E-Quality: An Analysis of Digital Equity Discourse and Co-Production in the Era of COVID-19

The digital divide refers to the social stratification due to an unequal ability to access, adapt, and create knowledge via information and communication technologies (Andreasson, 2015). Digitally disadvantaged individuals have inadequate access to services and resources, exacerbating existing vulnerabilities. The COVID-19 pandemic instigated a new model of digital equity policymaking that leverages co-production between numerous actors. As citizens faced new financial and community constraints and governments reached administrative capacities, both the digital divide and the policymaking process evolved. This inductive study explores how digital equity policymaking shifted to a co-production model (Ostrom, 1996) amid the pandemic. Using a sequential mixed-methods approach, this research considers the interconnections of digital equity, co-production, and crisis policymaking. Digital divide discourse was first examined through a large-scale text analysis of verified tweets. Methods of investigation include natural language processing techniques, regression modeling, and unsupervised machine learning topic modeling. Descriptive and inferential analyses demonstrate a statistically significant increase in policy discourse as well as a diversification of topics, though suggest a disconnect between outputs and on-the-ground needs. Next, semi-structured interviews were conducted with City of Boston policymakers, and the resulting data was open-coded and axially coded to reveal insights into the design and implementation of co-productive solutions. Additionally, interviews detail what conditions contribute to successful outcomes while working with limited time, knowledge, and resources. Analyses reveal that co-productive behavior is critical to coping with the effects of the pandemic and highlight the influential role of community-based organizations. Furthermore, the study provides contextual information on co-production prerequisites that were previously understood, and sheds light on interpersonal conditions that Ostrom does not address. This dissertation contributes to the developing body of scholarly literature on the digital divide in the era of COVID-19. This case study also advances theoretical knowledge, offers methodological innovations, and provides concrete policy recommendations to promote more egalitarian digital use

Why Assessment Matters: On the Road for Change

In higher education, assessment is used to intentionally develop, implement, and modify programs that are grounded in student learning outcomes (SLOs). Assessment results may highlight program effectiveness, or lack thereof. This gives educators the chance to revise components of the program in order to improve student learning (Meixner, 2016). Assessment also creates a sense of accountability by offering methods to justify the value of a program, especially when time and resources are limited. We offer a model for assessment as foundational to program development by highlighting our course-related consulting work with the Dux Leadership Center’s pilot On the Road for Change Spring Break Experience. This program challenged undergraduate students to apply leadership and ethical reasoning outside the classroom using the framework of the Student Leadership Challenge (SLC), by Kouzes and Posner, and JMU’s Eight Key Questions (8KQ) established by the Madison Collaborative. We developed specific, measurable learning outcomes, mapped programming components to learning outcomes, developed summative and formative assessment, and offered implementation appendices. In our presentation we will highlight the importance of assessment, our process, and best practices for program assessment in Student Affairs

A Case for Better Monitoring and Preventing Hate Crimes in the United States

This report is a joint publication of the Center for Peace, Democracy, and Development (CPDD) through its conflict early warning arm, the Conflict Early Warning Analytics Program (CEWAP) and the TRUST Network (TN), which is the first conflict early warning system in the United States. CEWAP is the conflict early warning analytical hub of the TRUST Network. Together, CEWAP and the TRUST Network aim to expand the utilization of authentic community-based conflict early warning and early response through practice, research, technology development, training, and community empowerment. This report focuses on hate crimes, hate groups and their connection to domestic extremism, and the threats posed by these crimes and groups to social cohesion. Hate crimes have a significant impact on communities beyond the direct victims, as they create a climate of fear and tension and contribute to the targeting of society’s most vulnerable groups. Addressing hate crimes and promoting tolerance and inclusivity is thus an important priority for both law enforcement and civil society. This report argues that any analysis of hate crimes, hate groups, or violent domestic extremism must be data driven and evidence based to track these threats more accurately and to respond to hate crimes, hate groups and domestic extremism more effectively

Risk of liver fibrosis associated with long-term methotrexate therapy may be overestimated

Background & Aims: The risk of significant liver fibrosis from prolonged methotrexate (MTX) exposure has been estimated at around 5%, prompting intensive monitoring strategies. However, the evidence is derived from retrospective studies that under-reported risk factors for liver disease. We evaluated the risk of long-term MTX therapy on liver fibrosis in a longitudinal cohort study using two non-invasive markers.Method: Between 2014-2021, adult patients diagnosed with rheumatoid arthritis (RA) or psoriasis for >−2 years were recruited prospectively from six UK sites. The MTX group included patients who received MTX for >−6 months, whereas the unexposed group included those who never received MTX. All patients underwent full liver profiling, with transient elastography (TE) and enhanced liver fibrosis (ELF) marker measurements.Results: A total of 999 patients (mean age 60.8 ± 12 years, 62.3% females) were included. Of 976 with valid TE values, 149 (15.3%) had liver stiffness >−7.9 kPa. Of 892 with a valid ELF, 262 (29.4%) had ELF >−9.8. Age and BMI were independently associated with elevated liver stiffness and ELF. Neither MTX cumulative dose nor duration was associated with elevated liver stiffness. Diabetes was the most significant risk factor associated with liver stiffness >−7.9 kPa (adjusted odds ratio = 3.19; 95% CI 1.95–5.20; p −9.8 (odds ratio = 1.76; 95% CI 1.20–2.56; p = 0.003), suggesting the degree of joint inflammation in RA may confound ELF as a non-invasive marker of liver fibrosis.Conclusion: The risk of liver fibrosis attributed to MTX itself might have been previously overestimated; there is a need to consider modifying current monitoring guidelines for MTX

POSITION STATEMENT: Glucose Intolerance in Polycystic Ovary Syndrome-A Position Statement of the Androgen Excess Society

Objectives: Women with polycystic ovarian syndrome (PCOS) are at increased risk for developing glucose intolerance and type 2 diabetes mellitus (DM). Recommendations for the timing and method of screening have varied. The purpose of this statement is to determine the optimal screening method, timing of screening, and treatment modalities for impaired glucose tolerance (IGT) among women with PCOS. Participants: The expert panel was appointed by the Androgen Excess Society (AES) to review the literature and make recommendations based on the available evidence. Meetings were open, and there was no funding for the panel. Evidence: A systematic review was conducted of the published, peerreviewed medical literature using MEDLINE to identify studies that addressed the prevalence, risk factors, testing, and treatment for IGT in both adults and adolescents with PCOS. Unpublished data were not considered. Consensus Process: The panel held meetings to review the literature and draft the statement as a committee. The AES board members reviewed and critiqued the manuscript, and changes were made based on their comments. Conclusions: The panel recommends that all patients with PCOS be screened for IGT with a 2-h oral glucose tolerance test. A few members of the AES board recommend alternatively screening women with PCOS for IGT and type 2 DM using an oral glucose tolerance test only in patients with a body mass index of 30 kg/m 2 or greater or in lean patients with additional risk factors. Patients with normal glucose tolerance should be rescreened at least once every 2 yr, or more frequently if additional risk factors are identified. Those with IGT should be screened annually for development of type 2 DM. PCOS patients with IGT should be treated with intensive lifestyle modification and weight loss and considered for treatment with insulinsensitizing agents. T HE POLYCYSTIC ovarian syndrome (PCOS) is a common endocrinopathy, affecting approximately 5-10% of women of reproductive age (1-4). In its classical form, the syndrome is characterized by oligo-or anovulation, biochemical or clinical hyperandrogenism, and polycystic ovarian morphology on ultrasonography (5). Although much remains unknown regarding the underlying pathophysiology of PCOS, a form of insulin resistance intrinsic to the syndrome appears to play a central role in its development. Among many women with PCOS, the observed insulin resistance is partially explained by excess adiposity; however, it is increasingly recognized that even lean women with PCOS have increased insulin resistance compared with normal controls (6). Given the significant metabolic burden of insulin resistance seen in women with PCOS, affected women may have an increased risk of impaired glucose tolerance (IGT) and type 2 diabetes mellitus (DM). IGT is a known risk factor for type 2 DM and the development of cardiovascular disease (7). Because IGT is often asymptomatic, the screening of women with PCOS for IGT has been recommended; however, recommendations have varied regarding the timing and method of screening for IGT (8, Process A systematic review was conducted of the published, peerreviewed medical literature to identify studies assessing the prevalence and risk factors for IGT in patients with PCOS, as well as the testing and treatment of IGT in both adults and adolescents using MEDLINE databases. To review the natural history of PCOS and IGT, MEDLINE was searched from 1966 through 2007. Medical Subject Headings (MeSH) used included polycystic ovary syndrom

Use of Co-Design to Identify Barriers to Health-Promoting Behaviors among African American Breast Cancer Survivors with Comorbid Obesity

Approximately 90% of African American patients with newly diagnosed breast cancer have multimorbidity – with obesity as one of the most common conditions. Obesity is related to negative impacts across all aspects of cancer care as well as more adverse side effects of cancer treatment. African American breast cancer survivors (BCS) show higher incidences of chronic conditions, like obesity, with barriers to body wellness. Lifestyle interventions can improve survivorship outcomes, but most have not been adapted to African American BCS needs. The purpose of this research is to explore and honor the lived experiences of breast cancer survivorship among African American women with obesity to better understand their experiences and perceptions of how their cancer journey intersects with other health behaviors and to identify barriers to health behaviors. A co-design approach with five participants was used to understand specific barriers to a healthy weight and lifestyle as well as potential solutions that would benefit African American or Black BCS entering an evidence-based lifestyle intervention that targeted weight and body wellness. Participants completed one co-design session for problem identification. This initial session identified the participants' most impactful cancer- and non-cancer-related barriers to building health behaviors. Cancer- and non-cancer-related carriers to a healthy lifestyle were identified from artifact creation and affinity diagramming for intensity and frequency. Top cancer-related barriers were pain and fatigue related to cancer treatment and its side effects. Non-cancer related barriers included time and responsibilities, nutrition, exercise, and the definition of health used by medical professionals. Both cancer-related and non-cancer related barriers were identified in contributing to difficulty in maintaining health behaviors. Further research should examine how these barriers can be addressed in lifestyle interventions targeted to African American BCS

Non-invasive markers of liver fibrosis for monitoring of long-term methotrexate therapy: A multi-centre longitudinal cohort study

Background: The risk of significant liver fibrosis from prolonged methotrexate (MTX) exposure has been estimated in around 5% of patients, which has led to intensive monitoring strategies. However, the evidence is derived from retrospective studies that underreported risk factors of liver disease. We evaluated the risk of long-term MTX therapy on liver fibrosis in a longitudinal cohort study using two non-invasive markers. Method: Between 2014-2021, adult patients diagnosed with Rheumatoid Arthritis (RA) or psoriasis for ≥2 years were recruited prospectively from six UK sites. MTX group included patients who received MTX for ≥6 months, whereas unexposed group included those who never received MTX. All patients underwent full liver profiling, enhanced liver fibrosis (ELF) markers, and transient elastography (TE). Results: 999 patients (mean age 60.8 ± 12 years, 62.3 % females) were included. Of 976 with valid TE values, 149 (15.3 %) had liver stiffness ≥7.9 kPa. Of 892 with valid ELF, 262 (29.4 %) had ELF ≥9.8. Age and BMI were independently associated with elevated liver stiffness and ELF. Neither MTX cumulative dose nor duration was associated with elevated liver stiffness. Diabetes was the most significant risk factor associated with liver stiffness ≥7.9 kPa (adjusted OR = 3.19, 95% CI 1.95 – 5.20, P <0.001). Regular use of non-steroidal anti-inflammatory drugs showed the strongest association with ELF ≥9.8 (OR = 1.76, 95% CI 1.20 – 2.56, P =0.003), suggesting the degree of joint inflammation in RA may confound ELF as a non-invasive marker of liver fibrosisConclusion: The risk of liver fibrosis attributed to MTX itself might have been previously overestimated; there is a need to consider modifying current MTX therapy monitoring guidelines

Mapping the human genetic architecture of COVID-19

The genetic make-up of an individual contributes to the susceptibility and response to viral infection. Although environmental, clinical and social factors have a role in the chance of exposure to SARS-CoV-2 and the severity of COVID-191,2, host genetics may also be important. Identifying host-specific genetic factors may reveal biological mechanisms of therapeutic relevance and clarify causal relationships of modifiable environmental risk factors for SARS-CoV-2 infection and outcomes. We formed a global network of researchers to investigate the role of human genetics in SARS-CoV-2 infection and COVID-19 severity. Here we describe the results of three genome-wide association meta-analyses that consist of up to 49,562 patients with COVID-19 from 46 studies across 19 countries. We report 13 genome-wide significant loci that are associated with SARS-CoV-2 infection or severe manifestations of COVID-19. Several of these loci correspond to previously documented associations to lung or autoimmune and inflammatory diseases3–7. They also represent potentially actionable mechanisms in response to infection. Mendelian randomization analyses support a causal role for smoking and body-mass index for severe COVID-19 although not for type II diabetes. The identification of novel host genetic factors associated with COVID-19 was made possible by the community of human genetics researchers coming together to prioritize the sharing of data, results, resources and analytical frameworks. This working model of international collaboration underscores what is possible for future genetic discoveries in emerging pandemics, or indeed for any complex human disease