As the scientific community globalizes, it is increasingly important to understand the effects of international collaboration on the quality and quantity of research produced. While it is generally assumed that international collaboration enhances the quality of research, this phenomenon is not well examined. Stem cell research is unique in that it is both politically charged and a research area that often generates international collaborations, making it an ideal case through which to examine international collaborations. Furthermore, with promising medical applications, the research area is dynamic and responsive to a globalizing science environment. Thus, studying international collaborations in stem cell research elucidates the role of existing international networks in promoting quality research, as well as the effects that disparate national policies might have on research. This study examined the impact of collaboration on publication significance in the United States and the United Kingdom, world leaders in stem cell research with disparate policies. We reviewed publications by US and UK authors from 2008, along with their citation rates and the political factors that may have contributed to the number of international collaborations. The data demonstrated that international collaborations significantly increased an article's impact for UK and US investigators. While this applied to UK authors whether they were corresponding or secondary, this effect was most significant for US authors who were corresponding authors. While the UK exhibited a higher proportion of international publications than the US, this difference was consistent with overall trends in international scientific collaboration. The findings suggested that national stem cell policy differences and regulatory mechanisms driving international stem cell research in the US and UK did not affect the frequency of international collaborations, or even the countries with which the US and UK most often collaborated. Geographical and traditional collaborative relationships were the predominate considerations in establishing international collaborations.

IMPORTANCE Women and black physicians encounter workplace challenges because of their gender and race. It is unclear whether these individuals are assessed with lower patient satisfaction or confidence ratings compared with white male physicians. OBJECTIVE To examine whether physician gender and race affect participant ratings in scenarios in which physician competence is challenged. DESIGN, SETTING, AND PARTICIPANTS This randomized trial enrolled a geographically diverse sample of 3592 online respondents in the United States who were recruited from 2 crowdsourcing platforms: Amazon Mechanical Turk (n = 1741) and Lucid (n = 1851). A 2 × 2 factorial design for the gender and race of simulated physicians was conducted between March 9 and July 25, 2018. Participants were excluded before intervention if they were younger than 18 years, were pregnant, or had a history of cancer or abdominal surgical procedures. INTERVENTIONS A clinical vignette was presented to the participant with a picture of the emergency department physician. Participants were randomly assigned to physicians with different gender and race, with 823 assigned to black women, 791 to black men, 828 to white women, and 835 to white men. A contradictory diagnosis from an online symptom checker introduced doubt about the clinical diagnosis. MAIN OUTCOMES AND MEASURES A composite outcome (range, 0-100, with 0 representing low patient confidence and satisfaction and 100 representing the maximum on the composite scale) measured participant (1) confidence in the physician, (2) satisfaction with care, (3) likelihood to recommend the physician, (4) trust in the physician's diagnosis, and (5) likelihood to request additional tests. RESULTS Among 3277 adult participants, complete data were available for 3215 (median age, 49 years [range, 18-89 years]; 1667 [52%] female; 2433 [76%] white). No significant differences were observed in participant satisfaction and physician confidence for the white male physician control physicians (mean composite score, 66.13 [95% CI, 64.76-67.51]) compared with white female (mean composite score, 66.50 [95% CI, 65.19-67.82]), black female (mean composite score, 67.36 [95% CI, 66.03-68.69]), and black male (mean composite score, 66.96 [95% CI, 65.55-68.36]) physicians. Machine learning with bayesian additive regression trees revealed no evidence of treatment effect heterogeneity as a function of participants' race, gender, racial prejudice, or sexism. (continued) Key Points Question In a simulated clinical encounter, do participants evaluate physicians differently based on the physician's gender or race? Findings In this randomized trial of 3592 online respondents, simulated physician gender and race did not significantly affect participant satisfaction or confidence in physician clinical judgment compared with a white male physician control. Meaning Participants reported equal satisfaction and confidence in the simulated physicians' diagnosis and treatment plans regardless of the physician's gender or race.

Background Containment of the coronavirus disease 2019 (COVID‐19) pandemic requires the public to change behavior under social distancing mandates. Social media are important information dissemination platforms that can augment traditional channels communicating public health recommendations. The objective of the study is to assess the effectiveness of COVID‐19 public health messaging on Twitter when delivered by emergency physicians and containing personal narratives. Methods On April 30, 2020, we randomly assigned 2007 U.S. adults to an online survey using a 2x2 factorial design. Participants rated 1 of 4 simulated Twitter posts varied by messenger type (emergency physician vs federal official) and content (personal narrative vs impersonal guidance). Main outcomes were: perceived message effectiveness (35‐point scale); perceived attitude effectiveness (15‐point scale); likelihood to share Tweets (7‐point scale); and writing a letter to their governor to continue COVID‐19 restrictions (write letter or none). Results The physician/personal message had the strongest effect and significantly improved all main messaging outcomes except for letter‐writing. Unadjusted mean differences between physician/personal and federal/impersonal were: perceived messaging effectiveness (3.2 [95%CI, 2.4‐4.0]); perceived attitude effectiveness (1.3 [95%CI, 0.8‐1.7]); likelihood to share (0.4 [95%CI, 0.15‐0.7]). For letter‐writing, physician/ personal made no significant impact compared to federal/ impersonal (odds ratio 1.14 [95%CI, 0.89‐1.46]). Conclusions Emergency physicians sharing personal narratives on Twitter are perceived to be more effective at communicating COVID‐19 health recommendations compared to federal officials sharing impersonal guidance.

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Study Objective: Seasonal Influenza continues to present a significant annual burden as the vaccination rate for all persons six months and older in the United States is 51.8%. Emergency Department (ED) based influenza programs have been successfully implemented and improve vaccine uptake, reduce incidence and costs, as well as improve outcomes. We modeled the process of implementing an ED based vaccination program for a large health system's Medicare (65+) and Medicaid populations. We utilized existing electronic health records (EHR) and evaluated the impact on the patient population and expenditures to health system.Methods: A retrospective review of ED encounters limited to Medicare and Medicaid populations was performed across 14 tertiary care hospital EDs and 6 freestanding EDs for calendar year 2020. Together, the total number of unvaccinated individuals was identified to determine the potential impact of an ED vaccination campaign. The average cost and loss per inpatient stay was identified from prior industry Medicare benchmark data. Medicare benchmark data was utilized to extrapolate Medicaid losses. Results from previously published cost-effectiveness studies identified the vaccination thresholds to prevent one additional case of influenza, one additional hospitalization, and one additional fatality. A predictive model was developed to assess the total preventable flu cases, hospitalizations, fatalities, and incremental cost avoidance based on total identified unvaccinated population.Results: A total of 39,463 unvaccinated individuals were identified with 14,064 individuals classified as Medicare aged 65 and over as well as 25,379 individuals classified as Medicaid. Assuming a 95% Target Outreach, 90% Medical Eligibility, and 70% acceptance rate, 414 flu cases would be prevented (266 Medicaid, 148 Medicare), 28 hospitalizations would be prevented (18 Medicaid, 10 Medicare), and 8 deaths would be prevented (5 Medicaid, 3 Medicare). Accordingly, a reduction in admissions would prevent $409,360 in total inpatient medical costs and $36,232 in losses to healthcare systems for Influenza-related admissions.Conclusion: An ED based influenza vaccination program would have measureable impact on patient influenza disease burden and associated medical expenditures.