The impact of US-China tensions on US science: Evidence from the NIH investigations.

Amid the discourse on foreign influence investigations in research, this study examines the impact of NIH-initiated investigations starting in 2018 on U.S. scientists' productivity, focusing on those collaborating with Chinese peers. Using publication data from 2010 to 2021, we analyze over 113,000 scientists and find that investigations coincide with reduced productivity for those with China collaborations compared to those with other international collaborators, especially when accounting for publication impact. The decline is particularly pronounced in fields that received greater preinvestigation NIH funding and engaged more in U.S.-China collaborations. Indications of scientist migration and broader scientific progress implications also emerge. We also offer insights into the underlying mechanisms via qualitative interviews.

Health workforce data needed to minimize inequities associated with health-worker migration.

A persistent challenge with health-worker migration is the inequities it creates. To minimize these inequities, systems of global governance of health-worker migration have arisen which include various global codes of practice, agreements and reporting requirements. Reporting that is rigorous, open and transparent, and subject to scrutiny from the public, researchers, civil society organizations and other interested stakeholders, is important. One element of these codes and agreements with perhaps the greatest potential to deal with the impact of health-worker migration is more robust planning of the health workforce to address the goal of self-sufficiency. Open platforms for data sharing enable engagement of the public and stakeholders with data on the distribution and national origin of health workers, and reveal policy strengths and weaknesses related to health-workforce planning. We explore recent policies directed at reducing the inequities from health-worker migration. While many of the examples used focus on nurses and doctors, the issues discussed are relevant to all cadres of internationally trained health workers.

La migration des professionnels de la santé constitue un problème persistant en raison des inégalités qu'elle engendre. Pour y remédier, des systèmes de gouvernance mondiale axés sur la migration des professionnels de la santé ont vu le jour. Ces systèmes comprennent différents codes de pratique, accords et exigences mondiaux en matière d'établissement de rapports. Il est essentiel que ces rapports soient rigoureux, ouverts et transparents et qu'ils fassent l'objet d'un examen minutieux de la part du public, des chercheurs, des organisations de la société civile et d'autres parties prenantes intéressées. L'un des éléments de ces codes de pratiques et accords qui induit peut-être le plus grand potentiel pour faire face à l'impact de la migration des professionnels de la santé est une planification plus soutenue des professionnels de la santé afin d'atteindre l'objectif d'autosuffisance. Des plateformes ouvertes de partage de données permettent au public et aux parties prenantes d'accéder aux données sur la répartition et l'origine nationale des professionnels de la santé et révèlent les forces et faiblesses des politiques liées à la planification du personnel de santé. Dans cette étude, nous explorons les politiques récentes visant à réduire les inégalités liées à la migration des professionnels de la santé. Bien que de nombreux exemples utilisés se concentrent sur le personnel infirmier et les médecins, les questions abordées concernent également tous les supérieurs des professionnels de la santé formés à l'étranger.

Uno de los desafíos persistentes de la migración de los profesionales sanitarios son las desigualdades que genera. Para minimizar estas desigualdades, han surgido sistemas de gobernanza mundial de la migración de los profesionales sanitarios que incluyen diversos códigos de prácticas, acuerdos y requisitos de presentación de informes a escala mundial. Es importante que los informes sean detallados, abiertos y transparentes, y que estén sujetos al escrutinio del público, los investigadores, las organizaciones de la sociedad civil y otras partes interesadas. Uno de los elementos de estos códigos y acuerdos con mayor potencial para hacer frente al impacto de la migración de los profesionales sanitarios es una planificación más sólida del personal sanitario para alcanzar el objetivo de la autosuficiencia. Las plataformas abiertas para el intercambio de datos permiten la participación del público y las partes interesadas con datos sobre la distribución y el origen nacional de los profesionales sanitarios y revelan las fortalezas y debilidades de las políticas relacionadas con la planificación del personal sanitario. Exploramos las políticas recientes dirigidas a reducir las desigualdades derivadas de la migración de los profesionales sanitarios. Aunque muchos de los ejemplos utilizados se centran en el personal de enfermería y los médicos, los temas tratados son relevantes para todos los tipos de profesionales sanitarios con formación internacional.

'We are all women here in Canada': Intimate bargains in WASH spaces.

In many parts of the world access to adequate water, sanitation and hygiene (WASH) is entwined with gender relations. While there is emerging research on how gender relations intersect with socio-cultural practices and norms to produce gender-based violence in WASH, little is known about how these gender relations are intimately produced, reproduced and embodied in place. Drawing insights from feminist political ecology and gendered geographies of power, this paper uses retrospective narratives of Ghanaian migrants in Canada to advance this scholarship in three significant ways. First, the findings demonstrate how gender relations in WASH produce everyday vulnerabilities differently among women and men. Second, they highlight the complex ways women bargain with patriarchal structures to ensure their safety in WASH spaces. Finally, the findings show how gender relations and roles in WASH transform in transnational spaces in which gendered WASH roles and responsibilities are blurred. The findings draw policy attention to the interconnectedness of WASH and gender equality and the need for policy and practice change to advance gender equity in WASH.

Partisan conflict over content moderation is more than disagreement about facts.

Social media companies have come under increasing pressure to remove misinformation from their platforms, but partisan disagreements over what should be removed have stymied efforts to deal with misinformation in the United States. Current explanations for these disagreements center on the "fact gap"-differences in perceptions about what is misinformation. We argue that partisan differences could also be due to "party promotion"-a desire to leave misinformation online that promotes one's own party-or a "preference gap"-differences in internalized preferences about whether misinformation should be removed. Through an experiment where respondents are shown false headlines aligned with their own or the opposing party, we find some evidence of party promotion among Democrats and strong evidence of a preference gap between Democrats and Republicans. Even when Republicans agree that content is false, they are half as likely as Democrats to say that the content should be removed and more than twice as likely to consider removal as censorship.

Complexities of health and care worker migration pathways and corresponding international reporting requirements.

The increasing complexity of the migration pathways of health and care workers is a critical consideration in the reporting requirements of international agreements designed to address their impacts. There are inherent challenges across these different agreements including reporting functions that are misaligned across different data collection tools, variable capacity of country respondents, and a lack of transparency or accountability in the reporting process. Moreover, reporting processes often neglect to recognize the broader intersectional gendered and racialized political economy of health and care worker migration. We argue for a more coordinated approach to the various international reporting requirements and processes that involve building capacity within countries to report on their domestic situation in response to these codes and conventions, and internationally to make such reporting result in more than simply the sum of their responses, but to reflect cross-national and transnational interactions and relationships. These strategies would better enable policy interventions along migration pathways that would more accurately recognize the growing complexity of health worker migration leading to more effective responses to mitigate its negative effects for migrants, source, destination, and transit countries. While recognizing the multiple layers of complexity, we nevertheless reaffirm the fact that countries still have an ethical responsibility to undertake health workforce planning in their countries that does not overly rely on the recruitment of migrant health and care workers.

How to make causal inferences using texts.

Text as data techniques offer a great promise: the ability to inductively discover measures that are useful for testing social science theories with large collections of text. Nearly all text-based causal inferences depend on a latent representation of the text, but we show that estimating this latent representation from the data creates underacknowledged risks: we may introduce an identification problem or overfit. To address these risks, we introduce a split-sample workflow for making rigorous causal inferences with discovered measures as treatments or outcomes. We then apply it to estimate causal effects from an experiment on immigration attitudes and a study on bureaucratic responsiveness.

The ethics of recruiting foreign-trained healthcare workers.

Canada's active immigration policy includes thousands of internationally trained health workers arriving annually. The effective utilization of these workers represents an ethical issue relevant to the WHO's Global Code of Practice on the International Recruitment of Health Personnel, to which Canada is a signatory. The ethical obligation for Canadian healthcare stakeholders is to continuously improve systems of credential evaluation and subsequent workplace integration to maximize immigrant health worker skills utilization and invest in better workforce data to meet Canada's ethical obligations regarding health workforce sustainability.

Assessing the contribution of immigrants to Canada's nursing and health care support occupations: a multi-scalar analysis.

BACKGROUND: The World Health Organization adopted the Global Strategy on Human Resources for Health Workforce 2030 in May 2016. It sets specific milestones for improving health workforce planning in member countries, such as developing a health workforce registry by 2020 and ensuring workforce self-sufficiency by halving dependency on foreign-trained health professionals. Canada falls short in achieving these milestones due to the absence of such a registry and a poor understanding of immigrants in the health workforce, particularly nursing and healthcare support occupations. This paper provides a multiscale (Canada, Ontario, and Ontario's Local Health Integration Networks) overview of immigrant participation in nursing and health care support occupations, discusses associated enumeration challenges, and the implications for health workforce planning focusing on immigrants. METHODS: Descriptive data analysis was performed on Canadian Institute for Health Information dataset for 2010 to 2020, and 2016 Canadian Census and other relevant data sources. RESULTS: The distribution of nurses in Canada, Ontario, and Ontario's Local Health Integration Networks reveal a growth in Nurse Practitioners and Registered/Licensed Practical Nurses, and contraction in the share of Registered Nurses. Immigrant entry into the profession was primarily through the practical nurse cadre. Mid-sized communities registered the highest growth in the share of internationally educated nurses. Data also pointed towards the underutilization of immigrants in regulated nursing and health occupations. CONCLUSION: Immigrants comprise an important share of Canada's nursing and health care support workforce. Immigrant pathways for entering nursing occupations are complex and difficult to accurately enumerate. This paper recommends the creation of an integrated health workforce dataset, including information about immigrant health workers, for both effective national workforce planning and for assessing Canada's role in global health workforce distribution and utilization.

COVID-19 increased censorship circumvention and access to sensitive topics in China.

Crisis motivates people to track news closely, and this increased engagement can expose individuals to politically sensitive information unrelated to the initial crisis. We use the case of the COVID-19 outbreak in China to examine how crisis affects information seeking in countries that normally exert significant control over access to media. The crisis spurred censorship circumvention and access to international news and political content on websites blocked in China. Once individuals circumvented censorship, they not only received more information about the crisis itself but also accessed unrelated information that the regime has long censored. Using comparisons to democratic and other authoritarian countries also affected by early outbreaks, the findings suggest that people blocked from accessing information most of the time might disproportionately and collectively access that long-hidden information during a crisis. Evaluations resulting from this access, negative or positive for a government, might draw on both current events and censored history.

Hiding in plain sight: the absence of consideration of the gendered dimensions in 'source' country perspectives on health worker migration.

BACKGROUND: Gender roles and relations affect both the drivers and experiences of health worker migration, yet policy responses rarely consider these gender dimensions. This lack of explicit attention from source country perspectives can lead to inadequate policy responses. METHODS: A Canadian-led research team partnered with co-investigators in the Philippines, South Africa, and India to examine the causes, consequences and policy responses to the international migration of health workers from these 'source' countries. Multiple-methods combined an initial documentary analysis, interviews and surveys with health workers and country-based stakeholders. We undertook an explicit gender-based analysis highlighting the gender-related influences and implications that emerged from the published literature and policy documents from the decade 2005 to 2015; in-depth interviews with 117 stakeholders; and surveys conducted with 3580 health workers. RESULTS: The documentary analysis of health worker emigration from South Africa, India and the Philippines reveal that gender can mediate access to and participation in health worker training, employment, and ultimately migration. Our analysis of survey data from nurses, physicians and other health workers in South Africa, India and the Philippines and interviews with policy stakeholders, however, reveals a curious absence of how gender might mediate health worker migration. Stereotypical views were evident amongst stakeholders; for example, in South Africa female health workers were described as "preferred" for "innate" personal characteristics and cultural reasons, and in India men are directed away from nursing roles particularly because they are considered only for women. The finding that inadequate remuneration was as a key migration driver amongst survey respondents in India and the Philippines, where nurses predominated in our sample, was not necessarily linked to underlying gender-based pay inequity. The documentary data suggest that migration may improve social status of female nurses, but it may also expose them to deskilling, as a result of the intersecting racism and sexism experienced in destination countries. Regardless of these underlying influences in migration decision-making, gender is rarely considered either as an important contextual influence or analytic category in the policy responses. CONCLUSION: An explicit gender-based analysis of health worker emigration, which may help to emphasize important equity considerations, could offer useful insights for the health and social policy responses adopted by source countries.

Understanding Social Network and Support for Older Immigrants in Ontario, Canada: Protocol for a Mixed-Methods Study.

BACKGROUND: Older adults are the fastest growing age group worldwide and in Canada. Immigrants represent a significant proportion of older Canadians. Social isolation is common among older adults and has many negative consequences, including limited community and civic participation, increased income insecurity, and increased risk of elder abuse. Additional factors such as the social, cultural, and economic changes that accompany migration, language differences, racism, and ageism heighten older immigrants' vulnerability to social isolation. OBJECTIVE: This mixed-methods sequential (qualitative-quantitative) study seeks to clarify older immigrants' social needs, networks, and support and how these shape their capacity, resilience, and independence in aging well in Ontario. METHODS: Theoretically, our research is informed by an intersectionality perspective and an ecological model, allowing us to critically examine the complexity surrounding multiple dimensions of social identity (eg, gender and immigration) and how these interrelate at the micro (individual and family), meso (community), and macro (societal) levels in diverse geographical settings. Methodologically, the project is guided by a collaborative, community-based, mixed-methods approach to engaging a range of stakeholders in Toronto, Ottawa, Waterloo, and London in generating knowledge. The 4 settings were strategically chosen for their diversity in the level of urbanization, size of community, and the number of immigrants and immigrant-serving organizations. Interviews will be conducted in Arabic, Mandarin, and Spanish with older women, older men, family members, community leaders, and service providers. The study protocol has received ethics approval from the 4 participating universities. RESULTS: Quantitative and qualitative data collection is ongoing. The project is funded by the Social Sciences and Humanities Council of Canada. CONCLUSIONS: Comparative analyses of qualitative and quantitative data within and across sites will provide insights about common and unique factors that contribute to the well-being of older immigrants in different regions of Ontario. Given the comprehensive approach to incorporating local knowledge and expert contributions from multilevel stakeholders, the empirical and theoretical findings will be highly relevant to our community partners, help facilitate practice change, and improve the well-being of older men and women in immigrant communities. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/12616.

Machine behaviour.

Machines powered by artificial intelligence increasingly mediate our social, cultural, economic and political interactions. Understanding the behaviour of artificial intelligence systems is essential to our ability to control their actions, reap their benefits and minimize their harms. Here we argue that this necessitates a broad scientific research agenda to study machine behaviour that incorporates and expands upon the discipline of computer science and includes insights from across the sciences. We first outline a set of questions that are fundamental to this emerging field and then explore the technical, legal and institutional constraints on the study of machine behaviour.

Efficacy of home-based visuomotor feedback training in stroke patients with chronic hemispatial neglect.

Hemispatial neglect is a severe cognitive condition frequently observed after a stroke, associated with unawareness of one side of space, disability and poor long-term outcome. Visuomotor feedback training (VFT) is a neglect rehabilitation technique that involves a simple, inexpensive and feasible training of grasping-to-lift rods at the centre. We compared the immediate and long-term effects of VFT vs. a control training when delivered in a home-based setting. Twenty participants were randomly allocated to an intervention (who received VFT) or a control group (n = 10 each). Training was delivered for two sessions by an experimenter and then patients self-administered it for 10 sessions over two weeks. Outcome measures included the Behavioural Inattention Test (BIT), line bisection, Balloons Test, Landmark task, room description task, subjective straight-ahead pointing task and the Stroke Impact Scale. The measures were obtained before, immediately after the training sessions and after four-months post-training. Significantly greater short and long-term improvements were obtained after VFT when compared to control training in line bisection, BIT and spatial bias in cancellation. VFT also produced improvements on activities of daily living. We conclude that VFT is a feasible, effective, home-based rehabilitation method for neglect patients that warrants further investigation with well-designed randomised controlled trials on a large sample of patients.

Labour market regulation as global social policy: The case of nursing labour markets in Oman.

This article examines global social policy formation in the area of skilled migration, with a focus on the Gulf Arab region. Across the globe, migration governance presents challenges to multiple levels of authority; its complexity crosses many scales and involves a multitude of actors with diverse interests. Despite this jurisdictional complexity, migration remains one of the most staunchly defended realms of sovereign policy control. Building on global social policy literature, this article examines how 'domestic' labour migration policies reflect the entanglement of multiple states' and agencies' interests. Such entanglements result in what we characterize as a 'multiplex system', where skilled-migration policies are formed within, and shaped by, globalized policy spaces. To illustrate, we examine policies that shape the nursing labour market in Oman during a period when the state aims to transition from dependence on an expatriate to an increasingly nationalized labour force. Engaging a case-study methodology including a survey of migrant healthcare workers, semi-structured interviews and data analysis, we find that nursing labour markets in Oman represent an example of global policy formation due to the interaction of domestic and expatriate labour policies and provisioning systems. The transnational structuring of policy making that emerges reflects a contingent process marked by conflicting outcomes. We contend that Oman's nursing labour market is an example of new spaces where global social policies emerge from the tension of competing national state and market interests.

Rasch Analysis of the Edmonton Symptom Assessment System.

CONTEXT: The Edmonton Symptom Assessment System (ESAS) is a widely used multisymptom assessment tool in cancer and palliative care settings, but its psychometric properties have not been widely tested using modern psychometric methods such as Rasch analysis. OBJECTIVES: To apply Rasch analysis to the ESAS in a community palliative care setting and determine its suitability for assessing symptom burden in this group. METHODS: ESAS data collected from 229 patients enrolled in a community hospice service were evaluated using a partial credit Rasch model with RUMM2030 software (RUMM Laboratory Pty, Ltd., Duncraig, WA). Where disordered thresholds were discovered, item rescoring was undertaken. Rasch model fit and differential item functioning were evaluated after each iterative phase. RESULTS: Uniform rescoring was necessary for all 12 items to display ordered thresholds. The best model fit was achieved after item rescoring and combining three pairs of locally dependent items into three superitems (χ2 = 29.56 [27]; P = 0.33) that permitted ordinal-to-interval conversion. CONCLUSION: The ESAS satisfied unidimensional Rasch model expectations in a 12-item format after minor modifications. This included uniform rescoring of the disordered response categories and creating superitems to improve model fit and clinical utility. The accuracy of the ESAS scores can be improved by using ordinal-to-interval conversion tables published in the article.

Causes, consequences, and policy responses to the migration of health workers: key findings from India.

BACKGROUND: This study sought to better understand the drivers of skilled health professional migration, its consequences, and the various strategies countries have employed to mitigate its negative impacts. The study was conducted in four countries-Jamaica, India, the Philippines, and South Africa-that have historically been "sources" of health workers migrating to other countries. The aim of this paper is to present the findings from the Indian portion of the study. METHODS: Data were collected using surveys of Indian generalist and specialist physicians, nurses, midwives, dentists, pharmacists, dieticians, and other allied health therapists. We also conducted structured interviews with key stakeholders representing government ministries, professional associations, regional health authorities, health care facilities, and educational institutions. Quantitative data were analyzed using descriptive statistics and regression models. Qualitative data were analyzed thematically. RESULTS: Shortages of health workers are evident in certain parts of India and in certain specialty areas, but the degree and nature of such shortages are difficult to determine due to the lack of evidence and health information. The relationship of such shortages to international migration is not clear. Policy responses to health worker migration are also similarly embedded in wider processes aimed at health workforce management, but overall, there is no clear policy agenda to manage health worker migration. Decision-makers in India present conflicting options about the need or desirability of curtailing migration. CONCLUSIONS: Consequences of health work migration on the Indian health care system are not easily discernable from other compounding factors. Research suggests that shortages of skilled health workers in India must be examined in relation to domestic policies on training, recruitment, and retention rather than viewed as a direct consequence of the international migration of health workers.

International migration of health professionals and the marketization and privatization of health education in India: from push-pull to global political economy.

Health worker migration theories have tended to focus on labour market conditions as principal push or pull factors. The role of education systems in producing internationally oriented health workers has been less explored. In place of the traditional conceptual approaches to understanding health worker, especially nurse, migration, I advocate global political economy (GPE) as a perspective that can highlight how educational investment and global migration tendencies are increasing interlinked. The Indian case illustrates the globally oriented nature of health care training, and informs a broader understanding of both the process of health worker migration, and how it reflects wider marketization tendencies evident in India's education and health systems. The Indian case also demonstrates how the global orientation of education systems in source regions is increasingly central to comprehending the place of health workers in the global and Asian rise in migration. The paper concludes that Indian corporate health care training systems are increasingly aligned with the production of professionals orientated to globally integrated health human resource labour markets, and our conceptual analysis of such processes must effectively reflect these tendencies.

Political science. Reverse-engineering censorship in China: randomized experimentation and participant observation.

Existing research on the extensive Chinese censorship organization uses observational methods with well-known limitations. We conducted the first large-scale experimental study of censorship by creating accounts on numerous social media sites, randomly submitting different texts, and observing from a worldwide network of computers which texts were censored and which were not. We also supplemented interviews with confidential sources by creating our own social media site, contracting with Chinese firms to install the same censoring technologies as existing sites, and--with their software, documentation, and even customer support--reverse-engineering how it all works. Our results offer rigorous support for the recent hypothesis that criticisms of the state, its leaders, and their policies are published, whereas posts about real-world events with collective action potential are censored.