Disproportionate Impact Research Articles

Troubled waters? The disproportionate impact of lead water pollution: Evidence from three American communities

<p>Although water is considered essential to life and an important natural resource, disadvantaged communities, such as low-income and minority communities, are disproportionately burdened by lead exposure in drinking water. In this paper, we highlight case studies that have received national press coverage as well as recent examples of community lead poisoning hazards that are still ongoing across various regions of the US. We show through these three case studies of Flint, Michigan, Washington, D.C., and Birmingham, Alabama, that the severity and frequency of this pervasive public health problem are highly concentrated in minority and low-income populations, and thus they bear the brunt of the socio-economic impacts. We identify the use of sensors to improve detection of hazardous materials and decrease inequities in drinking water contamination. To address water-related equity issues, we call for a sustainable community capacity approach that consists of shared governance between those who live in a community and stakeholders, such as businesses and health services, who have vested interests in it. We conclude by highlighting ways that a community could build collective social capital, safeguarding its environment from lead poisoning through health literacy education. Promoting water literacy is highly significant since water knowledge is crucial towards achieving water sustainability and equity.</p>

Infant rates of child protective services contact and termination of parental rights by First Nations status from 1998 to 2019: An example of intergenerational transmission of colonial harm

BackgroundRates of child removal by child protective services (CPS) in Manitoba are the highest in Canada with a profoundly disproportionate impact on First Nations families. Despite infants constituting the highest proportion of children affected, no research has examined population-level rates of infant contact with CPS. ObjectiveWe examined the incidence of infant contact with different levels of CPS, including termination of parental rights (TPR), according to First Nations status. ParticipantsWe identified 217,261 infants (47,416 First Nations; 169,845 non-First Nations) born between 1998 and 2014 in Manitoba, Canada and residing in the province until at least age 5. MethodsWe used linked administrative data to calculate population-level rates of contact with different levels of CPS by First Nations status, including an open file before age 1, out-of-home placement before age 1, and TPR before age 5. ResultsOverall 35.8 % of First Nations infants had an open file, 8.5 % experienced out-of-home placement, and 5.4 % experienced TPR. Among other infants, 8.5 % had an open file, 1.3 % experienced out-of-home placement and 0.7 % experienced TPR. The rate of early-stage contact increased the fastest among First Nations infants, with a rise of 22.4 % in our study period, compared to a rise of 1.7 % among all other infants. ConclusionsCPS contact was exceptionally high among First Nations infants compared to other infants, with early-stage contact accelerating most dramatically over time. Findings support calls to greatly reduce the disruption of system contact in the lives of First Nations families.

The disproportionate impact of enhanced evaporation from melting arctic sea ice on cold-season land precipitation trends

Diminishing Arctic sea ice has led to enhanced evaporation from the Arctic marginal seas (AMS), which is expected to alter precipitation over land. In this work, AMS evaporation is numerically tracked to quantify its contribution to cold-season (October–March) precipitation over land in the Northern Hemisphere during 1980–2021. Results show a significant 32% increase in AMS moisture contribution to land precipitation, corresponding to a 16% increase per million square km loss of sea ice area. Especially over the high-latitude land, despite the fractional contribution of AMS to precipitation being relatively low (8%), the augmented AMS evaporation contributed disproportionately (42%) to the observed upward trend in precipitation. Notably, northern East Siberia exhibited a substantial rise in both the amount and fraction of extreme snowfall sourced from the AMS. Our findings underscore the importance of the progressively ice-free Arctic as an important contributor to the escalating levels of cold-season precipitation and snowfall over northern high-latitude land.

A Quantitative Exploration of the Influence of Tobacco Use on Poverty in India

Abstract Introduction Tobacco use has a disproportionate impact on lower socioeconomic groups in India. The study quantifies the number of people who would fall under the national poverty line if the direct spending on tobacco and healthcare expenditures attributable to tobacco use were subtracted from their monthly expenditures. It also aims to estimate the extent to which tobacco use increases the probability of poverty status in India. Aims and Methods We quantify the increase in poverty by multiplying the difference between headcount ratios with and without tobacco-related spending by population size. We use propensity score matching to estimate the extent to which tobacco use increases the probability of poverty. Results About 18.4 million (1.5% of all Indians) are pushed into poverty due to either direct tobacco-related expenditures or tobacco-related healthcare spending. Tobacco use increases households’ likelihood of being poor by 3.4%–3.7%. Conclusions With over 22% of the global poor, achieving poverty reduction goals is a significant challenge for India. We show that this challenge is accentuated by increased tobacco spending, which pushes millions of Indians into poverty. To address this, the Government of India must implement both fiscal and non-fiscal policies that regulate tobacco use and, in turn, contribute to poverty reduction in the country. Implications Tobacco use has a disproportionate impact on lower socioeconomic groups in India, leading to increased and deeper poverty. This paper finds that, based on existing proven measures of poverty, tobacco use accounts for an additional 18.4 million poor individuals. It also shows that tobacco use increases the likelihood of a household being classified as poor by 3.4% to 3.7%. As India is home to a significant proportion of the global poor, addressing tobacco use becomes crucial for global and domestic poverty reduction goals. Fiscal and non-fiscal policies can be used to regulate tobacco and potentially reduce poverty levels in India.

Benefits of early highly effective versus escalation treatment strategies in relapsing multiple sclerosis estimated using a treatment-sequence model

Background: Uncertainty about disproportionate impact on health care budgets limits implementation of early highly effective treatment (EHT) in multiple sclerosis (MS). Objective: To estimate cost-effectiveness of escalation versus EHT disease-modifying treatment (DMT) sequences. Methods: Using a health-economic approach, we analysed health benefits (relapse rate reduction, disability prevention), direct/indirect DMT and societal costs of escalation versus EHT DMT sequences. In scenario analyses, we allowed (1) earlier use of alemtuzumab (ALE) and (2) a single retreatment with cladribine (CLA). Results: In our model, we showed that the ratio between costs and quality-adjusted life years (QALYs) for the most cost-effective EHT and escalation sequence results into a similar net health benefit with higher costs and also higher QALYs associated with an EHT versus escalation strategy. Earlier use of ALE is more cost-effective than in later lines, even when aggravating the impact of its side-effects tenfold. Retreatment with CLA was more cost-effective in both escalation and EHT sequences. Conclusions: Certain EHT sequences are equally cost-effective to escalation sequences and are likely to result in more health at uncertain additional costs. The favourable cost–benefit ratio of CLA and ALE suggests that a wider application of affordable highly effective therapies could promote the cost-effectiveness both EHT and escalation approaches.

'You're just a Guinea pig': Exploring the barriers and impacts of living with long COVID-19: A view from the undiagnosed.

The COVID-19 pandemic had a disproportionate impact on ethnically minoritised and other marginalised communities, yet little is known about the impacts of long COVID-19 (LC) on this group. Living with LC takes its toll both physically, emotionally and financially and even more so when a diagnosis is hard to come by. By using qualitative interviews centring the view of undiagnosed and marginalised communities already classed as 'underserved' in the medical literature, we show the range of barriers and impacts faced by these groups in the UK, and the strategies of resilience they use. Whether trapped on a 'diagnostic odyssey' at the level of primary care, struggling to maintain employment and businesses, or managing family commitments, we argue many minoritised communities are caught in a liminal space of misrecognition, invalidation and ambiguity. We show how these impacts are generated by tensions and challenges in the process and categorisation of diagnosis, and how this effects the daily lives of many individuals already on the receiving end of health inequity. We also offer some examples and suggestions for best practices.

Small translocations of endangered Gallinula galeata sandvicensis (Hawaiian Common Gallinule) may be sufficient to generate a viable reintroduced population

Abstract Where stable source populations of at-risk species exist, translocation may be a reasonable strategy for re-establishing extirpated populations. However, the success rates of such efforts are mixed, necessitating thorough preliminary investigation. Stochastic population modeling can be a useful method of assessing the potential success of translocations. Here, we report on the results of modeling translocation success for the Gallinula galeata sandvicensis or ‘alae ‘ula (Hawaiian Common Gallinule), an endangered waterbird endemic to the Hawaiian Islands. Using updated vital rates, we constructed a model simulating 3 existing extant (wild) source populations and a hypothetical recipient site on another island. We then projected the effects of 6 different translocation scenarios and sensitivity of the results to variation of three important demographic parameters on the probability of extinction (PE) of the reintroduced and donor populations. Larger translocations, of at least 30 birds, had low probability of extinction in the reintroduced population, but raised extinction risk of the smallest source population. Spacing out translocations in time (e.g., 10 birds translocated in total in 3 installments over 9 years), led to lower PE than translocating all individuals at once (i.e., bulk translocations) for both the source and reintroduced populations. Brood size and hatch-year juvenile survival had a disproportionate impact on reintroduced population viability. Importantly, the reported juvenile survival rate is very near the threshold for population failure. This suggests that post-introduction and subsequent management of wetlands, particularly predator control, could be critical to reintroduction success. We recommend that individuals should be translocated from multiple, genetically distinct subpopulations to reduce the possibility of inbreeding depression. Based on this analysis, the recipient wetland should be sufficiently large that it can support at least 25 pairs of gallinules. Based on recent estimates of population densities on O‘ahu, such a wetland would need to be between 3.75 and 74.6 ha.

Healthcare professional students’ skills in sexual health communication and history taking: inter-rater reliability of standardized patients and faculty ratings in dar es Salaam, tanzania- a cross-sectional study

BackgroundLow- and middle-income countries face a disproportionate impact of sexual health problems compared to high-income countries. To address this situation proper interpersonal communication skills are essential for clinician to gather necessary information during medical history-taking related to sexual health. This study aimed to evaluate the interrater reliability of ratings on sexual health-related interpersonal communication and medical history-taking between SPs and trained HCP faculty for health care professional students.MethodsWe conducted a cross-sectional comparative study to evaluate the interrater reliability of ratings for sexual health-related interpersonal communication and medical history-taking. The data were collected from medical and nursing students at Muhimbili University of Health and Allied Sciences, who interviewed 12 Standardized Patients (SPs) presenting with sexual health issues. The video-recorded interviews rated by SPs, were compared to the one rated by 5 trained Health Care Professional (HCP) faculty members. Inter-rater reliability was evaluated using percent agreement (PA) and kappa statistics (κ).ResultsA total of 412 students (mean age 24) were enrolled in the study to conduct interviews with two SPs presenting with sexual health concerns. For interpersonal communication (IC), the overall median agreement between raters was slight (κ2 0.0095; PA 48.9%) while the overall median agreement for medical sexual history-taking was deemed fair (κ2 0.139; PA 75.02%).ConclusionThe use of SPs for training and evaluating medical and nursing students in Tanzania is feasible only if they undergo proper training and have sufficient time for practice sessions, along with providing feedback to the students.

Toward Flash Flood Modeling Using Gradient Resolving Representative Hillslopes

AbstractIt is increasingly acknowledged that the acceleration of the global water cycle, largely driven by anthropogenic climate change, has a disproportionate impact on sub‐daily and small‐scale hydrological extreme events such as flash floods. These events occur thereby at local scales within minutes to hours, typically in response to high‐intensity rainfall events associated with convective storms. In the present work, we show that by employing physically based representative hillslope models that resolve the main gradients controlling overland flow hydrology and hydraulics, we can get reliable simulations of flash flood response in small data‐scarce catchments. To this end, we use climate reanalysis products and transfer soil parameters previously obtained for hydrological predictions in an experimental catchment in the same landscape. The inverted mass balance of flood reservoirs downstream is employed for model evaluation in these nearly ungauged basins. We show that our approach using representative hillslopes and climate data sets can provide reasonable uncalibrated estimates of the overland runoff response (flood magnitude, storm volume, and event runoff coefficients) in three of the four catchments considered. Given that flash floods typically occur at scales of a few km2 and in ungauged places, our results have implications for operational flash flood forecasting and open new avenues for using gradient resolving physically based models for the design of small and medium flood retention basins around the world.

Impact of obesity on breast cancer clinicopathological characteristics in underserved community dweller women of Chicagoland: An experience from a US safety-net hospital.

e22519 Background: Breast cancer (BC) continues to pose a significant public health challenge, with its incidence and disproportionate impact on underserved populations in the United States. The relationship between obesity and clinicopathological characteristics at presentation remains a critical area of investigation. Safety-net hospitals catering to diverse, underserved, and often marginalized communities provide a unique setting to explore these associations, shedding light on potential disparities and informing targeted interventions. This study seeks to address a critical gap in knowledge on obesity and BC characteristics in underserved populations in the United States. Methods: In this retrospective study, 927 BC patients were included. Analysis was conducted to assess the association between body mass index (BMI), age of diagnosis, tumor clinicopathologic characteristics, and molecular types. The analysis was stratified by menopausal status at diagnosis. Results: The average age at diagnosis was 57.52 ± 12.40 years; 60.2% were postmenopausal women. Patients were categorized based on BMI into underweight/normal, overweight, and obese categories. One-way ANOVA analysis revealed no significant difference in mean age at presentation between BMI groups (p = 0.08). A significant association was found between BMI and menopausal status (p < 0.05). Disease stage at presentation was significantly associated with BMI (p < 0.05). Further investigation into BMI categories and tumor characteristics revealed a significant correlation in postmenopausal women, with obesity linked to tumor size and lymph node status (p < 0.05). No significant associations were observed between HER-2 status, ER/PR status, and obesity in either premenopausal or postmenopausal groups. In the subgroup analysis focusing on ethnic groups, African American patients (with an average BMI of 32.8 ± 8.2 kg/m2) demonstrated a higher prevalence of obesity at BC diagnosis in both pre and post-menopausal females compared to other ethnic groups (p < 0.05). Conclusions: Obesity was associated with the disease stage and menopause status at diagnosis. In postmenopausal patients, obesity was associated with tumor size and lymph node disease status. Additionally, ethnic variations were evident, with African American patients displaying a higher prevalence of obesity. We need further investigations to tailor interventions addressing diverse demographic factors in BC management.

Women's health and rights in the twenty-first century.

In the twenty-first century, the complex relationship between women's health and rights has been influenced by a range of interconnected challenges, including gender inequity, reproductive health disparities, maternal mortality and morbidity, and women's inability to access life-saving, high-quality healthcare services including family planning. Going forward, the world needs to find ways to implement the unfinished agenda of the International Conference on Population and Development (ICPD) 1994 and the Sustainable Development Goals (SDGs), thus prioritizing health and rights for women and girls as essential not only to their survival but also to their progress, agency and empowerment. It is also important to consider the interconnection between women's health and rights and climate change, with its disproportionate impact on the well-being of girls and women, and to address the impact and opportunities afforded by digital technologies. By embracing a holistic approach, societies might be able to advance the cause of women's health and rights in a more inclusive and sustainable manner.

COVID-19 parent stress in Middle Eastern and North African countries: Relations to family adjustment.

The COVID-19 pandemic has been stressful for individuals worldwide, including parents. Most research investigating stress during the pandemic has focused on single stressors in relation to outcomes and has been conducted in Western countries. Among parents from Middle Eastern and North African (MENA) countries, the present study used latent class analysis to identify specific subgroups of individuals based on combinations of stressful events experienced during the first two waves of the COVID-19 global pandemic. Whether individuals in these classes differed on levels of both adaptive (individual resilience, family cohesion) and maladaptive outcomes (depressive symptoms) was tested. Finally, perceived marital satisfaction was tested as a moderator of relations between class membership and adjustment outcomes. Participants were 545 parents (66.8% women, Mage = 35.79 years) recruited online who indicated presence or absence of experiencing 21 stressors across domains such as a family member contracting COVID, increased caregiving burden, work-related stress, and child adjustment problems. Three latent classes were identified, with one group characterized by work and child adjustment stress, one by child adjustment stress only, and one by low levels of stress across domains. The two higher stress groups reported increased depression. No associations with positive outcomes were found. Martial quality was most important for impacting greater resilience for those individuals experiencing child adjustment stress. This study provides evidence that COVID-related stress had disproportionate impact across parents in MENA countries. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Effects of Energy Prices on the Inflation Rate of Western Balkan Countries

The Western Balkan countries have experienced significant economic fluctuations in recent years. Among the primary contributors to these fluctuations is the volatility of energy prices. Energy, being a fundamental input in both production and consumption, has a direct and often disproportionate impact on inflation trends. Therefore, this study analyzes how energy prices have contributed to inflation in the Western Balkan (WB) countries in the period 2002 and 2022. The panel regression models, such as the fixed and random effects model as well as the Least Square Dummy Variables (LSDV), have been employed. The results reveal that there is a positive and significant relationship between energy prices and inflation. Variations in energy dependency, domestic energy policies, and economic structures lead to different inflationary responses across the Western Balkan countries. Countries with higher dependence on imported energy tend to experience more pronounced inflationary pressures.

Real life data of KEYNOTE 522: The Cleveland Clinic experience.

e12612 Background: Triple-negative breast cancer (TNBC) constitutes approximately 15% of all breast cancers and predominantly affects younger women with a disproportionate impact on Black and Hispanic ethnicities. Historically, neoadjuvant therapy centered around chemotherapy alone. However, the KEYNOTE 522 trial has demonstrated improved outcomes with the incorporation of the PD-1 inhibitor Pembrolizumab alongside neoadjuvant chemotherapy. Methods: A retrospective cohort analysis of 106 patients treated with the KEYNOTE 522 regimen within Cleveland Clinic from January 2020 to July 2023. The objective is to evaluate the real-life experience, particularly concerning treatment tolerance and pathologic complete response rates (PCR). Results: Among the 106 female patients, 6.6% completed full neoadjuvant therapy without reporting adverse events (AE), achieving a 71.42% PCR rate. Complications were reported in various subgroups: 54.72% associated with paclitaxel and carboplatin, with discontinuation rates of 60.34%, reduction rates of 33.02%, and full continuation rates of 6.9%. The most prevalent AE included cytopenia (46.55%) and febrile neutropenia, along with other infections (27.59%). For patients discontinuing paclitaxel and carboplatin, the PCR was 68.57%, while with dose reductions, it was 68.75%. Complications related to doxorubicin and cyclophosphamide were reported in 16.04% of patients, with 47.06% either discontinuing or reducing dose, and 5.88% continuing full therapy. Febrile neutropenia, along with other infections (64.71%) and cytopenia (23.53%) were the prominent AE. The PCR for patients discontinuing or reduced doxorubicin and cyclophosphamide was 62.50%. Pembrolizumab-related complications were reported in 16.98% of patients, with a 50% discontinuation rate. The most common AE was dermatologic toxicities (27.78%). The PCR for patients discontinuing pembrolizumab was 83.33% versus 62.5% for those continuing full therapy. Conclusions: This retrospective analysis highlights infections and cytopenias as the primary adverse reactions. Notably, the dose reduction or discontinuation of agents did result in a deterioration of PCR rate compared to patients completing full therapy. Remarkably, PCR was improved for the pembrolizumab discontinuation group, perhaps suggesting a correlation between autoimmune toxicities and improved response. Additional prospective study with larger sample size is needed to understand whether all patients benefit from completing the Keynote 522 regimen. [Table: see text]

Altered extracellular matrix–related pathways accelerate the transition from normal to prefibroid myometrium in Black women

BackgroundBlack women experience a disproportionate impact of uterine fibroids compared to White women, including earlier diagnosis, higher frequency, and more severe symptoms. The etiology underlying this racial disparity remains elusive. ObjectiveThe aim of this study was to evaluate the molecular differences in normal myometrium (fibroid-free uteri) and at-risk myometrium (fibroid-containing uteri) tissues in Black and White women. Study designWe conducted whole-genome RNA-seq on normal and at-risk myometrium tissues obtained from both self-identified Black and White women (not Hispanic or Latino) to determine global gene expression profiles and to conduct enriched pathway analyses (n=3 per group). We initially assessed the differences within the same type of tissue (normal or at-risk myometrium) between races. Subsequently, we analyzed the transcriptome of normal myometrium compared to at-risk myometrium in each race and determined the differences between them. We validated our findings through real-time PCR (sample size range=5-12), western blot (sample size range=5-6), and immunohistochemistry techniques (sample size range=9-16). ResultsThe transcriptomic analysis revealed distinct profiles between Black and White women in normal and at-risk myometrium tissues. Interestingly, genes and pathways related to extracellular matrix and mechanosensing were more enriched in normal myometrium from Black than White women. Transcription factor enrichment analysis detected greater activity of the serum response transcription factor positional motif in normal myometrium from Black compared to White women. Furthermore, we observed increased expression levels of myocardin-related transcription factor-serum response factor and the serum response factor in the same comparison. In addition, we noted increased expression of both mRNA and protein levels of vinculin, a target gene of the serum response factor, in normal myometrium tissues from Black women as compared to White women. Importantly, the transcriptomic profile of normal to at-risk myometrium conversion differs between Black and White women. Specifically, we observed that extracellular matrix-related pathways are involved in the transition from normal to at-risk myometrium and that these processes are exacerbated in Black women. We found increased levels of Tenascin C, type I collagen alpha 1 chain, fibronectin and, phospho-p38 MAPK (Thr180/Tyr182, active) protein levels in at-risk over normal myometrium tissues from Black women, whereas such differences were not observed in samples from White women. ConclusionsThese findings indicate that the racial disparities in uterine fibroids may be attributed to heightened production of extracellular matrix in the myometrium in Black women, even before the tumors appear. Future research is needed to understand early life determinants of the observed racial differences.

Uncovering gaps in management of vasomotor symptoms: findings from a national need assessment.

This national needs assessment study explores the knowledge, attitude, beliefs, and practices (KABP) gaps related to vasomotor symptoms (VMS) associated with menopause among primary care and OB/GYN clinicians. VMS significantly impacts healthcare costs, workplace productivity, and patient psychosocial health, but a notable disconnect exists between healthcare providers and patients, with provider reticence and knowledge gaps playing a contributing role. This study aims to identify and propose optimal educational strategies to address these barriers, with attention to health disparities affecting women of color. Methods employed include a multimodal approach of literature review, expert opinion, qualitative interviews, surveys, focus groups, and case studies, ensuring diverse clinician input. Data collection involved in-depth clinician interviews, a nationally disseminated clinician survey, and focus groups. Results indicate a critical deficiency in healthcare providers' understanding and management of VMS, especially among OB/GYN residents, with 75 % showing limited knowledge. The study also highlights the disproportionate impact of knowledge gaps on women of color, emphasizing the need for a culturally informed approach in medical training and practice. There's a notable discrepancy between clinicians' current and desired abilities in managing VMS, indicating a need for ongoing professional development. Significant variability in approaches to diagnosing and treating VMS, as well as substantial knowledge gaps about treatment options, underscore the need for evidence-based protocols. Although VMS are a normal aspect of aging, they can significantly disrupt quality of life for many women, necessitating intervention. Beyond the immediate discomfort, VMS can impact quality of life and trigger insomnia and mood disturbances. This study exposes both new and previously recognized gaps in healthcare providers' knowledge and management skills concerning VMS treatment options, particularly regarding hormonal and nonhormonal therapies. Furthermore, our findings highlight the need for a deeper understanding of how VMS uniquely impacts women of diverse backgrounds. Research, including the Study of Women's Health Across the Nation (SWAN), suggests that the experience and severity of VMS may be influenced by socioeconomic status, race/ethnicity, body mass index (BMI), and smoking status. However, the complex interplay of these factors and their relative contributions remain unclear. Further investigation is crucial to facilitate equitable access to effective treatment for all women. To bridge these gaps, improved education starting as early as residency is essential. This education should address common misconceptions about VMS and its management. Healthcare providers must enhance their competence in discussing the broad spectrum of VMS impacts and employ effective communication strategies to ensure that patients are well-informed about their symptoms and available treatment options.

Principles for embedded emissions accounting to support trade-related climate policy

ABSTRACT Climate policy – though shaped by international regimes – has traditionally been heavily domestic in practice. Accordingly, public emissions accounting frameworks have been designed to support policies targeting emitting processes within the territory, and to facilitate the production of National Accounts. Now, a combination of emissions leakage, competitiveness, and both investor and consumer concerns are driving the rapid emergence of policies targeting emissions embodied in traded products. To support these product-targeted policies, governments are investing in the development of public embedded emissions accounting frameworks (EEFs). While EEFs as an information instrument have enormous potential to support the transition to a net-zero global economy, they equally have the potential to inhibit trade, slow the transition, and have a disproportionate impact on developing countries – both through their design, and through potential incompatibilities between accounting developed in different jurisdictions. This article contributes to addressing these challenges by describing the minimum viable set of principles for an emissions accounting information instrument to be compatible with both international trade law and climate change mitigation regimes. To identify these design principles, our method is a systematic review of carbon accounting and trade law literature. Noting the prominent place of principles in guidelines for carbon accounting practice, we additionally extract principles identified in leading emissions accounting guidelines. Theory-based identification and analysis of these systematically extracted principles is used to develop the synthesized set of key principles for the design of public embedded emissions accounting schemes for traded products. Public agencies developing approaches for product emissions accounting, such as to meet requirements for carbon border adjustment mechanisms, could use these principles to guide design and negotiation.

Who's in control? Situating expertise, (mis)trust, and power among the Latine/Hispanic community in COVID-19's liminal moments

BackgroundResearch has established the disproportionate impact of COVID-19 on Black, Indigenous, and People of color (BIPOC) communities, and the barriers to vaccine trust and access among these populations. Focusing on perceptions of safety, access, and trustworthiness, studies often attach barriers to community-members, and discuss vaccines as if developed from an objective perspective, or “view from nowhere” (Haraway). ObjectiveWe sought to follow Haraway's concept of “situated knowledges,” whereby no one truth exists, and information is understood within its context, to understand the exertions of expertise surrounding vaccines. We focused on perceptions of power among a BIPOC community during a relatively unexamined moment, wherein the status of the pandemic and steps to prevent it were particularly uncertain. MethodsWe report the findings of ten focus groups conducted among members of Rhode Island's Latine/Hispanic communities between December 2021 and May 2022. We called this time COVID-19's liminal moment because vaccines were distributed, mandates were lifted, vaccine efficacy was doubted, and new strains spread. We translated, transcribed, and analyzed focus groups using thematic analysis. ResultsCommunity-member (n = 65) perceptions of control aligned with three key themes: (1) no power is capable of controlling COVID-19, (2) we are the objects of scientific and political powers, and (3) we, as individuals and communities, can control COVID-19 through our decisions and actions. ConclusionsBy centering the perspectives of a minoritized community, we situated the scientific knowledge produced about COVID-19 within the realities of imperfect interventions, uncontrollable situations, and medical power-exertions. We argue that medical knowledge should not be assumed implicitly trustworthy, or even capable, but instead seen as one of many products of human labor within human systems. Trust and trustworthiness must be mutually negotiated between experts, contexts, and communities through communication, empowerment, and justice.

Sex-based differences in persistent lung inflammation following influenza infection of juvenile outbred mice.

Children are susceptible to influenza infections and can experience severe disease presentation due to a lack of or limited pre-existing immunity. Despite the disproportionate impact influenza has on this population, there is a lack of focus on pediatric influenza research, particularly when it comes to identifying the pathogenesis of long-term outcomes that persist beyond the point of viral clearance. In this study, juvenile outbred male and female mice were infected with influenza and analyzed following viral clearance to determine how sex impacts the persistent inflammatory responses to influenza. It was found that females maintained a broader cytokine response in the lung following clearance of influenza, with innate, type I and type II cytokine signatures in almost all mice. Males, on the other hand, had higher levels of IL-6 and other macrophage-related cytokines, but no evidence of a type I or type II response. The immune landscape was similar in the lungs between males and females postinfection, but males had a higher regulatory T cell to TH1 ratio compared with female mice. Cytokine production positively correlated with the frequency of TH1 cells and exudate macrophages, as well as the number of cells in the bronchoalveolar lavage fluid. Furthermore, female lungs were enriched for metabolites involved in the glycolytic pathway, suggesting glycolysis is higher in female lungs compared with males after viral clearance. These data suggest juvenile female mice have persistent and excessive lung inflammation beyond the point of viral clearance, whereas juvenile males had a more immunosuppressive phenotype.NEW & NOTEWORTHY This study identifies sex-based differences in persistent lung inflammation following influenza infection in an outbred, juvenile animal model of pediatric infection. These findings indicate the importance of considering sex and age as variable in infectious disease research.

‘Money anxiety’: Understanding HE students' experiences of the cost‐of‐living crisis

AbstractThe ongoing cost‐of‐living crisis is causing immense stress and hardship for families, individuals and communities, with increases in utility bills, food prices and transport costs. Actors from civil society, politicians and academics have demonstrated concern as to the effect this is having at local and national levels, specifically the disproportionate impact on already marginalised and vulnerable groups. One demographic particularly affected is higher education students, however, due to the lack of support measures being aimed at this cohort, they are at significant risk of becoming overlooked and forgotten. While recent survey data has acknowledged the negative experiences of this group, there is a lack of understanding of their everyday lived realities. To address this gap, this article draws on empirical research conducted with HE students in the North‐West of England between 2022 and 2023. The study explores the diverse ways in which students navigate the crisis and the impact this has on their health and well‐being. It concludes with a call for urgent action and policy response to elevate unprecedented and devastating student hardship triggered by the cost‐of‐living crisis.