Evaluating Study Design Rigor in Preclinical Cardiovascular Research: A Replication Study.

Background: Methodological rigor is a major priority in preclinical cardiovascular research to ensure experimental reproducibility and high quality research. Lack of reproducibility results in diminished translation of preclinical discoveries into medical practice and wastes resources. In addition, lack of reproducibility fosters uncertainty in the public's acceptance of reported research results. Methods: We evaluate the reporting of rigorous methodological practices in preclinical cardiovascular research studies published in leading scientific journals by screening articles for the inclusion of the following key study design elements (SDEs): considering sex as a biological variable, randomization, blinding, and sample size power estimation. We have specifically chosen to screen for these SDEs across articles pertaining to preclinical cardiovascular research studies published between 2011 and 2021. Our study replicates and extends a study published in 2017 by Ramirez et al. We hypothesized that there would be higher SDE inclusion across preclinical studies over time, that preclinical studies that also include human and animal substudies within the same study will exhibit greater SDE inclusion than animal-only preclinical studies, and that there will be a difference in SDE usage between large and small animal models. Results: Overall, inclusion of SDEs was low. 15.2% of animal only studies included both sexes as a biological variable, 30.4% included randomization, 32.1% included blinding, and 8.2% included sample size estimation. Incorporation of SDE in preclinical studies did not significantly increase over the ten year time period in the articles we assessed. Although the inclusion of sex as a biological variable increased over the 10 year time frame, that change was not significant (p=0.411, corrected p=8.22). These trends were consistent across journals. Reporting of randomization and sample size estimation differs significantly between animal and human substudies (corrected p=3.690e-06 and corrected p=7.252e-08, respectively.) Large animal studies had a significantly greater percentage of blinding reported when compared to small animal studies (corrected p=0.01.) Additionally, overall, large animal studies tended to have higher SDE usage. Conclusions: In summary, evidence of methodological rigor varies substantially depending on the study type and model organisms used. Over the time period of 2011-2021, the reporting of SDEs within preclinical cardiovascular studies has not improved and suggests extensive evaluation of other SDEs used in cardiovascular research. Limited incorporation of SDEs within research hinders experimental reproducibility that is critical to future research.

The Global Health Informatics landscape and JAMIA.

Global Health Informatics (GHI) as a branch of health informatics has been established for 2 decades now. During that time, great strides have been made in the creation and implementation of informatics tools to improve healthcare delivery and outcomes in the most vulnerable and remote communities worldwide. In many of the most successful projects, innovation has been shared between teams in high- and low- or middle-income countries (LMICs). In this perspective, we review the state of the academic field of GHI and the work published in JAMIA in the last 6 1/2 years. We apply criteria for articles about LMICs, those on international health, and on indigenous and refugee population, and subtypes of research. For comparison, we apply those criteria to JAMIA Open and 3 other health informatics journals which publish articles on GHI. We make recommendations for future directions and the role that journals like JAMIA can play in strengthening this work worldwide.

Emergency Absentee Voting for Hospitalized Patients and Voting During COVID-19: A 50-State Study.

INTRODUCTION: Voters facing illness or disability are disproportionately under-represented in terms of voter turnout. Earlier research has indicated that enfranchisement of these populations may reinforce the implementation of policies improving health outcomes and equity. Due to the confluence of the coronavirus 2019 (COVID-19) pandemic and the 2020 election, we aimed to assess emergency absentee voting processes, which allow voters hospitalized after regular absentee deadlines to still obtain an absentee ballot, and election changes due to COVID-19 in all 50 states. METHODS: We performed a cross-sectional study collecting 34 variables pertaining to emergency voting processes and COVID-19-related election changes, including deadlines, methods of submission for applications and ballots, and specialized services for patients. Data were obtained from, in order of priority, state boards of elections websites, poll worker manuals, application forms, and state legislation. We verified all data through direct correspondence with state boards of elections. RESULTS: Emergency absentee voting processes are in place in 39 states, with the remaining states having universal vote-by-mail (n = 5) or extended regular absentee voting deadlines (n = 6). The emergency absentee period most commonly began within 24 hours following the normal absentee application deadline, which was often seven days before an election (n = 11). Unique aspects of emergency voting processes included patients designating an "authorized agent" to deliver their applications and ballots (n = 38), electronic ballot delivery (n = 5), and in-person teams that deliver ballots directly to patients (n = 18). Documented barriers in these processes nationwide include unavailable online information (n = 11), restrictions mandating agents to be family members (n = 7), physician affidavits or signatures (n = 9), and notary or witness signature requirements (n = 15). For the November 2020 presidential election, 12 states expanded absentee eligibility to allow COVID-19 as a reason to request an absentee ballot, and 18 states mailed absentee ballot applications or absentee ballots to all registered voters. CONCLUSION: While 39 states operate emergency absentee voting processes for hospitalized voters, there are considerable areas for improvement and heterogeneity in guidelines for these protocols. For future election cycles, information on emergency voting and broader election reforms due to COVID-19 may be useful for emergency providers and patients alike to improve the democratic participation of voters experiencing illness.

Emergency Mail-in Voting in Rhode Island: Protecting Civic Participation During COVID-19 and Beyond.

The COVID-19 pandemic challenges safe and equitable voting in the United States' 2020 elections, and in response, several states including Rhode Island (RI) have made significant changes to election policy. In addition to increasing accessibility of mail-in voting by mailing applications to all registered voters, RI has suspended their notary/witness requirement for both the primary and general election. However, RI's "emergency" voting process still plays a crucial role in allowing voters who missed the mail-in ballot application deadline, such as those unexpectedly hospitalized in the days leading up to the election, to still cast their ballot. COVID-19 has also forced RI to modify its emergency voting procedures, most notably allowing healthcare workers to serve on bipartisan ballot delivery teams. This commentary highlights these salient updates to voting procedures and serves as a primer as to how interested health care workers may navigate this process alongside patients and lead in the arena of patient voting rights.