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This study adds to the concept that even in a highly complex sample of multi-problem young adults who underwent CPS interference in their youth distinct developmental pathways, at least for mental health problems, can be distinguished. Although this exploratory study was not intended to produce definite ideas on how the underlying latent subgroups may experience differential treatment effects, our findings do suggest that members of the groups might benefit from interventions specifically tailored to their differing patterns of problems. The development of specific secondary and tertiary prevention programmes for children with an early onset of CPS interference and severe family problems should receive priority from both policy makers and clinical practice. In addition, evidence based interventions should be developed to prevent problem behaviour of all children that underwent CPS interference in their youth to prevent mental health problems and the persistence of delinquent behaviour into (young) adulthood.
|
study
| 99.7 |
In 2010, 34.5 million people died from non-communicable diseases (NCDs). These deaths accounted for more than two thirds of the deaths worldwide . Further, nearly 80% of these deaths occurred in low- and middle-income countries (LMICs) . Hypertension (HTN) is among the main risk factors of NCDs. In 2008, the estimated prevalence of HTN in Africa was 46%, which translates to a population of nearly 30 million adults [3, 4]. Between 2003 and 2009, the WHO STEP wise approach to Surveillance (STEPS) study that was carried out in 20 African countries found that the prevalence of HTN ranged from 19.3% to 39.6% . In the Democratic Republic of Congo (DRC), the prevalence of HTN was 32.1% in men and 31.5% in women in 2014 .
|
review
| 96.56 |
Sub-Saharan African (SSA) countries are experiencing one of the most rapid epidemiological transitions but their health systems are more oriented to the management of infectious diseases [7–9]. Effective management of HTN in SSA is challenging due to limited resources, particularly human resources for health [10, 11]. In 2009, for example, it was estimated that there were 2 physicians and 11 nurses/midwives available per 10,000 populations in SSA compared with 19 physicians and 49 nurses/midwives per 10,000 populations in North America. In 2009, in the Democratic Republic of Congo (DRC), the total number of physicians was estimated at 5827 (1 physician per 10,000 population) and the total number of nurses at 28,789 (5 nurses per 10,000 population) .
|
study
| 99.56 |
Task shifting has been identified as a means to address the health worker crisis and improve access and cost-effectiveness in health systems . Task shifting, which dates back to the 1970s–1980s when auxiliary nurses took up the health care provider role, describes a strategy where some tasks that are normally performed by a physician or other specialized health staff are assigned to a health professional with a different or lower level of education and training, or to a person specifically trained to perform a limited task only, without having formal health education [14, 15]. Task shifting is a viable strategy in LMICs for the primary and secondary prevention of NCDs . Previous studies have shown that nurses are cheaper to employ and train than doctors, Furthermore, nurses are one of the largest groups of qualified health care providers . Task shifting has been shown to be cost-effective [17, 18].
|
review
| 99.7 |
Task shifting in the DRC, is based on the Primary Health Care (PHC) model. The health center (HC), which is managed by a head nurse, is the first contact between patients and health system. HCs provide accessible and affordable primary health care. Patients requiring further care are referred from the HC to a General Referral Hospital (GRH) . Although a recent study carried out in HCs of Kinshasa found a low proportion of patients with controlled HTN , to the best of our knowledge, there have been no studies that have examined the association between task shifting and the management of HTN in the DRC. The aim of this study was to investigate the association between task shifting and the management of HTN by comparing HTN control in HCs and GRHs patients.
|
study
| 99.94 |
The study included patients with an HTN diagnosis made by a healthcare provider and who were receiving care in the KPHC network facilities. Patients were eligible for the study if they were aged 18 years and older, presented for care in a participating health facilities on the day of the survey, and agreed to participate in the study.
|
study
| 100.0 |
The sample size was computed using the following formula:\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ n\ge \frac{\left[p1\left(1-p1\right)+p2\left(1-p2\right)\right]}{\left(P1-P2\right)}x\left(z1-\alpha +z1-\beta \right)2 $$\end{document}n≥p11−p1+p21−p2P1−P2xz1−α+z1−β2
|
study
| 99.25 |
Where p1 represents the proportion of patients with controlled HTN at the HC level (15.6%) ; p2 represents the proportion of patients with controlled HTN in the GRH level (we assumed that the proportion would be twice that in HCs (31.2%); z is the value of the standard normal distribution corresponding to a significance level of alpha of 0.05 (1.96); and β is power (80%), z1-β = 0.84.
|
study
| 99.9 |
The minimal sample size computed was 112 patients per group or 224 patients for both groups. To recruit patients, we obtained the list of GRHs and HCs from the KPHC network and visited all them to know the dates when HTN patients have follow-up clinics. We then visited the facilities on clinic dates and successively recruited patients until the desired sample size was achieved. The minimum sample size was achieved after visiting nine HCs and five GRHs.
|
study
| 99.94 |
Five trained data collectors’ conducted face-to-face interviews using a structured questionnaire. The questionnaire was pretested and translated into the local language (Lingala) before data collection. The questionnaire elicited information on the following variables: patients’ socio-demographic (sex, age, marital status, educational level, income) and clinical characteristics (duration of HTN, co-morbidity); health system variables (patient-provider relationship, the time devoted to consultation, waiting time, affordability and availability of healthcare); treatment related variables (types of antihypertensive drugs and dosage, experience of medication side effects, treatment adherence) and medical-related costs (consultation fees, medicines, laboratory, transportation and food).
|
study
| 99.94 |
The dependent variable was uncontrolled HTN, which was defined as having a systolic blood pressure (SBP) ≥ 140 mmHg and/or a diastolic blood pressure (DBP) ≥90 mmHg for patients without co-morbidity or having SBP ≥ 130 mmHg and/or DBP ≥ 80 mmHg for patients with co-morbidity . The primary explanatory variable, task shifting, was defined as the management of HTN at HCs level.
|
study
| 99.94 |
Co-morbidity was defined as HTN associated with diabetes mellitus or target organ damage (heart disease, stroke, or chronic kidney disease) based on diagnosis made by a healthcare provider. Antihypertensive types were categorized in two groups, monotherapy if a patient was on one type of antihypertensive medication and multitherapy if a patient was on two or more types of antihypertensive medications. Treatment adherence was measured using the Morisky Scale, which is a validated four-item scale with good internal consistency based on studies of inner-city patients with HTN [23, 24]. Patients responded “yes” or “no” to four questions (Do you ever forget to take your medicine? Are you careless at times about taking your medicine? When you feel better, do you sometimes stop taking your medicine? Sometimes if you feel worse when you take the medicine, do you stop taking it?). Based on their responses, patients were categorized into three groups: high, medium and low adherence. To facilitate statistical analysis, adherence was dichotomized with patients with low or medium adherence classified as non-adherent and patients with high adherence classified as adherent .
|
study
| 99.94 |
The costs of medicines were reported on a monthly basis. The transportation costs comprised roundtrip travel costs incurred by the patient and anyone who accompanied them to the health facility for HTN-related care. Food costs comprised expenditures related to food during HTN-related health facility visits. Consultation, medicines and laboratory costs were obtained from patient record notebooks, invoices and bills provided by patients. All KPHC patients have a patient record notebook where all information related to their care including costs are recorded. Transportation and food related costs were self-reported. The cost computations did not include productivity and opportunity costs. Costs were provided in Congolese Democratic Francs (CDF), the local currency, and converted into United States Dollars (US$) using the average exchange rate during the study period (920 CDF to US$ 1). To account for inflation, a rate of 2% was used in computing all costs incurred outside the reference period (2015 to 2017).
|
study
| 100.0 |
Data were entered into Epi data then exported to SPSS (Statistical Package for Social Sciences) version 20.0 (SPSS, Inc., Chicago, IL, USA) and Microsoft Excel for analysis. Descriptive statistics were used to summarize patients’ characteristics. Categorical variables were reported as frequencies and percentages. Continuous variables were reported using means with standard deviation. The Student’s t test and χ2 test were used to compare means and proportions respectively. Logistic regression was used to examine the association between task shifting and uncontrolled HTN after adjusting for others factors like socio-demographic, clinical factors. For all analyses, a p-value of less than 0.05 was considered statistically significant.
|
study
| 100.0 |
Patients’ socio-demographic and clinical characteristics are summarized in Table 1. Almost half of the patients were female (53.1%). The patients’ mean age was 59.5 years (standard deviation = 11.4 years). A significantly higher proportion of GRH patients than HC patients had ever attended school (87.7% vs 77.7%, p = 0.035). Co-morbidity was significantly more common in GRH patients compared with HC patients (45.4% vs 25.4%, p < 0.001). The majority (94.2%) of patients had been diagnosed with HTN within the 5 years preceding the study. Only 23% of all patients had controlled HTN. The proportion of patients with uncontrolled HTN did not differ by type of health facility (76.2% among GRH patients vs 77.7% among HC patients, p = 0.771).Table 1Patients’ socio demographic and clinical characteristics, by health facilityVariablesGRH patientsHC patientsTotal p-value(%) n = 130(%) n = 130(%) n = 260Gender Male46.946.946.90.999 Female53.153.153.1Attended school Yes87.777.782.70.035 No12.322.317.3Has a source of income Yes60.866.263.50.371 No39.233.836.5Marital status Married/cohabiting72.367.770.00.421 Single/separated/divorced /widowed27.732.330.0Co-morbidity Yes45.425.435.4<0.001 No54.674.664.6HTN duration < 594.693.894.20.798 ≥ 55.46.25.8HTN control Yes23.822.323.10.771 No76.277.776.9Mean age ± SD58.0 ± 11.661.05 ± 11.059.5 ± 11.4[95% CI][55.9;60.1][59.1;62.9][58.1;60.9] CI confidence interval, GRH General Referral Hospital, HC Health Center, SD standard deviation
|
study
| 100.0 |
Patients’ assessments of the quality of care are summarized in Table 2. A significantly greater proportion of GRH patients than HC patients stated that the consultation time was sufficient (96.9% vs 81.5%, p < 0.001). No statistically significant differences between GRH and HC patients were observed in terms of perceived accessibility, waiting times, affordability, satisfaction with the relationship with healthcare providers, types of antihypertensive drugs used, adherence to medication, and control of HTN. A greater proportion of GRH patients than HC patients reported medication side effects (22.6% vs 8.3%, p = 0.003). The proportion of patients who were not adherent to medication did not differ by facility (GRH 47.2% versus HC 38.5%, p = 0.204). No significant difference was also found between the two groups with regard to the control of HTN.Table 2Quality of health care assessmentVariablesGRH patientsHC patientsTotal p-value(%) n = 130(%) n = 130(%) N = 260Time given by HCP Sufficient96.981.589.2<0.001 Insufficient3.1018.510.8Distance HCF-Home < 5 km59.266.262.70.252 ≥ 5 km40.833.837.3Waiting time ≤ 30 min32.336.934.60.438 > 30 min67.763.165.4Perception of treatment cost Unaffordable63.870.066.90.296 Affordable36.230.033.1Perception of relationship Very good(excellent)/good96.992.394.60.109 Somewhat good/bad3.17.75.4Type of anti-hypertensive Multitherapy11.523.817.70.046 Monotherapy70.060.065.00.951 No treatment18.516.217.3Experience of side effects Yes22.68.315.30.003 No77.491.784.7Treatment adherence Yes52.861.557.20.204 No47.238.542.8 GRH General Referral Hospital, HC Health Center, HCP health care provider, HCF health care facility
|
study
| 99.94 |
Results of the logistic regression model employed to assess the factors associated with HTN control are summarized in Table 3. The type of facility was not significantly associated with HTN control. Co-morbidity and the type of antihypertensive medication used were associated with HTN control. Patients with co-morbidity were more likely than those without co-morbidity to have uncontrolled HTN (adjusted OR = 10.3; 95% CI: 3.8–28.3) while patients on multiple medications were more likely than those on a single medication to have uncontrolled HTN (adjusted OR = 4.6; 95% CI: 1.3–16.1).Table 3Bivariate and multivariate analysis of factors associated with uncontrolled HTNVariablesCrude OR[95%CI] p-valueAdjusted OR [95%CI]a p-valueGender (male vs female)1.3 [0.7–2.4]0.3531.3 [0.6–2.8]0.430Attended school No0.8 [0.4–1.6]0.5301.7 [0.5–5.2]0.365 Yes1Co-morbidity Yes8.5 [3.3–22.1]0.000b 10.3 [3.8–28.3]0.000b No11Type of anti-hypertensive drugs Multitherapy4.9 [1.4–16.6]0.011b 4.6 [1.3–16.1]0.017b No treatment0.8 [0.4–1.6]0.4460.6 [0.3–1.3]0.199 Monotherapy11Experience of side effects Yes1.0 [0.4–2.5]0.9651.1 [0.4–3.1]0.786 No1Treatment adherence No0.9 [0.4–1.6]0.6580.9 [0.4–1.7]0.658 Yes1Time given by HCP Insufficient1.1 [0.4–2.9]0.8270.6 [0.2–2.0]0.390 Sufficient1Type of HCF HC1.1 [0.6–1.9]0.7680.6 [0.3–1.2]0.160 GRH11 CI confidence interval, GRH general referral hospital, HC health center, HCP health care provider, HCF health care facility, OR odds ratio aAdjusted for gender, having attended school, the time given/allocated by the provider, the experience of side effects, types of anti-hypertensive, treatment adherence and co-morbidity; b statistically significant
|
study
| 99.94 |
Table 4 shows the results of the cost analysis. In the HC, the most expensive costs were medication costs (US$4.4 [95% CI: US$3.4 – US$5.4]) while in the GRH the most expensive costs were laboratory costs (US$23.6 [95% CI: US$ 16.9 – US$ 30.3]).The mean total cost was lower in the HC than in the GRH (US$ 7.7 [95% CI: US$ 6.6 – US$ 8.8] versus US$34.2 [95% CI: US$27.6 – US$40.9]).Table 4Analysis of healthcare costs in United States Dollars (US$), by facility typeHealthcare costsGeneral Referral HospitalHealth CenterMean cost in US$[95% CI]Mean cost in US$[95% CI]Consultation costs3.5[2.8–4.2]1.5[0.3–1.8]Medication costs4.6[3.8–5.3]4.4[3.4–5.4]Laboratory costs23.6[16.9–30.3]0.80.2 [0.5–1.2]Transport costs1.2[1.0 – 1.5]0.7[0.5–0.9]Food costs1.4[1.0–1.7]0.2[0.1–0.4]Total costs34.2[27.6–40.9]7.7[6.6–8.8] CI Confidence interval
|
study
| 100.0 |
In this study we investigated the association between task shifting and HTN control. Specifically, we compared patients seen in primary health centers that are managed by a head nurse and patients attending general referral hospitals who are typically managed by physicians. Similar to other studies, we found that majority of patients (76.9%) in both types of facilities had uncontrolled HTN [20, 26]. Uncontrolled HTN was not associated with the type of health facility. In contrast, Fahey and colleagues, who conducted a systematic review of randomized controlled trials (RCTs) for management of HTN, found that patients had a greater reduction in blood pressure when followed-up by non-physician health professionals . However, unlike our study, Fahey’s study was based on RCTs where non-physicians were trained on management of HTN. Fahey‘s study also assessed more organizational and structural factors associated with HTN control than our study.
|
study
| 99.94 |
The presence of co-morbidity was an independent predictor of uncontrolled HTN. Studies have shown that hypertensive patients with co-morbidity have poorer blood pressure control than those without co-morbidity .Given this high risk, patients with co-morbidities should not be managed by primary-level care facilities that only offer a minimum package of activities/treatment [20, 29]. These results also suggest the need for guidelines on the management of HTN at the HC-level that include a global assessment of cardiovascular risk.
|
review
| 84.94 |
In contrast to other studies showing that the use of more than one antihypertensive drug is an important factor in HTN control, we found that patients on multiple antihypertensive drugs were more likely to have uncontrolled HTN than those on one drug [30, 31]. The use of more than one antihypertensive drug may mean that the patient has complicated HTN, which is difficult to control. Further, patients on multiple medications may have lower adherence .
|
study
| 99.94 |
Findings should be interpreted in light of the study’s limitations. First, some of the data were based on self-reports, which are subject to bias. Second, we were unable to consider additional cost components such as productivity and opportunity costs. However, our overall findings corroborated the findings of previous studies and provide useful insights on how task shifting can affect the management of HTN.
|
study
| 99.94 |
This study shows that the management of HTN at primary healthcare level might be just as effective as at secondary level. However, the high proportion of patients with uncontrolled HTN underscores the need for HTN management guidelines at all healthcare levels.
|
study
| 68.06 |
The etiology and patho-mechanics of recurrent gleno-humeral dislocations are not completely known (Alkaduhimi et al., 2016; Arciero et al., 2015; Burkhart & De Beer, 2000; Di Giacomo et al., 2016; Shin et al., 2016; Symeonides, 1989; Symeonides, 1972) and optimal surgical management of anterior shoulder instability remains controversial. Few studies have been carried out on post-traumatic capsular elongation and hyperlaxity or on the healing process of the soft tissue on the glenoid edges after the first dislocation and after capsulolabral repair (Marco et al., 2017; Bonazza et al., 2017). On the contrary, considerable attention has been focused on the correlations among glenoid bone loss, humeral head defects and instability, particularly in the recurrent forms if correlated with engaging Hill-Sachs lesions (Cautiero et al., 2017). Recent studies show the biomechanical aspects of restoring the glenoid width using bone augmentation and the role of the anterior capsule in recentering the humeral head on the glenoid fossa (Arciero et al., 2015; Alvi et al., 2016; Fortun et al., 2016). Furthermore, severe bone lesions of the glenoid rim and the Hill-Sachs defect on the humeral head are associated with poor quality capsular tissues (Arciero et al., 2015; Burkhart & De Beer, 2000; Symeonides, 1972; Cole & Warner, 2000). Different techniques for surgical treatment of traumatic and atraumatic recurrent shoulder instability have been previously described, but arthroscopic Bankart repair is the most popular. The failure rate of this technique is reported to be from 15% to 64%, especially in unselected patients with severe glenoid bone loss (Burkhart & De Beer, 2000; Shin et al., 2016; Degen et al., 2016). The association of glenoid bone loss and capsular inconsistence represents the real limit of a standard arthroscopic anterior capsulorrhaphy or an isolated bone graft procedure (Cole et al., 2000; Field et al., 1999; Kleiner et al., 2016; Lafosse et al., 2007; Provencher et al., 2007). The remplissage technique has been proposed as a support for capsular insufficiency and for engaging Hill Sachs lesions, but the results are controversial, and failures are reported to be from 4% to 15% (Wolf & Arianjam, 2014). The use of a tendon sling made around the subscapularis tendon was proposed to prevent anterior instability in the shoulder, using a hamstring graft and enhancing the anterior rim of the glenoid with the same graft (Klungsøyr et al., 2015). Currently, the open or arthroscopic Latarjet procedures are considered to be the most effective techniques for treatment in cases of severe bone defects and poor-quality anterior soft tissue due to the coracoid transfer and conjoint tendon action, with a recurrency between 0 and 5% (Degen et al., 2016; Lafosse et al., 2007; Wolf & Arianjam, 2014; An et al., 2016; Cassagnaud et al., 2003; Latarjet, 1954; Matton et al., 1992; Russo et al., 1990; Russo et al., 1998; Steffen & Hertel, 2013; Taverna et al., 2006; Torg et al., 1987; Vander Maren et al., 1993). Also the conjoined tendon transfer allows stability restoration with no significant range-of-motion loss and a low recurrence rate (Douoguih et al., 2018).
|
review
| 99.9 |
Open and arthroscopic J-bone graft, considered to be much more anatomical approaches (Pauzenberger et al., 2017), can provide glenoid bone restoration, but certain technical aspects of the graft preparation and glenoid implant have led to a low popularity of those procedures. A new operation, consisting of an all arthroscopic bone graft glenoid augmentation using posterior instruments for glenoid drilling and graft stabilization was described (Taverna et al., 2006; Taverna et al., 2008; Taverna et al., 2014), and it seemed to be more reproducible compared to the J graft technique. The present technique is indicated in presence of a bone defect in patients practicing contact sports. Moreover compared to the Latarjet technique it does not modify the coracoacromial arch, the use of a posterior guide is safer and buttons compression fixation of the graft is more axial.
|
review
| 99.9 |
Considering the recent positive experience using partial subscapularis tenodesis on the glenoid rim, known as arthroscopic subscapularis augmentation (Maiotti & Massoni, 2013; Maiotti et al., 2017; Maiotti et al., 2016; Schröter et al., 2016) (ASA), to treat recurrent anterior instability with capsular inconsistence and moderate glenoid bone loss (GBL), we decided to apply both techniques - ASA and Bone Block (ASA-BB) - in very complex cases in which a glenoid bone defect equal to or greater than 25% is associated with capsular insufficiency. ASA procedure solve the problem of an hyperlax capsule or insufficient tissues, instead of treating it with a simple anterior capsulorraphy. The aim of this cadaver study was to demonstrate the feasibility and reproducibility of the combination of these two techniques in the treatment of severe glenoid bone loss (GBL) associated with anterior capsular insufficiency. Our hypothesis was that these two procedures could be combined arthroscopically.
|
study
| 99.94 |
The specimens were fresh-frozen and stored at a temperature of − 20 °C until experiments. The specimens were thawed at room temperature for 24 h prior to the procedure. All procedures were performed in the lateral decubitus position, with the arm at 45° of abduction. The posterior portal for the scope was created 1.0 cm lateral to the standard portal, so 1 cm medial and 5 mm inferior to the acromial edge. This portal was used to insert the posterior guide in a correct position on the glenoid, thus avoiding to do an accessory posterior portal.
|
other
| 98.9 |
Antero-superior and antero-inferior portals were created in the rotator interval, and two 8 mm cannulas were used. The gleno-humeral joint was inspected to assess the integrality of anatomic structures according to Detrisac and Johnson principles (Detrisac & Johnson, 1986). The centering of the humeral head was then checked from the antero-superior portal during full range of external rotation. The anterior capsule from the superior gleno-humeral ligament to the inferior ligament was carefully detached. We created a subtotal lesion of about 2 cm, without any possibility of reattachment to the glenoid rim. Glenoid bone loss of about 25% was created in the sub equatorial area of the glenoid using a motorized burr, and this specific percentage of defect was measured using the distance from the pathological glenoid rim and the bare area as a reference point, assuming that the bare spot of the glenoid is located at the geometric center of the inferior glenoid (Burkhart et al., 2002). After bone defect creation, the humeral head was completely dislocated.
|
clinical case
| 99.94 |
The posterior guide was inserted from the posterior portal, using the arthroscope from the anterosuperior portal. Care was taken to introduce the guide parallel to the glenoid surface and to have the bone tunnels perfectly perpendicular to the anterior glenoid neck according to Taverna et al. technique (Taverna et al., 2014). The hook was passed parallel to the glenoid face to avoid damage to the articular surface, and it was advanced over the anterior edge (Fig. 1a). The guide’s hook was placed at the center of the anterior glenoid defect (Fig. 1b). It was mandatory to align the glenoid guide with the posterior and anterior glenoid rims. Once the guide was positioned, a bullet was placed in each hole of the guide (Fig. 2). A 2.8 mm sleeved drill was placed in each bullet and advanced until it came out from the anterior aspect of the glenoid. The drills were placed 5 mm below the cortical edge of the glenoid rim, parallel to one another and 10 mm apart. The inner drill was removed leaving the cannulated outer sleeve. Once drilling was completed, the bullets were removed posteriorly. Flexible looped guidewires were introduced into the joint by passing one wire through each sleeve in a posterior to anterior direction. Each guidewire was retrieved using a loop grasper, which was passed through a cannula introduced through the rotator interval. The wires were separated and stored. The drill sleeves were removed after this step was completed. At this point, the inferior 8 mm anterior cannula was removed and was replaced by a metal cannula with a diameter of 15 mm suitable for passing the graft attached to the two buttons.Fig. 1Left shoulder, anterior on the right and posterior on the left, scope from antero-superior portal, hook guide from posterior portal. The Hook guide is parallel to the glenoid surface (a) and in the center of bone defect (b) (HH: humeral head, GL: glenoid)Fig. 2Left shoulder. The guide is positioned posteriorly on the glenoid neck and two bullets are placed in the guide’s holes
|
clinical case
| 99.9 |
In six cases, the tricortical bone graft was harvested from the clavicle because we had only the shoulder specimen. The graft was tailored, cutting off one side of it, so that the one side of the curved cortical aspect was flattened to make it cancellous and compatible with the glenoid bone defect. The graft dimensions were 20 mm × 9 mm × 9 mm. Two 2.8 mm drill holes were made 10 mm apart and 5 mm from each edge of the graft (Fig. 3). The size of the graft is mandatory because harvesting the graft with two metallic buttons increases the thickness such that a larger graft could not slide into a dedicated 15 mm cannula, and the exact position of the two holes was also important. The drill was placed through the superior cortex and exited the flattened cancellous side. The holes created corresponded to the distance of the cannulated drill sleeves previously placed in the glenoid neck. In one case, a substitute for bone graft was used. This xenograft (Osteoplant Bioteck SPA) was harvested from the proximal humeral epiphysis of the horse. The graft was completely deantigenated enzymatically, using Zimoteck. The graft can be pre-formed with the holes for the buttons, thus allowing greater precision and reduced operating times (Fig. 4).Fig. 3The tricortical clavicular graftFig. 4Left shoulder, anterior on the right and posterior on the left, scope from antero-superior portal. The preformed Xenograft (a) positioned on the glenoid anterior neck (b). (HH: humeral head, GL: glenoid, XG: Xenograft)
|
clinical case
| 99.8 |
Each looped guidewire was fed through the holes prepared in the graft, exiting on the cortical side, after ensuring that the looped guidewires were not tangled within the joint. The anterior implants were fed with the preassembled suture through the end of the looped guidewire using a classic slip-knot. This was achieved by passing the loop of the lead suture through the looped guidewire and feeding the implant through the lead suture. The graft was slid toward the end of the guidewires to lodge the implant. It was important to first retrieve the inferior suture from the antero-inferior portal, and when the whole graft was inside the joint, to retrieve the superior suture. It was important to carefully visualize the position of the graft from the posterior and superior portals. It was possible to correct the graft position by alternatively retrieving the inferior and superior wires using the superior cannula with a probe hook. Anterior round endobuttons (Smith & Nephew, London, England) were advanced until they laid flat on the bone block. The graft was tipped to allow insertion into the 15 mm cannula (Fig. 5) and advanced by pulling the guidewire out posteriorly. The suture advanced the implant until the graft was flush with the glenoid anterior neck, with each suture exiting the skin posteriorly. The graft should not be too medial nor too much lateral, so it must not overflow the articular surface (Allain et al., 1998). The guide hook is placed in the middle of the defect to be sure that the graft will be centered on the defect. The posterior implants were placed on the transporter by advancing the instrument through each eyelet of the posterior round endobutton. We then passed the sutures through the transporter and retracted the transporter to allow the suture to pass through the eyelets of the posterior round endobutton.Fig. 5Left shoulder, view from anterior, metal cannula in antero-inferior portal, arthroscopic cannula in antero-superior portal. The graft passed through the metal cannula
|
clinical case
| 99.9 |
The posterior round endobuttons were advanced using a sliding knot until they were flush with the posterior face of the glenoid. A suture tensioner device was used to secure the posterior round endobuttons. Once the implant was tensioned, we secured it with half hitches and cut suture tails (Taverna et al., 2014). After bone block procedure, graft stability was tested and humeral head stability and position were evaluated.
|
clinical case
| 99.75 |
The upper third of the subscapularis tendon - as described in the original technical paper (Maiotti & Massoni, 2013) - is usually fixed at 3 (R) or 9 (L) o’ clock positions on the glenoid neck. In this technique, the tenodesis bone holes are placed on the anterior glenoid edge in an upper position (at 10 o’clock in the left shoulders and 2 o’clock in the right shoulders) (Fig. 6) in all cases to avoid possible interference with the upper glenoid tunnel used for the fixation of the graft. A second reason is that by elevating the subscapularis, it is possible to shift the inferior capsulolabral complex up to get a better covering of the graft. The middle upper third of the subscapularis tendon was penetrated approximately 5 mm from its superior border with a suture passing device loaded with tape (Ultra Tape; Smith & Nephew) just over the graft (Fig. 7). Then, one of the free end is passed out through the upper cannula with a suture retriever and then passed again into the lower cannula (Fig. 8a-b). A punch device proved extremely useful to assess the direction and depth of the anchor bone hole. At this point, a loop was created, and both free ends of the tape were passed through the anchor’s eyelet (2.9 mm Bioraptor, Smith & Nephew); then, the anchor was pushed along the tape toward the bone hole (Fig. 8c). While the anchor was inserted into the bone, the tape sutures were kept in traction in a parallel position, and care was taken to keep the specimen’s arm in neutral rotation to avoid excessive tension on the tissue repair. It was important to control the insertion of the anchor’s eyelet and tape, thereby maintaining the correct direction before impacting. Advancement of the subscapularis tendon over the graft, effective closure of the anterior pouch and a posterior shifting of the humeral head in a correct position centered on the glenoid socket could be clearly visible and assessed by arthroscopic examination from the posterior and antero-superior portals (Fig. 9). For a good covering of the graft, capsular residue and ligaments should be able to make it almost extracapsular. After ASA procedure, graft and tenodesis stability were tested using a probe and humeral head stability and position were evaluated.Fig. 6Left shoulder, anterior on the top and posterior on the bottom, scope from posterior portal, drill from antero-superior portal. Drill hole at 10 o’clock position for the anchor (BG: bone graft, GL: glenoid)Fig. 7Left shoulder, anterior on the right and posterior on the left, scope from posterior portal, suture passing device from antero-inferior portal. The upper third of the subscapularis tendon is penetrated with a tape (HH: humeral head, SST: subscapularis tendon)Fig. 8The tape is carried out through the upper cannula with a suture retriever (a) and then passed again in the lower cannula (b). A loop was created, and both free ends of the tape were passed through the anchor’s eyelet and the anchor was pushed along the tape toward the bone hole (c)Fig. 9Left shoulder. Final view from the antero-superior portal showing the closure of the anterior pounce on the bone graft and subscapularis tenodesis (HH: humeral head, GL: glenoid, BG: bone graft, SST: subscapularis tendon)
|
clinical case
| 97.8 |
Left shoulder, anterior on the right and posterior on the left, scope from posterior portal, suture passing device from antero-inferior portal. The upper third of the subscapularis tendon is penetrated with a tape (HH: humeral head, SST: subscapularis tendon)
|
other
| 99.9 |
The tape is carried out through the upper cannula with a suture retriever (a) and then passed again in the lower cannula (b). A loop was created, and both free ends of the tape were passed through the anchor’s eyelet and the anchor was pushed along the tape toward the bone hole (c)
|
other
| 99.75 |
All seven specimens were dissected at the end of the two procedures to verify the graft stabilization anteriorly and posteriorly with the four buttons using a grasper, to assess the covering of the tendon on the graft and its position on the glenoid edge, and to identify any interference between the two glenoid tunnels and the anchor for the subscapularis tenodesis; the contact surface between the anterior part of the glenoid and the bone graft was measured using a ruler. Finally, we investigated the neurovascular structures in relation to the gleno-humeral joint.
|
study
| 99.94 |
The average time required to prepare the graft was 30 min; this time is avoided in the case in which we used the preformed xenograft. The average time to perform the ASA-BB procedure on the specimens was 112 min (80–150 min); the shorter time was obtained using the xenograft. The management of the sutures and buttons through the graft and glenoid tunnel was not difficult. In one case, it was necessary to flush out the graft at the glenoid level using a motorized burr. We have had no complications or fractures in any cases.
|
clinical case
| 99.25 |
No interferences were noticed between portals and the cephalic vein anteriorly. The center of the graft was located in a subequatorial position. The contact surface between the anterior part of the glenoid and the bone graft was 80% of the surface area of the bone block in the first 2 cases and 90% in the other 4 cases. No evidence was found of soft tissue interposition between the bone graft and the glenoid. All the grafts were positioned 1 mm more medial with respect to the articular surface. No interference was found between graft tunneling and the anchor side for the subscapularis tenodesis. There was a good covering of the graft by the tendon and a good position of its fixation on the glenoid neck. At the end of bone block procedure the shoulder was not easily dislocable as before the procedure in presence of a glenoid bone defect of about 25%. After ASA procedure the humeral head resulted recentered and shifted posteriorly under arthroscopic view. There was no vascular damage to the anterior and posterior vessels. No interference with the axillary nerve anteriorly and the suprascapular nerve posteriorly was noted. The axillary nerve was located 35 mm to 55 mm (average 40.3 mm) from the inferior gleno-humeral portal. The suprascapular nerve was located 8 mm to 15 mm (average 11 mm) from the two glenoid holes (Fig. 10). The musculocutaneous nerve was located 33 mm to 50 mm (average 38 mm) from the insertion of the coraco-biceps tendon (Fig. 11).Fig. 10Posterior side of the scapular neck: absence of interference of the upper graft fixation button with suprascapular nerve (arrow)Fig. 11Anterior aspect of muscolo-cutaneus nerve (arrow) showing the distance from the antero-inferior portal enlarged from seven mm to fiftheen (CP: coracoid process)
|
clinical case
| 99.94 |
This paper demonstrates the feasibility and reproducibility of the first all arthroscopic procedure to combining a glenoid bone graft augmentation according to Taverna (Taverna et al., 2014) and a partial subscapularis tenodesis according to Maiotti (Maiotti & Massoni, 2013) to treat recurrent complex anterior instability associated with glenoid bone loss of about 25% and capsular inconsistency. The optimal treatment of this pathology, especially if associated with a glenoid bone defect, has not yet been entirely established (Symeonides, 1989; An et al., 2016; Kempf et al., 1999; Morrey & Janes, 1976; Rowe et al., 1978; Wymenga & Morshuis, 1988). The open trans-glenoid Bankart reinsertion was considered for years the “gold standard” for treating recurrent instability and has given excellent results, with a recurrence rate of 1%. However, broad use of this technique, arthroscopically assisted using anchors and popularized as the Bankart repair, remains more controversial because of the relatively high number of recurrences of 20% to 64%, especially if associated with glenoid bone defects (Alkaduhimi et al., 2016; Burkhart & De Beer, 2000; Cole & Warner, 2000; Field et al., 1999; Morrey & Janes, 1976; Bankart, 1938). This clinical survey was supported by the biomechanical and clinical retrospective studies (Arciero et al., 2015; Longo et al., 2014).
|
review
| 99.75 |
In the current and previous decade, the literature has focused on the debate concerning the open and arthroscopic Latarjet procedure, and has supported this intervention to solve three main problems: glenoid bone loss, an engaging Hill-Sachs lesion and capsular insufficiency. The results for this procedure of recurrences at medium- and long-term follow up were between 0 and 5% (Alvi et al., 2016; Degen et al., 2016; Kleiner et al., 2016; Lafosse et al., 2007; An et al., 2016; Cassagnaud et al., 2003; Matton et al., 1992; Russo et al., 1990; Russo et al., 1998; Torg et al., 1987; Di Giacomo et al., 2011; Kany et al., 2016; Ramhamadany & Modi, 2016). This technique can be considered a non-anatomical procedure and is not without risks. Furthermore, results regarding the percentage of coracoid bone graft healing and the incidence of secondary gleno-humeral osteoarthritis seem to be less favorable. In particular, increased use of the arthroscopic Latarjet technique would increase peri-operative and post-operative complications to between 20% and 40% (Griesser et al., 2013). That is why other solutions are being considered to overcome the inherent technical difficulties in transferring the coracoid graft onto the glenoid (Matton et al., 1992; Di Giacomo et al., 2011; Athwal et al., 2016; Gartsman et al., 2017; Guity et al., 2002; Randelli et al., 2016; Young & Rockwood, 1991). A novel, all-arthroscopic technique using three cortical free bone grafts has been described using 4 buttons to stabilize the graft from back to front to avoid complications related to anterior screw fixation and anatomical modification of the coracoacromial arch (Taverna et al., 2008; Taverna et al., 2014). For our study, we chose the percentage of 25% because this is the glenoid defect size for which in literature it is well known that shoulder has to be treated with a bone block procedure because the standard anterior capsulorrhaphy is not indicated (Burkhart & De Beer, 2000; Provencher et al., 2010).
|
study
| 99.9 |
With this new technique, after the stabilization of the anterior glenoid graft, a Bankart repair is mandatory to center the head on the glenoid fossa. In cases of recurrent instability, the percentage of anterior capsule inconsistency can be very high, and this problem can create conditions not conducive to obtaining a good result. In 2013, it was proposed to treat recurrent instability with a moderate bone glenoid defect and capsular deficiency with a Bankart repair associated with an ASA technique (Maiotti & Massoni, 2013). In 2016, the first short term follow up series reported very good clinical results with recurrences of 2.5% without impairment of external rotation (Maiotti et al., 2016). The good biomechanical effect of the upper subscapularis tenodesis (Klungsøyr et al., 2015), as an anterior barrier in recentering the humeral head and a good sliding effect of the tendon with the arm in abduction, was demonstrated in a biomechanical study on specimens (Schröter et al., 2016). In a publication of a multicenter study, the reproducibility of this combination of treatments using the Bankart repair and the ASA technique was confirmed showing good results relative to failures and external rotation (Maiotti et al., 2017). Our aim was to demonstrate that the association of a free bone block using four buttons and the ASA technique to treat complex recurrent instability with glenoid bone loss and capsular insufficiency could be feasible and reproducible. We focused on glenoid defect in order to have less variables, without considering humeral head defects also because it is difficult to verify the position and the shape of the Hill Sachs lesion arthroscopically. We observed arthroscopically at the end of the procedure that the humeral head was recentered, even if an inferior gleno-humeral ligament reconstruction was not done. The association of both procedures can be easily performed after an adequate training by surgeons having a good skills level for arthroscopic shoulder surgery. No anatomical interference was observed between the two tunnels for the bone block stabilization and the subscapularis tenodesis hole anchor. In our opinion, the stabilization of the bone graft with four buttons can certainly be considered an improvement over the use of screws, and the procedure avoids the risk of mechanical contact with the humeral head and a non-orthogonal pressure on the fixation strength of the graft on the glenoid bone defect while in this procedure graft compression is perpendicular and not oblique allowing a better healing. We could verify in all specimens the high stability of the graft on the glenoid without any micro-motion. In all procedures, the partial subscapularis tenodesis allows the recentering of the head, pushing it posteriorly and acting in a way opposite to that of the Remplissage technique, creating a lift up effect on the inferior capsule. The procedure achieved closure of the axillary pouch and increased the contact between the graft, the subscapularis muscle and the residual capsule. We noticed no complications to the main vessels and nerves around the joint anteriorly and posteriorly using the four portals and the dedicated new instrumentation. In particular, the distance between the mid-glenoid portals of the 15 mm cannula can be considered not a risk for axillary nerve injury because it is 40 mm superior to the nerve. On the back side, the superior button for graft stabilization is less than 1 cm from the suprascapular nerve and can thus be used with relative safety, even though it might be at a relative risk. In conclusion, this new proposal of an all arthroscopic bone grafting procedure with concomitant soft tissue reconstruction using the upper part of the subscapularis tendon on specimens showed good stabilization of the shoulder in patients with combined glenoid defect of about 25% and capsular insufficiency. This procedure can be considered safe with respect to the risk of nerve damage, in the same manner as a simple Bankart repair anteriorly and posteriorly. Furthermore, we think that this new technique could be a feasible and reproducible alternative to the arthroscopic or open Latarjet procedures for patients with bone defect associated to capsular insufficiency practicing contact sports. In fact the effect of tenodesis could be comparable to that of the conjoint tendon in Latarjet procedure. Moreover this procedure is a low-risk technique, that can be performed using only three portals and not five as for the arthroscopic Latarjet; graft compression is perpendicular and not oblique allowing a better healing; the present technique is more anatomic, not modifying the coraco-acromial arch. Finally, the use of a preformed graft consistently reduced the surgical time.
|
study
| 99.94 |
Given that this combined arthroscopic technique (bone block associated with ASA) is safe and easily reproducible, it is our intent to conduct a clinical study. It is essential that this technique should be evaluated clinically before its application on a large scale.
|
other
| 99.9 |
This study has several limitations. The number of specimens treated is very small, and both techniques were applied to the shoulders using specimens non-homogeneous by age, sex and non-comparable glenoid bone defects; no study for measuring the glenoid version of the specimen was done. New biomechanically detailed studies should be carried out, examining, for example, modification of external rotation, the friction between the subscapularis tendon and the graft, the humeral head position relative to the glenoid rotational center after the removal of the capsulolabral complex and after the creation of a GBL of about 25%. This would allow the evaluation of the recentering effect of the subscapularis tenodesis alone or in association with the bone block in different arm positions, from 0° to 60° of elevation. Moreover, all anatomical structures should be subjected to cycles of movement to test the biomechanics of the head in this new anatomical position, considering also the strength of the fixation systems for both bone and tendon. Last but not least, knowledge is very limited on the healing of the free bone block using the button system and on the healing of the subscapularis tendon on the glenoid rim.
|
study
| 99.94 |
This is the first cadaver study to test the feasibility and safety of this new all-arthroscopic combined technique with bone block and ASA for treating gleno-humeral instability with glenoid bone loss of about 25% and anterior capsule-labral deficiency. Further studies have to be performed to assess the stable fixation of the bone graft, the re-centring of the humeral head and the restoration of shoulder stability and function.
|
study
| 99.94 |
Open science involves making scientific knowledge (in the form of papers, data, research tools, and other outputs) openly and practically available in order to accelerate discovery, innovation and clinical translation (Gold, 2016; Global Alliance for Genomics and Health, 2016; Fecher and Friesike, 2014). In a world first for an academic research institution, in 2016 the Montreal Neurological Institute and Hospital (the MNI) adopted a broad open science policy across all of its research activities. The MNI committed to make publicly available all positive and negative data by the date of first publication, to open its biobank to registered researchers and, perhaps most significantly, to withdraw its support of patenting on any direct research outputs (Figure 1; Poupon et al., 2017; Owens, 2016a; Rouleau, 2017). The span of this openness raises unique hopes and concerns for stakeholders, and also offers an important opportunity to examine and understand the potential benefits and costs of open science.
|
other
| 99.9 |
These principles cover five areas: the public release of data and other scientific resources; external research partnerships; the MNI Biobank; researcher and patient autonomy; and intellectual property. The authors developed draft Guiding Principles based on the results of this study. This draft was then presented to the MNI staff, management and researchers, who reviewed and amended the draft during two rounds of discussion and feedback. These Guiding Principles were adopted by the MNI in December 2016.
|
other
| 99.9 |
Despite the benefits offered by open science, it has proven difficult to implement its ideals (Edwards, 2016; Nelson, 2009; Open Research Data Task Force, 2017). Recent evidence suggests that providing incentives for individual researchers to participate is the key rate-limiting step (Kidwell et al., 2016; Longo and Drazen, 2016; Fecher et al., 2015). This has stimulated many to think more deeply about how cultural factors, policies and metrics may affect the uptake of open practices by researchers (European Commission, 2017; Wilsdon, 2015; Harley, 2013; Neylon, 2017). This study builds on this work by providing insight into the perspectives of researchers in the lead up to the adoption of an open science policy within their institution. We conducted semi-structured interviews with 25 researchers, staff and partners, approximately one-third of the MNI's constituency, to identify their attitudes toward open science, the incentives they felt necessary to engage in open science, disincentives, the role of patients, and the eschewal of intellectual property rights. We then applied qualitative thematic content analysis to these data to identify key topics for discussion and to derive the framework for the MNI’s Open Science Policy (Figure 1).
|
study
| 99.94 |
Our analysis yielded a number of key themes which we summarize below. Please see Ali-Khan et al. (2015) for the full research report, and MNI, 2017 for the latest information about the initiative. In this manuscript, we sometimes use proportions or numbers to quantify the number of interviewees who expressed a particular opinion: please see 'Materials and methods: Reporting' below for further details and a caveat.
|
other
| 99.4 |
Our analysis revealed that MNI researchers were generally favorable toward the notion of open science, reporting that they already engage in significant sharing. Nevertheless, almost half our interviewees noted that the concept is vague (Fecher and Friesike, 2014; Grubb and Easterbrook, 2011; OECD, 2015) and expressed uncertainty about what precisely open science would require of them (Open Research Data Task Force, 2017; Neylon, 2017; Ferguson, 2014). Based on our data, this uncertainty can discourage participation in two ways. First, the absence of clearly articulated definitions raised fears that open science practice may extend beyond comfort levels. Conversely, those who desired greater openness were cautious about taking part lest the lack of clarity prevent meaningful change.
|
other
| 98.1 |
In the context of the MNI’s initiative, just over half of researchers stated that an institution-level open science policy could only be successful if it was developed in close collaboration with researchers, rather than simply imposed in a top-down fashion by management. Researchers were concerned that a broad one-size-fits-all directive may have adverse effects on their scientific priority and curtail their academic freedom by denying them, for example, the right to choose where to publish (Levin et al., 2016), to patent findings (Murray, 2010), to publish first and to control access to research outputs (Fecher et al., 2015).
|
other
| 99.9 |
A further dominant opinion, explicitly mentioned by over a quarter of interviewees, was that open science should not be implemented for ‘its own sake’. Instead, policy should reflect the values and needs of key stakeholders. Misgivings about open science were always tied to perceived negative effects on their careers, on their relationships with the patients who participate in research projects, or on their collaborations with industry.
|
other
| 99.94 |
More than three quarters of interviewees reported that they already share data and research tools on request after publication as a standard practice, and that they share with established collaborators before publication. However, outside of the bioinformatics and imaging area, few engaged in large-scale public sharing. Willingness to share varied depending on the data type and the resources involved in their development. Unsurprisingly, interviewees noted that digital data is more shareable. Most said that patients’ clinical and genomic data should be widely shared, subject to consent and ethics protections (Kaye, 2012), due to the limited intellectual contribution made by the researcher who collected the data. Four researchers felt that these data belonged to patients and thus should not be hoarded. On the other hand, two interviewees said it would be unfair to force early sharing of data and materials yielded through resource-intensive processes, such as iPS cell lines, or rare and depletable biosamples. Overall, there was wide agreement among interviewees that it is appropriate to wait until after publication to share experimental data beyond established collaborators. This was true even in the case of bioinformatics and imaging researchers, whom we expected to be the most comfortable with open pre-publication sharing.
|
review
| 99.75 |
Approximately three quarters of our interviewees articulated ethical motivations for more rapid, open sharing of data and scientific resources. These include the belief that publicly-funded research outputs ought to be released with minimal delay and that consistent with patients’ wishes, researchers have a duty to ensure that samples are broadly shared to maximize research and discovery. Likewise, many alluded to the negative impact of data ‘bottlenecking’ before publication, and the increased efficiency that would result from earlier and greater access to research outputs (Fecher et al., 2015).
|
other
| 99.7 |
Career advancement was an even more prevalent motivation. All but one interviewee mentioned the potential for open science to bolster their professional standing. Many said that requests for reagents, data or other tools led to diverse and unanticipated collaborations, expanding their interests, visibility and professional impact. Others noted that sharing has a positive impact on publication productivity and citations (Piwowar and Vision, 2013). While many who currently share stated that this is good academic practice, interviewees said they did so anticipating reciprocal behavior (Edwards, 2016).
|
other
| 99.9 |
Related to this, almost all interviewees raised a fundamental concern: that open science may put them at a professional disadvantage if they were compelled to release data and other resources before they have extracted value from their work (Fecher et al., 2015; Harley, 2010; Levin et al., 2016; LERU Research Data Working Group, 2013). Over three-quarters said that they would like to share more broadly and earlier in the research process, but they feared being 'scooped' and/or compromising the possibility of publishing in a high-impact journal. Further, a few were concerned that the MNI would go too far ‘out on a limb’ by adopting open science before other institutions in Montreal, Canada and beyond followed suit. In this case, others might benefit from MNI resources without reciprocating.
|
other
| 99.9 |
Most interviewees stated a preference to fully understand and publish before publicly releasing a dataset or reagent. Further, approximately half of researchers mentioned that it is socially irresponsible to release data before it is fully validated and its quality is assured, as this could waste others’ time and promote erroneous conclusions. Several noted the potential for shared data to be used in research or for applications with which they do not agree (Wouters and Haak, 2017). They worried that their or the MNI’s reputation might be compromised by such associations. Thus, while nearly all interviewees said the culture of science is shifting toward greater openness, more than half cautioned that the MNI should advance with care.
|
other
| 99.9 |
Almost every interviewee emphasized the highly competitive nature of biomedical research (Harley, 2010), and the central importance of maintaining strong academic metrics. A third of interviewees underlined that ensuring proper attribution and returns for sharing would motivate their participation in open science practice (Wouters and Haak, 2017). They noted that this could include citation, acknowledgement and in some cases co-authorship for use of shared data, as well as the development of new metrics to measure sharing contributions (so that they could be included in funding and academic advancement decisions).
|
other
| 99.9 |
All but one interviewee stressed that openness is time- and resource-intensive, including for example, the need for payment of open access publication fees, and for the preparation, formatting and handling of data and other research outputs for sharing (Levin et al., 2016; LERU Research Data Working Group, 2013). More broadly, researchers spoke of the costs inherent in the set-up and management of sharing infrastructure, including cyber and biobanking frameworks. Thus, interviewees emphasized that institutional support will be critical to support open science practice amongst researchers (Das et al., 2016; Poupon et al., 2017).
|
other
| 99.9 |
The majority of interviewees underlined public and patient benefit as the preeminent goal of open science at the MNI (Rouleau, 2017). The institution’s dual research and clinical functions offer the potential for ongoing data collection from consented patients across multiple research modalities. Opening this platform to outside researchers promises a powerful collaborative discovery resource, but raises familiar concerns about the protection of patients and research participants (Kaye, 2012).
|
other
| 99.9 |
The setting in which patients would be engaged about open science research and the nature of informed consent mechanisms were key points of disagreement. Some interviewees favored engagement solely by treating physicians, while other advocated for a centralized location with dedicated staff. Likewise, some supported broad consent to maximize the future use of samples and data, while others said tiered or dynamic consent (Kaye, 2012) would ensure that the preferences of research participant were properly addressed. However, almost every interviewee emphasized the primacy of safeguarding both patient confidentiality and the autonomy to decline participation without prejudice.
|
other
| 99.9 |
A few researchers said that patients may be concerned about the potential for their data or samples to be shared with as-yet unknown researchers. However, most thought that patients would be strong advocates for open science, given the framework’s promise for advancing new understanding and treatments. Some further suggested that open science would increase patient and public trust (Royal Society, 2012; Grand et al., 2012) given its emphasis on minimizing intellectual property, increasing transparency and channeling benefits to patients, rather than to industry. They noted this could increase the stature of the MNI in attracting high-quality researchers and trainees, greater patient participation in research and augmented private donation. Finally, several interviewees pointed to the potential for open science to allow patients to become more equal and informed research partners due to greater transparency through the research process. Improvement of researcher-participant relationships could enable more patient-responsive studies, enhancing patient satisfaction and research outcomes.
|
review
| 99.75 |
Many interviewees emphasized the key role of the institutional Research Ethics Board (REB) in facilitating their open science practice. One third of interviewees suggested that the REB is sometimes overly stringent and acts as a barrier to efficient sharing of their own research data, or to making use of patient data shared through open web repositories. Conversely, just under two thirds of interviewees said that the REB is evolving in step with open approaches to science, for example partnering with researchers to develop detailed governance mechanisms and patient consent protocols to allow broad sharing (Das et al., 2016; Poupon et al., 2017). Some interviewees underlined that harmonizing ethical requirements across Canada and internationally is a key priority to realize the promise of global open science. One way that harmonization could accelerate open science would be the introduction of standard click-wrap agreements that are signed when patient-derived data are downloaded, thus avoiding the need use traditional (and cumbersome) side agreements that are signed (and sometimes notarized) by central administrators (NKI-RS, 2017).
|
other
| 99.2 |
Forgoing intellectual property, particularly patents, within the context of the MNI’s research activities is unprecedented for a major academic research institution (Stilgoe, 2016). Thus, unsurprisingly, the topic of intellectual property polarized opinion. Many of the basic science researchers we interviewed felt that pursuing patents is inefficient, noting that patenting is rarely worth its costs from either a commercial or translational standpoint. Conversely, many clinical-translational researchers said that the freedom to pursue intellectual property is an important aspect of their academic freedom and professional impact. Several underlined the importance of patents in facilitating partnerships with industry stakeholders (Murray and Stern, 2006). Only five of this latter group mentioned personal material benefit as a motivation. Further, some conceded that patents are often pursued too early in the research process, which may slow scientific progress. However, despite many of the interviewees not being interested in holding intellectual property themselves, there was a widespread belief that patents or other modes of legal protection are essential to ensure the translation of research later in the process.
|
other
| 99.7 |
A key area of resistance to open science concerned relationships with industry. These partnerships can bring researchers valuable professional opportunities and offer important avenues for translation and patient benefit. Some interviewees worried that mandated data sharing may deter industry from sponsoring clinical trials. Indeed, the MNI has said it will not impose a specific timeline for release of trial data by sponsors (Poupon et al., 2017). However, researchers note that all patient-participant data will be captured within the MNI Open Science Clinical Biological Imaging and Genetic (C-BIG) biobank: this means that when information on a therapeutic molecule is disclosed by collaborators, this information can be easily integrated with the corresponding patient data. Further, some interviewees said that making data and biosamples openly accessible might reduce the attractiveness of MNI researchers to potential collaborators, who may want to operate under a more closed model. However, the public launch of open science at the MNI seems to have stoked interest of companies in a range of sectors including pharmaceuticals, imaging, deep learning, big data and information technology (Poupon et al., 2017). The initiative has also impelled major gifts from private donors (Stilgoe, 2016).
|
review
| 98.5 |
Interviewees reported that the absence of intellectual property rights by the MNI over discoveries derived from C-BIG biobank materials or data is a key draw for partners. Nevertheless, there are dissenters. Some interviewees and some of the MNI’s potential industry collaborators stated that they will proceed with care, ‘testing the waters’ as they engage in open practices. Others, however, including the multinational biotechnology company Thermo Fisher Scientific, have rapidly secured open-science-based partnerships with the MNI, noting a shared objective in improving the accountability and efficiency of research. Thermo Fisher stated that the MNI’s open science policy will greatly accelerate the development and commercialization of more relevant reagents, while allowing the sharing of the experimental data with the research community. However, they underlined that maximizing the benefits of open science depends on broad community adoption.
|
other
| 99.9 |
One key problem highlighted by industry interviewees and MNI management is the legal implications of sharing materials that may be encumbered by existing intellectual property rights on tools that have been used in their creation (Rouleau, 2017). This real, but not insurmountable hurdle, has already slowed negotiations with Thermo Fisher. As Guy Rouleau, director of the MNI, said: “The irony is that this is a perfect example of what open science at the MNI seeks to avoid: intellectual property rights over scientific tools that chill research progress, with high social, economic and opportunity costs.”
|
other
| 99.9 |
To date, open science has largely depended on bottom-up forces to drive adoption as funders, publishers and governments have often been reluctant to enforce open science norms (Open Research Data Task Force, 2017; Royal Society, 2012). Our analysis reinforces the point that researchers’ sharing behavior is primarily motivated by rational self-interest rather than pure altruism (Fecher et al., 2015; Levin et al., 2016; Haeussler, 2011). Widespread uptake in competitive research environments requires that open science is not only theoretically attractive but that it is beneficial to stakeholder communities. Our analysis revealed key concerns arising from uncertainty about what open science will require of researchers, and the risks open science may pose for professional competitiveness and for relationships with important research partners. To realize the promise of open science for discovery, innovation, research impact and reproducibility, an open science policy must clearly lay out expectations, boundaries and mechanisms for participation, and must be shaped to explicitly support researchers’ values and those of other key stakeholders.
|
other
| 99.9 |
Recent work points to the pivotal role of institutions in influencing open science practice in their constituencies (Fecher et al., 2015; LERU Research Data Working Group, 2013; Huang et al., 2012). In this context, the MNI is an interesting case study because it is the first organization to introduce an institution-wide open-science platform (Rouleau, 2017) and because certain characteristics of biomedical research (it is highly competitive, it involves human subjects and the commercial returns can be very high) make it a challenging field for openness (Tenopir et al., 2011; Haeussler, 2011; Walsh et al., 2007). Our study underlines several relevant points.
|
other
| 93.44 |
First, our analysis emphasized the importance of fostering buy-in and trust by developing the MNI open science policy from the ground-up through researcher engagement. Others have also underlined the benefits of this approach (Open Research Data Task Force, 2017). This current research, which informed the MNI’s framework, represents part of that process. Over the next five years, studies engaging the range of important stakeholders including researchers, patients, philanthropy, governments, research participants and industry partners will contribute to further refining MNI policy (Gold, 2016). It has been reported that social milieu can help overcome the reluctance to share (Haeussler, 2011). The MNI’s policy, sanctioned by all MNI researchers (Poupon et al., 2017), may enhance participation compared with situations in which researchers act without specific institutional policy, support or advocacy on their behalf. Moreover, given the emphasis on open science within the MNI, participation may raise researchers’ social capital, further encouraging a willingness to share (Haeussler, 2011). Increasing adoption of open science practices may place greater pressure on competitors to adopt the same normative practices, as this affects their status in the community (Westphal et al., 1997). Thus, MNI policy may begin to shift norms not only within the institute, but across the broader community (Fauchart and von Hippel, 2008). We will examine these hypotheses in future work.
|
other
| 84.06 |
Second, our study reiterated the importance of clear policies over ownership and control of scientific outputs. For example, researchers want to benefit from their work before broad release (Fecher et al., 2015; Wouters and Haak, 2017). Allowing researchers to exercise reasonable choice over when and how they share, and providing the leeway to adapt practice to different research contexts, may reinforce their trust in open science and promote participation. Consistent with this notion, the MNI policy calls for data release before or on the date of first publication and underlines the principle of autonomy (Figure 1). Notably, while other studies underline researchers’ belief in ownership over data they produced (Fecher et al., 2015; Wouters and Haak, 2017), some of our interviewees suggested that publicly-funded research data and biosamples belong to the public or to patients, rather than the researchers themselves. This perspective may derive from interviewees’ proximity to patients and the needs that open neuroscience seeks to address, or it may be related to the local culture at the MNI (Rouleau, 2017), the local socio-political context or to individual personality differences.
|
other
| 94.3 |
Third, our study, underlined the need for institutional support to encourage open science practice. The MNI is addressing researcher concerns through substantial institutional investment. The development of specialized patient consent and other REB processes, cyber and biobank infrastructure, support staff and streamlined workflow promote clear and efficient sharing (Das et al., 2016; Poupon et al., 2017). These platforms aim to support researcher trust by enabling the discretion to choose when and what to publically share and by protecting researchers’ and partners’ interests within a secure sharing environment. Likewise, the MNI recently partnered with F1000 to launch an open research platform (https://mniopenresearch.org) to allow rapid sharing of articles, data and other outputs. The MNI also offers a stipend to support the use of the platform and for open access publication in journals of the researcher’s choice. These resources are designed to reduce barriers to participation, acting as carrots rather than sticks to encourage open science practices (Ferriera, 2008; Leonelli et al., 2015). Tracking the impact of explicit institutional policy and resources compared to their absence will yield important information on the conditions needed to enhance open practices.
|
other
| 99.7 |
Fourth, our analysis corroborates the need to ensure professional returns to promote open science Fecher et al., 2015; LERU Research Data Working Group, 2013). Developing relevant and effective performance indicators and incorporating them in career advancement and funding processes was highlighted in our study and others (Peekhaus and Proferes, 2016; Borgman, 2015; European Commission, 2017; Wilsdon, 2015; Harley, 2013). A report on research data in the UK recently noted that professional incentives for researchers to share remain weak at best (Open Research Data Task Force, 2017). In the context of open access publication, several studies note that current entrenched academic reward structures can stymie new modes of research and communication (Peekhaus and Proferes, 2016; Eger et al., 2015; Xia, 2010; Bjork, 2004). Advocacy, partnership-building and policy-alignment within and across institutions wishing to encourage openness (including governments, funders, journals and publishers) will be important to evolve reward structures that match policy goals and instigate the desired cultural shift (Leonelli et al., 2015; Neylon and Wu, 2009; Munafò et al., 2017).
|
other
| 97.0 |
Fifth, the role of intellectual property was contentious in our interviews, as has been previously noted (Ferguson, 2014). Recent decades have seen a decided policy focus in North America and beyond on encouraging academics to patent with the goal of augmenting translation and university funding (Nicol, 2008). However, there is little consistent evidence to support this model’s effectiveness (Kenney and Patton, 2009; Williams, 2017). Open science at the institutional level offers the potential for faster dissemination of academic outputs, greater leverage of research investments, and an emphasis on universities as hubs for knowledge generation and dissemination (Nicol, 2008). At the same time, open science is expected to promote the local innovation ecosystem by spreading socio-economic impact (Gold, 2016). Thus, the seeming conflict between commercialization and open science agendas may be more apparent than real. Exploration at the interface of these two streams is needed to clarify how they may cross-pollinate to maximize equity, justice and efficiency in exacting research benefits.
|
other
| 99.8 |
Our study reiterates previously reported researcher concerns toward the adoption of open science practices, and uncovers fresh nuance. In particular, the institutional setting, the broad scope of research undertaken at the MNI and the proximity of patient and industry partners provide a new context to explore these issues. Here, we provide baseline findings that will be important to follow. Ultimately, our analysis underlines that open science should not impose extra burdens on researchers. Rather, policy must make sharing simple and should be structured to enhance researcher competitiveness, research programs and partnerships with patients and industry. Over the next five years, we will monitor the impact of the MNI’s open science policy through the collection of scientific, innovation, economic, social, and stakeholder metrics that will be made publicly available (Gold, 2016). As quantitative and qualitative data accrue through this large-scale experiment, these data will be fed-back to fine-tune best practices at the MNI. At present, many actors may be cautious, yet as the initiative reaches critical mass, it may begin to generate clear evidence of benefits, shift community norms and expectations, and encourage participation. The proof of this open science pudding will be in the eating.
|
other
| 99.9 |
This study uses qualitative research methods: in-depth semi-structured interviews, followed by thematic content analysis. This methodology is best suited to in-depth exploration of the experiences and perceptions of research participants, and the meanings they attach to these (Braun and Clarke, 2006; Patton, 2002). As such, it is well-aligned with the needs of case studies undertaken to inform policy, as was the current research (Ritchie and Spencer, 2002). We report these methods according to Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines (Tong et al., 2007).
|
study
| 99.9 |
Due to the small community of relevant research participants, we used a purposive and snowball sample strategy to select invitees. The interviews were conducted in two phases. The first focused on MNI researchers and staff over Summer 2015. We conducted a second phase of interviews in Fall 2016, to address knowledge gaps concerning the viewpoints of researchers’ industry collaborators, and to update perspectives subsequent to launch of the open science initiative (Owens, 2016b). Thus, we re-interviewed three researchers and one whom we had not previously engaged, who all interact with industry partners. We also interviewed one industry collaborator, one industry veteran and one not-for-profit collaborator, and obtained a public statement from Thermo Fisher Scientific on its partnership with the MNI.
|
other
| 74.8 |
To begin the first phase of interviews, the MNI management provided a list of research areas and principal investigators that we independently used to selectively invite participants via email. During interviews we asked for suggestions for others who may provide insight, whom we subsequently invited. In the second phase we re-contacted select participants.
|
other
| 99.75 |
One of us (SEA) with LH and/or a colleague (Kendra Levasseur; KL) conducted the interviews. None of these researchers was known to any of the participants prior to receiving the study invitation. ERG, who did not participate in the interviews, may have been known to some, as all are employed at the same institution. We conducted all interviews with MNI researchers face-to-face at locations of the interviewees’ choosing, namely their offices or labs, in June through September 2015. Before beginning interviews, we described our credentials, professional positions, the study context, confidentiality and privacy considerations, and noted the independent, academic nature of our research. All interviews with industry or non-profit collaborators were conducted over the phone.
|
study
| 99.9 |
All but one interview was digitally recorded and transcribed verbatim by LH, KL or other research assistants. One participant declined recording, so manual notes were taken. Interviews lasted between 30 and 90 minutes. We developed the interview guide based on our review of the open science literature and knowledge of the MNI’s research focus (see http://paceomics.org/index.php/interview-guide/), incorporating the feedback of the MNI management on a first draft. The interview process was iterative, feeding forward key issues raised by interviewees to maximize the informativenes of our research.
|
study
| 51.3 |
To start each interview, we collected demographic information to facilitate comparative analysis across interviews. We then asked open-ended, semi-structured questions to explore individual experience and knowledge. In qualitative research, the dataset is considered complete when a point of theoretical saturation is achieved—meaning no new major ideas, information or themes are emerging from interviews (Morse, 1995). Participant recruitment continued until we reached this point, and with consideration for achieving balanced representation across gender and research area. In total, we conducted 21 interviews with MNI researchers and staff in the first phase. In the second we interviewed four MNI researchers, and three external participants as described in ‘Study sample’, resulting in 25 interviewees in total.
|
study
| 100.0 |
We analyzed these data using thematic content analysis methods (Braun and Clarke, 2006; Ritchie and Spencer, 2002) This process consists of seven iterative stages: (i) familiarization; (ii) generation of an initial coding framework and application of these codes to the dataset; (iii) searching for and verification of themes across the entire dataset; (iv) identification of relationships and distinct differences between codes/subgroups of ideas; (v) definition and naming of themes; (vi) re-reading of the interviews and modifying codes based on emerging themes; and finally (vii) mapping and interpretation of the overall narrative identified from the data. We used NVivo 10 software to organize and manage our analysis (QSR International, 2016). This software enables tracking of the research process, thereby facilitating auditability and reproducibility, and thus the credibility of the work.
|
study
| 99.94 |
During the thematic analysis process we developed several analytic categories. These capture what we defined as 1) 'substantive’; 2)’ auxiliary’; and 3)’ key’ data or issues. ‘Substantive’ categories captured interviewees’ opinions, concerns, ideas and motivations regarding open science. Those categorized as ‘auxiliary’ captured contextual information that we used to further our understanding of the ‘substantive categories’, such as the types of resources or stakeholders the interviewees mentioned as relevant. For example, where a researcher expressed concern about sharing iPS cells because of the large investment required to generate them, the text would be coded into a substantive category (“disincentives to sharing or open science – researcher time and money invested in resource creation”) and an auxiliary category (“types of resources – iPS cells and other cell lines”) to give contextual information. ‘Key categories’ represent the subset of interviewees’ opinions, concerns and motivations that we determined are the most relevant to the development of an open science policy at the MNI. Often, this material represents the most significant sources of disagreement or tension about the proposed shift to open science, and material that was the most emphasized by interviewees. See the full coding framework in the supplementary materials.
|
other
| 58.53 |
To support the validity of our analysis three coders (SEA, KL and LH) worked together to develop the initial coding framework and ensure it was consistently applied across interview transcripts. This coding framework was informed by our knowledge of the literature and the focus of our research questions (a top-down or deductive approach), in addition to new ideas that we identified inductively from the ‘grounded’ data (a bottom-up approach; Patton, 2002; Ritchie and Spencer, 2002). LH and KL then divided the interviews amongst them to code individually. SEA, KL and LH met regularly throughout the research process to compare and discuss data interpretation and modify the framework. The entire research team met on a weekly basis to discuss emerging findings (SEA, LH, KL and ERG).
|
study
| 99.94 |
KL and LH also undertook a formal inter-coder reliability analysis using NVivo 10 software (QSR International, 2016), by both coding the same interview and measuring agreement between the two copies. Most inter-coder percentage agreement at each category varied from 80 to 100%, revealing only minimal disagreement between coders. Categories at which agreement was lower were among the ‘auxiliary’ group. When we inspected discrepancies, we observed that this was due to minor differences in the length of the text coders had selected for auxiliary categories, with minimal implications for our analyses. Finally, we triangulated data across interviews and available policy, academic and web resources, further seeking to ensure the accuracy of our findings.
|
study
| 99.94 |
Our analysis yielded ten major themes of discussion, which we report here as nine themes after combining the intellectual property and collaboration themes to improve the flow of the text (see Ali-Khan et al., 2015 for the full report). We note that in this manuscript we may indicate the proportion or number of our interviewees who held the described opinions. Two limitations to this approach should be considered. First, our sample, while broadly representative of the units, demographics and responsibilities at the MNI, is not random. Further, we note that in the course of semi-structured interviews, respondents will answer according to their specific interests and knowledge (Patton, 2002; Ritchie and Spencer, 2002). Therefore, the content of individual interviews is not always directly comparable. Subject to this caution, we believe that the inclusion of proportions enhances the informativeness of our findings (Maxwell, 2010). Finally, we note that we took a reflexive standpoint on our data, critically considering them within the broader context of the academic and policy literature and our professional knowledge and experience in this domain.
|
study
| 99.94 |
In the interests of transparency, eLife includes the editorial decision letter and accompanying author responses. A lightly edited version of the letter sent to the authors after peer review is shown, indicating the most substantive concerns; minor comments are not usually included.
|
other
| 99.94 |
Thank you for submitting your article "Motivating Participation in Open Science by Examining Researcher Incentives" to eLife for consideration as a Feature Article. Your article has been reviewed by three peer reviewers, and the evaluation has been overseen by the eLife Features Editor (Peter Rodgers).
|
other
| 99.94 |
This is a valuable contribution to the discussion on the implementation of Open Science approaches reporting on an important and large-scale experiment in this space. The study tackles an important issue facing the research community today: while most researchers agree with the principles of Open Science, there continue to be barriers to adopting OS practices that are deeply rooted in the academic culture. Exploring and understanding the motivations for adopting or resisting OS practices is therefore an important part of making changes. Neuro's OS framework does appear to offer an interesting case study to explore these issues. The methods are presented well, and I have no concerns about the way the data collection and data analysis are described. The choice of semi-structured interviews is justified convincingly.
|
other
| 99.1 |
2) The issue of researchers' trust: The authors mention the role of incentives in publishing, and the significance of career outcomes for researchers. Publishing novel research can make researcher careers, while being 'scooped' may well break their careers. The concerns of scientists participating in open science initiatives often relate to the lack of trust in the system to safeguard their priority in publishing novel findings. I feel that the authors of this paper have somewhat ignored the issue of trust/distrust in science.
|
other
| 99.9 |
3a) One very recent study which is conspicuously absent from the reference list, and which may inform the analysis, is: Open Research Data Taskforce (2017) Research Data Infrastructures in the UK: www.universitiesuk.ac.uk/policy-and-analysis/research-policy/open-science/Documents/ORDTF%20report%20nr%201%20final%2030%2006%202017.pdf
|
other
| 99.94 |
This is a comprehensive review of Open Science (preservation and sharing of data, the responsibilities of researchers, institutions and funders) in various countries, including Canada. Very helpfully, the report summarizes the problems the policy causes for researchers/scientists (though these were not based on interviews with scientists). Perhaps it would be useful for the authors to compare their findings with what the authors of the UK report found. Some points made here resonate with the UK study, but others stand in contrast to it. Is this because of the specific context of the country, or perhaps the context of this particular institution that appears to be head of the game in the implementation of Open Science policies?
|
review
| 99.5 |
3b) I think the paper could be substantially strengthened and made more generally applicable through reference to existing frameworks and similar efforts. I am thinking particularly of the work of Fecher and Friesikie (a number of articles including the important "Open Science: One term, five schools of thought" but also recent work on barriers to data sharing in Germany). Christine Borgman's work on data sharing (Big Data, Little Data…) and more broadly dissections of incentives (European Commission Expert Group report on role of research evaluation in progress to Open Science, Metric Tide report) and potentially the literature around choices to public Open Access as well could be valuable. At the moment I feel that the article reinforces what we have seen in other cases, which is valuable. I think it would be stronger and more valuable if these issues were developed in those broader contexts.
|
other
| 99.8 |
3c) (From Cameron Neylon). Something from my own recent work that I feel would be worth exploring is the extent to which group level dynamics help or hinder adoption. What is unique about the effort at the Neuro is the way it operates at a departmental level. Does being part of a group shift the dynamics of issues? Does identity of being in the department vs identity of being part of external communities contribute to engagement, or hinder it?
|
other
| 99.94 |
3d) The article would benefit from a more thorough literature review that looks at barriers to the adoption of open practices. While some aspects of Open Science are not as well studied, Open Access (OA) has been written about extensively in the literature, including studies about opinions and attitudes, and some explicitly about barriers to change. There have also been efforts to document barriers to adoption of Open Data. A few references are below; a number of publishers have also conducted surveys of researchers' awareness of and attitudes towards both open access and open data.
|
review
| 99.9 |
However, more important from my perspective would be to relate this other work to what has already been written in the Discussion section. For example, researcher's misgivings based on a lack of awareness and understanding of openness has been previously documented. Similarly, the endless studies on the OA Citation Advantage speaks to the author's point that the OS community has attempted to find evidence of the benefits to researchers.
|
other
| 99.9 |
Harley, D., Acord, S. K., Earl-Novell, S., Lawrence, S., & King, C. J. (2010). Assessing the Future Landscape of Scholarly Communication: An Exploration of Faculty Values and Needs in Seven Disciplines. Center for Studies in Higher Education. Retrieved from http://escholarship.org/uc/item/15x7385g
|
other
| 99.94 |
Peekhaus, W., & Proferes, N. (2016). An examination of North American Library and Information Studies faculty perceptions of and experience with open-access scholarly publishing. Library & Information Science Research, 38(1), 18-29. https://doi.org/10.1016/j.lisr.2016.01.003
|
other
| 99.94 |
We have added data on all themes identified to the manuscript. These number nine not ten, as we combined some of them (notably on intellectual property and industry partners) to improve the flow of the text. Please see: Results section; Themes: “Current state of sharing”, “Attribution and publication”, “Infrastructure and resources” and “Research ethics”.
|
other
| 99.94 |
2) The issue of researchers' trust: The authors mention the role of incentives in publishing, and the significance of career outcomes for researchers. Publishing novel research can make researcher careers, while being 'scooped' may well break their careers. The concerns of scientists participating in open science initiatives often relate to the lack of trust in the system to safeguard their priority in publishing novel findings. I feel that the authors of this paper have somewhat ignored the issue of trust/distrust in science.
|
other
| 99.9 |
3a) One very recent study which is conspicuously absent from the reference list, and which may inform the analysis, is: Open Research Data Taskforce (2017) Research Data Infrastructures in the UK: www.universitiesuk.ac.uk/policy-and-analysis/research-policy/open-science/Documents/ORDTF%20report%20nr%201%20final%2030%2006%202017.pdf
|
other
| 99.94 |
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