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abstract: Drinking vinegar is a popularly discussed remedy for relieving heartburn symptom, as can be read on many websites; however, there has been no scientific research or theory to support its efficacy. This randomized, placebo-controlled, double-blind, cross-over research study tested the efficacy of the organic apple cider vinegar, with mother, on alleviation of the heartburn symptom related to Gastro-esophageal reflux disease (GERD). A minimum of one week separated the four trial arms: chili (placebo), antacid after chili meal (positive control), vinegar added to chili, and diluted vinegar after chili meal. Twenty grams of vinegar were used in both vinegar treatments, and 10 grams of liquid antacid were used in the antacid trial. A five-point Likert scale and a 10-cm visual analogue scale (VAS) were used to assess heartburn severity during a 120 minutes testing time. Seven of 15 recruited subjects' data was usable for statistical analysis (age: 39.6 ± 12.2 y, body mass index (BMI): 29.4 ± 4.2 kg/m2, waist circumference: 36.4 ± 4.1 inch). There was no statistically significant difference among the mean and incremental area-under-the-curve (iAUC) heartburn scores among different trials (Likert scale questionnaire p= .259, VAS questionnaire p= .659, iAUC Likert scale p= .184, iAUC VAS p= .326). Seven participants were further divided into antacid responder (n=4) and antacid non-responder groups (n=3). Likert scale mean heartburn score and iAUC data in antacid responder group had significant finding (p= .034 and p= .017 respectively). The significance lay between antacid and 'vinegar added to chili' trials. Effect size was also used to interpret data due to the small sample size: Likert scale: mean heartburn score= .444, iAUC= .425; VAS mean heartburn score= .232, iAUC .611. Effect size for antacid responder group was Likert scale: mean heartburn score= .967, iAUC= .936. Future research is needed to examine whether ingesting organic vinegar benefits alleviation of heartburn symptom related to GERD for people who do not respond well to antacid. / Dissertation/Thesis / Masters Thesis Nutrition 2016

The purpose of this essay is to compile a list of symptoms to aid voice teachers in the early detection of vocal problems resulting from bulimic behavior. Bulimia nervosa (BN) is an eating disorder characterized by bingeing and purging and has a high rate of occurrence among the college population. Entertainers form a high risk group for development of BN yet the effects of BN on the voice are largely ignored in vocal literature. The study begins with a literature review which links several factors that can influence the development of BN with "the singer’s personality." The two main character traits that appear most frequently are perfectionism and anxiety. The study continues with a narrative presentation of interviews by the author with three voice specialists in different fields of voice research and treatment. The research questions on which the interview portion of the study were based are: 1) Are otolaryngologists seeing an increase in vocal problems associated with eating disorders?; 2) Is there a belief among voice specialists that singer-actors are a high risk group for the development of eating disorders?; 3) What vocal symptoms should voice teachers watch and listen for if they suspect a student is bulimic?; 4) How should the voice teacher approach the recommendation of treatment, care, and use of the bulimic voice? This portion of the paper includes a clear and concise list of symptoms associated with BN that are easily identifiable by sight or sound. The paper concludes with a summary of the study results, suggestions for voice teachers training singers with the disorder, and ideas for further research.

Over half of patients with gastroesophageal reflux disease (GERD) report nocturnal symptoms. Proton pump inhibitors (PPIs) are the main medications used to treat GERD. Multichannel intraluminal impedance with pH (MII-pH) monitoring is the most sensitive method for detection and characterization of GERD. The aim of this study was to assess and compare reflux frequency in patients with refractory GERD symptoms on and off PPI therapy during the nocturnal recumbent period, as assessed by MII-pH testing. We analyzed 24-hour MII-pH studies performed in 200 patients monitored either on twice-daily (n=100) or off (n=100) PPI therapy. Demographic analysis of the on-therapy group revealed a mean age of 52 years (24-78 years) with 37% males, and the off-therapy group revealed a mean age of 49 years (18-84 years) with 40% males. All studies were interpreted to assess and characterize the number of acid and nonacid reflux episodes in the nocturnal recumbent period identified by each patient on an overnight recorder (Zephyr, Sandhill Scientific, Inc., Highlands Ranch, CO, USA). The nocturnal recumbent period was the period documented by patients during which they lie in the recumbent period at night to sleep with average periods lasting 456 and 453 minutes for patients on and off PPI therapy. There were more mean recumbent reflux episodes in the on-therapy group in comparison with the off-therapy group (3.76 mean reflux episodes [mre] per patient in the recumbent vs. 2.82 mre); the difference was not statistically significant (P=0.187). When the reflux events are classified into acid and non-acid reflux episodes, the relative occurrence of acid reflux events is less in the on-therapy group (P=0.047), while the off-therapy group have fewer nonacid reflux episodes (P=0.003). PPIs decrease the acidity of esophageal refluxate but do not decrease the relative frequency of reflux episodes in the recumbent position in patients with refractory GERD despite twice-a-day treatment with PPI therapy. The explanation for the finding of numerically increased, although not statistically significant, amount of reflux episodes in the PPI treatment group in this study, and previous studies is unclear and warrants further evaluation.