Prognosis and Survival of Older Patients With Dizziness in Primary Care:a 10-year prospective cohort study

Purpose: The prognosis of dizzy older patients in primary care is unknown. Our objective was to determine the prognosis and survival of patients with different subtypes and causes of dizziness. Methods: In a primary care prospective cohort study, 417 older adults with dizziness (mean age 75.5 years) received a full diagnostic workup in 2006-2008. A panel of physicians classified their dizziness subtype and primary cause of dizziness. Presyncope was the most common dizziness subtype (69.1%), followed by vertigo (41.0%), disequilibrium (39.8%), and other dizziness (1.7%). The most common primary causes of dizziness were cardiovascular disease (56.8%) and peripheral vestibular disease (14.4%). Main outcome measures were mortality and dizziness-related impairment assessed at 10-year follow-up.Results: At 10-year follow-up 169 patients (40.5%) had died. Multivariable adjusted Cox models showed a lower mortality rate for patients with the subtype vertigo compared to other subtypes (HR 0.62 (95% CI 0.40 to 0.96)), and for peripheral vestibular disease versus cardiovascular disease as primary cause of dizziness (HR 0.46 (95% CI 0.25 to 0.84)). After 10 years, 47.7% of patients who filled out the follow-up measurement experienced substantial dizziness-related impairment. No significant difference in substantial impairment was seen between different subtypes and primary causes of dizziness. Conclusions: The 10-year mortality rate was lower for the dizziness subtype vertigo compared to other subtypes. Patients with dizziness primarily caused by peripheral vestibular disease had a lower mortality rate than patients with cardiovascular disease. Substantial dizziness-related impairment in older dizzy patients 10 years later is high, and indicates that current treatment strategies by FPs may be suboptimal.<br/

Aula virtual CristoAct para mejorar la actitud de los estudiantes frente a la asignatura de cristología en la Universidad Católica Santo Toribio de Mogrovejo, Chiclayo 2014

La investigación surge como respuesta a la preocupación por las actitudes de rechazo y desinterés de los estudiantes frente a las asignaturas de teología, específicamente cristología; así mismo a la exigencia de la incorporación de la tecnología de la información y comunicación (TIC) en el proceso de enseñanza aprendizaje, potenciando así, la construcción del aprendizaje. Se propone la implementación del aula CristoAct, en la plataforma Moodle, como medio de apoyo a las sesiones presenciales de la asignatura de cristología; teniendo como objetivo demostrar que el uso del aula virtual CristoAct, mejora la actitud de los estudiantes frente a la asignatura de cristología de la Universidad Católica Santo Toribio de Mogrovejo. La metodología aplicada fue de tipo experimental, con diseño cuasi experimental de un sólo grupo, con pretest y postest. Teniendo como población, estudiantes matriculados en la asignatura de cristología distribuidos en 7 secciones; y como muestra a los estudiantes de la sección “G”. El grupo en estudio mejoró el nivel de actitud frente a la asignatura de cristología demostrando que la utilización del aula CristoAct ha facilitado espacios para compartir, interactuar y realizar la extensión de la temática en estudio, reflejándose los resultados en su rendimiento académico. La actitud positiva de los estudiantes se debió al uso del entorno virtual como elemento didáctico, ya que motivó a los estudiantes y acrecentó una actitud favorable frente a la asignatura; siendo reutilizables los recursos multimedia diseñados e implementados por el autor en cualquier plataforma y/o servidores de la web.Tesi

Personalized neck irradiation guided by sentinel lymph node biopsy in patients with squamous cell carcinoma of the oropharynx, larynx or hypopharynx with a clinically negative neck:(Chemo)radiotherapy to the PRIMary tumor only. Protocol of the PRIMO study

Background: Elective neck irradiation (ENI) is performed in head and neck cancer patients treated with definitive (chemo)radiotherapy. The aim is to eradicate nodal metastases that are not detectable by pretreatment imaging techniques. It is conceivable that personalized neck irradiation can be performed guided by the results of sentinel lymph node biopsy (SLNB). It is expected that ENI can be omitted to one or both sides of the neck in 9 out of 10 patients, resulting in less radiation side effects with better quality of life. Methods/design: This is a multicenter randomized controlled trial aiming to compare safety and efficacy of treatment with SLNB guided neck irradiation versus standard bilateral ENI in 242 patients with cN0 squamous cell carcinoma of the oropharynx, larynx or hypopharynx for whom bilateral ENI is indicated. Patients randomized to the experimental-arm will undergo SLNB. Based on the histopathologic status of the SLNs, patients will receive no ENI (if all SLNs are negative), unilateral neck irradiation only (if a SLN is positive at one side of the neck) or bilateral neck irradiation (if SLNs are positive at both sides of the neck). Patients randomized to the control arm will not undergo SLNB but will receive standard bilateral ENI. The primary safety endpoint is the number of patients with recurrence in regional lymph nodes within 2 years after treatment. The primary efficacy endpoint is patient reported xerostomia-related quality of life at 6 months after treatment. Discussion: If this trial demonstrates that the experimental treatment is non-inferior to the standard treatment in terms of regional recurrence and is superior in terms of xerostomia-related quality of life, this will become the new standard of care.</p

Development and usability evaluation of a nutrition and lifestyle guidance application for people living with and beyond cancer

There is a need to provide accessible information for health care professionals and for people living beyond treatment. Mobile and digital health technologies provide an ideal platform to access diet and nutrition guidance that is both trusted and evidence-based and so that people know how to alter and monitor eating patterns and behaviours to improve the quality of life. Participatory design and usability evaluation approaches have been utilised to develop a nutrition and lifestyle guidance smartphone application for both people living with and beyond cancer, and for health care professionals involved in advising such patients. The challenges centred on the design, development and evaluation of the first version of a new mobile application named ‘Life Beyond’ are presented. This proof of concept application aims to centralise evidence-based nutrition and lifestyle guidance for those living beyond cancer. It enables users to obtain guidance and information, create and track nutrition and activity related goals and track their progress in the completion of these goals. Consistent feedback from participatory design and usability evaluations drove this research and helped to create an initial solution that met the user expectations. The System Usability Scale (SUS) score of 67.69 denotes an ‘average’ usability and hence further development. More research of extensive end user engagement is needed before an optimal solution is disseminated

Ranking of Fuzzy Similar Faces Using Relevance Matrix and Aggregation Operators

AbstractIn perception based imaging, Sketching With Words (SWW) is a well-established methodology in which the objects of computation are fuzzy geometric objects (f-objects).The problem of facial imaging of criminal on the basis of onlooker statement is not lack of method and measures but the modeling of onlooker(s) mind set. Because the onlooker has to give statements about different human face parts like forehead, eyes, nose, and chin etc.The concept of fuzzy similarity (f-similarity) and proper aggregation of components of face may provide more flexibility to onlooker(s). In proposed work onlooker(s) statement is recorded. Thereafter it is compared with existing statements. The f-similarity with different faces in database is estimated by using ‘as many as possible’ linguistic quantifier. Three types of constraints over size of parts of face ‘small’, ‘medium’, and ‘large’ are considered. Possibilistic constraints with linguistic hedges and negation operator like ‘very long’, ‘not long’, ‘not very long’ etc. are used. Moreover we have generated ranking of alike faces in decreasing order by using the concepts of f-similarity and relevance matrix

Divergences in Real-Time Classical Field Theories at Non-Zero Temperature

The classical approximation provides a non-perturbative approach to time-dependent problems in finite temperature field theory. We study the divergences in hot classical field theory perturbatively. At one-loop, we show that the linear divergences are completely determined by the classical equivalent of the hard thermal loops in hot quantum field theories, and that logarithmic divergences are absent. To deal with higher-loop diagrams, we present a general argument that the superficial degree of divergence of classical vertex functions decreases by one with each additional loop: one-loop contributions are superficially linearly divergent, two-loop contributions are superficially logarithmically divergent, and three- and higher-loop contributions are superficially finite. We verify this for two-loop SU(N) self-energy diagrams in Feynman and Coulomb gauges. We argue that hot, classical scalar field theory may be completely renormalized by local (mass) counterterms, and discuss renormalization of SU(N) gauge theories.Comment: 31 pages with 7 eps figure