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Introduction: The employment landscape for multiply marginalized people with disabilities presents significant challenges, exacerbated by intersecting identities such as race/ethnicity, sexual orientation, gender identity, poverty, and geography. Recent studies highlight the compounded employment disparities faced by this group, including discriminatory hiring practices, inadequate accommodations, and uneven gains in employment during the COVID-19 public health emergency. Methods: Our study employed a three-round Delphi process with 20 diverse experts across 14 states across the United States (U.S.) to formulate recommendations for improving employment experiences for multiply marginalized people with disabilities. The panel's insights were gathered through surveys administered online, with each round designed to refine the collective recommendations. This iterative process aimed to build a consensus on the most effective policy and practice recommendations for improving employment outcomes within this population. Results: The Delphi study identified key areas for strategic focus, including emergency preparedness, education and training, transportation, assistive technology, workplace accommodations, and combating discrimination and stigma. Notable recommendations included improving emergency preparedness training, enhancing employment education, increasing funding for accessible transportation and assistive technology, and promoting inclusive hiring practices. The study also emphasized the need for policies supporting telework and simplifying disability-related benefits. Discussion: The findings highlight the critical role of tailored strategies to address employment challenges faced by people with disabilities from marginalized communities. Meaningfully and fully implementing these recommendations would create a more inclusive environment that improves employment outcomes for multiply marginalized people with disabilities.

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PURPOSE: The diversity of authors in orthopaedic literature is fundamental to the distribution of unique discoveries, innovations, and advancements. The purpose of the current study was to create and validate a comprehensive Author Diversity Scoring System (ADSS) to quantify authorship diversity in orthopaedic manuscripts. METHODS: Six items were included in the initial ADSS. The ADSS and associated survey were sent to 120 experts to evaluate the clarity, simplicity, and relevancy its components. Responses were used to validate the ADSS using Content Validity Ratio (CVR) and Content Validity Index (CVI). RESULTS: The initial ADSS contained author gender, ethnicity, academic rank/title, country of origin of the article, affiliated institution, and the publication history of the senior/corresponding author as representative items. Subsequently, 21 experts completed the survey (response rate 17.5%). Following validation, the final ADSS included author gender, ethnicity, and region of article origin, scored cumulatively on a 0-30 point scale with increasing scores indicating greater author diversity. CONCLUSION: The validated ADSS scoring system quantitatively assesses manuscript author diversity.

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BACKGROUND: Multiple sclerosis (MS) is a neurological condition leading to significant disability and challenges to quality of life. To slow progression and reduce relapses, it is critical to rapidly initiate disease-modifying therapy (DMT) after diagnosis. Patient demographics may play a role in timely DMT initiation. Financial barriers may also result in delays in DMT access. METHODS: This retrospective, single-center, cross-sectional study included patients seen at a neurology clinic at a large academic medical center for an initial evaluation of MS between January 1, 2022, and June 30, 2022. As an indicator of the quality of care, the primary study outcome was whether patients were offered DMT initiation on their first clinic visit. Secondary outcomes evaluated the time to DMT initiation, including differences in care based on demographic factors and financial coverage. RESULTS: Of the 49 eligible individuals studied, 45 (91.8%) were offered DMT at their initial MS visit. Descriptive statistics appeared to demonstrate that demographic factors did not impact whether DMT was offered. However, the majority of patients experienced access barriers relating to prior authorization requirements (80.0%) and/or the need for co-pay assistance (52.0%). CONCLUSIONS: DMT was appropriately offered to a majority of patients at their initial MS visit, regardless of demographic considerations. No offer of DMT and delays in initiation were primarily due to the need for imaging and specialty referrals, as well as financial barriers. Medication assistance teams may play a crucial role in limiting delays and financial hurdles associated with insurance coverage and co-pay assistance.

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Access to independent research experiences is a persistent barrier that stifles the recruitment and retention of students from diverse backgrounds in ecology, evolution, and behavioral biology. The benefits of field experiences are not equitably available to historically excluded and minoritized students. In this article, we summarize evidence that indicates course-based undergraduate research experiences (CUREs) provide a solution to ensure equitable access to independent research experiences in the life sciences. We draw from our own experiences of teaching CUREs in ecology, evolution, and behavioral biology and provide the complete curriculum for our effective and largely materials-free CURE in behavioral ecology (CURE-BxEco). We advocate for greater access to and synthesize the benefits of CUREs to promote inclusivity in education. The proliferation of such innovative pedagogical practices benefits science because these classroom methods are critical in recruiting and retaining historically excluded and minoritized students, who offer diverse perspectives in research.

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Equity, diversity, and inclusion (EDI) and anti-oppression (AO) policies are implemented in research to address intersecting systemic barriers for marginalized populations. Grant applications now include questions about EDI to ensure researchers have considered how research designs perpetuate discriminatory practices. However, complying with these measures may not mean that researchers have engaged with AO as praxis. Three central points emerged from our work as a women's research collective committed to embedding AO practices within the research methodology of our community-based study. First, research ideas must be connected to larger pursuits of AO in and across marginalized communities. Secondly, AO as praxis in the research design is an exercise in centering cultural knowledge and pragmatic research preparation and response that honours the collective. Lastly, AO approaches are not prescriptive. They must shift, adapt, and change based on the research project and team, creating space for transformative resistance and emancipation of racialized researchers and community workers.

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Positive and inclusive mentoring of undergraduate research students, particularly of students from historically underrepresented groups is critical. The Advancing Inclusive Mentoring (AIM) program was developed to share inclusive mentoring practices with mentors at undergraduate-focused campuses and was assessed across five minority-serving universities. Self-ratings of mentorship skill as very- and exceptionally developed increased by 58% after AIM completion, and 93% of participants indicated they were likely to change their mentoring following AIM. While 93% of mentors rated the AIM program as beneficial, and 88% found most or all six modules pertinent to their mentoring, campus variations existed in perceived benefit (87%-100%) and pertinence (80-97%). These results suggest that AIM is effective training for mentors of undergraduate researchers, including those from historically underrepresented groups.

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Obstetrics and gynecology hospitalists play a vital role in reducing maternal morbidity and mortality by providing immediate access to obstetric care, especially in emergencies. Their presence in hospitals ensures timely interventions and expert management, contributing to better outcomes for mothers and babies. This proactive approach can extend beyond hospital walls through education, advocacy, and community outreach initiatives aimed at improving maternal health across diverse settings.

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BACKGROUND: The underrepresentation of women in leadership remains a pervasive issue, prompting a critical examination of support mechanisms within professional settings. Previous studies have identified challenges women face, ranging from limited visibility to barriers to career advancement. This survey aims to investigate perceptions regarding the effectiveness of women's leadership programs, mentoring initiatives, and a specialized communication course. Particularly it specifically targets addressing the challenges encountered by professional women. METHODS: This multi-center, observational, international online survey was developed in partnership between ESICM NEXT and the ESICM Diversity and Inclusiveness Monitoring Group for Healthcare. Invitations to participate were distributed to both females and men through emails and social networks. Data were collected from April 1, 2023, through October 1, 2023. RESULTS: Out of 354 respondents, 90 were men (25.42%) and 264 were women (74.58%). Among them, 251 completed the survey, shedding light on the persistent challenges faced by women in leadership roles, with 10%-50% of respondents holding such positions. Women's assertiveness is viewed differently, with 65% recognizing barriers such as harassment. Nearly half of the respondent's experience interruptions in meetings. Only 47.4% receiving conference invitations, with just over half accepting them. A mere 12% spoke at ESICM conferences in the last three years, receiving limited support from directors and colleagues, indicating varied obstacles for female professionals. Encouraging family participation, reducing fees, providing childcare, and offering economic support can enhance conference involvement. Despite 55% applying for ESICM positions, barriers like mobbing, harassment, lack of financial support, childcare, and language barriers were reported. Only 14% had access to paid family leave, while 32% benefited from subsidized childcare. Participation in the Effective Communication Course on Career Advancement Goals and engagement in women's leadership and mentoring programs could offer valuable insights and growth opportunities. Collaborating with Human Resources and leadership allies is crucial for overcoming barriers and promoting women's career growth. CONCLUSIONS: The urgency of addressing identified barriers to female leadership in intensive care medicine is underscored by the survey's comprehensive insights. A multifaceted and intersectional approach, considering sexism, structural barriers, and targeted strategies, is essential.

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BACKGROUND: Inclusion in public health research of young people from low-income households and those from minority ethnic groups remains low. It is recognised that there is a need to change the way in which research is conducted so that it becomes more inclusive. The aim of this work was to identify novel and innovative ways to maximise recruitment and inclusion of diverse participants when doing co-production within very short time frames for emergency responses. METHOD: We conducted interviews with young people from low-income and minority ethnic backgrounds, and members or leaders of groups or organisations supporting or representing young people from underserved communities. RESULTS: A total of 42 participants took part in an interview. This included 30 young people from low income or minority ethnic backgrounds and 12 community leaders/service providers. Of the 30 young people, 26 participants identified as female and 12 participants identified as being from a minority ethnic background. Participants discussed a number of interrelated barriers to research involvement and identified ways in which barriers may be reduced. Prejudice and discrimination experienced by young people from underserved communities has led to substantial mistrust of educational and governmental establishments. Rigid and unfamiliar research practices further limit the involvement of young people. Four themes were identified as ways of supporting involvement, including: making opportunities available for young people, adaptations to research governance, understanding and acknowledging challenges faced by young people, and ensuring reciprocal benefits. CONCLUSION: This research explored barriers to engagement in rapid public health co-production. Working with communities to co-produce rapid recruitment and research procedures to suit the needs and the context in which young people live is necessary.

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OBJECTIVES: To investigate potential demographic bias in artificial intelligence (AI)-based simulations of otolaryngology, residency selection committee (RSC) members tasked with selecting one applicant among candidates with varied racial, gender, and sexual orientations. METHODS: This study employed random sampling of simulated RSC member decisions using a novel Application Programming Interface (API) to virtually connect to OpenAI's Generative Pre-Trained Transformers (GPT-4 and GPT-4o). Simulated RSC members with diverse demographics were tasked with ranking to match 1 applicant among 10 with varied racial, gender, and sexual orientations. All applicants had identical qualifications; only demographics of the applicants and RSC members were varied for each simulation. Each RSC simulation ran 1000 times. Chi-square tests analyzed differences across categorical variables. GPT-4o simulations additionally requested a rationale for each decision. RESULTS: Simulated RSCs consistently showed racial, gender, and sexual orientation bias. Most applicant pairwise comparisons showed statistical significance (p < 0.05). White and Black RSCs exhibited greatest preference for applicants sharing their own demographic characteristics, favoring White and Black female applicants, respectively, over others (all pairwise p < 0.001). Asian male applicants consistently received lowest selection rates. Male RSCs favored White male and female applicants, while female RSCs preferred LGBTQIA+, White and Black female applicants (all p < 0.05). High socioeconomic status (SES) RSCs favored White female and LGBTQIA+ applicants, while low SES RSCs favored Black female and LGBTQIA+ applicants over others (all p < 0.001). Results from the newest iteration of the LLM, ChatGPT-4o, indicated evolved selection preferences favoring Black female and LGBTQIA+ applicants across all RSCs, with the rationale of prioritizing inclusivity given in >95% of such decisions. CONCLUSION: Utilizing publicly available LLMs to aid in otolaryngology residency selection may introduce significant racial, gender, and sexual orientation bias. Potential for significant and evolving LLM bias should be appreciated and minimized to promote a diverse and representative field of future otolaryngologists in alignment with current workforce data. LEVEL OF EVIDENCE: N/A Laryngoscope, 2024.

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Interventions that aim to address equity, diversity, and inclusion (EDI) within the health professions often strive to promote the retention, recruitment, and success of individuals from historically underrepresented groups, who often belong to the same groups experiencing underservicing in health care. A pilot study aimed to examine the impact of ongoing EDI initiatives at Dalhousie University in Nova Scotia, Canada by exploring sense of belonging and curricular inclusion/representation from the perspectives of enrolled students. Intersectionality Theory was operationalized by way of considering the relational and contextual nature of marginalization. Results showed differences in perceptions of impacted sense of belonging and curricular inclusion/representation of diverse groups between respondents in the underrepresented subgroup as compared to their overrepresented counterparts. Differences in underrepresented and overrepresented subgroups' perceptions of impacted sense of belonging and curricular inclusion/representation suggest a need for further research to better understand the impact of EDI interventions on nursing students.

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We address the ethical implications of training and becoming family therapists in the United States when considering the colonial control and management of knowledge by the westernized institutionalized university. We do so decolonially. Through the work of decolonial thinkers, doers, and sensers, we center our discussion on the heteropatriarchal Eurocentric institutionalization of knowledge linked to the development and sustainability of structures of family therapy training through racialization and monetization. We discuss a decolonial understanding of race in relation to the liberalized politics of diversity, equity, and inclusion and upward mobility of family therapy education. Most importantly, we reflect upon the possibilities of reexistence within family therapy, fissuring the colonial structures of training tuition-based family therapists. We locate those possibilities through practices of crack-making, epistemic insurgence, and mischief. Our discussions and reflections are developed throughout by thinking, sensing, and speaking decolonially, storying our racialized incarnated lives from the saberes, ज्ञान, rhythms, vapors, or tastes of our communities, displaced by the European cannon. We embrace a decolonial pedagogy of learning without teaching, positioning family therapy education as a site for sociopolitical struggle and action toward possibilities of reexistence.

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Watching movies is among the most popular entertainment and cultural activities. How do viewers react when a movie sequel increases racial minority actors in the main cast ("minority increase")? On the one hand, such sequels may receive better evaluations if viewers appreciate racially inclusive casting for its novel elements (the value-in-diversity perspective) and moral appeal (the fairness perspective on diversity). On the other hand, discrimination research suggests that if viewers harbor biases against racial minorities, sequels with minority increase may receive worse evaluations. To examine these competing possibilities, we analyze a unique panel dataset of movie series released from 1998 to 2021 and conduct text analysis of 312,457 reviews of these movies. Consistent with discrimination research, we find that movies with minority increase receive lower ratings and more toxic reviews. Importantly, these effects weaken after the advent of the Black Lives Matter (BLM) movement, especially when the movement's intensity is high. These results are reliable across various robustness checks (e.g., propensity score matching, random implementation test). We conceptually replicate the bias mitigation effect of BLM in a preregistered experiment: Heightening the salience of BLM increases White individuals' acceptance of racial minority increase in a movie sequel. This research demonstrates the power of social movements in fostering diversity, equality, and inclusion.

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BACKGROUND: The set-up, activation, and delivery of clinical trials is pivotal for the advancement of medical science, serving as the primary mechanism through which new therapeutic interventions are validated for clinical use. Despite their critical role, the execution of these trials is often encumbered by a multitude of challenges. The North West London Clinical Trials Alliance (The Alliance) was established to address these complexities. It aims to bridge the gap between emerging scientific research and its clinical application through strategic collaborations among healthcare and research entities, thereby enhancing the regional ecosystem for clinical trials. MAIN TEXT: This commentary aims to offer clarity on the fundamental insights that underlie The Alliance, providing a comprehensive understanding of its operational structure and the ecosystem it has fostered to optimise clinical trial delivery and revenue generation. The strategy employed by The Alliance centres on the cultivation of strategic partnerships across a broad spectrum of stakeholders. This approach addresses key operational challenges in clinical trial management, facilitating improvements in the development, setup, activation, and recruitment stages. Notably, The Alliance has reduced the average time to initiate trials to 19 days, compared to the standard 75 days typically observed for commercial setups in North West London. The effectiveness of The Alliance's framework was notably demonstrated during the COVID-19 pandemic, particularly with the expedited recruitment performance in the Janssen COVID-19 vaccine study conducted at Charing Cross Hospital. This instance highlighted the Alliance's capability to meet and exceed recruitment targets promptly while maintaining diversity within study cohorts. Additionally, The Alliance has effectively harnessed digital technology and infrastructure, enhancing its attractiveness to commercially funded studies and illustrating a sustainable model for clinical trial financing and execution. CONCLUSION: The North West London Clinical Trials Alliance represents a strategic response to the conventional challenges faced in clinical trial management, emphasising the importance of cross-sectoral collaboration and resource optimisation. Its efforts, particularly highlighted by its response to the COVID-19 pandemic, provide a case study in enhancing trial delivery and efficiency with significant implications for both regional and global clinical trials research communities.

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Recruiting and retaining a diverse veterinary team requires intentionality. Without it, diversity initiatives often fall by the wayside. Implicit and explicit biases can occur at every stage of recruiting. To prevent them from disenfranchising candidates from historically devalued groups, it is important to enact best practices and policies. To prevent attrition, the work environment must be meticulously audited and primed to receive candidates from different backgrounds. Diverse teams outperform homogenous teams, but to unlock all the benefits of diversity, the work environment must be inclusive and have diverse leadership.

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OBJECTIVE: To identify LGBTQ+ diversity, equity, and inclusion (DEI) publications and contextualize the current frequency of the literature across subspecialty surgical fields. METHODS: A PRISMA systematic review using PubMed, MEDLINE, and Web of Science was conducted in April 2024. The main inclusion criterion was intrafield DEI content for defined subspecialties; exclusion criteria were foreign language, poor methodology, and duplicates. The primary endpoint was the number of publications across subspecialties. Secondary endpoints included publication dates, study design, and sample size. RESULTS: Of the 702 articles identified, 27 were included in the analysis. Neurologic surgery had 2 studies; plastic surgery, 11 studies; orthopedic surgery, 7 studies; otolaryngology, 5 studies; and thoracic surgery, 2 studies. There was a statistically significant different frequency of publications across subspecialties (P = 0.031). Post hoc residual analysis indicated that neurosurgery and thoracic surgery had statistically fewer publications, while plastic surgery had statistically more publications (P = 0.04, 0.002, 0.21, 0.42, and 0.04 for neurologic surgery, plastic surgery, orthopedic surgery, otolaryngology, and thoracic surgery, respectively). Secondary outcomes found a majority of publications between 2022 and 2024. Study methodologies involved cross-sectional studies, editorials, and retrospective reviews (14, 11, and 3 respectively) and had a median sample size of 248.5. CONCLUSIONS: This systematic review provides objective data to contextualize DEI literature across surgical subspecialties. Overall, this review highlights the lack of LGBTQ+ DEI literature in neurosurgery and advocates for correcting this gap for the benefit of both surgeons and patients. Understanding the current numbers and evaluating progress in other surgical fields might provide solutions.

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BACKGROUND: The COVID-19 pandemic significantly transformed the landscape of work and collaboration, impacting design research methodologies and techniques. Co-design approaches have been both negatively and positively affected by the pandemic, prompting a need to investigate and understand the extent of these impacts, changes, and adaptations, specifically in the health sector. Despite the challenges that the pandemic imposed on conducting co-design and related projects, it also encouraged a re-evaluation of co-design practices, leading to innovative solutions and techniques. Designers and researchers have explored alternative ways to engage stakeholders and end users, leveraging digital workshops and participatory digital platforms. These adaptations have the potential to enhance inclusivity, allowing for a wider range of individuals to contribute their perspectives and insights through co-design and thus contribute to healthcare change. OBJECTIVE: This study aims to explore the impacts of the pandemic on co-design and related practices, focusing on co-design practices in healthcare that have been gained, adapted, or enhanced, with a specific focus on issues of equity, diversity, and inclusion. METHODS: The study uses a realist synthesis methodology to identify and analyze the effects of the pandemic on co-design approaches in health, drawing on a range of sources including first-person experiences, gray literature, and academic literature. A community of practice in co-design in health will be engaged to support this process. RESULTS: By examining the experiences and insights of professionals, practitioners, and communities who were actively involved in co-design and have navigated the challenges and opportunities of the pandemic, we can gain a deeper understanding of the strategies, tools, and techniques that have facilitated effective co-design during the pandemic, contributing to building resilience and capacity in co-design in health beyond the pandemic. CONCLUSIONS: By involving community partners, community of practice (research), and design practitioners, we expect closer proximity to practice with capacity building occurring through the realist process, thus enabling rapid adoption and refinement of new techniques or insights that emerge. Ultimately, this research will contribute to the advancement of co-design methodologies and inform the future of co-design in health. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/58318.

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Older employees often face discrimination and exclusion from work teams. In two scenario studies, we tested the impact of age diversity statements on the representation and inclusion of older employees in teams. In Study 1 (N = 304), participants had to create a team and were either exposed to a diversity statement or not before selecting two teammates from a list of four differing in age and gender. Then, we measured participants' inclusive behavioral intentions towards a new, older member joining this team. Age diversity statements increased the representation but not the inclusion of older individuals in teams. In Study 2 (N = 518), we further manipulated the content of the statement (diversity or diversity and inclusion) and the organizational motive (reputation or change). We replicated the effects of diversity statements on representation. Moreover, statements also increased certain inclusive behaviors, but only when they targeted diversity and inclusion and reflected an organizational commitment to change. Taken together, these results suggest that age diversity statements foster diversity, yet fail to systematically increase inclusion.