Good afternoon, and welcome. Welcome to the IUPUI Center for Translating Research and D Practice Scholar of the Month Discussion Series. My name is Steve V Weg I serve as the Associate Director of the IUPI Center for Translating Research and D Practice. It is my pleasure to welcome you here today, where in a bit, we will have a conversation with our scholar of the Month, Professor Silk Soto. We are so excited that she's here today to join us. But before we get started, we like to share a little bit of information with you to set the stage. And first, we like to remind ourselves that this idea of having a space where we could converse with our translational scholars to learn more about their work and ask them questions and be part of the discussion was the brain child of Professor Sandra Prono translational researcher, Emeritus faculty of the Communication Studies Program here at IUPY. And her work is in the area of privacy management, of messaging and information that we share with one another. Our executive director, who is now stepping down, and going into retirement is Emeritus Chancellor Charles Banz, who has served for many years as a leader on our campus, encouraging this kind of research, research that is interdisciplinary, that is involving community partners and students and folks on campus and using or generating knowledge that we could use to solve problems in our community. So we're delighted that we're having a chance today to dig into some of that research and talk with each other here on campus. Many of you are familiar with Zoom. It's been our lives for the last few years, but we hope that you'll remind yourself to leave your microphone on mute. But later, when we get into the conversation, please, please turn on your camera so that we can see each other and begin to have a conversation and see each other and talk to each other. You're welcome to type comments and questions into the chat. We'll monitor that as we go along. So, you know, this presentation is going to be recorded, so folks could see it later. You may want to share that with other folks, but if that makes you uncomfortable to be on camera, we understand that you may not want to turn on your camera during the conversation piece. You will also be receiving a post event evaluation form. We encourage you. We know you get lots of those, but please take a moment to fill it out. It's helpful for us, but also for our presenters to know what's happening. We have a lot of things going on in our center, and so we hope that you'll check our website out to know upcoming events. But also, if you're interested in continuing education, you can go to I U Expand to learn more about how you can get credit for coming to these conversations for your own professional development and keeping track of those opportunities. Ways to follow us include lots of social media, Please like our Facebook page. Follow us on Twitter. You can check us out on Instagram. We like to share information about what's going on with our scholars, so it's an easy way for you to know what's happening. There's always exciting things happening. And if you get a chance, visit our YouTube channel where you can see past recordings of various events, if you didn't have a chance to see them, or if you want to tell a colleague about, Hey, go check this out. It's all right there in one convenient place on our YouTube channel. One of our partnerships is with the library where we work hard to make the journal and scholarly works of our faculty available freely and to folks in the community. So the way we do that is with the folks that participate in this series, for example, we call them scholars and featured scholars, and we have a place on our website where you can check them out. You can go, for example, to Silks Fabulous photo. Click on her page. It'll bring up some more information about her work. Translational work, and you can see down here links just a link to her journal article that is housed in Scholar Works. If you want to go to the top of that page, you can go to the Scholar works page of the library and see all of her works, as well as all of the other faculty who have taken advantage of this opportunity. It's a way to get out the work out into the community, and we've tried to put it in one simple place so that people have access to that. Now, next month, we are excited to be hosting Leah Bishop, who will be talking about ending Childhood Book Hunger. So if you're interested in that topic, put down the date Friday, June 23 at noon. That's our scholar of the month for that month. She'll be highlighted all month on our website if you want to get a preview of the kind of work that she's doing. But today, now we are excited to welcome Silk Soto, who is an associate professor, of Medicine. And she's the vice Chair for Faculty Affairs and Professional Development and the vice Chair for Diversity Equity Inclusion in the Department of Medicine at the Au School of Medicine. And today, she's going to lead us in a conversation about restoring trust and trustness. So welcome to you, doctor Soto. Please take it over and help us get started into this important conversation. And I will take close caption of the PowerPoint. So if individuals are interested in the transcript, you can see that through Zoom. Thank you again, very much for inviting me to give this talk for those of you that know me, know that the most exciting part really happens during the Q&A. I have no problems having a great discussion. So the topic of this talk is, I am interested in helping restore trust perspective on trust and trustworthiness and biomedical research. I have no conflict of interest to report, no commitments or anything like that, except that my bias will come through in all of my presentation and probably in my discussions as I see the world through an equity lens. I want to also take the opportunity not only to thank you for the invitation, but also thank the Indiana Clinical and Translational Science Institute, because they do support this work and the work of AN for Health. We will talk about trust and trustworthiness, and I will talk specifically about two studies that we have been that we have done through AN for Health that are related to trust and are related to community participation in research. With that said, we will leave plenty of time for that discussion. So first of all, I would like to start us with trying to define trust So, doctor Soto, if you'd like, I'll just share for the listening audience, the things that I'm seeing in the chat. So we have honesty Sa. Feeling safe. Another honesty, believing in others, doing what you say you will do, being reliable, having faith in, feeling safe, to be honest, integrity, comfort, believing in someone. Mm hmm. Wonderful. Those are all great. We know that and again, I hope that I'm showing the right screen here. But that trust is essential to building and maintaining, obviously mutually respectful relationships, especially when it comes to partnerships, involving patients and community stakeholders and researchers, et cetera. There is obviously in that relationship with patients, community members, researchers, et cetera, there is an inherent imbalance of power. On patients and community members who inform the design and conduct of our health research, rely on us as researchers, to be honest and willing to protect them from harm. And this is obviously really, really important. And in efforts to build that trust, we have changed the notion that individuals are simply subjects to our research. That's why we changed the language to talk about human research participants. Or in many instances, we're really talking about individuals that are co producing research along our side, especially when we're talking about community based participatory research or community engaged or community led research. We're engaging with them in ways that we have built them into consultancy roles, advisory board roles, and even patient and community members becoming co investigators or principal investigators in a lot of research. Hopefully, this change of roles really increases the importance of their participation but also the importance of trust amongst researchers and community members. I would like to point out that Consuelo Wilkins actually talks about trust in ways that are essential to engagement that after decades of still engagement in research, we're still thinking about trust as an elusive thing. That an individual may have trust in a specific researcher or the research enterprise, especially us as the institution of higher education and academic health centers. But there are a number of factors that truly influence that level of trust. A lot of my time has also spent talking about research ethics, and of course, we spent a lot of time talking about research atrocities and medical atrocities that have happened throughout history, that have in many ways taken advantage, especially of historically underrepresented groups or at least those that have been marginalized in our history. But despite that, we still follow the importance of trust. We follow similar strategies and discuss them as best practices for trust among research participants, but Wilkins and her group really talked about We're only beginning to talk about patients and community members who are involved in research as collaborators and partners. One of the things that we know about community engaged research is that it's very much centered around trust. And this is not a lesson on community engaged research. I'm sure that you have had plenty of talks, and we have excellent scholars within Indiana University. About this. But the gist of it is that in building trust, we really try to have effective communication, we really try to build or have this respect, show transparency in everything that we do that we're truly engaging in a bi directional relationship, and sometimes more than bi directional, right? If we consider who are our community health partners, et cetera, the importance of follow through also comes a lot when it comes to trust and how people define trust, the importance to really following through on your commitments and what you set out as expectations for particular projects or even discussions. Then again, the importance of providing training and resources, and as researchers really demonstrating humility and curiosity. So the role cannot be obviously underestimated or undervalued when it comes to research. Without this consistent effort and trust and building strong relationships every step of the way, we really would fail and fall far short when it comes to the success of what we're seeking to achieve. We also know the consequences very well about not having the trust of the community, and also when it comes to losing trust in our own research. It might show up in many ways in the the way that we design research or we interpret our findings or things of that nature, that we show we show stereotyping, especially again, when it comes to communities of color, that we actually may show some tokenism inability to engage certain communities is certainly an issue in biomedical research. But ultimately, the consequences of not having trust is this poor health and research outcomes, which is what we're trying to address as an academic community. Obviously, the main consequence and the reason why I'm here today is to really talk about the big issue of mistrust, right? We can talk about trust and we can talk about trustworthiness, but we also are fully aware of the consequences of bad research that involves, again, the exploitation of vulnerable populations, and, you know, earlier, Steven, you mentioned privacy, right? So invasion of privacy, failure to maintain confidentiality and all those things that lead to mistrust. We have a problem of mistrust. In this country, and this has come up recently from the Pew Research Center in their February report, where they actually talk about the partisan differences over trust and medical scientists, scientists continue to widen, especially since the corona virus outbreak. There is some interesting information about your political affiliation and how much confidence in medical scientists and scientists you have, how confident you are that those scientists are acting in the best interest of the public. Race and ethnicity also show up as well as education and how this shapes up. So you can see here that there is a decrease in trust from the public with medical scientists all the way to indeed the military. Here's another one that also shows up race and ethnicity, and you can see, again, the decrease in trust by this specific groups. So we know that mistrust is a problem, and we also know that we're losing trust from the public and what we do every day. So the factors and forces behind this distrust, WMC talked a little bit about this, and also in the context again of what we just saw with a pandemic, that the public has been overwhelmed by too much information. And the growing polarization. And of course, this information has not been quite accurate, right? That there have been disinformation campaigns by many entities, media media environment that rewarded outrage. And the increasingly public nature of scientific research. Now, that last one is actually a really good thing, right? We want our research to reach the public. However, this information has really created barriers to that trust as well as transparency and confidence in what we're putting out there. So, as I mentioned, in thanking the Indiana CTSI for support of this research and also for All in F Health, I wanted to tell you a little bit about All in F Health. So All in F Health is an initiative by the Indiana CTSI for which I'm director, but I actually have a great team that are really the doers of everyday actions. But our focus is certainly on a community academic partnership dedicated to helping improve the lives of Hoosiers by increasing health research literacy, as you see here, promoting health resources, as well as opportunities to participate in research and clinical studies. At the end of this session, I will put in the chat the link because I want all of you to register not only for all in for health newsletter, but also to be research participants. And don't be afraid, it's not all clinical trials. We also have simple surveys that you can all fill out. But we decided to actually ask a few questions about trust to this group of individuals, the AN group is over 13,000 volunteers that are receiving the newsletter and have indicated interest in participating in research. The first study was, do they really trust us, and I will tell you a little bit more about that. And the second one just happened out of the blue. And it was a question about their participation in health advisory boards, such as the one for ON for Health. So for do they really trust us? We really wanted to know and measure trust in biomedical research and healthcare organizations. So, what would I mean, what can be a better group, that individuals that said, Yeah, I'll sign up to participate in research, right? Then we also wanted to think about ways to use the data to improve recruitment as an organization. Again, we are part of our business is to be able to provide more access. Do health care, and obviously, participation in research is really an important part of that for many communities. So we had three scales that look at this, and at the end of the day, we have 663 participants. I will skip the mentimeter because it wasn't working very well, and that will leave us more time to talk. But the highlights of this particular survey, from what we gather from the 663 individuals, as you can see here, is that 50% of them disagree that patients get the same medical treatment regardless of race and ethnicity. 67% think it is safe to participate in medical research, yet 79% had never been asked to participate in medical research by their doctor. All right? 30% think that medical researchers act differently toward minority participants, and 10% believe that medical researchers select minorities for their most dangerous studies. And some medical research projects are secretly designed to expose minoritized groups to diseases. Now, if you don't find this information problematic, maybe that would be the best discussion at the end of this session, but certainly we were very much alarmed by this data because I want you to remember that these are individuals that have volunteer to participate in research in the State of Indiana. We also ask participants to tell us a little bit more about what would make them more comfortable to participate in research. And there were two main answers there. If they were asked by their doctor to participate and if the institutions involve better education programs and public messaging about medical research, that would be the way that they would trust biomedical research participation. In addition to that, of course, as an equity scholars, I have to ask additional questions and look at the data. Out of those 663 70 of them represented historically marginalized groups, and although I'm not going to go through all the data, I want to highlight five important aspects. Of that data. So these are statistically significant, but I want you to think about this in terms of the difference between views of the historically marginalized groups in biomedical research and the wide groups in this biomedical research. So again, there's differences in it's safe to participate in medical research. Most medical research would not lie to people to try to convince them to participate in research. So that is different. Some medical research projects are secretly designed, again, to expose minority groups to diseases. In addition, to get people to take part in a study, medical researchers usually do not explain all of the dangers about participation. So again, you can see difference here. Medical researchers act differently toward minority participants than toward white participants. And again, you can see the difference of 54% versus 74%. And patients get the same medical treatment from healthcare organizations, no matter what the patient's race or ethnicity is, again, you see that difference of 81. Percent and 68%. So obviously, we wanted to reaffirm the importance of understanding our community's trust and medical research. But we obviously understand that we have to critically assess our own trustworthiness. And that is again, the secondary aspect of this talk. How do we make ourselves as academicians trustworthy? And we should critically reflect on the authenticity of those efforts. So in terms of the study conclusions for, do they really trust us? Again, I said that we were alarmed. As a reminder, these are individuals that are in the volunteer registry. But we also know from the literature that trusting scientists has been below pre pandemic levels. So what does that mean again for our registry? Unfortunately, we didn't we didn't measure trust years ago. So this is our first trust measure within that registry, but it makes us wonder, has it always been at this level Do members of our registry still believe that research truly jeopardizes the lives of minoritized groups, especially Hoosiers in Indiana. Of course, we have the reaffirmation that understanding our community's trust and really understanding our own trustworthiness are important. Secondary aspect of it was also looking at our all in for health. So this is purely anecdotal at this point. We were looking at a health advisory board that really informs a lot of what we do and provide feedback, and they are amazing members from the community in the State of Indiana. And we had four or five open positions for board members. So we decided let's ask. Let's ask if those individuals would be interested in participating. 488 individuals contacted us and said, I am interested. I am interested in being part of the Health Advisory Board. That is amazing. What also was amazing is the selection process, especially when you're looking at 488 individuals. So we actually looked at the motivations and interest of individuals in participating. And health advisory boards, and you can think about it, as well as community advisory boards, especially into interest of advancing research. And these are some of those that come up their desire to share experiences. They had training and education. A lot of them were also members of Indiana University or alumni, or they wanted to give back to the institution. They had previous experience in boards and participating in research. But the three main items were they were caregivers, They wanted to contribute to the greater good, and they had some personal diagnosis related to that they wanted to help advance research on. And you can see also motivations related to change and the ability to advocate. So with that said, we also feel that these items inform how we can make ourselves trustworthy and how we can also think about the trust from our community members if we really tap into the good that they want to do in relation to biomedical research. There are plenty models out there, and of course, in translating research into practice. We have to think, I have to mention frameworks, and I have to mention the practical implications of the work that we're doing. This is also from Doctor Wilkins group, and, you know, they talk about the dimensions of trust. I'll mention some of these. As they also came up, Steven was reading what you thought about trust, right? Honesty, the importance of communication, confidence, again, the belief that you are involved in a relationship with a reliable party, right? In this case, other researchers, that there's competence, there's fairness, there's safety. I talk a lot also about cultural safety. In research as a model. Again, believing in the institutions, the processes and policies is really important. In addition to that, again, how do we become trustworthy or what trustworthiness mean? They talk about being easily reach as a researcher, being approachable, being attentive, being empathetic, honest, humble. Again, cultural humility is one of my favorite things to talk about, and then respectful. And then, again, when you put all those pieces together, the strategies to enhance and engender trust are easily, you can guess them, right? Balancing the power, dynamics, really making everybody at the same level and contributing in many ways in the same level, being transparent about the goals and motivations, why are you addressing this particular issue? Why you're going to that community? Developing cultural humility, the resources, effective communication, and then again, establishing a pattern of fulfilling trust. And again, that goes to the follow through. Who are we, if we're not following through on our research and outcomes and findings and what we do with those. So with that said, there's obviously ethics involved. I will not dig too deep, but I want us to think about trust and trustworthiness and where we have been, again, thinking about where research ethics and integrity policies have led us to that just because we have system that is based on research compliance doesn't guarantee us that there is a place for trust, as we have seen as far as, you know, recent decades, really research atrocities that have happened within our compliance system, within our US government rules and regulations in compliance. Obviously, the lack of trust is a threat to what we all do, not only from an education standpoint, but from the biomedical research that we're doing. And then, again, that trust is truly at the heart of science. So trust can be reinforced in many ways through the design and continuous improvement of our equitable partnerships, especially with communities in the way that we co produce, co learn, we share resources, we seek community input. How do we actually invest and utilize the resources to serve the needs to the community, that involvement in all aspects of research and health care services design and implementation. So all these aspects are really, really of importance. So this all means that doctors and health professionals and researchers need to better understand the nature of the credibility challenge that we're facing right now. So we can indeed craft effective countermeasures, so we can really strategically respond to disinformation or misinformation on social media and other venues to the way that institutions are working with trusted community, leaders to educate the public to educate government agencies and really trying to participate in these disinformation wars that we see out playing playing out. Just in general, I really hope that we can move trust to a critical public health type of lens in which we're really thinking about the status quo in ways that defined the problems and breakdown fundamental assumptions that we have. Trust obviously is critical, and it has been critical in the research area of community engagement and others. And it's actually at the very core of what we need to do, but I also would like this opportunity to push a little bit further and say, trust is really not the B all. Both things, right? That we work very hard for this trust, especially in community engaged research, but it's time that we also expand and see the other things that are playing out that really can be seen by applying a critical lens, not only to the research that we do, but also to health promotion, the political economy of health and, you know, related fields and the list goes on and on. I would like to end the talk. And I think Nori and Steven will be very proud that I'm ending on time with a poem. And I know that many of us, especially doing biomedical research, we do not bring this socio behavioral aspect to what we do. But these are the words that were used by those individuals that said, I am interested, k? I am interested in being part of the research, and I'm also interested in participating in the health advisory boards, and these are the reasons for. So with that, oops, now I'm going in some different direction. Sorry here. I don't know that I can read it without getting emotional, but, you know, here we go. So again, these are the words of the individuals that said I am interested in participating. My community, my mom, my father, my brother is hurting. I am hurting. Diseases and illnesses have claimed too many lives. I want to hell. My identities are vast. I'm a veteran, a caregiver, and a health professional. I am transgender, low income, a teacher, and a student. I am a patient, a black woman, and a parent. I have worked, and I have tried. Above all, I have strong ties to this community. My voice is valuable to these discussions. I want to change the way minorities are treated. All hosers deserve reliable health care and adequate representation in research. I want to be helpful, I want to help. I love helping. I am interested. With those participant voices and in their own words, I will end the presentation right now, and I hope that we all work towards not only gaining the trust of individuals and communities in the health care that we provide and in participating in research, but that we work extra hard in making ourselves trustworthy. There's no purpose in trying to gain trust without thinking about our own trustworthiness and the work that we do. So let me scape there Okay, Mia with you right now? Yep. Well, thank you for setting the stage for what, I hope will become an interesting and wonderful conversation. And this is the time for our participants to turn on your cameras and join the conversation. And let's begin to open it up for what questions or comments do folks have that they'd like to share? You could just raise your hand or perhaps. We'll try to watch that. But I think doctor Soto would love for us to engage in some conversation. I love conversation. Yeah. Question for you. If you were to take a look and do that survey among your health professionals, what differences would you see between the professionals who are doing the research, delivering the care and those who are receiving it? H. I really do not know the answer. May I call you Ken? Is that? Yes, please. Okay. You can all call me so. I really do not know the answer, Ken, but I can tell you that there was one question in the survey. And for those that have seen this data, they know that I always find it kind of funny. So we have presented this work twice already in the Indiana CTSI and the CTSA. Communities around the country. And the one stat that inevitably, every physician, provider, and biomedical researcher points out, is the one that says that 40% of them that 40% of the participants think that medical researchers do this for selfish reasons. And they all stand there Don't have the poster or the conversation inevitably goes to but I don't do this for selfish reasons, right? But when you talk, we had obviously focus groups also going through each of the items can. And when you talk to individuals, they're very cognizant about the fact that we do the elitism or how elitist academic medicine can be, thinking that we do it for papers, that we do it for grants, that we do it for the recognition and awards and things of that nature. So that's where their mindset is that you're doing this for other reasons other than really the greater good. So anyway, I just put that out there as the one stat that I think is interested, how all of us react to that notion that we do this for selfish reasons. Do you have ideas? And how? Well, I have concerns. One reason I'm on the call. I'm not on the medical side, but I do a lot of work on leadership, and one of those elements that really sits at the top of it is really trust. And that's really what you're talking about is how do we create that trust? And I think in the medical community and in the research community, there are these ancillary issues, which I think probably get in the way of the trust that should be there. And you just identified one of those. I mean, I think in the university, you know, there are some professors, or are some people that are seen as elitists and are doing things for their own best interests, which then certainly diminishes the value of trust. The other thing that concerns me about the medical community is that there are so many ancillary things going on that are around the community. Those of us that get healthcare are caught in the middle of insurance and access and all these other things, that those also, I think tend to taint how health care really is. And yet in my own personal experience, I've never felt any better about any practitioner that I've had that's done work for me or my family, and yet I see the issues around it, like the insurance or the other stuff really getting in the way that taint the real value and what I think the medical professionals are really trying to do. So I see that as kind of a cloudy problem here that even when you survey people, it's hard to dismiss those other factors that are going on. You're on Mute again silk. You're correct, Ken, in that, you know, we used these three trust scales and it was mistrust in biomedical research, distrust in healthcare organizations and mistrust in health care providers or something along those lines. And each of those scales, we tested with focus groups to make sure that they were still relevant and none of them really asked a question about those ancillary aspects of healthcare, right? We didn't ask questions about insurance, and how has your experience been navigating through that. Also, the trust scales talked about healthcare providers in general, like biomedical research. And the question that I also get often is like, Did they think about health care providers in general, or were these also thoughts about their primary care physician, right? Or how they interpreted healthcare organization? Is it really about clinical, is it or is it about IU Health as a whole or Escanasi, or, you know, things of that nature? So I think that there's obviously a wealth of information and conversations to still have with individuals to try to get to this meet of trust in healthcare organizations and biomedical research? Yeah. I would just hate to see The practitioners that you're working with, the researchers that you're working with, see that data on trust and feel badly about it without understanding these other factors that I think really may have an impact when in fact, are doing a much better job than perhaps they're getting credit for. Thank you, K. It strikes me interesting that it sounds like what you observed Silk, in some of the researchers looking at this information is that it's a mismatch for what they think is how they're being perceived. And so that's an important opportunity to think about it. And I was reflecting on in my work in the field of disability. And the work that I do. The disability community in the recent years has become very strong and comfortable to say nothing about us, without us to push back on that perception that you're coming up with ideas or research or but without including us. And that was a piece of what I was hearing you talk about around The research aspect is, how do we build trustiness? Might be including people in the discovery and the planning. And then that might change the perceptions a bit, too and help us to understand some of those other ancillary pieces that might go into Yeah, I would like to say one more thing about that. So one of the questions that again, my interest in that intersection of research ethics and health equity, which trust, falls in there is the fact that asking in these focus groups, and we will continue to try to do these focus groups throughout the summer, asking individuals about where they're the source of mistrust, and health care providers and biomedical researchers. It's not often brought up from Tuskege Syphilis Study or some other, you know, atrocity, right? It's not that individuals are unaware of these issues, but there's also a disconnect. The one thing that always comes up is the way that they were treated yesterday. In our healthcare system. The way that their aunt, their grandma was treated in the healthcare system. So for us to, I just want to highlight this piece because it always well, I did admit that I was going to show my biases. So There's that. But, you know, that for us to hide many times, these individuals are not participating in research because of, you know, these things that we did in the past, because of history and all those things might bring some truth to it, but it's also how we are navigating the health care system right now that also feeds into how people ultimately also participate in biomedical research. Who else has a comment or a question? I was just at a conference last week, actually, and some Canadians a dual US Canadian conference, and the wonderful things presented on research, engagement, and participation from the Canadian perspective, you have a legislation now that requires when you have government funded research that you have individuals and community members involved from the beginning to the end. And they were sharing some of the things which they have learned as scientists by having community members engaged from the beginning to the end. And one of the most potent benefits they found was, um, When you actually try to do health literacy. And you're a scientist, it's really hard. It's harder because you're vernacular and your norms are so set in science. And so that's one thing all of the reports from the scientists participants was about the benefit of having that voice to translate your work. Into work that is digestible by the very people that you're trying to hit? And it was such a beautiful translational benefit to having that participation. So and I know in Canada, it's easier because it's required and always makes things easier. But I wondered how far we are along in the US, was thinking about research and community participation, and, you know, are we moving closer to that, where it becomes the norm? Yeah. I don't know that I have the answers, and that is part of me demonstrating cultural humility. I don't know that I have all the answers, but I have to say that I'm very hopeful because indeed, more, at least from the federal grant, you know, lens, you know, thinking about National Institutes of Health and others, that there is this push to include community advisory boards and or health advisory boards to include community members in the research itself. So I believe that we're moving in the right direction, but I am not sure, again, if this will be such Canadian mandate for, you know, everything that we do, but certainly something that is being asked of us to really incorporate and making sure that we're doing that. As part of our professional development programs, I'm running one now on health equity and research scholars. The purpose of that is really this discussion about thinking about health equity. From the very beginning, from the conceptualization of the research question all the way to the dissemination piece. So in your comments, it also made me think about the dissemination piece, right? As in academics, we're really writing the journal article. Right? Like, how many of us really try to draft that one page, except for our health communication scholars and you know, other individuals, but I don't want to put us all on the same bucket, but how many times do we actually write to the community and tell them, Hey, these are the outcomes of this particular research study. Or again, we push our researchers to think about dissemination back to the community, especially as we talk about community engaged research. But that is not always the norm for clinical trial, for example, right? Do we tell individuals, you know, that these are the results, not really so, that dissemination and really talking to individuals at a level that they understand inevitably should increase trust, right? We're coming back to you and tell you, here's what happened in a language that is easily understood. And that might reinforce that notion that you shared about, this is for you, it's not for me. So if our mode, our final piece is to make an journal article, and that's our end piece, and we're not following through with the end for others to say, this is what happened because you participated in this, that might be fueling. There's things that we do that are our norms that just fuel that notion that you have some academic or some benefit for yourself. And even if you think of it structurally, the P&T process, fuels that by the requirements that are expectations of you for public. There's only certain ways your work counts. That's of those structural systems kind of disenfranchise and disempower that those voices of individuals and that likelihood that that is the mode by which you will disseminate or share or translate your results to the actual people who participated. There's so many things that, you know, we just don't often recognize that are shaping behaviors and that lack of bringing it back to the community. Yes. Thank you, Barbara. I can only make one comment about PNT. As some of you know, it's also one of my favorite topics. But in that aspect, indeed, right? L, we are doing the faculty and individuals that are doing the community engaged research or public scholarship, really can be disadvantage in a PNT system that is really thinking about the journal article instead of thinking about the work that our fabulous faculty and others are bringing to the community with the community and on behalf of the community, right. So thank you for your comment. And to clarify for everyone, P&T is referring to promotion and tenure for those who are not faculty members to know what that is. That's an intense process for people to demonstrate their value and their work within the academic system. And this conversation has been an opportunity to help illustrate the complexity of this work, right? Of engaging with community partners to solve problems, but to meet everybody's needs. And hopefully, we've had a chance to get some ideas about how the value of including our community partners as we try to build trust and trustworthiness, but also have more effective work, and this is a time for us to take a pause. Officially thank Silk Soca for spending time today with us to raise these issues and these questions and have some conversation. And we know that many of you have other things that you need to do today, starting at the top of the hour. So we want to thank you for coming today. Remind you to come join us another time. We will stay on here for a little bit long for those that haven't had a chance to say something and still want to participate in a conversation. But if you are one of those people that has to run to the next thing, we want to give you a few minutes to make that happen and make sure that you know how much we appreciate you joining us for these conversations to make this possible and helping us advance our questions and our ideas. So thank you, doctor Soto, for your work today. Thank you. And thank you all for coming.