Negative magnetic shear has been demonstrated in DIII-D and JT-60U to mitigate the confinement degradation typically observed with increasing the electron to ion temperature ratio (T-e/T-i). In recent experiments in DIII-D negative central magnetic shear (NCS) discharges, the thermal transport in the internal transport barrier formed around the radius of the minimum safety factor (q(min)) remained almost constant and modestly increased in the region outside of q(min) compared to the positive shear (PS) case, when T-e/T-i increased from about 0.8 to 1.1 through electron cyclotron heating (ECH). The benefit of NCS extending into the region outside of qmin can be explained by the lower magnetic shear in the NCS plasma over the plasma radius relative to the PS plasma. Reduced confinement degradation at high T-e/T-i with NCS plasmas was commonly observed in DIII-D and JT-60U. The mechanism of the different transport responses between the NCS and PS plasmas has been assessed in terms of fluctuation measurements and gyrokinetic simulations in DIII-D; NCS gave a smaller rise in the low-wavenumber broadband turbulent fluctuations with the increase in T-e/T-i compared with the PS case. This is consistent with gyrokinetic simulations, which show a smaller rise in the growth rates of the ion temperature gradient mode in the NCS plasmas, with increasing T-e/T-i. Gyrokinetic simulations also showed a change in the stability of the electron modes with ECH applied, consistent with higher-wavenumber fluctuation measurements, although more detailed simulations are needed to give a quantitative explanation for the experimental observations. Control of q-profile and magnetic shear will allow confinement improvement in future machines with dominant electron heating.