Objective: To examine whether weight history and weight transitions over adult lifespan contribute to physical impairment among postmenopausal women. Design: BMI categories were calculated among postmenopausal women who reported their weight and height at age 18 years. Multiple-variable logistic regression was used to determine the association between BMI at age 18 years and BMI transitions over adulthood on severe physical impairment (SPI), defined as scoring <60 on the Physical Functioning subscale of the Rand thirty-six-item Short-Form Health Survey. Setting: Participants were part of the Women's Health Initiative Observational Study (WHI OS), where participants' health was followed over time via questionnaires and clinical assessments. Subjects: Postmenopausal women (n 76 016; mean age 635 (sd 73) years). Results: Women with overweight (BMI=250-299 kg/m(2)) or obesity (BMI = 300 kg/m(2)) at 18 years had greater odds (OR (95 % CI)) of SPI (151 (135, 169) and 214 (172, 265), respectively) than normal-weight (BMI=185-249 kg/m(2)) counterparts. Transitions from normal weight to overweight/obese or to underweight (BMI<185 kg/m(2)) were associated with greater odds of SPI (197 (184, 211) and 135 (106, 171), respectively) compared with weight stability. Shifting from underweight to overweight/obese also had increased odds of SPI (152 (111, 209)). Overweight/obese to normal BMI transitions resulted in a reduced SPI odds (052 (039, 071)). Conclusions: Higher weight history and transitions into higher weight classes were associated with higher likelihood of SPI, while transitioning into lower weight classes for those with overweight/obesity was protective among postmenopausal women.

Aims Research suggests that people with a learning disability have difficulty processing and interpreting facial expressions of emotion. Emotion recognition is a fundamental skill and impairment in this area may be related to a number of negative, social and functional outcomes including increased frequency of aggressive behaviour, failure of community-based placements and mental illness. This thesis therefore had three aims: to review systematically the evidence for the presence of emotion recognition impairments in adults with a learning disability compared with the non-learning disabled population; to evaluate the emotion specificity hypothesis (which states that people with a learning disability perform less well on emotion recognition tasks as a result of a specific impairment in emotion recognition competence) and to evaluate the relationship between cognitive processing style and emotion recognition in people with a learning disability. Methods The first paper is a systematic review of studies that compared the performance of adults with a learning disability with that of a non-learning disabled control group on tasks of facial emotion recognition. The second paper reports on an empirical study that compared the performance of adults with a learning disability (n = 23) with adults (n = 23) and children (n = 23) without learning disability on tasks of facial emotion recognition and control tasks. The third paper reports further results from the empirical study which looks at cognitive processing style of adults with a learning disability and non-learning disabled children and adults. Results The systematic review found that all of the included studies reported evidence to support the proposal that adults with a learning disability are relatively impaired in recognising facial expressions of emotion. There are significant limitations associated with the research in this area and further studies are required in order to provide insight into the possible causes of emotion recognition deficits in this group of people. In the empirical study, adults with a learning disability were found to be relatively impaired on both emotion recognition and control tasks compared with both adult and child control groups. The availability of contextual information improved emotion recognition accuracy for adults with learning disability. The demands of the task also had an effect: identifying a target emotion from a choice of two images, rather than a choice of nine or naming the emotion also improved accuracy. Adults with learning disability were more likely to adopt a local processing style. A global processing style was associated with greater accuracy on the emotion recognition tasks. Conclusions Adults with learning disability are relatively impaired in facial emotion recognition when compared with non-learning disabled adults and children. This relative impairment was also evident on control tasks and therefore no evidence for the emotion specificity hypothesis was found. A number of issues in relation to future research are raised, specifically regarding the development of control tasks with comparable levels of difficulty to emotion recognition tasks.

Individuals with developmental language impairment can show deficits into adulthood. This suggests that neural networks related to their language do not normalize with time. We examined the ability of 16 adults with and without impaired language to learn individual words in an unfamiliar language. Adults with impaired language were able to segment individual words from running speech, but needed more time to do so than their normal-language peers. ICA analysis of fMRI data indicated that adults with language impairment activate a neural network that is comparable to that of adults with normal language. However, a regional analysis indicated relative hyperactivation of a collection of regions associated with language processing. These results are discussed with reference to the Statistical Learning Framework and the sub-skills thought to relate to word segmentation. (C) 2017 The University of Arizona. Published by Elsevier Inc.

The overarching purpose of both dissertation studies is to contribute to the extant literature base on language assessment in the context of poverty and African American English (AAE) dialect. Language assessment with culturally and linguistically diverse populations, in particular children who speak AAE, has been a longstanding challenge for professionals in the field of speech-language pathology despite the preponderance of scholarly attention this topic has received. The purpose of the first study is to conduct a systematic review of the literature to synthesize the existing literature on AAE from the past approximately three and a half decades, to identify aspects of language and assessment approaches that have been most informative for identifying language impairment in this population. The purpose of the second study is to examine the grammaticality judgments of school-age, AAE-speaking children as a function of their nonmainstream dialect density and language ability. Data for this study came from 273 African American children from low-income backgrounds who were participants in a larger project focused on language and literacy outcomes for children reared in urban areas. the relationship between language ability and dialect density was explored using correlational analysis and the contribution of language ability and dialect density on grammaticality judgments was analyzed using multiple regression. Finally, a multivariate analysis of variance was conducted to investigate the impact of dialect density and language ability on various items that differed in grammatical constructions. Results from both studies are discussed relative to the existing oral language profiles of AAE speakers and the impact of linguistic variation on assessment. Together, these papers contribute to the extant literature by supporting the development of a more comprehensive profile of AAE and increasing the field's understanding of language assessment and language impairment in child AAE speakers.

Magister Chirurgiae Dentium - MChD / Aim: The aim of the study was to investigate whether a correlation exists between the intra- operative position of the Inferior Alveolar Nerve (IAN) and the nerve position as noted on a pre-operative Cone Beam Computer Tomography (CBCT) scan in patients requiring Bilateral Sagittal Split Osteotomy (BSSO) of the mandible. Introduction: The BSSO of the mandible is of fundamental importance in the correction of dental facial deformities. The main post-operative complication of a BSSO of the mandible is Neurosensory Impairment (NSI). To avoid possible NSI it is important to have as much pre- operative information as possible. In this regard, pre-operative CBCT scans can provide the surgeon with an important assessment of the mandibular canal. This information on the buccolingual, superior and inferior position of the canal, especially in the region of the planned osteotomy, could help the surgical team to avoid IAN injury. Materials and Methods: This study correlates the pre-operative position of the IAN as indicated on a CBCT scan with the intra-operative IAN position in patients requiring BSSO of the mandible. Ten standardised cases were included in a prospective case series where twenty mandibular sides were assessed. Results: The variables assessed in this study were location of the nerve, age, sex, type of movement and side of mandible operated on. It was found that only the distance between the Inferior Alveolar Canal (IAC) and the lower border of the mandible are predictive of whether the IAN will be attached to - or free from - the proximal segment of the mandible. Conclusion: From the study it can be concluded that a CBCT scan is a useful and reliable modality in the pre-operative evaluation of patients undergoing BSSO especially with regard to the assessment and mapping of the mandibular canal.

Magister Psychologiae - MPsych / The propensity to blush is typical of many individuals with social anxiety disorder (SAD). SAD is also associated with significant disability or functional impairment. The relationship between SAD, blushing and functional impairment is still not completely understood however. This study has focused on the association between the propensity to blush and reported level of functional impairment due to SAD. Data from thirty-eight (n=38) individuals with SAD, were collected via a larger study conducted at the MRC Anxiety and Stress Disorders Unit. Assessment tools include the Structured Clinical Interview for Axis I disorders – Patient Version (SCID -I/P), Social Phobia Inventory (SPIN) and the Blushing Propensity Scale. Demographic and clinical data were gathered and reported on. Spearman rank order correlations were used to determine relationships between variables, including blushing propensity, disability and symptom severity. Results were reported on and then discussed using the social attention theory. Limitations and recommendations were proposed in the final and concluding chapter. This study, as part of a larger study at the MRC Research Unit on Anxiety and Stress Disorders, has been approved by the Research Ethics Committee of the Faculty of Health Sciences of the University of Stellenbosch

Small timing differences occur when sounds reach one ear before the other, creating interaural phase differences (IPDs). The phase-locked activity in the auditory nerve can, at low frequencies, preserve IPDs. IPDs are used for localising and separating sounds from different directions. Chapters 3, 5, and 6 report three studies of the independent effects of age and sensorineural hearing loss on the temporal processing of sound that aids spatial hearing. Chapters 2 and 4 describe two supporting methodological studies. Chapter 2 compared the duration of training required for stable IPD-discrimination thresholds for two stimulus presentation procedures. The procedure requiring the least training was adopted for subsequent studies. Age and hearing loss are related and both may affect sensitivity to IPDs. Chapter 3 demonstrated that hearing loss, regardless of listener age, is related to poorer sensitivity to IPDs in the temporal fine structure (TFS), but not in the temporal envelope. Chapter 3 also showed that age, independent of hearing loss, is related to poorer envelope-IPD sensitivity at low modulation rates, and somewhat poorer TFS-IPD sensitivity. In Chapter 5, listener age and IPD sensitivity were both compared to subcortical neural phase locking measured through the frequency-following response (FFR). Phase coherence in the envelope-FFR at 145 Hz modulation and in the TFS-FFR deteriorated with age, suggesting less precise phase locking in old age. However, age-related changes to IPD sensitivity were not strongly related to age-related changes in FFR phase coherence. IPD sensitivity declines may be predominantly caused by deterioration of binaural processing independent of subcortical phase locking. Chapter 4 showed that electrodes at the mastoids recorded TFS-FFR generated earlier in the auditory pathway than electrodes from the nape of the neck to forehead, which recorded FFR generated later in the brainstem. However, these electrode montages did not reveal different age- or hearing-loss-related FFR deficits in Chapter 5. Chapter 6 determined whether hearing loss affected the ability to use TFS IPDs to achieve better speech perception. On average, old hearing-impaired listeners gained a small, but significant, benefit from a lateral separation of the speech sources. Replacing the TFS with binaurally in-phase sine waves (removing the TFS IPDs) significantly reduced the benefit of lateral separation. How much a listener benefitted from intact TFS IPDs in speech perception was strongly related to the extent of their hearing loss at low frequencies and their monaural processing of TFS, but not to their ability to discriminate IPDs. In general, this thesis shows that low-frequency hearing loss is associated with poor sensitivity to TFS IPDs and the ability to benefit from them when sounds are laterally separated. The thesis also shows that old age can reduce sensitivity to IPDs and weaken subcortical temporal coding. Although only partly related, these effects are likely to cause problems for old individuals in challenging listening environments.

Introduction: Rheumatoid arthritis (RA) is a chronic disease and one of the more common auto-immune diseases. Patients with RA rely almost solely on pharmaceutical intervention to manage the disease. Autonomic impairment has been proven in previous studies on patients with RA. The positive effect of exercise on autonomic impairment has also previously been demonstrated, but not in the RA population. The purpose of this study was firstly to confirm autonomic impairment in a South African based female population with RA and secondly to evaluate the effect of exercise on the autonomic cardiac function (as measured by short-term heart rate variability), disease activity and functional capacity. Methods: The study was conducted at the University of Pretoria during 2009 and 2010. In the first phase of the study female RA patients were recruited from all rheumatology practices in Pretoria and healthy controls were recruited from family and friends of the research team and of the RA group. Cardiac autonomic function was compared between the two groups by means of short-term heart rate variability. Three techniques were used: time domain, frequency domain and Poincare plot analysis. In the second phase of the study, females with confirmed RA were randomly assigned to an exercise group and a control group. The exercise group was requested to train under supervision two to three times per week for a period of twelve weeks, while the control group continued with their sedentary lifestyle. At study completion the two groups were compared for the effect of exercise intervention on the following three aspects: <ul><li> Autonomic function (as measured by heart rate variability) </li><li> Disease activity (as measured by Disease Activity Score, Visual Analogue Scale and Health Activity Questionnaire) </li><li> Functional capacity (as measured by strength, flexibility and aerobic capacity) </li></ul> Results: In the first phase of the study comparing females with RA (n=45) to healthy females (n=39), the basal heart rate was significantly higher in the RA group. In the supine position significant differences existed between the RA group and the control group (p ≤ 0.01). Indicators of parasympathetic activity showed significantly lower variation in the RA group [RMSSD=14.70, pNN50=0.50, SD1=10.50, HF(ms2)=31] compared to the control group [RMSSD=29.40, pNN50=7.8, SD1=20.9, HF(ms2)=141.00]. Indicators of sympathetic variation were also significantly lower in the RA Group [SD2=36.70, LF(ms2)=65) compared to the Control group (SD2=49.50, LF(ms2)=175]. In the standing position 8 variables indicated autonomic impairment by significant differences (p≤0.01) between the 2 groups. The response of the RA Group to an orthostatic stressor showed less vagal withdrawal, [p-values for RMSSD=0.038, pNN50=0.022, SD1=0.043 and HF(ms2)=0.008 respectively]; and lower sympathetic response [p-values for SD2=0.001 and LF(ms2)<0.001] when compared to the Control group. In the second phase of the study, comparing an RA exercise group to a RA sedentary group, three aspects were evaluated: 1. Heart rate variability At baseline the control group (n=18) had significantly higher variability compared to the exercise group (n=19) for most heart rate variability (HRV) indicators. At study completion the variables showing significant changes (p=0.01 to 0.05) favoured the exercise group in all instances. Wilcoxon signed rank tests were performed to assess changes within groups from start to end. The exercise group showed significant improvement for most of the standing variables, including measurements of combined autonomic influence e.g. SDRR (p=0.002) and variables indicating only vagal influence e.g. pNN50 (p=0.014). The control group mostly deteriorated with emphasis on variables measuring vagal influence [RMSSD, pNN50, SD1 and HF(ms2)]. 2. Disease activity At baseline the two groups were comparable. At the end of the intervention, the exercise group had significant improvement for the tender joint count (p=0.015), swollen joint count (p=<0.001), physician global assessment (p=0.003) and DAS score (p=0.003) compared to the control group. To assess changes that happened within each group from start to end, Wilcoxon signed rank tests were performed. The exercise group improved significantly with regards to tender joint count (p=0.002), swollen joint count (p=0.001), physician global assessment (p=0.001), DAS score (0.001) and the visual analogue scale (p=0.032). The sedentary group improved significantly only in the health assessment questionnaire (p=0.032). 3. Functional capacity Comparing the groups at baseline the exercise group had better knee- and hip flexion on the left hand side but it took them longer to complete the arm curl test. At study completion the exercise group was mostly favoured with regards to flexibility (significant p-values ranging between 0.001 – 0.049), strength (handgrip right p<0.001, leg strength p=0.035, arm curl test p=0.010, sit to stand test p=0.025) and aerobic fitness (1 mile walk test p<0.001 and VO2 max p=0.007). Changes within each group were assessed by Wilcoxon signed rank tests. The exercise groups showed significant changes for many parameters in the three categories, i.e. flexibility (8 of 18), strength (5 of 5), and aerobic fitness (4 of 8). The control group mostly deteriorated in flexibility, while their strength also improved, but not to the same extent as for the exercise group. Their aerobic fitness did not change. Discussion: In the first phase of this study, using standardised methods to measure short-term HRV, females with RA showed less variability compared to a healthy age- and sex matched control group. An inability of the autonomic nervous system to efficiently compensate to internal and external environmental changes may predispose RA patients to arrhythmias thereby increasing cardiovascular mortality. All 3 methods used showed the same outcome, implying decreased HRV and thus an increased risk for arrhythmias in RA patients. Evaluating the autonomic nervous system might be critical in planning management of RA. In the second phase study results indicated that twelve weeks of exercise intervention, had a positive effect on cardiac autonomic function as measured by short-term HRV, in females with RA. Several of the standing variables indicated improved vagal influence on the heart rate. Exercise can thus potentially be used as an instrument to improve cardiac health in a patient group known for increased cardiac morbidity. The exercise programme was also effective in decreasing perception of pain as well as disease activity in female RA patients. Given our findings it seems warranted to include physical exercise as part of the treatment prescription of patients with class I and II RA. Lastly this research has shown that regular, controlled exercise for RA patients with controlled disease can decrease joint stiffness and improve joint mobility, strength and aerobic capacity without exacerbating pain or disease activity. Also, if one observes the decline in the sedentary group for many parameters, it is important to note that this happened over a relative short time period and that even a small change may have a detrimental impact on the RA patient. The current report supports previous literature on autonomic impairment in patients suffering from RA as well as the meaningful positive effect of exercise on disease activity and functional capacity. It is the only study on the effect of an exercise intervention on the cardiac autonomic function of RA patients. Future research in this field should aim for larger study samples, longer intervention periods and perhaps add analysis of blood pressure variability to support results obtained by HRV analysis. / Thesis (MD)--University of Pretoria, 2012. / Internal Medicine / unrestricted

Despite a considerable progress in developing and testing psychosocial treatments to reduce youth anxiety disorders, much remains to learn about the relation between anxiety symptom reduction and change in youth functional impairment. The specific aims of this dissertation thus were to examine: (1) the relation between different levels of anxiety and youth functional impairment ratings; (2) incremental validity of the Children Global Assessment Scale (CGAS); (3) the mediating role of anxiety symptom reduction on youth functional impairment ratings; (4) the directionality of change between anxiety symptom reduction and youth functional impairment; (5) the moderating effects of youth age, sex, and ethnicity on the mediated relation between youth anxiety symptom reduction and change in functional impairment; and (6) an agreement (or lack thereof) between youths and their parents in their views of change in youth functional impairment vis-à-vis anxiety symptom reduction. The results were analyzed using archival data set acquired from 183 youths and their mothers. Research questions were tested using SPSS and structural equation modeling techniques in Mplus. The results supported the efficacy of psychosocial treatments to reduce the severity of youth anxiety symptoms and its associated functional impairment. Moreover, the results revealed that at posttreatment, youths who scored either low or medium on anxiety levels scored significantly lower on impairment, than youths who scored high on anxiety levels. Incremental validity of the CGAS was also revealed across all assessment points and informants in my sample. In addition, the results indicated the mediating role of anxiety symptom reduction with respect to change in youth functional impairment at posttest, regardless of the youth’s age, sex, and ethnicity. No significant findings were observed with regard to the bidirectionality and an informant disagreement vis-à-vis the relation between anxiety symptom reduction and change in functional impairment. The study’s main contributions and potential implications on theoretical, empirical, and clinical levels are further discussed. The emphasis is on the need to enhance existing evidence-based treatments and develop innovative treatment models that will not only reduce youth’s symptoms (such anxiety) but also evoke genuine and palpable improvements in lives of youths and their families.

An examination of the composing processes of blind writers was conducted to determine the strategies used by these composers. Two individuals blind from birth and two persons blinded later in life participated in the study. Using participant observation and stimulated recall, the researcher examined the composing processes of these subjects. Each individual participated in four writing sessions and used the compose-aloud technique where by the composer repeats orally any thoughts that occur during writing. In addition, an interview was conducted with each participant which provided a writing history, attitude toward writing, and composing strategies. Results of the research indicated that blind writers use the same basic processes of writing as reported for sighted writers. Blind writers in this study did not make written plans prior to writing and spent between one and four minutes in prewriting. Planning was an ongoing feature of the composing process. The writers in this study demonstrated the recursive feature of composing. Rescanning was a continual part of their composing sessions . Three of the subjects reported using rescanning for planning and editing. One individual reported using rescanning for editing only. Some differences were found in the blind writers as compared to the research on sighted composers. First, blind writers averaged 39 rescansions per essay, while research on the sighted reported approximately six rescansions in each session. The difference in the number of rescansions between these two groups may be a result of the blind writer's need to locate position on the page or from a difference in short-term memory in the sighted and non-sighted. Writers blind from birth demonstrated a difference in the ability to organize an essay in the extensive mode. These composers made no global plans. Rather they allowed the writings to unfold as they wrote. This research would indicate that sight may have a role in composing.