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differences in eating disorder pathology also in uence the likely medical complications For example, while many high-risk behaviours in children are comparable to those of adults (reduced energy intake, purging, increased exercise), others are more closely related to increasing age, independence and culture (eg laxative and diuretic abuse, substance misuse) In addition there are a higher number of boys in the early onset population (Fosson et al, 1987), particularly among those with atypical eating problems Because growth is dynamic, severe nutritional dif culties can occur during the growth period without weight loss There is a literature on medical complications in the younger patient (see Fisher et al, 1995; Katzman & Zipursky, 1997; Nicholls et al, 1999, for reviews) Signi cant gaps in knowledge remain, however.

the present value of the overall costs over the time horizon of the forecast, typically on the order of 20 years To determine the variable costs one must perform an economic dispatch as described in 4 over the entire time horizon of the study Then the xed costs are added, and the algorithm must make optimal build and retirement decisions over the combined xed and variable costs There are two points of interest concerning this approach The rst is that the structure requires an optimization problem within an optimization problem The interior optimization problem is the economic dispatch from 4; an economic dispatch must be solved for over the entire study horizon The exterior optimization problem is a selection of generation additions and retirements that minimizes the present value of overall costs The second point of interest is a consequence of the rst.

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Setting an economic dispatch over the entire time horizon requires considerable computational time The time requirement is necessarily magni ed since the economic dispatch will have to be done over many different possible generation portfolios until the external optimization problem converges to an optimal solution The time expense must be reduced through a combination of methods Two possibilities are mentioned below Select representative time periods for performing the economic dispatch rather than dispatching over every single hour of every day Some planning departments use a typical week from each month Others select typical weeks by season Do not dispatch at the hourly level Instead, consider time blocks corresponding to demand patterns The time blocks should have the resolution to separate peaking units (combustion turbines) from intermediate units (combined cycles) Six 4-hourly time blocks are suf cient The remainder of this section formulates the optimization problem.

There is no internationally agreed cut-off for health versus malnutrition in children, no weight and height adjusted for pubertal maturation, and no standards for expected catch up after a period of growth failure The concept of target weight in early onset populations remains one of controversy, with the need for clinical precision at odds with the complexity and heterogeneity of adolescence As such there is no evidence base on which recommendations can be based, and wide variation in clinical practice exists Discussions about the need for adult patients to achieve adequate weight gain during the nutritional rehabilitation stage of treatment (Russell & Gross, 2000) are even more pertinent in the early onset population It seems likely that failure to attain suf cient weight restoration is contributing to the trend in increased severity of illness and complications.

The presentation follows our standard: First assumptions are set, and then the formulation is presented in words and equations..

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Overall the mortality rate in early onset and adolescent eating disorders is low (Steinhausen, 1997) This may in part be due to a lower threshold for intervention and/or hospitalisation in children (up to 80% of adolescents receive some inpatient care (Kreipe et al, 1989; Nussbaum et al, 1985; Steiner et al, 1990) More likely it is because the majority of complications are compounded by chronicity of illness..

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Misunderstandings can occur as the result of under-elaboration (for example, go to bed and take bed-rest might imply a day or a week of con nement); misperception of emphasis (for example, this operation has some risk, like all operations might mean one thing to the doctor and quite another to the patient, not least because it is the patient who must undergo the operation and the doctor who must perform or observe it); and misinterpretation through ambiguity (for example, the words safe , cancer and love have a range of meanings) A good health worker must be careful that comprehension is as accurate as possible It can be a valuable exercise for a health worker habitually to attempt to picture herself within the Rings expressed this way Although the Rings are not intended for urgent situations it can be helpful to have them in mind during some consultations.

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