No / PURPOSE: Epidemiologic research has shown that multifocal spectacle wearers (bifocal and progressive addition lenses [PALs]) are more than twice as likely to fall than are nonmultifocal spectacle wearers, with this risk further increasing when negotiating stairs. The present study investigated whether step and stair descent safety is improved by using single-vision distance lenses. METHODS: From a stationary standing position on top of a block, 20 long-term multifocal wearers stepped down (from different block heights) onto a lower level wearing bifocal, progressive addition, or single-vision distance lenses. RESULTS: Use of single-vision distance spectacles led to an increased single-limb support time, a reduced ankle and knee angle and vertical center-of-mass velocity at contact with the lower level, and a reduced ankle angular velocity and vertical center-of-mass velocity during initial landing (P < 0.03). These findings indicate that landing occurred in a more controlled manner when the subjects wore single-vision distance spectacles, rather than tending to "drop" onto the lower level as occurred when wearing bifocals or PALs. CONCLUSIONS: Use of single-vision distance spectacles led to improvements in landing control, consistent with individuals' being more certain regarding the precise height of the lower floor level. This enhanced control was attributed to having a view of the foot, step edge, and immediate floor area that was not blurred, magnified, or doubled and that did not suffer from image jump or peripheral distortions. These findings provide further evidence that use of single-vision distance lenses in everyday locomotion may be advantageous for elderly multifocal wearers who have a high risk of falling.

No / INTRODUCTION: Care home residents are at particular risk from medication errors, and our objective was to determine the prevalence and potential harm of prescribing, monitoring, dispensing and administration errors in UK care homes, and to identify their causes. METHODS: A prospective study of a random sample of residents within a purposive sample of homes in three areas. Errors were identified by patient interview, note review, observation of practice and examination of dispensed items. Causes were understood by observation and from theoretically framed interviews with home staff, doctors and pharmacists. Potential harm from errors was assessed by expert judgement. RESULTS: The 256 residents recruited in 55 homes were taking a mean of 8.0 medicines. One hundred and seventy-eight (69.5%) of residents had one or more errors. The mean number per resident was 1.9 errors. The mean potential harm from prescribing, monitoring, administration and dispensing errors was 2.6, 3.7, 2.1 and 2.0 (0 = no harm, 10 = death), respectively. Contributing factors from the 89 interviews included doctors who were not accessible, did not know the residents and lacked information in homes when prescribing; home staff's high workload, lack of medicines training and drug round interruptions; lack of team work among home, practice and pharmacy; inefficient ordering systems; inaccurate medicine records and prevalence of verbal communication; and difficult to fill (and check) medication administration systems. CONCLUSIONS: That two thirds of residents were exposed to one or more medication errors is of concern. The will to improve exists, but there is a lack of overall responsibility. Action is required from all concerned.

Yes / The NHS spends billions of pounds annually on repeat prescriptions in primary care, but data on their extent and use is out of date. Understanding the scale of repeat prescribing and for whom it is prescribed is important for the NHS to plan services and develop policies to improve patient care. Anonymous data on prescription numbers and practice population demographics was obtained from GP computer systems in a large urban area.Searches were conducted in November 2011 to identify the numbers of repeat items listed on individuals' repeat lists by sex and age.The proportion of all prescription items issued as repeats was identified by conducting searches on items issued as repeat and acute prescriptions. In the year of study 4,453,225 items were issued of which 3,444,769 (77%) were repeats (mean 13 items per patient/annum) and 1,008,456 (23%) acute prescriptions (mean 3.9 items per patient per annum). The mean number of repeat Items per patient was 1.87 (range 0.45 ages 0-9 years; 7.1 ages 80-89 years). At least one repeat medicine was prescribed to 43% of the population (range 20% for ages 0-9; over 75% for ages 60+). A significant proportion of the population receive repeat prescriptions and the proportion increases with age. Whilst the proportion of repeat items to acute items has remained unchanged over the last two decades the number of repeat prescriptions items issued has doubled (from 5.8 to 13.3 items/patient/annum). This has implications for general practice workload, patient convenience, NHS costs and risk.

No / The use of biomarkers of early genetic effects, predictive for cancer, such as micronuclei (MN) in lymphocytes, may help to investigate the association between diet and cancer. We hypothesised that the presence of mutagens in the diet may increase MN formation. A 'pooled' standardised analysis was performed by applying the same experimental protocol for the cytokinesis block micronucleus assay in 625 young healthy women after delivery from five European study populations (Greece, Denmark, UK, Spain and Norway). We assessed MN frequencies in mono- and binucleated T-lymphocytes (MNMONO and MNBN) and the cytokinesis blocked proliferation index using a semi-automated image analysis system. Food frequency questionnaires (FFQs) were used to estimate intake of fatty acids and a broad range of immunotoxic and genotoxic/carcinogenic compounds through the diet. Pooled difference based on delivery type revealed higher MNMONO frequencies in caesarean than in vaginal delivery (P = 0.002). Statistical analysis showed a decrease in MNMONO frequencies with increasing calculated omega-6 PUFA concentrations and a decrease in MNBN frequencies with increasing calculated omega-3 PUFA concentrations. The expected toxic compounds estimated by FFQs were not associated with MN formation in mothers after delivery. In pregnant women, an omega-3 and -6 rich diet estimated by FFQ is associated with lower MN formation during pregnancy and delivery.

Strong opposing views exist with the popularly held notion that a midlife crisis is a normative phenomenon whilst a number of international researchers assert that the evidence shows the opposite to be true. It is nevertheless acknowledged that the psychology of midlife was one of the least researched areas internationally until the 1990s when certain aspects of midlife were investigated in the United States. Findings from these studies did not include the impact of a multiplicity of factors in combination at midlife. A new approach to the study of the life course using a combination model taking account of the influence of societal structures as well as the interplay between parts has been suggested. Such an approach to midlife transition and crisis research is not known to have taken place in South Africa or internationally. A conceptual model of midlife transition and crisis was constructed from known research and relevant literature and tested using a sample of 220 individuals aged between 30 and 65. The validity of the model was established and a methodologically sound measuring instrument was validated as a more accurate measurement of midlife crisis than a self-described experience. Two factors provisionally named stagnation and death and aging anxiety were found to exist. A true midlife crisis was experienced by a minority of individuals (IS percent) but an additional 31 percent had a troublesome but manageable experience. A neurotic disposition. the absence of good parental relationships, and the use of inappropriate coping skills such as wishful thinking were in combination related to high scores on the midlife crisis scales. A qualitative study revealed that over 90 percent of respondents were able to define a midlife crisis accurately although they tended to overstate the occurrence thereof. This replicates the research findings in the United States. Stagnation was experienced more acutely by individuals aged between 40 and 50 years whilst death and aging anxiety was the primary experience for those over 50 years. The validated conceptual model and measuring instruments can be used by therapists and coaches to facilitate the counselling or coaching process with clients experiencing midlife crisis. / Psychology / D. Comm. (Consulting Psychology)

Strong opposing views exist with the popularly held notion that a midlife crisis is a normative phenomenon whilst a number of international researchers assert that the evidence shows the opposite to be true. It is nevertheless acknowledged that the psychology of midlife was one of the least researched areas internationally until the 1990s when certain aspects of midlife were investigated in the United States. Findings from these studies did not include the impact of a multiplicity of factors in combination at midlife. A new approach to the study of the life course using a combination model taking account of the influence of societal structures as well as the interplay between parts has been suggested. Such an approach to midlife transition and crisis research is not known to have taken place in South Africa or internationally. A conceptual model of midlife transition and crisis was constructed from known research and relevant literature and tested using a sample of 220 individuals aged between 30 and 65. The validity of the model was established and a methodologically sound measuring instrument was validated as a more accurate measurement of midlife crisis than a self-described experience. Two factors provisionally named stagnation and death and aging anxiety were found to exist. A true midlife crisis was experienced by a minority of individuals (IS percent) but an additional 31 percent had a troublesome but manageable experience. A neurotic disposition. the absence of good parental relationships, and the use of inappropriate coping skills such as wishful thinking were in combination related to high scores on the midlife crisis scales. A qualitative study revealed that over 90 percent of respondents were able to define a midlife crisis accurately although they tended to overstate the occurrence thereof. This replicates the research findings in the United States. Stagnation was experienced more acutely by individuals aged between 40 and 50 years whilst death and aging anxiety was the primary experience for those over 50 years. The validated conceptual model and measuring instruments can be used by therapists and coaches to facilitate the counselling or coaching process with clients experiencing midlife crisis. / Psychology / D. Comm. (Consulting Psychology)

Afrikaans text / Hierdie studie het ten doel gehad om die Opvoedkundig-Sielkundige Relasieteorie te gebruik in die identifisering van 'n middeljarekrisis by middeljariges. Met die oog hierop is daar hoofsaaklik op die volgende gekonsentreer: Die middeljare as fenomeen, met spesifieke verwysing na die belewing van krisis­ elemente tydens hierdie lewensfase, wat op 'n middeljarekrisis sou kon dui Die gebruik van die Opvoedkundig-Sielkundige Relasieteorie as gefundeerde teoretiese vertrekpunt in die identifisering van 'n middeljarekrisis Die daarstel van •n diagnostiese vraelys binne die raamwerk van die Opvoedkundig- Sielkundige Relasieteorie wat in die empiriese studie gebruik is om 'n middeljarekrisis te identifiseer Daar is bevind dat, aJhoewel nie aile middeljariges 'n krisistydperk ervaar nie, daar tien verskillende krisis-elemente is wat op 'n middeljarekrisis sou kon dui. 'n Diagnostiese vraelys is in terme van die Opvoedkundig-Sielkundige Relasieteorie veroperasionaliseer, en gebruik in die identifisering van 'n middeljarekrisis. / The aim of this study was to use the Edu-Psychological Relation Theory in the identification of a midlife crisis in middle aged persons. The researcher concentrated on the following main aspects: The middle years as phenomenon, with specific reference to the experience of crisis - elements during this life phase, which could lead to a crisis The use of the Edu-Psychological Relation Theory as well-grounded theoretical point of departure in the identification of a midlife crisis The compilation of a diagnostic questionnaireusing the Edu-Psychological Relation Theory as framework, which was used in the empirical study to identify a midlife crisis It was found that, although not all middle aged persons experience a crisis during this time, there are ten different crisis elements which could indicate a midlife crisis. A diagnostic questionnaire was operationalised in terms of the Edu-Psychological Relation Theory, and used in the identification of a midlife crisis. / Psychology of Education / M. Ed. (Voorligting)

Syftet med denna retrospektiva kvalitativa studie är att öka kunskapen om tre systrars upplevelse av sina relationers utveckling före och efter båda föräldrarnas död. Som forskningsdesign valdes en kvalitativ metod. Två syskongrupper om tre systrar i medelåldern 49-62 år intervjuades. Datamaterialet analyserades med empirisk tematisk analys. I resultatet framträdde en struktur med fyra olika tidsintervall med femton teman. Resultaten visar att trots de oerhört starka anknytningarna av dysfunktionell natur i ursprungsfamiljerna får systrarna syn på varandra när föräldrarna dör. Syskonrelationerna har kommit i skymundan av föräldrarnas närvaro och deras problem. Det har påverkat syskonrelationerna. Relationerna mellan systrarna och rollerna förändrades i processen före och efter föräldrarnas död och mognar till något annat. Detta går som en röd tråd genom hela materialet; att existera i tillvaron, syskonrelationer omprövas och detta leder till närhet, autonomi och differentiering, en acceptans att alla är olika i triaden som vägleder dem till att värna om varandra än mer i medelåldern. / The aim of this retrospective qualitative study is to increase knowledge about three sisters' experience of the development of their relationships before and after both parents death. A qualitative research method was chosen. Two sibling groups of three sisters in middle age 49-62 years were interviewed. The data were analyzed with empirical thematic analysis. The result showed a structure with four different time intervals with fifteen themes. Despite the extremely strong dysfunctional nature of the relations in their origin families the sisters caught sight of each other when the parents died. The sibling relationships have been overshadowed by the parents' presence and their problems. Relationships and roles changed in the process before and after parental death between the sisters and matured into something else. This runs as a thread throughout the material; to exist in life, sibling relationships are reviewed, and it leads to intimacy, autonomy and differentiation, an acceptance that everyone is different in the triad that guides them to protect each other even more in middle age.

Previous studies have reported that the ageing method of Suchey-Brooks (pubic bone) and some of the features applied by Lovejoy et al. and Buckberry-Chamberlain (auricular surface) can be confidently performed on 3D visualizations from CT-scans. In this study, seven observers applied the Suchey-Brooks and the Buckberry-Chamberlain methods on 3D visualizations based on CT-scans and, for the first time, on 3D visualizations from laser scans. We examined how the bone features can be evaluated on 3D visualizations and whether the different modalities (direct observations of bones, 3D visualization from CT-scan and from laser scans) are alike to different observers. We found the best inter-observer agreement for the bones versus 3D visualizations, with the highest values for the auricular surface. Between the 3D modalities, less variability was obtained for the 3D laser visualizations. Fair inter-observer agreement was obtained in the evaluation of the pubic bone in all modalities. In 3D visualizations of the auricular surfaces, transverse organization and apical changes could be evaluated, although with high inter-observer variability; micro-, macroporosity and surface texture were very difficult to score. In conclusion, these methods were developed for dry bones, where they perform best. The Suchey-Brooks method can be applied on 3D visualizations from CT or laser, but with less accuracy than on dry bone. The Buckberry-Chamberlain method should be modified before application on 3D visualizations. Future investigation should focus on a different approach and different features: 3D laser scans could be analyzed with mathematical approaches and sub-surface features should be explored on CT-scans.

Die Hypothese, dass das AP Clozapin, ebenso wie dessen Metabolit NDMC die Produktion von TxA2 beeinfluss könnten, stellten wir nach ausführlicher Literaturrecherche auf. Letztere zeigte, dass bereits beim ersten AP CPZ eine reduzierende Wirkung auf die TxA2-Produktion nachgewiesen werden konnte. TxA2 und die Aktivierung seines Rezeptors modulieren Vasokonstriktion und Thrombozytenaggregation. Weiterhin nehmen sie Einfluss auf dopaminerge und serotonerge Signalwege. In der Pathophysiologie der Schizophrenie spielen eben diese eine bedeutende Rolle und stellen somit Zielstrukturen für APs dar. Um die Konzentration von TxB2, dem Metaboliten des instabilen Moleküls TxA2 in stimulierten und unstimulierten Blutproben 10 gesunder Probandinnen zu messen, verwendeten wir ein Vollblutverfahren. Um signifikante Ergebnisse zu erhalten, stimulierten wir die Proben mit TSST-1 oder dem monoklonalen Antikörper OKT3 (Muromonab-CD3), der gegen das Oberflächenantigen CD3 gerichtet ist, kombiniert mit dem monoklonalen Antikörper 5C3, der mit dem Protein CD40 interagiert und es stimuliert. Weiterhin versetzten wir das Blut mit den APs CPZ, Clozapin oder NDMC in einer von vier verschiedenen Konzentrationen. Außerdem wurden die Thromboxanspiegel im Blut ohne Zusatz von APs unter verschiedenen Stimulationskonditionen gemessen. Durch den Zusatz von Clozapin in den verschiedenen Konzentrationen kam es zu einer signifikanten (p<0.05) Verringerung der TxB2-Produktion in den mit TSST-1 und ebenso in den mit OKT3/5C3 versetzen Proben, was wir im Rahmen unserer Studie feststellen konnten. Weiterhin konnten wir zeigen, dass CPZ in sehr niedriger Konzentration die TxB2-Spiegel im unstimulierten und im mit TSST-1 stimulierten Blut reduziert. Daraus lässt sich schlussfolgern, dass Clozapin, NDMC und CPZ auch über eine Modulation der TxA2- und TxB2-Produktion das Neurotransmittersystem beeinflussen könnten. Auch typische Nebenwirkungen der AP, wie zum Beispiel die orthostatische Hypotension, könnten aus den Veränderungen der TxA2- und TxB2-Konzentrationen resultieren.