Design, manufacture, and control of a low-cost positive airway pressure device.

Current positive airway pressure devices cost NZ$800-$2500, posing a financial barrier for the estimated 1 billion individuals worldwide with sleep apnea and those researching respiratory diseases. Increasing diagnoses and research interest in the area necessitate a low-cost, easily accessible alternative. Thus, the mePAP, a high-quality, multipurpose, low-cost (∼NZ$250) positive airway pressure device, was designed and prototyped specifically for respiratory disease research, particularly for sleep apnea. The mePAP allows user customization and provides researchers with an affordable tool for testing positive airway pressure algorithms. Unlike typical commercial devices, the mePAP offers adaptability with open-source data collection and easily modifiable software for implementing and analysing different control and diagnostic algorithms. It features three control modes: constant; bilevel; and automatic; and provides pressures from 4 to 20 cmH2O, controlled via a phone app through Wi-Fi, with a mini-sensor added at the mask for increased accuracy. Validation tests showed the mePAP's performance is comparable to a gold-standard Fisher & Paykel device, with extremely similar output pressures. The mePAP's low cost enhances accessibility and equity, allowing researchers to test ventilation algorithms for sleep apnea and other respiratory conditions, with all data openly available for analysis. Its adaptability and multiple applications increase its usability and usefulness across various research and clinical settings.

Ethical and Practical Considerations for an Agreement to Ensure Equitable Vaccine Access Comment on "More Pain, More Gain! The Delivery of COVID-19 Vaccines and the Pharmaceutical Industry's Role in Widening the Access Gap".

This paper discusses the potential of an international agreement to ensure equitable vaccine distribution, addressing the failures witnessed during the COVID-19 pandemic. COVAX was unable to prevent vaccine monopolization and unequal distribution, which led to significant disparities in vaccination rates and avoidable deaths. Any future agreement on equitable vaccine distribution must address ethical and practical issues to ensure global health equity and access. The proposed agreement should recognize healthcare as a human right and consider vaccines beyond mere commodities, emphasizing the social responsibility of pharmaceutical companies to prioritize affordability, availability, and accessibility, particularly for low-income countries (LICs). Voluntary licensing agreements are suggested as a means to enhance access to essential medicines. The paper also outlines the necessity of international cooperation, with robust compliance mechanisms, to effectively enforce such an agreement and mitigate future health crises.

Gender transformative innovation: Women's inclusion in livestock vaccine systems in northern Ghana.

CONTEXT: Owning livestock can support women's empowerment and progress toward gender-equitable agri-food systems. Gender inequality, however, can reduce women's ownership of livestock and access to animal vaccines. Gender accommodative approaches (GAAs), and more recently gender transformative approaches (GTAs), are increasingly implemented in development interventions. However, their impact on women's empowerment has not been systematically tested. Here, we describe the 'Women Rear Project', implemented in northern Ghana between 2019 and 2023, and assess the impact of GTAs and GAAs on women's empowerment, ownership of livestock, and access to animal vaccines. OBJECTIVE: We sought to systematically assess changes conferred by GAAs and GTAs on gender norms and women's empowerment and access to animal vaccines. METHODS: Using a mixed-methods approach, in 2021 and 2023 we collected quantitative and qualitative data regarding women's empowerment, gender norms, and access to animal vaccines. Qualitative data regarding women's and men's conceptualizations of gender norms and women's empowerment were obtained via focus group discussions and key informant interviews. Quantitative survey data were obtained from 500 households, using the Women's Empowerment in Livestock Index (WELI). Quantitative data on livelihood indicators were also collected, using the Rural Household Multi-Indicator Survey (RHoMIS) tool. We systematically assessed changes between baseline (2021) and endline (2023) in local conceptualizations of empowerment in the livestock sector, the effects of GTAs and GAAs on such conceptualizations, and how empowerment was experienced by women and men and the implications for women's access to animal vaccines. RESULTS AND CONCLUSION: Local conceptualizations of empowerment in 2021, among both women and men, emphasized financial independence, decision-making autonomy, self-reliance, and problem-solving skills. In 2023, this conceptualization of empowerment had expanded to include the ability to act without external restrictions; women were empowered by managing resources, running successful businesses, and making decisions in consultation with their husbands. Furthermore, women in communities where GTAs had been enacted scored significantly higher in empowerment compared with women in communities where only GAAs had been introduced. Gender norms impacted empowerment indicators, with respect among household members and autonomy in income both contributing to disempowerment. Gender norms also affected respondents' reporting. Women's access to livestock vaccines was more positive in GTA/GAA communities. We recommend efforts are made to reduce restrictive gender norms and enhance women's empowerment and access to resources such as animal vaccines. SIGNIFICANCE: We offer recommendations for pathways toward women's empowerment and healthy livestock via inclusive innovations in agri-food systems.

A note on heat kernel of graphs.

Consider a simple undirected connected graph G, with D ( G ) and A ( G ) representing its degree and adjacency matrices, respectively. Furthermore, L ( G ) = D ( G ) - A ( G ) is the Laplacian matrix of G, and H t = exp ⁡ ( - t L ( G ) ) is the heat kernel (HK) of G, with t > 0 denoting the time variable. For a vertex u ∈ V ( G ) , the uth element of the diagonal of the HK is defined as H t ( u , u ) = ( exp ⁡ ( - t L ( G ) ) ) u u = ∑ k = 0 ∞ ( ( - t L ( G ) ) k ) u u k ! , and H E ( G ) = ∑ i = 1 n e - t λ i = ∑ u = 1 n H t ( u , u ) is the HK trace of G, where λ 1 , λ 2 , ⋯ , λ n denote the eigenvalues of L ( G ) . This study provides new computational formulas for the HK diagonal entries of graphs using an almost equitable partition and the Schur complement technique. We also provide bounds for the HK trace of the graphs.

Strategies for advancing inclusive biodiversity research through equitable practices and collective responsibility.

Biodiversity research is essential for addressing the global biodiversity crisis, necessitating diverse participation and perspectives of researchers from a wide range of backgrounds. However, conservation faces a significant inclusivity problem because local expertise from biodiversity-rich but economically disadvantaged regions is often underrepresented. This underrepresentation is driven by linguistic bias, undervalued contributions, parachute science practices, and capacity constraints. Although fragmented solutions exist, a unified multistakeholder approach is needed to address the interconnected and systemic conservation issues. We devised a holistic framework of collective responsibility across all research participants and tailored strategies that embrace diversity and dismantle systemic barriers to equitable collaboration. This framework delineates the diverse actors and practices required for promoting inclusivity in biodiversity research, assigning clear responsibilities to researchers, publishers, institutions, and funding bodies. Strategies for researchers include cultivating self-awareness, expanding literature searches, fostering partnerships with local experts, and promoting knowledge exchange. For institutions, we recommend establishing specialized liaison roles, implementing equitable policies, allocating resources for diversity initiatives, and enhancing support for international researchers. Publishers can facilitate multilingual dissemination, remove financial barriers, establish inclusivity standards, and ensure equitable representation in peer review. Funders must remove systemic barriers, strengthen research networks, and prioritize equitable resource allocation. Implementing these stakeholder-specific strategies can help dismantle deep-rooted biases and structural inequities in biodiversity research, catalyzing a shift toward a more inclusive and representative model that amplifies diverse perspectives and maximizes collective knowledge for effective global conservation.

Estrategias para las prácticas equitativas y la responsabilidad colectiva en la investigación de la biodiversidad Resumen La investigación sobre biodiversidad es esencial para hacer frente a la crisis mundial de la biodiversidad, por lo que requiere la participación y la variedad de perspectivas de investigadores de diferente procedencia. Sin embargo, la conservación se enfrenta a un importante problema de inclusión, ya que los expertos locales de regiones ricas en biodiversidad, pero con economías desfavorecidas suelen estar infrarrepresentados. Esta infrarrepresentación se debe a prejuicios lingüísticos, contribuciones infravaloradas, prácticas científicas paracaidistas y limitaciones de capacidad. Aunque existen soluciones fragmentadas, se necesita un enfoque unificado de los múltiples actores para abordar los problemas de conservación interconectados y sistémicos. Ideamos un marco holístico de responsabilidad colectiva de todos los participantes en la investigación y estrategias a medida que abarcan la diversidad y desmantelan las barreras sistémicas a la colaboración equitativa. Se necesitan diversos actores y estrategias para promover la inclusión en la investigación sobre biodiversidad, y deben asignarse claramente las responsabilidades de investigadores, editores, instituciones y organismos de financiación. Las estrategias para los investigadores incluyen fomentar la autoconciencia, ampliar las búsquedas bibliográficas, fomentar las asociaciones con expertos locales y promover el intercambio de conocimientos. Para las instituciones, recomendamos establecer funciones de enlace especializadas, aplicar políticas equitativas, asignar recursos a iniciativas de diversidad y mejorar el apoyo a los investigadores internacionales. Las editoriales pueden facilitar la difusión multilingüe, eliminar barreras financieras, establecer normas de inclusión y garantizar una representación equitativa en la revisión por pares. Los financiadores deben eliminar las barreras sistémicas, reforzar las redes de investigación y dar prioridad a la asignación equitativa de recursos. La aplicación de estas estrategias específicas puede ayudar a desmantelar prejuicios profundamente arraigados y desigualdades estructurales en la investigación de la biodiversidad, catalizando un cambio hacia un modelo más inclusivo y representativo que amplifique las diversas perspectivas y maximice el conocimiento colectivo para una conservación global eficaz.

The Landscape of Genomic Services for Inherited Retinal Degenerations (IRDs) Across Europe.

Purpose: To map the existing genomic services available for patients with IRDs across Europe. Methods: A survey was conducted to 24 ophthalmic and/or genetic specialists across 19 European countries. The survey was conducted in an interview style via zoom for participants from 17 out of 19 countries. Interviewees were clinical/medical/ophthalmic geneticists, ophthalmologists/retina specialists and internal medicine specialists. The survey focused on referral pathways, genetic counseling, insurance coverage, awareness of genetic testing and counseling for IRDs among practitioners and patients, and preferred testing methodologies. Results: Genomic services (testing and counselling) for IRDs vary among countries from an awareness, availability and insurance coverage perspective. Affordability could be a barrier for patients in countries without any payment scheme (eg, Poland) and in countries where only a targeted population is covered (eg, Bulgaria). Genetic counseling via qualified genetic counsellors did not exist in many countries. The level of awareness regarding the benefits of genetic testing in IRDs among healthcare professionals (HCPs) and patients was perceived as low in some countries. Panel-based next-generation sequencing (NGS) was the first test of choice for genetic testing in 68% of the studied countries. Conclusion: There is some disparity in the approach to genetic testing for IRDs across Europe. Greater awareness of genetic testing services is required among the eye care professional community. A revised approach to the provision of genetic testing services such as centralized free genetic testing with associated interpretation and genetic counselling may help in ensuring equitable access and reimbursement, which will empower patients through improved access to clinical trials, expedite innovation, improve access to therapy and the delivery of care.

Toward a semiotics of midwifery: Multimodal communication's effects on accessibility, equity, and power dynamics.

According to semiotics, we live in a world of signs, where almost anything can act as a signifier and convey meaning. But what of the semiotic landscape of midwifery? What signs are present within a client's multi-sensory experience of their midwifery care? How are these signs functioning to increase equity and accessibility? Or worse, how might certain aspects of the client's experience communicate unjust power dynamics? Semiotics allows us to examine a wide communicative and educational environment. By paying particular attention to the multivalent meanings of different signs-be they written, visual, oral, or even physical-we can start to see how multimodal communication plays a vital role in a client's perception of equity and power. One way to improve client experience is by approaching education and semiotic experience from the same place as trauma-informed care. A more health-literate sensitive approach viewed through the lens of semiotics assumes all clients have little previous knowledge or comfort within a care setting. This hyperawareness and criticality of the semiotic environment would allow midwives to acknowledge various sensory and communicative biases and intentionally redesign the entire client experience. The semiotic landscape is then curated to meet the needs of the most important audience-those marginalized and discriminated against whether that is because of education, finances, race, gender, or any other intersectional identity. We must acknowledge the fact that all sign systems can either reinforce abusive power relations or work to improve them. For what is at stake here is not just a client's overall comfort, but their full understanding of the care they are receiving, the options they have, and their autonomy within their entire perinatal experience.

Addressing Teenage Pregnancy and Reproductive Health Among Latinx Adolescents and Young Adults.

Despite a national decline in teenage pregnancy rates, Latinxs and Black individuals continue to have higher teenage birth rates compared to white teens. In the United States, Latinx females (ages 15-19) are more than twice as likely to have a teenage birth compared to non-Latinx white teens. With an increasingly diverse nation, a shift towards culturally inclusive approaches to care is critical to achieving equitable patient outcomes. Improving access to preventative care, workforce diversity, and insurance coverage will lead to cost-savings and also help restore trust in a system that has failed past generations. In this commentary, targeted recommendations tailored specifically towards Latinx women will be provided including culturally competent birth control counseling, and a focus on reproductive justice. Not speaking English, low socioeconomic status, acculturation, legal status, and being uninsured are all teenage pregnancy risk factors unique to Latinx women. Cultural preferences and attitudes towards contraception must also be considered. Further expansion of Medicaid insurance coverage is also necessary to increase reproductive access among vulnerable populations. A cultural humility framework to reproductive health counseling and services is recommended. Within this framework family engagement is encouraged and women are free from reproductive coercion; they have the freedom to access over-the-counter contraception and receive guidance and support from providers and community health workers who are cognizant of culture and heritage. An integrated community-based approach that is culturally sensitive and in tune with Latinx heterogenicity is necessary to lower teenage pregnancy rates and achieve reproductive justice.

Advancing the future of equitable access to health care: recommendations from international health care leaders.

Disparities in access to health care are persistent and contribute to poor health outcomes for many populations around the world. Barriers to access are often similar across countries, despite differences in how health systems are structured. Health care leaders can work to address these barriers through bold, evidence-based actions. The Future of Health (FOH), an international community of senior health leaders, collaborated with the Duke-Margolis Institute for Health Policy to identify priority organizational and policy actions needed to improve equitable access to health care through a consensus-building exercise, a targeted literature review, and an expert discussion group. This paper describes four key action areas for health care leaders that FOH members identified as critical to enabling the future of equitable access to health care: ensuring prioritization of and accountability for equitable access to care; establishing comprehensive, organization-wide strategies to address barriers to access; clearly defining and incentivizing improvement on key measures related to reducing disparities in access; and establishing cross-sector partnerships to improve equitable access.

Enabling equitable and affordable access to novel therapeutics for pandemic preparedness and response via creative intellectual property agreements.

The COVID-19 pandemic demonstrated that the current purely market-driven approaches to drug discovery and development alone are insufficient to drive equitable access to new therapies either in preparation for, or in response to, pandemics. A new global framework driven by equity is under negotiation at the World Health Organization to support pandemic preparedness and response. Some believe that the global intellectual property (IP) system itself is part of the problem and propose a purely Open Science approach. In this article, we discuss how existing IP frameworks and contractual agreements may be used to create rights and obligations to generate a more effective global response in future, drawing on experience gained in the COVID Moonshot program, a purely Open Science collaboration, and the ASAP AViDD drug discovery consortium, which uses a hybrid, phased model of Open Science, patent filing and contractual agreements. We conclude that 'straight to generic' drug discovery is appropriate in some domains, and that targeted patent protection, coupled with open licensing, can offer a route to generating affordable and equitable access for therapy areas where market forces have failed. The Extended Data contains a copy of our model IP policy, which can be used as a template by other discovery efforts seeking to ensure their drug candidates can be developed for globally equitable and affordable access.

Drug discovery and development organizations usually recoup their investment in this risky and expensive process by filing patents on drug candidates which, if granted, give them a time-limited monopoly on the manufacture, sale or licensing of the drug. This means they can negotiate its price and terms of distribution, which creates distortions in access globally. In an alternative 'Open Science' approach, R&D organizations publish all the information about a prospective drug without applying for patents, meaning that anyone can use this knowledge to make and sell the drug, while the R&D organizations have no control over how it is priced or distributed. In a pandemic, fast-spreading viruses must be rapidly contained by delivering drugs to where they are most needed. This requires innovation and global access, but this is stifled in both models ­ in the first because of patent abuses, in the second because the lack of control may jeopardize the most efficient development. The authors share a model that prioritizes globally fair and affordable pricing by creating 'maximally permissive licenses' based on 'minimally defensive patents'. They explain the practical and bioethical background to their proposals and share an example of collective management of intellectual property and licensing agreement that is being used in the AI-driven Structure-enabled Antiviral Platform (ASAP) Center's Pandemic Preparedness work.

PASS Theory of Intelligence and Its Measurement Using the Cognitive Assessment System, 2nd Edition.

The goal of this paper was to describe the context within which the PASS theory of intelligence was conceived and the reasons why this theory was used to guide the construction of the Cognitive Assessment System and the several versions of the Cognitive Assessment System, 2nd Edition. We also discuss validity issues such as equitable assessment of intelligence, using PASS scores to examine a pattern of strengths and weaknesses related to academic variability and diagnosis, and the utility of PASS scores for intervention. We provide summaries of the research that informs our suggestions that intelligence testing should be theory-based, not constrained by the seminal work of test developers in the early 1900s, and neurocognitive processes should be measured based on brain function.

Equitable Access to Genomic Molecular Testing for Australian Cancer Patients: Insights from the Victorian Precision Oncology Summit.

The Victorian Precision Oncology Summit, convened in 2023, was a joint initiative between the Victorian Comprehensive Cancer Centre Alliance (VCCC Alliance) and the Monash Partners Comprehensive Cancer Consortium (MPCCC) and was proposed to guide a coordinated state-wide conversation about how the oncology sector can overcome some of the current obstacles in achieving equity of access to clinical cancer genomics for Victorian patients. Themes that emerged from discussion groups at the Summit include standardisation, centralisation, funding, education and communication and insights across those themes are outlined in this manuscript. The event served as a large consultation piece for the development of a broader precision oncology roadmap, which explores equitable access to molecular testing for Victorian patients, currently in development by the VCCC Alliance and MPCCC in collaboration with other key Victorian and national stakeholders. While this symposium was a Victorian initiative, it is felt that the insights garnered from this consultation piece will be of interest to consumer groups, clinicians, researchers, educators, policy makers and other key stakeholders in other states of Australia as well as in other countries implementing comprehensive genomic profiling within complex health systems.

Exam reform: an opportunity for the redistribution of academic power.

Students in STEM know well the stress, challenge, and effort that accompany college exams. As a widely recognizable feature of the STEM classroom experience, high-stakes assessments serve as crucial cultural gateways in shaping both preparation and motivation for careers. In this essay, we identify and discuss issues of power around STEM exams to further the understanding of exam practices that can unjustly hold students back. Through theory and practical examples, we consider the numerous ways in which power manifests both on and off the pages of the exams themselves, as well as ways in which power is consolidated away from students through logistical norms and tradeoffs. Centering the "rules of the culture of power" as delineated by Dr. Lisa Delpit, we reflect on exam practices that prioritize faculty voice and faculty convenience above student learning and student identity. We share some of what we have learned from our students as part of a call to improve STEM education by relinquishing some of our exam-related power over students, redistributing it to students so that they have more power to shape their own education.

Local Public Health Departments at the Intersection of Climate Change, Health Equity, and Public Health Laws and Policies.

Public health laws and policies are uniquely able to mitigate the adverse and inequitable health impacts of climate change. This article summarizes some key considerations in developing such laws and policies and a variety of approaches local public health departments are using to increase climate resilience and health equity.

Implementation of an interprofessional model for the management of postpartum hypertension.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: Postpartum hypertension (PPHTN) poses increased risks, including of stroke. Timely assessment and management by clinicians is imperative but challenging. Team-based care involving pharmacists has shown promise in improving blood pressure control, yet its application in PPHTN management remains unexplored. The objective of this study was to determine the impact and feasibility of an interprofessional model for PPHTN management. SUMMARY: This initiative implemented a novel interprofessional model at a safety-net hospital to address previous workflow limitations. Ambulatory care pharmacists collaborated with an obstetric nurse (OBRN) and a maternal fetal medicine specialist to manage high-risk patients with PPHTN utilizing electronic consults (e-consults). Data collection and symptom assessment were completed by an OBRN via telemedicine appointments. Pharmacists employed a collaborative practice agreement based on a preestablished algorithm to initiate medications. Data on patient demographics, consult volume, prescriptions, and pharmacist comfort were collected during the first quarter of full integration. Pharmacists completed 55 e-consults and generated 54 prescriptions. The average time spent per chart review was 12.5 minutes, and the average time to completion of e-consults was 54 minutes. Forty-five unique patients received care, who were primarily non-English-speaking and non-Hispanic Black patients. Pharmacists reported moderate to high comfort levels in managing PPHTN based on the algorithm and provided feedback leading to workflow adjustments. CONCLUSION: Integration of pharmacists into PPHTN care enables prompt medication initiation and titration. This innovative model, involving remote blood pressure monitoring, telemedicine visits with an OBRN, and e-consults completed by pharmacists, ensures delivery of timely and equitable care and improved access across a diverse population.

An integrated approach to analyze equitable access to food stores under disasters from human mobility patterns.

Limited access to food stores is often linked to higher health risks and lower community resilience. Socially vulnerable populations experience persistent disparities in equitable food store access. However, little research has been done to examine how people's access to food stores is affected by natural disasters. Previous studies mainly focus on examining potential access using the travel distance to the nearest food store, which often falls short of capturing the actual access of people. Therefore, to fill this gap, this paper incorporates human mobility patterns into the measure of actual access, leveraging large-scale mobile phone data. Specifically, we propose a novel enhanced two-step floating catchment area method with travel preferences (E2SFCA-TP) to measure accessibility, which extends the traditional E2SFCA model by integrating actual human mobility behaviors. We then analyze people's actual access to grocery and convenience stores across both space and time under the devastating winter storm Uri in Harris County, Texas. Our results highlight the value of using human mobility patterns to better reflect people's actual access behaviors. The proposed E2SFCA-TP measure is more capable of capturing mobility variations in people's access, compared with the traditional E2SFCA measure. This paper provides insights into food store access across space and time, which could aid decision making in resource allocation to enhance accessibility and mitigate the risk of food insecurity in underserved areas.

Reviewing the science on 50 years of conservation: Knowledge production biases and lessons for practice.

Drawing on 662 studies from 102 countries, we present a systematic review of published empirical studies about site-level biodiversity conservation initiated between 1970 and 2019. Within this sample, we find that knowledge production about the Global South is largely produced by researchers in the Global North, implying a neocolonial power dynamic. We also find evidence of bias in reported ecological outcomes linked to lack of independence in scientific studies, serving to uphold narratives about who should lead conservation. We explore relationships in the sample studies between conservation initiative types, the extent of Indigenous Peoples' and local communities' influence in governance, and reported social and ecological outcomes. Findings reveal positive ecological and social outcomes are strongly associated with higher levels of influence of Indigenous Peoples and local communities and their institutions, implying equity in conservation practice should be advanced not only for moral reasons, but because it can enhance conservation effectiveness.

Neurobiology of cognitive abilities in early childhood autism.

This perspective considers complexities in the relationship between impaired cognitive abilities and autism from a maturational, developmental perspective, and aims to serve as a helpful guide for the complex and growing investigation of cognitive abilities and Autism Spectrum Disorder (ASD). Low Intelligence Quotient (IQ) and ASD are frequently co-occurring. About 37% of 8-year old children and 48% of 4-year old children diagnosed with ASD also have Intellectual Disability, with IQ below 70. And, low IQ in early infancy, including below 1 year of age, carries a 40% greater chance of receiving ASD diagnosis in early childhood. We consider the evidence that may explain this co-occurrence, including the possibility that high IQ may "rescue" the social communication issues, as well as the possible role of critical periods during growth and development. We consider how early low IQ may subsume a part of a subgroup of individuals with ASD, in particular, those diagnosed with autism in very early childhood, and we provide neurobiological evidence in support of this subtype. Moreover, we distinguish the concept of early low IQ from the delay in speech onset in preschool and school-aged children, based on (i) age and (ii) impairments in both verbal and non-verbal domains. The etiology of these early-diagnosed, early low IQ ASD cases is different from later-diagnosed, average or higher-IQ cases, and from children with speech delay onset. Given recent interest in formulating new subtypes of autism, rather than continuing to conceive of ASD as a spectrum, as well as new subtypes that vary in the degree of severity along the spectrum, we identify gaps in knowledge and directions for future work in this complex and growing area.