Expert Views on COVAX and Equitable Global Access to COVID-19 Vaccines

Objectives: We face the impossibility of having enough COVID-19 vaccines for everyone in the near future. This study aims to contribute to the debate on equitable global access to COVID-19 vaccines, tackling key ethical discussions and policy challenges regarding early phases of COVAX, the global cooperation mechanism for supporting fair vaccine allocation.Methods: We conducted in-depth interviews with twelve experts and a literature research on academic articles, media sources and public statements. We built a data analysis matrix and conducted a thematic analysis.Results: Our findings show, first, that interviewed experts who hold different views on vaccine allocation, including moderate nationalist perspectives, agree on joining a global cooperation mechanism. Second, incentives to join COVAX vary greatly among countries. Third, specific barriers to COVAX emerged in the early implementation phase. And fourth, countries might be trapped in a zero-sum game regarding the global vaccine supply.Conclusion: We present findings that enrich analyses of early phases of COVAX (April 2020–21), we introduce three ethical discussions that provide a common ground for equitable access to COVID-19 vaccines, and we highlight policy challenges.

The Importance of Tissue Sanctuaries and Cellular Reservoirs of HIV-1

Purpose of Review: There have been significant developments in the treatment of people living with HIV-1/AIDS with current antiretroviral therapies; however, these developments have not been able to achieve a functional or sterilizing cure for HIV-1. While there are multiple barriers, one such barrier is the existence of pharmacological sanctuaries and viral reservoirs where the concentration of antiretrovirals is suboptimal, which includes the gut-associated lymphoid tissue, central nervous system, lymph nodes, and myeloid cells. This review will focus on illustrating the significance of these sanctuaries, specific barriers to optimal antiretroviral concentrations in each of these sites, and potential strategies to overcome these barriers. Recent Findings: Research and studies have shown that a uniform antiretroviral distribution is not achieved with current therapies. This may allow for low-level replication associated with low antiretroviral concentrations in these sanctuaries/reservoirs. Many methods are being investigated to increase antiretroviral concentrations in these sites, such as blocking transporting enzymes functions, modulating transporter expression and nanoformulations of current antiretrovirals. While these methods have been shown to increase antiretroviral concentrations in the sanctuaries/reservoirs, no functional or sterilizing cure has been achieved due to these approaches. Summary: New methods of increasing antiretroviral concentrations at the specific sites of HIV-1 replication has the potential to target cellular reservoirs. In order to optimize antiretroviral distribution into viral sanctuaries/reservoirs, additional research is needed.

How Can Large Manufacturers Digitalize Their Business Models? A Framework for Orchestrating Industrial Ecosystems

For manufacturers, remaining competitive depends on their ability to digitalize their business models (i.e., offer digital and digitally enhanced products and services). To achieve this, they must engage with new digital partners and help their existing suppliers, partners, and other stakeholders to digitalize. Orchestrating this growing ecosystem is challenging. Manufacturers struggle with this endeavor because of specific barriers associated with their existing legacy business model and related to their lack of digital vision, product-centric value chains, and a bias toward firm-centered profit formulas. To overcome these barriers, leading manufacturers have developed new approaches to ecosystem orchestration.

Barriers to work-based learning experiences: A mixed methods study of perceptions from the field

BACKGROUND: Work-based learning experiences (WBLEs) are significantly associated with improved postschool employment outcomes for students with disabilities; however, little is known about the specific barriers affecting implementation of WBLEs. OBJECTIVE: The purpose of this study was to identify community-and school-related barriers to implementing WBLEs. METHODS: This study used a mixed methods approach to analyze survey data from 170 secondary transition staff providing WBLEs to students with disabilities in three states. RESULTS: Findings provided a broader understanding of critical barriers as perceived by transition staff implementing WBLEs, including limited availability of resources, transportation, and lack of willing employers. CONCLUSIONS: Collaborative partnerships between vocational agencies and school districts have the potential to address some of these barriers and improve the delivery of employment supports and WBLEs in an effort to help students achieve their postschool employment goals.

Measurement of Barriers, Attitudes, and Expectations for Sitting Less in Pregnancy

Objective: Our objective was to develop, validate, and describe findings from an instrument to measure barriers, attitudes, and outcome expectations of sitting less in pregnant women. Methods: This validation (sub-study 1) and descriptive study (sub-study 2) evaluated a new questionnaire measuring sedentary time in pregnant women (N=131) in each trimester. Results: In sub-study 1, construct validity was supported by associations between device-measured sedentary time and questionnaire scores. An optimized questionnaire removed infrequently reported and non-correlated items. The original and optimized questionnaires with scoring instructions are provided. In sub-study 2, physical symptoms and work were most commonly reported as major reasons for sitting in pregnancy, followed by leisure, family, and social activities. Some women reported limiting sitting due to boredom/restlessness, to improve energy or health, and to control weight. In the third trimester, some women reported sitting more/less due to pain and encouragement from family, friends, and co-workers. Few women reported household chores or pregnancy risks as reasons to sit, felt sitting was healthy or necessary during pregnancy, or were encouraged to sit by healthcare providers. Conclusions: The developed questionnaire demonstrated validity and identified barriers to and expectations of sitting less during pregnancy. Prenatal interventions to reduce sitting should address general and pregnancy-specific barriers.

Using Human-Centered Design in Personalized Anticipatory Guidance: Enriching Anticipatory Guidance on Early Cognitive and Language Development

In this study, we aimed to create a novel tool to assist providers at 2 Chicago-area Federally Qualified Health Centers in giving guidance on early cognitive and language development during well-child visits. We utilized a human-centered design (HCD) process to address specific barriers to providing this guidance and create a tool shaped by the needs of providers and parents. Phase I involved collaborative prototype design; phase II involved implementation, feedback gathering, and responsive iterations of the tool; and phase III involved a collective review of the HCD process. The final version of the tool was a concise, colorful, and parent-accessible “Brain Building Guide” intended for interactive provider and parent use. It featured personalized information about parental knowledge and suggested areas for guidance. It was both satisfactory to stakeholders and efficacious in improving parental knowledge immediately post-visit and 1 month out. It should be further evaluated in a randomized controlled trial.

Community-based Culturally Tailored Education Programs for Black Adults With Cardiovascular Disease, Diabetes, Hypertension, and Stroke: a Systematic Review Protocol

Background: Chronic conditions and stroke disproportionately affect Black adults in communities all around the world due patterns of systemic racism, disparities in care, and lack of resources. Culturally-tailored programs can meet the needs of the communities they serve, including Black adults who tend to have reduced access to postacute services. To address unequal care received by Black communities, a shift to community-based programs that deliver culturally-tailored programs may give an alternative to a healthcare model which reinforces health inequities. However, community-based culturally-tailored programs (CBCT) are relatively understudied but show promise to improve the delivery of services to marginalized communities. The objectives of this review are to: (i) synthesize key program characteristics and outcomes of CBCT programs that are designed to improve health outcomes in Black adults with cardiovascular disease, hypertension, diabetes, or stroke and (ii) identify which of the five categories of culturally appropriate programs from Kreuter and colleagues have been used to implement CBCT programs.Methods: This is a protocol for a systematic review that will search MEDLINE, EMBASE and CINAHL databases to identify CBCT programs for Black adults with cardiovascular disease, hypertension, diabetes, or stroke.Discussion: Health inequities have disproportionately impacted Black communities and will continue to persist if adjustments are not prioritized within healthcare to provide services, care, and programs meant to address the specific barriers to better health. Many interventions meant to improve the health outcomes of marginalized groups are created using an outsider's perspective, with little input from target communities, leading to interventions that may not address the specific barriers contributing to poor health outcomes. The inclusion of community members in the design of CBCT programs allows for a deeper understanding of the issues facing the community and provides an opportunity to incorporate cultural values that may enhance the efficacy, relevance and appropriateness of programs to the target communities. Trial registration: PROSPERO CRD42021245772

Innovations in Accessible Scholarly Communication

What does it mean to make scholarly communications accessible to people with disabilities and those who face other specific barriers to access? This talk gives an overview of recent work to support equitable access across the lifecycle of scholarly communication, offering useful updates and strategies for scholars, editors, publishers, librarians, and other professionals. Participants will understand what accessibility means today and how they can reduce barriers in their work by following accessibility standards and best practices, and learning from leading examples in the field.

Perceived provider barriers to collecting and documenting a complete family history in a statewide oncology consortium.

221 Background: A complete family history is essential in identifying patients who may benefit from genetic evaluation for hereditary cancer syndromes. Fewer than 40% of patients with cancer have a complete family history documented in their medical record. As part of a larger study of patient- and provider-focused interventions for increasing genetic testing, we conducted a survey of provider barriers to collecting and documenting a complete family history in a statewide, physician-led quality consortium of nearly all medical and gynecologic oncologists in Michigan. Methods: A novel survey instrument was created by adapting existing literature and clinician input. Surveys were mailed to medical and gynecologic oncologists with follow up electronic surveys sent to non-respondents. Questions addressed patient-specific barriers as well as known constraints faced by oncologists. Each barrier was rated from low to high using a 10-point Likert scale. Descriptive statistics, including mean scores and standard deviations (SD), were calculated. Results: Of 317 surveys sent, 194 (61.2%) were returned. Oncologists rated constraints on their time lower than lack of patient knowledge and understanding of their family history and its importance as a barrier. Open-ended responses indicated that the processes of collecting a family history (e.g. templates for collecting family history that omit age at diagnosis) and patients being overwhelmed at the time of consultation also interfered with collecting a complete family history. Conclusions: Oncologists perceive patient knowledge of their family history, including the ages of affected family members, and understanding of its importance as barriers to completion and documentation of a family history. Explaining the importance of the family history to patients, prompting new patients to provide their family history, and improving the process, including the timing of collection, may increase the proportion of oncology patients who have a complete family history collected and documented.[Table: see text]

Community-Based Culturally Tailored Education Programs for Black Adults with Cardiovascular Disease, Diabetes, Hypertension, and Stroke: A Systematic Review Protocol

Background: Chronic conditions and stroke disproportionately affect Black adults in communities all around the world due patterns of systemic racism, disparities in care, and lack of resources. To address unequal care received by Black communities, a shift to community-based programs that deliver culturally tailored programs to meet the needs of the communities they serve, including Black adults who tend to have reduced access to postacute services, may give an alternative to a healthcare model which reinforces health inequities. However, community-based culturally tailored programs (CBCT) are relatively understudied but show promise to improve the delivery of services to marginalized communities. The objectives of this review are to: (i) determine key program characteristics and outcomes of CBCT programs that are designed to improve health outcomes in Black adults with cardiovascular disease, hypertension, diabetes, or stroke and (ii) identify which of the five categories of culturally appropriate programs from Kreuter and colleagues have been used to implement CBCT programs. Methods: This is a protocol for a systematic review that will search MEDLINE, CINAHL, and EMBASE databases to identify community-based culturally tailored programs for Black adults with cardiovascular disease, hypertension, diabetes, or stroke. Discussion: Health inequities have disproportionately impacted Black communities and will continue to persist if adjustments are not prioritized within healthcare to provide services, care, and programs meant to address the specific barriers to better health experienced. Many interventions, meant to improve the health outcomes of marginalized groups, are created with little input from target communities leading to interventions that may not address the specific barriers contributing to poor health outcomes and are designed and implemented from an outsider's perspective. The inclusion of community members allows for a deeper understanding of the issues facing the community and provides an opportunity to incorporate cultural values to potentially increase the efficacy, tailoring the intervention to distinct communities. An alternative to current healthcare interventions must be explored to reduce the health gap experienced by Black adults.