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This study investigated the challenges and support needs of adults aged 75 and older during and after treatment for a blood cancer to aid targeted supportive resource development.
Adults aged 75 and older with a blood cancer participated in in-depth, semi-structured interviews about challenges and unmet support needs. Participants recruited through The Leukemia & Lymphoma Society were (1) in treatment or previously in treatment for a blood cancer at age 75 or older and (2) living in the United States or its territories. A thematic analysis was conducted with findings compared between 2 groups: (1) chronic -living with a chronic blood cancer; (2) acute -living with an acute blood cancer or both an acute and chronic blood cancer.
Participants (n = 50) ranged from 75 to 91 years old. Both groups described similar experiences and identified 5 challenges and support needs: (1) socioemotional impact, (2) activities of daily living and instrumental activities of daily living (ADLs/iADLs), (3) uncertainty management, (4) treatment-related stressors, and (5) COVID-19-related strain. Properties for these themes illustrate challenges and support needs, with some differences between groups. For instance, those living with a chronic blood cancer highlighted financial strain with treatment-related stressors, while those with an acute blood cancer focused more on iADLs.
Significance of results
Findings inform an agenda for targeted resource development for older adults with a blood cancer nearing the end of the life span. Results demonstrate the need for supportive services and family communication interventions to help patients manage iADLs and navigate socioemotional needs and challenges.
Previous research has shown surplus dairy calves arrive at ‘formula-fed’ veal operations in North America in sub-optimal condition; however, little is known about the condition of ‘bob’ veal calves on arrival at abattoirs. The objectives of this study were to assess the condition of bob veal calves on arrival at an abattoir in Ohio and determine risk factors for poor health outcomes. On arrival, 35 calves in each of 12 cohorts (n = 420 calves) were assessed using a standardised health examination. A blood sample was also collected to assess failed transfer of passive immunity (FTPI) and hypoglycaemia. Descriptive statistics were used to describe the prevalence of poor health outcomes. Mixed-effects logistic regression models were used to identify if calf breed, sex, or source were risk factors for poor health outcomes. The most common physical health concern observed on arrival at the abattoir was dehydration (mean: 68.6%), followed by thin body condition (39.8%), and navel inflammation (25.7%). Approximately one-quarter (23.4%) of calves had FTPI and 73.4% were hypoglycaemic. Male calves were more likely than females to arrive hypoglycaemic. Hydration status was associated with breed; Jersey and crossbreed calves were less likely to be dehydrated than Holstein-Friesian calves. Buying station tended to be associated with FTPI. These results underline the need for more studies investigating morbidity, mortality, and their underlying risk factors to promote calf welfare prior to slaughter in each stage of the production chain: on the dairy farm of birth, during marketing, and in transit.
A review of the literature was undertaken to consider the possible effects of human intervention (shepherding) at around the time of parturition in extensively farmed sheep. There is little clear empirical evidence to suggest that shepherding ensures either easy births or the integrity of ewe–lamb contact — factors closely linked to the welfare of the animals at this time. There is similarly no clear support for shepherding being harmful. However, the following suggestions are made: first, human presence can inhibit or delay parturition; second, extended parturition can increase the risk of, or is associated with, dystocia; and third, disturbance at birth can compromise ewe-lamb bonding and consequently lamb survival. Furthermore, sheep populations that have undergone rigorous selection for ease of lambing and minimal shepherding in extensive environments have well-documented physical and behavioural traits underlying their predisposition for enhanced lamb survival. Although our cultural legacy may impose a duty to intensively monitor animals at lambing, it is concluded that, at least in some situations, shepherding may not be entirely beneficial. The commonly held view of the necessity for some human intervention in extensive livestock systems is perhaps overly paternalistic, and requires a more comprehensive appraisal.
With advances in care, an increasing number of individuals with single-ventricle CHD are surviving into adulthood. Partners of individuals with chronic illness have unique experiences and challenges. The goal of this pilot qualitative research study was to explore the lived experiences of partners of individuals with single-ventricle CHD.
Partners of patients ≥18 years with single-ventricle CHD were recruited and participated in Experience Group sessions and 1:1 interviews. Experience Group sessions are lightly moderated groups that bring together individuals with similar circumstances to discuss their lived experiences, centreing them as the experts. Formal inductive qualitative coding was performed to identify salient themes.
Six partners of patients participated. Of these, four were males and four were married; all were partners of someone of the opposite sex. Themes identified included uncertainty about their partners’ future health and mortality, becoming a lay CHD specialist, balancing multiple roles, and providing positivity and optimism. Over time, they took on a role as advocates for their partners and as repositories of medical history to help navigate the health system. Despite the uncertainties, participants described championing positivity and optimism for the future.
In this first-of-its-kind pilot study, partners of individuals with single-ventricle CHD expressed unique challenges and experiences in their lives. There is a tacit need to design strategies to help partners cope with those challenges. Further larger-scale research is required to better understand the experiences of this unique population.
Exclusion of special populations (older adults; pregnant women, children, and adolescents; individuals of lower socioeconomic status and/or who live in rural communities; people from racial and ethnic minority groups; individuals from sexual or gender minority groups; and individuals with disabilities) in research is a pervasive problem, despite efforts and policy changes by the National Institutes of Health and other organizations. These populations are adversely impacted by social determinants of health (SDOH) that reduce access and ability to participate in biomedical research. In March 2020, the Northwestern University Clinical and Translational Sciences Institute hosted the “Lifespan and Life Course Research: integrating strategies” “Un-Meeting” to discuss barriers and solutions to underrepresentation of special populations in biomedical research. The COVID-19 pandemic highlighted how exclusion of representative populations in research can increase health inequities. We applied findings of this meeting to perform a literature review of barriers and solutions to recruitment and retention of representative populations in research and to discuss how findings are important to research conducted during the ongoing COVID-19 pandemic. We highlight the role of SDOH, review barriers and solutions to underrepresentation, and discuss the importance of a structural competency framework to improve research participation and retention among special populations.
Chapter 4 examines the codification of agricultural knowledge, the process through which practical knowledge was transformed into writing. Rather than asking whether this produced ‘useful’ knowledge to improve farming methods, it asks: for whom was such knowledge useful? It first identifies the construction of ‘agriculture’ as a literary category and an independent body of theory in the seventeenth century, departing from classical and medieval genres. The main section analyses four key modes of codification from 1669 to 1792: systematic, theoretical, experimental and observational. It argues that fundamentally all these modes of codification were shaped by the need to subordinate customary knowledge and labour and establish the supremacy of written knowledge. It further argues that the art of husbandry was codified in accordance with the cultural preferences and managerial interests of landowners, professionals and large farmers. Hence farming books provided a managerial knowledge suitable for the emerging occupational structures of agrarian capitalism.
Chapter 1 sets out a new sociological model for analysing the relationship between agricultural books, knowledge and labour in early modern Britain. The first section argues that the major socio-economic trends in early modern agriculture, giving rise to agrarian capitalism, necessarily involved a concentration in managerial control and therefore required a change in the social system of knowledge. The second section explores recent sociological approaches to books, knowledge and labour. It concludes by summarising how these sociological insights can be applied to early modern agriculture to develop a new framework for understanding the cumulative social impact of printed information and advice. It establishes the basic research question pursued in later chapters: How did books contribute to new divisions of labour and new ways of controlling knowledge?
Chapter 3 argues that agricultural books should be understood as a tool to appropriate the practical art of husbandry by learned culture, enabling a ‘bottom-up’ transfer of knowledge as much as a ‘top-down’ diffusion of knowledge from expert to practitioner. It argues that there was a shift around mid-seventeenth century England as the gentry became more directly engaged in farm management. It shows how the customary art of husbandry was re-imagined for gentlemen, by elevating it to science of agriculture and undermining the authority of common husbandmen and housewives. It discusses how educated men collected into writing the knowledge of husbandry stored in customary practice and oral tradition. In particular, it highlights a hidden gendered dimension, in which women’s knowledge was transferred to male authors, contributing to the increased marginalisation of women’s farm work. Finally, it draws attention to how common farmworkers resisted the extraction of their knowledge by their social superiors.
Chapter 6 explores the efforts to institutionalise a new book-based expertise through the professionalisation of agriculture. First, it considers the reimagining of agriculture as a learned profession through contemporary analogies with medicine. Second, it examines how books were envisioned as part of a new system of learning by analysing proposals for educational reform. Third, it examines the development of the estate or land steward as an example of an agricultural profession that came to be defined by possession of universal book-based knowledge, through an analysis of manuals for stewards. It argues that while the vision of professionalised agriculture was only partly achieved, it reveals the scope of ambition of agricultural authors in their determination to monopolise knowledge.
This introduction sketches the main arguments about the contribution of farming books to the development of agrarian capitalism and lays the groundwork for the detailed argument in later chapters. It first offers a critique of the standard research paradigm, the enlightenment model, which only evaluates the role of books with respect to technological change and is insensitive to early modern social relations. It then explains the research method and scope, focused on British agricultural books printed between 1660 and 1800. Since the structure of the book is thematic, it presents a broad survey of agricultural books and authors to serve as a reference for the rest of the book. It ends by summarising how the core argument is developed over seven chapters.
This conclusion reflects upon the contribution of this study to different spheres of history. First, it considers how the analysis changes our understanding of agricultural books in early modern Britain, by revisiting the advantages of the sociological approach compared with the enlightenment model. It restates the core argument about the enclosure of knowledge in light of the detailed arguments of specific chapters. Second, it suggests that this study opens up space for a new field of research: the social history of agricultural knowledge. It discusses how the current arguments about book-knowledge can be tested, but also how alternative approaches might go beyond the focus on books. Third, it considers the implications for general histories of knowledge and capitalism, which is illustrated through three key concepts: the real subsumption of labour, deskilling and commodification. It argues that the story of early English agricultural literature is not only relevant, but foundational to the history of capitalism in general.
Chapter 7 re-examines the ‘book-farming’ controversy of the late eighteenth century. It first highlights the precarious power of book-knowledge, which offered mastery to an educated landowning class, but was a poor substitute for experience. The analysis distinguishes between a weak and a strong critique of agricultural books. The weak critique expressed by authors themselves condemned an overly theoretical approach or the overly speculative ideas in books. The strong critique was expressed in the reported hostility of working farmers, which was fundamentally suspicious of the value of learning about farming from books and challenged the proclaimed authority of writers. It argues that the strong opposition to book-farming can only be understood by considering the balance of power within agricultural labour relations. Hostility to book-farming was a form of ‘everyday resistance’ to the subordination of customary knowledge and the use of books as tools of management in the running of estates and large farms.
Chapter 2 establishes the context usually neglected by histories of agricultural literature: how farming was learned without books in the prevailing system of knowledge in the sixteenth and seventeenth centuries. It examines the discourse on the ‘mystery of husbandry’ (and closely associated discourse of ‘secrets’), a term denoting the knowledge and skills acquired by experienced practitioners that were inaccessible to amateurs, to both elucidate contemporary beliefs about learning through labour and to indicate the ways in which the publication of husbandry manuals disrupted existing notions of expertise. In doing so, it explores the parallels between craft and farming knowledge and borrows ideas from modern studies to argue that early modern husbandmen and housewives would have possessed a ‘peasant epistemology’ analogous to an ‘artisanal epistemology’. The chapter argues that when linked to broader socio-economic changes in farming, the emergence of the term ‘mystery of husbandry’ in the seventeenth century can be seen as a symptom of tectonic shifts in the social system of agricultural knowledge. In short, the knowledge of husbandry was being commodified in an increasingly competitive commercial environment.