The internet has significantly transformed how news is produced, consumed, and distributed. As a result, the news industry has transitioned from ad-supported to subscription-based models regulated by digital paywalls. In the light of this disruption, it is crucial to investigate not only how news consumers adapt to this change but also how economic incentives shape content coverage. We analyzed the staggered adoption of digital paywalls by 17 regional US newspapers over 17 years in a difference-in-difference framework to examine the impact of paywall adoption on topical news content coverage. Our results reveal a small but significant decrease in local and soft news coverage, with varying effects across different urban contexts. Specifically, local news coverage experienced a more substantial decline in smaller cities ( population < 500,000 ) and regions experiencing an influx of younger residents (age < 40 years). Conversely, soft news coverage increased in areas with a younger demographic influx, indicating a strategic shift by newspapers to cater to digital-savvy audiences and adapt to changing consumption patterns. Our findings underscore the delicate balance between financial imperatives and editorial choices in the newspaper industry and highlight the need for ongoing research into the effects of digital monetization strategies on journalistic content creation, media plurality, and civic accountability.
Transgender and gender diverse (TGD) young adults experience elevated risk for eating disorders (ED), partially due to cissexist discrimination and victimization; less is understood about how socioeconomic determinants contribute to their ED risk. Qualitative data collected from 66 TGD young adults (18-30 years old; 29% self-identified as transgender women, 29% as transgender men, 39% as nonbinary people, and 3% as another gender identity (e.g., māhū)) in eight asynchronous online focus groups explored how socioeconomic determinants in conjunction with other dimensions of identity and lived experience shape disordered eating behavior (DEB) and ED risk. Participants described how economic barriers-including poverty and dependency on others (e.g. parents for health insurance)-and challenges produced by insurance and healthcare systems impeded healthcare access to the detriment of their overall mental health and risk for ED. In addition, participants shared different ways they leveraged financial resources to cope with stress, sometimes in ways that impelled disordered eating behaviors. Finally, participants described how poverty, socioeconomic advantage and disadvantage, and classism compound other systems of oppression (e.g. racism, ableism, weight bias) to adversely impact their general health and ED risk.
LGBTQ+ people experience higher burdens of life-limiting illnesses, poorer health outcomes, and multilevel barriers to accessing palliative, end-of-life, and bereavement care. High quality evidence is needed to inform interventions to address these inequities, and inform inclusive practices and policies. Despite global initiatives to improve availability of peer-reviewed journal articles, the minority of research is open access (OA). We aimed to evaluate accessibility of literature related to LGBTQ+ inclusive palliative, end-of-life, and bereavement care. A rapid review of the evidence regarding LGBTQ+ inclusive palliative, end-of-life, and bereavement care was conducted; OA status of identified articles was assessed. Articles from three published systematic reviews were included (2012, 2016, and 2020). Review articles were updated using the original search and inclusion/exclusion strategies. 66 articles related to LGBTQ+ inclusive palliative, end-of-life and bereavement care were identified between 1990-2022. Of these, only 21% (n=14) were OA. Of the OA articles, 79% were published between 2017 and 2022, and 50% were published between 2020-2022, reflecting more recent shifts towards OA publishing. Health and social care professionals and policy makers rely on access to high quality evidence to inform their work. Failing to make articles related to the needs of LGBTQ+ people and populations OA risks further marginalisation and worsened inequities. Innovative journal policies and funding are needed to enable access, particularly for research that foregrounds the needs of marginalised communities. Where articles are currently behind paywalls, there is a need for accessible summaries or policy briefs to inform inclusive policy and practice.
In a national online longitudinal survey, participants reported their attitudes and behaviors in response to the recently implemented metered paywall by the New York Times. Previously free online content now requires a digital subscription to access beyond a small free monthly allotment. Participants were surveyed shortly after the paywall was announced and again 11 weeks after it was implemented to understand how they would react and adapt to this change. Most readers planned not to pay and ultimately did not. Instead, they devalued the newspaper, visited its Web site less frequently, and used loopholes, particularly those who thought the paywall would lead to inequality. Results of an experimental justification manipulation revealed that framing the paywall in terms of financial necessity moderately increased support and willingness to pay. Framing the paywall in terms of a profit motive proved to be a noncompelling justification, sharply decreasing both support and willingness to pay. Results suggest that people react negatively to paying for previously free content, but change can be facilitated with compelling justifications that emphasize fairness.
Naturalistic stimuli show significant potential to inform behavioral, cognitive, and clinical neuroscience. To date, this impact is still limited by the relative inaccessibility of both generated neuroimaging data as well as the supporting naturalistic stimuli. In this perspective, we highlight currently available naturalistic datasets and technical solutions such as DataLad that continue to advance our ability to share this data. We also review scientific and sociological challenges in selecting naturalistic stimuli for reproducible research. Overall, we encourage researchers to share their naturalistic datasets to the full extent possible under local copyright law.
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Many traditional journals have launched companion open access (cOA) journals with similar scope and aims. These journals seek better article dissemination through removal of the paywall and use of article processing charges (APCs). Traditional journals often suggest transfer to their cOA journal, leaving authors with a decision to accept transfer and pay an APC or resubmit elsewhere. We aim to compare costs and impact of these journals to better inform authors. The top 15 U.S.-based traditional journals within medicine, surgery, pediatrics, and OB/GYN were identified based on 2023 impact factor. Those with cOA journals were included, and all publication data between 2011 and 2023 were extracted. Citation counts were compared using Poisson regression; author demographics were analyzed using multivariable logistic regression. There were 14 traditional journals with cOA counterparts, constituting 52,232 publications from 36,577 authors. cOA articles had half the citations of traditional publications (9.4 vs 18.2) and collected an estimated $35 million in APCs. Female and low/middle income country (LMIC) authors were more likely to publish in cOA journals (aOR = 1.23, 1.14, respectively). Authors publishing in companion open access journals incur higher publication costs, and yet, receive fewer citations per publication.
Chat Generative Pre-trained Transformer, an artificial intelligence large language model chatbot, transforms how patients obtain information regarding health concerns, including sensitive questions. To assess and compare the accuracy, completeness, and consistency of answers by Chat Generative Pre-trained Transformer-3.5, -4, -5, and -5 Plus to common questions regarding fecal incontinence. Thirty questions, written in lay language and based on American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for fecal incontinence, were presented in sequential order twice to all Chat Generative Pre-trained Transformer versions. Question categories included general/background, diagnosis, treatment, and miscellaneous. Three board-certified professors of colorectal surgery with expertise treating fecal incontinence rated the answers "yes" or "no" for accuracy, completeness, and consistency with guidelines. A "no" prompted a free-text response. Quantitative and qualitative analysis was performed. Chat Generative Pre-trained Transformer-3.5, -4, -5 (free access), and -5 Plus (paid subscription). Patients with fecal incontinence were included. Patient questions. Accuracy, completeness, and consistency with practice guidelines. Reviewers rated 61% of answers accurate, 65% complete, and 68% consistent for Chat Generative Pre-trained Transformer-3.5; 72%, 73%, and 69% for Chat Generative Pre-trained Transformer-4; 50%, 73%, 68% for Chat Generative Pre-trained Transformer-5 Free; and 83%, 95%, and 82% for Chat Generative Pre-trained Transformer-5 Plus, respectively. Three questions triggered content warning by Chat Generative Pre-trained Transformer, flagging them as inappropriate and terminating the chat. Qualitative analyses revealed 10 emergent subthemes; the most frequent was inaccuracy of treatment recommendations. The current set of chatbots is not intended for medical use. No version of Chat Generative Pre-trained Transformer provided answers that were entirely accurate, complete, or consistent with clinical practice guidelines; however, the paid version performed markedly better than the other versions. Analysis of Chat Generative Pre-trained Transformer-5 Free versus Plus highlighted a dimension of disparity introduced by paywall-contingent model performance. Our study emphasizes the necessity for patient and provider education on the benefits and pitfalls of this technology regarding health information. See Video Abstract . ANTECEDENTES:ChatGPT, un chatbot basado en un modelo de lenguaje grande de inteligencia artificial, transforma la forma en que los pacientes obtienen información sobre cuestiones de salud, incluidas preguntas delicadas.OBJETIVO:Evaluar y comparar la precisión, exhaustividad y coherencia de las respuestas de ChatGPT-3.5, 4, 5 y 5 Plus a preguntas frecuentes sobre la incontinencia fecal.DISEÑO:Se presentaron treinta preguntas redactadas en lenguaje sencillo, basadas en las directrices de práctica clínica de la Sociedad Americana de Cirujanos de Colon y Recto para la incontinencia fecal, en orden secuencial y dos veces a todas las versiones de ChatGPT. Las categorías de preguntas incluían información general/antecedentes, diagnóstico, tratamiento y miscelánea. Tres profesores certificados en cirugía colorrectal con experiencia en el tratamiento de la incontinencia fecal calificaron las respuestas con «sí» o «no» en función de su precisión, exhaustividad y coherencia con las directrices. Un «no» daba lugar a una respuesta de texto libre. Se realizó un análisis cuantitativo y cualitativo.CONFIGURACIÓN:ChatGPT-3.5, ChatGPT-4, ChatGPT-5 (acceso gratuito), ChatGPT-5 Plus (suscripción de pago)INTERVENCIÓN:Preguntas de los pacientes.PRINCIPALES MEDIDAS DE RESULTADO:Exactitud, exhaustividad y coherencia con las directrices prácticasRESULTADOS:Los revisores calificaron el 61 % de las respuestas como exactas, el 65 % como completas y el 68 % como coherentes para ChatGPT-3.5, el 72 %, el 73 % y el 69 % para ChatGPT-4, 50 %, 73 % y 68 % para ChatGPT-5 gratuito, y 83 %, 95 % y 82 % para ChatGPT-5, respectivamente. Tres preguntas activaron la advertencia de contenido de ChatGPT, que las marcó como inapropiadas y terminó el chat. Los análisis cualitativos revelaron 10 subtemas emergentes; el más frecuente fue la inexactitud de las recomendaciones de tratamiento.LIMITACIONES:El conjunto actual de chatbots no está destinado a uso médico.CONCLUSIONES:Ninguna versión de ChatGPT proporcionó respuestas totalmente precisas, completas o coherentes con las directrices de práctica clínica, aunque la versión de pago funcionó notablemente mejor que el resto. El análisis de ChatGPT-5 free frente a Plus puso de relieve una dimensión de disparidad introducida por el rendimiento del modelo dependiente del muro de pago. Nuestro estudio hace hincapié en la necesidad de educar a los pacientes y a los proveedores sobre los aspectos positivos y los inconvenientes de esta tecnología en lo que respecta a la información sanitaria. (AI-generated translation ).
Free and open access to research data and findings promotes equity in access to healthcare knowledge and equity in patient care and treatment. To benefit the health care of the population studied, research findings must be accessible to clinicians, academics, and policymakers serving those populations. The aim of this study was to assess the extent of published Tanzanian neurosurgical data and its accessibility to those practicing within the country. A systematic review of all published neurosurgical studies from Tanzania was conducted. Authorship, funding, and open-access status were recorded. Tanzanian neurosurgeons were surveyed by telephone or in person about their methods of accessing literature. We identified 96 Tanzanian neurosurgical studies published in 42 journals between 1982 and 2023 with an exponentially increasing number of publications per year. Fifty-nine studies (62%) are available open access at the publisher. Open access publication is associated with Tanzanian first authorship (odds ratio = 2.6, 95% CI: 1.0-6.8) or last authorship (odds ratio = 2.7, 95% CI: 1.0-7.1). However, overall only 34 of 96 studies (35%) had Tanzanian first authors and 32 of 96 (33%) had Tanzanian last authors. We contacted 26 of 27 neurosurgeons working in Tanzania. None had in-country institutional library service access. One used a research initiative login to access neurosurgical literature, and 2 used institutional logins from outside Tanzania. Ten neurosurgeons (38%) reported alternative methods of accessing literature behind a paywall such as Sci-Hub or direct contact with authors. These methods could have given access to all but 9 of 96 neurosurgical studies (9%). Only 62% of Tanzanian neurosurgical literature is easily freely accessible to Tanzanian neurosurgeons, and 9% of all Tanzanian neurosurgical literature is extremely challenging to access for neurosurgeons working in Tanzania. Expanding open-access publishing, repositories, and publisher and institutional initiatives for equitable data and publication access are crucial for improving access to local data to improve patient care.
Large language models (LLMs) are generative-AI which generate text output like a human conversation. We wanted to assess the ability of LLMs to answer patient's questions and benchmark their output using a best evidence topic (BET). We asked LLMs whether robot-assisted thoracic surgery (RATS) or video-assisted thoracoscopic surgery (VATS) lobectomy had better perioperative outcomes for postoperative pain, length of hospital stay (LOS) and mortality. A BET was constructed according to a structured protocol for the same questions. An initial search yielded 324 papers, 12 represented the best evidence. LLM outputs are almost instantaneous while a BET took many hours of searching a database for relevant evidence. However, current iterations and models of LLMs did not provide relevant outputs, suffered from hallucinations, and could be restricted by copyright and paywall issues. The BET, on the other hand, was tailored to the scenario by specialist human oversight and therefore more reliable and nuanced. There were no major differences between RATS and VATS lobectomy for T1cN0M0 NSCLC apart from shorter LOS following RATS. Current LLMs may not be entirely reliable for answering clinical questions. An LLM-BET protocol could be used as a standardized process to compare LLM outputs for different clinical scenarios, each benchmarked with a BET. It can also be used to analyse outputs of different models of current and future LLMs.
Artificial intelligence (AI) chatbots perform well in answering English cancer questions. For Spanish, their performance is unknown and may differ by free vs. paywall versions. We evaluated the quality (range: 1-5 points), actionability (range: 0-100%), and readability (range: 1-13 grades) of six popular AI chatbots in responding to the 15 most searched Spanish questions regarding breast, prostate, and colon cancer. The quality of overall AI chatbot responses was good (mean [95% CI]: 3.5 [3.4-3.6] points), while the actionability was low (mean [95% CI]: 35.6% [30.8%-40.3%]). The readability was high-school-level (mean [95% CI]: 9.2 [8.8-9.6] grades), not concordant with the American Medical Association recommendation (≤ 6th grade). The quality, actionability, and readability did not differ by free and paywall versions (p > 0.05). Our findings suggested AI chatbots may generate good-quality responses to Spanish cancer questions, regardless of free or paywall versions. However, further improvement in actionability and readability is needed to benefit Spanish-speaking patients.
Scientific studies conducted without adhering to ethical principles or without obtaining necessary approvals may lead to retractions, thereby undermining both scientific credibility and public trust. This study examines Retractions due to Ethical Violations or Lack of Approval (REVLA) in medical and allied disciplines, analyzing the trend over time, classifying the reasons for retractions, and explaining how they are communicated. REVLA published between 2003 and 2022 were identified using Web of Science and Scopus. Reasons for retraction were extracted from the Retraction Watch Database (RWD). A total of 969 articles meeting the criteria were identified. Original research and clinical studies accounted for over 95% of REVLA. The number of retractions increased substantially in the last decade. 37.67% of REVLA are either under a paywall or unavailable on the journal pages. Papers on clinical practice constitute 57.79% of REVLA, followed by biological sciences (20.02%) and cancer research (15.69%). The analysis shows that no publishers or journals are immune to REVLA. Strengthening institutional review boards (IRB), imparting education on research and publication ethics, and ensuring public access to retraction notices and articles are essential to uphold research integrity. Stricter editorial vigilance and peer review are crucial to prevent the publication of ethically compromised studies, thereby reducing the need for future retractions.
Ineffective health communication can drive health disparities and limit the effectiveness of interventions to reduce them. Stock photo libraries are a critical tool for developers of patient education, health education, and intervention materials. It is not clear how well stock photo libraries represent communities bearing disproportionate burdens of disease. We conducted a search using five popular stock image libraries (Adobe Stock Images, Canva, Getty Images, Microsoft Office Image Library, and Pixabay) in November 2021 to evaluate diversity and representation in health-related stock photos. We searched for the following five key preventive health topics: healthy eating, exercising, quitting smoking, vaccination, and pregnancy. The images (N = 495) were coded for age, gender presentation, representation of perceived minoritized racial/ethnic identity, skin color using the Massey-Martin skin color scale, markers of high socioeconomic status (SES), and access costs. Results. The representation of perceived minoritized people, darker skin color, and inclusion of markers of high SES varied greatly by the search term and library. Images predominately portrayed young adults and adults, with limited representation of other age groups. Images in libraries with any paywall were significantly more likely to depict a person of perceived minoritized racial/ethnic identity and depict darker skin colors, and were significantly less likely to contain markers of high SES identity than images in libraries that were free to use. We found that it costs more to develop culturally relevant health education materials for minoritized populations and groups that do not represent high SES populations. This may hinder the development of effective communication interventions.
In this study we test ChatGPT-4's ability to provide accurate information about the origins and evolution of SWOT analysis, perhaps the most widely used strategy tool in practice worldwide. ChatGPT-4 is tested for historical accuracy and hallucinations. The API is prompted using a Python script with a series of structured questions from an Excel file and the results are recorded in another Excel file and rated on a binary scale. Our findings present a nuanced view of ChatGPT-4's capabilities. We observe that while ChatGPT-4 demonstrates a high level of proficiency in describing and outlining the general concept of SWOT analysis, there are notable discrepancies when it comes to detailing its origins and evolution. These inaccuracies range from minor factual errors to more serious hallucinations that deviate from evidence in scholarly publications. However, we also find that ChatGPT-4 comes up with spontaneous historically accurate facts. Our interpretation of the result is that ChatGPT is largely trained on easily available websites and to a very limited extent has been trained on scholarly publications on SWOT analysis, especially when these are behind a paywall. We conclude with four propositions for future research.
The intent of plain-language resources (PLRs) reporting medical research information is to advance health literacy among the general public and enable them to participate in shared decision-making (SDM). Regulatory mandates coupled with academic and industry initiatives have given rise to an increasing volume of PLRs summarizing medical research information. However, there is significant variability in the quality, format, readability, and dissemination channels for PLRs. In this scoping review, we identify current practices, guidance, and barriers in developing and disseminating PLRs reporting medical research information to the general public including patients and caregivers. We also report on the PLR preferences of these intended audiences. A literature search of three bibliographic databases (PubMed, EMBASE, Web of Science) and three clinical trial registries (NIH, EMA, ISRCTN registry) was performed. Snowball searches within reference lists of primary articles were added. Articles with PLRs or reporting topics related to PLRs use and development available between January 2017 and June 2023 were identified. Evidence mapping and synthesis were used to make qualitative observations. Identified PLRs were quantitatively assessed, including temporal annual trends, availability by field of medicine, language, and publisher types. A total of 9116 PLRs were identified, 9041 from the databases and 75 from clinical trial registries. The final analysis included 6590 PLRs from databases and 72 from registries. Reported barriers to PLR development included ambiguity in guidance, lack of incentives, and concerns of researchers writing for the general public. Available guidance recommendations called for greater dissemination, increased readability, and varied content formats. Patients preferred visual PLRs formats (e.g., videos, comics), which were easy to access on the internet and used short jargon-free text. In some instances, older audiences and more educated readers preferred text-only PLRs. Preferences among the general public were mostly similar to those of patients. Psychology, followed by oncology, showed the highest number of PLRs, predominantly from academia-sponsored research. Text-only PLRs were most commonly available, while graphical, digital, or online formats were less available. Preferred dissemination channels included paywall-free journal websites, indexing on PubMed, third-party websites, via email to research participants, and social media. This scoping review maps current practices, recommendations, and patients' and the general public's preferences for PLR development and dissemination. The results suggest that making PLRs available to a wider audience by improving nomenclature, accessibility, and providing translations may contribute to empowerment and SDM. Minimizing variability among available guidance for PLR development may play an important role in amplifying the value and impact of these resources. Plain-language resources (PLRs) can help people understand medical research information. This will allow them to make informed decisions about their health. However, PLRs vary in quality, format, and ways in which they are shared. In this study, researchers looked at how PLRs are made and publicly shared. They also studied what makes PLRs useful for the public and patients. Creating PLRs is not easy because of unclear guidelines on writing for the public. Using different formats and languages can make PLRs readable. Patients preferred PLRs as videos and comics. Older and educated readers liked text-only PLRs. The fields of psychology and oncology had the highest number of PLRs. Text-only PLRs were more common than digital or online formats. PLRs should be easily and freely accessible. Open-access journal websites, PubMed, third-party websites, email, and social media can be used to share PLRs. This study showed that PLRs can be helpful, but there are challenges in creating and sharing them. Good PLRs can inform patients and help them make better health-related decisions.
Authors are often faced with the decision of whether to maximize traditional impact metrics or minimize costs when choosing where to publish the results of their research. Many subscription-based journals now offer the option of paying an article processing charge (APC) to make their work open. Though such "hybrid" journals make research more accessible to readers, their APCs often come with high price tags and can exclude authors who lack the capacity to pay to make their research accessible. Here, we tested if paying to publish open access in a subscription-based journal benefited authors by conferring more citations relative to closed access articles. We identified 146,415 articles published in 152 hybrid journals in the field of biology from 2013-2018 to compare the number of citations between various types of open access and closed access articles. In a simple generalized linear model analysis of our full dataset, we found that publishing open access in hybrid journals that offer the option confers an average citation advantage to authors of 17.8 citations compared to closed access articles in similar journals. After taking into account the number of authors, Journal Citation Reports 2020 Quartile, year of publication, and Web of Science category, we still found that open access generated significantly more citations than closed access (p < 0.0001). However, results were complex, with exact differences in citation rates among access types impacted by these other variables. This citation advantage based on access type was even similar when comparing open and closed access articles published in the same issue of a journal (p < 0.0001). However, by examining articles where the authors paid an article processing charge, we found that cost itself was not predictive of citation rates (p = 0.14). Based on our findings of access type and other model parameters, we suggest that, in the case of the 152 journals we analyzed, paying for open access does confer a citation advantage. For authors with limited budgets, we recommend pursuing open access alternatives that do not require paying a fee as they still yielded more citations than closed access. For authors who are considering where to submit their next article, we offer additional suggestions on how to balance exposure via citations with publishing costs.