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Abstract Background Many untrue statements about cancer prevention and risks are circulating. The objective of this study was to assess Canadians’ awareness of known cancer risk factors and cancer myths (untruths or statements that are not completely true), and to explore how awareness may vary by sociodemographic and cognitive factors. Methods Cancer myths were identified by conducting scans of published, grey literature, and social media. Intuitive-analytic thinking disposition scores included were actively open- and close-minded thinking, as well as preference for intuitive and effortful thinking. A survey was administered online to participants aged 18 years and older through Prolific. Results were summarized descriptively and analyzed using chi-square tests, as well as Spearman rank and Pearson correlations. Results Responses from 734 Canadians were received. Participants were better at identifying known cancer risk factors (70% of known risks) compared to cancer myths (49%). Bivariate analyses showed differential awareness of known cancer risk factors (p 90% correctly identified), but recognition of other known risk factors was poor (as low as 23% for low vegetable and fruit intake). Mythical cancer risk factors with high support were consuming additives (61%), feeling stressed (52%), and consuming artificial sweeteners (49%). High uncertainty of causation was observed for glyphosate (66% neither agreed or disagreed). For factors that reduce cancer risk, reasonable awareness was observed for HPV vaccination (60%), but there was a high prevalence in cancer myths, particularly that consuming antioxidants (65%) and organic foods (45%) are protective, and some uncertainty whether drinking red wine (41%), consuming vitamins (32%), and smoking cannabis (30%) reduces cancer risk. Conclusions While Canadians were able to identify tobacco-related cancer risk factors, many myths were believed and numerous risk factors were not recognized. Cancer myths can be harmful in themselves and can detract the public’s attention from and action on established risk factors.

Bayesian estimation of latent variable models provides some unique advantages to researchers working with small samples and complex models when compared with the more commonly used maximum likelihood approach. A key aspect of Bayesian modeling involves the selection of prior distributions for the parameters of interest. Prior research has demonstrated that using default priors, which are typically noninformative, may yield biased and inefficient estimates. Therefore, it is recommended that data analysts obtain useful, informative priors from prior research whenever possible. The goal of the current simulation study was to compare several methods designed to combine results from prior studies that will yield informative priors for regression coefficients in structural equation models. These methods include noninformative priors, Bayesian synthesis, pooled analysis, aggregated priors, standard meta-analysis, power priors, and the meta-analytic predictive methods. Results demonstrated that power priors and meta-analytic predictive priors, used in conjunction with Bayesian estimation, may yield the most accurate estimates of the latent structure coefficients. Implications for practice and suggestions for future research are discussed.

Mairéad Conneely,1 Siobhán Leahy,2 Margaret O’Connor,3 Gillian Corey,3 Ahmed Gabr,3 Anastasia Saleh,3 Blessing Okpaje,3 Íde O’ Shaughnessy,1,3 Aoife Synnott,3 Aoife McCarthy,3 Alison Holmes,1 Katie Robinson,1 Lorna Ryan,1 Anne Griffin,1 Louise Barry,4 Dominic Trépel,5 Damian Ryan,6 Rose Galvin1 On behalf of Ageing Research Centre Public and Patient Involvement (PPI) Panel of older adults1School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland; 2Department of Sport, Exercise & Nutrition, School of Science & Computing, Atlantic Technological University, Galway, Ireland; 3Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland; 4School of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland; 5Trinity Institute of Neurosciences, School of Medicine, Trinity College Dublin, Dublin, Ireland; 6Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Limerick, IrelandCorrespondence: Mairéad Conneely, Email mairead.c.conneely@ul.ieBackground: Older adults frequently attend the emergency department (ED) and experience high rates of subsequent adverse outcomes including functional decline, ED re-presentation and unplanned hospital admission. The development of effective interventions to prevent such outcomes is a key priority for research and service provision. Our aim was to evaluate the feasibility of a physiotherapy-led integrated care intervention for older adults discharged from the ED (ED PLUS).Patients and Methods: Older adults presenting to the ED of a university teaching hospital with undifferentiated medical complaints and discharged within 72 hours were computer randomised in a ratio of 1:1:1 to deliver usual care, Comprehensive Geriatric Assessment (CGA) in the ED, or ED PLUS. ED PLUS is an evidence-based and stakeholder-informed intervention to bridge the care transition between the ED and community by initiating a CGA in the ED and implementing a six-week, multi-component, self-management programme in the patient’s home. Feasibility and acceptability were assessed quantitatively and qualitatively. All clinical and process outcomes were assessed by a research nurse blinded to group allocation. Data analyses were primarily descriptive.Results: Twenty-nine participants were recruited indicating a 67% recruitment rate. At 6 months, there was 100% retention in the usual care group, 88% in the CGA group and 90% in the ED PLUS group. ED PLUS participants expressed positive feedback, and there was a trend towards improved function and quality of life and less ED revisits and unscheduled hospitalisations in the ED PLUS group.Conclusion: ED PLUS bridges the transition of care between the index visit to the ED and the community and is feasible using systematic recruitment strategies. Despite recruitment challenges in the context of COVID-19, the intervention was successfully delivered and well received by participants. There was a lower incidence of functional decline and improved quality of life in the ED PLUS group.Trial Registration: The trial was registered in Clinical Trials Protocols and Results System as of 21st July 2021, with registration number NCT04983602.Plain Language Summary: Older people need support when they are discharged from the Emergency Department (ED) to their home as a visit to the ED is linked to negative outcomes. This study reports on a trial to reduce negative outcomes in older people discharged from the ED by an assessment in the ED and treatment in the home. Twenty-nine patients attending the ED of University Hospital Limerick were randomly assigned to three groups as follows: One group got the normal care and treatment; Group two received a comprehensive assessment by a dedicated geriatric doctor in the ED and were referred to other health professionals as needed; a third group, called ED PLUS, also received a comprehensive assessment by a dedicated geriatric doctor in the ED and an additional six-week treatment program led by a physiotherapist. The physiotherapist visited the older adult in their own home within twenty-four hours of discharge to start treatment based on what the older adult needed to do to live safely in their own home and again at week four and week six. The same geriatric doctor who saw the older adult in the ED telephoned the older adult in week two to check medications and discussed the case with the physiotherapist. A dietitian and occupational therapist telephoned the older adults to check nutritional intake and if any aids were needed in the home. All older adults in the ED PLUS group had improved quality of their life, improved mobility and did not need to go back to the hospital or ED at six weeks and six months unlike the two other groups. The COVID-19 pandemic affected recruitment, but all ED PLUS patients were extremely satisfied.Keywords: emergencies, recruitment, integrated care, care transitions, public and patient involvement

This qualitative study focuses on the intersectionality of race and rurality by looking at the responses of Wyoming principals and superintendents to the issues of diversity and social justice within Wyoming. The responses are presented and analyzed through a new framework called Cowboy Epistemology, and the Cultural Competency Continuum (Lindsey et al., 2009). It appears that despite double-digit increases in diversity between 2010 and 2018, some Wyoming school and district administrators continue to demonstrate actions and practices congruent with the demographic divide, cultural homophily, and Whiteness along with cultural worldviews that suggest a failure to: (1) value diversity, (2) engage political organizations and individuals in a manner that advocates for the needs of diverse students, (3) implement multicultural instruction beyond superficial means, and (4) engage the community in tolerance for others who are different from the traditional White Wyoming ranching, conservative, materials extraction, isolationist way of life. While outliers and standards for social justice and diversity exist in Wyoming among and for administrators, more needs to be done to prepare and train administrators to engage in culturally proficient and sustaining instructional leadership so that administrators can serve all students, engage in community leadership, and resist the negative influences of Cowboy Epistemology, demographic divide, cultural homophily, and Whiteness. Chief among the more needs to be done for Wyoming administrators is the adoption of culturally responsive school and culturally sustaining instructional leadership practices and training on the culturally proficient continuum.

Sangseo Kim,1 Sadikalmahdi Abdella,1 Fatima Abid,1 Franklin Afinjuomo,1 Souha H Youssef,1 Amy Holmes,1 Yunmei Song,1 Sachin Vaidya,2 Sanjay Garg1 1Centre for Pharmaceutical Innovation, Clinical and Health Sciences, University of South Australia, Adelaide, SA, 5000, Australia; 2Central Adelaide Local Health Network, The Queen Elizabeth Hospital, Woodville, SA, 5011, AustraliaCorrespondence: Sanjay Garg, Tel +61 8 8302 1575, Email Sanjay.garg@unisa.edu.auBackground: Imiquimod (IMQ) is an immunomodulating drug that is approved for the treatment of superficial basal cell carcinoma, actinic keratosis, external genital warts and perianal warts. However, IMQ cream (Aldara®) has several drawbacks including poor skin permeation, local toxicity, and compromised patient compliance as a topical pharmacological option.Methods: Our research aimed to develop and optimize nanostructured lipid carriers (NLCs) containing IMQ for the first time using a hybrid design of experiments approach. The optimized formulation was then incorporated into a matrix-type topical patch as an alternative dosage form for topical application and evaluated for IMQ deposition across different skin layers in comparison to the performance of the commercial product. Additionally, our work also attempted to highlight the possibility of implementing environment-friendly practices in our IMQ-NLCs formulation development by reviewing our analytical methods and experimental designs and reducing energy and solvent consumption where possible.Results: In this study, stearyl alcohol, oleic acid, Tween® 80 (polysorbate 80), and Gelucire® 50/13 (Stearoyl polyoxyl-32 glycerides) were selected for formulation development. The formulation was optimized using a 2k factorial design and a central composite design. The optimized formulation achieved the average particle size, polydispersity index, and zeta potential of 75.6 nm, 0.235, and – 30.9 mV, respectively. Subsequently, a matrix-type patch containing IMQ-NLCs was developed and achieved a statistically significant improvement in IMQ deposition in the deeper skin layers. The IMQ deposition from the patch into the dermis layer and receptor chamber was 3.3 ± 0.9 μg/cm2 and 12.3 ± 2.2 μg/cm2, while the commercial cream only deposited 1.0 ± 0.8 μg/cm2 and 1.5 ± 0.5 μg/cm2 of IMQ, respectively.Conclusion: In summary, IMQ-NLC-loaded patches represent great potential as a topical treatment option for skin cancer with improved patient compliance.Keywords: imiquimod, nanostructured lipid carrier, design of experiments, topical patches, skin cancer, greenness evaluation