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To establish what is known regarding the psychological and social problems faced by adult cancer survivors (people who are living with and beyond a diagnosis of cancer) and identify areas future research should address.

To establish what is known regarding the psychological and social problems faced by adult cancer survivors (people who are living with and beyond a diagnosis of cancer) and identify areas future research should address.

BACKGROUND: Patients who have completed initial cancer treatment (cancer survivors) have been relatively neglected. We need data to help us better understand the needs of this group and to underpin evidence-based service development. METHODS: Scoping reviews of research published in the last two decades focussing on the problems faced by cancer survivors, and the effectiveness of interventions for these problems were undertaken. The aim was to identify what we know, what we do not know and opportunities where research could provide new information. We searched for, retrieved and rapidly appraised systematic reviews sourced from the most common electronic databases supplemented by more recently published individual studies. RESULTS: The research evidence is surprisingly limited. We have some knowledge of the prevalence and nature of depression, pain and fatigue in cancer survivors. We know much less about cognitive and physical impairment, employment, financial well-being and relationships. Even where we have evidence, it is mostly of only moderate quality, is most often only for breast cancer and focuses almost exclusively on the early phase of survivorship. We have good evidence for the effectiveness of drug treatments for pain and moderate evidence for fatigue and depression, but not for other symptoms. Interventions based on rehabilitative and self-management approaches remain in the early stages of evaluation. INTERPRETATION: There has been a substantial amount of research describing many of the problems experienced by the cancer survivors. This is strongest in the area of symptoms in the period soon after treatment. However, the quality of the evidence is often poor, and some topics have been little examined. We urgently need data on the natural evolution and scale of the problems of cancer survivors obtained from well-designed, large-scale cohort studies and the robust testing of interventions in clinical trials. Given the current financially constrained resea

Purpose: A rapid and comprehensive review to identify what is known and not known about the physical and practical problems faced by adult cancer survivors. Methods: A systematic literature review process was used. This focused on published reviews to enable a fast but rigorous identification of both the gaps and well-researched areas within survivorship. Results: The search identified 5121 reviews, of which 42 were screened and 9 met the quality and inclusion criteria. The majority of papers focused on physical well being (n = 6) with the remaining papers focusing on practical well being (employment and finance). The quality of the reviews varied (ranging from weak to good). Gaps identified include sexual function, lower-limb lymphoedema, peripheral neuropathy, bladder and GI problems, hormonal sequelae, older cancer survivors, work impact of cancer and context-specific unmet supportive care needs. The review found a lack of standardised nomenclature for survivorship and methodological limitations. Conclusions: Four main gaps in knowledge relating to the practical and physical problems associated with cancer survivorship have been identified. These are key symptoms, unmet supportive care needs, employment and older cancer survivors, and should be addressed by future research and systematic literature reviews. Work is also needed to address the nomenclature of survivorship and to improve the methodology of research into cancer survivors (including standardised measures, theoretical frameworks, longitudinal design, inclusion of older survivors and age-matched controls for comparison). The review highlighted the need for better research within the identified areas in order to improve the experiences of cancer survivors. (C) 2011 Elsevier Ltd. All rights reserved.

Purpose: A rapid and comprehensive review to identify what is known and not known about the physical and practical problems faced by adult cancer survivors. Methods: A systematic literature review process was used. This focused on published reviews to enable a fast but rigorous identification of both the gaps and well-researched areas within survivorship. Results: The search identified 5121 reviews, of which 42 were screened and 9 met the quality and inclusion criteria. The majority of papers focused on physical well being (n = 6) with the remaining papers focusing on practical well being (employment and finance). The quality of the reviews varied (ranging from weak to good). Gaps identified include sexual function, lower-limb lymphoedema, peripheral neuropathy, bladder and GI problems, hormonal sequelae, older cancer survivors, work impact of cancer and context-specific unmet supportive care needs. The review found a lack of standardised nomenclature for survivorship and methodological limitations. Conclusions: Four main gaps in knowledge relating to the practical and physical problems associated with cancer survivorship have been identified. These are key symptoms, unmet supportive care needs, employment and older cancer survivors, and should be addressed by future research and systematic literature reviews. Work is also needed to address the nomenclature of survivorship and to improve the methodology of research into cancer survivors (including standardised measures, theoretical frameworks, longitudinal design, inclusion of older survivors and age-matched controls for comparison). The review highlighted the need for better research within the identified areas in order to improve the experiences of cancer survivors. (C) 2011 Elsevier Ltd. All rights reserved.

The Water Framework Directive (WFD) provides a template for sustainable water management across Europe. The WFD requires the development of procedures to ensure the appropriate mitigation of anthropogenic impacts on river ecosystems resulting from water abstraction and impoundments. It is widely acknowledged that alterations to the flow regime impacts on riverine ecosystems. As a result hydromorphology, which includes the hydrological regime, is embedded within the WFD as a supporting element to achieve Good Ecological Status (GES). Environmental flow releases from impoundments, such as reservoir dams, will need to be implemented to mitigate impacts caused by their construction and operation. This paper outlines the process involved in the analysis of available scientific information and the development of guidance criteria for the setting of environmental flow release regimes for UK rivers. The paper describes two methods for implementation of the WFD for rivers subject to impoundments developed by round table expert knowledge and discussions, supported by available data. First, a method for preliminary assessment of a water body to determine if it is likely to fail to achieve Good Ecological Status because of changes to the flow regime (indexed by simple flow regime statistics) in systems where appropriate biological assessment methods are limited or currently unavailable. Second, a method for defining an environmental flow regime release based on the requirements of riverine ecological communities and indicator organisms for basic elements (building blocks) of the natural flow regime.

Necessary developments for survival in today's highly competitive world markets can only be implemented if processes are sufficiently well understood to be expressed as accurate mathematical models, relating the controllable process variables to efficiency and product properties. Further advances, permitting flexible computer integrated manufacturing, automation and close process control, are only possible with a quantitative appreciation of fundamental physical relationships. This symposia attempts to give a broad overview of the state-of-the-art of modelling of metals processing operations ranging from mineral processing and extractive metallurgy to solid forming and shaping of final products and includes the necessary development of sensors and instrumentation for process control as well as process economics. The volume is split into 12 sections according to subject; Plenary (3 papers); Grinding circuit simulation (4 papers); Flotation cell simulation (5 papers); Column flotation (4 papers); Sensors and instrumentation (5 papers); Hydrometallurgy (6 papers); Ferrous (10 papers); Nonferrous (11 papers); Reactor technology (5 papers); Casting (6 papers); Reheat and deformation (4 papers); and Economics (4 papers)., Necessary developments for survival in today's highly competitive world markets can only be implemented if processes are sufficiently well understood to be expressed as accurate mathematical models, relating the controllable process variables to efficiency and product properties. Further advances, permitting flexible computer integrated manufacturing, automation and close process control, are only possible with a quantitative appreciation of fundamental physical relationships. This symposia attempts to give a broad overview of the state-of-the-art of modelling of metals processing operations ranging from mineral processing and extractive metallurgy to solid forming and shaping of final products and includes the necessary development of sensors and instrumentation for process control as well as process economics. The volume is split into 12 sections according to subject; Plenary (3 papers); Grinding circuit simulation (4 papers); Flotation cell simulation (5 papers); Column flotation (4 papers); Sensors and instrumentation (5 papers); Hydrometallurgy (6 papers); Ferrous (10 papers); Nonferrous (11 papers); Reactor technology (5 papers); Casting (6 papers); Reheat and deformation (4 papers); and Economics (4 papers).

After a brief consideration of the prospects for growth in the aluminium industry and of the trade-offs between levels of capital investment and energy costs in the design and operation of aluminium smelters, developments in Soderberg anode, cathode and cell design, manufacture and operation are discussed. Possible developments which will reduce capital intensity are: optimising electrode materials, electrode plant control, improved cell control, refractory hard metal cathodes, and non-consumable anodes. the last three will also reduce energy costs, as will green anode optimisation, ring furnace baking improvements, and technology to control liquid motion in the cells. Increased current efficiencies, more efficient carbon consumption, and the development of solvent refined coal should reduce import dependence. Improved cell control and green anode optimisation, and the use of non-consumable anodes in enclosed cells should minimise environmental effects., After a brief consideration of the prospects for growth in the aluminium industry and of the trade-offs between levels of capital investment and energy costs in the design and operation of aluminium smelters, developments in Soderberg anode, cathode and cell design, manufacture and operation are discussed. Possible developments which will reduce capital intensity are: optimising electrode materials, electrode plant control, improved cell control, refractory hard metal cathodes, and non-consumable anodes. the last three will also reduce energy costs, as will green anode optimisation, ring furnace baking improvements, and technology to control liquid motion in the cells. Increased current efficiencies, more efficient carbon consumption, and the development of solvent refined coal should reduce import dependence. Improved cell control and green anode optimisation, and the use of non-consumable anodes in enclosed cells should minimise environmental effects.

60 papers and 2 abstracts are presented, under the following session headings: Plenary lectures; Secondary recovery of aluminium; Recovery of zinc; Hydrometallurgical processing; Recovery of iron, steel and superalloys; Recycle of aluminium; Recovery of other metals (3 sessions, including papers on the recovery of critical metals from spent catalysts, cobalt, nickel, uranium, gold, silver, gallium, platinum, palladium, metals from coal fly ash, and chlorine); Recovery of copper; and Physical separations. There are author and subject indexes., 60 papers and 2 abstracts are presented, under the following session headings: Plenary lectures; Secondary recovery of aluminium; Recovery of zinc; Hydrometallurgical processing; Recovery of iron, steel and superalloys; Recycle of aluminium; Recovery of other metals (3 sessions, including papers on the recovery of critical metals from spent catalysts, cobalt, nickel, uranium, gold, silver, gallium, platinum, palladium, metals from coal fly ash, and chlorine); Recovery of copper; and Physical separations. There are author and subject indexes.

Means are proposed for reducing waste heat generation in smelting and for conserving energy in anode manufacture by furnace design and substitution of other materials for petroleum coke. Hall-Heroult Process modifications, alternative designs, and the Alcoa smelting process are discussed in terms of energy savings. Scrap recycling, more use of aluminium in transportation and the installation of offshore smelters in less developed countries are shown to be additional means of coping with possible energy crises., Means are proposed for reducing waste heat generation in smelting and for conserving energy in anode manufacture by furnace design and substitution of other materials for petroleum coke. Hall-Heroult Process modifications, alternative designs, and the Alcoa smelting process are discussed in terms of energy savings. Scrap recycling, more use of aluminium in transportation and the installation of offshore smelters in less developed countries are shown to be additional means of coping with possible energy crises.

Primary metals production is a major manufacturing activity in the United States and should continue as a major employer and generator of GNP through the turn of the century. In the short term, the importation of an important fraction of US metal needs must be accepted. Some of these imports can be offset by scrap recycling made economic through research and development. The importance of developing methods to extract economically a multiplicity of valuable metals and other products from single ores or waste streams is discussed., Primary metals production is a major manufacturing activity in the United States and should continue as a major employer and generator of GNP through the turn of the century. In the short term, the importation of an important fraction of US metal needs must be accepted. Some of these imports can be offset by scrap recycling made economic through research and development. The importance of developing methods to extract economically a multiplicity of valuable metals and other products from single ores or waste streams is discussed.

Background: Nutrition by enteral tube is a complex therapy requiring significant management to ensure safe, timely delivery of nutrients and avoidance of complications. In the home setting people with enteral tubes and their carers are required to self-manage the therapy, including the need to cope with problems that arise. Whilst previous studies have conveyed experiences of people with enteral tubes, few have described views on enteral tube problems. Aims and objectives: Drawing on the findings of a previously reported study (1), this paper aims to describe in-depth the experiences of people with enteral tubes and their carers of living with the tube day to day and managing problems that arise. Design: A qualitative descriptive design using semi-structured in-depth interviews was employed. Methods: A purposive sample of 19 people with enteral tubes and 15 carers of people with tubes participated. Interviews were recorded and transcribed. Using a thematic analysis approach, codes were defined and applied; themes developed and refined. Five themes with associated sub-themes were generated, of which one, “living with the tube”, is reported in-depth. The COREQ checklist was used. Results: Participants described the tube affecting both physical and psychosocial being and revealed it had resulted in significant changes to their daily living, necessitating adaptation to a new way of life. Participants reported spending much time and effort to manage tube problems, at times without support from healthcare practitioners knowledgeable in tube management. Discomfort associated with the tube was commonly described. Conclusions: Living with an enteral tube impacts significantly on daily life requiring adaptations to normal routine. People with tubes and their carers use a range of strategies to manage common complications. Relevance to clinical practice: Knowledge and understanding of how people with enteral tubes live with their tube and manage issues as they arise will enabl

Background: The number of people with an enteral tube (ET) living at home is increasing globally and services to support them to manage this complex and life-changing intervention vary across regions. This study aimed to gain an understanding of the experiences of people living at home with an ET and their carers, and explore their views of supporting services and ET related hospital admissions. Methodology: A qualitative inductive descriptive design was employed. Semi-structured, face-to face interviews with a purposive sample of people with an ET living at home and carers were undertaken. Interviews were transcribed, initial codes assigned for salient constructs, grouped and developed into themes and sub-themes. Results: Nineteen people with ETs and 15 carers of people with ETs were interviewed. Five themes were generated: home better than hospital, feelings about the tube, living with the tube, help when you need it and cost for health service. Participants indicated the ET significantly influenced daily life. Participants described becoming used to coping with the ET at home over time and developing strategies to manage problems, avoid hospital admission and reduce resource waste. Variation in supporting services were described. Conclusions: People with ETs and their carers need considerable support from knowledgeable, responsive healthcare practitioners during the weeks following initial placement of the ET. 24 hour services to support people with ETs should be designed in partnership with the aim of reducing burden, negative experience, waste and hospital admissions. National frameworks for home enteral nutrition could set the standard for support for people with ETs.

Subjective changes are increasingly recognised as important in recovery and rehabilitation following traumatic brain injury. Accumulation of subjective changes over time has led many to examine the question of ‘continuity of self’ post-injury. Vacillation between feeling the same and different is common and often at odds with the medical narrative preparing families for permanent change. This position of ambiguity was examined in a qualitative narrative study. The aim of this paper is to describe the narrative structures used by uninjured members of a family to understand change. These changes relate primarily, to their perspective of whether and how the injured person had changed, but also secondarily to whether and why they themselves felt they had changed in the first year post-injury. Nine uninjured family members from three families took part in three unstructured interviews during the first twelve months post-injury. In-depth narrative analysis showed family members used biographical attendance; biographical disruption; biographical continuity and biographical reconstruction to understand change. Drawing on these findings it is argued that concentrating on a narrative of change is too limiting and that engaging in biographical narratives may help humanise care provided to injured individuals and their families. Implications for research and practice are discussed.

AIM: To describe the challenges faced by those performing complex qualitative analysis during a narrative study and to offer solutions. BACKGROUND: Qualitative research requires rigorous analysis. However, novice researchers often struggle to identify appropriately robust analytical procedures that will move them from their transcripts to their final findings. The lack of clear and detailed accounts in the literature that consider narrative analysis and how to address some of the common challenges researchers face add to this problem. DATA SOURCES: A longitudinal narrative case study exploring the personal and familial changes reported by uninjured family members during the first year of another family member's traumatic brain injury. Review methods This is a methodological paper. DISCUSSION: The challenges of analysis included: conceptualising analysis; demonstrating the relationship between the different analytical layers and the final research findings; interpreting the data in a way that reflected the priorities of a narrative approach; and managing large quantities of data. The solutions explored were: the mapping of analytic intentions; aligning analysis and interpretation with the conceptual framework; and the use of matrices to store and manage quotes, codes and reflections. CONCLUSION: Working with qualitative data can be daunting for novice researchers. Ensuring rigorous, transparent, and auditable data analysis procedures can further constrain the interpretive aspect of analysis. Implications for research/practice The solutions offered in this paper should help novice researchers to manage and work with their data, assisting them to develop the confidence to be more intuitive and creative in their research.

To explore the narratives created by non-injured family members in relation to themselves and their family in the first year after head injury.