1983), opined that "aside from the wonderful 'Video Killed the Radio Star' — perhaps the most successful recent example of a single where the production was catchier than the material", the album was "high-tech dreck." Conversely, Melody Maker noted that the album is "all jerky twitchings and absurdly inflated post-punk melodrama" and named it as "essential." The Canberra Times's Keith Gosman found the production excellent and said the album sounded "crisp as fresh dollar bills." Smash Hits rated the album 8 out of 10 and called the "electronic and futuristic flavouring" of the album "quite human and therefore the most enjoyable of the lot.", including "lots of energy, well constructed, imaginative and above all a set of GREAT TUNES throughout".

Retrospective reviews
Among retrospective reviews, Jeri Montesano from AllMusic described it as "a fun record that doesn't need to be taken too seriously" and that "it would be difficult to find a record from this era that sounds half as good. Pop rarely reaches these heights." While reviewing the Buggles' second album, Montesano stated that both albums "still sound fresh" compared to 1990s pop music. Amazon editorial reviewer Grant Alden also compared the album to 1990s pop, and labelled the group as "Part of the early-1980s great explosion of pop music [...] to have any real impact."

The Encyclopedia of Science Fiction described the LP as "one of the best examples of the decade's characteristically disposable pop", while Spin named it one of the "8 Essentials of Post-Kraftwerk Pop." Napster's Nicholas Baker liked the album's composition and concluded that "this LP is not so much a guilty pleasure as an essential point in electropop history." Metro Pulse ' s Anthony Nownes found the tunes "punchy, memorable" and "accessible", concluding his review with "If all rock records sounded like this—shiny and slick and highly processed—the world would be terrible. But a few Trevor Horns—people who use studio technology the way a curious and playful child uses a room full of fictile toys—are nice to have around."

Less favourably, Joseph Stannard opined that The Age of Plastic "sounds like unfinished business, a series of good ideas in need of elaboration." In a review of the album's 1999 reissue, Richard Wallace of the Daily Mirror wrote that the record "shows how [The Buggles] pioneered the synth-led nonsense which fused much of the decade's pop, but had little creative imagination. That bombastic electro-sound became [Trevor] Horn's trademark as a producer. Skip it." Alexis Petridis of The Guardian called it "awful beyond measure", pointing to the liner notes conceding that "we did not have an album's worth of material" and called reissuing it "wasteful, it's stupid."

Legacy and influence
Popular French bands such as Justice, Daft Punk and Phoenix have been influenced by The Age of Plastic. Justice has said that they were "totally fascinated by The Buggles' first album [The Age of Plastic]. It's full of stuff we like - there's a bit of electro, a bit of pop, a bit of classical going on there... We like the way they operated too, as an autonomous duo..."

In 2000, as part of the Island Remasters series, the album was reissued with three bonus tracks, "Technopop", "Island" and "Johnny on the Monorail (A Very Different Version)". The album was remastered and re-released again on 24 February 2010 in Japan. The new edition included nine additional tracks, three of which were from the 2000 re-release album. A single and special DJ version of "Elstree" also appeared on the 2010 reissue of the album, as well as a 12" version of "Clean, Clean". The album's 2010 reissue briefly appeared at number 225 in Japan.

On 28 September 2010, the Buggles reunited to play their first full-length live performance of the album. The event was billed as "The Lost Gig" and took place at Ladbroke Grove's Supperclub in Notting Hill, London. It was a fundraiser with all earnings going to the Royal Hospital for Neuro-disability. With the exception of "Video Killed the Radio Star" and "The Plastic Age", which the band had previously played together, "The Lost Gig" saw the first live performances of all of the remaining songs from The Age of Plastic.

Personnel
Credits are adapted from the album's liner notes.

The Buggles – producers
 * Geoff Downes – keyboards, synthesizers, drums, percussion, vocoder
 * Trevor Horn – vocals, bass guitar, guitars

Additional musicians
 * Dave Birch – guitars on "The Plastic Age" and "Video Killed the Radio Star"
 * Richard James Burgess – drums
 * Tina Charles – background vocals
 * Debi Doss and Linda Jardim – background vocals on "Video Killed the Radio Star"
 * Phil Towner - drums on ”Video Killed the Radio star”
 * Paul Robinson – drums
 * Bruce Woolley – guitar

Technical personnel
 * Gary Langan – mixer, vocal recording
 * Bob Ludwig – mastering
 * Hugh Padgham – engineer, instrumental recording

title: The Age of Plastic


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William Hurt

William McChord Hurt (March 20, 1950 – March 13, 2022) was an American actor. He is widely known for his performances on stage and screen, he received various awards including an Academy Award, BAFTA Award, and Cannes Film Festival Award for Best Actor.

Hurt studied at the Juilliard School and began acting on stage in the 1970s. His film debut, in Ken Russell's science-fiction feature Altered States, was released in 1980, for which he received a Golden Globe nomination for New Star of the Year. In 1981, he had a leading role in the neo-noir Body Heat, co-starring Kathleen Turner. His starring roles in a series of critically acclaimed films garnered three consecutive nominations for the Academy Award for Best Actor: Kiss of the Spider Woman (1985), which he won; Children of a Lesser God (1986), and Broadcast News (1987). During this time he also starred in The Big Chill (1983), The Accidental Tourist (1988), Alice (1990), Until the End of the World (1991), Trial by Jury (1994), Michael (1996), Lost in Space, Dark City, and One True Thing (All in 1998) and Sunshine (1999).

Hurt earned his fourth Academy Award nomination for Best Supporting Actor in David Cronenberg's crime thriller A History of Violence (2005). His later character roles include A.I. Artificial Intelligence (2001), Tuck Everlasting and Changing Lanes (Both in 2002), The Village (2004), Syriana (2005), The Good Shepherd (2006), Mr. Brooks and Into the Wild (Both in 2007), Vantage Point and The Yellow Handkerchief (Both in 2008), Robin Hood (2010), The Host (2013), Winter's Tale (2014), Race (2016), The Miracle Season (2018), The Last Full Measure (2019), and The King's Daughter (2022). From 2008 to 2021, he portrayed Thaddeus Ross in the Marvel Cinematic Universe (MCU) films The Incredible Hulk (2008), Captain America: Civil War (2016), Avengers: Infinity War (2018), Avengers: Endgame (2019), and Black Widow (2021).

Hurt's various television projects included the FX legal drama Damages, which earned him a nomination for the Primetime Emmy Award for Outstanding Supporting Actor in a Drama Series. In 2011, he portrayed Henry Paulson in the HBO movie Too Big to Fail and received another Primetime Emmy nomination for Outstanding Lead Actor in a Limited Series or Movie.

On stage, Hurt appeared in off-Broadway productions including Henry V, Fifth of July, Richard II and A Midsummer Night's Dream; and made his Broadway debut in David Rabe's dark comedy Hurlyburly, for which he received a nomination for the Tony Award for Best Actor in a Play.

Early life and education
Hurt was born on March 20, 1950, in Washington, D.C., to Claire Isabel (née McGill; 1923–1971), who worked for Time Inc., and Alfred McChord Hurt (1910–1996), who worked for the United States Agency for International Development and the State Department. He had two brothers. With his father, he lived in Lahore, Mogadishu, and Khartoum. His parents divorced and, in 1960, his mother married Henry Luce III (1925–2005), a son of publisher Henry Luce.

Hurt attended the Middlesex School, where he was vice-president of the Dramatics Club and had the lead role in several school plays. He graduated in 1968 and his yearbook predicted, "you might even see him on Broadway." Hurt attended Tufts University and studied theology, but turned instead to acting and joined the Juilliard School (Drama Division Group 5: 1972–1976).

Career
Hurt began his career in stage productions. From 1977 to 1989, he was a member of the acting company at Circle Repertory Company. He won an Obie Award for his debut appearance there in Corinne Jacker's My Life, and won a 1978 Theatre World Award for his performances in Fifth of July, Ulysses in Traction, and Lulu. In 1979, Hurt played Hamlet under the direction of Marshall W. Mason opposite Lindsay Crouse and Beatrice Straight.

His first major film role was in the science-fiction film Altered States (1980), where his performance as an obsessed scientist gained him wide recognition. His performance opposite newcomer Kathleen Turner in Lawrence Kasdan's neo-noir film Body Heat (1981) elevated Hurt to stardom. Kasdan and he became frequent collaborators: Hurt co-starred in Kasdan's acclaimed comedy-dramas The Big Chill (1983) and The Accidental Tourist (1988), both of which were nominated for the Academy Award for Best Picture, and he later had a supporting role in the ensemble comedy I Love You to Death (1990).

Hurt appeared in the thriller Gorky Park (1983) opposite Lee Marvin. He received the Best Male Performance Prize at the Cannes Film Festival and the Academy Award for Best Actor for his turn as a prisoner in Hector Babenco's drama Kiss of the Spider Woman in 1985. “Mr. Hurt won a well-deserved best actor award at the Cannes Film Festival for a performance that is crafty at first, carefully nurtured and finally stirring in profound, unanticipated ways,” she wrote. “What starts out as a campy, facetious catalog of Hollywood trivia becomes an extraordinarily moving film about manhood, heroism and love.”.

He received three additional Oscar nominations: Best Actor for playing a speech teacher at a school for the deaf who falls for a deaf custodian in Children of a Lesser God (1986) and a pretty boy broadcaster in Broadcast News (1987; he was thus nominated for Best Actor for three consecutive years) and Best Supporting Actor for playing a powerful crime boss in A History of Violence (2005). Broadcast News, a romantic comedy directed by James L. Brooks, is possibly Hurt's most acclaimed film and is included at the National Film Registry by the Library of Congress.

After this run of particularly prominent roles in the 1980s, Hurt began to appear more frequently in supporting roles. Some of his notable roles include performances in Dark City (1998), Lost in Space (1998), Sunshine (1999), A.I. Artificial Intelligence (2001), Tuck Everlasting (2002), The Village (2004), A History of Violence (2005), and Syriana (2005). Hurt received particular acclaim for his role in A History of Violence, where despite less than 10 minutes of screen time, he received an Academy Award nomination.

In June 2007, Marvel Studios announced that Hurt would portray General Thaddeus "Thunderbolt" Ross in the 2008 film The Incredible Hulk alongside Edward Norton, Liv Tyler, and Tim Roth. Hurt reprised his role in four additional Marvel Cinematic Universe (MCU) films: Captain America: Civil War (2016), Avengers: Infinity War (2018), Avengers: Endgame (2019), and Black Widow (2021).

Other later film roles included Into the Wild (2007), Mr. Brooks (2007), Vantage Point (2008), The Yellow Handkerchief (2008), and Robin Hood (2010).

Hurt had several roles in television and theater. Hurt starred in the Sci Fi Channel miniseries adaptation Frank Herbert's Dune in 2000, playing Duke Leto Atreides; it was one of Syfy's highest-rated series ever. He was in the miniseries adaptation of Stephen King's Nightmares and Dreamscapes, in a piece titled Battleground (known for its complete lack of dialogue). He appeared in the cast of Vanya, an adaptation of Anton Chekhov's Uncle Vanya, at the Artists Repertory Theatre in Portland, Oregon. In 2009, Hurt became a series regular on the FX series Damages playing a corporate whistleblower opposite Glenn Close and Marcia Gay Harden. For his role in the series, he earned a 2009 Primetime Emmy Award nomination for Supporting Actor in a Drama Series. In September 2010, Hurt played United States Secretary of the Treasury Henry Paulson in the HBO film Too Big to Fail, an adaptation of Andrew Ross Sorkin's book. He also starred as Captain Ahab in the 2011 television adaptation of Herman Melville's novel Moby-Dick. Hurt was set to play Gregg Allman in the film Midnight Rider, but he left the production after an on-set accident.

In 2018, Hurt was cast as the lead in The Coldest Game (2019), but after he was injured in an off-set accident, he was replaced by Bill Pullman. In one of his final roles, Hurt played opposite F. Murray Abraham in a standalone episode of Mythic Quest in 2021. Hurt had been set to appear in the series Pantheon and films The Fence, Men of Granite, and Edward Enderby before his death in March 2022, though he ultimately only appeared in Pantheon.

Personal life
Hurt was married to actress Mary Beth Hurt (née Supinger) from 1971 to 1982, and to Heidi Henderson from 1989 to 1993. Hurt had four children: one with Sandra Jennings; two with Henderson; and one with French actress, film director, and screenwriter Sandrine Bonnaire.

In 1981, while he was still married, Hurt and Sandra Jennings began a relationship in Saratoga Springs, New York. Jennings became pregnant in the spring of 1982, which was followed by Hurt's divorce from Mary Beth, after which Hurt and Jennings relocated to South Carolina, a state that recognized non-ceremonial common-law marriages. Hurt and Jennings never held a marriage ceremony and later separated.

Hurt was a private pilot and owner of a Beechcraft Bonanza. He was fluent in French and maintained a home outside Paris.

Hurt and Marlee Matlin had a relationship for two years, which included living together.

Domestic violence allegations
Hurt's girlfriend Sandra Jennings sued Hurt in New York, seeking recognition of their relationship as a common-law marriage under South Carolina law. The New York court held that the relationship between Hurt and Jennings did not qualify as a common-law marriage under South Carolina law and found in Hurt's favor that no marriage existed. During Jennings' lawsuit against Hurt, she alleged that Hurt subjected her to physical and verbal abuse. His spokesperson denied that Hurt ever beat Jennings.

In her 2009 autobiography I'll Scream Later, Marlee Matlin said that their relationship involved drug use and physical violence from Hurt, including a rape. In response to the accusations aired on CNN on April 13, 2009, Hurt's agent declined to respond, but Hurt issued a statement the following day that his "own recollection is that we both apologized and both did a great deal to heal our lives. Of course, I did and do apologize for any pain I caused. And I know we have both grown. I wish Marlee and her family nothing but good."

In a 2022 essay for Variety, after Hurt had died, author Donna Kaz wrote about dating Hurt in their twenties, from 1977 to 1980. She accused Hurt of domestic abuse in the article.

Death and tributes
In May 2018, it was announced that Hurt had terminal prostate cancer that had metastasized to his bones. On March 13, 2022, he died of natural causes at his home in Portland, Oregon, just a week before his 72nd birthday.

Many paid tribute to Hurt, including Chris Evans, Robert Downey, Jr., Gwyneth Paltrow, Tom Hanks, Rita Wilson, Dennis Quaid, Marg Helgenberger, Kevin Costner, Russell Crowe, John Goodman, Patton Oswalt, Albert Brooks, Bryce Dallas Howard, Maria Bello, Jonathan Frakes, Ben Stiller, Mark Ruffalo, Jennifer Garner, Jeremy Renner, and Topher Grace.

title: William Hurt


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Wikipedia:WikiProject China/Chinese provinces workgroup/Status

Status page for the WikiProject China/Chinese provinces workgroup

Progress
Updated as of 23 November 2019


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Bulimia nervosa

Bulimia nervosa, also known as simply bulimia, is an eating disorder characterized by binge eating followed by purging or fasting, and excessive concern with body shape and weight. This activity aims to expel the body of calories eaten from the binging phase of the process. Binge eating refers to eating a large amount of food in a short amount of time. Purging refers to the attempts to get rid of the food consumed. This may be done by vomiting or taking laxatives.

Other efforts to lose weight may include the use of diuretics, stimulants, water fasting, or excessive exercise. Most people with bulimia are at normal weight. The forcing of vomiting may result in thickened skin on the knuckles, breakdown of the teeth, and effects on metabolic rate and caloric intake which cause thyroid dysfunction. Bulimia is frequently associated with other mental disorders such as depression, anxiety, borderline personality disorder, bipolar disorder, and problems with drugs or alcohol. There is also a higher risk of suicide and self-harm.

Bulimia is more common among those who have a close relative with the condition. The percentage risk that is estimated to be due to genetics is between 30% and 80%. Other risk factors for the disease include psychological stress, cultural pressure to attain a certain body type, poor self-esteem, and obesity. Living in a culture that commercializes or glamorizes dieting and having parental figures who fixate on weight are also risks.

Diagnosis is based on a person's medical history; however, this is difficult, as people are usually secretive about their binge eating and purging habits. Further, the diagnosis of anorexia nervosa takes precedence over that of bulimia. Other similar disorders include binge eating disorder, Kleine–Levin syndrome, and borderline personality disorder.

Signs and symptoms
Bulimia typically involves rapid and out-of-control eating, which may stop when the person is interrupted by another person or the stomach hurts from over-extension, followed by self-induced vomiting or other forms of purging. This cycle may be repeated several times a week or, in more serious cases, several times a day and may directly cause:
 * Chronic gastric reflux after eating, secondary to vomiting
 * Dehydration and hypokalemia due to renal potassium loss in the presence of alkalosis and frequent vomiting
 * Electrolyte imbalance can lead to abnormal heart rhythms, cardiac arrest, and even death
 * Esophagitis, or inflammation of the esophagus
 * Mallory-Weiss tears
 * Boerhaave syndrome, a rupture in the esophageal wall due to vomiting
 * Oral trauma, in which repetitive insertion of fingers or other objects causes lacerations to the lining of the mouth or throat
 * Russell's sign: calluses on knuckles and back of hands due to repeated trauma from incisors
 * Perimolysis, or severe dental erosion of tooth enamel
 * Swollen salivary glands (for example, in the neck, under the jawline)
 * Gastroparesis, or delayed gastric emptying
 * Constipation or diarrhea
 * Tachycardia or palpitations
 * Hypotension
 * Peptic ulcers
 * Infertility
 * Constant weight fluctuations are common
 * Elevated blood sugar, cholesterol, and amylase levels may occur
 * Hypoglycemia may occur after vomiting

These are some of the many signs that may indicate whether someone has bulimia nervosa:
 * A fixation on the number of calories consumed
 * A fixation on an extreme consciousness of one's weight
 * Low self-esteem and/or self-harming
 * Suicidal tendencies
 * An irregular menstrual cycle in women
 * Regular trips to the bathroom, especially soon after eating
 * Depression, anxiety disorders, and sleep disorders
 * Frequent occurrences involving the consumption of abnormally large portions of food
 * The use of laxatives, diuretics, and diet pills
 * Compulsive or excessive exercise
 * Unhealthy/dry skin, hair, nails, and lips
 * Fatigue, or exhaustion

As with many psychiatric illnesses, delusions can occur, in conjunction with other signs and symptoms, leaving the person with a false belief that is not ordinarily accepted by others.

People with bulimia nervosa may also exercise to a point that excludes other activities.

Interoceptive
People with bulimia exhibit several interoceptive deficits, in which one experiences impairment in recognizing and discriminating between internal sensations, feelings, and emotions. People with bulimia may also react negatively to somatic and affective states. Regarding interoceptive sensation, hyposensitive individuals may not detect normal feelings of fullness at the appropriate time while eating, and are prone to eating more calories in a short period of time as a result of this decreased sensitivity.

Examining from a neural basis also connects elements of interoception and emotion; notable overlaps occur in the medial prefrontal cortex, anterior and posterior cingulate, and anterior insula cortices, which are linked to both interoception and emotional eating.

Related disorders
People with bulimia are at a higher risk to have an affective disorder, such as depression or general anxiety disorder. One study found 70% had depression at some time in their lives (as opposed to 26% for adult females in the general population), rising to 88% for all affective disorders combined. Another study in the Journal of Affective Disorders found that of the population of patients that were diagnosed with an eating disorder according to the DSM-V guidelines about 27% also suffered from bipolar disorder. Within this article, the majority of the patients were diagnosed with bulimia nervosa, the second most common condition reported was binge-eating disorder. Some individuals with anorexia nervosa exhibit episodes of bulimic tendencies through purging (either through self-induced vomiting or laxatives) as a way to quickly remove food in their system. There may be an increased risk for diabetes mellitus type 2. Bulimia also has negative effects on a person's teeth due to the acid passed through the mouth from frequent vomiting causing acid erosion, mainly on the posterior dental surface.

Research has shown that there is a relationship between bulimia and narcissism. According to a study by the Australian National University, eating disorders are more susceptible among vulnerable narcissists. This can be caused by a childhood in which inner feelings and thoughts were minimized by parents, leading to "a high focus on receiving validation from others to maintain a positive sense of self".

The medical journal Borderline Personality Disorder and Emotion Dysregulation notes that a "substantial rate of patients with bulimia nervosa" also have Borderline personality disorder.

A study by the Psychopharmacology Research Program of the University of Cincinnati College of Medicine "leaves little doubt that bipolar and eating disorders—particularly bulimia nervosa and bipolar II disorder—are related." The research shows that most clinical studies indicate that patients with bipolar disorder have higher rates of eating disorders, and vice versa. There is overlap in phenomenology, course, comorbidity, family history, and pharmacologic treatment response of these disorders. This is especially true of "eating dysregulation, mood dysregulation, impulsivity and compulsivity, craving for activity and/or exercise."

Studies have shown a relationship between bulimia's effect on metabolic rate and caloric intake with thyroid dysfunction.

Biological
As with anorexia nervosa, there is evidence of genetic predispositions contributing to the onset of this eating disorder. Abnormal levels of many hormones, notably serotonin, have been shown to be responsible for some disordered eating behaviors. Brain-derived neurotrophic factor (BDNF) is under investigation as a possible mechanism.

There is evidence that sex hormones may influence appetite and eating in women and the onset of bulimia nervosa. Studies have shown that women with hyperandrogenism and polycystic ovary syndrome have a dysregulation of appetite, along with carbohydrates and fats. This dysregulation of appetite is also seen in women with bulimia nervosa. In addition, gene knockout studies in mice have shown that mice that have the gene encoding estrogen receptors have decreased fertility due to ovarian dysfunction and dysregulation of androgen receptors. In humans, there is evidence that there is an association between polymorphisms in the ERβ (estrogen receptor β) and bulimia, suggesting there is a correlation between sex hormones and bulimia nervosa.

Bulimia has been compared to drug addiction, though the empirical support for this characterization is limited. However, people with bulimia nervosa may share dopamine D2 receptor-related vulnerabilities with those with substance use disorders.

Dieting, a common behaviour in bulimics, is associated with lower plasma tryptophan levels. Decreased tryptophan levels in the brain, and thus the synthesis of serotonin, such as via acute tryptophan depletion, increases bulimic urges in currently and formerly bulimic individuals within hours.

Abnormal blood levels of peptides important for the regulation of appetite and energy balance are observed in individuals with bulimia nervosa, but it remains unknown if this is a state or trait.

In recent years, evolutionary psychiatry as an emerging scientific discipline has been studying mental disorders from an evolutionary perspective. If eating disorders, Bulimia nervosa in particular, have evolutionary functions or if they are new modern "lifestyle" problems is still debated.

Social
Media portrayals of an 'ideal' body shape are widely considered to be a contributing factor to bulimia. In a 1991 study by Weltzin, Hsu, Pollicle, and Kaye, it was stated that 19% of bulimics undereat, 37% of bulimics eat an average or normal amount of food, and 44% of bulimics overeat. A survey of 15- to 18-year-old high school girls in Nadroga, Fiji, found the self-reported incidence of purging rose from 0% in 1995 (a few weeks after the introduction of television in the province) to 11.3% in 1998. In addition, the suicide rate among people with bulimia nervosa is 7.5 times higher than in the general population.

When attempting to decipher the origin of bulimia nervosa in a cognitive context, Christopher Fairburn et al.'s cognitive-behavioral model is often considered the golden standard. Fairburn et al.'s model discusses the process in which an individual falls into the binge-purge cycle and thus develops bulimia. Fairburn et al. argue that extreme concern with weight and shape coupled with low self-esteem will result in strict, rigid, and inflexible dietary rules. Accordingly, this would lead to unrealistically restricted eating, which may consequently induce an eventual "slip" where the individual commits a minor infraction of the strict and inflexible dietary rules. Moreover, the cognitive distortion due to dichotomous thinking leads the individual to binge. The binge subsequently should trigger a perceived loss of control, promoting the individual to purge in hope of counteracting the binge. However, Fairburn et al. assert the cycle repeats itself, and thus consider the binge-purge cycle to be self-perpetuating.

In contrast, Byrne and Mclean's findings differed slightly from Fairburn et al.'s cognitive-behavioral model of bulimia nervosa in that the drive for thinness was the major cause of purging as a way of controlling weight. In turn, Byrne and Mclean argued that this makes the individual vulnerable to binging, indicating that it is not a binge-purge cycle but rather a purge-binge cycle in that purging comes before bingeing. Similarly, Fairburn et al.'s cognitive-behavioral model of bulimia nervosa is not necessarily applicable to every individual and is certainly reductionist. Every one differs from another, and taking such a complex behavior like bulimia and applying the same one theory to everyone would certainly be invalid. In addition, the cognitive-behavioral model of bulimia nervosa is very culturally bound in that it may not be necessarily applicable to cultures outside of Western society. To evaluate, Fairburn et al..'s model and more generally the cognitive explanation of bulimia nervosa is more descriptive than explanatory, as it does not necessarily explain how bulimia arises. Furthermore, it is difficult to ascertain cause and effect, because it may be that distorted eating leads to distorted cognition rather than vice versa.

A considerable amount of literature has identified a correlation between sexual abuse and the development of bulimia nervosa. The reported incident rate of unwanted sexual contact is higher among those with bulimia nervosa than anorexia nervosa.

When exploring the etiology of bulimia through a socio-cultural perspective, the "thin ideal internalization" is significantly responsible. The thin-ideal internalization is the extent to which individuals adapt to the societal ideals of attractiveness. Studies have shown that young women that read fashion magazines tend to have more bulimic symptoms than those women who do not. This further demonstrates the impact of media on the likelihood of developing the disorder. Individuals first accept and "buy into" the ideals, and then attempt to transform themselves in order to reflect the societal ideals of attractiveness. J. Kevin Thompson and Eric Stice claim that family, peers, and most evidently media reinforce the thin ideal, which may lead to an individual accepting and "buying into" the thin ideal. In turn, Thompson and Stice assert that if the thin ideal is accepted, one could begin to feel uncomfortable with their body shape or size since it may not necessarily reflect the thin ideal set out by society. Thus, people feeling uncomfortable with their bodies may result in body dissatisfaction and may develop a certain drive for thinness. Consequently, body dissatisfaction coupled with a drive for thinness is thought to promote dieting and negative effects, which could eventually lead to bulimic symptoms such as purging or bingeing. Binges lead to self-disgust which causes purging to prevent weight gain.

A study dedicated to investigating the thin ideal internalization as a factor of bulimia nervosa is Thompson's and Stice's research. Their study aimed to investigate how and to what degree media affects the thin ideal internalization. Thompson and Stice used randomized experiments (more specifically programs) dedicated to teaching young women how to be more critical when it comes to media, to reduce thin-ideal internalization. The results showed that by creating more awareness of the media's control of the societal ideal of attractiveness, the thin ideal internalization significantly dropped. In other words, less thin ideal images portrayed by the media resulted in less thin-ideal internalization. Therefore, Thompson and Stice concluded that media greatly affected the thin ideal internalization. Papies showed that it is not the thin ideal itself, but rather the self-association with other persons of a certain weight that decide how someone with bulimia nervosa feels. People that associate themselves with thin models get in a positive attitude when they see thin models and people that associate with overweight get in a negative attitude when they see thin models. Moreover, it can be taught to associate with thinner people.

Diagnosis
The onset of bulimia nervosa is often during adolescence, between 13 and 20 years of age, and many cases have previously experienced obesity, with many relapsing in adulthood into episodic bingeing and purging even after initially successful treatment and remission. A lifetime prevalence of 0.5 percent and 0.9 percent for adults and adolescents, respectively, is estimated among the United States population. Bulimia nervosa may affect up to 1% of young women and, after 10 years of diagnosis, half will recover fully, a third will recover partially, and 10–20% will still have symptoms.

Adolescents with bulimia nervosa are more likely to have self-imposed perfectionism and compulsivity issues in eating compared to their peers. This means that the high expectations and unrealistic goals that these individuals set for themselves are internally motivated rather than by social views or expectations.

Criteria
Bulimia nervosa can be difficult to detect, compared to anorexia nervosa, because bulimics tend to be of average or slightly above average weight. Many bulimics may also engage in significantly disordered eating and exercise patterns without meeting the full diagnostic criteria for bulimia nervosa. Recently, the Diagnostic and Statistical Manual of Mental Disorders was revised, which resulted in the loosening of criteria regarding the diagnoses of bulimia nervosa and anorexia nervosa. The diagnostic criteria utilized by the DSM-5 includes repetitive episodes of binge eating (a discrete episode of overeating during which the individual feels out of control of consumption) compensated for by excessive or inappropriate measures taken to avoid gaining weight. The diagnosis also requires the episodes of compensatory behaviors and binge eating to happen a minimum of once a week for a consistent time period of 3 months. The diagnosis is made only when the behavior is not a part of the symptom complex of anorexia nervosa and when the behavior reflects an overemphasis on physical mass or appearance. Purging often is a common characteristic of a more severe case of bulimia nervosa.

Treatment
There are two main types of treatment given to those with bulimia nervosa; psychopharmacological and psychosocial treatments.

Psychotherapy
Cognitive behavioral therapy is the primary treatment for bulimia. Antidepressants of the selective serotonin reuptake inhibitor (SSRI) or tricyclic antidepressant classes may have a modest benefit. While outcomes with bulimia are typically better than in those with anorexia, the risk of death among those affected is higher than that of the general population. At 10 years after receiving treatment about 50% of people are fully recovered.

Cognitive behavioral therapy (CBT), which involves teaching a person to challenge automatic thoughts and engage in behavioral experiments (for example, in session eating of "forbidden foods") has a small amount of evidence supporting its use.

By using CBT people record how much food they eat and periods of vomiting with the purpose of identifying and avoiding emotional fluctuations that bring on episodes of bulimia on a regular basis. Barker (2003) states that research has found 40–60% of people using cognitive behaviour therapy to become symptom free. He states in order for the therapy to work, all parties must work together to discuss, record and develop coping strategies. Barker (2003) claims by making people aware of their actions they will think of alternatives. People undergoing CBT who exhibit early behavioral changes are most likely to achieve the best treatment outcomes in the long run. Researchers have also reported some positive outcomes for interpersonal psychotherapy and dialectical behavior therapy.

Maudsley family therapy, developed at the Maudsley Hospital in London for the treatment of anorexia, has been shown promising results in bulimia.

The use of CBT has been shown to be quite effective for treating bulimia nervosa (BN) in adults, but little research has been done on effective treatments of BN for adolescents. Although CBT is seen as more cost-efficient and helps individuals with BN in self-guided care, Family Based Treatment (FBT) might be more helpful to younger adolescents who need more support and guidance from their families. Adolescents are at the stage where their brains are still quite malleable and developing gradually. Therefore, young adolescents with BN are less likely to realize the detrimental consequences of becoming bulimic and have less motivation to change, which is why FBT would be useful to have families intervene and support the teens. Working with BN patients and their families in FBT can empower the families by having them involved in their adolescent's food choices and behaviors, taking more control of the situation in the beginning and gradually letting the adolescent become more autonomous when they have learned healthier eating habits.

Medication
Antidepressants of the selective serotonin reuptake inhibitors (SSRI) class may have a modest benefit. This includes fluoxetine, also known as prozac, which is FDA approved, for the treatment of bulimia, other antidepressants such as sertraline may also be effective against bulimia. Topiramate may also be useful but has greater side effects. Compared to placebo, the use of a single antidepressant has been shown to be effective. Combining medication with counseling can improve outcomes in some circumstances. Some positive outcomes of treatments can include: abstinence from binge eating, a decrease in obsessive behaviors to lose weight and in shape preoccupation, less severe psychiatric symptoms, a desire to counter the effects of binge eating, as well as an improvement in social functioning and reduced relapse rates.

Alternative medicine
Some researchers have also claimed positive outcomes in hypnotherapy. ''The first use of hypnotherapy in Bulimic patients was in 1981. When it comes to hypnotherapy, Bulimic patients are easier to hypnotize than Anorexia Nervosa patients. In Bulimic patients, hypnotherapy focuses on learning self-control when it comes to binging and vomiting, strengthening stimulus control techniques, enhancing ones ego, improving weight control, and helping overweight patients see their body differently (have a different image).''

Risk factors
Being female and having bulimia nervosa takes a toll on mental health. Women frequently reported an onset of anxiety at the same time of the onset of bulimia nervosa. The approximate female-to-male ratio of diagnosis is 10:1. In addition to cognitive, genetic, and environmental factors, childhood gastrointestinal problems and early pubertal maturation also increase the likelihood of developing bulimia nervosa. Another concern with eating disorders is developing a coexisting substance use disorder.

Epidemiology
There is little data on the percentage of people with bulimia in general populations. Most studies conducted thus far have been on convenience samples from hospital patients, high school or university students; research on bulimia nervosa among ethnic minorities has also been limited. Existing studies have yielded a wide range of results: between 0.1% and 1.4% of males, and between 0.3% and 9.4% of females. Studies on time trends in the prevalence of bulimia nervosa have also yielded inconsistent results. According to Gelder, Mayou and Geddes (2005) bulimia nervosa is prevalent between 1 and 2 percent of women aged 15–40 years. Bulimia nervosa occurs more frequently in developed countries and in cities, with one study finding that bulimia is five times more prevalent in cities than in rural areas. There is a perception that bulimia is most prevalent amongst girls from middle-class families; however, in a 2009 study girls from families in the lowest income bracket studied were 153 percent more likely to be bulimic than girls from the highest income bracket. According to a study conducted in 2022 by Silen et al., which conglomerated statistics using various methods such as SCID, MRFS, EDE, SSAGA, and EDDI, the US, Finland, Australia, and the Netherlands had an estimated 2.1%, 2.4%, 1.0%, and 0.8% prevalence of bulimia nervosa among females under 30 years of age. This demonstrates the prevalence of bulimia nervosa in developed, Western, first-world countries, indicating an urgency in treating adolescent women. Additionally, these statistics may be misrepresentative of the true population affected with bulimia nervosa due to potential underreporting bias.

There are higher rates of eating disorders in groups involved in activities which idealize a slim physique, such as dance, gymnastics, modeling, cheerleading, running, acting, swimming, diving, rowing and figure skating. Bulimia is thought to be more prevalent among whites; however, a more recent study showed that African-American teenage girls were 50 percent more likely than white girls to exhibit bulimic behavior, including both binging and purging.

Etymology
The term bulimia comes from Greek βουλιμία boulīmia, "ravenous hunger", a compound of βοῦς bous, "ox" and λιμός, līmos, "hunger". Literally, the scientific name of the disorder, bulimia nervosa, translates to "nervous ravenous hunger".

Before the 20th century
Although diagnostic criteria for bulimia nervosa did not appear until 1979, evidence suggests that binging and purging were popular in certain ancient cultures. The first documented account of behavior resembling bulimia nervosa was recorded in Xenophon's Anabasis around 370 B.C, in which Greek soldiers purged themselves in the mountains of Asia Minor. It is unclear whether this purging was preceded by binging. In ancient Egypt, physicians recommended purging once a month for three days to preserve health. This practice stemmed from the belief that human diseases were caused by the food itself. In ancient Rome, elite society members would vomit to "make room" in their stomachs for more food at all-day banquets. Emperors Claudius and Vitellius both were gluttonous and obese, and they often resorted to habitual purging.

Historical records also suggest that some saints who developed anorexia (as a result of a life of asceticism) may also have displayed bulimic behaviors. Saint Mary Magdalen de Pazzi (1566–1607) and Saint Veronica Giuliani (1660–1727) were both observed binge eating—giving in, as they believed, to the temptations of the devil. Saint Catherine of Siena (1347–1380) is known to have supplemented her strict abstinence from food by purging as reparation for her sins. Catherine died from starvation at age thirty-three.

While the psychological disorder "bulimia nervosa" is relatively new, the word "bulimia", signifying overeating, has been present for centuries. The Babylon Talmud referenced practices of "bulimia", yet scholars believe that this simply referred to overeating without the purging or the psychological implications bulimia nervosa. In fact, a search for evidence of bulimia nervosa from the 17th to late 19th century revealed that only a quarter of the overeating cases they examined actually vomited after the binges. There was no evidence of deliberate vomiting or an attempt to control weight.

20th century
Globally, bulimia was estimated to affect 3.6 million people in 2015. About 1% of young women have bulimia at a given point in time and about 2% to 3% of women have the condition at some point in their lives. The condition is less common in the developing world. Bulimia is about nine times more likely to occur in women than men. Among women, rates are highest in young adults. Bulimia was named and first described by the British psychiatrist Gerald Russell in 1979.

At the turn of the century, bulimia (overeating) was described as a clinical symptom, but rarely in the context of weight control. Purging, however, was seen in anorexic patients and attributed to gastric pain rather than another method of weight control.

In 1930, admissions of anorexia nervosa patients to the Mayo Clinic from 1917 to 1929 were compiled. Fifty-five to sixty-five percent of these patients were reported to be voluntarily vomiting to relieve weight anxiety. Records show that purging for weight control continued throughout the mid-1900s. Several case studies from this era reveal patients with the modern description of bulimia nervosa. In 1939, Rahman and Richardson reported that out of their six anorexic patients, one had periods of overeating, and another practiced self-induced vomiting. Wulff, in 1932, treated "Patient D", who would have periods of intense cravings for food and overeat for weeks, which often resulted in frequent vomiting. Patient D, who grew up with a tyrannical father, was repulsed by her weight and would fast for a few days, rapidly losing weight. Ellen West, a patient described by Ludwig Binswanger in 1958, was teased by friends for being fat and excessively took thyroid pills to lose weight, later using laxatives and vomiting. She reportedly consumed dozens of oranges and several pounds of tomatoes each day, yet would skip meals. After being admitted to a psychiatric facility for depression, Ellen ate ravenously yet lost weight, presumably due to self-induced vomiting. However, while these patients may have met modern criteria for bulimia nervosa, they cannot technically be diagnosed with the disorder, as it had not yet appeared in the Diagnostic and Statistical Manual of Mental Disorders at the time of their treatment.

An explanation for the increased instances of bulimic symptoms may be due to the 20th century's new ideals of thinness. The shame of being fat emerged in the 1940s when teasing remarks about weight became more common. The 1950s, however, truly introduced the trend of aspiration for thinness.

In 1979, Gerald Russell first published a description of bulimia nervosa, in which he studied patients with a "morbid fear of becoming fat" who overate and purged afterward. He specified treatment options and indicated the seriousness of the disease, which can be accompanied by depression and suicide. In 1980, bulimia nervosa first appeared in the DSM-III.

After its appearance in the DSM-III, there was a sudden rise in the documented incidents of bulimia nervosa. In the early 1980s, incidents of the disorder rose to about 40 in every 100,000 people. This decreased to about 27 in every 100,000 people at the end of the 1980s/early 1990s. However, bulimia nervosa's prevalence was still much higher than anorexia nervosa's, which at the time occurred in about 14 people per 100,000.

In 1991, Kendler et al. documented the cumulative risk for bulimia nervosa for those born before 1950, from 1950 to 1959, and after 1959. The risk for those born after 1959 is much higher than those in either of the other cohorts.

title: Bulimia nervosa


text:
HD

HD may refer to:

Business

 * H-D or Harley-Davidson, a motorcycle manufacturer
 * The Home Depot, NYSE stock symbol: HD

Chemistry

 * Hydrogen deuteride, a diatomic compound of hydrogen and deuterium
 * Mustard gas

Codes

 * Air Do, formerly Hokkaido International Airlines, IATA designator
 * HD postcode area, covering Huddersfield, Brighouse and Holmfirth in England, UK
 * Heidelberg's vehicle registration plate code
 * Hunedoara County (Romania)'s ISO 3166 code

Medicine

 * Hansen's disease or leprosy
 * Hirschsprung's disease, a disorder of the abdomen
 * Huntington's disease, a genetic disorder affecting the central nervous system
 * HD (gene) or huntingtin, the IT15 gene, which codes for the huntingtin protein

People

 * H.D. or Hilda Doolittle (1886–1961), American poet and novelist
 * HD (commentator) or HDStarcraft, former e-sports commentator

Other uses

 * Helsingborgs Dagblad, a Swedish newspaper
 * Henry Draper Catalogue, an astronomical catalogue often used to designate stars
 * Department of Highways (disambiguation)
 * Högsta Domstolen, the Supreme Court of Sweden
 * Hurter and Driffield Numbers or H&D, an old scale for measuring film speed

Technology

 * Hard drive, an electro-mechanical data storage device
 * Hash digest, the output of a hash function
 * HD Photo, an image format
 * HD Radio, an abbreviation from the term hybrid digital/analog radio
 * HD Voice, or wideband audio
 * Heavy Duty (disambiguation)
 * High density, a diskette density
 * High-definition television (HDTV), a resolution that is substantially higher than that of standard-definition television
 * 720p (HD), a progressive HDTV signal format with 720 horizontal lines/1280 columns and an aspect ratio (AR) of 16:9
 * High-definition video, video of higher resolution and quality than standard-definition
 * Intel High Definition Audio, a specification for the audio sub-system of personal computers

title: HD