Amping up Diversity & Inclusivity in Medical Librarianship

This past week, I attended the 118th Medical Library Association (MLA) Annual Meeting in Atlanta, GA. While it was a standard conference in many respects, it was also a historic one. Beverly Murphy was named the first African American president of MLA since it was incepted in 1898.

When I first considered becoming a librarian, I quickly learned about #critlib, which centers the impact of oppression and marginalization of the many –isms in librarianship. I wanted to be in a profession where I could provide information in a critical way, dismantling library neutrality. I found this through a hashtag which allowed me to meet diverse, inspiring, kind, and intelligent librarians. However, I find it slightly more difficult to apply a social justice framework as an academic medical librarian focusing upon the School of Medicine. I have tried my best through critical search strategies and educating others about bias within publishing. And of course, subject areas specific to public and/or global health easily lend themselves to health disparities. Overall though, I have noticed that medical librarianship has been slower to the game, especially in terms of coming together as a community. During this meeting, however, it felt different.

The annual Janet Doe lecture was given by Elaine Martin, focused upon social justice. I have listened to some talks concerning social justice that just scratch the surface. They seem to give a nod to diversity as more of a check box rather than a critical interpretation and call for action. However, Elaine stressed mass incarceration as a public health issue; she emphasized dismantling library neutrality; she quoted Paulo Freire, the author of the seminal Pedagogy of the Oppressed. She received a standing ovation. It was inspiring, and while it may have just been pure emotion, it gave me hope.

I also attended a Diversity & Inclusivity Fishbowl session by MLA’s Diversity and Inclusivity Task Force. During a fishbowl, a moderator poses a question to a group of individuals seated in a few concentric circles. In our case, there were around 30 of us. There were four seats in the innermost circle, and the individuals in that circle answered the question and can be “tapped out” by others in the outside circles who wish to speak. Unless we were in the inner circle, we were solely active listeners. I’m not going to lie, when I saw the format of this meeting, which was three days into the conference and from 5:00 p.m.-6:30 p.m., I dreaded it. But I also knew this was an important issue. Not only did I feel welcome, but I enjoyed the structured yet conversational format. It can be difficult to talk about diversity and inclusion because everyone’s positions are well-intentioned, however, because this is an issue that historically induces trauma upon the marginalized, it can become very passionate. This passion is essential for affecting change, and this format provided a way to combine this passion with respect and compassion. While this is just the beginning of these discussions, it is important to understand perspectives, especially for those greatly affected by oppressions. It was assuring to see so many people coming together while sharing their individual experiences and beliefs for a topic I thought was somewhat dormant within medical librarianship. And, because of the incoming presidency of Beverly Murphy, I am full of hope and faith that events like these will result in an action plan.

I can’t say that I remember everything that Beverly said during the talk she gave after being named the new MLA president. But I can tell you how I felt in response. First, Beverly did not stand at the podium when delivering her words. She sat at a table on the stage to be in conversation with the MLA members. She included song, humor, and love in her words. It was warm. It was inviting. And given the previous events I witnessed, it felt promising. She incorporated the importance of diversity and inclusivity, so it wasn’t a mere check box. Rather, it was always part of the conversation. Just two days before, I met Beverly at the New Members Breakfast. As a co-convener of the MLA New Members Special Interest Group (SIG), I was interested in how we can further engage new members. Shannon Jones, the founder of the New Members SIG, was eager to share ideas with me and introduced me to Beverly, who immediately stated her commitment to advocating for new members. She also told me that she was asking first-time attendees she met to share their experiences, positive and negative, and to contact her directly. Real change comes from strong leaders and action. And diversity is more than an initiative – it is a way of being. Regardless of topic, subject area, or library role, it needs to be part of all we do. Beverly is firm in this commitment:

“No matter what race we are, what color we are, what ethnicity we are, what gender we have, or whether we have physical issues – we are all information professionals, with a common goal, and that is ‘to be an association of the most visible, valued, and trusted health information experts.’ Diversity drives excellence and makes us smarter, especially when we welcome it into our lives, our libraries, and our profession.” – Beverly Murphy

The solidarity and volume is increasing for diverse voices in medical librarianship, becoming a stronger driver for diverse and inclusive representation, pedagogy, scholarship, community, and more and vice versa. I know that equity of race, sexual orientation, gender, and ability is a long road. And I am appreciative we are on it.

 

I Liked, I Wished, I Wondered: A One-Year Review

One year ago today I flew one-way from ORD to LAX for my first real librarian job (and obviously for the weather). I’m going to take an assessment nugget I once learned from Jennifer Brown, Emerging Technologies Librarian at Columbia University and reflect upon this time using the following measurements: I Liked, I Wished, I Wondered.

I Liked

I liked plenty thus far as a Health & Life Sciences Librarian at UCLA. Most importantly, I am grateful for my work colleagues. I work with people that truly care about learning and how it is reflected within library practices. I work with inspiring and supportive people of color. I work with people that have more to talk about than libraries (this is so important!). While I didn’t necessarily imagine myself working as a librarian in the sciences, I like working in this domain! While I have health sciences experience from working as a speech-language pathologist,, I didn’t appreciate scientific research, its importance, its limitations, and its possibilities, as much as I do now. The sciences seemed a bit intimidating in the beginning, but I have been pleasantly surprised at how accessible it can be, even if someone doesn’t have a sciences background (or even an interest…I am curious how much these are linked). I also like the new matrixed organizational structure within the UCLA Library. It allows for librarians to do a little bit of everything while focusing on a specific area: Collections, Outreach, Research Assistance, Research Partnerships, or Teaching and Learning. This encourages communication across units. For example, I am on the Teaching and Learning Team with the Visual Arts Librarians. This is not a librarian with whom I would typically interact, however, this allows for collaboration, transparency, and information dissemination in seemingly unrelated functions and subject areas. Did I mention that I also like (LOVE) the weather? UCLA is a gorgeous campus all, come visit!

I Wished

I wished I came into my position having a better grasp of collections and scholarly communication. These are essential parts of my everyday duties, and while I have learned these functions over time, I think I would have hit the ground running a bit faster if I did a better job of taking a collections class or participating in a collections and/or scholarly communication focused internship during my MLIS.

I wished I had more time! There are moments where it’s hard to stay focused. This is likely due to a combination of my slightly average organizational skills and saying yes to opportunities. I do think I have been saying yes for the right reasons. I want to be of service, test my capacity in my role, and see what I liked (see above). The good news is that certain responsibilities do not last forever, and now I do have a better idea about what I would like to keep pursuing, what might make sense to stop in a year or two, and what to say yes/no to next time around. I want to be mindful of librarian burnout, so while I’m happy to try it all out, I don’t want to resent the profession either.

I Wondered

I wondered how things would be different if what I wished and what I liked had worked in concert. I wonder where I would be if I hadn’t come to UCLA. I wonder if I prefer to manage others or work as a subject or functional liaison. Will I stay in health sciences librarianship or would I branch out to other areas? I have truly enjoyed diving into medical librarianship, but I have wondered if a I would be better suited to focus upon a functional area. I enjoy pedagogy, active learning, outreach, and connecting different campus partners – perhaps there is a place for me in these areas? I enjoy wondering about this all at UCLA because the matrixed organization and professional development opportunities allow me to explore. I have also wondered if I will stay at an R1 institution, make the jump to a community college, or even try my hand in public libraries.

What Now?

I have always disliked the idea of having a 5-year or 10-year plan. I believe in intention, serendipitous moments, and blending that with your personal drive and abilities. I did not come to librarianship through a straight path, and, while I don’t want to change my career again, I am open to different possibilities that can harness and enhance my skill set. Writing this out has definitely forced me to reflect upon the past year, see how far I have come and what the future might hold. One year down and many more to go!

What are some different ways you taken assessment of your career path as a librarian?

Librarianship and Project Management Skills

I am almost a year into my tenure as a Health & Life Sciences Librarian at UCLA, so I’m starting to get a hang of things. I have a better understanding of our resources, I am able to dissect a research question more efficiently, and I am figuring out how my library actually works. My guess is that all of these, and more, will become even easier while providing more challenges along the way.

This is also about the time where I reflect on the coulda, woulda, shouldas from library school. While I did work at a library at the University of Illinois at Urbana-Champaign, I didn’t work there enough to truly understand how the library worked as a system and how individuals were serving this system. And while I stick by the benefits of laziness, especially in graduate school, there is one class I wish I took in my program: Administration & Management of Libraries and Information Centers (I especially wish I could have taken it with the amazing instructor Melissa Wong!)

First, I will first explain why I didn’t take it:

  1. I wanted to graduate ASAP. So I took enough classes to meet the minimum credit requirement.
  2. I wasn’t sure if I needed this class given my experience in the corporate world.
  3. I was (and still am) interested in reference and instruction, so I was afraid this would veer away from that focus.
  4. I wasn’t even thinking about being a manager in library school – my brain wasn’t thinking that far ahead. I was just trying to learn as much as I could about my interests as well as the mushy stuff (theory, library history, etc.) that I wouldn’t necessarily learn on the job.

Now, I shall debunk the above (hindsight is always 20/20):

  1. Yes, I did want to graduate ASAP, and I did enjoy all the classes I took, but there are one or two I could have done without.
  2. Experience in the corporate world ? libraries. Also, the individuals working in the corporate world are different than those working in libraries, especially when it comes to project management. I will expand on this more later.
  3. Understanding how libraries are administered and managed is the oxygen to navigating a library system. I didn’t really connect this before, but if I’m going to do reference or instruction or collections or whatever, these functions rely upon a larger structure which is essential to understand and critique.
  4. I did enjoy the mushy stuff. However, I think it would have benefited me to be a little more practical and learn the nuts and bolts about the administration of libraries. After all, if we think about the world and how socioeconomics, identity, and global politics affect us today, our place in the world starts becoming a little more situated as opposed to feeling independent or out of context. My point is, structure matters.

I want to talk about project management and librarians a little here. Keep in mind, this is based upon my less than two years experience working part-time at the University of Illinois at Urbana-Champaign and less than one year at UCLA. These are large academic research libraries. My experience is limited, however, I do think I’m onto something here. And that is: Most people do not initially go into librarianship to lead or manage.

I think many of us have had pretty library fantasies that are indeed wonderful. And I fully support this because this is where we came from. But we need to go back to Ranganathan’s fifth law of library science: a library is a growing organism. Libraries are different today than they were 10 years ago and 10 years before that and so on. Technology has accelerated the capabilities and possibilities for libraries, however, it is difficult to keep up. Because of this, project management skills are necessary. My first foray with project management was when I dove into my first job out of college as an IT consultant. I was slammed with project management methodology and project managers that were successful implementers. While there were, and still are, many things I despised about the corporate world, project management is a great skill for any individual to have within any type of organization.

I have noticed that many librarians (myself included) can get bogged down in the details of tasks instead of zooming out, looking at the landscape of a project, sketching out a timeline, determining project phases, corresponding tasks, and project members. However, those that work in corporations, especially consultancies, go into these fields to be project managers. I don’t think it’s bad that this isn’t the first priority of many librarians, but I do think it’s bad to ignore its importance.

When I go to conferences, I haven’t see many papers or lightning talks about project management specifically, and I wonder how librarianship could evolve if this was a focus. I have seen plenty about specific projects, but not as much about the tools they used to manage and implement them. The Project Management Institute has a Project Management Professional (PMP) certification. This is a certification that helps people make the big bucks and in companies. Is there an equivalent for libraries? Can there be one? Also, how can this be harmonized with leadership institutes and meeting the needs of marginalized populations? Is there a way that library science graduate programs can include this in curriculum?

It’s very possible that taking Administration & Management in Libraries and Information Centers would not have given me project management expertise. However, I do think it would have led me there earlier if I did take the course. Either way, I am glad I have been able to process and integrate my different career experiences to my work today. So far, my career in librarianship has been very rewarding, and I am confident that learning and building upon project management skills will make me a stronger librarian.

Have you had experience with project management programs? What are your thoughts about integrating these concepts with librarianship?

 

Narrative as Evidence

This past week I attended the MLGSCA & NCNMLG Joint Meeting in Scottsdale, AZ. What do all these letters mean, you ask? They stand for the Medical Library Group of Southern California and Arizona and Northern California and Nevada Medical Library Group. So basically it was a western regional meeting of medical librarians. I attended sessions covering topics including survey design, information literacy assessment, National Library of Medicine updates, using Python to navigate e-mail reference, systematic reviews, and so many engaging posters! Of course, it was also an excellent opportunity to network with others and learn what different institutions are doing.

The survey design course was especially informative. As we know, surveys are a critical tool used by librarians. I learned how certain question types (ranking, for example) can be misleading, how to avoid asking double-barreled questions, and how to not ask a leading question (i.e. Do you really really love the library?!?) Of course, these survey design practices reduce bias and attempt to represent the most accurate results. The instructor, Deborah Charbonneau, reiterated that you can only do the best you can with surveys. And while this seems obvious, I feel that librarians can be a little perfectionistic. But let’s be real. It’s hard to know exactly what everyone thinks and wants through a survey. So yes, you can only do the best you can.

The posters and presentations about systematic reviews covered evidence-based medicine. As I discussed in my previous post, the evidence-based pyramid prioritizes research that reduces bias. Sackett, Rosenberg, Gray, Haynes, and Richardson (1996) helped to conceptualize the three-legged stool of evidence based practice. Essentially, evidence-based clinical decisions should consider the best of (1) the best research evidence, (2) clinical expertise, and (3) patient values and preferences. As medical librarians we generally focus on delivering strategies for the best research evidence. Simple enough, right? Overall, the conference was informative, social, and not overwhelming – three things I enjoy.

On my flight home, my center shifted from medical librarianship to Joan Didion’s Slouching Towards Bethlehem. The only essay I had previously read in this collection of essays was “On Keeping a Notebook”. I had been assigned this essay for a memoir writing class I took a few years ago. (I promise this is going somewhere.)  In this essay, Didion discusses how she has kept a form of a notebook, not a diary, since she was a child. Within these notebooks were random notes about people or things she saw, heard, and perhaps they included a time/location. These tidbits couldn’t possibly mean anything to anyone else except her. And that was the point. The pieces of information she jotted down over the years gave her reminders of who she was at that time. How she felt.

I took this memoir class in 2015 at Story Studio Chicago, a lofty spot in the Ravenswood neighborhood of Chicago. It was trendy and up and coming. At the time, I had just gotten divorced, my dad had died two years prior, and I discovered my passion for writing at the age of 33. So, I was certainly feeling quite up and coming (and hopefully I was also trendy). Her essay was powerful and resonated with me (as it has for so many others). After I started library school, I slowed down with my personal writing and focused on working and getting my degree, allowing me to land a fantastic job at UCLA! Now that I’m mostly settled in to all the newness, I have renewed my commitment to writing and reading memoir/creative non-fiction. I feel up and coming once again after all these new changes in my life.

As my plane ascended, I opened the book and saw that I had left off right at this essay. I found myself quietly verbalizing “Wow” and “Yeah” multiples times during my flight. I was grateful that the hum of the plane drowned out my voice, but I also didn’t care if anyone heard me. Because if they did, I would tell them why. I would say that the memories we have are really defined by who we were at that time. I would add that memory recall is actually not that reliable. Ultimately, our personal narrative is based upon the scatterplot of our lives: our actual past, present, future; our imagined past, present, future; our fantasized past, present, and future. As Didion (2000) states:

I think we are well advised to keep on nodding terms with the people we used to be, whether we find them attractive company or not. Otherwise they turn up unannounced and surprise us, come hammering on the mind’s door at 4 a.m. of a bad night and demand to know who deserted them, who betrayed them, who is going to make amends. We forget all too soon the things we thought we could never forget. We forget the loves and the betrayals alike, forget what we whispered and what we screamed, forget who we were. (p. 124)

What does this have to do with evidence-based medicine? Well, leaving a medical library conference and floating into this essay felt like polar opposites. But were they? While re-reading this essay, I found myself considering how reducing bias (or increasing perspectives) in research evidence and personal narrative can be connected. They may not seem so, but they are really part of a larger scholarly conversation. While medical librarians focus upon the research aspect of this three-legged stool, we cannot forget that clinical expertise (based upon personal experience) and patient perspective (also based upon personal experience) provide the remaining foundation for this stool.

I also wonder about how our experiences are reflected. Are we remembering who we were when we decided to become librarians? What were our goals? Hopes? Dreams? Look back at that essay you wrote when you applied to school. Look back at a picture of yourself from that time. Who were you? What did you want? Who was annoying you? What were you really yearning to purchase at the time? Did Netflix or Amazon Prime even exist?? Keeping on “nodding terms” with these people allows us to not let these former selves “turn up unannounced”. It allows us to ground ourselves and remember where we came from and how we came to be. And it is a good reminder that our narratives are our personal evidence, and they affect how we perceive and deliver “unbiased” information. I believe that the library is never neutral. So I am always wary to claim a lack of bias with research, no matter what. I prefer to be transparent about the strengths of evidence-based research and its pitfalls.

A couple creative ways I have seen this reflected in medicine is through narrative medicine, JAMA Poetry and Medicine, and Expert Opinions, the bottom of the evidence-based pyramid, in journals. Yes, these are biased. But I think it’s critical that we not forget that medicine ultimately heals the human body which is comprised of the human experience. Greenhalgh and Hurwitz (1999) propose:

At its most arid, modern medicine lacks a metric for existential qualities such as the inner hurt, despair, hope, grief, and moral pain that frequently accompany, and often indeed constitute, the illnesses from which people suffer. The relentless substitution during the course of medical training of skills deemed “scientific”—those that are eminently measurable but unavoidably reductionist—for those that are fundamentally linguistic, empathic, and interpretive should be seen as anything but a successful feature of the modern curriculum. (p. 50)

Medical librarians are not doctors. But librarians are purveyors of stories, so I do think we reside in more legs of this evidence-based stool. I would encourage all types of librarians to seek these outside perspectives to ground themselves in the everyday stories of healthcare professionals, patients, and of ourselves.

 

References

  1. Didion, J. (2000). Slouching towards Bethlehem. New York: Modern Library.
  2. Greenhalgh, T., & Hurwitz, B. (1999). Why study narrative? BMJ: British Medical Journal, 318(7175), 48–50.
  3. Sackett D.L., Rosenberg W.M., Gray J.A., Haynes R.B., & Richardson W.S. (1996). Evidence based medicine: What it is and what it isn’t. BMJ: British Medical Journal, 312(7023), 71–2. doi: 10.1136/bmj.312.7023.71.

 

Questioning the Evidence-Based Pyramid

As a first year health sciences librarian, I have not yet conducted a systematic review. However, as a speech-language pathologist, I learned about evidence-based medicine and the importance of clinical expertise combined with clinical evidence and patient values. As a librarian, I’m now able to combine these experiences, allowing me to view see evidence-based medicine more holistically.

In the past month, I attended two professional development courses. The first was a Systematic Review Workshop held by the University of Pittsburgh. The second was an Edward Tufte course titled “Presenting Data and Information”. While these are two seemingly unrelated subjects, I left both reconsidering how we literally and figuratively view evidence-based medicine.

One of my biggest takeaways from the Systematic Review workshop was that a purpose of  systematic reviews is to search for evidence on a specific topic in order limit bias. This is done by searching multiple databases, reviewing grey literature, and having multiple team members  to screen papers and resolve disputes. One of my biggest takeaways from the Tufte course was that space should be used well to effectively arrange information and that displayed content should have integrity. In his book Visual Explanations, Tufte poses the following questions to test the integrity of information design (p. 70):

  • Is the display revealing the truth?
  • Is the representation accurate?
  • Are the data carefully documented?
  • Do the methods of display avoid spurious readings of the data?
  • Are appropriate comparisons and contexts shown?

When I think about visualization of evidence-based medicine, the evidence-based pyramid immediately comes to mind. It is an image used in many presentations related to evidence-based medicine:

EBM Pyramid and EBM Page Generator, copyright 2006 Trustees of Dartmouth College and Yale University. All Rights Reserved. Produced by Jan Glover, David Izzo, Karen Odato and Lei Wang.

While there is a lot of information in this image, I don’t think it is very clear. I have spoken to librarians (in the health sciences and not in the health sciences) that agree. I think this is a problem. I don’t think all librarians need to immediately know what cohort studies are, but I do think they should understand its context within the visual.

From what I have gathered and discussed with other professionals, quality of evidence/limited bias increases as you go up the pyramid. The pyramid is often explained in a hierarchical way; systematic reviews are considered highest standard of evidence, which is why it is at the top. There are usually fewer systematic reviews (since they take a long time and gather all the available literature about one topic), so the apex also indicates the least quantity. So let’s take a look each of the integrity questions about information design and investigate this further:

Is the display revealing the truth?

Is it? How do we know if this truthfully represent the quantity of each type of study/information? I believe that systematic reviews are probably the least in quantity and expert opinion are the most in quantity. That makes logical sense given the level of difficulty to produce and disperse this type of information. However, what about the types of research in between? Also, is one type of evidence inherently less biased than the ones below? Several studies suggest that systematic reviews may be systematic, but are not always transparent or completely reported and are outdated. This includes systematic reviews published in Cochrane, the highest standard of systematic reviews. While there are standards, they are very frequently not followed. However, following these standards can be very challenging and paradoxical. It’s very possible that a cohort study can be designed in a way that is much more systematic and informed than even a systematic review.

Is the representation accurate?

When I see the word “representation”, I am thinking about visual representation – the pyramid shape itself. There is an assumed hierarchy not just in terms of evidence, but also superiority here. This is a simplistic and elitist way of thinking about this information rather than being informative and useful. If you think about it, a systematic review cannot be conducted without having supporting RCT’s or case reports, etc. Research had to start somewhere. It this was seen as more of a scholarly conversation, I wonder if there would be a place for hierarchy.

I have learned that the slices of the pyramid represent the quantity of publications of each level of evidence. However, this is not something that can be easily understood by looking at this visual alone. Also, if the sizes of the slices represent quantity, why so? Quality is indicated in this version with the arrow going up the pyramid. This helps to represent idea of quality and quantity. However, if evidence-based medicine wants to prioritize quality, maybe the sizes of the slices should represent the quality, not quantity, of evidence. If it is viewed from that perspective, the systematic review slice should be the biggest because it is ideally the highest quality. Or, should the slices represent the amount of bias? This is all quite unclear.

Are the data carefully documented? Do the methods of display avoid spurious readings of the data?

I don’t believe that any data is actually represented here. Moreso, it feels like it’s being told to us so we believe it. I understand this is a visual model, but this image has been floating around so much that it is taken as the truth. I don’t think one can avoid spurious readings of the data because data aren’t represented here.

Are appropriate comparisons and contexts shown?

I do think that this pyramid provides visual way to compare information, however, I don’t think contexts are shown. Again, should the amount of each level of evidence referring quantity or quality? Is the context meant to indicate research superiority? If not, perhaps a pyramid isn’t the best shape. By virtue of its definition, a pyramid has an apex at the top, indicating superiority. Maybe a different shape or representation can provide alternate contexts.

So, how should evidence-based medicine be represented?

I have presented my own perceptions sprinkled with perceptions from others. I’m a new librarian, and my opinion has value. However, I also think this concept needs to be re-envisioned collectively with healthcare practitioners, researchers, librarians, and patients.

Another visualization that has been proposed is the Health Care Literature Wedge. It would look like  a triangle with the apex facing right indicating progressive research stages. I do think there are other shapes or concepts to consider. Perhaps concentric circles? Perhaps this can be a sort of spectrum? 3D maybe? I really don’t know. Another concept to consider is that systematic reviews are intended to reduce bias pertaining to a research question. Instead of reducing bias, maybe we can look at systematic reviews as having increased perspectives? How could this change the way evidence-based medicine is visualized?

I think the questions posed by Tufte can help to guide this. And I’m sure there are other questions and models than can also help. I would love to hear other epistemologies and/or models, so please share!

References

  1. Chang, S. M., Bass, E. B., Berkman, N., Carey, T. S., Kane, R. L., Lau, J., & Ratichek, S. (2013). Challenges in implementing The Institute of Medicine systematic review standards. Systematic Reviews, 2, 69. http://doi.org/10.1186/2046-4053-2-69
  2. Garritty, C., Tsertsvadze, A., Tricco, A. C., Sampson, M., & Moher, D. (2010). Updating Systematic Reviews: An International Survey. PLoS ONE, 5(4), e9914. http://doi.org/10.1371/journal.pone.0009914
  3. IOM (Institute of Medicine). (2011). Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press.) Retrieved from http://www.nationalacademies.org/hmd/Reports/2011/Finding-What-Works-in-Health-Care-Standards-for-Systematic-Reviews.aspx
  4. McKibbon, K. A. (1998). Evidence-based practice. Bulletin of the Medical Library Association, 86(3), 396–401.
  5. The PLoS Medicine Editors. (2007). Many Reviews Are Systematic but Some Are More Transparent and Completely Reported than Others. PLoS Medicine, 4(3), e147. http://doi.org/10.1371/journal.pmed.0040147
  6. Tufte, E. R. (1997). Visual Explanations: Images and Quantities, Evidence and Narrative. Cheshire, CT: Graphics Press.