The Heart of a Revolution

A 2009 graduate\u27s translation of a Salvadoran war hero\u27s memoir provides an insider\u27s account of the struggle to topple a military dictatorship

Quality of life of adults with intellectual disabilities

The replacement of institutional care for people with intellectual disabilities with community care and accommodation has been established social policy in many countries for a number of years. Successive studies have reported improvements on various dimensions of quality of life, immediately following community resettlement and over longer periods; however, the extent to which new service models promote lifestyles and life experiences comparable with those of the general population is less well documented.The thesis comprises four related studies which explore aspects of the quality of life of adults with intellectual disabilities in hospital and community settings in the context of recent developments in Scottish social policy; compare the life experiences of intellectually disabled adults in NHS and social care with that of adult members of the general public; and describe the adaptation and development of an international measure of quality of life (the WHOQOL) for the intellectual disability population.In pilot study one, the themes relevant for comprehensive assessment of the quality of life of adults with intellectual disabilities were generated by focus groups of clients in health and social care, staff working in this specialty, and relatives of individuals with intellectual disabilities. The findings suggested that the facets of quality of life measured by the WHOQOL were relevant to adults with intellectual disabilities also, but required to be supplemented by additional themes specific to this client group.These findings informed pilot study two in which the WHOQOL-BREF (the abbreviated version of the WHOQOL-100) was customised and developed for an intellectual disability population with simplified item wording (retaining semantic equivalence), the introduction of additional items (reflecting the supplementary quality of life facets), and pictorial augmentation of item response scales; and a small field trial of the adapted WHOQOL-ID was carried out, as part of which an initial analysis of the psychometric properties of the new scale was conducted.In a subsidiary study, a survey of 51 community based social care and accommodation projects for adults with intellectual disabilities was carried out; structured interviews were conducted with care staff about the suitability and effectiveness of this accommodation; and a pilot housing fit index reflecting the match between the care needs of resident clients and the characteristics of project accommodation was developed.The findings of pilot study two underpinned refinement of the WHOQOL-ID for use in the main study, which employed a three level between-groups design to compare the quality of life of 204 community clients living in the social care projects described in the subsidiary study, 213 learning disability hospital residents (matched with the community group for gender, age, and dependency) immediately prior to resettlement as part of a hospital closure programme, and 208 members of the general public (matched with both groups for gender and age, and with the community group for locality). The data collected were used to carry out a full evaluation of the psychometric properties of the final instrument also.Significant differences found between the three groups were discussed with reference to implications for social policy and service developments in intellectual disabilities; and suggestions for future research were outlined

Epidemiological Survey on the Prevalence of Nosocomial Infections Caused by Drug Resistant Bacteria

Nosocomial infections have been recognized for over a century as a critical problem affecting the quality of health care and a principal source of adverse health care outcomes. The National Nosocomial Infections Surveillance System defines a nosocomial infection as (1) a localized or systemic condition that results from adverse reaction to the presence of an infectious agent(s) or its toxin(s) and (2) that was not present or incubating at the time a patient is admitted to a hospital. Today, nosocomial infections affect over 2 million patients annually in the United States at a cost in excess of $4.5 billion (Hormaeche, 1992). Among all major complications of hospitalization, nosocomial infections account for over 50% and are responsible for about 20,000 deaths in the U.S. per year (Wilson, 2000). Nosocomial infections are the result of three factors occurring in tandem: high prevalence of pathogens; high prevalence of immunocompromised hosts; efficient mechanisms of transmission. Agents that cause nosocomial infections vary in structure and size from viruses to protozoa. However, bacteria together with some viruses and fungi are of greatest significance as nosocomial infection pathogens. Nosocomial infections are primarily caused by opportunists, particulary by: Enterococcus spp., Escherichia coli, 2 Pseudomonas spp., and Staphylococcus aureus. These organisms become dangerous when they acquire antibiotic resistance factors. Hospitals are viewed today as institutions where scientific advances are used to , provide the most up to date diagnostic and therapeutic services for patients. This optimistic view is tempered, however, by the realization that the hospital also can be a dangerous place for patients (Schaffner, 2002). According to a recent CDC study, more than 50 million of the 150 million antibiotic prescriptions written each year for patients outside of hospitals are unnecessary. Each time a patient takes an antibiotic for a bacterial infection the drug may kill most of the bacteria. However, a few tenacious germs may survive by mutating or acquiring resistance genes from other bacteria. These surviving genes can multiply, quickly creating drug resistant strains. Some commonly used antimicrobials that are not effective with drug resistant bacteria are: Penicillin, Ampicillin, Antipseudomonal and Antistaphylococcal Penicillins, Cephalasporins, Carbapenem, Aztreonam, Fluoroquinolones, Trimethoprim and Vancomycin. A new class of antibiotics known as oxazolidinones were introduced in the United States in April of 2000. These drugs are indicated for treatment of nosocomial infections involving Gram positive organisms that are resistant to many of the drugs listed above. The sites of nosocomial infections in order from most to least common are: urinary tract; surgical wounds; respiratory tract; skin-particularly bums; blood bacteremia; gastrointestinal tract; and central nervous system. These infections are spread from person to person via direct contact, droplet, airborne, fecal-oral and blood borne routes. 3 The interaction of host, microorganism, and environment constitutes the basis for the epidemiology of infectious diseases. When considering nosocomial infections, the interactions among a hospitalized patient or healthcare worker, pathogens, and the hospital environment, including various therapeutic and diagnostic procedures, determine the probability of various nosocomial infections. A number of risk factors have been linked to the development of nosocomial infections, especially the organisms with antibiotic resistant properties. The primary risk factor is prior treatment with antibiotics, especially broad spectrum agents. Surveillance of nosocomial infections can be used to assess the quality of care in a particular hospital. Also, surveillance can indirectly aid in the understanding of the causes of nosocomial infections. The purpose of this project is to evaluate the prevalence of nosocomial infections among patients at the Dental Branch of the University of Texas Health Science Center as well as at the Texas Tech University Medical Center. It is hoped that this research will be able to contribute to the ongoing battle against the pathogenicity of nosocomial infections by shedding light on the biology and biochemical processes that cause their spread, and their prevalence in this particular environmen

“What Credit Is That to You?” The Social Context Of Moneylending In Medieval England A Comparative Study 1340-1509

This study makes use of the manorial court rolls of Dyffryn Clwyd, a cantref in Northern Wales, and the certificates of debt from London to examine the lives of two medieval usurers, Ieuan Kery and Sir William Capell, between the years 1340 to 1352 , and 1478 to 1509 . By examining the life of these two individuals who both operated one of the rarest, most socially complex occupations of his place and time, this study begins to expose the ways in which usury helped to shape the fabric of late Medieval culture in the British Isles. The singular focus of this study and the use of manorial court rolls and debt records, which make such a close focus possible, have been criticized by scholars of the period. Although this study is by nature preliminary, it serves to demonstrate the immense value of approaching old sources in new and innovative way

Disadvantaged gifted and talented students who make it to college and those who don\u27t: Implications for school leaders

Gifted and talented education students demonstrate outstanding ability in the areas of general intelligence, creative thinking, productive thinking, leadership, the visual arts, the performing arts, or an academic aptitude in a specified area. This study is a comparative, qualitative analysis of two groups of disadvantaged students who were categorized as gifted and talented in elementary school, and their postsecondary goals. Twelve students of cross-cultural backgrounds are included in the study. The academic journey of the students from elementary through secondary school, and the factors that determined whether they made it to college or not are the focus of the study. The researcher draws comparisons between the students\u27 personal experiences including community and institutional influences. A goal of the research was to gain insight regarding disadvantaged, gifted students. The results are intended to assist educators with ideas for pro-active planning in meeting the needs of disadvantaged, gifted students, relative to college aspirations