Extending the CARE Principles from tribal research policies to benefit sharing in genomic research

Community-engaged artificial intelligence: an upstream, participatory design, development, testing, validation, use and monitoring framework for artificial intelligence and machine learning models in the Alaska Tribal Health System

American Indian and Alaska Native (AI/AN) communities are at a critical juncture in health research, where combining participatory methods with advancements in artificial intelligence and machine learning (AI/ML) can promote equity. Community-based participatory research methods which emerged to help Alaska Native communities navigate the complicated legacy of historical research abuses provide a framework to allow emerging AI/ML technologies to align with their unique world views, community strengths, and healthcare goals. A consortium of researchers (including Alaska Native Tribal Health Consortium, the Center for Alaska Native Health Research at University of Alaska, Fairbanks, Stanford University, Southcentral Foundation, and Maniilaq Association) is using community-engaged AI/ML methods to address air medical ambulance (medevac) utilization in rural communities within the Alaska Tribal Health System (ATHS). This mixed-methods convergent triangulation study uses qualitative and quantitative analyses to develop AI/ML models tailored to community needs, provider concerns, and cultural contexts. Early successes have led to a second funded project to expand community perspectives, pilot models, and address issues of governance and ethics. Using the Ethical, Legal, and Social Implications of Research framework to address implementation of AI/ML in AI/AN communities, this second grant expands community engagement, technical capacity, and creates a body within the ATHS able to provide recommendations about AI/ML security, privacy, governance and policy. These two projects have the potential to provide equitable AI/ML implementation in Alaska Native healthcare and provide a roadmap for researchers and policy makers looking to effect similar change in other AI/AN and marginalized communities.

Trusted partners, community priorities, and data protections: requirements for precision medicine research with Alaska Native peoples

Precision medicine holds promise for improving health care by tailoring disease treatment and prevention efforts to the needs of individual patients. It also raises ethical questions related to equitable distribution of the benefits of precision medicine; data management, including the terms of data ownership, sharing, and security; and, the nature and extent of community engagement in and oversight of research. These questions are particularly salient for minoritized communities that have been harmed by unethical research practices and often deprived the full benefit of advances in medical science. Understanding the perspectives of these communities is essential to the design and conduct of ethical and effective precision medicine research. This study explored perspectives on the acceptability, feasibility, value, and benefits and harms of precision medicine research among Alaska Native and American Indian (ANAI) peoples. We conducted four focus groups with ANAI individuals who receive primary care from a Tribal health organization in Anchorage, Alaska. Participants were willing to engage in precision medicine research provided specific requirements were met. Research must be conducted by the Tribal health organization or another trusted partner, community health priorities must drive the research agenda, and researchers must employ robust data protections to guard against loss of data security and maintain control over data use and access. These requirements work collectively to ensure research benefits and respects Tribal sovereignty. These findings could help inform efforts to design and implement precision medicine research programs tailored to concerns of ANAI peoples.

Using positionality and reflexivity to support equity in partnership-driven research

Social and economic position and power shape everyone, including scientists and researchers. The way researchers do conservation science and the voices centered in the process are a result of researcher upbringing, experiences, access to resources, and values and are a manifestation of positionality. Positionality is a concept that can help one think about one's position and power in one's work. Creating a successful research partnership requires careful thinking about how equity, diversity, inclusivity, and accessibility are accounted for in the research environment. We drew on our own experiences as early career, mid-career, and Indigenous researchers to explore researcher positionality and how understanding one's positionality can bring to the fore power dynamics in conservation science and research. We focused on the use of reflexive practice to recognize diverse roles and responsibilities, build strong project governance, and enrich relationships. We considered 2 large research partnerships, Apoqnmatulti'k (Mi'kmaw for we help each other) and the SakKijânginnaniattut Nunatsiavut Sivunitsangit (Inuttitut for Sustainable Nunatsiavut Futures) project, to examine moments of tension and interrogation of power and the ways in which this interrogation led to stronger relationships and better research. We advise that large transdisciplinary and cross-cultural research teams use positionality and reflexivity to explicitly make choices about power dynamics in the context of executing partnership-driven work. This can be accomplished through personal and collective interrogation of the power dynamics at play in project administration, research questions, and interpersonal relationships.

Data sharing ethics toolkit: The Human Cell Atlas

Striving to build an exhaustive guidebook of the types and properties of human cells, the Human Cell Atlas' (HCA) success relies on the sampling of diverse populations, developmental stages, and tissue types. Its open science philosophy preconizes the rapid, seamless sharing of data - as openly as possible. In light of the scope and ambition of such an international initiative, the HCA Ethics Working Group (EWG) has been working to build a solid foundation to address the complexities of data collection and sharing as part of Atlas development. Indeed, a particular challenge of the HCA is the diversity of sampling scenarios (e.g., living participants, deceased donors, pediatric populations, culturally diverse backgrounds, tissues from various developmental stages, etc.), and associated ethical and legal norms, which vary across countries contributing to the effort. Hence, to the extent possible, the EWG set out to provide harmonised, international and interoperable policies and tools, to guide its research community. This paper provides a high-level overview of the types of challenges and approaches proposed by the EWG.

Use of Cognitive Interviews in the Development of a Survey Assessing American Indian and Alaska Native Adult Perspectives on Genetics and Biological Specimens

The cognitive interview process is a method to validate a survey instrument's face validity and enhance confidence in item interpretation, as well as a method to engage communities in the research process. Trained American Indian and Alaska Native (AIAN) interviewers conducted retrospective cognitive interviews at three AIAN communities to assess the item quality of a 131-item survey item that measures AIAN knowledge and attitudes on genetics and biological specimens. A cognitive interview process was used to assess cultural consonance, thought processes used when considering survey instructions, items and responses, and language preference of survey items in the development of a survey to assess public knowledge and attitudes on genetics. Content analysis was used to analyze interview data. Survey instructions, items and scales generated no cognitive difficulties. The participants noted being unfamiliar with terminology used to describe genetic and biological specimens. In several cases, the participants' written response in the survey and verbal response in the interview did not align. A resultant 52-item survey for use in AIAN communities was finalized. Cognitive interviewing is resource-intensive; however, ignoring community engagement during survey development results in inappropriate interpretations about culturally diverse populations such as AIAN peoples.

Genetic research with Indigenous Peoples: perspectives on governance and oversight in the US

Introduction

Indigenous Peoples are increasingly exerting governance and oversight over genomic research with citizens of their nations, raising questions about how best to enforce research regulation between American Indian, Alaska Native, and Native Hawaiian peoples and researchers.

Methods

Using a community-engaged research approach, we conducted 42 semi-structured interviews with Tribal leaders, clinicians, researchers, policy makers, and Tribal research review board members about their perspectives on ethical issues related to genetics research with Indigenous Peoples in the US.

Results

We report findings related to (1) considerations for Indigenous governance, (2) institutional relationships upholding sovereignty, (3) expectations for research approvals, and (4) agreements enacting Indigenous governance. Participants described concerns about different ways of exerting oversight, relationships and agreements between Indigenous Peoples and researchers, and gaps that need to be addressed to strengthen existing governance of genomic data.

Discussion

The results will ultimately guide policy-making and development of new strategies for Indigenous Peoples to enforce oversight in research to promote ethically and culturally appropriate research.

Indigenous Peoples and research: self-determination in research governance

Indigenous Peoples are reimagining their relationship with research and researchers through greater self-determination and involvement in research governance. The emerging discourse around Indigenous Data Sovereignty has provoked discussions about decolonizing data practices and highlighted the importance of Indigenous Data Governance to support Indigenous decision-making and control of data. Given that much data are generated from research, Indigenous research governance and Indigenous Data Governance overlap. In this paper, we broaden the concept of Indigenous Data Sovereignty by using the CARE Principles for Indigenous Data Governance to discuss how research legislation and policy adopted by Indigenous Peoples in the US set expectations around recognizing sovereign relationships, acknowledging rights and interests in data, and enabling Indigenous Peoples' participation in research governance.

Indigenous Peoples' Rights in Data: a contribution toward Indigenous Research Sovereignty

Indigenous Peoples' right to sovereignty forms the foundation for advocacy and actions toward greater Indigenous self-determination and control across a range of domains that impact Indigenous Peoples' communities and cultures. Declarations for sovereignty are rising throughout Indigenous communities and across diverse fields, including Network Sovereignty, Food Sovereignty, Energy Sovereignty, and Data Sovereignty. Indigenous Research Sovereignty draws in the sovereignty discourse of these initiatives to consider their applications to the broader research ecosystem. Our exploration of Indigenous Research Sovereignty, or Indigenous self-determination in the context of research activities, has been focused on the relationship between Indigenous Data Sovereignty and efforts to describe Indigenous Peoples' Rights in data.

Neuroethical implications of focused ultrasound for neuropsychiatric illness

BACKGROUND

MR-guided focused ultrasound is a promising intervention for treatment-resistant mental illness, and merits contextualized ethical exploration in relation to more extensive ethical literature regarding other psychosurgical and neuromodulation treatment options for this patient population. To our knowledge, this topic has not yet been explored in the published literature.

OBJECTIVE

The purpose of this paper is to review and discuss in detail the neuroethical implications of MR-guided focused ultrasound for neuropsychiatric illness as an emerging treatment modality.

METHODS

Due to the lack of published literature on the topic, the approach involved a detailed survey and review of technical and medical literature relevant to focused ultrasound and established ethical issues related to alternative treatment options for patients with treatment-resistant, severe and persistent mental illness. The manuscript is structured according to thematic and topical findings.

RESULTS

This technology has potential benefits for patients suffering with severe mental illness, compared with established alternatives. The balance of technical, neuroscientific and clinical considerations should inform ethical deliberations. The nascent literature base, nuances in legal classification and permissibility depending upon jurisdiction, influences of past ethical issues associated with alternative treatments, tone and framing in media articles, and complexity of clinical trials all influence ethical assessment and evaluations of multiple stakeholders. Recommendations for future research are provided based on these factors.

CONCLUSION

Salient ethical inquiry should be further explored by researchers, clinicians, and ethicists in a nuanced manner methodologically, one which is informed by past and present ethical issues related to alternative treatment options, broader psychiatric treatment frameworks, pragmatic implementation challenges, intercultural considerations, and patients' ethical concerns.