A population study of the natural history of Wolff-Parkinson-White syndrome in Olmsted County, Minnesota, 1953-1989

BACKGROUND: Virtually all natural history studies of Wolff-Parkinson-White (WPW) syndrome have been case series and, as such, have been constrained by referral biases, skewed age and sex distributions, or brief follow-up periods. The purpose of our study was to examine the natural history, the development of arrhythmias, and the incidence of sudden death in an entire cohort of pediatric and adult WPW patients from a community-based local population. METHODS AND RESULTS: We identified 113 residents of Olmsted County, Minnesota, during the period 1953-1989 using the centralized records-linkage system provided by the Mayo Clinic and the Rochester Epidemiology Program Project. Medical records and ECGs were reviewed to confirm the diagnosis and to establish pathway location by ECG criteria. Follow-up, via record review and telephone interview, was complete in 95% of subjects through 1990. The incidence of newly diagnosed cases was approximately four per 100,000 per year. Preexcitation was not present on the initial ECG of 22% of the cohort. Approximately 50% of the population was asymptomatic at diagnosis, with 30% subsequently having symptoms related to arrhythmia at follow-up. Two sudden cardiac deaths (SCD) occurred over 1,338 patient-years of follow-up, yielding an overall SCD rate of 0.0015 (95% confidence interval, 0.0002-0.0054) per patient-year. No SCD occurred in patients asymptomatic at diagnosis. CONCLUSIONS: The incidence of sudden death in a local community-based population is low and suggests that electrophysiological testing should not be performed routinely in asymptomatic patients with WPW syndrome. Nevertheless, young, asymptomatic patients, particularly those < 40 years old, should return for medical follow-up should symptoms develop.     

Methotrexate in the management of severe steroid dependent asthma

AIMS: This study was designed to assess the efficacy of low dose methotrexate, 15 mg weekly, as a steroid-sparing agent in asthmatic patients requiring long-term oral prednisone treatment. METHODS: The study was a randomised, double blind, placebo controlled, cross over study of 48 weeks duration. Eleven patients with severe steroid-dependent asthma were included. A successful outcome was defined as a reduction in mean prednisone requirements of 7 mg daily compared to baseline requirements, during active treatment. RESULTS: Two patients were required to be withdrawn owing to methotrexate-related adverse effects. The mean prednisone dose for patients who completed the study was 14.4 mg per day (95% CI; 13.6, 15.1) during active treatment, and 12.9 mg per day (95% CI: 12.2, 13.6) during placebo treatment (NS). Only one patient reduced his individual dose requirements by more than 7 mg per day, whereas in three patients prednisone requirements actually increased during active treatment. There were no significant differences in symptom scores, pulmonary function data, and exacerbations between active and placebo treatments. CONCLUSION: No significant steroid-sparing effect was obtained using low dose methotrexate in this study. This negative outcome may be attributable to the small population of patients studied, low baseline FEV1, and the omission of a steroid minimisation run-in period. Our results highlight the importance of careful patient selection and a painstaking approach in the management of patients with steroid-dependent asthma.     

Condom use: A self-efficacy model.

A survey of heterosexually active college students gathered information about condom use, self-efficacy (SE), outcome expectancies, sexual attitudes, peer group influences, AIDS knowledge, and a perceived vulnerability to AIDS. On the basis of A. Bandura's (1986) social-cognitive theory, a structural model with SE as the central mediator was formulated and evaluated with LISREL. This model explained 46% of the variance in condom use from judgments of SE and effects attributable to peers and 53% of the variance in SE from outcome expectancies and peer group influences. Sexual attitudes, AIDS knowledge, and perceived vulnerability did not predict condom use. Most students were well-informed about HIV transmission but reported not feeling at risk, even though many engaged in risky sexual behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cigarette smoking and submaximal exercise test duration in a biracial population of young adults: the CARDIA study

Symptom-limited, graded exercise treadmill testing was performed by 4,968 white and black adults, ages 18-30 yr, during the baseline examination for the Coronary Artery Risk Development in Young Adults (CARDIA) study. Compared with nonsmokers, the mean exercise test duration of smokers was 29-64 s shorter depending on race/gender group (all P < 0.001), but mean duration to heart rate 130 (beats.min-1) ranged from 20-50 s longer (P < 0.05). In each race/gender group, test duration to heart rates up to 150 was 15-35 s longer (P < 0.05) in smokers than in nonsmokers after adjustment for age, sum of skinfolds, hemoglobin, and physical activity score. The mean maximum heart rate was lower in smokers than in nonsmokers (difference ranging from 6.7 beats.min-1 in white men to 11.2 beats.min-1 lower in black women, P < 0.001), although maximum rating of perceived exertion was nearly identical in smokers and nonsmokers. Chronic smoking appears to blunt the heart rate response to exercise, so that exercise duration to submaximal heart rates is increased even though maximal performance is impaired. This may result from downloading of beta-receptors caused by smoking. Smoking status should be considered in the evaluation of physical fitness data utilizing submaximal test protocols, or else the fitness of smokers relative to nonsmokers is likely to be overestimated.     

A mixed design approach for probabilistic structural durability

In this paper, a mixed approach for probabilistic structural durability design of mechanical systems is proposed. In this approach, a deterministic design optimization that considers structural crack initiation and crack propagation lives at critical points of the structural component as design constraints is performed first. After an optimal design is obtained, a reliability analysis is performed to ascertain if the deterministic optimal design is reliable. If the probability of the failure of the deterministic optimal design is found to be acceptable, a reliability-based design approach that employs a set of interactive design steps, such as trade-off analysis and what-if study, is used to obtain a near-optimal design that is reliable with an affordable computational cost. A 3-D tracked vehicle roadarm is employed to demonstrate the feasibility of the proposed approach.     

Parasitic-aware RF circuit design and optimization

RF circuit synthesis techniques based on particle swarm optimization and adaptive simulated annealing with tunneling are described, and comparisons of parasitic-aware designs of an RF distributed amplifier and a nonlinear power amplifier are presented. Synthesized in 0.35-/spl mu/m digital CMOS using a single 3.3-V power supply, the designs provide an 8-dB gain and 8-GHz bandwidth for a four-stage distributed amplifier, and 1.2-W output power with 55% drain efficiency at 900 MHz for a three-stage power amplifier. A standard circuit simulator, HSPICE or SPECTRE, embedded in an optimization loop is used to evaluate cost functions. The proposed design and optimization methodology is computationally efficient and robust in searching complex multidimensional design spaces.     

Deactivation of copper-ion-exchanged hydrogen-mordenite-type zeolite catalyst by SO2 for no reduction by NH3

Deactivation of copper-ion-exchanged hydrogen-mordenite-type zeolite catalyst by SO₂ for NO reduction by NH₃ was examined in a fixed-bed flow reactor. The deactivation of the catalyst was strongly dependent on reaction temperature. At high reaction temperatures over 300°C, the catalyst did not lose its initial activity up to 50 h of operation, regardless of SO₂ feed concentration from 500 to 20,000 ppm. However, at low reaction temperatures near 250°C, apparent deactivation did occur. Changes in the physicochemical properties such as surface area and sulfur content of deactivated catalyst well correlated with catalyst activity, depending upon reaction temperatures. The deactivation was due to pore blocking and/or filling by deactivating agents, which plugged and/or filled the pores of catalyst. The deactivating agents deposited on the catalyst surface were presumed to be (NH₄)₂SO₄ and/or (NH₄)HSO₄ from the results of TGA and ion-chromatography measurement.