Equity Gap Research Articles

The gender gap in the first deal: Equity split among founding teams

We investigate the gender gap in equity splits among members of founding teams using proprietary survey data on Japanese startups. The results reveal that, on average, female founder chief executive officers (CEOs) own 12 percentage points less equity than male founder CEOs. The gender equity gap is more pronounced in founding teams in which the founder CEO is a woman and the other founding members are men. However, the results vary depending on the founding teams’ characteristics. Notably, the gender equity gap is observed only in teams with individuals belonging to older generations and in teams from regions (prefectures) with great gender inequality. The findings indicate that gender norms influence the gender equity gap.

The California Community Colleges dual enrollment student journey: An equitable journey from participation to matriculation?

AbstractAcross the nation, community colleges have expanded dual enrollment programs to increase college enrollment and completion, particularly among historically underserved populations. The California Community College system—the largest system in the nation—is no different and recently expanded its dual enrollment programming to include College and Career Pathways Partnerships, in addition to Middle College High School and Early College High School. This article presents an original analysis of California Community Colleges Chancellor's Office system data to understand the dual enrollment student journey and any equity gaps that might exist in participation and outcomes, including college‐level math and/or English participation and completion, award attainment, and postsecondary matriculation. Though dual enrollment programs can be strategy to support equity, the authors find racial and regional equity gaps persist in both students’ access to these programs and their success. However, practitioners can take action to ensure it is an equitable journey at their school or college.

Teaching the Nature of Science Improves Scientific Literacy Among Students Not Majoring in STEM.

Traditionally, science courses focus on knowledge and practices within specific disciplines. There has long been a call, however, to increase the focus on the nature and process of science as a way to improve scientific literacy and increase the transfer of knowledge. Despite this, there are few systematic studies that seek to understand the impact of this approach. Revising a STEM course in a liberal arts curriculum to primarily focus on the nature and process of science rather than on the content of a specific discipline increased student scores on the Test of Scientific Literacy Skills and improved perceptions of STEM. In the revised course, students self-reported higher levels of confidence in their ability to learn scientific information and their ability to contribute to scientific progress compared to traditional methods. These data and other literature suggest that the traditional knowledge-focused approach to science education is insufficient to facilitate scientific literacy and address equity gaps in STEM. Proposed is a model where scientific literacy and feelings of inclusion in STEM are the product of direct engagement in the process of science and careful evaluation of the nature of science. Long-term, a holistic approach that includes an authentic discussion of the enterprise of sciences is needed to prepare students to engage in future problems that are best solved by cross-disciplinary collaboration.

Considering the Impact of Standardized Testing on Workforce Diversity

Today, we revisit our initial stance of eliminating standardized test scores from the college admissions process to improve equity and student diversity. With refreshed data about test-optional admissions, we address the import of institutional responsiveness to redress persistent equity gaps that impact our state’s workforce diversity and hiring challenges. Leveraging data to inform advocacy is representative of the skillset cultivated in the CANDEL program for evidence-based decision-making. Moreover, the pre-pandemic position over standardized testing exemplifies how CANDEL encouraged us to explore novel approaches to address persistent and troublesome equity issues. With leadership roles in the community college and the University of California systems and a particular emphasis on workforce development, we reflect on the CANDEL ethos of scholar-practitioner leadership in our practice areas to promote equitable educational and career outcomes.

Addressing equity gaps in fall-related injuries

Addressing equity gaps in fall-related injuries

Cervical cancer disparities in stage at presentation for disaggregated Asian Americans, Native Hawaiians, and Pacific Islanders

Over 20 million people in the United States identified as Asian American, Native Hawaiian, or Pacific Islander (AANHPI) in 2022. Despite the diversity of immigration histories, lived experiences, and health needs within the AANHPI community, prior studies in cervical cancer have considered this group in aggregate. We sought to analyze disparities in cervical cancer stage at presentation in the United States, focusing on disaggregated AANHPI groups. Data from the United States National Cancer Database from 2004 to 2020 of 122,926 patients newly diagnosed with cervical cancer was retrospectively analyzed. AANHPI patients were disaggregated by country of origin. Logistic regression, adjusted for clinical and sociodemographic factors, was used to calculate adjusted odds ratios. Higher adjusted odds ratios indicate an increased likelihood of metastatic versus non-metastatic disease at diagnosis. Out of 122,926 patients with cervical cancer, 5,142 (4.2%) identified as AANHPI. Compared to non-Hispanic White (NHW) patients, pooled AANHPI patients presented at lower stages of cancer (NHW: 58.7% diagnosed local/regional, AANHPI: 85.6% at local/regional, χ2 P<0.001). The largest AANHPI subgroups included Filipino Americans (n=1051, 20.4% of AANHPI), Chinese Americans (n=995, 19.4%), Asian Indian/Pakistani Americans (n=711, 13.8%), Vietnamese Americans (n=627, 12.2%), and Korean Americans (n=550, 10.7%) respectively. AANHPI disaggregation revealed that Pacific Islander American patients had higher odds of presenting with metastatic disease (aOR 1.58, 95% CI 1.21-2.06, p = 0.001) relative to non-Hispanic White patients. Conversely, Chinese American (aOR 0.47, 95% CI 0.37-0.59, p < 0.001), Vietnamese American (aOR 0.54, 95% CI 0.41-0.70, p < 0.001), Hmong American (aOR 0.46, 95% CI 0.22-0.97, p = 0.040), and Indian/Pakistani American (aOR 0.76, 95% CI 0.61-0.94, p = 0.013) patients were less likely to present with metastatic disease. Compared to the largest AANHPI group (Chinese American), nine other subgroups were more likely to present with metastatic disease. The largest differences were observed in Pacific Islander American (aOR 3.44, 95% CI 2.41-4.91, p < 0.001), Thai American (aOR 2.79, 95% CI 1.41-5.53, p = 0.003), Kampuchean American (aOR 2.39, 95% CI 1.29-4.42, p = 0.006), Native Hawaiian American (aOR 2.23, 95% CI 1.37-3.63, p = 0.001), and Laotian American (aOR 2.02, 95% CI 1.13-3.61, p = 0.017). In contrast, Vietnamese American (aOR 1.20, 95% CI 0.85-1.71, p = 0.303) and Hmong American (aOR 1.09, 95% CI 0.50-2.37, p = 0.828) patients did not show a statistically significant difference in presenting with metastatic disease compared to Chinese American patients. Aggregated evaluation of the Asian American, Native Hawaiian, or Pacific Islander monolith masks disparities in outcomes for distinct populations at risk for equity gaps. This disaggregation study shows that marginalized groups within the larger AANHPI population - including Pacific Islander American and Thai American patients - may face different exposures and larger structural barriers to cancer screening and early-stage diagnosis. A future focus on community based disaggregated research and tailored interventions is necessary to close these gaps.

Bridging the gaps in health and social equity for disabled children in low- and middle-income countries.

Bridging the gaps in health and social equity for disabled children in low- and middle-income countries.

Health Equity Research Outcomes and Improvement Consortium Prostate Cancer Health Precision Africa1K: Closing the Health Equity Gap Through Rural Community Inclusion

Health Equity Research Outcomes and Improvement Consortium Prostate Cancer Health Precision Africa1K: Closing the Health Equity Gap Through Rural Community Inclusion

Dual enrollment and multilingual English learners: From equity gaps toward solutions

Dual enrollment and multilingual English learners: From equity gaps toward solutions

Advancements in Interventional Pulmonology: Harnessing Ultrasound Techniques for Precision Diagnosis and Treatment.

Medical ultrasound has emerged as an indispensable tool within interventional pulmonology, revolutionizing diagnostic and procedural practices through its non-invasive nature and real-time visualization capabilities. By harnessing the principles of sound waves and employing a variety of transducer types, ultrasound facilitates enhanced accuracy and safety in procedures such as transthoracic needle aspiration and pleural effusion drainage, consequently leading to improved patient outcomes. Understanding the fundamentals of ultrasound physics is paramount for clinicians, as it forms the basis for interpreting imaging results and optimizing interventions. Thoracic ultrasound plays a pivotal role in diagnosing conditions like pleural effusions and pneumothorax, while also optimizing procedures such as thoracentesis and biopsy by providing precise guidance. Advanced ultrasound techniques, including endobronchial ultrasound, has transformed the evaluation and biopsy of lymph nodes, bolstered by innovative features like elastography, which contribute to increased procedural efficacy and patient safety. Peripheral ultrasound techniques, notably radial endobronchial ultrasound (rEBUS), have become essential for assessing pulmonary nodules and evaluating airway structures, offering clinicians valuable insights into disease localization and severity. Neck ultrasound serves as a crucial tool in guiding supraclavicular lymph node biopsy and percutaneous dilatational tracheostomy procedures, ensuring safe placement and minimizing associated complications. Ultrasound technology is suited for further advancement through the integration of artificial intelligence, miniaturization, and the development of portable devices. These advancements hold the promise of not only improving diagnostic accuracy but also enhancing the accessibility of ultrasound imaging in diverse healthcare settings, ultimately expanding its utility and impact on patient care. Additionally, the integration of enhanced techniques such as contrast-enhanced ultrasound and 3D imaging is anticipated to revolutionize personalized medicine by providing clinicians with a more comprehensive understanding of anatomical structures and pathological processes. The transformative potential of medical ultrasound in interventional pulmonology extends beyond mere technological advancements; it represents a paradigm shift in healthcare delivery, empowering clinicians with unprecedented capabilities to diagnose and treat pulmonary conditions with precision and efficacy. By leveraging the latest innovations in ultrasound technology, clinicians can navigate complex anatomical structures with confidence, leading to more informed decision-making and ultimately improving patient outcomes. Moreover, the portability and versatility of modern ultrasound devices enable their deployment in various clinical settings, from traditional hospital environments to remote or resource-limited areas, thereby bridging gaps in healthcare access and equity.

The Problem with Delaying Measles Elimination.

Measles is a highly infectious disease leading to high morbidity and mortality impacting people's lives and economies across the globe. The measles vaccine saves more lives than any other vaccine in the Essential Programme of Immunization and is also the most cost-effective vaccine, with an extremely high return on investment. This makes achieving measles elimination through vaccination a key child health intervention, particularly in low-income countries, where the overwhelming majority of measles deaths continue to occur. All countries and regions of the world have committed to achieving measles elimination, yet many have faced challenges securing political commitment at national and global levels and predictable, timely, and flexible support from global donors, and experienced setbacks during the COVID-19 pandemic. This has happened against a backdrop of stagnant measles vaccination coverage and declining enthusiasm for vertical programmes, culminating in a World Health Organization Strategic Advisory Group of Experts (WHO SAGE) review of the feasibility of measles eradication in 2019. Sustaining the elimination of measles long term is extremely difficult, and some countries have lost or nearly lost their measles elimination status in the face of ongoing importation of cases from neighbouring or closely connected countries in which elimination had been delayed. Thus, a widening equity gap in measles immunisation coverage creates challenges for all countries, not just those facing the greatest burden of measles morbidity and mortality. Delaying elimination of measles in some countries makes it cumulatively harder for all countries to succeed for three principal reasons: increased inequity in measles immunisation coverage makes outbreaks more likely to happen and to be larger; political will is very difficult to sustain; and immunity may wane to a point that transmission is re-established. New strategies are needed to support countries and regions in their vision for a world without measles, including ways to galvanise domestic, regional and global resources and ignite the political will that is essential to make the vision a reality.

Digital Footprints of Obesity Treatment: GLP-1 Receptor Agonists and the Health Equity Divide.

Our research investigates the societal implications of access to glucagon-like peptide-1 (GLP-1) agonists, particularly in light of recent clinical trials demonstrating the efficacy of semaglutide in reducing cardiovascular mortality. A decade-long analysis of Google Trends indicates a significant increase in searches for GLP-1 agonists, primarily in North America. This trend contrasts with the global prevalence of obesity. Given the high cost of GLP-1 agonists, a critical question arises: Will this disparity in medication accessibility exacerbate the global health equity gap in obesity treatment? This viewpoint explores strategies to address the health equity gap exacerbated by this emerging medication. Because GLP-1 agonists hold the potential to become a cornerstone in obesity treatment, ensuring equitable access is a pressing public health concern.

An Institutional Approach to Equity and Improvement in Child Health Outcomes.

Pediatric health inequities are pervasive. Approaches by health care institutions to address inequities often, and increasingly, focus on social needs screening without linked, robust responses. Even when actions in pursuit of health equity do occur within health care institutions, efforts occur in isolation from each other, standing in the way of cross-learning and innovation. Learning network methods hold promise when institutions are confronted with complex, multidimensional challenges. Equity-oriented learning networks may therefore accelerate action to address complex factors that contribute to inequitable pediatric health outcomes, enabling rapid learning along the way. We established an institutional Health Equity Network (HEN) in pursuit of excellent and equitable health outcomes for children and adolescents in our region. The HEN supports action teams seeking to eliminate pediatric health inequities in their clinical settings. Teams deploy targeted interventions to meet patients’ and families’ needs, addressing both medical and social factors affecting health and wellbeing. The primary, shared HEN measure is the equity gap in hospitalization rates between Black patients and all other patients. The HEN currently has 10 action teams and promotes rapid learning and scaling of interventions via monthly “action period calls” and “solutions labs” focused on successes, challenges, and potential common solutions (eg, scaling of existing medical-legal partnership to subspecialty clinics). In this Advocacy Case Study, we detail the design, implementation, and early outcomes from the HEN, our equity-oriented learning network.

Inclement Entrepreneurial Gaps in Community Wildlife Management Business Model: A Case of Mbarang’andu and Tunduru Wmas in Southern Tanzania

Purpose: This study examined entrepreneurial gaps in Mbarang’andu and Tunduru Wildlife Management Areas (WMAs) since their establishment during the 5 years of business plan operations and implications thereafter. Design/Methodology/Approach: The population of this study was five WMAs that formed the cases for the study, and for the case of WMA leaders, the population was 40 leaders. The sample size for the WMAs selected as the cases for the study were two (2), Tunduru and Mbarang’andu purposefully selected. Further, the sample size for WMA leaders was 20 (50% of the population) purposefully selected. Descriptive analysis was used to summarise demographic and revenue data, and a Pearson Chi-square test was performed on the demographic data. A paired samples T-test was used to compare the required business start-up and available funds to reveal the equity gap in the two WMAs and compare the level of implementation of planned business activities in the two WMAs. Research Limitation: The research was limited to two WMAs and a small sample size since the client determined its size, given that this paper emanated from the consultancy project. Findings: Findings indicate that both WMAs have a high potential for carbon trading, photographic tourism, beekeeping, fish farming, and heritage tourism. The difference in the required funding and available funds for various expenditures in business start-ups was found to be statistically significant in both WMAs. The difference in the level of implementation of planned business activities was also found to be statistically significant in the two WMAs. Practical implications: To bridge the entrepreneurial gaps in the WMAs, proactive fundraising, diversification of income-generating activities, including carbon trading, human resource capacity building, and appropriate marketing of tourism and nature-based products are needed. Social Implications: The results of this research will form the basis for bridging entrepreneurial gaps in the WMAs, hence fueling optimal exploitation of entrepreneurial opportunities in wildlife that benefit the community at large in return. Originality: This paper is original; only some extracts were used in the conference proceedings for the University of Dodoma (UDOM) 2019. Its novelty is inclined to expose entrepreneurial gaps and the framework for bridging such gaps in wildlife businesses.

Bundesbank-Verluste: Bilanzierungspraxis und etwaige Nachschusspflicht des Bundes

Abstract The Bundesbank’s balance sheet and those of other central banks in the eurozone are currently showing high “operating“ losses due to the discrepancy between the low interest bearing securities holdings from bond purchases and the now higher interest bearing commercial bank deposits. However, the current accounting practice does not reflect the associated losses in value anywhere near the market level – even though, according to the PSPP ruling of the German Federal Constitutional Court, the sale of securities before final maturity should be the rule. Even under the current valuation practice, an equity gap cannot be ruled out in the future, which is generally seen as unproblematic for central banks. However, there are risks in the context of recapitalisation by the state. Within the eurozone, national and European requirements could make such capital injections necessary.

How Do Curricula for Medical Students and Physician Learners Address the Social Determinants of Health? A Scoping Review.

Curricula about social determinants (drivers) of health (SDOH) are becoming more common in medical education, reflecting increasing expectations from payers and accreditors that health care systems do more to address health-related social needs and close pervasive health equity gaps. Few previous reviews have addressed the content of SDOH-related curricula. This review examines the scope and focus of medical education on SDOH and adjacent concepts. The authors screened 2,442 articles describing curricula delivered in undergraduate, graduate, and continuing medical education settings between 2010 and 2023 using PubMed and 2 field-specific databases, yielding 289 articles. Data on course duration, pedagogic approach, assessment methods, and curricular content were extracted and analyzed. Curricular content was categorized using the National Academies of Science, Engineering, and Medicine's (NASEM's) 5As framework, which recommends 5 key activities health care can undertake to mitigate social risk (awareness, adjustment, assistance, alignment, and advocacy). A total of 289 articles were included in this review. Curricula covering SDOH-related concepts have increased over time. Of the included articles, 190 (65.7%) referenced at least 1 of NASEM's 5 key activities. Training on social risk screening and other awareness activities were noted most frequently (123 [42.6%]), followed by curricula on helping patients get social care (assistance; 86 [29.8%]) and providing social risk-adjusted health care (adjustment; 81 [28.0%]). Curricula on system- and policy-level activities, including alignment of health care and social care organizations (alignment), and advocacy (advocacy) were described less frequently (43 [14.9%] and 49 [17.0%], respectively). Ninety-four articles (32.5%) referenced only general information about SDOH without describing specific actions to adjust care or reduce social adversity. NASEM's 5As framework provides a useful construct for characterizing SDOH-related curricula. Medical educators should teach not only the prevalence and pathophysiology of SDOH but also what physicians can do to address these factors.

A Quality Improvement-based Approach to Implementing a Remote Monitoring–Based Bundle in Transitional Care Patients for Heart Failure

Congestive heart failure (HF) is a leading cause of hospitalization and readmission, leading to increased health care utilization and cost. This is complicated by high incidence, prevalence, and hospitalization rates among racial and ethnic minorities, with a widening in the mortality disparity gap. Remote patient monitoring (RPM) has the potential to proactively engage patients after discharge to optimize medication management and intervene to avoid rehospitalization. However, it also may widen the equity gap due to technological barriers and bias. A prospective, observational quality improvement (QI) initiative leveraging an amended tool from the Institute for Healthcare Improvement Model for Improvement was incorporated with an equity lens and five Plan-Do-Study-Act (PDSA) cycles at a single site. The intervention used an HF bundle that included RPM, clinical telepharmacy, remote therapeutic monitoring, and community paramedicine. Between May 2022 and March 2023, five PDSA cycles were run involving 90 enrolled patients. In total, 38 (42.2%) patients received the complete HF bundle, 42 (46.7%) a partial bundle, and 10 (11.1%) only RPM. The patients with the complete bundle had a readmission rate of 2.6% compared to 14.3% in the partial bundle and 20.0% in RPM alone. The biggest impact of this program was the incorporation of community paramedicine. The program also noted an improvement in equitable enrollment after adjusting mid-program by avoiding cellular phone-enabled devices and transitioning to a hub-based model. This single-site QI-based initiative implemented an HF-based RPM program that leveraged clinical telepharmacy and community paramedicine. This program identified a disparity of care gap regarding the equitable distribution of services and made mid-study adjustments to improve the disparity gap. The program found that use of the HF bundle resulted in a decreased hospital readmission rate.

BRIDGING THE GAP: INDIA'S PROGRESS AND CHALLENGES IN ACHIEVING SDG 4: QUALITY EDUCATION FOR ALL

Sustainable Development Goal 4 (SDG 4) aspires to ensure inclusive &amp; equitable quality education for all. This study delves into India's progress towards this crucial objective. While advancements have been made in primary education enrolment and female literacy, significant hurdles remain. Millions of children lack fundamental literacy and numeracy skills, and overall learning outcomes fall short. The COVID-19 pandemic further exacerbated these inequalities, disproportionately impacting disadvantaged groups. India, a signatory to the SDGs, has implemented initiatives like the Right to Education Act (RTE) and digital learning platforms (DIKSHA, SWAYAM) to foster access and bridge geographical divides. However, substantial challenges persist. Socioeconomic disparities continue to hinder access for marginalized communities. Teacher shortages, inadequate training, and a lack of basic infrastructure in schools create further roadblocks in ensuring quality education. Achieving SDG 4 necessitates a multi-pronged approach in India. The curriculum and pedagogical approaches must be revamped to improve learning outcomes. Strategies to bridge the equity gap and address disparities based on gender, socioeconomic background, and location are vital. Investing in teacher training, addressing shortages, and providing essential school facilities are essential steps. Finally, promoting lifelong learning opportunities empowers individuals throughout their lives. Addressing these challenges with urgency is critical. By focusing on these priority areas, India can en route for achieving SDG 4 and ensure a future where quality education empowers all citizens.

Leveraging Power: A Multiple Embedded Case Study of Institutional Change Efforts for Racial Equity at Four Private Universities

ABSTRACT Despite research signaling the need to advance racial equity in university policies and practices, power dynamics in institutional change processes are not well understood. Using a constructivist embedded multiple case study design, critical theoretical perspective, and explanation-building technique, we analyzed how four private institutions with demonstrable change in student success and closing racial equity gaps in graduation rates enacted diversity, equity, and inclusion efforts over the last 5 years. Findings led to understanding how institutional agents synergistically used strategies in two phases: one, advocates, partnerships and coalitions, and capacity-building; second: resources, assessment, and accountability.

Closing the Equity Gap: Early Intervention in Sickle Cell Disease.

Closing the Equity Gap: Early Intervention in Sickle Cell Disease.