Preferential Publication Bias in Nepal’s Medical Journals

Preferential publ is hing; self-publishing; Medica l J ourn al s ; N epa l ; p ublic ation bias 1 DP Pant (dpa n t@ p ri . go v . n p ) , B Ac har ya (B. Achar ya bac h a rya@ p r i. go v .np) , MR Ka ttel (mr katte l @ pr i . g o v. np)| Po l ic y Rese arc h I nstit ute, Kath mandu N e p a l * Corre sp o n di n g A u th ors . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted August 17, 2022. ; https://doi.org/10.1101/2022.08.15.22278758doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. 2 Intro d uc tion Ideall y, s ci entific jour na l pa pers s hould be fr e e f rom a ny kinds of bia s e s . In practic e, ho we ve r , publica tion bia s e s g et reflecte d in v a r ious f orms and deg r ees. So me studies g et n e v er publis he d due t o “ f i le-dr a wer problem” – a situation whe r e b y co mple t e d s tudie s a r e nev e r p ubl is hed . Gene r a lly, s tudie s that a r e statisti cally significa nt (Nair, 20 1 9), that e xplore n ew and immedi ate social is sues into the academic di s cus sion, and those with positive r e s ults ge t published w ith p r i o ri t i e s ( M l i n a r i ć e t a l . , 2017 ) . T ri a l s w i th p o s i t i v e r e s u l t s a r e p u b l i s h e d s ooner tha n other trials (Hopewe ll et al. , 2 00 1). Tim e-la g bia s , s pec if i cally in the case of hea lth and clinic al studies, r e s ult s in due to v arious reas ons s uc h as the n a t ure of res ul t s of the studies and the pro c ess duration of regula to ry and s c r utiny author i t i es . Individual pape r s a r e g en erally be lie ved to be f ree from public ation bias e s a s t he y are polis he d thro u gh edi t orial vetting, re view s and s c r utiny . The proce s s m a k es the p a pe rs mor e scientific, less biased and trust w or thy than t hose t ha t a v o i d or esc a pe such s c r utiny ( Childe , 2 00 6). For such qu alitie s , editors serve both as qu a lity controllers a n d ga teke e pers . They , in principle , work towards avoiding all for ms o f biases via the applic ation o f established ed itoria l norms, such as fairness , objec tivity, tr a ns p a r e n c y, and rigour. Howev e r , som e j our n a ls m ay n ot f oll ow r igorous process e s of publica tion pr a ctice, ultim ately allowing a s i t ua tion whereby p ubl ication bia s es cree p into due to omiss ion s, lapses a nd une t hic al practic es on the part of edito rs and publishers. T he journals that publi s h m a nus cripts without a rigorous proce s s of scrutiny risk endorsing wh a t Ande r son a nd Rainie (2 017) call a doc tored narr a tive, whic h poses a serious threat to scie nti f ic inquiries and thei r outc o me s . In suc h a case , the jour n a ls c annot pl ay a significa nt role in advancing scie ntif i c knowle dge r ather they become t he platfor m for unve rified o r doubt f u l scientif ic know ledge. Edi t or-authors hip is one of the for m s of publica tion bi a s as editor -a ut hors e xert undue influenc es on their c ol leag ues to sym pathetic ally re view their submiss ions and cle a r them for publica tion (Luty e t al ., 2 0 09). Such c ontr i but ion s a r e , ho wever, hig hly selective, p urpos efully invited and str a t e gica lly ai me d. C ontr ibuting multiple full-leng t h article s regula r ly by the e dit ors ha vi ng a n exec utive role in the p u blic ation proce s ses of jour na l a r tic les contradic t s t he established editorial norms (Luty et al., 2 00 9; Mani et a l., 20 1 3), whic h s hould not be bre ac hed to kee p the integrity and s tanding of the journals. S u ch a t e n d en cy c o m p r o m i s e s t h e i n t e g r i t y o f journals, bre a ches the trus t of contr i b u t ors, promot e s s e lf- a dulation and, c o ns e quently, does a h u g e d i ss e r v i c e to s c i e n ti fi c e n q u i r y ( Bo šn j a k e t a l. , 2 01 1; T e ix e i ra d a S i l va , 2017 ) . As a networ k of author s, co-authors hip is one o f the mea s ures to a nalyse an indi vidual scholar’s abil it y to c ollabor ate with others and explore knowledg e from different per spective s within a similar cros s-dis c ipl ine domain of scientific e nquir y . Authors ' fie ld of a c ade mic st udy , the leve l of press ure to ge t published, r a n ks in ac ademia and the p u r suit of qu ality are p rob a ble f actors to bring authors toge t he r for co-authors hi ps ( P ie t te & R os s , 19 92). Scholars contr ibuting t o speci fic research a r eas a nd thos e w or king in diff e r e n t g eographic a l loca t ions tend to participate in specific c o- a ut horship ne tworks (Uddin et al. , 201 2), which pro vide a platf orm f or differen t sets of tale n t to jo int l y o r colle ct ively pro du ce a res earch output (Kum ar, 2 01 5). Co- authorsh i p, however, is not always w elcom e as i t m ay do d is ervic e to ethica l public atio n als o constitut i ng som e times to publi c ation bias. Th e net rela tions hip betwe en the o utputs attributable to individua l author a f ter discounting f or the numb e r of authors and the co- aut hors hip is ne gative (Hollis, 2 0 01). A ls o, unjustified and pr olific c o- a utho rship simply works a s o ne of the w a ys for inflation o f s ci entometr i c indic es that do not nece s s arily fur ther refle ct the tr ue q uali t y of a n individua l’s rese a r c h outp u t (Masic & J an kovi c , 2 02 1 ) . . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted August 17, 2022. ; https://doi.org/10.1101/2022.08.15.22278758doi: medRxiv preprint 3 Edi t ors a nd publishers ma y also c r e ate publica tion bias by preferring t he w or k of only one or a few auth ors, allowi n g t o publish in th e jour na ls they edit and s i m il ar othe r ways. I f eve r y journal in specific national c ont e xts a llows biased co- a ut horship, editor- a utho r ship or unus ua l preference to a single author such pr actic es could quali f y a public a t i on bias thereby pos ing a serious problem t o the national scie nt i f ic i nquir ie s and studies. The practice ultimately be co mes one o f the r e asons for national publica t i ons of no t e xcell ing international l y a n d m aintaining international s tanda r ds. In this ba ckground, this article e xplore s the st a tus of Nep a l’s journ als vis -à- vis m aintaining a nd ac hie ving inte r na t iona l qu ality standard s. F or the purpos e, w e explore the ex t ent of edi torial a nd publishers ’ practice s s pe cifica lly the preferentia l public ation bias e s of Nep a l’ s medic al jour nals , whic h ex is t t o s e r v e Ne pal’s m edic al f i eld of r e s ea r c h a n d inquiries c onf ine d in s mal l comm unities of prac t i ce. This article , therefor e , i s belie ved to contr ibute to st irring contr ibut ors and p u b l is he r s of Nepali journ a ls to r e ach out to i nt e r na tional communit ie s of p rac t ic e for qu al ity research and public a t i o n besides contributing t o br i dging n a tional r es ea r c hers with the internal prac t i ce a nd co m munities. M ethod olo gy For thi s pa per, w e an a lysed f ull - le ngth a r tic les publ is hed in the Nep al i me dic al journ als indexe d in the Scopus datab a s e: the Journal of N e p al Medic al Ass oci ation ( JNMA), the J ournal of Nep al Paedi atr i c Society ( JNPS), K athm andu Unive r sity Medica l J o urnal ( KUMJ), th e J ournal of Nep al Hea lth Research Coun c il (JNHR C ), N e pal M e dical C ollege Journ al ( NMCJ) and N e pal J ourn al of Ophthalmology (NJO) . The jour na ls are amon g t he 238 journals i n de xed by Nepal Jo urnal Online (NepJol), the only academic jou r na l dat abase in Nep a l m an aged by T ribhuv a n U niv ers ity Ce ntr a l Libr a r y. The six journ als a r e the only Nep a lese journ als ev er inde xe d in the Scopus data b as e ( tw o of them ha ve now been r e mo ved fr om the indexing ) . How ever , we used the dat a of the remov ed journal of until the date t he y w e r e active under the Scop us dat ab a s e . Table 1: N e p al’s Medica l J ourn al s Indexed by S copus Dat ab ase Nam e o f Journa l Qu arti le pe r f o r m a nc e Discipli n e Publi sh er H- In d e x o f jo u rn als Num ber o f artic le s index ed in Sc o pu s Data b ase Rem arks Journal of t h e Ne p al M e d i cal Assoc iation ( h t tps:/ / www.scima go jr.c om/journa lsearch. p hp ?q =15831&ti p=si d &c l e an =0 ) 19 9 9 (Q3), 20 0 0 - 20 0 5 ( non i n c l u d e d), 20 0 6 (Q4), 20 0 7 - 20 1 5 (Q3), 20 1 6 - 20 2 0 (Q4 ) M e di c i ne (Misce llan eous) Ne p al Me d i c al Associa tion 19 13 3 8 Cu rrently index e d in S copus Journal of Ne p al Hea l t h Res earch Counc il ( h t tps:/ / www.scima go jr.c om/journa lsearch. p hp ?q =2110019 7 340&tip =sid&cl ean=0 ) 20 1 1 (Q4), 20 1 2 - 2 0 16 ( Q 3 ) , 20 17 ( Q 4 ) , 20 18 - 2 02 0 (Q3) M e di c i ne (Misce llan eous) Ne p al He alth Rese arc h Counci l 13 72 0 Cu rrently In d e xe d in S copus . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted August 17, 2022. ; https://doi.org/10.1101/2022.08.15.22278758doi: medRxiv preprint 4 Kathmand u Un iversi ty Me dica l J ournal ( h t tps:/ / www.scima go jr.c om/journa lsearch. p hp ?q =4000148 1 03&ti p=si d &c l e an =0 ) 2 00 4 ( Q3 ) , 20 05 ( Q 4) 20 0 5-2 0 1 9(Q 3 ) , 20 2 0 (Q4) M e di c i ne (miscel lan e ou s ) Ka t hma nd u Univers ity ( In associat ion with me d ica l col l e ges affili a te d with Ka t hma nd u Univers ity ) 25 13 6 1 Cu rrently index e d in S copus Journal of Nepal Paediatr ic S o c iety ( h t tps:/ / www.scima go jr.c om/journa lsearch. p hp ?q =1970017 4 963&tip =sid&cl ean=0 ) 2 0 09 - 2 01 0 ( Q4 ), 20 1 1-2 0 1 4 (Q3), 2 0 15 - 2 02 0 ( Q4 ) Pediatr ics, Perin a to l o gy a n d C h ild Hea l th Ne p al Paediat r ic So c i et y 8 25 7 Cu rrently index e d in S copus Ne p al M ed i cal Co lleg e j o u rn al: NM C J ( h t tps:/ / www.scima go jr.c om/journa lsearch. p hp ?q =145147&tip =sid&c lean=0 ) 2 0 04 - 2 00 5 ( Q4 ), 20 0 6-2 0 1 7 (Q3) M e di c i ne (miscel lan e ou s ) Ne p al Me d i c al Colleg e 21 44 4 Disconti nued in Sc o p u s Journal O f T he Nepal O p h th a lmic S o c iety ( h t tps:/ / www.scima go jr.c om/journa lsearch. p hp ?q =1990019 1 831&tip =sid&cl ean=0 ) 20 1 0-2 0 1 1 (Q4) 2 0 12 - 2 01 6 ( Q3 ) 20 1 7 (Q4 ) 20 1 8 (Q3 ) 20 1 9 (Q4 ) M e di c i ne M e di c i ne (miscel lan e ou s ) Ne p al Ophtha lmic So c i et y 13 92 Disconti nued The Sc opus dat ab ase is one the larges t bibl i o me tr ic data b as e m ainta ined b y El s ev ier and has more tha n 2 2,0 00 activ e titles bes i des so me 1 3 , 0 00 in active one s . We used Scopus da tab ase as the s ource b e ca u s e of its global rec o g nition a s one of the qua lity indexing syst e ms . The Scopus data b as e publicly provide s journal articl es rela ted in for mation and a llows downloading the article s wi t h the hel p o f a specif ied scri pt via an inbuilt search engi ne. In d exe d unde r i t, journals ge t mor e visible, enjoy m ore pos sibilities of a v ailing thems e lves in t he library datab ases a nd, reac h o ut to a br oa der ac a de mic audience . I t, how e ver, does not me an th at ge tting indexe d under Scopus is t he ultimate a chiev e m ent, as there are other index ing d atab a s e s . To search the data for the study, we used the s ea r c h c ode “AFFI LCOUN TR Y (N e pal)” in t he Scopus s e arch engine , collec ted the n a me of the Nep al i j our na ls index ed and used the individua l search code fo r ea ch journal w it h E XA C T SRCTI TLE (" Name o f Nep alese J ourna l ") A N D (L IM I T- TO (DOCTYPE, "ar"). T he complete sea r c h c ode for particular journ al i s ( AFF ILCOUNTR Y ( nepal ) A N D ( ( P U B Y E AR > 19 8 0 ) AN D ( P UBY EAR < 20 22 ) ) ) AND ( L IMI T- TO ( S R C T Y P E , "j" ) ) AN D ( LIMIT -T O ( DOC T Y P E , " ar " ) ) AND ( LIMI T-T O ( EXACTSR C T ITL E , " J ournal Of Nepal He a lth Research C o u n c il " ) ). T he method resulted i n the number of art i cles indexe d under the jour na l title. For the purpose o f this s tudy , we e xclude d the ‘review a r tic les’ a nd ‘e ditor ia ls ’ as editors may be obliged to w r i t e such articles t o promot e . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted August 17, 2022. ; https://doi.org/10.1101/2022.08.15.22278758doi: medRxiv preprint 5 and p av e the direc tion of the jour na ls . In ge neral editorial practice , editorials do not unde r g o a pee r review pr oc ess but t he o the r article categ or ie s such as ‘ f ull-le ngth a r tic le’ (Scopus identi fies it as “ ar”) and ‘ r eview a r tic le’ (Sc o p u s ide n tif ie s as “re”) should be pe e r -review ed. For the an a lysis of the data, we us e d s ocia l networ k an aly s is a pplic a t i ons . V OSvie w er w as us e d to visuali s e the a uthor s w ho contribu ted to t he journals. Si nce t he Sc opus da tab ase identifies authors by sur name (as the firs t name) followed by the in itials o f the f ir s t and m i ddle names, it posed a pr oble m of multip le authors b eing c ounted as a s ingle author . To av oid th is po ss ib ili ty , we us e d t he Scopus author ide n tific ation numbers – the unique numbers assigned to ea ch author - be lieving that identifying authors by Scopus identif ica tion numbers is more ac c ur ate t ha n by the authors’ l ast names and initials. Resu lts Pr edomi n an ce of S ele ct A u th or s O v e r t he y ea rs , d o w n to 2021 , s om e of t h e s i x j o u rn a l s a na l y s e d ha ve i n c re a se d th e n u m be r o f published a r tic les ex ponentially . JNM A w a s est a blish e d in 19 6 3 but got inde xed in Sc opus in 20 05 only whe n it publi s hed 28 articles. T he n umb er inc r eased by 82 5 pe r cent to rea c h 25 9 article s in 20 2 1. Al o ng with the inc r e ase in the nu mbe r of article s , t he j ournal provided a significant percentag e of public ation s pace to selec tive a uthor s only. For e xa mple , an author published s e ven article s (2. 7 per cent o f the to tal a r tic les) in 20 21 , a noth e r seve n (2 . 8 9 p e r c ent) in 202 0 and f i ve a r tic les (4.1 3 p e r ce nt) in 201 9 . In 2 007 , it ha d pr ovi ded 8. 57 per c ent of publica tion s pa c e to an indiv idu al a ut h or. . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted August 17, 2022. ; https://doi.org/10.1101/2022.08.15.22278758doi: medRxiv preprint 6 Table 2 Predominance of Sele ct author s in a s el ected Ne p ali Medic al Jour n a ls Year NH R C KUM J NMC J J NP S N J O J NMA To tal Arti cle s Max i m u m no of arti c l e s by s i ng le autho r Perce n t To tal Artic l e s Ma xi mu m n o o f ar t i c l e s by sin g le au t h o r in Percen t To t a l Art i cle s Ma x i m u m no o f artic les by s i ng le au th or P e rcen t Total Arti cle s Ma ximu m n o of artic les by sing le au th or in Perc en t To tal Arti cle s max i m u m no o f a r t i cl es by s i ng l e autho r Percen t To t a l Article s ma x i m u m no of ar t ic les by singl e au th or Pe r c e n t 20 2 1 13 1 8 6.1 1% 57 4 7.02 % - - - 5 0 3 6 . 0 0% - - - 259 7 2.70% 20 2 0 14 3 15 10 .4 9 % 11 6 9 7.76 % - - - 4 4 3 6 . 8 2% - - - 242 7 2.89% 20 1 9 10 5 8 7.6 2% 72 6 8.33 % - - - 3 5 2 5 . 7 1% - - - 121 5 4.13% 20 1 8 68 7 10 .2 9 % 79 4 5.06 % - - - 5 7 3 5 . 2 6% - - - 103 4 3.88% 20 1 7 37 2 5.4 1% 82 5 6.10 % - - - 4 0 2 5 . 0 0% - - - 71 4 5.63% 20 1 6 41 3 7.3 2% 92 5 5.43 % - - - 7 0 2 2 . 8 6% 27 2 7.41 % 42 2 4.76% 20 1 5 45 9 20 .0 0 % 58 5 8.62 % - - - 6 2 3 4 . 8 4% 16 4 25 . 00 % 77 3 3.90% 20 1 4 45 2 4.4 4% 73 4 5.48 % 48 4 8.33% 5 4 3 5 . 5 6% 17 4 23 . 53 % 63 2 3.17% 20 1 3 63 6 9.5 2% 72 1 0 13 . 89 % 38 3 7.89% 6 1 3 4 . 9 2% 51 2 3.92 % 83 3 3.61% 20 1 2 33 2 6.0 6% 79 6 7.59 % 82 8 9.76% 5 7 2 3 . 5 1% 55 3 5.45 % 40 3 7.50% 20 1 1 41 4 9.7 6% 65 4 6.15 % 80 9 11.2 5 % 38 3 7. 89 % 3 7 4 10 . 81 % 33 2 6.06% 20 1 0 28 2 7.1 4% 71 4 5.63 % 66 3 4.55% 2 1 2 9 . 5 2% 24 5 20 . 83 % 71 3 4.23% 20 0 9 - - - 75 3 4.00 % 75 5 6.67% 1 8 4 22 . 2 2 % 22 4 18 . 18 % 72 3 4.17% 20 0 8 - - - 84 3 3.57 % 62 6 9.68% 1 6 3 18 . 7 5 % - - - 54 3 5.56% 20 0 7 - - - 10 4 5 4.81 % 67 6 8.96% - - - - - - 35 3 8.57% 20 0 6 - - - 94 5 5.32 % 75 4 5.33% - - - - - - 41 3 7.32% 20 0 5 - - - 86 5 5.81 % 41 3 7.32% - - - - - - 28 2 7.14% . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted August 17, 2022. ; https://doi.org/10.1101/2022.08.15.22278758doi: medRxiv preprint 7 20 0 4 - - - 62 5 8.06 % 39 5 12.8 2 % - - - - - - - - - 20 0 3 - - - 55 1 0 18 . 18 % 33 4 12.1 2 % - - - - - - - - - . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted August 17, 2022. ; https://doi.org/10.1101/2022.08.15.22278758doi: medRxiv preprint 8 JNP S publi s hed 16 art i cles in 20 0 8 – the numbe r inc r eased by over 21 2 pe r c e nt to 50 in the ye ar 2 02 1 – allowed a s ing le a uthor to publ is h four article s (occupy ing 22 . 22 per cent of the annual publica tion s pac e) in 2 00 9 . Like w is e , K UMJ published 55 articl es in 2 0 0 3 , whi ch inc r e as e d to 5 7 in the year 20 2 1. It provided 13. 8 9 per cent of t he jour na l s p ac e for a s ingle a uthor to publish in 2 01 3, all owing an a ut hor to publis h 1 0 out o f 72 published art i cles. In 2 01 0, NHRC h ad 2 8 article s , whic h rea ched 1 3 1 in 2 0 2 1, w ith an i ncrease of 368 per c ent. I n 20 1 5, a s i ngle author published nine ( 20 per cent) out of 4 5 a r tic les in the N HRC journal and 1 5 ( 10. 4 9 per cent ) article s out of 143 p ublished articl es by a single author in 20 2 0. NJO, which wa s re mo ve d from Scopus indexing in 2 01 6, published 2 2 article s in 20 0 9. Se ve n years do w n the line , in 2 01 6, the number decre a s e d to 1 6. In 201 5, it a l s o al lowed a single author to publish f our articles (2 5 per ce nt ) of t he t ota l a r tic les. N M C J , anot he r journal remo ved from the S c opus registr a t i on, published 33 articles in 200 3. It w as in de xed in Scopus unti l 2014 w hen it publ is hed 48 a r tic les. In 20 04 , it pro v ided 12. 8 2 pe r c ent of t he space f or a single author al lowing them to publis h five article s . C o - a u tho r s hi p N e tw o r k s Co- a ut horship information reveale d tha t thos e w or k ing as nod al c o - a utho rs w ere also found to be the e ditors o f journals. Ac r oss all journals of our s tudy , 10 9 a uthors were f ound to have published article s in the journals as editor s. Twenty-two edi t orial b oa r d memb ers hav e publis he d at le as t one art i cle be t w een 2 017 and 2 0 21 a nd the highest number of a r t ic les by a single e dito r ia l board me mbe r of the NHR C jour na l during that pe r i o d is 4 0. Simil a r ly , six editorial board memb ers of KUMJ ha v e publish e d at l east o ne art i cle betwe en 20 1 7 a n d 202 1, with the highest number of single - a utho r art i cles be ing 2 2. In the JNMA journ al , 2 1 editorial b o a r d m emb ers ha ve publis he d at le a s t one article dur ing 2 01 7 – 20 2 1, w ith an individu a l a uthor i n g as hig h as 1 1 article s . E ight editor ial board memb e r s of NMCJ journal ha d p ubl is hed a t least one article dur i n g 2 01 0 to 20 1 4 (la s t f ive ye ars before it was delist e d), with one member publishe d 2 4 a r tic les. T he JNP S journal p ubl is hes a sm all nu mber of articles co mp ared to other journ als annu ally , how ever, it also follows simila r trends of e ditori a l invol v ement. I n our da tas e t, w e f oun d that one edi tor published four article s f rom 20 17 to 2 02 1 . T h e NJO is not an exc e ption. Four te en e dito r ia l m e m be r s h a d p u b l i sh e d a t l e a s t o n e a r t i c l e f ro m 2 0 12 t o 2016 ( f i v e years before it was delisted ) and one o f the m published six article s during that pe r iod. . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted August 17, 2022. ; https://doi.org/10.1101/2022.08.15.22278758doi: medRxiv preprint Co-autho r n et work of th e most contr i b uti n g author in a jou rna l who pu bli shed 1 5 article s in tha t journal (a) Co-author network of t h e most contri bu ting au t h or w ho p ubli sh ed 45 articl es in t h a t journ al (b) Co-autho r n etwork of the mos t con t r ibuting auth or who p ubli sh ed 42 articles in t h at (c ) Co-author network of t h e most contri bu ting au t h or w ho p ubli sh ed 37 articl es in t h a t journ al (d) Figure 1 Co- a uth orsh ip net w ork o f maj or n ode ( a , b, c are edi t o r o f t h e j ourna l , d i s not ) Table 1 Ma x imum Perc entage of art ic l es w h ere th e ind i vidu al edi tor a ppeared as a c o- a uthor each year Year JNMA NHRC KUMJ N M CJ JNPS N J O 2 021 1.54% 6 .1 1% 7.02% - 4.00% - 2 020 2.48% 10 . 49% 6.90% - 2.27% - 2 019 1.65% 7 .6 2% 8.33% - 2.86% - 2 018 3.88% 10 . 29% 3.80% - 0 - 2 017 2.82% 5 .4 1% 2.44% - 0 - 2 016 2.38% 7 .3 2% 5.43% - 0 7.4 1 % 2 015 3.90% 20 . 00% 8.62% - 0 6.2 5 % 2 014 3.17% 4 .4 4% 5.48% 8.3 3 % 0 11 . 76% 2 013 2.41% 4 .7 6% 13. 8 9% 5.2 6 % 1.64% 3.9 2 % 2 012 2.50% 3 .0 3% 7.59% 9.7 6 % 0 3.6 4 % . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted August 17, 2022. ; https://doi.org/10.1101/2022.08.15.22278758doi: medRxiv preprint 10 2011 0 9.76% 4 .6 2% 11. 2 5% 2 .6 3% 5.41% 2010 2. 8 2% 3.57% 4 .2 3% 3.03% 4 .7 6% 12. 5 0% 2009 2. 7 8% - 1 .3 3% 6.67% 0 18. 1 8% 2008 3. 7 0% - 1 .1 9% 9.68% 6 .2 5% - 2007 2. 8 6% - 0 .9 6% 2.99% - - 2006 4. 8 8% - 3 .1 9% 5.33% - - 2005 0 - 2 .3 3% 4.88% - - 2004 - - 8 .0 6% 12. 8 2% - - 2003 - - 5 .4 5% 12. 1 2% - - D i s c us s i o n a n d C o nc l u s i on Jour na ls in a s m a ll scientific commu nity serve an i m portant education al f unc tion, and they provide outlets for researchers to learn r e s e arch r e p orting and r e por t s pe cif i c local kno w ledge. Becaus e of the function, a s m al ler nu mber of authors are exp e cted to publish more articles in journals. T his m ay not be tr ue for t he e ditor i al board members as t he y ar e the qu al ity contr ol ler of the journals a nd a ls o s e r ve a s the k nowledg e bridge be t ween m ainstr e am ac a de mic journ als and nation al jour na ls . Ho wever, it i s i m portant to diffe r e n tia te be t w een the public ations in a journal by e ditor s ha ving a de cision- m a king r ole , a nd the others with othe r functions such as revie wing and w r i t i n g articles. Th e conf lict of interes t of the de cisi on- making e ditor s dif fers f rom that of the other researche r s involve d in a journal. T hi s i s w hy the r e are standa r ds a nd best practic es to de al with the c onf lic t of in t erest of de cision- ma king editors , s uch as W AME polici es . It enc our a ges rese arch on the pr inc iples a n d pr actic e of m e dic a l edi t ing (see w ww.w a me.or g ), a mong others. The domina nc e of a fe w authors is a fea t ure that cuts ac r oss all the medic a l journal s we h a ve revie w ed. A n e ditor w ho publi s hed 5 7 art i cles w as found to publish as m any as 45 a r ticl es in one of the journals he edited. A large nu m be r of a r tic les by a single aut hor in the journals o ver the ye ars m ay not be a pr obl em, pr ovi ded that the author a ls o c ont ributes with th eir articles in o ther international journals. Multiple r e s e arc h publi cations by a s c h ol ar in any jou r na l indic ate th e ir productivity and, a s s uch, should not be a n is sue ( Abbasi et al., 2 0 11). Th e f i t , qu a lity, a n d spee d o f p u b l i c a t i o n d e t e r m i n e a u t h o r s’ c h o ic e o f a j o u r na l ( S o l o m o n & B j ö r k , 2012 ) . W e f o u n d tha t som e c ont ributors have exclusively c o nt ributed to the journals w hereas the re ex is t many other with s i m i lar a ims and s c opes. It pr ovide s a ground to doubt tha t the y m ay h av e bee n preferentially tr e ated. The a ut hors do not c ontribute to o ther local journa ls e ith e r . Hence, all owing unus u a l publ is hing space for a single au t hor in Ne pali medic a l jour na ls is w or rying. I t reflec t s the biased closeness of the comm unity in qu e s tion and promotes sc ientif ic inbreeding whe r e by a ce r ta in groups of p r ofes s i o na ls ha ve exc lus ively pr omoted the ms e lves, b arring the other c ont ributo rs from using the out le t s to s ha r e their k no w ledge products, or for the o ther contributor s the cl os e-comm unity is an a lien s pa c e. T his r e ality r a is e s the q uest i on of e dit o ria l trans pa r e ncy and pr ovide s enough s pace to sus pe ct w h y a particula r a uthor de cides a speci f i c journal to publish m ultiple research wo rks in the sa me year. We f ound that two of the journals we st udi ed were deli s ted fr om the Scopus datab a s e . Pr e s uma bly, f ailure to comply w it h the Sc opus st a ndard could be the reason f or getting de l is te d. If the c ur rent tr e nd of preferen tial a nd s equ es te r e d publi c ation continue s , other jour na ls too run the ris k of being de l is te d f rom Scopus. Als o, unl es s we p ay due a tt e ntion to minimizi n g preferential p u b l ication bia s e s , it w il l be di f ficu lt f o r the o ther journals t o get li sted in the international qu ality indexing s y s tem. I f that ha p pe ns , t he cha n ces of the s e non-m a ins tream journals contributing to hy br id knowle dge a s tr usted pa r tners of mainstr e a m journ als w ill be . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted August 17, 2022. ; https://doi.org/10.1101/2022.08.15.22278758doi: medRxiv preprint 11 over. T he de list ing a ls o questions the v alidi t y , qu ality and s ta ndard of the kn owledg e gener ate d and diss e minated to d ate thereby posing a serious q uestion – w h at will be the fate a nd future of the other medi cal j o u r nal s o f Nepa l that s how case Ne p al’s m edica l educa tion? Keeping on enjoy ing the s ta t us-quo a nd failing to comply with t he established editor i al prac t i ce will be a worris ome situation for t he s e ctor . The six journals a r e the fr ont f a ce of Ne p al’s medi c al education and resea r ch. The qu ality a nd rigour they m a intain uphold the ir profe s sional integrity and ele v ate them as a trus te d source of scientif ic know ledge , which m ai n stream journals can use without a doubt. They ca n , thus , be the medium to bridge the gap b etwe en loc al and glob a l kno wle dge, a nd also an indica tor that N ep a l’s medic al e duc a t ion is on par w ith the rest of the world. A ll it requires i s f or the ed itors a nd m anagers of the journals to ta ke a bold s te p to ove r haul the editorial a nd m an a ge ment pr actice s . Technic al journals, s uc h a s thos e we h ave re viewed, a ls o contribute – or ‘should’ contribute – to polici es that relate to the eve r y day live s of the people at la r ge . T o ris e to thes e expe ct ations a nd disciplina r y pr omises, they should not operate in silos a nd be under the c ont rol of a few individua ls w h ateve r o utstanding track rec or d the y m aintain. I dea s – a nd pieces of knowle dge for that matter – a r e cre ated and co-cre a ted colle ctivel y in participa tion of a s ma ny people as poss ible , both experts a n d novic es , to address outstanding ga ps betwe en r e s e arch and p ractice, w h i c h a re a s g l a r i n g i n t h e m e d i c a l fi e l d a s i n o th e r s ( L a n g l e y e t a l . , 2018 ) , m o re s o i n N e p a l, give n a limited focus and inv e s tment in res e arch . By w a y of conclusion, we su gge s t the following four a r eas for f urther investigation in o rder to arrive at the clarity and unders ta nding of some of the iss ue s w e h a ve f lagge d in our findings and discuss ions. a. Sel f -promo tion by editors vi a e ditor -a uthors hip is one of the rec ur ring f e atures in the journals investiga t e d. Ho wever, w hy it h a s happened w as not the qu estion we investiga t e d, we re com mend un d ert ak ing a focus e d st udy to expl o re the f actors t ha t underlie exce s s s e lf -public ation and its cons e quences , both shor t-term and lon g-term. b. The relia nc e of authors on a p a r tic ular journ al is another. The a uthor s ha v e multiple outlets to pick and c h oose fr om. W hy th e y, however, do rely on one p articula r outlet is an out standing is sue f or further res e arch a nd e x plor a t i o n. We le ave it, too, for other researche r s to ex a mine . c. Wh a t motiv a t e s the e xc lus iv e networ king of authors – who actu a lly ben e f it when going broad, inc lus iv e and p art i cipatory – is y et another que s tion that we think s hould be critica lly e x amined . Conflic t of interes t: T he author s dec lar e that there is no conflict of interest of any kind.

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(which was not certified by peer review) The copyright holder for this preprint this version posted August 17, 2022. ; https://doi.org/10.1101/2022.08.15.22278758doi: medRxiv preprint 13 Ap p en dix A : M ost Article s b y a single author i n Nep a l i M ed ic al Journa l (Tot al n um b e r of a r ticles in Sco pus by a u thor i s capt ured by s ea r ch co d e (A U -I D ( A u t h or S c o p u s I D ) A ND PU BY E A R < 2022 ) Tot a l Article s in Scopus by autho r Total ar t i cl e i n Ne p alese Journal i ndexed in S copus J NMA KUMJ NHR C NM C J J NPS NJ O V alus is 1 if t he a uthor is E dito r to the journal J NMA KUMJ NHR C NM C J J NPS NJ O 85 5 9 6 11 42 0 0 0 1 0 1 0 0 0 57 4 8 1 45 2 0 0 0 0 1 0 0 0 0 54 4 4 5 37 0 1 0 1 0 0 0 0 0 0 56 3 3 11 12 1 8 0 1 0 0 0 0 0 0 32 3 0 7 18 3 2 0 0 0 0 0 0 0 0 32 2 9 11 12 6 0 0 0 0 0 0 0 0 0 40 2 8 1 25 2 0 0 0 0 0 0 0 0 0 34 2 7 1 23 1 2 0 0 0 0 0 1 0 0 27 2 5 6 16 3 0 0 0 0 0 0 0 0 0 33 2 5 5 18 2 0 0 0 0 0 0 0 0 0 28 2 5 0 23 1 1 0 0 0 1 0 0 0 0 30 2 4 3 20 0 1 0 0 0 0 0 0 0 0 36 2 4 2 5 2 1 14 0 0 0 0 0 0 0 23 2 3 12 8 3 0 0 0 1 0 0 0 0 0 29 2 3 3 3 8 0 9 0 0 0 0 0 0 0 36 2 2 2 20 0 0 0 0 0 0 0 0 0 0 23 2 2 1 19 0 1 1 0 0 0 0 0 0 0 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted August 17, 2022. ; https://doi.org/10.1101/2022.08.15.22278758doi: medRxiv preprint 14 25 2 1 1 20 0 0 0 0 0 0 0 0 0 0 36 2 1 2 19 0 0 0 0 0 0 0 0 0 0 40 2 1 2 16 2 1 0 0 0 0 0 0 0 0 26 2 1 1 17 0 3 0 0 0 0 0 0 0 0 39 2 1 0 0 0 21 0 0 0 0 0 0 0 0 22 2 1 6 9 5 0 1 0 0 0 0 0 0 0 26 2 1 3 8 1 0 9 0 0 0 0 0 0 0 22 2 0 6 8 6 0 0 0 0 0 0 0 0 0 24 2 0 1 18 0 1 0 0 0 0 0 0 0 0 20 2 0 0 18 0 2 0 0 0 0 0 0 0 0 39 2 0 0 12 1 7 0 0 0 0 0 0 0 0 31 2 0 4 3 1 11 0 1 0 0 0 1 0 0 22 1 8 11 6 1 0 0 0 0 0 0 0 0 0 19 1 8 2 16 0 0 0 0 0 0 0 0 0 0 23 1 8 2 16 0 0 0 0 0 0 0 0 0 0 23 1 8 1 13 2 2 0 0 0 0 0 0 0 0 19 1 8 7 7 2 2 0 0 0 0 0 0 0 0 32 1 8 12 4 0 2 0 0 0 0 0 0 0 0 22 1 8 0 10 0 0 8 0 0 0 0 0 0 0 19 1 7 2 3 12 0 0 0 0 0 0 0 0 0 22 1 7 1 12 4 0 0 0 0 1 0 0 0 0 19 1 7 0 15 2 0 0 0 0 0 0 0 0 0 20 1 7 2 14 1 0 0 0 0 0 0 0 0 0 27 1 7 11 3 1 2 0 0 0 0 0 0 0 0 32 1 7 1 6 6 4 0 0 0 0 0 0 0 0 27 1 7 2 5 1 9 0 0 0 0 0 0 0 0 33 1 7 4 0 2 3 7 1 0 0 0 0 0 0 24 1 6 4 0 12 0 0 0 1 0 1 0 0 0 17 1 6 1 12 3 0 0 0 0 0 0 0 0 0 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted August 17, 2022. ; https://doi.org/10.1101/2022.08.15.22278758doi: medRxiv preprint 15 24 1 6 1 14 1 0 0 0 0 0 0 0 0 0 18 1 6 0 16 0 0 0 0 0 0 0 0 0 0 22 1 6 1 15 0 0 0 0 0 0 0 0 0 0 28 1 6 15 1 0 0 0 0 0 0 0 0 0 0 26 1 6 5 8 1 2 0 0 0 0 0 0 0 0 18 1 6 3 10 2 0 1 0 0 0 0 0 0 0 24 1 6 7 3 4 1 1 0 0 0 0 0 0 0 26 1 5 7 1 7 0 0 0 1 0 0 0 0 0 15 1 5 11 0 4 0 0 0 1 0 0 0 0 0 17 1 5 9 2 4 0 0 0 0 0 0 0 0 0 15 1 5 9 4 2 0 0 0 0 0 0 0 0 0 18 1 5 0 11 3 1 0 0 0 0 0 0 0 0 19 1 5 6 5 3 1 0 0 0 0 0 0 0 0 18 1 5 10 3 1 1 0 0 0 0 0 0 0 0 24 1 5 6 6 1 2 0 0 0 0 0 0 0 0 21 1 5 7 6 0 2 0 0 0 0 0 0 0 0 16 1 5 6 4 1 4 0 0 0 0 0 0 0 0 21 1 5 3 1 1 10 0 0 0 0 0 0 0 0 16 1 5 1 11 0 0 3 0 0 0 0 0 0 0 20 1 5 0 11 0 1 3 0 0 0 0 0 0 0 23 1 5 3 4 0 0 0 8 0 0 0 0 0 0 15 1 4 0 2 12 0 0 0 0 0 0 0 0 0 15 1 4 0 2 12 0 0 0 0 0 0 0 0 0 14 1 4 0 3 11 0 0 0 0 0 0 0 0 0 23 1 4 2 5 7 0 0 0 1 0 0 0 0 0 17 1 4 10 2 2 0 0 0 0 0 0 0 0 0 19 1 4 5 9 0 0 0 0 0 0 0 0 0 0 15 1 4 5 9 0 0 0 0 0 0 0 0 0 0 14 1 4 7 2 2 3 0 0 0 0 0 0 0 0 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted August 17, 2022. ; https://doi.org/10.1101/2022.08.15.22278758doi: medRxiv preprint 16 14 1 4 2 7 1 4 0 0 0 0 0 0 0 0 14 1 4 3 1 0 10 0 0 0 0 0 1 0 0 14 1 3 1 12 0 0 0 0 0 1 0 0 0 0 14 1 3 0 1 0 12 0 0 0 0 0 1 0 0 16 1 1 1 10 0 0 0 0 0 1 0 0 0 0 11 1 0 9 1 0 0 0 0 1 0 0 0 0 0 13 1 0 1 4 0 5 0 0 0 1 0 0 0 0 10 1 0 0 5 4 0 0 1 0 0 0 0 0 1 10 1 0 1 1 0 7 0 1 0 0 0 1 0 0 13 1 0 0 2 0 1 1 6 0 0 0 0 0 1 19 1 0 1 0 1 0 0 8 0 0 0 0 0 1 16 9 1 7 1 0 0 0 0 1 0 0 0 0 12 8 4 0 4 0 0 0 0 0 1 0 0 0 8 8 5 0 3 0 0 0 1 0 0 0 0 0 11 8 0 8 0 0 0 0 0 1 0 0 0 0 9 8 2 6 0 0 0 0 1 0 0 0 0 0 11 7 1 0 6 0 0 0 0 0 1 0 0 0 8 7 6 0 1 0 0 0 1 0 0 0 0 0 11 7 2 5 0 0 0 0 0 0 0 0 0 1 7 7 7 0 0 0 0 0 1 0 0 0 0 0 10 6 5 0 1 0 0 0 1 0 0 0 0 0 6 6 6 0 0 0 0 0 1 0 0 0 0 0 7 6 6 0 0 0 0 0 1 0 0 0 0 0 6 6 6 0 0 0 0 0 1 0 0 0 0 0 7 6 3 0 2 0 1 0 1 0 0 0 0 0 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted August 17, 2022. ; https://doi.org/10.1101/2022.08.15.22278758doi: medRxiv preprint 17 Ap pendix B: C o-au t hor n e tw ork fo rmed fro m the article pub lished in the particu l a r journ al. The Vo S View er s oftw are w as used to dr aw th e co-au thor n e t w edge represents the article pub lish e d i n a j o u r nal b y a t least tw o authors . C o -a utho r ship n etwork of J o urn al of N ep al M ed i c a l Ass o c i atio n ( J N M A ) ( 2 021- 2 00 5 )(1 4 35 artic les) ( a ) C o -a uthorship n e tw o r k o f J o urna l of N e p a l Pe d iatri c So c i et y ( 2 0 2 1- 20 08 ) ( 6 23 a rti c l e s ) (b) w o rk w here the . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted August 17, 2022. ; https://doi.org/10.1101/2022.08.15.22278758doi: medRxiv preprint 18 C o -a utho r ship n etwork o f K a th m a nd u U n iv e r s i ty M e dic al J o u r na l (2 02 1 -20 03 ) ( 147 6 artic les) ( c) C o -a uthorship n e twork of N e p al H ealth Re s e ar c h C o un cil Jo urna l (2 02 1-20 10) (78 0 artic l e s) (d) C o -a utho r ship n etwork of N e pal J o urn al of Op hthalm ol og y ( 2 01 6- 20 09) ( 2 49 a rti c l e s ) ( e) C o -a uthorship ne tw o r k o f N ep a l M ed i cal Co ll e g e J o urna l ( 201 4 -20 03 ) ( 7 06 a rt i c l e s ) (f) Figure 2 N et w ork formed by th e c o-au t h ors w ho pub l is hed th ei r art icles i n th e corre s p onding Journa l . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted August 17, 2022. ; https://doi.org/10.1101/2022.08.15.22278758doi: medRxiv preprint