Pandemic Challenges and Opportunities for Gender Equity in Clinical Research

In the arena of clinical research, gender equity accelerates research excellence: we need multiple perspectives and all the brain power we can muster to maximize research productivity and quality. [...]women physician investigators enhance enrollment of women as participants in clinical trials, which is crucial to our ability to generalize from the data and to maintain the health of women. Women are underrepresented among academic grand rounds speakers,14 speakers at medical conferences15, and award recipients from medical specialty societies.16 Time pressure is especially intense on young women faculty. Besides spending more time on domestic chores, they spend more time at work on teaching, service, and mentoring. Female primary care physicians spend more time with patients.22 Elderly hospitalized patients treated by female internists experience lower mortality and readmission rates.23 Patients undergoing coronary artery bypass grafting had shorter hospital length of stay when treated by an all-female physician team as compared with an all-male team.24 Female patients treated by male physicians following acute myocardial infarction have higher mortality than those treated by female physicians.25 Sex discordance between patient and surgeon is associated with increased likelihood of adverse postoperative outcomes-and that observation that is driven by worse outcomes for female patients treated by male physicians.26 Clinical trials play a fundamental role in bringing new medications and interventions to our patients, yet women have often been excluded from participation. Among 60 randomized controlled trials (RCTs) of lipidlowering therapies reported between 1990 and 2018, there was a modest increase in enrollment of women over time, but women remain underrepresented compared with the relative burden of disease.30 In another study of 317 RCTs of heart failure with reduced ejection fraction published in highimpact journals over the past 20 years, only 25% of participants overall were female, and females were under-enrolled in 72% of these trials.

Providing culturally responsible health care to Pacific Islander communities: The creation of a cultural competency training for healthcare professionals

Cultural competency is the ability to respectfully engage, understand, and communicate through conscientious interaction, enabling effective work and meaningful relationships in cross-cultural situations. Cultural competency recognizes the importance for organizations of participants' diverse social and cultural values, beliefs, and behaviors, and has gained attention because it can bridge health perspectives, understanding, and respect between health professionals and patients. There remains a need for cultural competency in healthcare as disparities persist across the U.S. in racial and ethnic minority groups who experience worse health outcomes and lower healthcare quality than the general public. Therefore, a cultural competency training curriculum was created using various resources to improve interactions between Pacific Islander patients and healthcare professionals. This training helps to reduce racial/ethnic disparities in healthcare by encouraging mutual understanding and improving patient satisfaction, adherence to medical instructions, and overall health outcomes by highlighting patient-centered care as a result of utilizing components of cultural competency. To improve patient experiences in Hawai'i, healthcare professionals need the tools to better interact with patients from different cultures, such as Pacific Islanders. This training provides healthcare professionals with culturally-based content for improving cultural competence techniques for interacting with Pacific Island patients. This training was pilot tested with key stakeholders from community organizations and Cancer Center faculty/staff. Local health clinics, providers, and practices will have the opportunity to participate in this training through a Zoombased electronic training format and be provided with three continuing medical education credits. The initial delivery of the training was intended for in-person sessions;however, a virtual format was adapted due to the COVID-19 pandemic and subsequent social distancing regulations. Healthcare providers are provided pre-training resources, a pre- and post-test, and a course evaluation to determine the validity of training objectives. To date, two Federally Qualified Health Centers have been provided the training, n=60, as well as one Cancer Health Equity Partnerships' Scientific Workshop, n=40. For attendees, the analysis of correct responses from the pretest to post-test showed a significant improvement on 6 of the 12 questions. Respondents also agreed that the training resources aligned with the course objectives. Improved patient interactions from this training can help support better patient outcomes, adherence to medical advice regarding cancer screenings, and many other aspects of improving health equity for Pacific Islanders.

Investigation of demographic implicit discrimination and disparate impact in chest radiography image-based AI for COVID-19 severity prediction

It is important to evaluate medical imaging artificial intelligence (AI) models for possible implicit discrimination (ability to distinguish between subgroups not related to the specific clinical task of the AI model) and disparate impact (difference in outcome rate between subgroups). We studied potential implicit discrimination and disparate impact of a published deep learning/AI model for the prediction of ICU admission for COVID-19 within 24 hours of imaging. The IRB-approved, HIPAA-compliant dataset contained 8,357 chest radiography exams from February 2020-January 2022 (12% ICU admission within 24 hours) and was separated by patient into training, validation, and test sets (64%, 16%, 20% split). The AI output was evaluated in two demographic categories: sex assigned at birth (subgroups male and female) and self-reported race (subgroups Black/African-American and White). We failed to show statistical evidence that the model could implicitly discriminate between members of subgroups categorized by race based on prediction scores (area under the receiver operating characteristic curve, AUC: median [95% confidence interval, CI]: 0.53 [0.48, 0.57]) but there was some marginal evidence of implicit discrimination between members of subgroups categorized by sex (AUC: 0.54 [0.51, 0.57]). No statistical evidence for disparate impact (DI) was observed between the race subgroups (i.e. the 95% CI of the ratio of the favorable outcome rate between two subgroups included one) for the example operating point of the maximized Youden index but some evidence of disparate impact to the male subgroup based on sex was observed. These results help develop evaluation of implicit discrimination and disparate impact of AI models in the context of decision thresholds © COPYRIGHT SPIE. Downloading of the is permitted for personal use only.

Global commodity and equity markets spillovers to Africa during the COVID-19 pandemic

This paper examines the connectedness among 12 African equity markets and the global commodity, developed equity markets, paying particular attention to their evolution during the COVID-19 pandemic's peak period. We find that whilst African equity markets connect weakly to these markets, the levels of connectedness among these markets improved significantly during the pandemic. In addition, the energy market dominates the transmission of shocks in the system with commodity markets. Regarding the system with equity markets, the French and South African equity markets transmit the highest spillover in the full sample and during the pandemic's peak period, respectively. • Examines the connectedness among African equity and the global equity and commodity markets. • Examines the evolution of connectedness among these markets during the COVID-19. • African equity markets are weakly integrated with the global commodity and equity markets • During the COVID-19 peak period, however, the level of integration among these increased significantly. [ FROM AUTHOR] Copyright of Emerging Markets Review is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Limits of science-based approaches in global health: Sociocultural and moral lessons from Ebola and COVID-19

This chapter explores the significance of sociocultural and ethical limitations of non-science-based approaches toward effectively containing, managing, and ending global health emergencies. It refers to the 2013-2016 Ebola epidemic in West Africa and the current COVID-19 global pandemic to underscore the limits of science-based approaches in tackling infectious disease outbreaks. Against this background, it points to the significance of measures rooted in the humanities that have been (or are being) used to demonstrate the values of social, cultural, and ethical approaches in addressing global health emergencies. This chapter shows that while science-based approaches are essential, they are not sufficient toward addressing the varied challenges of global health emergencies. The experiences of Ebola epidemics in Africa and the COVID-19 global pandemic have shown that science-based approaches need to be buttressed by sociocultural and ethical measures to be successful. It has become self-evident that global health emergencies can be addressed sooner if non-science-based approaches are incorporated into the core responses. The successful approaches toward addressing global health emergencies will be ones that adequately harmonized science-based approaches with sociocultural and ethical measures. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023. All rights reserved.

Innovative Methods for Integrating Social Determinants of Health Data with Administrative Claims to Facilitate Health Equity Research

Objectives: The Covid-19 pandemic highlighted the importance of considering Social Determinants of Health (SDoH) in healthcare research. Administrative claims databases are widely used for research, but often lack SDoH data or sufficient transparency in how these data were obtained. This study describes innovative methods for integrating SDoH data with administrative claims to facilitate health equity research. Method(s): The HealthCore Integrated Research Database (HIRD) contains medical and pharmacy claims from a large, national US payer starting in 2006 and includes commercial (Comm), Medicare Advantage (MCare), and Medicaid (MCaid) populations. The HIRD includes individually identifiable information, which was used for linking with SDoH data from the following sources: national neighborhood-level data from the American Community Survey, the Food Access Research Atlas, and the National Center for Health Statistics' urbanicity classification;and member-level data on race/ethnicity from enrollment files, medical records, self-attestation, and imputation algorithms. We examined SDoH metrics for members enrolled as of 05-July-2022 and compared them to the respective US national data using descriptive statistics. We also examined telehealth utilization in 2022. Result(s): SDoH data were available for ~95% of currently active members in the HIRD (Comm/MCare/MCaid 12.5m/1m/7.6m). Socioeconomic characteristics at the neighborhood-level differed by membership type and vs. national data: % of members with at least a high-school education (90/88/84 vs. 87);median family income ($98k/$76k/$70k vs. $82k);% of members living in low-income low-food-access tracts (9/14/18 vs. 13);urban (57/52/47 vs. 61). At the member-level, the % of White Non-Hispanics, Black Non-Hispanics, Asian Non-Hispanics, and Hispanics were 61/6/5/6 (Comm), 76/12/2/2 (MCare), and 45/26/5/19 (MCaid). Imputation contributed 15-60% of race/ethnicity values across membership types. Telehealth utilization increased with socioeconomic status. Conclusion(s): We successfully integrated SDoH data from a variety of sources with administrative claims. SDoH characteristics differed by type of insurance coverage and were associated with differences in telehealth utilization.Copyright © 2023

Equity, social justice and transformational giftedness: A gifted academy in a vulnerable community

Given that uncertainty has become the signe des temps for our students in the current Covid-19 climate, one can pose the question: what types of skills would be relevant for the current and the next generation of students that would help them make sense of the changing world? School curricula and testing still anchored in the traditional mode of the 3Rs has resulted in a cadre of gifted students who have performed well academically but who have not been educated to reflect on using their "gifts" to transform society in just and meaningful ways. As opposed to being purely speculative on what transformative giftedness could be, we describe the genesis of a gifted academy- a school within a school situated within an impoverished community grounded in the principles of equity, social justice, and transformational giftedness. In this academy, the curriculum based on both socio-emotional learning (SEL) and problem-based learning (PBL), in tandem with interdisciplinary projects, provides avenues for the potential to transform students into making sense of uncertainty in the changing world in meaningful ways. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022. All rights reserved.

Leaving: Residential mobility and housing conditions in France during the Covid-19 epidemic

In the spring of 2020, a national lockdown was declared in France to control the Covid-19 epidemic - the longest and strictest to date. This led to spontaneous population movements, widely publicised in the media as the urban exodus of Parisians. But were departures from large cities to low-density areas the only types of mobility during this period? And what can we learn from housing changes during lockdown about the ordinary residential practices and dwelling conditions of households, as well as about the resources mobilised to cope with these exceptional situations? Based on the EpiCOV survey (Inserm-Drees), conducted in France among a sample of 135,000 people aged 15 and over at the end of the first lockdown, this article examines the different types of residential mobility that took place in the spring of 2020 on French territory. While this study does not predict whether or not these movements are to become permanent, or whether they would be repeated during further phases of lockdown, it highlights the heterogeneity of mobility practices, captured here in terms of distance travelled, changes within the urban gradient, types and conditions of housing, as well as the variety of resources mobilised according to sex, age and social position of individuals. While long-distance mobility more often concerns wealthy populations, local movements are almost as frequent and concern more heterogeneous fractions of the population. © 2023 Geographie-Cites. All rights reserved.

Historically marginalized student expression through culturally sustaining

With the adoption of the new Common Core Visual and Performing Arts Standards by the California Department of Education in 2019, there was an emphasis on creating a more inclusive and equitable arts educational experience for students through their arts educators. Unfortunately, with the majority of educators in the Visual and Performing Arts departments within California with an average of more than five years teaching experience, they obtained their knowledge of mandatory California teacher standards before the adoption took place for new common core state standards. Therefore, how are current students enrolled in these courses, specifically Historically Marginalized Students, obtaining an arts education that emphasizes inclusivity and equity? Professional development has not been provided that emphasizes equity and inclusive as well as a shift with the COVID-19 pandemic that has affected the educational system. How are students interacting with curriculum, and how arts educators looking to increase student engagement? This three-part qualitative action research study builds on a collaboratively developed lesson plan to engage a diverse art class consisting of historically marginalized students. Within this secondary visual arts classroom setting the implementation of culturally sustaining pedagogical practices consistently occurs. Second, the study explores the effectiveness of this implementation through student self-expression in the form of media influenced, design concept analysis. Third, through the analysis of completed student artifacts and reflections, understand the effect of culturally sustaining pedagogical practices through artistic self-expression. The concluding recommendations support the implementation of culturally sustaining pedagogical practices to increase authentic student self-expression. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Converging Crises and the Cost of Exclusion: Unveiling the Invisible Women of Sri Lanka's Economy

In Sri Lanka, womens labor force participation has never exceeded 35% in over three decades. As of 2022, the country was ranked 110 out of 146 countries in the World Economic Forums Gender Gap Index. The gaps in womens participation in the formal economy alongside womens limited political empowerment are two leading causes for the country to be lagging in such global gender equality indicators. At a large cost to the economy, the existence of archaic gender norms that promulgate womens unpaid care work often exclude women from the formal labor force. This paper dissects the socio-economic and socio-political factors that lead to the invisibility of women in Sri Lankas economy, while seeking to understand how such underlying causes have been aggravated within the precarity of the post-pandemic context. It is important, now more than ever, to recognize the invisibility of women in Sri Lankas formal economy, while bringing about a transformative vision with a multi-pronged approach to address existing gaps and challenges. With reference to key principles of feminist economics, including the theoretical foundations of Claudia Goldin, Nancy Folbre, and Diane Elson, among others, the paper will make a case for inclusivity and intersectionality in policy recommendations aimed at encouraging womens entry, active engagement, contribution, and retention in Sri Lankas economy. The paper reaches a conclusion that when women lead, participate, and benefit equally in all aspects of life, societies and economies will thrive, thereby contributing to sustainable development and inclusive economic growth.

Impact of Electronic Word-Of-Mouth on Consumer-Based Brand Equity and Purchase Intention: Hotel Industry in Thailand

Electronic word-of-mouth is a new form of informal communication where messages are disseminated to others using social media and other electronic platforms. This research investigates eWOM to determine its impact on the perception of brand equity and the intentions of consumers to purchase hotel services in Thailand. Using a quantitative approach and a non-probability sampling method, 410 Thai respondents aged 18 and above with relevant hotel experiences participated in this study. Confirmatory Factor Analysis (CFA) and Structural Equation Modeling (SEM) were used to analyze the model fit and the validity and reliability of the variables. In addition, in order to investigate the relationship between the constructs, first-order and second-order approaches were used, in which eWOM was the second-order construct in the study, while its credibility, valence, and volume, were first-order constructs. The findings indicated that eWOM positively affects all brand equity dimensions and purchase intentions, showing the strongest significant positive effect on brand awareness. Additionally, brand equity dimensions were shown to mediate the effect of eWOM on purchase intentions. Details of the analyses and discussions are included in the latter part of this paper.

The impact of Covid-19 on the capital structure in emerging economies: evidence from India

PurposeCapital structure is an important corporate financing decision, particularly for companies in emerging economies. This paper attempts to understand whether the pandemic had any significant impact on the capital structure of companies in emerging economies. India being a prominent emerging economy is an ideal candidate for the analysis.Design/methodology/approachThe study utilizes three leverage ratios in an extended market index, BSE500, for the period 2015–2021. The ratios considered are short-term leverage ratio (STLR), long-term leverage ratio (LTLR) and total leverage ratio (TLR). A dummy variable differentiates the pre-epidemic (2015–2019) and pandemic (2020–2021) period. Control variables are used to represent firm characteristics such as growth, tangibility, profit, size and liquidity. Dynamic panel data regression is employed to address endogeneity.FindingsThe findings point out that Covid-19 has had a significant, negative effect on LTLR, while the impact on STLR and TLR was insignificant. The findings indicate that companies based in a culturally risk-averse environment, such as India, would reduce the long-term debt to avoid bankruptcy in times of uncertainty.Research limitations/implicationsThe study covers the impact of the pandemic on Indian companies. Hence, generalization of the findings to global context might not be valid.Practical implicationsTo maintain economic growth in the post-crisis period, Indian policymakers should ensure accessibility to low-cost capital. The findings provide impetus to deepen the insignificant corporate bond market in India for future economic revival.Originality/valueDeveloping countries are struggling to revive the economies postpandemic. This is particularly true for Asian economies which are heavily reliant on banks for survival. This research finds evidence to utilize bond market as a source of raising capital for economic revival.

Meeting the challenge of gender inequality through gender transformative research: lessons from research in Africa, Asia, and Latin America

While the global development agenda has prioritized gender equality, many challenges remain, and the COVID-19 crisis has exacerbated inequalities. Gender transformative approaches to social change have the potential to address the underlying causes of inequality. This paper draws insights from studies funded by Canada's International Development Research Centre to understand how integrating gender transformative approaches to research can support social change. The findings suggest that gender transformative research is most successful in supporting change when it analyzes and addresses the multiple causes of inequality, takes an intersectional and structural approach, embeds the research in local contexts, and engages power holders and perpetrators of inequality.Alternate :RÉSUMÉSi les objectifs de développement mondial ont donné la priorité à l'égalité des genres, il y a encore de nombreux défis à relever dans ce domaine et la crise de la COVID-19 a exacerbé les inégalités. Les approches transformatrices du genre nous permettent de faire face aux causes sous-jacentes de ces inégalités. Cet article base son analyse sur des études financées par le Centre de recherches pour le développement international, au Canada, et vise à mieux comprendre comment l'adoption d'approches transformatrices du genre dans le contexte de la recherche peut appuyer le changement social. Nos résultats suggèrent que la recherche se basant sur une approche transformatrice du genre a de meilleurs chances d'inciter des changements sociaux lorsqu'elle analyse et répond aux différentes causes des inégalités, lorsqu'elle adopte une approche intersectionnelle et structurelle, lorsqu'elle intègre la recherche dans des contextes locaux et lorsqu'elle confronte les détenteurs du pouvoir et les responsables des inégalités.

Return and volatility spillovers among global assets: Comparing health crisis with geopolitical crisis

This study investigates the dynamic mechanism across equity, cryptocurrency, and commodity markets before and during health and geopolitical crisis (Covid-19 and the Ukrainian war). We apply the (TVP-VAR) based extended joint connectedness methodology, to understand return and volatility connectedness of financial markets for 2010–2023 period. The empirical results indicate that spillovers were particularly high during the Covid-19 and Russia-Ukraine war. First, health and geopolitical risks considerably impact the return and volatility system. Second, the value of total joint connectedness during the COVID-19 period was greater than during Russia-Ukraine war crisis. Also, evidence suggests that Commodity markets, received the highest shocks from other markets after Russia-Ukraine war and wheat was the main commodity receiving chocks from both health and geopolitical crisis. Our findings indicate that spillover channels differ depending on the type of crisis. Specifically, low-frequency components are the main transmission channels during the health crisis, whereas high-frequency components are the main transmission channels during the geopolitical crisis. Finally, results indicate that, cryptocurrency markets played some minor role in transmitting risks between markets. Our results are important in understanding how assets affect return and volatility spillover during geopolitical and health crises and are of particular importance to policymakers, market regulators, investors, and portfolio managers.

Diversity in medical publications: a cross-sectional evaluation of COVID- 19 vaccine research

Objective: Representing diverse perspectives in medical publications is of great importance. We assessed diversity among investigators, study participants, authors and tweeters of recent publications on COVID-19 vaccine trials, a topic likely to have significant global implications. Research design and methods: Primary publications reporting on COVID vaccine randomized controlled trials (RCTs) were identified via PubMed (n=302 hits, 23 September 2022). The 100 articles with the greatest impact (Altmetric score) were selected for evaluation. National affiliation of authors and investigators, and demographics of participants were collected. Geographic locations of Tweets mentioning the publications were collected via Altmetric. Result(s): In our preliminary analysis, as expected, selected publications most frequently appeared in top-tier journals, e.g. New England Journal of Medicine (n=24) and Lancet (n=19), and had high Altmetric scores (median 886, range 30-29,153). Articles included authors from mean 2.2 countries, most frequently the USA (n=43 articles), the UK (n=31) and China (n=23). Investigators' locations were often not reported, but most frequent were the UK (n=2711 investigators), USA (n=1029) and South Africa (n=269). There was a gender balance among participants across the studies (mean 49.4% female). The most frequent ethnic groups were white, Hispanic and Asian. Tweets mentioning the publications most commonly came from the USA (8.1%), the UK (3.1%) and Japan (2.9%). Conclusion(s): Despite COVID-19 being a global health emergency, most authors, investigators and readers of high impact COVID-19 vaccine RCT publications were from a small group of countries, with some notable exceptions. Numerous studies did not report the geographic location of investigators or participant ethnicity. Consistent and transparent reporting would support the drive towards greater diversity and representation in medical research.

Getting to the STEM of Environmental Justice: Equity Causes Enrich Student Learning in Science Classrooms

From satellites to ground-based sensors, as well as mobile networks of monitors, the availability of massive data sets has increased the need for educating students in data literacy in order to ensure their competency in the global market (Bluhm et al. 2020;Gibson and Mourad 2018). The U.S. Environmental Protection Agency (EPA) defines environmental justice as, "... the fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income, with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies." According to Lacombe, more individuals die yearly from car exhaust (53,000) in the United States than road casualties (37,400). Students worked in groups to discuss their assumptions about factors they perceived to have an impact on air pollution levels (e.g., affluence, traffic, and vegetation).

Four Key Trends for Identifying Regulator and Payer Evidence Needs in Oncology Drug Development

[...]patients have been restricted from accessing services, resulting in delayed diagnoses and potential disruptions to therapy. [...]there has been a new emphasis on accelerating the movement of treatment into the community setting. The overall economic forecast, and the forecast for drug budgets, have also been subdued due to the pandemic. 1.Benefit s of early advice in oncology strategy development Sponsors ca n be highly strategic: i n tlie cu rrent landscape by seeking regulatory and p ayep advice early in the drug developmeAt process. A number of recent Oncologic Drug Advisory Committee (ODAC) meetings have resulted in withdrawals of accelerated approval where confirmation of clinical benefit was not forthcoming or where confirmatory studies were not successful.