Falls and fallinjuries are very common in peoples own homes in various institutions. Hospital inpatients often fall during daytime in connection with their visit to the toilet. Visual impairment such as cataract, glaucoma, macular degeneration and diabetic retinopathy can cause falls. The purpose of this study was to examine patient´s records where falls and fallinjuries were documented at an emergency clinic and to examine if they were registered to visual impairment. The records from 68 hospital inpatients from the age of 65 years and older who did fall during the year of 2004, were examined. In spite of different preventive actions that were taken, falls and fallinjuries often happened when the patients were on the move and left on their own. The number of patients who have any visual impairment and a record at an eye clinic, were 41. Thirtytwo of the patients who have any visual impairment did fall between 18:00 - 06:00. In the emergency clinics records, there were no records about how the patients experienced their visual ability. Objective and subjective visual impairment were only registered in the eye clinics records. When risk assessments are made, visual impairment should be considered as a riskfactor for falling. It should be considered as an independent riskfactor as well as in addition with other riskfactors. When the patient gets to the ward, the nurse should ask the patient and register if he or she has any visual impairment. The nurse can therefore use strategies to plan the caring and prevent falls and fallinjuries during the patients stay at the emergency clinic. Visual impairment as well as the natural ageing affects the visual ability and therefore the wards environment should contain sharp colours and bright lightening.

Introduction The present study explored the nature of the semantic deterioration normally displayed in the course of Alzheimer’s disease (AD). The aim was to disentangle the extent to which semantic memory problems in patients with AD are best characterized as loss of semantic knowledge rather than difficulties in accessing semantic knowledge. Method A longitudinal approach was applied. The same semantic tests as well as same items were used across three test occasions a year apart. Twelve Alzheimer patients and 20 matched control subjects, out of a total of 25 cases in each group, remained at the final test occasion. Results and Conclusions Alzheimer patients were impaired in all the semantic tasks as compared to the matched comparison group. A progressing deterioration was evident during the study period. Our findings suggest that semantic impairment is mainly due to loss of information rather than problems in accessing semantic information.

Denne masteroppgaven fokuserer på særtrekk eller vanskeområder ved CVI som kan komplisere sosial samhandling med jevnaldrende. Utgangspunktet for undersøkelsen har vært en antagelse om at noen særtrekk som kan vise seg ved CVI, kan komplisere sosial samhandling med jevnaldrende. Undersøkelser viser at blinde og svaksynte kan ha utfordringer knyttet til sosial samhandling, og at de ofte føler seg sosialt isolerte (McAlpine & Moore, 1995; Huurre & Aro, 1998; Huurre & Komulainen, 1999). Kanskje er det også slik for barn med CVI? Mestring av sosial samhandling er viktig for å bli bedre sosialt integrert, og for å få anledning til å tilegne seg sosial kompetanse. God sosial kompetanse og skolefaglige prestasjoner henger sammen (Utdanningsdirektoratet udatert, a). Det er derfor viktig at elevene trives og kjenner seg sosialt integrert i klassen og på skolen. Masteroppgaven tar utgangspunkt i en kvalitativ undersøkelse, hvor lærere og foreldre til tre barn med CVI er intervjuet om barnas utfordringer knyttet til sosial samhandling. Datainnsamlingen er gjort gjennom semistrukturerte intervjuer våren 2012. Intervjuene ble tatt opp som lydfiler, og er i etterkant transkribert fra lydfiler til tekst. Gjennom undersøkelsen kommer det frem at alle tre barna har utfordringer knyttet til sosial samhandling, dog i ulik grad. De har vansker med identifikasjon av kjente, med tolkning av ansiktsuttrykk og non-verbal kommunikasjon, samt orienteringsvansker. Det er sannsynlig at dette bidrar til å gjøre samhandling med andre vanskelig. Det er imidlertid umulig å si at det er disse særtrekkene ved CVI alene som forårsaker samhandlingsvanskene foreldre og lærere rapporterer om, men det er ikke usannsynlig at trekkene kompliserer samhandling med andre mennesker. Den store utfordringen er å finne ut hva vi skal gjøre for å tilrettelegge godt for denne gruppen barn, og ikke minst hvem som har ansvaret for å gi dem den hjelpen de trenger.

In a phonological assessment, the aim is to obtain systematic and reliable data of a child's speech output, which can then serve as a basis for a decision on an appropriate intervention (Wolk & Meisler, 1998). Whether phonological assessment should be derived from an analysis of picture-naming or a conversation with the child, and whether the two methods for elicitation generate equivalent results, has been debated among clinicians and researchers for an extended time (Masterson, Bernhardt & Hofheintz, 2005). The aim of the present study was to compare two methods of speech elicitation for phonological assessment: spontaneous conversation and picture-naming, respectively. In the study, the procedures have been used when assessing children with phonological disorders as well as children with typical language development. The results are presented using two levels of phonological analysis; degree of phonological impairment, in terms of percentage of phonemes correct (PPC), and type of phonological impairment, in terms of phonological simplification processes. Eighteen (18) children participated in the study, nine (9) with phonological impairment (age 3;10 – 5;11), and nine with typical phonologic development (age 3;2 – 4;6). No significant differences were found regarding the percentage of phonemes correct between the two elicitation methods, neither for the group of children with phonological impairment, nor for the group of children with typical phonological development. Thus, the degree of speech difficulties was the same regardless of elicitation method. In assessing the type of impairment, however, a comparison between the sensitivity and the specificity obtained in the two tests indicate that there is a difference in how well the two elicitation methods intercept the phonological simplification processes. In the two elicitating methods, exactly the same processes could not be found in the speech of any child. The discussion includes the consequences of word structure, position and context of phonemes in the different speech samples. Furthermore, advantages and disadvantages of using the different elicitation methods in phonological assessment are discussed. The present study contributes to an increased knowledge about the ability to capture phonological problems sing picture-naming and conversational speech samples, respectively, in assessing a child’s speech. Furthermore, the study presents input to the on-going debate on phonological assessment, and may contribute to reflectance when selecting a clinical assessment tool.

The Grand River watershed is the largest watershed in southern Ontario, and is expected to see major development and urban densification over the next 20 years. An expected 57% increase in population over the next two decades in urban centers such as Kitchener – Waterloo, Cambridge, Guelph and Brantford means an added load on the existing 30 wastewater treatment facilities serving the watershed. A subsequent increase in the amount of average flow and effluent released into the Grand River via the Waterloo and Kitchener wastewater treatment plants is also expected. The Waterloo and Kitchener wastewater plants are both secondary treatment plants, although neither plant currently nitrifies the wastewater prior to release. As a result, increased concentrations of ammonia and nitrate are found downstream of the treatment plant outfalls. Compounds introduced into the Grand River via the discharge of wastewater effluent can have impacts on resident biota such as fish. Disruption of the normal function of endocrine systems in fish has been associated with municipal effluents as well as chemicals that have been detected in these effluents. One of the major responses has been the presence of intersex (oocytes in testes) in fish downstream of the wastewater plant outfalls at sites around the globe. The research in this thesis examined resident fish for the variability and extent of intersex condition by adapting a new fragmented testis technique. Biomarkers of response such as relative gonad weight (GSI), relative liver weight (LSI) and condition (K) were also measured. The study focused on the Rainbow Darter (Etheostoma caeruleum) a dominant benthivorous fish species in the riffle habitats in the Grand River. An increased proportion of male Rainbow Darters sampled immediately downstream of the Waterloo outfall had a gonad lobe containing at least one testis-oocyte. The number of Rainbow Darter with more severe intersex (10-99 oocytes/lobe) also increased immediately downstream of the Waterloo outfall. A much more dramatic expression of intersex proportion and severity (>100 oocytes per testis lobe) was observed further downstream, below the Kitchener outfall. These patterns in intersex presence and severity were also observed in two other species collected at a subset of the original sites. Although there were minimal changes in GSI, LSI and K below the Waterloo outfall, differences were observed downstream of the Kitchener wastewater effluent outfall. Female Rainbow Darter downstream of the Kitchener outfall showed significant decreases in GSI and LSI, and increases in K. Male Rainbow Darter GSI and LSI data across sites did not express changes that coincided with MWWE outfalls, although small increases in condition were observed. These patterns of intersex and organism level responses suggest that the assimilation of wastewater effluent into natural receiving environments may have impacts on endocrine function and energy use and allocation in wild fish.

Aquatic receiving environments have long been used to dilute municipal wastewater effluents (MWWE) which are the largest discharge by volume into the aquatic environment in Canada. These treated effluents are a complex mixture of environmental contaminants that includes natural and synthetic hormones, pharmaceuticals, industrial chemicals, nutrients and ammonia. Discharge of MWWE may lead to serious problems in aquatic environments such as eutrophication, hypoxia as well as increased occurrence of disease and toxicity in resident aquatic biota. Reproductive impairment in fish has also been widely reported in association with exposure to wastewaters. Recently, concerns have been raised about the potential for municipal effluents to cause endocrine disruption in fish and other organisms. The effects of MWWE on fish and fish populations in Canada are currently poorly understood. The overall objective of this thesis is to contrast the impact of MWWE discharged into two Canadian rivers on sentinel fish species across levels of biological organization ranging from biochemical responses to changes at the fish community level. Results from these studies support the development of robust effects-based biological monitoring approaches to assess the effectiveness of regulations and remedial actions for minimizing the effects of MWWE. Understanding the temporal changes in physiological and reproductive parameters across the annual cycle of a sentinel species is necessary to optimize biomonitoring programs. The annual variability in terms of survival, reproduction and energy storage in the Greenside Darter (Etheostoma blennioides), a potential sentinel species for the Grand River, Ontario, was documented at a reference site across two years. Variation in energy storage and reproductive development indicated by somatic indices (i.e., relative organ size) and steroid production suggest that biomonitoring can be optimized for this species by sampling in late fall or early spring (pre-spawning). With this new knowledge, field studies conducted with small bodied species, including Rainbow Darter (E. caeruleum), Brook Stickleback (Culaea inconstans) and Fathead Minnow (Pimephales promelas) have demonstrated that, when sampled during the appropriate season (e.g., pre-spawning), they can be used as effective biomonitoring tools to detect fish responses associated with exposure to MWWEs. Two sentinel fish species, Rainbow Darter and Greenside Darter, were then used to examine the impact of two MWWE discharges on fish in the Grand River, Ontario, relative to reference sites in two seasons (fall and early spring). Fish responses, in terms of energy storage (condition factor, liver size), energy utilization (gonadosomatic indices) and reproduction (in vitro sex steroid production, cellular development and intersex) were assessed at each site. Both sentinel species were longer and heavier downstream of the wastewater outfalls. However, these larger fish did not demonstrate consistent increases in condition and liver somatic indices. MWWE-exposed male Rainbow and Greenside Darters had impaired capacity to produce androgens in vitro, lower gonadosomatic indices and altered sperm cell staging. Exposed female fish also had impaired capacity to produce estrogens in vitro, however, they did not demonstrate differences in oocyte development. Male Rainbow and Greenside Darters collected downstream of both MWWE discharges showed increased incidence of intersex (33 - 100%) in contrast to very low occurrences of this condition in upstream agricultural and urban reference sites. This increased incidence of intersex coincided with reductions in gonadosomatic indices and capacity to produce steroids, demonstrating the ability of MWWE to alter the reproductive systems of these fish. The fish communities downstream of the the MWWE outfalls demonstrated differences in abundance, diversity, and species composition when compared to reference sites. MWWE exposed sites had few of the darter species that dominate the fish community at reference sites. More mobile fish species such as suckers (Catostomidae spp.) and sunfish (Centrarchidae spp.) were more common downstream of the outfalls, with occurances becoming more pronounced downstream of the second sewage discharge. Wascana Creek, Saskatchewan, downstream of the wastewater treatment plant for the City of Regina can be up to 100% treated municipal wastewater. Brook Stickleback and Fathead Minnow exhibited delayed spawning and altered gonadal development downstream of the wastewater outfall. Exposed male Fathead Minnows were feminized, having lower expression of secondary sexual characteristics (i.e., loss of nuptial tubercles, dorsal pad, and dorsal fin dot) and induction of the female egg-yolk precursor protein, vitellogenin. Fathead Minnows also showed cellular damage to the gills and kidneys. These responses indicate exposure to a variety of environmental contaminants in the effluent such as ammonia as well as endocrine disruptors. The potential effect of MWWE discharges in these two Canadian watersheds on fish responses was demonstrated across various levels of biological organization including reduced sex steroid production, altered gonadal development, reduction in gonadosomatic indices, delayed spawning, and changes in fish assemblages. An effects-based monitoring approach using sentinel species can be successfully applied to detect changes associated with MWWE outfalls, as long as sampling of sentinel species is conducted during optimal time periods (i.e., when somatic indices are maximized and variability among individuals is minimized). MWWE can impair the reproductive potential of fish beyond a threshold where impacts are expressed at higher levels of organization such as populations or communities. It is essential to make mechanistic linkages between responses at different levels to determine the overall potential impact of effluents on fish. The collection of responses across multiple levels of biological organization can complement and support development of biomonitoring approaches that are focused at the population and community levels such as those being proposed for MWWE in Canada.

The aim of this study is to examine schoolchildren’s knowledge about malaria in Babati, Tanzania. It will also examine the impact of the disease on children’s education and if schoolchildren in Babati have the possibility to act as health change agents and be a part of combating the high malaria prevalence. The thesis is based on a qualitative method with secondary information retrieved from scientific articles and previous studies. It is also based on empirical data collected during a field study in Babati, Tanzania in 2012. Both structured and semi structured interviews were made with schoolchildren, teachers and health care personnel. The studies showed that malaria affects children’s education primarily through absence, but can also cause cognitive impairment as well as neurological damage. The interviews revealed the students to have varying knowledge about the disease and it also revealed that children only have the ability to act as health change agents if teachers with help of the government, the hospital or an NGO are willing to cooperate and provide the students with information.

Neurodegenerative diseases, such as multiple sclerosis (MS), are adversely affected by both stress and inflammation. Theiler's murine encephalomyelitis virus infection is an excellent animal model of MS, allowing examination of central nervous system inflammation during the acute phase of infection. Social disruption stress exacerbates acute Theiler's virus infection. Both social disruption stress and Theiler's virus infection elevate the proinflammatory cytokine, Interleukin-6 (IL-6). The current study examined the necessity and sufficiency of IL-6 in mediating the negative effects of social disruption stress in acute Theiler's virus infection. Experiment 1 blocked IL-6 function with a neutralizing antibody administered simultaneously with social disruption stress. All mice were then infected, and measures of illness, motor impairment and physiological signs of disease were collected up to 21 d postinfection. Experiment 2 administered exogenous IL-6 for one week (replacing social disruption with the cytokine treatment), followed by infection. Measures identical to those collected in Experiment 1 were collected for up to 21 d postinfection. Results indicate that IL-6 is necessary for the development of the sickness, motor impairment, and immunological effects of social stress in acute Theiler's virus infection. In contrast, IL-6 alone can induce some, but not all, of the sickness behavior exacerbations, and was not sufficient for the development of either motor impairment or immunological effects previously associated with social disruption stress. These results have many important implications for further research in the effects of social stress on Theiler's virus infection, as well as clinical implications for both MS and other inflammatory mediated diseases, such as Alzheimer's disease and Parkinson's disease.

This thesis examines the various approaches which have been taken to investigate the concrete/abstract word distinction both in normal subjects and in patients who, as a result of brain damage, have an impairment of lexical semantic representations. The nature of the definition task as a tool for assessing the semantic representations of concrete and abstract terms was examined. It was found that definitions for abstract words differed from those of concrete words only in style, not in semantic content. The metalinguistic demands of the definition task therefore make it inappropriate for assessing the semantic representations of concrete and abstract terms in patients with any form of language impairment. The performance of four patients with semantic impairments was examined using a variety of tasks designed to assess concrete and abstract word comprehension. While some of the data can be accommodated within the framework of several theories, no single theory can adequately account for the patterns of performance in all four patients. An alternative model of semantic memory is therefore proposed in which concreteness and frequency interact at the semantic level. Jones' Ease of Predication Hypothesis, which states that the difference between concrete and abstract terms can be explained in terms of disproportionate numbers of underlying semantic features (or "predicates") was also investigated. It was found that the ease of predication variable does not accurately reflect either predicate or feature distributions, and is simply another index of concreteness. As such, the validity of this concept as the basis of theories of semantic representation should be questioned. Models based on the assumption of a "richer" semantic representation for concrete words (e.g.: Plaut & Shallice, 1993) are therefore undermined by these data. The possibility that concrete and abstract concepts can be accessed from their most salient predicates and/or features was examined in a series of semantic priming experiments. It was concluded that it is not possible to prime either concrete or abstract concepts from their constituent parts. Significant facilitation only occurred for items in which the prime and target were synonymous and therefore map onto concepts which share almost identical semantic representations. In summary, it is apparent that no current theory of semantic representation can adequately account for the range of findings with regard to the concrete/abstract word distinction. The most plausible account is some form of distributed connectionist model. However, such models are based on unsubstantiated assumptions about the nature of abstract word representations in the semantic network. Alternative proposals are therefore discussed.

The Saint Louis University Mental Status (SLUMS) Examination is a relatively new brief cognitive screening measure developed for use with veterans. To date, there has been a paucity of research on its psychometric properties. Using a sample of 148 male veterans referred to a VA Mild Cognitive Impairment (MCI) Clinic for evaluation, the SLUMS’ ability to discriminate between MCI versus other diagnoses or no diagnosis was compared to results from a more comprehensive neuropsychological battery. Approximately 51% of the sample was diagnosed with MCI, 16% with Major Depressive Disorder (MDD), 17% did not meet criteria for a diagnosis, and 16% were given some other DSM-IV-TR diagnosis. The SLUMS demonstrated poor internal consistency (Cronbach’s alpha = .57), but scores were significantly correlated with scores on every neuropsychological measure, except for Trails B. Diagnostic discriminability was comparable to that of the more time intensive neuropsychological battery for discriminating between MCI and no diagnosis, and MCI and MDD. In the current sample, a cutoff score of 25 was optimal for discriminating between MCI and no diagnosis, whereas a slightly lower cutoff score of 24 is recommended for discriminating between MCI and those with MDD. Diagnostic indicators were poor for the SLUMS and the battery when discriminating between MCI and a heterogeneous group of other disorders. Possible reasons for low reliability in such a screening measure in the context of convergent validity are discussed. It is concluded that the SLUMS may be a viable brief cognitive screening measure in such veteran populations, particularly when discriminating between MCI and MDD; however, additional studies should be completed to evaluate other forms of consistency, such as test-retest reliability.