Inclusion Of Under-represented Groups Research Articles

The selective deployment of AI in healthcare: An ethical algorithm for algorithms.

Machine-learning algorithms have the potential to revolutionise diagnostic and prognostic tasks in health care, yet algorithmic performance levels can be materially worse for subgroups that have been underrepresented in algorithmic training data. Given this epistemic deficit, the inclusion of underrepresented groups in algorithmic processes can result in harm. Yet delaying the deployment of algorithmic systems until more equitable results can be achieved would avoidably and foreseeably lead to a significant number of unnecessary deaths in well-represented populations. Faced with this dilemma between equity and utility, we draw on two case studies involving breast cancer and melanoma to argue for the selective deployment of diagnostic and prognostic tools for some well-represented groups, even if this results in the temporary exclusion of underrepresented patients from algorithmic approaches. We argue that this approach is justifiable when the inclusion of underrepresented patients would cause them to be harmed. While the context of historic injustice poses a considerable challenge for the ethical acceptability of selective algorithmic deployment strategies, we argue that, at least for the case studies addressed in this article, the issue of historic injustice is better addressed through nonalgorithmic measures, including being transparent with patients about the nature of the current epistemic deficits, providing additional services to algorithmically excluded populations, and through urgent commitments to gather additional algorithmic training data from excluded populations, paving the way for universal algorithmic deployment that is accurate for all patient groups. These commitments should be supported by regulation and, where necessary, government funding to ensure that any delays for excluded groups are kept to the minimum. We offer an ethical algorithm for algorithms-showing when to ethically delay, expedite, or selectively deploy algorithmic systems in healthcare settings.

Protecting the Vulnerable and Including the Under-Represented: IRB Practices and Attitudes.

Since their inception, Institutional Review Boards (IRBs) have been charged with protecting the vulnerable in research. More recently, attention has turned to whether IRBs also have a role to play in ensuring representative study samples and promoting the inclusion of historically under-represented groups. These two aims-protecting the vulnerable and including the under-represented-can pull in different directions, given the potential for overlap between the vulnerable and the under-represented. We conducted a pilot, online national survey of IRB Chairs to gauge attitudes and practices with regard to protecting the vulnerable and including the under-represented in research. We found that IRBs extend the concept of vulnerability to different groups across various contexts, are confident that they effectively protect vulnerable individuals in research, and believe that IRBs have a role to play in ensuring representative samples and the inclusion of under-represented groups.

Population affinity estimation on a Spanish sample: Testing the validity and accuracy of cranium and mandible online software methods

Population affinity estimation is an important step in the identification of unknown individuals. To ensure accurate results, validation studies of newly developed methods must be performed using different target populations and skeletal elements. This research aimed to determine the accuracy and reliability of population affinity estimation on a modern Spanish sample using two online software applications.The sample consisted of 114 adult individuals (51 males, 63 females) using 38 measurements and one angle from the skull and mandible. AncesTrees was used for craniometric measurements and (hu)MANid for mandibular variables with different classification models and probability thresholds being evaluated. The required parameters were inputted for each individual and statistics were generated to assess the accuracy of the estimation.AncesTrees performed with the greatest accuracy as the program correctly classified the sample as Southwestern European or European, with highest accuracies being 54.56% (trial 1), 86.05% (trial 2), 82.61% (trial 3), 34.55% (trial 4) and 100% (trial 5). (hu)MANid correctly classified the sample as being from white origin with accuracies ranging from 70.59% to 80% without considering correct sex estimation, while accuracy ranged between 62.75% and 80% accounting for estimated sex.Population affinity estimation may determine subsequent methods used in the construction of the biological profile. Our results demonstrated varying accuracy rates depending on the element and method, offering a critical view in relation to software applicability and validity. Reference populations and intrinsic and extrinsic factors can potentially influence the method accuracy and reliability. Future research should focus on the inclusion of underrepresented groups.

Informed Consent in Clinical Studies Involving Human Participants: Ethical Insights of Medical Researchers in Germany and Poland.

BackgroundThe internationalization of clinical studies requires a shared understanding of the fundamental ethical values guiding clinical studies. It is important that these values are not only embraced at the legal level but also adopted by clinicians themselves during clinical studies.ObjectiveOur goal is to provide an insight on how clinicians in Germany and Poland perceive and identify the different ethical issues regarding informed consent in clinical studies.MethodsTo gain an understanding of how clinicians view clinical studies in the countries they work in, we carried out semi-structured problem-centered interviews per telephone in Poland (n = 6) and Germany (n = 6). Our interviewees concentrated on three main topics: an appraisal of the normative framework, challenges in the information process and the protection of all participants in clinical studies.ResultsClinicians generally supported the normative framework, even though they considered it quite complex. In the two study countries, a widely noted dilemma in the information process was whether to overburden participants with extensive information or risking leaving out important facts. Clinicians were ready to exclude larger population groups from participating in clinical studies when the information process could not be carried out with standard procedures or when their inclusion was ethically sensitive.ConclusionClinicians need to gain a better understanding of the consequences of excluding larger population groups form participating in clinical studies. They should seek assistance in improving the information process for the inclusion of underrepresented groups in clinical studies.

Disparities Persist in Inclusion of Female, Pregnant, Lactating, and Older Individuals in Inflammatory Bowel Disease Clinical Trials

There is an intensified focus in the United States regarding the inclusion of under-represented groups in medical research, particularly clinical trials. Editorial boards of medical journals have released statements on diversity and inclusion in their publications as well as calls for clarity in sex-, gender-, racial-, and ethnic-related nomenclature.1,2 Despite formal recommendations from the National Institutes of Health (NIH) to increase inclusion of women, older adults, and people who identify as members of racial or ethnic minority groups,3 recent studies using the largest database in the world, clinicaltrials.gov, have demonstrated disparities in inclusion.

Moving to opportunity: Student trajectories in the post-Bologna university system in Denmark

This paper examines whether the implementation of the Bologna bachelor’s + master’s structure has been followed by an increase of university students from under-represented groups, and whether the Bologna structure has been accompanied by new forms of student mobility between Danish university institutions. Looking at student movements from bachelor’s to master’s degrees from 1993 to 2011, I do not find that the implementation of the Bologna structure has been followed by changes in the inclusion of under-represented groups. The social gap in progression to master’s degrees remained small and constant across the period. However, the formal instalment of a new transition point in the Danish university system (from bachelor’s to master’s) has provided bachelor’s degree holders with the opportunity to flee less lucrative fields of study and less prestigious institutions, and they increasingly do so. I discuss the implications of these movements in the light of the aim to make higher education more inclusive.

Racial and ethnic disparities in diagnostic efficacy of comprehensive genetic testing for sensorineural hearing loss

Understanding racial and ethnic disparities in diagnostic rates of genetic testing is critical for health equity. We sought to understand the extent and cause of racial and ethnic disparities in diagnostic efficacy of comprehensive genetic testing (CGT) for sensorineural hearing loss (SNHL). We performed a retrospective cohort study at two tertiary children’s hospitals on a diverse cohort of 240 consecutive pediatric patients (76% publicly insured, 82% non-White) with SNHL of unknown etiology who underwent CGT. Definite and possible genetic diagnoses were assigned for each patient, representing the likelihood of a genetic cause of hearing loss. Associations between diagnostic rates were examined. 3.8 ± 2.1 variants were detected per patient; this frequency did not vary between White/Asian and Hispanic/Black cohorts. Overall, 82% of variants were variants of uncertain significance (VUS). Compared with White and Asian subjects, variants identified among Hispanic and Black children were less likely to be classified as pathogenic/likely pathogenic (15% vs. 24%, p < 0.001), and Hispanic and Black children were less likely to have a definite genetic diagnosis (10% vs. 37%, p < 0.001). The adjusted odds ratio for definite genetic diagnosis in Black and Hispanic children compared with White and Asian children was 0.19. Expanding genetic diagnostic criteria to include predicted deleterious VUSs reduced these disparities between White/Asian and Hispanic/Black children, with comparable molecular diagnostic rates (41% vs. 38%, p = 0.72). However, in silico predictions are insufficiently valid for clinical use. Increased inclusion of underrepresented groups in genetic hearing-loss studies to clinically validate these variants is necessary to reduce racial and ethnic disparities in diagnostic efficacy of comprehensive genetic testing.

The Promises and Pitfalls of Diversity and Inclusion in Organizations and Society

Despite efforts to diversify organizations and move toward a more antiracist society, progress toward these noble goals remains elusive and, often, misunderstood (Dobbin, Kim, & Kalev, 2011; Kraus, Rucker, & Richeson, 2017; Opie & Roberts, 2017; Williams, 2001). Historically underrepresented groups still struggle to integrate into, persist in, and feel included within organizational cultures (Acker, 2006; Ray, 2019; Rivera & Tilcsik, 2016). Corporate leaders continue to make racially biased statements, which observers can meet with intolerance and indignance. Furthermore, despite the amount of time, resources, and money put forth to create a more inclusive workplace and world, there is a lack of understanding surrounding what strategies are effective and why (Kalev, Dobbin, & Kelly, 2006). Considering the current dynamics of our society, organizational leaders are in need of consensus to create effective and sustainable diversity, equity, and inclusion initiatives. In this symposium, we consider the challenges, constraints, and possibilities within efforts to create a more diverse and inclusive society. We hope to suggest practical pathways forward to engage with and bring managers back into these conversations. What organizational policies and practices impede progress toward diversity and inclusion of underrepresented groups, such as women and racial minorities? What psychological processes predict whether onlookers respond to the prejudiced corporate leader with intolerance or forgiveness? How are diversity and inclusion personnel, particularly workers of color, enabled and constrained in their ability to improve the climate of a large-scale organization such as a university? These are a few of the questions our presenters will answer in this symposium on the promises and pitfalls of diversity and inclusion in organizations and society. Racialized Expertise and the Enabling and Constraining Character of Organizations Presenter: Sandra Portocarrero; Columbia U. Maternity Salience: How Concerns About Women’s Family Demands Undermine Fair Treatment Presenter: Ezgi Ozgumus; London Business School Presenter: Aneeta Rattan; London Business School Bias Intolerance: Predicting Condemnation of Apologetic Perpetrators of Prejudice Presenter: Ivuoma Onyeador; Northwestern Kellogg School of Management Presenter: Rebecca Neel; U. of California, Riverside - Anderson Graduate School of Management Presenter: Bethany Lassetter; U. of Toronto Presenter: Andre Wang; U. of California, Davis Presenter: Andrew Todd; U. of California, Davis Presenter: Jenessa Shapiro; U. of California, Los Angeles The Misperception of Progress Toward Diversity, Equity, and Inclusion in Organizations Presenter: Brittany Torrez; Yale U. Presenter: LaStarr Hollie; Yale School of Management Presenter: Michael W. Kraus; Yale School of Management

Inclusion of Underrepresented Groups in Preclinical Alzheimer Disease Trials—Opportunities Abound

Inclusion of Underrepresented Groups in Preclinical Alzheimer Disease Trials—Opportunities Abound

Improving physician diversity and inclusion benefits physicians and patients

A diverse physician workforce in the Canadian health care system would result in more cultural competence, greater patient satisfaction, and improved population health. However, increasing representation and diversity does not automatically resolve issues of inequity, inequality, and discrimination. In this article, we discuss three broad areas of health care — the clinical environment, academic advancement, and leadership — that require intentional, systemic change if we are to make a lasting impact in terms of increasing the diversity and inclusion of underrepresented groups in medicine, and consequently, improve health outcomes. Inclusive and equitable practices to target pay inequity, unconscious bias, opposition to career advancement, and sexual harassment are integral to diverse physician recruitment and retention. Equity strategies and checks to remediate systemic biases in academic advancement through grant funding, academic criteria of merit for promotion, and the acknowledgment of differences of experience can be employed to improve equity in academic medicine. The long-standing culture, policies, and traditions of institutions within the medical establishment must be combated with a collaborative effort to foster equity through the engagement of academics and physicians from underrepresented minority groups, and the implementation of implicit bias training and meaningful accountability for creating a safe, equitable work environment for diverse physicians. Any proposed solution to improve equity and diversity should not be taken as a fixed principle to follow uncritically, but rather as a starting point for understanding and implementing the unique changes required in various local contexts.

Committee on Minority Affairs: Advancing the chemical enterprise through the inclusion of underrepresented groups

Since its inception in 1993, the American Chemical Society Committee on Minority Affairs (CMA) has worked to help increase the proportion of underrepresented groups in the chemical sciences and hel...

Committee on Minority Affairs: Advancing the chemical enterprise through the inclusion of underrepresented groups

Committee on Minority Affairs: Advancing the chemical enterprise through the inclusion of underrepresented groups

Abstract IA29: Applying the Transcreation Framework to Address Psychosocial Health Disparities among Latina Breast Cancer Survivors

Abstract PURPOSE: Latina breast cancer survivors, especially those who primarily speak Spanish, experience worse symptoms and quality of life than non-Latina survivors. This presentation will describe a new framework, the Transcreation Framework for Community-Engaged Behavioral Interventions to Reduce Health Disparities, and how it was applied to develop a translational research program to address psychosocial health disparities among Spanish-speaking Latina breast cancer survivors (SSBCS). METHODS: Applying the Transcreation Framework (TF), the research program uses community-engaged interventions to equip SSBCS with information and skills to manage their disease. We focus on community-based self-care approaches because many underserved communities have limited access to cancer support services and oncology specialists. Applying the framework, we used rigorous scientific methods in community settings to develop, implement and evaluate the effectiveness of behavioral interventions in reducing psychosocial distress and symptoms among urban and rural SSBCS. RESULTS: We define transcreation as the process of planning, delivering, and evaluating interventions so that they resonate with the community experiencing health disparities, while achieving intended health outcomes. Following the TF’s seven iterative steps, we: 1) engaged community partners; 2) selected a theory to guide intervention development; 3) identified candidate evidence-based interventions and community best practices; 4) designed a new transcreated program prototype; 5) designed studies to test the intervention in community settings; 6) built community capacity to deliver the interventions; and 7) delivered and evaluated intervention implementation processes and outcomes. Formative research identified four general areas of need among SSBCS: fear; loss of control over cancer and life; lack of social support; lack of culturally appropriate care; and lack of cancer information in Spanish that they could understand. Population-based research identified cancer self-efficacy and social support as promising mechanisms to improve quality of life of SSBCS, thus we selected social-cognitive theory as the basis for the intervention prototype. With extensive community involvement, we identified an evidence-based stress management program and a community-based program and incorporated them with our prior research to develop Nuevo Amanecer, a new transcreated 8-week cognitive-behavioral stress management program for delivery by peers (trained SSBCS). Two sequential randomized controlled trials were conducted with urban SSBCS first, then rural SSBCS. The program improved several quality of life domains and decreased breast cancer concerns and depressive and bodily symptoms in the first RCT, and reduced anxiety and improved self-efficacy in performing several stress management skills in the 2nd RCT. Subsequently, we used the TF to develop a survivorship care planning and physical activity intervention (health coach plus mobile app and activity tracker) and tested it in a 2-month pilot study among SSBCS that resulted in reduced fatigue and health distress, improved emotional well-being, increased knowledge of needed follow-up care and resources, and an average increase of 1,313 daily steps. CONCLUSIONS: Engaging underserved communities in the design and implementation of behavioral interventions for cancer survivors leads to programs that are more likely to be effective and sustained because they are embedded and delivered in the communities experiencing cancer health disparities. Peer- and community health worker-delivered cancer support programs could be a low-cost, effective method for meeting the psychosocial needs of and increasing inclusion of underrepresented groups in cancer research. Research Implications: The TF can guide development and testing of behavioral interventions for communities experiencing cancer health disparities. The TF results in interventions that balance fidelity to evidence with fit to the setting because they are designed with community. Citation Format: Anna Maria Nápoles. Applying the Transcreation Framework to Address Psychosocial Health Disparities among Latina Breast Cancer Survivors [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr IA29.

Toward a Compassionate Intersectional Neuroscience: Increasing Diversity and Equity in Contemplative Neuroscience.

Mindfulness and compassion meditation are thought to cultivate prosocial behavior. However, the lack of diverse representation within both scientific and participant populations in contemplative neuroscience may limit generalizability and translation of prior findings. To address these issues, we propose a research framework called Intersectional Neuroscience which adapts research procedures to be more inclusive of under-represented groups. Intersectional Neuroscience builds inclusive processes into research design using two main approaches: 1) community engagement with diverse participants, and 2) individualized multivariate neuroscience methods to accommodate neural diversity. We tested the feasibility of this framework in partnership with a diverse U.S. meditation center (East Bay Meditation Center, Oakland, CA). Using focus group and community feedback, we adapted functional magnetic resonance imaging (fMRI) screening and recruitment procedures to be inclusive of participants from various under-represented groups, including racial and ethnic minorities, gender and sexual minorities, people with disabilities, neuropsychiatric disorders, and/or lower income. Using person-centered screening and study materials, we recruited and scanned 15 diverse meditators (80% racial/ethnic minorities, 53% gender and sexual minorities). The participants completed the EMBODY task – which applies individualized machine learning algorithms to fMRI data – to identify mental states during breath-focused meditation, a basic skill that stabilizes attention to support interoception and compassion. All 15 meditators’ unique brain patterns were recognized by machine learning algorithms significantly above chance levels. These individualized brain patterns were used to decode the internal focus of attention throughout a 10-min breath-focused meditation period, specific to each meditator. These data were used to compile individual-level attention profiles during meditation, such as the percentage time attending to the breath, mind wandering, or engaging in self-referential processing. This study provides feasibility of employing an intersectional neuroscience approach to include diverse participants and develop individualized neural metrics of meditation practice. Through inclusion of more under-represented groups while developing reciprocal partnerships, intersectional neuroscience turns the research process into an embodied form of social action.

Are We Differentiating Effectively for the Gifted or Not? A Commentary on Differentiated Curriculum Use in Schools

After reviewing curriculum materials and observing instructional practices, the author identified trends and issues in school districts related to the implementation of differentiated curriculum and stakeholders’ views. Although primary stakeholders hold positive views of a differentiated curriculum, limited differentiation is being used in the regular curriculum. When teachers used differentiated curriculum, they were quite effective in the fidelity of implementation. However, principals appeared to be disinterested in differentiating the general curriculum and left its implementation to the discretion of teachers and the gifted coordinator, and superintendents were more focused on differentiation strategies for all learners and the inclusion of underrepresented groups in the gifted program. Moreover, the implementation of differentiation was influenced by the type of grouping and concerns about student performance on the state test. The author concluded with a discussion of remedies to administrative perceptions about gifted curriculum and grouping models.

A business case for diversity and inclusion: why it is important for veterinarians to embrace our changing communities

Views: Commentary 1103 A diverse society and the inclusion of underrepresented groups in everything we do should be important to each and every one of us. Embracing diversity and promoting inclusion are part of our social fabric. When we welcome everyone to the table, we are fulfilling our social responsibility. We are living by The Golden Rule of doing unto others as we would have them do unto us. But there is more to it. Embracing diversity also produces tangible results for the business of veterinary medicine. As so aptly stated in the February 15, 2010, JAVMA News section, which was dedicated to diversity in veterinary medicine,