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While expository texts are an efficient and dominant genre used by science teachers in the United States, they generally lack justification for their claims and fail to reflect science as practice. In contrast, epistemically considerate texts detail specific scientific experiments, providing the reader insight into the methods and data of a biological discovery. This multi-case exploratory comparison analysed videos of students in introductory and advanced high school biology classes who individually read and then discussed the main ideas, sources of justification, and questions raised expository and alternate biology texts. Videos of eight class periods were analysed with a focus on the types of statements students made during the discussion, points of comprehension, questions posed, and whether and how students identified sources of justification for the texts’ claims. The epistemically considerate texts were perceived as more difficult to comprehend, but for both developmental levels, and particularly for students in the advanced class, these alternate texts elicited more sequences of productive talk and more elaborative, cognitively deep questions, particularly related to the practices of science. We discuss the potential implications for developing complementary sets of texts to optimise students’ science learning and link elements of genre to students’ reading and discussion experiences.

The current public health system is underresourced and understaffed, which has been exacerbated by the coronavirus pandemic. In addition, there has been a decline in the public health workforce at both state and local levels during the last decade. While workforce numbers dwindle, public health systems have to address increasingly complex challenges-such as climate change, chronic diseases, and health equity-challenges that require skilled, adaptive leaders. This article describes the importance of leadership development and how 3 public health training centers (PHTCs) are building leadership skills in the public health workforce.To address the need for public health leadership training, the PHTCs in the Healthamp; Human Services (HHS) Regions 4, 7, and 10 all offer public health leadership institutes (PHLIs).The 3 PHLIs discussed in this article vary in longevity (3-18 years), cohort length (8-12 months), and format (virtual, in-person, and hybrid); yet, all 3 emphasize adaptive leadership through a health equity lens and intentional opportunities to apply skills in practice.Each PHLI conducts extensive evaluation based on Kirkpatrick's levels of evaluation and collects common metrics collected by all PHTCs. Data from the PHLIs illustrate high levels of satisfaction with learning, presentation of data, identification of workplace actions, and improvement of subject matter understanding. Each PHLI also has numerous stories of impact.With public health leaders leaving the workforce and the complexities of practice increasing, leadership training is critical to the current workforce and succession planning. These PHTCs provide a significant, enduring resource toward the development of our nation's public health leaders, as well as meeting the unique needs of their regions' workforces.

In this article, we reflect as a group on our experiences working on a mental health crisis line as members of the psychological workforce. These reflections came from supervisions, team meetings and informal, day to day conversations between practitioners.

Abstract. Background: Social disconnection is associated with all-cause mortality and suicide. Measures of social disconnection with reliable cut-off scores are needed to aid in the assessment of clinically significant change. Aims: The current study sought to identify reliable clinical cut-off scores for the 15-item Interpersonal Needs Questionnaire (INQ-15), which assesses two indices of social disconnection associated with suicide ideation – thwarted belonging (TB) and perceived burden (PB) on others. Methods: The INQ-15 and measures of suicide ideation were administered to psychiatric outpatients ( Nsample1 = 493; Nsample2 = 213) and psychiatric inpatients ( Nsample3 = 79; Nsample4 = 87). Results: Reliable cut-off scores discriminating between the presence and absence of suicide ideation were identified across samples (TB ≥ 36 for psychiatric outpatients and ≥ 32 for inpatients; PB ≥ 12 for both psychiatric outpatients and inpatients). Limitations: Data are cross-sectional; thus, conclusions cannot be made about the predictive utility of INQ scores for future suicide ideation, attempts, or death. Conclusions: The INQ-15 yields scores with reliable cut-off scores for both TB and PB that represent clinically significant levels of social disconnection. These cut-off scores can be used in treatment trials and clinical practice to assess clinical improvement (or decline) in belonging and perceived burden.

The 2021 "PH WINS for All" pilot sought to address a rural research gap by including small local health departments in the Public Health Workforce Interests and Needs Survey (PH WINS) for the first time. To do so, the de Beaumont Foundation partnered with the Public Health Training Centers in Health and Human Services Regions V and X. This article describes the collaborative efforts that made the PH WINS for All pilot successful, presents respondent demographics by agency size, and discusses the importance of gathering such data to address the unique needs of the workforce in small local health departments.

IntroductionMotor neuron disease (MND) and frontotemporal dementia (FTD) comprise a neurodegenerative disease spectrum. Genetic testing and counselling is complex in MND/FTD owing to incomplete penetrance, variable phenotype and variants of uncertain significance. Affected patients and unaffected relatives are commonly referred to clinical genetics to consider genetic testing. However, no consensus exists regarding how such genetic testing should best be undertaken and on which patients.ObjectiveWe sought to ascertain UK clinical genetics testing practice in MND/FTD referrals, with the aim of helping inform guideline development.MethodsMND/FTD clinical genetics referrals comprising both affected patients and unaffected relatives between 2012 and 2016 were identified and a standardised proforma used to collate data from clinical records.Results301 referrals (70 affected, 231 unaffected) were reviewed across 10 genetics centres. Previously identified familial variants were known in 107 cases and 58% subsequently underwent testing (8 of 8 diagnostic and 54 of 99 predictive). The median number of genetic counselling appointments was 2 for diagnostic and 4 for predictive testing. Importantly, application of current UK Genomic Test Directory eligibility criteria would not have resulted in detection of all pathogenic variants observed in this cohort.ConclusionWe propose pragmatic MND/FTD genetic testing guidelines based on appropriate genetic counselling.

Introduction The Covid-19 pandemic triggered unprecedented nationwide regulations aimed primarily at slowing the spread of the virus. The objective of this study was to describe the effect of these regulations on the number and severity of trauma presentations to a regional emergency department in Kwa-Zulu Natal. Methods A retrospective cohort study of the triage register at Edendale Hospital Emergency Department was conducted, comparing all trauma presentations in the month of April 2020 with those from the preceding two years. The number of patients, mechanism of trauma and severity of illness were recorded and compared. Results A 47% reduction in the number of trauma cases was recorded for April 2020. The proportion of severe cases did not change. The categories showing a major decrease were motor vehicle accidents, pedestrian vehicle accidents, assault and gunshot wounds. The incidence of dog bite wounds and burns remained unchanged. Conclusion This study shows that the burden of trauma presenting to the emergency department was decreased in the month of April 2020 by the regulations implemented in response to the Covid-19 pandemic., Highlights • The study was conducted in a low-middle income setting in Africa. • The results may be compared with other African settings where similar measures are implemented. • The reduction of trauma and interpersonal violence is an important agenda in multiple African areas.

Context Identifying training gaps in public health competencies and skills is a first step in developing priorities for advancing the workforce. Objective Our purpose was to identify training gaps in competencies and skills among local, state, and nonjurisdictional public health employees in Washington State. Our secondary aim was to determine whether training gaps differed by employees' work-related and demographic characteristics. Design We used data from our training needs assessment of the public health workforce, conducted as an online cross-sectional survey in Spring/Summer of 2016. Respondents and setting Employees from governmental local, state, and nonjurisdictional public health departments in Washington State. Main outcome measures Training gaps were calculated for 8 public health competencies and 8 skills, using a composite score of respondents' ratings of their "training confidence" and "training need." For each domain and skill area, we calculated the percentage of associated items, where respondents rated their training needs as high and their confidence as low to create scores ranging from 0% to 100%. Results The largest training gaps in public health competencies were in the Financial Planning and Policy Development domains. For skills, Quality Improvement and Developing Effective Communication Campaigns had the largest training gaps. In adjusted models, female employees or employees working in local health departments in select Washington State regions had higher training gaps in Financial Planning, Policy Development, and Quality Improvement, relative to male or state health department employees. Employees who worked in specialized programs, such as Communicable Disease Control, and Maternal, Child, and Family Health, had higher training gaps in Financial Planning and Developing Effective Communication Campaigns than those who worked in Administrative and Support Services. Conclusions We identified important training gaps in several competency domains and skills. Findings are informing decisions about tailoring training opportunities for public health practitioners in Washington and other states.

This article describes the development and evaluation of an online workplace stress reduction toolkit for use by managers of 9-1-1 emergency communication centers (ECCs). A three-step process for development and testing of digital learning resources was used: (1) establishing need and focus through ECC manager stakeholder engagement, (2) pretesting of the toolkit with the target ECC manager audience, and (3) toolkit utilization and evaluation. The toolkit was developed in close partnership with stakeholders throughout the entire process. Toolkit usage was documented via registration data. The evaluation utilized an online survey that included closed and open-ended questions, which were analyzed using descriptive statistics and qualitative thematic analysis. Over a 20-month period, 274 people registered for the toolkit and, of those, 184 (67%) accessed the content. Respondents to the evaluation survey ( N = 156) scored the toolkit highly on satisfaction, self-efficacy, and perceived utility measures. Survey respondents reported intent to apply toolkit content through the following: providing organizational resources to help workers take better care of themselves (41%); creating a lower stress worksite environment (35%) and sharing resources with staff to (1) reduce stress (19%), (2) support conflict resolution (21%), and (3) prevent and/or stop bullying (17%). In delivering actionable content to ECC managers, the toolkit shows promise in addressing and mitigating occupational stress in ECCs. Further research needs to determine the relationship of this strategy for reducing ECC stress.

Efficiently evaluating industrial activities plays an essential role in determining the extent to which human–ecosystem interactions may lead to species loss, disrupted community dynamics, ...

Background Cancer treatment can be complex; and coordination of cancer care across different treatments and health settings is essential to high quality health care. Objective The aim of this study was to determine the location and scope of practice of health professionals involved in cancer care coordination in Victoria, Australia. Methods The study design was cross-sectional. An online survey was disseminated through 14 peak organisations for oncology health professionals to individuals whose work involved coordinating the care of cancer patients. Findings Analysis was conducted on a sample of 91 survey respondents. Only 26.4% (n=24) reported a job title of Cancer Care Coordinator. Overall, 67.0% (n=61) reported they were specifically funded to coordinate the care of cancer patients and 30.8% (n=28) devoted all their time to this role. The majority worked in public health services (n=73, 80.2%) and 37.4% (n=34) were located in rural areas. Compared with their metropolitan counterparts, rural coordinators were more likely to be funded by philanthropy (p=0.002); work part-time (p=0.017); and work with patients in the community (p In 37.4% (n=34) of cases patients were required to have a particular type of cancer to receive care coordination. Positions funded by philanthropy were more likely to have this requirement (p=0.002). Conclusion Health professionals undertaking cancer care coordination are diverse and the service offered differs according to location and funding source. There may be inequities in care, with people living in particular areas, attending particular health services or with certain tumour types more likely to receive cancer care coordination.

From Marx’s famous dictum that religion is “the opium of the people” to Weber’s recognition of the dignity reaped by the “religiously musical,” disagreement about both the prosocial and deleterious—even violent—effects of religious beliefs and practices has been a long discussion in social theory. The social scientific literature shows that religion is shaped by social structures—including economic and political structures—and also that, as an integral element of many cultures, it can shape those same structures in turn. This article discusses the dialectical relationship between religion and social structures to consider when and how religion has the capacity to alleviate poverty and where it might figure in inequality’s endurance or exacerbation. The range of the empirical cases considered here not only suggests the power of religion to address poverty, but also and importantly, the ways in which religion can be co-opted in sustaining the status quo for poor and politically subjugated groups. Taking a global view in case selection, this article shows that although differences in these processes do exist based on global location, there are many similarities that cross national and religious lines.

Supplemental Digital Content is Available in the Text., Objectives: To improve access to quality online training materials developed from 2010 to 2015 by 14 Preparedness and Emergency Response Learning Centers (PERLCs) by creating quality standards and enhancing searchability through a new Web-based public health training catalog. Methods: The PERLC-developed training materials (n = 530) were evaluated for their capability to support development of preparedness competencies as established by 2 evidence-based competency frameworks. Inclusion/exclusion criteria and evaluation guidelines regarding training quality (design, technology, and instructional components) were systematically applied to PERLC products to create a training catalog. Twenty emergency preparedness professionals pilot tested content and provided feedback to improve catalog design and function. Results: Seventy-eight percent of PERLC resources (n = 413) met our quality standards for inclusion in the catalog's searchable database: 358 self-paced courses, 55 informational briefs, and other materials. Twenty-one training bundles were curated. Discussion: We established quality guidelines, identified strengths and weaknesses in PERLC resources, and improved accessibility to trainings. Guidelines established by this work can be generalized to trainings outside the preparedness domain. Enhancing access to quality training resources can serve as a valuable tool for increasing emergency preparedness competence.

BACKGROUND Online information resources and support have been demonstrated to positively influence the well-being of people diagnosed with cancer. This has been explored in past literature for more common cancers; however, for rare cancers, such as neuroendocrine tumors (NETs), there are little to no support or resources available. Despite relatively good prognoses, the quality of life (QoL) of patients with NETs is significantly lower compared with samples of mixed cancer patients and the general population. Patients with NETs also typically report unclear and difficult pathways of disease management and treatment, given the heterogeneity of the diagnosis. There is a vital need to improve the availability of disease-specific information for this patient group and provide supportive care that is tailored to the unique needs of the NET patient population. OBJECTIVE This study described the protocol of a study aimed to better understand the outcomes and experiences of patients diagnosed with NETs and to develop and pilot test a nurse-led online and phone-based intervention that will provide tailored supportive care targeted to NET subgroups (functioning vs nonfunctioning). METHODS This is a multisite cohort with 3 phases, incorporating both quantitative and qualitative data collection. Phase 1 is a mixed methods prospective cohort study of NET patients identifying differences in patient experiences and priority of needs between NET subgroups. Phase 2 utilizes results from phase 1 to develop an online and nurse-led phone-based intervention. Phase 3 is to pilot test and evaluate the intervention’s acceptability, appropriateness, and feasibility. RESULTS Currently, the project is progressing through phase 1 and has completed recruitment. A total of 138 participants have been recruited to the study. To date, patient-reported outcome data from 123 participants at baseline and 87 participants at 6-month follow-up have been collected. Of these, qualitative data from semistructured interviews from 35 participants have also been obtained. Phase 2 and phase 3 of the project are yet to be completed. CONCLUSIONS Limited research for patients with NETs suggests that QoL and patient experiences are significantly impaired compared with the general population. Furthermore, past research has failed to delineate how the clinical variability between those with functioning and nonfunctioning NETs impacts patient supportive care needs. This study will improve on the availability of disease-specific information as well as informing the design of a nurse-led online and phone-based supportive care intervention tailored for the unique needs of the NET patient population. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/14361

Background Online information resources and support have been demonstrated to positively influence the well-being of people diagnosed with cancer. This has been explored in past literature for more common cancers; however, for rare cancers, such as neuroendocrine tumors (NETs), there are little to no support or resources available. Despite relatively good prognoses, the quality of life (QoL) of patients with NETs is significantly lower compared with samples of mixed cancer patients and the general population. Patients with NETs also typically report unclear and difficult pathways of disease management and treatment, given the heterogeneity of the diagnosis. There is a vital need to improve the availability of disease-specific information for this patient group and provide supportive care that is tailored to the unique needs of the NET patient population. Objective This study described the protocol of a study aimed to better understand the outcomes and experiences of patients diagnosed with NETs and to develop and pilot test a nurse-led online and phone-based intervention that will provide tailored supportive care targeted to NET subgroups (functioning vs nonfunctioning). Methods This is a multisite cohort with 3 phases, incorporating both quantitative and qualitative data collection. Phase 1 is a mixed methods prospective cohort study of NET patients identifying differences in patient experiences and priority of needs between NET subgroups. Phase 2 utilizes results from phase 1 to develop an online and nurse-led phone-based intervention. Phase 3 is to pilot test and evaluate the intervention’s acceptability, appropriateness, and feasibility. Results Currently, the project is progressing through phase 1 and has completed recruitment. A total of 138 participants have been recruited to the study. To date, patient-reported outcome data from 123 participants at baseline and 87 participants at 6-month follow-up have been collected. Of these, qualitative data from semistructured interviews from 35 participants have also been obtained. Phase 2 and phase 3 of the project are yet to be completed. Conclusions Limited research for patients with NETs suggests that QoL and patient experiences are significantly impaired compared with the general population. Furthermore, past research has failed to delineate how the clinical variability between those with functioning and nonfunctioning NETs impacts patient supportive care needs. This study will improve on the availability of disease-specific information as well as informing the design of a nurse-led online and phone-based supportive care intervention tailored for the unique needs of the NET patient population. International Registered Report Identifier (IRRID) DERR1-10.2196/14361

Recent findings of mosaicism (DNA sequence variation) challenge the dogma that each person has a stable genetic constitution. Copy number variations, point mutations and chromosome abnormalities in normal or diseased tissues have been described. We studied normal skin mosaicism of a single nucleotide polymorphism (SNP) [rs1426654, p.Thr111Ala] in SLC24A5, an ion transporter gene. This SNP is unusual in that more than 90% of people of European descent have homozygous germline A/A alleles, while more than 90% of East Asians and Blacks have homozygous germline G/G alleles. We found mosaicism in neonatal foreskins as well as in 69% of nearly 600 skin surface scraping samples from 114 donors of different ages. Strikingly, donors with germline (buccal or blood) A/A, A/G or G/G genotypes had all three sequences (A/A, A/G or G/G) in the skin surface scrapings. SNP sequence differences extended within the epidermis in the vertical dimension from basal cell layer to the stratum corneum at the surface, as well as across the two-dimensions of the skin surface. Furthermore, repeated scrapings in the same location revealed variation in the sequences in the same individuals over time, adding a fourth dimension to this variation. We then used this mosaicism to track the movement of epidermal cells during normal differentiation and characterize the patterning of epidermal cells during terminal differentiation. In this coordinated proliferation model of epidermal differentiation, the skin surface is alternatively populated by synchronous, cycling of waves of cells, with each group having a different DNA sequence. These groups of cells abruptly flatten into large sheets at the surface providing patches of uniform SNP sequence. This four-dimensional mosaicism is a normal, previously unrecognized form of dynamic mosaicism in human skin.

Since the sixteenth century, essayists such as Michel De Montaigne have been writing life's minutiae; trying to find words to ‘portray passing … from day to day, from minute to minute’. Even in its earliest articulation the word essay expressed an intention to venture forth into unfamiliar territory. In recent years, blogs have become an avenue for previously silenced writers to publish their personal experiences and perspectives, and no more so than in the ever-growing sphere of ‘mummy bloggers’. Though the term has developed social currency, it has also begun to encompass any and all online writing by mothers and includes a spectrum of styles. This paper suggests a new reading of blogs by mothers, using essayist Vivian Gornick's framework of ‘situation’ and ‘story’. By identifying the online writing which understands ‘why one is speaking’ and ‘who is speaking’, we are able to distinguish blogs that successfully utilise creative non-fiction techniques to articulate and advocate the voice of the m...

The cabbage looper, Trichoplusia ni (Hübner) (Lepidoptera: Noctuidae), is one of the most damaging insect pests of cabbage (Brassica oleracea variety capitata) and broccoli (B. oleracea variety italica) in North America. Leaf-feeding larvae attack crucifer and vegetable crops in greenhouses and fields. Here, we have studied a synthetic feeding deterrent, 1-allyloxy-4-propoxybenzene, and a botanical deterrent, neem (an extract from seeds of Azadirachta indica A. de Jussieu (Meliaceae)), in leaf disc choice bioassays with T. ni. We tested the two deterrents and the combination, and we found that the blend exhibits synergy between the two deterrents. We also tested the deterrents in assays with whole cabbage plants in ventilated enclosures and found that 1-allyloxy-4-propoxybenzene evaporated and, therefore, in that context addition of 1-allyloxy-4-propoxybenzene to neem did not enhance deterrence against T. ni.

Gastric cancer is a major cause of cancer-related mortality worldwide and is thought to be responsible for about 10% of cancer-related deaths across the globe. A small proportion of all gastric cancers arise because of a known hereditary syndrome, the most common of which is hereditary diffuse gastric cancer (HDGC). This is an autosomal dominant genetic disease characterized by an increased risk of developing diffuse gastric cancer at a young age. The gene responsible for HDGC is CDH1, also known as E-cadherin, a germline mutation conferring an 80% risk of developing gastric cancer during the lifetime of the carrier. Females with germline CDH1 mutations face an additional risk of developing lobular breast cancer, with a reported cumulative risk of 60% by the age of 80 years. .

Population assessment techniques for soft-sediment infauna (invertebrates within the substrate) requires excavation of specimens, damaging or killing the specimen and surrounding habitat, while being time-consuming and costly. Rapid population assessments of some marine burrowing decapods have been possible by counting burrow openings to estimate abundance, and while they may be used as indicator species, these decapods are not ubiquitous to environments requiring monitoring. Additionally, the presence of other burrowing macrofauna (invertebrates living in the sediment and retained on 1 mm mesh such as clams or large worms) may reduce the efficacy of burrow openings in estimating macrofauna abundance. As such, we assessed mudflats along the north coast of British Columbia, Canada, during summer 2017 to determine if macrofauna abundances could be estimated from burrow openings on the sediment surface in regions of low (n = 1 species) and high (n = 8 species) biodiversity. Abundance could not be estimated at the low diversity sites where only one macrofaunal species created burrows. At the high diversity site, species-specific models estimating abundance from burrow openings could not be constructed; however, the total number of burrow openings observed was useful in estimating total infaunal community abundance. As such, burrow openings may not be an effective tool in assessing species-specific abundances, but may be appropriate to estimate overall community changes.

Background Colorectal cancer (CRC) is the most common cancer affecting both men and women in Australia. The illness and related treatments can cause distressing adverse effects, impact on emotional and psychological well-being, and adversely affect social, occupational, and relationship functioning. Current models of follow-up fail to address the complex needs arising after treatment completion. Strategies to better prepare and support survivors are urgently required. Objectives This study aimed to develop and pilot test an innovative supportive care program for people with potentially curative CRC. Methods The SurvivorCare intervention was developed by a multidisciplinary team using 3 key principles: (1) promote patient involvement and engagement; (2) address the specific needs of individual patients, and (3) use evidence-based strategies to promote well-being and reduce treatment sequelae. It also addressed 4 essential components of survivorship planning, defined by the US Institute of Medicine. Ten survivors completed questionnaires and satisfaction interviews before and after receiving the intervention. Results SurvivorCare comprises survivorship educational materials (booklet, DVD, and question prompt list), a tailored survivorship care plan, a tailored nurse-led end-of-treatment consultation, and 3 follow-up telephone calls. Pilot data demonstrated that survivors considered the intervention appropriate, relevant, and useful. Conclusions SurvivorCare is a well-received, comprehensive intervention that will now be evaluated in a randomized controlled trial aiming to reduce distress and unmet needs and improve quality of life in CRC survivors. Implications for practice If SurvivorCare is shown to be effective, it will be possible to quickly and broadly disseminate this model of care.

In the nineteenth century female writers were only able to conceive of and construct two types of narrative endings for their gender: heterosexual love and marriage, or death. In response to this dichotomy many feminist writers of the twentieth century attempted to construct stories that transcend the interaction and interconnection between gender, heterosexual love and narrative closure. Novels such as Jean Rhys' Wide Sargasso Sea and Margaret Atwood's Surfacing separate the concepts of the female and heterosexual love, but ultimately end in madness or paralysis. These texts, which sever the narrative from formerly conventional structures of fiction, may momentarily imagine a world devoid from the patriarchal expectation of heterosexual love yet they ultimately leave their characters with feelings of futility, confusion and resignation. This paper argues that the narrative impact of separating female protagonists from heterosexual love is the creation of a new 'madwoman in the attic'; what I term the 'eternal madwoman'. Building on Rachel DuPlessis' Writing Beyond the Ending, and the collection of writing Famous Last Words edited by Alison Booth, the paper aims to offer possible responses to Marta Caminero-Santangelo's question, 'How can the symbolic resolution of the madwoman in fictional texts contribute to the transformation of gender ideologies?' Rather than reinforcing further ruptures in the female/love narrative, Maureen Murdock's The Heroine's Journey is seen as a possible framework for a more hopeful narrative world where descent and ascent and, in turn, the concepts of love and the female can be reunited.

This article presents a comprehensive review and synthesis of empirical and conceptually based literature documenting the impact of chemotherapy-induced menopause on the sexual functioning of women with breast cancer. A literature search of the CINAHL, MEDLINE, and Psych Lit from 1980 to 1999 databases was undertaken. This literature was systematically assessed to determine key findings and conclusions. Two major themes were identified and are reported here: physical and psychological sequelae associated with altered sexual functioning. Recommendations and suggestions for further directions in research are identified.

Relationships among cognitive and motivational factors in predicting medical help-seeking for Alzheimer's disease (AD) symptoms were tested.Community residents awaiting jury service (N = 280) completed questionnaires, including responses to a vignette depicting prototypical early symptoms of AD in a hypothetical mother. Cognitive responses to the vignette included AD symptom identification and AD attribution. Affective-motivational responses to vignettes were symptom impact and behavior appraisals. General knowledge of AD was assessed. Intention to seek medical help was the dependent variable.The impact and identification of AD symptoms, appraisals of risk, and attribution of the scenario to AD were modest, yet all contributed to prediction of medical-help-seeking intentions. The best fitting model had distinct but interrelated cognitive and motivational paths explaining 49% of the variability in medical help-seeking. Motivational variables had particularly important direct and indirect effects on help-seeking.Findings are interpreted as evidence of the importance of motivational as well as cognitive aspects of perceptions of illness behavior in another person. The substantial impact of the tested variables on the desired outcome of medical help-seeking may suggest options for public health efforts to enhance early medical help-seeking for AD that sets the stage for early intervention.

Increasing numbers of people survive cancer beyond diagnosis and treatment. Many survivors have ongoing needs and they may encounter fragmented, poorly coordinated follow up care. Survivorship care plans (SCP) have been promoted as a key aspect of survivorship care. This study aimed to survey key stakeholders in the care of people with colorectal cancer (survivors, primary care providers and hospital-based healthcare professionals) regarding follow-up and SCP. In study 1, cancer survivors completed a questionnaire regarding their follow-up and experiences during survivorship. Participants’ primary care physicians completed a phone interview regarding proposed SCP elements. A subgroup of survivors reviewed a sample SCP and participated in a phone interview regarding this. In study 2, healthcare professionals working with colorectal cancer patients completed a questionnaire regarding follow-up and proposed elements of a SCP. Twenty survivors completed the questionnaire, 14 primary care providers completed a phone interview and 12 survivors reviewed the sample SCP. Ninety-five healthcare professionals (30 medical professionals and 65 nurses) completed the questionnaire. There was strong support for core elements of the SCP. Additionally, nurses and survivors expressed support for supportive care and psychosocial elements. There was lack of consensus regarding who should prepare and discuss the SCP. There is strong support for the development and use of SCPs for bowel cancer survivors. There is some variation in opinion regarding ideal content of the SCP, who might prepare it, and how it might be discussed and utilised. Overcoming identified barriers to implementing SCPs for bowel cancer survivors is necessary for high quality cancer care.