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Previous observational studies suggested that vitamin D may control the absorption of iron (Fe) by inhibition of hepcidin, but the causal relevance of these associations is uncertain. Using placebo-controlled randomisation, we assessed the effects of supplementation with vitamin D on biochemical markers of Fe status and erythropoiesis in community-dwelling older people living in the UK. The BEST-D trial, designed to establish the optimum dose of vitamin D3 for future trials, had 305 participants, aged 65 years or older, randomly allocated to 4000 IU vitamin D3 (n 102), 2000 IU vitamin D3 (n 102) or matching placebo (n 101). We estimated the effect of vitamin D allocation on plasma levels of hepcidin, soluble transferrin receptor (sTfR), ferritin, Fe, transferrin, saturated transferrin (TSAT%) and the sTfR–ferritin index. Despite increases in 25-hydroxy-vitamin D, neither dose had significant effects on biochemical markers of Fe status or erythropoiesis. Geometric mean concentrations were similar in vitamin D3 arms v. placebo for hepcidin (20·7 [se 0·90] v. 20·5 [1·21] ng/ml), sTfR (0·69 [0·010] v. 0·70 [0·015] µg/ml), ferritin (97·1 [2·81] v. 97·8 [4·10] µg/l) and sTfR–ferritin ratio (0·36 [0·006] v. 0·36 [0·009]), respectively, while arithmetic mean levels were similar for Fe (16·7 [0·38] v. 17·3 [0·54] µmol/l), transferrin (2·56 [0·014] v. 2·60 [0·021] g/dl) and TSAT% (26·5 [0·60] v. 27·5 [0·85]). The proportions of participants with ferritin < 15 µg/l and TSAT < 16 % were unaltered by vitamin D3 suggesting that 12 months of daily supplementation with moderately high doses of vitamin D3 are unlikely to alter the Fe status of older adults.
The expensive-tissue hypothesis (ETH) posited a brain–gut trade-off to explain how humans evolved large, costly brains. Versions of the ETH interrogating gut or other body tissues have been tested in non-human animals, but not humans. We collected brain and body composition data in 70 South Asian women and used structural equation modelling with instrumental variables, an approach that handles threats to causal inference including measurement error, unmeasured confounding and reverse causality. We tested a negative, causal effect of the latent construct ‘nutritional investment in brain tissues’ (MRI-derived brain volumes) on the construct ‘nutritional investment in lean body tissues’ (organ volume and skeletal muscle). We also predicted a negative causal effect of the brain latent on fat mass. We found negative causal estimates for both brain and lean tissue (−0.41, 95% CI, −1.13, 0.23) and brain and fat (−0.56, 95% CI, −2.46, 2.28). These results, although inconclusive, are consistent with theory and prior evidence of the brain trading off with lean and fat tissues, and they are an important step in assessing empirical evidence for the ETH in humans. Analyses using larger datasets, genetic data and causal modelling are required to build on these findings and expand the evidence base.
Policymakers, practitioners and the public all have a role in health emergency and disaster risk management (Health EDRM). They need to access, understand and use evidence from research to take actions to reduce health risks and harm. They need the best available evidence to maximize their ability to save lives and reduce suffering. Evidence Aid seeks to meet this need through collections of specially prepared plain-language summaries of systematic reviews, freely available online in multiple languages (www.EvidenceAid.org). The summaries and webpages can be linked to reference management software and embedded in other websites.
Method:
Evidence Aid has added a substantial number of summaries to its collections since 2020, for example, adding a collection for reviews of relevance to the COVID-19 pandemic and its associated measures. From 2021, Evidence Aid built on its partnership with the Pan American Health Organization (PAHO/WHO) to identify and summarize reviews relevant to building resilience into health systems. This included enhancements enriching the content of each summary with the authors’ implications for practice and research, equity considerations and funding sources.
Results:
In November 2022, the Resilient Health Systems collection contained more than 200 summaries relevant to ensuring that health systems are resilient to emergencies, disasters and related challenges. There were also 600 summaries relevant to the COVID-19 pandemic, 150 on the health of refugees and asylum seekers, more than 100 on physical and mental health impacts of disasters and 110 on preventing and treating acute malnutrition.
Conclusion:
Evidence Aid’s 1000+ summaries of systematic reviews relevant to Health EDRM provide a unique gateway into this evidence base for policymakers, practitioners and the public wishing to ensure that disaster preparedness, response, recovery and rehabilitation are effective and efficient. It should be a key component in helping people and organizations to care, cope and overcome in an increasingly challenging world.
The impact of losing a limb in military service extends well beyond initial recovery and rehabilitation, with long-term consequences and challenges requiring health-care commitments across the lifecourse. This paper presents a systematic review of the current state of knowledge regarding the long-term impact of ageing and limb-loss in military veterans. Key databases were systematically searched including: ASSIA, CINAHL, Cochrane Library, Medline, Web of Science, PsycArticles/PsychInfo, ProQuest Psychology and ProQuest Sociology Journals, and SPORTSDiscus. Empirical studies which focused on the long-term impact of limb-loss and/or health-care requirements in veterans were included. The search process revealed 30 papers relevant for inclusion. These papers focused broadly on four themes: (a) long-term health outcomes, prosthetics use and quality of life; (b) long-term psycho-social adaptation and coping with limb-loss; (c) disability and identity; and (d) estimating the long-term costs of care and prosthetic provision. Findings present a compelling case for ensuring the long-term care needs and costs of rehabilitation for older limbless veterans are met. A dearth of information on the lived experience of limb-loss and the needs of veterans’ families calls for further research to address these important issues.
This collection of essays pays tribute to Nancy Freeman Regalado, a ground-breaking scholar in the field of medieval French literature whose research has always pushed beyond disciplinary boundaries. The articles in the volume reflect the depth and diversity of her scholarship, as well as her collaborations with literary critics, philologists, historians, art historians, musicologists, and vocalists - in France, England, and the United States. Inspired by her most recent work, these twenty-four essays are tied together by a single question, rich in ramifications: how does performance shape our understanding of medieval and pre-modern literature and culture, whether the nature of that performance is visual, linguistic, theatrical, musical, religious, didactic, socio-political, or editorial? The studies presented here invite us to look afresh at the interrelationship of audience, author, text, and artifact, to imagine new ways of conceptualizing the creation, transmission, and reception of medieval literature, music, and art.
EGLAL DOSS-QUINBY is Professor of French at Smith College; ROBERTA L. KRUEGER is Professor of French at Hamilton College; E. JANE BURNS is Professor of Women's Studies and Adjunct Professor of Comparative Literature at the University of North Carolina, Chapel Hill.
Contributors: ANNE AZÉMA, RENATE BLUMENFELD-KOSINSKI, CYNTHIA J. BROWN, ELIZABETH A. R. BROWN, MATILDA TOMARYN BRUCKNER, E. JANE BURNS, ARDIS BUTTERFIELD, KIMBERLEE CAMPBELL, ROBERT L. A. CLARK, MARK CRUSE, KATHRYN A. DUYS, ELIZABETH EMERY, SYLVIA HUOT, MARILYN LAWRENCE, KATHLEEN A. LOYSEN, LAURIE POSTLEWATE, EDWARD H. ROESNER, SAMUEL N. ROSENBERG, LUCY FREEMAN SANDLER, PAMELA SHEINGORN, HELEN SOLTERER, JANE H. M. TAYLOR, EVELYN BIRGE VITZ, LORI J. WALTERS, AND MICHEL ZINK.
The upper 20—30 m of ice-rich permafrost at three sites overridden by the northwest margin of the Laurentide ice sheet in the Tuktoyaktuk Coastlands, western Arctic Canada, comprise massive ice beneath ice-rich diamicton or sandy silt. The diamicton and silt contain (1) truncated ice blocks up to 15 m long, (2) sand lenses and layers, (3) ice veins dipping at 20—30°, (4) ice lenses adjacent and parallel to sedimentary contacts, and (5) ice wedges. The massive ice is interpreted as intrasedimental or buried basal glacier ice, and the diamicton and silt as glacitectonite that has never thawed. Deformation of frozen ground was mainly ductile in character. Deformation was accompanied by sub-marginal erosion of permafrost, which formed an angular unconformity along the top of the massive ice and supplied ice clasts and sand bodies to the overlying glacitectonite. After deformation and erosion ceased, postglacial segregated ice and ice- wedge ice developed within the deformed permafrost.
The active management of the experience of living with dementia appears to improve quality of life despite the lack of disease modification. However, research to date has been largely of modest scale and explanatory factors for improvements have been under-conceptualised. Thus, although promulgated through national strategies, the evidence base is relatively weak. This paper reports on a nation-wide study of the influence of the National Dementia Strategy for England in relation to Dementia Adviser and Peer Support Network services in 40 demonstration sites. The research aimed to identify ways in which the services contribute to the wellbeing and resilience of people with dementia and care partners. A mixed-methods research design collected data through: activity and outcome monitoring; organisational surveys; in-depth case studies, including qualitative interviews with people with dementia (N = 47) and care partners (N = 54), wellbeing and quality of life measures, and interviews with staff and other stakeholders (N = 82). Three themes are explored: addressing individual and community needs; promoting independence, control and choice; and getting a life back. Services promoted independence, control and choice, and consequently enabled people to re-narrate their lives as purposeful within their communities. Ways in which these are achieved resemble the public health model of lay health advisor and this research adds to the imperative to approach dementia as a key public health concern.
Described as "a golden age of pathogens", the long fifteenth century was notable for a series of international, national and regional epidemics that had a profound effect upon the fabric of society. The impact of pestilence upon the literary, religious, social and political life of men, women and children throughout Europe and beyond continues to excite lively debate among historians, as the ten papers presented in this volume confirm. They deal with the response of urban communities in England, France and Italy to matters of public health, governance and welfare, as well as addressing the reactions of the medical profession to successive outbreaks of disease, and of individuals to the omnipresence of Death, while two, very different, essays examine the important, if sometimes controversial, contribution now being made by microbiologists to our understanding of the Black Death. Contributors: J.L. Bolton, Elma Brenner, Samuel Cohn, John Henderson, Neil Murphy, Elizabeth Rutledge, Samantha Sagui, Karen Smyth, Jane Stevens Crawshaw, Sheila Sweetinburgh
During the first half of the sixteenth century, municipal councils across northern France issued ordinances designed to combat outbreaks of plague. The measures contained in these ordinances were extensive and formed the core of urban responses to plague throughout the early modern period. These ordinances did not appear out of a vacuum; rather, they represented the codification of stratagems adopted during the second half of the fifteenth century. This article will describe and account for the growth of the public health system developed by the magistrates of towns lying in the urban belt of northern and north-eastern France from the 1450s to the 1550s. It will concentrate on the towns and cities of Abbeville, Amiens, Beauvais, Paris, Rouen and Tournai, all of which possess good administrative records for the period. In addition to the texts of plague ordinances, the most valuable documents for this study are the registers of municipal deliberations, which allow us to follow the decision-making process that lay behind the development of plague legislation.
Many of the more celebrated measures against pestilence originated in fourteenth- and fifteenth-century Italy, and the bulk of our knowledge regarding the ways in which urban administrations reacted to these outbreaks is based on studies of northern Italian cities, such as Florence and Venice. Although historians have expanded the geographical scope of such studies to consider municipal responses to plague in England, Spain, Switzerland, Germany and the Low Countries, little research has been done on France during the fifteenth and sixteenth centuries.
This article will examine and compare the way that society coped with two of the major epidemics to affect Renaissance Italy: plague and the Great Pox. Even though these diseases impacted on Italy as severely as they did on the rest of Europe, different countries devised different solutions to the same problems. Discussing the strategies that Italy adopted in the long fifteenth century is valuable not just to those who work on Italian Renaissance history, but also to historians of countries such as England which developed very different measures. Indeed, in the sixteenth century, in the case of plague, the privy council and statesmen such as William Cecil, Lord Burghley, looked to continental and particularly Italian plague measures as a reflection of their ‘civility’, which made them worthy of imitation.
The main elements which constituted this ‘civility’ will be the subject of the first part of this article, which will examine society's reactions to plague in Renaissance Italy through the prism of how contemporaries understood the nature of the disease. One of the more traditional themes of historical studies of Italian plague is the idea that at the time there was a marked division in beliefs between doctors and health boards about how disease was spread, with the former supporting the idea of infected air, or miasma, and the latter espousing contagionist views. This story is complicated still further from the late fifteenth century by the emergence of the Great Pox.
John Clement, a brewer, entered the Norwich franchise in 1447. Over the next decade he was a constable nine times and a tax collector once, but he never discharged any other civic office. In spite of their important role in administering and maintaining order in English cities, men like Clement have been neglected as a result of English urban historians' tendency to focus on the better-documented and wealthier mercantile elite. Prosopographical analyses of urban political, economic, and social groups have directed some attention towards middling artisans and retailers because of their focus on collective biography, but the relative dearth of information about these groups has made even this approach more effective for understanding the senior officials. Moreover, although these studies have revealed much about civic hierarchies, they have perhaps encouraged the perception that a mercantile elite dominated all aspects of urban political life. Although no one would deny the virtual monopoly of high office by a privileged few, there is considerable evidence that mercantile control was not so comprehensive in the lower levels of civic government.
Non-elite urban officials have received little sustained analysis. Indeed, on the few occasions that mid-level offices have been examined they have generally been cast as part of the cursus honorum or as unwelcome chores rather than as potentially valuable positions. By focusing on a group of non-elite personnel, namely, constables, assessors, collectors, supervisors and searchers in Norwich between 1414 and 1473, this paper demonstrates the essential role played by such individuals and postulates that not all urban office-holders nursed greater ambitions.
The fact that the plague in its bubonic, septicaemic and pneumonic forms is still with us in the twenty-first century often comes as a shock to the general public. Memories of school projects have made them vaguely aware of the great pandemic, which arrived in southern Italy in 1347 and then raged across Europe, reaching England and Norway in 1348, through Oslo in 1348 and then through Bergen in 1349, and European Russia in 1351, where the city state of Novgorod was first infected. But then, surely, it went away? Not quite: outbreaks of plague in this second pandemic, first (allegedly) called the Black Death by Mrs Markham in 1823 in her History of England, from which the horrors of history and the complexities of party politics were removed as not suitable for young minds, lasted in England until the early eighteenth century, whilst in Italy what is generally regarded as its final appearance came at Naja, near Bari, in 1815. Even then the disease did not disappear. It merely became dormant until 1855, when a new pandemic began in China, spreading through the Pacific Rim and in 1899 to the United States where plague had previously been unknown. Indeed, as the well-known World Health Organisation map of plague loci and plague outbreaks 1970–1998 shows, the disease is enzootic or sylvatic (ever-present in certain animal populations and their fleas) in some fifty-eight different regions in the world and can still spread to more susceptible animals, including humans, in epizootic outbreaks.
