The impact of episodic and chronic vestibular disorders and their specific vs. unspecific diagnosis on Health-related quality of life

Vertigo and dizziness are relatively frequent complaints at primary, secondary and tertiary health-care settings. They tend to occur more often with increasing age and to negatively influence Health-related-quality of life (HRQoL) and functioning. Vestibular disorders are of episodic or chronic nature with a broad range of possible underlying causes. Episodic vestibular syndromes (EVS) present with unpredictable short attacks of vertigo and dizziness while chronic vestibular syndromes (CVS) present with long lasting episodes of vertigo and dizziness. Although they are manageable, vertigo and dizziness are often under- and misdiagnosed especially in primary care. It is not yet fully understood how EVS and CVS affect HRQoL and functioning. This far, little is known how an unspecific versus specific diagnosis of vertigo and dizziness is associated with HRQoL and its trajectories. Therefore, this doctoral thesis aims to study how EVS and CVS affect HRQoL and functioning. in addition to how an unspecific versus specific diagnosis of vertigo and dizziness is associated with HRQoL and its trajectories. The first analysis compares the effect of episodic and chronic vestibular diseases on HRQoL and functioning in a tertiary care setting, and the impact of lifestyle and sociodemographic factors. The second anal-ysis assesses the different effects of specific and unspecific diagnoses of vertigo and dizziness on HRQoL in a primary care setting. The change in HRQoL over one year is also assessed among specific and unspecific diagnoses. Data of study one originates from the “DizzyReg” database. The latter is an ongoing prospective registry for vertigo and dizziness patients. Patients showing up at the inter-disciplinary outpatient clinic of the German Center for Vertigo and Balance (DSGZ) at the Ludwig Maximilian University Hospital (LMU Klinikum) were included between De-cember 2015 and July 2019. The main outcomes are HRQoL and functioning scores which were measured by self-report using the 3-level version of the Euro-Qol five-dimensional (EQ5D3L) and the dizziness handicap inventory (DHI) questionnaires re-spectively. CVS and EVS classifications were based on a comprehensive thorough neu-ro-otological examination by the clinical experts at the DSGZ following diagnostic guide-lines of the international classification of vestibular disorders. The impact of CVS and EVS on HRQoL and functioning was assessed using multivariable linear regression models adjusting for possible confounders. Data of study two derives from the longitudinal MobilE-TRA which was collected be-tween 2017 and 2019. The latter is a multicenter observational practice-based prospec-tive cohort study among general practitioners (GPs) who have recruited patients with acute episode of vertigo and dizziness in the last quarter. Diagnosis was given by the GP at baseline and was classified as “Specific” if a clear underlying mechanism of verti-go and dizziness could be given, or “unspecific” otherwise. The main outcome was HRQoL score that had been measured also through EQ5D3L at 3- time points over one year (baseline, follow-up after 6 months and follow-up after 12 months). The association between the diagnosis and HRQoL over time was examined through mixed-effects re-gression models adjusting for possible confounders. The first analysis involved 548 participants with a mean age at the date of admission 51.35 years, among which 57% were women. Seventy-four percent had EVS while 26% had CVS. Compared to CVS, EVS patients had a female predominance (60% > 49%), younger age (48.5 58.08) and functioning (42.1 < 47.8) even after adjusting for confounders. The second analysis included 158 vestibular patients with a mean age at baseline 77.1 years (69% female, 42% had a specific diagnosis, 40% unspecific diagnosis and 18% left undecided). Compared to specific diagnosis, patients with unspecific diagnosis re-ported significantly lower HRQoL. No differential change in HRQoL over time could be shown, while being one year older was inversely associated with HRQoL. This thesis is leading in reporting: 1- lower HRQoL among CVS patients in compari-son to EVS and 2- worse HRQoL among patients with unspecific diagnosis of vertigo and dizziness compared to specific. The findings enhance the knowledge on the impact of both the nature of vestibular syndrome and the specificity of diagnosis on HRQoL of the patients. This knowledge might help to maintain better HRQoL among vestibular patients as they age. This could be done by shedding the light on mobility and balance in CVS patients on one hand, and referring patients with unspecific diagnosis for a more solid diagnosis (when possible) and better management of symptoms on the other hand. The findings of this thesis form a start for future research aiming to illuminate the above relationships and fill in the gaps to help preserve HRQoL of patients with vestibular dis-orders as they age

Valuing the Reload Features of Executive Stock Options

Under Statement of Financial Accounting Standards No. 123, the grant date value of executive stock options excludes the value of any reload feature because, at the time of writing the standard in 1995, the Financial Accounting Standards Board believed it was not feasible to value a reload feature at the grant date. We show how the Binomial Option Pricing Model can be used to determine the grant date value of such options. Ignoring the reload feature can substantially understate the value of the option: the reload feature increases the value of an otherwise similar option by 24 percent in the example we consider. In view of the potential significance of the reload feature and the versatility of the Binomial Option Pricing Model, the Financial Accounting Standards Board may wish to reconsider the accounting for options with a reload feature.

Netting specifications and maintenance of cages for finfish culture

A cage is a space enclosed with some type of mesh forming a container for aquatic animals to grow. It is typically box-shaped or tube like structure with a rope system which supports the netting material, gives shape and allows for tying to the raft unit. In box type cages, the cage is constructed of four panels at the sides and one bottom panel. Anti-predator nets are deployed around the cage to prevent entrance of predators such as sharks and sea lions into the cages. An additional net would be provided on top of the cage to prevent bird predation

ANALYSIS OF ENGLISH SYNTACTIC STRUCTURE OF COORDINATION IN "COVER STORY" COLUMN ARTICLES IN CAMPUS ASIA MAGAZINE

The study aims at describing the distributions of English syntactic structure of coordination and identifying the categories being coordinated in the Cover Story column articles in Campus Asia magazine based on syntactic structural approach. The object of the study is sentences having English syntactic structure of coordination in Cover Story column articles of Campus Asia Magazine. The method of data collection is documentation. The study is descriptive qualitative. The technique of analyzing data is based on structural grammar approach. It means that the researcher analyzes the data in the sentences having syntactic structure of coordination with using Chinese box. The findings show that (1) there are four kinds of distributions of syntactic structure of coordination based on its functions in sentence; subject, predicate, object, and complement. While there are two kinds of distributions specifically based on its functions in phrases; head and modifier. (2) the categories being coordinated are divided into three; clause which appears in independent clause and dependent clause; phrase which appears in noun phrases, verb phrases, infinitive phrases, prepositional phrases, and prepositional gerund phrases; and words which appears in noun, verb, adjective and adverb

Atopic dermatitis and distress

Atopic dermatitis (AD) is a chronic, inflammatory skin condition characterized by itching, redness, and skin lesions, affecting approximately 10–20% of children and 1–3% of adults worldwide. Distress associated with AD can negatively impact quality of life, work, and daily activities. The research aims were to explore the role of stress in AD patients and to further investigate brain activity during stress in AD patients compared with controls. Further, one possible mediator related to skin inflammation and stress, calcitonin gene-related peptide (CGRP), was studied in skin from AD patients and controls, and related to psychodemographic measurements. The initial parts of the project involved focus groups with patients and an online survey. Results from the focus group study and the survey study underlined the importance of stress as a trigger and worsening factor for patients with AD. Both studies indicated that stress, especially chronic stress, could be an important worsening factor. Decision-making and unforeseen events were often mentioned as stress triggers. In both the focus groups and the survey study, patients rated stress as of greater importance than climate factors. Itch was reported to be a result of stress and the type of stress possibly affected the nature of the pruritus experienced by patients. Furthermore, physical exercise was reported to have beneficial effects, something that was found in both the focus groups and the survey. Differences were found in possible mechanisms for stress processing in AD patients compared with controls. Reduced deactivation in the default mode network in response to stress (an arithmetic test) indicated that there is likely a cognitive functional variability in AD patients compared with healthy control subjects, manifested as lowered inhibition ability under psychological stress. This was also supported by different correlations between brain activities and various psycho-demographic data. Findings from a functional magnetic resonance imaging study indicated that psychological stress affected brain activities in the motor cortex, the somatosensory association cortex, and perception and sensory integration processing among AD patients. An immunohistochemical study showed an increase of CGRP in nerve-like fibers and inflammatory cells in inflamed skin of AD patients compared with non-lesional skin. The increase of CGRP-positive nerve-like fibers in skin correlated with depressive and anxiety scores in the patients. The results showed that psychological stress was an important trigger factor for AD and both differences in central processing of stress in AD and peripheral changes in CGRP levels in skin were observed. This emphasizes the importance of a holistic approach to treatment of AD, with the possibility for healthcare to offer more individualized treatment depending on each patient’s challenges and needs

IN SILICO STUDY OF CEPHALOSPORIN DERIVATIVES TO INHIBIT THE ACTIONS OF Pseudomonas aeruginosa

Studi In Silico Senyawa Turunan Sefalosporin dalam Menghambat Aktivitas Bakteri Pseudomonas aeruginosa Infeksi yang diakibatkan oleh bakteri gram-negatif, seperti Pseudomonas aeruginosa telah menyebar luas di seluruh dunia. Hal ini menjadi ancaman terhadap kesehatan masyarakat karena merupakan bakteri yang multi-drug resistance dan sulit diobati. Oleh karena itu, pentingnya pengembangan agen antimikroba untuk mengobati infeksi semakin meningkat dan salah satu yang saat ini banyak dikembangkan adalah senyawa turunan sefalosporin. Penelitian ini melakukan studi mengenai interaksi tiga dimensi (3D) antara antibiotik dari senyawa turunan Sefalosporin dengan penicillin-binding proteins (PBPs) pada P. aeruginosa. Tujuan dari penelitian ini adalah untuk mengklarifikasi bahwa agen antimikroba yang berasal dari senyawa turunan sefalosporin efektif untuk menghambat aktivitas bakteri P. aeruginosa. Struktur PBPs didapatkan dari Protein Data Bank (PDB ID: 5DF9). Sketsa struktur turunan sefalosporin digambar menggunakan Marvins Sketch. Kemudian, studi mengenai interaksi antara antibiotik dan PBPs dilakukan menggunakan program Mollegro Virtual Docker 6.0. Hasil yang didapatkan yaitu nilai rerank score terendah dari kelima generasi sefalosporin, di antaranya sefalotin (-116.306), sefotetan (-133.605), sefoperazon (-160.805), sefpirom (-144.045), dan seftarolin fosamil (-146.398). Infections caused by gram-negative bacteria, such as Pseudomonas aeruginosa, have been spreading worldwide. It is a threat to public health because of its multi-drug resistance and difficulty to treat. Therefore, the demand for developing antimicrobial agents to treat infections is increasing. One of them that is currently under development is cephalosporin derivative compounds. This research studied the three-dimensional (3D) interaction between antibiotics from cephalosporin derivatives and penicillin-binding proteins (PBPs) in P. aeruginosa. This study aimed to clarify whether the cephalosporin derivatives were effective in inhibiting the activity of P. aeruginosa. The PBPs structure was obtained from the Protein Data Bank (PDB ID: 5DF9). The structural sketch of the cephalosporin derivative was drawn using the Marvins Sketch, whereas the study on the interaction between antibiotics and PBPs was carried out using the Mollegro Virtual Docker 6.0 program. The results showed the lowest rerank score from five cephalosporin derivatives, namely cephalotin (-116,306), cephotetan (-133.605), cephoperazone (-160.805), cephpirome (-144.045), and cephtaroline fosamil (-146.398)