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Journal of Acute Medicine logoLink to Journal of Acute Medicine
. 2024 Sep 1;14(3):108–115. doi: 10.6705/j.jacme.202409_14(3).0002

International Collaboration in Taiwan Emergency Department Publications: A Social Network Analysis

Wen-Mei Cheng 1, Ching-Hsing Lee* 1
PMCID: PMC11366689  PMID: 39229354

Abstract

Background

Emergency medicine (EM) is a growing specialty both clinically and academically. Academic EM development can be measured by number of scientific publications. This study aimed to evaluate the academic international cooperation trend of Taiwan emergency departments (EDs) in the past two decades using social network analysis (SNA).

Methods

The study population were publications with first author affiliated with Taiwan EDs and the study duration was publication year before 2021. The enrolled publications were categorized into two groups: Group one, all authors were affiliated with Taiwan (domestic publications) and Group two, authors were affiliated with Taiwan and other countries (international publications). The primary outcome measurement was the degree centrality of Taiwan before 2021. The secondary outcome measurements included the trend in annual publication number of Group one and Group two, the trend in country number of each year in Group two, the top five countries that collaborate with Taiwan, the difference between the median of citation numbers in Group one and Group two, and the difference between the median of author numbers in Group one and Group two.

Results

A total 4,363 publications were enrolled, of which 4,046 publications were classified in Group one and 317 publications were in Group two. The annual publication number of both groups increased significantly. The annual country number of collaboration with Taiwan ED publications had also significantly increased. The median of citation number and author number in Group two were both significantly higher than Group one. The top five countries collaborating with Taiwan were the United States, China, Malaysia, Japan, and Australia.

Conclusions

Taiwan EDs’ growing international collaboration in the past two decades indicated a capacity to conduct multi-country research. International collaboration publications obtained higher citations compared to domestic publications. Researchers should enhance international collaborations for academic advancement.

Keywords: Keywords: emergency medicine , social network analysis , Taiwan , trend

Introduction

Emergency medicine (EM) was established as an independent specialty since 1970 in the United States, Canada, and United Kingdom and boosted worldwide in the following decades. 1 Growth of clinical EM further promoted the development of academic EM. 2 , 3 Similar developmental trend was also observed in Taiwan. The first society of EM in Taiwan was established in 1994. 4 As the growth of clinical EM, the performance of academic EM in Taiwan also progressed, which can be remarked by the publication of academic official journal of Taiwan Society of Emergency Medicine in 1999. The quantity of researches from Taiwan emergency departments (EDs) had steadily increased in recent decades. 3 The quality of researches from Taiwan EDs had been evaluated from the perspectives of diversity of publication journals and fields. 3 The impact of research may also be reflected from the complexity and diversity of research groups. 5 International collaboration is one of the parameters which reflect the complexity and diversity of research groups. 5 The concept can be applied to the evaluation of academic performance of Taiwan EDs. The increasing numbers of international collaboration research and complexity of international collaboration network in scientific publications can reflect the development of academic EM in Taiwan.

Analyzing relational data in a network is challenging in biomedical statistics. 6 Traditional statistical methods are often not appropriate to analyze complicated relational data because of the inherent dependence of individuals within a network. 6 Social network analysis (SNA) is a quantitative method for researchers to evaluate the relationships between individuals or groups within a network. 7 SNA can be applied to evaluate complex interactions among the studying network. 8 This study aimed to evaluate the quantity and complexity of international collaboration trend of Taiwan EDs’ academic publications.

Methods

Study Design and Setting

This was an observation study and no human or animal object was involved. The study had qualified for a waiver from our Institutional Review Board. The data of all publications were obtained from the Scopus database. 9 The study population were publications with first author affiliated with Taiwan EDs and the study duration was publication year before 2021.

Selection of Publications

Search term “AFFILORG (emergency) AND AFFILCOUNTRY (Taiwan)” were used to retrieve publications of any author affiliated with Taiwan EDs from Scopus database on June 17, 2022. Publications with first authors not affiliated with Taiwan EDs were excluded. Publications with first author affiliated with Taiwan EDs published before 2021 were enrolled for further analysis. We collected publications’ data on publication title, publication year, citation number, affiliated country of all authors, and number of authors. The enrolled publications were categorized into two groups by authors’ affiliated country: Group one, all authors affiliated with Taiwan were defined as domestic collaboration publications and Group two, authors affiliated with Taiwan and other countries were defined as international collaboration publications.

Measurements

The primary outcome measurement was the degree centrality of Taiwan before 2021 which was visualized by SNA software. The degree centrality of Taiwan referred to the total number of countries collaborated with Taiwan and represented the variety of international collaboration network between Taiwan and other countries. We also made sociograms to compare the collaborated difference between 2002 to 2011 and 2012 to 2021.

The secondary outcome measurements were: (1) trend in annual publication number of Group one and Group two which represented the increasing rate of each group, (2) trend in ratio of annual publication number of Group two to Group one which represented the changing proportion of international to domestic collaboration publications, (3) trend in country number of each year in Group two which indicated the changing of numbers of international collaboration partners, (4) top five countries that collaborate with Taiwan, (5) the difference between the median of citation numbers in Group one and Group two, and (6) the difference between the median of author numbers in Group one and Group two.

Data Analysis

The SNA parameters, degree centrality, was calculated and visualized by NodeXL Basic. Descriptive statistics were used to analyze the top five countries that cooperated with Taiwan. The slope of linear regression was used to evaluate the trend and the 95% confidence interval of the slope was calculated. Wilcoxon rank sum test was used to analyze the median of citation numbers and author numbers difference between Group one and Group two. These analyses were performed using IBM SPSS Statistics software version 28.

Results

A total of 8,674 publications were retrieved by the search term and 4,363 publications with first author affiliated with Taiwan ED before 2021 were enrolled for further analysis. The earliest publication was in 1988 which collaborated with Japan. Among these publications, 4,046 publications were classified in Group one and 317 publications were in Group two ( Fig. 1 ). The annual publication number of domestic (Group one) and international collaboration (Group two) publications were in Fig. 2 . The annual publication numbers for domestic and international collaborations increased from 0 and 1 in 1988 to 343 and 47 in 2022, respectively. Domestic and international collaboration publication number increasing rate were significantly ( Table 1 ). The ratio of publication number in Group two to Group one did not increase statistical significantly ( Table 1 ). The median of citation number of Group one and Group two were four and seven ( p < 0.001). The median of author number of Group one and Group two were five and seven ( p < 0.001).

Fig. 1 . Flowchart of research process.


Fig. 1

ED: emergency department.

Fig. 2 . The annual publication number of domestic (Group 1) and international collaboration (Group 2) publications between 1988 and 2021.


Fig. 2

Table 1 . Increasing rates of publication numbers, publication number ratios, and country number of collaboration .

ED: emergency department.

Trend

95% confidence interval

p -value

Domestic (Group 1) publication number increasing rate

0.958

8.756–10.883

< 0.001

International collaboration (Group 2) publication number increasing rate

0.813

0.763–1.292

< 0.001

Ratio of publication number in Group 2 to Group 1 increasing rate

–0.128

–0.008 to 0.004

0.471

Annual country number of collaboration with Taiwan ED publications increasing rate

0.783

0.305–0.549

< 0.001

Annual country number of collaboration with Taiwan ED publications ( Fig. 3 ) had increased significantly ( Table 1 ). The number of annual country collaborations rose from 1 in 1988 to 16 in 2022, reaching its peak at 21 in 2021. The top five country most frequently collaborated with Taiwan were the United States, China, Malaysia, Japan, and Australia, respectively.

Fig. 3 . Annual country number of international collaboration publications between 1988 and 2021.


Fig. 3

In the SNA, one country was represented by a node and the line between nodes represented collaboration in publications. The collaborative country numbers with Taiwan were represented by the parameter of degree centrality in SNA. The degree centrality of Taiwan between 2002 to 2011 and 2012 to 2021 had increased from 11 to 31 (Figs. 4 and 5). The overall degree centrality of Taiwan before 2021 was 33 ( Fig. 6 ).

Fig. 6 . Social network analysis of international collaboration in Taiwan emergency departments before 2021.


Fig. 6

Fig. 5 . Social network analysis of international collaboration in Taiwan emergency departments from 2012 to 2021.


Fig. 5

Discussion

The concept of SNA, also termed “structural analysis” was first described by Jacob Moreno in 1934. 10 , 11 The first published article entitled with SNA was in 1969 11 , which described urban situations in Unite States with SNA. 12 The applications of SNA in a variety of fields grow rapidly since 1981. 11 To analyze complicated relational data of social network, SNA uses non-standard statistical methods for establishing social structures. 6 SNA focuses on ties (which is termed “edges” in sociogram) between individuals (which is termed “nodes” in sociogram) of the network rather than individual itself. 11 In recent decades, SNA had applied in abundant fields including information science 11 , educational research 13 , and public health. 14 SNA was also used in numerous topics associated with medical fields; for example, researchers utilized SNA to evaluate effectiveness of healthcare system 8 and to estimate the spread of COVID-19 for policy implications. 15 There were a few articles in EM that adopt SNA to evaluate network. In 2013, Ghafouri et al. 16 applied SNA to identify interaction patterns among Iranian authors in EM. Burbano Santos et al. 17 analyzed Spanish research collaboration in EM between authors, hospitals and countries in 2017.

In our study on the international collaboration network of publications, the countries that most frequently collaborate with Taiwan were the United States and countries in East Asia. The academic collaboration pattern was identical to countries’ economic collaboration. Taiwan also established major trade relationship with these countries. 18 Between 2000 to 2021, the top three countries with major trade relationship was China, Japan, and United States, respectively. 18 We assumed that international research collaboration in Taiwan EDs was part of social, economic, and culture collaboration. Emergency physicians were more likely to seek academic cooperation between familiar countries in daily life. Whether this collaborative preference pattern also present in other medical specialties deserves further study.

The international academic collaboration complexity of Taiwan had increased in the past two decades. The complexity evolution was demonstrated in three aspects. First, the international collaboration publication number increased steadily and significantly. Second, the overall academic collaborated country increased from eleven in the first decade to thirty-one in the second decade. Third, the increased country number in one research. The connections between countries in Figs. 4 and 5 represented collaboration in one study. The connections between countries other than Taiwan in the first decade were three, which indicated publications were mostly collaboration between Taiwan and one country ( Fig. 3 ). Publications with collaboration of more than three countries were rare. In the recent decade, increased connection between collaborative countries indicated that the research groups were constituted by more countries ( Fig. 4 ). This presentation indicated that, in recent 10 years, the international academic collaboration of Taiwan EDs increased in triple aspects: research numbers, overall collaborative country numbers, and country number in one study. The increased complexity indicated that Taiwan EDs were progressively demonstrating their capacity to engage in multi-country academic researches.

Fig. 4 . Social network analysis of international collaboration in Taiwan emergency departments from 2002 to 2011.


Fig. 4

Citation number of one publication can partially represent the scientific impact of the article in certain specialty. 19 Many factors can influence citation number of one article. Patience et al. 19 listed several elements including article number in the published category, age of the references, journal impact factor, and funding agencies. Number of funding agencies also correlated with the number of authors and the number of international collaborations. 19 In our study, we disclosed that international collaborated publications were organized by more authors and more frequently been cited than domestic publications. The correlation between international collaboration and number of funding agencies was not studied in our study. International collaborated publications obtained more citations can be rationalized that (1) the research questions were important in more countries, (2) studies were led by experienced and reputable researchers, (3) data collected from multiple sites were representative. International collaboration, number of funding agencies, and number of authors may mutually affect each other as confounding factor. The independent impact of these factors needs further study to clarify.

There were three limitations of this study. First, we evaluated the publications with first author affiliated with Taiwan EDs. The publications with co-authors affiliated with Taiwan EDs and first author affiliated with other departments or countries were not enrolled. The collaboration mode of Taiwan EDs contributed as co-authors was not evaluated in this study. Second, we adopted the cited times as the indicator of publications’ impact. Frequently cited publications being impactful not necessarily means rarely cited publications are less impactful. There is no other universal, computable indicator that can be used to evaluate the impact of diverse types of publications. Cited times were imperfect but workable indicator. Third, the citation count and collaboration mode may be influenced by the type of publication. SCOPUS categorizes original articles, case reports, and images under the broad classification of “Article.” To gain a clearer understanding, further investigation is warranted to explore the impact of publication types on collaboration modes.

In conclusion, our study revealed correlation between Taiwan’s ED academic collaboration and economic trade relationships with the United States and East Asian countries. Over the past two decades, Taiwan EDs’ international academic collaboration has exhibited increased complexity which suggests a growing capacity for conducting multi-country academic research. Additionally, international collaborations were found to result in publications with more citation rates compared to domestic publications. The phenomenon may be attributed to the global relevance of research questions, leadership by experienced researchers, and the representative nature of data collected from multiple sites. Looking ahead, researchers in Taiwan EDs should reach out for more international academic collaboration outside of East Asia to enhance academic performance. Understanding the dynamics of international collaboration in the future will be crucial for advancing academic research in EM.

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