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

Erosion and Repair of Unlined Spillway Chute Excavated in Rock

Discharges up to 60,000 cfs that lasted 21 days caused extensive erosion of the unlined spillway chute excavated in alternating layers of limestone and shale. An empirical model allowed to evaluate the extent of erosion anticipated for future events. Parametric calculations showed that relatively low discharges a long period of time are critical for the induced damage. It was determined that the spillway can safely pass the design discharge if weathering of rock exposed by erosion is prevented. Accordingly, the interim repair was designed to protect the rock units, especially the critical limestone layers, from weathering. Although it is expected much of the repair to be eroded during future spillway flows, it will ensure the spillway can safely pass the next discharge event