Overestimating women's representation in medicine: a survey of medical professionals' estimates and their(un)willingness to support gender equality initiatives.

OBJECTIVE: Amidst growing numbers of women in certain areas of medicine (eg, general practice/primary care), yet their continued under-representation in others (eg, surgical specialties), this study examines (1) whether medical professionals mistakenly infer that women are now broadly well represented, overestimating women's true representation in several different areas and roles; and (2) whether this overestimation of women's representation predicts decreased support for gender equality initiatives in the field, in conjunction with one's own gender. DESIGN: Cross-sectional survey. SETTING: UK-based medical field. PARTICIPANTS: 425 UK medical consultants/general practitioners and trainees (ST/CT1+/SHO/Registrar); 47% were female. MAIN OUTCOME MEASURES: Estimates of women's representation in different areas/roles within medicine, examined as a composite estimate and individually; and a multi-item measure of support for gender-based initiatives in medicine. RESULTS: Medical professionals tended to overestimate women's true representation in several different areas of medicine (general practice, medical specialties, surgical specialties) and in various roles (consultants/general practitioners, trainees, medical school graduates). Moreover, these erroneous estimates predicted a decreased willingness to support gender-based initiatives, particularly among men in the field: composite overestimation*respondent gender interaction, B=-0.04, 95% CI -0.07 to -0.01, p=0.01. Specifically, while female respondents' (over)estimates were unrelated to their level of support (B=0.00, 95% CI -0.02 to 0.02, p=0.92), male respondents' tendency to overestimate the proportion of women in medicine predicted lower support for gender-based initiatives (B=-0.04, 95% CI -0.06 to -0.02, p<0.001). CONCLUSIONS: While some progress has been made in gender representation in the medical field, this research illustrates that there are still barriers to gender equality efforts and identifies who within the field is focally maintaining these barriers. It is those individuals (particularly men) who overestimate the true progress that has been made in women's representation who are at highest risk of undermining it.

Impact of Randomized Controlled Trials in the Social Media: Does Science Trend As Much As Everyday Events?

BACKGROUND: The approach to the scientific literature is evolving. Currently, dissemination of articles happens in real time through social media (SoMe) channels, and little is known about its impact in medicine. The aim of this study was to investigate if SoMe dissemination followed trends independent from articles type and content. METHODS: First, the SoMe engagement of a popular theme (#BlackFriday) and a relevant theme (#ClimateChange) was compared using a SoMe analytic tool to test if the popular theme would reach more engagement. In a second analysis, themes in colorectal surgery in the SoMe community were explored. Altmetric Explorer was searched for the term "colorectal surgery" and the outputs were categorized into 'randomized controlled trials' (RCTs) and 'other studies'. Subgroups were compared for the Altmetric scores using statistical analyses. RESULTS: The analytic tool documented that #BlackFriday outnumbered #ClimateChange in mentions and engagement (1.6 million vs 127.000 mentions). Following, Altmetric Explorer identified 1381 articles, including 92 RCTs (7.1%). Overall, 25,554 mentions were documented from 1205 outputs (97.0% by Twitter). A greater percentage of "other studies" ranked in the lower Altmetric score categories (p = 0.0007). Similarly, the median Altmetric score was higher in the RCT subgroup comparing with "other studies" (6.5 vs. 2.0, Mann-Whitney p = 0.0001). CONCLUSIONS: In this study, RCTs represented just the 7.1% of the studies and produced 11% of Twitter outputs. The median Altmetric scores obtained by RCTs were higher than those of other studies.

Choosing the new normal for surgical education using alternative platforms.

The traditional methods for surgical education and professional development are changing, from a variety of external factors. The COVID-19 pandemic accelerated the pace innovative alternative tools are introduced into clinical practice, creating a new normal for teaching and training. In this new normal is the challenge to create durable changes for the future of surgical education. Social media (SoMe), a tool that uses electronic communications and applications to allow users create and share information in dynamic ways, can meet this challenge. SoMe is reshaping how we communicate and learn, and offers great benefits for effective, individualized surgical education. The limits for SoMe appear endless, and elements have already help establish digital surgery to help improve the precision and outcomes of surgery. As we work to define the new normal in surgical education and professional development, SoMe digital surgery will be critical for continued growth and progress.

Reduced Renal Methylarginine Metabolism Protects against Progressive Kidney Damage.

Nitric oxide (NO) production is diminished in many patients with cardiovascular and renal disease. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of NO synthesis, and elevated plasma levels of ADMA are associated with poor outcomes. Dimethylarginine dimethylaminohydrolase-1 (DDAH1) is a methylarginine-metabolizing enzyme that reduces ADMA levels. We reported previously that a DDAH1 gene variant associated with increased renal DDAH1 mRNA transcription and lower plasma ADMA levels, but counterintuitively, a steeper rate of renal function decline. Here, we test the hypothesis that reduced renal-specific ADMA metabolism protects against progressive renal damage. Renal DDAH1 is expressed predominately within the proximal tubule. A novel proximal tubule-specific Ddah1 knockout (Ddah1(PT-/-)) mouse demonstrated tubular cell accumulation of ADMA and lower NO concentrations, but unaltered plasma ADMA concentrations. Ddah1(PT-/-) mice were protected from reduced kidney tissue mass, collagen deposition, and profibrotic cytokine expression in two independent renal injury models: folate nephropathy and unilateral ureteric obstruction. Furthermore, a study of two independent kidney transplant cohorts revealed higher levels of human renal allograft methylarginine-metabolizing enzyme gene expression associated with steeper function decline. We also report an association among DDAH1 expression, NO activity, and uromodulin expression supported by data from both animal and human studies, raising the possibility that kidney DDAH1 expression exacerbates renal injury through uromodulin-related mechanisms. Together, these data demonstrate that reduced renal tubular ADMA metabolism protects against progressive kidney function decline. Thus, circulating ADMA may be an imprecise marker of renal methylarginine metabolism, and therapeutic ADMA reduction may even be deleterious to kidney function.

Experimental models of renal disease and the cardiovascular system.

Cardiovascular disease is a leading cause of death among patients with end stage renal failure. Animal models have played a crucial role in teasing apart the complex pathological processes involved. This review discusses the principles of using animal models, the history of their use in the study of renal hypertension, the controversies arising from experimental models of non-hypertensive uraemic cardiomyopathy and the lessons learned from these models, and highlights important areas of future research in this field, including de novo cardiomyopathy secondary to renal transplantation.