Why should ethics approval be required prior to publication of health promotion research?

Issue Addressed: Most academic journals that publish studies involving human participants require evidence that the research has been approved by a human research ethics committee (HREC). Yet journals continue to receive submissions from authors who have failed to obtain such approval. In this paper, we provide an ethical justification of why journals should not, in general, publish articles with no ethics approval, with particular attention to the health promotion context. Methods: Using theoretical bioethical reasoning and drawing on a case study; we first rebut some potential criticisms of the need for research ethics approval. We then outline four positive claims to justify a presumption that research should, in most instances, be published only if it has been undertaken with HREC approval. Results: We present four justifications for requiring ethics approval prior to publication: (i) that HREC approval adds legitimacy to the research; (ii) that the process of obtaining HREC approval can improve the quality of an intervention being investigated; (iii) that obtaining HREC approval can help mitigate harm; and (iv) that obtaining HREC approval demonstrates respect for persons. Conclusion: This paper provides a systematic and comprehensive assessment of why research ethics approval should generally be obtained prior to publishing in the health promotion context. So what? Journals such as the HPJA have recently begun to require research ethics approval for publishing research. Health promotion researchers will be interested in learning the ethical justification for this change. Keywords Publication ethics, research, health promotion, ethics approva

Who attends a Children's Hospital Emergency Department for dental reasons? A two-step cluster analysis approach.

OBJECTIVES: Emergency departments (EDs) have been identified as key providers of dental care although few studies have examined patterns of attendance or clusters of characteristics. The aim was to identify the reasons for visits to an ED, whether these remained stable over time, and characterize clusters of patients by socio-demographic and attendance variables. METHODS: Pseudonymized data were obtained for children who attended the ED in 2003-2004, 2004-2005 and 2012-2013. Presenting complaint was categorized as attending for dental or nondental reasons. Other variables analysed included patient (age, sex, ethnicity and deprivation) and attendance characteristics (distance travelled, season, nature of complaint, time elapsed since onset of symptoms, day of week and hours of attendance), together with treatment outcome (advice, antibiotics and referral). To assess trends over time, analyses were conducted on patient, attendance and treatment outcome variables. To examine whether patients could be characterized by socio-demographic and attendance variables, a two-step cluster analysis was undertaken on 2003-2004 data set and validated on 2004-2005 and 2012-2013 data sets. RESULTS: In 2003-2004, 550 children attended the ED for dental reasons rising to 687 in 2012-2013. The most important predictors of dental attendance were as follows: nature of complaint, ethnicity, time elapsed, sex and deprivation of the area in which children lived. The analysis showed two clusters: cluster 1 was comprised of children who attended the ED for dental injury, were of White ethnicity and attended within 24 h of onset of symptoms. Children in this cluster were likely to be from the least or less deprived areas (compared to Cluster 2) and were more likely to be males. Cluster 2 comprised of children attending the ED for caries, oral mucosal lesions or other complaints, were likely to be of other (non-White) ethnicities and were likely to attend more than 24 h after symptoms began. Children in this cluster were more likely to come from the most deprived areas and were both males and females. The clusters varied according to treatment outcome; those patients in Cluster 2 were more likely to be prescribed medication, whilst those children in Cluster 1 were more likely to be referred to another specialty. CONCLUSIONS: A significant number of visits to the ED were for dental reasons with two clusters of children. The results have identified groups of patients for whom appropriate dental provision is lacking and where targeted services are needed to improve outcomes for children and reduce the burden on EDs

Sediment structure and physicochemical changes following tidal inundation at a large open coast managed realignment site

Managed realignment (MR) schemes are being implemented to compensate for the loss of intertidal saltmarsh habitats by breaching flood defences and inundating the formerly defended coastal hinterland. However, studies have shown that MR sites have lower biodiversity than anticipated, which has been linked with anoxia and poor drainage resulting from compaction and the collapse of sediment pore space caused by the site's former terrestrial land use. Despite this proposed link between biodiversity and soil structure, the evolution of the sediment sub-surface following site inundation has rarely been examined, particularly over the early stages of the terrestrial to marine or estuarine transition. This paper presents a novel combination of broad- and intensive-scale analysis of the sub-surface evolution of the Medmerry Managed Realignment Site (West Sussex, UK) in the three years following site inundation. Repeated broad-scale sediment physiochemical datasets are analysed to assess the early changes in the sediment subsurface and the preservation of the former terrestrial surface, comparing four locations of different former land uses. Additionally, for two of these locations, high-intensity 3D-computed X-ray microtomography and Itrax micro-X-ray fluorescence spectrometry analyses are presented. Results provide new data on differences in sediment properties and structure related to the former land use, indicating that increased agricultural activity leads to increased compaction and reduced porosity. The presence of anoxic conditions, indicative of poor hydrological connectivity between the terrestrial and post-inundation intertidal sediment facies, was only detected at one site. This site has experienced the highest rate of accretion over the terrestrial surface (ca. 7 cm over 36 months), suggesting that poor drainage is caused by the interaction (or lack of) between sediment facies rather than the former land use. This has significant implications for the design of future MR sites in terms of preparing sites, their anticipated evolution, and the delivery of ecosystem services

The experiences of student nurses on placements with practice nurses : a pilot study

To prepare the registered nurse of tomorrow in the United Kingdom (UK) to care for patients in general practice (GP)-led services, today's student nurses need to have the opportunity to experience placements with practice nurses to enable them to make positive career choices to become practice nurses in the future. The role of the practice nurse is described in the article. As a pilot project, seventeen students undertook placements with practice nurses in one of seven GP practices selected by the London GP Deanery and the university as having fulfilled the criteria to support student nurses in placements. A mentorship preparation programme was provided to prepare practice nurses for mentoring these students. An evaluation study was undertaken of this pilot project. Findings showed that students were highly positive about the experience; the majority rated this placement as being as good as or better than previous placement experiences. The evaluation also explored the impact on student learning and the value that the placement had. There was a positive impact on students' knowledge and skills in certain clinical areas especially related to health promotion. Students also indicated that they would like to have additional placements with practice nurses and would consider a career as a practice nurse in the future

The publication of ethically uncertain research: attitudes and practices of journal editors

<p>Abstract</p> <p>Background</p> <p>Publication of ethically uncertain research occurs despite well-published guidelines set forth in documents such as the Declaration of Helsinki. Such guidelines exist to aide editorial staff in making decisions regarding ethical acceptability of manuscripts submitted for publication, yet examples of ethically suspect and uncertain publication exist. Our objective was to survey journal editors regarding practices and attitudes surrounding such dilemmas.</p> <p>Methods</p> <p>The Editor-in-chief of each of the 103 English-language journals from the 2005 Abridged Index Medicus list publishing original research were asked to complete a survey sent to them by email between September-December 2007.</p> <p>Results</p> <p>A response rate of 33% (n = 34) was obtained from the survey. 18% (n = 6) of respondents had published ethically uncertain or suspect research within the last 10 years. 85% (n = 29) of respondents stated they would always reject ethically uncertain articles submitted for publication on ethical grounds alone. 12% (n = 4) of respondents stated they would approach each submission on a case-by-case basis. 3% (n = 1) stated they would be likely to publish such research, but only with accompanying editorial. Only 38% (n = 13) give reviewers explicit instruction to reject submissions on ethical grounds if found wanting.</p> <p>Conclusions</p> <p>Editorial compliance with the Declaration of Helsinki in rejecting research that is conducted unethically was difficult to ascertain because of a poor response rate despite multiple attempts using different modalities. Of those who did respond, the majority do reject ethically suspect research but few explicitly advise reviewers to do so. In this study editors did not take advantage of the opportunity to describe their support for the rejection of the publication of unethical research.</p

Mentoring student nurses and the educational use of self: A hermeneutic phenomenological study

Background In the United Kingdom, pre-registration nurse education relies on workplace mentors to support and assess practice learning. Despite research to clarify expectations and develop support structures, mentors nevertheless report being overwhelmed by the responsibility of mentoring alongside their clinical work. Understanding of their lived experience appears limited. Objectives The aim of the study was to achieve a deeper understanding of the lived experience of mentoring, searching for insights into how mentors can be better prepared and supported. Design The mentor lifeworld was explored utilizing a hermeneutic phenomenological methodology drawing on Heidegger. Settings and Participants Twelve mentors, who worked in a range of clinical settings in England were recruited via purposive and snowball sampling. Method Participants described their experiences of mentoring through in-depth interviews and event diaries which included ‘rich pictures’. Analysis involved the application of four lifeworld existentials proposed by van Manen — temporality, spatiality, corporeality and relationality. Findings The essence of being a mentor was ‘the educational use of self’. Temporality featured in the past self and moving with daily/work rhythms. Spatiality evoked issues of proximity and accountability and the inner and outer spaces of patients' bodies. Mentor corporeality revealed using the body for teaching, and mentors revealed their relationality in providing a ‘good educational experience’ and sustaining their ‘educational selves’. Conclusions ‘The educational use of self’ offers insight into the lived experience of mentors, and exposes the potentially hidden elements of mentoring experience, which can inform mentor preparation and support

Added dietary sulfur and molybdenum has a greater influence on hepatic copper concentration, intake, and performance in Holstein-Friesian dairy cows offered a grass silage- rather than corn silage-based diet

To test the hypothesis that the metabolism of Cu in dairy cows is affected by basal forage and added S and Mo, 56 dairy cows that were 35 (standard error ± 2.2) days postcalving and yielding 38.9 kg of milk/d (standard error ± 0.91) were offered 1 of 4 diets in a 2 × 2 factorial design for a 14-wk period. The 4 diets contained approximately 20 mg of Cu/kg of dry matter (DM), and had a corn silage-to-grass silage ratio of 0.75:0.25 (C) or 0.25:0.75 (G) and were either unsupplemented (−) or supplemented (+) with an additional 2 g of S/kg of DM and 6.5 mg of Mo/kg of DM. We found an interaction between forage source and added S and Mo on DM intake, with cows offered G+ having a 2.1 kg of DM lower intake than those offered G−, but no effect on the corn silage-based diets. Mean milk yield was 38.9 kg/d and we observed an interaction between basal forage and added S and Mo, with yield being decreased in cows offered G+ but increased on C+. No effect of dietary treatment on milk composition or live weight was noted, but body condition was lower in cows fed added S and Mo irrespective of forage source. We found an interaction between forage source and added S and Mo on milk somatic cell count, which was higher in cows offered G+ compared with G−, but not in cows fed the corn silage-based diets, although all values were low (mean values of 1.72, 1.50, 1.39, and 1.67 log10/mL for C−, C+, G−, and G+, respectively). Mean plasma Cu, Fe, and Mn concentrations were 13.8, 41.3, and 0.25 µmol/L, respectively, and were not affected by dietary treatment, whereas plasma Mo was 0.2 µmol/L higher in cows receiving added S and Mo. The addition of dietary S and Mo decreased liver Cu balance over the study period in cows fed either basal forage, but the decrease was considerably greater in cows receiving the grass silage-based diet. Similarly, hepatic Fe decreased more in cows receiving G than C when S and Mo were included in the diet. We concluded that added S and Mo reduces hepatic Cu reserves irrespective of basal forage source, but this decrease is considerably more pronounced in cows receiving grass silage- than corn silage-based rations and is associated with a decrease in intake and milk performance and an increase in milk somatic cell count

The “ebb and flow” of student learning on placement

There is a rise in interest in work based learning as part of student choice at subject level in the UK (DOE 2017) but there remains an absence of specific guidance on how to best support higher education students learning on placement. An alternative HE experience in England, the degree apprenticeship, underlies the continued focus by policy in securing placement experiences for students without stipulating the type of support that is required at the ‘coal face’ of work based learning. Policy documents (UUK 2016), that urge universities to enter into partnership agreements with both employers and FE colleges to plug skills shortages, are noticeably lacking in their appreciation of the unique qualities of work based learning and how best to support students in this setting (Morley 2017a). Unfortunately, this is not unusual as placements have predominantly been an enriching ‘add on’ to the real business of academic learning in more traditional university programmes. Support initiatives, such as that described in chapter 9, are a rare appreciation of the importance of this role. Undergraduate nursing programmes currently support a 50:50 split between practice learning in clinical placements and the theory delivered at universities. Vocational degrees, such as this, provide an interesting case study as to how students can be supported in the practice environment by an appreciation of how students really learn on placement and how hidden resources can be utilised more explicitly for practice learning. During 2013 – 2015 a professional doctorate research study (Morley 2015) conducted a grounded theory study of 21 first year student nurses on their first placement to discover how they learnt ‘at work’ and the strategies they enlisted to be successful work based learners