VOR gain by head impulse video-oculography differentiates acute vestibular neuritis from stroke

OBJECTIVE Vestibular neuritis is often mimicked by stroke (pseudoneuritis). Vestibular eye movements help discriminate the two conditions. We report vestibulo-ocular reflex (VOR) gain measures in neuritis and stroke presenting acute vestibular syndrome (AVS). METHODS Prospective cross-sectional study of AVS (acute continuous vertigo/dizziness lasting >24 h) at two academic centers. We measured horizontal head impulse test (HIT) VOR gains in 26 AVS patients using a video HIT device (ICS Impulse). All patients were assessed within 1 week of symptom onset. Diagnoses were confirmed by clinical examinations, brain magnetic resonance imaging with diffusion-weighted images, and follow-up. Brainstem and cerebellar strokes were classified by vascular territory-posterior inferior cerebellar artery (PICA) or anterior inferior cerebellar artery (AICA). RESULTS Diagnoses were vestibular neuritis (n = 16) and posterior fossa stroke (PICA, n = 7; AICA, n = 3). Mean HIT VOR gains (ipsilesional [standard error of the mean], contralesional [standard error of the mean]) were as follows: vestibular neuritis (0.52 [0.04], 0.87 [0.04]); PICA stroke (0.94 [0.04], 0.93 [0.04]); AICA stroke (0.84 [0.10], 0.74 [0.10]). VOR gains were asymmetric in neuritis (unilateral vestibulopathy) and symmetric in PICA stroke (bilaterally normal VOR), whereas gains in AICA stroke were heterogeneous (asymmetric, bilaterally low, or normal). In vestibular neuritis, borderline gains ranged from 0.62 to 0.73. Twenty patients (12 neuritis, six PICA strokes, two AICA strokes) had at least five interpretable HIT trials (for both ears), allowing an appropriate classification based on mean VOR gains per ear. Classifying AVS patients with bilateral VOR mean gains of 0.70 or more as suspected strokes yielded a total diagnostic accuracy of 90%, with stroke sensitivity of 88% and specificity of 92%. CONCLUSION Video HIT VOR gains differ between peripheral and central causes of AVS. PICA strokes were readily separated from neuritis using gain measures, but AICA strokes were at risk of being misclassified based on VOR gain alone.

Validity and reliability of using MVP 4 Function Walk4Life digital pedometers to assess physical activity levels among preschool-aged Head Start children

The Surgeon General recommends preschoolers 3-5 years old accumulate 60 minutes of moderate-to-vigorous physical activity (MVPA) per day. However, there is limited data measuring physical activity (PA) and MVPA amongst this population. The purpose of this cross-sectional study is to determine the validity, reliability, and feasibility of using MVP 4 Function Walk4Life digital pedometers (MVP-4) in measuring MVPA among preschoolers using the newly modified direct observational technique, System for Observing Fitness Instruction Time-Preschool Version (SOFIT-P) as the gold standard. An ethnically diverse population of 3-5 year old underserved children were recruited from two Harris County Department of Education (HCDE) Head Start centers. For 2 days at baseline and 2 days at post-test, 75 children enrolled wore MVP-4 pedometers for approximately 6-hours per observation day and were observed using SOFIT-P during predominantly active times. Statistical analyses used Pearson "r" correlation coefficients to determine mean minutes of PA and MVPA, convergent and criterion validity, and reliability. Significance was set at p = <0.05. Feasibility was determined through process evaluation information collected during this study via observations from data collectors and teacher input. Results show mean minutes of PA and MVPA ranged between 30-42 and 11-14 minutes, respectively. Convergent validity comparing BMI percentiles with MVP-4 PA outcomes show no significance at pre-test; however, each measurement at post-test showed significance for MVPA (p = 0.0247, p = 0.0056), respectively. Criterion validity comparing percent MVPA time between SOFIT-P and MVP-4 pedometers was determined; however, results deemed insufficient due to inconsistency in observation times while using the newly developed SOFIT-P. Reliability measures show no significance at pre-test, yet show significant results for all PA outcomes at post-test (p = 0.001, p = 0.001, p = 0.0010, p = 0.003), respectively. Finally, MVP-4 pedometers lacked feasibility due to logistical barriers in design. Researchers feel the significant results at post-test are secondary to increased familiarity and more accurate placement of pedometers across time. Researchers suggest manufacturers of MVP-4 pedometers further modify the instrument for ease of use with this population, following which future studies ought to determine validity using objective measures or all-day direct observation techniques.^

Association between cerebral oxygen metabolic rate and the incidence of nosocomial pneumonia in head injury patients

The development of nosocomial pneumonia was monitored in 96 head-trauma patients requiring mechanical ventilation for up to 10 days. Pneumonia occurred in 28 patients (29.2%) or 53.9 cases per 1,000 admission days. The incidence of nosocomial pneumonia was negatively correlated with cerebral oxygen metabolic rate (CMRO$\sb2$) measured during the first five days. The relative risk of nosocomial pneumonia for patients with CMRO$\sb2$ less than 0.6 umol/gm/min is 2.08 (1.09$-$3.98) times those patients with CMRO$\sb2$ greater than 0.6 umol/gm/min. The association between cerebral oxygen metabolic rate and nosocomial pneumonia was not affected by adjustment of potential confounding factors including age, cimetidine and other infections. These findings provide evidences underlying the CNS-immune system interaction. ^

Measuring value in cancer-related health care: A case study in head and neck cancer

In the current climate of escalating health care costs, defining value and accurately measuring it are two critical issues affecting not only the future of cancer care in particular but also the future of health care in general. Specifically, measuring and improving value in cancer-related health care are critical for continued advancements in research, management, and overall delivery of care. However, in oncology, most of this research has focused on value as it relates to insurance industry and payment reform, with little attention paid to value as the output of clinical interventions that encompass integrated clinical teams focusing on the entire cycle of care and measuring objective outcomes that are most relevant to patients. ^ In this study, patient-centered value was defined as health outcomes achieved per dollar spent, and calculated using objective functional outcomes and total care costs. The analytic sample comprised patients diagnosed with three common head and neck cancers—cancer of the larynx, oral cavity, and oropharynx—who were treated in an integrated tertiary care center over an approximately 10-year period. The results of this study provide initial empirical data that can be used to assess and ultimately to help improve the quality and value of head and neck cancer care, and more importantly they can be used by patients and clinicians to make better-informed decisions about care, particularly what therapeutic services and outcomes matter the most to patients.^

Extensive boiling as a precipitation mechanism for precious and base metal ores, Bienaventurada Mine, Huancavelica, Perú

The Bienaventurada mine operates a polymetallic Ag-Pb-Zn (Cu, Au) vein system of the low sulphidation epithermal type. Fluid inclusions, FI, are abundant in quartz, sphalerite and adularia. FI petrography demonstrates typical primary growth zoning which occurs frequently in crystalline quartz, and defines the most common primary FI. These are usually very small, but several types of primary, P, and secondary, S, FI Assemblages (FIAs) comprising FI of measurable size (3 to > 100 μm) can also be identified through careful petrographic work. The fluids are aqueous and undersaturated, and no evidence of CO2 was found; the degree of fill is usually high (~70-80 %) in the L-rich inclusions, but extremely low in V-rich inclusions. The measured microthermometric values are very consistent in the FIAs selected; they are for the most part roughly similar in the P and S assemblages: the median is typically ~258ºC for total homogenization temperatures, Th, and -1.5 ºC for ice melting temperatures, Tm (corresponding to 2.57 wt% NaCl eq). The widespread occurrence of L-rich and V-rich FI in the same FIA and the consistent Th values point to an extensive boiling system along the vein. In these conditions, Th equals T of trapping, and the ores are assumed to have been precipitated from an aqueous low salinity boiling fluid, of likely meteoric origin, at some 250-280º C, under ~500 m hydrostatic head.

Istruzioni per l'ammissione ed intervento alle mense comuni pei signori scienziati /

Acquisition made accessible thanks to a 2015-2017 grant from the Council on Libraries and Information Resources.

An evaluation of head restraints - Federal Motor Vehicle Safety Standard 202.

Mode of access: Internet.

Reseña económica del Perú,

At head of title: Ministerio de fomento.

Tractatus posthumus Jani Jacobi Boissardi Vesuntini De divinatione & magicis praestigiis : quarum veritas ac vanitas solidè exponitur per descriptionem deorum fatidicorum qui olim responsa dederunt : eorundemque prophetarum, sacerdotum, phoebadum, sybyllarum & divinorum, qui priscis temporibus celebres oraculis exstiterunt ; adjunctis simul omnium effigiebus, ab ipso autore e gemmis, marmoribus, tabulisq[ue] antiquis ad vivum delineatus : jam modo eleganter aeri incisis per Joh. Theodor. de Bry ...

Includes errata, last p.

Narrazione delle solenni reali feste : fatte celebrare in Napoli da Sua Maestà il re delle Due Sicilie Carlo infante di Spagna, duca di Parma, Piacenza &c. &c. per la nascita del suo primogenito Filippo real principe delle Due Sicilie.

The plates depict floor plans of the Palazzo reale and of the Teatro di San Carlo in Naples, a vertical cross section of the Palazzo reale; interior decoration of the Teatro di San Carlo; most plates depict festivities taking place in the decorated interiors of the theater and the royal palace, including a masquerade at the royal palace, the stage scenery and a scene from the opera "Il sogno di Olimpia" by Ranieri de Calzabigi, which was performed at the Teatro di San Carlo; a view of the illuminated Castello Nuovo in Naples, the fireworks installation at the Piazza del Castello Nuovo, and a floorplan of the fire works installation. Plate XI depicts the mythical land of plenty "Cuccagna", arranged as a landscaped hill with an architectural grotto, richly decorated with food and drink, which was offered as part of the festivities to the common people. Most plates have a detailed legend in the lower margin.

Dictionarium magnum ac perutile Varini Phavorini Camertis Nucerini episcopi. E multis variisque auctoribus collectum totius linguae græcæ commentarium, secunda hac editione per Nicolaum Glichi typographum diligentissime equidem castigatum, & copia dictionum auctum.

"Licenza allo stampatore" at end, dated Venezia, 1800.

Inscrizioni sparse per Castiglione delle Stiverie raccolte sul fine dell'anno MDCCLIX : cosái come stanno incise.

Acquisition made accessible thanks to a 2015-2017 grant from the Council on Libraries and Information Resources.

Sentimenti umilissimi esposti dalla Sp. Valle Trompia all'illustriss. et eccellentiss. sig. Lonardo Mocenigo dignissimo capitanio di Brescia per otternerne la protezione.

Acquisition made accessible thanks to a 2015-2017 grant from the Council on Libraries and Information Resources.

Degl'istorici delle cose veneziane, i quali hanno scritto per pubblico decreto ...

The editorial matter includes lives of the authors.

Un nuovo velo per apicoltori.

At head of title: Dino Scaffai.