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his paper describes a three-month surveillance project performed to determine the incidence of meticillin-resistant Staphylococcus aureus carriage on admission to community hospitals in North Cumbria. The survey also attempted to identify the rate of acquisition of MRSA in the community hospitals during the study period. Study design and limitations are described. Results reveal that almost 9% of admissions had previously undetected MRSA carriage. Discharge screening demonstrated that 2.8% of patients admitted during the study period probably acquired MRSA during their admission. The utility of this information is discussed, and possibilities for future work explored.

espite being considered by many as a minor disease, influenza remains a leading cause of respiratory infection, attributing to many deaths in the UK each year. This article offers an overview of influenza and its prevention, focusing on the use of influenza vaccination in healthcare workers as a public health measure. It highlights potential benefits beyond the protection of individuals against influenza, and considers the impact of health behaviour on improving vaccination uptake in healthcare workers.

PEER REVIEW: One peer reviewer contributed to the peer review report. Reviewers’ reports totaled 27 words, excluding any confidential comments to the academic editor. FUNDING: The author(s) received no financial support for the research, authorship, and/or publication of this article. DECLARATION OF CONFLICTING INTERESTS: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Author Contributions Both the authors contributed to all aspects of the manuscript.

I describe and evaluate an exercise in which graduate students provide blind reviews of each other's term papers. Besides helping students with their own papers, the exercise seems to help them learn to give constructive, substantive feedback to colleagues. Student ratings of the educational value of peer review are high, but a hoped-for effect of increasing interest in publishing papers has not emerged. A study of reviews from three courses suggested that students' reviews show higher interrater reliability than do professional peer reviews of journal manuscripts. Implications of this finding are discussed in relation to some of the explanations offered in the literature for the low reliability of professional peer reviews.

Fifty issues of the British Medical Journal (BMJ), The Lancet, The British Journal of Psychiatry and Psychological Medicine were scrutinised. Papers were designated as invited or peer reviewed and the geographical location of the first author was recorded. For UK-based authors, the latitude and longitude of the host institution was noted and was allocated to one of the UK regions. Of invited papers 805 of 1227 (66%) were by UK-based authors compared with 1442 of 2896 peer reviewed papers (50%), odds ratio 1.92 (95% CI 1.67 − 2.21) with a similar pattern prevailing in each of the four journals. Within the UK, authorships of invited versus peer reviewed papers showed a preponderance of invited authors based in southeast England, odds ratio 1.30 (95% CI 1.09 − 1.56). For individual Journals, the Lancet and the British Journal of Psychiatry showed fewer regional disparities in authorship than the BMJ and Psychological Medicine. These disparities may lead to nationalism and parochiality in the content of invited papers. Journal editors may wish to review selection practices for authorship of invited papers.

Using simply age to screen for cardiovascular disease is as effective as more complicated methods using blood pressure and serum cholesterol. That is the main conclusion of a study published in PloS One in May by Nick Wald, Mark Simmonds and Joan Morris.1 I consider here whether the message is right, what the implications might be and what we might learn from the prolonged passage to publication of this paper. The authors used a Monte Carlo simulation with 500,000 people aged 0–89 to reach their conclusion. Taking being 55 or over as a positive test will detect 86% of cardiovascular events with a 24% false-positive rate. This simple assessment is compared with screening everybody from age 40 at five-yearly intervals using the standard Framingham risk score until people reach the risk of a 20% chance of a cardiovascular event in the next 10 years, the cut-off for treatment recommended by the National Institute of Health and Clinical Excellence (NICE). For the same 86% detection rate the false-positive rate is 21%. In other words, the two methods are effectively the same; almost nothing is gained from a series of visits to doctors, measurements, and blood tests. Can this be right? It is. I write this after reading the comments of 24 reviewers of the paper. None of them seriously disputes the conclusion. Indeed, many say that the finding is unsurprising because, within the Framingham score of risk, age is so dominant. The finding is, however, counterintuitive and contrary to current perception. Can people's family history, smoking status, blood pressure, serum lipids, and weight – all recognized risk factors for cardiovascular disease – not make much difference? As the paper says, ‘causal CVD risk factors, even in combination, are poor CVD screening tests.’1 Risk factors and screening tests are different. Many will also wonder why it is that we have a whole industry of screening tests – not only Framingham but also the Reynolds risk score2 or QRISK23 – if age alone is just as good. There is also substantial research effort being applied to using genetic and other biomarkers to try and predict more accurately who will have heart attacks and strokes, research that has had disappointing results.4 Should we then abandon screening people for risk of cardiovascular events using the various scores and use simply age? People wouldn't have to visit doctors for screening assessments. They wouldn't have to have blood tests. They wouldn't have to try to understand what their Framingham score meant, and they wouldn't be divided into healthy sheep and unhealthy goats. Complicated risk assessments might end, but risk reduction – encouraging and helping people to stop smoking, lose weight, increase physical activity, eat healthier diets, and drink less alcohol – should continue. Others apart from doctors and nurses can do this work. Risk reduction is sensible for everybody, but the point of risk assessment is to limit treatment to those above a specified risk. It is well recognized now that it is a person's overall risk (so-called ‘global risk’) that should be assessed and not simply raised blood pressure or serum lipids. One implication of the new study is that everybody might begin treatment at 55. This fits with the strategy proposed by Wald and Law in 20005 and in 2003 in the BMJ6 to take a polypill containing blood pressure lowering drugs, a statin, and possibly aspirin and folic acid. This remains a controversial idea, although less controversial than when first described. Several companies in India have manufactured polypills, and two trials have been published showing their effect on measures like blood pressure and serum lipids.7,8 So will complicated risk assessments be abandoned? Perhaps not in the short term as we know that there is a long lag between evidence and action and as there is too much vested interest in both conducting the assessments and trying to devise new ones. Both are industries with markets to protect. The new evidence, although not surprising, does strengthen the case for the strategy of offering the polypill to everybody at 55, but this strategy also threatens vested interests and traditional thinking. Pharmaceutical companies see lucrative markets being destroyed. Doctors, particularly cardiologists, are sensitive to the implicit criticism that their strategy of assessing risk and treating is unnecessarily complex and overlooks the fact that many cardiovascular events occur in people without high risk factors, the ‘prevention paradox’.9 Public health practitioners fear the polypill offers a licence to people to avoid healthy lifestyles, although there is every reason for people to combine the polypill with healthy lifestyles and no reason not to. Finally, some worry about medicalization, although, as I've argued elsewhere, giving people the pill without tests is the opposite of medicalization in that those who take the polypill can avoid falling into the hands of doctors.10 One of the aspects of this paper that fascinates me – as a former editor of the BMJ and a current member of the board of the Public Library of Science – is its publication history. A version of the paper was first submitted to a journal, the BMJ, in March 2009. It was finally published in PloS One in May 2011, more than two years after it was first submitted. During that time the paper has been rejected seven times by four journals, including PloS One at first, and reviewed by 24 reviewers. At a conservative estimate of two hours per review this is more than a week of academic time. If the academics are paid at a rate of £50 an hour, again conservative, the cost is over £2000. That figure does not include the editorial costs or the opportunity costs. The academics might have spent their time doing something much more valuable than reviewing a paper that 23 other reviewers had also reviewed. This long delay and high cost might have been justified if what was eventually published was much superior to what was initially submitted. It's different, but the central message that age alone is as good as complex risk assessment scores is still the same and has not been seriously disputed. The comments of the reviewers could have been a useful discussion around the paper, part of the process of digesting it and deciding its true importance. As it is, their comments are lost in the memory stores of editorial computers. It is not clear to me whether the journals rejected the paper because it was too unsurprising or too radical in its threat to established interests or, paradoxically, both. What is clear is that nothing would have been lost and much gained if this paper had been published straight away and the debate over its value had been conducted in public rather than behind closed doors for over two years at considerable expense. The evidence, as opposed to the opinion, on prepublication peer review shows that its effectiveness has not been demonstrated and that it is slow, expensive, largely a lottery, poor at spotting error, biased, anti-innovatory (as perhaps in this case), prone to abuse, and unable to detect fraud.11 The global cost of peer review is $1.9 billion12, and it is a faith-based rather than evidence-based process, which is hugely ironic when it is at the heart of science. My conclusion is that we should scrap prepublication peer review and concentrate on postpublication peer review, which has always been the ‘real’ peer review in that it decides whether a study matters or not. By postpublication peer review I do not mean the few published comments made on papers, but rather the whole ‘market of ideas,’ which has many participants and processes and moves like an economic market to determine the value of a paper. Prepublication peer review simply obstructs this process – as happened with this important paper showing that age alone is enough for screening for cardiovascular disease. Declaration of interest: RS was the editor of the BMJ and the chief executive of the BMJ Publishing Group, which once owned the Journal of Medical Screening, and is a member of the board of the Public Library of Science. He is also a long established enthusiast for the polypill and takes it every night.

According to several recent studies, an unexpectedly high number of landmark papers seem to be not reproducible by independent laboratories. Nontherapeutic antibodies used for research, diagnostic, food analytical, environmental, and other purposes play a significant role in this matter. Although some papers have been published offering suggestions to improve the situation, they do not seem to be comprehensive enough to cover the full complexity of this issue. In addition, no obvious improvements could be noticed in the field as yet. This article tries to consolidate the remarkable variety of conclusions and suggested activities into a more coherent conception. It is concluded that funding agencies and journal publishers need to take first and immediate measures to resolve these problems and lead the way to a more sustainable way of bioanalytical research, on which all can rely with confidence.

This paper explores the interplay between social and physical aspects of food retail in disaster and post-disaster contexts and discusses how it can inform better market support interventions and food retail modernization agendas. To this end, this paper draws on a case study analysis of three distinct marketplaces in metropolitan Port-au-Prince to explore aspects of food provision and access. The findings demonstrate the pertinence of beneficial reciprocal relationships among traders and between traders and customers, as well as the physical preconditions for the existence and maintenance of these relationships over time. The study also reviews the impacts of destroyed and changing physical infrastructure in disaster and post-disaster contexts on these social relationships. It concludes by calling for an acknowledgement of the interrelated attributes of solidarity, proximity and stability of existing marketplaces in urban planning and humanitarian practices in the efforts to improve urban food security and disaster recovery.

This paper analyses peer review deliberations in four evaluation panels that differ in terms of scope and disciplinary heterogeneity. Based on evaluation reports and discussions with panel members, it illustrates a variety of ways in which reviewers bridge their epistemological differences and achieve consensus on the quality of research proposals. The analysis demonstrates that peer review panels are forums in which communication across disciplinary boundaries occurs and interdisciplinary judgments arise. At the same time, disciplinary gate-keeping and incommensurabilities may set limits on such communication. The comparison of deliberative processes sheds light on how collective judgments are shaped and constrained by the disciplinary set-up of the panels in which the reviewers operate and in which the intersubjective dynamics of the deliberations unfold. Based on these findings, the paper considers conditions that may enhance disciplinary interaction and complementary judgments in the peer review of proposals, and thereby expands the prospects for interdisciplinary research.

Background The usefulness of peer review has been expressed as a method to improve the quality of published work. However, there has been a lack of systematic reviews to date to highlight the essential themes of the peer-review process. Methods We performed a search of the English language literature published prior to October 2011 using PubMed to identify articles regarding peer review. Inclusion and exclusion criteria were developed a priori. Data were extracted and then analyzed for the prevalence of peer-review themes contained within the literature. Results Of the 941 articles found during our original literature search, 37 were selected for review. The majority were commentary/editorial articles. The themes in our search included the structure and process of the peer-review system, the criteria for papers, ethics, and the different forms of the peer-review process. Conclusions The criteria for submission will vary, but our systematic review provides a comprehensive overview of what reviewers expect from authors. Our systematic review also highlighted ethical considerations for both authors and reviewers during the peer-review process. Although the topic of peer review is expansive and its process may vary from journal to journal, the understanding of the themes outlined in this paper will help authors recognize how to write a more successful paper. Also, more research must be carried out to establish the efficacy of the different styles of peer review, and it would be presumptuous to draw conclusions until further research is established.

This paper provides a case study illustrating how information sharing, knowledge creation and learning processes might be fostered in the tourism industry via the peer to peer virtual community of DIALOGOI of the Association of Greek Tourism Enterprises (SETE). Primary data were collected through observation of postings on DIALOGOI (desk study) and questionnaires administered to community participants. The primary data collection of the research paper found that: the virtual community promoted information sharing and idea generation; and members geographically dispersed and working for different sectors managed to communicate asynchronously thus initiating both a social network and yielding usable information which can develop into knowledge once applied in a business context. This research could not comment on the knowledge creation potential of the community as information needs to be applied in a business context to become usable. The authors therefore propose further longitudinal studies of the virtual community. Refereed/Peer-reviewed

Objective.Apply a “best practices” model to evidence regarding group smoking cessation to inform organizational decisions about adopting such programs. The best-practices model attempts to integrate rigorous review of evidence with context and practical considerations important to organizations contemplating adoption.Data Sources.First, we identified effective practices by systematic literature review with two blinded reviewers to (1) search databases (99.8% agreement), (2) hand search journals with five or more papers selected in first step (99.9% agreement), (3) search reference lists of included papers (99.4% agreement), and (4) contact published experts. Second, model programs, theory, and expert opinion suggested plausible practices. Finally, a practitioner-researcher advisory group suggested practical considerations affecting adoption decisions.Study Selection.All 67 studies included in the review met six requirements: (1) peer reviewed, (2) primary studies, (3) using experimental or quasi-experimental design, (4) compared one or more smoking-cessation interventions that involved two or more group sessions, (5) studied persons 18+ years old, and (6) reported ≥ 6-month point prevalence or continuous abstinence outcomes.Data Extraction.Two independent raters assessed study quality (89.5% agreement). Effective practices consistently exhibited a statistically significant effect. Plausible practices showed consistency across three types of evidence. An advisory group based practicality criteria on critical review and experience.Data Synthesis.Two practices were rated effective: multicomponent behavioral intervention and nicotine replacement therapy. Five practices received plausible ratings: components of behavioral skills, information about smoking, self-monitoring, social support, and four or more sessions of 60 to 90 minutes. The Advisory Group identified 11 practicality questions to assist organizations to make adoption decisions regarding effective and plausible practices.Conclusions.No research evidence guides potential smoking-cessation program adopters regarding program participants, providers, settings, or quality assurance. Reviews to influence practice must consider science and practice (context) to facilitate adoption of best practices.

Obsessive–compulsive disorder (OCD) is a neuropsychiatric illness that often develops in childhood, affects 1%–2% of the population, and causes significant impairment across the lifespan. The first step in identifying and treating OCD is a thorough evidence-based assessment. This paper reviews the administration pragmatics, psychometric properties, and limitations of commonly used assessment measures for adults and youths with OCD. This includes diagnostic interviews, clinician-administered symptom severity scales, self-report measures, and parent/child measures. Additionally, adjunctive measures that assess important related factors (ie, impairment, family accommodation, and insight) are also discussed. This paper concludes with recommendations for an evidence-based assessment based on individualized assessment goals that include generating an OCD diagnosis, determining symptom severity, and monitoring treatment progress.

Summary A study was designed to test the hypothesis that experts who review papers for publication are prejudiced against an unconventional form of therapy. Two versions were produced (A and B) of a ‘short report’ that related to treatments of obesity, identical except for the nature of the intervention. Version A related to an orthodox treatment, version B to an unconventional treatment. 398 reviewers were randomized to receive one or the other version for peer review. The primary outcomes were the reviewers’ rating of ‘importance’ on a scale of 1-5 and their verdict regarding rejection or acceptance of the paper. Reviewers were unaware that they were taking part in a study. The overall response rate was 41.7%, and 141 assessment forms were suitable for statistical evaluation. After dichotomization of the rating scale, a significant difference in favour of the orthodox version with an odds ratio of 3.01 (95% confidence interval, 1.03 to 8.25), was found. This observation mirrored that of the visual analogue scale for which the respective medians and interquartile ranges were 67% (51% to 78.5%) for version A and 57% (29.7% to 72.6%) for version B. Reviewers showed a wide range of responses to both versions of the paper, with a significant bias in favour of the orthodox version. Authors of technically good unconventional papers may therefore be at a disadvantage in the peer review process. Yet the effect is probably too small to preclude publication of their work in peer-reviewed orthodox journals.

At the recent Healthcare Design '08 conference, one of the attendees asked me, "What does it mean that HERD is peer reviewed?" I gave him my usual answer: peer review is the process of sending a submitted manuscript stripped of author identifiers to a panel of three reviewers expert in the focus area of the manuscript. After careful review, they offer their opinions to the editors about the accuracy of the content, the appropriateness of the research design and methods if the article is a research paper, or the quality of the content and writing if the article is an opinion or theory paper. The author does not know who the reviewers are, and the reviewers do not know who the author is. After explaining the process, I was aware that I still had not answered the "So what?" question to his satisfaction, and I realized that while peer review is a common term among academics, it may not be for practitioners in design, nursing, medicine, or other fields related to healthcare design. So what is a peer-reviewed journal, and why does it matter?A peer-reviewed (or refereed) journal is a scholarly publication that requires that each article submitted be critically appraised by an independent panel of subject experts who are peers of the author (in the same discipline). Articles not approved by a majority of these experts are not accepted for publication in the journal. If the review panel recommends revisions, the editors review and consider their recommendations. If the editor agrees with the reviewers' comments and recommendations, they are forwarded to the author (absent identifying information about the reviewers) with a request to make any needed changes before the manuscript can be accepted for publication. This process is the same for all scholarly journals (Cline Library; University of Illinois, 2004).Not all articles in a peer-reviewed journal are subject to the peer review process. In HERD, such things as letters to the editors, book reviews, and editorial columns are not peer reviewed, although both coeditors and the managing editor review and edit this content. Any article (other than the columns) written by one of the coeditors is assigned to the other editor for management and is subjected to the same rigorous review required of all submitted manuscripts.Peer review is the undisputed cornerstone of scientific writing; its purpose is to ensure that the published content-both information and data-is of the highest quality. Most reputable scientific journals in all disciplines send papers out to a refereed panel to judge the manuscript on its originality, the importance of its conclusions to the field of study, and the validity of its claims (Greenhalgh, 2001; Wager, Godlee, & Jefferson, 2002). Peer review is also required of journals that aspire to be indexed in databases such as PubMED, Web of Science, Academic Search Premier, OVID, Science Citation Information Expanded, Social Sciences Citation Index, Arts and Humanities Citation Index, and a host of other databases that facilitate the search for articles on specific topics. Using an electronic database to locate evidence-based articles is critical for practitioners who want to translate what is published into design decisions or academics who want to use the information in their own research or writing. HERD is working toward being indexed, and strict criteria must be met regarding the peer review process, timeliness, content, the international diversity of the Editorial Advisory Board, and citation analysis. The latter influences the "impact factor," which is derived from the number of times that HERD is cited in other publications and the references cited by HERD's contributing authors. All of these elements are considered when the journal is being assessed for worthiness to be assigned an impact factor and listed in the scientific databases (Thomson Reuters, 2008).Answering the Question, "So What?"Much has been published in popular magazines, newspaper articles, and industry journals about healthcare design. …

The British Journal of Occupational Therapy strives to publish high quality research and scholarly papers. The journal faces a challenge in how best to meet this aim in the future. Regardless of the choices it makes, the focus on quality cannot be lost. One of the key features of quality is the peer review process, which all submitted articles must undergo. This paper reviews the policy of double-blind (anonymous) peer reviewing and suggests that an open peer review policy would provide greater transparency, accountability and credit, thereby enhancing the quality of the journal and strengthening its position for the future.

The Sustainable Development Goals mandate that by 2030, all children should have access to quality early child development opportunities, healthcare and pre-primary education (United Nations, 2015). Yet validated measures of ECD in low and middle income countries (LMICs) are rare. To address this gap, a Systematic Review (SR) of measures available to profile the development of children between the ages of 0-5 years in LMICs was undertaken. Drawing on education, psychology and health databases, we identified reliable, valid or measures adapted for use in LMICs for either assessments of children’s development or their learning environments. The inclusion criteria were (1) peer reviewed papers published between January 2009 and May 2019; (2) assessment tools used to measure cognitive/language development or the early years or home environment in at least one LMIC; (3) report of the psychometric properties (validity and reliability) of the tool, and/or description of the cultural adaptability/translation process undertaken before applying it to a LMIC. Two hundred and forty-nine available records published in the last decade in peer-review journals and nine relevant systematic literature reviews were identified. Fifty-seven records were qualitatively synthesized based on their psychometric properties and cultural adaptation. Forty-three tools were reviewed utilising twelve criteria. Five elements of analysis present in Table 2 and 3 (study, population tested, validity, reliability and cultural adaptability/translation) focused on the tools’ psychometric properties and previous application in LMICs. A further seven dimensions outlined in Tables 4 and 5 identified specific characteristics of the tools from target age, administration method, domains, battery, accessibility, language and country/institution. We suggest these twelve key considerations for the selection of measurement tools that are applicable to effectively assess ECD in LMICs.

With 2014 upon us, I wish good health and a productive year to all JHC readers, authors, reviewers, editors and our staff. For some, 2013 was a tough year, with choppy waters of funding uncertainties to navigate. Let us hope for more stable and predictable times ahead. The world of science publishing is also changing rapidly. More journals have come onto the scene, and for some unfortunately, the raison d’etre is profit from the Open Access (OA) revolution. I wonder how many JHC contributors have, like me in 2013, been invited to join numerous editorial boards. Any thoughts that this reflects recognition for work well done in the past quickly evaporate when it is clear that I have been invited onto editorial boards of journals in fields where I have absolutely no expertise! Of course, calls for papers in all these journals are commonplace too. It is salutary to realize that some journals, called “predatory” in some quarters, are simply prepared to publish almost anything for a substantial fee. What of the peer review process? Peer review is under scrutiny again, as it is from time to time. Even the Economist has been devoting column inches recently to the notion that a significant proportion of peer-reviewed studies cannot be reproduced. This, surely, is one in the eye for pre-publication peer review? Clearly those journals populating their editorial boards with non-experts are doing the peer review process no favors. In fact, this suggests two things: first, peer review should be as skilled as possible; and second, that confirmation or even refutation of previously published data is an important component of the scientific process. There are, clearly, those who believe that the era of anonymous peer review before publication is, or should be, over. Some journals now advocate a policy of “light touch” peer review, followed by the possibility of post-publication peer review on-line. This mostly concerns journals that are completely open access. However, my visits to some of the papers published in this way show very few comments added after publication. Of around 70 papers in one sub-category of an on-line journal of large size, published over several years, just one comment of two lines concerning a missing control had been appended. In three other cases, a short and inconsequential comment had been added by the journal board itself. Not a high response rate. However, undaunted, PubMed Commons has been launched, at least in trial format (as of October 2013). This allows anyone with an account to add comments to any article that is lodged with PubMed. This therefore includes JHC content. It will be interesting to see how this feature evolves. Naturally, the aim is constructive discourse and the rules make clear what constitutes unacceptable activity, which may be removed. The question is whether added comments will be useful or subject to misuse and, indeed, if this commentary is “peer” reviewed. Will comments be applied to papers by contributors with real expertise in the area? In addition, will authors of papers that are listed in PubMed check regularly to see who is attaching comments and respond? I have to confess that I am not sure this will be a high priority for me. The traditional anonymous pre-publication peer review process has a considerable pedigree. I hope that I am not a Luddite; but, while not perfect, for me it is the least worst process, as it is for grant proposals. It might be valuable to describe how JHC undertakes its review process. Once manuscripts are entered into the system and checked for completeness, they come to me. At least one editor reviews all submissions, and in the majority of cases, each manuscript is then sent to a Monitoring Editor with relevant expertise. In some cases, manuscripts are not sent to a Monitoring Editor where, for example, the scope of the manuscript lies outside that of JHC and the work should be directed to a more relevant journal. In these cases, the review process is terminated to save the authors’ and reviewers’ time. On receiving manuscripts, the Monitoring Editors also review the submission and select two or three reviewers with appropriate expertise. At JHC, our Editors and most of our reviewers have many years of relevant experience of research publication and have often published in JHC and similar journals. When reviews are returned, the Monitoring Editor considers the primary reviews and renders a decision that includes his or her own views on the manuscript. Sometimes there is discrepancy between reviewers and an additional review may be sought. The Monitoring Editor then returns all reviews to me for a final decision. It is my job, and that of the Monitoring Editors, to ensure that the process has been fair, even-handed and of a high caliber. With everyone doing his or her job well, there are checks and balances in the system, and of course authors are free to contest points raised in the review process. We have considered a process whereby reviewers’ names are attached to reviews, but this may have undesirable consequences for some reviewers; I am not convinced this is the way forward. Likewise, a meaningful process of post-publication review relies on enthusiastic, skilled contributors. If serious deficiencies are noted, will the paper be withdrawn or remain in the literature? How will authors of controversial papers decide whether the critiques are balanced and sufficiently persuasive that they might seek retraction? We are, regrettably, in a publish-or-perish environment. Investigators’ careers and promotions can depend on publications, particularly in “high impact” journals. This can create enormous pressure for authors. Moreover, high-end journals generally do not publish confirmatory studies; this creates incentives for scientists not to spend time on such activities. At JHC, we subscribe to the DORA principles (1); journal impact factors can be misleading, manipulated and sometimes misused. What matters is the contribution to the field, and one measure of that is how often an article is cited by others, regardless of where it is published. Journals, such as JHC, have an important part to play in this scientific endeavor. Therefore, as a New Year gets underway, with a tradition of over 60 years, JHC remains committed to standards of high quality in review and publication. We shall continue to deliver fast, fair and knowledgeable reviews of submitted manuscripts. Our breadth of coverage will remain wide, encompassing new insights in cell and tissue biology, development, disease and relevant techniques such as imaging. Moreover, JHC will publish articles that confirm and extend previous work, or even refute published data. This is a vital aspect of self-correction, and is essential for progress in science. Along with generous page limits and free color, in these times of financial constraint, we offer low publication costs and, where requested, highly competitive open access fees. We look forward to your research articles, reviews and perspectives in 2014 and beyond.

Background: There has been a call for palliative care (PC) published research to support the impact and need for more specialty PC services. Objective: The purpose of this study was to characterize research in PC over a 15-year period in 3 PC journals published in the United States. Design: The authors reviewed every issue of the Journal of Pain and Symptom Management, Journal of Palliative Medicine, and American Journal of Hospice and Palliative Medicine from 2004 through 2018. Studies included were original articles and brief reports. Study type (qualitative, quantitative), author (first and last), gender, and professional degree of the author (first and last) were recorded. Results: A total of 4881 articles were included in this study. The proportion of quantitative papers significantly increased across 3 time points from 63% to 67% to 78%. The proportion of women first authors increased across all 3 time points (54%, 2004-2008; 57%, 2009-2013; 60%, 2014-2018), and the proportion of women last authors increased across all time points (38%, 2004-2008; 44%, 2009-2013; 46%, 2014-2018). More than 40% of authors were physicians. Conclusions: Published PC studies are increasingly quantitative in design. Gender authorship is female dominant for the first authors and increasingly equal across genders for the last authors.

Peer review is indeed ‘... a flawed process, full of easily identified defects with little evidence that it works’, as Richard Smith concludes in his thoughtful article (April 2006 JRSM1)—but even flawed refereeing is better than not being peer reviewed at all. Increasingly, prestigious journals put submissions through a preliminary triage before they are even allowed to be seen by real scientists. This pre-selection process aims to identify ‘sexiness’; however important a paper in terms of advancing its subject, if it is not regarded as sufficiently topical or is too intellectually demanding (perhaps it has some maths) it will be returned with a computer-generated letter to the effect that it would be better ‘in a more specialized journal’. Typically, a request for further information about exactly how the paper failed to meet the pre-selection criteria is met with further boilerplate generalities: the process is secret and unregulated. Of course, journals such as Nature and Science are under pressure from the huge increase in submissions that has resulted from the whole-scale adoption of impact-factor bibliometrics in the research assistant excersise. But sooner or later scientists are going to ask whether it is worth wasting time on this demeaning and dispiriting ritual, and whether perhaps the internet is now grown up enough that we can cope with web publication—and dispense with the luxury of peer review. Once publication per se confers no particular prestige, the cancerous over-publication that afflicts us all will be stopped in its tracks. The metastatistics generated by Google and Amazon demonstrate how one can use the extraordinary power of the internet itself to create systems that prevent one drowning in unreliable information. Would a free-for-all be so very terrible?

T he peer review process is an important component of scientific publishing and is essential in assisting editors to make final decisions about whether to publish an author’s paper. Most journals today are refereed (including The Diabetes Educator), a process whereby editors send out manuscripts received for publication to outside experts for their comments on the papers’ significance and suitability. Scholarly peer review is referred to as refereeing. Referred materials are often cited as peer reviewed. While there are often no set referee qualifications or evaluation guidelines, criteria may vary widely within and among journals. Without getting into specifics regarding criteria associated with reviewing manuscripts, several basic guidelines need to be considered when providing feedback to the editor. 1. Is the manuscript readable, with one major purpose, adequate sentence structure, and logical flow of information? The manuscript must be readable, with a clear and concise problem statement. The opening paragraphs need to describe the problem and focus on what is being studied. The problem statement justifies the study by citing background information about the problem and its contributions to practice, theory, or both. At the end of the problem statement (introduction), a purpose statement is expressed as a single statement or question specifying the overall goal and intent of the research while clarifying the knowledge to be gained. 2. Is the manuscript timely, useful, and clinically applicable? Content associated with manuscripts submitted to The Diabetes Educator should preferably focus on topics that develop, refine, and/or extend knowledge in the field of diabetes care and education. As diabetes educators, we are instrumental in ensuring and providing evidence-based practice. We must always ask the questions “What is the best evidence for this treatment/intervention?” or “How do we provide best practices?” and “Are these the highest achievable outcomes for the individual with diabetes and his or her family?” These types of manuscripts are useful and clinically applicable, resulting in better patient outcomes while contributing to a unique body of knowledge. 3. Does content associated with the manuscript provide readers with new information or make a significant and novel contribution to the field? Content associated with a manuscript should provide readers with new information. Authors must effectively and informatively communicate the contribution that the new knowledge brings to an audience of diabetes educators. As a reviewer, you should ask “What is the defined contribution of this manuscript? What is its proposed value?” Be cautious that manuscripts may not provide readers with many new insights or research opportunities, often providing repetitive or redundant contributions. Again, while the above-mentioned guidelines do not cover the range of reviewer opinions, they do provide reviewers with an overview of how to comment on the significance and suitability of a paper. Editors will find comments addressing these issues helpful in judging the quality of the manuscript with authors assured of professional review under some broad guidelines.

The received wisdom is that peer review is a thankless task. Peer reviewers are overworked, unpaid, unacknowledged and generally unrewarded. Peer-review processes are not standardized, and each journal or grant review body has its way of deciding what should be approved for publication or funding, respectively. Peer review has also been a secretive process that was largely unstudied until the 1990s. The evidence on peer review in journals has improved in that time, although the central conclusion still holds: peer review is best for improving the quality of articles that editors decide to publish but it is not an objective decision-making process for selecting the best articles. A publication in a major journal is no guarantee of quality and will probably contain several errors, since peer review is poor at eradicating those errors or detecting research misconduct. Sensible journal editors have accepted this reality, and acknowledge the flaws in the system they supervise. Beyond this honest appraisal of peer review, journals can help by introducing open peer-reviewer processes whereby the identity of authors and peer reviewers are not hidden to each other. The research evidence suggests that open peer review does not affect the quality of decision-making at a journal but improves the quality of the conversation between the authors, reviewers and journals. The JRSM has an open peer-review process. The identity of peer reviewers, however, is still usually hidden from readers. Sometimes authors are kind enough to thank peer reviewers in their acknowledgements at the end of a paper. Some journals list peer reviewers without linking them to specific papers – a policy that the JRSM used to follow. A few other journals pay reviewers a small amount or offer them institutional or membership discounts, an existing JRSM benefit. Nonetheless, the reward that peer reviewers receive is paltry in relation to their effort and the contribution that a good peer reviewer can make to improve a paper. Many peer reviewers justify the effort as a necessary contribution to scientific discourse but also as a contribution to their personal development. Many are simply interested enough in the topic to lend their services. Scientific journals only thrive because of the passion of peer reviewers and the patience of readers. From 2010, the JRSM will be taking a bold step in improving the transparency of peer review. We will name peer reviewers on each peer-reviewed article that we publish. This journal does not have the resources to conduct a randomized trial before making this change as bigger journals are able to do. But the editorial team believes that it is the right decision in terms of openness. Any peer reviewers who do not wish to be named can simply decline to peer review the article they have been sent. We would welcome your views on this small but important development.

ObjectiveThere is a critical need to develop rapid, inexpensive and easily accessible screening tools for mild cognitive impairment (MCI) and Alzheimer’s disease (AD). We report on the efficacy of collecting speech via the telephone to subsequently develop sensitive metrics that may be used as potential biomarkers by leveraging natural language processing methods.MethodsNinety-one older individuals who were cognitively unimpaired or diagnosed with MCI or AD participated from home in an audio-recorded telephone interview, which included a standard cognitive screening tool, and the collection of speech samples. In this paper we address six questions of interest: (1) Will elderly people agree to participate in a recorded telephone interview? (2) Will they complete it? (3) Will they judge it an acceptable approach? (4) Will the speech that is collected over the telephone be of a good quality? (5) Will the speech be intelligible to human raters? (6) Will transcriptions produced by automated speech recognition accurately reflect the speech produced?ResultsParticipants readily agreed to participate in the telephone interview, completed it in its entirety, and rated the approach as acceptable. Good quality speech was produced for further analyses to be applied, and almost all recorded words were intelligible for human transcription. Not surprisingly, human transcription outperformed off the shelf automated speech recognition software, but further investigation into automated speech recognition shows promise for its usability in future work.ConclusionOur findings demonstrate that collecting speech samples from elderly individuals via the telephone is well tolerated, practical, and inexpensive, and produces good quality data for uses such as natural language processing.

This study identifies key mechanisms in youth clubs for fostering well-being among vulnerable youths. We develop a framework to conceptualise prerequisites of well-being in youth, namely having a safe place to be, positive relations with others and possibilities for growth. This conceptualisation maintains insights from psychological elements of well-being while bringing psychosocial theory of identity in youth into a sociological orientation. Understanding youth as a dynamic and situated phase expands the investigation of both well-being and youth clubs from merely revolving around ‘risk’ and ‘protection’. Based on interviews with youth workers and participants in youth clubs in Norway, the paper describes how ‘hanging out’ in adult-supervised but otherwise unstructured spaces provides youths with safety, belonging and a gradual sense of mastery. As such, the club may function as an institutionalised safe space and gives time, a ‘moratorium’, offering vulnerable youths shelter from adult responsibilities and the acceleration of societal demands. This work was commissioned and financially supported by The Norwegian Directorate of Health.

This commentary examines the problem of predatory journals, low-quality open-access journals that seek to earn revenue from scholarly authors without following scholarly publishing best practices. Seeking to accept as many papers as possible, they typically do not perform a standard peer review, leading to the publication of improperly vetted research. Some predatory journals repeatedly use templates as their peer review reports. Related scams also victimize education researchers.

Accounting and auditing are often cited as key sites where business regulation has been privatized, globalized and neoliberalized. Yet, these sites have also undergone a legitimacy crisis in recent years, marked by a shift from self-regulation to increased public oversight. This paper investigates these developments by reference to the evolution of a public/private audit oversight regime (audit of the auditors) in Russia. We show how, in the early stages of post-Soviet reforms, old state-administered forms of financial oversight were replaced with market-oriented arrangements (peer reviews) offered by newly founded private professional accountancy associations as a service to their members. Fifteen years later, the process of regulatory privatization culminated in a reinvigoration of public authority. Our longitudinal analysis highlights the pivotal role of the state in the liberalization of governance by showing how audit oversight privatization was not only enabled by, but also provided a condition for, the strengthening of government actors. We introduce the term ‘legislative layering’ to denote the mechanism that enabled public actors to redeploy themselves in the face of the rising market logic to ensure continuity in their regulatory objectives.

This research contributes to the knowledge on academics’ attitudes towards peer review, through an international and inter-disciplinary survey of academics, which profiles academics’ views on the value of peer review, its benefits and the prevalence of unethical practices. Generally, academics regarded peer review as beneficial to improving their article and felt that peer review contributed significantly to the effectiveness of scholarly communication. Academics agreed that peer review could improve the readability and quality of the published paper, as well as check for accuracy, appropriate methodology, novelty and relevance to the journal. There are significant differences in the views of respondents on the basis of role, with those involved as reviewers and editors being less positive about peer review than authors. In addition, there is evidence of some disciplinary differences in views on the benefits of peer review.

While several studies suggest that cannabis users are at increased risk of interpersonal violence, it is not clear to what extent the association is causal. Our paper aims to assess the association between cannabis use and violence by using a method that diminishes the risk of confounding. We analysed data on cannabis use and violent behaviour from the second (1994) and third (1999) waves of the Young in Norway Longitudinal Study (cumulative response rate: 68.1%, n = 2681). We applied fixed-effects modelling to estimate the association between these behaviours, implying that changes in the frequency of violence were regressed on changes in the frequency of cannabis use. The effects of time-invariant confounders were hence eliminated. In addition, we included two time-varying covariates. The elasticity estimate implies that a 10% increase in cannabis use frequency is associated with a 0.4% increase in frequency of violence (p=.024). Analyses of panel data on Norwegian youths reveals a statistically significant association between cannabis use and violence. Selv om noen tidligere studier har funnet en samvariasjon mellom cannabisbruk og vold, kan man likevel tenke seg at cannabisbruken ikke nødvendigvis er en årsak til vold, og at samvariasjonen skyldes andre faktorer. Slike faktorer kan for eksempel være personlighetstrekk, atferdsproblemer, alkoholbruk og vennemiljø. I denne studien er det benyttet en analysemetode som reduserer sannsynligheten for at slike faktorer tilslører en mulig årsakssammenheng. Studien analyserte longitudinelle data (opplysninger samlet over en lengre periode) fra spørreundersøkelser blant norsk ungdom. Forskerne fant først at cannabisbrukere oftere rapporterte voldsbruk enn andre ungdommer. I det neste analysetrinnet tok forskerne høyde for en rekke andre faktorer som kan bidra til en slik samvariasjon, som for eksempel alkoholbruk og impulsivitet. De fant da at samvariasjonen mellom cannabisbruk og vold ble mye mindre, men at det fremdeles var en viss sammenheng. Analysemodellen fant at en fordobling i hyppigheten av cannabisbruk ville øke frekvensen av voldsbruk med 4 prosent. Studien har sine begrensninger. Blant annet vet man ikke om voldstilfellene ungdommene rapporterte skjedde samtidig med cannabisbruk. Forskerne vet kun at de som rapporterte økt bruk av cannabis også rapporterte økning i voldsutøvelse.

This is the author's accepted manuscript version. The published version is available at http://dx.doi.org/10.1177/1471301216682626 Western health care policy emphasizes continuity of care for people with dementia. This paper presents formal and family caregivers’ descriptions of collaboration in home-based dementia care and explores whether this collaboration inhibits or enables continuity of care and the use of the statutory individual plan. Empirical data were derived from 18 in-depth interviews with formal and family caregivers and brief fieldwork. The results reveal dynamic positions in collaborative practice and, from these positions, discrepancies in descriptions of practices and the needs of the person with dementia. Such micro-level discrepancies may serve as barriers for macro-level continuity of care objectives. To ensure continuity of care, formal and family caregivers must be aware of their positions and discuss specific expectations for information flow, involvement and care responsibilities. Individual plan can serve as a starting point for such discussions.

Background of the study: Palliative nursing requires specialized knowledge and skills to enable nurses facing complicated conditions and symptoms. Norwegian white papers recommend health services to take place close to the home, which necessitates specialized nursing competence at all levels of nursing care. In Norway, The Center for Competence in Palliative Care coordinates the regional palliative care service, while community employees coordinate the patient-oriented palliative care. Aim: Palliative Care Network of nurses with special competence in palliative care provides the nurses’ training. This study describes how nurses develop competence through participation in this Network. Method: By means of two focus groups ten self-selected nurses have been interviewed. Result: The Network is referred as arena for socialization and learning, where nurses share their experience as a source of knowledge. Case discussion from the clinical field is preferred learning approach. Integration of theory and research in practice is highlighted however it seems challenging to implement research into practice-discussions. Therefore, such focus is to be contained in lectures, web presentations, and daily communication between participants within the Network. Conclusion: Case-based learning has been emphasized as an important approach for nursing competence development. The Network strengthens the nurses’ competence and enhances their professional confidence.

In this piece I argue that Organization Studies, like other academic journals, is not a sovereign subject able to chart its own path and make sovereign decisions on its strategy and direction. Instead, the journal is seen as embedded in complex networks of institutions and practices over which the editorial team has limited control; chief among them are the conventions of peer review, the proliferation of academic journals, the escalating pressures on academics to publish and the ceaseless struggle to improve ranking and citations. A useful way of looking at the journal is as a place where, following different institutional practices, ideas arrive, settle and meet each other, sometimes fight it out or, more often than not, decide to coexist in a civilized and polite way. Like the spaces of large cities, journals too become spaces crucial for the formation of individual and group identities, something that is accompanied by much agonizing about quality, acceptance, purity, contamination and even annihilation. The paper concludes with some reflections on the ethic of rational critique, at once the bedrock of academic discourse but also capable of inflicting much damage and of prematurely closing promising lines of inquiry. The author proposes that this ethic must be complemented by an ethic of care which stems from a recognition of fallibility and limits to our rationality. An ethic of care must inform not only the interactions among a journal’s different stakeholders but may spread to an attitude of stakeholders towards the journal itself, an attitude that approaches the journal as a valued intellectual space to be nurtured and cared for.

Peer review – the process of asking experts in a particular field to critically evaluate a piece of research – has, since the second half of 20th century, become the norm among academic journals as they endeavour to sort the scholarly wheat from the chaff. Nevertheless, in the light of recent controversies over peer-reviewed climate science (Whittaker, 2010) and heated debate among established scientists, editors and reviewers in the UK about peer review in particular scientific journals (such as those publishing articles on stem-cell research), the 32nd volume of the (European) Physical Education Review (EPER) seems an opportune time to reflect upon peer review as it appertains to EPER. In a recent BBC radio programme Mark Whitaker (2010) investigated what he referred to as ‘the tarnished image of a flawed process’ underpinning the publication of more than one million research papers in over 20,000 academic journals world-wide on an annual basis (Ware and Monkman, 2009). Peer review, he continued, ‘is supposed to be the keystone of quality control for research projects and academic studies, yet evidence of its many deficiencies has been building up for over 20 years’. Among contributors to the programme was Professor Drummond Rennie, deputy editor of the Journal of the American Medical Association, who was cited more than 20 years previously delivering the following damning indictment of peer review

Objective: Several Asian regions have undergone a dramatic transformation, some becoming very affluent. This paper aims to ascertain how countries that are becoming wealthy have dealt with child and adolescent mental health issues. Method: Population health status, child and adolescent mental health services, child psychiatry training, the number of child psychiatrists and related matters were examined in Hong Kong, Malaysia and Singapore. Results: Hong Kong, Malaysia and Singapore are ethnically, religiously, socially and politically very different. In spite of considerable wealth and a growing recognition that mental health problems in the young are increasing, they face similar problems – lack of access to treatment due to a dearth of services and a lack of child psychiatrists (2.5, 0.5 and 2.8 per million people, respectively). Conclusions: Because the number of child psychiatrists is so small, their ability to provide services, advocate, train, maintain a professional identity, and deal with future crises is very limited. Other rapidly developing countries can learn from this experience and should take action early to prevent a similar outcome.

This is the author's version before it was sent to the publisher. Therefore, it may differ slightly from the published version. For the published version, please go to: http://hea.sagepub.com/content/early/2014/03/28/1363459314524802.refs.html Area-based initiatives (ABIs) have formed an important part of public policy towards more socio-economically deprived areas in many countries. Co-ordinating service provision within and across sectors has been a common feature of these initiatives. Despite sustained policy interest in ABIs, little empirical work has explored relations between ABI providers and partnership development within this context remains under-theorised. This paper addresses both of these gaps by exploring partnerships as a social and developmental process, drawing on concepts from figurational sociology to explain how provider relations develop within an ABI. Qualitative methods were used to explore, prospectively, the development of an ABI targeted at a town in the north west of England. A central finding was that, although effective delivery of ABIs is premised on a high level of coordination between service providers, the pattern of interdependencies between providers limits the frequency and effectiveness of cooperation. In particular, the interdependency of ABI providers with others in their organisation (what is termed here ‘organisational pull’) constrained the ways in which they worked with providers outside of their own organisations. ‘Local’ status, which could be earned over time, enabled some providers to exert greater control over the way in which provider relations developed during the course of the initiative. These findings demonstrate how historically constituted social networks, within which all providers are embedded, shape partnership development. The theoretical insight developed here suggests a need for more realistic expectations among policy makers about how and to what extent provider partnerships can be managed.

The recent Sixth International Congress on Peer Review and Biomedical Publication (September 2009) was packed with intense discussions about improving quality and credibility of biomedical publishing. Meeting every 4 years, the Congress has provided the opportunity for editors (past and present) to confer and debate on what constitutes quality publishing and how to achieve and maintain it. Not surprisingly, external peer review was one of the key topics: (1) What makes a good peer reviewer? (2) How does the quality of reviews submitted by reviewers differ over their careers? and (3) How can we train, encourage, and attract the best quality peer reviewers? Although the use of external peer reviewers is now seen as the fundamental approach for improving quality in science, it is easy to forget that many scientific journals did not use peer review until the 20th century. Unfortunately, peer review is an imperfect system, and a 2003 Cochrane Review found little empirical evidence to support editorial peer review as a means to improve biomedical publishing. Nonetheless, that Cochrane Review identified methodological problems in research on peer review and stated ‘‘that the absence of evidence on efficacy and effectiveness cannot be interpreted as evidence of their absence.’’ However, high-quality peer review does seem to have value in advancing biomedical publishing and our suggestion of the characteristics of that ideal peer reviewer (to provide this high-quality peer review) is shown in Table 1. In essence, the high-quality peer reviewer is a colleague who makes a major contribution to the quality of the scientific literature by having been involved in the peer-review process. The importance of this contribution cannot be understated and that gets to the core of assuring adequate recognition of these colleagues for their valuable contributions. Authors making contributions to the biomedical literature automatically have something substantive to show for their time and expertise (author names appear under the title of the article and are listed by the major indexing services, such as Medline [PubMed]). In contrast, peer reviewers, by and large, are anonymous with no tangible evidence of their contributions. This lack of tangible recognition impairs the ability of journal editors to entice reviewers. This is particularly problematic in the biomedical sciences where productivity measures are now increasingly tied to salary, rank, and tenure. Likely there are some internal motivations to be a peer reviewer including helping to advance their field, staying up to date, and educating oneself by learning what other reviewers reading the same paper thought of it (assuming editors share the reviews), which helps in getting people to agree to review, but it does not recognize the contributions to the biomedical literature. However, volunteering time to provide peer review that is not recognized as scholarly achievement and thus would reduce time devoted to other measurable productivity standards will generally be discouraged in academic environments. This makes it difficult for journal editors to obtain peer reviews of submitted materials. For example, for the Journal of Child Neurology, as the number of noneditorial submissions has increased from approximately 270 in 2005 to more than 370 in 2009, the ability to obtain more than 1 completed peer review per submission has decreased over that same time period from nearly 25% to less than 5%. This highlights a crisis that threatens to undermine the quality of biomedical publications and the urgency of finding a solution that will permit peer reviewing to be considered by the scientific community as a recognized valuable scholarly contribution. How can journals acknowledge high-quality peer reviewers in a way that will be tangible as scholarly achievement that the academic community will be willing to recognize? Some of the current mechanisms used to recognize the contributions of peer reviewers include publishing reviewer names periodically, providing continued medical education (CME) credits, offering discounts for journal subscriptions, or providing

The process of academic peer review—i.e., students evaluating each other's work—can help instructors address a host of higher institutional objectives, not the least of which is the total quality management of collegiate teaching. But more is known about this process from the viewpoint of instructors than from the perspective of students. The purpose of this study was to formally examine student views of a specific peer-review system in which undergraduates assigned final grades to each other's term papers. A survey instrument revealed a high degree of comfort with the process, as well as some insights into why a few students were uncomfortable with it.

This paper examines unethical behaviour in scientific publishing, in particular in peer-reviewed journals. This behaviour is a result of authors being subject to the publish or perish syndrome. The effect on the quality and quantity of literature is discussed with examples given of gift authorship, multiple publication, salami publication and fraud. Methods introduced by journals and academic institutions to combat unethical behaviour are explained.

Writing your first paper for a peer reviewed journal is a fairly daunting prospect. One stepping stone is to submit an abstract for presentation at a national or international conference.

In chemical carcinogenicity and drug-safety testing, a cacinogen is defined as an agent that when administered by an appropriate route causes an increased incidence of tumors in experimental animals as compared to unexposed control animals. Although a carcinogen may cause the appearance of tumors in organs where tumors do not usually occur in a given strain, the usual response is to increase the types of tumors seen spontaneously and to shorten the period of latency. The use of cacinogenesis experiments for research and safety assessment requires properly designed and well-conducted experiments and a knowledge of background data and variations in tumor incidences of control animals. Many factors can influence the reported incidences of spontaneous tumors. These include species, strain, sex, age, and source of the experimental test animal; study duration; extent of the pathology examination; dietary and environmental conditions; qualifications and experience of the study pathologist; diagnostic criteria and nomenclature conventions; and quality assurance and review procedures. This paper discusses several factors which may influence the incidence of tumors in control and test animals, and provides examples to illustrate the potential for these factors to affect the data.

About ten percent of total Medicaid expenditures are for drugs. Because a growing share of drug costs, and the consequences of their misuse, are being derived from tax dollars, those in government are seeking methods to hold drug-related expenditures down. The problems of high drug costs and drug misutilization have been clearly documented and indicate a need for effective drug utilization review (DUR). This need is especially acute in ambulatory patient populations, which suffer from a lack of good drug use control due to a general inability to reliably track ambulatory drug use patterns. The advent of government reimbursed drug benefits, which require compilation of all recipient drug claims regardless of the number of pharmacist or physician providers involved, and the pressures of drug cost control and drug use problems, have led to the creation and growth of a new health industry, the fiscal intermediary (FI). The FI combines expertise in electronic data processing (EDP) with knowledge of the drug delivery system. In this business milieu, new and unique opportunities have emerged for the clinically-trained pharmacist. This paper reviews the various levels of drug utilization review (DUR) employed by FIs, from elementary quantitative computer screens to highly sophisticated professional and peer review functions. The potential role of the clinically trained pharmacist in assuring the practice of optimal therapeutics across broad, ambulatory patient populations is illustrated. Specifically, the clinical pharmacist's functions in DUR problem identification, drug use criteria setting, DUR criteria evaluation, and as drug information resource person to the peer review networks, are discussed.