Faculty Recital: David Earll, tuba: Music of Heroes & Monsters

TesisEl presente proyecto de investigación tuvo como objetivo principal determinar las características del financiamiento y la rentabilidad de las micro y pequeñas empresas del sector Ferreterías en la ciudad de Huaraz, periodo 2017, el tipo de investigación aplicado fue de enfoque cuantitativo y con un nivel de investigación descriptivo simple no experimental – transversal; la población estuvo comprendida por 39 representantes legales, la técnica utilizada fue la encuesta y el instrumento de medición fue el cuestionario estructurado, obteniendo los resultados siguientes: el 100 % de los encuestados tenían entre 26-65 años de edad, el 31% de los encuestados tienen estudio superior mientras que un 28% tienen estudios secundarios culminados, en las características del financiamiento; el 79% financian su actividad con fondos terceros, el 54% solicitó alguna vez su crédito en alguna entidad bancaria, el 56% afirmaron el tiempo que se le otorgó el préstamo solicitado es de largo plazo, 28% precisa en que fue invertido en capital de trabajo, en las principales características de la rentabilidad; el 74% cree que el financiamiento otorgado mejoró la rentabilidad de su empresa, el 67% cree mejoró la rentabilidad de su empresa, el 38% refieren que lograron incrementar los activos de su empresa, el 45% menciona que sus activos no se incrementaron en el año 2017. En Conclusión se han determinado las características del financiamiento y la rentabilidad del sector comercio, rubro Ferreterías en la ciudad de Huaraz. Periodo 2017 con los datos presentados en los resultados

Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo

Objectives: This guideline provides evidence-based recommendations on managing benign paroxysmal positional vertigo (BPPV), which is the most common vestibular disorder in adults, with a lifetime prevalence of 2.4 percent. The guideline targets patients aged 18 years or older with a potential diagnosis of BPPV, evaluated in any setting in which an adult with BPPV would be identified, monitored, or managed. This guideline is intended for all clinicians who are likely to diagnose and manage adults with BPPV. Purpose: The primary purposes of this guideline are to improve quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary tests such as radiographic imaging and vestibular testing, and to promote the use of effective repositioning maneuvers for treatment. In creating this guideline, the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of audiology, chiropractic medicine, emergency medicine, family medicine, geriatric medicine, internal medicine, neurology, nursing, otolaryngology-head and neck surgery, physical therapy, and physical medicine and rehabilitation. Results: The panel made strong recommendations that 1) clinicians should diagnose posterior semicircular canal BPPV when vertigo associated with nystagmus is provoked by the Dix-Hallpike maneuver. The panel made recommendations against 1) radiographic imaging, vestibular testing, or both in patients diagnosed with BPPV, unless the diagnosis is uncertain or there are additional symptoms or signs unrelated to BPPV that warrant testing; and 2) routinely treating BPPV with vestibular suppressant medications such as antihistamines or benzodiazepines. The panel made recommendations that 1) if the patient has a history compatible with BPPV and the Dix-Hallpike test is negative, clinicians should perform a supine roll test to assess for lateral semicircular canal BPPV; 2) clinicians should differentiate BPPV from other causes of imbalance, dizziness, and vertigo; 3) clinicians should question patients with BPPV for factors that modify management including impaired mobility or balance, CNS disorders, lack of home support, and increased risk for falling; 4) clinicians should treat patients with posterior canal BPPV with a particle repositioning maneuver (PRM); 5) clinicians should reassess patients within 1 month after an initial period of observation or treatment to confirm symptom resolution; 6) clinicians should evaluate patients with BPPV who are initial treatment failures for persistent BPPV or underlying peripheral vestibular or CNS disorders; and 7) clinicians should counsel patients regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up. The panel offered as options that 1) clinicians may offer vestibular rehabilitation, either self-administered or with a clinician, for the initial treatment of BPPV and 2) clinicians may offer observation as initial management for patients with BPPV and with assurance of follow-up. The panel made no recommendation concerning audiometric testing in patients diagnosed with BPPV. Disclaimer: This clinical practice guideline is not intended as a sole source of guidance in managing benign paroxysmal positional vertigo. Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. The guideline is not intended to replace clinical judgement or establish a protocol for all individuals with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem