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Association between serum vitamin D and severe headache or migraine: A population-based analysis

Background Vitamin D is thought to play a role in the development of migraine, but the nature of the relationship is still not fully understood. Although some studies have shown an association between vitamin D deficiency and migraine, other studies have had inconsistent or inconclusive results. Therefore, further research is needed to better understand the relationship between vitamin D and migraine headaches. Methods We selected 9142 participants from the 2001–2004 National Health and Nutrition Examination Survey (NHANES). In our study, the term "serum vitamin D" refers to the concentration of 25OHD2 + 25OHD3 (nmol/L) in the blood. Migraine was assessed based on self-reports in the miscellaneous pain section of the NHANES questionnaire. Associations between vitamin D and the risk of migraine were examined using multiple logistic regression, smoothed curve fitting, and stratified analyses. Results In our study, 20.53% of the participants suffered from migraine. The prevalence of migraine was higher in those with lower serum vitamin D levels. Participants in the highest quartile of serum vitamin D levels were found to have a 16% lower prevalence than those in the lowest quartile in the fully adjusted model (OR = 0.84, 95% CI 0.71–0.99). This result was supported by stratified analysis and smoothed curve fitting. Conclusion Our study showed a significant negative correlation between serum vitamin D levels and the prevalence of migraine in American adults.

Association between exclusive or dual use of combustible cigarettes and heated tobacco products and depressive symptoms

Purpose Despite the advent of heated tobacco products (HTPs), their relationship to mental health remains unclear. This study aimed to determine associations between the use of combustible cigarettes (CCs) and HTPs with depressive symptoms. Methods This descriptive-analytical cross-sectional study was conducted in March 2023. Using the 8th Korea National Health and Nutrition Examination Survey, 5,349 adults aged 19 years or older were classified into four groups: non-users, CC-only users, HTP-only users, and dual users. Relationships between exclusive or dual use of CCs and HTPs and depressive symptoms were analyzed using item scores and total scores of the Patient Health Questionnaire-9 (PHQ-9). To examine associations between exclusive or dual use of CCs and HTPs and depressive symptoms, a multinomial regression analysis was performed using the PHQ-9 total score. Results HTP-only users had the highest proportion of those with anhedonia and depressed mood. CC-only users had the highest proportion of individuals with trouble sleeping, while dual users had a higher proportion of those with fatigue and appetite problems. After adjusting for general characteristics, compared to non-users, CC-only users were more likely to have mild and moderate to severe depressive symptoms. HTP-only users and dual users were also more likely to have moderate to severe depressive symptoms. Conclusions All smokers have a higher risk of depression than non-smokers. Health care providers should closely monitor depressive symptoms, especially in HTP users and dual users of tobacco products.

Investigating the contributors to hit-and-run crashes using gradient boosting decision trees

A classification prediction model is established based on a nonlinear method—Gradient Boosting Decision Tree (GBDT) to investigate the factors contributing to a perpetrator’s escape behavior in hit-and-run crashes. Given the U.S. Crash Report Sampling System (CRSS) dataset, the model is trained and compared with the state-of-art methods (Classification and Regression Tree, Random Forest, and Logistic Regression). The results show that the GBDT outperforms other methods, achieving the lowest negative log-likelihood (0.282), misclassification rate (0.096), and the highest AUC (0.803). GBDT also demonstrates superior computational efficiency, with a LIFT value of 4.087, making it a more accurate and efficient model for predicting hit-and-run crashes compared to CART, Random Forest, and Logistic Regression. The results obtained from the GBDT show that the relative importance of crash type and relation to trafficway rank 4th and 5th, respectively. Neither is mentioned in previous studies, indicating that GBDT has the ability to mine hidden information. In addition, the interaction between influencing variables can also be obtained to investigate the joint effect of various variables. The results of this study have practical applications in hit-and-run incident prevention, accident safety analysis, and other engineering applications.

Using DNA metabarcoding and direct behavioural observations to identify the diet of proboscis monkeys (Nasalis larvatus) in the Kinabatangan Floodplain, Sabah

Characterizing the feeding ecology of threatened species is essential to establish appropriate conservation strategies. We focused our study on the proboscis monkey (Nasalis larvatus), an endangered primate species which is endemic to the island of Borneo. Our survey was conducted in the Lower Kinabatangan Wildlife Sanctuary (LKWS), a riverine protected area that is surrounded by oil palm plantations. We aimed to determine the diet of multiple proboscis monkey groups by using two methods. First, we conducted boat-based direct observations (scan and ad libitum sampling) and identified 67 plant species consumed by the monkeys at their sleeping sites in early mornings and late afternoons. Secondly, we used the DNA metabarcoding approach, based on next-generation sequencing (NGS, MiSeq Illumina) of faecal samples (n = 155), using the short chloroplast sequence, the trnL (UAA) P6 loop. In addition, we built a DNA reference database with the local plants available in the LKWS. When combining feeding data from both methods, we reported a diverse dietary ecology in proboscis monkeys, with at least 89 consumed plant taxa, belonging to 76 genera and 45 families. Moreover, we were able to add 22 new genera as part of the diet of this endangered colobine primate in the LKWS. The two methods provided congruent and complementary results, both having their advantages and limitations. This study contributed to enhance the knowledge on the feeding ecology of proboscis monkeys, highlighting the significance of several plant species that should further be considered in habitat restoration plans or corridor establishment.

Automated CAD system for early detection and classification of pancreatic cancer using deep learning model

Accurate diagnosis of pancreatic cancer using CT scan images is critical for early detection and treatment, potentially saving numerous lives globally. Manual identification of pancreatic tumors by radiologists is challenging and time-consuming due to the complex nature of CT scan images and variations in tumor shape, size, and location of the pancreatic tumor also make it challenging to detect and classify different types of tumors. Thus, to address this challenge we proposed a four-stage framework of computer-aided diagnosis systems. In the preprocessing stage, the input image resizes into 227 × 227 dimensions then converts the RGB image into a grayscale image, and enhances the image by removing noise without blurring edges by applying anisotropic diffusion filtering. In the segmentation stage, the preprocessed grayscale image a binary image is created based on a threshold, highlighting the edges by Sobel filtering, and watershed segmentation to segment the tumor region and we also implement the U-Net method for segmentation. Then refine the geometric structure of the image using morphological operation and extracting the texture features from the image using a gray-level co-occurrence matrix computed by analyzing the spatial relationship of pixel intensities in the refined image, counting the occurrences of pixel pairs with specific intensity values and spatial relationships. The detection stage analyzes the tumor region’s extracted features characteristics by labeling the connected components and selecting the region with the highest density to locate the tumor area, achieving a good accuracy of 99.64%. In the classification stage, the system classifies the detected tumor into the normal, pancreatic tumor, then into benign, pre-malignant, or malignant using a proposed reduced 11-layer AlexNet model. The classification stage attained an accuracy level of 98.72%, an AUC of 0.9979, and an overall system average processing time of 1.51 seconds, demonstrating the capability of the system to effectively and efficiently identify and classify pancreatic cancers.

The survey of vaccination hesitancy among the residents in Jinan

Introduction Vaccination is an important way to prevent disease, but vaccine hesitancy will impact vaccine coverage and indirectly affect health. This study aims to survey the status of vaccine hesitancy among adults in Jinan. Methods A cross-sectional study was conducted using the vaccine hesitancy scale among the parents of children and teenagers at hospitals in Jinan, China. We described the attitude of the parents to the vaccination through the dimensions of confidence (items: L1-L7) and the risk (items:L8-L10).The participants will be regarded as lacking confidence if the score is over 21 among the items (L1-L7), and participants will consider the vaccination to be a “Risk” if the score is over 9 among the items (L8-L10). Using the chi-square test to analyse the differences of attitude between different participants. Results 202 individuals were enrolled, and most respondents (88.70%) agreed that vaccines are important for their child’s health. 33.50% agreed and strongly agreed that new vaccines carried more risks than older vaccines. The average score for the lack of confidence in the vaccination was 11±0.25. The average score for risk for vaccination was 9.92±0.04. Participants aged below 30 years, females, those with lower education, and those without medical workers in the family were more concerned about the risks of vaccines. Conclusions Participants were confident about the vaccination. But they were also concerned about the risks of vaccines. A lack of vaccine knowledge may led the participants to have hesitancy about vaccinations.

Mental health in Germany before, during and after the COVID-19 pandemic

Based on nationally representative panel data (N person-years = 40,020; N persons = 18,704; Panel Labour Market and Social Security; PASS) from 2018 to 2022, we investigate how mental health changed during and after the COVID-19 pandemic. We employ time-distributed fixed effects regressions to show that mental health (Mental Health Component Summary Score of the SF-12) decreased from the first COVID-19 wave in 2020 onward, leading to the most pronounced mental health decreases during the Delta wave, which began in August 2021. In the summer of 2022, mental health had not returned to baseline levels. An analysis of the subdomains of the mental health measure indicates that long-term negative mental health changes are mainly driven by declines in psychological well-being and calmness. Furthermore, our results indicate no clear patterns of heterogeneity between age groups, sex, income, education, migrant status, childcare responsibilities or pre-COVID-19 health status. Thus, the COVID-19 pandemic appears to have had a uniform effect on mental health in the German adult population and did not lead to a widening of health inequalities in the long run.

Cell recruitment and the origins of Anterior-Posterior asymmetries in the Drosophila wing

The mechanisms underlying the establishment of asymmetric structures during development remain elusive. The wing of Drosophila is asymmetric along the Anterior-Posterior (AP) axis, but the developmental origins of this asymmetry is unknown. Here, we investigate the contribution of cell recruitment, a process that drives cell fate differentiation in the Drosophila wing disc, to the asymmetric shape and pattern of the adult wing. Genetic impairment of cell recruitment in the wing disc results in a significant gain of AP symmetry, which results from a reduction of the region between longitudinal vein 5 and the wing margin (L5-M) in the adult wing. Morphometric analysis confirms that blocking of cell recruitment results in a more symmetric wing with respect to controls, suggesting a contribution of cell recruitment to the establishment of asymmetry in the adult wing. In order to verify if this phenotype is originated during the time in which cell recruitment occurs during larval development, we examined the expression of a reporter for the selector gene vestigial (vg) in the corresponding pro-vein regions of the wing disc, but our findings could not explain our findings in adult wings. However, the circularity of the Vg pattern significantly increases in recruitment-impaired wing discs, suggesting that cell recruitment may contribute to AP asymmetries in the adult wing shape by altering the roundness of the Vg pattern. We conclude that cell recruitment, a widespread mechanism that participates in growth and patterning of several developing systems, may contribute, at least partially, to the asymmetric shape of the Drosophila wing.

Development and validation of the health education demand scale for HPV infected patients based on KANO model

Objective The purpose of this study is to develop and validate the scale of health education demand of patients with HPV infection based on KANO model, so as to provide a tool for further exploring the types of health education demand and influencing factors of patients with HPV infection. Methods This study is a scale development and validation study using a three-stage cross-sectional design. In stage 1, a preliminary item pool is formed using literature review, semi-structured interviews and the Delphi method. In stage 2, six experts were invited to assess content validity. A cross-sectional survey was conducted on 1169 patients with HPV infection, Questionnaire results from 583 patients were used for exploratory factor analysis. In stage 3, the remaining 586 patients to validate the factor structure through confirmatory factor analysis. Results In stage 1, an initial 35-item scale was developed and the items were transformed positive and reverse based on KANO model. In stage 2, Exploratory factor analysis formed a scale of 28 items in 5 factors: disease information demand, social support, emotional demand, family support and health education style demand. Cronbach’s alpha was 0.940 for the entire scale and 0.763~0.908 for the five subscales in the positive items, 0.955 for the entire scale and 0.739~0.946 for the five subscales in reverse items. The content validity index of the scale: S-CVI/UA = 0.91, S-CVI/Ave = 0.98. In stage 3, the confirmatory factor analysis showed that the χ2/df, RMSEA, CFI and TLI of the positive items after four model modifications were 3.650, 0.067, 0.901, 0.888, and the SRMR value was < 0.001. The fitting of the five-factor model was good. Conclusion The KANO model based questionnaire on health education demand of HPV infected patients has good reliability and validity, and is suitable for the investigation of health education demand of HPV infected patients.

Suboptimal dietary knowledge predicts lower diet quality for cancer prevention among university students in Beirut

University students are at a pivotal stage of shaping cancer risk factors. Little is known about their dietary behavior in Lebanon, a country heavily burdened by cancer. This cross-sectional study assessed the dietary knowledge of and adherence to cancer prevention guidelines among university students in Beirut, Lebanon. We hypothesized that students would exhibit low knowledge, poor diet quality, and that knowledge predicted diet quality. Dietary knowledge was explored using a dedicated questionnaire, with scores above the 60th percentile considered as Knowledgeable (Kn+), and those below as less knowledgeable (Kn-). Dietary adherence to cancer prevention guidelines and the predictors of the Alternative Healthy Eating Index (AHEI)- a measure of diet quality calculated using the Modified Mediterranean Prime Screen, were also examined. The sample included 300 participants (55% females, mean age: 20 years). The mean knowledge score was 49.5%. Over 50% of students were aware of the association between red and processed meat, sodium, fruits and vegetables, obesity, and cancer. Kn+ group had a higher intake of vegetables and a lower intake of meats and sweetened beverages. Increased knowledge (B = 0.78, 95%CI: 0.18,1.37) and high physical activity (B = 4.62, 95%CI: 1.66,7.59) were associated with elevated AHEI scores. A significant positive interaction was observed between knowledge and enrollment in a health-related major. University students’ dietary knowledge of and adherence to cancer prevention guidelines are suboptimal. Although higher knowledge predicts high-quality diets, the association was weak. Further studies should investigate the food systems influencing university students’ dietary intake of university students in Lebanon and identify effective interventions to enhance health behavior.

Correction: Calcium-Activated-Calcineurin Reduces the In Vitro and In Vivo Sensitivity of Fluconazole to Candida albicans via Rta2p

Early neutrophil activation and NETs release in the pristane-induced lupus mice model

Background NETosis is recognized as an important source of autoantigens. Therefore, we hypothesized whether the pristane-induced lupus mice model shows early activation of neutrophils, the presence of low-density granulocytes (LDGs), and neutrophil extracellular traps (NETs) release, which could contribute to the development of a lupus phenotype. Methods Twelve female wild-type Balb/c mice were intraperitoneally injected with pristane (n = 6; pristane group) or saline (n = 6; control group). Five days after the injection, blood, peritoneal lavage, bone marrow, and spleen samples were collected for flow cytometry analyses of activated neutrophils (Ly6G+CD11b+), LDGs (CD15+CD14low), and NETs release (Sytox Green+). Results The pristane-induced mice group had a significantly increased number of blood activated neutrophils and LDGs as well as NETs released by these cells compared to the saline-injected control group and the basal values determined 12 days before the injection. The pristane group also had a significantly increased number of activated neutrophils, LDGs, and NETs released compared to the control group for the peritoneal lavage and bone marrow, except total cell count in spleen. Conclusions We demonstrated early changes in the innate immune response such as an increased number of activated neutrophils and LDGs and mainly increased NETosis in the pristane-induced mice model which may be considered as the primary event triggering lupus development.

Optimizing Kernel Extreme Learning Machine based on a Enhanced Adaptive Whale Optimization Algorithm for classification task

Data classification is an important research direction in machine learning. In order to effectively handle extensive datasets, researchers have introduced diverse classification algorithms. Notably, Kernel Extreme Learning Machine (KELM), as a fast and effective classification method, has received widespread attention. However, traditional KELM algorithms have some problems when dealing with large-scale data, such as the need to adjust hyperparameters, poor interpretability, and low classification accuracy. To address these problems, this paper proposes an Enhanced Adaptive Whale Optimization Algorithm to optimize Kernel Extreme Learning Machine (EAWOA-KELM). Various methods were used to improve WOA. As a first step, a novel adaptive perturbation technique employing T-distribution is proposed to perturb the optimal position and avoid being trapped in a local maximum. Secondly, the WOA’s position update formula was modified by incorporating inertia weight ω and enhancing convergence factor α, thus improving its capability for local search. Furthermore, inspired by the grey wolf optimization algorithm, use 3 excellent particle surround strategies instead of the original random selecting particles. Finally, a novel Levy flight was implemented to promote the diversity of whale distribution. Results from experiments confirm that the enhanced WOA algorithm outperforms the standard WOA algorithm in terms of both fitness value and convergence speed. EAWOA demonstrates superior optimization accuracy compared to WOA across 21 test functions, with a notable edge on certain functions. The application of the upgraded WOA algorithm in KELM significantly improves the accuracy and efficiency of data classification by optimizing hyperparameters. This paper selects 7 datasets for classification experiments. Compared with the KELM optimized by WOA, the EAWOA optimized KELM in this paper has a significant improvement in performance, with a 5%-6% lead on some datasets, indicating the effectiveness of EAWOA-KELM in classification tasks.

The impact of the centralized volume-based procurement policy on Chinese pharmaceutical manufacturing firms’ R&D investment: A difference-in-differences approach

Centralized drug procurement is a common practice worldwide to relieve the healthcare burden and promote high-quality development in the pharmaceutical industry. However, scholars have not yet reached an agreement on whether centralized procurement can facilitate the innovation activities of pharmaceutical firms. China’s centralized volume-based procurement (CVBP) implemented in 2018 provides an ideal quasi-natural experiment to evaluate the effect of centralized procurement on the R&D investment of the firms. Drawing data from listed manufacturing firms in China’s A-share market (2015–2020), the results from a difference-in-differences analysis with different model specifications indicate that the CVBP significantly promotes the pharmaceutical manufacturing firms’ R&D investment. Moreover, the positive effect of the CVBP on R&D investment is stronger in pharmaceutical manufacturing firms with high marketing expenses. A series of robustness tests including the parallel trend test, placebo test, and the PSM-DID analysis show that our findings are solid. This paper advances our understanding of centralized procurement in emerging markets and provides new insights into how governments and pharmaceutical manufacturing firms can strengthen innovation.

Assessing the drivers of sexual behavior among youth and its social determinants in Nepal

Introduction Sexual behavior among youth is a public health concern, particularly in contexts where cultural norms, socio-economic factors, and access to comprehensive sexual education play pivotal roles. This paper aims to examine the determinants of sexual behavior among Nepali youths. Methods This study analyzed data from 7,122 individuals aged 15–24 years from the Nepal Demographic and Health Survey (NDHS) 2022, focusing on a nationally representative sample. This study assessed the prevalence of sexual behaviors, including premarital sex, recent sexual activity, and multiple sexual partners. Determinants examined included socio-demographic characteristics, media use, smoking, and alcohol consumption. Bivariate and multivariate logistic regression analysis were conducted to determine the associations between social determinants and sexual behaviors. Results The prevalence of premarital sex among the youth was 10.4%, with 15% of male youths reporting recent sexual activity and 2.8% having sexual intercourse with multiple partners. Variables significantly associated with premarital sex included older age groups (AOR = 2.81; 95% CI: 1.98–3.99), male (AOR = 7.87; 95% CI: 5.00–12.39), sales occupations (AOR = 2; 95% CI:1.12–3.57), smoking (AOR = 2.71; 95% CI:1.74–4.23), smokeless tobacco products (AOR = 1.94; 95% CI:1.12–3.34), and alcohol consumption (AOR = 2.97; 95% CI:2–4.41). Variables significantly associated with recent sexual activity included older age groups (AOR = 2.1; 95% CI:1.46, 3.03), being unmarried (AOR = 9.34; 95% CI:5.19–16.82), smoking (AOR = 2.01; 95% CI:1.33–3.05), use of smokeless products (AOR = 1.7; 95% CI:1.98–3.67), and alcohol consumption (AOR = 1.91; 95% CI:1.30–2.82). Youths using smokeless products had higher odds (AOR = 3.33; 95% CI:1.75–6.35) of having multiple sexual partners compared to those youths not using smokeless products. Conclusion Social determinants, along with smoking and alcohol consumption, were associated with sexual behaviors among youth. This study highlights the need for multicomponent health promotion (new public health) interventions which consider multi-level strategies, including culturally tailored sexual health programs, drug use behaviors, healthy lifestyle choices, comprehensive sexual health education for evidence-based interventions.

Bacteriological quality of drinking water and its associated factors in Ethiopia: A systematic review and meta-analysis

Introduction Drinking contaminated water is a significant cause of mortality and morbidity in Sub-Saharan Africa, where access to safe drinking water is limited. Although numerous studies have investigated the bacteriological quality of drinking water in Ethiopia, their findings have been inconsistent and varied, hindering the implementation of effective water quality monitoring. Moreover, there is a lack of nationwide assessment of the bacteriological quality of drinking water in Ethiopia. Therefore, this systematic review and meta-analysis aimed to determine the bacteriological quality of drinking water and its associated factors in Ethiopia. Methods An international electronic database, including PubMed, Science Direct, Global Health, CINAHL, African Journals Online, HINARI, and Google Scholar was employed to retrieve the relevant articles. The study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA) guidelines. A random-effects model was used to estimate the pooled effect size, and the Egger regression model was employed using STATA 14 software to assess potential publication bias. Results A total of 26 studies involving 7,962 water samples met the eligibility criteria for meta-analysis. The pooled prevalence of at least one bacteriological contamination of drinking water was 52.26% (95%CI: 39.09–65.43), with extreme heterogeneity (I2 = 99.7%; p-value < 0.001). The pooled prevalence of total and fecal coliform in drinking water was 49.55% (95% CI: 34.88–64.23) and 44.27% (95%CI: 34.36–54.19), respectively. 14.13% of the water source was at a very high sanitary risk level (unfit for drinking), with significant heterogeneity (I2 = 94.1%, p< 0.001). The absence of household-level water treatment (OR = 3.3; 95%CI: 1.28–5.32) and drawing water using dipping methods (OR = 4.52; 95%CI: 1.71–7.34) were determinant factors for bacteriological contamination of drinking water. Conclusion We found that the bacteriological quality of drinking water did not comply with the World Health Organization and Ethiopia’s standard guidelines for drinking water, which call for urgent intervention. One out of seven water sources was at a high sanitary risk level, which could increase the risk of infectious disease in the country. The absence of household-level water treatment and drawing water using dipping was a significant factor in the bacteriological quality of drinking water. Based on these findings, the water supply and sewerage authority should prioritize regular monitoring of the bacteriological quality of drinking water.

Incorporating earned value management into income statements to improve project management profitability and elevate application in the business and management

Our goal is to improve Project Management (PM) profitability and reduce discrepancies in information among stakeholders, which can result in conflicts. This will be accomplished by incorporating Earned Value Management (EVM) with the Income Statement and incorporating earnings before interest, tax, depreciation, and amortization (EBITDA) with the work breakdown structure (WBS). These incorporations will streamline information sharing between PM, other management professionals, and the stakeholders, ultimately fostering the application of PM within broader business and management contexts. We drew on theories from Project, Operations, Financial Management, Agency Theory, and the Theory of Performance Frontiers. We conducted multiple case studies in a shipbuilding corporation with 25 projects and an aircraft manufacturing corporation with 20 projects. Our analysis involved both qualitative and quantitative methods, ensuring the accuracy and practicality of our hypotheses and instilling confidence in our research findings. This integration addresses the information gap on profitability for non-project management professionals, empowering stakeholders to enhance project performance. This integration benefits the company by allowing the project manager and stakeholders to gain real-time insights into the project’s profitability, which enables continuous optimization of daily EBITDA by improving efficiency and productivity to achieve the project’s profitability target. This study and its innovative findings originate from the author’s unique approach, which is a significant contribution to the field of Project Management. This research focused on project management using EVM in for-profit organizations. Integrating EVM in the income statement also facilitates PM application in other management systems.

Disparities in time to treatment initiation of invasive lung cancer among Black and White patients in Tennessee

Background Early initiation of treatment for lung cancer has been shown to improve patient survival. The present study investigates disparities in time to treatment initiation of invasive lung cancer within and between Black and White patients in Tennessee. Methods A population-based registry data of 42,970 individuals (Black = 4,480 and White = 38,490) diagnosed with invasive lung cancer obtained from the Tennessee Cancer Registry, 2005–2015, was analyzed. We conducted bivariate ANOVA tests to examine the difference in time to treatment initiation among independent factors, and multivariable Cox proportional hazard models to identify independent factors that influence median time to treatment initiation after diagnosis. Results When considering the estimate of the proportion of time to treatment initiation based on the combined influence of all independent factors (sex, age, race, marital, county of residence, health insurance, cancer stage, and surgical treatment), Black patients were generally more at risk of delayed treatment compared to Whites. Black patients aged <45 years (adjusted hazard ratio [aHR] = 1.40; 95% confidence interval [CI] = 1.01–1.94) and married White patients (aHR = 1.13; 95% CI = 1.07–1.18) had the highest increased risk of late treatment among their respective racial subgroups. In the general sample, patients with private health insurance had (aHR = 1.08; 95% CI = 1.01–1.16) higher risk of late treatment beyond 2.7 weeks compared to self-pay/uninsured patients. This was consistent among both Black and White subsamples. Patients with localized and regional lung cancer stages had a decreased risk of delayed treatment compared to those diagnosed at the distant stage among both Black and White patients. Conclusions Black patients were often at greater risk of late initiation of treatment for invasive lung cancer in Tennessee. Additional research is needed to understand factors influencing time to treatment initiation for Black patients in Tennessee. Further, cancer care resources are needed in Black communities to ensure timely treatment of invasive lung cancer, reduce disparities, and promote equitable care for all cancer patients.

Being “resilient” and achieving “resilience”: From governmental discourses to the national research agenda in the contexts of food insecurity and cost of living

The concept of ‘resilience’ is pervasive, permeating academic disciplines and political discourses. This paper considers (i) the construal of ‘resilience’ in the contexts of food insecurity and cost-of-living in governmental discourses in the United Kingdom (UK); (ii) to what extent the political representations are reflected in research funding calls of UK national funding bodies, thus showing possibility of shaping research agendas; and (iii) to what extent official uses of ‘resilience’ reflect lay understandings. We are combining a corpus-based discourse analysis of UK governmental discourses and research funding calls with a study of focus group discussions. Representations of ‘resilience’ are further compared with those available in general English corpora. We are observing a shift in the use of ‘resilience’: from an individual psychological attribute to a primarily socioeconomic and environmental characteristic. Funding calls construe resilience in relation to communities, reflecting economy and environment adaptability, whereas governmental discourses frame references to individuals in terms of ‘vulnerability’. Focus groups reveal divergent conceptions of ‘resilience’, which may lead to potential misunderstandings. While this variety of uses may be productive in political discourses for rhetorical purposes, there is a need for specificity in shaping research and in public-facing communications.

Age-related disparities in national maternal mortality trends: A population-based study

Objective An upward trend in maternal age has been observed in the United States (US) over the last twenty years. The study objective was to examine the association of maternal age with maternal mortality in the US and examine temporal trends in mortality by maternal age. Methods A retrospective population-based analysis in the US between 2000–2019 was conducted using records from the Centers for Disease Control and Prevention’s “Mortality Multiple Cause” and “Birth Data” files. Annual incidence and period trends in maternal deaths were calculated using the annual maternal deaths over annual live births across age groups. Multivariate logistic regression models were used to estimate the association between maternal age and risk of maternal mortality and calculate temporal changes in risk of mortality over the study period. Results Between 2000–2019, 21,241 deaths were observed in women during pregnancy and childbirth for an average incidence of 26.3 maternal deaths/100,000 births (95% CI 21.8–31.2). Of all deaths, 6,870 (32.3%) were in women ≥35 years, while only 15.1% of live births were attributed to women ≥35 years. Compared with women 25–29 years of age, there was a significantly greater risk of maternal mortality among women 35–39 (OR 1.60, 1.53–1.67), 40–44 (3.78, 3.60–3.99), 45–49 (28.49, 26.49–30.65) and 50–54 (343.50, 319.44–369.37). Risk of mortality increased over time, with the greatest rise in women ≥35 years. Conclusion In the US, maternal mortality increased during the past two decades, especially in women ≥35 years. Given these findings, targeted strategies to reduce the increasing maternal mortality should become a priority.