'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

Estudio epidemiológico de la litiasis en Armilla (Granada) (T. C)

Se estudia la incidencia de la litiasis renal en población completa. La unidad elegida ha sido Armilla y en este estudio además de relacionar la incidencia con diversos parámetros, tales como edad, sexo, recidivas, etc., se comparan los resultados obtenidos con los de otros autores en distintas partes del mundo.In this study we have pointed out the incidence of the lithiasis at a whole poblation and as the town of Armilla (Granada - Spain). We have shown the relationships between the nephritic calculi and several parameters such as Age. sex. etc. We have also compared out results with other of differents authors several parts of the world

Estudio epidemiológico de la litiasis en Armilla (Granada) (T. C)

In this study we have pointed out the incidence of the lithiasis at a whole poblation and as the town of Armilla (Granada - Spain). We have shown the relationships between the nephritic calculi and several parameters such as Age. sexo etc. We have also compared out results with other of differents authors several parts of the world.Se estudia la incidencia de la litiasis renal en población completa. La unidad elegida ha sido Armilla y en este estudio además de relacionar la incidencia con diversos parámetros, tales como edad, sexo, recidivas, etc., se comparan los resultados obtenidos con los de otros autores en distintas partes del mundo

Initial Data and Coordinates for Multiple Black Hole Systems

We present here an alternative approach to data setting for spacetimes with multiple moving black holes generalizing the Kerr-Schild form for rotating or non-rotating single black holes to multiple moving holes. Because this scheme preserves the Kerr-Schild form near the holes, it selects out the behaviour of null rays near the holes, may simplify horizon tracking, and may prove useful in computational applications. For computational evolution, a discussion of coordinates (lapse function and shift vector) is given which preserves some of the properties of the single-hole Kerr-Schild form

Grazing Collisions of Black Holes via the Excision of Singularities

We present the first simulations of non-headon (grazing) collisions of binary black holes in which the black hole singularities have been excised from the computational domain. Initially two equal mass black holes $m$ are separated a distance $\approx10m$ and with impact parameter $\approx2m$. Initial data are based on superposed, boosted (velocity $\approx0.5c$) solutions of single black holes in Kerr-Schild coordinates. Both rotating and non-rotating black holes are considered. The excised regions containing the singularities are specified by following the dynamics of apparent horizons. Evolutions of up to $t \approx 35m$ are obtained in which two initially separate apparent horizons are present for $t\approx3.8m$. At that time a single enveloping apparent horizon forms, indicating that the holes have merged. Apparent horizon area estimates suggest gravitational radiation of about 2.6% of the total mass. The evolutions end after a moderate amount of time because of instabilities.Comment: 2 References corrected, reference to figure update

Malnutrition as assessed by nutritional risk index is associated with worse outcome in patients admitted with acute decompensated heart failure: an ACAP-HF data analysis

Malnutrition is common at hospital admission and tends to worsen during hospitalization. This controlled population study aimed to determine if serum albumin or moderate and severe nutritional depletion by Nutritional Risk Index (NRI) at hospital admission are associated with increased length of hospital stay (LOS) in patients admitted with acute decompensated heart failure (ADHF). Serum albumin levels and lymphocyte counts were retrospectively determined at hospital admission in 1740 consecutive patients admitted with primary and secondary diagnosis of ADHF. The Nutrition Risk Score (NRI) developed originally in AIDS and cancer populations was derived from the serum albumin concentration and the ratio of actual to usual weight, as follows: NRI = (1.519 × serum albumin, g/dL) + {41.7 × present weight (kg)/ideal body weight(kg)}. Patients were classified into four groups as no, mild, moderate or severe risk by NRI. Multiple logistic regressions were used to determine the association between nutritional risk category and LOS