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Objective:To explore how practitioner engagement and disengagement occurred, and how these may influence patient care and engagement.Design:A qualitative study using the Voice Centred Relational Methodology. Data included interviews, focus groups and observations.Setting:Inpatient and community stroke rehabilitation services.Subjects:Eleven people experiencing communication disability after stroke and 42 rehabilitation practitioners.Interventions:Not applicable.Results:The practitioner’s engagement was important in patient engagement and service delivery. When patients considered practitioners were engaged, this helped engagement. When they considered practitioners were not engaged, their engagement was negatively affected. Practitioners considered their engagement was important but complex. It influenced how they worked and how they perceived the patient. Disengagement was taboo. It arose when not feeling confident, when not positively impacting outcomes, or when having an emotional response to a patient or interaction. Each party’s engagement influenced the other, suggesting it was co-constructed.Conclusions:Practitioner engagement influenced patient engagement in stroke rehabilitation. Practitioner disengagement was reported by most practitioners but was often a source of shame.

Purpose: In this paper, we critically investigate the implementation of person-centered care with the purpose of advancing philosophical debates regarding the overarching aims and delivery of rehabilitation. While general agreement exists regarding person centered care's core principles, how practitioners reconcile the implementation of these principles with competing practice demands remains an open question. Materials and methods: For the paper, we drew on post-qualitative methods to engage in a process of "diffractive" analysis wherein we analyzed the micro-doings of person-centered care in everyday rehabilitation work. Working from our team members' diverse experiences, traditions, and epistemological commitments, we engaged with data from nine "care events" generated in previous research to interrogate the multiple forces that co-produce care practices. Results: We map our analyses under three categories: scripts mediate practice, securing compliance through "benevolent manipulations", and care(ful) tinkering. In the latter, we explore the notion of tinkering as a useful concept for approaching person centered care. Uncertainty, humility, and doubt in one's expertise are inherent to tinkering, which involves a continual questioning of what to do, what is best, and what is person centered care within each moment of care. The paper concludes with a discussion of the implications for rehabilitation and person-centered care. ä IMPLICATIONS FOR REHABILITATIONDeterminations of what constitutes good, better, or best rehabilitation practices are inevitably questions of ethics. Person-centered care is promoted as good practice in rehabilitation because it provides a framework for attending to the personhood of all engaged in clinical encounters. Post-critical analyses suggest that multiple interacting forces, conditions, assumptions, and actions intersect in shaping each rehabilitation encounter such that what constitutes good care or personcentered care cannot be determined in advance. "Tinkering" is a potentially useful approach that involves a continual questioning of what to do, what is best, and what is person-centered care within each moment of care. ARTICLE HISTORY

The objective of the present study was to compare serum IgG concentration, weight gain, and health characteristics in Irish spring-born dairy calves fed colostrum stored using a range of conditions. Immediately after birth, 75 dairy heifer calves were assigned to 1 of 5 experimental colostrum treatments: (1) fresh pasteurized colostrum, fed immediately after pasteurization; (2) fresh colostrum, fed immediately after collection but not pasteurized; (3) colostrum stored unpasteurized at 4°C in a temperature-controlled unit for 2d before being fed to calves; (4) colostrum stored unpasteurized at 13°C in a temperature-controlled unit for 2d before being fed to calves; and (5) colostrum stored unpasteurized at 22°C in a temperature-controlled unit for 2d before being fed to calves. All colostrum had IgG concentrations >50g/L and was fed to calves promptly after birth. Blood samples were obtained from calves via the jugular vein at 0h (before colostrum feeding) and at 24h of age to determine the rate of passive transfer of IgG; individual calf live-weights were recorded to monitor weight gain (kg/d) from birth to weaning. Colostrum stored in warmer conditions (i.e., 22°C) had >42 times more bacteria present and a pH that was 0.85 units lower and resulted in a serum IgG concentration that was almost 2 times lower compared with colostrum that was pasteurized, untreated, or stored at 4°C for 2d. Colostrum stored at 4°C for 2d had more bacteria present than pasteurized and fresh colostrum but did not result in reduced calf serum IgG concentrations. Average daily weight gain from birth to weaning did not differ among treatments. Even if colostrum has sufficient IgG (>50g/L) but cannot be fed to calves when freshly collected, storage at ≤4°C for 2d is advisable to ensure adequate passive transfer when it is consumed by the calf.

Healthy calves are fundamental to any profitable dairy enterprise. Research to-date, has focused on year-round calving systems which experience many different challenges compared to spring-calving systems. The objective of the present study was to determine the on-farm dry cow, calving, and colostrum management practices of spring-calving dairy production systems, and quantify their associations with herd size and herd expansion status (i.e. expanding or not expanding). Information on these management practices was available from a survey of 262 Irish spring-calving dairy farmers, representative of the Irish national population. Herd expansion in the 2 years before, and the year that the survey was conducted was not associated with any of the management practices investigated. Fifty-three percent of respondents had an average calving season length of 10 to14 weeks with 35% of herds having a longer calving season. Previous research in cattle has documented that both colostrum source and feeding management are associated with the transmission of infectious disease from cow to calf. In the present study 60% of respondents fed calves colostrum from their own dam; however, 66% of those respondents allowed the calf to suckle the dam, 23% of survey respondents fed calves pooled colostrum. Larger herds were more likely ( P < 0.01) to use pooled colostrum supplies, while smaller herds were more likely ( P < 0.05) to allow the calf to suckle the dam. The majority (86%) of respondents had stored supplies of colostrum; average-sized herds had the greatest likelihood of storing colostrum ( P < 0.05), compared to other herd sizes; larger sized herds had a lesser likelihood ( P < 0.05) of storing colostrum in a freezer, compared to other herd sizes. Although freezing colostrum was the most common method used to store colostrum (54% of respondents), 17% of respondents stored colostrum at room temperature, 29% of which stored it at room temperature for greater than 4 days. The results from the present study indicate that a particular focus needs to be placed on calving and colostrum management because this study has highlighted a number of areas which are below international standards, and may have repercussions for calf health. Furthermore, management practices on larger farms could be improved and, as these represent the future of dairy farming, a focus needs to be placed on them. Expanding herds are not a particular concern as herd expansion, independent of herd size, does not seem to be associated with calving and colostrum management practices on Irish spring-calving dairy herds.Keywords: dry period, calving, colostrum, calves, dairy ImplicationsThe results from the present study provide information on dry-cow, calving and colostrum management practices used in spring-calving systems. It highlights the management areas that are similar to and the areas that are different from yearround calving systems. Practices such as grouped calving pens and short term colostrum storage are more common in springcalving systems due to a l...

The objective of the present study was to measure the effect of storing colostrum in different conditions for varying amounts of time on IgG concentration, bacteria, and pH. In experiment 1, colostrum from 12 Holstein-Friesian cows (6 primiparous and 6 multiparous) was collected within 3h of calving, and colostrum from another 12 multiparous cows was collected within 3h of calving (6 cows) and >9h postpartum (6 cows). Aliquots were refrigerated or stored at room temperature for up to 72h, depending on treatment. In experiment 2, colostrum was collected from 6 multiparous cows within 9h of calving, and aliquots were stored for up to 72h in temperature-controlled units set at 4, 13, and 20°C. All colostrum samples were analyzed for IgG concentration, total bacteria count, and pH after 0, 6, 12, 24, 36, 48, 60, and 72h of storage. Storage conditions did not affect the IgG concentration of colostrum. Bacterial growth was most rapid in the first 6h of storage, reducing thereafter, but bacteria multiplied at a significantly greater rate when stored in warmer conditions (i.e., >4°C). The pH of colostrum was not significantly altered when stored at temperatures <13°C, but when stored at 20°C the pH significantly decreased after 24h of storage. Storing colostrum in warmer conditions significantly alters both total bacteria count and pH; consequently, colostrum should be stored at ≤4°C.

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This qualitative descriptive study explored cancer survivors' experiences of barriers and facilitators to undertaking physical activity to inform how services and professionals might offer better support. Purposive and theoretical sampling was used to recruit 25 people who were up to 5 years post-cancer diagnosis. Participants took part in face to face, semi-structured interviews, and transcripts were analysed using thematic analysis. The analysis identified five interrelated themes which represented cancer survivors' views: 1) You're on your own-a sense of abandonment post-treatment, and lack of sufficient and tailored information; 2) Dis-ease-disruption to self and identity, and a heightened awareness of physical self and fragility; 3) Becoming acclimatised-physical activity in the face of treatment-related side effects and residual impairment; 4) Importance of others-encouragement and support from health professionals, family and friends, and cancer-specific exercise groups; 5) Meanings people ascribed to physical activity-these were central and could help or hinder engagement. Our findings suggest being able to live well and re-engage in meaningful activities following a diagnosis of cancer is both complex and challenging. There appear to be gaps in current service provision in supporting the broader health and well-being of cancer survivors.