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Abstract Background The PAROLE-Onco program was introduced in the province of Quebec, Canada in 2019. It integrates accompanying patients (APs), i.e., people who have been affected by cancer, into the clinical team as full members. These APs use their experiential knowledge with people undergoing treatment and with clinical teams. The aim of this paper is to evaluate, within the framework of two university medical centers, the perceptions of breast cancer patients who receive support from APs, particularly in terms of their active involvement in their care trajectory. Methods A qualitative study based on semi-structured interviews with accompanied patients was performed. Fourteen individual interviews were conducted between July and September 2021 with women presenting different profiles in terms of age, education, professional status, type of treatment, family situation, and clinical background. The data were analyzed using thematic analysis, focusing on patients’ perceptions of APs’ contributions and suggested improvements for accessing AP support. Results Three themes emerged from the semi-structured interviews: communication modalities used to connect patients with their APs, the characteristics of the support provided by APs, and the perceived effects of this support on the patients. Patients expressed a preference for telephone communication, highlighting its convenience and accessibility. The support provided by APs included emotional and informational support, neutrality, and adaptability. This relationship improved patient communication, reduced anxiety, helped regain control, and enhanced overall quality of life. The results emphasized the added value of APs in complementing the support offered by healthcare professionals. Patients noted the critical role of APs in helping them navigate the healthcare system, better understand their treatment processes, and manage their emotions. The ability of APs to provide practical advice and emotional reassurance was particularly valued. Overall, the findings underscored the significant impact of AP support on patients’ experiences and highlighted areas for enhancing this service. Conclusion This study highlights, during the care trajectory of people affected by breast cancer, APs’ contribution to patients’ emotional well-being because they improve, in particular, the management of emotions and communication with health professionals.

Hemp fibers derived from Cannabis sativa L. have experienced a resurgence in popularity over the past few decades, establishing themselves as one of the most sought-after fibers. This article delves into the intricacies of the hemp production chain, offering a comprehensive understanding from field to fiber. Key aspects covered include the botany of hemp, cultivation requirements, the impact of various factors on plant growth, the harvesting process, different methods of fiber extraction, fibers properties, and suitable spinning processes. Recent studies of hemp’s Life Cycle Assessment are explored, shedding light on how it compares to other sustainable crops and providing insights into the true sustainability of hemp, substantiated by numerical data. The article also addresses challenges encountered throughout the hemp production chain and speculates on future directions that may unfold in the coming years. The overall goal of this study is to provide a knowledge base encompassing every facet of hemp fiber production. It elucidates how different technological approaches and the technical properties of fibers play pivotal roles in determining their ultimate applications. By offering a comprehensive overview, this article contributes to the broader understanding of hemp as a valuable and sustainable resource in the textile industry.

Background: Previous studies that suggest a shorter time from cervical ripening balloon placement to delivery with shorter total balloon placement time have excluded patients with prior cesarean deliveries. Objective: To evaluate, in patients with a prior history of cesarean delivery undergoing cervical ripening with a double-balloon catheter, whether planned removal of device after 6 vs 12 hours would result in shorter time to vaginal delivery. Study Design: A before-and-after study was performed after a practice change occurred November 2020, shortening the planned time of double-balloon catheter placement for cervical ripening from 12 to 6 hours. Data were collected via retrospective electronic chart review. Primary outcome was time from balloon placement to vaginal delivery. Secondary outcomes included rates of cesarean delivery, maternal intraamniotic infection, and uterine rupture. Kaplan–Meier curves compared median times to delivery between the groups. A Cox proportional-hazards model was used to adjust for time of balloon placement, number of previous vaginal deliveries, and co-medications used. Results: From November 2018 to November 2022, 189 analyzable patients with a prior history of cesarean delivery received a double-balloon catheter for cervical ripening during their trial of labor. Patients were separated into pre- and postpolicy change groups (n=91 and 98, respectively). The median time to vaginal delivery for the pregroup was 28 hours (95% CI: 26, 35) and 25 hours (95% CI: 23, 29) for those in the postgroup (P value .052). After adjusting for dilation at time of balloon placement, number of previous vaginal deliveries, and co-medication, the estimated hazard ratio for successful vaginal delivery postpolicy change was 1.89 (95% CI: 1.27, 2.81). There were no differences in rates of secondary outcomes. Conclusion: In patients with prior cesarean delivery undergoing mechanical cervical ripening with a double-balloon catheter, planned removal at 6 hours compared to 12 hours may result in higher chances of successful vaginal delivery and possibly a shorter time to delivery, without increasing rates of cesarean delivery and intraamniotic infection.

Physical education teachers use motivational strategies that can (positively or negatively) affect their students' level of motivation and engagement. Indeed, according to their experiences and beliefs, some teachers may focus on strategies that thwart, rather than support, students' psychological needs (autonomy, competence, and relatedness). Effective professional development represents an excellent opportunity to help teachers use research-supported motivational strategies. Therefore, this study aimed to discover if attendance at a 2-day training course could positively affect PE teachers' beliefs regarding empowering motivational strategies. Specifically, 11 PE teachers (experimental group = 6 [attending the training]; control group = 5 [no training]) from primary school (n = 6) and secondary school (n = 5) expressed their beliefs (effectiveness, feasibility, and normality) regarding 31 empowering motivational strategies proposed during training at the beginning (October) and the end (April) of the school year. Results of the Wilcoxon signed-rank test for related samples indicated no significant differences for the belief regarding effectiveness in either group. However, some positive significant changes (p < .05) occurred in the experimental group for two motivational strategies supporting students' need for autonomy and one supporting their need for competence. Given the small sample, positive trends (p < .10) are also considered results of interest. In conclusion, the training appears likely to impact teachers' beliefs. However, future professional development should provide additional feedback and follow-up time with teachers during experimentation with students to allow teachers to refine their understanding and use of the motivational strategies proposed., Regular practice of physical activity is essential for children's development. In addition to improving their physical condition and self-confidence, it can help reduce symptoms of depression and anxiety (Biddle et [...]

Currently, there are no known human biomonitoring studies that concurrently examine biomarkers of dicamba and 2,4-D. We sought to compare biomarkers of exposure to herbicides in pregnant women residing in the US Midwest before and after the adoption of dicamba-tolerant soybean technology using urine specimens obtained in 2010–2012 from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (N = 61) and in 2020–2022 from the Heartland Study (N = 91). Specific gravity-standardized concentration levels for each analyte were compared between the cohorts, assuming data are lognormal and specifying values below the LOD as left-censored. The proportion of pregnant individuals with dicamba detected above the LOD significantly increased from 28% (95% CI: 16%, 40%) in 2010–2012 to 70% (95% CI: 60%, 79%) in 2020–2022, and dicamba concentrations also significantly increased from 0.066 μg/L (95% CI: 0.042, 0.104) to 0.271 μg/L (95% CI: 0.205, 0.358). All pregnant individuals from both cohorts had 2,4-D detected. Though 2,4-D concentration levels increased, the difference was not significant (p-value = 0.226). Reliance on herbicides has drastically increased in the last ten years in the United States, and the results obtained in this study highlight the need to track exposure and impacts on adverse maternal and neonatal outcomes.

Abstract Background Resilience in healthcare is the capacity to adapt to challenges and changes to maintain high-quality care across system levels. While healthcare system stakeholders such as patients, informal carers, healthcare professionals and service managers have all come to be acknowledged as important co-creators of resilient healthcare, our knowledge and understanding of who, how, and in which contexts different stakeholders come to facilitate and support resilience is still lacking. This study addresses gaps in the research by conducting a stakeholder analysis to identify and categorise the stakeholders that are key to facilitating and sustaining resilience in healthcare, and to investigate stakeholder relationships relevant for the enactment of resilient healthcare systems. Methods The stakeholder analysis was conducted using a sample of 19 empirical research projects. A narrative summary was written for 14 of the projects, based on publicly available material. In addition, 16 individual interviews were undertaken with researchers from the same sample of 19 projects. The 16 interview transcripts and 14 narratives made up the data material of the study. Application of stakeholder analysis methods was done in three steps: a) identification of stakeholders; b) differentiation and categorisation of stakeholders using an interest/influence grid; and c) investigation and mapping of stakeholder relationships using an actor-linkage matrix. Results Identified stakeholders were Patients, Family Carers, Healthcare Professionals, Ward/Unit Managers, Service or Case Managers, Regulatory Investigators, Policy Makers, and Other Service Providers. All identified stakeholders were categorised as either ‘Subjects’, ‘Players’, or ‘Context Setters’ according to their level of interest in and influence on resilient healthcare. Stakeholder relationships were mapped according to the degree and type of contact between the various groups of stakeholders involved in facilitating resilient healthcare, ranging from ‘Not linked’ to ‘Fully linked’. Conclusion Family carers and healthcare professionals were found to be the most active groups of stakeholders in the enactment of healthcare system resilience. Patients, managers, and policy makers also contribute to resilience to various degrees. Relationships between stakeholder groups are largely characterised by communication and coordination, in addition to formal collaborations where diverse actors work together to achieve common goals.

Abstract Objectives Since 2018, four establishments in Quebec have been instrumental in implementing the PAROLE-Onco program, which introduced accompanying patients (APs) into healthcare teams to improve cancer patients’ experience. APs are patient advisors who have acquired specific experiential knowledge related to living with cancer, using services, and interacting with healthcare professionals. They are therefore in a unique and reliable position to be able to provide emotional, informational, cognitive and navigational support to patients who are dealing with cancer. We aimed to explore APs’ perspectives regarding the limiting and facilitating factors in terms of how they are integrated into the clinical oncology teams. Methods A qualitative study based on semi-structured interviews and focus groups was conducted with 20 APs at the beginning of their intervention (T1) and, two years later, during a second data collection (T2). Limiting and facilitating factors of APs’ integration into clinical teams were analyzed in terms of governance, culture, resources and tools. Results The limited factors raised by APs to be integrated into clinical teams include the following: confusion about the specific roles played by APs, lifting the egos of certain professionals who feel they are already doing what APs typically do, lack of identification of patient needs, absence of APs in project governance organizational boundaries, and team members' availability. Various communication challenges were also raised, resulting in the program being inadequately promoted among patients. Also mentioned as limiting factors were the lack of time, space and compensation. Creating opportunities for team members to meet with APs, building trust and teaching team members how APs’ activities complement theirs were enhancing factors. Other facilitators include APs being involved in decision-making committees, being leaders in promoting the PAROLE-Onco program to patients and clinical team members and creating opportunities to communicate with team members to help enhance their work and provide feedback to improve patient services. Awareness of APs’ added value for the team and patients is also a key facilitator. Regarding tools, offering accompanying services by telephone allows both patients and APs to benefit from the flexibility they need. Conclusion Over time, APs were able to identify optimal factors for successful implementation. Recommendations include APs and professionals working in co-construction on organization, leadership, resources and status factors. This could help catalyze a change in culture within health establishments and allow people dealing with cancer to benefit from the experiential knowledge of other patients within their clinical team.

Abstract We evaluated biochemical changes in skeletal muscle of women with breast cancer initiating aromatase inhibitors (AI), including oxidation of ryanodine receptor RyR1 and loss of stabilizing protein calstabin1, and detailed measures of muscle function. Fifteen postmenopausal women with stage I–III breast cancer planning to initiate AI enrolled. Quadriceps muscle biopsy, dual-energy x-ray absorptiometry, isokinetic dynamometry, Short Physical Performance Battery, grip strength, 6-min walk, patient-reported outcomes, and serologic measures of bone turnover were assessed before and after 6 months of AI. Post-AI exposure, oxidation of RyR1 significantly increased (0.23 ± 0.37 vs. 0.88 ± 0.80, p

IntroductionThe learning health system (LHS) aligns science, informatics, incentives, stakeholders, and culture for continuous improvement and innovation. The Agency for Healthcare Research and Quality and the Patient-Centered Outcomes Research Institute designed a K12 initiative to grow the number of LHS scientists. We describe approaches developed by 11 funded centers of excellence (COEs) to promote partnerships between scholars and health system leaders and to provide mentored research training.MethodsSince 2018, the COEs have enlisted faculty, secured institutional resources, partnered with health systems, developed and implemented curricula, recruited scholars, and provided mentored training. Program directors for each COE provided descriptive data on program context, scholar characteristics, stakeholder engagement, scholar experiences with health system partnerships, roles following program completion, and key training challenges.ResultsTo date, the 11 COEs have partnered with health systems to train 110 scholars. Nine (82%) programs partner with a Veterans Affairs health system and 9 (82%) partner with safety net providers. Clinically trained scholars (n = 87; 79%) include 70 physicians and 17 scholars in other clinical disciplines. Non-clinicians (n = 29; 26%) represent diverse fields, dominated by population health sciences. Stakeholder engagement helps scholars understand health system and patient/family needs and priorities, enabling opportunities to conduct embedded research, improve outcomes, and grow skills in translating research methods and findings into practice. Challenges include supporting scholars through roadblocks that threaten to derail projects during their limited program time, ranging from delays in access to data to COVID-19-related impediments and shifts in organizational priorities.ConclusionsFour years into this novel training program, there is evidence of scholars' accomplishments, both in traditional academic terms and in terms of moving along career trajectories that hold the potential to lead and accelerate transformational health system change. Future LHS training efforts should focus on sustainability, including organizational support for scholar activities.

Teacher preparation programs and school districts annually invest significant personnel and money to support cohorts of preservice teachers and new first-year teachers. Despite this support, the transition from teacher preparation to the first years of teaching remains challenging. In this article, the authors discuss the impact of a New Teacher Learning Community (NTLC) on supporting the social emotional learning (SEL) of first-year teachers. The NTLC encouraged new K-12 teachers to engage in community building with peers, reflective thinking, and collaborative problem solving. Data included a satisfaction survey and semistructured interviews with participants. New K-12 teachers who participated in the NTLC (n = 21) found increased confidence around key SEL constructs, including relational skills through fostering a sense of belonging and communication abilities and decision-making through practice with problem solving. NTLC findings have implications for future collaboration between teacher preparation programs and school districts to jointly support new teachers and together mitigate challenges first-year teachers face.

This research study shows one teacher preparation program's (TPP) attempt to better gauge coteaching implementation and how a TPP can provide more immediate pair support. We present findings from the analysis of 777 weekly coteaching reflection surveys completed by 44 secondary preservice teachers over 20 weeks of the clinical experience. The research team developed "ideal" benchmarks for the coteaching reflection prompts and analyzed the data in respect to these benchmarks to see how close preservice teachers met coplanning, coinstructing, and coassessing benchmarks. Data are reported according to these benchmarks, presenting these data for the entire cohort and by individual disciplines before providing detailed case studies for two pairs within the English cohort. Recommendations are provided for TPPs who want to use a similar coteaching reflection survey and approach to data analysis to inform more immediate pair support.

Physical education teachers use motivational strategies that can (positively or negatively) affect their students' level of motivation and engagement. Indeed, according to their experiences and beliefs, some teachers may focus on strategies that thwart, rather than support, students' psychological needs (autonomy, competence, and relatedness). Effective professional development represents an excellent opportunity to help teachers use research-supported motivational strategies. Therefore, this study aimed to discover if attendance at a 2-day training course could positively affect PE teachers' beliefs regarding empowering motivational strategies. Specifically, 11 PE teachers (experimental group = 6 [attending the training]; control group = 5 [no training]) from primary school (n = 6) and secondary school (n = 5) expressed their beliefs (effectiveness, feasibility, and normality) regarding 31 empowering motivational strategies proposed during training at the beginning (October) and the end (April) of the school year. Results of the Wilcoxon signed-rank test for related samples indicated no significant differences for the belief regarding effectiveness in either group. However, some positive significant changes (p [less than or equal to] 0.05) occurred in the experimental group for two motivational strategies supporting students' need for autonomy and one supporting their need for competence. Given the small sample, positive trends (p [less than or equal to] 0.10) are also considered results of interest. In conclusion, the training appears likely to impact teachers' beliefs. However, future professional development should provide additional feedback and follow-up time with teachers during experimentation with students to allow teachers to refine their understanding and use of the motivational strategies proposed.

Objectives Understanding flexibility and adaptive capacities in complex healthcare systems is a cornerstone of resilient healthcare. Health systems provide structures in the form of standards, rules and regulation to healthcare providers in defined settings such as hospitals. There is little knowledge of how hospital teams are affected by the rules and regulations imposed by multiple governmental bodies, and how health system factors influence adaptive capacity in hospital teams. The aim of this study is to explore the extent to which health system factors enable or constrain adaptive capacity in hospital teams.Design A qualitative multiple case study using observation and semistructured interviews was conducted between November 2020 and June 2021. Data were analysed through qualitative content analysis with a combined inductive and deductive approach.Setting Two hospitals situated in the same health region in Norway.Participants Members from 8 different hospital teams were observed during their workday (115 hours) and were subsequently interviewed about their work (n=30). The teams were categorised as structural, hybrid, coordinating and responsive teams.Results Two main health system factors were found to enable adaptive capacity in the teams: (1) organisation according to regulatory requirements to ensure adaptive capacity, and (2) negotiation of various resources provided by the governing authorities to ensure adaptive capacity. Our results show that aligning to local context of these health system factors affected the team’s adaptive capacity.Conclusions Health system factors should create conditions for careful and safe care to emerge and provide conditions that allow for teams to develop both their professional expertise and systems and guidelines that are robust yet sufficiently flexible to fit their everyday work context.

Background In England in 2021, an estimated 274 000 people were homeless on a given night. It has long been recognised that physical and mental health of people who are homeless is poorer than for people who are housed. There are few peer-reviewed studies to inform health and social care for depression or anxiety among homeless adults in this setting. Aims To measure the symptoms of depression and anxiety among adults who are homeless and who have difficulty accessing healthcare, and to describe distribution of symptoms across sociodemographic, social vulnerability and health-related characteristics. Method We completed structured questionnaires with 311 adults who were homeless and who had difficulty accessing healthcare in London, UK, between August and December 2021. We measured anxiety and depression symptoms using the 4-item Patient Health Questionnaire (PHQ-4) score. We compared median PHQ-4 scores across strata of the sociodemographic, social vulnerability and health-related characteristics, and tested for associations using the Kruskal–Wallis test. Results The median PHQ-4 score was 8 out of 12, and 40.2% had scores suggesting high clinical need. Although PHQ-4 scores were consistently high across a range of socioeconomic, social vulnerability and health-related characteristics, they were positively associated with: young age; food insecurity; recent and historic abuse; joint, bone or muscle problems; and frequency of marijuana use. The most common (60%) barrier to accessing healthcare related to transportation. Conclusions Adults who are homeless and have difficulty accessing healthcare have high levels of depression and anxiety symptoms. Our findings support consideration of population-level, multisectoral intervention.