Representation of Women and Underrepresented Groups in US Academic Medicine by Specialty

Research Letter 

Health Policy

August 30, 2021

Alexander Yoo, MD¹; Benjamin P. George, MD, MPH¹; Peggy Auinger, MS¹; et alEmma Strawderman²; David A. Paul, MD³

Author Affiliations Article Information

JAMA Netw Open. 2021;4(8):e2123512. doi:10.1001/jamanetworkopen.2021.23512

Introduction

Diversity in the physician workforce has always been and remains a critical issue. Prior studies demonstrate the number of women and members of underrepresented groups in medicine (URM), such as American Indian or Alaskan Native, Black, Latino or Hispanic, and Native Hawaiian or other Pacific Islander individuals, are increasing throughout academic medicine.^1,2 However, little is known in the current literature regarding variation and trends in demographics of academic faculty across medical specialties or the retention of residents identifying as women or URM as academic faculty. This study adds to the literature by examining 30-year demographic trends across academic medicine departments and providing novel comparisons of the proportion of individuals identifying as women or URM between academic faculty and specialty-matched residents.

Methods

This cross-sectional study was deemed exempt from review and informed consent by the University of Rochester institutional review board because it was deemed non–human participant research. This study is reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

We evaluated the distribution of women and URM among US medical school faculty for 16 clinical academic medicine departments using the Association of American Medical Colleges Faculty Roster from 1990 through 2019. Race/ethnicity of faculty was self-identified. Linear mixed-effects models were used to estimate the mean change per year (ie, linear slope) in percentages of women and percentages of URM, which included department, time, and a department-by-time interaction term with an autoregressive correlation structure for repeated measures (eAppendix in the Supplement). Bonferroni correction for multiple comparisons was used; statistical significance defined as 2-sided P < .003.

Demographics, including race and ethnicity, of US resident physicians from 2012 to 2013 were obtained from the Accreditation Council of Graduate Medical Education. Representation ratios³ were calculated by dividing the proportion of women or URM faculty in 2019 by the proportion of women or URM residents in the 2012 to 2013 academic year (allowing for a 6-year time lag). This metric denotes the representativeness of women or URM faculty compared to the corresponding trainee pipeline (eAppendix in the Supplement).

Analyses were performed using SAS version 94 (SAS Institute), and representation ratios were calculated using R version 4.04 (R Project for Statistical Computing). Data were analyzed in December 2019.

Results

From 1990 to 2019, there were a total of 3 146 342 faculty entries, including 1 089 892 women (34.6%) and 2 252 134 faculty entries for White physicians (71.9%). Proportions of women faculty increased, with women comprising more than 50% of faculty members in 5 of 16 clinical academic departments by 2019 (Table). Proportions of URM faculty also increased for 8 of 16 specialties (Table).

In 2019, specialties with high proportions of women faculty did not necessarily have high representativeness compared with residents. Obstetrics and gynecology, which has the highest proportion of women faculty, demonstrated the third lowest representation ratio (0.81). In contrast, despite having the lowest overall proportion of women faculty, orthopedic surgery had the highest representation ratio (1.48) (Figure, A). In respect to URM, most specialties had representation ratios less than 1.0 (overall representation ratio, 0.76) (Figure, B-D).

Discussion

This cross-sectional study found increases in the proportions of women faculty across clinical academic departments over the past 3 decades. Racial and ethnic diversity among faculty also increased, although at a lower rate. Increasing faculty diversity can be partially attributed to comparably modest improvements in diversity among medical students and residents.⁴ However, URM faculty are underrepresented compared with the resident pipelines for most specialties. Nearly all departments captured only a fraction of the available URM resident pipeline, and there were differences in representation ratios across departments for women. Further investigation is needed to understand factors that may dissuade or obstruct women and URM trainees from pursuing academic careers. Previous studies, such as a 2013 study by Peek et al,⁵ have found that medical schools with URM role models and available, experienced mentors (URM and non-URM) were more likely to have high proportions of URM students. Studies are needed to determine modifiable differences and how to implement change to optimize faculty demographics.

This study has some limitations. The interpretation of the representation ratio in this study is limited by the inability to control for trainee preferences for academics and does not account for personal and structural factors that may influence career choice. Other limitations include the use of nationally aggregated deidentified data, which prohibits control of confounding factors, including regional demographics and status of Historically Black Colleges and Universities. Further study of individualized faculty and institutional-level data are needed.

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Article Information

Accepted for Publication: June 28, 2021.

Published: August 30, 2021. doi:10.1001/jamanetworkopen.2021.23512

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Yoo A et al. JAMA Network Open.

Corresponding Author: Alexander Yoo, MD, Department of Neurology, University of Rochester Medical Center, 601 Elmwood Ave, Box 673, Rochester, NY 14642 (alexander_yoo@urmc.rochester.edu).

Author Contributions: Dr Yoo had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Yoo, George, Paul.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Yoo, George.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Auinger, Paul.

Administrative, technical, or material support: Yoo, George.

Supervision: George.

Conflict of Interest Disclosures: None reported.

References

1.

Yehia  BR, Cronholm  PF, Wilson  N,  et al.  Mentorship and pursuit of academic medicine careers: a mixed methods study of residents from diverse backgrounds.   BMC Med Educ. 2014;14:26. doi:10.1186/1472-6920-14-26PubMedGoogle ScholarCrossref

2.

Ogunwole  SM, Dill  M, Jones  K, Golden  SH.  Trends in internal medicine faculty by sex and race/ethnicity, 1980-2018.   JAMA Netw Open. 2020;3(9):e2015205. doi:10.1001/jamanetworkopen.2020.15205
ArticlePubMedGoogle Scholar

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Hofler  LG, Hacker  MR, Dodge  LE, Schutzberg  R, Ricciotti  HA.  Comparison of women in department leadership in obstetrics and gynecology with those in other specialties.   Obstet Gynecol. 2016;127(3):442-447. doi:10.1097/AOG.0000000000001290PubMedGoogle ScholarCrossref

4.

Lett  LA, Murdock  HM, Orji  WU, Aysola  J, Sebro  R.  Trends in racial/ethnic representation among US medical students.   JAMA Netw Open. 2019;2(9):e1910490. doi:10.1001/jamanetworkopen.2019.10490
ArticlePubMedGoogle Scholar

5.

Peek  ME, Kim  KE, Johnson  JK, Vela  MB.  “URM candidates are encouraged to apply”: a national study to identify effective strategies to enhance racial and ethnic faculty diversity in academic departments of medicine.   Acad Med. 2013;88(3):405-412. doi:10.1097/ACM.0b013e318280d9f9PubMedGoogle ScholarCrossref

THIRD WORLD USA

750,000 households face eviction by January with possible 'severe' public health consequences, Goldman says

jzeballos@businessinsider.com (Joseph Zeballos-Roig)

 The Maricopa County constable signs an eviction order on

 October 7, 2020 in Phoenix, Arizona. 

John Moore/Getty Images

Goldman Sachs projects 750,000 households face eviction by January with potentially "severe" COVID-19 consequences.

The Supreme Court struck down the federal eviction moratorium last week.

Democrats and the White House are prioritizing fixes to an emergency rent relief program.

Goldman Sachs projects that landlords could evict 750,000 households by the end of 2021 after the Supreme Court's recent decision to strike down a federal eviction ban. They also warned there could be "severe" public health consequences from the coming wave of evictions."

The Goldman analysts estimated 3.5 million households are struggling to catch up on rent, the group said in a note released Sunday. Collectively, those households owe landlords around $17 billion in unpaid rent, Goldman projected.

Goldman wrote that while the coming evictions may dent household consumption and job growth, the public health consequences are probably more "severe" and it may increase virus infections. COVID-19 cases from the Delta variant have surged nationwide, along with hospitalizations in many parts of the US.

Up until July 31, renters who hadn't made monthly payments were shielded from eviction due to a moratorium imposed by the Centers for Disease Control and Prevention. That went in tandem with an emergency rental assistance program designed to provide renters with federal aid so they can stay in their homes.

But the money has been slow to get to beleaguered renters in most states and cities due to bureaucratic snags and onerous documentation requirements, among other problems. It helped spark a last-minute Democratic push to extend the moratorium so renters could have more time to receive federal relief, but it collapsed because of resistance from moderates.

Faced with withering pressure from progressives, the Biden administration enacted a limited moratorium in counties struggling with high infection rates earlier this month. But the Supreme Court struck that down on Thursday evening in a 6-3 ruling.

Video: Federal ban on evictions expires as renters face rising covid cases (The Washington Post)

Conservative justices banded together and ruled that the public health agency had overstepped its authority, which could pave the way for additional federal overreach.

In the wake of the ruling shutting down the federal eviction ban, only seven states and the District of Columbia have eviction moratoriums. Housing experts warn a looming wave of evictions could hit low-income Black Americans the hardest.

"Evictions will occur where unemployment rates are highest-that is, where poor and mostly black service industry workers live," Paul Williams, a fellow at the Jain Family Institute, wrote Monday on Twitter. He added most homeless shelters are already at capacity.

On Friday, the White House appeared to concede Democrats couldn't muster the votes in Congress to renew a federal eviction ban. Instead, it was prioritizing ironing out the problems in the rental relief program.

"If there were enough votes to pass an eviction moratorium in Congress, it would have happened," White House Press Secretary Jen Psaki said at a daily news briefing. "It hasn't happened."

Reps. Alexandria Ocasio Cortez of New York and Cori Bush of Missouri joined 61 House Democrats in calling for Democratic leaders to assist in extending the moratorium.

"The impending eviction crisis is a matter of public health and safety that demands an urgent legislative solution to prevent further harm and needless loss of human life," the letter said.

Read the original article on Business Insider

Original Investigation 

Public Health

August 30, 2021

Eviction Moratoria Expiration and COVID-19 Infection Risk Across 

Strata of Health and Socioeconomic Status in the United States

Sebastian Sandoval-Olascoaga, MSc^1,2; Atheendar S. Venkataramani, MD, PhD^3,4; Mariana C. Arcaya, ScD, MCP¹

Author Affiliations Article Information

JAMA Netw Open. 2021;4(8):e2129041. doi:10.1001/jamanetworkopen.2021.29041

Key Points

Question  Is lifting a state-level eviction moratorium associated with the risk of individuals in that state being diagnosed with COVID-19?

Findings  In this cohort study of 509 694 individuals living in the United States, a difference-in-differences survival analysis found that residents in states that lifted eviction moratoria had an increased risk of receiving a COVID-19 diagnosis 12 weeks after the moratorium was lifted relative to residents in states where moratoria remained in place. These associations increased over time, particularly among individuals with more comorbidities and lower socioeconomic status.

Meaning  These findings suggest that eviction-led housing insecurity may have exacerbated the COVID-19 pandemic.

Abstract

Importance  Housing insecurity induced by evictions may increase the risk of contracting COVID-19.

Objective  To estimate the association of lifting state-level eviction moratoria, which increased housing insecurity during the COVID-19 pandemic, with the risk of being diagnosed with COVID-19.

Design, Setting, and Participants  This retrospective cohort study included individuals with commercial insurance or Medicare Advantage who lived in a state that issued an eviction moratorium and were diagnosed with COVID-19 as well as a control group comprising an equal number of randomly selected individuals in these states who were not diagnosed with COVID-19. Data were collected from OptumLabs Data Warehouse, a database of deidentified administrative claims. The study used a difference-in-differences analysis among states that implemented an eviction moratorium between March 13, 2020, and September 4, 2020.

Exposures  Time since state-level eviction moratoria were lifted.

Main Outcomes and Measures  The primary outcome measure was a binary variable indicating whether an individual was diagnosed with COVID-19 for the first time in a given week with International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code U07.1. The study analyzed changes in COVID-19 diagnosis before vs after a state lifted its moratorium compared with changes in states that did not lift it. For sensitivity analyses, models were reestimated on a 2% random sample of all individuals in the claims database during this period in these states.

Results  The cohort consisted of 509 694 individuals (254 847 [50.0%] diagnosed with COVID-19; mean [SD] age, 47.0 [23.6] years; 239 056 [53.3%] men). During the study period, 43 states and the District of Columbia implemented an eviction moratorium and 7 did not. Among the states that implemented a moratorium, 26 (59.1%) lifted their moratorium before the US Centers for Disease Control and Prevention issued their national moratorium, while 18 (40.1%) maintained theirs. In a Cox difference-in-differences regression model, individuals living in a state that lifted its eviction moratorium experienced higher hazards of a COVID-19 diagnosis beginning 5 weeks after the moratorium was lifted (hazard ratio [HR], 1.39; 95% CI, 1.11-1.76; P = .004), reaching an HR of 1.83 (95% CI, 1.36-2.46; P < .001) 12 weeks after. Hazards increased in magnitude among individuals with preexisting comorbidities and those living in nonaffluent and rent-burdened areas. Individuals with a Charlson Comorbidity Index score of 3 or greater had an HR of 2.37 (95% CI, 1.67-3.36; P < .001) at the end of the study period. Those living in nonaffluent areas had an HR of 2.14 (95% CI, 1.51-3.05; P < .001), while those living in areas with a high rent burden had an HR of 2.31 (95% CI, 1.64-3.26; P < .001).

Conclusions and Relevance  The findings of this difference-in-differences analysis suggest that eviction-led housing insecurity may have exacerbated the COVID-19 pandemic.

Introduction

On September 4, 2020, the US Centers for Disease Control and Prevention (CDC) enacted a national eviction moratorium because “the evictions of tenants could be detrimental to public health control measures to slow the spread of the virus that causes COVID-19.”¹ The moratorium came at a time when an estimated 47.0% of individuals in renter-occupied housing behind on their payments were likely to leave their homes due to eviction,² sequalae of the United States’ long-standing housing-affordability crisis and the COVID-19 pandemic’s impact on employment and income.³

A growing body of evidence suggests that eviction activity may be associated with increased COVID-19 infection rates. For example, a study⁴ using ecologic data on COVID-19 infection rates and timing of state-level eviction bans found that COVID-19 rates increased after eviction moratoria expired. Other investigations using simulations have since found that households experienced an increased risk of infection not just due to personal experiences but also due to spillover from the transmission processes amplified by community evictions.⁵

However, limitations in public health surveillance data do not allow for exploration of differential policy effects based on individual-level health and socioeconomic characteristics. Understanding whether expiring eviction moratoria are particularly dangerous for people and local geographies that have already experienced disproportionate effects of the pandemic, including individuals with preexisting health problems and low-income communities, could help to inform how nonpharmaceutical interventions are deployed with an equity focus. For example, shelter-in-place orders, which protect professional class workers but not essential workers from occupational exposures, likely have different distributional impacts than do eviction moratoria, which we expect to disproportionately protect lower-income and rent-burdened populations and places.

We used detailed health care claims data from a large national database in the United States to conduct what we believe to be the first individual-level analysis of how eviction policy affects the hazard of a COVID-19 diagnosis within health and neighborhood-level socioeconomic strata. We used a difference-in-differences research strategy to compare changes in the risk of being diagnosed with COVID-19 before and after the lifting of state-level eviction moratoria vs the same changes in states that maintained these moratoria. We also assessed how associations between eviction moratoria and the risk of COVID-19 diagnosis varied by an individual’s Charlson Comorbidity Index (CCI) score as well as by zip code–level poverty and rent burden prevalence, to test the hypotheses that (1) individuals with poorer baseline health, as measured by the CCI, will experience higher risk of infection after moratoria are allowed to expire because baseline health status and eviction risk are both socially patterned and (2) individuals in low-income and rent-burdened communities will be at heightened risk of infection after expiring moratoria due to higher risk of exposure to eviction-related COVID-19 transmission driven by local evictions and subsequent crowding.

READ THE REST HERE

 Eviction Moratoria Expiration and COVID-19 Infection Risk Across Strata of Health and Socioeconomic Status in the United States | Health Disparities | JAMA Network Open | JAMA Network

"DUTY TO ACCOMODATE"

The Pandemic Forced Employers to (Finally) Offer Workplace Accommodations
Krystal Jagoo 

Years ago, I had agreed to speak on a mental health and academia panel. I was still dealing with the trauma of taking legal action against a former employer for white supremacist workplace harassment. But my commitment to my students, integral to my job as an accessibility advisor at Canada’s largest university, forced me to push through my fears. As I looked to the right and left of me, I was reassured by the lineup of BIPOC professionals. A researcher introduced himself, and he shared frustration over how the institution had just doubled its team of accessibility advisors, likely without hiring folx with actual lived experiences of disabilities.

© Writer Krystal Jagoo, photographed by Galit Rodan

(Related: 5 Canadians with Disabilities on the Upsides of Working from Home)

I have been navigating migraine disorder since my teens, and sleep issues and back pain for years. Especially when my period comes, it is not uncommon for me to be bedridden for days. And although I can access 15 weeks of sick time according to my union’s collective agreement, I still have an absenteeism warning letter in my HR file (despite not using even close to that allotted time). So, in fact, the institution had hired someone with lived experience—but they didn’t know it. I wasn’t yet comfortable with identifying as disabled, even to myself. When it came to my turn to speak that day, I described myself as a social worker.

Since then, I have unpacked much of my internalized ableism through my work with students, which helps me cope with the reality of a life with disabilities. Over the last 18 months, I have reassured students that their delays with coursework were likely related to limited executive functioning as they attempted to manage the uncertainty of COVID-19—and I realized those insights applied to me too. When my chiropractic treatment, an essential tool for managing my chronic pain, was suddenly unavailable because of lockdowns, it was devastating.

When the pandemic hit, I saw an immediate expansion in the academic accommodations deemed “reasonable” for students with disabilities. In the past, when students had reported difficulty attending lectures on campus and inquired about the possibility of getting instructors to provide them with recordings for disability-related absences, they were told repeatedly that we were not an online university. Those in positions of power, who often lack lived experience of disabilities, were simply unwilling to provide the necessary accommodations. Thanks to COVID-19, we have successfully operated remotely for over a year, just like many of us have always known was possible.

According to the 2017 Canadian Survey on Disability (CSD), among staff with disabilities between the ages of 25 and 64 years old, 37 percent had required at least one workplace accommodation to be able to complete their duties. Based on these statistics, over 772,000 Canadians made use of workplace accommodations to manage disability-related challenges. Of those, 59 percent reported having all their needs met, while 19 percent reported some and 21 percent reported none.

(Related: Reminder: Black Women Shouldn't Have to Reach a Breaking Point to Deserve Wellness)

With those numbers in mind, I’m unsurprised that both students and employees with disabilities are apprehensive about disclosing their challenges. I also recall my students describing their bittersweet realization that it wasn’t until folx without disabilities were unable to attend lectures on campus for the sake of their health that accommodations for remote learning were finally put in place. It made my students feel that they had not mattered.

According to the Canadian Psychological Association, approximately eight percent of Canadians who experience a traumatic event develop post-traumatic stress disorder, and these figures are likely under-reported. As a mental health professional for over a decade, I know the mental health impacts of this traumatic global pandemic have yet to be understood. As we look toward the future, it is more crucial than ever to develop trauma-informed approaches to effectively meeting the needs of folx with disabilities—especially for those of us who are marginalized in other ways, such as being BIPOC and/or LGBTQIA+.

Greater autonomy to manage our work responsibilities remotely may be one of the few ways employers can accommodate us. I know I have benefited from not having to sit in brightly lit office spaces that trigger my migraine—just as I’ve benefited from not sitting through meetings where my colleagues exchange opressive, racist views. If these are my concerns as a queer, disabled, racialized woman in a unionized job, I shudder to think of BIPOC LGBTQIA+ students with disabilities whose experiences of multiple marginalizations put them at great risk.

Maya Angelou once said, “Do the best you can until you know better. Then when you know better, do better.” And that is what this disabled social worker hopes will be embraced as folx plan for a return to some semblance of workplace equilibrium following the pandemic.

Next: “The Uncertainty Was a Big Piece. And I Couldn’t Get Answers”

The post The Pandemic Forced Employers to (Finally) Offer Workplace Accommodations appeared first on Best Health Magazine Canada.

 

COVID-19 hit Indiana Black and rural communities harder than other populations

Data suggests public health should target specific populations for pandemic interventions

Peer-Reviewed Publication

REGENSTRIEF INSTITUT

INDIANAPOLIS -- In the largest study of its kind to date, Black communities and rural residents were hit harder than other populations by the COVID-19 pandemic, demonstrated by data from across the state of Indiana. Researchers at Regenstrief Institute and Indiana University say this information highlights important disparities that need to be addressed by public health efforts.

“This large-scale study shows that racial and ethnic minorities as well as those in rural communities were more likely to be hospitalized and die from COVID-19, confirming results of smaller studies and highlighting the disparities we know exist,” said lead author Brian Dixon, PhD, MPA, director of public health informatics at Regenstrief and IU Richard M. Fairbanks School of Public Health. “We hope this information will help to shape both pandemic response and recovery efforts.”

The research team used data from the Indiana Network for Patient Care, managed by Indiana Health Information Exchange (IHIE), which contains patient information from 38 health systems and more than 100 hospitals in Indiana as well as COVID testing results from the Indiana Department of Health. Testing data were linked with hospitalizations and death records. The data used in this study came from 1.8 million Indiana residents who were tested for COVID-19 between March 2020 and the end of December 2020. 

The data showed that during the first wave of the virus beginning in March 2020, infections were highest in urban areas, and specifically among Black residents. Starting in the summer, hospitalizations and deaths in rural areas outpaced urban areas. And across the majority of 2020, Black populations and those in rural areas suffered more than white and urban populations. 

“This study was conducted before vaccines were widely available, but now that they are, these two populations are some of the most reluctant to receive shots,” said. Dr. Dixon. “COVID-19 has already greatly impacted these groups, so it’s important that public health officials focus their attention on interventions to help these populations. In addition to virus mitigation through vaccination, they may need programs to address social determinants of health and help in recovery from the pandemic.”

Data identifies disparities 

This large-scale study was made possible by the data sharing infrastructure that exists in Indiana. 

“The ability to link community-based testing with hospital data and death records allows us to measure and monitor these disparities,” said Dr. Dixon. “This helps to demonstrate the power of health information exchanges and the multiple ways they can be leveraged to improve healthcare and public health.”

“The synchronicity of COVID-19 disparities: Statewide epidemiologic trends in SARS-CoV-2 morbidity, hospitalization, and mortality among racial minorities and in rural America” is published online PLOS One.

###

In addition to Dr. Dixon, authors are Shaun Grannis, M.D., M.S. of Regenstrief and IU School of Medicine; Lauren Lembcke, M.S., Nimish Valvi, MBBS, MPH, and Anna Roberts, M.S., all of Regenstrief; and Peter Embí, M.D., M.S. of Regenstrief and IU School of Medicine. 

Dr. Dixon receives funding from the U.S. Agency for Healthcare Research and Quality (R21HS025502) to study health information exchange. Regenstrief and Fairbanks School of Public Health received funds from the State of Indiana and Marion County Public Health Department to support COVID-19 response and mitigation, including disease surveillance and outcomes measurement.

About Brian E. Dixon, PhD, MPA  

In addition to his role as Regenstrief Institute and Indiana University Richard M. Fairbanks School of Public Health at IUPUI director of public health informatics, Brian E. Dixon, PhD, MPA, is a research scientist at Regenstrief and an associate professor of epidemiology at the Fairbanks School of Public Health. He is also an affiliate scientist at the U.S. Department of Veterans Affairs Health Services Research and Development Center for Health Information and Communication, Richard L. Roudebush VA Medical Center. 

About Regenstrief Institute  

Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe. 

Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute’s research mission. 

About Fairbanks School of Public Health

Located on the IUPUI and Fort Wayne campuses, the Richard M. Fairbanks School of Public Health is committed to advancing the public’s health and well-being through education, innovation and leadership. The Fairbanks School of Public Health is known for its expertise in biostatistics, epidemiology, cancer research, community health, environmental public health, global health, health policy and health services administration. 

About IU School of Medicine  

IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability.  

---

JOURNAL

PLoS ONE

DOI

10.1371/journal.pone.0255063 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

The synchronicity of COVID-19 disparities: Statewide epidemiologic trends in SARS-CoV-2 morbidity, hospitalization, and mortality among racial minorities and in rural America

ARTICLE PUBLICATION DATE

23-Jul-2021

University professors study — and embody — the Two Row Wampum


At the time, Bonnie Freeman and Trish Van Katwyk were too busy trying not to drown to appreciate the symbolism.

The pair were paddling the Grand River alongside Indigenous and non-Indigenous youth as part of a Two Row on the Grand canoeing expedition in 2016.

“I had never paddled before and the thing I was most afraid of was capsizing,” said Freeman, a social work professor at McMaster University.

As their canoe approached some rapids near the Lorne Bridge in Brantford, the paddlers started to panic.

“We were kind of struggling. Not in sync with each other,” Freeman said. “We see people nicely go through, and then it’s our turn.”

Sitting at the head of the canoe, Van Katwyk started to steer, a responsibility best left to the paddler at the back.

“I was trying to be helpful but I overstepped my role,” said Van Katwyk, who teaches social work at the University of Waterloo.

“It was really Bonnie who was going to steer us through the current, and then I interfered.”

In no time, the two professors were in the drink.

“All of a sudden the canoe turns and capsizes, and we’re floundering,” Freeman said.

She frantically grabbed for the canoe and held onto the nearest rock.

“So that’s what I was doing, thinking I’m drowning,” Freeman said.

The two friends propped each other up, watching helplessly as Van Katwyk’s hat floated down the river.

“We finally get our bearings and stand up, and the water was to my knees,” Freeman said with a laugh.

This not-so-harrowing incident had a deeper meaning for the two friends. By coming to each other’s aid, Freeman, who is Haudenosaunee, and Van Katwyk, whose ancestry is Dutch, lived out the Two Row Wampum, a treaty their ancestors made to set out how the two nations would peacefully coexist.

“The Two Row Wampum looks at how Haudenosaunee and non-Indigenous people come together harmoniously upon this land and upon the waters with peace, friendship and respect,” Freeman explained.

The treaty is personified by a belt made of white and purple wampum shells. The purple shells run horizontally in two parallel rows, representing two boats containing the cultures and laws of each nation.

The boats are close enough to help each other if needed, but not so close as to interfere and impose their way of life on the other.

After graduating together from Wilfrid Laurier University’s PhD program, Van Katwyk and Freeman decided to focus their academic work on studying how living the Two Row Wampum principles could foster relationships and reconciliation between Indigenous and non-Indigenous youth.

That work has taken traditional forms like scholarly articles and research projects, but the duo also takes part in paddle trips like last month’s Two Row on the Grand Youth Engagement Camp at Chiefswood Park in Ohsweken.

“Usually people think reconciliation is this formality, you know? A structured, formal (process),” Freeman said.

“Reconciliation is about the daily living. It’s not this big capital R with an agenda set forward that can’t really be accomplished. It needs to be these community-based things.”

Van Katwyk witnessed “small-r reconciliation” in campers doing the dishes together and helping pull their canoes out of the water.

“That co-operative spirit really has an impact, and I think it’s because colonization is a process of unco-operating us,” she said.

The self-proclaimed “paddle sisters” hope their own friendship can serve as a model of reconciliation.

“It’s not that we never help each other out. We’re constantly helping each other out. It’s about finding that place of balance,” Van Katwyk said.

The relationship is rooted in conversations that started back in their school days, with Freeman — the only Indigenous student in the social work PhD program — answering her classmates’ questions about Haudenosaunee culture.

Van Katwyk said seeing Freeman come to class “distressed” over the ongoing standoff at a housing development in Caledonia — the former Douglas Creek Estates, which was occupied by Six Nations land defenders in 2006 — motivated her to seek answers elsewhere.

“It felt wrong for me to ply (Freeman) with all sorts of questions about what was happening,” Van Katwyk said.

“So I went to the newspapers and tried to learn about it so that I could understand this pain that Bonnie was in. And by trying to understand, I also ended up learning a lot.”

As a teacher, Freeman continues to invite questions from students looking to understand the impact of residential schools and other historical traumas on Indigenous communities.

“I try to create a safe space as well as a brave space for my students to feel comfortable to ask those questions and have a discussion,” Freeman said. “It is painful for me, but as an educator I feel it’s important to be open.”

When writing papers together, the two academics try to stick to their strengths while standing by to help if needed.

“Sometimes we stop and go, wait, we’re floundering. We’ve just capsized again. But then we go back,” Van Katwyk said.

That can mean resisting the urge to impose, such as when Van Katwyk tried to steer the canoe instead of navigating.

“Which is really a settler way of doing things — ‘Here, let me do that. I’ve got the better answer,’” she said.

Falling into the river was the reminder they needed to paddle together.

“That was a light bulb moment for us, because after that we became in sync,” Freeman said.

J.P. Antonacci, Local Journalism Initiative Reporter, The Hamilton Spectator

 

Researchers identify record number of ancient elephant bone tools

Peer-Reviewed Publication

UNIVERSITY OF COLORADO AT BOULDER

Ancient humans could do some impressive things with elephant bones.

In a new study, University of Colorado Boulder archaeologist Paola Villa and her colleagues surveyed tools excavated from a site in Italy where large numbers of elephants had died. The team discovered that humans at this site roughly 400,000 years ago appropriated those carcasses to produce an unprecedented array of bone tools—some crafted with sophisticated methods that wouldn’t become common for another 100,000 years.

“We see other sites with bone tools at this time,” said Villa, an adjoint curator at the CU Boulder Museum of Natural History. “But there isn’t this variety of well-defined shapes.”

Villa and her colleagues published their results this month in the journal PLOS ONE.

The study zeroes in on a site called Castel di Guido not far from modern-day Rome. Hundreds of thousands of years ago, it was the location of a gully that had been carved by an ephemeral stream—an environment where 13-foot-tall creatures called straight-tusked elephants (Palaeoloxodon antiquus) quenched their thirst and, occasionally, died. 

Castel di Guido’s hominids made good use of the remains, occupying the site off and on over the years. The researchers report that these Stone Age residents produced tools using a systematic, standardized approach, a bit like a single individual working on a primitive assembly line.

“At Castel di Guido, humans were breaking the long bones of the elephants in a standardized manner and producing standardized blanks to make bone tools,” Villa said. “This kind of aptitude didn’t become common until much later.”

Stone Age toolbox

These feats of ingenuity came at a significant time for hominids in general.

Right around 400,000 years ago, Neanderthals (Homo neanderthalensis) were just beginning to emerge in Europe. Villa suspects that Castel di Guido’s residents were Neanderthals. 

“About 400,000 years ago, you start to see the habitual use of fire, and it’s the beginning of the Neanderthal lineage,” Villa said. “This is a very important period for Castel di Guido.”

It may have been a productive one, too. In their new study, Villa and her colleagues identified 98 bone tools from Castel di Guido, which was excavated from 1979 to 1991. The findings represent the highest number of flaked bone tools made by pre-modern hominids that researchers have described so far. That rich toolbox offered a wide range of useful items: Some tools were pointed and could, theoretically, have been used to cut meat. Others were wedges that may have been helpful for splitting heavy elephant femurs and other long bones.

“First you make a groove where you can insert these heavy pieces that have a cutting edge,” Villa said. “Then you hammer it, and at some point, the bone will break.”

But one tool stood out from the rest: The team discovered a single artifact carved from a wild cattle bone that was long and smooth at one end. It resembles what archaeologists call a “lissoir,” or a smoother, a type of tool that hominids used to treat leather. The curious thing: Lissoir tools didn’t become common until about 300,000 years ago.

“At other sites 400,000 years ago, people were just using whatever bone fragments they had available,” Villa said.

Useful finds

Something special, in other words, seemed to be happening at the Italian site.

Villa doesn’t think that the Castel di Guido hominids were any more intelligent than their counterparts elsewhere in Europe. Instead, these early humans simply used the resources they had lying around. She explained that this region of Italy doesn’t have a lot of naturally-occurring, large pieces of flint, so ancient humans couldn’t make many large stone tools.

What the region might have had a lot of, however, were dead elephants. As the Stone Age progressed, straight-tusked elephants slowly disappeared from Europe. During the era of Castel di Guido’s bone-crafters, these animals may have flocked to watering holes at the site, occasionally dying from natural causes. Humans then found the remains and butchered them for their long bones.

“The Castel di Guido people had cognitive intellects that allowed them to produce complex bone technology,” Villa said. “At other assemblages, there were enough bones for people to make a few pieces, but not enough to begin a standardized and systematic production of bone tools.”

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Other coauthors of the new study include Giovanni Boschian and Daniela Saccà of the University of Pisa in Italy; Luca Pollarolo of the University of the Witwatersrand in South Africa; Fabrizio Marra of the National Institute of Geophysics and Volcanology in Italy; and Sebastien Nomade and Alison Pereira of the University of Paris-Saclay in France.

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JOURNAL

PLoS ONE

DOI

10.1371/journal.pone.0256090 

METHOD OF RESEARCH

Case study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Elephant bones for the Middle Pleistocene toolmaker