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Item Medical School Without Walls: 50 Years of Regional Campuses at Indiana University School of Medicine(Wolters Kluwer, 2022-12) Wallach, Paul M.; Birnbaum, Deborah R.; Ryan, Elizabeth R.; Pieczko, Brandon T.; Hess, Jay L.The history of Indiana University School of Medicine (IUSM) dates to 1871, when Indiana Medical College entered into an affiliation with Indiana University in Bloomington to offer medical education. In 1971, the Indiana General Assembly passed a bill to create and fund a distributed model for medical education for which IUSM was responsible, an innovative approach to implementing a statewide medical education program. IUSM became one of the first U.S. medical schools to implement what is today known as a regional medical campus model. This regional medical campus system has permitted IUSM to expand enrollment based on national and local concerns about physician shortages, increase access to care locally, support expansion of graduate medical education, and provide opportunities for research and scholarship by faculty and students statewide. This effort was made possible by partnerships with other universities and health care systems across the state and the support of local community and state leaders. The model is a forward-thinking and cost-effective way to educate physicians for service in the state of Indiana and is applicable to others. This article highlights milestones in IUSM’s 50-year history of regional medical education, describes the development of the regional medical campus model, recognizes significant achievements over the years, shares lessons learned, and discusses considerations for the future of medical education.Item Determining the Cost of Open Access: Estimating Annual Article Processing Charges for Science, Technology, Engineering, and Medicine Articles at a Large Midwestern University(2022-10-24) Pieczko, Brandon T.; Odell, Jere D.; Pike, Caitlin; Dirzis, AshleyObjectives: Article Processing Charges (APCs) for articles published in for-fee, gold open access journals are paid in a number of ways at this institution. These include a library-managed Open Access (OA) Fund, grant accounts, faculty professional development funds, departmental discretionary funds, and private faculty funds. The institution is currently considering several new approaches to providing authors with OA funding assistance, and the main objective for this research project was to determine an estimate for the total annual cost of APCs to the campus. Secondary goals included determining the financial impact of APCs on the institution’s research grants and corresponding authors. Methods: We conducted an affiliation search in Web of Science for the institution to identify articles published by authors at the university. We chose to limit results to articles published in 2019, as we wanted a sample year that would reflect the typical publishing output for the authors since the COVID-19 pandemic disrupted research and publishing patterns during 2020 and into 2021. We then selected only the articles that were designated as gold open access, as those articles were published openly in their final versions and were either supported by APCs or published by no fee OA journals. The results list (n=421) was then exported to a spreadsheet and our team analyzed each article using the following criteria to determine which articles would be included: Was the corresponding author for the article affiliated with the institution? If the article provides a funding acknowledgement, does it acknowledge a grant to the institution? What is the current APC for the journal as stated on the publisher’s website (in U.S. Dollars)? Results: Of the 421 articles our team analyzed, 168 had a corresponding author affiliated with the institution [combined APC total: $430,959 US]; of these, 143 were published in journals indexed by the Directory of Open Access Journals (DOAJ) [combined APC total: $349,699.89]; 100 of the DOAJ-index articles acknowledged grant funding to the institution [combined APC total: $274,688 USD]. Conclusions: Based on the findings of our research, if our university wanted to cover all APCs by corresponding authors published in DOAJ-indexed, “Gold OA” journals, the anticipated cost would be approximately $350,000 USD annually (with projected increases of 6% per year). These results highlight major concerns about the sustainability of current funding models for open access research and publishing in science, technology, engineering, and medicine.Item Executive Summary: International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A PALISI Network Document(American Thoracic Society Journals, 2022-08-15) Abu-Sultaneh, Samer; Iyer, Narayan Prabhu; Fernández, Analía; Gaies, Michael; González-Dambrauskas, Sebastián; Hotz, Justin Christian; Kneyber, Martin C.J.; López-Fernández, Yolanda M.; Rotta, Alexandre T.; Werho, David K.; Baranwal, Arun Kumar; Blackwood, Bronagh; Craven, Hannah J.; Curley, Martha A.Q.; Essouri, Sandrine; Fioretto, Jose Roberto; Hartmann, Silvia M.M.; Jouvet, Philippe; Korang, Steven Kwasi; Rafferty, Gerrard F.; Ramnarayan, Padmanabhan; Rose, Louise; Tume, Lyvonne N.; Whipple, Elizabeth C.; Wong, Judith Ju Ming; Emeriaud, Guillaume; Mastropietro, Christopher W; Napolitano, Natalie; Newth, Christopher J.L.; Khemani, Robinder G.RATIONALE: Pediatric specific ventilator liberation guidelines are lacking despite the many studies exploring elements of extubation readiness testing. The lack of clinical practice guidelines has led to significant and unnecessary variation in methods used to assess pediatric patients' readiness for extubation. METHODS: Twenty-six international experts comprised a multi-professional panel to establish pediatric specific ventilator liberation clinical practice guidelines, focusing on acutely hospitalized children receiving invasive mechanical ventilation for more than 24 hours. Eleven key questions were identified and first prioritized using the Modified Convergence of Opinion on Recommendations and Evidence. Systematic review was conducted for questions which did not meet an a-priori threshold of ≥80% agreement, with Grading of Recommendations, Assessment, Development, and Evaluation methodologies applied to develop the guidelines. The panel evaluated the evidence, drafted, and voted on the recommendations. MEASUREMENTS AND MAIN RESULTS: Three questions related to systematic screening, using an extubation readiness testing bundle and use of a spontaneous breathing trial as part of the bundle met Modified Convergence of Opinion on Recommendations criteria of ≥80% agreement. For the remaining 8 questions, 5 systematic reviews yielded 12 recommendations related to the methods and duration of spontaneous breathing trials; measures of respiratory muscle strength; assessment of risk of post-extubation upper airway obstruction and its prevention; use of post-extubation non-invasive respiratory support; and sedation. Most recommendations were conditional and based on low to very low certainty of evidence. CONCLUSION: This clinical practice guideline provides a conceptual framework with evidence-based recommendations for best practices related to pediatric ventilator liberation.Item A Network Meta-analysis of Dexamethasone for Preventing Post-Extubation Upper Airway Obstruction in Children(American Thoracic Society Journals, 2022-08-17) Iyer, Narayan P.; López-Fernández, Yolanda M.; González-Dambrauskas, Sebastián; Baranwal, Arun K.; Hotz, Justin C.; Zhu, Meng; Zhang, Yuan; Craven, Hannah J.; Whipple, Elizabeth C.; Abu-Sultaneh, Samer; Khemani, Robinder G.RATIONALE: Peri-extubation corticosteroids are commonly used in children to prevent upper airway obstruction (UAO). However, the best timing and dose combination of corticosteroids is unknown. OBJECTIVES: To compare effectiveness of different corticosteroid regimens in preventing UAO and reintubation. METHODS: MEDLINE, CINAHL and Embase search identified randomized trials in children using corticosteroids to prevent UAO. All studies used dexamethasone. The studies were categorized based on timing of initiation of dexamethasone (early use: >12 hours prior to extubation) and the dose (high dose: (>/= 0.5mg/kg/dose). We performed Bayesian network meta-analysis (NMA) with studies grouped into four regimens- High dose, Early use (HE); Low dose, Early use (LE); High dose, Late use (HL) and Low dose, Late use (LL). RESULTS: 8 trials (n=903) were included in the analysis. For preventing UAO, (odds ratio, 95% credible interval), HE (0.13; 0.04, 0.36), HL (0.39; 0.19, 0.74) and LE (0.15; 0.04, 0.58) regimens appear to be more effective compared to no dexamethasone (low certainty). HE and LE had the highest probability of being the top ranked regimens for preventing UAO [surface under the cumulative ranking (SUCRA) 0.901 and 0.808 respectively]. For preventing reintubation, the effect estimate was imprecise for all four dexamethasone regimens compared to no dexamethasone (very low certainty). HE and LE were the top ranked regimens (SUCRA 0.803 and 0.720 respectively) for preventing reintubation. Sensitivity analysis showed that regimens which started >12 hours prior to extubation were likely more effective than regimens started >6 hours prior to extubation. CONCLUSIONS: Peri-extubation dexamethasone can prevent post-extubation UAO in children but effectiveness is highly dependent on timing and dosing regimen. Early initiation (ideally >12 hours prior to extubation) appears to be more important than the dose of dexamethasone. Ultimately the specific steroid strategy should be personalized considering the potential for adverse events associated with dexamethasone and the individual risk of UAO and reintubation.Item Leveraging Wikidata to Build Scholarly Profiles as Service(University of Victoria Libraries, 2022-07-27) Lemus-Rojas, Mairelys; Odell, Jere D.; Brys, Lucille Frances; Ramirez Rojas, MirianIn this article, the authors share the different methods and tools utilized for supporting the Scholarly Profiles as Service (SPaS) model at Indiana University–Purdue University Indianapolis (IUPUI). Leveraging Wikidata to build a scholarly profile service aligns with interests in supporting open knowledge and provides opportunities to address information inequities. The article accounts for the authors' decision to focus first on profiles for women scholars at the university and provides a detailed case study of how these profiles are created. By describing the processes of delivering the service, the authors hope to inspire other academic libraries to work toward establishing stronger open data connections between academic institutions, their scholars, and their scholars' publications.Item Understanding the Experiences of Black Women Medical Students and Residents: A Narrative Review..(2022-06-14) Sharp, Sacha; Hixson, Ashley; Stumpff, Julia C; Williamson, FrancescaBackground: Few research studies examine medical students and residents with intersectional identities. In the emerging literature, data on Black women’s experiences may be misrepresented and misinterpreted as studies aggregate data for women, students of color, and Black/African American men. As such, these studies do not account for the nuanced experiences of gendered racism that Black women students and residents may encounter during their medical education. Methods: Using Crenshaw’s intersectionality as an analytical tool, we conducted a narrative review to highlight how Black women medical students and residents are rendered invisible in the current literature on medical education. Results: The results generated 13 citations specifically discussing Black women medical students and residents, with only six studies being empirical research. Conclusion: We conclude that 13 articles is inadequate for understanding the experiences of these populations. Without centering Black women or using an intersectional lens, researchers could invalidate the lived experiences of this population and create barriers to the political resources Black women learners need to be successful. Moreover, the lack of intention behind addressing the needs of Black women can be viewed as complicity in the oppressive structures that serve to subjugate them.Item Clinical non-effectiveness of clopidogrel use for peripheral artery disease in patients with CYP2C19 polymorphisms: a systematic review.(Springer, 2022-06-03) Huang, Shu; Yang, Seonkyeong; Ly, Shirly; Yoo, Ryan H.; Lo-Ciganic, Wei-Hsuan; Eadon, Michael T.; Schleyer, Titus; Whipple, Elizabeth; Nguyen, Khoa AnhPurpose: To conduct a systematic review to identify studies that assessed the association between CYP2C19 polymorphisms and clinical outcomes in peripheral artery disease (PAD) patients who took clopidogrel. Methods: We systematically searched Ovid EMBASE, PubMed, and Web of Science from November 1997 (inception) to September 2020. We included observational studies evaluating how CYP2C19 polymorphism is associated with clopidogrel's effectiveness and safety among patients with PAD. We extracted relevant information details from eligible studies (e.g., study type, patient population, study outcomes). We used the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) Tool to assess the risk of bias for included observational studies. Results: The outcomes of interest were the effectiveness and safety of clopidogrel. The effectiveness outcomes included clinical ineffectiveness (e.g., restenosis). The safety outcomes included bleeding and death related to the use of clopidogrel. We identified four observational studies with a sample size ranging from 50 to 278. Outcomes and comparison groups of the studies varied. Three studies (75%) had an overall low risk of bias. All included studies demonstrated that carrying CYP2C19 loss of function (LOF) alleles was significantly associated with reduced clinical effectiveness and safety of clopidogrel. Conclusions: Our systematic review showed an association between CYP2C19 LOF alleles and reduced functions of clopidogrel. The use of CYP2C19 testing in PAD patients prescribed clopidogrel may help improve the clinical outcomes. However, based on the limited evidence, there is a need for randomized clinical trials in PAD patients to test both the effectiveness and safety outcomes of clopidogrel.Item Impact of Covid-19 on Academic Health Sciences Library Programs and Services: Lessons Learned(2022-03-17) Whipple, Elizabeth C.; Ragon, Bart; Rethlefsen, Melissa L.Our research team conducted longitudinal surveys of academic health sciences library leaders to record the impact of COVID-19 on their library programs and services over time: April 2020, August 2020, and February 2021. Our multi-modal analysis highlights lessons learned in the context of new service models, new opportunities, skills needed, wellness as an integral necessity, and policy considerations for libraries. Overwhelmingly, libraries were successful in providing many services remotely and will continue in some variation thereof. Libraries also experimented with new configurations of space, staffing models, and reduced hours. New opportunities abounded to demonstrate the expertise of our profession: educational expertise and course development to support medical education; collaboration with institutional and external partners for COVID-19 information gathering, analysis, and dissemination; remote learning support; and library space upgrades or space utilization by external groups for COVID-19 support. Flexibility, agility, adaptability, and resiliency were repeatedly mentioned as skills needed to both support one another and to provide continuity of services. The needs related to wellness morphed over time, as many libraries were initially in “support” mode for their staff and navigating ways to connect with one another, both personally and professionally; later on, wellness concerns underscored anxiety over returning to work. Additionally, some libraries consciously began discussions regarding equity, both around acknowledging financial disparities among staff, and the inequity in current library staffing structures. As libraries moved out of acute crisis mode, many recognized the need for better policies around topics such as remote work, technology needs, and disaster preparedness.Item Medical Student Responses in Critical Appraisal: A Qualitative Analysis(2022-05-06) Vetter, Cecelia J.; Menard, Laura; Blevins, Amy E.; Trujillo, Daniel J.Title: Medical Student Responses in Critical Appraisal: A Qualitative Analysis Objectives: To identify themes in medical student critical appraisal skills when asked to complete an evidence-based medicine (EBM) assignment. Researchers will analyze identified themes to find common approaches used by medical students when critically appraising a research article. Methods: Our team (three medical librarians and a statistician) will conduct a qualitative analysis of first year clerkship (third year of medical school) students’ responses to an EBM assignment wherein students are asked to critically appraise a research article and apply it to patient care. Previously, we noted that many students use factors such as journal reputation or impact factor as proxies for critically appraising study methodology and results. The librarian team is conducting a qualitative analysis of textual responses by gathering one years’ worth of quiz responses. Each team member is individually reviewing each response for general themes. After this open coding is completed, librarian team members will collaboratively develop a code list. Each team member will then code each assignment individually. Statistics will be run for inter-rater reliability and discrepancies will be resolved by librarian group consensus. Results: The team will present main and secondary themes. Commentary and examples will be provided by the librarian team on trends seen in medical student critical appraisal. Conclusions: This project is ongoing. However, we anticipate that our results will inform EBM instruction by identifying common themes in medical trainees' early attempts to apply critical appraisal skills to a clinical scenario.Item Analysis of Public Preprint Server Comments on NIH Preprint Pilot Articles(2022-05-04) Sawyer, Amanda; Cruise, Allison; Dolan, Levi; Chatmon, BriannaObjectives: Given the increased prevalence of preprints during the COVID-19 pandemic, this project sought to analyze public comments left on a sample of preprint articles from the NIH Preprint Pilot to determine if they were substantive in nature. Analysis of article titles and qualitative coding of the comments was conducted. This analysis was designed to obtain both quantitative and qualitative measures of comments on a selected group of articles so that the relationship between public commenting and scientific rigor could be explored. Methods: The first 1,000 preprint articles to be indexed in PubMed Central and hosted on two preprint platforms (bioRxiv and medRxiv) were selected. Using the preprint servers’ associated commenting platforms, full text comment threads and Twitter information was obtained, and summary statistics of commenting platforms were produced. From the article sample a total of 494 comments were collected from public commenters using the Disqus platform to provide feedback on the articles. Using the article titles, the authors explored indications of the relationship between article topic and frequency of commenter engagement. Preliminary coding was conducted using a ‘thumbs up/thumbs down’ method and potential categorizations were suggested. Utilizing these suggestions, the authors created and refined a draft codebook. Finally, thirteen categorizations, ten for substantive comments and three for not substantive comments, were created and used to qualitatively code the comment sample. Results: Two rounds of coding were completed to reach sufficient interrater reliability. The authors found that most of the public comments were substantive, with over 28% meeting the criteria for critique, 21.5% as questions for authors, and over 11% having aspects of a formal peer review process. The analysis revealed engagement between commenters and preprint authors, demonstrated through author responses to questions, updates, and feedback. Commenters also provided suggestions for future research (3.6%) and indicated their intent to utilize the preprint findings in future research projects of their own (2.6%). Conclusions: This project provides evidence of the impact of public commenting on scientific rigor. Public commenting was frequently substantive, and provided critique which sometimes led to direct revisions of the preprint article. Commenters also provided responses similar in nature to the formal peer review process, providing authors with feedback faster than the traditional process. Through preprints authors can disseminate their research to a wide audience earlier, and comments indicated that some readers intended to use the preprint findings in their own research, accelerating the potential for scientific discovery. As the prevalence of preprints continues to grow and public engagement with preprints increases, this paper’s methodology can be replicated and refined to further analyze the value of public commenting on preprints.