Cost Barriers Research Articles

Abstract PO3-27-07: Age at diagnosis and the food environment are associated with postdiagnosis weight gain among Black American breast cancer survivors in Maryland

Abstract Background: Weight management is now included in the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guidelines due to its clinical impact on breast cancer (BC) survivorship outcomes. While numerous individual-level risk factors for weight gain after BC diagnosis have been identified, such as younger age at diagnosis, cancer stage, and cancer treatments (chemotherapy), there are limited data on the impact of neighborhood-level factors associated with weight change postdiagnosis among Black BC survivors. Methods: Utilizing social media recruitment strategies and survivor networks, we recruited 100 Black female BC survivors to complete an online survey, including demographic, clinical characteristics, and lifestyle factors, between January 5, 2022, and August 18, 2022. To capture the food environment, we utilized the 2023 Food Environment Index County Health Rankings, which accounts for access to healthy foods due to proximity and income (considering the distance an individual lives from a grocery store or supermarket, locations for health food purchases in most communities, and the inability to access healthy food because of cost barriers). The index ranges from 0 (worst) to 10 (best). Our outcome of postdiagnosis weight gain was calculated as percent weight change from time at diagnosis to time of survey, calculated as ([weight at survey – weight at diagnosis]/weight at diagnosis) × 100. Participants were grouped into mutually exclusive categories of stable weight (within ± 3%) or weight loss (≤-3%) compared to weight gain (≥ 3%). Adjusted odds ratios (aORs) and 95% confidence intervals (CI) were calculated for the associations between clinical factors, county-level food environment index, and postdiagnosis weight gain. Results: The average ages at time of survey and at primary BC diagnosis were 58.6 years (standard deviation [SD]= 10.1) and 49.1 years (SD=10.2), respectively. Most women (70%) were diagnosed with invasive BC and only 22% were currently undergoing treatment at the time of the survey. While only 7% reported being obese at the time of BC diagnosis, 54% reported being obese at the time of survey which was on average 9 years post-BC diagnosis; and while 61 women had weight loss or stable weight, 34 women experienced weight gain postdiagnosis. Among the 95 women included in multivariable models who reported weight and height measurements for calculating weight change, women ≥50 years of age at BC diagnosis (versus < 50 years) were 3.43 times more likely to gain weight after diagnosis (95% CI 1.13-11.50). Women living in counties with a Food Environment Index ≥8.8 (median cut-point compared to < 8.8) were significantly less likely to experience weight gain (aOR 0.11; 95% CI 0.01-0.90). Stage and BC treatments were not significantly associated with weight gain. Conclusions: Our study findings demonstrate the importance of evaluating the food environment during BC survivorship and longitudinal monitoring of weight postdiagnosis to mitigate weight gain among Black BC survivors. Our findings will be used to inform a larger prospective study and future interventions among this population. Citation Format: Avonne Connor, Katherine Ho, Kate Dibble, Kala Visvanathan. Age at diagnosis and the food environment are associated with postdiagnosis weight gain among Black American breast cancer survivors in Maryland [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-27-07.

A Survey of Mobile Application Based Collision Detection Alert System for Motor Vehicles

Accidents involving motor vehicles are a big problem on a global scale, and they frequently result in terrible deaths. Responding to emergencies in a timely manner is absolutely necessary in order to improve survival rates in instances like these. Alternatively, this reaction time is dependent upon the presence of automatic in-vehicle crash detection and reporting approaches, which are commonly seen in high-end or luxury automobiles. Due of this, there is a gap in safety, particularly in low-end automobiles, which are widespread in developing nations. Original equipment manufacturers (OEMs) do not often install such devices in their vehicles. This research provides a unique way to solve this important issue, which is an autonomous collision detection system which uses smartphones. Our method makes use of the sensor capabilities of cellphones, such as Accelerometer, Gyroscope,GPS and GSM , in order to correctly detect collisions. This is accomplished despite the limits of the sensors, which includes range and sensitivity. As a result of this, this system presents an option that is more cost-effective than the expensive collision detection systems that are combined with the premium automobiles. In addition, this method eliminates the cost barrier, which enables it to be compatible with Android devices whereas it was previously only compatible with iPhones. The focus of this approach is mainly placed on the significance of minimising reaction times in the event of traffic accidents. It highlights the disparity between different car categories in terms of safety features and provides the solution that is based on smartphones.

Single-cell transcriptomics: background, technologies, applications, and challenges.

Single-cell sequencing was developed as a high-throughput tool to elucidate unusual and transient cell states that are barely visible in the bulk. This technology reveals the evolutionary status of cells and differences between populations, helps to identify unique cell subtypes and states, reveals regulatory relationships between genes, targets and molecular mechanisms in disease processes, tumor heterogeneity, the state of the immune environment, etc. However, the high cost and technical limitations of single-cell sequencing initially prevented its widespread application, but with advances in research, numerous new single-cell sequencing techniques have been discovered, lowering the cost barrier. Many single-cell sequencing platforms and bioinformatics methods have recently become commercially available, allowing researchers to make fascinating observations. They are now increasingly being used in various industries. Several protocols have been discovered in this context and each technique has unique characteristics, capabilities and challenges. This review presents the latest advancements in single-cell transcriptomics technologies. This includes single-cell transcriptomics approaches, workflows and statistical approaches to data processing, as well as the potential advances, applications, opportunities and challenges of single-cell transcriptomics technology. You will also get an overview of the entry points for spatial transcriptomics and multi-omics.

Is private insurance enough to address barriers to accessing dental care? Findings from a Canadian population-based study

BackgroundIn Canada, as in many other countries, private dental insurance addresses financial barriers to a great extent thereby facilitating access to dental care. That said, insurance does not guarantee affordability, as there are issues with the quality and level of coverage of insurance plans. As such, individuals facing barriers to dental care experience poorer oral health. Therefore, it is important to examine more keenly the socio-demographic attributes of people with private insurance to particularly identify those, who despite having insurance, face challenges in accessing dental care and experience poorer oral health.MethodsThis study is a secondary data analysis of the most recent available cycle (2017-18) of the Canadian Community Health Survey (CCHS), a national cross-sectional survey. Univariate analysis was conducted to determine the characteristics of Ontarians with private insurance (n = 17,678 representing 6919,814 Ontarians)—bivariate analysis to explore their financial barriers to dental care, and how they perceive their oral health. Additionally, logistic regressions were conducted to identify relationships between covariates and outcome variables.ResultsAnalysis shows that the majority of those with private insurance do not experience cost barriers to dental care and perceive their oral health as good to excellent. However, specific populations, including those aged 20–39 years, and those earning less than $40,000, despite having private dental insurance, face significantly more cost barriers to access to care compared to their counterparts. Additionally, those with the lowest income (earning less than $20,000 annually) perceived their oral health as “fair to poor” more than those earning more. Adjusted estimates revealed that respondents aged 20–39 were six times more likely to report cost barriers to dental care and ten times more likely to visit the dentist only for emergencies than those aged 12–19. Additionally, those aged 40–59 were two times more likely to report poorer oral health status compared to those aged 12–19.ConclusionGiven the upcoming implementation of the Canadian Dental Care Plan, the results of this study can support in identifying vulnerable populations who currently are ineligible for the Plan but can be benefitted from the coverage.

Money and place: Quantifying the types of obstacles associated with seeking an abortion after 10 weeks’ gestation, 2019–2020

ObjectiveIdentify factors associated with presenting for abortion after 10 weeks’ gestation in a large, geographically diverse sample. Study DesignFrom October 2019 to March 2020, we surveyed 1,089 patients seeking abortion at 7 U.S. facilities. We identified four domains of barriers: geographic, financial, logistical/personal, and legislative. Using multivariable logistic regression, we investigated the relationship between each domain and presenting for abortion after 10 weeks’ gestation, overall and stratified by state policy landscape. ResultsOne-third of participants reported geographic (33.0%), financial (33.3%), and logistical/personal (31.4%) barriers; fewer (4.8%) reported legislative barriers. One-third (30.8%) traveled over 50 miles to the clinic. One-quarter (25.2%) presented after 10 weeks’ gestation. In multivariable analyses, financial barriers (adjusted Odds Ratio (aOR)=1.49, 95% Confidence Interval (CI)=1.06-2.09), geographic barriers (aOR=2.05, 95% CI=1.44-2.90) and difficulty meeting basic expenses (aOR=1.47, 95% CI=1.15-1.89) were associated with presenting after 10 weeks’ gestation across the 7 clinics. Among participants accessing care at clinics in states with supportive abortion policies (n=178), geographic barriers remained significantly associated with presenting after 10 weeks’ gestation. ConclusionIn a large, geographically diverse sample, financial and geographic barriers were associated with presenting after the threshold for medication abortion. In supportive states, the association with geographic barriers persisted. Cost and geographic barriers are increasing as more states restrict abortion post-Dobbs, highlighting the urgent need to expand financial and travel support. ImplicationsPeople seeking abortion faced barriers before the Dobbs decision. Now post-Dobbs, restrictions to abortion have only increased, making barriers to care even more threatening. Providing access to financial resources and transportation for people seeking abortion and expanding telehealth medication abortion is now even more important.

Implementation of a Global Pediatric Trauma Course in an Upper Middle–Income Country: A Pilot Study

IntroductionOver 90% of pediatric trauma deaths occur in low- and middle-income countries (LMICs), yet pediatric trauma-focused training remains unstandardized and inaccessible, especially in LMICs. In Brazil, where trauma is the leading cause of death for children over age 1, we piloted the first global adaptation of the Trauma Resuscitation in Kids (TRIK) course and assessed its feasibility. MethodsA 2-day simulation-based global TRIK course was hosted in Belo Horizonte in October 2022, led by one Brazilian and four Canadian instructors. The enrollment fee was $200 USD, and course registration sold out in 4 d. We administered a knowledge test before and after the course and a postcourse self-evaluation. We recorded each simulation to assess participants’ performance, reflected in a team performance score. Groups received numerical scores for these three areas, which were equally weighted to calculate a final performance score. The scores given by the two evaluators were then averaged. As groups performed the specific simulations in varying orders, the simulations were grouped into four time blocks for analysis of performance over time. Statistical analysis utilized a combination of descriptive analysis, Wilcoxon signed-rank tests, Kruskal–Wallis tests, and Wilcoxon rank-sum tests. ResultsTwenty-one surgeons (19 pediatric, one trauma, one general) representing four of five regions in Brazil consented to study participation. Women comprised 76% (16/21) of participants. Overall, participants scored higher on the knowledge assessment after the course (68% versus 76%; z = 3.046, P < 0.001). Participants reported improved knowledge for all tested components of trauma management (P < 0.001). The average simulation performance score increased from 66% on day 1% to 73% on day 2, although this increase was not statistically significant. All participants reported they were more confident managing pediatric trauma after the course and would recommend the course to others. ConclusionsCompletion of global TRIK improved surgeons’ confidence, knowledge, and clinical decision-making skills in managing pediatric trauma, suggesting a standardized course may improve pediatric trauma care and outcomes in LMICs. We plan to more closely address cost, language, and resource barriers to implementing protocolized trauma training in LMICs with the aim to improve patient outcomes and equity in trauma care globally.

Hydrogen Role on the Properties of Silicon Nitride for Flexible Thin Film Encapsulation

High transmittance, high density, and good mechanical properties of silicon nitride (SiNx) make it a potential candidate for barrier layers of flexible organic light emission diodes (FOLEDs). However, the overall characteristics and water oxygen barrier properties of the films are easily affected by the dangling bonds in the films. After adding hydrogen flow rate to the deposition conditions of SiNx films, the hydrogen content interacts with the dangling bonds in amorphous SiNx, which could reduce the number of dangling bonds and improve the density of the hydrogenated amorphous silicon nitride (SiNxHy) films. The high‐density film layer could effectively prevent the invasion of water vapor due to its smaller pinhole density. Therefore, the water oxygen barrier performance of SiNxHy is significantly improved, the maximum decrease in water vapor transmittance rate (WVTR) value is approximately 22.4%. In addition, the increase of hydrogen content also changed the overall properties of the films, including transmittance, elastic modulus, hardness, residual stress, and fracture strain. Therefore, compared with SiNx films, SiNxHy films have more excellent mechanical and optical properties. The SiNxHy films featuring a simplified preparation process with high efficiency, low cost, and superior barrier performance is of great potential for the commercial applications.

The competitiveness of South African table grape exports in the European markets: Threats from Peru and Chile

ABSTRACT International trade in table grapes is expanding rapidly, with Peru overtaking South Africa as the second-largest exporter from the Southern Hemisphere behind Chile. The primary objective of the study was to the determine whether South Africa, with 75% of its exports destined for Europe, will be negatively affected by changes in Peru and Chile's export orientation. This question is addressed by breaking it down into four key factors. The first is the role of policy by applying Anderson et al.'s (2006) empirical framework of nominal rate of assistance (NRA) followed by measures of competitiveness, namely relative trade advantage (RTA), normalised revealed comparative advantage (NRCA) and the logarithmic relative export advantage (InRXA). The last two measures – indirect freight cost and trade barriers - zoom in on trade from one country to a specific destination. The results and discussion highlight that Peru, operating in close to a zero-distorted environment, has the potential to increase its competitiveness in the global table grape market. Whilst South Africa's table grape exporters also have this potential, given the advantages of a depreciating rand, broader and more favourable market access outside the EU and UK is paramount.

History and Current State of Neurosurgery in the Gambia

BackgroundDespite global efforts to improve surgical care access, many low and middle-income countries, especially in neurosurgery, face significant shortages. The Gambia exemplifies this, with only one fully qualified neurosurgeon serving its population of 2.5 million people. This scarcity results in higher morbidity and mortality. ObjectiveWe aim to document the history and current state of neurosurgery in The Gambia to raise awareness and promote neurosurgery development. MethodsThe study reviews The Gambia's healthcare system, infrastructure, neurosurgical history, workforce, disease burden, and progress, with information derived from reference sources as well as author experience and interviews with key partners in Gambian healthcare. ResultsNeurosurgery in The Gambia began in the 1970s, facing constraints due to competing healthcare demands. Significant progress occurred much later in the early 2010s, marked by the initiation of Banjul Neuro-Missions and the establishment of a dedicated neurosurgery unit.We report significant progress with neurosurgical interventions in the past few years showcasing the unit's dedication to advancing neurosurgical care in the Gambia. However, challenges persist, including a lack of trained neurosurgeons, equipment shortages such as ventilators and diagnostic imaging. Financial barriers for patients, particularly related to the costs of CT scans, pose significant hurdles, impacting the timely diagnosis and intervention for neurological conditions. ConclusionNeurosurgery in Gambia is progressing, but challenges like equipment scarcity hinder further progress. We emphasize the need for addressing cost barriers, improving infrastructure, and fostering research. Engaging the government and international collaborations are vital for sustained development in Gambian neurosurgery.

Development of DCS SCADA Module for Factory I/O Pick and Place XYZ Case Based on Siemens S7-1200 PLC and HMI Excel Link

The DCS SCADA course plays a significant role in the latest curriculum introduced at Politeknik ATI Makassar in 2022. However, the utilization of real plant instrumentation in industrial environments often proves costly. To overcome this cost barrier, this research develops a DCS SCADA module employing an industrial simulation application, namely the virtual plant Factory I/O, with a case study involving Pick and Place XYZ. This scenario entails the placement of boxes onto pallets using a three-axis robotic manipulator. The module utilizes the PLC Siemens S7-1200 as the control device and HMI Excel Link as the supervisory device. To detect the boxes and parts, two retroreflective sensors are employed, with three conveyors facilitating transportation and a robotic pick and place arm moving in three XYZ axes. Through integrated procedural testing, the system's performance evaluation demonstrates a 100% success rate (OK status).

Stigma, risks, and benefits of medicinal cannabis use among Australians with cancer.

People with cancer who use medicinal cannabis do so despite risks associated with limited clinical evidence, legalities, and stigma. This study investigated how Australians with cancer rationalise their medicinal cannabis use despite its risks. Ten adults (5 males and 5 females; mean age of 53.3) who used cannabis medicinally for their cancer were interviewed in 2021-2022 about how they used and accessed the substance, attitudes and beliefs underpinning their use, and conversations with others about medicinal cannabis. Participants had cancer of the bowel, skin, oesophagus, stomach, thyroid, breast, and Hodgkin lymphoma for which they were receiving treatment (n = 5) or under surveillance (n = 5), with most (n = 6) encountering metastatic disease. Cannabis was used to treat a variety of cancer-related symptoms such as pain, poor sleep, and low mood. Cannabis was perceived as natural and thus less risky than pharmaceuticals. Participants legitimised their medicinal cannabis use by emphasising its natural qualities and distancing themselves from problematic users or riskier substances. Cost barriers and a lack of healthcare professional communication impeded prescription access. Similarly, participants navigated medicinal cannabis use independently due to a lack of guidance from healthcare professionals. Findings highlight the need for robust data regarding the harms and efficacy of medicinal cannabis and dissemination of such information among healthcare professionals and to patients who choose to use the substance. Ensuring healthcare professionals are equipped to provide non-judgmental and evidence-based guidance may mitigate potential safety and legal risks.

Structure, Properties, and Recent Developments in Polysaccharide- and Aliphatic Polyester-Based Packaging—A Review

Food packaging plays an imperative role in the food processing sector by safeguarding foods from their point of harvesting until the moment of consumption. In recent years, biopolymers have attracted the attention of the scientific community as an alternative to conventional packaging materials. Among the available biopolymer sources, a lot of the focus has been on polysaccharides due to their superior barrier properties against gases, oils, and odors and their processing versatility. Moreover, there is also a growing interest in aliphatic polyester as a potential replacement for petrochemical-based synthetic plastics. Both polysaccharides and aliphatic polyesters have gained popularity in sustainable food packaging due to their unique characteristics, including their low cost, availability, biodegradability, gas and moisture barrier properties, film-forming capabilities, excellent heat resistance, and ability to be processed into films, trays, and coatings. This review highlights the structural features, properties, and recent advancements of several vital polysaccharides, namely, starch, chitosan, cellulose, alginate, pectin, carrageenan, and aliphatic polyesters, including polylactic acid (PLA) and polyhydroxybutyrate (PHB) for developing packaging materials, and their applications in the food industry. Conventional packaging and future perspectives of biopolymer-based food packaging are also comprehensively covered in this review.

Pathway toward Scalable Energy-Efficient Li-Mediated Ammonia Synthesis.

Lithium-mediated ammonia synthesis (LiMAS) is an emerging electrochemical method for NH3 production, featuring a meticulous three-step process involving Li+ electrodeposition, Li nitridation, and Li3N protolysis. The essence lies in the electrodeposition of Li+, a critical phase demanding current oscillations to fortify the solid-electrolyte interface (SEI) and ensure voltage stability. This distinctive operational cadence orchestrates Li nitridation and Li3N protolysis, profoundly influencing the NH3 selectivity. Increasing N2 pressure enhances the NH3 faradaic efficiency (FE) up to 20 bar, beyond which proton availability controls selectivity between Li nitridation and Li3N protolysis. The proton donor, typically alcohols, is a key factor, with 1-butanol observed to yield the highest NH3 FE. Counterion in the Li salt is also observed to be significant, with larger anions (e.g., exemplified by BF4-) improving SEI stability, directly impacting LiMAS efficacy. Notably, we report a peak NH3 FE of ∼70% and an NH3 current density of ∼-100 mA/cm2 via a delicate balance of process conditions, encompassing N2 pressure, proton donor, Li salt, and their respective concentrations. In contrast to the recent literature, we find that the theoretical maximum energy efficiency of LiMAS hinges significantly on the proton source, with LiMAS utilizing H2O calculated to have a maximum achievable energy efficiency of 27.8%. Despite inherent challenges, a technoeconomic analysis suggests high-pressure LiMAS to be more feasible than both ambient LiMAS and a modified green Haber-Bosch process. Our analysis finds that, at a 100 mA/cm2 NH3 current density and a 6 V cell voltage, LiMAS delivers green NH3 at an all-inclusive cost of $456 per ton, significantly lower than conventional cost barriers. Our economic analysis underscores high-pressure LiMAS as a potentially transformative technology that may revolutionize large-scale NH3 production, paving the way for a sustainable future.

Insurance Coverage for Gender-Affirming Voice and Communication Services: An In-Depth Analysis in a Midwestern U.S. State

Purpose: The aim of this study was to explore the gap between the need for gender-affirming voice and communication services (GAVCS) and insurance coverage within one state. Method: An electronic, cross-sectional survey of transgender/gender-diverse (TGD) adults assessed the incidence of insurance and cost barriers to GAVCS. Then, policies from 22 major insurers were reviewed using a web-based search and telephone inquiries. Finally, a tool was developed for clinicians to share available coverage for GAVCS by insurer. Results: Over half (53%) of 115 respondents reported vocal incongruence, but only 19.1% had pursued GAVCS. Of those who had not, 57% reported cost and/or insurance coverage were barriers (most of whom were commercially insured). Less than half of major Ohio insurance plans mentioned GAVCS coverage, and of those who did, less than half would consider covering it on a case-by-case basis. Creation of a tool that explained coverage across insurance companies was helpful, but challenging and labor-intensive. Conclusions: TGD individuals often experience a mismatch between their gender identity and societal perceptions of their voice, which can worsen dysphoria and compromise safety. GAVCS align voice with gender identity but are inconsistently covered by health insurance and can be costly, particularly for individuals who face socioeconomic marginalization. Inconsistent transparency in communicating coverage criteria further exacerbates access to GAVCS. Poor insurance coverage of GAVCS is an important barrier to accessing this evidence-based care, and more transparency and consistency in coverage is critical.

Marketing Strategy and Preference Analysis of Electric Cars in a Developing Country: A Perspective from the Philippines

The wide-scale integration of electric vehicles (EVs) in developed countries represents a significant technological innovation and a step toward reducing carbon emissions from transportation. Conversely, in developing nations like the Philippines, the adoption and availability of EVs have not been as rapid or widespread compared to other countries. In identifying this gap, this study delved into the preferences and factors influencing Filipino consumers’ willingness to purchase EVs. The study gathered 311 valid responses utilizing conjoint analysis with an orthogonal approach to assess the attributes influencing customers’ purchase decisions. Conjoint analysis tools such as IBM SPSS v25 statistics were utilized to infer consumer preference. The results determined that cost is the primary concern for consumers by a considerable margin; followed by battery type and charging method; along with the type of EV, driving range, and charging speed; and most minor concern is regenerative brakes. Therefore, there is an apparent sensitivity to price and technology. This study is the first to apply conjoint analysis to the Philippine market, delivering in-depth consumer preference insights that can help manufacturers and policymakers customize their approach to making EVs more attractive and more viable in less developed markets. The results suggest that a targeted effort to overcome cost barriers and improve technological literacy among prospective buyers should be productive for speeding up EV adoption in the Philippines. The results could be extended in future research to a broader assessment of socioeconomic and environmental benefits, laying out a broader plan for promoting sustainable solutions in transportation.

Examining the Uncertainties Surrounding Exosome Therapy in Androgenetic Alopecia: A Call for Evidence-Based Practice.

Hair loss, a pervasive and often distressing condition, affects a substantial number of individuals globally. Although conventional treatments such as hair transplantation, topicals, oral medications, and injectables exist, they have limitations, including the necessity for repeated treatments, potential adverse effects, and cost barriers. Exosome therapy, an innovative and burgeoning option within regenerative medicine, offers a novel approach to hair loss treatment. Exosomes are small vesicles that are produced from the membranes of late-endosomes and secreted by cells, playing a crucial role in intercellular communication. Research on humans is limited,1-4 and animal studies have shown that exosomes derived from various cell types can stimulate hair growth, resulting in increased research and development of exosome therapy for hair loss.5 Establishing a uniform reporting method for exosome therapy is vital as research in this area continues to expand. A standardized approach to research reporting and results is essential for comprehending the underlying mechanisms, safety, and efficacy of exosome therapy. This article provides an in-depth analysis of the current state of exosome therapy for hair loss, including potential advantages, and limitations, as well as directions for future research. J Drugs Dermatol. 2024;23(3)&nbsp; &nbsp; doi:10.36849/JDD.7603.

Lives Saved Through Increasing Adherence to Follow-Up After Abnormal Cervical Cancer Screening Results.

To model the potential number of cancers prevented and life-years saved over a range of adherence rates to cervical cancer screening, surveillance follow-up, and follow-up colposcopy that may result from removing financial barriers to these essential clinical services. A previously validated decision-analytic Markov microsimulation model was used to evaluate the increase in adherence to screening, surveillance, and colposcopy after an abnormal cervical cancer screening result. For each incremental increase in adherence, we modeled the number of cervical cancer cases avoided, the stages at which the cancers were detected, the number of cervical cancer deaths avoided, and the number of life-years gained. Compared with current adherence rates, the model estimated that an optimized scenario of perfect screening, surveillance, and colposcopy adherence per 100,000 women currently eligible for screening in the United States was 128 (95% CI, 66-199) fewer cervical cancers detected (23%), 62 (95% CI, 7-120) fewer cervical cancer deaths (20%), and 2,135 (95% CI, 1,363-3,057) more life-years saved. Sensitivity analysis revealed that any increase in adherence led to clinically meaningful health benefits. The consequences of not attending routine screening or follow-up after an abnormal cervical cancer screening result are associated with preventable cervical cancer morbidity and premature mortality. Given the potential for the removal of consumer cost sharing to increase the use of necessary follow-up after abnormal screening results and to ultimately reduce cervical cancer morbidity and mortality, public and private payers should remove cost barriers to these essential services.

Entrepreneurial barriers in achieving sustainable business and cultivation of innovation: a resource-based view theory perspective

PurposeThe study aims to highlight the barriers faced by the entrepreneurs toward achieving sustainability in business and innovation cultivation by offering solutions for academicians, practitioners and policymakers. The study uses the resource-based view (RBV) theory to discuss how an organization’s resources and capabilities influence the competitive ambience and barriers faced by entrepreneurs.Design/methodology/approachThe present research uses grey-causal modelling (GSC) to analyse the barriers against successful entrepreneurship.FindingsThe research focuses on the usefulness of dynamic capabilities, managing and cooperating resources in the entrepreneurship setting. The paper highlights the importance of resource gathering and nurturing as a method to combat scarcity. This research further identifies that financial limitations, regulatory obstacles, challenges to sourcing qualified labour, poor infrastructure and technology, limited mentorship opportunities, lack of scalability, low initial cost barriers in product development and risk-averse attitudes are the major factors hindering entrepreneurs from obtaining sustainable business and innovation.Originality/valueThe contribution of this research to the literature is that it assesses RBV theory within the realm of entrepreneurship, providing a different perspective on resources and capabilities as well as the challenges faced by entrepreneurs. The systematic approach to the analysis and prioritization of various barriers is innovative, and it adds knowledge in this area.

A novel temporal mixed-integer market penetration model for cost-effective uptake of electric boilers in the UK chemical industry

The UK chemical industry is the largest consumer of natural gas for process heating and power generation, with an annual consumption of 26.3 TWh. Reduction in natural gas consumption and associated carbon emissions can be achieved through electrification of heat. However, the adoption of electric boilers is lethargic due to economic barriers. Hence, market-based policy interventions are required. This study aims to accelerate the adoption of electric boilers in the UK's chemical industry, aligning with the UK's ambitious 2035 industrial decarbonisation goals while considering economic impacts, by designing market-based policy interventions and comparing two adoption patterns. A novel multi-period Mixed-Integer Market Penetration Optimisation Model is developed and applied to inform decisions about transitioning from natural gas to electric boilers. The model is applied to a case study of all the heating systems (490 boilers) in the UK chemical industry from 1 MW to 60 MW boilers. Results show that effectively implementing a gas tax, electricity subsidy, annual grant and carbon tax can generate sufficient demand-pull to reduce the cost of electric boilers from 30 to 85 % depending on the boiler size. A carbon tax starting at £280 per tCO2e and reducing to £170 per tCO2e coupled with electricity subsidies is essential for this transition. The policies are designed such that a win-win is achieved between government and industry; specifically, revenue from the carbon tax and gas tax is used to support the grant and electricity subsidy thereby achieving cost neutrality for government. At 100 % uptake of electric boilers in 2033, the total carbon emissions reduce by 89 %, which is above the 2035 UK industry goal of 60 % reduction. The research establishes a robust policy timeline that can drive industrial electrification in the UK's chemical sector. It highlights the need for a multi-faceted approach, incorporating various policy instruments to overcome the barriers of high initial capital costs.

Prostate Cancer Screening Uptake in Transgender Women

There is no consensus in prostate-specific antigen (PSA) screening guidelines regarding transgender women despite their known prostate cancer risk. To identify factors associated with recent (within the last 2 years) PSA screening in transgender women compared with cisgender men. This case-control study used data from the 2018 and 2020 Behavioral Risk Factor Surveillance System (BRFSS) surveys to characterize rates of PSA screening for prostate cancer within the past 2 years and multivariable logistic regressions to characterize factors associated with recent screening among transgender women. The BRFSS program of the Centers for Disease Control and Prevention annually surveys over 400 000 US adults on behavioral risk factors, chronic illnesses, and use of preventive services. Respondents to the BRFSS who were cisgender men or transgender women 40 years or older and who had complete PSA testing responses and no prostate cancer history were included; 313 transgender women and 138 937 cisgender men met inclusion criteria. Matching was performed by age, race and ethnicity, educational level, employment, annual income, survey year, and cost barriers to care. Data were collected on November 2, 2022, and analyzed from November 2, 2022, to December 3, 2023. Rates of and factors associated with recent PSA screening in transgender women. Among the 1275 participants included in the matched cohort (255 transgender women and 1020 cisgender men; 570 [44.7%] aged 55-69 years), recent PSA screening rates among transgender women and cisgender men aged 55 to 69 were 22.2% (n = 26) and 36.3% (n = 165), respectively; among those 70 years and older, these rates were 41.8% (n = 26) and 40.2% (n = 98), respectively. In the matched cohort, transgender women had lower univariable odds of recent screening than cisgender men (odds ratio [OR], 0.65 [95% CI, 0.46-0.92]; P = .02). In a hierarchical regression analysis adding time since the last primary care visit, effect size and significance were unchanged (OR, 0.61 [95% CI, 0.42-0.87]; P = .007). After adding whether a clinician recommended a PSA test, there was no statistically significant difference in odds of screening between transgender women and cisgender men (OR, 0.83 [95% CI, 0.45-1.27]; P = .21). The results were further attenuated when clinician-led discussions of PSA screening advantages and disadvantages were added (OR, 0.87 [95% CI, 0.47-1.31]; P = .32). In a multivariable logistic regression among transgender women, having a recommendation for PSA testing was the factor with the strongest association with recent screening (OR, 12.40 [95% CI, 4.47-37.80]; P < .001). In this case-control study of one of the largest cohorts of transgender women studied regarding PSA screening, the findings suggest that access to care or sociodemographic factors were not principal drivers of the screening differences between transgender women and cisgender men; rather, these data underscore the clinician's role in influencing PSA screening among transgender women.