Health-related quality of life of individuals with transfemoral amputation fitted with the Transcutaneous Bone Anchoring Prosthesis following the OGAAP

Background The benefits and safety transcutaneous bone anchored prosthesis relying on a screw fixation are well reported.[1-17] However, most of the studies on press-fit implants and joint replacement technology have focused on surgical techniques.[3, 18-23] One European centre using this technique has reported on health related quality of life (HRQOL) for a group of individuals with transfemoral amputation (TFA).[3] Data from other centres are needed to assess the effectiveness of the technique in different settings. Aim This study aimed at reporting HRQOL data at baseline and up to 2-year follow-up for a group of TFAs treated by Osseointegration Group of Australia who followed the Osseointegration Group of Australia Accelerated Protocol (OGAAP), in Sydney between 08/12/2011 and 09/04/2014. Method A total of 16 TFAs (7 females and 9 males, age 51 ± 12 y, height 1.73 ± 0.12 m, weight 83 ±18 kg) participated in this study. The cause of amputation was trauma or congenital limb deficiency for 11 (69%) and 5 (31%) participants, respectively. A total of 12 (75%) participants were prosthetic users while 4(25%) were wheelchair bound prior the surgery. The HRQOL were obtained from Questionnaire for Persons with Transfemoral Amputation (Q-TFA) using the four main scales (i.e., Prosthetic use, Mobility, Problem, Global) one year before and between 6.5 and 24 months after the Stage 1 of the surgeries for the baseline and follow-up, respectively. Results The lapse of time before and after Stage 1 was -6.19±3.54 and 10.83±3.58 months respectively. The raw score and percentage of improvement are presented in Figures 1 and 2, respectively. Discussion & Conclusion The average results demonstrated an improvement in each domain, particularly in the reduction of problems and an increase in global state. Furthermore, 56%, 75%, 94% and 69% of the participants reported an improvement in Prosthetic use, Mobility, Problem, Global scales, respectively. These results were comparable to previous studies relying of screwed fixation confirming that press-fit implantation is a viable alternative for bone-anchored prostheses.[1, 7, 8]

Transcutaneous bone-anchoring prosthesis with hip replacement: A novel treatment for amputees

Background Over the last two decades, Transcutaneous Bone-Anchored Prosthesis (TCBAP) has proven to be an effective alternative for prosthetic attachment for above knee amputees, particularly for individuals suffering from socket interface related complications. [1-17] Amputees with a very short femoral residuum (<15 cm) are at a considerable higher risk for these complications as well as high risk of implant failure, if they underwent a typical TCBAP due to the relatively small bony-implant contact leading to a need of a novel technique. Aim A. To describe the surgical procedure combining THR with TCBAP for the first time; and B. To present preliminary data on potential risks and benefits with assessment of clinical and functional outcomes at follow up Method We used a TCBAP connected to the stem of a Total Hip Replacement (THR) prosthesis enabling the femoral residuum and the hip joint to act as weight sharing structures by transferring the load directly to the pelvis. We performed a tri-polar THR connected to a custom made TCBAP at the first stage followed by creating a skin implant interface as a second stage. We retrospectively reviewed three cases of transfemoral amputations presenting with extremely short femoral residuum. Patients were assessed clinically and functionally including standard measures of health-related quality of life, amputee mobility predictor tool, ambulation tests and actual activity level. Progress was monitored for 6-24 months. Results Clinical outcomes including adverse events show no major complications. Functional outcomes improved for all participants as early as 6 months follow up. All cases were wheelchair bound preoperatively (K0 – AMPRO) improved to walking with One stick (K3 – AMPRO) at 3 months follow up. Discussion & Conclusion THR and TCBAP were combined for the first time in this proof-of-concept case series. The preliminary outcomes indicated that this procedure is potentially a safe and effective alternative despite the theoretical increase in risk of ascending infection through the skin-implant interface to the external environment for this patient group. We suggest larger comparative series to further validate these results.

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.

Battery Assisted Wheel Chair

Wheelchair is required for the mobility of the disabled people. It can be categorized into two categories: manual, powered wheelchair. This paper deals with series hybrid combination of manual and battery powered wheelchair. The control scheme used is simpler than other hybrid wheelchairs. It includes the sensor less control of the speed. Battery assisted wheelchair (BAW) has less number of components in its hardware. Effort made by rider is reduced considerably. The control scheme also includes the dead man's switch feature. Speed loop is provided for the smooth variation of the speed. The current limit is governed by peak current mode control.

Universal Access-NY User’s Guide

What is Universal Access-NY? Universal Access-NY is a complete online planning toolkit, www.UniversalAccessNY.org, where a One-Stop Delivery System can assess its practices, and develop work plans to improve physical and programmatic accessibility for all One-Stop customers. This web site and manual was developed by Cornell University’s Employment and Disability Institute, through the support and guidance of the New York State Department of Labor, with funding from two U.S. Department of Labor Work Incentive Grants (WIG 1 and 2). This web site was designed for use in a collaborative manner, bringing together One-Stop personnel, agency partners, business leaders and customers with disabilities. Universal Access-NY supports continuous improvement, with features that encourage multiple uses and incremental systems change.

A Comparison of the Implementation of the Employment Provisions of the Americans with Disabilities Act of 1990 (ADA) in the United States and the Disability Discrimination Act (DDA) 1995 in the United Kingdom

This summarizes the results of recently conducted surveys in the United States and Britain to assess employer response in each of these countries to their respective employment disability nondiscrimination legislation.

Disability in a Technology-Driven Workplace

New Internet and Web-based technology applications have meant significant cost and time efficiencies to many American businesses. However, many employers have not yet fully grasped the impact of these new information and communication technologies on applicants and employees with certain disabilities such as vision impairments, hearing problems or limited dexterity. Although not all applicants and employees who have a disability may experience IT-access problems, to select groups it can pose a needless barrier. The increasing dominance of IT in the workplace presents both a challenge and an opportunity for workers with disabilities and their employers. It will be up to HR professionals to ensure that Web-based HR processes and workplace technologies are accessible to their employees with disabilities. .

Vaikeavammaisen nuoren aikuistuminen : Yksilöllinen ja erilainen elämänkulku

Transition to adulthood of severely disabled adolescents. Diversity in individual life courses. The focus of this study is to examine the transition to adulthood of severely disabled adolescents as part of their life course. The data for this study were gathered through interviews with nine severely disabled adolescents, who were interviewed several times over a period of eight years. At the beginning of the study the adolescents were between 18 and 24 years old. The informants had severe disabilities manifesting themselves as physical incapacity, cerebral palsy, vision or hearing impairment, neurological disease, or developmental disability. One of the adolescents communicated with symbols. All except one used a wheelchair. As severely disabled adolescents, they received benefits from Kela for persons with severe disabilities, such as the higher-rate or special disability allowance or disability pension, the higher-rate or special pensioners' care allowance, or medical rehabilitation services. The interviews focused on a number of selected themes such as relationships, family, education, work, leisure-time activities, dating, decision-making, independence, happiness, and one s self-image and identity. Data were also derived from interviews with five experts. Two of the experts interviewed were severely disabled themselves. The theoritical foundation of the study lies in perviuos research on the severly disabled, the transition to adulthood and the life course. The method of analysis and interpretation is qualitative and based on interviews with the adolescents. In terms of the analytical process, the focus is on recognizing individual events in the transition process to adulthood and identifying the meanings assigned to them by the adolescents. The narratives also provide a method to shed light on the individuality of the transition. The individual situations of severely disabled adolescents vary, and their disability impacts the range of options available to them as they plan their life course. The medical and social models of disability also have an effect on life courses. Although severely disabled adolescents are able to attain some goals, they remain outsiders in many respects. Key words: Disabled person, severely disabled person, adolescent, transition to adulthood, identity, life course.

Influência do exercício físico sobre a massa e o metabolismo ósseo de indivíduos com lesão medular cervical

Indivíduos que permanecem longo tempo em cadeira de rodas apresentam importante perda de massa óssea, principalmente nos membros inferiores, possivelmente agravada pela baixa ingestão de cálcio dietético e pelo inadequado estado nutricional de vitamina D. O exercício físico pode contribuir para a manutenção ou aumento da massa óssea em diferentes populações e nos indivíduos com lesão medular pode contribuir para atenuar a perda de massa óssea. O objetivo do presente estudo foi avaliar a influência da prática regular de exercício físico sobre a adequação da massa óssea, indicadores bioquímicos do metabolismo ósseo e estado nutricional de vitamina D em indivíduos com lesão medular cervical há pelo menos um ano. Em vinte e cinco homens de 19 a 56 anos sendo 15 fisicamente ativos e 10 sedentários, foi realizada análise sérica de cálcio, PTH, 25(OH)D, IGF-1, osteocalcina e NTx. As medidas do conteúdo mineral ósseo, densidade mineral óssea (DMO), massa magra e massa gorda foram realizadas por DXA. A pigmentação da pele (constitutiva e por bronzeamento) foi determinada por colorimetria com o objetivo de investigar sua influência sobre o estado de vitamina D. A ingestão habitual de cálcio foi registrada em um questionário de frequência alimentar direcionado para alimentos fonte. As comparações entre os dois grupos foram realizadas pela aplicação do Teste t de Student exceto para as variáveis ósseas que foram realizadas após ajustes pela massa corporal total, tempo de lesão e ingestão de cálcio utilizando-se análise de co-variância. Associações entre as variáveis estudadas foram avaliadas através de análise de correlação de Pearson. Valores de p<0.05 foram considerados significativos. Não foram observadas diferenças estatisticamente significativas entre os grupos para nenhuma variável óssea com exceção do z-score da DMO da coluna lombar, que foi significativamente maior no grupo de indivíduos sedentários (0,9 1,7 vs -0,7 0,8; p<0,05). No entanto, entre os indivíduos ativos, aqueles que iniciaram a prática de exercício físico com menos tempo decorrido após a lesão apresentaram maior DMO do fêmur (r=-0,60; p<0,05). Nos indivíduos ativos, a freqüência do exercício apresentou associação negativa com a concentração sérica de i-PTH (r = -0,50; p =0,05) e positiva com a concentração de 25(OH)D (r= 0,58; p <0,05). Após ajustes pela massa corporal total e tempo de lesão foram observadas associações positivas entre a ingestão diária de cálcio e z-score da DMO da coluna lombar (r = 0,73 e p <0,01) e DMO do rádio (r = 0,56 e p <0,05). Os resultados do presente estudo apontam para um efeito benéfico do exercício físico sobre a massa óssea e o perfil hormonal relacionado ao metabolismo ósseo. O início da prática regular de exercício físico o quanto antes após a lesão parece contribuir para atenuar a perda de massa óssea nos membros inferiores. Além disso, os resultados deste estudo sugerem uma possível potencialização do efeito osteogênico do exercício físico quando combinado a uma adequada ingestão de cálcio.

Memórias da equipe de enfermagem na primeira década da epidemia da Aids

Na década de 80 dramáticas ocorrências atingiram o país e o mundo na área da saúde com a descoberta da Síndrome da Imunodeficiência Adquirida (Aids) síndrome, causada pelo Vírus da Imunodeficiência Humana (HIV). O objetivo deste estudo foi descrever as representações sociais do HIV/Aids e as memórias sociais do cuidado de enfermagem construídas na década de 80 pela equipe de enfermagem. Optou-se por uma abordagem qualitativa, embasada na teoria de representações sociais e nos conceitos do campo da memória social. Os sujeitos do estudo foram 20 profissionais de enfermagem de serviços ambulatoriais e/ou da atenção básica, atuantes em 11 instituições públicas de saúde da cidade do Rio de Janeiro que possuem o Programa Nacional de DST/Aids. A coleta de dados foi realizada através de entrevista semiestruturada e questionário de caracterização sócio profissional. A análise dos dados deu-se em duas etapas, a primeira atraves da técnica de análise de conteúdo temática destinada a identificar nos depoimentos dos entrevistados os conteúdos discursivos relativos a década de 80. Posteriormente os trechos selecionados foram submetidos à análise lexical pelo software Alceste 4.10. Obteve-se três classes temáticas que abordaram: As percepções e as ações do cuidado de enfermagem na década de 80; Os primeiros contatos profissionais e pessoais com HIV/Aids e A mídia e a construção das representações sociais do HIV/Aids. Na primeira classe os profissionais de enfermagem relatam as memórias referentes aos cuidados prestados na década de 80, descrevendo como esse cuidado era prestado, o medo da contaminação e os profissionais que atuavam na prestação de serviços. Na classe 2 os sujeitos resgatam as primeiras vivências com as pessoas com HIV/Aids e os sentimentos experimentados neste primeiro contato. As características físicas, os aspectos emocionais, a introdução do AZT e o abandono familiar são elementos destacados. Na classe 3 são relatas as memórias referentes ao início da epidemia de HIV/Aids, com destaque para as ancoragens representacionais do surgimento do vírus, tendo especialmente o macaco como hospedeiro. Os meios de comunicação surgiram como formadores das memórias do início da epidemia, veiculando imagens, como a do cantor Cazuza, fortemente citado pelos sujeitos. Conclui-se que este estudo permitiu compreender, através das memórias e das representações, como se constituiu a atuação dos profissionais no início da epidemia, assim como a permanência de elementos simbólicos até hoje nas representações sociais do HIV/Aids.

Manifestações de violência no cotidiano de mulheres cadeirantes: um olhar inovador para a Enfermagem

O objeto deste estudo trata das manifestações de violência no cotidiano das mulheres cadeirantes. Ao reportarmos este fenômeno para Pessoas com Deficiência (PcD) faz-se necessário considerar uma sociedade segregante que valoriza o belo e que atravessa um processo de transformação para a aceitação da diversidade. Compreende-se que estruturas sociais vulnerabilizantes, isolamento, preconceito e violação de direitos aumentam a vulnerabilidade deste grupo e podem deflagrar situações de violência. A violência às mulheres com deficiência é parte da questão maior que envolve a violência às PcD, pois associa fatores socioculturais com as desigualdades de gênero. Partindo do desafio em desvelar a relação das mulheres com sua própria deficiência, com a cadeira de rodas - que traz consigo um importante arsenal simbólico, e suas percepções acerca da violência cotidiana, delimitou-se como participantes deste estudo mulheres com deficiência física cadeirantes. A relevância e as particularidades da violência às mulheres cadeirantes definiu o objetivo geral: discutir as violências vivenciadas por mulheres cadeirantes em seu cotidiano, considerando a perspectiva de gênero e dos estigmas sociais. Objetivos específicos: descrever as perspectivas da mulher cadeirante sobre sua condição; analisar as situações de violência vivenciadas pela mulher cadeirante, em seu cotidiano. Desenvolveu-se uma pesquisa descritivo-exploratória, com abordagem qualitativa, onde optou-se pelo método denominado Narrativa de Vida - referencial metodológico de Daniel Bertaux que contempla de forma ampla a expressão das participantes selecionadas. Para produção dos dados realizou-se treze entrevistas, em dois cenários que atendem PcD. Para complementar a captação das participantes, utilizou-se a técnica "bola de neve". Deste processo emergiram duas categorias analíticas: "A condição de mulher e cadeirante: necessidades e possibilidades" e "As violências cotidianas vivenciadas pela mulher cadeirante". Categorias estas que contemplam nossos objetivos. À guisa da conclusão, verificou-se que o entendimento destas mulheres acerca das manifestações de violência revelou aspectos que fazem parte de seus cotidianos que, primariamente não seriam consideradas situações de violência, e sim situações que envolvem a relação mulher-deficiência, o reconhecimento de um "novo corpo" e sua ligação com a cadeira de rodas. Destacaram-se questões concernentes à gênero que para mulheres com deficiência seriam ainda mais complexas, principalmente no que se referem as questões relativas à sexualidade/maternidade. Quanto às percepções das situações de violência, emergiram manifestações intrafamiliares, interpessoais e sexuais. No entanto, as violências institucionais e as que se relacionam com o cuidado em saúde prevaleceram. Grande parte das manifestações encontradas se relacionariam de alguma forma com a natureza psicológica da violência. Situações estigmatizantes narradas expuseram episódios reveladores, no que se refere ao comportamento de uma sociedade excludente que reage às diferenças. Conhecer o processo de "construção de uma situação de violência" pode significar um instrumento fundamental para a formação de vínculos e uma futura relação dialógica com os profissionais de saúde, particularmente enfermeiros. A enfermagem e suas práticas reúnem subsídios que podem dar início ao preenchimento da lacuna da assistência em saúde à estas mulheres, no tocante à violência.

悬索桥隧道式锚碇与围岩系统的破坏模式研究

The anchorages are unparalleled structures only in a suspension bridge, and as main bearing facilities, play an important role in connecting the superstructures and the ground. The tunnel anchorage, as one alternative type of the anchorages, has more advantages over its counterpart, the gravity anchorage. With the tunnel anchorages adopted, not only can surface excavation be reduced to protect the environment, and natural condition of the rock be utilized and potential bearing capacity of surrounding rock be mobilized to save engineering cost, but also the technological predominance of auxiliary engineering measures, such as prestressed concrete, anchoring piles, rock anchors and collar beam between the two separated anchorages, can be easily cooperated to work together harmoniously under the circumstances of poor rock quality. There are plentiful high mountains and deep canyons in west part of China, and long-span bridge construction is inevitably encountered in order to realize leapfrogging development of the transportation infrastructure. Western mountainous areas usually possess the conditions for constructing tunnel anchorages, and therefore, the tunnel anchorages, which are conformed to the conception of resource conservative and sustainable society, extremely have application and popularization value in western underdeveloped region. The scientific and technological problem about the design, construction and operation of tunnel anchorages should be further investigated. Combining the engineering of western tunnel anchorages for the Balinghe Suspension Bridge, this paper probed into the survey method and in-situ test method for tunnel anchorages, scientific rock quality evaluation of surrounding rock to provide reasonable physical and mechanical parameters for design, construction and operation of tunnel anchorages, bearing capacity estimation for tunnel anchorage, deformation prediction of the anchorage-rockmass system, tunnel-anchorage slope stability analysis and the evaluation of excavation stability and degree of safety of the anchorage tunnel. The following outcomes were obtained: 1. Materials of tunnel anchorages of suspension bridge built (and in progress) at home and abroad were systematically sorted out, with the engineering geological condition and geomechanical property of surrounding rock around the anchorage tunnel, the design size of anchorages and the construction method of anchorage tunnel paid more emphasis on, to unveil the internal relationship between the engineering geological conditions of surrounding rock and the design size and axis angle of anchorages and provide references for future design, construction and study of tunnel anchorages. 2. Physical and mechanical parameters were recommended based on three domestic and foreign methods of rock quality evaluation. 3. In-situ tests, adopting the back-thrust method, of two kinds of reduced scale model, 1/30 and 1/20, for the tunnel anchorages were conducted in the declining exploration drift with rock mass at the test depth being the same as surrounding rock around real anchorages, and reliable field rockmass displacement data were acquired. Attenuation relation between the increment of distance from the anchorage and the decrement of rockmass displacement under maximum test load, and influential scope suffered by anchorage load were obtained. 4. Using similarity theory, the magnitude of real anchorage and rockmass displacement under design load and degree of safety of the anchorage system were deduced. Furthermore, inversion analysis to deformation modulus of slightly weathered dolomite rock, the surrounding rock of anchorage tunnel, was performed by the means of numerical simulation. 5. The influential law of the geometrical size to the limit bearing capacity of tunnel anchorage was studied. 6. Based on engineering geological survey data, accounting for the combination of strata layer and adverse discontinuities, the failure patterns of tunnel anchorage slope were divided into three modes: sliding of splay saddle pier slope, superficial-layer slippage, and deep-layer slippage. Using virtual work principle and taking anchorage load in account, the stability of the three kinds of failure patterns were analyzed in detail. 7. The step-by-step excavation of anchorage tunnel, the numerical overload and the staged decrement of rock strength parameters were numerically simulated to evaluate the excavation stability of surrounding rock around anchorage tunnel, the overload performance of tunnel anchorage, and the safety margin of strength parameters of the surrounding rock.

Validity and Test –retest Reliability of the TIVRE-Basket® Test for the Determination of Aerobic Power in Elite Male Basketball Players

The aims of this study were to 1) determine the relationship between performance on the court-based TIVRE-Basket® test and peak aerobic power determined from a criterion lab-based incremental treadmill test and 2) to examine the test-retest reliability of the TIVRE-Basket® test in elite male basketball players. To address aim 1, 36 elite male basketball players (age 25.2 + 4.7 years, weight 94.1 + 11.4 kg, height 195.83 + 9.6 cm) completed a graded treadmill exercise test and the TIVRE-Basket® within 72 hours. Mean distance recorded during the TIVRE-Basket® test was 4001.8 + 176.4m, and mean VO2 peak was 54.7 + 2.8 ml.kg.min-1, and the correlation between the two parameters was r=0.824 (P= <0.001). Linear regression analysis identified TIVRE-Basket® distance (m) as the only unique predictor of VO2 peak in a single variable plus constant model: VO2 peak = 2.595 + ((0.13* TIVRE-Basket® distance (m)). Performance on the TIVRE-Basket® test accounted for 67.8% of the variance in VO2 peak (t=8.466, P=<.001, 95% CI 0.01 - 0.016, SEE 1.61). To address aim 2, 20 male basketball players (age 26.7±4.2; height 1.94±0.92; weight 94.0±9.1) performed the TIVRE-Basket® test on two occasions. There was no significant difference in total distance covered between Trial 1 (4138.8 + 677.3m) and Trial 2 (4188.0 + 648.8m; t = 0.5798, P = 0.5688). Mean difference between trials was 49.2 + 399.5m, with an ICC of 0.85 suggesting a moderate level of reliability. Standardised TEM was 0.88%, representing a moderate degree of trial to trial error, and the CV was 6.3%. The TIVRE-Basket® test therefore represents a valid and moderately reliable court-based sport-specific test of aerobic power for use with individuals and teams of elite level male basketball players. Future research is required to ascertain its validity and reliability in other basketball populations e.g. across age groups, at different levels of competition, in females and in different forms of the game e.g. wheelchair basketball.

Tony Biernacki Collection, 1967, 1979-1980, n.d.

Tony Biernacki's rowing career began in 1950 in Ottawa with his first Henley medal in 1952 in the coxless four. Sculling became his real means to success. Since 1955 he has posted record times and had numerous wins in the single. He represented Canada at the National Team between 1958 and 1967 and raced in the single at the British Empire Games and Pan Am Games (Chicago, silver medal) and pair at the Worlds in Yugoslavia in 1966. He won the Olympic trials in 1960 in Rome, but was unable to go. Upon his retirement from competition Tony was hired as the Team Manager for the following Pan Am Games. Tony was hired by Brock University in 1965 as a technician in the Chemistry Department. He became the head rowing coach that same year and began women’s rowing at the university level in Ontario with the first women’s crew in 1967. As Brock's second coach ever, he led the teams to championship form and kept the athletes racing through the summer regatta season. Tony remained at Brock from 1965 to 1980. He was one of the founders of The Canadian Masters Rowing Committee and he helped to initiate master's racing at the Canadian Henley. In 1985 he won the single, double and quad at the World Masters Regatta in Toronto. For a number of years he was also the world record holder for his age category on the C2 ergometer. His last heartfelt project was the construction of a wheelchair ramp at Resurrection Lutheran Church where he was an active member. Mr. Biernacki passed away on January 9, 1998 at the age of 66 after a valiant battle with cancer only a month after being awarded the Canadian Coaching Provincial Coaching Award. He is survived by his wife Janet, daughters Tracy, Tammy Pauls, and Tory Phannenhour, and son, Tony Jr. He is also survived by several grandchildren.