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BD is a 34-year-old semi-professional rugby union player and a part-time schoolteacher. Three years ago she suffered three concussions during one season and required a prolonged period of rest. Following an extended RTP protocol, which involved a month away from any rugby contact and a gradual increase in physical activity, she was integrated back into the team environment although she always thought she never reached her previous level of performance.
Selection for prolificacy in sows has resulted in higher metabolic demands during lactation. In addition, modern sows have an increased genetic merit for leanness. Consequently, sow metabolism during lactation has changed, possibly affecting milk production and litter weight gain. The aim of this study was to investigate the effect of lactational feed intake on milk production and relations between mobilization of body tissues (adipose tissue or skeletal muscle) and milk production in modern sows with a different lactational feed intake. A total of 36 primiparous sows were used, which were either full-fed (6.5 kg/day) or restricted-fed (3.25 kg/day) during the last 2 weeks of a 24-day lactation. Restricted-fed sows had a lower milk fat percentage at weaning and a lower litter weight gain and estimated milk fat and protein production in the last week of lactation. Next, several relations between sow body condition (loss) and milk production variables were identified. Sow BW, loin muscle depth and backfat depth at parturition were positively related to milk fat production in the last week of lactation. In addition, milk fat production was related to the backfat depth loss while milk protein production was related to the loin muscle depth loss during lactation. Backfat depth and loin muscle depth at parturition were positively related to lactational backfat depth loss or muscle depth loss, respectively. Together, results suggest that sows which have more available resources during lactation, either from a higher amount of body tissues at parturition or from an increased feed intake during lactation, direct more energy toward milk production to support a higher litter weight gain. In addition, results show that the type of milk nutrients that sows produce (i.e. milk fat or milk protein) is highly related to the type of body tissues that are mobilized during lactation. Interestingly, relations between sow body condition and milk production were all independent of feed level during lactation. Sow management strategies to increase milk production and litter growth in modern sows may focus on improving sow body condition at the start of lactation or increasing feed intake during lactation.
The University of Arkansas for Medical Sciences (UAMS), like many rural states, faces clinical and research obstacles to which digital innovation is seen as a promising solution. To implement digital technology, a mobile health interest group was established to lay the foundation for an enterprise-wide digital health innovation platform. To create a foundation, an interprofessional team was established, and a series of formal networking events was conducted. Three online digital health training models were developed, and a full-day regional conference was held featuring nationally recognized speakers and panel discussions with clinicians, researchers, and patient advocates involved in digital health programs at UAMS. Finally, an institution-wide survey exploring the interest in and knowledge of digital health technologies was distributed. The networking events averaged 35–45 attendees. About 100 individuals attended the regional conference with positive feedback from participants. To evaluate mHealth knowledge at the institution, a survey was completed by 257 UAMS clinicians, researchers, and staff. It revealed that there are opportunities to increase training, communication, and collaboration for digital health implementation. The inclusion of the mobile health working group in the newly formed Institute for Digital Health and Innovation provides a nexus for healthcare providers and researches to facilitate translational research.
Reintroduction to, or reinforcement of, threatened wild populations are commonly used conservation strategies. Reintroductions of the Southern Ground-hornbill Bucorvus leadbeateri have been tested as a potential conservation tool for this vulnerable species since 1995. Forty-two individuals have been reintroduced under varying management strategies. We analysed the outcomes of these attempts to assess which factors contributed most to success or failure. The species exhibits complex social learning and hierarchy, and is long-lived, with delayed sexual maturity. Immediate survival was significantly affected by the season in which the release was done and by the quality of the released birds. The best-quality release birds were reared with wild behavioural characteristics and were well-socialised to captive conspecifics prior to being placed into managed groups (‘bush schools’), where social learning was led by an experienced, wild alpha male. Once reintroduced birds had survived their first year after release, continued wild experience and wild mentorship significantly affected their survival. Since sample sizes limited the rigour of some statistical analyses, other factors were considered that may also determine success. These quasi-experimental reintroductions revealed novel threats to the species, such as the importance of a nest to group cohesion, that harvested second-hatched chicks provide viable release birds, which essentially doubles wild productivity, and that reintroductions generate valuable civil society awareness of the plight of the species.
This article examines Adam of Eynsham's Life of Hugh of Lincoln, the Magna Vita, and its portrayal of that bishop's interactions with the Angevin kings of England. Through a close reading of the text, and by placing the incidents recorded by Adam in a wider context, it explores Adam of Eynsham's conception of how a saintly bishop should criticize a king, and how clerics might do so without provoking royal wrath. Previous interpretations of the incidents recorded by Adam have centred on the notion that the Angevin kings lacked the sacrality or legitimacy of their predecessors and have claimed that those same monarchs sought to rectify this deficiency by associating themselves with figures such as Hugh of Lincoln.
This paper therefore has two aims. First, it challenges the argument that Hugh's interactions with the Angevin kings constitute a useful or viable measure of royal sacrality. Second, it suggests that Hugh of Lincoln's admonition of the Angevin kings drew upon both insular and far more widespread traditions of how a bishop should criticize the Lord's Anointed. By examining Adam's portrayal of these incidents in more detail, and in particular the specific targets of Hugh's criticisms and his methods of pursuing them, we draw attention to the possibilities and limitations of episcopal admonition. In addition, the article offers a broader reassessment not just of Adam of Eynsham's portrayal of the Angevin kings but also of the government and royal agents over which they presided, by exploring the incidents he described in greater depth than has hitherto been the case.
Adam of Eynsham's Magna Vita has been seized upon as a source to characterize the Angevin kings. The text has been quarried both as a source of anecdotes relating to the personalities of particular monarchs and, more substantially, to argue that the Angevins as a royal dynasty lacked the sacrality and legitimacy enjoyed by their predecessors. Historians, with the exception of Karl Leyser, have rarely scrutinized the Magna Vita in detail, however, and a reassessment of Adam's portrayal of Angevin kingship is long overdue.
There has been increasing interest in identifying individuals with pathological healthy eating behaviours, or orthorexia nervosa (ON). This study aimed to investigate the validity (construct- and criterion-related) and reliability (internal consistency) of the Eating Habits Questionnaire (EHQ) as a measure of ON. A secondary aim was to examine how the EHQ would predict a distinct feature of ON, adequate dietary intake.
Cross-sectional online questionnaire incorporating existing measures of ON and dietary intake.
Participants were recruited online via social media and a university’s research webpage.
Women (n 286) ranging in age from 17 to 73 years.
Exploratory factor analysis established that the EHQ represented four ON dimensions (Healthy Eating Cognitions, Dietary Restriction, Diet Superiority and Social Impairment), inconsistent with the scale’s original three dimensions (Problems, Knowledge and Feelings). Cronbach’s α coefficients ranged from 0·72 to 0·80 for the four subscales and was 0·89 for the total EHQ scale. Criterion-related validity revealed a significant moderate to strong correlation (r = −0·54, P < 0·001) between the EHQ and ORTO-10 (a ten-item version of ORTO-15). The EHQ, particularly the EHQ–Diet superiority subscale, was found to be predictive of better, as opposed to, poorer dietary adequacy.
Findings suggest that improvements still need to be made to the EHQ for it to be a valid and reliable measure of ON. Ideally, new assessment tools based on established diagnostic criteria are needed to advance our understanding of ON.
Integration of depression treatment into primary care could improve patient outcomes in low-resource settings. Losses along the depression care cascade limit integrated service effectiveness. This study identified patient-level factors that predicted detection of depressive symptoms by nurses, referral for depression treatment, and uptake of counseling, as part of integrated care in KwaZulu-Natal, South Africa.
This was an analysis of baseline data from a prospective cohort. Participants were adult patients with at least moderate depressive symptoms at primary care facilities in Amajuba, KwaZulu-Natal, South Africa. Participants were screened for depressive symptoms prior to routine assessment by a nurse. Generalized linear mixed-effects models were used to estimate associations between patient characteristics and service delivery outcomes.
Data from 412 participants were analyzed. Nurses successfully detected depressive symptoms in 208 [50.5%, 95% confidence interval (CI) 38.9–62.0] participants; of these, they referred 76 (36.5%, 95% CI 20.3–56.5) for depression treatment; of these, 18 (23.7%, 95% CI 10.7–44.6) attended at least one session of depression counseling. Depressive symptom severity, alcohol use severity, and perceived stress were associated with detection. Similar factors did not drive referral or counseling uptake.
Nurses detected patients with depressive symptoms at rates comparable to primary care providers in high-resource settings, though gaps in referral and uptake persist. Nurses were more likely to detect symptoms among patients in more severe mental distress. Implementation strategies for integrated mental health care in low-resource settings should target improved rates of detection, referral, and uptake.
We systematically reviewed implementation research targeting depression interventions in low- and middle-income countries (LMICs) to assess gaps in methodological coverage.
PubMed, CINAHL, PsycINFO, and EMBASE were searched for evaluations of depression interventions in LMICs reporting at least one implementation outcome published through March 2019.
A total of 8714 studies were screened, 759 were assessed for eligibility, and 79 studies met inclusion criteria. Common implementation outcomes reported were acceptability (n = 50; 63.3%), feasibility (n = 28; 35.4%), and fidelity (n = 18; 22.8%). Only four studies (5.1%) reported adoption or penetration, and three (3.8%) reported sustainability. The Sub-Saharan Africa region (n = 29; 36.7%) had the most studies. The majority of studies (n = 59; 74.7%) reported outcomes for a depression intervention implemented in pilot researcher-controlled settings. Studies commonly focused on Hybrid Type-1 effectiveness-implementation designs (n = 53; 67.1), followed by Hybrid Type-3 (n = 16; 20.3%). Only 21 studies (26.6%) tested an implementation strategy, with the most common being revising professional roles (n = 10; 47.6%). The most common intervention modality was individual psychotherapy (n = 30; 38.0%). Common study designs were mixed methods (n = 27; 34.2%), quasi-experimental uncontrolled pre-post (n = 17; 21.5%), and individual randomized trials (n = 16; 20.3).
Existing research has focused on early-stage implementation outcomes. Most studies have utilized Hybrid Type-1 designs, with the primary aim to test intervention effectiveness delivered in researcher-controlled settings. Future research should focus on testing and optimizing implementation strategies to promote scale-up of evidence-based depression interventions in routine care. These studies should use high-quality pragmatic designs and focus on later-stage implementation outcomes such as cost, penetration, and sustainability.
I make a Quinean case that Quine’s ontological relativity marked a wrong turn in his philosophy, that his fundamental commitments point toward the classical view of ontology that was worked out in most detail in his Word and Object (1960). This removes the impetus toward (a version of) structuralism in his later philosophy.
Caring for people in distress or illness is emotionally draining and physically demanding. This article focuses on the experiences and needs of health service staff as professional carers. It overviews the current circumstances in the UK and links readers to the findings of: the Stevenson/Farmer Review of 2017; the report of the General Medical Council on the state of medical education and practice of 2018; and the British Medical Association survey of doctors and medical students published in 2019. We review the sources of stress that affects healthcare practitioners and introduce the concepts of emotional labour, psychological safety and psychosocial resilience. We draw attention to the vital importance of social support and leadership to protecting healthcare staff. We conclude this review of the topic by outlining a stepped model for actions that aim to: develop staff of healthcare services and help them to thrive at work; support staff who are struggling at work; and intervene to care for staff who are distressed or unwell whether they are continuing to work or not.
John Locke held the post of censor in 1664. In 1695 he played a noteworthy part in ending pre-publication censorship in England. On the face of it, Locke's two censorship moments should connect, with implications for our understanding of the ‘philosopher of freedom’. However, although separately each has received some attention, together they appear to have had none. Locke's role as censor moralis philosophiae at his Oxford college seems incidental to his later works and perhaps to his 1664 writings on the law of nature; his later contribution to parliament's abandonment of the 1662 Printing Act, so consequential for press freedom, disappoints inquirers who find Locke's anti-censorship case mired in mundane book trade issues. There is a more obvious reason for neglect of a connection, however, which is less the three decades separating the events than the linguistic and conceptual shifts over the next three centuries which separate our sense of ‘censorship’ from that of Locke's lifetime. In our time, it fell to Mark Goldie quietly to correct an influential misapprehension, that in 1695 Locke countenanced a replacement ‘Licensing Act’ retaining some measure of ‘preprinting censorship’. Goldie affirmed that ‘Locke's claim is that there should be no pre-publication censorship’. As he was aware, this usage of ‘censorship’ is ours, not Locke's, a useful shorthand standardly deployed in writing about past press control. In projecting the term on to the past, the question for scholars has tended to be whether ‘censorship’ connotes only pre-publication restraints, ‘for licensing is only part of the story’, as Goldie remarks. Historians debate whether England in 1695 saw ‘the end of censorship’, but in that time and place neither press licensing nor post-publication punishments were known as ‘censorship’.
In Locke's England, the terminology and concept remained closely bound to its classical antecedent: the ancient Roman office of censor charged with assessing citizens and overseeing morals and manners. Application of the words ‘censorship’ or ‘censor’ to the press was rare; application of the terminology to offices like that of Locke at Christ Church was unusual (it still is) but apt in context. In late 1663, it was Locke who was given the title ‘censor’ whereas Roger L'Estrange, to historians the censor of Restoration England, was made ‘Surveyour and Licencer’ of the press.
This paper presents a scoping review of the literature on child participatory research in Australia published in academic journals between 2000 and 2018. The review focused on research designed to engage with children and young people in the development, implementation and evaluation of services. A total of 207 papers were identified and distributed across eight service sectors: child protection and family law, community, disability, education, health, housing and homelessness, juvenile justice and mental health. The papers were reviewed against Shier’s participation matrix, demonstrating that almost all of the identified papers included children only as participants who contributed data to adult researchers. Only a small number of papers involved children and young people in the other phases of research, such as designing research questions, analysis and dissemination. There is a clear interest in the engagement of children and young people in service design and decision-making in Australia. This paper is intended to serve as a catalyst for discussion on where there are gaps and where further Australian research is needed.
We present a broad study of linear, clustered, noble gas puffs irradiated with the frequency doubled (527 nm) Titan laser at Lawrence Livermore National Laboratory. Pure Ar, Kr, and Xe clustered gas puffs, as well as two mixed-gas puffs consisting of KrAr and XeKrAr gases, make up the targets. Characterization experiments to determine gas-puff density show that varying the experimental parameter gas-delay timing (the delay between gas puff initialization and laser-gas-puff interaction) provides a simple control over the gas-puff density. X-ray emission (>1.4 keV) is studied as a function of gas composition, density, and delay timing. Xe gas puffs produce the strongest peak radiation in the several keV spectral region. The emitted radiation was found to be anisotropic, with smaller X-ray flux observed in the direction perpendicular to both laser beam propagation and polarization directions. The degree of anisotropy is independent of gas target type but increases with photon energy. X-ray spectroscopic measurements estimate plasma parameters and highlight their difference with previous studies. Electron beams with energy in excess of 72 keV are present in the noble gas-puff plasmas and results indicate that Ar plays a key role in their production. A drastic increase in harder X-ray emissions (X-ray flash effect) and multi-MeV electron-beam generation from Xe gas-puff plasma occurred when the laser beam was focused on the front edge of the linear gas puff.
Disasters and major incidents, while uncommon in each country, occur sufficiently frequently worldwide and have such societal impacts that they make headlines on most days. Perhaps, paradoxically, emergencies are so common as to be almost ordinary, if only in purely statistical terms, if it were not for the human impact, worry and suffering that is involved. This chapter shows how disasters are integral to and, thus, present a microcosm of our worlds. Our intention is to use them, in common with each of the topics in Section 3 of this book, to explore social influences on how people, communities and societies respond to and cope with the physical and psychosocial impacts of major events. This chapter links John Drury et al.’s exploration of the contribution of social psychology to crowd science in Chapter 15 with Drury and Alfadhli’s Chapter 17, on disasters. We intend that Chapters 15, 16 and 17 provide another window on the human condition, the importance of social relationships and the powerful influences of social identity.
This book illustrates the burgeoning literature focusing on the ill effects of many forms of adversity, misfortune and disaster, whether deliberate and human-inspired or of, so-called, natural origins. There appear to be many possible ways in which humans can fare badly in response to endogenous and exogenous stress, inequity and inequality. But, by contrast with the risks and the all-too-real suffering of so many survivors, we are struck by the positive ways in which so many people appear to cope with the stress, strain and potentially deleterious impacts. Indeed, post-traumatic growth and mental health problems that are consequent on disasters do not appear to lie at the opposite extremes of a spectrum of outcome, but may co-occur.
We are moved to ask how so many people do well or reasonably well and in what ways that learning might be applied to preventing people from developing problems in the future.
Public health is defined by the UK’s Faculty of Public Health as ‘The science and art of promoting and protecting health and well being, preventing ill health and prolonging life through the organised efforts of society’.
This definition locates the causes of ill health and the remedies in the realms of personal and societal agency, and not only in the remit of health practitioners. Although the latter have a role as members of society to make prevention a reality for themselves, families and communities, they play a special part in preventing further ill health for people who suffer mental illness and are seeking help for it.
Other chapters in this book attend to the relational and social fabric that enables people to flourish; it is made of good and trusting relationships, and material conditions that permit thought about purpose and meaning beyond survival.
This chapter pulls together key matters in this book. Its title is a quote from a line given to one of the characters in Hamlet by Shakespeare. That sentence perfectly outlines the intention of Section 5 of this book and the function of this final chapter in which I endeavour to align theory, research and the practical impacts of the topics covered by this book with the circumstances in which we find health services as we near the close of the second decade of the twenty-first century. But, first, I return to Chapter 1, to recapture some of those circumstances. Then, I look at the matters on which I think we should focus in order to sustain healthcare services and incorporate the social agenda identified in this book.