Abundance and Equality

The technology driven post-scarcity society is upon us. Ubiquitous technologies are eradicating scarcity in many industries. These macroscopic system trends are causing our economy to transition from relative scarcity to relative abundance. For many people in the world however, in both developed, developing, and underdeveloped countries, the notion of an Age of Abundance will sound utterly bizarre. There is a tension between abundance and equality. Good governance considers in what manner the state conducts public policy, manages public resources and promotes overall prosperity. This chapter connects good governance to the end of scarcity and integrates equality into abundance. The chapter critically examines the normative justifications of our scarcity based legal institutions, such as property and intellectual property (IP) systems, in light of 10 exponential, Fourth Industrial Revolution (4IR) technologies, and the post-scarcity economy. Starting point is that absolute and relative abundance are not utopian. Technology will erase scarcity in more and more economic areas in the foreseeable future, but not everywhere or for everybody. The chapter views relative scarcity and relative abundance as temporal socio-economic categories at two opposite sides of a continuum. The chapter unifies good governance with equality and abundance, by introducing a post-Rawlsian Equal Relative Abundance (ERA) principle of distributive justice. This includes defining a set of material and immaterial primary goods, warranting adequate, sufficient levels of relative abundance (which depend on technological evolution), and equitable results per region or group. Crucially, ERA integrates desert-based principles to the degree that some may deserve a higher level of material goods because of inequality in contributions, i.e., their hard work, talent, luck or entrepreneurial spirit, only to the extent that their unequal rewards do also function to improve the position of the least advantaged. A society governed by the ERA principle should in theory be able to solve the poverty trap on a global level. As lifting people from poverty in Europe is a different thing than achieving ERA in the US, applying equal relative abundance techniques in Asia and Africa each have their own specific challenges and dimensions.

Intersectional Stigma for Autistic People at Work: A Compound Adverse Impact Effect on Labor Force Participation and Experiences of Belonging

Background

Little research addresses the experiences of autistic people at work, yet employment prospects remain bleak. The extant literature takes a largely remedial perspective and does not focus on harnessing this population's considerable talents. In global organizational practice, several programs purposefully target autistic people for their abilities. However, preliminary evidence suggests that such programs are inadvertently attracting mainly White males, to the exclusion of other demographics. Therefore, stigma surrounding autism at work remains, creating potential compound adverse impacts by marginalizing identities, including gender, race, ethnicity, sexuality, and socioeconomic status. We explored the intersection of autism with other marginalizing identities in the context of work. The research focused on labor force participation for autistic people and, for those in employment, perceptions of exclusion and inclusion. We compared the aforementioned variables by gender identity, racial identity, sexuality, socioeconomic background, and geographic origin.

Methods

We undertook a global cross-sectional survey, advertised through various social media platforms and promoted directly to relevant organizations. The survey included a range of validated measures as well as demographic information. We analyzed the data with frequencies, cross tabulations, chi-square tests, and non-parametric, group-wise comparisons.

Results

We found preliminary evidence of reduced rates of employment participation by race and geographic location. Females and non-binary people had lower perceptions of inclusion and belonging at work. The perception of accommodation provision had a strong association with inclusion and belonging; more so than incidental provision of flexibility in environment and scheduling not framed as a specific accommodation.

Conclusions

The findings highlight the relational aspects of accommodation and a more universal inclusion perspective. We urge practitioners and researchers to monitor employment participation and levels of inclusion/exclusion using intersectional demographic identification. We appeal for cross-cultural collaboration with academic institutions outside the anglosphere to improve our knowledge of global programs and their impact.

Prenatal testing, disability equality, and the limits of the law

This article will review reasons why it is argued that the law on abortion on the grounds of disability is discriminatory, as well as recent unsuccessful attempts to address this discrimination in the law. These attempts include ones which would have moderately restricted access to abortion in certain limited cases, and another that might have opened to door to a number of different possibilities, including both to options that could have restricted access to abortion, and to other options that might have increased access. Finally, this article will also examine reasons why some of the most important challenges surrounding disability equality cannot be sufficiently addressed through legal change alone. While there are strong reasons to support some form of change in the law, a more foundational change in values is necessary if we want to live in a more ethical society that is truly capable of welcoming disabled children.

Using cultural safety to enhance nursing care for children and young people

People from minority groups frequently experience adversity in various aspects of their lives, including when accessing healthcare services. Culture has a significant role in all healthcare encounters between nurses, multidisciplinary teams, and children and young people and their families. This article defines culture and explains the importance of considering people's cultural values, beliefs and practices when providing care. It outlines the principles of cultural safety - an approach that incorporates ideas such as cultural awareness, sensitivity and competence - and describes how it can enhance the care of children and young people from a wide range of backgrounds.

Navigating the glass labyrinth: Addressing gender diversity in Australian and New Zealand representative radiology leadership

INTRODUCTION

Gender inequity among representative leadership in Clinical Radiology is a global issue, with the lack of gender diversity in leadership even more marked when compared to workforce representation. Women leaders face a disproportionate magnitude of seen and unseen challenges to leadership engagement and progression when compared to men (a 'glass labyrinth'), which is likely contributing to this discrepancy. The aim of the study was to examine and reflect on the state of gender diversity in representative leadership within the RANZCR Faculty of Clinical Radiology.

METHODS

Review of the 2021 Royal Australian and New Zealand College of Radiologists (RANZCR) Board, Clinical Radiology Faculty Council and local Branch Committees with regard to the numbers of women and men in representative roles.

RESULTS

In 2021, the RANZCR Board had no women representatives from Clinical Radiology (one woman representative from Radiation Oncology). 1/5 Clinical Radiology Faculty Council office Bearers were women. Local Branch Committees had 16.3% (13/80) women representatives. Three branches (the NSW, ACT and Victorian branches) had no women representatives. There were no women Committee Chairs, Branch Secretaries or Treasurers, with 2/7 Branch Education Officers women.

CONCLUSION

The issues underpinning gender inequality in representative leadership are complex and diverse, resulting in disproportionate losses of women radiologists along the leadership pathway compared to men. Unconscious biases, including assumptions of inferior capability, capacity and credibility among women radiologist leaders, create unique challenges at organisational, institutional and personal levels. Change cannot be achieved by passive momentum alone: concrete initiatives and active engagement are required. To improve leadership diversity, strategies must be multifaceted and supported at an organisational level.

Understanding and mitigating low health literacy

To take control of their health, patients and their families and carers need to understand the information they receive from healthcare professionals and be able to apply that information - in short, they require optimal health literacy. People with low health literacy may find it challenging to manage their condition and take steps to prevent ill-health, which may lead to an increased use of healthcare services. Low health literacy is one of the main barriers preventing healthcare professionals from adequately transmitting information to people in their care. It is crucial that nurses do not assume that everyone will understand information about their health, so nurses should adapt their communication and create an environment where people feel empowered to ask questions. This article describes factors affecting health literacy, explains the consequences of low health literacy, and identifies strategies and techniques nurses can use to mitigate low health literacy.

A community-based, cross-sectional study of gender egalitarianism: A promising scenario from an urban field practice area attached to a teaching institute from Central India

Context

Gender-based discrimination is more predominant in India. In spite of various laws, gender inequality is an evil that plagues society even today. This is an important challenge for meeting our Sustainable Development Goals.

Methods

This cross-sectional study was carried out in an urban field practice area. Study subjects were married women and their husbands in the age-group of 15-49 years along with their under-five children. Gender egalitarianism was assessed for factors like education, employment and media exposure. Factors which were studied for revealing gender egalitarianism among children included sex ratio, immunization status, nutritional status and health care expenditure. Completed family size and preference for the sex of the child were enquired about to assess the inclination towards male gender of the baby. Anthro software was used for statistical analysis.

Results

Gender egalitarianism was found with regards to education. However, significant difference was noted in the employment status of men and women. Overall, sex ratio was in favor of girls. Though gender inequality was evident from the results, it was more in favor of girls. There was no evidence of gender bias for immunization of children. It was observed that more boys were stunted than girls and almost equal proportion of boys and girls were wasted.

Conclusions

Factors like high literacy, control over income, access to financial resources made women more empowered and such empowered women were less likely to show son preference. Hence, there was no gender inequality among children in the present study.

Co-producing transgender awareness training for healthcare students and professionals

Nurses and doctors must be culturally competent to care for transgender patients. However, there is little time dedicated to lesbian, gay, bisexual, transgender and queer plus (LGBTQ+) health in undergraduate and postgraduate nursing and medicine education and healthcare professionals often lack the competence and skills to treat transgender patients sensitively. At Queen's University Belfast, a transgender awareness training session was developed to enhance the cultural competence of nursing and medicine students and academic staff. The training was co-produced with students and transgender people and delivered by a transgender person. Training on transgender health should be designed in collaboration with transgender people and should be a core component of undergraduate and postgraduate healthcare curricula.

Quantifying the internationalization and representativeness in research

Author-level performance metrics do not account for collaboration and knowledge transfer between people, institutions, and countries. We propose the i-index and r-index, publication metrics that aim to incentivize the collaboration between researchers and research institutions across borders. These indices promote benefit-sharing among countries of different levels of development.

Experimental evidence of physician social preferences

Physicians routinely face trade-offs among their own interests, the interests of their patients, and society’s interest in preserving medical resources. To manage these trade-offs, society relies on both traditional professional ethics and bureaucratic monitoring and control. Our results—that physicians are twice as likely to be altruistic as all other samples but indistinguishable from the general population in terms of equality–efficiency orientation—suggest that professional norms can meaningfully contribute to physicians putting patients first and highlight the importance of nurturing these norms of physician professionalism. However, our findings also suggest that policymakers may not rely on physician professionalism to ensure an efficient allocation of medical resources.

Physicians’ professional ethics require that they put patients’ interests ahead of their own and that they should allocate limited medical resources efficiently. Understanding physicians’ extent of adherence to these principles requires understanding the social preferences that lie behind them. These social preferences may be divided into two qualitatively different trade-offs: the trade-off between self and other (altruism) and the trade-off between reducing differences in payoffs (equality) and increasing total payoffs (efficiency). We experimentally measure social preferences among a nationwide sample of practicing physicians in the United States. Our design allows us to distinguish empirically between altruism and equality–efficiency orientation and to accurately measure both trade-offs at the level of the individual subject. We further compare the experimentally measured social preferences of physicians with those of a representative sample of Americans, an “elite” subsample of Americans, and a nationwide sample of medical students. We find that physicians’ altruism stands out. Although most physicians place a greater weight on self than on other, the share of physicians who place a greater weight on other than on self is twice as large as for all other samples—32% as compared with 15 to 17%. Subjects in the general population are the closest to physicians in terms of altruism. The higher altruism among physicians compared with the other samples cannot be explained by income or age differences. By contrast, physicians’ preferences regarding equality–efficiency orientation are not meaningfully different from those of the general sample and elite subsample and are less efficiency oriented than medical students.

Barriers and challenges in providing standard breast cancer care in low resource settings

In this study, we investigated the barriers to the delivery of internationally accepted breast cancer care in low resource settings (LRS) as compared to well-endowed resource settings (WRS) via an online survey. The survey was completed by 199 surgeons from eleven countries: 51 from WRS and 148 from LRS, based on our definition. The two most common facilities lacking in LRS were sentinel lymph node biopsy and immune-histochemistry (67% and 60% respectively). Only 22% respondents from LRS confirmed that all their eligible patients received hormonal therapy and only 8% radiotherapy as compared to 98% and 75% from WRS. Widespread limitations exist in most LRS, making internationally accepted breast cancer treatment guidelines impossible to follow, and thus resulting in suboptimal cancer care.

Neoliberalism and the Ideological Construction of Equity Beliefs

Researchers across disciplines, including psychology, have sought to understand how people evaluate the fairness of resource distributions. Equity, defined as proportionality of rewards to merit, has dominated the conceptualization of distributive justice in psychology; some scholars have cast it as the primary basis on which distributive decisions are made. The present article acts as a corrective to this disproportionate emphasis on equity. Drawing on findings from different subfields, we argue that people possess a range of beliefs about how valued resources should be allocated-beliefs that vary systematically across developmental stages, relationship types, and societies. By reinvigorating notions of distributive justice put forth by the field's pioneers, we further argue that prescriptive beliefs concerning resource allocation are ideological formations embedded in socioeconomic and historical contexts. Fairness beliefs at the micro level are thus shaped by those beliefs' macro-level instantiations. In a novel investigation of this process, we consider neoliberalism, the globally dominant socioeconomic model of the past 40 years. Using data from more than 160 countries, we uncover evidence that neoliberal economic structures shape equity-based distributive beliefs at the individual level. We conclude by advocating an integrative approach to the study of distributive justice that bridges micro- and macro-level analyses.

Psychosocial status of older adults aged 65 years and over during lockdown in Turkey and their perspectives on the outbreak

Older adults over the age of 65 were announced as a high-risk group in the COVID-19 outbreak and had to be placed on lockdown for a long time. The research was conducted to identify the psychosocial status, attitudes, and experiences of individuals aged 65 and over who were in-home lockdown during the COVID-19 outbreak in Turkey. In the study, 51 older adults were reached using the snowball sampling method. The research data were collected through qualitative interviews from older adults who were in house restrictions during the pandemic period, and thematic analysis was performed. As a result of the interviews, four main themes revealed as (a) Growing old is like a crime: The public perception of the older adults regarding the stigma associated with aging, (b) The inevitable course: Potential possibilities arising as a result of the pandemic period, (c) The cost of lockdown at home: Risk factors arising due to staying at home for a long time, (d) The desire for equality: The developing resistance against lockdown and demands for equality. The lockdown applied exclusively to older adults forced them to create new routines and made them aware of some values; however, they asserted that they were stigmatized and lonely, that their concerns about death/catching COVID-19 increased, and they were treated unfairly. Measures should be taken to prevent mental problems in older adults. In addition, public health nurses are advised to provide preventive care services and counselling for early intervention.

The Women of FOCIS: Promoting Equality and Inclusiveness in a Professional Federation of Clinical Immunology Societies

The authors of this article, all women who have been deeply committed to the Federation of Clinical Immunology Societies (FOCIS), performed a retrospective analysis of gender equality practices of FOCIS to identify areas for improvement and make recommendations accordingly. Gender data were obtained and analyzed for the period from January 2010 to July 2021. Outcome measures included numbers of men and women across the following categories: membership enrollment, meeting and course faculty and attendees, committee and leadership composition. FOCIS’ past and present leaders, steering committee members, FCE directors, individual members, as well as education, annual meeting scientific program and FCE committee members and management staff of FOCIS were surveyed by email questionnaire for feedback on FOCIS policies and practice with respect to gender equality and inclusion. Although women represent 50% of the membership, they have been underrepresented in all leadership, educational, and committee roles within the FOCIS organization. Surveying FOCIS leadership and membership revealed a growing recognition of disparities in female leadership across all FOCIS missions, leading to significant improvement in multiple areas since 2016. We highlight these changes and propose a number of recommendations that can be used by FOCIS to improve gender equality.

Aboriginal and Queer Identity/ies in Western Australia: When There is a Need to Know in Therapeutic Settings

A central question for the exploratory Aboriginal and LGBTQ+ researcher led project 'Breaking the Silence: Being Indigenous and identifying LGBTQ+' (Breaking the Silence) is how provision of genuinely inclusive service responses for Aboriginal and Torres Strait Islander people identifying as LGBTQ+ can be developed. This article presents the qualitative findings of this mixed-methods research project to show how organizational staff working in health, education and social support services in Western Australia consider the Aboriginal LGBTQ+ identity/experience. Analysis of the written, interview and focus group responses to a question about the relevance of LGBTQ+ identity show that these questions need to be considered and evaluated within diverse service cultures and philosophies of services. Staff views are diverse and organizational consensus on the relevance (or not) of LGBTQ+ identity needs to be the precursor before the development or consideration of changes to service delivery and models.

The Decriminilisation of Homosexuality in Botswana

This article discusses the decriminalisation of homosexuality in Botswana. It discusses the various cases that addressed issues relating to LGBTIQ+ in Botswana to highlight the incremental approach toward decriminalisation of homosexuality laws. The article also highlights the role and the contribution of civil society to the decriminalization of homosexuality in Botswana. It does so by providing an overview of queer activism in Botswana and highlights the various queer actors in the country. The article notes that the Botswana Court of Appeal has emphatically settled the debate concerning the constitutional protection of members of the LGBTIQ+. This article points out that the successes recorded in Botswana by civil society as regards the decriminalisation of homosexuality are attributable to several factors. These factors include the consolidated efforts of civil society in the country, the advocacy that accompanied the decriminalisation of homosexuality litigation and the use of various public interest litigation strategies. Combined, these factors paint a clear picture of the nature of queer lawfare in Botswana. Overall, the article highlights that while some sections of the society in Botswana are still reluctant to recognize members of the LGBTIQ+ community as right bearers, there is sufficient evidence to suggest that there has been a great shift toward inclusivity.

Leaving a Mark and Passing the Torch: Intended Legacies of Older Lesbian and Gay Spanish Activists

Aging paradigms should entail all individuals. More research on older LGBT+ adults is needed since the literature has been mainly built on heteronormative and cisgender standards. The creation and shaping of the kind of legacy an individual would like to leave behind when he/she dies is key in aging well. This study explores the intended legacies of older lesbian and gay adults (50+ years old) who were activists in social movements in Spain. Eighteen participants (12 gay men) participated in a semi-structured interview on their intended legacies. Thematic analysis was used to analyze the interviews. The main findings showed that all participants reported intended legacies: i) personal, to transmit their lived knowledge and to be remembered as good and committed persons; ii) broader, to contribute to LGBT+ rights, and to a better society; iii) composite, the desire that younger generations recognize their contributions, and to know they helped to protect new generations. The participants in this study lived a life of intense involvement in social movements, and currently their intended legacies involve leaving a mark and passing the torch to younger generations. This understanding will help us to develop adequate practices that promote well-being in older LGBT+ adults.

A Survey of Women in the Perfusion Workforce: 2021

A diverse and equitable working environment is desirable. In 2011, a survey was distributed to all female perfusionists in the United States. This survey suggested that the female perfusionists share the same difficulties as women in the labor force. The role of women in society in general is clearly changing. Female perfusionists have been part of that evolution. Promoting equality and respecting diversity are central to life today. A follow-up survey was distributed to evaluate the status and the change in gender stereotypes in the field of perfusion over the past 10 years. Women make up nearly half of the U.S. labor force and 35.7% of the present perfusion workforce in North America (1,077 certified women). Women make 82 cents for every dollar that men earn and this disparity widens for women with more education. The purpose of this survey was to poll women in perfusion to evaluate concerns and opinions in their careers and to compare to the 2011 survey results. In December 2021, a 39-question survey (surveymonkey.com, San Mateo, CA) was made available to all female perfusionists in North American via social media websites (Facebook.com, Perfusion.com, LinkedIn.com, Perflist, Perfmail, and FPP Listserv). There were 384 responses to the 2021 survey compared to the 538 responses in 2011. About 32.1% of the survey participants have been used in perfusion for more than 20 years; 37.6% have earned a master's degree compared to 2011, where 18.3% had master's level education; 72.5% are the financial providers for their family with 44.2% earning $101-150,000.00 and 40.3% greater than $200,000.00, which is a significant change from 2011; 61.5% consider themselves under moderate stress compared to 63.0% in 2011; 94.3% take call on a regular basis; and 74.1% feel they miss essential family functions because of their schedules. Similarly, 62.8% felt discriminated against because of gender compared to 50.9% in 2011. This survey suggests that the female perfusionists have shown to be assertive (72% are the primary financial supporter of their families) and competent in the field of cardiovascular perfusion (nearly 40% have masters degrees). Further analysis is needed to discern whether female perfusionists are treated with comparable respect as their male colleagues when 50.0% report some discrimination or harassment in their workplace.

Beyond the garden: The complexity of "global and individual living" at the heart of the international commitment towards a healthy, more resilient and fairer society

BACKGROUND

The right to fully enjoy the highest possible state of health is certainly nothing new in the agenda of the world's governments, and yet today it becomes a top priority not just in the restructuring of the health care system, but also in the promotion of multi-sector policies aimed at fostering and safeguarding the potential of every individual to achieve what could be defined, in general terms, as "common good".

OBJECTIVE

The current paper aimed at singling out the most useful strategies to promoting and achieving a healthy, more resilient and fairer society.

METHODS

Starting from principles 1 and 14 of the Declaration of Rome, the aim was to analyse and develop the concepts of resilience and health, questioning their possible future variations against the background of the current health emergency and the increasingly radical widespread use of new technologies as universally-applied and cross-sectional tools for human progress.

RESULTS

The "health for all" objective can only be achieved if we act on three key aspects: 1. Adding life to years; 2. Adding life to life; 3. Adding years to life.

CONCLUSIONS

Each individual should raise their health awareness as a key resource to leading a fulfilling existence and to developing the required qualities to fully tap into health possibilities - whether integral or residual - to tackle life.

Socioeconomic Disparities in Cleft Lip Care

OBJECTIVE

The purpose of this study was to utilize a multicenter dataset to elucidate whether socioeconomic factors were associated with access to cleft lip surgery, treatment by higher-volume providers, and family choice for higher-volume centers.

DESIGN

Retrospective cohort study.

SETTING

Hospitals participating in the Pediatric Health Information System.

PATIENTS

Primary cleft lip repair performed in the United States between 2010 and 2020.

OUTCOMES

Travel distance, hospital volume, hospital choice.

RESULTS

During the study interval, 8954 patients underwent unilateral (78.4%, n  =  7021) or bilateral (21.6%, n  =  1933) primary cleft lip repair. Patients with unilateral cleft lip were repaired significantly earlier if they were White (P < .001) and significantly later if they lived in an urban community (P  =  .043). Similarly, patients with bilateral cleft lip were repaired significantly earlier if they were White (P < .001). Patients from above-median income households (P  =  .011) and living in urban communities (P < .001) were significantly more likely to be treated at high-volume hospitals, whereas those living in underserved communities (P < .001) were significantly less likely to be treated at high-volume hospitals. White patients were significantly more likely to be treated by high-volume surgeons (P < .001). Patients with White race were significantly more likely to choose a higher-volume hospital than the one most locally available (P < .001).

CONCLUSIONS

Patients with White race are more likely to travel farther and be treated by high-volume surgeons although at smaller hospitals. Patients from underserved areas travel significantly farther for cleft care and are treated at lower-volume hospitals. Patients in urban communities have shorter travel distances and are treated at higher-volume hospitals.

Practising cultural humility to promote person and family-centred care

The concept of cultural humility in nursing involves an awareness of diversity and how an individual's culture can affect their health behaviours. Nurses can use this awareness to develop sensitive, tailored and person-centred approaches to patient care, which ultimately contribute to a positive healthcare experience. This article examines the concept of cultural humility with reference to person and family-centred care. It also explores how individuals and organisations can challenge discriminatory attitudes and behaviours in the workplace.

Evaluating diversity in neurosurgery through the use of a multidimensional statistical model: a pilot study

OBJECTIVE

There is a growing body of evidence demonstrating the benefits of diversity across many domains. However, neurosurgery consistently lags most of medicine in many aspects of diversity. Any inability to make progress in this arena is likely due to the multifactorial and complex nature of the issue, which makes it difficult to meaningfully measure and track diversity within the workforce. The goal of this pilot study was to assess the utilization of a multidimensional statistical model to quantify and assess diversity within neurosurgery. The authors sought to 1) assess the diversity of neurosurgery residents using Simpson's Diversity Index and Sullivan's Composite Diversity Index (CDI) and 2) determine if a medical school's intrinsic academic opportunities and resources, indicated by US News & World Report's (USNWR's) best research medical schools ranking, are related to the number of neurosurgery residents produced per medical school.

METHODS

A cross-sectional study of all neurosurgery residents (projected graduation years 2020-2026) and 1st-year medical students (matriculating years 2016-2019) was undertaken. Biographical diversity data (gender and matriculation data) were collected from institutional websites between December 2019 and June 2020. The CDI expresses the diversity of a given population by representing the effective proportion of categories present across all diversity attributes and was calculated for neurosurgery residents and medical students. Statistical results are reported as the median and interquartile range.

RESULTS

Neurosurgery residency program CDI (0.21, IQR 0.16-0.25) was significantly less (p < 0.001) than medical school CDI (0.42, 0.37-0.48). There was no significant difference in CDI between top-40 and non-top 40 Doximity ranked research output neurosurgery residency programs (p = 0.35) or between top-40 and non-top 40 USNWR ranked research medical schools (p = 0.11). Over a 7-year period, top-40 ranked research medical schools produced significantly more (p < 0.001) neurosurgery residents (11.9, IQR 7.1-18.9) than the non-top 40 ranked research medical schools (5.6, IQR 2.6-8.5).

CONCLUSIONS

The authors demonstrated the feasibility of using a multidimensional statistical model as a measure to understand the complex issues of diversity. Their preliminary data suggested that neurosurgery's challenge in achieving the desired diversity relates to uneven attraction and/or recruitment across an increasingly diverse medical student body. In recent years, neurosurgery has made great progress in the arena of diversity and has shown a strong desire to do more. Utilization of these diversity measures will help the neurosurgery field to monitor progress along this valuable journey.

Colonization, cadavers, and color: Considering decolonization of anatomy curricula

Anatomy is a discipline that, despite its universal nature, offers limited diversity in terms of representation in cadavers, imagery, technology, and models used within teaching. The universal move toward inclusive curricula has put anatomy education under the microscope, particularly with respect to efforts to decolonize curricula. This paper considers the challenges and opportunities to diversify the anatomy curriculum. Decolonizing anatomy education curricula will entail addressing the ingrained cultures within the disciplines, such that produces a number of challenges including: underrepresentation of certain bodies, difficulty talking about difference, and the hidden curriculum in anatomy education. In order to aid educators in achieving inclusive anatomy curricula, a toolkit and considerations are presented, alongside both do's, don'ts and case examples. We highlight the black-or-white dichotomy, and the absence of brown in between. The paper is a conversation starter for what it means to begin the process of decolonizing the curriculum within anatomy education.

On the morality of vaccination tourism

Vaccination tourism (whereby citizens of one nation travel to a different, usually more developed nation to receive a vaccine unavailable or with little availability at home) during the COVID pandemic raises a host of moral issues and is usually met with criticism. From the perspective of the society of origin, the criticism is that those who use their socio-economic privileges to go abroad and receive the vaccine ahead of other citizens instead of 'making the line' act objectionably because in doing so they use their purchasing power to obtain a benefit that should not be distributed like any other product in the market. From the perspective of the society of destination, the criticism is that citizens and residents should receive the vaccines first; after all, their government purchased vaccines (with their taxes) to immunize the local population. The paper calls into question both objections to vaccination tourism. There might be other reasons to oppose it, but this pair of objections cannot ground a moral criticism of the practice.

Inequality in early childhood chronic health conditions requiring hospitalisation: A data linkage study of health service utilisation and costs

BACKGROUND

The cost of socioeconomic inequality in health service use among Australian children with chronic health conditions is poorly understood.

OBJECTIVES

To quantify the cost of socioeconomic inequality in health service use among Australian children with chronic health conditions.

METHODS

Cohort study using a whole-of-population linked administrative data for all births in Queensland, Australia, between July 2015 and July 2018. Socioeconomic status was defined by an areas-based measure, grouping children into quintiles from most disadvantaged (Q1) to least disadvantaged (Q5) based on their postcode at birth. Study outcomes included health service utilisation (inpatient, emergency department, outpatient, general practitioner, specialist, pathology and diagnostic imaging services) and healthcare costs.

RESULTS

Of the 238,600 children included in the analysis, 10.4% had at least one chronic health condition. Children with chronic health conditions in Q1 had higher rates of inpatient (6.6, 95% confidence interval [CI] 6.4, 6.7), emergency department (7.2, 95% CI 7.0, 7.5) and outpatient (20.3, 95% CI 19.4, 21.3) service use compared to children with chronic health conditions in Q5. They also had lower rates of general practitioner (37.5, 95% CI 36.7, 38.4), specialist (8.9, 95% CI 8.5, 9.3), pathology (10.7, 95% CI 10.2, 11.3), and diagnostic imaging (4.3, 95% CI 4.2,4.5) service use. Children with any chronic health condition in Q1 incurred lower median out-of-pocket fees than children in Q5 ($0 vs $741, respectively), lower median Medicare funding ($2710, vs $3408, respectively), and higher median public hospital funding ($31, 052 vs $23, 017, respectively).

CONCLUSIONS

Children of most disadvantage are more likely to access public hospital provided services, which are accessible free of charge to patients. These children are less likely to access general practitioner, specialist, pathology and diagnostic imaging services; all of which are critical to the ongoing management of chronic health conditions, but often attract an out-of-pocket fee.

Assisted dying requests from people in detention: Psychiatric, ethical, and legal considerations-A literature review

The principle of equivalence of care states that prisoners must have access to the same standard of health care as the general population. If, as recent court decisions suggest, assisted dying is not limited to people with a terminal physical illness or irremediable suffering, it might also be requested by people with severe mental illness in detention. Some of the countries with legal regulations on assisted dying also have recommendations on how to handle requests from prisoners. However, detention itself can lead to psychological distress and suicidality, so we must consider whether and how people in such settings can make autonomous decisions. Ethical conflicts arise with regard to an individual's free will, right to life, and physical and personal integrity and to the right of a state to inflict punishment. Furthermore, people in prison often receive insufficient mental health care. In this review, we compare different practices for dealing with requests for assisted dying from people in prison and forensic psychiatric facilities and discuss the current ethical and psychiatric issues concerning assisted dying in such settings.

'Conversion Therapy' As Degrading Treatment

This article responds to the widespread uncertainty in UK and international human rights law over the legality of 'conversion therapy', a set of practices that aim to eradicate LGBTIQ+ sexualities and gender identities. The article pursues two main arguments. First, it is argued that all forms of 'conversion therapy' are disrespectful of the equal moral value of LGBTIQ+ people and violate specific protected areas of liberty and equality that are inherent in the idea of human dignity. Secondly, the article develops a theoretical account of degrading treatment under article 3 of the European Convention on Human Rights that illuminates the relationship between the prohibition of degrading treatment, human dignity and antidiscrimination. It is then argued that 'conversion therapy', in all its different forms, spawns the specific kind of degradation that UK and international human rights law prohibit. The article ends by analysing the positive state obligations that arise in this context.

Developing Future Physical Education Teachers' Intercultural Competence: The Potential of Intertwinement of Transformative, Embodied, and Critical Approaches

Purpose: This article is based on a study that explored learning processes related to intercultural competence of PE teacher trainees. The context of the study was the Faculty of Sport and Health Sciences at the University of Jyväskylä, Finland. The study was conducted in connection to two courses that focused on equality in physical education and sport in 2020-2021. Methods: Adopting an interpretive, as well as a critical approach, the authors focused on how the students described their conceptions and learning experiences. Based on their analysis they have then aimed to shed light on how interculturality, equality, equity, and diversity may be addressed in higher education in a more profound manner. The students' accounts were analyzed first through an open reading and subsequently through a more critical lens. The analysis was supported by theories of transformative learning, embodied learning, and intercultural education. Results: Students' initial interest toward equity, equality, and interculturality seemed to expand during the courses. They increasingly reflected on the complexity of these issues and discussed the widening professional responsibilities of future PE teachers in promoting equality and supporting pupils in cultural heterogeneous classes. Discussions and practical activities that involved emotional and embodied elements seemed to be important in facilitating their learning processes. However, it is difficult to foresee how permanent the changes in their habits of mind and subsequent actions are. Discussion: The authors suggest that embodied, practical approaches where the student is fully engaged in the learning process, and where conceptual, reflective, emotional, and affective levels are connected, may be a key in developing teachers' intercultural competence. They also suggest that it is crucial to revise higher education curricula from the perspectives of intercultural competence and structural inequality. In addition to separate courses, equality, equity, and diversity should be seen as red threads throughout higher education.

Real-World Evidence for Equality

As stakeholders in the transformative medical research ecosystem, real-world evidence researchers must conduct observational research with an awareness of racism. Advancements in understanding of the impact of racism on health outcomes, the abundance of health care data, and innovations in health information technology provide tools that create opportunities to conduct more focused research that illustrates how racism in health care deters the advancement of equity.

A kinder approach to science

To be kind is to protect and promote the well-being of others. We borrow this definition from the philosophical literature to formulate a simple and powerful principle to make scientific communities and institutions healthier, fairer, and more inclusive.

Gender diversity in nursing: time to think again

Despite recent discussions and campaigns to widen nursing's appeal to people of diverse gender identities, it continues to be perceived as a largely female profession. In the context of an ageing workforce, and alongside recruitment and retention challenges, efforts should be directed at developing a more inclusive profession rather than focusing on why people other than women do not become nurses. To attract more men, transgender people and those who identify as nonbinary, as well as women, the approach to nursing recruitment needs to change. The profession must develop a more inclusive culture and examine and promote the advantages that gender diversity can bring to nursing. This article explores the lack of gender diversity in contemporary nursing, briefly examines the history of gender in nursing, and considers how the profession might evolve into a more gender-diverse and inclusive workforce.

Proactive measures to eradicate Malaysia's poverty in IR4.0 era: a shared prosperity vision

Background: In the country's shared prosperity vision, Malaysia aspires to uplift the bottom 40% household income group (B40) by addressing wealth and income disparities. By 2030, the nation seeks to eradicate poverty through the provision of employment opportunities and career progression plans. A grey area between the nation's aspirations and actions in practice can be observed because the goals have not been achieved despite numerous efforts aimed at the upliftment of the B40 group. The nation is still way behind its targeted outcomes despite various policies being implemented, which could be attributed to the mismatch between government policies and that of organisational practice. Thus, this study explores the rationale of strategic government intervention in managing B40 talent in the IR4.0 era. Methods: A general qualitative inquiry method that used 11 semi-structured interviews was carried out with representatives of Malaysia's policy makers', training providers, and trainees. All Interview questions centred around measures, importance and outcomes of B40 youth training from a multi-stakeholder perspective. Data were thematically analysed in five stages using NVivo. Results: Training, which includes IR4.0 era digital skills, is the key to uplifting the B40 youth to eradicate poverty. Proactive measures are imperative in the success of B40 youth training towards poverty eradication. Conclusions: This study contributes to the existing literature and helps practitioners by addressing the current gap in Malaysia's aspirations versus organisational practice. Stakeholders should formulate proactive strategies to ensure that the right trainees are matched with the right training providers and government policies. A linkage between government policies and industry requirements needs to be established as opposed to the present discontinuity. A structured training needs analysis should be applied through a collaboration between industries and governments. Then, B40 individuals commonly found in lower-level positions can be pooled into the career pathway towards a shift into M40.

Proactive measures to eradicate Malaysia's poverty in IR4.0 era: a shared prosperity vision

Background: In the country's shared prosperity vision, Malaysia aspires to uplift the bottom 40% household income group (B40) by addressing wealth and income disparities. By 2030, the nation seeks to eradicate poverty through the provision of employment opportunities and career progression plans. A grey area between the nation's aspirations and actions in practice can be observed because the goals have not been achieved despite numerous efforts aimed at the upliftment of the B40 group. The nation is still way behind its targeted outcomes despite various policies being implemented, which could be attributed to the mismatch between government policies and that of organisational practice. Thus, this study explores the rationale of strategic government intervention in managing B40 talent in the IR4.0 era. Methods: A general qualitative inquiry method that used 11 semi-structured interviews was carried out with representatives of Malaysia's policy makers', training providers, and trainees. All Interview questions centred around measures, importance and outcomes of B40 youth training from a multi-stakeholder perspective. Data were thematically analysed in five stages using NVivo. Results: Training, which includes IR4.0 era digital skills, is the key to uplifting the B40 youth to eradicate poverty. Proactive measures are imperative in the success of B40 youth training towards poverty eradication. Conclusions: This study contributes to the existing literature and helps practitioners by addressing the current gap in Malaysia's aspirations versus organisational practice. Stakeholders should formulate proactive strategies to ensure that the right trainees are matched with the right training providers and government policies. A linkage between government policies and industry requirements needs to be established as opposed to the present discontinuity. A structured training needs analysis should be applied through a collaboration between industries and governments. Then, B40 individuals commonly found in lower-level positions can be pooled into the career pathway towards a shift into M40.

Injuries in Quidditch: A Prospective Study from a Complete UK Season

Background

Quidditch is a mixed-gender, full-contact sport founded in the USA in 2005, played worldwide by an estimated 25,000 players. It is one of the few mixed-gender full-contact sports, yet there remain few published studies regarding injury rates and patterns. A previous study suggested that the overall rate of injury in quidditch is in line with other contact sports, however raised concerns that female players were sustaining a higher rate of concussion when compared to male players.

Purpose

To examine injury rates and injury patterns in UK quidditch athletes over the course of a single season.

Study design

Prospective epidemiological study

Methods

Data were prospectively collected by professional first aid staff for the 2017-18 season spanning all major UK tournaments, involving 699 athletes. Anonymized player demographics were collected by an online survey. Time loss injury rates were measured per 1000 athletic exposures (AEs) and hours of play.

Results

The overall time loss injury rate was 20.5 per 1000 hours or 8.0 per 1000 AEs. The combined rate of concussion was 7.3 per 1000 hours or 2.8 per 1000 AEs. There was no statistical difference between time loss injuries in males (20.9/1000 hours and 8.1/1000 AEs) and females (13.9/1000 hours and 5.4/1000 AEs) (p=0.30) and no statistical difference between concussion rates in males (n=7) and females (n=4) (p=0.60).

Conclusions

Total time loss injury rates in quidditch appear to be comparable with other full-contact sports such as football. The rate of concussions for both males and females appear higher when compared to other contact sports.

Level of evidence

3

What Price Are We Willing to Pay for the Dream of Equal Justice?†

The injustices wrought by unequal access to the legal system pose a direct threat to the rule of law, yet such injustices are widespread in England and elsewhere. Lawyers regularly criticise governments for a lack of funding for the legal system, but the private market for delivering legal services receives much less scrutiny. A private market for legal resources is antithetical to equal justice because it makes the outcome of cases turn on arbitrary factors such as wealth. The solution, according to Wilmot-Smith in his book Equal Justice, is to socialise the allocation of legal services so that the rich cannot buy the best lawyers, and to prevent them from contracting out of this public system by making private arbitrations unenforceable. This review article argues that Wilmot-Smith's thesis is persuasive, but there might also be second-best solutions that could deliver greater legal equality at lower cost.

Women in neurointervention, a gender gap? Results of a prospective online survey

BACKGROUND AND PURPOSE

Women's representation in medicine has increased over time yet the proportion of women practicing neurointervention remains low. We conducted an anonymous online survey through which we could explore the gender gap in neurointervention, identify potential issues, difficulties, or obstacles women might face, and evaluate if men encounter similar issues.

METHODS

An online questionnaire was designed in SurveyMonkey®. Invitation to participate was emailed through national and international neurointerventional societies as well as directly through private mailing lists to men and women working in neurointervention. Responses were collected from 10 May 2019 to 10 September 2019.

RESULTS

There were 295 complete responses, 173 (59%) male and 122 (41%) female. Most respondents (83%) fell within age categories 35-60 years, with representation from 40 countries across five continents. In all 95% were working full time, 73% had worked as a neurointerventionalist for >6 years, 77% worked in University-affiliated teaching institutions. Almost half of the respondents indicated no female neurointerventionalist worked in their center. Female respondents were younger and age-adjusted analysis was undertaken. Significantly fewer females than males were married and had children. Significantly fewer females held supervisory roles, held academic titles, and significantly less had a mentor. Females were less satisfied in their careers. More females felt they receive less recognition than colleagues of the opposite sex. Males had a greater proportion of work time dedicated to neurointervention. Similar proportions of both genders experienced bullying in work (40%-47%); however, sexual harassment was more common for females. There were no differences between genders in how they dealt with complications or their effects on mental well-being.

CONCLUSION

There are many potential reasons why women are underrepresented in neurointervention, however, the literature suggests this is not unique to our specialty. Multiple long-term strategies will be necessary to address these issues, some of which are discussed in the article.

Enhancing the care of transgender and non-binary patients through effective communication

There is increasing evidence to suggest that transgender (trans) and non-binary people encounter significant societal discrimination, stereotypical and misleading representation in the media, and frequent misgendering. They may also experience several barriers to accessing healthcare, as well as discrimination from staff and other patients. This article explores how and why trans and non-binary people experience discrimination, and discusses how healthcare professionals, including nurses, can enhance the care experience for these patients, with a particular emphasis on language and communication.

Patient capability: Justice and grassroots healthcare delivery in China

The current reform of China's healthcare system focuses mainly on two dimensions: the promotion of primary healthcare and the improvement of quality of grassroots healthcare (GH). Specifically, the reforms are aimed at meeting the needs of patients in the grassroots areas (PGAs) through the provision of universal healthcare and hierarchical diagnosis and treatment (HDT). In practice, however, disparities in health outcomes between the grassroots and upper levels persist. The gaps between increased health coverage and heightened barriers to accessing quality medical care in the grassroots areas are growing ever larger. What explains this paradox is the limited capability of PGAs to transform healthcare resources into better health-seeking behaviors and health outcomes, resulting in injustice that is built into the system, which is neither ethical nor fair. Using Amartya Sen's capability approach (CA) to explore issues of justice in relation to China's GH system and its performance, we suggest that an institutional structure, one that focuses on promoting universal coverage in the grassroots areas, although necessary, is by itself insufficient in promoting justice and equality in accessing healthcare. Institutional disparities in the healthcare system and China's household registration policy, constructed according to the rural-urban divide, have also produced injustices. We argue that greater attention should be given to meeting the medical needs of PGAs and empowering them with greater choice, permitting them a higher level of freedom and agency, and thus remedying the problems that we describe. We conclude with policy recommendations aimed at improving justice within the system.

"Connection to Culture Is Like a Massive Lifeline": Yarning With Aboriginal Young People About Culture and Social and Emotional Wellbeing

Culture is an important social and emotional wellbeing factor for Aboriginal peoples in Australia, particularly regarding recovery from colonization. However, little is understood about how culture and wellbeing interact for young urban Aboriginal people. This study used Yarning methods to explore experiences and perceptions of culture and wellbeing for young urban Aboriginal people in Narrm, Australia. Findings indicate that culture is experienced as connection, and that perceived connection or disconnection has an essential influence on the wellbeing of young people. Through sharing young people stories, a range of factors, including colonization, relationships, cultural knowledge, community support, and agency, were identified as affecting perceptions of connectedness, and therefore on wellbeing. Youth were able to develop strategies to increase connection and provided illuminating advice and suggestions for improving connection for future generations. This study thus contributes to efforts to improved understanding of Aboriginal perspectives about social and emotional wellbeing and culture.

Developing Suicide Safety Protocols for Qualitative Research as a Universal Equity Practice

Qualitative research offers a range of approaches to elucidate the health and social experiences of populations and communities that are historically oppressed and repressed, yet is not without ethical and practical challenges that may have unintended consequences and added risks for certain individuals and communities. As a result of experiences of trauma and environmental factors, many oppressed and repressed populations have disproportionately high rates of suicide, but there are no widely accepted standards or best practices for addressing suicidality while conducting qualitative research. We describe an example of a qualitative interview during which a participant reported thoughts of suicide, even though the study topic was not directly related to mental health or suicide. We describe how the research team responded and present a framework for developing suicide safety protocols when conducing qualitative research with oppressed and repressed populations.

The Podiatric Medical Profession: A Gender Comparison

The number of women in podiatric medicine and surgery has increased steadily over the past 4 decades; however, there appears to be a large and continued gender gap with respect to representation in academic medicine and other positions of power. National and state level organizational data were obtained from multiple podiatry professional societies to evaluate the rate at which women achieved leadership roles within the podiatric profession over time. A secondary questionnaire was also developed and electronically mailed to 8684 doctors of podiatric medicine to help capture additional leadership information and to provide further insight into the trends observed. The response rate was 26% (2276/8684). Female representation in academia, research/publications, most leadership positions, and board certifications has increased over time, but at a slower rate than the number of women entering the profession. We observed a decreasing trend of females completing fellowships, speaking at national meetings, becoming residency directors, and receiving American College of Foot and Ankle Surgeons- and American Podiatric Medical Association-sponsored grants/awards. Based on the survey results, female podiatric physicians were more likely to be single, have fewer children, spend more time in a clinical setting, be less satisfied with work, and experience higher work stress levels than their male colleagues. Of the female respondents, 73% described experiencing gender discrimination at some point in their career, and 42% reported experiencing sexual harassment, compared with only 6% and 5% of men, respectively. There continues to be a gender gap in leadership roles, which may be explained partially by work/life balance issues, gender discrimination, and other issues.

Combatting Covid-19. Or, "All Persons Are Equal but Some Persons Are More Equal than Others?"

Vaccines, when available, will prove to be crucial in the fight against Covid-19. All societies will face acute dilemmas in allocating scarce lifesaving resources in the form of vaccines for Covid-19. The author proposes The Value of Lives Principle as a just and workable plan for equitable and efficient access. After describing what the principle entails, the author contrasts the advantage of this approach with other current proposals such as the Fair Priority Model.

Do Black, Asian and Minority Ethnic nurses and midwives experience a career delay? A cross-sectional survey investigating career progression barriers

BACKGROUND

Black, Asian and Minority Ethnic nurses and midwives are under-represented in higher and managerial roles.

AIMS

This study explored the presence and nature of career progression delays for Black, Asian and Minority Ethnic nurses and midwives and investigated where the barriers to progression were.

DESIGN

A secondary analysis of data from a wider cross-sectional survey investigating workplace experiences, burnout and patient safety in nurses and midwives.

METHODS

538 nurses and midwives were recruited from four UK hospitals between February and March 2017. A career progression delay was viewed as being present if Black, Asian and Minority Ethnic nurses and midwives had spent longer on the entry level nursing grade and less time on higher grades in the previous 10 years. The analysis included items pertaining to: receipt of professional training, perceived managerial support for progression, likelihood of submitting applications and application success rates. Data were analysed using linear regression, odds ratios and t-tests. Results were reported using the STROBE Checklist.

RESULTS

Black, Asian and Minority Ethnic nurses and midwives (n = 104; 19.4%) had spent more months working at the entry-level grade (M = 75.75, SD = 44.90) than White nurses and midwives (n = 428; 79.7%; M = 41.85, SD = 44.02, p < 0.001) and fewer months at higher grades (M = 15.29, SD = 30.94 v 29.33, SD = 39.78, p = 0.006 at Band 6; M = 6.54, SD = 22.59 v M = 19.68, SD = 37.83, p = 0.001 at Band 7) over the previous 10 years. Black, Asian and Minority Ethnic nurses and midwives were less likely to have received professional training in the previous year (N = 53; 53.0% v N = 274; 66.0%, p = 0.015) and had to apply for significantly more posts than White nurses and midwives before gaining their first post on their current band (M = 1.22, SD = 1.51 v M = 0.81, SD = 1.55, p = 0.026).

CONCLUSIONS

Interventions are needed to improve racial equality regarding career progression in nurses and midwives. Increasing access to professional training and reducing discriminatory practice in job recruitment procedures may be beneficial.

IMPACT STATEMENT

Black, Asian and Minority Ethnic nurses and midwives experience career progression inequalities. Interventions should improve transparency in recruitment procedures and enhance training opportunities.