To investigate whether a formal mentoring program involving mentors from the business community could improve the quality of life (QoL) of sarcoma survivors struggling with the late effects of treatment.  Seven former sarcoma patients participated in an eight-month formal mentoring program. The program was assessed through a qualitative study involving a phenomenological approach that utilized a hermeneutical design. In-depth, semistructured interviews were conducted with the mentees after the intervention and six months later. The mentors were interviewed after the program was over. The gathered data were interpreted using a thematic analysis.  The program facilitated dialogue between the mentors and mentees as well as between the mentees. Afterwards, the mentees were more willing to accept the challenges they faced following cancer treatment. During the program, the mentees were pushed out of their comfort zone, which led to mastery and personal growth in them all. However, the program also revealed some additional challenges, including unfulfilled expectations in two mentor-mentee relationships.  The mentoring program facilitated the mentees' reorientation and enhanced their QoL. Its eight-month duration appeared important in terms of allowing the mentees to go through a long-lasting process with continued support. The program could serve as the basis for larger studies involving other cancer survivors. Sarcoma survivors, who are most commonly adolescents and young adults, frequently struggle with the late effects of treatment –3. SarcoMentoring is a well-established method for promoting personal development, and it could be a valuable approach for cancer survivors who are struggling with the late effects of treatment. The goal of mentorship is to make the mentee aware of their resources as well as to provide guidance on how to use those. Mentoring often takes the form of a relationship between a more experienced person (the mentor) and a less experienced person (the mentee). The connection between the two parties should be reciprocal, albeit asymmetrical, and it can be useful for both of them, although the primary goal of mentoring is to foster the growth and development of the mentee . The ideA number of mentoring programs in which health professionals or peers act as mentors have been studied. For instance, support programs that include former cancer patients mentoring newly diagnosed cancer patients appear to have a positive impact on the satisfaction of the mentee , 17. TheThe aim of this qualitative study was to explore whether a formal mentoring program involving mentors from the business community could facilitate the reorientation of sarcoma survivors who were struggling with the late effects of treatment and so help to improve their QoL.This qualitative study adopted a psychosocial perspective on health and illness with the aim of identifying the reasons behind the experienced phenomena, as expressed by the participants themselves. In line with the study's methodological framework as well as the research questions to be addressed, we applied an interpretative phenomenological approach to disease and illness , 19. PheThis retrospective study included 14 participants who took part in the mentoring program: seven sarcoma survivors/mentees and seven mentors. The sarcoma survivors were recruited into the program through information provided via Sarkomer's website (sarkomer.no), social media channels such as Facebook and Instagram, and brochures handed out at the OUH NRH's sarcoma outpatient clinic. All former sarcoma patients were invited to send in an application describing their challenges and motivations, in addition to any personal goals they wanted to achieve through participating in the program. Twelve applications were received. Among them, five potential participants were excluded: two who were considered to be facing significant mental challenges and so were referred back to the health-care system instead, one who experienced a recurrence of sarcoma during the selection process, and two who did not express any goals and so would probably not have benefited from the program. The selection of mentees was carried out by a social worker and a cancer nurse, both with long experience in patient guidance. Six of the seven patients had getting back to work or increase their working time as the main goal. Other goals were to gain a better social life and/or start physical activities. The clinical and epidemiological data of the seven former sarcoma patients are summarized in To recruit the mentors, we contacted various private companies. The companies were each asked to contribute €4000, half of which would help to finance the program, while the other half would be donated to a charity . In addition, the companies were each asked to provide a suitable mentor for the program. These mentors came from different backgrounds, but they shared a genuine desire to help another human being. They also believed that this program could increase their knowledge about cancer survivorship and add a new perspective of life. Four mentors were women and three men, aged between 35 and 50. Unlike a regular mentoring program, where the mentor has knowledge and skills in a given field, the mentors in this study were not expected to have any previous experience of cancer survivorship. Two mentors had nurse education, and the other had different positions in human resources, engineering, and economics.The content of different parts of this program was based on experiences from a similar program for cancer survivors in Sweden and the knowledge and experience of a social worker and a nurse. The mentoring program ran for an eight-month period from September 2017 to May 2018. It included three joint eight-hour sessions in which both the mentees and the mentors participated together with two nurses, a social worker, and an oncologist. The sessions involved lectures about sarcoma and long-term side effects with a special emphasis on fatigue, as well as crisis management. These topics were especially important for the mentors because they got an understanding on the challenges the mentees may encounter after sarcoma treatment. In addition, everyone participated in group discussions, and conversations took place between the mentees and mentors. Throughout the entire period of the program, there was individual contact between the mentees and mentors. They were told to be in contact at least once a month. The number of contacts and how they met was an agreement between each dyad, individually tailored to the need of each mentee. During their first meetings, they were asked to establish goals for the cooperation and clarify expectations to each other. The program ended with a one-week trip to Nepal during which the mentees and mentors visited, among other things, a cancer hospital for children and a home for girls who had been sexually abused. This trip was an important part of the program for the mentees to challenge their comfort zone and let them know they could manage to achieve such a long travel. The trip to Nepal was mandatory for the mentees and voluntary for the mentors, although six out of seven of the latter participated. After the program ended, the sarcoma survivors/mentees were invited to deliver a lecture at their specific mentor's workplace concerning their cancer treatment journey as well as their experience of the program. The reason for this lecture was to challenge the mentees and to give the companies an increased insight what it is like to be a sarcoma survivor. The same nurses, social worker, and oncologist that participated on the joint sessions were available to all the mentees and mentors during the meetings and throughout the entire program if they needed guidance.The participants were informed that participation in the study would not affect their oncological follow-up treatment and that they had the option to withdraw from the study at any point. The first author interviewed the mentors at their offices after the intervention was completed, while the last author interviewed the mentees twice: once after the intervention finished and then again six months later to see if any positive changes would last over time. The first interviews with the mentees were all conducted on a face-to-face basis, while the second interviews were either face-to-face or conducted by phone. The average length of the interviews was approximately 45 minutes. The interviews were conducted in accordance with a semistructured framework. They were audio recorded and then transcribed verbatim by a medical secretary.It is important to disclose that author one worked as a cancer nurse and author two worked as an oncologist, both at the sarcoma department at OUH NRH. They knew some of the participants before the program, but not the mentors. They took part in the whole mentor program, as well as the Nepal trip. Therefore, the last author, who is not a health-care provider and did not know the participants and the program, conducted both the interviews with the mentees and was responsible for the data analysis.The participants were invited to narrate their story from the point of diagnosis to the present day. In particular, they were requested to describe their life situations as sarcoma survivors prior to the intervention. They were also asked questions concerning their experiences of the mentorship program: How has your everyday life been affected by participating in the mentorship program? How would you describe your relationship with your mentor? How did you experience the trip to Nepal and how did it affect you? What do you think your future holds? , and written informed consent was obtained from all the participants.The gathered data were analyzed using a reflexive thematic analysis based on the approach of Braun and Clarke  to identThe mentoring program facilitated dialogue and the exchange of experiences between the mentors and mentees as well as between the seven mentees. We determined that this made the mentees more willing to accept the challenges they face following cancer treatment and in the life they are now living. During the program, the mentees experienced being pushed out of their comfort zone, which led to mastery and personal growth for all of them.The program also involved a number of challenges, including unfulfilled expectations, challenges in the mentor-mentee relationship, and the long distances between the parties. Both the mentors and mentees agreed that the duration of the program was important and suggested that it should be increased from eight months to one year .All the mentees reported that their extensive cancer treatment had resulted in late effects that had major impacts on their lives. As Betty put it, “I don't think I can be the way I used to be before I got sick. […] it feels kind of like I have almost completely lost my identity.” The mentees stated that participating in the mentoring program had helped them to accept that neither they nor their life would be the same as before they had cancer. They noted the particular importance of the many talks they had with the mentors and of being in a group with peers who share the same experience and understanding. The mentees' increased self-acceptance meant that they had left various challenges behind and been able to get on with their lives under the new conditions. In this context, it is important to note that the mentors helped the mentees to reverse negative and destructive thought patterns. For instance, Susan's mentor described her experience of Susan's development as follows: “We shifted our focus from concentrating on the challenges and all the negative things to seeing the opportunities.”The mentoring program demonstrated that the mentees were subject to different conditions than before their treatment, although the program also made them realize that they were just as valuable as they were before. Accepting themselves and their new situation meant that the mentees stopped making an effort to be exactly the same as prior to having cancer. This helped them to relax and let go of feelings such as shame and worthlessness. As Chris said, “But still, in fact, I can do most of what other people can do, maybe it takes me more effort, but at the same time I have some things that many other people don't have. I can see things from another angle, which other people can't.”It was difficult for many of the mentees to accept that they did not have as much energy as they did before. Several of them pushed themselves too hard, despite the fact that they had little energy. Half of the mentees were, therefore, encouraged by their mentors to accept that they could not be as active as they used to be. Furthermore, they were told that it was perfectly alright to take things easy. Helen said, “I can accept more now, including just lying down on the couch. I accept that I'm not worth less than others even though I need to rest.” The mentees also stated that they could now take breaks without experiencing a guilty conscience.Many mentees reported having often felt alone with their thoughts and feelings for many years after the end of their treatment. Being with others who faced the same everyday experiences and challenges helped to increase their understanding of what people normally experience following cancer treatment, which made them less critical of themselves. Susan stated “I think we all got the feeling that we weren't alone. […] and kind of feeling 100% normal again, that was really amazing.” Moreover, Janet said “It helped a lot to accept the situation.” Such acceptance made it easier for the mentees to be open about their situation at work and their experiences in social settings. They realized that what they had previously been ashamed of was actually a normal consequence of the treatment they had undergone. They also reported that the program had equipped them with words they could use to explain their situation to others. As Susan noted, “It's all about communication, finding good ways to explain things.” All the mentors confirmed these findings. For instance, John's mentor said “Whatever thoughts he's had, he may have felt that they were particular to him, but then, it turned out that many of his thoughts and challenges were the same as those experienced by the others.”The findings during the first round of interviews concerning the mentees' increased acceptance of who they were and the life they were now living became even more evident during the second rounds of interviews some six months later. The majority of them felt that greater self-acceptance was the most positive change they experienced as a result of the mentoring program, and they found that the change lasted long after the program ended.All the mentees reported having experienced a sense of mastery and personal growth because they had been pushed out of their comfort zone. They had previously been uncomfortable or afraid when faced with the challenges associated with participating in the program. As they had been closely followed up by their mentors and because they were part of a group of peers, they found that they were actually comfortable when outside of their comfort zone.The majority of mentees initially found it frightening to open up to a stranger. However, this feeling soon dissipated, and all the mentees felt that it was good to talk to their mentors. Janet's mentor said “We had an open dialogue, very open and honest. It was a trusting relationship from day one.” The mentees found that they were pleased to talk to a person who knew nothing about them and who was not a family member, friend, or health professional. They felt that they could talk more freely. Furthermore, it was easier to open up and talk about their challenges. Betty described her experience in the following way:“You know, it's been a […] really incredible experience to dare to have a close relationship, to open up to people you don't know, and to get that support […], to feel the effect of it, I'd never have believed it, you really have to experience it for yourself.”The mentors underlined the importance of the mentees relating their stories to someone from the outside who could see everything with new eyes. Indeed, Betty's mentor likened it to her mentee's story being front-page news again.The mentees had different challenges that they wanted to work on during the program, for example, getting a job or restarting their social life. After over a decade of cancer, Sara began her first job when she was middle-aged: “My first job [...] going to work, I felt so great. Absolutely beautiful. But still, when I face challenges, I'm simply terrified.” She commented that it was reassuring to have a mentor who supported her and gave her good advice: “Sometimes, I was really dreading something [...] so then I could call my mentor. She managed to push me and told me not to give up.” Sara reflected that her mentor's support was crucial in terms of helping her to keep her job, which was important to her sense of mastery and personal growth. John's goal was to resume his social life, which had proved challenging due to his pain and disability. He also had a poor self-image. John explained that his mentor pushed him to contact his friends and family and then followed up on it in a supportive manner. “Then, he'd check that I'd done it and that was fine because then I just had to go off and visit people.” Many mentees recognized the value of having a mentor who pushed them to make agreements and then checked on them afterwards. This meant that they followed through on performing the agreed activities more frequently and, thus, achieved the goals they had set. This was confirmed by John's mentor: “When he was pushed to make contact, it didn't take long before a friend called him and asked if he wanted to join them. That was something he described as almost unimaginable before (the mentoring program).”All the mentees challenged themselves to try new activities or to resume activities they had not engaged in for a long time. They reported still being physically active six months after completing the program. The mentees were also good at motivating each other to join in activities. For instance, two mentees started to exercise in a pair. The mentors and mentees collaborated in planning a joint relay race for a year later, despite the mentees' major physical challenges. Here, the group stood together to set a goal that they also achieved.The most challenging activity for most of the mentees, which pushed them way outside of their comfort zone, was the trip to Nepal. One participant, Betty, had actually decided in advance not to go on the trip: “I'd actually signed up for the mentoring and thought I'd drop the trip because it was scary and, well, it was just too much.” They all had various concerns before the trip. They were afraid of diseases, bacteria, pain, or being unable to complete the whole program due to fatigue. It was also challenging to spend a week with people they did not know very well. In particular, the long flight would be difficult for those with major disabilities. However, their concerns turned out to be unjustified. The trip exceeded all the mentees' expectations and they were highly satisfied. Betty described the trip as follows:“So, it was an absolutely amazing experience, and well, as I said, all about mastery. Just to travel a long way and to be able to join in with all the activities there, every single day, having enough energy for that.”The experience of mastering challenging situations boosted the mentees' confidence, and they all felt tougher and more daring after the trip. John said “But now, it's like I have an alarm clock in my head that tells me I can do much more than I think I can. I mean, if I could do that trip, well, then I can do a lot more things at home too.”The visit to the home for girls who had been victims of sexual abuse as well as the trip to the pediatric cancer ward left a strong impression on the mentees and gave them new perspectives on their own situation. Susan said “That was a trip to put things into perspective, and like so many of the others said afterwards, my God, our lives are absolutely great. We're very lucky, despite what we've been through. […] and […] this extreme realization of what the world is like and how lucky we are to be living in Norway and getting treatment here.”Most of the mentees stated that the reassurance of having their mentor with them and the support provided by the group gave them a feeling of mastery throughout the trip. During the second round of interviews, all the mentees confirmed that they were no longer afraid to venture outside of their comfort zone. Chris said “I can still feel the sense of mastery. I'm always stepping a bit outside of my comfort zone, so yes, that's a good feeling.” They found that they were tougher and capable of setting boundaries and standing up for themselves. Their self-confidence had improved, and many had set new goals for the future.Most of the mentors stated that one of the main dilemmas they faced was determining how much they could push their mentee outside of his or her comfort zone. Fatigue was an unfamiliar experience for the mentors, and they saw how it constrained the mentees' everyday lives. However, none of the mentees reported that they had been pushed too hard.All the mentees felt that it was important to have their mentor available to them throughout the program. None of the mentors found this to be a burden. Sara's mentor said “It really benefits me a lot to be used for something I'm good at, something that doesn't drain me, but something I look forward to and get something out of.”The mentors had all volunteered to take part in the program, and they received no payment for their participation. They signed up because they wanted to give something of themselves and to be part of something they considered meaningful. Janet's mentor explained “I wanted to develop an alternative perspective to my work perspective, which was pretty much focused on business and the hard side of life, so I wanted to see a different dimension and focus a bit more on people and actually be able to help someone.”The mentors felt that they had learned a lot about themselves during the program and gained new perspectives on life. As Susan's mentor pointed out, “I feel that this program has strengthened my existential preparedness. […] I'm very grateful that I've been part of this.”Mentoring was new to both the mentors and the mentees. The two groups had different expectations and thoughts regarding what they could contribute, which led to various challenges. For instance, John's initial mentor was replaced because he did not maintain regular contact with his mentee: “First I got a mentor who didn't help me at all. He never called me. I was the one who had to contact him all the time, which I didn't think that was the idea. And he suggested things I wasn't really interested in.” Conversely, one mentor was frustrated because her mentee did not want to meet her as often as she had expected. Betty's mentor said “She doesn't answer the phone. Also, I tried to meet her several times, but it was never suitable.” One mentee, Janet, stated that having a mentor of the opposite sex rather inhibited communication. She said “Maybe it would have been easier for me if [my mentor] was a woman. I thought about that afterwards, not while we were in contact. I think I might have been even more open.” Several mentees felt that living a long way from their mentor proved challenging for their relationship. John and his mentor lived far from each other, and John emphasized “My mentor could have lived closer so we could have met for a cup of coffee […]. It's important to have real contact with people, not just over the phone.” Several participants felt it was very important that arrangements were made for the mentors and mentees to meet on a face-to-face basis.This program was a pilot, and some experiences were made that could be considered in future programs. The feedback from both mentors and mentees gave us several inputs on areas that could be improved.All the participants (both mentees and mentors) underlined the importance of the mentoring program lasting for eight months. To achieve lasting change, it was necessary for the process to be a long one. The mentors had to repeat their messages many times throughout the program. Susan was constantly reminded by her mentor of the importance of feeling good about herself:“You're active and you can actually give a lot of yourself, in spite of your fatigue. And she drummed that into my head many times, so I felt it as a kind of confidence boost.”The majority of mentees and mentors wished that the program lasted even longer, for example, for a whole year. They wanted the program to continue and have one more meeting after the trip to Nepal.There were other challenges associated with the program, including finding private companies that had employees who wanted to volunteer as mentors and who lived in the same areas as the mentees. In our program, we tried to match the mentors and mentees in terms of their locations, interests, and genders. In cases where we did not achieve this, challenges did arise, especially for the mentees. In the future, it is important to work to overcome such challenges and better meet the needs of the mentees.Several mentors highlight the importance of including mentees who are motivated and prepared to make an effort to reach their goals. Chris's mentor expressed “I think the value increases if they are challenged harder on the accepted entrance.” To achieve a functioning cooperation between the mentor and mentee, the mentors stated that they need to have the same expatiations to the process of their collaboration. To make sure this happens, future programs should have more strict criteria to be included in the program and that the staff should keep closer contact to both mentors and mentees, especially the first months of the program.The program had confidentiality rules that were found to be too demanding. This made it difficult for the mentors to discuss challenges they experience with their mentee, with other mentors in the program. They believe it limited the collaboration between the mentors and the possibility to learn and support each other. Betty's mentor explains: “We should be allowed to talk to each other because it could have made it a little easier, in relation to frustrations which both mentors and participants can feel.” In the future program, confidentiality should be maintained, but the program could have some new guidelines inside the group. This could give the possibility for both mentors and mentees to talk more openly to other members of the program.After eight months, the program was completed and the formal obligations to both mentor and mentee stopped. Still, some mentors and mentees explained that they felt insecure about whether the contact could be maintained or not. The frames of future programs should make sure they all know what to expect when the program is over.To the best of our knowledge, this study is the first to explore a formal mentoring program in cancer survivors where the mentor is neither a peer nor a health-care provider. Our findings indicate that the QoL of sarcoma survivors who are struggling with fatigue, disabilities, pain, a changed identity, and reduced self-image, as a consequence of their cancer treatment, can be enhanced by a mentoring program involving mentors from the business community. In such a program, the focus is on healthy and normal relationships with family and friends and participation in work and other activities, as well as self-image. The mentorship program seemingly resulted in a better QoL for the mentees, including increased self-acceptance regarding who they had become following their cancer treatment and feeling comfortable moving outside of their comfort zone. This led to better coping in everyday life as well as greater faith in themselves and how they could contribute and participate. They could now set new goals they had not dreamed of before joining the mentorship program.The mentees emphasized that accepting themselves and the fact that their life had changed following their cancer treatment was the most important outcome of the mentoring program. Being cured of cancer does not necessarily mean returning to the life you lived prior to falling ill. For many, recovery from cancer means starting a new life based on different conditions . PatientA mentor's task might involve making their mentee aware of their strengths and resources and helping them to see opportunities, which will facilitate the growth and development of the mentee . All theIt is easy to stagnate in the safe and the familiar when life becomes challenging and daily chores seem insurmountable, when your body works against you, the pain disturbs your sleep, and the fatigue never goes away. The mentors' task included challenging this state of affairs. One advantage the mentors had was that they did not know the mentees prior to the program. It proved demanding for the mentees to open up to a stranger, but it also proved useful to talk to someone from the outside, who had not closely observed all their challenges and who looked at them with fresh eyes. The challenges they were supported in addressing included restarting a social life with family and friends as well as focusing on working life and increased participation in various activities. The mentors focused on prompting the mentees to look forward, seize opportunities, and break barriers. The mentors noted that the mentees all too frequently placed limitations on themselves due to fatigue, pain, and impairment, although through participating in the mentorship program, they came to feel that the unknown and impossible were possible. In fact, the mentees were stimulated to do the unthinkable. In particular, the trip to Nepal showed them how much they could still do. During the trip, they ventured far outside of what they had defined as their comfort zone, and they found that doing so went very well. Both the mentors and the mentees expressed gratitude for the opportunity to participate in the program, and they emphasized that they had gained new and valuable perspectives on life through doing so.All the mentees commented that they struggled with chronic fatigue, the most common and arguably most troublesome long-term side effect following cancer treatment –30. FatiIn line with prior research , some chThe current study did have some limitations. First, the small sample size may limit the generalizability of the findings. Second, the selection process used in this study introduced a bias toward a group of sarcoma survivors who were particularly struggling following treatment. Yet, in qualitative research, one does not seek to gather representative data, but rather to elucidate the phenomena that the participants experience based on their own perspectives. We conducted a retrospective pilot study on this program to explore the impact of the intervention and the participants' experiences. Therefore, no interviews were conducted at baseline, which would have elicited expectations for the program and observed how these changed over time. Another important limitation to acknowledge is that this was a convenience sample, the authors cannot be sure that saturation was reached, but the selection proved to be adequate in this study, as the gathered narratives were rich and full of nuanced examples. Lastly, we must acknowledge that a mentorship program, as seen in the present study, is time and resource consuming, which means that it might be difficult to implement on a larger scale. However, for those who are young and particularly those who are struggling to return to their work, social life, and other activities, there are unfortunately no quick fixes. A program such as the one implemented in this study could facilitate reorientation and so has a major positive impact on the QoL of cancer survivors.In this study, the formal cancer survivorship mentoring program involving mentors from the business community assisted with reorientation and improved the QoL of the participating sarcoma survivors. We believe that it is key to the success of this kind of intervention that the mentees enter into a long-lasting process with continued support to overcome their challenges. The mentorship program explored in this study could serve as the basis for larger studies involving other groups of cancer survivors.


The outcome measures included sense of purpose, self-esteem, attitudes toward older people, confidence interacting with older people, and interest in working with older people. Quantitative and qualitative data were also collected regarding the subjective assessments of the program’s success. We found significant positive effects for the BCLT participants regarding their sense of purpose in life, attitudes toward older people, comfort interacting with older people, and interest in working with older people. The subjective assessments of the participants were overwhelmingly positive. The findings indicate that BCLT had positive effects for the youth participants and support the further development and testing of wisdom-sharing intergenerational programs.Adolescents’ opportunities to benefit from the life wisdom of older persons are very limited. To address this issue, we designed and tested the Building a Community Legacy Together (BCLT) program based on research on the benefits of older people’s wisdom for youth development. In the intervention, the youth participants were trained prior to conducting interviews with older persons regarding their advice for living. The youth participants analyzed the information obtained and presented a summary report to the community. The participants were 93 middle and high school youth who were randomly assigned to the treatment condition with the BCLT program ( In 2015, adults aged 65 and older made up only 9% of the population worldwide (617.1 million) .The lack of contact also makes it impossible for young people to learn from older people’s accumulated life wisdom. Sharing wisdom has positive effects on youthyounger persons, including assistance with the development of life skills, exposure to new relationships and opportunities, and help with overcoming obstacles and barriers ,5,6. To Intergenerational programs (IGPs), which promote activities that bring generations together for mutually rewarding purposes, represent a potential answer to these challenges . To dateOne goal of this effort was to address methodological weaknesses in the IGP research . First, Most IGPs attempt to enhance young people’s perceptions of older adults. Studies show that IGPs can increase children’s knowledge about the aging process and living as an older adult, help them become more accepting of older people, and reduce age-related stereotypes ,11. IGPsThese changes in young people’s attitudes are not necessarily limited to the specific older individuals with whom they interact, but are also generalizable to the older demographic at large. In a recent systematic review, IGPs were found to reduce ageism overall among young people . FurtherOther IGPs pursue changes in youth participants’ academic self-perceptions and lifestyle choices. For instance, IGPs that involve older adult tutors or mentors can enhance young people’s beliefs that they will succeed academically . FurtherSubstantially less research attention has been paid to the possibility that IGP participation produces positive physical or mental health outcomes for children and adolescents, with reviews finding few investigations that measure health effects . AlthougThe present study advances prior research by focusing on a specific mechanism for hypothesized positive effects of an IGP for youth: the opportunity to receive advice and life wisdom directly from older people. From the earliest stages of development of IGPs, a fundamental assumption supported by empirical evidence is that older people benefit from opportunities to express generativity—making the world a better place for further generations . Almost Several bodies of research suggest that wisdom-sharing may be a potent mechanism for beneficial effects in young people. The research on wisdom has flourished over the past decades, with multiple theoretical frameworks and an expanding literature on experimental psychology. This literature has shed light on determinants of wisdom, as well as its consequences for such areas as clinical judgement, occupational success, psychological well-being, and physical health .Although wisdom is closely associated in the public mind with the later years, an evolving line of research has examined how wisdom may develop in adolescence and emerging adulthood. The research supports the growth potential of wisdom-sharing in adolescence, suggesting that “the seeds of wisdom lie in adolescence”  (p. 360)Staudinger and Baltes  argue thHowever, little attention has been paid to a more obvious possibility: creating situations where young people actually listen to and process the wisdom and advice of older people. An underlying premise of the BCLT program is that interactions in which younger people receptively solicit older people’s wisdom, engage in structured discussions of what they have learned and present it to others, is a promising intervention strategy. Glück  proposesOur conceptual framework centered on the role of intergenerational wisdom-sharing follows the theoretical model developed by Kessler and Staudinger . Their mThis theoretical framework suggests that advice-giving is a potential mechanism for effects of an intergenerational program. Further, advice-giving is likely to bolster the effects of intergenerational interaction, because it is perceived as a very meaningful transfer of experiential knowledge . In the Based on this framework, there is an important distinction between the BCLT program and numerous IGPs that involve interviewing older people about their life stories and reminiscences. The wisdom-sharing intervention employed in the present study differs from past research on intergenerational storytelling in several ways. First, storytelling interventions are often conducted within family contexts cf. ,30) and  and 30])Second, storytelling can involve anecdotes about minor experiences , whereasThird, storytelling interventions are less likely to involve an element of reciprocity. In storytelling programs, the focus is on offering older adults the opportunity to reminisce to an attentive listener. In contract, wisdom-sharing is meant to be of practical value to recipients. IGPs that include a give-and-take dynamic are more effective for participants . Based oThe present study focuses on outcomes for youth participants. The conceptual framework and design of the BCLT program are organized around testing benefits for youth participants, and program resources are largely devoted to training them. In part, this focus was determined by the funding source, a center for youth development that was primarily concerned with IGP outcomes for young people. In addition, the emphasis was determined to be a more critical need, given the plethora of evidence on the benefits of generativity for older people ,8.The evaluation focused on two types of outcomes for youth participants. First, we hypothesized positive changes in the treatment group (when compared to controls) for several proximal outcomes; that is, the more immediate results of program activities. One outcome assessed the degree to which youth participants felt confident in using the skills taught in the program, such as the ability to conduct an interview with an older person. The second proximal outcome was attitudes toward older people. In both cases, we hypothesized that the BCLT youth treatment group would improve significantly compared to the non-intervention youth control group. Third, a concrete outcome of attitude change toward older adults is whether a young person would find working with older people to be interesting or rewarding.We also hypothesized positive treatment effects for distal outcomes; that is, anticipated final outcomes of the intervention that are further removed from the immediate effects. First, we hypothesized that experiencing and internalizing older people’s wisdom would significantly increase youth participants’ self-esteem as a result of BCLT participation. In addition, we hypothesized that interactions with older people around their lessons for living would enhance youth participants’ sense of purpose. Additional measures of health and well-being were not included in the study and should be employed in future research.A goal of the program development process was to incorporate evidence-based practices into the design of the BCLT program . First, Third, we created a collaboration with a strong organizational partner that demonstrated enthusiastic buy-in to the program. We worked with the New York State 4-H Youth Development Program, which maintains a high-profile and trusted role in all counties in the state. Fourth, we identified a hypothesized mechanism for intervention effects (imparting advice for living from older to younger people). Fifth, we employed a rigorous research design to evaluate the BCLT program.BCLT is a manualized intervention that includes a set of standard components for all implementations .Youth training. BCLT begins with four hours of training prior to conducting face-to-face interviews with older adults. The goal of the training is to build skills and capacity for youth to interact with older adults. The training covers interview and communication skills tailored specifically to interactions with older adults, clarifying expectations when interacting with older adults, and methods to handle possible obstacles. An additional four hours of training were provided after the interviews to summarize the interview data and prepare a community report. The specific training curriculum is detailed in “What are some of the most important lessons you feel that you have learned over the course of your life? That is, if young people asked you, ‘What have you learned in your ____ years in this world’, what would you tell them?”“Some people say they have had difficult or stressful experiences but that they have learned lessons from them. Is that true for you? Can you give examples of these experiences and what you learned?”“What would you say are the major values or principles that you live by?”An important component of the training sessions is a guided opportunity for the youth participants to generate their own questions, based on their perceived need for life advice. Three questions are required to be included, because they were found to be particularly effective in eliciting life lessons from older people in prior research . These i“Have you ever been bullied by someone? If so, what did you learn about responding to people that gave you a hard time?”“Were you ever discriminated against for something you believed in? What do you think is the best way to react to being in that situation?”“Do you have suggestions on ways to handle problems with siblings?”“What kind of advice do you have about being a good husband/wife or father/mother?”“What advice would you give youth about their role in politics today?”“Many young people today are involved in relationships that are more accepted today but still controversial, such as mixed-race or same-sex relationships. Is this something you can relate to and do you have advice for overcoming difficult relationship challenges?”“How did you know when you were in love? What are your recommendations on how to handle love?”A training session was devoted to generating additional questions derived from the youth participants experiences and interests. Questions emerged around typical challenges of adolescence, such as handling difficult interpersonal situations, romantic relationships, and current cultural and political issues. The following are examples of youth-generated questions:Interviews with older adults. Following the training, youth are paired with an older adult to conduct an hour-long individual interview. The older adults receive an orientation on the BCLT program prior to the interview. They are provided with background information on the program and they are given the list of questions they will be asked in the interview, allowing them time to reflect on the advice they may want to convey to a young person. Pilot-testing of the BCLT program demonstrated the need to provide older participants with this preparation so they could organize their thoughts prior to the interview.Summarizing individual and group findings. Upon completion of the interview, the youth individually summarize the major lessons learned during their interviews and report their findings in a group meeting. With guidance from the group leader, participants analyze the qualitative responses of the older adults and come to consensus on the core set of lessons learned as a group. The lessons are synthesized into a single list of the most important advice received for each interview question. This component of BCLT treats the interviews as qualitative data and helps participants organize the lessons into general themes with characteristic examples.Community presentation. The BLCT program culminates in an approximately one hour-long presentation for community members in which youth present the older participants’ lessons. The goal is to provide an opportunity for youth to publicly foster positive images of older people as sources of wisdom, thus reinforcing their individual experiences in the interviews. Guidance is provided for preparing the presentation and accompanying audiovisual materials. The older participants are invited to the community presentation to reinforce the importance of their participation and increasing their sense of generativity. Parents, friends, and members of community organizations are typically invited.Thus, the BCLT intervention included several components that were likely to benefit middle school and high school youth, which are transferable to other situations. The training process provided them with useful interviewing and active listening skills. The organization of the questionnaire design and data analysis offered opportunities for cooperative learning. Further, the BCLT intervention helps youth to hone public speaking skills that are used in the community presentation. Measurement of the impact of these components is included in our measures of proximal outcomes.This article presents data using a randomized, controlled design that took place in five sites across New York State. However, prior to the implementation of this study, the BCLT program was implemented in six earlier sites and a detailed process evaluation was conducted at each site. The process evaluation included interviews with youth and older participants as well as program leaders to determine strengths of the BCLT program and potential improvements. Identical process evaluation activities took place in the randomized, controlled sites. From the accumulated intervention experience, several considerations emerged regarding program implementation.The program is designed for middle and high school age youth. This decision emerged from the experience of the initial implementations of the BCLT program, which included elementary school students. It was determined that the younger age group was challenged by the level of information in the training sessions and was much less able to conduct meaningful and detailed wisdom interviews. Adaptation for younger children is an important consideration for future program development.The BCLT program is designed to be led by a youth group, school, or similar organization in collaboration with a local aging service provider. Any interested organization that works with youth can initiate and implement the BCLT program. The BCLT leaders must have experience with teaching or program leadership with adolescents, as they facilitate the BCLT training. The benefit of using school classes or established youth programs  is that recruitment can take place at one time and the BCLT program can be completed during regular program hours. In this case, BCLT becomes part of the curriculum or planned activities for that specific youth group. For example, the BCLT program can be implemented to complete a school service-learning requirement.Overall, reports from program leaders indicated that the BCLT intervention is an accessible program and is relatively easy to implement. Program leaders reported that the program manual is thorough and easy to read. Leaders also appreciated that the youth training offers a selection of exercises for any single training concept, which may include brainstorming, roleplaying, small-group discussions, watching videos, or other activities. In addition to endorsing the curriculum, program leaders universally reported that there is sufficient information about how to plan for and run the BCLT program, including detailed guidance regarding the logistical and administrative activities required to implement it. Further, program leaders appreciated that university-based BCLT program staff provided ongoing consultation and training to assist them in running the program.Although the overall feedback from program leaders was overwhelmingly positive, there were also challenges that program leaders faced. Some leaders noted that finding and recruiting the youth and senior participants was time-consuming. We encouraged engaging community partners to assist with recruitment , but some sites found such connections difficult to do based on their location.Implementing the BCLT program requires that staff have sufficient time to manage program details successfully. Activities for program leaders include recruiting participants, obtaining parental consent for youth, and scheduling the training, interviews, and community presentation. These needs have led to the recommendation that the responsibility for leading the BCLT program be shared by two individuals, thus reducing the amount of administrative time required. Overall, challenges met by program leaders have been consistently mitigated by the thoroughness of the training manual and the consultative support from the university-based BCLT program staff team.http://citra-bclt.human.cornell.edu/). Some program leaders opted to provide refreshments for participants, a certificate of completion, and/or offered a small gift to participants, such as a gift card. These expenses amount to $200 or less. The most significant cost for running the BCLT program is the need to cover the program leader’s salary for the time they are implementing the BCLT. However, BCLT has been integrated into the regular programming activities of the program leaders such that their time is already accounted for. We estimate that implementing the BCLT requires up to 50 h of program leader time, with half of that time allocated to administrative tasks and half to the youth training, interviews, and the community presentation. Of course, two program leaders decrease the time required for each individual.The cost of implementing the BCLT is low. The BCLT program manual is free and can be downloaded easily from the program website . Given differences in programs and resources, considerable leeway was allowed in recruiting younger and older participants. In two sites, youth participants were recruited through the local 4-H program. In the remaining three sites, program leaders used existing connections with schools, including a high school leadership program, an after-school program, and student recruitment from social science classes. Older participants were recruited primarily through agency contacts of the program leaders, such as with local senior centers. Another source was older individuals involved with the county Cooperative Extension Association as volunteers.n = 47) or into a non-intervention control group (n = 46). Control group participants did not receive the intervention and completed pre-test and post-test questionnaires. No statistically significant differences were found between the treatment and control groups on gender, age, race, or middle school/high school status. Sample characteristics for the treatment and control groups are presented in A total of 93 youth participants were recruited, who were then randomized at the individual level into the BCLT intervention (BCLT participants completed a pre-test questionnaire within two weeks of beginning the program and a post-test one week following the end of the program (approximately nine weeks from baseline). Shortly after completing the post-test, participants were contacted individually by telephone for a follow-up interview that solicited qualitative feedback about the program. Control participants took the pre- and post-test questionnaires at the same time as treatment participants; no follow-up interview was conducted for the control group. The pre-test included questions on participant demographics . The treatment post-test included a feedback component that consisted of both quantitative and qualitative questions assessing program satisfaction.Perceived competency. Youth responded to a 6-item Competency Scale that assessed their perceived ability to conduct and interpret interviews with older people. Using a 4-point scale anchored at (1) Certain you can’t do it and (4) Certain you can do it, youth rated how certain they were they could carry out activities such as listening attentively, taking notes, working in a team, and asking follow-up questions. Responses were summed up into a single score (6–24 points).Attitudes toward older people. Perceptions concerning older adults were measured using the 9-item Attitudes Toward the Elderly Scale ?” and “Please list some things you got out of participating in the Building a Community Legacy Together (BCLT) program.”Youth responded to assessments of the program’s enjoyableness .We obtained descriptive statistics for the sociodemographic variables and outcome variables at baseline. The core model for each outcome for evaluation of the intervention included treatment (2 levels—control and BCLT intervention) and time of assessment (2 levels—pre-tests at baseline and post-tests one week later at the completion of the intervention) as fixed classification factors, the interaction of these 2 factors, and individuals as levels of a random classification factor. The models also included The interaction of each of the additional variables—as well as other variables such as site—with treatment and time was also examined. This involved a 3-way interaction of fixed factors for the additional categorical variables and homogeneity of regressions of the covariate by levels of treatment and time for the additional quantitative variables . There wAnalysis was by general linear mixed models assuming normality with unstructured error. Degrees of freedom were computed using the first-order Kenward-Rogers method . The keyThe primary analyses for evaluation of the program are shown in p = 0.0002), attitudes toward older people (p ≤ 0.0001), interest in working with older people (p = 0.007), and purpose in life (p = 0.053). Self-esteem, although in a direction that favors the program, did not reach statistical significance (p = 0.196). Interactions among treatment, time, and sociodemographic variables were examined fully. There was no coherent pattern, and interactions are not included in the final models. There were no differences by site.As can be seen from Subjective evaluations of program experience were extremely positive based on the post-intervention questionnaire. In their overall evaluation of the program, 97 percent of youth participants reported that the BCLT program was enjoyable. All youth participants felt the experience was useful, and 97 percent also believed the program was useful to the older participants. Almost all (91 percent) of youth participants would recommend the program to someone else.“Having patience to talk with me, and help me with some advice for the future.”“Hearing about their past and the things they took away from their experience.”“I liked gaining advice from someone who has actually lived through life and gaining advice on my career.”“Hearing their ideas about how to deal with challenges in life.”Responses to open-ended questions found similarly positive responses, with most youth participants specifically referring to the benefits of receiving life advice. Examples include: These high levels of participant satisfaction provide further evidence of successful implementation of the program components.The findings from this evaluation provide encouraging evidence for the benefits of wisdom sharing as a mechanism for positive effects in an IGP. The pattern for all outcomes was an increase in means over time for both control and treatment groups, but a considerably larger increase for program participants. The randomized, controlled design lends confidence that these effects emerged from program participation. In addition, the subjective evaluations of the value of the program were very high. Although further replication is needed, these quantitative findings—supported by the overwhelmingly positive program satisfaction data—provide support for the effectiveness of the BCLT program.The program’s focus on obtaining elder wisdom can address a potential problem in intergenerational programs: the issue of “generative mismatch.” Because of rapid social and technological change, the skills and knowledge of older adults could be seen by young people as being outdated or irrelevant ,40. HoweThere are a number of limitations to the study, however, that point to needed directions for future research. First, we were able to assess only a limited range of outcomes, and over a relatively short time period. A major priority for future research should be illuminating the effects of IGP participation on physical and mental health outcomes. We were able to assess two domains that are associated with greater well-being. Sense of purpose improved significantly, and self-esteem also improved but failed to reach statistical significance. Multiple post-tests that focus on health-related outcomes are needed, especially given research findings discussed earlier suggesting that wisdom interventions may improve health.Second, this study compared youth participants in the BCLT intervention with a non-intervention control group. The resources for this project did not allow us to include an additional arm of the study that would more firmly establish wisdom-sharing as the mechanism of effects. To identify the relative contribution of wisdom-sharing in relation to the program’s other facets , future studies could include a comparison arm focused on contact and activities other than wisdom-sharing.Third, it is likely that the sample of youth participants disproportionately included individuals who already had some interest in older people and were receptive to their life advice. It is very difficult to avoid such potential bias in a study that involves recruitment in real-world settings. The randomization of youth participants into treatment and control groups ensures that this bias did not influence the intervention results.Fourth, this study is limited by its focus on the youth participants. Older participants were engaged as advice-givers and received an orientation specific to that activity. One reason for this design decision was to allow wisdom-sharing to take place more naturally, without extensive coaching and preparation beforehand of older participants. Further, as noted earlier, a priority was testing the effects of the receipt of advice for youth, given that it is an understudied phenomenon. Subjective assessments of the program were very positive on the part of the older adults, who found BCLT participation to be rewarding and enjoyable. Program modifications are now underway that expand the preparation, training, and engagement of older participants with the goal of increasing positive outcomes for them .Interest in IGPs has proliferated over the past decade, making the field an exciting one for both researchers and practitioners. As studies embrace more sophisticated research designs and theory-based interventions, guidance for designing the most effective programs will be enhanced. The present study incorporated a number of recommendations for rigorous evaluation of IGPs, including specifying the mechanism for effects, ensuring treatment fidelity through a manualized intervention, and using a randomized, controlled design. The findings of this study indicate that the BCLT had positive effects for youth participants. Thus, the research supports the development and promotion of programs that focus on the transfer of wisdom from older to younger persons.The study also indicates the potential for linking the growing field of wisdom research to that on IGPs. To date, there has been limited interaction between these two perspectives, with few wisdom researchers conducting studies that include real-world intergenerational interactions. The results of our research point to the potential of research translation between the two fields, which can not only lead to the development of new, evidence-based IGPs, but also can contribute to basic knowledge of how wisdom is transmitted and its potential effects on health and well-being.


However, none of them showed a significant difference between the SCLC and NC groups, and only the IgM autoantibody against JAK2 showed a higher expression in LUSC than in NC (p = 0.046). Through logistic regression analysis, with the five IgM autoantibodies and carcinoembryonic antigen (CEA), one diagnostic model was constructed for LUAD. The model yielded an AUC of 0.827 . The diagnostic efficiency was superior to that of either CEA (AUC = 0.692) or IgM autoantibodies alone (AUC = 0.698). Notably, the accuracy of this model in early-stage LUAD reached 83.02%. In conclusion, we discovered and identified five novel IgM indicators and developed a multi-analyte model combining IgM autoantibodies and CEA, which could be a valuable and powerful auxiliary diagnostic tool and might improve the accuracy of early detection of LUAD.Immunoglobulin M (IgM) autoantibodies, as the early appearing antibodies in humoral immunity when stimulated by antigens, might be excellent biomarkers for the early detection of lung cancer (LC). We aimed to develop a multi-analyte integrative model combining IgM autoantibodies and a traditional tumor biomarker that could be a valuable and powerful auxiliary diagnostic tool and might improve the accuracy of early detection of lung adenocarcinoma (LUAD). A customized protein array based on cancer driver genes was constructed and applied in the discovery cohort consisting of 68 LUAD patients and 68 normal controls (NCs); 31 differentially expressed IgM autoantibodies were identified. The top 5 candidate IgM autoantibodies [based on the area under the receiver operating characteristic curve (AUC) ranking], namely, TSHR, ERBB2, survivin, PIK3CA, and JAK2, were validated in the validation cohort using enzyme-linked immunosorbent assay (ELISA), which included 147 LUAD samples, 72 lung squamous cell carcinoma (LUSC) samples, 44 small cell lung carcinoma (SCLC) samples, and 147 NCs. These indicators presented diagnostic capacity for LUAD, with AUCs of 0.599, 0.613, 0.579, 0.601, and 0.633, respectively ( LUAD, a% of cancCurrently, low-dose spiral CT (LDCT) and pathological tissue biopsy are used to screen and detect LC patients clinically, but the former has high false-positive rates and the latter is traumatic, which causes some excessive diagnosis, unnecessary tests, invasive procedures, and, rarely, radiation-induced cancers . In receTumors are the products of the malignant transformation of normal cells, which are characterized by continuous proliferation and metastasis in the body. The prominent feature of tumor cells in immunology is the appearance of certain tumor-associated antigens that are not visible or have low expressions in normal cells of the same type . Due to In the present study, we aimed to screen valuable IgM autoantibody indicators for LUAD by protein array and verify them in another sample cohort with enzyme-linked immunosorbent assay (ELISA). Ultimately, the five candidate IgM autoantibodies and CEA were integrated to construct a diagnostic model to improve the diagnostic efficiency for LUAD. The diagnostic model might be able to improve the treatment status of LC patients and increase their survival rate.All serum samples included in this study were obtained from the Specimen Biobank in Henan Key Medical Laboratory of Tumor Molecular Biomarkers collected from a provincial hospital in Zhengzhou, Henan Province, China, between 2016 and 2019. Two independent sample cohorts  were used in this research. The discovery cohort consisted of 68 LUAD patients (LUADs) and 68 normal controls (NCs) matched by gender and age. In addition, 147 LUADs, 147 matched NCs, 72 LUSC patients, and 44 SCLC patients were included in the validation cohort. The blood samples of all LC patients were drawn upon their first diagnosis without any other cancers, antitumor treatment, and autoimmune diseases. All NCs were individuals who had a health checkup without history of cancer, pulmonary diseases, and autoimmune diseases. The sera were extracted and stored according to standard protocols .The human protein array assay was commissioned to BC Biotechnology Co., Ltd.  based on the conception of our laboratory. The protein chip contained 154 recombinant proteins or protein fragments, 11 of which , with potential diagnostic value, were reported in our previous research , 21; theIn order to eliminate the deviation caused by the inconsistency of the background value between different samples, the ratio of the foreground value to the background value of each protein (F median/B median) was calculated, namely, the signal-to-noise ratio (SNR). Statistical analyses of the samples were based on the SNR value. The tests for the test samples were repeated 30 times at different time points, different chips, and different positions to evaluate the stability of the operation.p < 0.05]. In view of the optimal choice in terms of the number of indicators when constructing the model, we set the top 5 based on AUC rankings  among the 31 differential autoantibodies as the candidate IgM indicators  of each autoantibody in LUADs and NCs was applied based on the SNR value of each samples. Thirty-one IgM autoantibodies were screened and showed higher distinguishing values in LUADs .Given the insufficiency of a single IgM autoantibody for LUAD detection, we selected and matched the populations (83 LUADs and 83 NCs) with CEA results from the validation cohort to construct a diagnostic model that combines candidate IgM autoantibodies and CEA. Binary logistic regression was adopted to combine the IgM autoantibodies with CEA. It was found that the AUC of CEA alone was only 0.692 and that of the five IgM autoantibodies (combined) was 0.698. However, the AUC of the model that included both five IgM autoantibodies and CEA reached 0.827 (vs. advanced stage (0.803) and without lymph node metastasis (0.565) vs. with lymph node metastasis (0.900) vs. without distant metastasis (0.557) vs. with distant metastasis (0.905), all p < 0.05]  (p > 0.05)  and CEA for LUADs is exhibited in . 83 NCs Table 3.In recent studies, the EarlyCDT-Lung test has achieved remarkable results in distinguishing LC patients from high-risk subjects. The panel, which includes seven IgG autoantibodies, demonstrated sensitivity and specificity values for newly diagnosed LC of about 40% and 90%, respectively –24. RegrA fundamental target in cancer research is to understand the mechanisms of cell transformation. Cancer driver genes are involved in tumorigenesis and development across cancer types . Hence, ERBB2 is a member of the epidermal growth factor (EGF) receptor family of receptor tyrosine kinases, and its IgG autoantibody has been extensively assessed as a potential diagnostic biomarker for gastric cancer  and breaIn phase II of the present study, we found that single-autoantibody indicators always showed an insufficient diagnostic ability, as in previous studies –37. MoreInterestingly, the diagnostic performance of the model with five IgM autoantibodies and CEA (AUC = 0.827) was a little higher than that of the model with three IgG autoantibodies and CEA (AUC = 0.781). Additionally, for early-stage LUAD, the model with five IgM autoantibodies and CEA showed great diagnostic value, but the model with three IgG autoantibodies and CEA had no diagnostic value. This would justify IgM autoantibodies as having the advantage of potentially identifying malignant lesions at an earlier stage than IgG autoantibodies, as reported in the study of Pedchenko et al. , where hOur study displayed several novel features. Firstly, we adopted a new modality of a customized protein array based on cancer driver genes to improve the possibility of screening potential IgM autoantibodies, which yielded satisfactory results. Secondly, ELISA was applied to validate the candidate IgM autoantibodies in an independent validation cohort with the aim of identifying robust LUAD biomarkers. Thirdly, the model constructed with the combination of IgM autoantibodies and CEA improved the diagnostic value of the existing clinical auxiliary diagnostic method, which implied that multi-analyte tests could ameliorate the problem of the insufficient diagnostic value of biomarkers.There were certain limitations in this retrospective study. In future work, we will longitudinally explore the levels of these IgM indicators using pre-diagnostic longitudinal sera from LUADs. Moreover, we will verify the performance of the diagnostic model in a larger sample cohort to evaluate its capability in the early stage of LUAD.In conclusion, we performed a meaningful approach of a protein array assay to identify novel IgM autoantibodies for the detection of LUAD. The diagnostic model that combined five IgM autoantibodies and CEA may be a more accurate method for the early detection of LUAD and possess certain predictive power for the severity of tumor.The original contributions presented in the study are included in the article/The studies involving human participants were reviewed and approved by the Medical Ethics Committee of Zhengzhou University. The patients/participants provided written informed consent to participate in this study. Written informed consent was obtained from individual(s) for the publication of any potentially identifiable images or data included in this article.LD was responsible for study conception and design. LD and JZ provided administrative support. TW, LP, FL, XiZ, and XW contributed to the provision of study materials or patients. XuZ, JL, YW, ML, and DJ collected and organized data. XuZ analyzed and interpreted the data and wrote the manuscript. All authors contributed to the article and approved the final manuscript.This work was supported by the Leading Talents of Science and Technology Innovation in Henan Province (grant no. 20420051008), the National Natural Science Foundation of China (grant no. 8167291), the Major Project of Science and Technology in Henan Province (grant no. 16110311400), the Key Project of Discipline Construction of Zhengzhou University (grant no. XKZDQY202009), and the Project of Basic Research Fund of Henan Institute of Medical and Pharmacological Sciences (grant no. 2020BP0202).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.


Limited data support the use of pneumococcal urinary antigen testing (PUAT) for patients admitted with community-acquired pneumonia (CAP) as a stewardship tool to curtail the use of broad-spectrum antimicrobials. At NYULH, CAP guidelines and admission order set were developed to standardize diagnostic testing, including PUAT. In this study we describe patients with positive versus negative PUAT and evaluate de-escalation and patients’ outcomes. This was a retrospective study of adults admitted with diagnosis of CAP between January-December 2019 who had a PUAT performed. The primary outcome was incidence and timing of de-escalation of antimicrobials following PUAT result. Among patients with a positive PUAT we compared hospital length of stay (LOS), incidence of Clostridioides difficile infection (CDI), infection-related readmission within 30 days, and in-hospital mortality among those who were de-escalated versus those who were not de-escalated/required escalation. We evaluated 910 patients, of which 121 (13.3%) were PUAT positive. No difference in baseline characteristics, including severity of illness as represented by the Pneumonia Severity Index  and Charlson Comorbidity Index, were observed between PUAT positive and negative groups. Time to PUAT testing occurred shortly after presentation to the hospital in both cohorts . Initial de-escalation occurred in 97/117 (82.9%) and 629/775 (81.2%) of PUAT positive and negative patients, respectively (p = 0.749). Median time to de-escalation was shorter in the PUAT positive cohort . Among the PUAT positive group, hospital LOS stay was shorter in patients who were de-escalated compared to those who were not de-escalated/required escalation  with no difference in the incidence of CDI , in-hospital mortality , or 30-day infection-related readmission . PUAT positivity resulted in quicker time to targeted therapy for CAP. Among patients with a positive PUAT, initial de-escalation of antimicrobials did not lead to worse patient outcomes. All Authors: No reported disclosures


The program consists of 2 phases: a 12-week intensive phase and a 40-week maintenance phase . The intervention in both phases is composed of presential home visits and phone-call follow ups, including exercise training and the self-management educational program Living Well with COPD. Dyspnea, impact of the disease, emotional status, and level of dyspnea during activities of daily living are used as patient-reported outcomes measures. A one-minute sit-to-stand test is used as a functional outcome, and the number of steps as a measure of physical activity. To ensure safety, fall risk and the cognitive function are assessed. Data are collected at baseline, at 12 weeks, at 26 weeks and at 52 weeks. This is the first nationwide protocol on enhancing access to PR, providing appropriate responses to CRD patients’ needs through a structured and personalized home-based program in Portugal.Home-based models represent one of the solutions to respond to the poor accessibility of pulmonary rehabilitation (PR) services in patients with chronic respiratory disease (CRD). The main goal of this protocol is to present the implementation of the first nationwide home-based PR program— The World Health Organization (WHO) indicates that hundreds of millions of people worldwide are affected by chronic respiratory diseases (CRD), including chronic obstructive pulmonary disease (COPD) . These cPulmonary rehabilitation (PR) is an essential component in the management of CRD with the aim to improve patients’ exercise and functional capacity and psychological condition with long-term adherence to health-enhancing behaviors, including exercise training and self-management skills ,11,12. TThus, it is important to undertake actions that improve access to and delivery of PR services for suitable patients. One of the strategies in the international guidelines is the creation of new models of programs, where a home-based approach is indicated . Home-bareabilitAR program was created on a value-added model of care that can contribute to increase the access of patients with CRD in Portugal. Additionally, this program provides a safe home-based PR of high quality with a direct assessment on the patients’ needs, and the environment in which PR is conducted. Its implementation makes it the first nationwide, structured, and personalized home-based PR in Portugal. The goal of this project is to present and implement the home-based PR program—reabilitAR—in patients with CRD. The main outcomes are to measure the short- and long-term effects of this specific home-based program on patients’ symptoms, the impact of the disease, emotional status, functional capacity, and level of physical activity. The secondary outcomes are to investigate the short- and long-term effects in the number of exacerbations and healthcare utilization. The first population included in this program were COPD patients because they represent the largest proportion of referrals in PR and much of the existing related evidence is in this population [According to these positive results, the pulation .reabilitAR program was building an operational instruction manual according to the best practices and international guidelines [reabilitAR team and to ensure the quality of the PR intervention, since all the procedures of the program are applied at the patients’ homes, including the assessment moments and intervention.A real-world pre- and post-intervention protocol was designed for patients with CRD. The first step in the development of the idelines ,17,20,21reabilitAR team is constituted by healthcare professionals, including a pulmonologist , a respiratory nurse  and a trained physiotherapist (mainly responsible for the exercise training and assessments). The program also presents the collaboration of a nutritionist, a cardiopulmonary technician, a pharmacist, and a psychologist, although they do not have a direct approach in patients’ intervention, they help the other team members in the decisions making . During the process it is also expected that the medical doctor explains the goal and benefits of PR, according to the 1)/forced vital capacity (FVC) ratio <70% [Patients are eligible if they are diagnosed with CRD. Specifically, COPD patients have to meet the following inclusion criteria: (i) diagnosis based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria—postbronchodilator forced expiratory volume in 1 s  ECtio <70% .reabilitAR program presented below, by adding visits at the beginning of the program to offer a specific exercise program for fall risk for a subsequent safe and effective self-management intervention.For the eligible patients, the case manager proceeds to a phone-call for a standard and structured assessment through a questionnaire, which includes socio-demographic , general clinical information , eating habits and smoking habits. This data collection is sent to the physiotherapist to schedule the first home visit to complete the baseline assessment. Written informed consent is obtained prior to this baseline data collection. The outcomes measured during the first home visit are: anthropometric measures  ,24; sympreabilitAR program, considering a scale of 1 to 10, where 10 represents “very confident”. This evaluation is adapted from the LWWCOPD. Furthermore, patients are asked the expectations/objectives they pretend to achieve with the program, always reflecting the functional performance  [During this baseline assessment is also assessed the self-efficacy for the ability to follow the exercise program regularly (≥3 days a week) over the ivities) .After the baseline assessment, the pulmonologist of the program validates the inclusion of patients according to his analysis of the collected data , ensuring the safety for the home-based approach.During the program, data are also collected from patients at 12 weeks (end of intensive phase), at 26 weeks (during maintenance phase) and 52 weeks (end of maintenance phase) of the program .The program consists of 2 phases: a 12-week intensive phase and a 40-week maintenance phase for a total duration of 52 weeks (1 year). Intervention in both phases consists of a hybrid conception of presential home visits for the exercise training and the self-management sessions, and phone-call follow-ups including motivational follow-up, assessment of the clinical condition, and the progression of exercise training. The intensive phase (week 1 to 12) includes a total of 14 home visits, with more visits in the first two weeks of the program (4 visits). From the third week, one visit is replaced by a phone-call, for a total of 10 phone-calls . The genIn the maintenance phase, weeks 13 to 26, the intervention remains the same, with one home visit and one phone call per week. During weeks 27 to 52, starts a 4-week cycle intervention with 3 visits in the first weeks and one phone-call on the last week .reabilitAR program includes the self-management educational program Living Well with COPD (LWWCOPD) . Each home visit has a duration of 60 min and is delivered by a physiotherapist which includes a clinical assessment , blood pressure (BP), oxygen saturation (SpO2) and perceived dyspnea and fatigue with the modified Borg scale), the teaching of the exercise training and the self-management educational intervention. The exercise training is performed according to the module “Integrating an Exercise Program into Your Life” of LWWCOPD and includes warm-up, endurance, resistance/strength, flexibility, balance training and a cool down period. Every session the physiotherapist revisits the nature of the exercise, its frequency, duration, intensity, and progression. The endurance training is performed on a portable cyclo-ergometers and steps/stairs for a target duration of 30 min per session and the training intensity measured and limited to a Borg dyspnea or fatigue score of 4 to 6 [The f 4 to 6 ,18. The f 4 to 6 . The flef 4 to 6  and balaf 4 to 6 ,39. DuriThe self-management educational intervention is based on the modules of LWWCOPD and is performed especially during the intensive phase of the program. Beside the module on exercise training, each patient receives one other module entitled “Being Healthy with COPD”, that includes every educational topic concerning self-management (4). If needed, the other modules presented in LWWCOPD are available according to the patients’ specific needs. A detailed description and the selected order of the themes are presented in Patients also receive a pedometer and recommendations on how to use it to increase physical activity.reabilitAR program is available in An overview of the timeline and procedures of the After the assessment moments , a report with the total scores of patient-reported outcomes measures , the performance of the functional test outcome (1MSTS), physical activity (number of steps), and the number of exacerbations and healthcare utilization are registered along with the baseline data for a term of comparison. According to the available evidence, established minimal clinically important differences (MCID) are also included according to the respective diagnosis of CRD. This report is sent to the referrer doctor on each assessment moment.reabilitAR program in patients with COPD, data from the study of Vaidya and colleagues (2016) [reabilitAR program. For this purpose, we will include 25 patients in our recruitment since PR programs have considerable dropout rates, varying between 20 and 40% [In order to detect the benefits of the s (2016) , by usin was 4.2 , resultireabilitAR program will be verified using paired t-test or Wilcoxon signed-rank tests, accordingly to data normality. Differences between the different time points will be assessed using a one-way analysis of variance with repeated measures to establish the significant effects of time. With a significant effect of time, post hoc analyses will be made with pairwise comparisons using the Bonferroni correction.Statistical analyses will be performed using IBM SPSS Statistics  with a level of significance of 0.05. Descriptive statistics  will be used to describe the patients. The benefits of the reabilitAR program content, which is the most important factor in the development of PR programs. This statement is proved by the evidence, where the benefits of the structured home-based models are already comparable to those obtained with the hospital-based PR [This real-world protocol presents the first nationwide home-based PR program in Portugal, focusing on enhancing patients’ access to PR. During the development of this program, the collaboration of national and international clinical experts in PR has ensured the highest standards, with a structured and personalized intervention. These strategies allowed to increase the quality of based PR , which mbased PR ,41, focuOne of the important steps in the development of our program was the choice of the outcomes measures to demonstrate its benefits, since this program is totally conducted in the patients’ homes, including the assessments moments and intervention. The mMRC, CAT and LCADL are recommended by the PR guidelines  and theiFor the assessment of the physical component, the 1MSTS was chosen because it requires limited equipment and space , unlike reabilitAR program could offer is the full assessment of the health experience of patients with CRD, according to the International Classification of Functioning, Disability, and Health (ICF) [Another important aspect that the th (ICF) . Traditith (ICF) ,54. The reabilitAR program complies one of the recommendations of the ATS/ERS Policy Statement for the long-term adherence to health enhancing behaviors, as a key goal of PR for patients with CRD [In the literature, we can find evidence that indicates that home-based programs with longer durations can have longer-lasting benefits . Additiowith CRD . Currentwith CRD , where oThis initiative to develop an alternative model of PR reflects the Portuguese Government’s concerns to provide appropriate responses to CRD patients’ needs and increase their access to PR according to their geographic distribution . It is areabilitAR program. Nevertheless, the exercise intensity is selected by the perceived dyspnea and fatigue on the modified Borg scale [It is important to acknowledge the limitations of this protocol. With the intent to implement a real-world home-based PR, patients’ referral to the program is mandatorily done through a medical doctor, rather than directly through the program. Therefore, the number of patients validated to the program is exclusively dependent on the number of medical referrals. In order to overcome this barrier, this program also has the objective to raise awareness amongst health professionals about PR, its benefits, the target population, referrals, and the available program. Another concrete limitation is the option for exercise training. According to the Portuguese orientation of the Directorate-General of Health for PR , grounderg scale ,18, whicreabilitAR program represents the ideal opportunity to explore future research to advance evidence-based in home-based PR. One proposal is to assess the maximal voluntary muscles contraction with handheld dynamometer to explore the characterization of the muscular strength and its short- and long-term effects with home-based PR in patients with CRD. The assessment of this outcome is important since it is served as a predictor of mortality [The implementation of the ortality . AnotherreabilitAR program will enhance the patients’ access to PR in Portugal and provide an evidence-based insight into the positive impact on symptoms, emotional status, functional capacity, and physical activity in patients with CRD.We expect that the