Persons with advanced cancer and their relatives experience physical, emotional, and psychosocial consequences of the illness. Most of the time, they must deal with these themselves. While peer self-management support programs may be helpful, there is little evidence on their value for this population. We present the research protocol of our SMART study that will evaluate the effectiveness of the “Living with Cancer” peer self-management support program, aimed at improving self-management behaviors, self-efficacy, and health-related quality of life of persons with advanced cancer and their relatives.We will conduct a non-randomized stepped wedge study in the Netherlands. We will include 130 persons with advanced cancer and 32 relatives. Participants can choose to either start the program within 4 weeks after inclusion or after eight to 10 weeks. The “Living with Cancer” is a peer self-management support program, based on the Chronic Disease Self-Management Program. It consists of six 1,5 hours video-conferencing group meetings with eight to 12 participants, preceded by two or three preparatory audio clips with supportive text per session. The program has the following core components: the learning of self-management skills , discussing relevant themes , and sharing experiences, knowledge, and best practices. The primary outcome for both persons with advanced cancer and relatives is self-management behavior assessed by the subscale “constructive attitudes and approaches” of the Health Education Impact Questionnaire. Secondary outcomes are other self-management behaviors, self-efficacy, health-related quality of life, symptoms, depression and anxiety, and loneliness. Participants complete an online questionnaire at baseline, and after eight and 16 weeks. After each session, they complete a logbook about their experiences. Group meetings will be video recorded.SMART aims to evaluate an innovative program building on an evidence-based self-management program. New features are its use for persons with advanced cancer, the inclusion of relatives, and the video-conferencing format for this population. The use of both quantitative and qualitative analyses will provide valuable insight into the effectiveness and value of this program.NL9806.This study was registered in the Dutch Trial Register on October 2021, identifier The online version contains supplementary material available at 10.1186/s12904-022-00994-5. In recent years, there has been a shift towards participatory healthcare , 2. PersSelf-management is about how a person with a long term condition deals with medical, role, and emotional issues . A key fOne way to support self-management and enhance self-efficacy is through peer support and modeling. This is the support of persons who share their experiential knowledge, and/or emotional, social or practical support to others in similar conditions . Peer suAfter examining several programs, we identified the Chronic Disease Self-Management Program (CDSMP), developed in the USA by Lorig et al. , as amonIn this article, we present the research protocol of our SMART study to evaluate the “Living with Cancer” program for persons with advanced cancer and their relatives. We used The Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) to describe relevant aspects of the study . See AddThe overall aim of this study is to assess the effectiveness of the program on self-management behaviors, self-efficacy and health-related quality of life of persons with advanced cancer, and explore its effectiveness in a smaller group of relatives. Moreover, through qualitative analyses, we will study the experiences of both groups with the program.N = 10), healthcare professionals (N = 5) and researchers in palliative care (N = 8). A pilot study was conducted to evaluate the initial acceptability and feasibility of the “Living with Cancer” program. In this pilot, 12 participants  completed the program and an online questionnaire  and listening activities (e.g. relaxation). The facilitators support participants in selecting challenges on which they would like to work, but do not suggest activities , and encourage them in completing their self-selected goals . For detFacilitators are peers and are persons with stable (advanced) cancer, cancer survivors, relatives of persons with cancer or bereaved relatives of patients who died at least 6 months before the facilitators’ training. Peer facilitators are trained to follow a structured protocol with standardized scripts, to ensure consistency of delivery and content of the program. This requires a 24-hour online training distributed over 6 weeks, in which they participate in the program and learn how to facilitate it. Two certified master trainers provide the training, consisting of content delivery, adherence to timing and sequence of themes, coverage of the activities as set out in the protocol, and dealing with sensitivities and specific complex situations. Peer facilitators are instructed that they are not allowed to give medical advice. To ensure the quality of the meetings and adequate delivery of the content, fidelity will be checked with the CDSMP fidelity checklist by a selection of the recorded meetings.We will conduct a non-randomized stepped wedge study . ParticiPatients and relatives can participate together in the study, in the same or separate groups, as preferred. Patients can also participate without a relative and vice versa. Relatives can be partners, parents, children and other significant others such as close friends or neighbors.Inclusion and exclusion criteria are described in Table www.smart-onderzoek.nl [Participants will be recruited in two ways: via participating hospitals  and via self-referral. Self-referral has been described to increase ecological validity, facilitate greater equity of access to psycho-oncology research, and facilitate faster implementation of effective interventions into clinical practice . The sturzoek.nl . PersonsParticipants will receive the participant information sheet and oral information. They will be given adequate time (at least 1 week) to read and consider participation. Written consent will be obtained without any coercion of participants.Questionnaire study. All participants will fill in an online questionnaire at three moments: right after inclusion (baseline), after 8 weeks and after 16 weeks. Completion of a questionnaire will take approximately 20 minutes. A written questionnaire can be provided if preferred. We will use both validated and self-constructed questionnaires ? How was the group experience? Which exercises were useful? Participants will be asked to document their action plans.Recorded video-conferencing sessions. The group meetings will be video recorded with the consent of the participants.In the SMART study, we will take the following measurements:To show an effect size of at least 0.5 SD on the HEIQ scale “constructive attitudes and approaches” , with a We will use the online survey tool Lime Survey  to send We will follow the intention-to-treat principle for the analyses of the primary and secondary outcomes. Descriptive statistics will be used to summarize patient characteristics .For the patient outcomes, we will use linear mixed models with a random intercept to adjust for repeated measures over time. As fixed effects, we will include time points of measurement  and a variable denoting when the participant received the program at each time point (early versus late starters). To adjust for possible confounding, we additionally will add age, sex, ethnicity, Social Economic Status, cancer type and time since diagnosis as fixed effects to the model.Furthermore, we will assess whether there is a dose-response relationship between the number of sessions of the program and outcome. We will perform a similar analysis as for the main effect, but include the number of sessions instead of the intervention group.The quantitative data analyses for relatives will be conducted in a similar way but it will have an explorative nature due to its expected lower number of participants.A complementary qualitative study will be carried out to explore the lived experiences of participants with the “Living with Cancer” program. Data concern the recordings of the video-conferencing groups and participants’ logbooks. We will conduct inductive, thematic content analyses , 55 descSelf-management for persons with advanced cancer and their relatives is multifaceted due to multilayered consequences and the uncertainties they face. To our knowledge, there is a lack of research into peer self-management support for this population.The SMART study aims to fill this gap in knowledge. We will evaluate a self-management program to support persons with advanced cancer and their relatives. The program has been built on the CDSMP, an evidenced-based peer self-management support program for persons with chronic conditions , 13. NewPeer support for persons with advanced cancer and their relatives has rarely been researched . AlthougOur SMART study has several risks. The study population and the program contain several factors that cannot be fully controlled. Firstly, there will be a considerable risk of drop out, either partly (some meetings) or completely, to disease progression or treatment burden of our vulnerable population . To miniAdditional file 1.Additional file 2.Additional file 3.


Accumulating evidence has demonstrated that carbohydrate response element binding protein (CHREBP) has a crucial function in tumor pathology. In this study, we found CHREBP downregulation in gastric cancer (GC) tissues, and CHREBP was determined to be an independent diagnostic marker of GC. The downregulation of CHREBP promoted cell proliferation and inhibited apoptosis. Moreover, the level of cyclin D1 was significantly correlated with CHREBP expression in GC and paracancerous normal samples. In addition, CHREBP transcriptionally inhibited cyclin D1 expression in GC cells. Tumor suppressor activity of CHREBP could be affected by the upregulation of cyclin D1. In summary, CHREBP was found to be an independent diagnostic marker of GC and to influence GC growth and apoptosis via targeting the cyclin D1-Rb-E2F1 pathway. GC is the fifth most common malignant tumor and the third leading cause of cancer-associated deaths worldwide . In 2020CHREBP, a transcription factor that is affiliated with the Mondo family , was firCyclin D1 functions as a pivotal regulatory protein,which switches from G1 to S phase in cell cycle progression [gression . To dategression  and havegression –16. Uncogression . HoweverFor current study, a low expression of CHREBP was detected in GC cells, and the regulation of CHREBP expression was found to influence both the proliferation and anti-apoptosis capabilities of cells. In particular, CHREBP was found to transcriptionally inhibit cyclin D1 expression in GC cells, and we identified a novel signaling pathway, the CHREBP-cyclin D1-Rb-E2F1 pathway, which critically regulates GC proliferation. Altogether, these results indicate that CHREBP could be a promising prognostic marker of GC.P = 0.004), nerve invasion (P = 0.013), and TNM stage (P = 0.005)  Fig. , Table 1P = 0.032) and DFS (P = 0.036) (Supplementary Table P = 0.0114) and DFS (P = 0.0130)  but not with DFS. In the whole, these results demonstrate that CHREBP might function as an independent diagnostic marker for GC.Univariate analysis of 60 fresh-frozen GC tissues indicated that a lower CHREBP expression was relevant to a shorter OS (30) Fig. . The res30) Fig. . AdditioTo select the cell lines for subsequent assays, initial detection of CHREBP expression in GC cell lines by both qRT–PCR and WB Fig. , outcomeWe attempted to assess the role of CHREBP in vitro. As shown in Fig. The results of flow cytometry revealed that in contrast with the control group, CHREBP knockdown markedly facilitated GC progression via the G1/S phase shift. Furthermore, CHREBP knockdown significantly inhibited apoptosis comparing with the control group. Conversely, CHREBP overexpression increased the ratio of cells in G0 and G1 phases while reduced the ratio in S phase and promoted apoptosis Fig. . These fTo explore CHREBP characteristics in vivo, a BALB/c nude mouse xenograft model of GC was established. SGC-7901/vector and SGC-7901-overexpressing (OE) cell suspensions were subcutaneously injected into male nude mice. As depicted in Fig. We changed the level of CHREBP in cells, and noticed that both the mRNA and protein levels of cyclin D1 were elevated when the level of CHREBP was downregulated in AGS cells; and vice versa the opposite trend was observed in SGC-7901 cells Fig. . FurtherTo understand CHREBP role in the cyclin D1-mediated proliferative phenotype, enforced CHREBP expression in SGC-7901 cells was co-transfected with cyclin D1. As shown in Figure To further clarify the correlation between the levels of CHREBP and cyclin D1 in the same GC cases, we detected the levels of CHREBP and cyclin D1 in the same GC specimens, and it was found that cyclin D1 expression was mostly higher in the GC than in the control group Fig. . FurtherCollectively, the results showed that there was a negative interrelation between cyclin D1 and CHREBP expression of GC cells. As depicted in Fig. In the present study, a novel transcription factor, CHREBP, was assessed to determine its role in GC, and it was revealed that CHREBP suppresses GC progression by promoting cell apoptosis and inhibiting the cell cycle, thereby affecting tumor proliferation, and that it could serve as a significant prognostic biomarker. A reduction in CHREBP expression was found to upregulate the level of cyclin D1 through direct binding to its promoters, which ultimately led to the proposal of a novel signaling pathway that regulates GC proliferation: CHREBP/cyclin D1/Rb/E2F1.Evidence is now accruing to confirm the significant function of CHREBP in tumor pathology and tumorigenesis . CHREBP For our study, CHREBP was found to act as a tumor suppressor. It was indicated that CHREBP expression was markedly decreased in GC samples according to the data obtained from the Oncomine database. Furthermore, the qRT–PCR outcomes indicated decreased CHREBP expression mainly in GC samples versus normal para-carcinoma samples. In addition, the results of IHC analysis of 54 cancerous and noncancerous tissues were consistent with those of qRT–PCR. CHREBP expression was also negatively significantly correlated with shorter OS and DFS in the survival analyses. Furthermore, in vitro experiments confirmed that the downregulation of CHREBP promoted the growth of GC cells and that the overexpression of CHREBP exerted inhibitory effects, which could be further proven by an in vivo tumor xenograft assay.Mechanistically, CHIP-seq analysis of CHREBP gene binding in mouse liver and HepG2 cells indicates that the role of CHREBP in tumorigenesis has augmented from metabolic reprogramming to cell cycle control , 24. TheCells have developed detection mechanisms to ensure DNA replication and chromosome allocation during the cell cycle that have been preserved over long-term evolution, which are typically called checkpoints or restriction points. There are three checkpoints of cell cycle, namely, G1/S phase, G2/M phase, and spindle assembly checkpoint . Cyclin Transcription factor activity could be transformed through a variety of direct mechanisms, which were demonstrated in multiple cancer types, chromosomal translocations, gene amplification or deletion, point mutations, and altered expression included , 32. As CHIP assay manifested that CHREBP direct bound to the cyclin D1 promoter, and dual-luciferase reporter assay strongly proved that CHREBP knockdown might enhance cyclin D1 promoter activity and transcriptionally upregulate the level of cyclin D1, which could be participated in carcinogenic mechanism underlying CHREBP-induced tumorigenesis. We still found that CHREBP knockdown immensely upregulated mRNA levels of cyclin D1, E2F1, and Ki-67 while negatively regulating the mRNA level of Rb. However, CHREBP overexpression led to the opposite results. Altogether, these results confirmed that the CHREBP/cyclin D1 axis could regulate GC progression via the Rb/E2F1 pathway, the activation of which has been elaborated to promote G1/S transition and enhance tumor cells proliferation .To sum up, our study indicated that CHREBP could be an vital tumor suppressor gene for GC, as its expression level was significantly decreased in GC cells. A reduction in CHREBP expression contributed to GC growth in vitro and in vivo by transcriptionally upregulating cyclin D1 expression. An increased cyclin D1 expression further inactivated the tumor suppressor gene Rb and released the transcription factor E2F1. Importantly, we not only confirmed that CHREBP could be a valuable prognostic marker for GC but also revealed the significance of the CHREBP/cyclin D1/Rb/E2F1 pathway in GC development, which might assist clinicians in more effectively treating GC patients.From February 2015 to October 2017, a total of 60 specimens were gained from GC patients undergoing radical gastrectomy at Shanghai General Hospital  and stably reserved at −80 °C for subsequent RNA assay. A total of 57 wax specimens from GC patients who underwent radical surgery were collected from March 2013 to January 2014. After a series of immunohistochemical procedures, 57 cases of GC and para-cancerous formalin-fixed paraffin-embedded blocks were reviewed and diagnosed by two pathologists (with more than 10 years of experience), after which 3 pairs of non-mucosal wax blocks were excluded. Finally, 54 paired GC samples were identified for inclusion and subjected to tissue microarrays (TMAs). The subject was with approval of the Ethics Committee of the Shanghai General Hospital. Seven human GC cell lines were adopted at follow-up investigation: HGC-27, MKN-28, MKN-45, MGC-803, BGC-823, AGS, and SGC-7901. All cell lines were obtained from the Cell Center of the Chinese Academy of Sciences , which were cultured by RPMI-1640 medium  added in 10% fetal bovine serum , 1% penicillin and streptomycin  included, as previously described .Full-length CHREBP was synthesized to generate CHREBP-overexpressing lentiviral vectors (pLVX-CHREBP) to evaluate its role in GC progression. ShCHREBPs lentiviral vectors was employed for CHREBP knockdown . The targeted sequences for particular shRNAs (shCHREBP#1–3) were synthesize indicated below: Sh-CHREBP-1: 5′- GGCGCATCTACTACAAGAA-3′; Sh-CHREBP-2: 5′-GGCCTGGTATATCCAGTAT-3′; and Sh-CHREBP-3: 5′-CAAGCCTGGATGACTTCAT-3′. In addition, lentivirus was transfected into AGS and SGC‑7901 cells, and Lipofectamine 2000  was adopted to conduct plasmid DNA transfection in accordance with the manufacturer’s protocols. Five microliters plasmid to be transfected was aspirated, and 5 microliters transfection reagent was added to 250 µl Opti-MEM medium  without serum and antibiotic. The solution was mixed gently and incubated for 20 min at room temperature prior to transfection. Cells were harvested 48 h after transfection for subsequent analysis, as previously described .Cells were harvested, fixed, and then stained with 0.5 mL of propidium iodide/RNase staining buffer  in the dark for half an hour. A flow cytometer  was used to analyze the percentages of the respective parts of the cells. GC cells at the logarithmic growth stage were taken and digested by trypsin into a single-cell suspension. After suction and purification, 10 μL of 7-AAD and 5 μL of Annexin V-PE  were added to each tube successively. Then, the cell suspension was gently mixed, followed by incubation for 15–30 min without light. Cell apoptosis rate was calculated as previously specified .6 cells/100 μl) to establish a tumor xenograft animal model. Tumor volumes were measured once a week following the formula: volume = (length × width2)/2 [BALB/c nude mice were injected with SGC-7901 cells (5 × 10idth2)/2 . All mic-ΔΔCt method. The primer sequences for qRT–PCR were summarized in Supplementary Table Total RNA from GC samples was extracted using TRIzol  methods, then reverse transcribed into cDNA using the isolated RNA (500 ng). Then, qRT–PCR was conducted adopting the SYBR Premix Ex Taq kit  with cDNA acting as the amplified template. Gene expression was analyzed by the 2Total protein extraction was performed with RIPA lysis supplemented with 1% PMSF , then protein quantification was determined by the BCA kit  method. Proteins were electrophoresed into a 10% SDS–PAGE gel  and then transferred into a PVDF membrane , which was blocked in 5% nonfat milk  and afterwards incubated with the corresponding antibodies. The list of antibodies used was presented in Supplementary Table 6-well plates were seeded with 1000 cells/well lasting 2 weeks to conduct colony formation. Then, they were washed, fixed, stained, afterwards the colonies were calculated and analyzed. Cell counting kit-8 (CCK-8) assay was proceeded as previously noted . In the Samples were fixed, sectioned and incubated with antibodies. The CHREBP  and cyclin D1  intensity proportions were categorized indicated below: 0–10% (0 points), 10–25% (1 points), 25-50% (2 points), 50-75% (3 points), and >75% (4 points). Staining intensity scores were evaluated as following: 0 points for no staining, 1 point for blue, 2 points for brown, and 3 points for dark brown. Final score was multiplying results between the staining intensity and proportion. In this experiment, 0–3 points were judged as negative, 4–7 points were judged as weakly positive, and 8–12 points were judged as strongly positive.#NB400-135, Novus Biologicals, Germany) and anti-cyclin D1  antibodies at 4 °C for 24 h. Samples were then blocked, washed, and incubated with a FITC-conjugated goat anti-rabbit or Cy3-conjugated goat anti-mouse IgG antibody . In addition, DAPI  was employed to stain cell nuclei for 3 min. TCS SP8 confocal microscope  was utilized to microscopically analyze cells.AGS and SGC-7901 cells were cultured on a confocal laser dish, which were then washed, fixed, permeabilized. Afterwards it was incubated with anti-CHREBP  was transfected with pCHREBP or the control vector into the target cells. Cyclin D1 promoter activity was normalized to Renilla luciferase reporter, which acted as internal reference in accordance with the manufacturer’s protocols for the Dual Luciferase Assay Kit . The luciferase activity results were assessed by a spectrophotometer . The ratio of firefly luciferase/Renilla activity was conducted to calculate CHREBP impact on the luciferase reporter.6) stably transfected with CHREBP or vector were well cultured for ChIP via ChIP assay kit  in accordance with the manufacturer’s instructions. Then, 270 µl of formaldehyde  was directly added to a petri dish containing 10 ml of medium for histone and DNA crosslinking at an ultimate concentration of 1% and incubated for 10 min at 37 °C. After crosslinking, cells were resuspended in 200 µL of SDS lysis buffer  and incubated on ice for 10 min to quench reaction. Then, the cells were lysed and disrupted by sonication on ice until the DNA was sheared into fragments between 200 and 1000 base pairs in size. The sonicated samples were added to Protein A/G Agarose beads before incubation with 2 μg anti-CHREBP overnight at 4 °C for antigen-antibody binding. The final DNA fragments containing the cyclin D1 promoter were amplified using PCR with the primers 5′- ATTCTGCCGGCTTGGATATGGG-3′ (forward) and 5′- TTTCTCCCCGCCAGGGAGA-3′ (reverse).SGC-7901 cells  and disease-free survival (DFS) were plotted via the Kaplan–Meier method and the log-rank test, respectively. P-value less than 0.05 was considered statistically significant.The data were analyzed by SPSS 25.0 software . Student’s SUPPLEMENTAL MATERIALOriginal Data FileFigure S1Figure S2


There is increasing recognition of the wicked nature of the intertwined climate, biodiversity and economic crises, and the need for adaptive, multi-scale approaches to understanding the complexity of both the problems and potential responses. Most science underpinning policy responses to sustainability issues, however, remains overtly apolitical and focussed on technical innovation; at odds with a critical body of literatures insisting on the recognition of systemic problem framing when supporting policy processes. This paper documents the experience of implementing a mixed method approach called quantitative story-telling (QST) to policy analysis that explicitly recognises this normative dimension, as the methodology is part of a post-normal science (PNS) toolkit. The authors reflect on what was learnt when considering how QST fared as a tool for science–policy interaction, working with European Union (EU) level policy actors interested in sustainable agriculture and sustainable development goal 2. These goals—also known as UN Agenda 2030—are the latest institutionalisation of the pursuit of sustainable development and the EU has positioned itself as taking a lead in its implementation. Thus, the paper illustrates our experience of using PNS as an approach to science policy interfaces in a strategic policy context; and illustrates how the challenges identified in the science–policy literature are amplified when working across multiple policy domains and taking a complex systems approach. Our discussion on lessons learnt may be of interest to researchers seeking to work with policy-makers on complex sustainability issues. The publication of the UN 2030 agenda and its 17 sustainable development goals (SDGs) renewed rhetorical commitment to sustainability. The Agenda and SDGs promote shared responsibility between the global North and South; and the involvement of societal actors from the public, private and civic domains  is suggested for when the "facts [are] uncertain, values in dispute, stakes high and decisions urgent"  and Legitimacy (CRELE)   focal ‘story’. The first QST cycle 2017–18) focussed on “CAP aims to ensure European agricultural competitiveness in the world market and aims to deliver public goods, such as biodiversity conservation, water quality, and climate change mitigation. These aims are in opposition.” This focal story responded to the proposed revision of Common Agricultural Policy (CAP) objectives and pressure to integrate agricultural policy with delivery of climate and environmental objectives  positioned itself in terms of how the CAP was becoming enrolled in delivery of the Sustainable Development Goals. The focus for the second cycle was “Sustainable agriculture is an important societal goal: it helps to support environmental policies as well as being a key component of SDG2. The European Commission claim CAP enables sustainable agriculture, supports environment policies, such as WFD and N2K, and supports progress to the SDGs. However, agricultural externalities harm European progress to achieve its sustainability goals both within and beyond Europe”. At the time of the second QST cycle, the EU’s SDG implementation had been criticised for being too focussed on encouraging development in non-EU States and neglecting its internal unsustainable trends .Decide what to represent in societal metabolism analysis: This stage develops a more specific shared understanding of what will be analysed and how to make the issues identified in stage 1 amenable to societal metabolism  accounting. This stage moves progressively from deciding higher-level priorities , towards decisions on the specific aspects of systems that have to be represented that will shape the quantitative analysis .Compile data and carry out societal metabolism accounting: This stage sees the formalisation of the systems relevant to the themes identified in stage 1. The accounting framework is populated with quantitative data to become a quantified  representation of the system. The first cycle used a societal metabolism approach focussed on associations between different Farm Accounting Data Network (FADN) indicators, whereas the second cycle used the full Multi-Scale Integrated Analysis of Societal and Ecosystem Metabolism (MuSIASEM) accounting methodology  and viability (within socio-economic limits) and desirability  of the system as it is represented by the quantified data.Discuss interpretations and implications: This stage sees the deliberative interpretation of the outputs of the QST analysis with policy actors. It is both a process of ‘closing the loop’ and the shaping of any further cycles—either with new stories or with alternative cases.The cycle explains the sequence of methodological steps undertaken to derive the results presented below. The aim is to complete the QST cycle in transdisciplinary teams to generate meaningful outputs that stimulate deliberations about the implications of these metrics for tackling sustainability challenges  to fill in the gaps from our policy review of the EU implementation of SDGs during May 2019. Field notes from attending the Commission’s Green Week 2019 were also used for context. Three different workshops were held in November 2019, January 2020 and June 2020 . The first workshop was held in Brussels, at Scotland House, a venue independent from the official EU institutions, attended by fifteen participants from DG Devco, DG Clima, DG Agri, DG Research, EASME and a think tank. As with the first cycle, the one and a half hour workshop summarised the purpose of the research, the methodology and the findings. The second workshop was a ‘parliamentary breakfast’ hosted by a member of European Parliament, attended by twelve participants from the Commission and Parliament. The third workshop was a webinar with eight participants from the European Environment Agency and associated topic centre researchers. The second and third workshops used the same structure as the first workshop.In both cycles, the last QST stage was designed to ask the policy actors to share their knowledge and expertise both during workshops and afterwards privately through feedback forms. A workshop report was provided to the participants with an invitation to follow up any points of interest with the MAGIC scientific team. To improve our understanding of how QST was experienced by the non-MAGIC participants, a colleague not involved in the workshops undertook four feedback interviews with participants from the Commission and agencies during April–June 2020.The nature of the QST process means data were collected from a self-selecting sample of those motivated to engage with PNS and QST. Researchers also attempted to engage with people from other relevant Commission agencies, but were either unable to, as in the case of DG Sante, or had limited success, in the case of DG Env. Therefore, the results must be interpreted within these caveats. The interviews were recorded and transcribed. In all workshops, full field notes were taken by a dedicated researcher. The experience of the MAGIC science team was captured through internal meeting notes and research memos. The research received authorisation from the James Hutton Institute Research Ethics Committee.The transcripts, field notes, meeting notes and feedback form data were managed using the qualitative research database NVIVO 12 and labelled with case attributes to allow analysis by type of actor, policy domain and different settings (workshop or interview). Initial thematic coding illustrated what was learnt in the QST process for technical reporting  in terms of identifying themes relevant to identified actors. It was more important to invest in the last stage of the cycle than perfect the first stage.Decide what to represent in societal metabolism analysis: This stage proved very important for the shared learning within the MAGIC researchers. We used the Eurostat Farm Accountancy Data Network (FADN) as the best dataset on which to base a pan-EU farm systems sustainability assessment but generated constraints regarding what data were available, at what resolution and decomposition by scale or sector  and socio-economic pressures (viability), but desirability remained a product of deliberation reserved for stage 5. The environmental pressures were converted to spatial impacts in the second QST cycle. The main challenge for QST was considering which metrics to represent visually for deliberation in stage 5  and perhaps generated expectations of a traditional ‘show and tell’ scientific presentation. The presentations asked about the political and bureaucratic configurations that block or enable transformation. In the second phase, we provided our own view of the implications before asking workshop participants whether they agreed with us. However, very little of the subsequent discussion addressed these questions. Provision of feedback forms, to enable people to express views privately also did not generate much insight. Even when discussing the results with environmental policy actors, most of the discussion was regarding the technicalities of societal metabolism and comparisons with lifecycle analysis. The innovation of ‘feedback’ interviews was extremely useful to get insights into how the policy actors experienced QST and we would recommend this as an important part of the QST cycle. This stage was both a way to close the QST cycle, but also the springboard for further QST cycles.Here we (the authors) set out the aspects that generated the most reflection about the practice of undertaking QST, discussed according to each stage of QST  were used in both QST cycles. The metrics were presented by standard farm types (based on the European Farm Accountancy Data Network typology). The metrics addressed environmental pressures  on soil, water quality, pollinators and water quantity and GHG emissions in the first cycle; and this was extended in the second cycle—for example, differentiating green and blue water. In the first cycle, metrics across EU28 were also produced for viability aspects, such as farm productivity, net farm income ; and in the second cycle, more information, such as reliance on family labour and seasonal labour, was generated. The second cycle introduced data on nutritional demand and dietary choices. Central to societal metabolism analyses is the production of both extents  and intensity . In both cycles, visualisations were used to illustrate data in both extents and intensities, often on the same figure .Multi-scale analysis was presented in both QST cycles. In the first cycle, environmental and social data were presented by member state and NUTS2 regions and by different farm type; and intensity metrics presented by hectare, hour or euro. In the first cycle, change over time was indicated, but the second phase tended to produce static data for a single year. In both cycles, EU commodity imports and exports were explored; with the second phase introducing the dependence of EU agricultural commodities on imported materials and labour, illustrating the difficulties of reducing inputs from beyond the EU.Multiple policy domains were involved in both cycles, with participants from different DGs  or to broaden the focus. The former would have allowed further iterations. It may have been more relevant to one or two actors, but it diverted the focus away from a systemic approach to sustainability into a specific aspect on production steps. Instead, we chose to extend the QST to look more explicitly at how CAP was enrolled in delivering of the UN SDGs, through coherence with other policies  methodology, quantitative story-telling, with EU policy actors. Each QST cycle covered issue framing, running societal metabolism analyses, selecting and presenting metrics and deliberating over what the metrics mean for policy actors , we propose the QST cycle as a useful framework for PNS SPIs. Although challenging to implement, QST is rare in balancing multiple perspectives on problem framing with deliberation over integrated, holistic and cross-scale quantitative assessment of current situations. Explicit attention to problem framing before seeking solutions is fundamental to a PNS and deep sustainability. Potentially, the challenging the problem framing of current policies could be combined with other solution- or future-orientated SPI approaches that are more attractive to policy actors.As existing SPI literature highlights, QST should be guided by a policy entrepreneur and seek inputs from a diverse ‘transdisciplinary team’. Users should expect to expend significant time on decisions around selecting and visualising metrics, combined with additional time to reflect on the effects of these decisions. Using QST requires not only a strong academic team with multiple scientific specialisms but also wider transdisciplinary skills, such as relationship maintenance, political sensitivity, determination, and confidence.However, using QST also has implications for non-academic members of QST transdisciplinary teams Stokols . QST is We offer this paper as a contribution to the growing body of literature that reflects honestly on implementing SPIs in practice. We document what has been learnt when using a PNS approach at a pan-EU scale. Our observations add to those from other QST research (Cabello et al.


M = 16.46, SD = 0.78) from one team playing in a competitive hockey league. The players participated in six leadership intervention workshops over the course of the season, and completed inventories measuring athlete leadership behaviours, cohesion, and collective efficacy pre-and post-intervention. In addition, a focus group was conducted to assess the impact of the athlete leadership development program at the end of the season. Bayesian t tests showed that the leadership program generally helped to maintain levels of athlete leadership behaviours, cohesion, and collective efficacy pre-and post-intervention. The results of the focus group following the intervention revealed the players believed the leadership development program helped buffer against the negative effects of their on-ice performances.The purpose of the current study was to implement and evaluate an athlete leadership development program in youth boys ice hockey. The sample consisted of 14 male U17 hockey players ( The importance of leadership in sport is well documented e.g., . In factAthlete leadership is defined as “an athlete occupying a formal or informal role within a team who influences team members to achieve a common goal” , p. 144.While Second, cohesion was selected for the current study given its positive association to athlete leadership behaviours. For example, In addition to cohesion, the other group dynamics variable targeted in the current study is collective efficacy. With athlete leadership behaviours related to both cohesion and collective efficacy, it would be helpful to have a conceptual model that highlights these relationships. Frameworks used to study athlete leadership have largely been based on organizational psychology and sport coaching research. Two of the most widely used theoretical models are The FRML proposes that effective leaders utilize a wide variety of behaviours including transformational leadership behaviours . AccordiResearch focusing on athlete leadership development programs is limited. Currently, most athlete leadership development research has been conducted among two demographic groups, youth and intercollegiate athletes. Among the few studies focusing on youth athlete leadership development, Although these studies highlight the benefits of conducting athlete leadership development programs, limitations remain. Primarily, M = 16.46, SD = 0.78) and had been playing hockey for an average of 10.79 years (SD = 2.04). The regular season for this team started in September and concluded in March. The team ended their season with a record of 3–26-5 , collecting 11 points out of a possible total of 68 points for a 16.18% winning percentage.Participants in the current study were 14 male U17 ice hockey players from one Southwestern Ontario team playing in a competitive hockey league. In Canada, U17 is the second highest level of minor youth hockey. Players in the present study ranged in age from 15 to 17 years (never to (5) always with higher scores reflecting higher occurrences of the leadership behaviours. Athlete leadership behaviours were assessed using two questionnaires. The first questionnaire was the Leadership Scale for Sports LSS;  consistinot at all to (5) all the time.The second questionnaire used to measure athlete leadership behaviours was the Differentiated Transformational Leadership Inventory DTLI; . The DTLstrongly disagree to (9) strongly agree, with higher scores reflecting greater perceptions of cohesion. Confirmatory factor analyses provided support for the factorial validity of the YSEQ with an acceptable model fit: CFI = 0.90 and SRMR = 0.07  extremely confident, with higher values representing a greater rating of the team’s confidence in their ability to successfully achieve a goal. A CFA revealed a good model fit: CFI = 0.92, NNFI = 0.90, SRMR = 0.04, and RMSEA = 0.09  and post-intervention . At baseline, athletes were asked to read and sign a consent to participate in research form. Pre-intervention questionnaires were administered measuring demographics, athlete leadership behaviours , cohesion , and collective efficacy . Following baseline testing, athletes participated in six leadership development workshops, approximately every 3 weeks, over the course of the season. The baseline data collection occurred at the end of October and post-intervention data were collected at the end of January. Each workshop lasted approximately 45–60 min. One week following the final workshops, participants completed all of the questionnaires post-intervention. One month following post-intervention data collection, a focus-group interview was conducted to evaluate the impact of the athlete leadership development program.The six workshops were based on As for the delivery of the workshops, we utilized an educational approach recommended by t tests were carried out to determine the impact of the intervention.The data were screened for missing values, outliers, skewness, and kurtosis. The data were deemed to be normally distributed, therefore no transformations to the data were necessary. To determine whether there were differences in leadership behaviours, cohesion, and collective efficacy from pre-to post-intervention, a series of Bayesian paired-samples p values, Bayes factors provide a more accurate estimate of the evidence present in the data available  that the difference is larger than zero. Additionally, a Bayes factor of BF0+ quantifies evidence for the null hypothesis (H0) relative to the one-sided alternative hypothesis that the difference is larger than zero. According to Bayesian analyses were conducted using the JASP software . The resFollowing the end of the intervention, an email was sent to all participants asking if they wanted to participate in a focus group. The four athletes who responded were members of the team’s leadership group consisting of one captain and three assistant captains. The purpose of this focus group was to allow participants to reflect on their season and qualitatively evaluate the effectiveness of the athlete leadership development program. Athletes were able to provide a detailed account of their personal opinions and perceptions concerning the leadership program and its effect on individual players and the team as a whole.The qualitative aspect of this study was conducted using a constructivist philosophical position, focusing on understanding the meanings people create for themselves and attribute to their experiences . The undTo better understand the various idiosyncrasies concerning people’s experiences, the constructivist viewpoint assumes a subjectivist and transactional epistemological position . That isThe data were examined using hierarchical content analysis, allowing for the identification and description of patterns in the data . SpecifiAn interview guide, composed of four sections, was developed for this stuy and is available upon request. The interview guide consisted of questions designed to create discussion around the team’s performance throughout the season, athlete’s impressions of the leadership development program, the content of the responses, and concluding questions that allowed participants to provide recommendations on how to improve the athlete leadership development program. The focus group was audio recorded and transcribed verbatim.Means, standard deviations, and internal consistencies for the leadership behaviours, cohesion, and collective efficacy are presented in 1), the Bayesian paired samples t tests indicated weak evidence for training and instruction (BF+0 = 0.12), democratic behaviour (BF+0 = 0.11), social support (BF+0 = 0.55), appropriate role model (BF+0 = 0.34), inspirational motivation (BF+0 = 0.61), high performance expectation (BF+0 = 0.31), intellectual stimulation (BF+0 = 0.72), and individual consideration (BF+0 = 0.27). Additionally, substantial evidence was found for positive feedback (BF+0 = 3.18) and acceptance of group goals (BF+0 = 3.00).When quantifying evidence in favour of the alternative hypothesis (H0), the Bayesian paired samples t tests indicated weak evidence for positive feedback (BF0+ = 0.32) and fostering acceptance of group goals (BF0+ = 0.34). However, the results indicated anecdotal evidence for social support (BF0+ = 1.82), inspirational motivation (BF0+ = 1.66), and intellectual stimulation (BF0+ = 1.39). Finally, the results indicated substantial evidence for training and instruction (BF0+ = 8.06), democratic behaviour (BF0+ = 4.27), appropriate role model (BF0+ = 3.00), high performance expectation (BF0+ = 3.25), and individual consideration (BF0+ = 3.68).When quantifying evidence in favour of the null hypothesis (H1), the Bayesian paired samples t tests indicated weak evidence for both task cohesion (BF+0 = 0.09) and social cohesion (BF+0 = 0.15). When quantifying evidence in favour of the null hypothesis (H0), the Bayesian paired samples t tests indicated substantial evidence for social cohesion (BF0+ = 6.48) and strong evidence for task cohesion (BF0+ = 10.65).When quantifying evidence in favour of the alternative hypothesis (H1), the Bayesian paired samples t tests indicated weak evidence for ability (BF+0 = 0.42), persistence (BF+0 = 0.50), preparation (BF+0 = 0.52), and unity (BF+0 = 0.34), and anecdotal evidence for effort (BF+0 = 2.00). When quantifying evidence in favour of the null hypothesis (H0), the Bayesian paired samples t tests indicated weak evidence for effort (BF0+ = 0.50), anecdotal evidence for ability (BF0+ = 2.34), persistence (BF0+ = 2.00), and preparation (BF0+ = 1.93), and substantial evidence for unity (BF0+ = 3.00).When quantifying evidence in favour of the alternative hypothesis .Furthermore, the athlete leadership development program was useful in maintaining the team’s cohesiveness despite having a lack of team success. As HP2 noted:The leadership program gave us the mindset that hockey is a team sport and while losing is difficult, the program put it into perspective that you have to stick together win or lose. Our win-loss record definitely does not imply that we had a good season, but we bonded as a team, we got closer and this was important since we had a lot of new players this year on the team.Despite not having a successful season, the participants discussed how the leadership behaviors they learned during the workshops impacted the way the team played. In particular, the participants noted that the team played in a tournament following the season and credited the way the team performed well to what they learned throughout the workshops. Specifically, the players mentioned being more cohesive, which influenced their performance.The team benefited from it [the leadership program] because right after the season, we had a tournament and we won most of our games, we only lost one game. We got a lot of goals but the leadership program inspired everyone to work together and be on the same page (HP3).The players mentioned how the athlete leadership development program helped them deal with their frustrations  by teaching them to communicate more effectively with one another. As one participant noted, “We were talking to each other more, people were actually stepping up and saying what they had to say” (HP4). The enhanced communication was particularly useful in dealing with conflicts that occurred throughout the season.When conflict arose, instead of yelling and getting mad at each other, we just told ourselves let us settle down, talk it out, and find a good solution that benefits both sides and let us get back in the game and focus (HP3).The participants noted how the athlete leadership development program taught them about the importance of sharing the leadership responsibilities among team members. As one player noted,I learned that you do not have to have a “C” or an “A” on your jersey to be a leader. Anyone can step up. As well, you do not have to necessarily be a verbal leader, you can lead by example (HP2).The participants also expressed how their own leadership behaviours impacted their teammates, “The athlete leadership development program taught you how to make everyone around you a leader as well and teach everyone else how to lead the team” (HP3).The participants revealed some of benefits of the athlete leadership development program. Specifically, the participants discussed learning how to motivate their teammates and taking their teammates’ opinion into consideration when making decisions. One player noted,The athlete leadership development program taught me how to motivate my teammates, get them to be on the same page, be more open minded. It also taught me how to take other people’s opinion and work it in with my own ideas and form one single plan that would work for everyone (HP1).The participants also discussed how the leadership program was useful outside of hockey. The players noted that they transferred the knowledge gained from this program to other aspects of their life.I used what I learned here and brought it to the classroom. For instance, at school one thing we have to do is to help younger students with their studies. So, I definitely used these skills and transferred them over to different aspects of my life. (HP2).t tests indicated weak to anecdotal evidence. That is, the athlete leadership development program did not positively impact the measured constructs pre-to post-intervention. However, when quantifying evidence in favour of the null hypothesis of no change, the results indicated that the program maintained the level of athlete leadership behaviours, cohesion, and collective efficacy throughout the season. These findings are corroborated in the focus group interview which showed that the athlete leadership development program was beneficial in helping the players maintain their leadership behaviours, along with perceptions of cohesion and collective efficacy. Further benefits from the focus group interview included better communication amongst team members and dealing with conflict more effectively.The purpose of the current study was to implement and evaluate an athlete leadership development program targeting the enhancement of athlete leadership behaviours, cohesion, and collective efficacy with male youth hockey players from one team. It was hypothesized that the athlete leadership development program would positively impact athlete leadership behaviours, cohesion, and collective efficacy. The results partially support this hypothesis. When quantifying evidence in favour of the alternative hypothesis, the results of the Bayesian paired-samples cancers , collecting 11 points out of a possible total of 68 points for a 16.18% winning percentage. When we started delivering our athlete leadership development program with this team, we did not know that their on-ice performance was going to be poor as the season progressed. Very little research has examined the impact of losing within the context of sport teams. However, as cancers . As for cancers . We beliThe quantitative results indicated the participants did not increase their use of athlete leadership behaviours following the athlete leadership development program, as measured using the LSS  and the In fact, the findings of the focus group interview helped shed light on the usefulness of the intervention on the development of various leadership behaviours. The participants mentioned learning how to step up and take action, regardless of whether they fulfilled a formal leadership role . Additionally, participants mentioned learning how to communicate more effectively with teammates, remain positive in face of conflict, share the leadership roles, and the importance of staying cohesive. This is consistent with previous athlete leadership development research where participants in M = 6.46) in the current study was similar to the level of task cohesion in previous research utilizing the YSEQ . In contrast, the mean score for social cohesion in the current study (M = 6.97) was higher than in other studies . As such, it appears that the athletes in the current study were already a fairly cohesive team at baseline. It is possible that a comparable effect to Senécal and colleagues occurred in the present study given the results of Bayesian t tests when quantifying evidence in favour of the null hypothesis of no change. However, it is difficult to ascertain this without the presence of a control condition.Similar to the athlete leadership behaviours, cohesion levels also were maintained from pre-to post-intervention. This result is similar to the findings of The results of the current study are impressive when you consider the losing record of the team. Meta-analyses examining cohesion  have fouConflict and communication were two unique results from the focus group interview pertaining to the benefits of having participated in the athlete leadership development program. Athletes noted their poor on-ice performances created moments of conflict amongst the team. However, the participants mentioned that the leadership development program provided them with the skills to communicate more effectively, allowing them to constructively deal with conflict by finding solutions that benefited all team members. According to Additionally, participants mentioned utilizing the skills they learned during the leadership development program outside of the sporting context. The findings of the current study are consistent with previous research exploring life skill development and transfer among wrestlers , where sThe current study is not without limitations. First, the small sample size may have impacted the statistical power. Studies with low statistical power have a reduced ability to detect a true effect . TherefoTaken together, the results from the current study provide researchers, coaches, and mental performance consultants with preliminary evidence highlighting the importance of an athlete leadership development program as a method of maintaining levels of athlete leadership behaviours, cohesion, and collective efficacy throughout the season. Specifically, is appears that the athlete leadership development program can potentially act as a buffer against the negative effects of poor performance. Hopefully, this study will lead to further examination into the benefits of developing athlete leadership behaviours, cohesion, and collective efficacy. Finally, it is hoped that the information presented in this study will encourage coaches and mental performance consultants to implement an athlete leadership development program with their teams.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by University of Windsor Research Ethics Board. Written informed consent from the participants’ legal guardian/next of kin was not required to participate in this study in accordance with the national legislation and the institutional requirements.MB implemented the athlete leadership development program, analyzed the data, and wrote the first draft of the manuscript. TL and KM-C contributed to the development of the athlete leadership development program, assisted in analyzing the data, and writing/editing subsequent drafts of the manuscript. All authors contributed to the article and approved the submitted version.This research was supported by the Social Sciences and Humanities Research Council (SSHRC) Insight Grant program (grant no. 435-2020-0526).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Spontaneous aneurysms are rare in the pediatric age group. Aneurysms of peripheral arteries are even rarer. The diagnosis should not be missed to prevent distal limb ischemia and life-threatening complications. Hence, timely surgery to save the affected limb is advised. There is an increasing number of reported cases of such aneurysms in the English scientific literature. We present a rare case of pediatric idiopathic popliteal artery aneurysm (PAA), with no known risk factors. This scientific writing is unique in its way of reporting an idiopathic aneurysm with spontaneous onset. However, we have successfully investigated and managed the patient considering the established guidelines on aneurysmal surgery. An aneurysm is defined as an irreversible, focal dilatation in the arterial wall, with the largest diameter of more than 50% of the normal. The normal diameter of the popliteal artery varies from 0.7 to 1.1 cm in a living human being. The mean age at presentation of popliteal aneurysms is 65 years, with males having a 20 times greater rate of incidence as compared to females .Various risk factors are attributable to PAAs, which include modifiable risk factors such as smoking, atherosclerosis, and connective tissue disorders including Marfan syndrome and Ehlers-Danlos syndrome. Advanced age, male gender, white race, and a family history of an aneurysmal disease are non-modifiable risk factors . The etiThe clinical signs and symptoms of PAAs include pain or discomfort behind the knee, localized swelling behind the knee, knee pain, leg pain, and a sense of pulsation behind the knee . ComplicThe management of PAAs includes conservative measures and operative intervention. All asymptomatic and symptomatic cases with a diameter of more than 2 cm require operative intervention to reduce the risk of limb ischemia and related complications . VariousThis case report highlights the fact that pediatric popliteal aneurysms can present without a history of trauma or established risk factors, and hence, clinicians need to consider spontaneous PAAs when making the differential diagnoses of popliteal fossa swellings in children. There are insufficient data available on pediatric PAAs, and we found only four cases of idiopathic, spontaneous, thrombosed, and true popliteal artery aneurysms in the pediatric population in the English scientific literature.An eight-year-old male presented in November 2021 at Doctors Hospital & Medical Center, Lahore, with an active complaint of dull pain behind the left knee. He had a history of swelling behind the left knee for the past three months. The patient and his parents denied any history of trauma to his knee. On examination, the swelling was located in the upper part of the left popliteal fossa, 4 × 3 cm in size, spherical in shape, soft in consistency, having an expansile pulsation, fluctuant, compressible, and non-illuminant on the translucency test. It was not adherent to the overlying skin. There was no wound, sinus, or any kind of discoloration of the overlying skin. The left-sided knee was fixed in a semi-flexed posture during the entire examination. The left calf and foot were cold to touch. Left-sided dorsalis pedis and posterior tibial pulses were absent. The power of the left ankle dorsiflexor and plantar flexor muscles was 3/5. The contralateral limb was normal in all these aspects, with intact neurovascular status.The differential diagnoses of popliteal swelling in the pediatric population under consideration were popliteal artery aneurysm, popliteal vein varix, ganglion cyst, para-meniscal cyst, and hematoma. The left knee X-ray  showed normal anatomy. However, the expansile pulsation strongly suggested a swelling of vascular origin; therefore, CT angiography was ordered. It revealed an isolated, thrombosed left popliteal artery aneurysm at the superior angle of the popliteal fossa, as shown in Figure This case report presents a unique case of idiopathic, isolated, thrombosed, spontaneous, true aneurysm of the popliteal artery in a healthy eight-year-old male. The various risk factors for nontraumatic, spontaneous popliteal artery aneurysm, except for the male gender, such as smoking, connective tissue disorders, family history of aneurysm, and advanced age, were absent in our case . On metiThrombosed, spontaneous aneurysms should be considered a differential diagnosis in all cases of acute peripheral swellings, with no known risk factors. The open method of PAA resection with a venous graft interposition is the method of choice in cases of acute limb ischemia to save the limb. We emphasize the practice of detailed clinical examination and the opted surgical technique, as, in this case, the adequate clinical examination helped in deciding the preferred imaging modality. There are insufficient guidelines regarding the management of pediatric aneurysms. However, their treatment in tertiary care setups is highly advisable.


The goal of the Rutgers Youth Enjoy Science Program (RUYES) is to increase the diversity of the cancer research workforce. RUYES provides hands-on mentored cancer research experience and curriculum development support to high school science teachers. RUYES also engages high school and undergraduate students from underrepresented backgrounds (URG) in mentored cancer research and professional career development activities. Rutgers Cancer Institute faculty members with active, well-funded research programs and extensive mentoring experience serve as research mentors. In addition, RUYES provides support to participants to develop innovative cancer related outreach activities to connect with families and communities of participants. Teachers and students engage in research and program related activities for a total of 12 weeks per year, for two years. Teachers engage in cancer research for eight weeks each for two consecutive summers . Collaborative partnership with Rutgers Office of STEM Educations supports teachers in developing novel instructional approaches that relate to their research experience. Students have the opportunity to conduct cancer research for ten weeks each for two consecutive summers . Students receive co-curricular and professional development support throughout their participation. In addition, teachers and students engage in post-summer program engagement for 4 and 2 weeks, respectively. We recruit program participants from all over New Jersey with special emphasis on school districts with high percentages of students from URG. This report details the components of the RUYES program, outcome evaluation plan, successes and challenges, and lessons learned for others interested in establishing similar programs at their institutions. Cancer incidence rates are estimated to rise from 1.6 million in 2010 to 29.5 million by 2040 . IndividWith 21 counties, New Jersey (NJ) is one of the most racially, ethnically and socioeconomically diverse regions in the US. The State is home to a large immigrant and minority population and disparities in education level, English language proficiency, immigrant status, income, population density, and access to cancer care. The three major cities in the State - Newark, Trenton, and Camden - have a large population of minority, low income, and immigrant residents. New Jersey has significant cancer health disparities and poor outcomes in members of culturally and racially underserved communities .Research studies show that lack of diversity in the oncology workforce contributes to inequalities in cancer care and outcomes . IncreasResearch focusing on underrepresentation of minorities in the broader biomedical workforce supports educational pipeline programs for students early on during their academic training, for increasing diversity in health professions . FurtherStudies show that teacher involvement in scientific research also benefits students . StudentThe overall goal of the Rutgers Youth Enjoy Science (RUYES) Program at Rutgers Cancer Institute is to attract and train students from URG (early on in their academic trajectory) in cancer research and healthcare careers. To achieve the goal RUYES provides a multipronged yet integrated experiential learning experience to high school science teachers and youth from URG. RUYES components include research and curriculum development activities for high school science teachers; hands-on research training and professional development activities for students from URG; and outreach to middle school students, their families and communities. Experienced leadership team with record of accomplishment in developing, implementing and evaluating pipeline programs for students from URG, supports the Program.The Program takes advantage of synergistic collaborations that leverage resources and expertise of similar programs across Rutgers and other regional institutions. Both formative and summative evaluation by an external evaluator are integral parts of the Program. Rutgers Cancer Institute, the state’s only NCI designated Comprehensive Cancer Center provides a multi-disciplinary research environment, robust educational and outreach resources for RUYES.Forty-seven high school students successfully completed the program. All of these students (100%) pursued higher education and thirty-nine (83%) of them selected STEM majors in college.Eighteen CURE alumni who participated at the high school level are pursuing biomedical careers including pharmacy, nursing, occupational therapy, pre-med and PhD in Forensic Science.Of the fifty-seven undergraduates who successfully completed the program a vast majority  pursued graduate studies in STEM including PhD, MD, MD, PhD at top-tier programs including Harvard Medical School, University of Pennsylvania, and University of Southern California etc.Thirty-five of the undergraduate alumni of the CURE program are also now in the biomedical workforce as physicians, pharmacists, and researchers.RUYES builds on and expands the scope of the highly successful Continuing Umbrella for Research Experience (CURE) pipeline program. Funded by the National Cancer Institute, Center to Reduce Cancer Health Disparities, CURE targeted highly motivated students from URG in the local New Brunswick community. CURE recruited sophomore or junior high school and undergraduate students from the New Brunswick Health Sciences Technology High School (NBHSTHS) and Rutgers, New Brunswick, respectively. Students engaged in mentored hands-on research, academic, and professional enrichment activities for full time during summer and half day per week during the academic year for two years. The first cohort of eight students (four high school and four undergraduate) recruited in 2004, completed training in 2006. From 2006 through 2019, the CURE program successfully trained 102 participants from under-represented groups in cancer research, contributing 8–9 high school and undergraduate students annually to the biomedical workforce pipeline. Summarized below are key outcomes of the CURE participants from 2004–2019.Provide broad overview of cancer as a disease to facilitate integration of students in their research experience.Provide opportunities for students to interact with each other so that they cultivate a sense of belonging and feel a part of the community of learners that supports each other.Develop partnerships with school and families of the students so they feel supported and nurtured.Be cognizant of the barriers faced by the students and help them in overcoming them.Formative and summative evaluation of the student participants and mentors in the CURE program, using biannual surveys and interviews, provided important feedback to help in designing the components of the current RUYES program. Key lessons learned included:With funding from the Recruitment from across the entire state of New Jersey (our catchment area);Recruitment of high school science teachers and students;Curriculum development support to teachers to create novel cancer focused Problem Based Learning curriculum aligned with NGSS standards;Professional development support to students;Community outreach activities by RUYES trainees for middle school students, families, and communities.Theory of Planned Behavior and Social Cognitive Career Theory provide a structural framework for the RUYES program.intention to perform the behavior determines a person’s actual behavior. An individual’s positive or negative feelings toward the behavior (motivation) influence intention. The subjective norms  about the performance of the behavior (family/peer influence); and the individual’s perception of the ease with which the behavior can be performed  influence intention. TPB addresses the limitations of the theory of reasoned action , influence the decision-making process continually. Fourth, ethnicity, gender and socio-economic status have a direct overarching influence on all factors. Last career choices (academic majors) are not static but in a dynamic flux. Elements from both the theory of planned behavior and social cognitive career theory provided a conceptual framework for RUYES program design.RUYES is open to teachers and students from New Jersey with consideration on five urban school districts including New Brunswick, Newark, Paterson, Trenton and Camden with high percentage of students from underrepresented backgrounds. While New Jersey is one of the most diverse states in the country, significant racial disparities exist among the various school districts. Urban areas including Newark, Paterson, Trenton, Camden and New Brunswick tend to enroll mostly African-American or Latino students while suburban schools have mostly white students . New JerRUYES website, brochure, flyers and recruitment emails provide the RUYES eligibility criteria, list of Research Mentors and descriptions of their research projects. Interested applicants apply through an online portal on the RUYES website, after answering a short survey to determine their eligibility. Complete application material includes demographic, academic information, Personal Statement including goals, and letters of recommendation. An Applicant Selection Committee consisting of the Program Director, program coordinators and two faculty research mentors review the applications and select applicants for acceptance. Selection is based on the applicants’ interest in conducting research, developing novel instructional approaches to take back to their school (only for teachers), and letters of recommendation. A final list of applicants who met the selection criteria is developed and sent to research mentors who have agreed to accept RUYES trainees. The mentors select 2–3 candidates who fit their research interests and meet them to discuss mutual research interests and establish compatibility. The program coordinators subsequently work with the mentors to honor their selections and match the mentor’s choices with those of participants as closely as possible.RUYES provides mentor supervised hands-on research training in basic, clinical or behavioral cancer research to high school science teachers; and high school and undergraduate students for 8 to 10 weeks respectively, in summer. During this time, participants fully engage in their research experience and work hands-on an actual research project as a member of a team on an existing project of research investigator (mentor) at Rutgers Cancer Institute. Participants have access to an exceptional group of investigators organized in multi-disciplinary research teams focusing on a broad spectrum of cancer research organized into five programmatic areas. These include: 1) Cancer Metabolism and Immunology (CMI); 2) Clinical Investigations and Precision Therapeutics (CIPT); 3) Genomic Instability and Cancer Genetics (GICG); 4) Cancer Pharmacology; and 5) Cancer Prevention and Control. They interact with a diverse group of undergraduate, graduate, postdoctoral and faculty researchers on projects related to their academic and career interests. Projects include (not limited to): Tumor Biology, Bioinformatics, Psychosocial/Behavioral aspects in oncology, Pharmacy and Population-based settings. Some examples of research projects of participants during summer of 2021 include: Qualitative Analysis of Lung Cancer Screening Implementation in New Jersey; Role of LIF (Leukemia Inhibitory Factor) in Cancer Cachexia; Immune Checkpoint Protein Expression in Pancreatic Ductal Adenocarcinoma (PDAC); Correlates and Predictors of Childhood Sun Safety: A Systematic Literature Review; Robert Wood Johnson Barnabas Health System healthcare professional survey regarding lung cancer screening and tobacco treatment practices; How Framing Impacts Social Media Engagement in Health Communication.Culturally Aware Mentor Training Workshop. The workshop helps mentors to identify their personal assumptions, biases, and privileges that may operate in their mentoring relationships. Through group discussion, case studies, and role-play, mentors have the opportunity to learn and practice culturally aware mentoring skills. The National Research Mentoring Network, which has a chapter at Rutgers, New Brunswick offers this workshop. The Center for Graduate Recruitment, Retention, and Diversity, at Rutgers University facilitates this workshop.Strong mentors are a critical part of the meaningful learning experience of the participants. Many studies have examined the role of mentoring in academic settings . Under-rTeachers participating in the program use their research experience to develop effective science instructional and learning strategies to take back to their students in their schools. Development of novel curriculum approaches is facilitated through extensive support provided by experts in cancer focused curriculum and professional development. Each year (during two years of program participation), teachers meet with expert facilitators during weekly sessions. During these sessions, they discuss key materials for creating curriculum components. Two half-day workshops in the last two weeks of summer are organized for teachers to create curricular/instructional units that align with their goals and context of their local environment. This component of the program leverages partnerships with two Rutgers departments, the Center for Mathematics, Science and Computer Education (CMSCE) and the School of Public Health (SPH). Both these departments at Rutgers bring complementary expertise. The CMSCE conducts professional development programs in the STEM field for K-12 teachers, at the Center and in-district. These professional development programs are aligned with Next Generation Science Standards. While CMSCE has expertise in developing profession development programs for teachers in the broader STEM field, SPH brings strengths in developing cancer-focused curriculum targeted to high school students.opics in Cancer Biology sessions by senior graduate students and post-doctoral fellows at the Rutgers Cancer Institute, which include (not limited to) topics such as oncogenes, tumor suppressors, apoptosis, signaling pathways in cancer. Additional support is provided through seminars held at Rutgers Cancer Institute including the Cancer Center Grand Rounds, Distinguished Lecture series, and Predoc/Postdoc Trainee seminars. Seminar attendance is followed by a 30-minute discussion on the research topic and career path of the speaker. Special lectures and professional enrichment activities organized specifically for the participants in the program include monthly journal clubs, “survival skill” presentations and career counseling by the Program Director. Teachers and students do podium presentations at the culmination of their summer research training experience at the Annual Research Day.Providing a meaningful learning experience to participants at high school and undergraduate level is crucial for the success of research training programs. If specific efforts are not undertaken there is a risk of participants becoming mere “lab-hands.” To address this need, RUYES specifically created supplemental instruction in cancer biology for the student participants. This includes TWe also believe that continuity of training experience rather than short summer experiences may be better for engaging participants for the long-term. Thus, RUYES teachers and students engage in 2–4 weeks of post-summer program activities to engage them throughout the academic year. Post-summer activities may include (not limited to), monthly check-in sessions for all participants; engagement in online Professional Learning Communities; outreach activities in first and second year of participation; preparation of posters/abstracts for presentation in local, regional and national meetings and testing and implementing curriculum developed during summer (only for teachers). RUYES program coordinators organize and track these activities.Several venues described below are used to conduct extensive outreach for recruitment, advertisement and to enhance the value of science education and research among families and communities of participants.The RUYES provides information on various program components for teachers as well as students, faculty mentors and their areas of research, online application portal and eligibility and selection criteria. The program is cross-referenced on several other Rutgers websites including those of Pre-college Summer Programs, Rutgers Office of STEM Education and CMSCE.Paper and electronic versions of the brochures and flyers detailing program components including the eligibility and selection criteria, program benefits to participants, and contact information for program staff. These flyers are mailed to all the middle and high schools and science departments of colleges and universities across New Jersey, which has 731 middle schools, 422 high schools and 48 four-year colleges and universities.We work with the 4-H Youth Programs at Rutgers to distribute flyers and brochures introducing the program to all 21 counties across Rutgers. The 4-H program has monthly county fairs for youth involvement, which serve as an excellent venue for distributing print material for program recruitment. The Office of Community Outreach and Engagement and Office of Communications at Rutgers Cancer Institute also assists in recruitment efforts by distributing flyers and information about the program at community outreach events throughout the state. In addition, we advertise the program through the network of National Science Foundation Robert Noyce Teacher Scholarship Program and Science Education and Literacy Center (SELECT) for STEM teachers at Rider University.To nurture supportive learning environments where science education and research are valued, we conduct outreach to middle school students, their families and other community members. The objective of the outreach efforts is to increase knowledge and awareness of cancer research, importance of general health and science education and biomedical, cancer research careers. Positive social contextual relationships such as parental support/encouragement positively affects an individual’s learning behavior and career choice . StudiesEach cohort of RUYES students and teachers together develop a different outreach initiative in first and second year of participation. Working together on both these events described below, benefits program participants, by engaging them with each other in teams and building a community of learners.This initiative leverages the expertise and network of the Rutgers Office of STEM Education, Science Explorer program to develop cancer relevant modules for outreach to middle schools. To maximize impact in schools and local communities, participants develop an interactive module that includes group activities while using tailored lesson plans, visual aids and age-appropriate handouts for middle school students. Rutgers Science Explorer fellows, who are usually graduate students or post-docs within the STEM disciplines with an interest in teaching and/or science communication, deliver this module together with students and teachers in the RUYES program to middle school students in their communities. Examples of modules developed during summer 2021 include those on skin cancer prevention and effects of vaping on lungs.Each cohort of students and teachers develop this outreach event during second year of their participation. The Office of Community Outreach and Engagement (COE) at Rutgers Cancer Institute supports the participants in developing and implementing this event by providing both didactic and experiential content related to the science of population health, implementation science and community outreach interventions during the weekly meetings in summer. The culminating project related to this teaching objective is an outreach event held in participant’s schools in their communities (e.g. during back to school nights or after school clubs).Ongoing evaluation and feedback of all components of the program, and the participants is crucial for providing a high-quality experience, satisfaction of the mentoring faculty, and successful continuation of the program. The evaluation is important to track fidelity and to look at implementation and outcomes. It also helps to understand which aspects of the program are successful and what we might be able to improve upon in subsequent years of the program. An experienced external (to the program) evaluator at Rutgers School of Management and Labor Relations conducts the evaluation. Rutgers IRB approved the evaluation study. Summer 2021 was first year of RUYES Program implementation. We describe below the measures, methodology and preliminary results from the evaluation.We list below evaluation questions and outcome measures aligned with the program activities and specific aims.Pre-matriculation survey- within one week of matriculating in RUYESPost-matriculation survey 1- at the end of the year 1 of participation in the programPost-matriculation survey 2 - at the end of the year 2 of participation in the programWe plan to conduct a prospective, longitudinal evaluation of individual beliefs/attitudes, social support, and intent to pursue a research career in students from URG and high school science teachers participating in RUYES program over a period of 5 years. Participants complete a pre (once) and post survey (same survey administered at two different time points) as described below. Survey instruments (Pre and Post) examine knowledge and interest in biomedical research and biomedical careers, based on the Likert-scale. The first survey tracks current interest and expectations about the program and the following surveys look at changes in interest and results of the program. Survey administration time points include:Surveys are administered electronically via Qualtrics at the time points listed above.Survey questions are drawn from validated surveys  used in published papers resulting from a prior study . ScientiPost-matriculation interview 1- at the end of the year 1 of participation in the programPost-matriculation interview 2- at the end of the year 2 of participation in the programThe evaluation methods also include interviews with study subjects. These interviews look at their experiences with the programs and their thoughts about what works and what could be improved. We also probe into their thoughts on how they will use what they have learned as they move forward in their classrooms or with their own educational experiences. Interviews are conducted by the external evaluator at 2 time points. Interview questions are based on attached interview guide used in a prior published research study  and condWe report below preliminary evaluation data collected from RUYES participants in summer 2021.Q1. Is the RUYES program effective in reaching intended target populations of teachers and underrepresented students?For both teacher and student applicants, RUYES recruitment efforts were concentrated in Camden, Essex, Hudson, Middlesex, and Passaic counties of the state of New Jersey as these areas have large urban centers and significant populations of underrepresented students. RUYES participants were selected from 166 applicants . While teachers were not required to come from underrepresented backgrounds, a diverse applicant pool was sought during recruitment outreach . Racial Fourteen individuals were selected to participate in the 2021 RUYES summer program- four high school teachers, five undergraduate students, and five high school students. Eleven of the fourteen participants come from school districts in the targeted counties .The Application Review Committee endeavored to select a diverse pool of program participants. Of the 14, seven are white; five are Spanish, Hispanic, or Latino; four are Black or African American; two are Asian; one is from more than one race; and one is from a race not listed here. As with the applicant pool, participants were encouraged to select all races and ethnicities that apply to them, and so numbers will total more than 100%. Twelve of last year’s participants were female and two were male .Q2. To what extent does RUYES program provide effective mentoring, high quality hands-on research training, and professional development support?The high school science teacher cohort was overall positive about their experiences with the program. Most teachers indicated that their expectations of the programs were met or exceeded. The high school student cohort was also positive about the program, and survey data reflected the program had a positive influence on their thinking about career choices and education. The undergraduate student group reported having a mixed experience with the program. Students indicated the pace and intensity of the program were challenging and felt the program was meant for students with more advanced skills than they possessed.“I love the lab experience. I have never had that opportunity, so now I know what our students need to succeed in college…I love that I have contacts with scientists that I can now bring into the classrooms.”Teacher 1“I honestly loved going to the lab for the first week. I even told my mentor how I loved coming there and how exciting it was.”Student 1“Prior to this program, I had never even considered research at all. It wasn’t something that I thought about. So, it has kind of opened a new door.”Student 2“One thing I would change is that Fridays are jam-packed. The week is already hectic. From Monday-Thursday, I leave at 4:30–5:00, so that’s a whole day and there is not much down time.”Teacher 1“It gets jam packed between reading. If we can get assignments earlier, it would be easier to schedule work with them and distribute our time better.”Teacher 2“I feel like there was a little either miscommunication or just poor communication, specifically with my mentor, because I think she expected me to have a lot more knowledge coming into the lab than I had.”Student 1“It is a lot of time and a lot of work. But I definitely appreciate my research team. They were really accommodating if I didn’t have enough time to do something. I was able to accomplish a lot.”Student 2“The only dislike I have is that it is very time consuming, but I guess I have to realize that comes with more responsibility and entering the workforce.”Student 3Q3. Did participation in the RUYES program contribute to advancing self-reported scientific research competencies in teachers, and science research self-efficacy beliefs in teachers and students?Being back in the lab is the best thing. I am learning new lab techniques and I can’t say enough about that” (Teacher 1).Three of the four teachers reported high impact and one teacher reported moderate impact of the contribution of RUYES on their scientific research competency. No significant changes in science research self-efficacy and science communication skills of teachers were observed because of participation in RUYES. Three of the four teachers reported high contribution of RUYES on creating NGSS aligned novel cancer focused curriculum. During further probing during focus groups teachers reported the program contributed to advancing their competencies in relevant areas of scientific research: “The high school student cohort reported an increase in confidence about science research skills from preto post- surveys. The only areas where some students remained less confident were in obtaining laboratory data and performing experimental procedures. This may be because not all students participated in lab-based projects.The undergraduate student group reported having a mixed experience with the program. Student self-efficacy beliefs in their research skills and magnitude of interest in scientific research activities declined slightly in some areas from preto post-survey results.Understand how scientific research is carried out.” Other items on the 26 item self-efficacy scale that were rated high by students included, “work with other collaboratively on a scientific project” and “think critically about scientific findings you read in the media.” During focus group interviews, students indicated program’s contribution to increased confidence:I think I got a lot more confident. In school, we’ve maybe done some things in science classes that are slightly reminiscent of the things some of us did during this summer, but I don’t think anything really compares to how in-depth and complex we were involved. I don’t think I have been ever able to immerse myself that much, so it’s definitely given me a lot more confidence.Student 1)All high school students indicated that the program had a positive influence on their career and science course-taking decisions. They all reported they will take science courses in the fall semester, including some Advanced Placement courses. After completion of the program, high school students expressed increased interest in pursuing important educational elements that can lead to a scientific career . Notably, students reported an increased interest in reading articles about science. These responses were further voiced during focus group interviews.Q5. Does participation in RUYES influence teacher’s interest in developing cancer-focused curriculum to take back to their classrooms?I hope to start my unit on cells based on cancer research. I will be giving my students a PBL [project-based lesson] on cancer.”In response to survey question, two teachers indicated they planned curricula changes based on participation in the program. One respondent said: “The best thing was learning how to write curriculum and be a part of the scientific community.”During interviews the teachers indicated that the “Preliminary evaluation of the RUYES program indicates that it is successful in providing an engaging research experience and professional development support to students as well as teachers and increases science research self-efficacy beliefs and STEM/science research career motivation and intent. The undergraduate students reported a slight decrease in self-efficacy pre and post Program participation. One explanation for this could be that first-year undergraduates are overconfident about their self-efficacy beliefs . Many participants in both the teacher and undergraduate student cohorts specifically identified Fridays as consistently being the most stressful day of the week due to the length of time they were required to be online. Going forward, we have spread out the curriculum support instructions, professional development and outreach activities in short 1–2 hour blocks spread across 3 days of the week.Research training programs such as YES benefit not only the student participants but also the institution that supports them. Through such programs, the institution provides critical outreach function to the local community; forms networking alliances with other regional and national programs; brings in additional funding to support similar programs; ensures a candidate pool of future graduate and post-graduate students and gains fresh perspective and intellectual inquiry in the laboratories. Tangible benefits of participation for the students include an opportunity to gain valuable research experience, networking and mentorship from experienced scientists and clinicians, recommendation letters for admission into medical school, graduate programs etc., financial support, opportunity to do research thesis credits etc. Thoughtful Process and Outcome evaluation of research training programs is critical for Program participants, administrators, funding agencies, policy makers and other stakeholders.