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Guest Blog: ‘Breaking Down Walls – Taking Translation and Dissemination to the Next Level’

26 Sep, 16 | by Angy El-Khatib

 

Often, when people think of translational research, it is through the lens of Grand Rounds, seminars, and conference presentations. It is usually clinical in nature and comes directly from the researcher. There is another type of translational research – NIH calls it Type 2 translation.

I am part of a Type 2 translational research team at a child injury research center. Our team of five has a mission to educate and empower the vast audience of people who care about kids and keeping them safe. We do this by sharing information on child injury in a format that is accessible by meeting health literacy guidelines and providing opportunities for prevention through realistic, actionable safety steps.

That’s a pretty lofty goal but we are very good at what we do. When researchers from our center publish papers, it is not unusual for their work to be picked up by media around the world. In the last six months, we’ve had two papers that had over one billion impressions (estimates of potential audience size), and two others that have had around one million impressions. It helps that our product is related to kids – it makes people care. But there is more to it than that.

In working with media, we strive to understand their needs and how to create value for them to cover our work. This is not as simple as it sounds. We spend several days working on a press release. Our hospital sees the value in the work we do and often contributes resources for us to create supporting videos, including sound bites, demonstrations, and B-roll.

We pay attention to the ever-changing way the masses consume information, staying up to date on the pulse of the public to meet them where they are. Gone are the early days of technology where you could create a website, direct people there, and then forget about it. Now, a website must stay fresh, providing new content frequently. It must also stay current in the way it looks. If its appearance is outdated, no one will look at your information because there will be the assumption (correct or not) that what is on the site is also likely outdated. People may believe you and/or your organization are outdated, or worse yet, irrelevant. We constantly assess social media platforms, analyze how we can best use them for maximum effect, and then develop our marketing plans.

We talk to doctors, administrators, researchers, and other public health professionals about the findings of our research. We also train them to effectively communicate with those who trust them and look to them for guidance. After that, we can’t sit back and rest on our laurels – we have to do it all over again, and then again. By doing all of this, we increase the likelihood of and the speed with which our research can lead to changes in policy, regulation, and behavior.

In the realm of translational research, teams like ours are not the norm and our team didn’t become this successful overnight. When our manager began her quest to have a team devoted to translational research, translation and dissemination were barely on the radar. Beyond journal publication, dissemination typically just meant printing  copies of a paper and having it available upon request or presenting it at conferences. Our manager had a vision of something bigger and better. She specializes in health communication and has the passion and drive to push for what she believes in. Her director supported her vision and was willing to take a chance on, and fund, something that really hadn’t been done.

Slowly, she grew her team. What makes us effective and successful is that although we each have our own projects to manage, we bring our complementary sets of skills and experiences to the table, both literally and figuratively, collaborating on all of our products. These products include press releases, multi-media releases, media interviews, blog articlescynthia-anderson-profile-picture, website development and management, social media outreach, toolkits, photo shoots, conference planning, and network building. We hone our work through brainstorming sessions, writes, edits, and re-writes. Our work is always better after it has been through the rounds of the team.

Our manager began winning over colleagues one researcher at a time, as they saw the reach and the impact of their work grow. It took 10 years for her to get her team to where we are now – having a big impact and doing innovative work that can help keep kids safer.

Written by:
Cynthia Anderson, MPH, CHES.
She is a Program Coordinator at The Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio. She can be contacted at cynthia.anderson@nationwidechildrens.org.

 

 

Life post-injury, aka preventing further injury

20 Sep, 16 | by Bridie Scott-Parker

While we as injury-prevention professionals, practitioners and policy-makers work tirelessly to prevent injury, the reality is – never more evident than at the Safety 2016 conference underway as I type in Tampere, Finland – that

“Beyond deaths tens of millions of people suffer injuries that lead to hospitalization, emergency department visits, and treatment by general practitioners. Many are left with temporary or permanent disabilities….”  Etienne Krug, MD, MPH, Director, Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization.

Moreover, diseases such as diabetes, heart disease, cancer, mental illness, and respiratory conditions to name a few, arguably lead to injury and disability, therefore we must continue in our efforts to reduce the incidence of disease wherever possible.

Now, to the other side of the coin…..

If you are one of the many lucky people out there who has never had to live with an injury (whether it was temporary or permanent) or a disease (particularly one that you have incurred through no fault of your own), try being the one living with that injury or that disease. Try then to prevent incurring further injury. As a person who has tango-ed for many years with the she-beast Multiple Sclerosis (MS), I can tell you it is pretty darn hard. Having recently visited our developed-nation’s capital, Canberra, for a conference, I was dismayed to encounter  injury-prevention issues every day. Two examples:

Example 1. I can no longer traverse stairs without a great deal of difficulty (and hilarity as my Students and/or Research Assistants are required to act as my ‘squishies’ by forming a human beanbag around me in case I fall during the journey up or down), and while there was an elevator that was available to use in an adjoining building (a casino), despite being advised by building b (my hotel) that I could use this elevator during casino hours, casino security advised me I was unable to use it as I was not a casino-patron. Despite all of my conference colleagues traversing the steps within 30 feet of the elevator, I had to leave the building to repeat my early morning trek of a (now uphill) ramp, road, broken paving (again uphill), footpath, and construction zone, using my walking stick and my wheelie bag to keep me upright, with an overall distance that was at least 3 times that of my able-bodied colleagues. I fall quite regularly and I am always very careful in how I land as if I lose the use of one or more arms through an injury my capacity to care for myself, let alone work, be a mother etc, will be greatly impacted upon. Managing fatigue is very important for staying upright, and having a finite pool of energy which is impacted upon by MS, this is not the way to prevent further physical injury. How about offering assistance or solutions that are not only realistic but also allow me some independence? I am not my disease or my disability.

 

Broken paving which strikes fear in the heart of anyone who is a falls' risk

Broken paving which strikes fear in the heart of anyone who is a falls’ risk

 

Example 2. There was a delay with our return flight home, as there often is as we leave our nation’s capital, and as I have mobility issues I need assistance to board the plane. My friend and colleague was kind enough to assist me through this process, and we were ‘bumped’ to the head of the queue so that we could get seated with as little difficulty as possible. Unfortunately as we traveled down the ramp to the plane a fellow traveler yelled out ‘So what did you do to yourself?’, to which I stopped, steadied myself with the handrail and turned around before replying ‘I didn’t do anything to myself, I have multiple sclerosis’. Understandably the gentleman was very apologetic, however it can be very confronting to have complete strangers ask you why you walk the way you do, or you use a stick, or you are in a wheelchair. Some days it just rolls right off me, but other days when your reserves might be low, you might already have had a dozen people ask you, and you have managed to get through airport security with a walking stick (no easy feat itself!), you just feel like saying ‘Give me a break, did I ask if you have hemorrhoids?’ I am pretty resilient – indeed I could be the poster child for resilience and tenacity, despite my husband saying it is just plain pigheadedness and stubbornness – but even I reach my limits. We are already coping with a pretty full load, 24 hours a day, 7 days a week, with no break EVER. Someone stronger may not be able to cope with the constant questioning. This is not the way to prevent further mental injury. Again, how about offering assistance or solutions that are not only realistic but also allow me some independence? I am not my disease or my disability.

Here in Queensland last week was Disability Action Week, with the aim of empowering people with disability, raising awareness of disability issues, and improving access and inclusion throughout the wider community. This year has been pretty tricky. Unfortunately I had a pretty horrid weekend before the DAW, and the doctors at our local hospital were just wonderful despite struggling with my collapsing veins.

You can see the result of two collapsed veins during failed IV insertion, 10 days later (you can’t see the bruise from the one that succeeded, on the back of my hand)

The result of two collapsed veins during IV insertion, 10 days later

 

I had intended to blog last week about the exciting Rio 2016 Paralympic Games and what a great chance for people to see disability and disease through a different lens. Instead I spent much of last week struggling to manage new medication, work, being a mum/wife/daughter/friend, and independence as friends and family acted as chauffeurs and gophers, nurses and hug-machines.

Anyone who knows me knows that I am a do-er. Get in there and get it done! As the saying goes, if you want something done, ask a busy person 🙂 I don’t usually share about how tricky it can be living with MS ALL DAY EVERY DAY, but this seemed the ideal time to give some tiny insight into what it is like to further prevent injury when you already have an injury, which is what we also need to be about if we are to make injury prevention progress.

How to cut violence painlessly: Increase alcohol taxes

1 Sep, 16 | by Sheree Bekker

photo-1455641064490-74f5f8dbf598

[SB] This post is by Nicholas Page and Jonathan Shepherd.

Nicholas Page is a Senior Research Assistant at the Wales Institute of Social and Economic Research, Data and Methods (WISERD) and former Research Associate at Cardiff University’s Violence Research Group. Follow Nick on Twitter @Nick_Alan_Page

Jonathan Shepherd is a Professor of Oral and Maxillofacial Surgery and Director of the award winning Violence Research Group based at Cardiff University. Follow the Violence Society RG on Twitter @ViolenceSociety

[NP & JS] Alcohol abuse is a major risk factor for violence. For this reason, interventions seeking to reduce alcohol consumption often form a central part of violence prevention strategies, both globally and domestically. Increasing the price of alcohol, for instance, has been linked to significant reductions in many alcohol-related disease and injury conditions, including violent injury. A study in England and Wales, for example, found a negative relationship between violent injury and the price of beer, after accounting for other potentially influential factors. The logic here is that higher prices mean we buy and drink less alcohol – an assumption that is well supported by numerous peer-reviewed studies. From this, we understand the relationship between alcohol price and violence as a two-stage process; first, from alcohol price to alcohol consumption and second, from alcohol consumption to acts of violence.

But, in this previous study, violence was measured using rates of emergency department (ED) attendance between 1995 and 2000, and the price of beer was based on the average value of a single pub-bought (tavern-bought) pint over the same period. Acknowledging that purchasing trends and licensing laws have changed over the last two decades, we at Cardiff University’s Violence Research Group – the authors of the original study – repeated the study using the same ED violence measure but substantially extended the scope of the research beyond the price just of beer and on-license prices.

This latest study – recently published online in Injury Prevention – compares violence-related attendances from 100 EDs across England and Wales between 2005 and 2012, with alcohol prices (including beers, wines, spirits, and ‘alcopops’ – flavoured alcoholic beverages) from both on-trade (e.g. pubs and clubs) and off-trade (e.g. supermarkets and off-licenses) alcohol outlets. In support of our previous finding, the risk of violent injury was once more strongly negatively related to the price of alcohol in both outlet types; again, taking into account the influence of other potential confounding factors.

The implications of these findings are both theoretical and practical. First, because alcohol prices are not affected by rates of violence, the argument that links between violence and alcohol simply reflect the propensity of violent people to drink more alcohol than people who are nonviolent can be dismissed in this instance. Second, and most importantly, our findings showed that as little as a 1% increase in alcohol prices could reduce the number of patients attending EDs for treatment of violence-related injuries in England and Wales by around 6,000 patients per year. Crucially, to achieve such a substantial reduction, the price of alcohol must be raised in both on-trade and off-trade outlets. This would mean, since on-trade prices were found to be more influential in driving violence and that alcohol prices in this trade are already far in excess of the proposed minimum unit price (MUP) range of around 45-50 pence in the UK, that alcohol pricing policies which focus on tax increases are likely to have a greater influence on violent injury than MUP.

Together with similar findings from the USA, this research provides compelling evidence that making alcohol more expensive would reduce violence. Increasing the price of alcohol through tax increases is a national intervention which would be relatively straightforward to implement. The evidence speak for itself: even small price increases could substantially reduce alcohol-related harms, lead to safer towns and cities, decrease costs to health and criminal justice services, and increase revenue for governments.

So what are policy makers waiting for?

 

Celebrating science and inspiring the next generation of scientists

22 Aug, 16 | by Bridie Scott-Parker

Last week in Australia was National Science Week, a nation-wide celebration of science and technology via three key pathways.

Pathway one is to inspire the general public to be involved in science – creating new knowledge – through engaging activities such as Citizen Science. This year’s Citizen Scientists are identifying Australian wildlife that are featured in photos captured via automatic cameras, and anyone with internet access can participate whether they have a university qualification or not. This fantastic activity means that science is indeed inclusive, when many times it can feel like science is a members-only club.

The second pathway is through showcasing the contributions of scientists to the world of knowledge through the Australian Institute of Policy and Science Tall Poppy Awards. As the joint-Queensland 2015 winner of this award, I was delighted to attend the 2016 award evening on Wednesday and was pleased to learn about innovative projects across a breadth of disciplines, such as infecting coeliacs with hookworms, the sexual attractiveness of facial hair, and optimising agricultural irrigation to name a few. Next month I will be one of the inaugural Flying Scientists, bringing science to rural regions in which exposure to science can be limited.

The third pathway relates to a flurry of activities to inspire the next generation to be scientists – both today and in their future education and career paths. Recognising the importance of encouraging girls in particular to become – and stay – engaged in scientific pursuits, I was delighted to host the first University of the Sunshine Coast Growing Tall Poppies program in my research unit here at the University of the Sunshine Coast earlier this year.

Adolescent Risk Research Unit team members Jeanne, Jamie, and Natalie, mentoring Sasha, Isabella, Mikayala, and Sian.

The four Grade 10 students learnt about career paths through and in science, and conducted their own research project under the guidance of members of my team, before making a presentation of their research activities and the key findings before the senior school assembly on Wednesday morning. This presentation was very well-received by the students and teachers in attendance, further breaking silos such as ‘academics’, ‘schools’, and ‘science’ which can pervade.

Bridie with the 4 GTPs after the school assembly presentation

Bridie and the 4 GTP stars after their school assembly presentation.

If we are to continue to effectively prevent injury, we need to make science accessible to everyone, and to the next generation especially.

 

The deadly selfie game – the thrill to end all thrills | The Conversation

8 Aug, 16 | by Sheree Bekker

[SB] This post by Amanda du Preez (University of Pretoriaoriginally appeared on The Conversation Africa on May 18 2016, and is republished in its entirety under a Creative Commons Attribution No Derivatives licence. 

According to the popular press it was more likely in 2015 for a person to die while taking a selfie than to be killed by a shark – this is globally. This means that, officially, the deadly “monster” shark from the “Jaws” movie franchise has become less frightening than capturing your own image on a smartphone – that is if the 12 reported selfie deaths of 2015 are compared with the eight fatal shark attacks in the same year.

These are selfies taken from the top of a skyscraper while dangling in mid-air, or while perched on the brink of an overhanging cliff just before the selfie-taker’s foot slipped.

The invention of the selfie stick – which Wikipedia helpfully explains is “a monopod used to take selfies by positioning a smartphone or digital camera beyond the normal range of the arm” – has worsened the situation. Reports show that tourists in particular no longer look where they are going, but are transfixed by their images on their phones’ screens. Many landmarks and tourist places have started to ban selfies and especially selfie sticks to prevent untimely accidents and even deaths. But putting these safety measures in place does not stop adventurous souls continuing to push the boundaries of dangerous activities.

The latest extreme craze exported from Russia is called “skywalking” (Picture 1). It entails “standing or walking atop very tall structures at dangerous heights, such as the rooftop of a skyscraper building or a bridge”. As such these images are breathtaking and awesome. Provided the taker of the selfie does not slip, he or she may be rewarded with hundreds of “likes” on social media. Takers of dangerous selfies are, after all, considered heroes who unflinchingly put themselves in harm’s way to experience what should probably not be experienced.

Picture 1: Skywalker Alexander Remnev on top of a Moscow skyscraper (2013/14).
Skyscraper Dictionary

But how can we determine what counts as “a selfie death” or “death by selfie”? There are at least three types of deadly selfies:

  • selfies unknowingly taken before death;
  • selfies of death where the taker’s death is almost witnessed; and
  • selfies with death where the taker stands by while someone else dies.

In the first instance (unknowingly before death) the selfie is not the cause of death but is taken just before a tragic event. In these cases the selfies signify more as memorials for the departed, who are remembered in the moments before their demise. These are the selfies where we are confronted with the faces a group of friends in an aeroplane minutes before it destructs, as happened with Mexican singer Jenni Rivera and her crew (Picture 2), or of a motorist just before a fatal accident.

Picture 2: Selfie of Mexican singer Jenni Rivera and her crew before an aeroplane crash in December 2012.

In these cases, the viewer cannot help but interpret the faces looking out at him or her as sad and tragic. In fact, one may even convince oneself that the sadness is palpable in the eyes of the deceased, as in the case of the reggaeton singer Jadiel (real name Ramon Alberto González Adam), who posted a selfie in May 2014 shortly before a fatal motorbike accident in Rochester, New York.

In the cases of selfies of death or death by selfie, we are exposed to the hopeful faces of adventurers, extremists and the unlucky ones. Although these selfies overlap with the previous category of selfies before death, they differ in the sense that they are taken in circumstances that can be considered mortally dangerous.

Particularly arresting is the selfie by the young Russian girl, Xenia Ignatyeva (Picture 3), who in April 2014 climbed a high bridge to impress her friends, but then slipped and fell and was electrocuted when she grabbed live cables. Her beautiful young face looks flushed as she stares into the camera, exhilarated and energised. She stares the sublime in the face as her selfie gazes back at her from the smartphone screen with the devouring abyss at her back. Is this the image of her death framed by expectation and self-grandeur?

Picture 3: Image of selfie taken by Xenia Ignatyeva in 2014.

Lastly, there is the case of selfies taken with death. An example is that of the Turkish police officer who, in September 2014, took a selfie while a person committed suicide in the background by jumping off a bridge (Picture 4). Naturally, the selfie was shared on social media by the police officer. Suffice it to say, the police officer was investigated afterwards.

Picture 4: Image of a police officer taking a selfie with a man who jumps
from a bridge in Ankara, Turkey in 2014.

It is an undeniable thrill – and attention-seeking strategy – to be in the presence of another’s death while experiencing how pain subsides into pleasure. One may speculate whether, if the technology were available during the eighteenth century, for instance, people would not take selfies during executions. No doubt a selfie taken against the background of the beheading of Marie Antoinette – France’s queen, who was executed during the French Revolution – would be considered an “ultimate selfie”.

To be taking a selfie of death is a technologically mediated encounter with the unthinkable and can, therefore, be considered a sublime experience. The contemporary obsession to take an “epic selfie”, an “extreme selfie” or the “ultimate selfie” may be interpreted as an extension of the pursuit of the sublime.

The Conversation

Amanda du Preez, Professor in Visual Culture Studies, University of Pretoria

This article was originally published on The Conversation. Read the original article.

The academic publishing process: A lesson in antifragility

6 Jul, 16 | by Sheree Bekker

Mosaico Trabajos Hércules (M.A.N. Madrid) 02

Image: Mosaico Trabajos Hércules (M.A.N. Madrid) 02 by Luis García under CC BY SA 2.0

“Some things benefit from shocks; they thrive and grow when exposed to volatility, randomness, disorder, and stressors and love adventure, risk, and uncertainty. Yet, in spite of the ubiquity of the phenomenon, there is no word for the exact opposite of fragile. Let us call it antifragile. 

Antifragility is beyond resilience or robustness. The resilient resists shocks and stays the same;

the antifragile gets better”

Antifragile: Things that gain from disorder ~ Nassim Nicholas Taleb

Sheree Bekker and Dr Bridie Scott-Parker have teamed up to write this post on their experiences of the academic publishing process – they provide reflections from the point of view of a rookie researcher (SB) and a more experienced researcher (BSP). 

[Sheree Bekker] Congratulations rained in when I published my first academic paper. I had been open about my publishing journey on social media, and had shared each step it had taken me over the course of eighteen months – with rejections and revisions aplenty. The academic publishing process can be daunting for a rookie researcher, and sharing my failures and then ultimate success with my community on social media gave me a place to both vent and celebrate with others who had been through the process many times before.

As most academics do, I have now come to expect rejection. There is nothing unusual about such in academia – research is built on peer-review and journals with high standards and even higher rejection rates. Rejection is both a rite of passage and a way of life for academics. We are reminded of this often through corridor conversations, mentorship, and our own experiences.

Yet failure is not openly and honestly shared or spoken about in the wider sphere of academia. Sure, we all know that failure is the name of the game, but it is not really spoken about. I remember this negative CV doing the rounds on social media last year – and how radical it seemed at the time that someone was willing to share all their failures (gasp!) in an arena where a career – and for many academics self-worth – is tied to wins. Yet wins cannot be achieved without the failures. Go figure.

I am a big advocate for sharing our life’s work on social media, but have often wondered why we only share our ‘wins’. Do the failures speak to a lack of competency? No, I don’t believe so. Declaring a failure for the world to see speaks to shame and vulnerability – and also to courage and commitment. Now, I am not suggesting that all academics share all their failures all of the time – for I am told that you just get to a point where it does not bother you any longer as there are just too many to share – but I do believe that we owe it to emerging academics to, at the very least, open up the conversation a little more. Indeed, a Guardian piece recently reminded us academics: you are going to fail, so learn how to do it better.

The opposite of fragility is not resilience or robustness, it is antifragility. The ability to be poised to benefit or take advantage of stress, errors and change, the way, say, the mythological Hydra generated two new heads, each time one was cut off. Perhaps it is this antifragility that we need to cultivate as emerging researchers, rather than mere stubborn grit. Growing and learning out of our academic challenges, rather than merely ploughing through them.

[Bridie Scott-Parker] Seven years later, I still recall the daunting – nay terrifying – experience of submitting my first manuscript for peer review. While the paper from my Honours thesis emerged quite organically over a month or so (hilarious that I thought this took forever to happen), I actually spent more than 6 hours frantically checking everything was attached correctly, screens were completed, etcetera, then reading the entire PDF generated by the journal’s online submission system, before clicking ‘yes I want to submit this article for peer-review’ (and no I won’t change my mind because I am not allowed to….). Then the dreaded reviews arrived and I was crushed. Clearly I was a complete failure as a researcher, an academic, and as a human, and I should abandon all hope and live in a cave for the remainder of my life! Again, hilarious as my supervisors said that the comments were pretty good! I could see no good and I took some persuading that it is not personal. Having survived the review-revise-respond-review-revise-respond merry-go-round many many times since then, I have the benefit of hindsight to see that those reviews were indeed quite favourable. I also have the benefit of understanding that this is a normal part of disseminating findings, and that as researchers, academics, and authors, our skills are strengthened considerably each time we receive constructive feedback.

Please note also that I don’t live in fairy land. Sometimes reviews are one or two sentences along the lines of ‘this is rubbish, go away’ or ‘this is good and could be improved by some minor changes’, without actually providing any guidance regarding what was good, what was less good, and how to improve the manuscript. Such reviews are a waste of time for the reviewer, the editor who manages the review process, and the authors who are trying their best to share their research in an engaging and informative manner.

I have found over time that I have become the ‘poster child’ for antifragility. Take all feedback on board – good and bad – and learn from it. Where are my research and writing strengths? Where are my research and writing weakness? Don’t be afraid to ask peers and colleagues for unbiased feedback regarding your strengths and weaknesses. This information will only help you in the long run.

Last week I had the wonderful opportunity to serve as a mentor to a group of PhD students as they traversed the steeplechase-like process of preparing and submitting a paper for peer review. While I have no experience or skills in Indonesian diglostics, storm runoff, and conceptualisation of climate change adaptation, I have antifragility. I shared my own experiences and tips and tricks I have discovered to make the writing process that little bit easier. I also shared what reviewers look for, and cautioned against easy ways to ‘annoy’ reviewers and editors (my personal all-time favourite, don’t use any punctuation!). Yes, I completed my doctoral dissertation by peer-reviewed publication, and yes, I have a steady stream of post-doctoral peer-reviewed publications. However what you don’t see is the many frogs I proverbially had to kiss before the manuscripts turned into princes. My personal best (not my own project, I am pleased to say) was 18 different versions submitted to 9 different journals, and 3 email conversations between myself as corresponding author and the journal editor, before the paper was finally accepted. Each time the paper was revised, and sometimes it was resubmitted to the journal that provided the reviewer feedback (if not outright rejected). Yes, this is frustrating, but the final article (my silk purse) is so much better that the original submission (the sow’s ear). Bear in mind also that revising a manuscript in light of reviewers’ comments – even when you have done so 4 times – does not guarantee that it will be published within that journal.

Again, antifragility is the way to go 🙂

 

Censoring research

23 Jun, 16 | by Barry Pless

I am posting this for all Injury Prevention blog readers who are researchers or interested in research. I do so in part because John Langley is one of the pioneers in our field and was one of the Senior members of our editorial board from IP’s earliest days. But I also do so because the issue that prompted him to write this op-ed for his local Otago paper is by no means restricted to New Zealand. It is a widespread and important issue that has the potential to corrupt research in all manner of ways. IBP 

Read it and think carefully about the implications for your own work. Thanks to John for sharing it and for ODT for permission to reproduce it. Thankfully Injury Prevention, to the best of my knowledge, has never had to deal with this issue.

 Restrictive publication clauses in health research contracts

I was both pleased and disappointed to read the two ODT articles (20 February, 5 March) on this subject. Public airing of this important issue is long overdue. I was disappointed as I gained the impression that despite several scientists publicly expressing their concerns, the University of Otago Deputy Vice-Chancellor for Research appeared to have none. The Deputy Vice-Chancellor’s apparent lack of concern, however, is consistent with my experiences of research administration at the University.

For 20 years I was the Director of the University of Otago’s Injury Prevention Research Unit. This Unit was entirely dependent on funds from government agencies. Contrary to my expectations, the University of Otago did not pro-actively seek to protect me, or the public, from clauses in draft contracts that placed restrictions on publishing research findings. Protecting researchers increases the chances that they can serve the public interest, and meet the University’s legislated role of being the critic and conscience of society.

I spent a significant amount of time challenging clauses that would allow a government agency to censor a finding they disagreed with, or deny the right to publish work at all. On a couple of occasions during contract negotiations I was reminded by government agencies that they could purchase the outputs they wanted from other Universities or private organisations who would accept the restrictive clauses.

Why would Universities be accepting these clauses? I believe a key factor is the importance of, and competition associated with, generating research income. Collectively, NZ’s eight publicly funded universities derive approximately 15% of their income from research contracts. The success a University has, relative to others, in obtaining external research funds also has a significant role in determining the funding it receives from government through the Performance Based Research Funding scheme. Research income is critical to ensuring high quality research, thereby maintaining and enhancing a university’s reputation and thus attracting students, staff, and further funding. The purchasers of research can use the competition between universities, and researchers, to their advantage in getting restrictive publication clauses accepted.

Private research suppliers can accept restrictive publication clauses as they are typically uninterested in publishing in peer-reviewed journals and have no statutory or moral obligation to serve the public interest. While they would produce a research report for the purchaser, these reports are not frequently published, easy to access, or subject to rigorous quality control, e.g., independent peer review.

It was also my experience that many senior researchers did not care about the restrictive clauses. Why would this be so? Success in attracting research funding is, for most researchers, critical to pursuing their research, producing publications, and to promotion and public recognition.

This behaviour contrasts with Royal Society of New Zealand’s (RSNZ) Code of Professional Standards and Ethics in Science, Technology, and the Humanities. Section 8.1 of that code states that members of the Society must: “oppose any manipulation of results to meet the perceived needs or requirements of employers, funding agencies, the media or other clients and interested parties whether this be attempted before or after the relevant data have been obtained;”

I accept the right of a purchaser of research to see an advance copy of any paper for publication and to make any comments on it. But requiring modification beyond correcting factual errors is unacceptable. Even purchasers suggesting toning down a phrase here and there and putting in some qualifiers is problematic from a purchaser who is concerned to minimize bad publicity that might arise from the paper. It also places the researchers in a bind. Should they comply? If they don’t comply are they putting at risk future research funding from the purchaser? I suggest they might be. Why deal again with a ‘difficult’ group of researchers when you can purchase the work elsewhere?

The best approach to this issue is transparency. Make the deliberations between researchers and purchaser accessible to all as in the open review practiced by some scientific journals so readers can trace the discussion. This approach would not deal with contracts that explicitly prohibit the researchers publishing at all.

The Health Promotion Agency (HPA), a crown entity, charged with promoting healthy lifestyles recently put out a request for proposals (RFP) to assess whether the reduction in trading hours in Wellington has any impact on alcohol-related harm. The ‘indicative’ contract for this RFP stated: The Supplier will not publish the results of the Services undertaken pursuant to this Contract”. Only when challenged did HPA advise that it was a negotiable clause. Potential University researchers interested in bidding for such research should be able to take the ‘indicative’ contract as a reflection of the intent of the purchaser. Irrespective of this, preparing a high quality research proposal involves significant resources and many researchers would consider it was not worth the effort given the uncertainty of their right to publish.

In effect, some government purchasers are getting to decide what findings, if any, the public gets to see from research the public has paid for, either by pressuring some universities to accept restrictive clauses or by buying what they want from private suppliers.

Universities of New Zealand, the representative body of New Zealand’s eight universities, and the RSNZ need to enter in discussions with Government with a view to ensuring government research RFPs do not impose these restrictions. Interference with researchers ability to bid for, execute, and publish research compromises the role universities have as critics and conscience of society.

We need an independent audit of government research contracting to determine to what degree restrictive publication practices and the use of private suppliers is undermining the public’s right to be fully informed of the findings of research they have paid for.

Emeritus Prof John Langley

Concussion in sport: Changing the “Culture”

8 Jun, 16 | by Sheree Bekker

 

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Photo by Scott Beale / Laughing Squid CC BY-NC-ND 2.0

[SB] Concussion remains the current hot topic in sports injury prevention. Injury Prevention has published many an article on the topic, including the recent An examination of concussion education programmes: a scoping review methodology. I have blogged about this here too.

I have invited Dr Johna Register-Mihalik (follow her on Twitter @johnamihalik), an assistant professor in the Department of Exercise and Sport Science at The University of North Carolina at Chapel Hill, to share her thoughts on concussion prevention with us. Dr Register-Mihalik serves as a research scientist at the Injury Prevention Research Centre at UNC-CH. She is on the Brain Injury Association of North Carolina Board and USA Baseball’s Medical and Safety Advisory Committee, and is also an active member of the National Athletic Trainers’ Association (NATA) and the American College of Sports Medicine (ACSM), amongst others.

[JRM] Few injuries receive the attention and the discussion that concussion does, especially those occurring in sports such as football, in both the mainstream and medical communities. Concussion is a complex injury that is the result of forces transmitted through the brain, resulting in a complex neurometabolic cascade leading to a wide array of signs and symptoms. The more we learn about concussion, as well as exposure to head impacts, the more we realize that we don’t know. It is an injury, that – perhaps because it is the brain that is affected – most in the sporting community are hyper aware of, regardless of level of participation.

However, due to this increasing attention and focus, one of the most common discussions and recommendations is to change the “culture” to improve safety concerning concussion and head trauma. However, when we say “change the culture”, what are we actually trying to change? Certainly, we can think of key things we want to see changed universally, such as: recognizing as many injuries as possible, student-athletes disclosing these injuries if they haven’t been identified (when possible), individuals and organizations consistently adhering to  no same day return to play, no student-athlete returning to play without clearance from a medical professional with the training to make the decision, and perhaps more general, a sporting environment that encourages safe practices, not playing through injury, and creates a positive environment for players, coaches, fans, and families alike. I am sure we could continue to add to this list of things we want to change or see as a consistent part of sport. However, most factors or behaviors around the culture of sport are complex and multifaceted.

For one, many aspects of the culture of sport that are at their core good, may progress to risky decisions down the road. Let’s take the concept of persistence and not quitting. While at the core those are good things, these may be the constructs that then drive playing through injuries, especially those like concussions that we cannot always see.  While no studies have directly addressed these relationships, data does highlight not wanting to let teammates or coaches down and not wanting to be pulled from play as primary reasons for not disclosing a concussion (McCrea, 2004, Register-Mihalik, 2013; Kerr, 2016). In addition, there is data to show that even some of the efforts that we direct to improve the culture, may have a negative effect (Kroshus et al, 2015) . This body of work highlights the importance of careful thoughtful messaging and imagery giving in our educational sessions, videos, and programs.

The type of change we talk about around concussion and head trauma is multifaceted. As such, the work to truly improve outcomes, improve behaviors, and create a “safe” environment (both social and physical) must also be multifaceted and affect multiple levels of the socio-ecological framework. It is also work that should be thoughtful, not sensationalized, and rooted in evidence – which can all be difficult things in the face of such heightened attention around a topic, where many have opinions. The work to truly insightful change will continue to require an interdiscplinary and community-based approach to not only develop the interventions and tools for change, but to see them be both successfully implemented and sustainable. I for one am excited about this work ahead and look forward to working with others to continue to see change happen for the better.

Fatality Free Friday | Road Safety | Australia

27 May, 16 | by Sheree Bekker

Fatality Free Friday is an initiative that started in Australia in 2007, and the campaign has continued to expand its operation and is now recognised as Australia’s only national community based road safety program.

Road safety is a complex issue but we believe that if drivers consciously think about road safety and safe driving for just one Friday in the year, that day’s toll – statistically about 5.3* deaths – could be reduced to zero.

That’s our aim. Not a single road death in Australia for just one day. Just one Fatality Free Friday.

We believe that if drivers are asked to actively concentrate on road safety and safe driving for just one day in the year, they’ll drive safer for the next few days too and, over time, change their outlook completely, consciously thinking about safety each and every day they get behind the wheel.

*DataSource: Australian Transport Safety Bureau

(From Fatality Free Friday)

Drivers can take the pledge to drive safely here.

On advocacy: championing young driver safety

2 May, 16 | by Sheree Bekker

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[SB] In this post, public health consultant Dr Sarah J Jones (follow her on Twitter @GDLSarahJones), an advocate for better safety for young drivers and all
who share the roads with them, shares her experiences on her efforts to advocate for Graduated Driver Licencing in the UK
. In her previous role, Sarah was an injury epidemiologist at Cardiff University, researching a range of injury prevention topics and completing a PhD on Child Pedestrian Injuries and Deprivation, a study that included analysis of the links between traffic calming distribution, deprivation and narrowing inequalities. 

[SJJ] It all began in 2008. I was in the final stages of Public Health Registrar Training when my supervisor told me to “go somewhere and do something”. My interests in road traffic crash prevention lead me first to Dot Begg at Otago, Dunedin and then on to Erin Cassell at Monash, Melbourne. The main objective, as well as a fascinating insight into how pandemic flu and other public health issues were being dealt with (I travelled the week after the 2009 swine flu pandemic first emerged), was an estimate of the effect that Graduated Driver Licensing (GDL) could have if implemented in the UK.

Back home, I presented what I had done, sat back, exceptionally pleased with myself, after all the case was now made, and awaited the “pat on the back” from my supervisor. “Nice” he said. “Now get it implemented”. “How” I lamely asked. “I don’t know. Work it out” was the response.

I’m still trying to work it out. Seven years on I have talked to a lot of people. I’ve given presentations to vaguely interested lay people in village halls, as well as to Members of Parliament. I have written articles for newspapers, magazines and peer reviewed journals. I have given newspaper, television and radio interviews, some live, and have participated in “phone-ins”.

Yet, we still do not have GDL in the UK. So, in seven years, I have achieved nothing.

I think people are more generally aware of GDL than when I started talking, but that may be completely unrelated to anything I have done. I am still looking for the guide on “How to bring about legislative change”, but there does not seem to be one. I have learned a lot about the policy process in the UK and about how reluctant people are to change their viewpoint, even in the face of overwhelming evidence to the contrary.

I always knew that the pace of Public Health change was painfully slow, but even with that knowledge continuing to advocate for change is difficult and often demoralising. It’s little wonder that we have become locked into a cycle of quick fixes (action that is just a proxy for effective action) to match political cycles that can then be quietly sidelined when they do not have the effect that was intended.

After 8 years in research / academia, my move into service based public health was my “translational research”. I am coming to believe that advocacy is the most important, but most overlooked area of both public health and injury prevention, partly because it is so difficult to measure the effect of what is being done. How we support people to become effective advocates is likely to be key to effective intervention prevention in the future.

[SB] I too have written on the vital importance of advocacy: here and here. As researchers, it is important to remember that we do not always need to disseminate purely our most up-to-date research results, or even the most innovative interventions; sometimes our work life’s work is bigger than that. Sometimes we need to advocate for the very heart that lies at our work: simple, credible information and resources that can make a difference in even one person’s life.

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