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School re-entry of children who have been absent from school due to severe illness is a complex process and requires effort and adjustment from the child and his parents, teachers, school systems, and classmates. To contribute to the understanding and accuracy of the school re-entry process of ill children, and to the development of re-entry programs in Israel, the present study examined the re-entry experience from the viewpoint of mothers and teachers. The study included 27 semi-structured interviews with mothers and teachers of children who re-entered school after a prolonged absence due to childhood cancer. The study findings suggest that changes in the child's self-perception, physical limitations brought on by the illness, as well as social difficulties, and altered academic abilities make it very difficult to re-enter school. School re-entry is more optimal when the sick child's relationship with the teacher and classmates is maintained during the absence, and when it is tailored and continuous learning support from the school. These findings emphasize the importance of maintaining an ongoing relationship during the ill child's absence from school and setting a clear re-entry plan by the school in accordance with the child and his parents.

Introduction: Incidence rates for developing breast cancer are similar for women regardless of intellectual ability. However, women with an intellectual disability present with advanced breast cancers, which often have a poor prognosis. Method: A structured narrative review of the literature was performed to explore the concepts of breast awareness and breast cancer awareness and subsequently, identify barriers to breast cancer awareness encountered by women with an intellectual disability. Results: A total of 22 studies involving people with varying levels of intellectual disability informed this review. The barriers to breast cancer awareness encountered by women with an intellectual disability include: lack of their understanding, the role of the carer and literacy issues. Conclusion: Identifying the barriers to breast cancer awareness for women with an intellectual disability will help to facilitate breast cancer awareness which has the potential to result in better long-term outcomes through an early diagnosis of breast cancer.

Background: Adequate sun safety during childhood is crucial for decreasing skin cancer risk in later life. Although parents are an essential target group in applying sun protection measures for their children, insight into the determinants associated with their sun protection behaviors is limited. Aims: This study aims to identify the most relevant determinants in predicting multiple parental sun protection intentions and behaviors in different sun exposure situations. Method: A longitudinal survey study with two measurements was conducted among Dutch parents (N = 670) of children (4-12 years old). Twenty-seven sociocognitive determinants were examined in terms of relevance regarding four parental sun protection behaviors in different sun exposure situations. The Confidence Interval-Based Estimation of Relevance approach was used to visualize room for improvement (sample means) on all determinants and their association strengths (correlations) with sun protection intentions and behaviors. Results: Behavior-specific rather than generic determinants were most relevant in explaining all sun protection behaviors. Of these determinants, attitude, self-efficacy and action planning, and especially parental feelings of difficulty in performing sun protection behaviors, were most relevant. Altogether, the explained variance of all sociocognitive determinants was highest for shade-seeking behavior (R[superscript 2] = 0.41 and 0.43) and lowest for supportive behavior (R[superscript 2] = 0.19 and 0.29) in both planned and incidental sun exposure situations, respectively. Discussion: This study provides detailed insight into relevant sociocognitive determinants of parental sun protection behaviors in various sun exposure situations and directions for composing parental skin cancer prevention interventions. Conclusions: Future composition of sun safety interventions should emphasize on enhancing parental feelings of self-efficacy, especially for shade-seeking and clothing behaviors.

Skin cancers are the most common malignancy in Australia. Regular sunscreen use can reduce the incidence of cutaneous squamous cell carcinomas and actinic keratoses and has been associated with reducing the incidence of basal cell carcinomas and melanomas. However, sunscreen effectiveness is limited by the failure of the population to use it routinely. Interventions that promote the daily application of sunscreen may reduce the morbidity, mortality, and economic burden associated with skin malignancies. We reviewed the literature that examines the effectiveness of interventions to increase routine sunscreen use and found that no one strategy has been shown to be clearly effective in adults and that relatively few studies have aimed to increase routine use in groups at extreme skin cancer risk. Future research should consider how interventions can be best designed and how sunscreen use is measured so that cost-effective, feasible strategies that result in improved sunscreen use in adults can be established.

Background: Performing regular muscle-strengthening activity has numerous health benefits, including improvements in blood pressure, hemoglobin A1c, and lean body mass. Despite the disproportionate prevalence of lifestyle-related chronic disease in Latinas (diabetes, hypertension, obesity), most do not report meeting the national guidelines for muscle-strengthening activity. Existing physical activity (PA) research in Latinas has focused almost exclusively on aerobic PA. Our study examined Latinas' sociodemographic and psychosocial correlates of meeting muscle-strengthening PA guidelines that can inform future PA interventions. Method: A cross-sectional study of participants (N = 436) enrolled in a randomized controlled trial promoting PA and cancer screening in Latinas was conducted, and t tests examined the associations between sociodemographic and psychosocial factors with self-reported muscle-strengthening activities. Hierarchical regression was conducted in separate blocks guided by the socioecological model (sociodemographic, individual, and interpersonal factors) to examine the independent contribution of each block to the outcome of meeting national guidelines for muscle-strengthening PA. Results: Participants who met the national PA guidelines of [greater than or equal to]2 days/week of muscle-strengthening activities reported significantly higher social support for PA (p < 0.001), greater use of behavioral strategies for PA (p < 0.001), and lower barriers to PA (p < 0.03) than those who did not meet the guidelines. Hierarchical binary logistic regression indicated behavioral strategies for PA was the only significant correlate of meeting the national guidelines for muscle-strengthening PA (odds ratio = 1.39, 95% confidence interval [1.18, 1.65], p < 0.001). Discussion/Conclusion: Results support a hypothesis that instructing Latinas to use behavior change strategies could help them increase muscle-strengthening PA.

Skin cancer prevention efforts in Australia have increasingly incorporated a focus on protection during incidental sun exposure. This complements the long-present messages promoting protection in high-risk settings and avoidance of acute intense bouts of sun exposure. Data from two waves of a cross-sectional direct observational survey was used to assess the prevalence and correlates of N = 12,083 adolescents' and adults' sun protection behavior (arm and leg cover, hat, sunglasses, and shade cover). Individuals were observed in public outdoor settings in Melbourne, Australia during peak ultraviolet (UV) times (11 a.m.-3 p.m.) on summer weekends. Settings included pools and beaches, parks and gardens, and for the first time in 2018, outdoor streets and cafés which may capture more incidental forms of sun exposure and represent another public setting where Australians commonly spend time outdoors. Females and older adults were consistently better protected than males and adolescents. Physical activity was strongly associated with low shade cover across settings. Weather was more strongly associated with sun protection at outdoor streets/cafes and parks/gardens than at pools/beaches but use of observed sun protection (particularly arm cover and covering hat) was low across settings. Continued public education about UV risk and its relation to weather and the seasons is needed to promote the routine use of multiple forms of sun protection during outdoor activities in peak UV times, especially among males and adolescents. Findings also highlight the importance of considering activity demands of public spaces in shade planning to optimize sun protection during outdoor activities in public spaces.

Down syndrome (DS) research is advancing rapidly, yet efforts have raised ethical questions. This mixed methods study describes views of people with DS (self-advocates) and their parents regarding medical interventions for DS. Responses from 35/171 (20.5%) self-advocates and 430/867 (49.6%) parents showed the majority of self-advocates were glad they have DS (27/35; 77.1%) and liked who they are (33/35; 94.3%), but did want to learn faster (23/35; 65.7%). Parents much more commonly agreed with a willingness to give medications to prevent Alzheimer's disease (427/429; 99.5%) or blood cancer (428/430; 99.5%) as compared with a medicine to cure DS (225/425; 52.9%). Qualitative comments intertwined DS with identity, yet indicated desire for improved quality of life and opportunities. Responses decoupled DS itself from the complications of DS, with treatment of complications being more acceptable.

Using the Hartung-Knapp method and 95% prediction intervals (PIs) in random-effects meta-analyses is recommended by experts but rarely applied. Therefore, we aimed to reevaluate statistically significant meta-analyses using the Hartung-Knapp method and 95% PIs. In this methodological study, three databases were searched from January 2010 to July 2019. We included systematic reviews reporting a statistically significant meta-analysis of at least four randomized controlled trials in advanced cancer patients using either a fixed-effect or random-effects model. We investigated the impact of switching from fixed-effect to random-effects meta-analysis and of using the recommended Hartung-Knapp method in random-effects meta-analyses. Furthermore, we calculated 95% PIs for all included meta-analyses. We identified 6234 hits, of which 261 statistically significant meta-analyses were included. Our recalculations of these 261 meta-analyses produced statistically significant results in 132 of 138 fixed-effect and 114 of 123 random-effects meta-analyses. When switching to a random-effects model, 19 of 132 fixed-effect meta-analyses (14.4%) were no longer statistically significant. Using the Hartung-Knapp method in random-effects meta-analyses resulted in 34 of 114 nonsignificant meta-analyses (29.8%). In the full sample (N = 261), the "null effect" was included by the 95% PI in 195 (74.7%) and the "opposite effect" (e.g., hazard ratio 0.5, opposite effect 2) in 98 meta-analyses (37.5%). Using the Hartung-Knapp method and PIs substantially influenced the interpretation of many published, statistically significant meta-analyses. We strongly encourage researchers to check if using the Hartung-Knapp method and reporting 95% PIs is appropriate in random-effects meta-analyses.

We follow a radioactive sample from production in a reactor to its use in a biological application to model the complexities in the use of radioactive isotopes from a student's perspective. Specifically, we describe a way to use gamma ray detection outside the body to estimate the clearance rate of these radioisotopes from the body and how that rate can be used to assess thyroid cancer remnant mass. This procedure has a long history in nuclear medicine and is well established. Classroom discussion questions are included to think more deeply about the proper (and improper) handling of radiopharmaceuticals as well as patient safety.

This case study addressed the authors' efforts to design an 8-week small-group independent study (IS) experience that facilitated undergraduate speech-language pathology students' (n=19) higher-level thinking and overall metacognitive awareness. We hoped to encourage both in order to improve students' overall cognitive growth while enhancing their reflection about and knowledge of professional perspectives regarding the assessment and treatment of laryngeal cancer. To take on this challenge, we combined case-based learning (CBL) and perspective-taking (PT) pedagogies across the IS. Students completed the Metacognitive Awareness Inventory (MAI) pre- and post-IS, and written reflections after each of eight weekly discussion meetings. The MAI was quantitatively analyzed, while reflections were qualitatively coded using Bloom's taxonomy. Findings indicated that metacognitive awareness significantly improved and that higher-level cognitive processing was increasingly evidenced across students' IS experience. Results indicate the potential to maximize metacognition and cognitive processing by combining CBL and PT by the methods used here. Applications of combined CBL and PT to other disciplines and teaching and learning situations will be discussed along with the implications of our findings.

Undergraduate research is a valuable tool to demonstrate both the dedication and time required to be a successful biologist. One area of research that has intrigued students over the last several years is cytotoxicity. However, at smaller undergraduate institutions, the time, training, and funding available for these research studies may be limited. Direct counting of cells is tedious and leads to mistakes, and although there are now several colorimetric toxicity assays, some have several steps and require near-perfect pipetting skills. To identify the most reproducible and affordable method(s) for undergraduate students to perform cell-based toxicity studies, we compared three colorimetric assays to counting viable cells directly. Using a breast cancer model system, students applied cantharidin to two different breast cancer cell lines, MCF-7 and MDA-MB231, and performed MTT, resazurin, and crystal violet colorimetric assays or counted viable cells directly. We hypothesized that the MTT assay would be the most reproducible assay. Our results indicate that the crystal violet assay was not as reproducible as direct counting of cells, and therefore, not the best assay to use for toxicity tests. In contrast, the MTT and resazurin assays were highly reproducible and relatively low cost, and thus ideal assays for student research.

Palliative care services have not been developed in Northern Cyprus despite the increased incidence of cancer cases in recent years. The aim of this study is to measure the level of knowledge of the people living in country on palliative care services by conducting an awareness research. People who reside in Northern Cyprus have been surveyed via internet. The questionnaire included 10 questions about the palliative care services as well as the demographic information. Of the 150 participants who completed the questionnaire: 39% of the respondents stated that they did not know what palliative care is, and 69% stated that they did not know whether there is a palliative care center. 34% of the participants do not have any idea about the need for this service. These results emphasize that there is lack of palliative care services around country and that awareness should be raised. Increasing life-span in chronic diseases as well as in cancer cases increases the importance of palliative care together with developments in medicine. It is inevitable to create teams / centers working on this issue by adhering to sociocultural, economic and legal procedures.

Teachers' beliefs about science teaching vary greatly. To analyze the relationships between teachers' beliefs and other variables related to teaching and learning, researchers can use the following two options: single item belief models or belief scales. In this study, we compared both models in the context of teachers' beliefs regarding teaching about cancer. Although both models exhibited a good model fit, each approach had both advantages and disadvantages when we judged the modelling approaches in terms of fulfilling the requirements of common psychometric standards and adequately acknowledging the diversity of different beliefs. We discuss the predictive value of both models and their contribution to planning belief-based interventions for cancer education. We argue that researchers should combine the advantages of single item and scale models when analyzing the diversity of teachers' beliefs.

With the study, titled "Women's Breast Cancer Consciousness and Sport Burdur Example" aimed at the awareness and practice of breast cancer in women at Burdur city center. In our study, descriptive screening and structured interview technique were applied. At the end of the research, regardless of the education level of women, it is determined that awareness of breast cancer is high with the information and guidance received from both health institutions and the media and the people who have previously faced breast cancer, and it is determined that early diagnosis can save life and can beat breast cancer with the least damage. However, this training should be provided by Family Education Centers and Provincial Health Directorates to all women who are aware of the necessity of regular and good eating habits. When we compare the results of our study with other related researches, it was determined that early diagnosis in breast cancer saved lives.

The National Institutes of Health and the National Science Foundation have made a compelling call to action not only to strengthen the pipeline of available STEM-trained talent, but in addition to foster students who are members of populations currently under-represented in science. furthermore, the scientific community must not only increase the accessibility of STEM-related education, but also implement and test evidence-based practices. Presented here, we detail the proceedings of a hands-on, science-focused informal learning opportunity aimed at educating an underrepresented population in cancer biology. Fifteen undergraduate and graduate student volunteer instructors from the University of Nebraska at Omaha and the University of Nebraska Medical Center engaged with 89 high school students, mostly Native American, in an informal learning event called "Cancer Biology and You Day." Throughout the event, students completed two independent lessons focusing on breast cancer and skin cancer and demonstrated strong learning gains associated with the lessons as assessed by KWL charts. Exit surveys of the students indicated high levels of satisfaction with the event, and positive attitudes associated with considering a career in science/research were evident in survey responses. Overall, we report the event as a success and outline how similar experiences may be achieved.

Histological assessment of tissues is a critical component of diagnosing diseases and determining disease severity or stage. In order to fully appreciate tissue pathology, an understanding of healthy tissue layers is required. Students traditionally learn this information by memorizing different layers within healthy tissue. This is often a daunting task if not placed into a meaningful real-world context. Described here is a hands-on inquiry-based laboratory where students make a diagnosis based on their knowledge of tissue layers. Students are provided readily available preserved tissue from two patients. Students are unaware that one patient is normal while the other has bladder cancer. Students stain the tissues using a common histological technique and are responsible for providing a bladder cancer diagnosis with corresponding cancer stage. This activity not only provides real-world technical experience, but since cancer staging is determined by the tissue layers the tumor has infiltrated, it also reinforces the importance of knowing different tissue layers. Following their diagnosis, pathology reports are assembled using images from either a microscope or cell phone. Students then compare these results with professional pathology reports accompanying the tissue. This activity is well suited for health sciences, cancer biology, histology, or pathology classes.

This article investigates miscommunication in sequences of talk where an oncologist asks about patients' co-morbidities, that is, their other illnesses beyond cancer. Using conversation analysis, we examine ways in which the participants identify and manage two sources of miscommunication: a divergence in the doctor's and the patient's understandings about the scope of the question; and a divergence in the doctor's and the patient's (and sometimes their companion's) understandings about the matters that the question targets. Our findings have implications for practice, highlighting ways in which clinicians and patients can manage these sources of miscommunication. These include practices to retrospectively or pre-emptively manage ambiguities and to check the accuracy of patients' answers. Additionally, our study addresses some theoretical and methodological problems in the study of miscommunication. Our data consist of 25 video-recorded first consultations in an Italian hospital; the participants speak Italian.

Colorectal cancer (CRC) screening rates are suboptimal, partly due to poor communication about CRC risk. More effective methods are needed to educate patients, but little research has examined best practices for communicating CRC risk. This multi-method study tests whether tailoring CRC risk information increases screening intentions. Participants (N = 738) were randomized with a 2:2:1 allocation to tailored, targeted, and control message conditions. The primary outcome was intention to screen for CRC (yes/no). Additional variables include perceived message relevance, perceived susceptibility to CRC, and free-text comments evaluating the intervention. A chi-square test determined differences in the proportion of participants who intended to complete CRC screening by condition. A logistic-based path analysis explored mediation. Free-text comments were analyzed using advanced topic modeling analysis. CRC screening intentions were highest in the tailored intervention and significantly greater than control (P = 0.006). The tailored message condition significantly increased message relevance compared with control (P = 0.027) and targeted conditions (P = 0.002). The tailored condition also increased susceptibility (P < 0.001) compared with control, which mediated the relationship between the tailored condition and intention to screen (b = 0.04, SE = 0.02, 95% confidence interval = 0.02, 0.09). The qualitative data reflect similar trends. The theoretical mechanisms and practical implications of tailoring health education materials about CRC risk are discussed.

This study was intended to analyze the effect of multiple initiations on beliefs about cervical cancer, health responsibility, and screening participation. In total, 134 women aged 40-55 years, who were at risk of cervical cancer and had never had a Pap smear before, were randomly assigned to the experimental (n = 67) and control (n = 67) groups. The 14 weeks of sessions involving the experimental group included group training on cervical cancer, counselling, reminder phone calls and delivery materials, all aimed to increase motivation to be screened regularly for cervical cancer. The control group received the usual care. The study data were collected using an information form, the Health Belief Model Scale, the Healthy Lifestyle Behaviors Scale II and the Assessment Form for Undergoing Pap-Smear Test. After the multiple interventions, there was a significant difference between the experimental and control group's Health Responsibility, Pap smear benefit and motivation, obstacle and health motivation scores (P < 0,05). The participation rate of women in the experimental group to cervical cancer screening was found to be 93%. Multiple nursing interventions (group training, counselling, reminder phone calls and delivery materials) were effective in increasing participation in cervical cancer screening programs.

Purpose: This study examined the acoustic properties of Taiwanese (Southern Min) lexical tones produced in esophageal speech (ES) and pneumatic artificial laryngeal speech (PAL), including onset fundamental frequency (F0), slope of F0 contour, duration, and amplitude (intensity) of the vowel portion of syllables carrying seven Taiwanese tones. Method: Seven ES speakers, seven PAL speakers, and 18 normal laryngeal (NL) speakers (all male) read aloud target syllables carrying the tones in monosyllables, disyllables, and sentences. Acoustic features were measured with "Praat." Results: Acoustic analysis revealed (a) no significant effects of linguistic level on acoustic parameters except for duration, which generally significantly decreased from monosyllables to disyllables to sentences for Tones 1 and 5; (b) significant differences across the speaker groups in onset F0 (PAL > ES > NL), duration (PAL > NL and PAL > ES for all tones), and mean amplitude (PAL > NL > ES); and (c) no significant difference in mean slope of F0 contour across the speaker groups. Conclusions: These preliminary data on acoustic properties of Taiwanese tones produced by ES and PAL speakers could facilitate the design of therapeutic strategies for improving the intelligibility of alaryngeal lexical tones. Further studies are recommended to examine the relative perceptual importance of the acoustic parameters.

In this study, the authors evaluated the potential role of an activity-based guitar training program on reducing anxiety and providing fulfillment for younger relatives of cancer patients. Ten active members of KHYD (The Society for Relatives of Cancer Patients), between ages 11 and 17 participated in an 8-week guitar education program. The participants filled out two questionnaires before and after their engagement in the 8-week program, one to measure changes in their anxiety levels (State-Trait Anxiety Inventory) and the other to measure changes in their general fulfillment levels (Multidimensional Students' Life Satisfaction Scale). Wilcoxon signed rank test, as well as descriptive statistics were used in the analysis of data. Mean rank differences were observed to be statistically significant with respect to total state and trait anxiety scores; in both cases, the participants' scores decreased after their engagement in the program. Statistically significant mean rank differences were also observed in the overall MSLSS scores and its "friends" and "environment" sub-dimensions; with respect to these, participants' scores increased after their engagement in the program. Recommendations for more comprehensive, larger-scale studies are given at the end.

Background: Colorectal cancer (CRC) is the third most common cancer for Chinese Americans. Family history (FH) plays an important role in clinical practice for CRC prevention. Nevertheless, Chinese Americans' FH of CRC communication with primary care physicians (PCPs) are still unknown. Aims: This study examined Chinese Americans' behavior and the underlying psychological factors for FH of CRC communication with PCPs. Method: A total number of 742 Chinese Americans completed a survey developed based on the health belief model, the theory of planned behavior, and the social cognitive theory. Data were analyzed using structural equation modeling. Results: Majority of the Chinese American participants (75.3%) had never discussed FH of CRC with their PCPs. Lack of inquiries from the PCPs was the main barrier. Structural equation modeling results suggested a good model fit between our theoretical model and the survey data (comparative fit index [CFI] = 0.946, root mean square error of approximation [RMSEA] = 0.070, and standardized root mean square residual [SRMR] = 0.020). Participants' FH of CRC communication with PCPs was positively associated with their intention ([beta] = 0.30, p < 0.001), which was positively correlated to attitudes ([beta] = 0.29, p < 0.001) and self-efficacy in discussing FH of CRC with PCPs ([beta] = 0.57, p < 0.001). Their attitudes were positively associated with perceived susceptibility to CRC ([beta] = 0.08, p < 0.05) and the perceived benefits of communicating FH of CRC ([beta] = 0.52, p < 0.001). Conclusions. Given that most Chinese Americans in this study did not communicate their FH of CRC with their PCPs, it is important to promote such behavior among Chinese Americans. Our structural equation modeling findings can guide future interventions and education for this underserved racial/ethnic minority group.

Course-based undergraduate research experiences (CUREs) allow students to apply the scientific method to novel questions, which can serve as a gateway for mentored research. Here, we present a model for using cross-disciplinary CUREs to vertically integrate courses from different disciplines. This approach creates opportunities for students to (1) ask and answer authentic research questions, (2) apply knowledge from different disciplines to a research topic, and (3) expand their interest in additional research. To achieve these goals, a research theme of metal-containing anticancer drugs was used to link 100- and 300-level courses in both biology and chemistry. Across four courses, developmentally appropriate strategies were used to investigate the metal complex KP1019 (indazolium "trans"-[tetrachlorobis(1H-indazole)ruthenate(III)]). In chemistry courses, students synthesized KP1019 and quantitatively analyzed how novel environmental variables alter its hydrolysis and redox properties. In biology courses, students used the yeast "Saccharomyces cerevisiae" as a model for characterizing how environmental variables affect KP1019 bioactivity, and they performed a partial phenomic screen to identify yeast genes that influence drug sensitivity. To promote cross-talk between courses, undergraduate researchers uploaded their findings to a wiki that subsequent students used to drive the design of novel experiments. Survey and focus group results suggest the revised laboratory projects successfully engaged students in the scientific process, promoted integration of concepts from biology and chemistry, and led to a disproportionately large number of impacted students participating in mentored research. Importantly, a wide range of interdisciplinary research questions can be adapted for use with this model of vertical integration across STEM disciplines.

Biological systems exhibit strong dynamic variations; for example, a system may have a tendency towards either a steady state, periodic behaviour or chaotic oscillations. These findings, explained by dynamic systems theory, have allowed researchers to formally relate a wide variety of systems, such as the theory of rumour propagation, glucose metabolism or the activity of a neuronal circuit. Interestingly, among all of the dynamic characteristics mentioned, qualitative aspects frequently observed in highly complex systems can be obtained through the recursive application of a very simple parabolic function known as the logistic equation. Currently, the importance of these dynamic phenomena for biomedicine is recognized, but simple models such as the logistic equation have not been sufficiently exploited in the training of biologists and health professionals. We briefly review some properties of the dynamics governed by the logistic equation, with a direct application to the theory of cancer based on the dynamics of aneuploidy. We believe that this already known mathematical application is an opportunity for integrated teaching of mathematics and biology. For this purpose we finally provide an appendix with some activities, all of them related to this article, which can be practiced in a simple spreadsheet that we have shared.

For people with symptoms that could indicate cancer, prompt presentation to a health care practitioner facilitates early diagnosis, improves survival, and is encouraged by public health agencies and cancer charities. Nevertheless, time to presentation from symptom onset (the patient interval) is known to vary widely. We report findings from a mixed-methods study examining help-seeking among people with symptoms of lung or colorectal cancer. Patients referred for urgent investigation were invited to complete a questionnaire about their symptoms and help-seeking experiences; 26 of these participants then took part in a semi-structured interview. Discrepant accounts of help-seeking were reported through the different research methods, with longer 'patient intervals' reported in interviews. We use the concept of 'public and private accounts' to reflect upon why socially conforming accounts of early presentation were presented in the questionnaires, whilst accounts of longer 'patient intervals' tended to be presented within an interview encounter.

Purpose: Oncological diseases, especially if experienced in the first 3 years of life, expose young children to conditions of serious physical and emotional stress causing delays in their physical development, cognitive acquisitioning and issues related to their emotional and social functioning. This study examines the effects of the participation in an early childcare intervention to support the children's development, which was proposed to children from 0 to 36 months, at the moment of cancer diagnosis in their hospital setting. Method: A prospective multicenter programme was offered to young children (<3 years) newly diagnosed with cancer. These children were treated in three pediatric oncology centers affiliated to the Italian Association of Pediatric Hematology-Oncology. The children's strengths and weaknesses, in different developmental areas, were examined pre-programme and 6 months post-programme. Results: Fifty-three young children were enrolled in the study. The data showed that at the moment of diagnosis the majority of the children demonstrated low scores across all the abilities in the subscales examined, highlighting a mental age below their chronological age ([delta][subscript T0] = 3.5 months). However, post-programme, the children were shown to have significantly reduced the gap between their chronological and mental age ([delta][subscript T1] = 1 month), demonstrating improvements in all their developmental abilities. Conclusion: The study confirms significant implications for early childcare programmes, delivered in hospitals for young children with cancer, in terms of support for their ongoing physical, cognitive and social development. Therefore, the study demonstrated the necessity, for all pediatric oncology centers, to invest in early childhood education programmes.

Purpose: Breast cancer (BC) presents a major public health challenge world-over including India. While several risk-factors, early signs and symptoms of BC are known, the knowledge and awareness of this disease remains poor among the population. The present study aimed to determine the extent of knowledge and awareness of BC, its risk factors, early signs and symptoms and breast self-examination (BSE) practice as an early detection method among Indian college-going female students. Design/methodology/approach: The authors conducted a cross-sectional survey at a University in Delhi-NCR. Data on socio-demographic, knowledge and awareness of BC including BSE was collected using a pretested questionnaire. Chi-square test and logistic regression analysis was performed. All tests were two-sided and significance was set at p < 0.05. Findings: A total of 866 female students participated in the study with mean age of 22.32 (±0.146) years having mean body mass index (BMI) of 21.22 (±3.52). As high as 82.1% of the participants had heard of BC but while 74.8% thought early detection is possible, 70.7% believed BC cannot be prevented. Gene mutations (60.2%) were identified as a significant risk factor, while breast pain (61.4%) was commonly recognized as a sign of BC. Only 29.8% of students ever performed BSE. Increased odds of performing BSE (OR = 3.4) was found among students who recognized gene mutations as an important BC risk factor. Research limitations/implications: Knowledge and awareness of BC including BSE among female college students were found to be below average. It is suggested that there is an urgent need for increasing BC awareness among young girls through workshops and mobile-health interventions. Practical implications: This study provides new information on the level of knowledge and awareness of BC risk factors, sign and symptoms and self-examination practice among young college girls. Moreover, this study advocates the need for design and implementation of a sustainable digital health model for active population BC screening, which is not being done currently. Social implications: BC is a highly aggressive disease, which is now one of the leading causes of morbidity and mortality in India and world over. Although the knowledge of BC risk factors and its signs and symptoms have increased, the awareness of these elements among the general population at large is low and/or missing, especially in India. Furthermore, as a consequence of unorganized screening programs in the country, majority of women are presenting young with locally advanced disease. Understanding the existing level of knowledge and educating school, college and University students of the pertinent factors and screening practices such as BSE could drastically help in improving the self-screening and/or clinical examination rates. This could potentially lead to early detection and improved prognosis, thus ameliorating disease burden. Originality/value: This study is one of the few studies conducted in India among young female college students belonging to non-medical backgrounds, delineating the level of knowledge and awareness of BC risk factors and signs and symptoms along with practice of early detection method such as BSE. The study has a considerable sample size and provides valuable evidence for a need to implement programs incorporating digital health models for accelerating awareness and screening of young girls in both rural and urban settings.

Lung cancer is the second most common cancer diagnosis and is the leading cause of cancer-related death in the United States for both men and women. The etiologies of many different types of lung cancer can be linked to risk factors that can be prevented, such as chronic tobacco smoking. Lung cancer is significantly more prevalent among socioeconomically disadvantaged and minority populations. Due to the significance of lung cancer as a public health issue, the authors have developed a module on the topic of pulmonology--a medical specialty field that deals with disease processes involving the respiratory system--to (1) explain the basics of normal lung physiology; (2) explain the pathological changes associated with lung cancer and other lung diseases; (3) provide preventive education on the importance of tobacco abstinence and the damaging effects of tobacco smoking on the lungs; and (4) introduce students to some pulmonologic interventions. The Cancer Education Initiative Program is targeted toward first- through third-grade students from underrepresented minorities of the Los Angeles Unified School District (LAUSD) and aims to address students' misconceptions and lack of knowledge regarding the pathogenesis, diagnosis, and treatment of cancer; provide preventive health promotion education so that students may make more healthy lifestyle choices, and foster students' interests in STEM and health care fields. In compliance with the "Next Generation Science Standards" (NGSS), a cancer education curriculum was developed and implemented featuring lessons based in science, technology, engineering, and math (STEM) concepts in relation to cancer. The lesson plans and activities align with grades 3-5 NGSS standards; however, they were implemented with students of grades 1-3.

The entertainment education (EE) approach shows that entertainment storylines influence people's attitudes, opinions, and behavior, and this occurs, among others, when it comes to health and disease. In the case of TV shows and movies cancer is the most frequently shown disease, and this is especially important when considering the rise of VOD platforms, gaining in subscribers and popularity. The article aims at signaling Netflix's EE potential, hence it could be a starting point for future studies of streaming platform's EE, a highly neglected area. Netflix is thus 1) compared with other popular VODs in terms of the number of cancer content (this being the main interest of the presented analysis) and 2) three content categories are indicated. Also, 3) a brief description of selected texts is presented. The aim of the article is exploratory, and it highlights the need for future research, as the potential of Netflix's EE seems the greatest when compared to other platforms analyzed. Netflix has the largest number of contents featuring cancer, and these could influence audiences, i.e., raise awareness, change attitudes, and motivate individuals to act.

Purpose: This secondary data analysis explores the unmet needs of adolescents experiencing maternal cancer in Ireland. Research has shown that one of the challenges adolescents deal with at the time of maternal cancer is having unmet needs that can impact negatively on their experience and their ability to cope through this difficult challenge. Design/methodology/approach: Fifteen adolescents completed qualitative interviews as part of a larger study that explored the experience of adolescent adjustment to maternal cancer. The transcripts of these original interviews were analysed using a secondary content analysis underpinned by the categories included in the Offspring Cancer Needs Instrument (Patterson et al., 2013). Findings: The findings of this study suggest a necessity to individually explore the unmet needs of adolescents as these were not uniform even within a small sample of 15 adolescents. Unmet needs change and evolve over time as does maternal illness. Adolescents themselves identified the need for more education in the general public and in clinical practitioners on how to respond appropriately to their needs. It is crucial that adolescent's needs and emotions are validated at the time as part of the support provided for them. Originality/value: This study provides important recommendations for practice and policy on how to provide tailored supports for adolescent who experience cancer in their families as currently there is a lack of effective and evidence-based targeted supports for this specific age group.

This paper considers two studies that address negative affective states and moral reasoning while taking the Defining Issues Tests (DIT, DIT2). Both studies confirmed earlier findings that the DIT dilemma, 'Heinz and the Drug,' and the DIT2 dilemma, 'Famine,' are related to increased anger and sadness and decreased moral reasoning. Similar findings were observed in the context of a video consideration of a real-life dilemma paralleling these two dilemmas (Study 1). Comparable findings pertaining to Famine were also observed among three samples of different moral judgment developmental levels, further implicating the role of dilemma content where the trends observed are concerned (Study 2). Overall, both studies illustrated similar patterns of affective states and moral reasoning across all considered DIT/DIT2 dilemmas thereby offering further evidence of the joint involvement of rational deliberation and affective states in the consideration of DIT/DIT2 dilemmas.

Effective communication between cancer patients and their healthcare professionals is an essential ingredient in providing quality medical care. There is a correlation between poor healthcare communication and chronic stress in cancer patients. Chronic stress impedes the human immune system and promotes tumor growth. There is also a negative correlation between cancer communication discomfort in patients and their level of education. To address poor healthcare communication, chronic stress, and improve health outcomes, healthcare providers must act as educators. It is important for providers to (1) utilize effective methods when communicating face-to-face with cancer patients, (2) present written information that can be understood at sixth to eighth grade levels, and (3) utilize the power of computer-mediated communication in order improve the health literacy and outcomes of their cancer patients.

Physical and life science disciplines emphasize how basic structural units influence function, yet it is challenging for students to understand structure-function relationships, particularly at molecular scales. Undergraduates in our biology capstone course struggled to connect mutations in a gene encoding a key protein in a cell development regulation pathway to the function of that protein. We hypothesized that physical molecular models and interactive activities exploring the pathway would help students overcome this learning challenge. Four years of iterative assessment cycles, curricular revisions, and assessment rubrics based on these classroom strategies allowed us to pinpoint students' struggles to make specific connections between genetic structural mutations and protein function. Student scores on summative assessments and self-reports of learning improved over the 4 years. Furthermore, student comments both supported the summative data and helped us understand how these curricular materials are helpful. We present an evidence-based example in which STEM educators successfully incorporate a novel teaching material by integrating scaffolds that allow students to see how experts make sense of complex and dynamic systems.

Biomimicry is a useful method to develop students' skills, such as design and systems thinking, particularly when complemented with inquiry-based learning. The research seeks to uncover how students engage in the biomimicry process and what types of designs they produce to reveal insights that could assist educators in teaching biomimicry. A study was conducted with 70 undergraduate students who were placed into 12 groups. Using an inquiry-based learning method, students selected their own health challenge and proposed a biomimetic design. Students submitted reports which were analysed via thematic analysis revealing numerous findings, including two common forms of biomimicry carried out by students, further insights into the strategy of 'cross breed mimicry', the types of organisms students imitated, and the successes and difficulties students faced in applying biomimicry. It contributes to the understanding of how students engage in biomimicry. This research is among one of the first studies to apply an existing six stage biomimicry process and to test this in the field of biomedical engineering.

People miss a high proportion of targets that only appear rarely. This low prevalence (LP) effect has implications for applied search tasks such as the clinical reading of mammograms. Computer aided detection (CAD) has been used to help radiologists search mammograms by highlighting areas likely to contain a cancer. Previous research has found a benefit in search when CAD cues were correct but a cost to search when CAD cues were incorrect. The current research investigated whether there is an optimal way to present CAD to ensure low error rates when CAD is both correct and incorrect. Experiment 1 compared an automatic condition, where CAD appeared simultaneously with the display to an interactive condition, where participants could choose to use CAD. Experiment 2 compared the automatic condition to a confirm condition, where participants searched the display first before being shown the CAD cues. The results showed that miss errors were reduced overall in the confirm condition, with no cost to false alarms. Furthermore, having CAD be interactive, resulted in a low uptake where it was only used in 34% of trials. The results showed that the presentation mode of CAD can affect decision-making in LP search.

Purpose: Globally, cancer represents an increasing proportion of child mortality as progress against infectious causes is made. Approximately 400,000 children will develop cancer, each year, around the world. Only about half of these cancers will ever be diagnosed. In high-resource settings, 80% of children will survive, but only about 30% will survive in low-resource settings. Digital solutions have a valuable role in increasing health professional knowledge, skills and empowerment to diagnose, treat and otherwise care for children and adolescents with cancer. This review sought to identify digital resources that support the training and development of the paediatric oncology workforce in resource -poor settings. Design/methodology/approach: This paper presents a narrative descriptive review of peer-reviewed publications and digital platforms that contribute to health professionals' education and training regarding paediatric oncology, particularly in rural and other low-resource settings. Findings: Digital solutions were identified for building communities of practice, facilitating access to information and support and providing access to training, education and supervision specifically for paediatric oncology health professionals. A total of 33 resources are discussed in depth. A quality assessment of the digital resources is provided using the Currency, Relevance, Authority, Accuracy and Purpose (CRAAP) tool and suggestions to improve the quality of resources are discussed. Practical implications: The authors anticipate that this summary of digital resources for the global paediatric oncology professional community will inform digital health investments and design of digital innovations to meet emerging needs and will have an impact on the workforce in the real world. Ultimately, this work will contribute to an improvement in the diagnosis and treatment of children and adolescents with cancer in resource-poor settings. Originality/value: This is the first discussion and summary of digital education platforms which educate, train and offer support to health professionals with respect to paediatric oncology. These digital platforms are often aimed at, and are essential for, health professionals in rural and other low-resource settings.

Background: The free water protocol (FWP) is an alternate management strategy for patients with dysphagia, who would otherwise be nil by mouth or prescribed thickened fluids, allowing them to drink and potentially aspirate water under strict guidelines to minimize the risk of adverse consequences. The FWP is not widely implemented in acute settings, and it is unclear whether this is due to the complexity of patient presentations, clinician decision-making or barriers related to the setting. Aims: To explore the perceptions and decision-making process of clinicians about using FWPs to manage dysphagia for patients admitted to acute stroke and general medicine. Methods & Procedures: A qualitative, critical realist approach was adopted to allow for in-depth exploration of the perspectives of four dietitians, seven medical officers, eight registered nurses and 17 speech and language pathologists (SLPs) from three hospitals in a capital city of Australia. Data from semi-structured interviews were analysed using the Situated Clinical Decision-Making Framework (CDF). Outcomes & Results: Participants were cautious about FWP for patients with neurological conditions, head and neck cancer, dementia, poor immunity, chronic or recurrent respiratory illness, and certain types of stroke. Medical status and the implications for aspiration were paramount, particularly respiratory status, oxygen supplementation, cognitive status, fatigue and mobility. Participants considered patient quality of life, preferences and choices for care, but indicated that factors influencing safety often outweighed patient preference for water. Indirect factors affecting decision-making included the roles of the multidisciplinary team, individual clinical experience and attitude to risk, and availability of supervision. Conclusions & Implications: Despite the benefits of FWPs in other settings, in acute stroke and general medicine, clinicians erred on the side of safety and, in most cases, would not implement an FWP. Future clinical research is needed to systematically design high-quality and feasible clinical trials to determine the benefits and safety of FWPs for patients with dysphagia in these settings. This would lay the foundations for guidelines to support the complex clinical decision-making regarding patient suitability for FWPs.

Many studies have shown that using a computer-aided detection (CAD) system does not significantly improve diagnostic accuracy in radiology, possibly because radiologists fail to interpret the CAD results properly. We tested this possibility using screening mammography as an illustrative example. We carried out two experiments, one using 28 practicing radiologists, and a second one using 25 non-professional subjects. During each trial, subjects were shown the following four pieces of information necessary for evaluating the actual probability of cancer in a given unseen mammogram: the binary decision of the CAD system as to whether the mammogram was positive for cancer, the true-positive and false-positive rates of the system, and the prevalence of breast cancer in the relevant patient population. Based only on this information, the subjects had to estimate the probability that the unseen mammogram in question was positive for cancer. Additionally, the non-professional subjects also had to decide, based on the same information, whether to recall the patients for additional testing. Both groups of subjects similarly (and significantly) overestimated the cancer probability regardless of the categorical CAD decision, suggesting that this effect is not peculiar to either group. The misestimations were not fully attributable to causes well-known in other contexts, such as base rate neglect or inverse fallacy. Non-professional subjects tended to recall the patients at high rates, even when the actual probably of cancer was at or near zero. Moreover, the recall rates closely reflected the subjects' estimations of cancer probability. Together, our results show that subjects interpret CAD system output poorly when only the probabilistic information about the underlying decision parameters is available to them. Our results also highlight the need for making the output of CAD systems more readily interpretable, and for providing training and assistance to radiologists in evaluating the output.

Evidence-based algorithms can improve both lay and professional judgements and decisions, yet they remain underutilised. Research on advice taking established that humans tend to discount advice--especially when it contradicts their own judgement ("egocentric advice discounting")--but this can be mitigated by knowledge about the advisor's past performance. Advice discounting has typically been investigated using tasks with outcomes of low importance (e.g. general knowledge questions) and students as participants. Using the judge-advisor framework, we tested whether the principles of advice discounting apply in the clinical domain. We used realistic patient scenarios, algorithmic advice from a validated cancer risk calculator, and general practitioners (GPs) as participants. GPs could update their risk estimates after receiving algorithmic advice. Half of them received information about the algorithm's derivation, validation, and accuracy. We measured weight of advice and found that, on average, GPs weighed their estimates and the algorithm equally--but not always: they retained their initial estimates 29% of the time, and fully updated them 27% of the time. Updating did not depend on whether GPs were informed about the algorithm. We found a weak negative quadratic relationship between estimate updating and advice distance: although GPs integrate algorithmic advice on average, they may somewhat discount it, if it is very different from their own estimate. These results present a more complex picture than simple egocentric discounting of advice. They cast a more optimistic view of advice taking, where experts weigh algorithmic advice and their own judgement equally and move towards the advice even when it contradicts their own initial estimates.

This article looks at the social and cultural contexts of children's experiences of illness, through a particular focus on the context of the Global South and the role of the social media platform YouTube in children's culture. It takes a socio-constructivist approach to discuss the case of "CarecaTV" (BaldTV), a Brazilian YouTube channel with more than one million followers created by Lorena Reginato at the age of 12 when she was recovering from brain cancer. In CarecaTV, cancer subjectivity co-exists with and is expressed through digital commercialization. On the one hand, through this process, Lorena Reginato gains agency as she offers an inspirational and credible first-person testimony about cancer during childhood and becomes an emerging cancer activist. On the other, she uses entrepreneurship strategies associated with the digital influencer model of YouTube to promote herself as a (cancer) micro-celebrity, taking the lead in a youthful and playful culture.

This article shares lessons learned in applying system evaluation theory (SET) to evaluate a Clinical and Translational Research Center (CTR) funded by the National Institutes of Health. After describing how CTR support cores are intended to work interdependently as a system, the case is made for SET as the best fit for evaluating this evaluand. The article then details how the evaluation was also challenged to facilitate a CTR culture shift, helping support cores to move from working autonomously to working together and understanding how the cores' individual operating processes impact each other. This was achieved by incorporating the Homeland Security Exercise and Evaluation Program (HSEEP) building block approach to implement SET. Each of the seven HSEEP building blocks is examined for alignment with each of SET's three steps and the ability to systematically support the goal of moving CTR cores toward working interdependently. The implications of using HSEEP to support SET implementation for future evaluations are discussed.

Objective: The effectiveness of health education for patients has often been suboptimal. The neglect of a focus on empowerment and the presence of implementation barriers have been put forward as possible explanations for this. This study aimed to gain insight into how to co-create and develop an empowerment theory-based health education intervention for urological cancer patients. Design: Bravo's empowerment intervention model provided the theoretical foundations for the work undertaken with urological cancer patients in the Netherlands, using a participatory interactive learning and action approach. Method: Insights into needs regarding health education were obtained through semi-structured interviews with patients (n=22) and health professionals (n=17). Subsequently, eight co-creation sessions (n=30) were organised to translate these needs into a health education intervention. Results: An intervention in the form of digital patient information was developed. The information offered provides a view of the different care steps based on clinical guidelines but personalised in different ways. By connecting patients' empowerment needs to the information provided, and by taking health professionals' perspectives into account, barriers to health education were made visible and addressed. Conclusion: Patient empowerment theory proved valuable in better aligning a participatory research process with the empowerment needs of urological cancer patients. The programme theory developed may offer a valuable template for the development of future health education interventions.

This study aimed to increase understanding of barriers to cervical cancer prevention and control in Haitian women using photovoice methodology. Consented participants were (1) trained to use a digital camera and encouraged to capture their screening barriers, (2) interviewed to unpack and analyze their images, and (3) invited to participate in follow-up focus groups for refined discussion and data triangulation for content analysis using NVivo software. The sample included women (n = 25) who were on average 42 years (SD = 9.8, range: 26-57) and born and raised in Haiti. Results highlighted multiple barriers, including gendered family responsibilities, concerns about quality of care, financial and time constraints, worries about discomfort and exam efficacy, and emotional deterrents such as frustration. Framed by the PEN-3 model's dimensions of cultural identity, relationships and expectations, and cultural empowerment, women's recommendations to overcome barriers spanned education, evaluation, and empowerment, respectively, across individual, interpersonal, and institutional systems. Study results call for more extensive examination of the diversity present in the groups of African origin to unearth transnational, multifaceted determinants of health by biology, beliefs, and behaviors including sociocultural and socioenvironmental access. Future interventions must include development of proactive policies, which deliberately pressure the government and global community to prioritize health infrastructure while simultaneously educating women about and dispelling fear of cervical cancer, thus empowering Haitian women to live their healthiest lives. Accordingly, this study may contribute to understanding global health equity advances and improving public health infrastructure in underresourced settings in low- and middle-income countries in the Caribbean.

Evaluation of multiple community-based approaches to improve Latinas' breast cancer (BC) screening utilization has resulted in inconsistent findings. Factors contributing to this variation include heterogeneity in approaches (e.g., types of conceptual frameworks) and study quality (e.g., lack of measurement of spillover effects). This pilot study sought to clarify which approach may be most effective by evaluating the relative efficacy of two conceptual approaches using an area-level design with 145 Latinas nonadherent to U.S. Preventive Services Taskforce (USPSTF) BC screening guidelines. Each study arm included identical intervention format and duration (e.g., three group-based sessions, logistic assistance (LA) via five monthly calls and referral to free/low-cost screening programs). However, study content differed. While educate+LA addressed participants' BC prevention and screening behavior, empower+LA addressed participants' and their social networks' BC screening. After adjusting for age, insurance status, and baseline mammography intention, when compared with educate+LA participants, empower+LA participants were more likely to report obtaining mammograms, engaging more individuals about BC, initiating BC conversations in public settings, and discussing mammography specifically. Our study has important implications regarding the utility of evaluating behavioral interventions overall in terms of behavioral and spillover network effects.

It would be safe to say that nearly every student enrolled in college knows someone who has been impacted by cancer. After all, cancer killed nearly 8.2 million people worldwide in 2012 (International Agency for Research on Cancer, 2014). Using this fact as the impetus for change, we decided to make cancer the focus of a "transdisciplinary" (Marshall, 2014) collaborative effort to simulate a reciprocal-learning experience between undergraduate biology and visual art students attending a university in Southeastern Michigan. The goal of the 2015 project was to create an active and authentic collaboration utilizing the university visual arts and biology curricula. By engaging and connecting scientific and artistic critical thinking processes, we wanted to know: could we design a class structure that would enable collaborative teams of art and biology students to create a visual model that represents a hallmark of cancer designed so that the model could also stand alone on artistic merit? In other words, could cancer visualization be transformed into works worthy of gallery display while maintaining scientific accuracy? In this paper we discuss the planning, implementation, results, and impact this work has had upon the way we now envision transdisciplinary collaboration.