RESUMEN
Gender stereotypes and lack of access to relatable role models, mentors, and STEM opportunities have been suggested to deter middle school girls and students from underrepresented backgrounds away from STEM. Seeds of Success, an out-of-school program, is designed to inspire girls to consider STEM careers by countering gender stereotypes through relatable role models, promoting STEM confidence through STEM workshops and hands-on activities, and encouraging alignment between cultural and STEM identities through community-based STEM projects that develop leadership skills. Since 2015, the program has impacted 453 students who in turn have reached more than 42,777 people in Puerto Rico through their STEM Ambassadors projects. A robust mix-method evaluation of the 2020 and 2021 cohorts demonstrates significant improvements in participants' STEM attitudes and science identity, as well as in their self-perception as a leader, confidence in their ability to succeed in science, knowledge about STEM careers and opportunities, and access to STEM role models. Moreover, 95% of participants intend to continue participating in STEM activities after the program and overall scores for the entire survey were significantly higher after the program than before. We discuss lessons learned for other programs seeking to empower girls from historically underserved backgrounds in STEM.
RESUMEN
Optimal treatment outcomes for breast cancer are dependent on a timely diagnosis followed by an organized, multidisciplinary approach to care. However, in many low- and middle-income countries, effective care management pathways can be difficult to follow because of financial constraints, a lack of resources, an insufficiently trained workforce, and/or poor infrastructure. On the basis of prior work by the Breast Health Global Initiative, this article proposes a phased implementation strategy for developing sustainable approaches to enhancing patient care in limited-resource settings by creating roadmaps that are individualized and adapted to the baseline environment. This strategy proposes that, after a situational analysis, implementation phases begin with bolstering palliative care capacity, especially in settings where a late-stage diagnosis is common. This is followed by strengthening the patient pathway, with consideration given to a dynamic balance between centralization of services into centers of excellence to achieve better quality and decentralization of services to increase patient access. The use of resource checklists ensures that comprehensive therapy or palliative care can be delivered safely and effectively. Episodic or continuous monitoring with established process and quality metrics facilitates ongoing assessment, which should drive continual process improvements. A series of case studies provides a snapshot of country experiences with enhancing patient care, including the implementation of national cancer control plans in Kenya, palliative care in Romania, the introduction of a 1-stop clinic for diagnosis in Brazil, the surgical management of breast cancer in India, and the establishment of a women's cancer center in Ghana.