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Smoking remains the leading cause of preventable death in the United States, with 87% of smokers starting before the age of 18. Age of initiation is a major predictive factor for smoking frequency and successful smoking cessation. People who initiate smoking during adolescences are 2.33 times more likely to become heavy smokers and half as likely to quit compared with smokers who started during adulthood. Additionally, schizophrenia, a disease state linked to altered neurodevelopment during adolescence, is a major predictive factor for smoking status. Smoking rates among people suffering from schizophrenia are between 60% and 90%. Interestingly, the Neuregulin Signalling Pathway (NSP), which plays an important role in neurodevelopment, is implicated in both schizophrenia and nicotine use disorder. Specifically, SNPS in neuregulin 3 (Nrg3) and Erb-B2 Receptor Tyrosine Kinase 4 (ErbB4) have been associated with smoking cessation outcomes and schizophrenia. Here, we examine the effects of chronic nicotine (18 mg/kg/day) and 24-h withdrawal on NSP gene expression in the hippocampus of adult (20-week-old) and adolescent (4-week-old) mice. We show that withdrawal from chronic nicotine decreased the expression of Erbb4 mRNA in the hippocampus of the adult mice but increased the expression of cytosolic Erbb4 protein in adolescent mice. Nrg3 mRNA and protein expression was not altered by chronic nicotine or withdrawal in the adult or adolescent cohorts, but Nrg3 mRNA and synaptosomal protein expression was lower in the adult withdrawal group when compared with their adolescent counterparts. These results highlight the age-specific effects of nicotine withdrawal on the NSP and may contribute to the lower quit rate and higher cigarette consumption of smokers who initiation during adolescences.

COVID-19. Ugh. The world has heard this word ad nauseam in the past several months, and it probably will be many additional months before it can simply fade into a bad memory. The world has experie...

Purpose International attention is increasingly turning to the challenge of creating age-friendly environments. This study aims to examine the application of asset-based approaches in undertaking community development projects with older people. The paper intends to share the learning that may be useful when designing community development projects for older people in the future. Design/methodology/approach This study followed a multiple project case study design, with a focus on project delivery practices. It was undertaken as a co-production exercise involving university researchers and trained older volunteer community researchers (CRs). Over 18–24 months of qualitative research was conducted in relation to six area-based urban projects between 2018 and 2020. Findings There were five leading themes as follows: mapping and building on assets in highly localised settings; creating governance and direction through steering groups; developing activities with diverse groups of older people; reaching isolated and lonely older people; building local capacity to embed sustainability. Practical implications The effectiveness of assets-based approaches in promoting age-friendly agendas appears to be contingent on the values, skills, capacity and resourcing of delivery agencies, alongside wider public sector investment in communities. Diversity and inequalities amongst older people need to be taken into account and community development that specifically focuses on older people needs to be balanced with the whole population and intergenerational practice. Originality/value This paper provides an empirical account of the practical application of assets practices specifically in the context of the age-friendly community agenda. The co-production method brings together insights from academic and volunteer older CRs.

IntroductionVaginal pain during intercourse and urinary incontinence are common complaints after gynaecological cancer treatments. Pelvic health physiotherapy treatments aim at optimising function through education on the use of vaginal moisturisers, dilation therapy programme and pelvic floor muscle training. Given that barriers such as time, travel, and costs are known to limit access to physiotherapy services, a virtual pelvic health physiotherapy programme may help to facilitate access. The primary objective of this study is to identify preferences, barriers and facilitators from individuals with gynaecological cancer regarding virtual pelvic healthcare survivorship care.Methods and analysisThis patient-oriented, mixed-methods study will involve an online cross-sectional survey data (phase I) and qualitative data from a series of virtual focus groups (phase II). Phase I: an anonymous survey will be used to assess the demographics, health status, prevalence of urogenital symptoms, as well as knowledge, barriers and facilitators to pelvic health services of people with gynaecological cancer. A total of N=50 participants from Canada will be recruited through convenience and self-selection sampling. Phase II: a series of virtual semi-structured focus groups will be conducted with 10–15 participants on key topics related to virtual pelvic healthcare. Interviews will be audio-recorded and transcribed, from which key themes and quotes will be identified. An interpretive description qualitative method will guide analysis and implementation of results.Ethics and disseminationApproval from the Health Research Ethics Board of Alberta—Cancer Committee (HREBA.CC-21-0498) and of the CISSS Bas-Saint-Laurent (CISSSBSL-2021-10) have been obtained. Informed, electronically signed consent will be required from all participants. Results from this work will be published in a peer-reviewed journal and will be used to inform the development and implementation of a new Pelvic eHealth Module for individuals treated for gynaecological cancers. This module will be incorporated into a comprehensive educational and exercise programme offered by a web-based application.

Cancer-related sexual dysfunction is documented as one of the most distressing and long-lasting survivorship concerns of cancer patients. Canadian cancer patients routinely report sexuality concerns and difficulty getting help. In response to this gap in care, clinical practice guidelines were recently published in the Journal of Clinical Oncology. A sweeping trend is the creation of specialized clinics for patients' sexual health concerns. However, this much-needed attempt to address this service gap can be difficult to sustain without addressing the cancer care system from a broader perspective. Herein, we describe the implementation of a tiered systemic model of cancer-related sexual health programming in a tertiary cancer center. This program follows the Permission, Limited Information, Specific Suggestions, Intensive Therapy (PLISSIT) model, used previously for guiding individual practitioners. Visually, the model resembles a pyramid. The top 2 levels, corresponding to Intensive Therapy and Specific Suggestions, are comprised of group-based interventions for common cancer-related sexual concerns and a multi-disciplinary clinic for patients with complex concerns. The bottom 2 levels, corresponding to Permission and Limited Information, consist of patient education and provider education and consultation services. We describe lessons learned during the development and implementation of this program, including the necessity for group-based services to prevent inundation of referrals to the specialized clinic, and the observation that creating specialized resources also increased the likelihood that providers would inquire about patients' sexual concerns. Such lessons suggest that successful sexual health programming requires services from a systemic approach to increase sustainability.

Objectives: State (situational) anxiety can create suboptimal outcomes for patients across a variety of health care specializations. While anxiolytic medications reduce anxiety, problematic side effects can compromise outcomes. These challenges have spurred searches for nonpharmaceutical approaches to alleviate patient anxiety. This systematic literature review, largely following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, aimed to determine patterns and effectiveness of interventions across medical health care specialty areas, including dentistry. Methods: A systematic review was conducted, using PubMed, CINAHL, and PsycINFO databases, with search terms related to anxiety, specific interventions, and medical or dental procedures. Hand searching for additional citations was performed on the bibliographies of dissertations, meta-analyses, and systematic reviews that met article inclusion criteria. The search process yielded 48,324 articles and 257 dissertations published in English between 1974 and 2018. Each abstract was evaluated for inclusion by two reviewers, yielding 718 articles that were read and evaluated for outcomes, risk of bias, pretest and post-test, controls and quality, using a Critical Appraisal Skills Programme instrument. Of these, 408 articles, describing 501 experimental trials, were accepted for inclusion in this analysis. Results: A total of 50,343 patients were included in these experiments, with an overall success rate of 71% for reducing patient anxiety. Results are summarized by health care specialty area: surgery, oncology, cardiology, obstetrics/gynecology, dentistry, and pain/trauma, and the following diagnostic testing and intervention areas: imaging, colonoscopy, mechanical ventilation, and other. The largest number of experiments (114) was in the surgery category. The types of interventions included music, education, relaxation, cognitive behavioral therapy (CBT), massage, distraction, hypnosis, acupuncture/acupressure, social support, aromatherapy, nature sounds, natural visual stimuli, special garment, and other. The largest numbers of experiments were done with music (143) and education (130). Discussion: The following interventions were most successful, reducing anxiety in over 70% of experiments: music, CBT, relaxation, massage, acupuncture/acupressure, hypnosis, and natural sounds. Confidence in results is limited by publication bias, small sample sizes, and the lack of placebo controls. Directions for future research are discussed.

Many patients with advanced cancer receive primary supports from informal caregivers (IC). As patient health deteriorates, IC assume increasing responsibility, often accompanied by distress. We investigated the quality of life (QOL) of IC of patients referred to a palliative radiotherapy (PRT) program. IC accompanying patients to a dedicated PRT clinic completed a survey based on the validated Caregiver Quality of Life Index-Cancer (CQOLC). Demographics, burden, and engagement in support services were evaluated. Summary statistics were calculated, and parameters were assessed for association with CQOLC scores by a generalized linear model. Two hundred one surveys were analyzed representing 197 unique patients. The mean age was 68.3 years, with predominantly lung (25.0%) and prostate (19.3%) malignancies. 24.4% had been in hospital/long-term care within the previous 7 days. IC were 60.8% female, and 60.6% were the patient’s spouse. 69.5% lived with the patient and 38.3% were additionally employed. IC spent a daily mean of 6.6 h (SD 7) assisting with instrumental (72.5%) and basic (37.5%) activities of daily living. Mean CQOLC score was 82.1/140 (SD 20). 63.8% of IC had previously accessed support service(s), most commonly home care (37.2%) and pharmacy (29.1%). 55.9% indicated interest in services not yet accessed. Multivariate analysis revealed additional employment, cohabitation, poor patient performance status, and interest in accessing more support services significantly correlated with higher IC burden. Employing the CQOLC to screen IC of patients referred to a PRT program permits early identification of vulnerable IC to facilitate linkage with appropriate supports.

Cancer-related sexual dysfunction is documented as one of the most distressing and long-lasting survivorship concerns of cancer patients. Canadian cancer patients routinely report sexuality concerns and difficulty getting help. In response to this gap in care, clinical practice guidelines were recently published in the Journal of Clinical Oncology. A sweeping trend is the creation of specialized clinics for patients' sexual health concerns. However, this much-needed attempt to address this service gap can be difficult to sustain without addressing the cancer care system from a broader perspective. Herein, we describe the implementation of a tiered systemic model of cancer-related sexual health programming in a tertiary cancer center. This program follows the Permission, Limited Information, Specific Suggestions, Intensive Therapy (PLISSIT) model, used previously for guiding individual practitioners. Visually, the model resembles a pyramid. The top 2 levels, corresponding to Intensive Therapy and Specific Suggestions, are comprised of group-based interventions for common cancer-related sexual concerns and a multi-disciplinary clinic for patients with complex concerns. The bottom 2 levels, corresponding to Permission and Limited Information, consist of patient education and provider education and consultation services. We describe lessons learned during the development and implementation of this program, including the necessity for group-based services to prevent inundation of referrals to the specialized clinic, and the observation that creating specialized resources also increased the likelihood that providers would inquire about patients' sexual concerns. Such lessons suggest that successful sexual health programming requires services from a systemic approach to increase sustainability.

The number of Asian immigrants has risen dramatically in recent decades, making them the fastest growing immigrant group in the United States. Home healthcare clinicians are expected to meet the healthcare needs of patients regardless of their ethnic or cultural background, but this can be challenging without a basic understanding of the patient's culture. This article is intended to provide information about the cultural traditions and health conditions clinicians may encounter when caring for patients and families who have immigrated to the United States from the top five Asian countries as determined by the U.S. Census, and concludes with resources that home healthcare clinicians can utilize when engaging in patient education.

Sexual difficulties and vulvovaginal changes are common for women undergoing, and following, cancer treatments. These changes have significant impacts on quality of life and significant relationships. The current study aimed to (1) evaluate women’s interest and attendance in a group-based educational workshop to address changes in vulvovaginal health and sexuality after cancer, and (2) describe participant characteristics and presenting concerns. Two hundred eighteen women with a history of cancer expressed interest in receiving information about the workshop and completed phone screening. Interested women (n = 156) completed an online questionnaire package examining vulvovaginal health and sexual function prior to attending the workshop. Approximately 75% of the women who completed screening attended the workshop. Clinically significant sexual distress was reported by 91% of participants, and 97% of sexually active participants exceeded the threshold for sexual dysfunction (per FSFI). Women within 1–2 years of diagnosis tended to report less sexual distress, less severe vulvovaginal symptoms, and less impact from these symptoms compared to women farther out from diagnosis. While the majority of women reported vaginal dryness and pain during intercourse, only a minority reported engaging in health promotion strategies sufficient to expect symptom improvement. The current study suggests that group-based educational workshops for vulvovaginal and sexual concerns are utilized by patients and should be offered to women well into disease survivorship. Workshops targeting vulvovaginal symptoms and sexual concerns may be a cost-effective method of reducing sexual distress and improving patients’ sexual function and quality of life.

Nursing career novels, published in the 1930s and extending through the 1960s provided girls with nurse role models and encouraged young women to choose nursing as a career. In view of their popularity, we wondered how these books depicted nurses and the profession of nursing. We examined 18 nurse career novels by different authors published between 1932 and 1970 to determine how nurses and nursing were portrayed at various times. A literature review suggested a guiding framework, with four themes related to motivation to become a nurse; image of nursing; stereotypes; and nurse/physician relationships. This article discusses our endeavor by reviewing the study purpose and methods, and we discuss the results in the framework of the four themes. Our discussion notes that many of these novels described examples of nurses contributing in times of great social uncertainty, such as during wars. They contained characters who were independent thinkers and successful nurses, caring for patients and saving lives. We conclude that the novels could have easily inspired young women of the time to choose nursing as a profession, and discuss the challenge to motivate men and women of today who seek purposeful, intellectually fulfilling work in a changing, uncertain world.

Evidence-based practice (EBP) is becoming standard in today's healthcare arena and home care organizations are not exempt from integrating evidence into practice to improve patient outcomes. There is a scarcity of research literature that examines the behaviors and attitudes of home healthcare nurses (HHNs) regarding EBP. In this study, a descriptive survey design was used to investigate HHNs' a) information-seeking behaviors when providing nursing care, b) administrative support for EBP (as perceived by HHNs), c) attitudes toward EBP, and d) EBP engagement and confidence in providing EBP nursing care. Self-reported data were collected by internet and paper survey. The survey consisted of a 65-item questionnaire that included the Nurses' Attitudes Toward Evidence-Based Practice Scale, which has previously established validity and reliability. A convenience sample of 95 HHNs participated in the study. Results suggest HHNs' EBP attitudes are positive. A positive and significant relationship was found between attitudes and hours worked (r = 0.21, p = 0.047) and educational level (r = 0.45, p = 0.0001); 95% confidence level. Confidence levels in providing EBP care were moderate, and HHNs did not perceive EBP as an agency priority. HHNs need to be supported and encouraged in the facilitation of EBP, a task made easier when they are knowledgeable about EBP, have confidence in their EBP skills, and have the support of their organizations.

With the goal of improving the quality of sexual health care provision at our tertiary cancer centre, we developed, implemented, and assessed a multidisciplinary sexuality in an oncology program, to identify patient needs and apply interventions that could be effective in a broader oncology care context. The establishment of our institution’s first oncology-focused sexual health program is described within a quality improvement framework. A complementary retrospective chart review was performed to evaluate clinicodemographic data, including responses to validated sexual health questionnaires, from a 2-year clinical pilot. A sexual health program was introduced for cancer patients identified by health care providers or self-referred, receiving 130 referrals and conducting 64 consultation and 75 follow-up visits within a 2-year pilot period. Patients attending the program were 75% female, of mean age 52 years, and had most often breast (33%) or hematologic (30%) malignancies. Most (84%) had completed curative-intent treatment, with no evidence of disease, with 34% on ongoing endocrine therapy. The most frequent reasons for referral were sexual pain (38%), decreased libido (35%), and vaginal dryness (35% of females). All female patients demonstrated sexual dysfunction on the Female Sexual Function Index, and 80% of male patients demonstrated moderate to severe erectile dysfunction on the Sexual Health Inventory for Men. Patients waited a median of 63 days (SD 107, range 3–516) from referral to consultation, suggesting that demand for multidisciplinary sexual health care overwhelmed existing resources. We have demonstrated unmet sexual health needs across a diverse oncology patient population and have presented a framework for addressing these issues, highlighting the challenges encountered and proposing improvements. Insights emerging from a quality improvement perspective included the role of group-based sexual health support to improve accessibility and the need for staff education to encourage proactive intervention before referral for specialized care is needed.

In this action research case study, the researchers used a multiple baseline across two student pairs design to investigate the effects of the error self-correction method on the spelling accuracy ...

Evidence-based practice requires access to practice guidelines, research articles, and other resources; however, home healthcare clinicians can face barriers when seeking health information. The purpose of this article is to provide home care clinicians with: a) free resources available on the internet, b) suggestions for searching and evaluating health information found on the internet, and c) opportunities for free continuing education for home healthcare clinicians.

BackgroundThis study was set in 39 neighbourhoods involved in a government-funded regeneration programme called New Deal for Communities (NDC) that began in 1998. We tested whether or not different approaches to engage residents in decision-making in these areas had different social and health impacts.MethodsFirst, NDC approaches to community engagement (CE) were grouped into four types. We then assessed the impact of these types and whether or not their cost-effectiveness could be calculated. We used existing data from surveys and from NHS and government sources. New data were collected from interviews with residents of NDC areas and former staff. We have also made these data publicly available so that other researchers can assess impacts over a longer time period.ResultsThe four CE types included an empowering resident-led approach (type A), in which residents had a lot of control over decisions, and an instrumental professional-led approach (type D), in which CE was more often used to promote the priorities of public sector organisations. Type B was initially empowering but over time became instrumental and type C balanced empowerment and instrumental approaches from the beginning. There were few statistically significant differences in health and social impacts by CE type. However, when there were statistically significant differences, the results suggest that type A, and to a lesser extent, types B and C approaches may have had better outcomes than the type D approach in relation to levels of participation and trust between residents, control or influence over decisions, social cohesion and mental health. NDC areas with a type D approach were the only ones where residents’ ‘sense of control’ deteriorated over time. Residents of these areas were less likely to feel that the NDC had improved their area and to experience improvements in mental health. However, some aspects of cohesion and trust improved in type D areas. The findings of our economic analyses are mixed. It was difficult to cost engagement activities, measures of effectiveness were not robust and relating costs that could be calculated to specific measures of effectiveness was difficult. There were almost as many negative as positive scores, making the calculation of cost-effectiveness an arbitrary exercise.ConclusionsOur results are consistent with a theory that the greater the levels of control that residents have over decisions affecting their lives the more likely there are to be positive impacts. It is plausible that an empowerment approach to CE would help build trust and community cohesion, and that having a greater influence over NDC decisions could lead to more people feeling that the NDC initiative had improved an area. Conversely, our results are also consistent with a theoretical position which suggests that instrumental approaches, which try to engage residents in agendas that are not theirs, will have relatively little positive impact and that community cohesion and well-being may be undermined. The study has not produced firm evidence on the effectiveness of different approaches to CE. However, the findings do suggest that programmes involving CE will be more likely to have positive impacts if the approaches to CE are experienced as more empowering and less instrumental (i.e. less focused on the agendas of external agencies). Future methodological research is needed to develop better measures of empowerment at the collective level and more robust approaches to empowerment on health and well-being at the population level.FundingThe National Institute for Health Research Public Health Research programme.

CancerChatCanada is a pan-Canadian initiative with a mandate to make professionally led cancer support groups available to more people in Canada. Although online support groups are becoming increasingly popular, little is known about therapist-led, synchronous groups using live chat. The purpose of this study was to generate a rich descriptive account of communication experiences in CancerChatCanada groups and to gain an understanding of processes associated with previously-reported benefits. We used interpretive description to analyze interview segments from 102 patients, survivors and family caregivers who participated in CancerChatCanada groups between 2007 and 2011. The analysis yielded four inter-related process themes (Reaching Out From Home, Feeling Safe, Emotional Release, and Talking With Text) and one outcome theme (Resonance and Kinship). The findings extend previous research about text-only online support groups and provide novel insights into features of facilitated, live chat communication that are valued by group members.

Distress is a common and substantive problem associated with the invasive nature of cancer. Psychosocial interventions can alleviate distress and enhance quality of life, with a wealth of research demonstrating benefits of group interventions. Less is known, however, about the value of individual psychological counseling for cancer patients. The goal of our study was to understand patients’ experiences of attending an individual psycho-oncology counseling service in a comprehensive cancer center in Canada. We conducted six focus groups to ask patients about their perceived benefits of the early phase of counseling. The 23 participants were predominantly women living in urban areas who sought counseling for emotional and coping difficulties. Using inductive analysis, we identified four interrelated themes: distress and need for support, challenges to service access, service benefits, and the therapeutic encounter. The therapeutic encounter formed a core component of patients’ experiences, highlighting the benefits of specific therapeutic interventions and processes.

Objectives: Travellers are a minority population in Ireland and Great Britain, who have poorer health status than the general population. This study aims to investigate Traveller health service utilization and experiences of health service quality. Methods: Community-based census survey of all Traveller households on the island of Ireland in 2008 and 2009. Comparisons were made with survey data from a nationally representative sample of the Irish general public entitled to means-tested general medical services from the INSIGHT ′07 survey. Results: Valid responses were provided by 1,947 Traveller respondents (32.5% males). Travellers reported significantly higher use of hospital services including Emergency Room services (sex- and age-adjusted relative risk (RR) 2.37, 95% CI 1.99-2.82) and mental health services (adjusted RR 2.89, 95% CI 2.02-4.14). They described significantly poorer quality health care experiences than did the comparator population, with fewer Travellers expressing trust in caregivers (adjusted RR 0.51, 95% CI 0.47-0.55) and rating the quality of health service they received as being very good or excellent (adjusted RR 0.59, 95% CI 0.55-0.64). After multivariable adjustment for the dimensions of service quality, population (Traveller or INSIGHT ′07) was not associated with an overall rating of health service quality. Conclusions: Travellers report greater use of and adequate access to health services, but describe a consistently poorer quality health care experience. This quality gap has implications for Traveller engagement with health care professionals.

Objective: Counsellor familiarity and engagement with technology-mediated communication represents an important factor in the ability to implement support programs to cancer patients. This study describes the experiences of a cohort of expert psycho-oncology counsellors who learned to facilitate online support groups (OSGs) and identifies the important elements of their learning experience that led to their engagement. Procedure and method: Six psycho-oncology counsellors were trained to facilitate OSGs and later facilitated OSGs in their own practice context. They subsequently reflected on and discussed their experiences with OSGs over time: in a panel discussion within 6 months of training, and in two focus groups. A participatory method was used to describe and interpret key elements of the learning process. Results and discussion: Three themes of the counsellors' learning experience emerged: immersion in experiential learning, perceptions of clinical value and benefit, and overcoming challenges with adapted skills. Counsellors described components of their experiential learning: co-facilitating online cancer support groups with an expert, debriefing online, and participating in an online peer supervision group, as critical to their becoming engaged. Despite initial challenges, the counsellors learned new skills, and adapted known clinical skills, to the text-only environment. Conclusion: With appropriate training and practice over time, counsellors familiar with delivering face-to-face support groups to cancer patients became skilled and engaged in leading OSG's for cancer patients. Learning to facilitate OSGs shifted practice by significantly expanding the scope of services they were able to provide their patients and has implications for expanding access to support services. Copyright © 2010 John Wiley & Sons, Ltd.

RadiologyInfo is a Web site maintained by the American College of Radiology and the Radiological Society of North America devoted to providing information about radiology. Topics include explanations of over eighty radiological procedures, careers in the field of radiology, current radiological news, safety, basic background information, and more. The information is provided in a variety of formats including text, videos, and images. RadiologyInfo is a helpful, well organized, informative, and user-friendly consumer health resource.

Background A rigorous research response is required to inform clinical and public health decision-making during an epi/pandemic. However, the ethical conduct of such research, which often involves critically ill patients, may be complicated by the diminished capacity to consent and an imperative to initiate trial therapies within short time frames. Alternative approaches to taking prospective informed consent may therefore be used. We aimed to rapidly review evidence on key stakeholder (patients, their proxy decision-makers, clinicians and regulators) views concerning the acceptability of various approaches for obtaining consent relevant to pandemic-related acute illness research. Methods We conducted a rapid evidence review, using the Internet, database and hand-searching for English language empirical publications from 1996 to 2014 on stakeholder opinions of consent models (prospective informed, third-party, deferred, or waived) used in acute illness research. We excluded research on consent to treatment, screening, or other such procedures, non-emergency research and secondary studies. Papers were categorised, and data summarised using narrative synthesis. Results We screened 689 citations, reviewed 104 full-text articles and included 52. Just one paper related specifically to pandemic research. In other emergency research contexts potential research participants, clinicians and research staff found third-party, deferred, and waived consent to be acceptable as a means to feasibly conduct such research. Acceptability to potential participants was motivated by altruism, trust in the medical community, and perceived value in medical research and decreased as the perceived risks associated with participation increased. Discrepancies were observed in the acceptability of the concept and application or experience of alternative consent models. Patients accepted clinicians acting as proxy-decision makers, with preference for two decision makers as invasiveness of interventions increased. Research regulators were more cautious when approving studies conducted with alternative consent models; however, their views were generally under-represented. Conclusions Third-party, deferred, and waived consent models are broadly acceptable to potential participants, clinicians and/or researchers for emergency research. Further consultation with key stakeholders, particularly with regulators, and studies focused specifically on epi/pandemic research, are required. We highlight gaps and recommendations to inform set-up and protocol development for pandemic research and institutional review board processes. PROSPERO protocol registration number CRD42014014000 Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-1110-6) contains supplementary material, which is available to authorized users.

ABC Access, Booking and Choice (MA Programme) AC Association of Coloproctology BAUS British Association of Urological Surgeons (www.baus.org.uk) BASO British Association of Surgical Oncologists (www.baso.org) BE Barium Enema BGS British Society of Gastrology (www.icr.ac.uk/research) BGS British Gynaecology Society (www.bspoga.ukgateway.uk) BSP Breast Screening Programme BX Biopsy CA 1. Calcium 2. Cancer 3. Carcinoma CAT Cancer Action Team C and D Capacity and Demand CHART Continuous Hyperfractionated Accelerated Radiation therapy CHI/CHAI Commission for Health Improvement (www.healthcarecommission.org.uk) Commission for Healthcare Audit and Inspection CSC-IP Cancer Services Collaborative-Improvement Partnership CT Computerised tomography (Radiology), a type of body scan

The uses, classification, distribution and cultural requirements of the Japanese banana, Musa basjoo Siebold ex Baker (Musaceae) are discussed; an illustration is provided, together with a full description.

Eriobotrya japonica (Thunb.) Lindl. (Rosaceae) is a shrub or small tree, probably originating from China but long-cultivated in Japan. The species is illustrated, a full description is provided and its cultivation requirements and commercial value are discussed.

One of the developments frequently foreseen as an outcome of the human genome project is 'predictive medicine'. This is usually taken to mean identification of individuals with genetic risk factors...

Background: Professional-led cancer support groups can improve quality of life and address unmet needs, but most Canadians affected by cancer do not have access to or do not make use of cancer support groups. A collaborative interdisciplinary team developed, operated, and evaluated Internet-based, professional-led, live-chat support groups (osgs) for cancer patients, caregivers, and survivors across Canada. Objective: Our study aimed to report participant and participation characteristics in the pan-Canadian initiative known as CancerChatCanada, and to understand participant perspectives about the quality of communication and professional facilitation, overall satisfaction, and psychosocial benefits and outcomes. Methods: Participants in osgs provided informed consent. Participant and participation characteristics were gathered from program data collection tools and are described using frequencies, means, and chi-squares. Patient, survivor, and caregiver perspectives were derived from 102 telephone interviews conducted after osg completion and subjected to a directed qualitative content analysis. Results: The 55 professional-led osgs enrolled 351 participants from 9 provinces. More than half the participants came from rural or semirural areas, and more than 84% had no received previous cancer support. The attendance rate was 75%, the dropout rate was 26%, and 80% of participants were satisfied or very satisfied. The convenience and privacy of osgs were benefits. Meaningful communication about important and difficult topics, kinship and bonding with others, and improved mood and self-care were perceived outcomes. Conclusions: Our results demonstrate that this collaborative initiative was successful in increasing reach and access, and that pan-Canadian, professional-led osgs provide psychosocial benefit to underserved and burdened cancer patients, survivors, and family caregivers.

Canada is a pioneer in remote cancer care delivery to underserved populations, however, it is trailing behind on policies that would support clinicians in providing care using distance technologies. The current policy framework is disjointed, and discussions by professional boards about online jurisprudence associated with licensure appear to be regressive. We hope that by addressing the discrepancies in interjurisdictional practice and focusing on the key issue of &ldquo, where therapy resides,&rdquo, we will be able to nudge dialogue and thinking closer toward the reasoning and recommendations of national telehealth organizations. We present this discussion of jurisdictional issues and e-health practice in the context of a pan-Canadian online support program developed for cancer patients and family members. Although the present paper uses online support groups as a springboard to advocate for e-health, it ultimately addresses a broader audience: that of all Canadian health care stakeholders.

The health expectancy of Irish Travellers, a disadvantaged indigenous minority group in Ireland has not been previously estimated. This study aimed to examine health expectancy inequalities between Irish Travellers and the general population.We used Sullivan's life table method to construct healthy life expectancy (HLE) and disability-free life expectancy (DFLE). The All-Ireland Traveller Health Study provided Irish Traveller population's mortality and health data. Vital registration, census and comparable national survey health data were used for the general population. We calculated the absolute and relative life expectancy, HLE and DFLE gaps between Irish Travellers and the general population and decomposed the HLE and DFLE gaps into mortality and morbidity contributions.Irish Travellers had consistently lower HLE and DFLE than the general population. The health expectancy gap displayed notable age and gender variations and was wider than the life expectancy gap. Mortality contributed more than morbidity to the health expectancy gap in men but not in women.This study illustrated the true extent of health inequalities experienced by an indigenous minority in Europe, clarifying the importance of reducing the burden of non-fatal disabling conditions for addressing these inequalities. The health expectancy measure used has application for other similar indigenous minorities elsewhere.

This paper addresses the meanings of “ignorance” in the context of “don't know” responses to questionnaires. First, we consider some of the broader functions of questionnaires, suggesting that they reflect and mediate between particular types of institutions, respondents and society. We then unpack some of the meanings of “don't know” responses. Specifically, we argue that the “don't know” response is not merely a sign of deficit but, potentially, a potent political statement. Moreover, in relation to studies of the public understanding of science, it can be employed as a resource by people reflexively to express their identity through their relationship with science. Next we consider ignorance in the more expansive contexts of late modernity, which include concerns about the ambivalent role of science in general, the transgressive quality of biotechnology in particular and the impetus to narrate the self. Consideration of these factors, we argue, may be useful for further interrogation of the meanings of “don't know” responses.