'Just Little Things': Nurses' perceptions of quality of life for people with severe multiple impairments.

ABSTRACT Notions of quality of life dictate philosophies and policies for services for people with developmental disabilities. There is an abundance of research on quality of life, much of which has influenced the significant amount of study of quality of life for people with developmental disabilities. According to specialist developmental disability nurses, however, this research has little meaning for one group of people with developmental disabilities with whom they work - people with severe multiple impairments. Nevertheless, judgements and decisions about the lives of this group continue to be driven by the idea of quality of life. While the literature review found that researchers are urged to seek the perceptions of people regarding their own quality of life by asking them, some authors have noted the difficulty in pursuing such a method with people, such as people with severe multiple impairments, who are unable to communicate in the usual ways. Given, then, that it is difficult to directly determine the views of people with severe multiple impairments, this study sought the perceptions of nurses about the quality of life of the people with whom they work. In order to discover and conceptualise nurses' views, a symbolic interaction perspective was chosen to guide this study and data were analysed using the grounded theory approach. The study was conducted in two stages. Stage One consisted of semi-structured indepth interviews with expert nurses to explore their perceptions of quality of life for the people with whom they worked. A significant finding in these interviews was that perceptions of quality of life are mediated by interaction. Consequently, Stage Two involved a participant observation study in which the interactions of nurses and people with severe multiple impairments were examined. Specialist developmental disability nurses have a unique view of quality of life for people with severe multiple impairments. They refer to it as 'just little things', a phrase which masks complex nursing knowledge and skills, and which can be described by four interrelated categories which emerged from the data: humans being, supporting, becoming intimate, and situated belonging. As nurses become more intimate with individuals, they perceive that people with severe multiple impairments are humans being as they wish, and that quality resides in supporting their everyday lives in a context of situated belonging. This thesis represents a new conceptualisation of quality of life for people with severe multiple impairments, a conceptualisation which may have significance for other groups and, indeed, for the whole quality of life enterprise. This conceptualisation draws on knowledge not usually related to quality of life, that is, knowledge of the body, of the emotions, of identity and of humanness. Such findings demonstrate the power of an interpretive approach in explicating the meanings nurses have regarding quality of life. Further, these findings have implications for how the question of quality of life is approached, for how different ways of thinking about people impact on quality of life, and for the importance of the life in quality of life

Barriers to specialist palliative care in interstitial lung disease: a systematic review

Background: Current guidelines recommend palliative care based on individual needs for patients with idiopathic pulmonary fibrosis. However, patients with interstitial lung disease (ILD) are less likely to receive specialist palliative care services compared with patients with malignant disease. The aim of this review is to summarise recent studies addressing barriers to referring patients to specialist palliative care services. Methods: PubMed, Embase, Medline and Web of Science were reviewed to identify relevant publications. Studies were selected if they examined the frequency of specialist palliative care referral and/or addressed issues surrounding access to palliative care services for patients with ILD. Results: Ten studies with a total of 4073 people with ILD, 27 caregivers and 18 healthcare professionals were selected and analysed. Frequency of palliative care referrals ranged from 0% to 38%. Delay in palliative care referrals and end-of-life decisions, patients' fear of talking about the future, prognostic uncertainty and confusion about the roles of palliative care were identified as barriers to accessing palliative care services. Conclusion: Further research should concentrate on the early identification of patients who need specialist palliative care possibly with establishment of criteria to trigger referral ensuring that referrals are also based on patient's needs

Discussion: Hybrid anode concrete corrosion protection - independent study

Discussion: Hybrid anode concrete corrosion protection - independent stud

Development of a Submillimetric GNSS-Based Distance Meter for Length Metrology

[EN] Absolute distance determination in the open air with an uncertainty of a few tenths of a millimetre is increasingly required in many applications that involve high precision geodetic metrology. No matter the technique used to measure, the resulting distances must be proven consistent with the unit of length (SI-metre) as realized in the outdoor facilities traditionally used in length metrology, which are also known as calibration baselines of reference. The current calibration baselines of reference have distances in the range of 10 to 1000 m, but at present there is no solution on the market to provide distances with submillimetric precision in that range. Consequently, new techniques such as multi-wave interferometry, two-wave laser telemeters or laser trackers are being developed. A possible alternative to those sophisticated and expensive techniques is the use of widely used Global Navigation Satellite Systems (GNSS) in order to provide a GNSS-Based Distance Meter (GBDM). The use of a GBDM as a potential technique for length metrology has been thoroughly analysed in several European research projects by using the state-of-the-art geodetic software, such as Bernese 5.2, but no definite conclusions have been drawn and some metrological questions are considered still open. In this paper, we describe a dedicated approach to build up a submillimetric GBDM able to be applied in the current calibration baselines of reference, as well as possible methods to cope with the multipath error of the GNSS signals which is the major limitation for the practical uptaking of the technique in metrology. The accuracy of the proposed approach has been tested following the length metrology standards in four experiments carried out in the Universitat Politecnica de Valencia (UPV). The results demonstrate that the proposed GBDM can provide an accuracy of a few tenths of a millimetre in the current calibration baselines of referenceThis work was partly performed within the 18SIB01 GeoMetre project of the European Metrology Programme for Innovation and Research (EMPIR). This project has received funding from the EMPIR programme co-financed by the Participating States and from the European Union's Horizon 2020 research and innovation programme. This research was also partly funded by the Spanish Ministry of Education, Culture and Sports (PRX17/00371).García-Asenjo Villamayor, L.; Baselga Moreno, S.; Atkins, C.; Garrigues Talens, P. (2021). Development of a Submillimetric GNSS-Based Distance Meter for Length Metrology. Sensors. 21(4):1-21. https://doi.org/10.3390/s2104114512121

Marketecture: A Simulation-Based Framework for Studying Experimental Deregulated Power Markets

In this paper, we present MARKETECTURE, an agent-based, microeconomic, scalable model for studying deregulated power markets. Features that distinguish it from previously studied models include: the ability to generate individualistic, demographics based, elastic demand profiles; a highly configurable system that supports different matching algorithms for buyers and sellers, different market clearing mechanisms; ability to aggregate individuals to different classes; an electrical grid to physically clear the economic contracts etc. This paper describes the model and its various features in detail. A case study is done for the city of Portland, Oregon, to evaluate the performance and efficiency of the market under different market clearing algorithms and sellers’ strategies. We analyze the structural properties of the market under different scenarios to validate our model. Our results show that if Vickrey auction clearing mechanism can induce the sellers to reveal their true production costs and bid at competitive level, the market performance can be almost pareto-efficient. The weighted average clearing method in the poolco market results in the lowest market clearing price (MCP). However, the market clearing quantity (MCQ) is also low which results in deadweight loss to the society. Our findings also show that the different orders of market execution (bilateral and poolco) can significantly affect the performance of the markets

Eisman and Warrack Standard & Poor\u27s Structured Finance Teleconference Transcript

Transcript of Standard & Poor\u27s Structured Finance meeting/conference call discussing its press release issued that same morning announcing that it placed 612 subprime RMBS classes on Credit Watch Negative

Advanced Oxygen Recovery via Series-Bosch Technology

Oxygen recovery from metabolically-produced carbon dioxide (CO2) is of critical importance for long-duration manned space missions beyond low Earth orbit. On the International Space Station (ISS), oxygen is provided to the crew through electrolysis of water in the Oxygen Generation Assembly (OGA). Prior to 2011, this water was entirely resupplied from Earth. A CO2 Reduction Assembly based on the Sabatier reaction (1) was developed by Hamilton Sundstrand and delivered to ISS in 2010. The unit recovers oxygen by reducing metabolic CO2 with diatomic hydrogen (H2) to produce methane and product water. The water is cleaned by the Water Purification Assembly and recycled to the OGA for continued oxygen production. The methane product is vented overboard

Temperature dependence of binary and ternary recombination of H3+ ions with electron

We study binary and the recently discovered process of ternary He-assisted recombination of H3+ ions with electrons in a low temperature afterglow plasma. The experiments are carried out over a broad range of pressures and temperatures of an afterglow plasma in a helium buffer gas. Binary and He-assisted ternary recombination are observed and the corresponding recombination rate coefficients are extracted for temperatures from 77 K to 330 K. We describe the observed ternary recombination as a two-step mechanism: First, a rotationally-excited long-lived neutral molecule H3* is formed in electron-H3+ collisions. Second, the H3* molecule collides with a helium atom that leads to the formation of a very long-lived Rydberg state with high orbital momentum. We present calculations of the lifetimes of H3* and of the ternary recombination rate coefficients for para and ortho-H3+. The calculations show a large difference between the ternary recombination rate coefficients of ortho- and para-H3+ at temperatures below 300 K. The measured binary and ternary rate coefficients are in reasonable agreement with the calculated values.Comment: 15 page

Repeated Acceleration Activity in Competitive Youth Soccer

Soccer match-play is increasingly characterised by short, high-speed bursts reliant on the ability to accelerate. Performance is impaired after peak acceleration activity and during the second half and may compromise a player’s effectiveness. To date, information about repeated acceleration sequences is lacking but would provide further insight into high-speed activity during competition. This study examined repeated acceleration ability (RAA) using GPS (5 Hz) and accelerometer (100 Hz), during 14 competitive youth soccer matches from the 2014–2015 season. Results showed that RAA profiles were relatively homogeneous, and there were no significant differences between playing positions. RAA activity was also relatively stable between playing halves and only the activity of forwards declined significantly. In summary, this study suggests that RAA is a generic requirement of match-play at this level but presents a specific focus for conditioning regimens

Should We Trust our Judgments about the Proficiency of Motivational Interviewing Counselors?A Glimpse at the Impact of Low Inter-rater Reliability

Standardized rating systems are often used to evaluate the proficiency of Motivational Interviewing (MI) counselors. The published inter-rater reliability (degree of coder agreement)  in many studies using these instruments has varied a great deal; some studies report MI proficiency scores that have only fair inter-rater reliability, and others report scores with excellent reliability. How much can we to trust the scores with fair versus excellent reliability? Using a Monte Carlo statistical simulation, we compared the impact of fair (0.50) versus excellent (0.90) reliability on the error rates of falsely judging a given counselor as MI proficient or not proficient. We found that improving the inter-rater reliability of any given score from 0.5 to 0.9 would cause a marked reduction in proficiency judgment errors, a reduction that in some MI evaluation situations would be critical. We discuss some practical tradeoffs inherent in various MI evaluation situations, and offer suggestions for applying findings from formal MI research to problems faced by real-world MI evaluators, to help them minimize the MI proficiency judgment errors bearing the greatest cost