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Three black dolls appear in the etchingsby H. K. Browne (Phiz) that accompany Charles Dickens'sBleak House(1853). They hang, strange fruit, from strings on walls and in shop windows, and their purpose as commentary on the text remains unclear because it is also initially unclear what they might represent. The dolls are never mentioned in the text of the novel, nor do they receive any substantial criticism in readings ofBleak House's illustrations. This article plumbs the archive for evidence of the dolls, and uses the resulting range of associations, from the American cotton trade to Victorian advertising techniques, to argue for a greater integration of the analysis of text and illustrations in serialized, illustrated novels such asBleak House. Material culture readings of the novel to this date have overlooked elements of the illustrations (which are themselves material objects), or have focused on illustrations as print culture, and not conversations with the written text. Examining the dolls in this context not only enrichesBleak House, but also attests to the value of observing the interplay of text and illustration, as well as text and advertising, in readings of the novel's serialized form.

Cervical cancer is the leading cause of cancer mortality in India, accounting for 17% of all cancer deaths among women aged 30 to 69 years. At current incidence rates, the annual burden of new cases in India is projected to increase to 225,000 by 2025, but there are few large-scale, organized cervical cancer prevention programs in the country. We conducted a review of the cervical cancer prevention research literature and programmatic experiences in India to summarize the current state of knowledge and practices and recommend research priorities to address the gap in services. We found that research and programs in India have demonstrated the feasibility and acceptability of cervical cancer prevention efforts and that screening strategies requiring minimal additional human resources and laboratory infrastructure can reduce morbidity and mortality. However, additional evidence generated through implementation science research is needed to ensure that cervical cancer prevention efforts have the desired impact and are cost-effective. Specifically, implementation science research is needed to understand individual- and community-level barriers to screening and diagnostic and treatment services; to improve health care worker performance; to strengthen links among screening, diagnosis, and treatment; and to determine optimal program design, outcomes, and costs. With a quarter of the global burden of cervical cancer in India, there is no better time than now to translate research findings to practice. Implementation science can help ensure that investments in cervical cancer prevention and control result in the greatest impact.

Background Rowcroft Hospice’s strategic aim is ‘taking care further’. This includes providing greater access to services and end of life care for people with non-cancer diagnoses. Working with Devon Partnership NHS Trust an intervention was developed to offer people post diagnosis with dementia, and their families/carers in South Devon. The ‘Planning Ahead’ session is delivered as part of a ‘Memory Matters’ course. Aim 4 weekly 2 hour sessions for those recently diagnosed with dementia and carers. Informal introduction to advance care planning - focus on changing ability to communicate and make decisions in the future. Provision of information about the legal framework and support tools. Promote choice – place of care, preferences, hopes and wishes, nature of medical intervention etc. Provide a supportive and safe group to explore these issues. Approach An informal psycho-education group. The use of group discussion enables individuals to talk about personal experiences/concerns. This facilitates the sharing of information and literature specific to planning ahead. We used mixed media including: video clips, hand-outs, power point, local and national booklets. Outcomes Initial evaluation by participants: Improved understanding about decision making in the event of changes in communication/capacity. These conversations are difficult to have/or start in families without support. Peer support/normalising effect of the group has been helpful. Observations of facilitator: Shared opportunity to start difficult conversations. Carers empowered to consider their own preferences and wishes – the universal relevance of planning ahead for all. Individuals with dementia who attend need support to participate and encouragement to be involved. Carers/family members can dominate. Application Advance Care Planning is a cornerstone of Specialist Palliative Care. Developing bespoke ways to meet the varying needs of different patient groups and their families is essential.

Cervical cancer is the leading cause of cancer mortality in India, accounting for 17 percent of all cancer deaths among women age 30 to 69 years. At current incidence rates, the World Health Organization (WHO) estimates that the annual burden of new cases in India will increase to nearly 225,000 by 2025. Despite the considerable burden of cervical cancer morbidity and mortality in India, there are few large-scale, organized cervical cancer prevention programs in the country. We reviewed the research literature and conducted interviews with individuals engaged in research and public health program implementation to identify important elements of cervical cancer prevention efforts in India and implementation issues that merit further investigation. Although primary prevention through HPV vaccination has been endorsed by WHO, under certain conditions, in low- and middle-income countries (LMICs), its cost, partial efficacy and safety have been intensely debated in India. Further research and advocacy efforts are needed to determine the optimal strategies for its introduction and sustained use in the country. However, there is considerable research and programmatic evidence in support of secondary prevention of cervical cancer through screening and treatment. Regardless of screening approach, research and prevention programs have underscored the importance of ensuring strong linkages between screening, diagnosis, and treatment services for program and cost effectiveness. Available evidence also emphasizes that programs that are 'women-centered,' or actively respond to women's concerns and constraints are likely to be the most successful. In conclusion, research and prevention program experiences provide a strong rationale for investments in cervical cancer prevention in India.