LGBTQIA+ Outness in Otolaryngology Residency Applications

Lesbian, gay, bisexual, transgender, queer, intersex, and asexual/aromantic (LGBTQIA+) providers improve health outcomes of sexual and gender minority (SGM) patients, which demonstrates the importance of understanding the state of LGBTQIA+ representation at all levels of medical training. The U.S. does not systematically collect sexual orientation and gender identity (SOGI) data from applicants, trainees, and attending physicians, prompting us to wonder whether SGM representation in surgical fields, such as otolaryngology, is adequate. Personal statements submitted to an otolaryngology program from 2019 to 2021 were searched for LGBTQIA+ terms, and those containing LGBTQIA+ terms underwent full text review to determine whether applicants identified themselves as LGBTQIA+. Across these 2 application cycles, the sampled residency program received 928 applications. Only 2 applicants of 928 (0.2%) self-disclosed their LGBTQIA+ identities in their personal statements. These results signify a scarcity of SGM diversity in otolaryngology and warrant deeper exploration into factors preventing residency applicants from self-disclosure of LGBTQIA+ identities.

Computation for cognitive science: Analog versus digital

Cognitive science was founded on the idea that the mind/brain can be understood in computational terms. While computational modeling in science is ubiquitous, cognitive science takes the stronger stance that the mind/brain literally performs computations. Moreover, performing computations is crucial to explaining what the mind/brain does, qua mind/brain. Unfortunately, most scientists fail to consider analog computation as a legitimate and theoretically useful type of computation in addition to digital computation; to the extent that analog computation is acknowledged, it is mostly based on a simplistic and incomplete understanding. Taking computation to consist of only one type (i.e., digital) while ignoring another, interestingly distinct type (i.e., analog) leads to an impoverished understanding of what it could mean for minds/brains to compute. A full appreciation and understanding of analog computation-particularly in relation to digital computation-allows researchers to develop computational frameworks and hypotheses in new and exciting ways. Thus, somewhat counterintuitively, looking to the once-dominant computing paradigm of yesteryear can provide novel computational ways of thinking about the mind and brain. This article is categorized under: Philosophy > Foundations of Cognitive Science.

Is a Simple Checklist Associated With Improvement in Gender Representation at the AAO-HNSF Annual Meeting?

OBJECTIVE

In September 2017, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) added 2 questions querying panel organizers if gender/racial diversity was considered in selecting panel presenters, beginning with the 2018 Annual Meeting (AM). This study examines how this checklist impacted the gender diversity of panel presenters at the AAO-HNS AM.

STUDY DESIGN

This was a cross-sectional investigation comparing female representation before and after the addition of questions inquiring about diversity in 2018.

SETTING

A review of abstract submissions for the AMs from 2015 to 2021.

METHODS

AM Official Program Abstracts were used to obtain presenter names and specialty area for each panel. The percentage of female presenters, in total and stratified by specialty area, were compared before and after 2018 to quantify changes following the addition of the checklist.

RESULTS

There was a significant increase in the proportion of female panel presenters from 22.3% (total n = 1199) in 2015 to 2017 to 33.0% (total n = 1868) in 2018 to 2021 (P < .001) and in all panel specialties. The number of female moderated panels also significantly increased after checklist implementation from 22% to 38% (P < .001). Correspondingly, the number of panels with no female representation decreased from 42% in 2015 to 2017 to 23% in 2018 to 2021 (P < .001).

CONCLUSION

The addition of a checklist asking panel organizers to consider diversity in selecting panelists was associated with an increased proportion of female presenters at the AM. This simple strategy can be implemented by all medical conferences to help close the gender gap.

A comprehensive review of the recent advances on predicting drug-target affinity based on deep learning

Accurate calculation of drug-target affinity (DTA) is crucial for various applications in the pharmaceutical industry, including drug screening, design, and repurposing. However, traditional machine learning methods for calculating DTA often lack accuracy, posing a significant challenge in accurately predicting DTA. Fortunately, deep learning has emerged as a promising approach in computational biology, leading to the development of various deep learning-based methods for DTA prediction. To support researchers in developing novel and highly precision methods, we have provided a comprehensive review of recent advances in predicting DTA using deep learning. We firstly conducted a statistical analysis of commonly used public datasets, providing essential information and introducing the used fields of these datasets. We further explored the common representations of sequences and structures of drugs and targets. These analyses served as the foundation for constructing DTA prediction methods based on deep learning. Next, we focused on explaining how deep learning models, such as Convolutional Neural Networks (CNNs), Recurrent Neural Networks (RNNs), Transformer, and Graph Neural Networks (GNNs), were effectively employed in specific DTA prediction methods. We highlighted the unique advantages and applications of these models in the context of DTA prediction. Finally, we conducted a performance analysis of multiple state-of-the-art methods for predicting DTA based on deep learning. The comprehensive review aimed to help researchers understand the shortcomings and advantages of existing methods, and further develop high-precision DTA prediction tool to promote the development of drug discovery.

Do Women with Skin of Color Think They Are Well Represented in Skin Aging Prevention Information?

Objective

There are clinical differences in healthy skin requirements and skin-aging features by race and ethnicity. However, individuals of color are underrepresented in dermatology-related medical information. We sought to gather information from women of color regarding their attitudes about the importance of the prevention of skin aging, available information, and perception of representation in skin-aging prevention information.

Methods

This study involved an observational, cross-sectional, online survey of women aged 18 to 70 years residing in the United States. Participants were placed into one of seven cohorts based on self-reported race/ethnicity. Relative frequencies of responses were compared across cohorts; adjusted logistic regression was used to assess perception of representation in skin-aging prevention information.

Results

The mean age of the 1,646 participants was 44.4 years. The mean (standard deviation) rating (from 0, "not at all important" to 10, "extremely important") of the importance of the prevention of skin aging ranged from 7.3 to 8.2 across the seven cohorts. All cohorts reported the most trusted source of information for skin-aging prevention products and treatments was a skin-care professional, but not all cohorts believed they are well represented in available sources of information. Older age, lower median household income, and a race/ethnicity of Black, Asian, "Other," and "More Than One Race" were less likely to report being well represented.

Limitations

People without internet access could not participate, potentially excluding some older and lower-income groups.

Conclusion

Women of color are less likely to feel represented in available information on the prevention of skin aging.

Towards Two Bloch Sphere Representation of Pure Two-Qubit States and Unitaries

We extend Bloch sphere formalism to pure two-qubit systems. Combining insights from Geometric Algebra and the analysis of entanglement in different conjugate bases we identify two Bloch sphere geometry that is suitable for representing maximally entangled states. It turns out that the relative direction of the coordinate axes of the two Bloch spheres may be used to describe the states. Moreover, the coordinate axes of one Bloch sphere should be rignt-handed and those of the other one should be left-handed. We describe and depict separable and maximally entangled states as well as entangling and non-entangling rotations. We also offer a graphical representation of the workings of a CNOT gate for different inputs. Finally, we provide a way to also represent partially entangled states and describe entanglement measures related to the surface area of the sphere enclosing the state representation.

Dorsolateral prefrontal activity supports a cognitive space organization of cognitive control

Cognitive control resolves conflicts between task-relevant and -irrelevant information to enable goal-directed behavior. As conflicts can arise from different sources (e.g., sensory input, internal representations), how a limited set of cognitive control processes can effectively address diverse conflicts remains a major challenge. Based on the cognitive space theory, different conflicts can be parameterized and represented as distinct points in a (low-dimensional) cognitive space, which can then be resolved by a limited set of cognitive control processes working along the dimensions. It leads to a hypothesis that conflicts similar in their sources are also represented similarly in the cognitive space. We designed a task with five types of conflicts that could be conceptually parameterized. Both human performance and fMRI activity patterns in the right dorsolateral prefrontal cortex support that different types of conflicts are organized based on their similarity, thus suggesting cognitive space as a principle for representing conflicts.

Medical Student Perceptions of Academic Surgery: Rose-Colored Glasses or Jaded Prism?

OBJECTIVE

Stereotypes of surgeons are pervasive and play a role in medical students' decisions about pursuing a surgical career. This study aimed to determine: (1) how medical students' perceptions of surgery and surgeons changed following exposure to surgery during clerkship rotations; and (2) if gender and racial/ethnic identification played a role in this process.

DESIGN, SETTING, AND PARTICIPANTS

In this mixed-method study, clerkship students at one U.S. medical school were asked to anonymously contribute words and phrases that they associated with surgery to an online "word cloud" at the beginning and end of their 12-week surgery clerkship. In addition, an end-of-year, anonymous survey of their perceptions was administered and analyzed using a Grounded Theory approach.

RESULTS

Of 154 students invited to complete the online survey, analysis of 24 completed surveys suggested that students believe surgical culture to be toxic, with unfriendly attitudes, strict hierarchy, and lack of work-life balance. Analysis of 678 Word Cloud responses, however, indicated that the frequency of complimentary responses increased following surgery clerkships (25% vs 36%; z = -3.26; p = 0.001), while the proportion of responses describing surgery/surgeons as male-dominated, egotistical, and scary decreased (5% vs 1%, z = 2.86, p = 0.004; 9% vs 4%, z = 2.78, p = 0.005; 3% vs 0.3%, z = 2.56, p = 0.011, respectively). The association between surgeons and being White disappeared entirely. Female students were more likely than male students to state that their perceptions did not change following exposure (40% vs 0%; z = 2.19; p = 0.029).

CONCLUSIONS

With exposure to surgery, students' preconceived notions may be positively influenced. However, students continue to hold negative perceptions, and this effect may be stratified by gender identification. Institutions should work to address these perceptions in pre-clerkship years to attract a more diverse pool of future surgeons.

Disparities in race, ethnicity, sex, and age inclusion in pancreatic cancer screening studies: A systematic review and meta-analysis

BACKGROUND AND AIM

There are substantial differences in pancreatic cancer outcomes across ethnoracial stratifications. We sought to assess racial, ethnic, sex and age reporting and inclusion of participants in pancreatic cancer screening studies.

METHODS

A systematic search of Cochrane Library, Ovid Embase, Google Scholar, Ovid Medline, PubMed, Scopus, and Web of Science Core Collection from inception to 2022 was conducted. Original studies on pancreatic cancer screening were identified and assessed for reporting and inclusion on race, ethnicity, sex, and age. The pooled proportions of study participants for these characteristics were calculated and compared with population-based benchmarks.

RESULTS

Among 27 eligible pancreatic cancer screening studies, 26 reported data on either sex, race, or ethnicity, with a total of 5273 participants. Information on participant sex was reported by 26, race by 12, and ethnicity by 8 studies. Participants in these studies were almost all White (pooled proportion=93.1%; 95%CI:89.7%-96.4%) and non-Latino (pooled proportion=97.4%, 95% CI:94.0%-100%), and these groups were overrepresented when compared with the general population. Females were well represented with pooled proportion=63.2% (95% CI:59.9%-66.6). When reported, mean or median participant age was < 60 years. Meta regression revealed higher proportion of females in studies from the United States (p=0.002). No association between increasing participation of racial or ethnic underrepresented populations and study quality, ascending year of publication, or source of study funding was noted.

CONCLUSION

Substantial disparities in race, ethnicity, sex, and age reporting and inclusion in pancreatic cancer studies were noted, even among high-quality and publicly funded studies.

Drawing the COVID-19 pandemic: how do children incorporate the health crisis and its consequences into their everyday thinking?

OBJECTIVE

The general objective of this research was to explore how children understand and represent COVID-19 health crisis in their everyday thinking.

DESIGN

This research is based on a qualitative interpretive research methodology that uses 6-12 years children's drawings from San Sebastian (Basque Country, northern of Spain) to collect data. This technique allows children to visualize how they face this situation through a tool that promotes expression of their feelings and representations.

RESULTS

A total of 345 drawings were collected, and 949 elements related to the different coded categories were coded. The themes that have arisen were related to symbols of the pandemic (n = 307, 32.34%), emotions (n = 290, 30.55%), actions carried out (n = 258, 27.18%) and socialization (n = 94, 9.90%). No differences by age-range were found.

CONCLUSIONS

Children have a realistic representation of the COVID-19 virus and its consequences, which closely resembles the representation shown by the media and society. The children show a good understanding of the new measures and social rules associated with the pandemic. They are also very aware of the need to support their emotions by different spheres (family, educational and social context). Alternative play activities and art-based education must be promoted, avoiding the abuse of screens to reinforce their well-being.

The effect of hair type and texture on electroencephalography and event-related potential data quality

Research utilizing event-related potential (ERP) methods is generally biased with regard to sample representativeness. Among the myriad of factors that contribute to sample bias are researchers' assumptions about the extent to which racial differences in hair texture, volume, and style impact electrode placement, and subsequently, study eligibility. The current study examines these impacts using data collected from n = 213 individuals ages 17-19 years, and offers guidance on collection of ERP data across the full spectrum of hair types. Individual differences were quantified for hair texture using a visual scale, and for hair volume by measuring the amount of gel used in cap preparation. Electroencephalography data quality was assessed with multiple metrics at the preprocessing, post-processing, and variable generation stages. Results indicate that hair volume is associated with small, but systematic differences in signal quality and signal amplitude. Such differences are highly problematic as they could be misattributed to cognitive differences among groups. However, inclusion of gel volume as a covariate to account for individual differences in hair volume significantly reduced, and in most cases eliminated, group differences. We discuss strategies for overcoming real and perceived technical barriers for researchers seeking to achieve greater inclusivity and representativeness in ERP research.

Representation Matters: Trust in Digital Health Information Among Black Patients With Prostate Cancer

PURPOSE

Although the majority of US adults obtain health information on the internet, the quality of information about prostate cancer is highly variable. Black adults are underrepresented in online content about prostate cancer despite a higher incidence of and mortality from the disease. The goal of this study was to explore the perspectives of Black patients with prostate cancer on the importance of racial representation in online content and other factors influencing trust.

MATERIALS AND METHODS

We conducted 7 virtual focus groups with Black patients with prostate cancer in 2022 and 2023. Participants completed an intake questionnaire with demographics followed by a group discussion, including feedback on purposefully selected online content. Transcripts were independently analyzed by 2 investigators experienced in qualitative research using a constant comparative method.

RESULTS

Most participants use online sources to look for prostate cancer information. Racial representation is an important factor affecting trust in the content. A lack of Black representation has consequences, including misperceptions about a lower risk of prostate cancer and discouraging further information-seeking. Other key themes affecting trust in online content included the importance of a reputable source of information, professional website structure, and soliciting money.

CONCLUSIONS

Underrepresentation of Black adults in prostate cancer content has the potential to worsen health disparities. Optimal online communications should include racially diverse representation and evidence-based information in a professional format from reputable sources without financial conflict.

[Sex therapy and support for women and couples]

Sexuality is shaped by experience and by what has been passed down. Body image and sex influence desire and pleasure. In the case of endometriosis, suffering and pain can lead to shame and guilt. Encouraging people to talk to each other helps to create a free eroticism that resembles the couple.

"Catastrophic" set size limits on infants' capacity to represent objects: A systematic review and Bayesian meta-analysis

Decades of research has revealed that humans can concurrently represent small quantities of three-dimensional objects as those objects move through space or into occlusion. For infants (but not older children or adults), this ability apparently comes with a significant limitation: when the number of occluded objects exceeds three, infants experience what has been characterized as a "catastrophic" set size limit, failing to represent even the approximate quantity of the hidden array. Infants' apparent catastrophic representational failures suggest a significant information processing limitation in the first years of life, and the evidence has been used as support for prominent theories of the development of object and numerical cognition. However, the evidence for catastrophic failure consists of individual small-n experiments that use null hypothesis significance testing to obtain null results (i.e., p > 0.05). Whether catastrophic representational failures are robust or reliable across studies, methods, and labs is not known. Here we report a systematic review and Bayesian meta-analysis to examine the strength of the evidence in favor of catastrophic representational failures in infancy. Our analysis of 22 experiments across 12 reports, with a combined total of n = 367 infants aged 10-20 months, revealed strong support for the evidence for catastrophic set size limits. A complementary analysis found moderate support for infants' success when representing fewer than four objects. We discuss the implications of our findings for theories of object and numerical cognitive development. RESEARCH HIGHLIGHTS: Previous work has suggested that infants are unable to concurrently represent four or more objects-a "catastrophic" set size limit. We reviewed this work and conducted a Bayesian meta-analysis to examine the robustness of this limit across individual small-n experiments. We found strong support for the evidence for catastrophic set size limits, and moderate support for infants' success when representing fewer than four objects.

Psychiatry, racism and crime: the case of Christopher Clunis reconsidered

In December 2022, the death of Christopher Clunis was made public. He had actually died in February 2021. Christopher Clunis was convicted of the manslaughter of a stranger, Jonathan Zito. He attacked Mr Zito at a train station. This paper will argue that this terrible event became a totemic symbol of the wider failings of the policy of community care. The image of Clunis being driven away from Court was repeatedly used in newspaper and other media reports as a reference point. The image reflects a number of long-standing traits in the representation of the "mentally ill." These are combined with a racial stereotype of Black men. The paper examines historical representations of the mentally ill as a context for a discussion of the Clunis case. The paper uses the work of Stuart Hall as an analytical tool to examine the questions of race and representation, and the moral panic following failings of community care.

Diversifying the dental curriculum: A review of the Bachelor of Dental Surgery degree reading lists in a UK dental school

INTRODUCTION

Analysis of the diversity of reading lists on courses offered by universities is one way to assess what is being taught and how it shapes our understanding of the world. Very little work has been carried out so far within dentistry on decolonising the curriculum. Existing work looks at the representation of women or ethnic minorities but not at the dental curriculum per se. This article starts to address this.

METHODS

The reading lists within the 5 year Bachelor of Dental Surgery curriculum in a large UK dental school were collected and assessed. A data extraction spreadsheet was developed and journal articles on every course reading list across the 5 year curriculum were read in detail. Information on authorship and author affiliations, alongside patient and population representation within the article itself, were collected and collated.

RESULTS

We found that there are 2.5 times more male authors than female authors, and almost three times more male lead authors in the articles evaluated. The majority of journal articles included in the reading lists are written by academics and/or clinicians affiliated with institutions in the United Kingdom and most articles are from the global north. In addition, 65% of articles do not specify the focus patient or population group studied.

DISCUSSION

It is unlikely that current reading lists within dentistry fully reflect the composition of the profession itself, the variety of knowledge needed to provide evidence-based practice in a globalised oral health arena or the heterogeneous nature of the patient population.

Race, Ethnicity, and Other Cultural Background Factors in Trials of Internet-Based Cognitive Behavioral Therapy for Depression: Systematic Review

BACKGROUND

There is a growing interest in developing scalable interventions, including internet-based cognitive behavioral therapy (iCBT), to meet the increasing demand for mental health services. Given the growth in diversity worldwide, it is essential that the clinical trials of iCBT for depression include diverse samples or, at least, report information on the race, ethnicity, or other background indicators of their samples. Unfortunately, the field lacks data on how well diversity is currently reported and represented in the iCBT literature.

OBJECTIVE

Thus, the main objective of this systematic review was to examine the overall reporting of racial and ethnic identities in published clinical trials of iCBT for depression. We also aimed to review the representation of specific racial and ethnic minoritized groups and the inclusion of alternative background indicators such as migration status or country of residence.

METHODS

Studies were included if they were randomized controlled trials in which iCBT was compared to a waiting list, care-as-usual, active control, or another iCBT. The included papers also had to have a focus on acute treatment (eg, 4 weeks to 6 months) of depression, be delivered via the internet on a website or a smartphone app and use guided or unguided self-help. Studies were initially identified from the METAPSY database (n=59) and then extended to include papers up to 2022, with papers retrieved from Embase, PubMed, PsycINFO, and Cochrane (n=3). Risk of bias assessment suggested that reported studies had at least some risk of bias due to use of self-report outcome measures.

RESULTS

A total of 62 iCBT randomized controlled trials representing 17,210 participants are summarized in this study. Out of those 62 papers, only 17 (27%) of the trials reported race, and only 12 (19%) reported ethnicity. Reporting outside of the United States was very poor, with the United States accounting for 15 (88%) out of 17 of studies that reported race and 9 (75%) out of 12 for ethnicity. Out of 3,623 participants whose race was reported in the systematic review, the racial category reported the most was White (n=2716, 74.9%), followed by Asian (n=209, 5.8%) and Black (n=274, 7.6%). Furthermore, only 25 (54%) out of the 46 papers conducted outside of the United States reported other background demographics.

CONCLUSIONS

It is important to note that the underreporting observed in this study does not necessarily indicate an underrepresentation in the actual study population. However, these findings highlight the poor reporting of race and ethnicity in iCBT trials for depression found in the literature. This lack of diversity reporting may have significant implications for the scalability of these interventions.

Strengthening TikTok Content Analysis in Academia Using Follower Count and Engagement

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Representational structures as a unifying framework for attention

Our visual system consciously processes only a subset of the incoming information. Selective attention allows us to prioritize relevant inputs, and can be allocated to features, locations, and objects. Recent advances in feature-based attention suggest that several selection principles are shared across these domains and that many differences between the effects of attention on perceptual processing can be explained by differences in the underlying representational structures. Moving forward, it can thus be useful to assess how attention changes the structure of the representational spaces over which it operates, which include the spatial organization, feature maps, and object-based coding in visual cortex. This will ultimately add to our understanding of how attention changes the flow of visual information processing more broadly.

Modeling Similarity and Psychological Space

Similarity and categorization are fundamental processes in human cognition that help complex organisms make sense of the cacophony of information in their environment. These processes are critical for tasks such as recognizing objects, making decisions, and forming memories. In this review, we provide an overview of the current state of knowledge on similarity and psychological spaces, discussing the theories, methods, and empirical findings that have been generated over the years. Although the concept of similarity has important limitations, it plays a key role in cognitive modeling. The review surfaces three key themes. First, similarity and mental representations are merely two sides of the same coin, existing as a similarity-representation duality that defines a psychological space. Second, both the brain's mental representations and the study of mental representations are made possible by exploiting second-order isomorphism. Third, similarity analysis has near-universal applicability across all levels of cognition, providing a common research language.

Training-Dependent Gradients of Timescales of Neural Dynamics in the Primate Prefrontal Cortex and Their Contributions to Working Memory

Cortical neurons exhibit multiple timescales related to dynamics of spontaneous fluctuations (intrinsic timescales) and response to task events (seasonal timescales) in addition to selectivity to task-relevant signals. These timescales increase systematically across the cortical hierarchy, for example, from parietal to prefrontal and cingulate cortex, pointing to their role in cortical computations. It is currently unknown whether these timescales are inherent properties of neurons and/or depend on training in a specific task and if the latter, how their modulations contribute to task performance. To address these questions, we analyzed single-cell recordings within five subregions of the prefrontal cortex (PFC) of male macaques before and after training on a working-memory task. We found fine-grained but opposite gradients of intrinsic and seasonal timescales that mainly appeared after training. Intrinsic timescales decreased whereas seasonal timescales increased from posterior to anterior subregions within both dorsal and ventral PFC. Moreover, training was accompanied by increases in proportions of neurons that exhibited intrinsic and seasonal timescales. These effects were comparable to the emergence of response selectivity due to training. Finally, task selectivity accompanied opposite neural dynamics such that neurons with task-relevant selectivity exhibited longer intrinsic and shorter seasonal timescales. Notably, neurons with longer intrinsic and shorter seasonal timescales exhibited superior population-level coding, but these advantages extended to the delay period mainly after training. Together, our results provide evidence for plastic, fine-grained gradients of timescales within PFC that can influence both single-cell and population coding, pointing to the importance of these timescales in understanding cognition.

Diversity Among American Dermatological Association Members by Sex and Geographic Region

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'I Am they.' Non-Binary Representation in Television Fiction as a Manifestation of Social Conceptions

This qualitative research uses a case study to observe non-binary representation in TV fiction. The Dan character from the Spanish series HIT (RTVE, 2020-present), who is the first openly non-binary character in Spanish TV fiction, is analyzed through the lens of Queer Media Studies. The research applies a combination of content and discourse analysis. Qualitative content categories include a character's visibility, identity, relevance, embodiment, and social interaction. Discourse analysis categories include character's construction, lexicalization, propositional framing, and focus. Results show that Dan's non-binary depiction revolves around three significant axes: dualism, confusion, and exceptional talent. These axes frame social attitudes toward non-binary people and are composed by a set of features identified in Dan's case which also informs society's mind-sets. These traits are proposed as an analytical-theoretical tool for further analyses of non-binary representation in different cultural contexts. The outcomes of this research may inform audiovisual industries, regulations and academia, and are useful to consolidate non-binary media studies.

Underrepresentation of Women in Reduced Ejection Heart Failure Clinical Trials With Improved Mortality or Hospitalization

BACKGROUND

There are established sex-specific differences in heart failure with reduced ejection fraction (HFrEF) outcomes. Randomized clinical trials (RCTs) based on cardiovascular outcome benefits, typically either reduced cardiovascular mortality or hospitalization for heart failure (HHF), influence current guidelines for therapy.

OBJECTIVES

The authors evaluate the representation of women in HFrEF RCTs that observed reduced all-cause or cardiovascular mortality or HHF.

METHODS

We queried Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica dataBASE, Medical Literature Analysis and Retrieval System Online, and PubMed for HFrEF RCTs that reported a statistically significant benefit of intervention resulting in improved mortality or HHF published from 1980 to 2021. We estimated representation using the participation-to-prevalence ratio (PPR). A PPR of 0.8 to 1.2 was considered representative.

RESULTS

The final analysis included 33 RCTs. Women represented only 23.2% of all enrolled participants (n = 24,366/104,972), ranging from 11.4% to 40.1% per trial. Overall PPR was 0.58, with per-trial PPR estimates ranging from 0.29 to 1.00. Only 5 trials (15.2%) had a PPR of women representative of the disease population. Representation did not change significantly over time. The proportion of women in North American trials was significantly greater than trials conducted in Europe (P = 0.03). The proportion of women was greater in industry trials compared to government-funded trials (P = 0.05).

CONCLUSIONS

Women are underrepresented in HFrEF RCTs that have demonstrated mortality or HHF benefits and influence current guidelines. Representation is key to further delineation of sex-specific differences in major trial results. Sustained efforts are warranted to ensure equitable and appropriate inclusion of women in HFrEF trials.

The power of representation: Statistical analysis of diversity in US Alzheimer's disease genetics data

INTRODUCTION

Alzheimer's disease (AD) is a complex disease influenced by genetics and environment. More than 75 susceptibility loci have been linked to late-onset AD, but most of these loci were discovered in genome-wide association studies (GWAS) exclusive to non-Hispanic White individuals. There are wide disparities in AD risk across racially stratified groups, and while these disparities are not due to genetic differences, underrepresentation in genetic research can further exacerbate and contribute to their persistence. We investigated the racial/ethnic representation of participants in United States (US)-based AD genetics and the statistical implications of current representation.

METHODS

We compared racial/ethnic data of participants from array and sequencing studies in US AD genetics databases, including National Institute on Aging Genetics of Alzheimer's Disease Data Storage Site (NIAGADS) and NIAGADS Data Sharing Service (dssNIAGADS), to AD and related dementia (ADRD) prevalence and mortality. We then simulated the statistical power of these datasets to identify risk variants from non-White populations.

RESULTS

There is insufficient statistical power (probability <80%) to detect single nucleotide polymorphisms (SNPs) with low to moderate effect sizes (odds ratio [OR]<1.5) using array data from Black and Hispanic participants; studies of Asian participants are not powered to detect variants OR <= 2. Using available and projected sequencing data from Black and Hispanic participants, risk variants with OR = 1.2 are detectable at high allele frequencies. Sample sizes remain insufficiently powered to detect these variants in Asian populations.

DISCUSSION

AD genetics datasets are largely representative of US ADRD burden. However, there is a wide discrepancy between proportional representation and statistically meaningful representation. Most variation identified in GWAS of non-Hispanic White individuals have low to moderate effects. Comparable risk variants in non-White populations are not detectable given current sample sizes, which could lead to disparities in future studies and drug development. We urge AD genetics researchers and institutions to continue investing in recruiting diverse participants and use community-based participatory research practices.

Developing a secure base in family intervention: using the adult attachment projective system to assess attachment in family relationships

Families are core to human well-being. Therapeutic intervention may be needed in the context of family disruptions. Attachment theory conceptualizes parents as the secure base and safe haven that support children's optimal development. Parents who have experienced their own attachment difficulties or traumas may not provide quality caregiving necessary for balanced secure parent-child attachment relationships. Following Bowlby's original thinking (1988), an attachment approach to family intervention views the therapist as a secure base that enables families to explore individual and system problems to restore equilibrium. Attachment informed therapy uses attachment theory to understand family functioning. However, the unavailability of valid economical assessment for examining attachment representations has constricted the practical utility of attachment theory in family therapy beyond applications of general concepts. This chapter describes the Adult Attachment Projective Pictures System (AAP) and explores its use as an efficient manner for assessing attachment representations within families that allows therapists to understand problematic interactions, disabling defensive processes, make predictions concerning negative patterns, and create targets for change and restorative intervention. Consolidating three decades of attachment and caregiving system research, we describe how distinct patterns of AAP responses for each adult attachment group map onto expected parenting and family system expectations and behaviors to provide a concise and informative framework. In addition to the traditional adult attachment patterns (Secure, Dismissing, Preoccupied, Unresolved), we describe for the first time expectations for two additional forms of incomplete pathological mourning (Failed Mourning and Preoccupied with Personal Suffering) that have been overlooked in the field.

Representation of autism in fictional media: A systematic review of media content and its impact on viewer knowledge and understanding of autism

LAY ABSTRACT

The way autism is represented in fictional media can impact people's views of autistic people. For example, representations may contribute to negative views of autistic people as being unusual or dangerous, or they may challenge stereotypes and instead highlight the strengths of autistic people. This work aimed to review previous research to understand how autistic people have been represented in fictional media (Part A). It also sought to understand whether viewing fictional portrayals of autism has an impact on people's knowledge of autism and attitudes towards autistic people (Part B). Of 14 studies that were included in Part A, several unhelpful and stereotypical portrayals of autism emerged. Positive portrayals were those that highlighted the strengths of autistic people and reflected nuance. There is a need for greater diversity in representation of autism in fictional media. For example, not all autistic people are white heterosexual males. Across the five studies included in Part B, there were no improvements in people's knowledge of autism after watching or reading a short segment from a fictional TV series or novel that depicts an autistic person. Although there was a significant improvement in people's attitudes towards autistic people, these findings do not provide a complete picture given the short length of the media exposure and small number of studies. Future studies should investigate how multiple exposures to the representation of autistic people in both fictional and non-fictional sources can affect people's understanding of autism. There is also a need to develop more accurate and respectful ways of measuring people's knowledge of, and attitudes towards, autism.

Ensuring Trust in Genomics Research

Reproducibility, transparency, representation, and privacy underpin the trust on genomics research in general and genome-wide association studies (GWAS) in particular. Concerns about these issues can be mitigated by technologies that address privacy protection, quality control, and verifiability of GWAS. However, many of the existing technological solutions have been developed in isolation and may address one aspect of reproducibility, transparency, representation, and privacy of GWAS while unknowingly impacting other aspects. As a consequence, the current patchwork of technological tools only partially and in an overlapping manner address issues with GWAS, sometimes even creating more problems. This paper addresses the progress in a field that creates technological solutions that augment the acceptance and security of population genetic analyses. The text identifies areas that are falling behind in technical implementation or where there is insufficient research. We make the case that a full understanding of the different GWAS settings, technological tools and new research directions can holistically address the requirements for the acceptance of GWAS.

Systematic Review and Meta-analysis: Reporting and Representation of Race/Ethnicity in 310 Randomized Controlled Trials of Attention-Deficit/Hyperactivity Disorder Medications

OBJECTIVE

To evaluate the reporting of race/ethnicity data in randomized controlled trials (RCTs) of attention-deficit/hyperactivity disorder (ADHD) medications. Secondary objectives were to estimate temporal trends in the reporting, and to compare the pooled prevalence of racial/ethnic groups in RCTs conducted in the US to national estimates.

METHOD

We drew on, adapted, and updated the search of a network meta-analysis by Cortese et al. (2018) up to March 2022. We calculated the percentage of RCTs reporting data on race/ethnicity of participants in the published article or in related unpublished material. Temporal trends were estimated with logistic regression. The pooled prevalence of each racial/ethnic group across US RCTs was calculated using random-effects model meta-analyses.

RESULTS

We retained 310 RCTs (including 44,447 participants), of which 231 were conducted in children/adolescents, 78 in adults, and 1 in both. Data on race/ethnicity were reported in 59.3% of the RCTs (75% of which were conducted in children/adolescents and 25% in adults) in the published article, and in unpublished material in an additional 8.7% of the RCTs. Reporting improved over time. In the US RCTs, Asian and White individuals were under- and overrepresented, respectively, compared to national estimates in the most recent time period considered.

CONCLUSION

More than 30% of the RCTs of ADHD medications retained in this review did not include data on race/ethnicity in their published or unpublished reports, and more than 40% in their published articles, even though reporting improved over time. Results should inform investigators, authors, editors, regulators, and study participants in relation to efforts to tackle inequalities in ADHD research.

DIVERSITY & INCLUSION STATEMENT

One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote sex and gender balance in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Three-Dimensional Virtual Reconstructions of Shoulder Movements Using Computed Tomography Images: Model Development

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Skin of Color Is Underrepresented on Instagram: Assessing South Jersey Skin Talk as an Educational Tool to Increase Awareness

Background Instagram, a widely used social media platform with over two billion active users, has the potential to propagate dermatologic health information within the public sphere. However, there is a lack of representation of people of color (POC), making it crucial to share accurate and inclusive posts to increase awareness about dermatologic conditions. It is also necessary to address the misconceptions about skin diseases and other hereditary conditions within various ethnic groups. To combat this, a group of medical students created South Jersey Skin Talk (SJST), an initiative aimed to improve dermatologic health literacy in skin-of-color communities, particularly in underserved areas like Camden County, NJ. Using reliable sources to prevent the spread of misinformation, SJST's accessible Instagram page explains skin conditions, especially emphasizing appearances and manifestations in POC. The hypothesis being investigated by this group is that the implementation of SJST as a community intervention is expected to improve dermatologic health literacy in POC. Methods A 13-question survey was conducted via Qualtrics (Seattle, Washington) and was distributed on social media (Instagram, Facebook, Reddit, Twitter, TikTok, and GroupMe). It remained open for eight weeks during which users 18 years or older were invited to participate. The survey was divided into four sections: demographics, Instagram usage, knowledge of dermatology, and inclusion and diversity on SJST's page. A total of 184 total responses were collected, which were compared using chi-squared analyses on Qualtrics software. Results POC felt less represented on social media compared to White respondents prior to visiting SJST on Instagram (p < 0.00001). However, after viewing SJST, 87.5% of White participants and 88% of POC reported feeling represented on the page. Additionally, both groups of respondents indicated that they felt more knowledgeable about their primary skin concern after viewing the SJST's posts. Furthermore, 86.8% of POC reported that they would feel more confident participating in a conversation with their dermatologist regarding their primary dermatologic concern. Conclusion SJST is a community outreach organization focused on improving health literacy for POC and bridging the gap in healthcare disparities between White and POC populations. The results from this survey confirm the hypothesis and illustrate that community interventions targeted at education for POC increase health literacy and patient autonomy. These results also show that there is a need for more representation and diversity in medical dermatology on social media. Further studies should be done to investigate other disparities affecting adequate representation for POC.

Does Case-Finding for Admission to Aged Care Rapid Investigation and Assessment Unit for Older Patients Improve Hospital Length of Stay? Evaluation of ARIA Unit

Introduction

Many older people present to emergency departments annually, often with complex geriatric syndromes, yet current acute care models and traditional admissions process may under-serve their needs. The multidisciplinary Aged Care Rapid Investigation and Assessment (ARIA) Unit seeks to bridge this gap, by actively identifying and assessing patients.

Methods

A prospective case-control study was undertaken at a single-centre tertiary referral institution. Patients were eligible for inclusion in ARIA group if admitted to ARIA via case-finding by the geriatrician or Aged Care Services Emergency Team, whilst standard geriatric admissions formed the control group. This study evaluates whether ARIA reduced hospital length-of-stay (LOS) and representation rates.

Results

370 patients were included (185 each arm) with similar baseline demographics, frailty scores, and Charlson Comorbidity Indices. Patients admitted to ARIA had significantly shorter hospital LOS than those via standard pathway (3.3 days [IQR2.2-5.8] vs 7.5 days [IQR4.2-13.7], p < 0.00001). There were no significant differences in 90-day representation rates (n = 66 [35.7%] vs n = 64 [34.6%], p = 0.82).

Discussion/Conclusion

Introduction of an ARIA unit with a targeted approach to frontline geriatric services and case-finding is associated with improved LOS of older acute hospital patients. An economical cost analysis of this study would be beneficial in exploring potential financial savings.

Emotion representations in context: maturation and convergence pathways

How does the human brain develop stable emotion representations? According to recent work by Camacho et al., neural representations of contextualized emotional cues are distinct and fairly stable by mid-to-late childhood and activation patterns become increasingly similar between individuals during adolescence. Here, I propose a framework for investigating contextualized emotion processing.

The (cognitive) future of motor control and learning

An ongoing debate exists regarding the compatibility of dynamic systems theory (DST) and symbol processing accounts (SPA), where SPA assume abstract representations and processing. Another aspect under discussion is if either one appropriately describes and explains motor control and the modification of motor skills. Both frameworks have their strengths and weaknesses. DST provides mechanistic explanations and takes system complexity and the environment into account without reference to mental entities. System behaviour is described mathematically and considered deterministic. In contrast, SPA propose that abstract content, that is, mental representations of the (own) body, and task requirements are critically important for movement control. It is argued that neither approach nor an (unaccomplished) unification of these frameworks can achieve a comprehensive understanding of motor control and learning. In this perspective article, it is argued that further effective sources of motor learning, such as emotional support and motivational guidance, have the potential to improve and preserve motor skills indirectly and should, thus, be recognised. Qualitative approaches focussing on understanding the athlete and the situation might be appropriate for applied work.

Task-dependent optimal representations for cerebellar learning

The cerebellar granule cell layer has inspired numerous theoretical models of neural representations that support learned behaviors, beginning with the work of Marr and Albus. In these models, granule cells form a sparse, combinatorial encoding of diverse sensorimotor inputs. Such sparse representations are optimal for learning to discriminate random stimuli. However, recent observations of dense, low-dimensional activity across granule cells have called into question the role of sparse coding in these neurons. Here, we generalize theories of cerebellar learning to determine the optimal granule cell representation for tasks beyond random stimulus discrimination, including continuous input-output transformations as required for smooth motor control. We show that for such tasks, the optimal granule cell representation is substantially denser than predicted by classical theories. Our results provide a general theory of learning in cerebellum-like systems and suggest that optimal cerebellar representations are task-dependent.

The feasibility of identifying health inequalities in social prescribing referrals and declines using primary care patient records

Background

Social prescribing (SP) is part of universal personalised care and available to everyone in the UK National Health Service. However, emerging evidence suggests access disparities in social prescribing. This study aimed to investigate the feasibility of using primary care records to access and analyse data on social prescribing. Our secondary aim was to compare characteristics of patients who are offered referral, referred to or decline referral for social prescribing to explore possible inequalities in access to social prescribing.

Methods

Patient records (n=3086) were extracted from 11 GP practices across Northwest England for accepted, offered and declined social prescribing referrals. Patient demographics collected included sex, age, ethnicity, mental and physical health diagnoses. Patient characteristics in social prescribing referrals were compared to the overall practice population (practice information from Public Health England). Referral and decline rates were compared by group (e.g. male/female decline rates).

Results

GP referral data showed inconsistent recording of wider determinants of health. Patient age, sex and mental and physical health conditions were consistently recorded. Other variables (marital status, interpreter need, education, disability, sexual orientation, non-English language, nationality) were recorded only sporadically and could not be used for analysis. Practices varied in referral patterns. Our preliminary findings identified under-referring of younger age groups and Asians, and higher declined referrals among individuals with physical health diagnoses.

Conclusions

Recording discrepancies meant that many patient factors could not be used to identify trends in social prescribing referrals and declines and assess equity. Primary care data recording must be consistent to understand SP referral trends and inequalities relating to the wider determinants of health. Preliminary results suggest some patient groups may be underrepresented in SP referrals, however this requires further investigation.

Diversity Audit of Medical School Examination Questions

Phenomenon: This article reports the under-researched presentation of demographic, social, and economic diversity in medical school examination questions. Approach: The present study audited 3,566 pre-clinical and clinical multiple-choice and short answer examination questions in the same year (2018) from three medical schools in two continents to review the diversity of patients portrayed. The audit was based on an extension of Critical Race Theory beyond race and ethnicity to include pertinent social determinants of health. Findings: Patients were presented in 1,537 (43.1%) of the audited examination questions. Apart from age (89.4%) and binary genders (93.9%), other diversity characteristics were rarely portrayed (ethnicity 7.2%, relationship status 1.9%, sexual identity 1.1%, socio-economic status 0.5%, geographic residence 0.1%, disability 0.1%), or not at all (non-binary genders; residency status; religion/spirituality). Insights: While presenting excessive and unnecessary patient characteristics in examination questions should be avoided, the absence of many diversity aspects may reduce examination authenticity and defeat the teaching of diversity in medicine. Medical schools should consider a routine audit and reasonable improvement of the diversity features of patients in examination questions to support teaching and learning activities addressing patients' diversity.

Examining Diversity in Digital Therapeutics Clinical Trials: Descriptive Analysis

BACKGROUND

Digital therapeutics (DTx) are an emerging class of software-based medical therapies helping to improve care access and delivery. As we leverage these digital health therapies broadly in clinical care, it is important to consider sociodemographic representation underlying clinical trials data to ensure broad application to all groups.

OBJECTIVE

We review current sociodemographic representation in DTx clinical trials using data from the Digital Therapeutics Alliance Product Library database.

METHODS

We conducted a descriptive analysis of DTx products. We analyzed 15 manuscripts associated with 13 DTx products. Sociodemographic information was retrieved and compared with the US population's demographic distribution.

RESULTS

The median study size and age of participants were 252 and 43.3 years, respectively. Of the 15 studies applicable to this study, 10 (67%) reported that females made up 65% or greater of the study cohort. A total of 14 studies reported race data with Black or African American and Asian American individuals underrepresented in 9 and 11 studies, respectively. In 7 studies that reported ethnicity, Hispanics were underrepresented in all 7 studies. Furthermore, 8 studies reported education levels, with 5 studies reporting populations in which 70% or greater had at least some college education. Only 3 studies reported health insurance information, each reporting a study cohort in which 100% of members were privately insured.

CONCLUSIONS

Our findings indicate opportunities for improved sociodemographic representation in DTx clinical trials, especially for underserved populations typically underrepresented in clinical trials. This review is a step in examining sociodemographic representation in DTx clinical trials to help inform the path forward for DTx development and testing.

Distinct ventral stream and prefrontal cortex representational dynamics during sustained conscious visual perception

Instances of sustained stationary sensory input are ubiquitous. However, previous work focused almost exclusively on transient onset responses. This presents a critical challenge for neural theories of consciousness, which should account for the full temporal extent of experience. To address this question, we use intracranial recordings from ten human patients with epilepsy to view diverse images of multiple durations. We reveal that, in sensory regions, despite dramatic changes in activation magnitude, the distributed representation of categories and exemplars remains sustained and stable. In contrast, in frontoparietal regions, we find transient content representation at stimulus onset. Our results highlight the connection between the anatomical and temporal correlates of experience. To the extent perception is sustained, it may rely on sensory representations and to the extent perception is discrete, centered on perceptual updating, it may rely on frontoparietal representations.

The development of public engagement as a core institutional role for parliaments

Public engagement has become a noticeable activity for parliaments across the world. However, we lack understanding of its role despite considerable developments in scholarly work on public engagement in the sciences and on deliberative and participatory democracy by social scientists. This article provides a framework to understand the significance of parliamentary public engagement and to evaluate its effectiveness. It explains how parliamentary public engagement has emerged because of a representational shift in who is doing the representing in parliament and in what is represented, following key societal changes. We define parliamentary public engagement, showing the importance of differentiating between the activity, its effects and broader democratic ideals. We identify information and education as the types of engagement activity most developed by parliaments, with much still to do in consultation and participation activities. The article finishes with a discussion of seven key challenges in developing and implementing effective institutional parliamentary public engagement practices.

[Pain within the healthcare team, a source of dyscommunication]

The subjective nature and complexity of the pain phenomenon make it a difficult symptom to take into consideration, regardless of where the patient is being cared for, leading to multiple sources of dyscommunication between professionals. Despite the undeniable progress that has been made, this recurring theme has received little attention in the professional literature. It is therefore worthwhile analyzing the causes of these relational problems and proposing avenues of reflection and work that could help remedy them.

Interviews about pandemics and protective measures: studying key informants' representation to develop a web-application for fostering children and adolescents' resilience

COVID-19 pandemic can be defined as a biological disaster whose impact is particularly evident for children and adolescents, vulnerable populations because of their level of cognitive and affective development. For this reason, it is of paramount relevance to develop actions focused on disaster-related prevention and preparedness, including psycho-education. In this study, we aimed at exploring key informants' representation of the pandemic, also to identify the contents for the first two levels of a psycho-educational web-application for children and adolescents, i.e., PandHEMOT® (Pandemics - Helmet for EMOTions). We involved 25 experts with different professional roles through semi-structured interviews about a variety of aspects related to the pandemic. We coded each proposition according to four categories (i.e., Basic knowledge, Procedural knowledge, Safety behaviors, and Consequences). First, a generalized linear mixed model revealed that Safety behaviors was the most frequent category, followed by Consequences, and in turn by Procedural and Basic knowledge. Second, through a cluster analysis we identified three clusters corresponding to different response patterns and pandemic representations. Third, we conducted a thematic analysis to select the items to be inserted in the first and second level of PandHEMOT®, focused on the nature of pandemics and pandemic-related protective measures. Notwithstanding the limitations related to the small sample, this research permitted to explore the representation of different experts concerning the COVID-19 pandemic. Also, these findings enabled to identify the contents for the initial levels of a web-application designed for increasing children and adolescents' knowledge on pandemics, emotions, and coping strategies. This initiative can be an example of a psycho-educational tool to enhance young people's disaster-related resilience.

Police of the psyche: the psychiatrist and psychiatry in Spanish punk songs

Previous research has revealed that stigma is not restricted to people with mental health problems but extends to the professionals involved in their care and treatment. Unlike other artistic manifestations, the study of the depictions of psychiatry in popular music is still a less-explored topic. This article addresses the subcultural portrayals of the psychiatrist and psychiatric treatments within Spanish popular music. The predominance of negative depictions of mental health professionals as social control agents was a striking finding, given the topicality that characterises punk music. It is suggested that the allegorical role assigned to the psychiatrist in such a specific narrative framework, marked by ideological factors, could potentially explain these findings. In contrast to other cultural manifestations that show a tendency towards more balanced views of psychiatric treatment and practice, the negative representations in Spanish punk songs seem to have evolved little over decades, reflecting outdated views of the psychiatric approach.

A personal reflection upon navigating into a senior academic role

There are 22,795 University professors in the UK, where 6,340 are women and only 40 are Black women, whilst Asian women are a few more in number. This clearly demonstrates the uncommon narrative of the under-representation of Black minority ethnic (BME) academics in higher education (HE) which has been written about in detail. In contrast, it is rare to read reports on initiatives to successfully navigate senior academic posts. In this article, I will describe two initiatives that I have developed and organized to successfully navigate senior BME academic posts, which have impacted my journey. The first initiative was to understand why postdoctoral researchers were "post-docing" for years, having not been successful in making the transition to lecturers. What was hindering the transition? I was one of them, and some of my female peers as well, who incidentally left HE. I was determined not to leave. I again thought about how to tackle it. It is a known fact that hearing successful BME people experiences and journeys and also understanding how they navigated HE can be powerful. In addition, empowering oneself with additional skills including mentoring, networking, applying for positions, not excluding ourselves due to the lack of confidence, and finally, the importance of having a work-life balance is important as health is wealth. I used this to put together the BME Early Career Researcher (ECR) conference-How to Stay in Academia. After 6 years, it is still going strong. In this article, I will share the impact made over the years which will include testimonies and promotions, including my recent promotion to an associate professor. The second initiative was to understand the barriers and challenges of senior lecturers being promoted to readers and professors. Having successfully transitioned to a lecturer, being overlooked for promotion was now an issue. The project was conducted in 2016/17 at KCL as part of the action plans that needed to be delivered having been a recipient of the Bronze Race Equality Charter Mark. I was provided with a cohort of 51 names of BME staff from different disciplines and was directed to see how I would engage them to hear their experiences. My first concern was that the staff would have engaged in previous initiatives with little or no benefits to them; however, this did not deter me. I thought of the best approach which commenced with a phone interview and then followed up with a focus group, ending with an informal conversation with the Principal of the University. Within 6 months, a BME male was promoted to professor. After a year, both genders were promoted to associate professors (readers) and professors, and to date, I am aware of at least 10 promotions. In both examples, I will demonstrate the support from our allies, some of whom are senior leaders that have openly supported us in our journey. This article will demonstrate a slight shift in the narrative, but a lot more needs to be done, and I am convinced the time is right to start pushing for more. This special issue is an example.

Widespread partisan gerrymandering mostly cancels nationally, but reduces electoral competition

Congressional district lines in many US states are drawn by partisan actors, raising concerns about gerrymandering. To separate the partisan effects of redistricting from the effects of other factors including geography and redistricting rules, we compare possible party compositions of the US House under the enacted plan to those under a set of alternative simulated plans that serve as a nonpartisan baseline. We find that partisan gerrymandering is widespread in the 2020 redistricting cycle, but most of the electoral bias it creates cancels at the national level, giving Republicans two additional seats on average. Geography and redistricting rules separately contribute a moderate pro-Republican bias. Finally, we find that partisan gerrymandering reduces electoral competition and makes the partisan composition of the US House less responsive to shifts in the national vote.