Does any therapy really work for neurocardiogenic syncope?

Effectiveness of a treatment for neurocardiogenic syncope can be defined in terms of symptom response, quality-of-life, healthcare utilization, treatment side effects and cost-effectiveness. Most trials have focused on syncope recurrence or burden, without assessing quality-of-life formally. Drug and device interventions are characterized by a dearth of randomized controlled trials, with those few of robust design demonstrating little impact on recurrence of syncope. General advice includes hydration, trigger recognition and counter pressure maneuvers to attenuate episodes. Lifestyle recommendations have limited comparative effectiveness evidence, but are favored due to lack of side effects and low cost. The frequency of syncope improves in many patients regardless of the intervention, although ultimate recurrence of syncope remains high. In the minority of patients seeking treatment due to recurrence, midodrine has reasonable supporting evidence for effectiveness with some evidence for beta-blockers in older age patients. Emerging evidence favors pacing in patients with asystole during spontaneous (as opposed to provoked) syncope. Combining long-term implantable cardiac monitoring, tilt and adenosine triphosphate testing may yet accurately define the optimal minority who benefit from pacing. In the remaining majority, pharmacologic and device interventions should be used sparingly until clear benefits are established. Better understanding of patient fears, beliefs and behaviors may help develop cognitive therapies and improve quality-of-life alongside the focus on physical symptoms

An Analysis of Fitness Affiliated Direct-To-Consumer Genetic Tests

Based on current scientific literature, Direct-to-Consumer (DTC) genetic tests for fitness capability generally lack validation and have little predictive value. We aimed to evaluate DTC genetic fitness testing companies found through Google searches. Website information including genes tested and claims made by the companies was collected. In total, thirty-one companies were evaluated. Only 8 of 31 companies identify genes being tested and of these 8, only 4 cite any scientific literature. The 6 most common genes tested (MCGT) were ACE, ACTN3, AGT, FTO, IL6, a nd PPARG. The 5 most common claims (MCC) were genetically tailored nutrition, genetically tailored workout, information on injury risk, personalized fitness program, and response to training. Given the lack of information provided by the companies, we cannot fully assess the claims, and can only express skepticism about the limited value of such testing as per the current scientific literature. Therefore, more research is needed to better understand genetic differences associated with athletic traits for the benefit of consumers

Feasibility of self-structured current accessed bubble devices in spacecraft recording systems

The self-structured, current aperture approach to magnetic bubble memory is described. Key results include: (1) demonstration that self-structured bubbles (a lattice of strongly interacting bubbles) will slip by one another in a storage loop at spacings of 2.5 bubble diameters, (2) the ability of self-structured bubbles to move past international fabrication defects (missing apertures) in the propagation conductors (defeat tolerance), and (3) moving bubbles at mobility limited speeds. Milled barriers in the epitaxial garnet are discussed for containment of the bubble lattice. Experimental work on input/output tracks, storage loops, gates, generators, and magneto-resistive detectors for a prototype device are discussed. Potential final device architectures are described with modeling of power consumption, data rates, and access times. Appendices compare the self-structured bubble memory from the device and system perspectives with other non-volatile memory technologies

A second eigenvalue bound for the Dirichlet Schroedinger operator

Let $\lambda_i(\Omega,V)$ be the $i$th eigenvalue of the Schr\"odinger operator with Dirichlet boundary conditions on a bounded domain $\Omega \subset \R^n$ and with the positive potential $V$. Following the spirit of the Payne-P\'olya-Weinberger conjecture and under some convexity assumptions on the spherically rearranged potential $V_\star$, we prove that $\lambda_2(\Omega,V) \le \lambda_2(S_1,V_\star)$. Here $S_1$ denotes the ball, centered at the origin, that satisfies the condition $\lambda_1(\Omega,V) = \lambda_1(S_1,V_\star)$. Further we prove under the same convexity assumptions on a spherically symmetric potential $V$, that $\lambda_2(B_R, V) / \lambda_1(B_R, V)$ decreases when the radius $R$ of the ball $B_R$ increases. We conclude with several results about the first two eigenvalues of the Laplace operator with respect to a measure of Gaussian or inverted Gaussian density

Alcohol Use and Cognition at Mid-Life: The Importance of Adjusting for Baseline Cognitive Ability and Educational Attainment

The nature of the relationship between cognition and alcohol consumption remains controversial. Studies have reported negative, positive, and nonsignificant effects of alcohol consumption on cognition. Problematic throughout the literature is that baseline cognitive ability has not been adequately controlled in previous studies, and even educational attainment is only sometimes controlled. Because such variables may be associated with both alcohol intake and later-life cognition, we hypothesize that the observed relationship between alcohol intake and cognition may change when these variables or other conditions in early life have been controlled. Methods : We examined the relationship of alcohol intake and cognition at age 53 using the Wisconsin Longitudinal Study, which has followed Wisconsin high school graduates from 1957 to 1992. Our measures include cognitive ability test scores from the freshman and junior years of high school, educational attainment, an abstract reasoning test score at age 53, alcohol intake at age 53, and other measures. Results : When no controls were used, both men and women with low levels of alcohol consumption at 53 (i.e., 0–1 drink per day) had better scores on the abstract reasoning subtest of the Wechsler Adult Intelligence Scale (WAIS-R) at age 53 than subjects who never drank or currently did not drink. However, after adjusting for adolescent-measured cognitive ability and educational attainment, men with low levels of consumption no longer had higher abstract reasoning scores than nondrinking men, but they still did have higher abstract reasoning scores than men who drank more than one drink per day. For women, adjusting for cognitive ability and educational attainment eliminated all significant effects of alcohol on cognition, and reversed the nonsignificant result that women with higher consumption had the highest cognition scores. These results demonstrate the importance of adjusting for baseline cognitive ability when attempting to study the effect of long-term alcohol use patterns on cognition, and that educational attainment cannot be considered a valid substitute for baseline cognition scores. Conclusions : Much of the apparent benefit of moderate alcohol intake on cognition in our society may well be explained by differential rates of alcohol consumption among subjects with differing baseline cognitive ability scores. Neither is there evidence that moderate alcohol intake reduces cognitive functioning.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65631/1/01.ALC.0000078060.18662.C1.pd

Effects of fluoxetine on the oral environment of bulimics

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73809/1/j.1399-302X.1993.tb00545.x.pd

Paradoxical impact of socioeconomic factors on outcome of atrial fibrillation in Europe: trends in incidence and mortality from atrial fibrillation

Aims: To understand the changing trends in Atrial Fibrillation (AF) incidence and mortality across Europe from 1990 to 2017, and how socioeconomic factors and sex differences play a role. Methods and Results: We performed a temporal analysis of data from the 2017 Global Burden of Disease Database for 20 countries across Europe using Joinpoint regression analysis. Age-adjusted incidence, mortality and mortality to incidence ratios (MIRs) to approximate case fatality rate are presented. Incidence and mortality trends were heterogenous throughout Europe, with Austria, Denmark and Sweden experiencing peaks in incidence in the middle of the study period. Mortality rates were higher in wealthier countries with the highest being Sweden for both men and women (8.83 and 8.88 per 100,000, respectively) in 2017. MIRs were higher in women in all countries studied, with the disparity increasing the most over time in Germany (43.6% higher in women versus men in 1990 to 74.5% higher in women in 2017). Conclusion: AF incidence and mortality across Europe did not show a general trend, but unique patterns for some nations were observed. Higher mortality rates were observed in wealthier countries, potentially secondary to a survivor effect where patients survive long enough to suffer from AF and its complications. Outcomes for women with AF were worse than men, represented by higher MIRs. This suggests there is widespread healthcare inequality between the sexes across Europe, or that there are biological differences between them in terms of their risk of adverse outcomes from A

The effects of continuous naltrexone infusions on diet preferences are modulated by adaptation to the diets

Two groups of male rats were placed on a feeding regimen in which a fat/protein diet and a carbohydrate/protein diet were available ad lib. Naltrexone was infused via osmotic minipumps either at the time the diets were introduced or after one week of adaptation to the diets. In rats adapted to the diets, naltrexone caused a decrease in the intakes of fat/protein and carbohydrate/protein diets. Relative preferences for the two diets were generally unchanged. In contrast, when naltrexone was infused at the time of introduction of the diets, a polarization phenomenon was observed: rats tended to consume nearly all of their daily calories from either one diet or the other. Six rats (out of 10) showed a stronger preference for the carbohydrate/protein diet than did any of the saline-treated rats, while 3 showed a stronger preference for the fat/protein diet than did any of the saline-treated rats. Thus, the effect was not diet- or macronutrient-specific. These preferences became significantly less extreme after termination of naltrexone infusions. Conditioned aversions and naltrexone-induced reductions in exploratory behavior are discussed as potential explanations for this polarization effect. These results indicate that naltrexone has differential effects on the development versus the maintenance of diet preferences. Further, they emphasize the importance of examining individual differences as well as baseline preferences in studies on the control of intake and diet selection.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30229/1/0000622.pd

The relationship between saccharin and alcohol intake in rats

Male rats were given daily sessions during which a palatable saccharin solution was available. Based on intakes averaged over 3 days, groups with low, intermediate, or high intake of saccharin were formed. These rats were then given daily sessions in which alcohol (2-8%) or water were available. Initially, sessions were conducted with rats on a food restriction schedule; in later sessions, food was available ad lib. When rats were food restricted, there were no differences among the groups in terms of alcohol or water intake. When the food restriction schedule was discontinued, alcohol intake in the intermediate and high saccharin intake groups was generally higher than that of the low saccharin group. On the final series of alcohol sessions, the high saccharin group consumed significantly more 2% and 6% alcohol than the low saccharin group. These results are consistent with reports which have found that rats selected for high or low alcohol intake have corresponding high and low intakes of saccharin.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30072/1/0000442.pd