The rapid expansion of algorithm-curated short-form video (ACSFV) platforms has raised concerns about their potential association with youth mental health, particularly through personalized content streams that may amplify psychological vulnerabilities and exposure to harmful material. This study examined the relationship between ACSFV use and self-harm behaviors, probable borderline personality disorder (BPD) traits indicators, and anxious personality traits among Saudi adolescents and young adults. It also examined associations with depression, anxiety, stress, and sociodemographic factors. A cross-sectional study was conducted among Saudi individuals aged 12-30 years, utilizing self-reported data on social media use. The Taylor Manifest Anxiety Scale-50 (TMAS-50) was used to assess anxious personality traits, and the Self-Harm Inventory (SHI) was used to screen for BPD traits indicators and evaluate the lifetime history of self-harm. The questionnaire also included the Depression, Anxiety, and Stress Scale-21 (DASS-21). Among the 566 participants (74% female, 51.8% aged 19-25 years), daily engagement with ACSFV content was frequent, with 22.5% using it for 3-4 h and 15.3% for more than 4 h per day. The most frequently used platforms were TikTok (84.2%), Snapchat (80.0%), and Instagram (70.0%). Self-harm behaviors (37.5%), BPD indicators (9.5%), and severe / very severe anxious traits (31.0%) were prevalent. Self-harm correlated with age category 15-25 years, depression, and stress. Anxious traits were associated with extensive engagement with ACSFV content in unadjusted analysis, while Facebook use and higher depression and anxiety scores remained significant in adjusted analysis. BPD indicators were independently associated with psychiatric consultations and stress levels. This study highlights high rates of self-harm, anxious traits, and BPD indicators among Saudi adolescents and young adults, emphasizing the complex associations between social media use and psychological distress and the need for culturally tailored interventions, school-based programs, and further research.
Quantification of drug-cell interactions and subsequent cellular responses by using experimental data together with mathematical models of assumed binding and signalling schematics is vital to many research programmes; data fitting provides estimates for important pharmacological parameters including kinetic parameters controlling drug affinity and efficacy. Ordinary differential equation (ODE) models are a key component of many receptor theory studies used for this purpose. In using ODE simulations to fit experimental data and estimate these parameters, the theory of the identifiability properties of the system is often overlooked. Indeed, structural identifiability analysis (SIA) is often overlooked in many fields of bio-modelling. Building on recent SIA for linear ligand binding models in receptor theory, we present a new analysis of identifiability properties of nonlinear receptor theory models. We include models of ligand depletion in binding assays and ligand-induced dimerisation (LID). The classical SIA approaches of Taylor Series and similarity transformation are applied, using detailed step-by-step calculations to illustrate the complexity of the implementations. New results are obtained which show that the nonlinear ligand-depletion counterpart models of non-identifiable linear ligand excess models are globally identifiable from a single timecourse. Also, the LID model is shown to be globally identifiable if an experimental aparatus-dependent parameter is obtained. The analysis highlights issues of tractability of the methods for similar and higher-dimensional nonlinear models in receptor theory.
Drug procurement represents a substantial component of healthcare expenditure, particularly in low- and middle-income countries (LMICs). While ABC-VEN analysis remains important for balancing economic and clinical priorities, existing literature lacks critical evaluation of its cross-country adaptability and methodological rigor. This study aims to synthesize international evidence on ABC-VEN application within healthcare facilities to identify structural knowledge gaps and comparative findings. A structured narrative review was conducted using literature from PubMed, Scopus, Taylor & Francis and Google Scholar. To improve reporting transparency, study selection was mapped using a PRISMA 2020 framework. Studies included were those that applied the ABC-VEN method in hospitals and primary healthcare centers. This review also proposes a conceptual framework to explain how ABC-VEN supports procurement decision-making across different healthcare settings. The method also facilitates the identification of wasteful spending and ensures more stringent monitoring of critical drug categories. The synthesis of 19 included studies showed that Category I expenditures consistently consumed 71.69% to 90% of pharmaceutical budgets. However, the review revealed substantial heterogeneity in methodological execution, lack of reviewer transparency, and an absence of formal quality appraisal across the existing literature. While the ABC-VEN matrix offers a valuable baseline for resource allocation, its operational effectiveness is highly dependent on institutional capacity and geographic context. This review provides a novel conceptual framework that transitions ABC-VEN from a static classification model into a dynamic decision-support mechanism, emphasizing the need for standardized implementation to achieve sustainable medicine availability.
There is growing interdisciplinary interest in the potential for 'nature-based interventions' (NBIs) to foster physical, social, cognitive, and emotional well-being in children. This review aims to identify the methodological strengths and weaknesses of NBIs and analyze the various activities conducted in NBIs that enhance developmental domains in children. The systematic search was conducted using electronic databases such as PubMed, PsycINFO, Taylor and Francis, and Google Scholar from inception to the present. Children aged 4-12 without health or developmental conditions were eligible to participate in the review. Out of 5168 studies, 12 quantitative studies were selected with an overall sample size of (N = 2,444) inclusion/exclusion criteria. Two authors independently performed the literature search, record screening, data extraction, and quality assessment of each included systematic review. The risk of bias in the systematic reviews was assessed using a well-established modified McMaster Critical Review Form for quantitative studies. Due to the heterogeneity of activities delivered in interventions and measurements, there is a lack of evidence to draw firm conclusions regarding the effectiveness of NBIs. Despite the need to overcome some challenges and knowledge gaps, the studies consistently suggest that NBIs profoundly affect children's socio-emotional, physical, and cognitive domains.
Medication errors are a persistent challenge in health care across the world. In this News and Perspectives article, JMIR Correspondent Luke Taylor reports on NoHarm, a nonprofit AI tool changing pharmacy in Brazil, and its potential to relieve burden and improve patient safety elsewhere.
Classical statistical estimators are limited by their reliance on deterministic data, making them ineffective when observations are imprecise or indeterminate. Neutrosophic statistics overcome this issue by giving observations in the form [Formula: see text] with 'a' denoting the determinate component and 'bI' representing the indeterminate component. In this paper, we present a novel neutrosophic estimator for estimating population mean under indeterminacy. The bias and mean squared error equations for the proposed estimator are derived up to first-order Taylor series, and its efficiency is compared with current classical and neutrosophic estimators. Theoretical features of the estimator are determined by applying standard, large-sample approximations inside the neutrosophic framework. Furthermore, efficiency requirements are defined to identify instances in which the suggested estimator outperforms the competing estimators examined in this work. The proposed estimator's performance is evaluated using Monte Carlo simulations and three real-world case studies involving medical diagnostics (estimation of body temperature using blood pressure data in gastroenterology), network traffic analysis, and longitudinal sales data collected during the COVID-19 pandemic. The results show that, for the investigated populations and simulation settings, the suggested estimator achieves lower mean squared error and a greater percentage relative efficiency than the competing estimators considered in this study.
Human papillomavirus vaccine acceptance is influenced by the parental perceptions of the vaccine, but there are few related studies in Ethiopia, and most have focused on quantitative approaches. Therefore, this qualitative study intended to explore parental perceptions about the human papillomavirus vaccine acceptance. To explore the perceived facilitators and barriers against human papillomavirus among rural parents with eligible daughters in the Alle district, southern Ethiopia. A qualitative study using focus group discussion and in-depth interviews was conducted from April 25, 2023, to May 25, 2023, among eligible parents of daughters in the Alle district, southern Ethiopia. A convenience sample of 53 parents was recruited for focus group discussions, and 15 parents were purposely sampled for in-depth interviews. The data were collected by a semi-structured focus group discussion guide and in-depth interview questionnaires. The interview data were translated into English after transcription, and thematic analysis was done by Atlas software version 7.1.16. Among the total participants, 66.2% were female parents and 60.2% were protestant religious followers. Findings were split between two major themes: perceived facilitators and barriers to human papillomavirus vaccine acceptance. The perceived facilitators identified were preventing cervical cancer, seeing it as an expression of parental role and responsibility, and believing in the recommendation of health professionals as facilitators of human papillomavirus vaccination. The identified perceived barriers to human papillomavirus vaccination included: a lack of awareness, a lack of reliable information sources, a lack of trust in the vaccine, misconceptions, fear of side effects, and cultural and religious factors affecting the acceptance of human papillomavirus vaccination. Parents identified various facilitators and barriers to accepting the human papillomavirus vaccine. Therefore, we recommend that the government and concerned institutions work in collaboration to address the identified challenges to improve the acceptance of human papillomavirus vaccination.
Developing new separation technologies for rare-earth elements is essential for sustaining the critical materials supply chain. Toward this end, we developed a pH-controlled solvent extraction strategy employing an aqueous-phase holdback agent to enable selective lanthanide separations, using an integrated computational, machine learning, and automated experimental high-throughput workflow. Database screening, density functional theory (DFT) calculations, and initial experimental evaluation identified oxaloacetic acid as a promising holdback agent that enhanced selective extraction of four lanthanides (Nd, Eu, Dy, Ho) when paired with the di(2-ethylhexyl)phosphoric acid (HDEHP or D2EHPA) extractant. Within this framework, the dependence of lanthanide solvent extraction was determined across a multidimensional chemical matrix (pH, extractant concentration, holdback agent concentration, and salt concentration) using automated, high-throughput experiments coupled with multi-objective Bayesian Optimization. Through efficient exploration of a large experimental space, we discovered Eu, Dy, and Ho could be selectively extracted over Nd in acidic media at pH ∼2.0, while a modest decrease in pH to ∼0.5 shifted the selectivity to enable Eu separation from Dy and Ho. The use of multi-objective Bayesian Optimization quickly yielded a 4-fold increase in separation factors compared to our HDEHP-only system, eliminating the need for a complete grid-based, exhaustive sampling approach. Overall, this work establishes a hierarchical and data-driven framework to identify selective separation conditions and provides a foundation for accelerating separations discovery and design.
Sudden Unexpected Death in Infancy (SUDI) remains a leading cause of post-neonatal mortality in Aotearoa New Zealand. We analysed New Zealand coronial findings and recommendations to identify recurring modifiable risks, social determinants of health, and system-level failures that might inform prevention strategies. A structured thematic synthesis was conducted on 127 New Zealand coronial findings and recommendations released between 2012 and 2025. Data were abstracted on infant demographics, sleep environments, caregiver factors, socioeconomic determinants, and the nature of specific coronial recommendations. Bed sharing was present in 81% (n = 103) of cases. Maternal smoking was documented in 34 cases. Deaths clustered in early infancy, with 50% occurring before 3 months of age. Social complexities, including overcrowding, damp housing, and financial hardship, contributed to the sleep environment in 60% of cases (n = 76). Coroners issued 22 distinct types of recommendations targeting systems-level rather than just individual change. Findings show that sudden infant deaths are complex, with contributing factors operating at many levels and not simply due to parent's failure to follow prevention advice. SUDI prevention must shift from parental messaging to include multi-level interventions that address structural poverty, prioritised provision of in-bed sleepers, agency accountability, and mandatory workforce training.
Candidates awaiting liver transplantation may undergo waitlist suspension, the temporary inactivation of candidates from organ allocation, for various medical or logistical reasons. We performed a national cohort study using the United Kingdom Transplant Registry to evaluate the association between waitlist suspension and outcomes in adults listed for liver-only transplantation. Adjusted time-varying cause-specific Cox models, with start-stop times for suspension, were used as the primary analysis . Separate sensitivity analyses adjusted for centre-specific effects, censoring for COVID-19-related suspensions, censoring clinical improvement suspensions, and incorporating a 30-day landmark removing early events from the risk set. Among 13,596 candidates, 3,250 (23.9%) experienced at least one suspension episode. In adjusted time-varying analyses, reactivation following suspension was strongly associated with reduced access to transplantation (HR 0.36, 95% CI 0.32-0.39, p<0.001), but was not associated with increased death/delisting hazard (HR 0.95, 95% CI 0.84-1.08, p=0.451), and currently suspended status showed no consistent association with death/delisting (HR 1.11, 95% CI 0.90-1.37, p=0.310). Findings were robust across centre-adjustment and sensitivity analyses. Waitlist suspension identifies a clinically important transition point after which transplant access remains reduced despite reactivation.
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The alkyne 1,2-difunctionalization represents a versatile transformation whereby one or both of the π-bonds of the alkyne are engaged in bond-forming processes to generate products that contain newly formed C-C or C-heteroatom bonds at both carbons. Depending on the characteristics of the employed reagents and the bond-forming processes, the C-C bond of the alkyne can serve as a saturated or unsaturated functionality within a cyclic framework or remain acyclic. The nature of the alkyne as a 1,2-dicarbene reveals its inherent propensity to participate in nitrene- and carbene-mediated transformations, especially in metal-associated forms, thereby improving reactivity and selectivity. In this review, representative 1,2-difunctionalization reactions involving metal-nitrenoids and metal-carbenoids (examples of 1,1-difunctionalization with copper-carbenoid) are described. The contents are organized into two main sub-parts, metal-nitrenoids and metal-carbenoids, and each part follows the order of the atomic number. This review is not intended to be comprehensive, but rather to provide an overview of the reactivity profiles of alkynes as a source or counterpart in nitrene- and carbene-mediated reactions.
BackgroundThe current study describes the trajectory of caregiver-reported cognitive functioning for children treated for acute lymphoblastic leukemia (ALL) and correlations with post-treatment caregiver-reported and performance-based cognitive functioning.MethodThe PROMIS parent proxy cognitive function questionnaire was collected at four time points during childhood ALL treatment for 40 participants who also completed post-treatment PROMIS parent proxy reports and neurocognitive evaluations.ResultsPatients (52.5% male) were diagnosed with standard (45.0%) or high-risk B-ALL (47.5%) at a mean age of 7.80 years. During the first year of treatment, caregiver reports revealed a statistically significant (p < .01) decline in child cognitive functioning of 0.37 SD (95% CI: [0.12-0.62]) evaluated using mixed-effects linear regression. Caregiver report of cognitive functioning at the end of the first year of treatment correlated with post-treatment ratings (p < .05), after accounting for demographic and clinical factors. Post-treatment caregiver-reported cognitive functioning was significantly associated with estimated IQ (p < .01), attention (p < .05), word reading (p < .05), and calculation (p < .01).DiscussionTreatment for childhood ALL results in subtle changes in caregiver perception of cognitive functioning that are detectable shortly after diagnosis and may persist into survivorship. Furthermore, this study presents preliminary evidence for use of the PROMIS parent proxy cognitive function questionnaire as a screener for cognitive difficulties that may require further neurocognitive monitoring or comprehensive evaluation.
Fatigue is characterized as a feeling of exhaustion or lack of energy, is a common symptom of multiple chronic illnesses and interferes with daily activities and quality of life. There is a limited availability of animal models to examine potential underlying mechanisms, ultimately limiting development of potential therapeutic strategies. The primary purpose of this study was to develop a mouse model of persistent fatigue. A secondary purpose was to characterize potential measures of "fatigue-like" behaviors. An exploratory goal was to examine for immune and metabolic changes in the model. We examined voluntary wheel running and open field as measures of physical fatigue, and muscle and paw sensitivity as measures of pain. We also examined immune cell phenotype and plasma metabolite profiles after development of persistent fatigue. Acute stress paired with LPS or saline reduced wheel running compared to LPS alone or stress alone. Animals that received acute stress and LPS, showed a decreased ratio of T-helper to T-cytotoxic cells and reduced fatty acid metabolites 10 days after induction; there were no changes in the other groups. Thus, we characterized two unique methods, each requiring multiple stressors, to induce long-lasting fatigue-like behaviors that were associated with different mechanistic changes.
How specific physical illnesses differentially contribute to the persistent mortality gap in severe mental illness (including schizophrenia spectrum disorders, bipolar disorder, and major depressive disorder) remains poorly understood. Using a harmonised multi-country design, we aimed to analyse excess mortality across diagnoses and causes of death to identify high-burden and high-inequity mortality patterns to inform public health prioritisation and organisation of care. In this population-based multi-country cohort study using national health registers, we identified people diagnosed with severe mental illness at age 15-65 years in five European countries (Denmark, Finland, France, Poland, and Sweden) during 2004-23 to establish excess mortality before age 75 years in relation to country-specific general population mortality. We defined cause-specific mortality using ICD-10. Random effects meta-analysis was used to pool mortality estimates representing country-specific relative mortality inequities (sex-standardised and age-standardised mortality ratios), absolute excess burden (sex-standardised and age-standardised death rates per 10 000 person-years), and the severity of premature mortality (potential years-of-life-lost before age 75 years). Subgroup analyses were conducted to test for potential effect modification. Between Jan 1, 2004, and Dec 31, 2023, there were 4 861 795 people with severe mental illness, and 561 903 deaths from any cause. All-cause mortality was 2·6-fold higher in people with severe mental illness compared with the general population (pooled standardised mortality ratio [SMR] 2·64, 95% CI 2·25-3·11). Absolute excess mortality was highest in cardiovascular disease (schizophrenia spectrum disorders: standardised excess death rate 22·08 per 10 000 person-years, 95% CI 8·77-35·39; bipolar disorder: 8·36 per 10 000 person-years, 2·96-13·75; and major depressive disorder: 9·82 per 10 000 person-years, 3·18-16·45). Relative excess mortality was highest in respiratory diseases (schizophrenia spectrum disorders: SMR 6·49; 95% CI 5·52-7·64; bipolar disorder: 2·72, 2·04-3·63; and major depressive disorder: 3·48, 2·63-4·62), followed by endocrine and metabolic diseases (schizophrenia spectrum disorders: 5·09, 4·29-6·04; bipolar disorder: 2·60, 2·26-2·98; and major depressive disorder: 3·07, 1·84-5·12), and in gastrointestinal diseases (schizophrenia spectrum disorders: 3·47, 2·58-4·67; bipolar disorder: 2·34, 2·00-2·74; and major depressive disorder: 3·48, 2·63-4·62). The mortality gap was characterised by distinct patterns of absolute excess mortality and relative inequality across causes of death and severe mental illness diagnoses. Considering both dimensions of excess mortality can inform public health priorities that are not apparent from either measure alone or from focusing on cause-specific numbers of deaths. Reducing premature mortality will therefore require an integrated public health approach that combines universal strategies with targeted interventions to address both high-burden causes of death and those characterised by the greatest relative inequalities. 2024 European Partnership on Transforming Health and Care Systems.
It remains unclear which cardiovascular disease (CVD) risk scores are optimized for people living with treated HIV with high rates of viral suppression. We evaluated the performance of commonly used CVD risk scores in a population of primarily well-treated HIV patients in England. A multi-centre retrospective cohort analysis was performed, including people living with HIV (PLWH) above the age of 40 with no prior major adverse CVD events (MACE), regularly attending 7 HIV clinics in England during 2014. Outcomes were MACE over the following 5 years: myocardial infarction, invasive cardiac procedure e.g. primary angioplasty, cerebrovascular events, new heart failure, and CVD-related death. Clinical outcomes were aligned with the respective risk scores. The following CVD risk models were evaluated: the UK primary-care validated QRISK3, Framingham laboratory and non-laboratory (Office) scores, Data collection on Adverse events of anti-HIV Drugs (D:A:D), Pooled Cohort Equation (PCE), and the World Health Organization (WHO) laboratory and non-laboratory models. Models were scaled for 5-year CVD estimates. We assessed the discrimination and calibration of these 5-year models within our population. Multiple imputation was used to address missing data. Of 2582 people, 94 had at least one MACE documented during follow-up. All seven scores demonstrated moderate discrimination. QRISK3 demonstrated the best calibration in this cohort with an O:E ratio of 1.169, 95% CI 0.950, 1.439, mean calibration-in-the-large (CITL) value of 0.156 (95% CI -0.052, 0.364) and slope of 0.897 (0.682, 1.113). Framingham Office generally overpredicted risk, while WHO scores and D:A:D generally underpredicted risk. Imputing for missing data yielded results similar to the complete case analysis. CVD risk scores demonstrated moderate performance in a well-treated PLWH cohort. Our findings emphasize the need to calibrate each CVD risk score to the local population to guide prioritization of clinical resources for CVD prevention. Evidence before this study: We systematically searched Medline, Embase, and Cochrane Library database from January 1995 to August 2023, using the following terms 'HIV/AIDS and Cardiovascular Disease (CVD) outcomes', with an updated search to 2025. The risk of CVD has been reported to be up to two times that of people living without HIV, along with increased rates of heart failure and sudden death. Commonly used CVD risk scores have demonstrated variable performance for PLWH, and only the D:A:D study equation has been specifically validated in an HIV-positive population. Within an era of modern ART regimes and high rates of viral suppression, there have been numerous comparisons of CVD risk across scoring systems, but few studies with observed outcomes of CVD rates to validate the predictions. It remains unclear which CVD risk calculator is the most suitable for PLWH. The use of routinely collected clinical data may also impact the accuracy of results due to the presence of incomplete or missing data fields. In this study, we aimed to evaluate the performance of commonly used CVD risk scores in a population of primarily well-treated HIV patients in England using routinely collected clinical data. Added value of this study: We demonstrate that of the seven CVD risk scores evaluated (QRISK3, Framingham laboratory and non-laboratory (Office) scores, D:A:D, Pooled Cohort Equation (PCE), and the WHO laboratory and non-laboratory models), all showed moderate discrimination compared to observed major adverse cardiovascular events (MACE) rates in an English multicentre cohort of people living with HIV attending clinics. QRISK3, using a large UK primary care database to validate predicted CVD risk, appeared to be most closely calibrated to CVD outcomes in our cohort without the need for additional calibration. Our findings also suggest that the use of non-laboratory scores, which have been suggested for low and middle-income settings where laboratory results may not be available, should be interpreted with caution, and further testing may be required due to their miscalibration in this cohort. Implications of all the available evidence: Using real-world clinical data from people with HIV who are engaged in care in England, these findings emphasize the need to calibrate each CVD risk score to the local population it is used for in order to accurately guide prioritization of clinical resources for primary CVD prevention.
Early-phase clinical trials of Bruton's tyrosine kinase (BTK) degraders have demonstrated efficacy in patients with BTK inhibitor-resistant chronic lymphocytic leukemia (CLL). How clinical resistance to BTK degraders arises is unknown. Here we sequenced serial CLL samples from patients enrolled in the phase I trials of zelebrudomide and bexobrutideg and observed recurrent expansion of preexisting BTK A428D mutations at relapse. Unlike previously studied BTK inhibitor resistance mutations, BTK A428D conferred pan-resistance to BTK inhibitors and degraders. In the absence of BTK-directed therapies, however, cells bearing BTK A428D exhibited a competitive disadvantage. A crystal structure of BTK A428D revealed that the mutant aspartate clashes with the adenine ring of ATP and the adenine-mimetic moiety of BTK inhibitors and degraders. Combining BTK degraders with venetoclax mitigated the expansion of BTK A428D. These results provide the molecular basis for clinical resistance to BTK degraders and will inform the development of next-generation BTK degrader therapies.
The Lancet Oncology Commission on Global Cancer Surgery recommended that access to and the quality of surgical care be improved. This study aimed to understand differences in surgical quality between emergency and elective resection among patients with potentially curative colorectal cancer. This preplanned secondary analysis included patients undergoing only curative-intent surgery for colorectal cancer from three contemporary global prospective cohort studies (GlobalSurg-3, 5506 patients; CovidSurg-Cancer, 6719 patients; APOLLO, 876 patients) registered from 2018 to 2023. Hierarchical multilevel logistic regression models quantified associations between the urgency of surgery (elective versus emergency) and surgical quality, measured by margin-positive resection, adjusting for patient, disease, and health system factors. Bootstrap multivariable simulations evaluated effect modification by country income level, cancer stage, and location. Of the 45 699 patients registered, 13 101 across 95 countries were included in this analysis. Overall, 678 patients (5.4%) had margin-positive resections, with higher rates in the emergency than elective surgery group (13.7 versus 4.5%; P < 0.0001). In adjusted multilevel models, emergency surgery was associated with increased odds of margin-positive resections (adjusted odds ratio 2.45, 95% confidence interval (c.i.) 1.86 to 3.22), consistent across all country income groups and robust to alternative health system indicators. Bootstrap-derived absolute risk differences revealed the greatest disparities in patients with stage III-IV rectal cancers, with absolute differences of 12.6% (95% c.i. 10.2 to 15.7) in high-income countries, 19.0% (95% c.i. 13.6 to 23.9) in upper middle-income countries, and 14.1% (95% c.i. 10.9 to 16.5) in lower middle- and low-income countries. Variance decomposition demonstrated that hospital- and country-level factors accounted for 76% of the explained variation in surgical quality. Emergency surgery was associated with a two- to threefold increase in the risk of margin-positive resections globally, independent of resource availability, highlighting a neglected area of global surgical practice. These findings challenge the assumption that poorer outcomes after emergency surgery are due to advanced disease stage. For patients presenting as an emergency with potentially curative resection, enhanced decision-making around resectability, ensuring specialist surgeon availability, and developing bridge-to-surgery pathways represent immediate, low-cost strategies to improve global cancer outcomes.