Stroke in the young

CITATION: De Villiers, R. V. P., February, E. & De Villiers, M. L. 2003. Stroke in the young. South African Medical Journal, 93(11):836-837.The original publication is available at http://www.samj.org.za[No abstract available]Publisher’s versio

An approach to balance problems and falls in elderly persons

Gait instability and falls are common in elderly persons and have devastating consequences, with substantial morbidity and mortality. Furthermore, they are a precipitant for functional decline, increasing frailty and institutionalisation. The rate of falls and severity of complications increase with age and frailty. A consequence of falls with or without injury is that at least a third of persons develop a fear of falling, which leads to functional decline and a progressive decline in gait. The causes of falls in elderly persons are multifactorial and include physiological changes of ageing, frailty, pathologies, and environmental and situational factors. Maintaining postural control requires a complex integration of sensory input, central processing, motor co-ordination and musculoskeletal function, which decrease with ageing. This change, combined with sarcopenia, leads to slowed and weakened postural control and muscle responses, resulting in gait instability and falls.The assessment and management of a patient who is at risk of falls or who has fallen require a multidisciplinary approach to identify and address factors contributing to the fall. The assessment, which includes history, physical examination, and evaluation of gait, postural control and mental function, is aimed at identifying situational and associated factors surrounding a fall, intrinsic impairments in gait or pathologies that increase the risk of falls. The components of the assessment comprise a full medical evaluation for pathologies, including vision, medication review (including over-the-counter medication) with regard to polypharmacy and high-risk medications, psychogeriatric review, functional status (instrumental activities of daily living (IADLs) and activities of daily living (ADLs)), functional assessment of gait and balance, and assessment of environmental hazards in the home. Laboratory investigations are guided by clinical suspicions or diagnoses arising from the medical assessment and screening for common conditions that may increase the risk of falls.Management and prevention of falls focus on maintaining mobility and balance, and identifying those at risk of a fall for multidisciplinary assessment and intervention. Intervention to reduce the risk of subsequent falls is targeted at modification of the contributory factors. Intervention includes management of underlying pathologies, strength and balance training by a physiotherapist, assessment and modification of environmental hazards in the home by an occupational therapist, medication review and rationalisation of high-risk medications and polypharmacy, and supplementation of vitamin D where indicated

Pneumonia in the elderly - diagnosis and treatment in general practice

Pneumonia is common in the elderly and clinical manifestations are frequently atypical. Pneumonia should be considered in any older person presenting with falls, confusion, incontinence, worsening comorbidities or a deterioration in functional status. The respiratory rate is the most reliable sign to alert the health carer to the presence of pneumonia. Therapy should follow the recommendations of the South African Pneumonia Guidelines. Prevention strategies include the prevention and management of aspiration, reduction in the use of neuroleptic medication, influenza vaccination, maintenance of oral hygiene, smoking cessation and possibly the use of the newer antiviral preparations

Evidentiality, Questions and the Reflection Principle in Tibetan: What do Children Learn when they Learn About Evidentiality?

Evidentials fall in the borderland between traditional semantics and pragmatics. A situation semantics for evidentials helps to explain their puzzling developmental pathway in children. Drawing on our work in Tibetan, we argue that there is no necessity for a child to master Theory of Mind, that is, awareness of others\u27 mental states, in order to make or to understand assertions that carry evidential force. The meaning of evidentials does not make reference to states of knowledge of persons, but rather encodes relations between discourse, evidence and evaluation situations. On the other hand, when a Tibetan speaker asks a question, the form of the evidential used in the question must anticipate the kind of knowledge the interlocutor can access in reply. Full mastery of questions in Tibetan-speaking children does require attention to and representation of others\u27 states of knowledge and belief

Diffraction and Pattern Perturbation Effects in Offset Gregorian Reflector Antennas with Wideband Feeds

The offset Gregorian reflector system of the Square Kilometer Array radio telescope is required to operate with wideband feed (WBF) antennas down to very low frequencies, where reflectors become (electrically) relatively small. The considered WBF technologies are the log-periodic (Eleven) antenna and the quadruple-ridged flared horn. This paper investigates some of the performance degradation effects that are specific for the low frequencies and typical for these WBFs, including the feed pattern perturbations and diffraction. Several performance metrics, such as the antenna receiving sensitivity and side lobe levels are considered

Determining The Impact Of Capitalising Long-Term Operating Leases On The Financial Ratios Of The Top 40 JSE-Listed Companies

Operating leases forma great part of companies’ financing structures in today’s economicenvironment. Some accounting standard-setters and other users of financialstatements are of the opinion that the current standard on accounting foroperating leases, IAS 17, does not provide sufficient guidelines on the disclosureof a company’s leasing activities. The current accounting standard on leasesprovides companies with the opportunity to classify lease contracts intodifferent classes which leads to off-balance-sheet financing. This problem iscurrently being addressed by the IASB as they are in the process of developingan improved standard on leases. The main focus ofthis paper is to determine the impact of the improved accounting standard onthe financial statements and the resulting financial ratios of theJSE Top 40 companies when operating leases are accounted for ason-balance-sheet debt. The differences between the current IAS 17 and theExposure draft (ED/2010/9) are identified and the comparison indicatessignificant differences between these two approaches on accounting foroperating lease activities. The focus of the IASBin developing this exposure draft was to provide the users of financialstatements with a universal picture of the leasing activities that the companyis engaged in. The findings include that this objective is achieved as usersare not left uninformed about any of the financing activities that stakeholdersare exposed to if indeed a company is engaged in operating lease activities.The study also revealed that the capitalising of long-term operating leaseswill have a significant effect on the key financial ratios that stakeholdersuse to interpret a company’s financial performance

A Pathway to Commitment in the South African Supermarket: An Exploratory Study

The supermarket sector is a major component of the retail industry in South Africa. Yet, these retail chains largely exist in a ‘sea of sameness’ where only subtle characteristics differentiate them from each other. This paper aims to investigate the means through which such chains can achieve competitive advantage through the creation of customer commitment. Whilst structural bonds might create the impression that customers are loyal, commitment goes beyond behavioural loyalty and is argued to be a better indicator of the customer’s propensity to patronise the retailer into the foreseeable future. Through consideration of the retail mix, this study determines that low prices, in-store promotions and facilities do not necessarily lead to customer commitment, whereas superior customer service and quality and variety of store merchandise are considerably more influential in this respect. However, on the whole, customer commitment in the supermarket sector remains somewhat poor and needs to be further entrenched. Key words: Supermarkets, Satisfaction, Behaviour, Commitment, Structural Bonds, Retail Mix, South Afric

Stroke outcomes in a socio-economically disadvantaged urban community

Aims. To determine survival, disability and functional outcomes of stroke patients following their discharge from an acute stroke unit in an urban community with limited rehabilitative resources. Methods. Stroke patients were recruited from a district hospital in Cape Town and followed-up for 6 months. Clinical characteristics, demographic and socioeconomic data, and disability and function as measured by modified Rankin Score (mRS), modified Barthel Index (mBI) at recruitment and 3 follow-up visits, were recorded. Results. The study included 196 patients. Median age was 60 (IQR 51 - 69) years, 135 (68.9%) were female, 57.7% black, 42.3% coloured, and 45 (23%) died within 6 months. At discharge, median mBI score was 7 (IQR 3 - 12) and median mRS 4 (IQR 3 - 5). In the multivariate regression models, only function (mBI OR 0.88, 95% confidence interval (CI) 0.79 - 0.96, p<0.0001) and disability (mRS 0R 2.34, 95%CI 1.20 - 4.54, p<0.0001) were independently associated with risk of death. Shack housing was independently associated with moderate or severe disability (odds ratio 3.42, 95%CI 1.22 - 9.59, p=0.02). Despite limited rehabilitation resources, 67% of survivors had mild to moderate disability at 6 months. Conclusion. Apart from initial stroke severity, risk factors for poor survival were a severe disability category and the presence of impaired swallowing at discharge. Shack housing was independently associated with poor functional outcomes. These findings should be helpful in allocating home-based care and inpatient rehabilitation resources to high-risk groups to improve outcomes

Thick domain walls around a black hole

We discuss the gravitationally interacting system of a thick domain wall and a black hole. We numerically solve the scalar field equation in the Schwarzschild spacetime and obtain a sequence of static axi-symmetric solutions representing thick domain walls. We find that, for the walls near the horizon, the Nambu--Goto approximation is no longer valid.Comment: 18 pages, 11 figures, one reference adde