key: cord-0260724-yfur1p0m authors: Lalonde, K.; Ruzycki, S.; Mielniczuk, L.; Weatherald, J. title: Sex disparities in authorship in pulmonary hypertension research: a scoping review protocol date: 2021-11-24 journal: nan DOI: 10.1101/2021.11.21.21266658 sha: 87eb4a5bbb84afd5dcc9972ad8af423d20e7f8e0 doc_id: 260724 cord_uid: yfur1p0m From Protocol Introduction: Our aim is to examine female authorship and sex disparities in the domain of pulmonary hypertension (PH) research. Despite PH disproportionately affecting females, we hypothesize that the proportion of studies with women as first or senior author will be < 50% and women will be underrepresented in publications in more prestigious journals. In many aspects of research and medicine there has been increasing attention on sex and gender equality, opportunity and achievement. Over time, there has been an increasing number of females being admitted into medical school and subsequently more female physicians in many countries, including Canada, the United States and Britain 1,2,3 . However, the increasing proportion of female physicians does not necessarily equate to equal leadership opportunity or authorship in academia 4, 5, 6, 7, 8 . Less favorable assessments of women as principal investigators may explain lower success in grant funding 9 . These biases in academia may lead to inequitable opportunities for and inadequate representation of female across different roles. Several recent articles examined gender and sex disparities in the pulmonary literature. One 11 . This paper highlighted that far fewer women were publishing and those that did were more likely to publish as co-authors and/or in lower impact journals as compared to their male counterparts. There was also very little increase in the proportion of female first or senior authors between 2009-2018. Our aim is to examine female authorship and sex disparities in the domain of pulmonary hypertension (PH) research. Despite PH disproportionately affecting females, we hypothesize that the proportion of studies with women as first or senior author will be < 50% and women will be underrepresented in publications in more prestigious journals. 3. To determine the proportion of manuscripts with a female first or senior author among the top 500 most cited papers in PH. 4 . To describe temporal trends in female authorship in the PH literature. This study will be a scoping review of the literature that will follow the PRISMA-ScR reporting recommendations 12 . This protocol will be published on a pre-print server prior to initiation of article screening. We will perform a broad search in Medline/OVID. The search terms will include: -"Pulmonary Hypertension" in title or abstract (with no adjacency) -"Pulmonary Arterial Hypertension" in title or abstract (with no adjacency) We have chosen this strategy as it allows capture of other important disease synonyms, including "Primary pulmonary hypertension" and related diseases such as "Chronic Thromboembolic Pulmonary Hypertension". We will pilot our search results by ensuring 17 landmark PH papers with female first or senior authorship (Appendix 1) are captured in the search results. When examining the density of published literature across time, there are many more articles published in PH in more recent years. For that reason, we have decided to include a large time span of 20 years as it will enable us to evaluate trends over a longer time interval without markedly increasing the workload to an unmanageable level. . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint We will restrict articles to those published in the 80 pre-specified journals (Appendix 2), in order to make the number of citations manageable. We have purposively selected a range of journals, including respiratory medicine and cardiology journals, surgery, general medical, basic science, and pediatric journals. These journals have varying degrees of number of articles published on pulmonary hypertension and a wide range of impact factors. This list of journals is based on a consensus between two content experts (LM and JW). We will ensure that each journal has at least 1 article present after the data set has been refined by date (no journals with 0 publications on PH will be included). We have included 9 pediatric journals to specifically account for the pediatric population. We will limit inclusion to articles that are clinical trials (including randomized control trials), observational studies, basic science/translational reports, systematic reviews with or without meta-analysis, guidelines, narrative review articles, case report/series, and editorials. These will not be included as they are often opinion-based rather than original research. These will not be included as they often have solitary authors contributing to each chapter; the importance order of authorship is not always clear when there are multiple authors listed. Though this would provide insight into who may be participating in current PH research, it would not answer our question of women's authorship in peer review publications for PH. . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint We will not apply a language filter. Non-English articles will have title and abstract translated with Google Translate to screen suitability. For those articles unable to be translated sufficiently, these will be excluded from the overall data set. We will screen articles by title and abstract for relevance by one team member. Given the large number of anticipated search results, screening for relevance will proceed after applying inclusion criteria filters (Figure 1 ). The search results from Medline/OVID will be imported into EndNote 20. In EndNote, the articles will be screened for duplicates. Exact duplicates will be removed. If articles have been published in more than one journal, they will be included. Replies and editorials will be kept if identified as duplicates at this stage. Then the article data will be filtered by year -including 2000-2021 (November 1). Then, the selected journals will be identified and filtered as such. The paired down search results will be imported to Covidence.org, where duplicates will be identified and removed (as a secondary check). Then, this data set will be sorted through by Dr. Lalonde and Dr. Weatherald, where they will each follow the pre-set inclusion and exclusion criteria. As this is not a review paper, we will not require that each article is screened twice (i.e., each article will be screened once). The final data will be exported from Covidence into Excel for analysis. We will extract the following information from each article that meet the eligibility criteria. First author name First author sex M/F/unknown . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint We will use similar methodology in our sex determination strategy: 1) Use first name and country in Gender API website (https://gender-api.com/en) and set the gender accuracy above 80%. 2) Then, for those that are still undetermined, we will use their middle names and country in Gender API. 3) If there is still uncertainty, we will use a database called Genderize (https://genderize.io/). We will use first names and set the accuracy to above 80%. 4) Then we will use middle names and set the accuracy to above 80% in Genderize. For those still undetermined, we will manually research their salutation by looking at their academic institution websites, professional pages and other venues to attempt to ascertain the sex of the author 6) For those remaining unknown, we will label them "unknown". . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint Genderize was also used in the study by Vranas et al. (2020) 11 . When the sex of authors is uncertain we will attempt to access academic institution websites, professional pages and other online articles to ascertain the sex of the authors, where possible. The primary outcome is the proportion of all articles with female first or senior authorship. We will assess the association between sex of first/senior authorship (dependent variable) with journals impact factor and continent of publication using logistic regression. We will assess the association between female senior authorship and sex of the first author using logistic regression. We will stratify analyses by clinical and basic science manuscripts. Given the international nature of scientific research and lack of gendered names in same languages or countries, it is possible that we may not be able to identify the sex of all authors. We will do a sensitivity analysis excluding articles with unknown sex of either first or last author, or with "anonymous" authorship, or with authors limited to working groups/steering committee titles. . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint There is no funding to report for this study. KL and JW conceived this study. KL, JW, SR, and LM designed the methods. KL and JW wrote the study protocol. Final study protocol has been approved by all authors. . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint We will include: Clinical trials, RCTs, editorials, pediatric and adult research, original research, reviews, meta-analyses, case reports/series, main topic is PH (true relevance) We will exclude: conference presentations, conference abstracts, commentaries/replies, non-English articles that cannot be sufficiently translated STEP 6: Upload Refined Search into Covidence 1) Use first name and country in Gender API website (https://gender-api.com/en) and set the gender accuracy above 80%. 2) Then, for those that are still undetermined, we will use their middle names and country in Gender API. 3) If there is still uncertainty, we will use a database called Genderize (https://genderize.io/). We will use first names and set the accuracy to above 80%. 4) Then we will use middle names and set the accuracy to above 80% in Genderize. 5) For those still undetermined, we will manually research their salutation by looking at their academic institution websites, professional pages and other venues to attempt to ascertain the gender/sex of the author 6) For those remaining unknown, we will label them as such. Use EndNote's duplicate function. Manually sort through duplicates and remove as appropriate Filter results to the 80 identified journals . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint The copyright holder for this this version posted November 24, 2021. ; https://doi.org/10.1101/2021.11.21.21266658 doi: medRxiv preprint Appendix 1 -List of 17 articles for search validation Risk assessment, prognosis and guideline implementation in pulmonary arterial hypertension Long-term outcome in pulmonary arterial hypertension patients treated with subcutaneous treprostinil Survival in pulmonary arterial hypertension patients awaiting lung transplantation Pulmonary Arterial Hypertension-related morbidity is prognostic for mortality Beraprost therapy for pulmonary arterial hypertension Transition from intravenous epoprostenol to intravenous treprostinil in pulmonary hypertension Ambrisentan in portopulmonary hypertension: A multicenter, open-label trial Retinoids and pulmonary hypertension Effect of warfarin treatment on survival of patients with Pulmonary Arterial Hypertension (PAH) in the registry to evaluate early and long-term PAH disease management (REVEAL) Psychometric validation of the Pulmonary Arterial Hypertension-symptoms and impact (PAH-SYMPACT) Questionnaire: Results of the SYMPHONY Trial Association of N-Terminal Pro Brain Natriuretic Peptide and long-term outcome in patients with Pulmonary Arterial Hypertension Effect of breathing oxygen-enriched air on exercise performance in patients with precapillary pulmonary hypertension: randomized, sham-controlled cross-over trial Effect of nocturnal oxygen and acetazolamide on exercise performance in patients with pre-capillary pulmonary hypertension and sleep-disturbed breathing: randomized, double-blind, cross-over trial Chronic thromboembolic pulmonary hypertension (CTEPH): results from an international prospective registry Microvascular Disease in Chronic Thromboembolic Pulmonary Hypertension: Hemodynamic Phenotyping and Histomorphometric Assessment Pulmonary vascular reactivity and prognosis in patients with chronic thromboembolic pulmonary hypertension: a pilot study