Short-term changes in Arctic sea-ice concentration (SIC) are largely driven by weather, and strong ice loss typically occurs during intense Arctic cyclones causing unusually warm and stormy conditions. Such conditions are prolonged when several cyclones follow rapidly on each other. Here, we analyze changes in SIC for such periods of serial cyclone clustering utilizing satellite observations and reanalysis data from 1979-2024. While cyclones generally decrease SIC compared to non-cyclone conditions, cyclone clusters impact the ice approximately 2.5 times longer and cause two times stronger overall SIC-reductions than solitary cyclones. The amount of SIC-loss due to cyclone clusters scales with the intensity and number of clustered cyclones, and intensified SIC-loss occurs from 2004-2024 compared to 1979-1999, even within fixed SIC-categories. These findings highlight the relevance of accumulated impacts of clustered weather events for Arctic sea-ice variability and emphasize the need to understand drivers of serial cyclone clustering in the Arctic.
To evaluate national mortality trends associated with choking before and after the introduction of the Heimlich maneuver in 1974. We analyzed CDC Multiple Cause-of-Death data from 1970 to 2021 to identify deaths in which choking was the primary cause, using ICD-8, -9, and -10 codes. Deaths in which choking was coded only as a contributing cause were excluded. Mortality rates were stratified by age (15-64 and ≥ 65); for data from 1979 to 2021, deaths were additionally stratified by location (inpatient vs. outpatient) within each age stratum. Temporal trends were assessed using Joinpoint regression, with annual percentage change (APC) as the primary outcome. Among individuals aged 15-64, choking mortality increased from 1970 to 1975 (APC +2.45%) then declined significantly from 1975 to 1985 (APC -5.15%) and continued to decrease through 2021. Outpatient deaths in this age group declined consistently from 1979 to 2021. Among adults ≥ 65 years, no sustained mortality reduction was observed; inpatient deaths in this group fluctuated with alternating periods of increase and decrease. A sustained decline in choking-related mortality among nonelderly adults coincided temporally with the introduction and widespread adoption of the Heimlich maneuver, particularly in outpatient settings. No corresponding reduction was observed among older adults in inpatient settings. These findings are consistent with a population-level benefit of the maneuver in community settings, though causality cannot be established from these data. Tailored preventive strategies are needed for high-risk elderly populations.
Scaphocephaly, the most common single-suture craniosynostosis, results from premature sagittal suture closure. Surgery aims to restore normal skull morphology and prevent raised intracranial pressure. We used artificial intelligence-based methods to assess craniofacial morphology in patients with nonsyndromic scaphocephaly, comparing pre- and postoperative 2-dimensional (2D) facial photographs with controls to evaluate the outcomes of 2 age-specific techniques and identify the key morphological parameters. We analyzed a database of 1369 patients (1979-2023) using 1544 2D frontal and lateral photographs, including 358 patients with scaphocephaly-130 treated with Renier H-cranioplasty and 119 with total vault remodeling (TVR). Our approach combined automatic facial landmark detection, point-cloud superimposition, geometric morphometrics, texture analysis, classification algorithms, and generation of synthetic patient faces. Patients treated with Renier H-cranioplasty were compared with those treated with TVR. Significant morphological differences were found between patients with scaphocephaly and controls, both before and after surgery. Postoperatively, patients retained a distinguishable craniofacial phenotype, indicating that surgery did not fully normalize the skull shape. Early Renier H-cranioplasty reduced the anteroposterior diameter more effectively than late TVR. Both techniques had limited impact on posterior cranial vault morphology. Artificial intelligence-based analysis of 2D facial photographs provided valuable insights into diagnosis and surgical morphological outcomes in scaphocephaly. Postoperatively, patients maintained a nonnormalized phenotype, with early correction yielding better results than late remodeling. Further studies are needed to correlate these shape modifications with intracranial pressure values.
The reliability of transfer parameters in radiological assessment is essential for estimating the food chain transfer of radionuclides, which commonly uses the concentration ratio (CRplant-soil) as a key parameter in evaluating ingestion dose exposure to humans. Rice (Oryza sativa L.) is a staple food consumed by half of the world's population, and it plays a particularly significant role in Thailand's diet and economy. The CRrice-soil dataset reported by the International Atomic Energy Agency (IAEA) shows high variability across different environments (temperate and tropical), with a notable scarcity of related parameters such as soil properties within specific study sites. This scarcity is particularly evident in Thailand, where CRrice-soil data have been reported in only a few studies. This study determined CRrice-soil values for natural radionuclides (40K, 226Ra, 228Ra, and 228Th) and trace elements (As, Cd, Co, Cr, Cs, Cu, Li, Ni, Pb, Rb, Se, Sr, Th, Tl, U, Y, and Zn) using 295 paired samples of soil and rice plants (root, stem, and grain) collected from Thailand's principal rice-growing areas. The arithmetic mean CRrice-soil values from this study were generally higher than those reported in international references (IAEA TRS 472 and MODARIA II TECDOC-1979). For most elements, CR values in rice plant parts decreased in the order CRroot > CRstem > CRgrain. A significant negative correlation between CRrice-soil values and soil physicochemical properties (pH, CEC, and OM) was observed using Spearman's rho. Spatial variation in CRrice-soil was also linked to soil texture. This study provides the first macro-scale quantification of CRrice-soil values in Thai rice and may support radiological assessments in tropical and international contexts.
Lung cancer screening implementation is taking shape worldwide. Programme design requires specifying eligibility criteria, screening interval, and the optimal age range. We estimate benefits and harms of competing strategies, integrating NELSON results, smoking cessation interventions, contemporary treatment costs, and the management of feasible CT capacity. 1080 strategies are evaluated using the MISCAN-Lung microsimulation model, calibrated to NELSON and NLST data. 1945-1979 Dutch cohorts are simulated using a representative smoking history generator. For each strategy, the (cost-)effectiveness is evaluated, as well as CT requirements and the incremental benefit of a smoking cessation intervention (pharmacotherapy). Lung cancer screening was found to be cost-effective overall. Risk-based recruitment (PLCOm2012) is more efficient than pack-year-based criteria. Annual screening ages 55-75 from > 1.5% lung cancer risk is cost-efficient (ICER < €20 k), and would cost €12,201 per quality-adjusted life-year (QALY) relative to no screening (or €19,713 compared to less intensive screening). Population-wide, lung cancer mortality would be reduced by 10.8% (1072 cases/year) at full uptake, or by 6.2% at 50% uptake. For the first three years, at 50% uptake of screening, the strategy requires a 16.1% increase of national CT volume. Nearly half of CT costs are offset by reductions in terminal care expenditures. Integrated smoking cessation is cost-effective at €10,043/QALY (relative to screening without integrated cessation), yielding 32% additional life-years gained. Lung cancer screening is increasingly cost-effective and may be critically considered for implementation, including integrated smoking cessation. We find annual screening ages 55-75 for those > 1.5% (PLCOm) risk to be within a €20 k willingness-to-pay and feasible CT requirements.
It is well-known that results from adaptive multi-arm experiments with treatment selection are subject to the bias of the selection process. In this article, we consider designs with a binary outcome that begin with randomized parallel arms. After each of the preplanned interim looks at data, researchers proceed to the next stage with treatments selected according to predetermined rules. The experiment ends with the best arm, and the binomial parameter is estimated from all the observations accrued throughout the experiment in this arm. We present a comprehensive and unified Bayesian approach to the point and interval estimations, which uses a class of design-dependent priors obtained from the reference prior theory (Bernardo 1979). The approach is applicable regardless of the treatment selection rule, and is not affected by the inclusion of a control arm if the treatment selection is based on direct comparisons of the response rates relative to the control arm. The frequentist characteristics of the posterior estimators are studied and compared with alternative methods, where available. To this end, we introduce specific tools that facilitate the evaluation of estimation methods in binary data analysis. We also study the influence of the treatment selection rule and the effect of the prior correction on estimates through various examples. The approach is easy to implement in the experimental practice, and can be used in the interim analyses to help researchers in the treatment selection process.
Over the years, diagnostic arthroscopy has been the key to accurately diagnosing lesions in the knee. However, accessing the posterior compartment of the knee remains a challenge for upcoming arthroscopy surgeons. Gillquist was the first surgeon to publish a technique for accessing the posteromedial compartment in 1979, following which several techniques were developed, like modified Gillquist and switching stick maneuvers. According to Gillquist, "posterior compartments are the litterbox of the knee" and the advantages of posterior evaluation include evaluation of ramp lesions, remnants after partial meniscectomy, loose bodies, and to safely create posterior portals for arthroscopic visualization, posterior cruciate ligament (PCL) surgery and ramp repair. However, there is a risk of damaging the lateral portion of the medial femoral condyle chondral damage and broken arthroscope while attempting these blind maneuvers, and these techniques require expertise and more operative time. Our approach aims to simplify these procedures, reducing the time require to access the posteromedial compartment while minimizing the risk of unintended damage to the medial femoral condyle cartilage.
Availability of the hepatitis B virus (HBV) vaccine in the United States since 1982 and recommendations for universal/catch-up vaccination of infants and children since the 1990s may be associated with lower HBV prevalence among people with human immunodeficiency virus (HIV; PWH) born after 1980. Active HBV infection prevalence, defined as the proportion of patients with a positive hepatitis B surface antigen result, was assessed among PWH at entry into a clinical cohort. Patients were categorized into birth-year cohorts of 1940-1959, 1960-1979, or 1980-1999 and then further dichotomized into pre- and post-1980 birth-year cohorts. Log binomial regression was used to assess the association of birth-year cohort with hepatitis B surface antigen positivity, adjusting for race/ethnicity, HIV infection risk factor, baseline HIV viral load and CD4+ cell count, HBV active therapy, and year of/age at cohort entry. Among 5598 PWH, most were male (67%) and Black (77%), with a mean age (SD) of 39.7 (9.6) years at cohort entry. Approximately a third of the participants (30%) identified as men who have sex with men, and 39% reported a history of injection drug use. At cohort entry, the majority had a CD4+ cell count <350/µL and a viral load >1000 copies/mL. The HBV prevalence was 6.7% overall but varied by birth-year cohort: 6.2% for 1940-1959, 7.9% for 1960-1979, and 2.6% for 1980-1999. The risk of HBV infection was lower in the post-1980 than in the pre-1980 cohort (adjusted prevalence ratio, 0.19 [95% confidence interval, .09- .42]). PWH born after 1980 had a lower prevalence of HBV coinfection than those born before 1980, supporting the potential impact of universal childhood HBV vaccination.
This study uses an intersectional framework to evaluate age, period, and birth cohort trends in activity limitations among adults aged 30-45. We estimated cohort effects for activity limitation prevalence using cross-sectional data from the National Health Interview Survey between 1973 and 2016. We conducted an Age-Period-Cohort (APC) analysis using the median polish approach to calculate the prevalence ratios (PR) estimating birth cohort effects. We then calculated stratified estimates for Black and white women and men. The overall prevalence of activity limitations was higher in more recent birth cohorts than the earliest cohorts identified in the study. The cohort effect was 1.04 (95% CI:1.00, 1.07) for the 1979-1982 birth cohort and 1.04 (95% CI: 0.99-1.08) for the 1983-1986 birth cohort relative to referent 1943-1946 birth cohort. When stratified by race and gender, this cohort effect was only seen in White men. For Black men, significant cohort effects were pronounced in individuals born between the late 1940s and mid-1950s. There were no significant cohort effects for Black women or White women, however Black women had higher prevalence across time periods and age groups relative to White Women. Modeling race and gender separately obscures important differences in activity limitation trends across populations. Findings highlight the importance of an intersectional approach to understanding health inequities with respect to activity limitations, an outcome that reflects the interaction of health, the social environment, and structural ableism.
Neurosurgical fellowships to obtain additional surgical training after residency are a career option widely available to the newer generation of neurosurgeons. This study aims to analyze current trends in fellowship training among spine neurosurgeons in Florida and factors that influence the choice of fellowship based on year, location, and academic trajectory. This retrospective cross-sectional study collected demographic data and bibliometric information on neurosurgeons specializing in spine, comparing those with fellowship training and those without. The information was gathered from the American Association of Neurological Surgeons and the Florida Department of Health databases.  Results: A total of 113 spine-specialized neurosurgeons with active medical licenses were identified in the state of Florida at the time of this study in 2026. A proportion (23.53%; n = 12) of Florida-based spine neurosurgeons obtained their fellowship training in Florida, most commonly at the University of Miami/Jackson Health System. Out of a total of 113, only two (1.77%) spine neurosurgeons are female, and four (3.54%) have osteopathic doctoral degrees (D.O.). In 1960-1964 and 1975-1979, none (n = 0) had completed a spine fellowship, while 33.33% (n = 1) had done so in 1970-1974. The proportion was 28.57% (n = 2) in 1980-1984 and 16.67% (n = 2) in 1985-1989. An overall increase was observed in subsequent years: 23.53% (n = 4) in 1990-1994, 47.83% (n = 11) in 1995-1999, 50.00% (n = 4) in 2000-2004, 62.50% (n = 5) in 2005-2009, and 75.00% (n = 6) in 2010-2014. The highest percentage was observed in 2015-2019 at 73.33% (n = 11), followed by 66.67% (n = 6) in 2020-present.  Over the past 60+ years, there has been an increase in the number of Florida-based spine neurosurgeons pursuing fellowship training, with the highest percentage seen in those graduating from 2015-2019. However, there is still a low representation of female and osteopathic spine neurosurgeons in Florida. This growing trend of spine-specialization highlights a potential shift in neurosurgery career trajectories and has important implications for future workforce planning and patient care in spine surgery.
The PIRAGUA_atmos_analysis and PIRAGUA_hydro_analysis datasets have been developed to support a comprehensive assessment of current water resources across the Pyrenees region, encompassing Spain, France, and Andorra. PIRAGUA_atmos_analysis is a daily, gridded dataset of near-surface meteorological variables designed to serve as input for hydrological and land-surface models. It is based on the SAFRAN reanalysis framework and assimilates observational data from both the Spanish and French meteorological agencies, covering the hydrological years from September 1979 to August 2014. PIRAGUA_hydro_analysis provides monthly water balance components derived from the SASER and SWAT hydrological models for the 1981-2010 period, driven by PIRAGUA_atmos_analysis forcing. This article documents the development of both datasets and illustrates their potential applications. Alongside the datasets, we provide example R scripts for data exploration, an interactive visualization and analysis platform, and access through a dedicated geo-server. These resources aim to foster transparency, reproducibility, and informed decision-making in regional water management and planning.
Rural communities face worsening surgical access because of hospital closures and workforce shortages. Although osteopathic physicians have historically practiced in rural settings, their contribution to the contemporary rural surgical workforce remains poorly defined. Cross-sectional analysis of 74,404 US attending surgeons across seven specialties using the 2023 Centers for Medicare & Medicaid Services Doctors and Clinicians database. Practice addresses were linked to 2020 Rural-Urban Commuting Area codes, Area Deprivation Index quintiles, and census tract population density. Rural practice (mean Rural-Urban Commuting Area score ≥4) was modeled using multivariable logistic regression adjusted for specialty, graduation cohort, sex, Census division, and state urbanization, with state-clustered standard errors. Rural practice was more common among DO than MD surgeons (18.3% vs 9.7%; risk difference, 8.6 percentage points; 95% CI, 7.6-9.6). Across all specialties, DO surgeons practiced in more socioeconomically deprived communities. After adjustment, DO surgeons had twice the odds of rural practice compared with MD surgeons (OR, 2.05; 95% CI, 1.85-2.28). Rural areas had 13.8 surgeons per 100,000 residents versus 23.6 per 100,000 in metropolitan areas. Surgeons graduating in 2010 or later had approximately half the odds of rural practice compared with those graduating in 1979 or earlier (adjusted OR, 0.48; 95% CI, 0.42-0.56). Osteopathic surgeons disproportionately practice in rural and socioeconomically disadvantaged communities, identifying an important workforce component for maintaining rural surgical access. The declining likelihood of rural practice among more recent training cohorts raises concerns regarding the future rural surgical workforce.
Given the alarming rise in physical inactivity among Iranian children and adolescents, the present study aimed to analyze policy documents focused on promoting physical activity in this age group. This qualitative study employed a document analysis methodology. Policy documents concerning the promotion of physical activity among Iranian children and adolescents were analyzed using the four-stage READ framework. Thematic analysis was conducted to identify key themes through systematic coding and categorization. The reviewed documents covered a period spanning from 1979 to 2024. The analysis of 36 documents revealed that current policies mainly focus on five key areas including school-based approaches, resources and infrastructure, intersectoral collaboration, education and public awareness, and monitoring and evaluation. The findings indicated that despite their diversity, these policies often lack coherence, clearly defined implementation strategies, and effective evaluation systems. Additionally, institutional collaboration and the adoption of modern technologies have been limited. These results could serve as a foundation for improving future policymaking.
Global climate warming has intensified in recent years, with extreme weather events occurring more frequently and severely impacting ecosystems and social production. According to the "China Climate Change Blue Book (2023)," China's temperature rise rate exceeds the global average, with increasingly significant impacts on ecosystems. Hyphantria cunea, an invasive forest pest first discovered in China in 1979, has spread widely, causing serious damage to forestry and agriculture and posing a significant threat to China's ecological security. To address this threat, this study employed seven modeling algorithms (GLM, GBM, CTA, ANN, SRE, FDA, MARS, RF, and MaxEnt) from the R Biomod2 package to develop an ensemble model. The core research objective of this work is to quantify climate-driven range shifts of H. cunea under ongoing global climate change. Previous nationwide SDM studies on invasive forest pests have consistently demonstrated that climatic variables dominate broad-scale nationwide suitable habitat patterns at the macro-regional level. Supplementary topographic, vegetation cover, and human land-use disturbance layers were incorporated to capture fine-scale habitat filtering effects and long-distance pest dispersal facilitated by human activities, which together fully characterize the suitable regional environments of this pest. By integrating climate, topography, vegetation, and human disturbance data, we predicted the potential geographical distribution of H. cunea in China under four future climate scenarios (SSP1-2.6, SSP2-4.5, SSP3-7.0, and SSP5-8.5). The ensemble model achieved excellent performance with TSS and ROC values of 0.901 and 0.984, respectively. Currently, highly suitable areas for H. cunea are concentrated in 12 provinces, including Shandong, Jiangsu, Hebei, Henan, and Anhui, covering 56.33 × 104 km2, with Shandong showing the highest proportion (25.48%). The suitable habitat range is projected to expand northeastward, with significant increases under high emission scenarios (SSP5-8.5). Analysis of environmental variables reveals that nighttime light brightness, precipitation in the warmest season, the seasonal temperature variation coefficient, and average temperature in the driest season are key factors influencing H. cunea distribution. Nighttime light brightness shows the highest contribution (27.7%), indicating significant human impact on species spread. Response curves suggest that H. cunea favors warm, humid areas with pronounced seasonal changes. This study demonstrates that climate change will increase H. cunea expansion risk, necessitating strengthened cross-regional monitoring and biological control techniques. These findings provide a scientific foundation for understanding H. cunea spatiotemporal distribution patterns under future climate scenarios and for developing effective prevention and control strategies.
Organ transplantation is the ultimate treatment that extends and improves the quality of life for patients with end-stage organ failure, and among these, brain-dead organ donation enables life-sustaining heart and lung transplants. Since the first kidney transplantation from a brain-dead donor in Korea in 1979, the Organs Transplant Act was enacted in 1999 and comprehensively revised in 2010. This amendment marked a shift in the national framework from "Preventing Organ Trafficking and Ensuring Fair Allocation" toward "Establishing an Active Organ Procurement System" to promote donation. The number of brain-dead donors increased every year from 2010 to 2016 following the comprehensive amendment of the Organs Transplant Act. Since 2017, however, this trend has plateaued and subsequently declined, raising concerns about the widening gap between organ supply and demand, increasing reliance on living donation, and prolonged waiting times and mortality among transplant candidates. The major underlying causes of brain death, including traumatic brain injury, intracranial hemorrhage, and hypoxic brain injury, are frequently encountered in neurocritical care. Therefore, neurosurgeons play a crucial role in the brain-dead organ donation pathway. This review examines the institutional framework and current status of brain-dead organ donation in Korea. It also discusses the major clinical conditions leading to brain-dead organ donation and explores the role of neurosurgeons, as well as points of collaboration with the Korea Organ Donation Agency.
Early marriage remains a significant public health and social issue in Lesotho, with profound implications for women's health, education, and economic empowerment. Despite legal frameworks aimed at curbing the practice, a substantial proportion of women continue to marry before the age of 18, driven by sociocultural norms, economic constraints, and limited access to opportunities. This study investigates the timing and factors associated with first marriage among women in Lesotho using advanced multilevel survival analysis to inform targeted interventions. We analyzed retrospective time-to-event data from the nationally representative, cross-sectional 2023-24 Lesotho Demographic and Health Survey (LDHS), employing a log-logistic accelerated failure time (AFT) model within a multilevel framework to account for individual, household, and community-level factors. The analysis included 6,413 women aged 15-49, with 48.76% having experienced first marriage (events) and 51.24% right-censored. Statistical computations were performed using R statistical software (version 4.4.3), incorporating survey weights to ensure representativeness. The median age at first marriage was 24 years (95% CI: 24-25), with significant variation across socioeconomic and contextual factors. Employment (TR = 1.072, 95% CI: 1.043-1.103), middle wealth quintile (TR = 1.060, 95% CI: 1.012-1.110), low community poverty (TR = 1.094, 95% CI: 1.045-1.145), and urban residence (TR = 1.079, 95% CI: 1.033-1.126) were statistically associated with later age at first marriage (p < 0.05). In contrast, primary education (TR = 0.856, 95% CI: 0.749-0.979), younger birth cohorts (1979-2003: TR range 0.774-0.907), richest wealth quintile (TR = 0.927, 95% CI: 0.875-0.981), and rural residence (TR = 0.927, 95% CI: 0.888-0.967) were associated with earlier age at first marriage. The intraclass correlation coefficient (ICC = 0.0029) indicated that only 0.3% of the variation in age at first marriage was attributable to community-level differences. Although statistically significant, the magnitude of these associations is modest. The findings show that employment, middle wealth status, low community poverty, and urban residence are associated with a later age at first marriage, while primary education, younger birth cohorts, richest wealth quintile, and rural residence are associated with earlier marriage. The minimal community-level variation suggests that individual and household-level factors are more important determinants of marriage timing. Policymakers could consider prioritizing multisectoral interventions, including expanded educational access, economic empowerment programs, and poverty reduction strategies, with particular attention to rural-urban disparities. Addressing these structural factors may be relevant to achieving sustainable development goals related to gender equality and women's empowerment in Lesotho.
The influence of Kuroshio Extension (KE) variability on North Pacific atmospheric circulation has been increasingly recognized in high-resolution observations and models. While the role of fine-scale air-sea interactions has been highlighted, the dynamics underlying KE atmospheric impacts remain elusive. Here, based on observational analyses and a suite of model simulations, we report two contrasting atmospheric circulation patterns that arise from temporal variations in KE boundary forcing on the atmosphere. During the late 20th century (1979-1999), the positive KE phase, along with a northward shifted Kuroshio SST front, anchors the Pacific storm track farther poleward accompanied by an anomalous anticyclonic circulation. In contrast, during the early 21st century (2000-2022), KE variability exhibits stronger linkages with central tropical Pacific SST that drives a southward shift of the storm track with an anomalous cyclonic circulation, further amplified by enhanced Kuroshio latent heat release. Our findings suggest that accounting for decadal shifts in KE SST boundary forcing is critical for accurately representing KE downstream impacts.
Public trust in security services is a critical social-psychological phenomenon, yet existing theoretical accounts remain fragmented and insufficiently attentive to the structural power asymmetries characterising security-public relations. This article argues that the dominant paradigm, procedural justice theory, requires fundamental revision within intergroup and institutional power dynamics. Drawing upon procedural justice theory (Why people obey the law, 1990, Yale University Press; Why people obey the law, 2nd ed., 2006, Princeton University Press), social identity and self-categorisation theory (The social psychology of intergroup relations, 1979, 33, Brooks/Cole; Rediscovering the social group: A self-categorization theory, 1987, Blackwell), the integrative model of organisational trust (Academy of Management Review, 1995, 20, 709), intergroup contact theory (The nature of prejudice, 1954, Addison-Wesley), system justification theory (British Journal of Social Psychology, 1994, 33, 1), institutional betrayal theory (American Psychologist, 2014, 69, 575) and the political trust tradition (A systems analysis of political life, 1965, Wiley; Trust and trustworthiness, 2002, Russell Sage Foundation; Annual Review of Political Science, 2000, 3, 475), the article advances three propositions. First, trust formation is asymmetric: trust erodes faster than it accrues, with the asymmetry amplified for subordinate-status groups. Second, procedural justice effects are identity-contingent: perceived fairness operates differently depending on whether the authority is categorised as in-group protector or out-group enforcer. Third, trustworthiness appraisal under institutional betrayal requires reconceptualising Mayer et al.'s integrity dimension as epistemic credibility. A four-pathway model is proposed, with power asymmetry as a structural moderator and recursive feedback producing virtuous or vicious trust spirals.
Concerns regarding cancer incidence, particularly non-Hodgkin lymphoma, among U.S. Air Force missile community members prompted the initiation of the Missile Community Cancer Study. This phased, retrospective process study was designed around the unique needs of the Missile Community and adapted to these requirements. A cohort of all active duty Department of the Air Force (DAF) service members from 1976 to 2010 (N∼1.82 million), including approximately 65,000 personnel in missile-related career fields, was created via multiple data sources through a phased approach. Phase 1A examined Department of Defense (DoD) electronic health records (EHR) (2001-2020); Phase 1B added DoD and Department of Veterans Affairs (VA) cancer registry data (1976-2020) and VA EHR (1991-2020); and Phase 1C analyzed cancer mortality using National Death Index data (1979-2020). Armed Forces Health Surveillance Division and Surveillance, Epidemiology, and End Results cancer incidence and mortality case definitions were applied. In Phase 1A, 4,865 incident cancers were identified from the DoD EHR across the cohort, including 198 cases in the missile community. After adding DoD and VA registry data and VA EHR data in Phase 1B, an additional 50,359 cases were identified, including 1,641 missile community cases. Mortality analysis (Phase 1C) identified 37,100 cancer deaths across the cohort, including 1,145 in the missile community. Across Phases 1A, 1B, and 1C, no statistically significant excess incidence or mortality of non-Hodgkin lymphoma or the 13 other study cancers was observed in the missile community compared to other DAF members or the U.S. population. The overlap between EHRs and cancer registries within both the VA and DoD systems found over half of EHR-identified cases were also included in their respective cancer registries and 76.1% of all Phase 1 cancer cases were captured in a registry. This study's multi-phase approach with both internal and external comparison groups enhanced the comprehensiveness and accuracy of cancer case identification. The phased data linkage and validation approach provided a replicable framework for epidemiological cancer studies in military populations, illustrating methods for integrating and prioritizing data sources to address health concerns. The findings may ultimately guide future epidemiologic studies of cancer in the military to select optimal datasets, optimizing resource utilization and streamlining study timelines.
High-resolution, bias-corrected climate data from the Coordinated Regional Downscaling Experiment (CORDEX) are essential for regional climate analysis and impact assessments. However, several existing products often rely on inconsistent adjustment methods, heterogeneous observational references, and limited spatial coverage, which hampers comparability across regions. To address this gap, we introduce GloBCORD-QD, a quasi-global dataset at 0.25° (~25 km) resolution covering the historical period (1979-2005) and future projections (2006-2099) under RCP2.6 and RCP8.5 scenarios. The dataset is generated by applying the trend-preserving ISIMIP3BASD quantile mapping approach to dynamically downscaled CORDEX-CORE simulations from four Earth System Models, using CHELSA-W5E5 as a unified observational reference across five key climate variables. Comprehensive validation demonstrates that GloBCORD-QD reduces systematic biases, increases distributional performance (Perkins Skill Score increasing from 0.66 to 0.97), and preserves climate change signals across variables, regions, and scenarios. The dataset integrates multiple CORDEX domains into a consistent quasi-global framework, enabling robust spatial comparisons while maintaining regional detail. By spanning a range of climate sensitivities across multiple models and providing methodologically consistent, high-resolution coverage, GloBCORD-QD can supports robust and comparable climate impact assessments across  various regions and sectors, contributing to improved uncertainty quantification and evidence-based climate adaptation and policy development.