Smell and taste dysfunction following minor stroke: A case report

Smell (olfactory) and taste (gustatory) are key senses in the regulation of nourishment and individual safety. Olfactory and gustatory dysfunctions have been infrequently reported together in patients following stroke (Landis et al., 2006; Leopold et al., 2006). This case report details two patients who experienced smell and taste dysfunction following minor stroke events. Symptoms reported included hyposmia (diminished sense of smell) and anosmia (complete loss of smell), and dysgeusia (distorted taste). Patients' sense of smell and taste were assessed in an ambulatory care stroke prevention clinic eight months following their strokes. Patient A presented with minor stroke due to a lesion in the anterior circulation, patient B with a lesion in the posterior circulation. Both patients reported intense olfactory and gustatory dysfunction immediately following their strokes. Examination revealed a general inability to detect subtle odours and the ability to identify only 'sweet' tastes for both patients. In addition, both patients reported heavily salting or sweetening their food to mask the distorted and unpleasant taste, which also impacted comorbid conditions such as hypertension and diabetes. Patients and their spouses reported a decrease in their appreciation of family-related activities due to the patients' olfactory and gustatory dysfunction. Patients reported weight loss, lack of energy and strength, likely due to poor nutrition. Olfactory and gustatory dysfunctions are potentially deleterious outcomes following minor stroke and should be assessed by health care professionals prior to patient discharge. Assistance may be required to promote the health and well-being of patients and their carers if smell and taste are impacted by the stroke event.

'Sink or swim': An evaluation of the clinical characteristics of individuals with high bone mass

Summary High bone mineral density on routine dual energy X-ray absorptiometry (DXA) may indicate an underlying skeletal dysplasia. Two hundred fifty-eight individuals with unexplained high bone mass (HBM), 236 relatives (41% with HBM) and 58 spouses were studied. Cases could not float, had mandible enlargement, extra bone, broad frames, larger shoe sizes and increased body mass index (BMI). HBM cases may harbour an underlying genetic disorder. Introduction High bone mineral density is a sporadic incidental finding on routine DXA scanning of apparently asymptomatic individuals. Such individuals may have an underlying skeletal dysplasia, as seen in LRP5 mutations. We aimed to characterize unexplained HBM and determine the potential for an underlying skeletal dysplasia. Methods Two hundred fifty-eight individuals with unexplained HBM (defined as L1 Z-score ≥ +3.2 plus total hip Z-score ≥ +1.2, or total hip Z-score ≥ +3.2) were recruited from 15 UK centres, by screening 335,115 DXA scans. Unexplained HBM affected 0.181% of DXA scans. Next 236 relatives were recruited of whom 94 (41%) had HBM (defined as L1 Z-score + total hip Z-score ≥ +3.2). Fifty-eight spouses were also recruited together with the unaffected relatives as controls. Phenotypes of cases and controls, obtained from clinical assessment, were compared using random-effects linear and logistic regression models, clustered by family, adjusted for confounders, including age and sex. Results Individuals with unexplained HBM had an excess of sinking when swimming (7.11 [3.65, 13.84], p < 0.001; adjusted odds ratio with 95% confidence interval shown), mandible enlargement (4.16 [2.34, 7.39], p < 0.001), extra bone at tendon/ligament insertions (2.07 [1.13, 3.78], p = 0.018) and broad frame (3.55 [2.12, 5.95], p < 0.001). HBM cases also had a larger shoe size (mean difference 0.4 [0.1, 0.7] UK sizes, p = 0.009) and increased BMI (mean difference 2.2 [1.3, 3.1] kg/m 2, p < 0.001). Conclusion Individuals with unexplained HBM have an excess of clinical characteristics associated with skeletal dysplasia and their relatives are commonly affected, suggesting many may harbour an underlying genetic disorder affecting bone mass.

Assistance arrangements and use of services among persons with multiple sclerosis and their caregivers

A large population-based survey of persons with multiple sclerosis (MS) and their caregivers was conducted in Ontario using self-completed mailed questionnaires. The objectives included describing assistance arrangements, needs, and use of and satisfaction with services, and comparing perceptions of persons with MS and their caregivers. Response rates were 83% and 72% for those with MS and caregivers, respectively. Based on 697 respondents with MS whose mean age is 48 years, 70% are female, and 75% are married. While 24% experience no mobility restrictions, the majority require some type of aid or a wheelchair for getting around. Among 345 caregivers, who have been providing care for 9 years on average, the majority are spouses. Caregivers report providing more frequent care than do persons with MS report receiving it, particularly for the following activities of daily living: eating, meal preparation, and help with personal finances. Caregivers also report assistance of longer duration per day than do care recipients with MS. Frequency and duration of assistance are positively associated with increased MS symptom severity and reduced mobility. Generally there is no rural-urban disparity in service provision, utilization or satisfaction, and although there is a wide range of service utilization, satisfaction is consistently high. Respite care is rarely used by caregivers. Use of several services is positively associated with increased severity of MS symptoms and reduced mobility. Assistance arrangements and use of services, each from the point of view of persons with MS and their caregivers, must be taken into account in efforts to prolong home care and to postpone early institutionalization of persons with MS.

A qualitative study of the spouse's experience following coronary artery bypass surgery: Implications for Nursing Practice

Findings from numerous quantitative studies suggest that spouses of patients undergoing Coronary Artery Bypass (CAB) surgery experience both physical and emotional stress before and after their partner's surgery. Such studies have contributed to our understanding of the spouses' experiences, however they have largely failed to capture the qualitative experience of what it is like to be a spouse of a partner who has undergone CAB surgery. The objective of this study was to describe the experience of spouses of patients who had recently undergone CAB surgery. This study was guided by Husserl's phenomenological approach to qualitative research. In accordance with the nature of phenomenological research the number of participants necessarily needs to be small because phenomenology values the unique experience of individuals. Therefore this study gathered data from four participants utilising open ended indepth interviews. The method of analysis was adapted from Amedeo Giorgi's five step empirical phenomenological process which brackets preconceived notions, reducing participants' accounts to the essential essence or meanings. Numerous themes common to each of the spouses emerged. These included: seeking information; the necessity for rapid decision making; playing guardian; a desire to debrief with their partner and lastly, uncertainty of their future role. This study has attempted to understand the phenomena of the spouse's experience and in doing so, believe that we now have a better understanding and insight into the needs of spouses of CAB surgery patients. This has added another dimension to our existing body of knowledge and further facilitates holistic patient care.

Acute myocardial infarction: The spouse's experience

Given the marked changes in length of hospital stay and the number of CAB procedures being performed, it is essential that health professionals are aware of the potential impact these changes could have on the spouses of patients who have undergone CAB surgery. Results from numerous quantitative studies suggest that spouses of patients undergoing CAB surgery experience both physical and emotional stress before and after their partners surgery. While such studies have contributed to our understanding, they fail to capture the qualitative experience of what it is like to be a spouse of a partner who has undergone CAB surgery, specifically in the context of changes in the length of hospital stay. The objective of this study was to describe the experience of spouses of patients who had recently undergone CAB surgery. This study utilised a qualitative methodology and was guided by Husserl's phenomenological approach. Data was obtained from four participants by in depth open ended interviews. This study has implications for all health professionals involved in the care of patients and their families undergoing CAB surgery. If health professionals are to provide holistic care, they need to understand more fully the qualitative experience of spouses of critically ill patients. The purpose of this study was to describe the experience of spouses whose partner's had suffered an acute myocardial infarction (MI). The study was guided by a phenomenological approach. This qualitative type of study is new to nursing inquiry, therefore this investigation creates links with understanding the notion of psychosocial nursing processes with the leading cause of death in Australia. Literature concerning the spouses of myocardial infarction patients has predominantly employed quantitative methods, as such results have centred on structured data collection, and categorised outcomes. Such methods have failed to capture the insight of what it is like to be a spouse of a patient who has had an MI. In-depth interviews were conducted with three participants (2 females and 1 male) about their experiences. The major findings of the study were categorised under the headings of uncertainty, emotional turmoil, support information and lifestyle change. Conclusions suggest that spouses are neglected by health professionals and they require as much psychosocial support as their partner in terms of cardiac discharge planning. Spouses need to be granted special consideration, as they progress through a grieving and readjustment process in coming to terms with: (1) the need to support and care for their partner, (2) changes in their roles and (3) adjustments to their current lifestyles.

Crime stories from the country of huopatossu and juhannusruusut : Translation strategies for Finnish cultural realia in the English translations of two of Matti Yrjänä Joensuu’s crime novels

Pro gradu –tutkielman aiheena on kulttuurin ominaispiirteiden kääntäminen. Teksteissä kulttuurin jälki voi näkyä monin eri tavoin. Tutkielman kohteena ovat erityisesti käännösstrategiat, joita kääntäjät käyttävät kohdatessaan kulttuurisidonnaisia viittauksia. Tutkielma nostaa esiin myös niitä tekijöitä, jotka vaikuttavat siihen, minkälaisia käännösstrategioita kääntäjät valitsevat. Näistä tekijöistä tutkielma keskittyy kääntämisen normeihin. Tutkielma pureutuu kulttuurisidonnaisten viitteiden kääntämiseen tarkastelemalla kahta suomalaista kaunokirjallista teosta ja niiden käännöksiä. Tutkielman aineistona ovat Matti Yrjänä Joensuun kaksi rikosromaania ja näiden käännökset. Teoksista toinen on vuonna 1983 suomeksi julkaistu Harjunpää ja poliisin poika, jonka englanninkielinen käännös Harjunpaa the stone murders julkaistiin vuonna 1986. Toinen teos on vuonna 2003 julkaistu Harjunpää ja pahan pappi ja sen käännös The Priest of Evil vuodelta 2006. Tutkielman tavoitteena on selvittää, minkälaisia kulttuurisidonnaisia viittauksia romaanit sisälsivät, minkälaisia käännösstrategioita kääntäjät käyttivät kääntäessään näitä viittauksia ja mikä voisi selittää heidän strategisia valintojaan. Tutkielma pyrkii vastaamaan kysymykseen siitä, voisiko jonkin kääntämistä koskevan normin olemassa olo selittää kääntäjien strategisia valintoja. Tutkielman tavoitteena on myös selvittää, suositaanko kääntämisessä englannin kieleen niin kutsuttuja kotouttavia käännösstrategioita ja ovatko käännösstrategiat ja kääntämistä koskevat normit muuttuneet kahdenkymmenen vuoden aikana. Näihin kysymyksiin vastaamiseksi suomenkielisistä teksteistä on etsitty kaikki kulttuurisidonnaisia viittauksia sisältävät tekstinkohdat. Näitä vastaavat kohdat on sitten etsitty käännöksistä ja suomen- ja englanninkielisiä kohtia on vertailtu keskenään. Molemmat suomenkieliset romaanit sisältävät runsaasti kulttuurisidonnaisia viittauksia. Suurimman kulttuurisidonnaisten viittausten ryhmän muodostivat molemissa romaaneissa henkilöiden nimet. Romaanin sisälsivät myös runsaasti viittauksia maantieteeseen, erityisesti kulttuurimaantieteeseen, ja yhteiskuntaan. Sitä vastoin viittaukset suomalaiseen kulttuuriin ja historiaan olivat vähäisempiä. Tutkielma osoittaa, että kääntäessään suomesta englannin kielelle suomalaisen rikoskirjallisuuden kääntäjät saattavat käyttää enemmän vieraannuttavia strategioita kuin kotouttavia strategioita ja että he suosivat vieraannuttavia strategioita kasvavassa määrin. Harjunpään ja pahan papin kääntäjä käytti enemmän vieraannuttavia strategioita kuin Harjunpään ja poliisin pojan kääntäjä kaksikymmentä vuotta aikaisemmin. Tutkielman tulokset eivät tue väitettä siitä, että käännettäessä englannin kielelle suosittaisiin kotouttavia strategioita. Näyttää siltä, että vieraannuttavia strategioita on käytetty enemmän ja käytetään yhä enenevässä määrin. Lisääntyvän vieraannuttamisen taustalla voi olla useita syitä, kuten suomalaisen kulttuurin lisääntynyt tunnettuus maailmalla, rikosromaanin genren vaatimukset tai muutokset kääntäjäyhteisön arvoissa. Tutkielman tulosten perusteella näyttää siltä, että ainakin muutoksia normeissa ja arvoissa on tapahtunut. Lisätutkimuksen avulla voitaisiin selvittää, pätevätkö tutkielman tulokset muihin romaaneihin ja niiden käännöksiin tai muihin genreihin käännettäessä suomesta englantiin. Lisätutkimus voisi nojautua laajempaan ja erilaisia tekstejä kattavaan aineistoon. Jatkotutkimus voisi myös sisältää kääntäjien haastatteluita tai kyselyitä kääntäjille. Näiden avulla voitaisiin saada lisäselvyyttä syistä heidän strategisille valinnoilleen. Asiasanat: Käännöskirjallisuus – kaunokirjallisuus Kääntäminen – suomen kieli – englannin kieli Kääntäminen – strategia Kääntäminen - normi

Aggressive surgical interventions for severe stroke: Impact on quality of life, caregiver burden and family outcomes

Introduction: Decompressive hemicraniectomy, clot evacuation, and aneurysmal interventions are considered aggressive surgical therapeutic options for treatment of massive cerebral artery infarction (MCA), intracerebral hemorrhage (ICH), and severe subarachnoid hemorrhage (SAH) respectively. Although these procedures are saving lives, little is actually known about the impact on outcomes other than short-term survival and functional status. The purpose of this study was to gain a better understanding of personal and social consequences of surviving these aggressive surgical interventions in order to aid acute care clinicians in helping family members make difficult decisions about undertaking such interventions. Methods: An exploratory mixed method study using a convergent parallel design was conducted to examine functional recovery (NIHSS, mRS & BI), cognitive status (Montreal Cognitive Assessment Scale, MoCA), quality of life (Euroqol 5-D), and caregiver outcomes (Bakas Caregiver Outcome Scale, BCOS) in a cohort of patients and families who had undergone aggressive surgical intervention for severe stroke between the years 2000–2007. Data were analyzed using descriptive statistics, univariate and multivariate analysis of variance, and multivariate logistic regression. Content analysis was used to analyze the qualitative interviews conducted with stroke survivors and family members. Results: Twenty-seven patients and 13 spouses participated in this study. Based on patient MOCA scores, overall cognitive status was 25.18 (range 23.4-26.9); current functional outcomes scores: NIHSS 2.22, mRS 1.74, and BI 88.5. EQ-5D scores revealed no significant differences between patients and caregivers (p=0.585) and caregiver outcomes revealed no significant differences between male/female caregivers or patient diagnostic group (MCA, SAH, ICH; p=""0.103).<"/span><"/span> Discussion: Overall, patients and families were satisfied with quality of life and decisions made at the time of the initial stroke. There was consensus among study participants that formal community-based support (e.g., handibus, caregiving relief, rehabilitation assessments) should be continued for extended periods (e.g., years) post-stroke. Ongoing contact with health care professionals is valuable to help them navigate in the community as needs change over time.

Theory and Analysis of Classic Heavy Metal Harmony

This thesis explores melodic and harmonic features of heavy metal, and while doing so, explores various methods of music analysis; their applicability and limitations regarding the study of heavy metal music. The study is built on three general hypotheses according to which 1) acoustic characteristics play a significant role for chord constructing in heavy metal, 2) heavy metal has strong ties and similarities with other Western musical styles, and 3) theories and analytical methods of Western art music may be applied to heavy metal. It seems evident that in heavy metal some chord structures appear far more frequently than others. It is suggested here that the fundamental reason for this is the use of guitar distortion effect. Subsequently, theories as to how and under what principles heavy metal is constructed need to be put under discussion; analytical models regarding the classification of consonance and dissonance and chord categorization are here revised to meet the common practices of this music. It is evident that heavy metal is not an isolated style of music; it is seen here as a cultural fusion of various musical styles. Moreover, it is suggested that the theoretical background to the construction of Western music and its analysis can offer invaluable insights to heavy metal. However, the analytical methods need to be reformed to some extent to meet the characteristics of the music. This reformation includes an accommodation of linear and functional theories that has been found rather rarely in music theory and musicology.

Kuluttaminen ja ylhäisaatelin elämäntapa 1700-luvun Ruotsissa

Consumption and the lifestyle of the high nobility in eighteenth-century Sweden This monograph is an analysis of the lifestyle, consumption and private finances of the Swedish high nobility during the eighteenth century (ca 1730 1795). It describes the lifestyle of one noble house, the House of Fersen. The Fersen family represents the leading political, economic and cultural elite in eighteenth-century Sweden. The analysis concentrates on Count Carl von Fersen (1716 1786) and his brother Count Axel von Fersen (1719 1794), their spouses and children. Carl von Fersen was a courtier whilst Axel von Fersen was an officer and one of the leaders of the Francophile Hat party. His son, Axel von Fersen the younger, was in his time an officer and a favourite of Gustavus III, King of Sweden, as well as a favourite and trusted confidant of Marie-Antoinette, Queen of France. The research is based upon the Fersen family s private archives, the Counts personal account books, probate inventories, letters and diaries. The study discusses the Fersens landed property and investments in ironworks and manufacturing, the indebtedness of the high nobility, high offices in civil administration, the militia and at court, as well as marriages as the foundations of noble wealth and power. It analyses the Count von Fersens revenue and expenditure, their career options and personal expenses, their involvement in the building and decorating of palaces, and the servants in service of the Fersen family as well as the ideal nobleman and his consumption. Central themes are inheritance, children s education, marriages and ladies preparing their trousseaux, the nobility ordering luxury goods from France, the consumption of Counts and Countesses before and after marrying and having children, the pleasures of a noble life as well as the criticism of luxury and sumptuousness. The study contributes to the large body of research on consumption and nobility in the eighteenth century by connecting the lifestyle, consumption and private finances of the Swedish high nobility to their European context. Key words: nobility, Fersen, lifestyle, consumption, private finances, Sweden, eighteenth century

Specimen-based databases of Australian plant pathogens: past, present and future

Specimen-based records of most of the plant pathogens that occur in Australia can be accessed through the Australian Plant Disease Database and the Australian Plant Pest Database. These databases and the herbaria that underpin them are important resources for resolving quarantine and trade issues as well as for the diagnosis of plant diseases. The importance of these collections and databases to Australia's agricultural industries is discussed.

An annotated check list of Ramularia species in Australia

An annotated check list of Ramularia species in Australia, based on re-examinations of collections deposited at BRIP, DAR and VPRI, is presented. Twenty-eight species are reported in Australia, most of them on introduced host plants. The new species Cladosporium myrtacearum, Ramularia craspediicola and R. muehlenbeckiae are described. Collections of Cladosporium uredinicola, Neoramularia karelii, Passalora perfoliati and Pseudocercospora pongamiae-pinnatae, previously deposited in Australian herbaria under 'Ramularia sp.', are newly recognised for Australia.

Evaluation of driving ability of the disabled persons in the context of the psychological activity theory

In the future the number of the disabled drivers requiring a special evaluation of their driving ability will increase due to the ageing population, as well as the progress of adaptive technology. This places pressure on the development of the driving evaluation system. Despite quite intensive research there is still no consensus concerning what is the factual situation in a driver evaluation (methodology), which measures should be included in an evaluation (methods), and how an evaluation has to be carried out (practise). In order to find answers to these questions we carried out empirical studies, and simultaneously elaborated upon a conceptual model for driving and a driving evaluation. The findings of empirical studies can be condensed into the following points: 1) A driving ability defined by the on-road driving test is associated with different laboratory measures depending on the study groups. Faults in the laboratory tests predicted faults in the on-road driving test in the novice group, whereas slowness in the laboratory predicted driving faults in the experienced drivers group. 2) The Parkinson study clearly showed that even an experienced clinician cannot reliably accomplish an evaluation of a disabled person’s driving ability without collaboration with other specialists. 3) The main finding of the stroke study was that the use of a multidisciplinary team as a source of information harmonises the specialists’ evaluations. 4) The patient studies demonstrated that the disabled persons themselves, as well as their spouses, are as a rule not reliable evaluators. 5) From the safety point of view, perceptible operations with the control devices are not crucial, but correct mental actions which the driver carries out with the help of the control devices are of greatest importance. 6) Personality factors including higher-order needs and motives, attitudes and a degree of self-awareness, particularly a sense of illness, are decisive when evaluating a disabled person’s driving ability. Personality is also the main source of resources concerning compensations for lower-order physical deficiencies and restrictions. From work with the conceptual model we drew the following methodological conclusions: First, the driver has to be considered as a holistic subject of the activity, as a multilevel hierarchically organised system of an organism, a temperament, an individuality, and a personality where the personality is the leading subsystem from the standpoint of safety. Second, driving as a human form of a sociopractical activity, is also a hierarchically organised dynamic system. Third, in an evaluation of driving ability it is a question of matching these two hierarchically organised structures: a subject of an activity and a proper activity. Fourth, an evaluation has to be person centred but not disease-, function- or method centred. On the basis of our study a multidisciplinary team (practitioner, driving school teacher, psychologist, occupational therapist) is recommended for use in demanding driver evaluations. Primary in a driver’s evaluations is a coherent conceptual model while concrete methods of evaluations may vary. However, the on-road test must always be performed if possible.

A one-tube fluorescent assay for the quarantine detection and identification of Tilletia indica and other grass bunts in wheat

A molecular assay with enhanced specificity and sensitivity has been developed to assist in the surveillance of Karnal bunt, a quarantineable disease with a significant impact on international trade. The protocol involves the release of DNA from spores, PCR amplification to enrich Tilletia-specific templates from released DNA and a five-plex, real-time PCR assay to detect, identify and distinguish T. indica and other Tilletia species (T. walkeri, T. ehrhartae, T. horrida and a group comprising T. caries, T. laevis, T. contraversa, T. bromi and T. fusca) in wheat grains. This fluorescent molecular tool has a detection sensitivity of one spore and thus bypasses the germination step, which in the current protocol is required for confirmation when only a few spores have been found in grain samples. The assay contains five dual-labelled, species-specific probes and associated species-specific primer pairs in a PCR mix in one tube. The different amplification products are detected simultaneously by five different fluorescence spectra. This specific and sensitive assay with reduced labour and reagent requirements makes it an effective and economically sustainable tool to be used in a Karnal bunt surveillance program. This protocol will also be valuable for the identification of some contaminant Tilletia sp. in wheat grains.

Tombstone of unidentified Levite; Old Cemetery; Oberstrasse, Hannover Cemeteries Tombs

The hand pouring water from a jug indicates a descendant of the Levi tribe, whose function in the Temple was to wash the hands of the Priest (tombstone unrelated to the Gottschalk or Krakauer families)