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Key PointsHealth Implications of Climate Change and Extreme HeatHeat waves are increasing in frequency, duration, and intensity and are already a substantial threat to human health.Health risks from heat include cardiovascular events, respiratory conditions, kidney disease, adverse pregnancy outcomes, increased anxiety and depression, increased suicidality, and aggressive behavior and violence.Heat exposure is a serious health threat in terms of both the level of heat and the increase from the historical temperature baseline.Multisectoral research is needed to better understand direct and indirect health consequences of a warmer world, with increased heat extremes, and to identify effective strategies for improving resilience.Particular attention is needed to develop effective strategies for adaptation among those at highest risk, such as older populations, members of marginalized racial or ethnic groups, persons with low socioeconomic status, and those with coexisting conditions.

Burnout and Depression among PhysiciansDiminished well-being among physicians is of growing concern. The authors review measures of burnout and depression, causal factors, and interventions to improve well-being.

In response to the new U.S. Supreme Court ban on race-conscious admissions, medical schools have an opportunity to refocus on affirmative action’s original vision.

Adjustment for race is discouraged in lung-function testing, but the implications of adopting race-neutral equations have not been comprehensively quantified. We obtained longitudinal data from 369,077 participants in the National Health and Nutrition Examination Survey, U.K. Biobank, the Multi-Ethnic Study of Atherosclerosis, and the Organ Procurement and Transplantation Network. Using these data, we compared the race-based 2012 Global Lung Function Initiative (GLI-2012) equations with race-neutral equations introduced in 2022 (GLI-Global). Evaluated outcomes included national projections of clinical, occupational, and financial reclassifications; individual lung-allocation scores for transplantation priority; and concordance statistics (C statistics) for clinical prediction tasks. Among the 249 million persons in the United States between 6 and 79 years of age who are able to produce high-quality spirometric results, the use of GLI-Global equations may reclassify ventilatory impairment for 12.5 million persons, medical impairment ratings for 8.16 million, occupational eligibility for 2.28 million, grading of chronic obstructive pulmonary disease for 2.05 million, and military disability compensation for 413,000. These potential changes differed according to race; for example, classifications of nonobstructive ventilatory impairment may change dramatically, increasing 141% (95% confidence interval [CI], 113 to 169) among Black persons and decreasing 69% (95% CI, 63 to 74) among White persons. Annual disability payments may increase by more than $1 billion among Black veterans and decrease by $0.5 billion among White veterans. GLI-2012 and GLI-Global equations had similar discriminative accuracy with regard to respiratory symptoms, health care utilization, new-onset disease, death from any cause, death related to respiratory disease, and death among persons on a transplant waiting list, with differences in C statistics ranging from -0.008 to 0.011. The use of race-based and race-neutral equations generated similarly accurate predictions of respiratory outcomes but assigned different disease classifications, occupational eligibility, and disability compensation for millions of persons, with effects diverging according to race. (Funded by the National Heart Lung and Blood Institute and the National Institute of Environmental Health Sciences.).

The Social Determinants of HealthAs we increasingly recognize the profound effects of social determinants of health, clinicians and health systems should understand the unique power they hold with regard to social care.

Equity, diversity, and inclusion (EDI) are social constructs which when used in clinical trials, or clinical research broadly help generate the highest quality evidence for interventions in the populations most likely to benefit. However, the incorporation of these constructs is unclear and inconsistent. This scoping review sought to understand how EDI is applied in clinical trials with broader application across clinical research. We reviewed literature from PubMed and Google Scholar, selecting studies 1) published from 2000 to 2023, 2) literature which described concepts, tools, metrics, or frameworks, and 3) provided information on conceptualization, operationalization (measuring) or utilization (analyzing). Additionally, internet searches were conducted to identify websites of research partners such as government institutions, funders, regulators and publishers across the research lifecycle. Websites retrieved were included for our review of EDI consideration (either concepts or statements) outside but impacting upon the published literature. We reviewed 2385 titles and abstracts and included 75 (3%) in analyses. From gray literature searches of 269 identified key research partners, additional 49 records were included. Studies conceptualized EDI as interconnected rather than distinct constructs. These concepts were often reinforcing, such as efforts to enhance diversity which also promote equity and foster inclusion. Regarding operationalization, 12 frameworks, 20 tools/metrics were identified for EDI assessment across the research lifecycle. These metrics were primarily used for reporting EDI data, and utilization across research lifecycle remains limited. Among research partners, a third of publishers (6 of 20) had any EDI considerations; followed by 2 of 19 trial registries, 12 of 44 research funders, 7 of 60 journals, and none of ethics committee and data repositories reported statements on EDI. This review highlights that a range of EDI relevant tools, frameworks and metrics, each with their unique strengths and limitations. We found a wider adoption of EDI considerations by research partners is still lacking. Future research could explore the impact of different EDI criteria on trial outcomes and the generalizability of trial results. [Display omitted] •A scoping review explored EDI considerations by health partners across research lifecycle.•Identified tools, frameworks and metrics vary, each with their unique strengths and limitations.•Wider adoption of EDI considerations by health partners is still lacking.•Research could assess EDI criteria's impact on trial outcomes and generalisability.

Since 1976, the Supreme Court has held that deliberate indifference to the serious medical needs of incarcerated people violates the constitutional prohibition against cruel and unusual punishment. What does this mean in practice?

From 2013 to 2022, the number of patients who underwent genomic testing for cancer increased. The percentage of these patients who were of African ancestry increased by 0.45 percentage points per year.

The demographic landscape of the United States is changing daily, and the demand for representation in today's workforce is both a moral and practical imperative for creating workplaces diverse in thought, expression, and people. The purpose of this study was to investigate workplace culture and the direct and indirect influence of supervisors on inclusion of minoritized communities, including those who have experienced marginalization for race, ethnicity, religion, national origin, age, marital status, ability, sexual orientation, sex, gender, gender identity and expression, socioeconomic status, spirituality, political affiliation, literacy, or the intersectionality of multiple identities. Consensual qualitative research study. Semistructured interview. Eighteen participants were recruited through direct contact via their public domain email addresses that are located on college/university websites. Demographic data were collected through a web-based recruitment survey, which was also used to schedule a semistructured interview. We used the multiphased consensual qualitative research tradition to identify domains and categories representative of the data. Three domains emerged. The environment domain spoke to the culture each supervisor created through relationship building and intention; intention was further characterized as active or passive behaviors whereby almost all participants described both. Only one-third of participants referenced diversity, equity, inclusion, and accessibility policies and procedures within their organization. The resources domain represented the existence and awareness of organizational diversity, equity, inclusion, and accessibility resources, or lack thereof. The perceptions domain characterized the beliefs of the supervisors relative to diversity, equity, inclusion, and accessibility. Structural efforts must include the creation and implementation of policies and procedures for employee inclusion, not just patient inclusion. The awareness and use of organizational resources is an important component to support supervisor efforts and should be leveraged from within the unit.

Biomedical science and federal funding for scientific research are not immune to the systemic racism that pervades American society. A groundbreaking analysis of NIH grant success revealed in 2011 that grant applications submitted to the National Institutes of Health in the US by African-American or Black Principal Investigators (PIs) are less likely to be funded than applications submitted by white PIs, and efforts to narrow this funding gap have not been successful. A follow-up study in 2019 showed that this has not changed. Here, we review those original reports, as well as the response of the NIH to these issues, which we argue has been inadequate. We also make recommendations on how the NIH can address racial disparities in grant funding and call on scientists to advocate for equity in federal grant funding.