Revisiting the un/ethical: the complex ethics of elite studies research

Current ethical codes inadequately speak to the complexities of researching elite groups. These groups contribute to broader inequalities and yet are protected from scrutiny by their own resources and, in the research context, ethical guidelines. For this reason, Gaztambide-Fernández (2015) called for those researching elite groups to adopt an ‘un/ethical’ position. This position circumvents conventional ethical codes to disrupt the power of research participants. In this paper, we put forward a considered assessment of this position. We reflect on and theorise our own experiences in the field from this ethical perspective, paying particular attention to our multifaceted insider/outsider statuses. We find that an un/ethical position offers short-term benefits but also does long-term damage to the elite studies scholar community. Thus, we counter-propose a way forward that dismantles power relations while avoiding the drawbacks of the un/ethical approach. Our proposal continues a necessary discussion around the ethics of elite studies research

Revisiting the Un/Ethical: The Complex Ethics of Elite Studies Research

Current ethical codes inadequately speak to the complexities of researching elite groups. These groups contribute to broader inequalities and yet are protected from scrutiny by their own resources and, in the research context, ethical guidelines. For this reason, Gaztambide-Fernández (2015) called for those researching elite groups to adopt an ‘un/ethical’ position. This position circumvents conventional ethical codes to disrupt the power of research participants. In this paper, we put forward a considered assessment of this position. We reflect on and theorise our own experiences in the field from this ethical perspective, paying particular attention to our multifaceted insider/outsider statuses. We find that an un/ethical position offers short-term benefits but also does long-term damage to the elite studies scholar community. Thus, we counter-propose a way forward that dismantles power relations while avoiding the drawbacks of the un/ethical approach. Our proposal continues a necessary discussion around the ethics of elite studies research.Introduction Theorising research ethics Our experiences in the field In lieu of a conclusion: a way forward Notes Reference

An exploration of the pedagogies employed to integrate knowledge in work-integrated learning

This article describes a three‐sector, national research project that investigated the integration aspect of work‐integrated learning (WIL). The context for this study is three sectors of New Zealand higher education: business and management, sport, and science and engineering, and a cohort of higher educational institutions that offer WIL/cooperative education in variety of ways. The aims of this study were to investigate the pedagogical approaches in WIL programs that are currently used by WIL practitioners in terms of learning, and the integration of academic‐workplace learning. The research constituted a series of collective case studies, and there were two main data sources — interviews with three stakeholder groups (namely employers, students, and co‐op practitioners), and analyses of relevant documentation (e.g., course/paper outlines, assignments on reflective practice, portfolio of learning, etc.). The research findings suggest that there is no consistent mechanism by which placement coordinators, off‐campus supervisors, or mentors seek to employ or develop pedagogies to foster learning and the integration of knowledge. Learning, it seems, occurs by means of legitimate peripheral participation with off‐campus learning occurring as a result of students working alongside professionals in their area via an apprenticeship model of learning. There is no evidence of explicit attempts to integrate on‐ and off‐campus learning, although all parties felt this would and should occur. However, integration is implicitly or indirectly fostered by a variety of means such as the use of reflective journals

How standard is standard care? Exploring control group outcomes in behaviour change interventions for young people with type 1 diabetes

Objective: Poor descriptions of standard care may compromise interpretation of results in randomised controlled trials (RCTs) of health interventions. We investigated quality of standard care in RCTs of behaviour change interventions for young people with type 1 diabetes and consider implications for evaluating trial outcomes. Design: We conducted systematic searches for articles published between 1999 and 2012. We extracted standard care descriptions and contacted trial authors to complete a checklist of standard care activities. The relationship between standard care quality and outcomes was examined via subgroup meta-analyses and meta-regression. Main outcome measures: Standard care descriptions, standard care quality, and relationships between standard care quality with medical and psychological outcomes. Results: We identified 20 RCTs described across 26 articles. Published descriptions of standard care were limited to service-level features. Author responses indicated standard care provision extended beyond published accounts. Subgroup analyses suggested control groups receiving higher standard care quality showed larger improvements in both medical and psychological outcomes, although standard care quality did not predict outcomes significantly. Conclusion: The quality of care delivered to control group participants can influence outcomes of RCTs. Inadequate reporting exacerbates this issue by masking variations between trials. We argue for increased clarity in reporting standard care in future trials

Psychological interventions as vaccine adjuvants: a systematic review

Objectives: The effectiveness of vaccines is known to be altered by a range of psychological factors. We conducted a systematic review to evaluate the effects of psychological interventions on the ability of vaccines to protect against disease, as measured by antibody responses. Methods: Electronic databases (EMBASE, Medline, PsychINFO, CINAHL) were searched from their inception to 6th February 2018.Results: The search yielded 9 eligible trials conducted with 1603 participants and four broad categories of intervention: meditation/mindfulness (n=3), massage (n=3), expressive writing (n=2) and cognitive behavioural stress management (n=1). Some evidence of benefit on the antibody response to vaccination was observed in 6/9 of all trials and in 4/7 of randomised controlled trials. However, effects on antibody levels were often mixed, with only 3 of 6 trials showing benefit demonstrating an improvement in all antibody outcomes and at all time points assessed. Trials demonstrating benefit also provided direct or indirect evidence of adequate adherence with the intervention; and in 50% of these trials, there was also evidence that the intervention was effective in changing the mediating psychological constructs targeted by the intervention.Conclusions: This literature is characterised by considerable heterogeneity in terms of intervention type, vaccine type, age of participants and the temporal relationship between vaccination and intervention. We conclude that there is early evidence to suggest that psychological interventions may enhance the antibody response to vaccination. However, the effects are inconsistent, with the greatest likelihood of benefit seen in trials evidencing adequate adherence with the intervention. Future work would benefit from rigorous intervention development that focuses on achieving adequate adherence and large well-controlled randomised trials with a focus on an agreed set of outcomes

Quantitative faecal immunochemical test for patients with 'high risk' bowel symptoms: a prospective cohort study

Objectives: To evaluate whether quantitative measurement of faecal haemoglobin (f-Hb) using faecal immunochemical testing (FIT) can be used to rule out colorectal cancer (CRC) for patients who present to primary care with ‘high risk’ symptoms defined by national guidelines for urgent referral for suspected cancer (NICE NG12). / Design: Prospective cohort study carried out between April 2017 and March 2019. / Setting: 59 GP practices in London and 24 hospitals in England. / Participants: Symptomatic patients in England referred to the urgent CRC pathway who provided a faecal sample for FIT in addition to standard investigations for cancer. / Main outcome measures: CRC was confirmed by established clinical and histopathology procedures. f-Hb (μg per gram of stool) was measured in a central laboratory blinded to cancer outcome. We calculated sensitivity (percentage of patients with CRC who have f-Hb exceeding specified cut-offs); false-positive rate [FPR] (percentage of patients without CRC whose f-Hb exceeds the same cut-offs); and positive predictive value [PPV] (percentage of all patients with f-Hb above the cut-offs who have CRC). / Results: 4676 patients were recruited of whom 3596 patients were included (had a valid FIT test and a known definitive diagnosis). Among the 3596, median age was 67 years, 53% were female and 78% had colonoscopy. 90 patients were diagnosed with CRC, 7 with other cancers, and 3499 with no cancer found. f-Hb did not correlate with age, sex or ethnicity. Using f-Hb ≥4μg/g (lowest limit of detection), sensitivity, FPR and PPV were 87.8%, 27.0% and 7.7% respectively. Using f-Hb ≥10μg/g, the corresponding measures were 83.3%, 19.9% and 9.7%. 15 patients with CRC had f-Hb below 10μg/g. If FIT had been used at thresholds of 10μg/g or 4μg/g, 1 in 6 or 1 in 8 patients with cancer respectively would have been missed. If the absence of anaemia or abdominal pain is used alongside f-Hb 10 μg/g, only 1 in 18 cancers would be missed but 56% of people without CRC could potentially avoid further investigations including colonoscopies. / Conclusions: In our study, if FIT alone had been used to determine urgent referral for patients with ‘high risk’ symptoms for definitive cancer investigation, some patients with bowel cancer would not have been diagnosed. If used in conjunction with clinical features, particularly in the absence of anaemia, the efficacy of FIT is significantly improved. With appropriate safety netting, FIT could be used to focus secondary care diagnostic capacity on patients most at risk of CRC

Faecal immunochemical test for patients with 'high-risk' bowel symptoms: a large prospective cohort study and updated literature review

Background: We evaluated whether faecal immunochemical testing (FIT) can rule out colorectal cancer (CRC) among patients presenting with ‘high-risk’ symptoms requiring definitive investigation. Methods: Three thousand five hundred and ninety-six symptomatic patients referred to the standard urgent CRC pathway were recruited in a multi-centre observational study. They completed FIT in addition to standard investigations. CRC miss rate (percentage of CRC cases with low quantitative faecal haemoglobin [f-Hb] measurement) and specificity (percentage of patients without cancer with low f-Hb) were calculated. We also provided an updated literature review. Results: Ninety patients had CRC. At f-Hb < 10 µg/g, the miss rate was 16.7% (specificity 80.1%). At f-Hb < 4 µg/g, the miss rate was 12.2% (specificity 73%), which became 3.3% if low FIT plus the absence of anaemia and abdominal pain were considered (specificity 51%). Within meta-analyses of 9 UK studies, the pooled miss rate was 7.2% (specificity 74%) for f-Hb < 4 µg/g. Discussion: FIT alone as a triage tool would miss an estimated 1 in 8 cases in our study (1 in 14 from meta-analysis), while many people without CRC could avoid investigations. FIT can focus secondary care diagnostic capacity on patients most at risk of CRC, but more work on safety netting is required before incorporating FIT triage into the urgent diagnostic pathway

Putting the \u27integrated\u27 in work-integrated learning

A key aspect of work-integrated learning (WIL) is the notion that it entails the integration of knowledge and skills gained in the educational institution and in the workplace. WIL educators are interested in what way students take what they learn on campus into the workplace; and conversely how what they learn in the workplace becomes related to, or incorporated into, the next phase of learning when the student returns to the campus after completing a work placement Here we report on a major national study of the pedagogical approaches used in New Zealand WIL programs in terms of integration of student knowledge, and consider what impact these might have on student learning.<br /

Psychological impact of lung cancer screening using a novel antibody blood test followed by imaging : the ECLS randomized controlled trial

This work was supported by the Scottish Government and Oncimmune Ltd. Follow-up data collection for psychological outcome measures was supported by Oncimmune Ltd.Background: The Early CDT®-Lung antibody blood test plus serial computed tomography scans for test-positives (TPGs) reduces late-stage lung cancer presentation. This study assessed the psychological outcomes of this approach. Methods: Randomized controlled trial (n = 12 208) comparing psychological outcomes 1-12 months post-recruitment in a subsample (n = 1032) of TPG, test-negative (TNG) and control groups (CG). Results: Compared to TNG, TPG had lower positive affect (difference between means (DBM), 3 months (3m: -1.49 (-2.65, - 0.33)), greater impact of worries (DBM 1m: 0.26 (0.05, 0.47); 3m: 0.28 (0.07, 0.50)), screening distress (DBM 1m: 3.59 (2.28, 4.90); 3m: 2.29 (0.97, 3.61); 6m: 1.94 (0.61, 3.27)), worry about tests (odds ratio (OR) 1m: 5.79 (2.66, 12.63) and more frequent lung cancer worry (OR 1m: 2.52 (1.31, 4.83); 3m: 2.43 (1.26, 4.68); 6m: 2.87 (1.48, 5.60)). Compared to CG, TPG had greater worry about tests (OR 1m: 3.40 (1.69, 6.84)). TNG had lower negative affect (log-transformed DBM 3m: -0.08 (-0.13, -0.02)), higher positive affect (DBM 1m: 1.52 (0.43, 2.61); 3m: 1.43 (0.33, 2.53); 6m: 1.27 (0.17, 2.37)), less impact of worries (DBM 3m: -0.27 (-0.48, -0.07)) and less-frequent lung cancer worry (OR 3m: 0.49 (0.26, 0.92)). Conclusions: Negative psychological effects in TPG and positive effects in TNG were short-lived and most differences were small.Publisher PDFPeer reviewe

The application of protein microarray assays in psychoneuroimmunology

Protein microarrays are miniaturized multiplex assays that exhibit many advantages over the commonly used enzyme-linked immunosorbent assay (ELISA). This article aims to introduce protein microarrays to readers of Brain, Behavior, and Immunity and demonstrate its utility and validity for use in psychoneuroimmunological research. As part of an ongoing investigation of psychological and behavioral influences on influenza vaccination responses, we optimized a novel protein microarray to quantify influenza-specific antibody levels in human sera. Reproducibility was assessed by calculating intra- and inter-assay coefficients of variance on serially diluted human IgG concentrations. A random selection of samples was analyzed by microarray and ELISA to establish validity of the assay. For IgG concentrations, intra-assay and inter-assay precision profiles demonstrated a mean coefficient of variance of 6.7% and 11.5% respectively. Significant correlations were observed between microarray and ELISA for all antigens, demonstrating the microarray is a valid alternative to ELISA. Protein microarrays are a highly robust, novel assay method that could be of significant benefit for researchers working in psychoneuroimmunology. They offer high throughput, fewer resources per analyte and can examine concurrent neuro-immune-endocrine mechanisms