The role of geographic bias in knowledge diffusion: a systematic review and narrative synthesis

The People You Meet and the Books You Read: The Importance of Geographic Diversity in Nursing Research and Journals

Editors, reviewers, and readers of practice journals must recognize that diverse publishing practices contribute to a more inclusive nursing community and give voice to various perspectives.

Assessing unConventional Evidence (ACE) tool: development and content of a tool to assess the strengths and limitations of 'unconventional' source materials

BACKGROUND

When deciding whether to implement an intervention, decision-makers typically have questions on feasibility and acceptability and on factors affecting implementation. Descriptions of programme implementation and of policies and systems are rich sources of information for these questions. However, this information is often not based on empirical data collected using explicit methods. To use the information in unconventional source materials in syntheses or other decision support products, we need methods of assessing their strengths and limitations. This paper describes the development and content of the Assessing unConventional Evidence (ACE) tool, a new tool to assess the strengths and limitations of these sources.

METHODS

We developed the ACE tool in four stages: first, we examined existing tools to identify potentially relevant assessment criteria. Second, we drew on these criteria and team discussions to create a first draft of the tool. Third, we obtained feedback on the draft from potential users and methodologists, and through piloting the tool in evidence syntheses. Finally, we used this feedback to iteratively refine the assessment criteria and to improve our guidance for undertaking the assessment.

RESULTS

The tool is made up of 11 criteria including the purpose and context of the source; the completeness of the information presented; and the extent to which evidence is provided to support the findings made. Users are asked to indicate whether each of the criteria have been addressed. On the basis of their judgements for each criterion, users then make an overall assessment of the limitations of the source, ranging from no or very minor concerns to serious concerns. These assessments can then facilitate appropriate use of the evidence in decision support products.

CONCLUSIONS

Through focussing on unconventional source materials, the ACE tool fills an important gap in the range of tools for assessing the strengths and limitations of policy-relevant evidence and supporting evidence-informed decision-making.

Authorship equity in global health research: who gets the credit at University of California, San Francisco?

Authorship inequity exists in global health research and can be representative of unequal partnerships. Previous studies showed that low-income and middle-income country (LMIC) authors are under-represented in publications from global collaborative research between LMIC and high-income countries (HIC). However, there are little data on trends for how specific HIC institutions are performing concerning equitable authorship. We used Web of Science to find published articles affiliated with the University of California, San Francisco (UCSF), where an LMIC was referred to in the title, abstract or keywords from 2008 to 2021. The country affiliation of each author for all included articles was grouped based on World Bank data. A total of 5805 articles were included. On average, 53.6% (n=3109) of UCSF affiliated articles had at least one low-income country (LIC) or LMIC author; however, this number increased from 43.2% (n=63) in 2008 to 63.3% (n=421) in 2021. Overall, 16.3% (n=948) of UCSF affiliated articles had an LIC or LMIC researcher as the first author, 18.8% (n=1,059) had an LIC or LMIC researcher as second author, and 14.2% (n=820) had an LIC or LMIC researcher as last author. As long as manuscripts produced by UCSF have no LIC or LMIC authors included the university's commitment to authentic equity is undermined. Global health partnerships cannot be equitable without changing authorship trends between HIC and LMIC institutions.

Interventions to reduce wait times for adolescents seeking mental health services: a scoping review protocol

INTRODUCTION

The demand for adolescent mental health services has increased significantly in recent years, leading to excessive wait times for adolescents seeking mental health services and poor mental health outcomes. Timely access to mental health services is critical to reducing the risk of symptom chronicity and progression to mental disorder. A better understanding of whether and how interventions to reduce wait times impact mental health outcomes is needed to guide mental health policymakers and service planners in their approach to reducing wait times.

METHODS AND ANALYSIS

The scoping review will use Arksey and O'Malley's six-stage framework for scoping reviews and Rayyan to support screening, data extraction and evidence synthesis. The review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. We will search the Cochrane Library, EBSCOhost, MEDLINE (Ovid), PsycArticles (Ovid), PsycINFO (Ovid), EMBASE (Ovid), Web of Science, ProQuest and Scopus databases for peer-reviewed texts published in English between 1 January 2000 and 28 February 2023. We will also search Google Scholar for additional grey literature. To be eligible for inclusion, studies must focus on adolescent populations aged 13-18 years and report on interventions to reduce wait times for any mental health service except crisis and emergency services. Title, abstract and full-text screening will be done by two reviewers. We will extract data describing the interventions and their effects on wait times and adolescent mental health outcomes, and we will identify strengths and limitations in the evidence base to inform recommendations for future research. A youth advisory group with lived experience of mental health difficulties will be consulted throughout the review process.

ETHICS AND DISSEMINATION

Ethics approval is not required. Findings will be disseminated via peer-reviewed publications and presented at conferences.

STUDY REGISTRATION

The protocol was registered with the Open Science Framework on 20 February 2023 (https://osf.io/qt4zy).

How Race, Ethnicity, and Social Determinants of Health Are Reported in Three European Pediatric Journals

OBJECTIVES

To evaluate how geography, ethnicity, ancestry, and race or religion (GEAR) and social determinants of health (SDOH) data are reported and discussed in 3 European pediatric journals and to compare practices between European and American journals.

STUDY DESIGN

A retrospective analysis of all original articles that enrolled children (<18 years old) published from January through June 2021 in 3 European pediatric journals: Archives of Disease in Childhood, European Journal of Pediatrics, and Acta Paediatrica. We categorized SDOH using the 5 domains as outlined by the US Healthy People 2030 framework. For each article, we recorded whether GEAR and SDOH were reported in the results and interpreted in the discussion sections. We then compared these European data by χ2 tests with data from 3 US pediatric journals.

RESULTS

Of the 320 studied articles, 64 (20%) and 80 (25%) reported GEAR and SDOH data in the results sections, respectively. Of those articles, 32 (50%) and 53 (66.3%) studies interpreted the GEAR and SDOH data in their discussion sections, respectively. On average, articles reported factors from 1.2 GEAR and 1.9 SDOH categories with great variability in the variables collected and data groupings. Articles published in European journals were less likely to report GEAR and SDOH than articles published in US journals (P < .001 for both).

CONCLUSIONS

Articles published in European pediatric journals did not commonly report either GEAR or SDOH, and there was wide variation in how data were collected and reported. Harmonization of categories will allow for more accurate interstudy comparisons.

I am a scientist: Overcoming biased assumptions around diversity in science through explicit representation of scientists in lectures

The lack of diversity in Science, Technology, Engineering, and Mathematics (STEM) is a significant issue for the sector. Many organisations and educators have identified lack of representation of historically marginalised groups within teaching materials as a potential barrier to students feeling that a Science, Technology, Engineering, and Mathematics (STEM) career is something that they can aspire to. A key barrier to addressing the issue is providing accessible and effective evidence-based approaches for educators to implement. In this study, we explore the potential for adapting presentation slides within lectures to 'humanise' the scientists involved, presenting their full names and photographs alongside a Harvard style reference. The intervention stems from an initial assumption that many formal scientific referencing systems are demographic-neutral and exacerbate prevailing perceptions that STEM is not diverse. We adopt a questionnaire based methodology surveying 161 bioscience undergraduates and postgraduates at a UK civic university. We first establish that students project assumptions about the gender, location, and ethnicity of the author of a hypothetical reference, with over 50% of students assuming they are male and Western. We then explore what students think of the humanised slide design, concluding that many students see it as good pedagogical practice with some students positively changing their perceptions about diversity in science. We were unable to compare responses by participant ethnic group, but find preliminary evidence that female and non-binary students are more likely to see this as good pedagogical practice, perhaps reflecting white male fragility in being exposed to initiatives designed to highlight diversity. We conclude that humanised powerpoint slides are a potentially effective tool to highlight diversity of scientists within existing research-led teaching, but highlight that this is only a small intervention that needs to sit alongside more substantive work to address the lack of diversity in STEM.

NK/T-cell Lymphoma With Orbital Involvement: A Case Report and Systematic Review of the Literature

PURPOSE

To present the clinical course of a patient with recurrent NK/T-cell lymphoma (NKTL) involving the orbit and to review the literature on patients with NKTL involving the orbit.

METHODS

The PubMed database was searched for all cases of NKTL involving orbital, intraocular, or adnexal ocular structures.

RESULTS

Ninety-six patients were included in the final analysis. The mean age of diagnosis was 48.1 ± 16.8 years. The patients were 53/96 (55.2%) male and 43/96 (44.8%) female. Tumor location varied and included the orbit in 80/96 (83.3%), nasosinus in 56/96 (58.3%), uvea in 11/96 (11.5%), lacrimal gland in 9/96 (9.4%), lacrimal drainage system in 11/96 (11.5%), and conjunctiva in 7/96 (7.3%) cases. Management included surgical debulking in 29/96 (30.2%) cases, radiotherapy in 52/96 (54.2%) cases, and chemotherapy in 82/96 (85.4%) cases. Median survival was 6 months (95% CI: 5-9). Chemotherapy (hazard ratio = 0.80, 95% CI: 0.67-0.95, p = 0.013), radiotherapy (hazard ratio = 0.75, 95% CI: 0.64-0.87, p < 0.001), and orbital involvement being a recurrence of disease (hazard ratio = 0.79, 95% CI: 0.67-0.95, p = 0.009) were associated with improved survival. Advanced Ann Arbor stage (III-IV) at diagnosis (hazard ratio = 1.22, 95% CI: 1.08-1.38, p = 0.001), vision loss (hazard ratio = 1.18, 95% CI: 1.04-1.34, p = 0.009), proptosis (hazard ratio = 1.15, 95% CI: 1.01-1.30, p = 0.035) and periorbital swelling (hazard ratio = 1.15, 95% CI: 1.00-1.33, p = 0.048) were associated with poor survival.

CONCLUSIONS

NK/T-cell lymphoma involving the orbit, globe, or ocular adnexa heralds a poor prognosis where early diagnosis and therapy are critical. The use of radiotherapy and chemotherapy is associated with improved survival.

Blinding of Peer Review and the Impact on Geographic Diversity of Authors in the Medical Literature

Background

Blinding of reviewers is hypothesized to improve the peer review process by removing potential bias. This study aimed to evaluate the impact of blinding of peer review on the geographic diversity of authors in medical/clinical journals.

Methods

MEDLINE-indexed medical journals were evaluated, where journals that only publish in basic sciences or administration, non-English journals, journals that publish solely solicited materials, and journals that employ open review process were excluded. Journals were divided into single-blinded or double-blinded. Diversity was calculated by dividing the number of countries from which 20 evaluated articles come and multiplying by 100 (%diversity). The second method involved calculating Simpson's diversity index (SDI).

Results

Of 1054 journals, 766 employ single-blinded review and 288 were double-blinded. Journals had a median age of 28 years and were mostly international (n=355 single-blinded and 97 double-blinded). No difference was observed between the two groups in median %diversity (45 in both groups; P=0.199) and SDI (0.84 vs 0.82; P=0.128). The indexing of journals in Science Citation Index Expanded (SCIE) collection of Web of Science and Scopus, and a higher CiteScore were significantly associated with higher %diversity and SDI (P<0.05).

Conclusion

Although double blinding of peer review was not associated with higher geographic diversity of authors, several factors are also involved in the review process that could not be evaluated, such as blinding of editors. However, editors and publishers are encouraged to consider work from different countries to be able to index their journals in SCIE, Scopus, and MEDLINE where geographic diversity is a requirement.

Analysis of peer reviewers' response to invitations by gender and geographical region: cohort study of manuscripts reviewed at 21 biomedical journals before and during covid-19 pandemic

OBJECTIVES

To describe gender and geographical inequalities in invitations to review and the response to these invitations and to assess whether inequalities increased during the covid-19 pandemic.

DESIGN

Retrospective cohort study.

SETTING

19 specialist medical journals and two large general medical journals from BMJ Publishing Group.

POPULATION

Reviewers invited to review manuscripts submitted between 1 January 2018 and 31 May 2021. The cohort was followed up to 28 February 2022.

MAIN OUTCOME MEASURES

Reviewer's agreement to review.

RESULTS

A total of 257 025 reviewers were invited (38.6% (88 454/228 869) women), and 90 467 (35.2%) agreed to review. Invited reviewers were mainly (217 682; 84.7%) affiliated with high income countries: Europe (122 414; 47.6%), North America (66 931; 26.0%), Africa (25 735; 10.0%), Asia (22 693; 8.8%), Oceania (16 175; 6.3%), and South America (3076; 1.2%). Independent factors associated with agreement to review were gender (odds ratio 0.89, 95% confidence interval 0.87 to 0.92, for women compared with men), geographical affiliation (2.89, 2.73 to 3.06, for Asia; 3.32, 2.94 to 3.75 for South America; 1.35, 1.27 to 1.43, for Oceania; and 0.35, 0.33 to 0.37, for Africa compared with Europe), and country income (0.47, 0.45 to 0.49, for upper middle income; 5.12, 4.67 to 5.61, for lower middle income; and 4.66, 3.79 to 5.73, for low income compared with high income country). Agreement was also independently associated with editor's gender (0.96, 0.93 to 0.99, for women compared with men), last author's geographical affiliation (0.80, 0.78 to 0.83, for Asia; 0.89, 0.85 to 0.94, for Oceania compared with Europe), impact factor (1.78, 1.27 to 2.50, for >10 compared with <5), and type of peer review process (0.52, 0.35 to 0.77, for open compared with anonymised). During the first and second phases of the pandemic, agreement was lower than in the pre-pandemic period (P<0.001). The interaction between time periods and covid-19 related topic and reviewer's gender was non-significant. However, significant interaction was found between time periods and covid-19 related topic and reviewer's geographical affiliation.

CONCLUSIONS

To reduce bias and improve diversity, editors need to identify and implement effective strategies and continually evaluate progress against these to ensure that more women and researchers from upper middle income and low income countries are involved in review.

Translating Cultural Safety to the UK

Disproportional morbidity and mortality experienced by ethnic minorities in the UK have been highlighted by the COVID-19 pandemic. The 'Black Lives Matter' movement has exposed structural racism's contribution to these health inequities. 'Cultural Safety', an antiracist, decolonising and educational innovation originating in New Zealand, has been adopted in Australia. Cultural Safety aims to dismantle barriers faced by colonised Indigenous peoples in mainstream healthcare by addressing systemic racism.This paper explores what it means to be 'culturally safe'. The ways in which New Zealand and Australia are incorporating Cultural Safety into educating healthcare professionals and in day-to-day practice in medicine are highlighted. We consider the 'nuts and bolts' of translating Cultural Safety into the UK to reduce racism within healthcare. Listening to the voices of black, Asian and minority ethnic National Health Service (NHS) consumers, education in reflexivity, both personal and organisational within the NHS are key. By listening to Indigenous colonised peoples, the ex-Empire may find solutions to health inequity. A decolonising feedback loop is required; however, we should take care not to culturally appropriate this valuable reverse innovation.

Effect of Dietary Intervention, with or without Cointerventions, on Inflammatory Markers in Patients with Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis

Nonalcoholic fatty liver disease (NAFLD) encompasses a spectrum of disease from simple steatosis to nonalcoholic steatohepatitis, with inflammatory cytokines and adipokines identified as drivers of disease progression. Poor dietary patterns are known to promote an inflammatory milieu, although the effects of specific diets remain largely unknown. This review aimed to gather and summarize new and existing evidence on the effect of dietary intervention on inflammatory markers in patients with NAFLD. The electronic databases MEDLINE, EMBASE, CINAHL, and Cochrane were searched for clinical trials which investigated outcomes of inflammatory cytokines and adipokines. Eligible studies included adults >18 y with NAFLD, which compared a dietary intervention with an alternative diet or control (no intervention) group or were accompanied by supplementation or other lifestyle interventions. Outcomes for inflammatory markers were grouped and pooled for meta-analysis where heterogeneity was allowed. Methodological quality and risk of bias were assessed using the Academy of Nutrition and Dietetics Criteria. Overall, 44 studies with a total of 2579 participants were included. Meta-analyses indicated intervention with an isocaloric diet plus supplement was more effective in reducing C-reactive protein (CRP) [standard mean difference (SMD): 0.44; 95% CI: 0.20, 0.68; P = 0.0003] and tumor necrosis factor-alpha (TNF-α) (SMD: 0.74; 95% CI: 0.02, 1.46; P = 0.03) than an isocaloric diet alone. No significant weighting was shown between a hypocaloric diet with or without supplementation for CRP (SMD: 0.30; 95% CI: -0.84, 1.44; P = 0.60) and TNF-α (SMD: 0.01; 95% CI: -0.43, 0.45; P = 0.97). In conclusion, hypocaloric and energy-restricted diets alone or with supplementation, and isocaloric diets with supplementation were shown to be most effective in improving the inflammatory profile of patients with NAFLD. To better determine the effectiveness of dietary intervention alone on a NAFLD population, further investigations of longer durations, with larger sample sizes are required.

How many submissions are needed to discover friendly suggested reviewers?

It is common in scientific publishing to request from authors reviewer suggestions for their own manuscripts. The question then arises: How many submissions are needed to discover friendly suggested reviewers? To answer this question, as the data we would need is anonymized, we present an agent-based simulation of (single-blinded) peer review to generate synthetic data. We then use a Bayesian framework to classify suggested reviewers. To set a lower bound on the number of submissions possible, we create an optimistically simple model that should allow us to more readily deduce the degree of friendliness of the reviewer. Despite this model's optimistic conditions, we find that one would need hundreds of submissions to classify even a small reviewer subset. Thus, it is virtually unfeasible under realistic conditions. This ensures that the peer review system is sufficiently robust to allow authors to suggest their own reviewers.

Scholarly publishing and peer review in the Global South: the role of the reviewer

Peer review is an integral part of contemporary scholarly publishing, especially journal publishing. Work submitted by scholars from all parts of the world is subjected to it. This includes submissions by scholars from the Global South, who wish to publish in “international” journals or in local journals which follow the same model. These authors may not be native English speakers and may be unfamiliar with the conventions of Western scholarship. Many of them conduct research and write their manuscripts under challenging circumstances. They may find it difficult to comply with the requirements of the journals to which they submit their articles. Their manuscripts quite often pose challenges to the peer reviewers. The purpose of this article is to provide some background on scholarly publishing in the Global South and the challenges those colleagues face, and to outline what this may mean for the role of the reviewer.

Respectful maternity care in the UK using a decolonial lens

Respectful maternity care (RMC) is part of a global movement addressing the previous absence of human rights in global safe maternal care guidance. RMC is grounded in kindness, compassion, dignity and respectful working conditions. The decolonisation movement in healthcare seeks to dismantle structural biases set up from a historically white, male, heteronormative Eurocentric medical system. This article applies a decolonising lens to the RMC agenda and examines barriers to its implementation in UK healthcare systems. Searches of peer-reviewed journals about decolonising maternity care in the UK revealed little. Drawing from wider information bases, we examine power imbalances constructed throughout a history of various colonial biases yet lingering in maternity care. The overarching findings of our analysis revealed 3 areas of focus: professional structures and institutional biases; power imbalances between types of staff and stakeholders of care; and person-centred care through a decolonial lens. To uproot inequity and create fairer and more respectful maternity care for women, birthing people and staff, it is vital that contemporary maternity institutions understand the decolonial perspective. This novel enquiry offers a scaffolding to undertake this process. Due to significant differences in colonial history between Western colonising powers, it is important to decolonise with respect to these different territories, histories and challenges.

The Influence of International Collaboration on the Scientific Impact in V4 Countries

Several strategies are used by researchers and research facilities to increase their scientific production and consequent research quality. Bibliometric records show that coauthorship and the number of participating organizations in research publications are steadily increasing; however, the effect of collaboration varies across disciplines, and the corresponding author’s country appears to influence research impact. This finding inspired our research question for this study: How does international cooperation affect scientific impact, and does the affiliation of corresponding authors influence citation impact indicators at the level of individual publications? To this end, we provide a comparative evaluation of research articles published in Q1 journals among Visegrad Group countries (Czech Republic, Hungary, Poland and Slovakia) in Medical and Health sciences between 2017 and 2021. The study investigates the relationship between collaboration type (national vs. international) and scientific impact (impact factor of the journal and category normalized citation impact or research papers), as well as the impact of the country of the corresponding author’s affiliation on quantitative quality of individual papers. We show that Q1 research papers in international collaboration have a higher scientific impact than papers published in national partnerships. Moreover, the corresponding authors’ country of affiliation significantly affects scientific impact.

Global marine litter research 2015-2020: Geographical and methodological trends

A systematic review of research on marine macrolitter densities in the past five years (2015-2020) revealed considerable knowledge gaps in the field. Nearly half he reviewed studies were on stranded litter. Data are scarce from many of the regions estimated to mismanage the largest amounts of plastic waste. In regions where data are available these are typically from coastal areas with few data from the high and deep seas; 57% and 87% of studies on pelagic and seafloor litter, respectively, took place within 100 km from shore. Data on pelagic litter are generally constrained to the sea surface and only two of 30 pelagic studies have measured macrolitter deeper in the water column. Reported litter densities are generally highest for stranded litter, although seafloor litter densities by weight are high in some areas. Reported densities of floating litter are several orders of magnitude lower. However, a lack of standardisation of methods makes it difficult both to assess and to compare litter densities within and across the different environmental compartments in time and space. The review illustrates a great need for survey design development within the field of macroplastics and point to some long-established considerations from ecological research pertaining to independence of data points, spatial autocorrelation, sampling scale, and plot size and shape which are highly relevant also for marine litter research. These considerations are relevant both for global standardisation efforts and for independent studies. Furthermore, the knowledge gaps created by geographic and compartment biases in research needs to be addressed to identify further research needs, validate models and inform policy.

Assessing the impact of polio supplementary immunisation activities on routine immunisation and health systems: a systematic review

Introduction

The Global Polio Eradication Initiative uses polio supplementary immunisation activities (SIAs) as a strategy to increase vaccine coverage and cease poliovirus transmission. Impact of polio SIAs on immunisation systems is frequently debated. We reviewed the impact of polio SIAs on routine immunisation and health systems during the modern era of polio eradication.

Methods

We searched nine databases for studies reporting on polio SIAs and immunisation coverage, financial investment, workforce and health services delivery. We conducted a narrative synthesis of evidence. Records prior to 1994, animal, modelling or case studies data were excluded.

Results

20/1637 unique records were included. Data on vaccine coverage were included in 70% (14/20) studies, workforce in 65% (13/20) and health services delivery in 85% (17/20). SIAs positively contributed to vaccination uptake of non-polio vaccines in seven studies, neutral in three and negative in one. Some polio SIAs contributed to workforce strengthening through training and capacity building. Polio SIAs were accompanied with increased social mobilisation and community awareness building confidence in vaccination programmes. Included studies were programmatic in nature and contained variable data, thus could not be justly critically appraised.

Conclusion

Polio SIAs are successful at increasing polio vaccine coverage, but the resources and infrastructures were not always utilised for delivery of non-polio vaccines and integration into routine service delivery. We found a gap in standardised tools to evaluate SIAs, which can then inform service integration. Our study provides data to inform SIAs evaluations, and provides important considerations for COVID-19 vaccine roll-out to strengthen health systems.

PROSPERO registration number

CRD42020152195.

A Systematic Review of Interventions for Multilingual Preschoolers With Speech and Language Difficulties

Purpose There is a shortage of information on evidence-based interventions for supporting young multilingual children. The purpose of this review was to identify interventions that have been evaluated with preschool-age multilingual children with a speech and/or language disorder or who are at risk of poor speech, language, literacy, and/or educational outcomes. Method This review considered speech, language, and early literacy interventions evaluated with preschool-age multilingual children with a speech and/or language disorder or who have been identified as being at risk of language difficulties (PROSPERO ID: 165892). The following electronic databases were searched: EBSCO (CINAHL Plus, ERIC, PsycINFO, Medline, Education) and Linguistics, Language, and Behavior Abstracts. Data were extracted describing article, participant, methodological, and intervention variables, and effect sizes. The Council for Exceptional Children's (CEC) standards for evidence-based practice were used to examine the quality of studies. Results Fifty-six relevant studies were identified in 52 articles and these studies described 4,551 participants who had speech sound disorder (six articles), developmental language disorder (11 articles), or were considered to be at risk (36 articles). The interventions targeted speech production (seven studies), language (45 studies), and early literacy (11 studies) skills. Most studies reported positive effects. Only 15 studies met all quality indicators specified by the CEC (2014) and these described 18 interventions targeting language and literacy skills. The only intervention with sufficient evidence to be considered an evidence-based practice was Nuestros Niños [Our Children] for children's early literacy and phonological awareness skills. Conclusions A number of high-quality studies exist that describe speech, language and/or literacy interventions for preschool-age multilingual children with a speech and/or language disorder, or who have been identified as being at risk of language difficulties. However, there remains limited evidence for specific interventions as to their ability to inform evidence-based practices. Supplemental Material https://doi.org/10.23641/asha.16632649.

Knowledge syntheses in medical education: Meta-research examining author gender, geographic location, and institutional affiliation

Introduction

Authors of knowledge syntheses make many subjective decisions during their review process. Those decisions, which are guided in part by author characteristics, can impact the conduct and conclusions of knowledge syntheses, which assimilate much of the evidence base in medical education. To better understand the evidence base, this study describes the characteristics of knowledge synthesis authors, focusing on gender, geography, and institution.

Methods

In 2020, the authors conducted meta-research to examine authors of 963 knowledge syntheses published between 1999 and 2019 in 14 core medical education journals.

Results

The authors identified 4,110 manuscript authors across all authorship positions. On average there were 4.3 authors per knowledge synthesis (SD = 2.51, Median = 4, Range = 1–22); 79 knowledge syntheses (8%) were single-author publications. Over time, the average number of authors per synthesis increased (M = 1.80 in 1999; M = 5.34 in 2019). Knowledge syntheses were authored by slightly more females (n = 2047; 50.5%) than males (n = 2005; 49.5%) across all author positions. Authors listed affiliations in 58 countries, and 58 knowledge syntheses (6%) included authors from low- or middle-income countries. Authors from the United States (n = 366; 38%), Canada (n = 233; 24%), and the United Kingdom (n = 180; 19%) published the most knowledge syntheses. Authors listed affiliation at 617 unique institutions, and first authors represented 362 unique institutions with greatest representation from University of Toronto (n = 55, 6%). Across all authorship positions, the large majority of knowledge syntheses (n = 753; 78%) included authors from institutions ranked in the top 200 globally.

Conclusion

Knowledge synthesis author teams have grown over the past 20 years, and while there is near gender parity across all author positions, authorship has been dominated by North American researchers located at highly ranked institutions. This suggests a potential overrepresentation of certain authors with particular characteristics, which may impact the conduct and conclusions of medical education knowledge syntheses.

Epistemic injustice in academic global health

This Viewpoint calls attention to the pervasive wrongs related to knowledge production, use, and circulation in global health, many of which are taken for granted. We argue that common practices in academic global health (eg, authorship practices, research partnerships, academic writing, editorial practices, sensemaking practices, and the choice of audience or research framing, questions, and methods) are peppered with epistemic wrongs that lead to or exacerbate epistemic injustice. We describe two forms of epistemic wrongs, credibility deficit and interpretive marginalisation, which stem from structural exclusion of marginalised producers and recipients of knowledge. We then illustrate these forms of epistemic wrongs using examples of common practices in academic global health, and show how these wrongs are linked to the pose (or positionality) and the gaze (or audience) of producers of knowledge. The epistemic injustice framework shown in this Viewpoint can help to surface, detect, communicate, make sense of, avoid, and potentially undo unfair knowledge practices in global health that are inflicted upon people in their capacity as knowers, and as producers and recipients of knowledge, owing to structural prejudices in the processes involved in knowledge production, use, and circulation in global health.

The Impact of Mental Health Literacy Training Programs on the Mental Health Literacy of University Students: a Systematic Review

Student mental health is of growing concern for the university education sector. Supporting opportunities to increase mental health literacy of students is one strategy in which universities and colleges are actively investing to support students build their capacity to be well. This study is a systematic review of mental health literacy training (MHLT) programs, other than Mental Health First Aid training, to examine their impact on the mental health literacy of university students. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) (Online Resource 1) and A Measurement Tool to Assess Systematic Reviews (AMSTAR2) guidelines. Search terms related to mental health literacy concepts, mental health literacy training and university students were used in four major databases (i.e. EBSCOhost, Ovid, ProQuest and Web of Science), retrieving a total of 1219 articles, with 44 studies selected for full-text review, and a final number of 24 studies included for review based on pre-determined eligibility criteria. Results were reported against three main themes: types of MHLT offered; common practices, processes and implementation elements; and effectiveness of intervention. Results indicate a high level of variability in approaches to mental health literacy interventions and measures of assessment and reporting. Additionally, reported benefits to mental health literacy failed to report on comparable units of improvement or the sustainability of benefits. Although it is in the best interest of universities to prioritise early intervention programs to address mental health and improve wellbeing, more robust data is required to establish the effectiveness of MHLT programs in achieving this aim.

Single-Blind and Double-Blind Peer Review: Effects on National Representation

Purpose: To assess whether the type of peer-review (single-blinded vs double-blinded) has an impact on nationality representation in journals.Methods: A cross-sectional study analyzing the top 10 nationalities contributing to the number of articles across 16 ophthalmology journals.Results: There was no difference in the percentage of articles published from the journal's country of origin between the top single-blind journals and double-blind journals (SB = 42.0%, DB = 26.6%, p = .49), but there was a significant difference between the percentage of articles from the US (SB = 48.0%, DB = 22.8%, p = .02). However, there was no difference for both country of origin (SB = 38.0%, DB = 26.6%, p = .43) and articles from the US (SB = 35.0%, DB = 22.8%, p = .21) when assessing the top eight double-blind journals matched with single-blind journals of a similar impact factor. The US (n = 16, 100%) and England (n = 16, 100%) most commonly made the top 10 lists for article contribution. This held true even for journals established outside the United States (US=11/12, England = 11/12).Conclusions: There was no significant difference in country-of-origin representation between single-blind journals and double-blind journals. However, higher income countries contributed most often to the journals studied even among journals based outside the US.

Implicit bias in healthcare: clinical practice, research and decision making

Bias is the evaluation of something or someone that can be positive or negative, and implicit or unconscious bias is when the person is unaware of their evaluation. This is particularly relevant to policymaking during the coronavirus pandemic and racial inequality highlighted during the support for the Black Lives Matter movement. A literature review was performed to define bias, identify the impact of bias on clinical practice and research as well as clinical decision making (cognitive bias). Bias training could bridge the gap from the lack of awareness of bias to the ability to recognise bias in others and within ourselves. However, there are no effective debiasing strategies. Awareness of implicit bias must not deflect from wider socio-economic, political and structural barriers as well ignore explicit bias such as prejudice.