GRADE equity guidelines 3: considering health equity in GRADE guideline development: rating the certainty of synthesized evidence

Objectives: The aim of this paper is to describe a conceptual framework for how to consider health equity in the Grading Recommendations Assessment and Development Evidence (GRADE) guideline development process. Study Design and Setting: Consensus-based guidance developed by the GRADE working group members and other methodologists. Results: We developed consensus-based guidance to help address health equity when rating the certainty of synthesized evidence (i.e., quality of evidence). When health inequity is determined to be a concern by stakeholders, we propose five methods for explicitly assessing health equity: (1) include health equity as an outcome; (2) consider patient-important outcomes relevant to health equity; (3) assess differences in the relative effect size of the treatment; (4) assess differences in baseline risk and the differing impacts on absolute effects; and (5) assess indirectness of evidence to disadvantaged populations and/or settings. Conclusion: The most important priority for research on health inequity and guidelines is to identify and document examples where health equity has been considered explicitly in guidelines. Although there is a weak scientific evidence base for assessing health equity, this should not discourage the explicit consideration of how guidelines and recommendations affect the most vulnerable members of society

ILR Impact Brief - Community College Websites and Barriers to Access

[Excerpt] Community colleges, on average, serve 335 students with disabilities, although that number climbs to 5,000 at the largest college surveyed for this project. Nearly all community colleges that participated in the survey rely on the web for a variety of student services, but only half have instituted requirements regarding web accessibility for individuals with disabilities. Actual evaluations of accessibility and ease of use revealed that none of the websites analyzed complied with all federal standards on accessibility, and many web pages encompassed usability obstacles (e.g., unfamiliar terminology, unintuitive navigation schemes, and hard-to-read design elements) that affected disabled and non-disabled individuals alike

Human development and inequality in the 20th Century : the Mercosur countries in a comparative perspective

This article is in line with the United Nations attempts to approach human development in wider terms than per capita GDP, and in line with an ever lively debate on the historical standard of living and on the role of inequality in development. We focus on three Mercosur countries (Argentina, Brazil and Uruguay) and we view them in comparison with four core countries (France, Germany, USA and UK) along the 20th Century. The paper makes different attempts to construct diverse indices and to change the weights of their different components in order to better explain human development in different periods. A contribution of the paper, so long limited to Uruguay and the USA, is to adjust the historical human development index by inequality measures for all of its components. The results show that Argentine started to diverge, even in human development, at early stages of the 20th Century; that Uruguay diverged from the mid-century and that Brazil continued to tighten the gap up to 1980, diverging afterwards without being able to come close to the levels of the core countries. Total inequality in Uruguay and USA showed similar levels and trends: it decreased until the 1950s, and increased afterwards to similar levels. While inequality affects human development within both countries, it doesn?t help to understand the differences between them, due to the mentioned similarity of the Gini-coefficients

Resistance and resilience of social–ecological systems to recurrent typhoon disturbance on a subtropical island: Taiwan

Tropical cyclones (TCs) have major effects on ecological and social systems. However, studies integrating the effects of TCs on both social and ecological systems are rare, especially in the northwest Pacific, where the frequency of TCs (locally named typhoons) is the highest in the world. We synthesized studies of effects of recurrent typhoons on social and ecological systems in Taiwan over the last several decades. Many responses to TCs are comparable between social and ecological systems. High forest ecosystem resistance, evident from tree mortality below 2% even following multiple strong typhoons, is comparable with resistance of social systems, including the only 4% destruction of river embankments following a typhoon that brought nearly 3000 mm rainfall in three days. High resilience as reflected by quick returns of leaf area index, mostly in one year, and streamwater chemistry, one to several weeks to pre‐typhoon levels of ecosystems, are comparable to quick repair of the power grid within one to several days and returns of vegetable price within several weeks to pre‐typhoon levels of the social systems. Landslides associated with intense typhoons have buried mountain villages and transported large quantities of woody debris to the coast, affecting the coastal plains and reefs, illustrating a ridge‐to‐reef link between ecological and societal systems. Metrics of both social and ecological function showed large fluctuations in response to typhoons but quickly returned to pre‐disturbance levels, except when multiple intense typhoons occurred within a single season. Our synthesis illustrates that the social–ecological systems in Taiwan are highly dynamic and responsive to frequent typhoon disturbance, with extraordinarily high resistance and resilience. For ecosystems, the efficient responsiveness results from the selective force of TCs on ecosystem structure and processes. For social systems, it is the result of the effects of TCs on planning and decision making by individuals (e.g., farmers), management sectors, and ultimately the government. In regions with frequent TCs, the social–ecological systems are inevitably highly dynamic and rapid responses are fundamental to system resistance and resilience which in turn is key to maintaining structure and function of the social–ecological systems