A perspective on integration and outreach: Guiding concepts in the evolution of health informatics.

BACKGROUND: The National Library of Medicine's Integrated Academic/Advanced Information Management Systems (IAIMS) initiative played a central role in the evolution of health informatics over the project's lifetime (1983-2009) and continues to do so. AIM: Our objective is to demonstrate how IAIMS and two key IAIMS concepts, integration and outreach, have functioned at very different times during this evolutionary process. APPROACH: Using a framework drawn from Lorenzi and Stead's 2021 history of IAIMS, we examine the role of integration and outreach in work at the University of Maryland Baltimore (UMB) in the early 1980s and at the University of Texas Arlington (UTA) in 2020. RESULTS: Guided by these concepts, UMB implemented a campus-wide information utility, while UTA established a center to accelerate research and innovation. CONCLUSIONS: Outreach and integration have been formative in the evolution of health informatics and will continue to hold their power.

Adoption of the voluntary conflict of interest statement on PubMed.

In 2017, the National Library of Medicine (NLM) added a voluntary field for conflict of interest (COI) statements ("posted COI") on the abstract page of PubMed, but the extent to which it is used is unknown. This repeated cross-sectional study examined journals and articles indexed on PubMed from 2016 through 2021. We described the proportion of all journals with at least one article that included a posted COI and the percentage of all articles that included a posted COI over time. We also examined 100 randomly selected articles published between June 2021 and May 2022 from each of the 40 highest impact journals. For these, we established whether the articles had published COIs, and, of these, the proportion that included a posted COI. Among approximately 7,000 journals publishing articles each year, the proportion of journals with at least one article with a posted COI statement increased from 25.9% in 2016 to 33.2% in 2021. Among nearly 400,000 articles published each year, the proportion of articles that included a posted COI also increased from 9.0% in 2016 to 43.0% in 2021. Among 3,888 articles published in the 40 highest impact journals in 2021-2022, 30.2% (95% CI: 28.7%-31.6%) had published COIs; of these, 63.3% (95% CI: 60.4%-66.0%) included a posted COI. Use of the PubMed COI statement has increased since it became available in 2017, but adoption is still limited, even among high impact journals. NLM should carry out additional outreach to journals that are not using the statement to promote greater transparency of COIs.

Connecting lab, clinic, and community.

Despite great progress in biomedical research, the health of the US population appears to be getting worse. The United States spends substantially more per capita on health care than other wealthy countries, yet US life expectancy ranks low among its peers. Mortality rates have been increasing for segments of the US population, including those in rural areas, certain racial and ethnic groups, and individuals with low socioeconomic status. A whole-of-society approach is required to address such negative trends and disparities, and the biomedical research enterprise must play a key role.

The NCBI Comparative Genome Viewer (CGV) is an interactive visualization tool for the analysis of whole-genome eukaryotic alignments.

We report a new visualization tool for analysis of whole-genome assembly-assembly alignments, the Comparative Genome Viewer (CGV) (https://ncbi.nlm.nih.gov/genome/cgv/). CGV visualizes pairwise same-species and cross-species alignments provided by National Center for Biotechnology Information (NCBI) using assembly alignment algorithms developed by us and others. Researchers can examine large structural differences spanning chromosomes, such as inversions or translocations. Users can also navigate to regions of interest, where they can detect and analyze smaller-scale deletions and rearrangements within specific chromosome or gene regions. RefSeq or user-provided gene annotation is displayed where available. CGV currently provides approximately 800 alignments from over 350 animal, plant, and fungal species. CGV and related NCBI viewers are undergoing active development to further meet needs of the research community in comparative genome visualization.

Manual versus machine: How accurately does the Medical Text Indexer (MTI) classify different document types into disease areas?

The Medical Subject Headings (MeSH) thesaurus is a controlled vocabulary developed by the U.S. National Library of Medicine (NLM) for classifying journal articles. It is increasingly used by researchers studying medical innovation to classify text into disease areas and other categories. Although this process was once manual, human indexers are now assisted by algorithms that automate some of the indexing process. NLM has made one of their algorithms, the Medical Text Indexer (MTI), available to researchers. MTI can be used to easily assign MeSH descriptors to arbitrary text, including from document types other than publications. However, the reliability of extending MTI to other document types has not been studied directly. To assess this, we collected text from grants, patents, and drug indications, and compared MTI's classification to expert manual classification of the same documents. We examined MTI's recall (how often correct terms were identified) and found that MTI identified 78% of expert-classified MeSH descriptors for grants, 78% for patents, and 86% for drug indications. This high recall could be driven merely by excess suggestions (at an extreme, all diseases being assigned to a piece of text); therefore, we also examined precision (how often identified terms were correct) and found that most MTI outputs were also identified by expert manual classification: precision was 53% for grant text, 73% for patent text, and 64% for drug indications. Additionally, we found that recall and precision could be improved by (i) utilizing ranking scores provided by MTI, (ii) excluding long documents, and (iii) aggregating to higher MeSH categories. For simply detecting the presence of any disease, MTI showed > 94% recall and > 87% precision. Our overall assessment is that MTI is a potentially useful tool for researchers wishing to classify texts from a variety of sources into disease areas.

US Generic Antiseizure Medication Supply Chain: Observations from Analysis of US Government Databases.

BACKGROUND: Generic drug manufacturing has shifted away from the U.S. in the last few decades. The medication supply chain, from manufacturers to resellers, has become increasingly globalized and complex. This has led to bottlenecks in their manufacture resulting in medication shortages. Review of this process as it pertains to antiseizure medications (ASM) shows gaps in our comprehension of its complexities. Understanding these processes will be essential for preventing medication shortages. OBJECTIVES: The aim of this research is to examine the generic ASM supply with an emphasis on production, labeling, and repackaging. METHODS: Data from the United States Food and Drug Administration (FDA) and the National Library of Medicine (NLM) website DailyMed was used to evaluate supply chain details to gather information on antiseizure medication formulations, manufacturing locations, and labeling. RESULTS: Out of 3142 ASM-related active National Drug Code (NDC-9) codes, 2663 NDC-9 codes with Abbreviated New Drug Application (ANDA) status were included in the analysis. Most (94.8 %) were enteral, with only 5.2 % being parenteral (intravenous and intramuscular route). We identified the manufacturing country for 82 % of these codes, corresponding to 306 unique ANDA numbers. 119 manufacturing sites in 12 countries produce generic ASM Finished Dosage Forms (FDF): 103 for enteral and 21 for parenteral. India is the main producer of enteral ASM FDFs with 49 sites, followed by the US with 36. Regarding parenteral formulation, five countries had 21 unique manufacturing locations. 42 % of the 103 enteral ASM FDFs manufacturing sites produced multiple ASM FDFs, with one facility making eight distinct ASMs. 34.4 % of facilities were associated with over 3 ANDAs, and 15.1 % with more than 5. 22.7 % of ANDAs lacked a manufacturing facility identifier. Repackaged ASM FDFs constituted 48 % of NDC-9 s. Gabapentin and pregabalin were the most common oral ASMs. CONCLUSIONS: India is the major source for generic ASM FDFs manufacturing, leading to concerns about overall supply dependency on that country. There is a paucity of facilities for the global supply of parenteral ASM FDFs. There is missing data for many NDC-9 codes emphasizing urgency for transparency in the supply chain.

Interactive Images in Library Instruction: A Case Study.

This paper discusses the design and implementation of the H5P image hotspots and describes additional use cases for library instruction in order to teach learners from across the country on how different spaces can be used to create private, accessible areas where patrons can conduct telehealth appointments. The Network of the National Library of Medicine created an online class using H5P image hotspots to allow learners to virtually explore a physical space. The class used Moodle, an open-source learning platform, and H5P image hotspots to demonstrate how libraries implemented telehealth programs.

Database resources of the National Center for Biotechnology Information.

The National Center for Biotechnology Information (NCBI) provides online information resources for biology, including the GenBank® nucleic acid sequence database and the PubMed® database of citations and abstracts published in life science journals. NCBI provides search and retrieval operations for most of these data from 35 distinct databases. The E-utilities serve as the programming interface for most of these databases. Resources receiving significant updates in the past year include PubMed, PMC, Bookshelf, SciENcv, the NIH Comparative Genomics Resource (CGR), NCBI Virus, SRA, RefSeq, foreign contamination screening tools, Taxonomy, iCn3D, ClinVar, GTR, MedGen, dbSNP, ALFA, ClinicalTrials.gov, Pathogen Detection, antimicrobial resistance resources, and PubChem. These resources can be accessed through the NCBI home page at https://www.ncbi.nlm.nih.gov.

Notes on the data quality of bibliographic records from the MEDLINE database.

The US National Library of Medicine has created and maintained the PubMed® database, a collection of over 33.8 million records that contain citations and abstracts from the biomedical and life sciences literature. This database is an important resource for researchers and information service providers alike. As part of our work related to the creation of an author graph for coronaviruses, we encountered several data quality issues with records from a curated subset of the PubMed database called MEDLINE. We provide a data quality assessment for records selected from the MEDLINE database and report on several issues ranging from parsing issues (e.g. character encodings and schema definition weaknesses) to low scores for identifiers against several data quality metrics (e.g. completeness, validity and uniqueness). Database URL  https://pubmed.ncbi.nlm.nih.gov.

Future advancement of health care through standardized nursing terminologies: reflections from a Friends of the National Library of Medicine workshop honoring Virginia K. Saba.

OBJECTIVE: To honor the legacy of nursing informatics pioneer and visionary, Dr. Virginia Saba, the Friends of the National Library of Medicine convened a group of international experts to reflect on Dr. Saba's contributions to nursing standardized nursing terminologies. PROCESS: Experts led a day-and-a-half virtual update on nursing's sustained and rigorous efforts to develop and use valid, reliable, and computable standardized nursing terminologies over the past 5 decades. Over the course of the workshop, policymakers, industry leaders, and scholars discussed the successful use of standardized nursing terminologies, the potential for expanded use of these vetted tools to advance healthcare, and future needs and opportunities. In this article, we elaborate on this vision and key recommendations for continued and expanded adoption and use of standardized nursing terminologies across settings and systems with the goal of generating new knowledge that improves health. CONCLUSION: Much of the promise that the original creators of standardized nursing terminologies envisioned has been achieved. Secondary analysis of clinical data using these terminologies has repeatedly demonstrated the value of nursing and nursing's data. With increased and widespread adoption, these achievements can be replicated across settings and systems.

Automated indexing using NLM's Medical Text Indexer (MTI) compared to human indexing in Medline: a pilot study.

Objective: In 2002, the National Library of Medicine (NLM) introduced semi-automated indexing of Medline using the Medical Text Indexer (MTI). In 2021, NLM announced that it would fully automate its indexing in Medline with an improved MTI by mid-2022. This pilot study examines indexing using a sample of records in Medline from 2000, and how an early, public version of MTI's outputs compares to records created by human indexers. Methods: This pilot study examines twenty Medline records from 2000, a year before the MTI was introduced as a MeSH term recommender. We identified twenty higher- and lower-impact biomedical journals based on Journal Impact Factor (JIF) and examined the indexing of papers by feeding their PubMed records into the Interactive MTI tool. Results: In the sample, we found key differences between automated and human-indexed Medline records: MTI assigned more terms and used them more accurately for citations in the higher JIF group, and MTI tended to rank the Male check tag more highly than the Female check tag and to omit Aged check tags. Sometimes MTI chose more specific terms than human indexers but was inconsistent in applying specificity principles. Conclusion: NLM's transition to fully automated indexing of the biomedical literature could introduce or perpetuate inconsistencies and biases in Medline. Librarians and searchers should assess changes to index terms, and their impact on PubMed's mapping features for a range of topics. Future research should evaluate automated indexing as it pertains to finding clinical information effectively, and in performing systematic searches.

Promoting rural residents' participation in clinical trials: clinical trials basics programming and training for rural public librarians.

Background: Having diverse representation in clinical trial participation is important. Historically, rural residents have been underrepresented in clinical trial research. Public librarians have an opportunity to promote clinical trial participation among rural residents by offering consumer health information services that help patrons to understand what clinical trials are and how they can find relevant clinical trials. Case Presentation: A consumer health library and a clinical trial center located at a large academic medical center collaborated to provide clinical trial information programming to rural public libraries. The group was awarded a Network of the National Library of Medicine (NNLM) Community Outreach Grant and was able to plan, develop, promote, and implement programs including training workshops, a speaker event, and a book discussion to rural public librarians. Discussion: Marketing the programs to rural public libraries was difficult and many barriers were encountered. Though registration and subsequent participation were low, participants expressed interest and gratitude for the programs. For any future programs targeting this population, further strategies will need to be implemented to ensure increased registrations and attendees.

PubMed's core clinical journals filter: redesigned for contemporary clinical impact and utility.

Objective: The Core Clinical Journals (CCJ) list, produced by the U.S. National Library of Medicine (NLM), has been used by clinicians and librarians for half a century for two main purposes: narrowing a literature search to clinically useful journals and identifying high priority titles for library collections. After documentation of low usage of the existing CCJ, a review was undertaken to assess current validity, followed by an update to current clinical needs. Methods: As the subject coverage of the 50-year-old list had never been evaluated, the CCJ committee began its innovative step-wise approach by analyzing the existing subject scope. To determine whether clinical subjects had changed over the last half-century, the committee collected data on journal usage in hospitals and medical facilities, adding journal usage from Morning Report blogs recording the journal article citations used by physicians and residents in response to clinical questions. Patient-driven high-frequency diagnoses and subjects added contextual data by depicting the clinical environment. Results: The analysis identified a total of 80 subjects and selected 241 journals for the updated Clinical Journals filter, based on actual clinical utility of each journal. Discussion: These data-driven methods created a different framework for evaluating the structure and content of this filter. It is the real-world evidence needed to highlight CCJ clinical impact and push clinically useful journals to first page results. Since the new process resulted in a new product, the name warrants a change from Core Clinical Journals (CCJ) to Clinically Useful Journals (CUJ). Therefore, the redesigned NLM Core Clinical Journals/AIM set from this point forward will be referred to as Clinically Useful Journals (CUJ). The evidence-based process used to reframe evaluation of the clinical impact and utility of biomedical journals is documented in this article.

Collaborative collection development: a MedPrint case report.

Background: In response to several of Texas' largest medical libraries being forced to discard all serial print holdings, the Texas A&M University System and University of Texas System's Joint Library Facility (JLF) staff worked to help provide a solution to save and store these resources. This process fire-started a comprehensive effort by JLF staff to contact the National Library of Medicine (NLM) and devise a blueprint that would be used to help save and preserve all serial medical resources listed in NLM's medical retention program. Case Presentation: In an unprecedented approach, the Texas A&M JLF staff launched efforts to collect and preserve the complete holdings range of all NLM MedPrint periodical runs. This case report details the planning and steps JLF staff took to accomplish this feat; highlights important matters of consideration for the medical community which heavily relies upon continuous access to MedPrint materials; and provides insight on the apparent preservation vulnerabilities these materials increasingly face in an environment where digitization may create a false sense of security. Discussion: By May 2021, JLF had collected complete title runs up to year 2000 for 202 of the 254 MedPrint titles, which consists of more than twelve thousand volumes. These efforts proved particularly beneficial in the wake of the COVID-19 pandemic, which forced NLM to halt ILL processing from their print collection. During this time, JLF was uniquely positioned to meet and respond to the historic high number of medical literature ILL requests it received during this time.

2022 Janet Doe Lecture, health science libraries in the emerging digital information era: charting the course.

The great challenge medical library professionals are facing is how we evolve and respond to the emerging digital era. If we successfully understand and adapt to the emerging digital information environment, medical librarians/Health Information Professionals (HIPs) can play an even greater role in the advance in the health care of our nation and its residents. The opportunities and challenges are at the level we successfully responded to in the late 1960's and the 1970's under the leadership of the National Library of Medicine with its MEDLARS/Medline programs and Medical Library Assistance Act which enabled medical libraries to enter what I have referred to as The Golden Age of Medical Libraries. In this presentation, I focused on the transition of the health-related print Knowledge-Based Information base to the emerging digital health-related ecosystem. I review how this transition is being driven by evolving information technology. The development of "data driven health care" built on this emerging information ecosystem is being led by the National Library of Medicine's 2017-2027 Strategic plan and the Medical Library Association's programs in support of developing medical librarian/HIP's training, skills, and services to support their users access and use of this rapidly expanding health information ecosystem. I then present a brief description of the digital health information ecosystem that is just starting to emerge and the emerging new roles and services HIPs and their libraries are developing to support effective institutional access and use.

Examination of reporting status of pediatric oncology trials within the national library of medicine's trial database.

Finding safer and more effective treatment options are critical in progressing the field of pediatric oncology. These treatment options are discovered through completion and publication of clinical trials. The primary objective of this study was to assess the overall study characteristics of pediatric oncology clinical trials initiated between 2008 and 2021. The secondary objective of our study was to assess rates of discontinuation and reporting of results as required by the Food and Drug Administration (FDA). After acquiring pediatric oncology clinical trials from ClinicalTrials.gov, a cross-sectional study was performed. Included trials have an intervention exclusive to pediatrics and were conducted between 2008 and 2021. The results measured were characteristics of the clinical trials and their rate of discontinuation. Of the 7,930 trials originally returned from the search, 349 trials met inclusion criteria. The majority of the trials were phase 1 and 2 pharmaceutical interventions studying brain and blood cancer. Our study found that 14.9% (52) of the pediatric oncology trials were discontinued. Given the breadth of study within pediatric oncology, our overarching assessment shows that drug trials geared toward treating cancers of the brain and blood were dominant in the field. It is crucial for the advancement of science that results of trials are known. This avoids duplication of studies and waste of funds. Of the trials that were completed, 40.3% (58) did not report results to ClinicalTrials.gov. The nonreporting of this data limits the information available delaying the advancement of treatment options.

Bookshelf: A Biomedical Database of Books and Documents.

Bookshelf is a database maintained by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine that contains freely accessible online biomedical documents, including systematic reviews, technical reports, textbooks, and reference books. The database allows users to browse and search across all content and within individual books, and it is linked to other NCBI content. This article provides an overview of Bookshelf and demonstrates its usage in a sample search. The resources available in Bookshelf are useful for students, researchers, healthcare professionals, and librarians.

Chemical identification and indexing in full-text articles: an overview of the NLM-Chem track at BioCreative VII.

The BioCreative National Library of Medicine (NLM)-Chem track calls for a community effort to fine-tune automated recognition of chemical names in the biomedical literature. Chemicals are one of the most searched biomedical entities in PubMed, and-as highlighted during the coronavirus disease 2019 pandemic-their identification may significantly advance research in multiple biomedical subfields. While previous community challenges focused on identifying chemical names mentioned in titles and abstracts, the full text contains valuable additional detail. We, therefore, organized the BioCreative NLM-Chem track as a community effort to address automated chemical entity recognition in full-text articles. The track consisted of two tasks: (i) chemical identification and (ii) chemical indexing. The chemical identification task required predicting all chemicals mentioned in recently published full-text articles, both span [i.e. named entity recognition (NER)] and normalization (i.e. entity linking), using Medical Subject Headings (MeSH). The chemical indexing task required identifying which chemicals reflect topics for each article and should therefore appear in the listing of MeSH terms for the document in the MEDLINE article indexing. This manuscript summarizes the BioCreative NLM-Chem track and post-challenge experiments. We received a total of 85 submissions from 17 teams worldwide. The highest performance achieved for the chemical identification task was 0.8672 F-score (0.8759 precision and 0.8587 recall) for strict NER performance and 0.8136 F-score (0.8621 precision and 0.7702 recall) for strict normalization performance. The highest performance achieved for the chemical indexing task was 0.6073 F-score (0.7417 precision and 0.5141 recall). This community challenge demonstrated that (i) the current substantial achievements in deep learning technologies can be utilized to improve automated prediction accuracy further and (ii) the chemical indexing task is substantially more challenging. We look forward to further developing biomedical text-mining methods to respond to the rapid growth of biomedical literature. The NLM-Chem track dataset and other challenge materials are publicly available at https://ftp.ncbi.nlm.nih.gov/pub/lu/BC7-NLM-Chem-track/. Database URL https://ftp.ncbi.nlm.nih.gov/pub/lu/BC7-NLM-Chem-track/.

Database resources of the National Center for Biotechnology Information in 2023.

The National Center for Biotechnology Information (NCBI) provides online information resources for biology, including the GenBank® nucleic acid sequence database and the PubMed® database of citations and abstracts published in life science journals. NCBI provides search and retrieval operations for most of these data from 35 distinct databases. The E-utilities serve as the programming interface for most of these databases. New resources include the Comparative Genome Resource (CGR) and the BLAST ClusteredNR database. Resources receiving significant updates in the past year include PubMed, PMC, Bookshelf, IgBLAST, GDV, RefSeq, NCBI Virus, GenBank type assemblies, iCn3D, ClinVar, GTR, dbGaP, ALFA, ClinicalTrials.gov, Pathogen Detection, antimicrobial resistance resources, and PubChem. These resources can be accessed through the NCBI home page at https://www.ncbi.nlm.nih.gov.