The dizzy patient: A review of etiology, differential diagnosis and management

Introduction: Dizziness is a lay term used to describe a variety of sensations. Unfortunately, the term dizziness does not have a precise medical definition, so additional information is typically required to further define the patient\u27s problem. Classifications: When dizziness is a presenting complaint, distinctions must be made between vertigo (a sense of false movement), near-syncope (a feeling of impending faint), disequilibrium (loss of balance), and ill-defined lightheadedness (an inability to concentrate or focus the mind, e.g. , a dazed feeling). Etiologies: Possible causes of dizziness include conflicts between visual and vestibular information, vascular problems, medication adverse reactions, psychological difficulties, systemic disease, and the effects of aging. Management: Dizziness is a symptom of a physiological or psychological illness, therefore management is typically directed toward treatment of the underlying illness. However, in some cases the cause of the dizziness cannot be found or is untreatable. In these cases, management is directed toward symptom reduction. Summary: Dizziness is a relatively common problem that can arise from a variety of causes. In many cases, optometrists can participate in the diagnosis and management patients with complaints of dizziness

U.S. Radio in the 21st Century: Staying the Course in Unknown Territory

This essay examines the development of the radio industry in the United States as it makes its way into the 21st century. Issues of regulation, technology, commerce, and culture are addressed

Health System Performance for the High-Need Patient: A Look at Access to Care and Patient Care Experiences

Achieving a high-performing health system will require improving outcomes and reducing costs for high-need, high-cost patients—those who use the most health care services and account for a disproportionately large share of health care spending. Goal: To compare the health care experiences of adults with high needs—those with three or more chronic diseases and a functional limitation in the ability to care for themselves or perform routine daily tasks—to all adults and to those with multiple chronic diseases but no functional limitations. Methods: Analysis of data from the 2009–2011 Medical Expenditure Panel Survey. Key findings: High-need adults were more likely to report having an unmet medical need and less likely to report having good patient–provider communication. High-need adults reported roughly similar ease of obtaining specialist referrals as other adults and greater likelihood of having a medical home. While adults with private health insurance reported the fewest unmet needs overall, privately insured highneed adults reported the greatest difficulties having their needs met. Conclusion: The health care system needs to work better for the highest-need, most-complex patients. This study's findings highlight the importance of tailoring interventions to address their need

From polymers to quantum gravity: triple-scaling in rectangular matrix models

Rectangular $N\times M$ matrix models can be solved in several qualitatively distinct large $N$ limits, since two independent parameters govern the size of the matrix. Regarded as models of random surfaces, these matrix models interpolate between branched polymer behaviour and two-dimensional quantum gravity. We solve such models in a `triple-scaling' regime in this paper, with $N$ and $M$ becoming large independently. A correspondence between phase transitions and singularities of mappings from ${\bf R}^2$ to ${\bf R}^2$ is indicated. At different critical points, the scaling behavior is determined by: i) two decoupled ordinary differential equations; ii) an ordinary differential equation and a finite difference equation; or iii) two coupled partial differential equations. The Painlev\'e II equation arises (in conjunction with a difference equation) at a point associated with branched polymers. For critical points described by partial differential equations, there are dual weak-coupling/strong-coupling expansions. It is conjectured that the new physics is related to microscopic topology fluctuations.Comment: 29 page

Null Distribution Of The Likelihood Ratio Statistic For Feed-Forward Neural Networks

Despite recent publications exploring model complexity with modern regression methods, their dimensionality is rarely quantified in practice and the distributions of related test statistics are not well characterized. Through a simulation study, we describe the null distribution of the likelihood ratio statistic for several different feed-forward neural network models

A Qualitative Analysis of Students’ Perceptions of Pursuing Pharmacy as a Potential Vocation

We present the findings from a phenomenological, qualitative research study that explored the personal constructs of an inaugural class, entering a newly-established direct-entry, preferred admission, pre-pharmacy program at a private, selective, Midwestern university with an enrollment of 3000. The focus of the study was to appraise students\u27 perceptions regarding their rationale for pursuing a future career in pharmacy. The sample consisted of 36 students (26 females, 10 males). Data was collected via in-depth interviews of each student who had enrolled in the first year of the program. Overall, students demonstrated their belief that they would be a good fit for the pharmacy field and looked forward to enjoying their future profession. Participants also expressed having a penchant for science and healthcare, and having previously interacted with pharmacists and the pharmacy field prior to entering college. Benefits such as salary, job security, and prestige were of secondary importance to students, but they played a role nonetheless, and encouragement from parents and other respected individuals also was significant

A Qualitative Analysis of Students\u27 Perceptions of Pursuing Pharmacy as a Potential Vocation

We present the findings from a phenomenological, qualitative research study that explored the personal constructs of an inaugural class, entering a newly-established direct-entry, preferred admission, pre-pharmacy program at a private, selective, Midwestern university with an enrollment of 3000. The focus of the study was to appraise students\u27 perceptions regarding their rationale for pursuing a future career in pharmacy. The sample consisted of 36 students (26 females, 10 males). Data was collected via in-depth interviews of each student who had enrolled in the first year of the program. Overall, students demonstrated their belief that they would be a good fit for the pharmacy field and looked forward to enjoying their future profession. Participants also expressed having a penchant for science and healthcare, and having previously interacted with pharmacists and the pharmacy field prior to entering college. Benefits such as salary, job security, and prestige were of secondary importance to students, but they played a role nonetheless, and encouragement from parents and other respected individuals also was significant

Association of small versus diminutive adenomas and the risk for metachronous advanced adenomas: data from the New Hampshire Colonoscopy Registry

Background and Aims Limited data are available to investigate the impact of index adenoma size on the risk of metachronous advanced adenomas. Our goal was to examine the impact of having small (5-9 mm) versus diminutive (<5 mm) adenomas on the future risk of advanced adenomas within the categories for polyps <1 cm currently used in the United States: 1 to 2 and 3 or more tubular adenomas. Methods We included data from individuals participating in the statewide, population-based New Hampshire Colonoscopy Registry (NHCR). Groups were based on index findings: (1) 1 to 2 adenomas <5 mm (both diminutive), (2) 1 to 2 adenomas <1 cm (one or both small), (3) 3 to 10 adenomas <5 mm (all diminutive), (4) 3 to 10 adenomas <1 cm (one or more small), and (5) advanced adenomas (AA). AAs were defined as adenomas ≥1cm or those with villous elements or high-grade dysplasia or colorectal cancer (CRC). Outcomes were the absolute and adjusted risk of metachronous AAs. Covariates included age, sex, body mass index, family history of CRC, lifestyle factors, presence of serrated polyps, and time since the index examination. Results After adjusting for the covariates, we observed that having 1 to 2 adenomas with at least one 5 to 9 mm adenoma (adjusted odds ratio [AOR], 1.54; 95% confidence interval [CI], 1.12-2.11), 3 to 10 diminutive adenomas (AOR, 1.75; 95% CI, 1.03-2.95), 3 to 10 adenomas <1 cm (1 or more small) (AOR, 2.14; 95% CI, 1.39-3.29) or AAs (AOR, 2.77; 95% CI, 2.05-3.74) were associated with an increased risk for metachronous AA compared with having 1 to 2 diminutive adenomas. A further stratification of group 2 showed that those with exactly 2 small adenomas had an absolute risk of future AA of 7.6% (11/144) (95% CI, 4.3%-13.2%), higher than the absolute risk in the 1 to 2 diminutive polyp group, and similar to the risk for 3 to 10 adenomas of 8.2% (95% CI, 5.4-11.9). Conclusions For individuals with 1 to 2 adenomas <1 cm, having at least 1 small adenoma increased the metachronous risk of AA compared with having only diminutive adenomas. Furthermore, the subset with 2 small adenomas had a risk of future AA similar to the risk for 3 to 10 adenomas. These data suggest that individuals with at least 1 small adenoma may be at higher risk for future AAs and thus require closer follow-up than those with only diminutive adenomas. These data may be valuable to guideline committees for the creation of future surveillance recommendations