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(ICC), vol 6, pp 3481 3485, June 2004 [28] Y Yu, D Estrin and R Govindan, Geographical and energy-aware routing: a recursive data dissemination protocol for wireless sensor networks , UCLA Comp Sci Dept, Tech Rep 010023, May 2001 [29] C Intanagonwiwat, R Govindan, D Estrin, J Heidemann and F Silva, Directed diffusion for wireless sensor networking , ACM/IEEE Transactions on Networking, vol 11, no 1, pp 2 16, February 2003 [30] WR Heinzelman, J Kulik and H Balakrishnan, Adaptive protocols for information dissemination in wireless sensor networks , Proc 5th ACM/IEEE Int l Conf Mob Comp and Net (MOBICOM), pp 174 185, August 1999 [31] J Kulik, WR Heinzelman and H Balakrishnan, Negotiation based protocols for disseminating information in wireless sensor networks , Wireless Networks, vol 8, pp 169 185, 2002 [32] D Braginsky and D Estrin, Rumor Routing Algorithm for Sensor Networks , Proc.

Vasovagal syncope As a consequence of increased vagal and decreased sympathetic activity, the heart slows and blood pools peripherally Cardiac output decreases and there is inadequate perfusion of the brain when the patient is in the upright position He loses consciousness, falls, becomes horizontal, venous return improves, cardiac output improves and consciousness is restored The attack is worse if the patient is held upright and it is relieved or prevented by lowering the patient s head below the level of the heart Common features of vasovagal syncope are as follows: they are more common in teenage and young adult life; they may be triggered by standing for a long time, and by emotionally upsetting circumstances (hearing bad news, hearing or seeing explicit medical details, experiencing minor medical procedures, eg.

who demonstrated that there may be a role for uoxetine in the prevention of relapse in patients who regained weight Following inpatient weight restoration, 10 of 16 (63%) subjects on uoxetine remained well over a one-year outpatient follow-up period, whereas only 3 of 19 (16%) remained well on placebo (Kaye et al, 2001) Fluoxetine was associated with maintaining a healthy body weight and with a signi cant reduction in obsessions and ritualistic preoccupations These contradictory results may be explained because of the differing nutritional status of the two patient groups In the starved state there may be reduced synaptic 5-HT, due to reduced availability of tryptophan, the essential amino-acid precursor of serotonin Cyproheptadine, a serotonin antagonist, prescribed as an anti-allergic medicine with weight gain as a side-effect, showed some positive results in double-blind RCTs (Vigerski & Loriaux, 1977; Goldberg et al.

of the 1st ACM International Workshop on Wireless Sensor Networks and Applications, 2002 [33] F Ye, A Chen, L Songwu and Z Lixia, A scalable solution to minimum cost forwarding in large sensor networks , Proceedings of the 10th International Conference on Computer Communications and Networks, vol 8, pp 304 309, October 2001..

venipuncture, sutures); the patient has a warning of dizziness, visual blurring, feeling hot or cold, sweating, pallor; the patient is unconscious for a short period (30 120 seconds) only, during which time there may be a brief urry of myoclonic jerks but then the patient is accid and motionless; the patient feels nauseated and sweaty on recovery, but is back to normal within 15 minutes or so Postural hypotension In circumstances of decreased sympathetic activity affecting the heart and peripheral circulation, the normal cardioacceleration and peripheral vasoconstriction that occurs when changing from the supine to the erect position does not occur, and cardiac output and cerebral perfusion are inadequate in the standing position, resulting in loss of consciousness The situation recti es itself as described above in vasovagal syncope.

, 1979), although the effect on decreasing the number of days to achieve a normal body weight was marginal (Halmi et al, 1986) No signi cant differences in weight gain were found Cisapride, a drug that is prescribed for stomach complaints, did not perform better than placebo in one small RCT (Szmukler et al, 1995) In many countries this drug has now been withdrawn because of the potential to cause arrythmias..

The cause of the decreased sympathetic activity is usually pharmacological (overaction of antihypertensive agents or as a side-effect of very many drugs given for other purposes), though it is occasionally due to a physical lesion of the sympathetic pathways in the central or peripheral nervous system Postural hypotension should be suspected if the patient: is middle-aged or elderly, and is on medication of some sort; complains of dizziness or lightheadedness when standing; only experiences attacks in the standing position and can abort them by sitting or lying down; has a systolic blood pressure which is lower by 30 mmHg or more when in the standing position than when supine..

Target sector #2

Psychogenic vomiting is a diagnostic category in ICD-10, although little clinical elaboration is provided other than to make the clear distinction between vomiting associated with other psychological disturbances and vomiting as seen in bulimia nervosa. The diagnosis includes vomiting in association with dissociative disorders and in hypochondriacal disorder. The symptom may be anxiety related, in which case it might simply be seen as a symptom of food phobia or other anxiety disorder. Overt anxiety is not always present however, and it may be that the child has developed an extreme sensitivity to emetic triggers. A child who has a past history of gastro-oesophageal re ux or of vomiting associated with other illness may be more at risk. Occasionally the vomiting may be of suf cient severity to inhibit all food intake. In these cases anxiety management techniques in combination with family work can be effective once nutritional intake has been re-established. As with any anxiety disorders, the key is in an understanding and non-confrontational approach, and provision of appropriate support.