Frequency Of Purging Research Articles

Purging frequency and number of purging methods as indicators of severity in bulimia nervosa: Interactive effects with binge eating episodes.

In the Diagnostic and Statistical Manual of Mental Disorders-5, severity of bulimia nervosa (BN) is defined by the frequency of purging behaviour. Previous research suggests the number of purging methods as an alternative rating. The current analysis investigated characteristics (sociodemographic and treatment-related variables, body mass index [BMI], eating disorder-specific and general psychopathology) of persons with BN as a function of purging frequency and number of purging methods in order to examine which approach might be better suited for indicating severity of BN. Two-hundred and sixty-one persons (98.5% female; mean age 25.2years, SD=9.41; mean BMI 22.0kg/m2, SD=3.79) with BN completed self-report questionnaires on eating disorder-specific and general psychopathology at admission to inpatient (n=214) or daypatient (n=47) treatment. Higher severity based on either purging frequency or number of purging methods tended to relate to lower BMI and higher eating disorder-specific and general psychopathology. In addition, binge-eating frequency differentially related to eating disorder-specific and general psychopathology as a function of severity groups. This study partially supports the utility of both purging frequency and the number of purging methods as indicators of severity in persons with BN. However, focussing only on purging behaviours may be short-sighted as it appears necessary to consider the number of binge-eating episodes as well when evaluating severity of BN.

Suicidal thoughts and attempts in a transdiagnostic eating disorder sample: Do diagnostic severity criteria predict risk?

Eating disorders (EDs) are associated with elevated suicide. Low body mass index (BMI) and frequency of purging and binge eating represent severity criteria for EDs and distinguish full-threshold EDs from other specified feeding and eating disorders (OSFED). However, no work has taken a transdiagnostic approach to studying whether severity of these or other features is associated with suicidal ideation (SI) and attempts. We examined diagnostic status, ED features, and SI and attempts in a large, transdiagnostic, community sample of 257 women with EDs and 45 controls without a current or past ED in the United States using the EDs Examination interview and the Structured Clinical Interview for the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). SI and suicide attempts (SA) were elevated in OSFED compared to controls but did not differ between OSFED and full-threshold EDs. Higher BMI predicted increased SI. Number of purging methods, but not frequency, was related to history of SA. Binge episode frequency and size were not significant predictors. OSFED presents with elevated SI and SA, and ED severity criteria that distinguish OSFED from full-threshold EDs do not predict SI or SA. Suicide risk assessments should be implemented universally across EDs in clinical practice.

An experimental study on the hydrogen utilization in air-cooled proton exchange membrane fuel cell stack with a novel anode outlet design

In the realm of portable power system, air-cooled fuel cells stand out for their lightweight design and emission-free operation. Anode purging has emerged as an effective method to alleviate performance degradation in the dead-end anode stack. However, purging frequency can affect hydrogen utilization and output performance. This research aims to reduce the purging frequency and enhance hydrogen utilization of air-cooled fuel cell stacks by introducing a novel anodic outlet endplate. The novel outlet helps to remove liquid water and nitrogen from the stack, improve the output performance, and save the hydrogen usage in the air-cooled fuel cell stack. The peak power outputs of stacks equipped with the novel and conventional anodic outlets are recorded at 2313.95 W and 2213.35 W, respectively. Significantly, the novel anodic outlet configuration demonstrates a 4.54 % increase in peak power. Moreover, this configuration extends the purging interval, leading to a reduction in purging frequency. Under current load of 62 A, the novel anode outlet stack prolongs the purging interval of 134.73 s compare to its counterpart with a conventional anodic outlet than that of the conventional anode outlet. The findings presented in this study are poised to offer valuable insights into optimizing their efficiency and promoting sustainable solutions.

Habitual behavioural control moderates the relation between daily perceived stress and purging.

Evidence suggests that interpersonal stress plays a role in maintaining binge eating and purging (e.g., self-induced vomiting, misuse of laxatives). Stress is especially likely to promote engagement in maladaptive behaviour if the behaviour is habitual; therefore, individuals whose binge eating and/or purging are habitual may be particularly likely to engage in these behaviours in the context of interpersonal stress. We aimed to investigate this hypothesis in a sample of women with binge eating and/or purging using ecological momentary assessment (EMA). Women (N=81) with binge-eating and/or purging symptoms completed a self-report measure assessing habit strength of binge eating and purging followed by a 14-day EMA protocol assessing daily perceived interpersonal stress and binge-eating and purging episodes. Habit strength of purging moderated the within-person effect of interpersonal stress on purging frequency, such that higher daily stress was associated with greater same-day purging frequency when purging was more habitual. Contrary to expectations, the interactive effect of habit strength of binge eating and daily interpersonal stress on same-day binge-eating frequency was non-significant. Findings suggest that individuals with habitual purging may be vulnerable to engaging in purging when they are experiencing high levels of interpersonal stress.

The role of sexual assault history and PTSD in responses to food intake among women with bulimic-spectrum eating disorders

ABSTRACT Sexual abuse or assault (SA) history is associated with eating disorder severity and psychiatric comorbidity, including post-traumatic stress disorder (PTSD). Beyond persistent alterations in mood and cognitions characterizing PTSD, PTSD due to SA may contribute to greater increases in negative affect and body image concerns following food intake in bulimic syndromes (BN-S). To test this, participants (n = 172) with BN-S who reported PTSD due to SA, PTSD due to other forms of trauma, or neither completed clinical interviews and momentary reports of negative affect and shape/weight preoccupation before and after food intake. Participants with PTSD, regardless of trauma source, reported higher purging frequency whereas PTSD due to SA was associated with more frequent loss of control eating. For one task, changes in negative affect following food intake differed across the three groups. Negative affect decreased significantly in participants with PTSD without SA whereas nonsignificant increases were observed in those with PTSD with SA. Results of the present study suggest that source of trauma in PTSD may impact likelihood that eating regulates affect and provide insight into ways current treatments may be adapted to better target purging in BN-S comorbid with PTSD.

The role of habit in maintaining binge/purge behaviors: An ecological momentary assessment study.

Individuals with eating disorders transdiagnostically engage in binge eating (BE) and/or purging, despite life-threatening consequences. Little is known about factors that contribute to the persistence of these behaviors. This study explored whether habitual control over binge/purge (B/P) spectrum behaviors contributes to symptom persistence and whether negative reinforcement via reductions in negative affect is less influential in maintaining B/P behaviors that are under habitual control and are persistent. Women with BE and/or purging (N = 81) completed self-report measures assessing habit strength of BE and purging. Then, they completed a 14-day ecological momentary assessment (EMA) protocol during which they completed measures of negative affect, BE, and purging multiple times per day. Habitual control over purging was associated with a greater frequency of purging during the EMA period. However, habitual control over BE was not associated with the severity of loss of control eating or the frequency of BE episodes. Habitual control did not moderate temporal relations between negative affect and B/P behaviors during the EMA period. However, exploratory analyses revealed that individuals with a longer duration of BE and greater habitual control over BE showed a less pronounced reduction in negative affect following BE. Overall, these findings suggest that purging may be maintained by habitual stimulus-response learning. In addition, they support the possibility that reduction in negative affect may play a less prominent role in maintaining BE that is habitual and persistent. This study investigated whether habit contributes to the persistence of symptoms in women with binge/purge spectrum behaviors and whether negative reinforcement via reductions in negative affect is less influential in maintaining binge/purge behaviors that are under habitual control. The findings suggest that purging may be maintained through habit. This supports the potential utility of habit reversal interventions to decrease habitual purging.

Impact of fixture purging on water age and excess water usage, considering stochastic water demands

Higher water ages are linked with water quality decline as chlorine dissipates, temperatures become more favorable for microbial growth, and metals and organic matter leach from the pipes. Water fixtures with automated purging devices can limit water age in premise plumbing systems, but also increase water use. To develop purging strategies that lower age while also minimizing water use, the stochastic nature of water demands must be considered. In this research, a hydraulic plumbing network model, with stochastic demands at fixtures, was used to compare water age and water use for five purging conditions: purging at regular intervals, “smart” purging (considering the time of last use), purging with different volumes of water, purging at different fixtures, and the purging with different levels of home occupancy. Higher purging frequency and volume resulted in lower water ages, but higher water use. Purging greatly reduced the variability in water ages, avoiding extreme ages entirely. Water age was minimized by scheduling the purging around occupancy behavior, such as before the occupants wake up or return from work. Scheduled purging used more water than smart purging. Purging after 12 h of nonuse used only 55% of the additional water required for purging every 12 h. Purging after 24 h of nonuse at the kitchen tap and shower used only 38% of the additional water required for purging every 24 h, while maintaining lower water ages and removing the variability in water ages. While larger purging volumes had a greater impact on water age, there were diminishing returns. Purging has a larger impact on low-occupancy homes because fixtures have less frequent use. Overall, this research provides a methodology to compare purging strategies that minimize both water age and water use. While the numerical results presented here are only valid for the specific layout and usage habits, they provide insights and trends applicable to other cases.

Innovative Moments and the Process of Change in the Treatment of Bulimia Nervosa

Problematic patient narratives emerging in the process of treatment have been identified as important factors in the maintenance of psychopathology, and their change is associated with desired treatment outcomes. This increased focus in psychotherapy research has triggered the investigation of innovative moments (IMs) as novelties in patient narratives in therapy. This exploratory study aims to investigate the development of IMs throughout treatment in bulimia nervosa (BN) in a sample of good and poor outcome cases, and examine their longitudinal associations with binge and purge frequency change. IMs were coded in sixty sessions across five good outcome and five poor outcome cases in different stages of treatment. Generalized estimating equation analyses indicated that IMs evolved significantly over time, with different trajectories between good and poor outcome groups. High-level IMs showed higher proportion in the good outcome group at the end of treatment indicating that the ability to elaborate on how and why change might occur (as measured by high-level IMs) plays a role in the process of change in BN. Additionally, both low- and high-level IMs predicted symptom decrease in the following session. The study provides a preliminary understanding of important patient narrative processes in psychotherapy for BN and their association with treatment change.

Parental characteristics in association with disordered eating in 11- to 12-year-olds: A study within the Danish National Birth Cohort.

We examined the association between parental characteristics and disordered eating among 11- to 12-year-olds within the Danish National Birth Cohort. Frequency of fasting, purging, and binge eating was obtained by self-report from 37,592 children and combined into a measure of disordered eating (no, monthly, and weekly). Information on parental characteristics was obtained during pregnancy, from the 7-year follow-up, and by linkage to population registers. Data were analysed using multinomial logistic regression models with robust standard errors. In total, 3.1% reported weekly and 4.1% reported monthly disordered eating. Parental young age, low educational level, and overweight/obesity were associated with disordered eating. The relative risk ratios for, respectively, weekly and monthly disordered eating according to maternal eating disorder were 1.01 [0.75, 1.37] and 1.09 [0.84, 1.42]. Disordered eating is common among children and is associated with several parental characteristics. We found social inequality in disordered eating, but our data did not support an association with maternal eating disorder.

Patient baseline interpersonal problems as moderators of outcome in two psychotherapies for bulimia nervosa

Objective: We tested an aptitude by treatment interaction; namely, whether patients’ baseline interpersonal problems moderated the comparative efficacy of cognitive-behavioral therapy (CBT) vs. interpersonal psychotherapy (IPT) for bulimia nervosa (BN). Method: Data derived from a randomized-controlled trial. Patients reported on their interpersonal problems at baseline; purge frequency at baseline, midtreatment, and posttreatment; and global eating disorder severity at baseline and posttreatment. We estimated the rate of change in purge frequency across therapy, and the likelihood of attaining clinically meaningful improvement (recovery) in global eating disorder severity by posttreatment. We then tested the interpersonal problem by treatment interactions as predictors of both outcomes. Results: Patients with more baseline overly communal/friendly problems showed steeper reduction in likelihood of purging when treated with CBT vs. IPT. Patients with more problems of being under communal/cold had similar reductions in likelihood of purging across both treatments. Patients with more baseline problems of being overly agentic were more likely to recover when treated with IPT vs. CBT, whereas patients with more problems of being under agentic were more likely to recover when treated with CBT vs. IPT. Conclusions: Interpersonal problems related to communion and agency may inform treatment fit among two empirically supported therapies for BN.

Driven exercise in the absence of binge eating: Implications for purging disorder.

Purging disorder (PD) is characterized by recurrent purging without objectively large binge-eating episodes. PD has received relatively little attention, and questions remain about the clinical significance of "purging" by exercise that is driven or compulsive (i.e., as extreme compensatory or weight-control behavior). The little available research suggests that individuals who use exercise as a compensatory behavior might have less eating-disorder psychopathology than those who purge by vomiting or laxatives, but those studies have had smaller sample sizes, defined PD using low-frequency thresholds, and defined exercise without weight-compensatory or driven elements. Participants (N = 2,017) completed a web-based survey with established measures of eating-disorder psychopathology, depression, and physical activity. Participants were categorized (regular compensatory driven exercise, PD-E, n = 297; regular compensatory vomiting/laxatives, PD-VL, n = 59; broadly defined anorexia nervosa, AN, n = 20; and no eating-disordered behaviors, NED, n = 1,658) and compared. PD-E, PD-VL, and AN had higher eating-disorder psychopathology and physical activity than NED but did not significantly differ from each other on most domains. PD-VL and AN had higher depression than PD-E, which was higher than NED. Findings suggest that among participants with regularly compensatory behaviors without binge eating, those who use exercise alone have similar levels of associated eating-disorder psychopathology as those who use vomiting/laxatives, although they have lower depression levels and overall frequency of purging. Findings provide further support for the clinical significance of PD. Clinicians and researchers should recognize the severity of driven exercise as a compensatory behavior, and the need for further epidemiological and treatment research.

Group psychotherapy for eating disorders: A meta-analysis.

In the current meta-analysis, we review the effect of group psychotherapy compared to both wait-list controls and other active treatments for adults with eating disorders (EDs). Twenty-seven randomized controlled trials (RCTs) that provide direct comparisons with a total of 1,853 participants were included. Group psychotherapy is significantly more effective than wait-list controls at achieving abstinence rates of binge eating and/or purging (RR = 5.51, 95% CI: 3.73, 8.12), decreasing the frequency of binge eating and/or purging (g = 0.70, 95% CI: 0.51, 0.90), and reducing related ED psychopathology (g = 0.49, 95% CI: 0.32, 0.66) after treatment. The effects of group psychotherapy and other active treatments (e.g., behavioral weight loss, self-help, individual psychotherapy) did not differ on any outcome at post-treatment or at follow-ups. Group cognitive behavioral therapy (CBT) and other forms of group psychotherapy did not differ significantly on outcomes at any time point. Additional research is needed to evaluate other group psychotherapy approaches, along with CBT, to provide more evidence-based treatment options for individuals with an ED. Group psychotherapy appears as effective as other common treatments and is perhaps more cost-effective than the most popular treatment, individual psychotherapy. Only 8.33% of comparisons in the current meta-analysis had at least 80% power to detect a moderate effect (d = .50) and we recommend that future RCTs be adequately powered.

The effects of psychotherapy treatment on outcome in bulimia nervosa: Examining indirect effects through emotion regulation, self‐directed behavior, and self‐discrepancy within the mediation model

The purpose of this investigation was to examine the indirect effects of Integrative Cognitive-Affective Therapy (ICAT-BN) and Cognitive-Behavioral Therapy-Enhanced (CBT-E) on bulimia nervosa (BN) treatment outcome through three hypothesized maintenance variables: emotion regulation, self-directed behavior, and self-discrepancy. Eighty adults with BN were randomized to 21 sessions of ICAT-BN or CBT-E. A regression-based bootstrapping approach was used to test the indirect effects of treatment on outcome at end of treatment through emotion regulation and self-directed behavior measured at mid-treatment, as well as the indirect effects of treatment at follow-up through emotion regulation, self-directed behavior, and self-discrepancy measured at end of treatment. No significant differences in outcome between treatment conditions were observed, and no significant direct or indirect effects were found. Examination of the individual paths within the indirect effects models revealed comparable treatment effects. Across treatments, improvements in emotion regulation and self-directed behavior between baseline and mid-treatment predicted improvements in global eating disorder scores but not binge eating and purging frequency at end of treatment. Baseline to end of treatment improvements in emotion regulation and self-directed behavior also predicted improvements in global eating disorder scores at follow-up. Baseline to end of treatment improvements in emotion regulation predicted improvements in binge eating and baseline to end of treatment increases in positive self-directed behavior predicted improvements in purging at follow-up. These findings suggest that emotion regulation and self-directed behavior are important treatment targets and that ICAT-BN and CBT-E are comparable in modifying these psychological processes among individuals with BN.

Associations between emotion regulation difficulties, eating disorder symptoms, non-suicidal self-injury, and suicide attempts in a heterogeneous eating disorder sample

BackgroundThis study examined the associations between specific dimensions of emotion dysregulation and eating disorder (ED) symptoms and behaviors, non-suicidal self-injury (NSSI), and suicide attempts in a heterogeneous ED sample. MethodsParticipants (N=110) completed the Difficulties in Emotion Regulation Scale (DERS), the Eating Disorder Examination Questionnaire (EDE-Q), and self-reported the presence of lifetime NSSI and a lifetime suicide attempt. ResultsThe EDE-Q global score, a primarily cognitive measure of ED symptoms, was significantly positively correlated with DERS strategies, clarity, and awareness subscale scores and DERS total score (ps<0.01). Only the strategies subscale was uniquely positively associated with EDE-Q global score in a multivariate regression analysis. There was no association between the frequency of binge eating or frequency of driven exercise and any of the DERS subscale scores or total score (ps>0.01). Frequency of purging was significantly, positively associated with DERS impulse subscale score and total score (p<0.01). None of the DERS subscale scores were significantly different between those with and without NSSI or between those with and without a lifetime suicide attempt (ps>0.01). ConclusionsFindings indicate that in a heterogeneous ED sample, emotion regulation deficits are more strongly associated with cognitively-oriented symptoms of EDs than behavioral symptoms such as a binge eating, purging, driven exercise, NSSI, or suicide attempts.

CBT4BN: A Randomized Controlled Trial of Online Chat and Face-to-Face Group Therapy for Bulimia Nervosa

Objective: Although cognitive-behavioral therapy (CBT) represents the first-line evidence-based psychotherapy for bulimia nervosa (BN), most individuals seeking treatment do not have access to this specialized intervention. We compared an Internet-based manualized version of CBT group therapy for BN conducted via a therapeutic chat group (CBT4BN) to the same treatment conducted via a traditional face-to-face group therapy (CBTF2F). Method: In a two-site, randomized, controlled noninferiority trial, we tested the hypothesis that CBT4BN would not be inferior to CBTF2F. A total of 179 adult patients with BN (2.6% males) received up to 16 sessions of group CBT over 20 weeks in either CBT4BN or CBTF2F, and outcomes were compared at the end of treatment and at the 12-month follow-up. Results: At the end of treatment, CBT4BN was inferior to CBTF2F in producing abstinence from binge eating and purging. However, by the 12-month follow-up, CBT4BN was mostly not inferior to CBTF2F. Participants in the CBT4BN condition, but not CBTF2F, continued to reduce their binge-eating and purging frequency from the end of treatment to the 12-month follow-up. Conclusions: CBT delivered online in a group chat format appears to be an efficacious treatment for BN, although the trajectory of recovery may be slower than face-to-face group therapy. Online chat groups may increase accessibility of treatment and represent a cost-effective approach to service delivery. However, barriers in service delivery such as state-specific license and ethical guidelines for online therapists need to be addressed.

Local potential evolutions during proton exchange membrane fuel cell operation with dead-ended anode – Part II: Aging mitigation strategies based on water management and nitrogen crossover

Abstract Proton exchange membrane (PEM) fuel cells operate with dead-ended anode in order to reduce system cost and complexity when compared with hydrogen re-circulation systems. In the first part of this work, we showed that localized fuel starvation events may occur, because of water and nitrogen accumulation in the anode side, which could be particularly damaging to the cell performance. To prevent these degradations, the anode compartment must be purged which may lead to an overall system efficiency decrease because of significant hydrogen waste. In the second part, we present several purge strategies in order to minimize both hydrogen waste and membrane-electrode assembly degradations during dead-ended anode operation. A linear segmented cell with reference electrodes was used to monitor simultaneously the current density distribution along the gas channel and the time evolution of local anode and cathode potentials. To asses MEA damages, Platinum ElectroChemical Surface Area (ECSA) and cell performance were periodically measured. The results showed that dead-end mode operation with an anode plate maintained at a temperature 5 °C hotter than the cathode plate limits water accumulation in the anode side, reducing significantly purge frequency (and thus hydrogen losses) as well as MEA damages. As nitrogen contribution to hydrogen starvation is predominant in this thermal configuration, we also tested a microleakage solution to discharge continuously most the nitrogen accumulating in the anode side while ensuring low hydrogen losses and minimum ECSA losses provided the right microleakage flow rate is chosen.

Empirically derived personality subtyping for predicting clinical symptoms and treatment response in bulimia nervosa.

Evidence suggests that eating disorder subtypes reflecting under-controlled, over-controlled, and low psychopathology personality traits constitute reliable phenotypes that differentiate treatment response. This study is the first to use statistical analyses to identify these subtypes within treatment-seeking individuals with bulimia nervosa (BN) and to use these statistically derived clusters to predict clinical outcomes. Using variables from the Dimensional Assessment of Personality Pathology-Basic Questionnaire, K-means cluster analyses identified under-controlled, over-controlled, and low psychopathology subtypes within BN patients (n = 80) enrolled in a treatment trial. Generalized linear models examined the impact of personality subtypes on Eating Disorder Examination global score, binge eating frequency, and purging frequency cross-sectionally at baseline and longitudinally at end of treatment (EOT) and follow-up. In the longitudinal models, secondary analyses were conducted to examine personality subtype as a potential moderator of response to Cognitive Behavioral Therapy-Enhanced (CBT-E) or Integrative Cognitive-Affective Therapy for BN (ICAT-BN). There were no baseline clinical differences between groups. In the longitudinal models, personality subtype predicted binge eating (p = 0.03) and purging (p = 0.01) frequency at EOT and binge eating frequency at follow-up (p = 0.045). The over-controlled group demonstrated the best outcomes on these variables. In secondary analyses, there was a treatment by subtype interaction for purging at follow-up (p = 0.04), which indicated a superiority of CBT-E over ICAT-BN for reducing purging among the over-controlled group. Empirically derived personality subtyping appears to be a valid classification system with potential to guide eating disorder treatment decisions. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:506-514).

Antidiarrheal activity of 80% methanol extract of the aerial part of Ajuga remota Benth (Lamiaceae) in mice.

BackgroundIn the Ethiopian traditional medicine, the aerial part of Ajuga remota Benth is used in the treatment of diarrhea. There are different mechanisms by which Ajuga remota may have antidiarrheal effect. Some of the possible mechanisms are through its anthelmintic and antibacterial activity. The present study aimed to evaluate whether the antidiarrheal effect of the plant also include antimotility and antisecretory effect using 80 % methanol extract of A. remota (MEAR).MethodsThe MEAR was administered at doses of 200, 400, 600 and 800 mg/kg to four groups of mice (six animals per group) orally in castor oil diarrhea model. The effect of the extract on enteropooling and gastrointestinal transit model was also evaluated using the same grouping and dosing. Two other groups, one as control and the other as standard (loperamide 5 mg/kg) were used for comparison with the treatment groups.ResultsThe extract at the doses of 400, 600, and 800 mg/kg produced a dose-dependent and significant inhibition both on the frequency and onset of diarrhea. The percentage purging frequency was 53.4, 66.7, 79.6, and 66.7 % (p < 0.001) at three doses of MEAR (400, 600, and 800 mg/kg) and with loperamide (5 mg/kg), respectively. The percentage inhibition in intestinal fluid accumulation was 42.5, 62.1, and 74.2 % (p < 0.001) at the doses of 400, 600 and 800 mg/kg of MEAR, respectively. The MEAR also inhibited the intestinal transit of charcoal meal in a dose dependent manner both in the normal and castor oil induced intestinal transit.ConclusionThis study has shown that the 80 % methanol extract of A. remota contains pharmacologically active substances with significant antimotility and antisecretory effect contributing for its antidiarrheal activity.

Hydrogen purge and reactant feeding strategies in self-humidified PEM fuel cell systems

A 6 kW proton exchange membrane fuel cell system, operating in self-humidified conditions, was characterized in two anode operative modes: dead-end and flow through with exhaust recirculation. The anode sub-system was specifically designed in order to adjust the level of recycled anodic stream. The role of anode purge frequency, anode recirculation level and air stoichiometric ratio was analysed in the power range 1–5 kW. The aim of this study was to define management strategies to assure efficient and reliable cell performance during steady-state, warm-up and load variation phases. The results evidenced the combined effect of hydrogen purge, air flow rate impulse, and recycled anodic stream on individual cell performance recovery when unstable working conditions were detected during system start-up and load variations.

Examining weight suppression as a predictor of eating disorder symptom trajectories in anorexia nervosa.

Research in individuals with bulimia nervosa has highlighted the clinical significance of weight suppression (WS), defined as the difference between one's highest and current weight. More recently, studies have suggested that WS also may play a role in symptom maintenance and weight gain during treatment in anorexia nervosa (AN) and that the influence of WS on AN outcomes may depend on an individual's body mass index (BMI). However, no study has investigated whether WS or the interaction between WS and BMI is associated with the longer-term course of eating pathology following treatment discharge in patients with AN. The current study examined a sample of females with AN (N = 180) who completed interviews and self-report questionnaires at discharge from intensive treatment and at 3, 6, and 12-months after discharge. Latent growth curve models tested whether WS, BMI, or the WS by BMI interaction significantly predicted the trajectory of eating disorder symptoms (i.e., Eating Disorder Examination global score, BMI, frequency of loss of control eating, frequency of purging) over the year following discharge. WS at discharge predicted change in BMI, and the interaction between WS and BMI predicted growth in eating disorder severity and purging frequency over time. Neither WS nor its interaction with BMI predicted growth in loss of control eating frequency. Results provide further support for the clinical significance of WS in AN symptom maintenance, but suggest that the influence of WS likely depends on an individual's BMI as well as the outcome being measured. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:753-763).