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Phenomenon: Marginalized individuals in medicine face many structural inequities which can have enduring consequences on their progress. Therefore, inequity must be addressed by dismantling underlying unjust policies, environments, and curricula. However, once these injustices have been taken apart, how do we build more just systems from the rubble? Many current strategies to address this question have foundational values of urgency, solutionism, and top-down leadership., Approach: This paper explores a counternarrative: Design Justice. As a set of guiding principles, Design Justice centers the experiences and perspectives of marginalized individuals and communities. These principles include mutual accountability and transparency, co-ownership, and community-led outcomes, and honoring local, traditional, Indigenous knowledge., Findings: Rooted in critical scholarship and critical design, Design Justice recognizes the interconnectedness of various forms of marginalization and works to critically examine power dynamics that exist in every design process. These co-created principles act as practical guardrails, directing progress toward justice., Insights: This paper begins with an overview of Design Justice's history in critical scholarship and critical design, providing foundational background knowledge for medical educators, scholars, and leaders in key concepts of justice and design. We explore how the Design Justice principles were developed and have been applied across sectors, highlighting its applications, including education applications. Finally, we raise critical questions about medical education prompted by Design Justice.

In this preliminary study, we explored the relationship between auditory imagery ability and the maintenance of tonal and temporal accuracy when singing and audiating with altered auditory feedback (AAF). Actively performing participants sang and audiated (sang mentally but not aloud) a self-selected piece in AAF conditions, including upward pitch-shifts and delayed auditory feedback (DAF), and with speech distraction. Participants with higher self-reported scores on the Bucknell Auditory Imagery Scale (BAIS) produced a tonal reference that was less disrupted by pitch shifts and speech distraction than musicians with lower scores. However, there was no observed effect of BAIS score on temporal deviation when singing with DAF. Auditory imagery ability was not related to the experience of having studied music theory formally, but was significantly related to the experience of performing. The significant effect of auditory imagery ability on tonal reference deviation remained even after partialling out the effect of experience of performing. The results indicate that auditory imagery ability plays a key role in maintaining an internal tonal center during singing but has at most a weak effect on temporal consistency. In this article, we outline future directions in understanding the multifaceted role of auditory imagery ability in singers' accuracy and expression., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: Meat consumption could increase the risk of type 2 diabetes. However, evidence is largely based on studies of European and North American populations, with heterogeneous analysis strategies and a greater focus on red meat than on poultry. We aimed to investigate the associations of unprocessed red meat, processed meat, and poultry consumption with type 2 diabetes using data from worldwide cohorts and harmonised analytical approaches., Methods: This individual-participant federated meta-analysis involved data from 31 cohorts participating in the InterConnect project. Cohorts were from the region of the Americas (n=12) and the Eastern Mediterranean (n=2), European (n=9), South-East Asia (n=1), and Western Pacific (n=7) regions. Access to individual-participant data was provided by each cohort; participants were eligible for inclusion if they were aged 18 years or older and had available data on dietary consumption and incident type 2 diabetes and were excluded if they had a diagnosis of any type of diabetes at baseline or missing data. Cohort-specific hazard ratios (HRs) and 95% CIs were estimated for each meat type, adjusted for potential confounders (including BMI), and pooled using a random-effects meta-analysis, with meta-regression to investigate potential sources of heterogeneity., Findings: Among 1 966 444 adults eligible for participation, 107 271 incident cases of type 2 diabetes were identified during a median follow-up of 10 (IQR 7-15) years. Median meat consumption across cohorts was 0-110 g/day for unprocessed red meat, 0-49 g/day for processed meat, and 0-72 g/day for poultry. Greater consumption of each of the three types of meat was associated with increased incidence of type 2 diabetes, with HRs of 1·10 (95% CI 1·06-1·15) per 100 g/day of unprocessed red meat (I 2 =61%), 1·15 (1·11-1·20) per 50 g/day of processed meat (I 2 =59%), and 1·08 (1·02-1·14) per 100 g/day of poultry (I 2 =68%). Positive associations between meat consumption and type 2 diabetes were observed in North America and in the European and Western Pacific regions; the CIs were wide in other regions. We found no evidence that the heterogeneity was explained by age, sex, or BMI. The findings for poultry consumption were weaker under alternative modelling assumptions. Replacing processed meat with unprocessed red meat or poultry was associated with a lower incidence of type 2 diabetes., Interpretation: The consumption of meat, particularly processed meat and unprocessed red meat, is a risk factor for developing type 2 diabetes across populations. These findings highlight the importance of reducing meat consumption for public health and should inform dietary guidelines., Funding: The EU, the Medical Research Council, and the National Institute of Health Research Cambridge Biomedical Research Centre., Competing Interests: Declaration of interests J-PD-C received research grants and consulting fees from the Dairy Farmers of Canada, research grants from The Weston Family Foundation, and travel support from the International Dairy Federation in the past 5 years, unrelated to the submitted work. SS-M received research funding (2019 and 2023 unrestricted grants) for epidemiological studies on dairy products and cardiometabolic diseases from the Dutch Dairy Association and the Danish Dairy Research Foundation, and funds from Nutrimedes (Affligem, Belgium)., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Aesthetic preference is intricately linked to learning and creativity. Previous studies have largely examined the perception of novelty in terms of pleasantness and the generation of novelty via creativity separately. The current study examines the connection between perception and generation of novelty in music; specifically, we investigated how pleasantness judgements and brain responses to musical notes of varying probability (estimated by a computational model of auditory expectation) are linked to learning and creativity. To facilitate learning de novo, 40 non-musicians were trained on an unfamiliar artificial music grammar. After learning, participants evaluated the pleasantness of the final notes of melodies, which varied in probability, while their EEG was recorded. They also composed their own musical pieces using the learned grammar which were subsequently assessed by experts. As expected, there was an inverted U-shaped relationship between liking and probability: participants were more likely to rate the notes with intermediate probabilities as pleasant. Further, intermediate probability notes elicited larger N100 and P200 at posterior and frontal sites, respectively, associated with prediction error processing. Crucially, individuals who produced less creative compositions preferred higher probability notes, whereas individuals who composed more creative pieces preferred notes with intermediate probability. Finally, evoked brain responses to note probability were relatively independent of learning and creativity, suggesting that these higher-level processes are not mediated by brain responses related to performance monitoring. Overall, our findings shed light on the relationship between perception and generation of novelty, offering new insights into aesthetic preference and its neural correlates., (© 2024. The Author(s).)

This article describes a national sample of 989 current mental health clients' views regarding whether and how their mental health care providers integrated the client's religion/spirituality (RS) into treatment. Within the online Qualtrics survey, two open-ended items asked respondents what (if anything) the client perceived their therapist having done regarding the client's RS that was (1) helpful/supportive or (2) hurtful/harmful. Participants also reported various ways therapists included the topic of RS in practice, if any. Nearly half freely described helpful ways their providers integrated the client's RS, and half indicated it was not discussed or applicable. Although 9.6% described hurtful experiences, most indicated their provider had not done anything harmful related to integrating RS. Implications for practice and training across mental health disciplines are discussed., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Music is a non-verbal human language, built on logical, hierarchical structures, that offers excellent opportunities to explore how the brain processes complex spatiotemporal auditory sequences. Using the high temporal resolution of magnetoencephalography, we investigated the unfolding brain dynamics of 70 participants during the recognition of previously memorized musical sequences compared to novel sequences matched in terms of entropy and information content. Measures of both whole-brain activity and functional connectivity revealed a widespread brain network underlying the recognition of the memorized auditory sequences, which comprised primary auditory cortex, superior temporal gyrus, insula, frontal operculum, cingulate gyrus, orbitofrontal cortex, basal ganglia, thalamus, and hippocampus. Furthermore, while the auditory cortex responded mainly to the first tones of the sequences, the activity of higher-order brain areas such as the cingulate gyrus, frontal operculum, hippocampus, and orbitofrontal cortex largely increased over time during the recognition of the memorized versus novel musical sequences. In conclusion, using a wide range of analytical techniques spanning from decoding to functional connectivity and building on previous works, our study provided new insights into the spatiotemporal whole-brain mechanisms for conscious recognition of auditory sequences., (© The Author(s) 2024. Published by Oxford University Press.)

In the past century, the history of popular music has been analyzed from many different perspectives, with sociologists, musicologists and philosophers all offering distinct narratives characterizing the evolution of popular music. However, quantitative studies on this subject began only in the last decade and focused on features extracted from raw audio, which limits the scope to low-level components of music. The present study investigates the evolution of a more abstract dimension of popular music, specifically melody, using a new dataset of popular melodies spanning from 1950 to 2023. To identify "melodic revolutions", changepoint detection was applied to a multivariate time series comprising features related to the pitch and rhythmic structure of the melodies. Two major revolutions in 1975 and 2000 and one smaller revolution in 1996, characterized by significant decreases in complexity, were located. The revolutions divided the time series into three eras, which were modeled separately with autoregression, linear regression and vector autoregression. Linear regression of autoregression residuals underscored inter-feature relationships, which become stronger in post-2000 melodies. The overriding pattern emerging from these analyses shows decreasing complexity and increasing note density in popular melodies over time, especially since 2000., (© 2024. The Author(s).)

Aims: This review aims to identify the evidence base for the consequences of over and undertreatment of type 2 diabetes mellitus in a frail population., Method: In this systematic review, we searched MEDLINE, Embase, PubMed, CINAHL and the Cochrane Library for studies from January 2001 to 15th August 2022. We included a variety of study types that assessed and reported frailty including patients ≥18 years old. Studies included those that reported the prevalence of over or undertreatment of diabetes mellitus in a frail population and those examining outcomes related to glucose control in frail older people living with diabetes. Data were extracted using a bespoke extraction table using a narrative synthesis approach., Results: A total of 4114 articles were identified with 112 meeting inclusion criteria. These included 15,130 participants across the 11 studies with sample sizes ranging from 101 to 11,140. Several areas were identified in the included studies where under or overtreatment of diabetes impacted outcomes for patients. These included hospital admissions, readmissions, length of stay, falls, mortality, cognitive impairment and cardiovascular disease outcomes., Conclusion: The results showed that there was a high heterogeneity of outcomes between the studies and that many examined small numbers of participants. In this review, both over and undertreatment were shown to increase adverse outcomes in frail older people. Further research around optimal glycaemic control for frail older people living with diabetes is required with the aim to identify ideal target ranges and produce practical clinical guidelines to promote attainment of these., (© 2024 The Authors. Endocrinology, Diabetes & Metabolism published by John Wiley & Sons Ltd.)

Background: Home parenteral nutrition (HPN) refers to the intravenous administration of macronutrients, micronutrients and fluid. The aims of treatment are to increase survival and improve quality of life (QoL). However, patients struggle with physiological symptoms, time-consuming invasive therapy and an increased occurrence of depression and social isolation. Our aim is to understand how HPN impacts the QoL of patients, and the contribution played by the complications of treatment, for example, liver disease., Methods and Analysis: A multicentre, longitudinal, observational study will be conducted using routinely collected clinical data. Participants will also be asked to complete three QoL questionnaires (EuroQol-5 Dimensions, Short Form 36 and HPN-QoL) at baseline and 12 months. The primary outcome is mean change in QoL scores over 12 months. Secondary outcomes include how factors including liver function, gut microbiota, number of infusions of PN per week, nutritional composition of PN and nutritional status impact on QoL scores., Ethics and Dissemination: Ethical approval was obtained from HRA and Health and Care Research Wales Research Ethics Committee (21/SC/0316). The study was eligible for portfolio adoption, Central Portfolio Management System ID 50506. Results will be disseminated through peer-reviewed scientific journals and presented at national and international meetings., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

G-protein-coupled receptors (GPCRs) are the largest and most versatile cell surface receptor family with a broad repertoire of ligands and functions. We've learned an enormous amount about discovering drugs of this receptor class since the first GPCR was cloned and expressed in 1986, such that it's now well-recognized that GPCRs are the most successful target class for approved drugs. Here we take the reader through a GPCR drug discovery journey from target to the clinic, highlighting the key learnings, best practices, challenges, trends and insights on discovering drugs that ultimately modulate GPCR function therapeutically in patients. The future of GPCR drug discovery is inspiring, with more desirable drug mechanisms and new technologies enabling the delivery of better and more successful drugs., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: John Unitt reports a relationship with Sygnature Discovery Ltd that includes: employment and equity or stocks. All authors are employees of Sygnature Discovery Ltd., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)