'SO STONED' : common sense approach of the dizzy patient

The history taking of a dizzy patient is of utmost importance in order to differentiate the possible etiologies of vertigo. The key factors that allow a first approximation of diagnosis identification are based on the time profile, symptom profile, and trigger profile of the disease. Here, the proposed mnemonic "SO STONED" comprises eight different dimensions that characterize the vertigo-related complaints of the patient and guide the clinician in his or her decision scheme. All the letters "SO STONED" have a specific meaning: Symptoms, Often (Frequency), Since, Trigger, Otology, Neurology, Evolution, and Duration. Since the most common vestibular diseases have different fingerprints when all dimensions are considered, this tool can facilitate the identification of the appropriate vestibular diagnosis

Episodic vestibular symptoms in children with a congenital cytomegalovirus infection

Objective: Congenital cytomegalovirus (cCMV) infection is the most common non-genetic cause of sensorineural hearing loss in children. Although cCMV-induced vestibular loss is demonstrated in several studies, the occurrence of vertigo has been described in only two cases to date. The aim of this paper is to discuss the underlying pathophysiology of recurrent vestibular symptoms in children with cCMV, based on five cases investigated in our center and an extensive research of the literature. Study design: Retrospective case series. Setting: Tertiary referral center. Patients: This case series describes five pediatric cCMV-patients (three boys, two girls). Four of them were symptomatic at birth, one was asymptomatic. Three patients underwent cochlear implantation. The age of onset of the vestibular symptoms varied from 2;0 to 7;3 years of age. Intervention: None. Main outcome measures: Details regarding the patient history and results of cranial imaging, audiological, vestibular, and neurological assessments were collected retrospectively. Results: The selected cases suffered from recurrent vestibular symptoms. All patients had delayed onset, fluctuating, and/or progressive hearing loss. In all cases, the attacks were accompanied with nausea and vomiting and occurred without clear-cut trigger. Migraine and epilepsy often were proposed as first diagnosis, although they could not be confirmed eventually. Four out of five patients were diagnosed with a peripheral vestibular deficit. Conclusions: Diagnosis of vestibular symptoms in children with cCMV is complex, given the multiple morbidities than can occur. Peripheral vestibular causes should be considered in the diagnosis, as important vestibular deficits are demonstrated in this population

Bicycling to school during the transition from childhood into adolescence : a six-year longitudinal study

Little is known about bicycling to school as children age. At baseline (2002) self-report data from 1070 children were gathered (51.9% boys; mean age: 10 years). The measurements were repeated in 2003 (n = 1039), 2004 (n = 907), 2005 (n = 549) and 2008 (n = 515). The rates of children bicycling to school significantly varied across time points from 46% at the age of ten, 69% at the age of 11, 83% at the age of 12, 70% at the age of 13 toward 78% at the age of 16. Starting from the age of 11, the average duration of time spent bicycling to school significantly increased over time. According to multilevel regression analyses 13.6% of the variance in rates of bicycling to school was situated at the school level. 39.6% at the pupil level and 46.7% at the measurement level. The differences in rates and durations across time points were independent from gender, BMI, SES and having siblings. Pupils engaging in bicycling to school at younger ages had a higher change of engaging in bicycling to school at 16 years old (ORs: 2.69-7.61; ICC bicycling rates: 0.46, ICC bicycling durations: 0.82). This finding emphasizes the need for promoting bicycling to school at young age

Imagined witness : representing the Holocaust in American women's fiction

This thesis explores representations of the Holocaust in fiction by American women writers who have no autobiographical involvement with the Holocaust. It demonstrates that their texts comprise fictional meditations on the meaning of testimony, and are concerned with the ways in which narrators and readers of testimonies remember and imagine the Holocaust. The introduction outlines the key thematic, formal and theoretical concerns of the thesis within their academic context. It proposes that a self-reflexive awareness of the subjectivity and constructedness of Holocaust representation in fiction provides insight into valuable and necessary processes of the imagination. Four chapters examine different approaches to the imagination. The first interprets Norma Rosen's Touching Evil through her notion of witness-through-the-imagination. Drawing on concepts such as empathy, identification, secondary trauma and the addressee, it explores the meaning of Holocaust testimony for the reader. The second considers the subjectivity of memory by comparing the testimonies and memories of the traumatised survivor protagonists in the historical novels of Susan Fromberg Schaeffer's Anya and Sherri Szeman's The Kommandant's Mistress. The third chapter analyses the imagination as an alternative reality for mourning the past in Cynthia Ozick's The Shawl. It also engages with the dialectic between personal and collective memory through notions of ethnic uprootedness and assimilation. The fourth addresses the fantastical imagination of the Holocaust in the fiction of Judy Budnitz through her use of various literary genres and complex narratological and metafictional devices that draw attention to the acts of storytelling and witnessing. In conclusion, the thesis shows that this body of Holocaust texts examines fiction as a meaningful tool to bridge and to draw attention to the gaps between experience and representation. It broadens the implications of bearing witness due to their discourses about the significant mediation of imaginary realities.EThOS - Electronic Theses Online ServiceArts and Humanities Research Council : Faculty of Arts, Newcastle University : Department of English, Newcastle University : British Association for American StudiesGBUnited Kingdo

Test-retest reliability of questionnaires regarding attitudes and beliefs toward noise, hearing loss and hearing protector devices in young adults

Context: Young people expose themselves to high noise levels during leisure activities, and might thus be at risk of acquiring hearing-related problems. Therefore, information regarding risk-taking behavior is necessary to prevent future hearing problems and to optimize future preventive campaigns. Aim: This study evaluated the test–retest reliability of the Youth Attitude to Noise Scale (YANS) and beliefs about hearing protection and hearing loss (BAHPHL) instrument. Settings and Design: Forty-three young adults between 18 and 29 years filled in a questionnaire at two test moments. Materials and Methods: The YANS and BAHPHL instrument were used to evaluate the attitudes toward noise, hearing loss, and hearing protection. Each participant completed the retest within 21–55 days after the first administration of the questionnaire. Results: Paired Student’s t-tests showed no significant differences in mean scores between test and retest for both the entire YANS and BAHPHL instrument as well as their factors. Furthermore, a good agreement between test and retest scores was seen by Bland–Altman analyses. Intraclass correlation coefficients were above 0.70 for the entire YANS and the factor related to youth culture as well as for the entire BAHPHL and all the factors of the BAHPHL instrument, except for the factor related to the severity of the consequences of hearing loss. Conclusion: Reliable test–retest measurements of the YANS and BAHPHL instrument can be performed. Hence, these questionnaires can be used in longitudinal studies to explore young adults’ changes in attitudes toward noise, hearing loss, and hearing protection, with or without an educational intervention

Relationship of physical activity and dietary habits with body mass index in the transition from childhood to adolescence : a 4-year longitudinal study

OBJECTIVE: To explore the relationship between several physical activity (PA) and dietary behaviours and BMI Z-score and to investigate the relationship between changes in these variables and in the BMI Z-score over a 4-year period from childhood to adolescence. DESIGN: Longitudinal study in which children were included in the fifth grade and measured for four consecutive years. Dietary and PA behaviours as well as height and weight were measured by means of self-reported validated questionnaires. SETTING: Fifty-nine Flemish elementary schools. SUBJECTS: The baseline sample consisted of 51·9 % boys and the mean age was 10 (sd 0·4) years. During the first measurement year (2002), data on 1670 fifth graders were gathered. These measurements were repeated after 1 (n 1557), 2 (n 1151) and 3 (n 807) years. RESULTS: Significant inverse relationships with BMI Z-score were observed for frequency of breakfast consumption (β = -0·033, se = 0·012) and frequency of sports participation (β = -0·011, se = 0·004) across four time points. Significant inverse relationships between changes in BMI Z-score and changes in frequency of sports participation (β = -0·011, se = 0·006) and hours of physical education (PE; β = -0·052, se = 0·023) were observed, meaning that decreases in sports participation and hours spent in PE were associated with increases in BMI Z-score. CONCLUSIONS: The present study provides an important insight into different dietary and PA behaviours related to (changes in) BMI Z-score during the transition from childhood to adolescence