The recognition of the importance of research experience is welcomed; committed research supervisors should be identified for each trainee and research planning should start as early as possible in the traineeship. It would be welcome if employing authorities and postgraduate deans were to provide personal support for up to one year and modest research expenses for trainees undertaking research. In the absence of such support, application would need to be made to grant-giving bodies well in advance. Certain posts may need to be earmarked for the training of future clinical scientists. Academic units should regard themselves as challenged, but not necessarily threatened, by the new proposals. With appropriate consultation and involvement, and a modest allocation of funding, the overall result should enhance the quality of both service and academic communities.
OBJECTIVE: To provide guidance on improving the quality of case studies in health services research. DATA SOURCES: Secondary data, drawing from previous case study research. RESEARCH DESIGN: Guidance is provided to two audiences: potential case study investigators (eight items) and reviewers of case study proposals (four additional items). PRINCIPAL FINDINGS: The guidance demonstrates that many operational steps can be undertaken to improve the quality of case studies. These steps have been a hallmark of high-quality case studies in related fields but have not necessarily been practiced in health services research. CONCLUSIONS: Given higher-quality case studies, the case study method can become a valuable tool for health services research.
Migrant farmworker communities present distinct challenges that require new approaches for community participation in research. In the State of Oregon an agency that advocates for the migrant farmworker community has collaborated successfully with university researchers to implement a research program directed to reducing pesticide exposures among the children of migrant farmworkers. The research process has included both qualitative research methods with members of the community and quantitative approaches to measure pesticide dust residues in homes, biomarkers of pesticide exposure, and effects on health. A committee of university and community stakeholders advises the research. Evaluative processes have been initiated to assess the effectiveness of the participatory model used in this project. The components of the preliminary process evaluation and results are presented. Evaluative data show that researchers and community members differ on perceptions of community involvement and the extent to which communication problems have been resolved between the two groups. Suggestions for improved community involvement and communication are given.
A survey was carried out of the undergraduate backgrounds and research achievements of 885 (94.1%) of all 940 medically qualified professors and readers in medical faculties in the United Kingdom. A total of 217 (24.5%) of the graduates in these senior academic positions had graduated from Oxford or Cambridge and 137 (15.5%) had an intercalated BSc. The corresponding figures for a control group matched for sex and date of graduation were 118 (13.3%) for Oxford and Cambridge (academic to control odds ratio 2.11:1) and 34 (3.8%) for the BSc (odds ratio 4.58:1). Those with an intercalated BSc in the clinical specialties raised substantially more research grants from the Medical Research Council than their peers from Oxford and Cambridge or those without a BSc. The Oxford and Cambridge group raised more grants in the non-clinical specialties. Bibliometric analysis was carried out on the United Kingdom graduates within the broad specialty of medicine (n = 218) matched for date of graduation. Academics with a BSc had a better publication record over 10 years (median number of original publications 72) than the Oxford and Cambridge group (median 59) and a substantially better record than those from other schools without a BSc (median 46). Citation analysis was carried out on subsets of the above sample matched for date of graduation and frequency of publication. Those with an intercalated BSc were cited more often (8.04 citations/paper) than the Oxford and Cambridge graduates (7.63) and substantially more than their peers without a BSc (4.16). These data show very clearly that research training or experience...
The behavioral research on teaching individuals who have profound multiple handicaps is reviewed. The primary focus is on determining the degree to which behavioral research has demonstrated the teaching of meaningful skills to this population. Results of the review indicate that investigations have demonstrated, albeit inconsistently, that behavior change has resulted from contingency management interventions with persons who have profound multiple handicaps. However, there is little evidence that such interventions have resulted in meaningful behavior change according to currently accepted criteria for beneficially affecting the quality of life of persons with serious handicaps. Potential explanations for the lack of such evidence are offered, including the relative lack of research attention given to this issue, the possible ineffectiveness of the components of the technology applied, and possible ineffective application of the potentially effective technology. Suggestions for future research are discussed in terms of developing more effective educational and habilitative services for persons with profound multiple handicaps. In particular, we suggest research on a wider variety of behavioral teaching procedures, providing more comprehensive evaluations of the applications of procedures and developing treatment programs that do not focus solely on traditional skill acquisition.
Scientific research progresses along planned (programmatic research) and unplanned (discovery research) paths. In the current investigation, we attempted to conduct a single-case evaluation of the overjustification effect (i.e., programmatic research). Results of the initial analysis were contrary to the overjustification hypothesis in that removal of the reward contingency produced an increase in responding. Based on this unexpected finding, we conducted subsequent analyses to further evaluate the mechanisms underlying these results (i.e., discovery research). Results of the additional analyses suggested that the reward contingency functioned as punishment (because the participant preferred the task to the rewards) and that withdrawal of the contingency produced punishment contrast.
Primary care research networks are being publicly funded in the United Kingdom to promote a culture of research and development in primary care. This paper discusses the organisational form of these networks and how their productivity can be evaluated, drawing on evidence from management science. An evaluation of a research network has to take account of the complexity of the organisation, the influence of its local context, and its stage of development. Output measures, such as number of research papers, and process measures, such as number of research meetings, may contribute to an evaluation. However, as networking relies on the development of informal, trust-based relationships, the quality of interactions within a network is of paramount importance for its success. Networks can audit and reflect on their success in promoting such relationships and a more formal qualitative evaluation by an independent observer can document their success to those responsible for funding.
The General Practice Research Club was established in 1969, and now has 120 members. A meeting of the club is held twice a year, at which various papers, from research ideas through to completed, published studies are presented. A survey of 40 individuals who had presented papers at meetings during the period 1984-89 showed that almost half (18) had presented papers on clinical topics. As a result of the presentation, 29 individuals had modified their research, with 11 undertaking major alterations. The meeting was rated most highly by those offering ideas and plans for research. Most individuals responded positively to the meetings, commenting that they valued peer review, found the meetings encouraging, and useful for focusing ideas. Lack of criticism and feedback was commented upon. The club has an important role to play in encouraging research by service general practitioners.
The practical problem of assuaging the opponents of animal research may be solved without formally addressing (or resolving) the underlying ethical questions of the debate. Specifically, a peaceful boycott of the "fruits" of animal research may lead to a wider cessation of such research, than, say, vocal or even violent protest. To assist those who might wish to participate in such a boycott- and, moreover, to critically inform them of the implications of their actions-1 offer a modest proposal: the use of an "animal research advance directive", a form which enumerates precisely which "fruits of research" are declined.
The practicality and moral value of community review of human genetic research has become a focus of debate. Examples from two Native American communities are used to address four aspects of that debate: (1) the value of community review in larger, geographically dispersed populations; (2) the identification of culturally specific risks; (3) the potential conflict between individual and group assessments of research-related risks; and (4) the confusion of social categories with biological categories. Our experiences working with these two communities suggest that: (1) successful community review may require the involvement of private social units (e.g., families); (2) culturally specific implications of genetic research may be identifiable only by community members and are of valid concern in their moral universes; (3) community concerns can be incorporated into existing review mechanisms without necessarily giving communities the power to veto research proposals; and (4) the conflation of social and biological categories presents recruitment problems for genetic studies. These conclusions argue for the use of community review to identify and minimize research-related risks posed by genetic studies. Community review also can assist in facilitating participant recruitment and retention...
BACKGROUND: With the expansion of academic departments, the National Research and Development initiative, and the Culyer report, United Kingdom (UK) general practice research is undergoing a period of investment and change. AIM: To examine the content and methodological quality of UK-published general practice research, and in particular to focus on the quantity and proportion of studies that were of high methodological quality, namely randomized controlled trials (RCTs). METHOD: We manually searched three UK-published journals over a five-year period: the British Journal of General Practice (BJGP), Family Practice, and the British Medical Journal (BMJ), which has a section devoted to general practice research. Studies were classified according to the International Classification of Health Problems of Primary Health Care (ICHPPC-2). RESULTS: Nearly half of published studies in UK primary care journals were concerned with either organization and administration issues in primary care or social problems (509 studies, 48%). Just over half were either qualitative studies or surveys of opinion or attitudes (528 studies, 50%). The overall number of RCTs was low (67 studies, 6%), and the proportion published has not changed over time (chi 2 for trend = 3.79...
Recombinant DNA is a technique of major importance in basic biomedical research and, increasingly, in industrial applications. Although the risks of this research remain hypothetical, scientists working in the field have spearheaded discussions of safety. The original National Institutes of Health (NIH) Guidelines for Recombinant DNA Research were issued in June 1976. They assigned each type of recombinant DNA experiment a specific level of "physical containment" and of "biological containment." Responsibility for overseeing the application of the guidelines belongs to the NIH Recombinant DNA Advisory Committee (RAC)--composed of scientists and laymen, including non-voting representatives from many Federal agencies--and local institutional biosafety committees at each university where recombinant DNA research is conducted. The NIH guidelines were subsequently adopted by other Federal agencies, but congressional proposals aimed at extending the guidelines to private industry did not result in national legislation. Some States and localities regulate recombinant DNA research, however, and many private companies have voluntarily submitted information on their recombinant DNA work for RAC and NIH approval. The NIH guidelines underwent a major revision in December 1978 and have been revised approximately every 3 months since then. NIH supports experiments to assess recombinant DNA risks and publishes and updates a plan for a risk assessment program.
In order to define the clinical syndrome of AIDS and begin to deal with it effectively, scientists needed to understand how the immune system works. Fortunately, considerable knowledge was available: research in immunology over the last two decades had provided the technological advances and basic information about cell-mediated immunity that were necessary for identification of the syndrome. Without this knowledge base, immune suppression would not have been recognized as the common link among AIDS patients manifesting a variety of infections and unusual neoplasms. Similarly, research on infectious diseases, and in particular on the role of viruses as etiologic agents, has had an important bearing on understanding of AIDS. The epidemiologic data to date indicate that an infectious agent most likely is involved and that transmission of the disease requires intimate contact and perhaps some passage of blood. Among the candidates for viral agents are Epstein-Barr virus, cytomegalovirus, and human T-cell leukemia virus. All have been isolated from the cells of AIDS victims, but whether they are etiologic agents or opportunistic pathogens remains unresolved. Knowledge gained from the study of any of these viruses will contribute to understanding of AIDS...
OBJECTIVES: AIDS service organizations (ASOs) rarely have access to the information needed to implement research-based HIV prevention interventions for their clients. We compared the effectiveness of 3 dissemination strategies for transferring HIV prevention models from the research arena to community providers of HIV prevention services. METHODS: Interviews were conducted with the directors of 74 ASOs to assess current HIV prevention services. ASOs were randomized to programs that provided (1) technical assistance manuals describing how to implement research-based HIV prevention interventions, (2) manuals plus a staff training workshop on how to conduct the implementation, or (3) manuals, the training workshop, and follow-up telephone consultation calls. Follow-up interviews determined whether the intervention model had been adopted. RESULTS: The dissemination package that provided ASOs with implementation manuals, staff training workshops, and follow-up consultation resulted in more frequent adoption and use of the research-based HIV prevention intervention for gay men, women, and other client populations. CONCLUSIONS: Strategies are needed to quickly transfer research-based HIV prevention methods to community providers of HIV prevention services. Active collaboration between researchers and service agencies results in more successful program adoption than distribution of implementation packages alone.
We now have had 15 years of public discussion of and research on needle exchange programs. The data have shown these programs to be usually, but not always, effective in limiting HIV transmission among injection drug users. Needle exchange programs are conceptualized within a larger framework of providing ready availability of sterile injection equipment for injection drug users. Continuing research is clearly needed regarding how to maximize the availability of sterile injection equipment and how to integrate this with other needed health and social services for drug users. Many initial opponents of needle exchange programs have become supporters of the programs. The number of programs in the United States has been increasing by about 20% per year, and this can be considered substantial progress in reducing HIV infection among injection drug users. Important opposition remains, however, based primarily on the symbolic values expressed in government support for the programs. These value conflicts over needle exchange, which have existed since it was first considered in the United States, cannot be resolved with data. In the late 1980s, the value conflicts greatly hampered the collection of relevant data--there was no federal funding of research on needle exchange programs. Currently...
The hypothesis has been put forward that humans and wildlife species adverse suffered adverse health effects after exposure to endocrine-disrupting chemicals. Reported adverse effects include declines in populations, increases in cancers, and reduced reproductive function. The U.S. Environmental Protection Agency sponsored a workshop in April 1995 to bring together interested parties in an effort to identify research gaps related to this hypothesis and to establish priorities for future research activities. Approximately 90 invited participants were organized into work groups developed around the principal reported health effects-carcinogenesis, reproductive toxicity, neurotoxicity, and immunotoxicity-as well as along the risk assessment paradigm-hazard identification, dose-response assessment, exposure assessment, and risk characterization. Attention focused on both ecological and human health effects. In general, group felt that the hypothesis warranted a concerted research effort to evaluate its validity and that research should focus primarily on effects on development of reproductive capability, on improved exposure assessment, and on the effects of mixtures. This report summarizes the discussions of the work groups and details the recommendations for additional research.
Efforts to curtail alcohol abuse and alcoholism can be divided into primary, secondary, and tertiary prevention. Primary prevention attempts to stop a problem or illness from occurring in the first place. Secondary prevention identifies persons in the early stages of problematic or illness behavior and refers them for counseling or treatment, which is considered tertiary prevention. Five research areas concerned with primary and secondary prevention are selected for discussion: youth, the mass media, the worksite, blacks and Hispanics, and alcohol-related behavior that increases the risk of AIDS. Several of these themes have been in the forefront of alcohol prevention research; others such as AIDS are emergent areas of injury. The discussion to follow briefly summarizes research approaches, key findings, methodological shortcomings, and suggested issues for future investigation. Although scientifically solid prevention studies have been conducted, more rigorous, more comprehensive, and more innovative research is needed. Given the dynamic sociocultural and economic systems in which prevention occurs, research techniques that can address this complexity are required. A range of appropriate methodologies is described.
Research focused on occupational exposure has been one of the cornerstones of epidemiological research into the etiology of cancer. It is appropriate to critically assess the contribution of this research effort and to assess the potential for making significant progress in the future in unraveling the etiology of cancer by studying the occupational environment. The study of the occupational environment has indeed been very fruitful. It is likely that there remain many more carcinogens to be discovered, but we have not deployed adequately sensitive study methods. The two major obstacles to quality research have been inadequate exposure assessment and insufficient sample sizes. Quality exposure assessment requires the participation of trained experts (industrial hygienists, chemists, etc.); it also requires an adequate information base on the exposures that occur in different workplaces. We need structures and career paths that facilitate the participation of exposure experts in epidemiological research. We need active large-scale industrial hygiene surveys to better characterize the U.S. workplace. This will be useful for epidemiological studies and for public health purposes. Community-based case-control studies will need to be much larger than they have been traditionally...
Assessment plays a crucial role in the learning process, but current assessments focus on assessment of learning rather than assessment for learning. In this study, a novel method for open-book continuous assessment (CA) was developed. The aim was to encourage students to learn beyond the textbook by challenging students with questions linked to a research article. Research articles closely related to lecture contents were selected and released to students before the CA for perusal. CA questions were set at three different levels to assess conceptual understanding, application, and synthesis. The CA was administered to first-year undergraduate students majoring in life science as part of Molecular Genetics, a compulsory module. It contributed 10% of the student's grade for the module. Students’ CA scores indicated that the majority could answer correctly all the questions. Students’ feedback on the CA showed that most of them praised the CA model for its novelty, motivation, and application. Only a few criticized it due to its poor coverage of lecture contents. Overall, this CA went beyond the traditional role of assessments in the assignment of scores and stimulated curiosity and self-directed learning.
The sequencing of the genome of Plasmodium falciparum promises to revolutionize the way in which malaria research will be carried out. Beyond simple gene discovery, the genome sequence will facilitate the comprehensive determination of the parasite's gene expression during its developmental phases, pathology, and in response to environmental variables, such as drug treatment and host genetic background. This article reviews the current status of the P. falciparum genome sequencing project and the unique insights it has generated. We also summarize the application of bioinformatics and analytical tools that have been developed for functional genomics. The aim of these activities is the rational, information-based identification of new therapeutic strategies and targets, based on a thorough insight into the biology of Plasmodium spp.