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Although much about holiness in Chaucer’s works remains disputed, elliptical, or even contradictory, many of his images of religious devotion and popular piety are themselves situated in a broader cultural context than is usually recognised. For Chaucer, as for most late medieval Christians of his day, holiness was instantiated in matter, present and manifest in shrines, relics, holy objects and in the natural world, and he shows himself attentive to such materiality in his images of popular religion. Many of the Tales celebrate orthodox Christian materiality in ways that align his devotional interests with those found in a broad range of English religious writings by authors with whom he is not typically connected, including Julian of Norwich and the Carthusian Nicholas Love. Other Tales offer an incisive critique of holiness in the context of contemporary practices within the Church. Chaucer’s many-sided works hold these glimmering tensions in balance.
As referrals to specialist palliative care (PC) grow in volume and diversity, an evidence-based triage method is needed to enable services to manage waiting lists in a transparent, efficient, and equitable manner. Discrete choice experiments (DCEs) have not to date been used among PC clinicians, but may serve as a rigorous and efficient method to explore and inform the complex decision-making involved in PC triage. This article presents the protocol for a novel application of an international DCE as part of a mixed-method research program, ultimately aiming to develop a clinical decision-making tool for PC triage.
Five stages of protocol development were undertaken: (1) identification of attributes of interest; (2) creation and (3) execution of a pilot DCE; and (4) refinement and (5) planned execution of the final DCE.
Six attributes of interest to PC triage were identified and included in a DCE that was piloted with 10 palliative care practitioners. The pilot was found to be feasible, with an acceptable cognitive burden, but refinements were made, including the creation of an additional attribute to allow independent analysis of concepts involved. Strategies for recruitment, data collection, analysis, and modeling were confirmed for the final planned DCE.
Significance of results
This DCE protocol serves as an example of how the sophisticated DCE methodology can be applied to health services research in PC. Discussion of key elements that improved the utility, integrity, and feasibility of the DCE provide valuable insights.
Giardia duodenalis and Cryptosporidium spp. are common intestinal protozoa that can cause diarrhoeal disease. Although cases of infection with Giardia and Cryptosporidium have been reported in Alaska, the seroprevalence and correlates of exposure to these parasites have not been characterised. We conducted a seroprevalence survey among 887 residents of Alaska, including sport hunters, wildlife biologists, subsistence bird hunters and their families and non-exposed persons. We tested serum using a multiplex bead assay to evaluate antibodies to the Giardia duodenalis variant-specific surface protein conserved structural regions and to the Cryptosporidium parvum 17- and 27-kDa antigens. Approximately one third of participants in each group had evidence of exposure to Cryptosporidium. Prevalence of Giardia antibody was highest among subsistence hunters and their families (30%), among whom positivity was associated with lack of community access to in-home running water (adjusted prevalence ratio [aPR] 1.15, 95% confidence interval (CI) 1.02–1.28) or collecting rain, ice, or snow to use as drinking water (aPR 1.09, 95% CI 1.01–1.18). Improving in-home water access for entire communities could decrease the risk of exposure to Giardia.
A 4-year (2010–2013) plot study was undertaken to evaluate the effect of nitrogen (N) fertilizer rate (0, 60, 120, 196 and 240 kg N/ha/year) on seasonal responses and species persistency in frequently and tightly grazed (⩽4 cm) grass-only (GO) and grass white clover swards (GWc). Increasing N application rate increased herbage removed and pre-grazing sward height. Cows frequently grazed the GWc tighter than the GO. Increasing N rate reduced clover content, especially during the warmest months of the year, but less so up to 120 kg N/ha/year. The GWc had greater amounts of herbage removed than GO in the May–September period but the effect was less as N rate increased. Cumulative herbage removed from GWc was greater than GO swards receiving the same N rate and herbage quality was better in GWc than GO. Such effects were reduced as swards aged and with increasing N rate. It was concluded that under frequent and tight grazing management: (1) clover inclusion increased annual herbage removed; (2) herbage removed from GWc swards receiving no N was the same as the GO sward receiving 240 kg N/ha, and greater for the 240 GWc swards than the 240 GO swards; (3) clover inclusion benefits were mainly from summer onwards; (4) the management strategy applied in the current experiment may be capable of alleviating the detrimental effect of N fertilizer on clover, to a point between 60 and 120 kg N/ha.
Sustainable ruminant production systems depend on the ability of livestock to utilize increased quantities of grazed herbage. The current study aimed to compare the effect of white clover (WC) inclusion and perennial ryegrass (PRG) ploidy on herbage dry matter (DM) production, plant morphology, nutritive value and biological nitrogen (N) fixation (BNF) under high N fertilizer use (250 kg N/ha) and high stocking rates (2.75 livestock units/ha). Four sward treatments (diploid-only, tetraploid-only, diploid-WC, tetraploid-WC) were evaluated over a full grazing season at a farmlet scale. White clover inclusion had a significant effect on herbage DM production, herbage growth rate, tiller density, organic matter digestibility, crude protein and BNF. Tetraploid swards had a lower tiller density, lower sward WC content and post-grazing sward height and increased organic matter digestibility and crude protein than diploid swards. White clover inclusion improved herbage DM production and nutritive value across a full grazing season, with tetraploid and diploid swards producing similar herbage DM yields across the year. Perennial ryegrass ploidy had an effect on WC morphology as plants in diploid-WC swards had narrower, longer stolons, fewer branches and more petioles than tetraploid-WC swards. The current study highlights the benefit of including WC in grass-based systems under a high N fertilizer regime and high stocking rate.
The Irish Sport Horse has commanded huge respect amongst horse owners and competitors of other nations, winning international, championship and Olympic medals for Great Britain (Shear L’eau, Supreme Rock), USA (Custom Made and Brazil (Special Envoy). The Irish Studbook continues to top the World Breeders Federation of Sport Horse (WBFSH) rankings for event horses based on competition results. The production of young horses through competition (training, novice and intermediate levels) has been an acknowledged format for identifying horses with the potential to excel at the highest levels of competition. However increasing production costs may be affecting the profitability of sport horse production. Reduced profit margins or possible negative returns may reduce the number of producers and this combined with the scientific improvements within other studbooks may threaten to reduce the potential for the Irish Sport Horse to retain its WBFSH event horse ranking. Furthermore, prize money offered in novice and intermediate competition appear to represent only nominal returns and fail to meet the costs of training and production.
Foodbook24 is a self-administered web-based 24-h dietary recall tool developed to assess food and nutrient intakes of Irish adults. This paper describes the first step undertaken in developing Foodbook24 which was to limit participant burden by establishing a concise list of food items for inclusion in the tool. The aim of the present study was to evaluate whether using a concise food list (as opposed to an extensive list) with generic composition data would influence the estimates of nutrient intakes in a nationally representative sample of Irish adults. A 2319-item food list generated from the Irish National Adult Nutrition Survey (NANS) (2008–2010) (n 1500) was used as the basis for a shortened food list for integration into the tool. Foods similar in nutritional composition were recoded with a generic type food code to produce a concise list of 751 food codes. The concise food list was applied to the NANS food consumption dataset and intake estimates of thirty-five nutrients were compared with estimates derived using the original extensive list. Small differences in nutrient intakes (<6 %) with limited effect size (Cohen's d < 0·1) were observed between estimates from both food lists. The concise food list showed strong positive correlations (rs 0·9–1·0, n 1500, P < 0·001) and a high level of agreement with the extensive list (80–97 % of nutrient intakes classified into the same tertile; >90% of intakes similarly categorised according to dietary reference values). This indicates that a concise food list is suitable for use in a web-based 24-h dietary recall tool for Irish adults.
The experience of caregiving in the context of motor neurone disease (MND) is extremely challenging. Over the past 15 years, quantitative and qualitative studies have delineated the psychosocial aspects of this experience, exploring its impact on caregivers' quality of life, rates of depression, distress, anxiety, and burden. Our paper aimed to provide an overview of the lived experience of MND caregivers, identifying the variables that can influence MND caregiver functioning that are relevant to the development of an intervention.
A narrative review was conducted, synthesizing the findings of literature retrieved from 2000 to early 2016.
A total of 37 articles were included in the review. The articles varied considerably in terms of methodology and quality. The main influential aspects reported and identified were factors pertaining to the patient, factors intrinsic to the caregiver, relationship factors, and social support factors.
Significance of Results:
There is evidence to support the fact that caregivers have poorer outcomes when they care for patients with a more severe clinical profile, poorer emotional health or neurobehavioral concerns, or when the caregivers themselves struggle with adaptive problem-solving and coping skills. The availability and use of social support are also likely to be important for caregiver psychosocial outcomes. Further investigation is required to clarify the influence of changes in the relationship with the patient. Significant factors affecting the caregiver experience are considered in relation to their amenability to psychosocial intervention. Recommendations are made regarding the optimal features of future psychosocial intervention research.
The current experiment was undertaken to investigate the effect of including white clover (Trifolium repens L.; WC) into perennial ryegrass (Lolium perenne L.; PRG) swards (PRG/WC) receiving 250 kg nitrogen (N) per hectare (ha) per year compared with PRG only swards receiving 250 kg N/ha/year, in an intensive grass-based spring calving dairy production scenario. Forty spring-calving cows were allocated to graze either a PRG/WC or PRG sward (n = 20) from 6 February to 31 October 2012. Fresh herbage was offered daily (17 kg dry matter (DM)/cow) supplemented with concentrate in times of herbage deficit (total supplementation 507 kg/cow). Pre-grazing herbage mass (HM), sward WC content and milk production were measured for the duration of the experiment. Herbage DM intake was estimated in May, July and September. Pre-grazing HM (±s.e.) was similar (1467 ± 173·1 kg DM/ha) for both treatments, as was cumulative herbage production (14 158 ± 769 kg DM/ha). Average WC content of the PRG/WC swards was 236 ± 30 g/kg DM. The PRG/WC cows had greater average daily milk yield and milk solids yield from June onwards. Cumulative milk yield and milk solids yield were greater for the PRG/WC cows compared with the PRG cows (5048 and 4789 ± 34·3 kg milk yield/cow, and 400 and 388 ± 1·87 kg milk solids/cow, respectively). Cows had similar DM intake in all measurements periods (15·1 ± 0·42 kg DM/cow/day). In conclusion, including WC in N-fertilized PRG swards increased milk production from cows grazing the PRG/WC swards compared with PRG, particularly in the second half of the lactation.
To measure the trends in traditional marine food intake and serum vitamin D levels in Alaska Native women of childbearing age (20–29 years old) from the 1960s to the present.
We measured a biomarker of traditional food intake, the δ15N value, and vitamin D level, as 25-hydroxycholecalciferol (25(OH)D3) concentration, in 100 serum samples from 20–29-year-old women archived in the Alaska Area Specimen Bank, selecting twenty-five per decade from the 1960s to the 1990s. We compared these with measurements of red-blood-cell δ15N values and serum 25(OH)D3 concentrations from 20–29-year-old women from the same region collected during the 2000s and 2010s in a Center for Alaska Native Health Research study.
The Yukon Kuskokwim Delta region of south-west Alaska.
Alaska Native women (n 319) aged 20–29 years at the time of specimen collection.
Intake of traditional marine foods, as measured by serum δ15N values, decreased significantly each decade from the 1960s through the 1990s, then remained constant from the 1990s through the present (F5,306=77·4, P<0·0001). Serum vitamin D concentrations also decreased from the 1960s to the present (F4,162=26·1, P<0·0001).
Consumption of traditional marine foods by young Alaska Native women dropped significantly between the 1960s and the 1990s and was associated with a significant decline in serum vitamin D concentrations. Studies are needed to evaluate the promotion of traditional marine foods and routine vitamin D supplementation during pregnancy for this population.