Reaching the Sacred Through the Secular: Biblical Elements and the Superiority of Divine Love in Three of Marie de France’s Lais

In the Prologue to her Lais, Marie de France hints that her text possesses multiple layers of meaning: “The custom among the ancients…was to speak quite obscurely / in the books they wrote, / so that those who were to come after / and study them / might gloss the letter / and supply its significance from their own wisdom” (9, 11-16). Critics who study the Lais agree that the tales overwhelmingly focus on romantic love, and most of the existing scholarship overlooks the fact that this theme is merely one layer of the text’s significance. To the contrary, this study examines three particular lais and the biblical elements within them in order to clarify Marie’s true aim in her text: to show divine love is superior to flawed human love. Guigemar, Equitan, and Eliduc all present courtly romances that expose the protagonists’ spiritual deficiencies. Guigemar’s liaison with a married woman is characterized by selfishness and lust; and the lai’s biblical motifs, including talking animals, a ship that rescues, and references to Solomon, hint at the existence of a more profound love than that found in physical affection. Equitan, a king, has an affair with his seneschal’s wife and plots the man’s murder, mirroring the biblical account of David and Bathsheba. Whereas David confesses and finds forgiveness, Equitan dies with his sins, allowing Marie to insist that the type of love that saves David from himself—divine love— is the highest type. Eliduc, torn between two women, is the picture of pride and selfcenteredness. In the end, though, the love demonstrated by his soul-like wife moves both him and his lover to a renewed bond with God that transcends romance. In conclusion, Marie’s depiction of courtly love scenarios consistently shows those relationships to be flawed. In fact, all human relationships in the Lais are imperfect. Only with God can people experience a perfect love, one that moves them to charity and selflessness. By employing elements from the biblical text in her Lais, Marie points her readers to this higher love

The effect of bacterial supplementation on black soldier fly larval growth and development

With a growing human population, food insecurity is becoming a worldwide problem. As the search for sustainable sources of protein continues, black soldier fly larvae come to the forefront as a partial solution. Full of proteins and fats, the larvae will consume most organic matter and rapidly develop into a usable form. Supplementing black soldier fly larvae with oleaginous microbes Arthrobacter AK19 and Rhodococcus rhodochrous increases their body size by 25%, potentially accelerates their development by one day, and increases their conversion efficiency. Supplementing with Bifidobacterium breve decreased body size, slowed development, and decreased conversion efficiency, underscoring the importance of selecting supplemental microbes and testing first on a small-scale. Promising results on the small-scale led to an industrial study, where similar results were also seen, resulting in greater optimization of this system

Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients

The risk of death in hemodialysis patients treated with calcium-containing phosphate binders or sevelamer is not known. We assessed all-cause mortality in 127 patients new to hemodialysis assigned to calcium-containing binders or sevelamer after a median follow-up of 44 months from randomization. This was a predetermined secondary end point of a randomized clinical trial designed to assess progression of coronary artery calcium (CAC) scores in the two treatment arms. Thirty-four deaths occurred during the follow-up period: 23 in subjects randomized to calcium-containing phosphate binders and 11 in subjects randomized to sevelamer. Baseline CAC score was a significant predictor of mortality after adjustment for age, race, gender, and diabetes with increased mortality proportional to baseline score (P=0.002). Mortality was borderline significantly lower in subjects randomized to sevelamer (5.3/100 patient years, confidence interval (CI) (2.2–8.5) compared to those randomized to calcium-containing binders (10.6/100 patient years, CI 6.3–14.9) (P=0.05). The greater risk of death for patients treated with calcium-containing phosphate binders persisted after full multivariable adjustment (P=0.016, hazard ratio 3.1, CI 1.23–7.61). In subjects new to hemodialysis baseline CAC score was a significant predictor of all-cause mortality. Treatment with sevelamer was associated with a significant survival benefit as compared to the use of calcium-containing phosphate binders

Communication and the electronic health record training: a comparison of three healthcare systems

Background The electronic health record (EHR) used in the examination room, is becoming the primary method of medical data storage in primary care practice in the USA. One of the challenges in using EHRs is maintaining effective patient–provider communication. Many studies have focused on communication in the examination room.Purpose Scant research exists on the best methods in educating nurse practitioners and other primary care providers (clinicians). The purpose of this study was to explore various health record training programmes for clinicians.Methods One researcher participated in and observed three health systems’ EHR training programmes for ambulatory care providers in the Pacific Northwest. A focused ethnographic approach was used, emphasising patient–provider communication.Results Only one system had formalised communication training in their class, the other two systems emphasised only the software and data aspects of the EHR.Conclusions The fact that clinicians are expected to use EHRs in the examination room necessitates the inclusion of communication training in EHR training programmes and/or as a part of primary care nurse practitioner education programmes

An exploration of the implementation of open disclosure of adverse events in the UK : a scoping review and qualitative exploration

Background: In 2009 the UK National Patient Safety Agency relaunched its Being Open framework to facilitate the open disclosure of adverse events to patients in the NHS. The implementation of the framework has been, and remains, challenging in practice. Aim: The aim of this work was to both critically evaluate and extend the current evidence base relating to open disclosure, with a view to supporting the implementation of a policy of open disclosure of adverse events in the NHS. Methods: This work was conducted in three phases. The first phase comprised two focused systematic literature reviews, one summarising empirical research on the effectiveness of interventions to enhance open disclosure, and a second, broader scoping review, looking at reports of current opinion and practice and wider knowledge. The second phase involved primary qualitative research with the objective of generating new knowledge about UK-based stakeholders' views on their role in and experiences of open disclosure. Stakeholder interviews were analysed using the framework approach. The third phase synthesised the findings from the first two phases to inform and develop a set of short pragmatic suggestions for NHS trust management, to facilitate the implementation and evaluation of open disclosure. Results: A total of 610 papers met the inclusion criteria for the broad review. A large body of literature discussed open disclosure from a number of related, but sometimes conflicted, perspectives. Evidential gaps persist and current practice is based largely on expert consensus rather than evidence. There appears to be a tension between the existing pragmatic guidance and the more in-depth critiques of what being consistent and transparent in health care really means. Eleven papers met the inclusion criteria for the more focused review. There was little evidence for the effectiveness of disclosure alone on organisational or individual outcomes or of interventions to promote and support open disclosure. Interviews with stakeholders identified strong support for the basic principle of being honest with patients or relatives when someone was seriously harmed by health care. In practice however, the issues are complex and there is confusion about a number of issues relating to disclosure policies in the UK. The interviews generated insights into the difficulties perceived within health care at individual and institutional levels, in relation to fully implementing the Being Open guidance. Conclusions: There are several clear strategies that the NHS could learn from to implement and sustain a policy of openness. Literature reviews and stakeholder accounts both identified the potential benefits of a culture that was generally more open (not just retrospectively open about serious harm). Future work could usefully evaluate the impact of disclosure on legal challenges within the NHS, best practice in models of support and training for open disclosure, embedding disclosure conversations in critical incident analysis and disclosure of less serious events

The Sinister Way to Salvation: Directionality in Dante’s Inferno

PURPOSE: Dante’s Inferno is a tale about a journey; hence, it involves directions, locations, and points relative to other points. This study examined how, just as the character Dante descends through Hell to ascend to Paradise and makes left turns to proceed to the right around the circles of Hell, so also Dante must recognize his own sin in order to repent and be redeemed. PROCEDURES: Careful examination was made of medieval definitions of directional binary oppositions such as sinister and dexter, as well as binary oppositions related to spirituality such as sin and repentance. This word research was combined with the study of critics’ previous work on the significance of left and right in the Middle Ages and other spatial elements of Dante’s work. OUTCOME: This study’s author concluded that in the directionality of Dante’s Inferno, the real issue is not which way Dante turns as he enters each circle of Hell, but rather what direction he ends up traveling and where he finishes his journey. In other words, what is most important is how each person responds to his/her sins. Does he/she continue turning “left,” or is sin used as a motivator to “right” repentance? IMPACT: The value of this study to the field of English literature is that it takes into account elements of Dante’s work that are oftentimes viewed as insignificant to the story and its overall themes. Instead, this paper emphasizes that every detail of a story is important—even its most minor directional terminology

Shoulder Pain Assessment for the Occupational Health Nurse

Shoulder pain is a common complaint in the workplace. A shoulder condition may arise from acute trauma or non-traumatic work-related activities. Shoulder pain falls into three categories: acute, chronic, and referred pain. The occupational health nurse can document detailed health histories and focused complaint-driven physical examinations. Nurses' expert assessments can guide injured workers to necessary treatment, case management, and return to full employment

Shoulder Pain Assessment for the Occupational Health Nurse

Shoulder pain is a common complaint in the workplace. A shoulder condition may arise from acute trauma or non-traumatic work-related activities. Shoulder pain falls into three categories: acute, chronic, and referred pain. The occupational health nurse can document detailed health histories and focused complaint-driven physical examinations. Nurses' expert assessments can guide injured workers to necessary treatment, case management, and return to full employment