Editorial: making the invisible visible in STEMM

Our editorial focused on the concept of "Making the Invisible Visible in Science, Technology, Engineering, Mathematics, and Medicine (STEMM)." We highlight 11 manuscripts submitted to our research topic, which offer unique and innovative, evidence-backed solutions to improve diversity, equity, and inclusion in STEMM. Notably, often racial, and ethnic minority scientists are forgotten and placed in the background even when they make a significant contribution to research. The manuscripts highlighted here begin to undo this and empower by making the invisible visible.

Minimally Invasive Ways to Monitor Changes in Cardiocirculatory Fitness in Running-based Sports: A Systematic Review

This systematic review provides a synthesis of research investigating submaximal protocols to monitor changes in cardiocirculatory fitness in running-based sports. Following PRISMA guidelines, 2,452 records were identified and 14 studies, representing 515 athletes, satisfied the eligibility criteria. While most studies found large associations between changes in heart rate at standardized, submaximal running speeds and changes in aerobic fitness (r=0.51-0.88), three studies failed to establish a relationship (r=0.19-0.35). The intensity of the submaximal protocols seems to be relevant, with changes in running speeds at 90% of maximal heart rate showing larger relationships with changes in aerobic fitness (r=0.52-0.79) compared to 70% of maximal heart rate (r=0.24-0.52). Conversely, changes in post-exercise heart rate variability were very largely associated with changes in aerobic fitness when the testing protocols were less intense (70% of maximal heart rate) (r=0.76-0.88), but not when the test required participants to achieve 90% of their maximal heart rate (r=-0.02-0.06). Studies on post-exercise heart rate recovery revealed inconclusive results (r=-0.01- -0.55), while rate of heart rate increase may be a promising athlete monitoring metric (r=0.08- -0.84) but requires further research. In summary, when executed, analyzed, and interpreted appropriately, submaximal protocols can provide valuable information regarding changes in athlete cardiocirculatory fitness.

[What the invisible microbiota shows about the care giving system]

When we talk about micro-organisms, the notion of hygiene prevails. However, this invisible ecosystem, which permeates us and connects us to patients, should make us aware of the intimate relationship among human beings.

Lifeworld interpretation of tinnitus

Lifeworld-led care provides a route through which research and practice can navigate the 'biopsychosocial' allowing us to overcome the shortfalls of the medical model and enabling us to prioritise humanity in the care of people living with tinnitus. In this article, we sought to explore qualitative descriptions of life with tinnitus. We aimed to address the question 'what it is like to live with tinnitus?' In doing so we examined qualitative studies and provide suggestions about key themes that seem consistent. This is a narrative, thematic overview of the way lifeworld has been conceptualised and explored in tinnitus research.

Fluctuation, invisibility, fatigue - the barriers to maintaining employment with systemic lupus erythematosus: results of an online survey

Objectives

Systemic lupus erythematosus (SLE) is associated with high levels of workplace disability and unemployment. The objective of this study was to understand the reasons for this and to describe the barriers and facilitators of employment identified by people with SLE to develop appropriate solutions. Unemployment, as well as unsuitable work, has adverse health outcomes.

Methods

Adults with SLE completed a UK-specific online survey, through the LUPUS UK website, designed to find out more about the difficulties and successes that people with SLE have in maintaining employment. The survey was predominantly qualitative, to understand participants’ employment experiences to generate possible solutions.

Results

Three hundred and ninety-three people gave detailed responses to the survey within eight weeks. Every respondent reported a detrimental effect of SLE on their ability to work: 40.45% had left employment because of it. The themes of concern to respondents were unambiguous: (i) the difficulties of working (and career damage) with SLE, (ii) fear and anxiety overshadowing work/family life, (iii) the greater potential to remain in some employment or stay in full employment when modifications of work pattern and support from management and colleagues were available. SLE-related fatigue, its invisibility and fluctuating nature were felt to be the main barriers to maintaining employment. Numerous respondents could work only part-time and anxiety was high regarding their future ability to continue working. Many had taken substantial pay reductions and refused offered promotions to preserve their health. Distress due to loss of work and the benefits it brings were reported by every respondent who had left work.

Conclusion

SLE presents specific difficulties for maintaining employment – fatigue, fluctuation and invisibility – not addressed by current anti-discrimination legislation or currently available ‘reasonable adjustments’. This study demonstrates that (i) employment is an important area of concern for people with SLE, (ii) SLE has significant detrimental effects on individuals’ ability to participate and progress in employment, (iii) legislators and employers need information about SLE as invisibility and fluctuation cause hidden problems, and (iv) more data is needed to inform workplace adjustments if individual distress and societal loss of skills are to be addressed.

Invisible Lichen Planopilaris Unmasked by Dermatoscopy

Lichen planopilaris is a form of lymphocyte-mediated primary cicatricial alopecia characterized by perifollicular scaling progressing to patches of alopecia depending on the clinical variant. The course is relentlessly progressive and chronic. Hence, early diagnosis and institution of therapy are imperative to halt the disease progress. Although definitive diagnosis is made by scalp biopsy, the detection is usually delayed. Dermatoscopy helps in early recognition of this condition which at that stage is clinically invisible. We report a 23-year-old female who presented with hair loss and scalp scaling without clinically obvious patches of alopecia.

Subthreshold diode micropulse laser photocoagulation (SDM) as invisible retinal phototherapy for diabetic macular edema: a review

PURPOSE

To present the state-of-the-art of subthreshold diode laser micropulse photocoagulation (SDM) as invisible retinal phototherapy for diabetic macular edema (DME).

METHOD

To review the role and evolution of retinal laser treatment for DME.

RESULTS

Thermal laser retinal photocoagulation has been the cornerstone of treatment for diabetic macular edema for over four decades. Throughout, laser induced retinal damage produced by conventional photocoagulation has been universally accepted as necessary to produce a therapeutic benefit, despite the inherent risks, adverse effects and limitations of thermally destructive treatment. Recently, SDM, performed as invisible retinal phototherapy for DME, has been found to be effective in the absence of any retinal damage or adverse effect, fundamentally altering our understanding of laser treatment for retinal disease.

SUMMARY

The discovery of clinically effective and harmless SDM treatment for DME offers exciting new information that will improve our understanding of laser treatment for retinal disease, expand treatment indications, and improve patient outcomes.