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1.  The Relationship of Previous Training and Experience of Journal Peer Reviewers to Subsequent Review Quality 
PLoS Medicine  2007;4(1):e40.
Peer review is considered crucial to the selection and publication of quality science, but very little is known about the previous experiences and training that might identify high-quality peer reviewers. The reviewer selection processes of most journals, and thus the qualifications of their reviewers, are ill defined. More objective selection of peer reviewers might improve the journal peer review process and thus the quality of published science.
Methods and Findings
306 experienced reviewers (71% of all those associated with a specialty journal) completed a survey of past training and experiences postulated to improve peer review skills. Reviewers performed 2,856 reviews of 1,484 separate manuscripts during a four-year study period, all prospectively rated on a standardized quality scale by editors. Multivariable analysis revealed that most variables, including academic rank, formal training in critical appraisal or statistics, or status as principal investigator of a grant, failed to predict performance of higher-quality reviews. The only significant predictors of quality were working in a university-operated hospital versus other teaching environment and relative youth (under ten years of experience after finishing training). Being on an editorial board and doing formal grant (study section) review were each predictors for only one of our two comparisons. However, the predictive power of all variables was weak.
Our study confirms that there are no easily identifiable types of formal training or experience that predict reviewer performance. Skill in scientific peer review may be as ill defined and hard to impart as is “common sense.” Without a better understanding of those skills, it seems unlikely journals and editors will be successful in systematically improving their selection of reviewers. This inability to predict performance makes it imperative that all but the smallest journals implement routine review ratings systems to routinely monitor the quality of their reviews (and thus the quality of the science they publish).
A survey of experienced reviewers, asked about training they had received in peer review, found there are no easily identifiable types of formal training and experience that predict reviewer performance.
Editors' Summary
When medical researchers have concluded their research and written it up, the next step is to get it published as an article in a journal, so that the findings can be circulated widely. These published findings help determine subsequent research and clinical use. The editors of reputable journals, including PLoS Medicine, have to decide whether the articles sent to them are of good quality and accurate and whether they will be of interest to the readers of their journal. To do this they need to obtain specialist advice, so they contact experts in the topic of the research article and ask them to write reports. This is the process of scientific peer review, and the experts who write such reports are known as “peer reviewers.” Although the editors make the final decision, the advice and criticism of these peer reviewers to the editors is essential in making decisions on publication, and usually in requiring authors to make changes to their manuscript. The contribution that peer reviewers have made to the article by the time it is finally published may, therefore, be quite considerable.
Although peer review is accepted as a key part of the process for the publishing of medical research, many people have argued that there are flaws in the system. For example, there may be an element of luck involved; one author might find their paper being reviewed by a reviewer who is biased against the approach they have adopted or who is a very critical person by nature, and another author may have the good fortune to have their work considered by someone who is much more favorably disposed toward their work. Some reviewers are more knowledgeable and thorough in their work than others. The editors of medical journals try to take in account such biases and quality factors in their choice of peer reviewers or when assessing the reviews. Some journals have run training courses for experts who review for them regularly to try to make the standard of peer review as high as possible.
Why Was This Study Done?
It is hard for journal editors to know who will make a good peer reviewer, and there is no proven system for choosing them. The authors of this study wanted to identify the previous experiences and training that make up the background of good peer reviewers and compare them with the quality of the reviews provided. This would help journal editors select good people for the task in future, and as a result will affect the quality of science they publish for readers, including other researchers.
What Did the Researchers Do and Find?
The authors contacted all the regular reviewers from one specialist journal (Annals of Emergency Medicine). A total of 306 of these experienced reviewers (71% of all those associated with the journal) completed a survey of past training and experiences that might be expected to improve peer review skills. These reviewers had done 2,856 reviews of 1,484 separate manuscripts during a four-year study period, and during this time the quality of the reviews had been rated by the journal's editors. Surprisingly, most variables, including academic rank, formal training in critical appraisal or statistics, or status as principal investigator of a grant, failed to predict performance of higher-quality reviews. The only significant predictors of quality were working in a university-operated hospital versus other teaching environment and relative youth (under ten years of experience after finishing training), and even these were only weak predictors.
What Do These Findings Mean?
This study suggest that there are no easily identifiable types of formal training or experience that predict peer reviewer performance, although it is clear that some reviewers (and reviews) are better than others. The authors suggest that it is essential therefore that journals routinely monitor the quality of reviews submitted to them to ensure they are getting good advice (a practice that is not universal).
Additional Information.
Please access these Web sites via the online version of this summary at
• WAME is an association of editors from many countries who seek to foster international cooperation among editors of peer-reviewed medical journals
• The Fifth International Congress on Peer Review and Biomedical Publication is one of a series of conferences on peer review
• The PLoS Medicine guidelines for reviewers outline what we look for in a review
• The Council of Science Editors promotes ethical scientific publishing practices
• An editorial also published in this issue of PLoS Medicine discusses the peer review process further
PMCID: PMC1796627  PMID: 17411314
2.  STI prevention and the male sex industry in London: evaluating a pilot peer education programme 
Sexually Transmitted Infections  2000;76(6):447-453.
Objective: To evaluate the effectiveness of a pilot peer education STI prevention programme with male sex workers.
Design: A process and outcome evaluation of the pilot programme undertaken in three London male escort agencies, using a quasi-experimental design.
Subjects: Workers in three London escort agencies, including 88 who completed a questionnaire, five peer educators, and a further 16 men (including management) working in two of these agencies.
Methods: A peer education STI prevention programme run by the Working Men Project (WMP), a specialist sexual health service for male sex workers, was piloted in two London escort agencies. Five male sex workers participated in a 2 day peer education training programme. They then returned to their respective agencies to disseminate information and condoms, in an attempt to influence norms of behaviour.
An outcome evaluation aimed to assess changes in STI related knowledge, high risk sexual behaviour, and attendance at a sexual health service. A pre-intervention questionnaire assessing variables such as STI related knowledge, sexual behaviour, and demographic information was administered in both agency A and agency B and a third agency, C, which acted as a control. Ten weeks after the peer educators returned to their agencies, the same questionnaire was administered in the same agencies. Peer educator referrals to the WMP were also recorded over this time period. The process evaluation involved interviews and focus groups with peer educators, and the completion of diaries about their experiences in the role. A further 16 men working in the agencies (including managers and an owner) were interviewed about their experience of the programme. Participant observation was also undertaken through regular outreach work to the agencies.
Results: 57 men completed the questionnaire at time 1 and 44 at time 2. Unfortunately, only 13 of these were matched, precluding any meaningful analysis of change in STI related knowledge and sexual behaviour. The questionnaire provided a profile of the men working in the agencies. Of the 88 men who completed the questionnaire at least once, the majority were homosexual, and in their late teens/early 20s. Most were of a "white" ethnic group, though there was some range within these categories. Most preferred to speak English and education levels were high. Relative STI knowledge revealed a high understanding of HIV and hepatitis B, moderate understanding of gonorrhoea, syphilis, genital warts and herpes, and little knowledge of non-specific urethritis (NSU) or chlamydia. Sexual behaviour suggested a highly sexually active population with both male and female paying and non-paying partners. Condom use was highest for paying partners, particularly for anal sex. Condom use for oral sex with all partners was less consistent, and condom use for all types of sex with regular partners was lower than with other partners. The small number of men engaging in vaginal sex with paying and regular partners were less likely to use condoms. 26 new patients registered at the WMP as a result of peer educator referrals, representing 65% of all new contacts over the study period. The process evaluation revealed that while the training programme was considered adequate and while peer educators felt the programme and their roles to be a success, their experience of the role was difficult. The role of management support was crucial in supporting the programme. The assumption that "peers" are particularly effective educators was not borne out by the results. While peers were considered suitable to discuss some aspects of the industry, many preferred to consult "professionals" about health related matters. The concept of "peers" was problematic with most of the men drawing "peers" from subgroups within the agencies. Other constraints on behaviour such as a lack of power, particularly with regard to a lack of management support, or poverty, had a substantial impact on behaviour which were not influenced by the peer educators.
Conclusions: The study illustrated the difficulties of utilising quasi-experimental evaluation methodology with this client group. It also demonstrated the limitations of peer education based on information provision health education models which focus on individual behaviour change. Suggestions are given for future interventions.
Key Words: male sex workers; peer education; evaluation
PMCID: PMC1744253  PMID: 11221127
3.  The IGOR Cloud Platform: Collaborative, Scalable, and Peer-Reviewed NGS Data Analysis 
Technical challenges facing researchers performing next-generation sequencing (NGS) analysis threaten to slow the pace of discovery and delay clinical applications of genomics data. Particularly for core laboratories, these challenges include: (1) Computation and storage have to scale with the vase amount of data generated. (2) Analysis pipelines are complex to design, set up, and share. (3) Collaboration, reproducibility, and sharing are hampered by privacy concerns and the sheer volume of data involved. Based on hands-on experience from large-scale NGS projects such as the 1000 Genomes Project, Seven Bridges Genomics has developed IGOR, a comprehensive cloud platform for NGS Data analysis that fully addresses these challenges: IGOR is a cloud-based platform for researchers and facilities to manage NGS data, design and run complex analysis pipelines, and efficiently collaborate on projects.Over a dozen curated and peer-reviewed NGS data analysis pipelines are publicly available for free, including alignment, variant calling, and RNA-Seq. All pipelines are based on open source tools and built to peer-reviewed specifications in close collaboration with researchers at leading institutions such as the Harvard Stem Cell Institute.Without any command-line knowledge, NGS pipelines can be built and customized in an intuitive graphical editor choosing from over 50 open source tools.When executing pipelines, IGOR automatically takes care of all resource management. Resources are seamlessly and automatically made available from Amazon Web Services and optimized for time and cost.Collaboration is facilitated through a project structure that allows researchers working in and across institutions to share files and pipelines. Fine-grained permissions allow detailed access control on a user-by-user basis for each project. Pipelines can be embedded and accessed through web pages akin to YouTube videos.Extensive batch processing and parallelization capabilities mean that hundreds of samples can be analyzed in the same amount of time that a single sample can be processed. Using file metadata, batch processing can be automated, e.g., by file, library, sample or lane.
The IGOR platform enables NGS research as a “turnkey” solution: Researchers can set up and run complex pipelines without expertise in command-line utilities or cloud computing. From a lab and facility perspective, the cloud-based architecture also eliminates the need to set up and maintain a large-scale infrastructure, typically resulting in at least 50% cost savings on infrastructure. By facilitating collaboration and easing analysis replication, the IGOR platform frees up the time of core laboratories to emphasize and focus on the research questions that ultimately guide them.
PMCID: PMC3635388
4.  An Experience of Peer Education Model among Medical Science University Students in Iran 
The purpose of this study was to evaluate the effectiveness of peer education among university students for reproductive health promotion based on researchers’ experiences.
This interventional study was conducted in Qazvin University of Medical Science during 2002 to 2004 through stakeholders’ partnership and selection of 24 volunteer students according to their knowledge, interest, communication skills. Capacity building was performed through holding an interactive reproductive health coarse contained marital health, illegal abortion, family planning, STI/AIDS, communication and counseling skills. Trained peer educators have introduced to other student and present education and counseling formally and informally. A post interventional study was conducted after 9 months in order to find its effectiveness.
In our experience Stakeholders’ partnership in community interventional programs led to the best expected availability of better health through ownership and adopting policies. In present study, the proper determined criteria for selection of peer educators and clear understood expectations of the peer educators’ role were very important in health promotional program. Although peer education was acceptable program for university students, more support and supervising for peer groups are needed. The students believed that the power point of peer education and counseling related to same age groups sympathy, confident, well behaved, cheerful, and kind-hearted and peer educators awareness.
Universities are appropriate real world for experience a friendly youth program and then disseminate it to other young communities. There seems peer education is effective strategy for reproductive health promotion and reinforce positive behaviors in youth.
PMCID: PMC3481725  PMID: 23113055
Peer education; Reproductive health; University students; Iran
5.  Views on the peer review system of biomedical journals: an online survey of academics from high-ranking universities 
Peer review is the major method used by biomedical journals for making the decision of publishing an article. This cross-sectional survey assesses views concerning the review system of biomedical journals among academics globally.
A total of 28,009 biomedical academics from high-ranking universities listed by the 2009 Times Higher Education Quacquarelli Symonds (THE-QS) World University Rankings were contacted by email between March 2010 and August 2010. 1,340 completed an online survey which focused on their academic background, negative experiences and views on biomedical journal peer review and the results were compared among basic scientists, clinicians and clinician scientists.
Fewer than half of the respondents agreed that the peer review systems of biomedical journals were fair (48.4%), scientific (47.5%), or transparent (25.1%). Nevertheless, 58.2% of the respondents agreed that authors should remain anonymous and 64.4% agreed that reviewers should not be disclosed. Most, (67.7%) agreed to the establishment of an appeal system. The proportion of native English-speaking respondents who agreed that the “peer review system is fair” was significantly higher than for non-native respondents (p = 0.02). Similarly, the proportion of clinicians stating that the “peer review system is fair” was significantly higher than that for basic scientists and clinician-scientists (p = 0.004). For females, (β = −0.1, p = 0.03), the frequency of encountering personal attacks in reviewers’ comments (β = −0.1, p = 0.002) and the frequency of imposition of unnecessary references by reviewers (β = −0.06, p = 0.04) were independently and inversely associated with agreement that “the peer review system is fair”.
Academics are divided on the issue of whether the biomedical journal peer review system is fair, scientific and transparent. A majority of academics agreed with the double-blind peer review and to the establishment of an appeal system. Female academics, experience of personal attacks and imposition of unnecessary references by reviewers were related to disagreement about fairness of the peer review system of biomedical journals.
PMCID: PMC3685540  PMID: 23758823
Academics; Peer review; Biomedical journal; Online survey
6.  Misrepresentation of Randomized Controlled Trials in Press Releases and News Coverage: A Cohort Study 
PLoS Medicine  2012;9(9):e1001308.
A study conducted by Amélie Yavchitz and colleagues examines the factors associated with “spin” (specific reporting strategies, intentional or unintentional, that emphasize the beneficial effect of treatments) in press releases of clinical trials.
Previous studies indicate that in published reports, trial results can be distorted by the use of “spin” (specific reporting strategies, intentional or unintentional, emphasizing the beneficial effect of the experimental treatment). We aimed to (1) evaluate the presence of “spin” in press releases and associated media coverage; and (2) evaluate whether findings of randomized controlled trials (RCTs) based on press releases and media coverage are misinterpreted.
Methods and Findings
We systematically searched for all press releases indexed in the EurekAlert! database between December 2009 and March 2010. Of the 498 press releases retrieved and screened, we included press releases for all two-arm, parallel-group RCTs (n = 70). We obtained a copy of the scientific article to which the press release related and we systematically searched for related news items using Lexis Nexis.
“Spin,” defined as specific reporting strategies (intentional or unintentional) emphasizing the beneficial effect of the experimental treatment, was identified in 28 (40%) scientific article abstract conclusions and in 33 (47%) press releases. From bivariate and multivariable analysis assessing the journal type, funding source, sample size, type of treatment (drug or other), results of the primary outcomes (all nonstatistically significant versus other), author of the press release, and the presence of “spin” in the abstract conclusion, the only factor associated, with “spin” in the press release was “spin” in the article abstract conclusions (relative risk [RR] 5.6, [95% CI 2.8–11.1], p<0.001). Findings of RCTs based on press releases were overestimated for 19 (27%) reports. News items were identified for 41 RCTs; 21 (51%) were reported with “spin,” mainly the same type of “spin” as those identified in the press release and article abstract conclusion. Findings of RCTs based on the news item was overestimated for ten (24%) reports.
“Spin” was identified in about half of press releases and media coverage. In multivariable analysis, the main factor associated with “spin” in press releases was the presence of “spin” in the article abstract conclusion.
Editors' Summary
The mass media play an important role in disseminating the results of medical research. Every day, news items in newspapers and magazines and on the television, radio, and internet provide the general public with information about the latest clinical studies. Such news items are written by journalists and are often based on information in “press releases.” These short communications, which are posted on online databases such as EurekAlert! and sent directly to journalists, are prepared by researchers or more often by the drug companies, funding bodies, or institutions supporting the clinical research and are designed to attract favorable media attention to newly published research results. Press releases provide journalists with the information they need to develop and publish a news story, including a link to the peer-reviewed journal (a scholarly periodical containing articles that have been judged by independent experts) in which the research results appear.
Why Was This Study Done?
In an ideal world, journal articles, press releases, and news stories would all accurately reflect the results of health research. Unfortunately, the findings of randomized controlled trials (RCTs—studies that compare the outcomes of patients randomly assigned to receive alternative interventions), which are the best way to evaluate new treatments, are sometimes distorted in peer-reviewed journals by the use of “spin”—reporting that emphasizes the beneficial effects of the experimental (new) treatment. For example, a journal article may interpret nonstatistically significant differences as showing the equivalence of two treatments although such results actually indicate a lack of evidence for the superiority of either treatment. “Spin” can distort the transposition of research into clinical practice and, when reproduced in the mass media, it can give patients unrealistic expectations about new treatments. It is important, therefore, to know where “spin” occurs and to understand the effects of that “spin”. In this study, the researchers evaluate the presence of “spin” in press releases and associated media coverage and analyze whether the interpretation of RCT results based on press releases and associated news items could lead to the misinterpretation of RCT results.
What Did the Researchers Do and Find?
The researchers identified 70 press releases indexed in EurekAlert! over a 4-month period that described two-arm, parallel-group RCTs. They used Lexis Nexis, a database of news reports from around the world, to identify associated news items for 41 of these press releases and then analyzed the press releases, news items, and abstracts of the scientific articles related to each press release for “spin”. Finally, they interpreted the results of the RCTs using each source of information independently. Nearly half the press releases and article abstract conclusions contained “spin” and, importantly, “spin” in the press releases was associated with “spin” in the article abstracts. The researchers overestimated the benefits of the experimental treatment from the press release as compared to the full-text peer-reviewed article for 27% of reports. Factors that were associated with this overestimation of treatment benefits included publication in a specialized journal and having “spin” in the press release. Of the news items related to press releases, half contained “spin”, usually of the same type as identified in the press release and article abstract. Finally, the researchers overestimated the benefit of the experimental treatment from the news item as compared to the full-text peer-reviewed article in 24% of cases.
What Do These Findings Mean?
These findings show that “spin” in press releases and news reports is related to the presence of “spin” in the abstract of peer-reviewed reports of RCTs and suggest that the interpretation of RCT results based solely on press releases or media coverage could distort the interpretation of research findings in a way that favors experimental treatments. This interpretation shift is probably related to the presence of “spin” in peer-reviewed article abstracts, press releases, and news items and may be partly responsible for a mismatch between the perceived and real beneficial effects of new treatments among the general public. Overall, these findings highlight the important role that journal reviewers and editors play in disseminating research findings. These individuals, the researchers conclude, have a responsibility to ensure that the conclusions reported in the abstracts of peer-reviewed articles are appropriate and do not over-interpret the results of clinical research.
Additional Information
Please access these Web sites via the online version of this summary at
The PLOS Hub for Clinical Trials, which collects PLOS journals relating to clinical trials, includes some other articles on “spin” in clinical trial reports
EurekAlert is an online free database for science press releases
The UK National Health Service Choices website includes Beyond the Headlines, a resource that provides an unbiased and evidence-based analysis of health stories that make the news for both the public and health professionals
The US-based organization HealthNewsReview, a project supported by the Foundation for Informed Medical Decision Making, also provides expert reviews of news stories
PMCID: PMC3439420  PMID: 22984354
7.  Workplace learning through peer groups in medical school clerkships 
Medical Education Online  2014;19:10.3402/meo.v19.25809.
When medical students move from the classroom into clinical practice environments, their roles and learning challenges shift dramatically from a formal curricular approach to a workplace learning model. Continuity among peers during clinical clerkships may play an important role in this different mode of learning. We explored students’ perceptions about how they achieved workplace learning in the context of intentionally formed or ad hoc peer groups.
We invited students in clerkship program models with continuity (CMCs) and in traditional block clerkships (BCs) to complete a survey about peer relationships with open-ended questions based on a workplace learning framework, including themes of workplace-based relationships, the nature of work practices, and selection of tasks and activities. We conducted qualitative content analysis to characterize students’ experiences.
In both BCs and CMCs, peer groups provided rich resources, including anticipatory guidance about clinical expectations of students, best practices in interacting with patients and supervisors, helpful advice in transitioning between rotations, and information about implicit rules of clerkships. Students also used each other as benchmarks for gauging strengths and deficits in their own knowledge and skills.
Students achieve many aspects of workplace learning in clerkships through formal or informal workplace-based peer groups. In these groups, peers provide accessible, real-time, and relevant resources to help each other navigate transitions, clarify roles and tasks, manage interpersonal challenges, and decrease isolation. Medical schools can support effective workplace learning for medical students by incorporating continuity with peers in the main clinical clerkship year.
PMCID: PMC4245452  PMID: 25427851
clinical education; workplace learning; peer continuity
8.  The Toxic Effects of Cigarette Additives. Philip Morris' Project Mix Reconsidered: An Analysis of Documents Released through Litigation 
PLoS Medicine  2011;8(12):e1001145.
Stanton Glantz and colleagues analyzed previously secret tobacco industry documents and peer-reviewed published results of Philip Morris' Project MIX about research on cigarette additives, and show that this research on the use of cigarette additives cannot be taken at face value.
In 2009, the promulgation of US Food and Drug Administration (FDA) tobacco regulation focused attention on cigarette flavor additives. The tobacco industry had prepared for this eventuality by initiating a research program focusing on additive toxicity. The objective of this study was to analyze Philip Morris' Project MIX as a case study of tobacco industry scientific research being positioned strategically to prevent anticipated tobacco control regulations.
Methods and Findings
We analyzed previously secret tobacco industry documents to identify internal strategies for research on cigarette additives and reanalyzed tobacco industry peer-reviewed published results of this research. We focused on the key group of studies conducted by Phillip Morris in a coordinated effort known as “Project MIX.” Documents showed that Project MIX subsumed the study of various combinations of 333 cigarette additives. In addition to multiple internal reports, this work also led to four peer-reviewed publications (published in 2001). These papers concluded that there was no evidence of substantial toxicity attributable to the cigarette additives studied. Internal documents revealed post hoc changes in analytical protocols after initial statistical findings indicated an additive-associated increase in cigarette toxicity as well as increased total particulate matter (TPM) concentrations in additive-modified cigarette smoke. By expressing the data adjusted by TPM concentration, the published papers obscured this underlying toxicity and particulate increase. The animal toxicology results were based on a small number of rats in each experiment, raising the possibility that the failure to detect statistically significant changes in the end points was due to underpowering the experiments rather than lack of a real effect.
The case study of Project MIX shows tobacco industry scientific research on the use of cigarette additives cannot be taken at face value. The results demonstrate that toxins in cigarette smoke increase substantially when additives are put in cigarettes, including the level of TPM. In particular, regulatory authorities, including the FDA and similar agencies elsewhere, could use the Project MIX data to eliminate the use of these 333 additives (including menthol) from cigarettes.
Please see later in the article for the Editors' Summary
Editors' Summary
The tobacco industry in the United States has recognized that regulation of its products was inevitable as early as 1963 and devoted increasing attention to the likelihood of regulation by the US Food and Drug Administration in the mid-1990s, which finally became law in 2009. In addition, the World Health Organization (WHO) Framework Convention on Tobacco Control (WHO FCTC), which came into force in June 2003, includes provisions addressing the regulation of the contents of tobacco products and the regulation of tobacco product disclosures. Although these steps represent progress in tobacco control, the events of the past few decades show the determination of the tobacco industry to avoid regulation, including the regulation of additives. In the United States, executives of the tobacco company Philip Morris (PM) recognized the inevitability of regulation and responded by initiating efforts to shape legislation and regulation by reorganizing its internal scientific activities and conducting scientific research that could be used to shape any proposed regulations. For example, the company conducted “Project MIX,” a study of chemical constituents in and toxicity of smoke produced by burning cigarettes containing three different combinations of 333 cigarette additives that “were constructed to resemble typical commercial blended cigarettes.” The resulting four papers published in Food and Chemical Toxicology in January 2002 concluded that there was no evidence of substantial toxicity attributable to the cigarette additives studied.
Why Was This Study Done?
The use of cigarette additives is an important concern of the WHO, FDA, and similar national regulatory bodies around the world. Philip Morris has used the published Project MIX papers to assert the safety of individual additives and other cigarette companies have done similar studies that reached similar conclusions. In this study, the researchers used documents made public as a result of litigation against the tobacco industry to investigate the origins and design of Project MIX and to conduct their own analyses of the results to assess the reliability of the conclusions in the papers published in Food and Chemical Toxicology.
What Did the Researchers Do and Find?
The researchers systematically examined tobacco industry documents in the University of California San Francisco Legacy Tobacco Documents Library (then about 60 million pages made publicly available as a result of litigation) and used an iterative process of searching, analyzing, and refining to identify and review in detail 500 relevant documents.
The researchers found that in the original Project MIX analysis, the published papers obscured findings of toxicity by adjusting the data by total particulate matter (TPM) concentration. When the researchers conducted their own analysis by studying additives per cigarette (as was specified in the original Project MIX protocol), they found that 15 carcinogenic chemicals increased by 20%. The researchers also reported that, for unexplained reasons, Philip Morris deemphasized 19 of the 51 chemicals tested in the presentation of results, including nine that were substantially increased in smoke on a per cigarette basis of additive-added cigarettes, compared to smoke of control cigarettes.
The researchers explored the possibility that the failure of Project MIX to detect statistically significant changes in the toxicity of the smoke from cigarettes containing the additives was due to underpowered experiments rather than lack of a real effect by conducting their own statistical analysis. This analysis suggests that a better powered study would have detected a much broader range of biological effects associated with the additives than was identified in Philip Morris' published paper, suggesting that it substantially underestimated the toxic potential of cigarette smoke and additives.
The researchers also found that Food and Chemical Toxicology, the journal in which the four Project MIX papers were published, had an editor and 11 of its International Editorial Board with documented links to the tobacco industry. The scientist and leader of Project MIX Edward Carmines described the process of publication as “an inside job.”
What Do These Findings Mean?
These findings show that the tobacco industry scientific research on the use of cigarette additives cannot be taken at face value: the results demonstrate that toxins in cigarette smoke increase substantially when additives are put in cigarettes. In addition, better powered studies would probably have detected a much broader range of adverse biological effects associated with the additives than identified to those identified in PM's published papers suggesting that the published papers substantially underestimate the toxic potential combination of cigarette smoke and additives.
Regulatory authorities, including the FDA and similar agencies elsewhere who are implementing WHO FCTC, should conduct their own independent analysis of Project MIX data, which, analyzed correctly, could provide a strong evidence base for the elimination of the use of the studied additives (including menthol) in cigarettes on public health grounds.
Additional Information
Please access these Web sites via the online version of this summary at
For PLoS Medicine's own policy on publishing papers sponsored by the tobacco industry see
The World Health Organization (WHO) provides information on the Framework Convention on Tobacco Control (FCTC)
The documents that the researchers reviewed in this paper can be found at the Legacy Tobacco Documents Library
PMCID: PMC3243707  PMID: 22205885
9.  Creating a Social World 
Archives of general psychiatry  2007;64(8):958-965.
Peer-group deviance is strongly associated with externalizing behaviors. We have limited knowledge of the sources of individual differences in peer-group deviance.
To clarify genetic and environmental contributions to peer-group deviance in twins from mid-childhood through early adulthood.
Retrospective assessments using a life-history calendar. Analysis by biometric growth curves.
General community.
Members of male-male pairs from the population-based Virginia Twin Registry personally interviewed in 1998–2004 (n=1802).
Main Outcome Measure
Self-reported peer-group deviance at ages 8 to 11, 12 to 14, 15 to 17, 18 to 21, and 22 to 25 years.
Mean and variance of peer-group deviance increased substantially with age. Genetic effects on peer-group deviance showed a strong and steady increase over time. Family environment generally declined in importance over time. Individual-specific environmental influences on peer-group deviance levels were stable in the first 3 age periods and then increased as most twins left home. When standardized, the heritability of peer-group deviance is approximately 30% at ages 8 to 11 years and rises to approximately 50% across the last 3 time periods. Both genes and shared environment contributed to individual differences in the developmental trajectory of peer-group deviance. However, while the correlation between childhood peer-group deviance levels and the subsequent slope of peer-group deviance over time resulting from genetic factors was positive, the same relationship resulting from shared environmental factors was negative.
As male twins mature and create their own social worlds, genetic factors play an increasingly important role in their choice of peers, while shared environment becomes less influential. The individual specific environment increases in importance when individuals leave home. Individuals who have deviant peers in childhood, as a result of genetic vs shared environmental influences, have distinct developmental trajectories. Understanding the risk factors for peer-group deviance will help clarify the etiology of a range of externalizing psychopathology.
PMCID: PMC4246499  PMID: 17679640
10.  Senior medical student perceived ability and experience in giving peer feedback in formative long case examinations 
BMC Medical Education  2013;13:79.
Learning to provide feedback on a peer’s performance in formative clinical assessments can be a valuable way of enriching the students’ own learning experience. Students are often reluctant to provide honest, critical feedback to their peers. Nevertheless, it is an area of practice that is important to develop as students report feeling ill prepared in feedback techniques when entering the medical workforce. We sought to investigate students’ perceptions of their ability to provide feedback to their peers using the positive critique method, and their perceived benefits and challenges during the experience.
Over a two year period (2011 to 2012), senior medical students assessed and gave feedback to their peers alongside academic examiners during formative long case clinical examinations. Rating scales, open ended questions and focus group discussions were used to evaluate student perceptions.
Of the 94 participants, 89/94 (95%) completed the questionnaire, and 39/94 (41%) participated in focus groups. Students found the positive critique method provided a useful framework. Some students raised concerns about the accuracy of their feedback, and felt that further training was required. A substantial number of respondents (42%) did not report feeling confident providing negative feedback to their peers, and qualitative analysis indicated concerns around potential impacts on social relationships. Despite these concerns, the majority (90%) of respondents found the exercise useful, identifying several benefits, including development in the understanding of knowledge content; development of professionalism skills, and increased responsibility.
Students identified several challenging aspects to providing feedback to their peers. While the experience of giving feedback to peers was perceived by students to provide a valuable learning experience, further training in this area may help to improve the learning experience for students and better prepare them for their future careers.
PMCID: PMC3679984  PMID: 23725417
11.  Using the Internet for Surveys and Health Research 
This paper concerns the use of the Internet in the research process, from identifying research issues through qualitative research, through using the Web for surveys and clinical trials, to pre-publishing and publishing research results. Material published on the Internet may be a valuable resource for researchers desiring to understand people and the social and cultural contexts within which they live outside of experimental settings, with due emphasis on the interpretations, experiences, and views of `real world' people. Reviews of information posted by consumers on the Internet may help to identify health beliefs, common topics, motives, information, and emotional needs of patients, and point to areas where research is needed. The Internet can further be used for survey research. Internet-based surveys may be conducted by means of interactive interviews or by questionnaires designed for self-completion. Electronic one-to-one interviews can be conducted via e-mail or using chat rooms. Questionnaires can be administered by e-mail (e.g. using mailing lists), by posting to newsgroups, and on the Web using fill-in forms. In "open" web-based surveys, selection bias occurs due to the non-representative nature of the Internet population, and (more importantly) through self-selection of participants, i.e. the non-representative nature of respondents, also called the `volunteer effect'. A synopsis of important techniques and tips for implementing Web-based surveys is given. Ethical issues involved in any type of online research are discussed. Internet addresses for finding methods and protocols are provided. The Web is also being used to assist in the identification and conduction of clinical trials. For example, the web can be used by researchers doing a systematic review who are looking for unpublished trials. Finally, the web is used for two distinct types of electronic publication. Type 1 publication is unrefereed publication of protocols or work in progress (a `post-publication' peer review process may take place), whereas Type 2 publication is peer-reviewed and will ordinarily take place in online journals.
PMCID: PMC1761932  PMID: 12554560
Clinical Trials; Confidentiality; Data Collection; Ethics, Research; Evaluation Studies; Informed Consent; Internet; Patient Selection; Qualitative Research; Research Design; Selection bias; Survey research; Research Subjects
12.  "She would sit with me": mothers' experiences of individual peer support for exclusive breastfeeding in Uganda 
Different strategies have been used to improve the initiation and duration of breastfeeding. Peer counsellors are reported to improve exclusive breastfeeding levels, but few studies have assessed the satisfaction of women with the support given, especially in Africa. In this paper we describe women's experiences of peer counselling for exclusive breastfeeding in an East African setting.
In the Ugandan site of PROMISE-EBF, a multi-centre community randomised trial to evaluate the effect of peer counselling for exclusive breastfeeding on infant health, 370 women in the intervention arm participated in a study exit interview. Individual peer counselling was offered to women in 12 of the 24 study clusters, scheduled as five visits: before childbirth and during weeks 1, 4, 7 and 10 after childbirth. During the visits, the women were given information and skills to help them breastfeed exclusively. After the 10-week visit, they were interviewed about their feelings and experiences related to the peer counselling.
Overall, more than 95% of the women expressed satisfaction with the various aspects of peer counselling offered. Those who had received five or more visits were more likely to give positive responses about their experience with peer counselling than those who had received fewer visits. They explained their satisfaction with time spent with the peer counsellor in terms of how much she discussed with them. Most women felt their knowledge needs about breastfeeding were covered by the peer counsellors, while others expressed a desire to learn about complementary feeding and family planning. Attributes of the peer counsellors included their friendliness, being women and giving support in a familiar and relaxed way. Women were positive about the acquisition of knowledge and the benefit to their babies from the peer counselling. They preferred a peer counsellor to a health worker for support of exclusive breastfeeding because of their friendly approach.
Individual peer counselling to support exclusive breastfeeding was positively received by the women.
Trial Registration no: NCT00397150.
PMCID: PMC2987850  PMID: 20977715
13.  The Junior Faculty Laboratory: An Innovative Model of Peer Mentoring 
Mentoring in academic medicine has been shown to contribute to the success of junior faculty, resulting in increased productivity, career satisfaction, and opportunities for networking. Although traditional dyadic mentoring, involving one senior faculty member and one junior protégé, is the dominant model for mentoring in the academic environment, there is increasing recognition that the sharing of knowledge, skills, and experiences among peers may also contribute to the career development of junior faculty. The authors describe the structure, activities, and outcomes of the Junior Faculty Laboratory (JFL), a self-organized, flexible, and dynamic peer mentoring model within the Duke University Center for the Study of Aging and Human Development. As an innovative mentoring model, JFL is entirely peer-driven and its activities are determined by the real-time needs of members. In contrast to some other peer mentoring models, JFL lacks senior faculty input or a structured curriculum, members are multidisciplinary, meeting times are project-driven rather than preset, and participation in collaborative projects is optional based on the interests and needs of group members. Additionally, JFL was not formed as a substitute for, but as a complement to the dyadic mentoring relationships enjoyed by its members. The model, now in its fifth year, has demonstrated success and sustainability. The authors present the JFL as an innovative, mentoring model that can be reproduced by other junior faculty seeking to foster collegial relationships with peers while simultaneously enhancing their career development.
PMCID: PMC3680343  PMID: 22030756
14.  Health effects and wind turbines: A review of the literature 
Environmental Health  2011;10:78.
Wind power has been harnessed as a source of power around the world. Debate is ongoing with respect to the relationship between reported health effects and wind turbines, specifically in terms of audible and inaudible noise. As a result, minimum setback distances have been established world-wide to reduce or avoid potential complaints from, or potential effects to, people living in proximity to wind turbines. People interested in this debate turn to two sources of information to make informed decisions: scientific peer-reviewed studies published in scientific journals and the popular literature and internet.
The purpose of this paper is to review the peer-reviewed scientific literature, government agency reports, and the most prominent information found in the popular literature. Combinations of key words were entered into the Thomson Reuters Web of KnowledgeSM and the internet search engine Google. The review was conducted in the spirit of the evaluation process outlined in the Cochrane Handbook for Systematic Reviews of Interventions.
Conclusions of the peer reviewed literature differ in some ways from those in the popular literature. In peer reviewed studies, wind turbine annoyance has been statistically associated with wind turbine noise, but found to be more strongly related to visual impact, attitude to wind turbines and sensitivity to noise. To date, no peer reviewed articles demonstrate a direct causal link between people living in proximity to modern wind turbines, the noise they emit and resulting physiological health effects. If anything, reported health effects are likely attributed to a number of environmental stressors that result in an annoyed/stressed state in a segment of the population. In the popular literature, self-reported health outcomes are related to distance from turbines and the claim is made that infrasound is the causative factor for the reported effects, even though sound pressure levels are not measured.
What both types of studies have in common is the conclusion that wind turbines can be a source of annoyance for some people. The difference between both types is the reason for annoyance. While it is acknowledged that noise from wind turbines can be annoying to some and associated with some reported health effects (e.g., sleep disturbance), especially when found at sound pressure levels greater than 40 db(A), given that annoyance appears to be more strongly related to visual cues and attitude than to noise itself, self reported health effects of people living near wind turbines are more likely attributed to physical manifestation from an annoyed state than from wind turbines themselves. In other words, it appears that it is the change in the environment that is associated with reported health effects and not a turbine-specific variable like audible noise or infrasound. Regardless of its cause, a certain level of annoyance in a population can be expected (as with any number of projects that change the local environment) and the acceptable level is a policy decision to be made by elected officials and their government representatives where the benefits of wind power are weighted against their cons. Assessing the effects of wind turbines on human health is an emerging field and conducting further research into the effects of wind turbines (and environmental changes) on human health, emotional and physical, is warranted.
PMCID: PMC3179699  PMID: 21914211
Wind turbines; health; annoyance; infrasound; sound pressure level; noise
15.  Undergraduate technical skills training guided by student tutors – Analysis of tutors' attitudes, tutees' acceptance and learning progress in an innovative teaching model 
Skills labs provide a sheltered learning environment. As close supervision and individual feedback were proven to be important in ensuring effective skills training, we implemented a cross-year peer tutor system in our skills lab of internal medicine that allowed intense training sessions with small learning groups (3–4 students) taught by one student tutor.
The expectations, experiences and criticisms of peer tutors regarding the tutor system for undergraduate skills lab training were investigated in the context of a focus group. In addition, tutees' acceptance of this learning model and of their student tutors was evaluated by means of a pre/post web-based survey.
14 voluntary senior students were intensely prepared by consultants for their peer tutor activity. 127 students participated in the project, 66.9% of which responded to the web-based survey (23 topics with help of 6-point Likert scale + free comments). Acceptance was very high (5.69 ± 0.07, mean ± SEM), and self-confidence ratings increased significantly after the intervention for each of the trained skills (average 1.96 ± 0.08, all p < 0.002). Tutors received high global ratings (5.50 ± 0.07) and very positive anonymous individual feedback from participants. 82% of tutees considered the peer teaching model to be sufficient, and a mere 1% expressed the wish for skills training to be provided by faculty staff only. Focus group analyses with tutors revealed 18 different topics, including profit in personal knowledge and personal satisfaction through teaching activities. The ratio of 1:4 tutor/tutees was regarded to be very beneficial for effective feedback, and the personalized online evaluation by tutees to be a strong motivator and helpful for further improvements. The tutors ascribed great importance to the continuous availability of a contact doctor in case of uncertainties.
This study demonstrates that peer teaching in undergraduate technical clinical skills training is feasible and widely accepted among tutees, provided that the tutors receive sufficient training and supervision.
PMCID: PMC2324090  PMID: 18400106
16.  Enhancing Knowledge Flow in a Health Care Context: A Mobile Computing Approach 
JMIR mHealth and uHealth  2014;2(4):e17.
Advances in mobile computing and wireless communication have allowed people to interact and exchange knowledge almost anywhere. These technologies support Medicine 2.0, where the health knowledge flows among all involved people (eg, patients, caregivers, doctors, and patients’ relatives).
Our paper proposes a knowledge-sharing environment that takes advantage of mobile computing and contextual information to support knowledge sharing among participants within a health care community (ie, from patients to health professionals). This software environment enables knowledge exchange using peer-to-peer (P2P) mobile networks based on users’ profiles, and it facilitates face-to-face interactions among people with similar health interests, needs, or goals.
First, we reviewed and analyzed relevant scientific articles and software apps to determine the current state of knowledge flow within health care. Although no proposal was capable of addressing every aspect in the Medicine 2.0 paradigm, a list of requirements was compiled. Using this requirement list and our previous works, a knowledge-sharing environment was created integrating Mobile Exchange of Knowledge (MEK) and the Easy to Deploy Indoor Positioning System (EDIPS), and a twofold qualitative evaluation was performed. Second, we analyzed the efficiency and reliability of the knowledge that the integrated MEK-EDIPS tool provided to users according to their interest topics, and then performed a proof of concept with health professionals to determine the feasibility and usefulness of using this solution in a real-world scenario.
. Using MEK, we reached 100% precision and 80% recall in the exchange of files within the peer-to-peer network. The mechanism that facilitated face-to-face interactions was evaluated by the difference between the location indicated by the EDIPS tool and the actual location of the people involved in the knowledge exchange. The average distance error was <6.28 m for an indoor environment. The usability and usefulness of this tool was assessed by questioning a sample of 18 health professionals: 94% (17/18) agreed the integrated MEK-EDIPS tool provides greater interaction among all the participants (eg, patients, caregivers, doctors, and patients’ relatives), most considered it extremely important in the health scenario, 72% (13/18) believed it could increase the knowledge flow in a health environment, and 67% (12/18) recommend it or would like to recommend its use.
The integrated MEK-EDIPS tool can provide more services than any other software tool analyzed in this paper. The proposed integrated MEK-EDIPS tool seems to be the best alternative for supporting health knowledge flow within the Medicine 2.0 paradigm.
PMCID: PMC4260076  PMID: 25427923
knowledge sharing; health care; mobile computing; Medicine 2.0; collaborative interaction; social computing
17.  JXTA: A Technology Facilitating Mobile P2P Health Management System 
Mobile JXTA (Juxtapose) gaining momentum and has attracted the interest of doctors and patients through P2P service that transmits messages. Audio and video can also be transmitted through JXTA. The use of mobile streaming mechanism with the support of mobile hospital management and healthcare system would enable better interaction between doctors, nurses, and the hospital. Experimental results demonstrate good performance in comparison with conventional systems. This study evaluates P2P JXTA/JXME (JXTA functionality to MIDP devices.) which facilitates peer-to-peer application+ using mobile-constraint devices. Also a proven learning algorithm was used to automatically send and process sorted patient data to nurses.
From December 2010 to December 2011, a total of 500 patients were referred to our hospital due to minor health problems and were monitored. We selected all of the peer groups and the control server, which controlled the BMO (Block Medical Officer) peer groups and BMO through the doctor peer groups, and prescriptions were delivered to the patient’s mobile phones through the JXTA/ JXME network.
All 500 patients were registered in the JXTA network. Among these, 300 patient histories were referred to the record peer group by the doctors, 100 patients were referred to the external doctor peer group, and 100 patients were registered as new users in the JXTA/JXME network.
This system was developed for mobile streaming applications and was designed to support the mobile health management system using JXTA/ JXME. The simulated results show that this system can carry out streaming audio and video applications. Controlling and monitoring by the doctor peer group makes the system more flexible and structured. Enhanced studies are needed to improve knowledge mining and cloud-based M health management technology in comparison with the traditional system.
PMCID: PMC3738710  PMID: 24159509
JXME; JXTA; mobile healthcare; P2P
18.  The Knowledge, Attitudes, and Practices of Canadian Master of Physical Therapy Students Regarding Peer Mentorship 
Physiotherapy Canada  2012;64(1):65-76.
Purpose: To describe Canadian Master of Physical Therapy (MPT) students' knowledge, attitudes, and practices regarding peer mentorship. Methods: A quantitative cross-sectional survey study was conducted. An online questionnaire was sent to 945 MPT students via e-mail, using a modified Dillman approach. Data were analyzed using descriptive statistics to describe the knowledge, attitudes, and practices of Canadian MPT students. Results: A total of 260 MPT students (27.5%) responded to the questionnaire. Most respondents (68.7%) did not have any experience in a peer mentorship relationship during their MPT programme. A few respondents (5.4%) reported having received formal training on peer mentorship as part of their PT curriculum. Respondents generally held positive attitudes toward peer mentorship: 65.9% agreed that including peer mentorship is important, 89.5% agreed that peer mentorship can assist with learning in clinical internships, and 84.1% agreed that peer mentorship can help the transition from student to professional. Most respondents (52.5%) did not participate in a peer mentorship relationship during a typical month. Conclusions: MPT students' attitudes toward peer mentorship are positive, yet their knowledge of and resources for peer mentorship are limited, and few students have been involved in peer mentorship practices. The findings highlight the importance of university programme support to provide a nurturing environment and structure to overcome barriers, promote commitment, and facilitate successful participation. The evidence from this study provides a rationale to support and guide peer mentorship programming for Canadian MPT students.
PMCID: PMC3280711  PMID: 23277687
mentors; physical therapy; students; étudiants; mentors; physiothérapie; thérapie physique
19.  Peer mentoring: evaluation of a novel programme in paediatrics 
Archives of Disease in Childhood  2013;99(2):142-146.
Mentoring is important for personal and professional development of doctors. Peer mentoring is a core skill in the UK paediatric postgraduate curriculum. However, there is a paucity of peer mentoring programmes aimed at postgraduate doctors in training (postgraduate trainees), and there are no such schemes within paediatrics described in the literature. We developed a regional peer mentoring programme for postgraduate trainees in paediatrics to assess demand and need for peer mentoring and to explore the benefits for both peer mentees and mentors.
Programme design
Junior postgraduate trainees, randomly selected from volunteers, received peer mentoring from more senior trainees for 1 year. Peer mentors were selected by competitive application and undertook tailored training followed by an experiential learning programme. The programme was evaluated using structured questionnaires.
90% (76/84) of first-year postgraduate trainees in paediatrics applied to participate, demonstrating high demand. 18 peer mentor–mentee pairs were matched. Peer mentors and mentees reported high satisfaction rates, acquisition of new and transferable skills and changed behaviours. All peer mentors intended to use the skills in their workplace and, later, as an educational supervisor.
Our programme represents a novel approach to meeting the demonstrated demand and the curriculum requirement for peer mentoring, and enabled peer mentors and mentees to develop a valuable and versatile skill set. To our knowledge, it is the first such programme in paediatrics and provides a feasibility model that may be adapted locally to allow education providers to offer this important experience to postgraduate trainees.
PMCID: PMC3913287  PMID: 24152570
Medical Education; General Paediatrics
20.  Efficient, Distributed and Interactive Neuroimaging Data Analysis Using the LONI Pipeline 
The LONI Pipeline is a graphical environment for construction, validation and execution of advanced neuroimaging data analysis protocols (Rex et al., 2003). It enables automated data format conversion, allows Grid utilization, facilitates data provenance, and provides a significant library of computational tools. There are two main advantages of the LONI Pipeline over other graphical analysis workflow architectures. It is built as a distributed Grid computing environment and permits efficient tool integration, protocol validation and broad resource distribution. To integrate existing data and computational tools within the LONI Pipeline environment, no modification of the resources themselves is required. The LONI Pipeline provides several types of process submissions based on the underlying server hardware infrastructure. Only workflow instructions and references to data, executable scripts and binary instructions are stored within the LONI Pipeline environment. This makes it portable, computationally efficient, distributed and independent of the individual binary processes involved in pipeline data-analysis workflows. We have expanded the LONI Pipeline (V.4.2) to include server-to-server (peer-to-peer) communication and a 3-tier failover infrastructure (Grid hardware, Sun Grid Engine/Distributed Resource Management Application API middleware, and the Pipeline server). Additionally, the LONI Pipeline provides three layers of background-server executions for all users/sites/systems. These new LONI Pipeline features facilitate resource-interoperability, decentralized computing, construction and validation of efficient and robust neuroimaging data-analysis workflows. Using brain imaging data from the Alzheimer's Disease Neuroimaging Initiative (Mueller et al., 2005), we demonstrate integration of disparate resources, graphical construction of complex neuroimaging analysis protocols and distributed parallel computing. The LONI Pipeline, its features, specifications, documentation and usage are available online (
PMCID: PMC2718780  PMID: 19649168
LONI Pipeline; software tools; resources; workflows; tool interoperability; data provenance; tool integration; neuroimaging
21.  Impact and Process Evaluation of Integrated Community and Clinic-Based HIV-1 Control: A Cluster-Randomised Trial in Eastern Zimbabwe 
PLoS Medicine  2007;4(3):e102.
HIV-1 control in sub-Saharan Africa requires cost-effective and sustainable programmes that promote behaviour change and reduce cofactor sexually transmitted infections (STIs) at the population and individual levels.
Methods and Findings
We measured the feasibility of community-based peer education, free condom distribution, income-generating projects, and clinic-based STI treatment and counselling services and evaluated their impact on the incidence of HIV-1 measured over a 3-y period in a cluster-randomised controlled trial in eastern Zimbabwe. Analysis of primary outcomes was on an intention-to-treat basis. The income-generating projects proved impossible to implement in the prevailing economic climate. Despite greater programme activity and knowledge in the intervention communities, the incidence rate ratio of HIV-1 was 1.27 (95% confidence interval [CI] 0.92–1.75) compared to the control communities. No evidence was found for reduced incidence of self-reported STI symptoms or high-risk sexual behaviour in the intervention communities. Males who attended programme meetings had lower HIV-1 incidence (incidence rate ratio 0.48, 95% CI 0.24–0.98), and fewer men who attended programme meetings reported unprotected sex with casual partners (odds ratio 0.45, 95% CI 0.28–0.75). More male STI patients in the intervention communities reported cessation of symptoms (odds ratio 2.49, 95% CI 1.21–5.12).
Integrated peer education, condom distribution, and syndromic STI management did not reduce population-level HIV-1 incidence in a declining epidemic, despite reducing HIV-1 incidence in the immediate male target group. Our results highlight the need to assess the community-level impact of interventions that are effective amongst targeted population sub-groups.
In cluster-randomised trial in Zimbabwe integrated peer education, condom distribution, and management of sexually transmitted infections did not reduce incidence of population-level HIV-1.
Editors' Summary
Sub-Saharan Africa has been hit heavily by HIV/AIDS, and Zimbabwe in particular has been very badly affected, with over one-fifth of its adult population infected with HIV. However, this proportion has been declining slowly in recent years, and the same trend has also been seen in a few other African countries. It is not clear whether these trends are related to changes in the way people behave, perhaps as a result of public health and prevention campaigns, or rather are due to changes in the natural spread of the HIV epidemic. However, there is considerable uncertainty about how we should carry out campaigns that try to get people to change their behavior. One possible approach for achieving behavior change involves peer education: that is, education carried out within the community, by at-risk community members themselves. Another approach involves tying together a set of related programs that deliver information and education through health clinics and directly in the community. Such programs are termed “integrated community and clinic-based HIV prevention.”
Why Was This Study Done?
The researchers wanted to find out whether providing integrated community and clinic-based strategies for HIV prevention in Eastern Zimbabwe could reduce the proportion of people within the community infected with HIV. If successful, then the strategies could be effective elsewhere, for example in other African countries where behavior patterns and the HIV epidemic are similar to the situation studied here.
What Did the Researchers Do and Find?
The research was done as a cluster-randomized trial. This means that different communities were assigned by chance to one of two trial arms, either an “intervention arm”, where the community and clinic-based strategies would be delivered, or a “control” arm which would not have additional services. Six pairs of communities in Eastern Zimbabwe were compared, each of which had its own health center. Control communities received the standard government services for preventing HIV. The other communities received a package of various additional strategies. These included education and condom distribution amongst sex workers and their clients; better services at sexually transmitted infection (STI) clinics (STIs can increase the risk of HIV infection); and educational HIV/AIDS open days at health centers. The researchers planned to compare, between the two arms, the number of people who became infected with HIV over the course of the trial. They found that there was no statistical difference in the number of people in the intervention arm who became infected with HIV over the course of the trial, as compared to people in the control arm. Men in the intervention communities were more likely to have effective treatment for STIs, but women were more likely to show risky behaviors, such as having sex at a younger age, and having unprotected sex. However, men in the intervention communities were more knowledgeable about HIV/AIDS than men in the control communities. One strategy in the intervention arm (delivery of education and condom distribution among sex workers and their clients) may have been less successful because of the economic situation at the time, which meant that the income-generating projects that were supposed to support this initiative were impossible.
What Do These Findings Mean?
Some of the results from this trial are encouraging, for example an improvement in male participants' knowledge and behavior. However, overall, the intervention did not have an impact on the HIV infection rate in the community. Some other trials have also shown similar results. These results mean that other strategies need to be developed, and tested, which will encourage people to change their behavior patterns and reduce the risk of getting HIV. However, trials such as this are very difficult to design, carry out, and interpret. In particular, if a complex intervention such as this fails, it is often hard to tell whether it did so because the intervention was not delivered successfully, or because it did not work.
Additional Information.
Please access these Web sites via the online version of this summary at
Information from Avert, an international HIV/AIDS charity, on HIV and AIDS in Zimbabwe
Information from UNAIDS, the United Nations Programme on HIV/AIDS, on strategies for HIV prevention
HIV/AIDS minisite from the World Health Organization
The Web site of the Manicaland HIV/STD Prevention Project discusses this project
PMCID: PMC1831737  PMID: 17388666
22.  Writing to Learn: An Evaluation of the Calibrated Peer Review™ Program in Two Neuroscience Courses 
Although the majority of scientific information is communicated in written form, and peer review is the primary process by which it is validated, undergraduate students may receive little direct training in science writing or peer review. Here, I describe the use of Calibrated Peer Review™ (CPR), a free, web-based writing and peer review program designed to alleviate instructor workload, in two undergraduate neuroscience courses: an upper- level sensation and perception course (41 students, three assignments) and an introductory neuroscience course (50 students; two assignments). Using CPR online, students reviewed primary research articles on assigned ‘hot’ topics, wrote short essays in response to specific guiding questions, reviewed standard ‘calibration’ essays, and provided anonymous quantitative and qualitative peer reviews. An automated grading system calculated the final scores based on a student’s essay quality (as determined by the average of three peer reviews) and his or her accuracy in evaluating 1) three standard calibration essays, 2) three anonymous peer reviews, and 3) his or her self review. Thus, students were assessed not only on their skill at constructing logical, evidence-based arguments, but also on their ability to accurately evaluate their peers’ writing. According to both student self-reports and instructor observation, students’ writing and peer review skills improved over the course of the semester. Student evaluation of the CPR program was mixed; while some students felt like the peer review process enhanced their understanding of the material and improved their writing, others felt as though the process was biased and required too much time. Despite student critiques of the program, I still recommend the CPR program as an excellent and free resource for incorporating more writing, peer review, and critical thinking into an undergraduate neuroscience curriculum.
PMCID: PMC3592621  PMID: 23493247
peer review, writing to learn; web-based learning; learning technology; Calibrated Peer Review
23.  The role of peer communication in the socialization of adolescents' pain experiences: a qualitative investigation 
BMC Pediatrics  2008;8:2.
Recurrent pain is a common complaint among adolescents. Children learn to resolve or cope with pain largely through family dynamics, particularly maternal influences. By adolescence, young people possess an array of pain behaviors, the culmination of multiple opportunities for modeling and reinforcement of attitudes and beliefs about pain. Adolescence is a time of increased autonomy characterized by, among other complex factors, significant increases in peer influence. Although peers are influential in health-risk behavior, little is known how peers impact adolescents' pain experience. The present study explored the role of peers in adolescents' attitudes toward pain, pain behaviors and over-the-counter analgesics.
Sixty-minute focus groups were conducted with a sample 24 junior high school students from Halifax, Nova Scotia, Canada (11 male: mean age = 13.45 years, range = 12–15 years; 13 female: mean age = 13.31 years, range = 12–15 years). Participants were randomly assigned to one of five same-gender focus groups designed to explore a wide breadth and depth of information. Sessions were run until theoretical data saturation. Textual data, from transcribed audiotapes, were analyzed with the constant comparative method.
Peer influences were apparent in how adolescents communicate about pain and how those communications effect pain expression. Overt pain responses to injury were primarily contextual and depended on perceived threats to peer-time and pain severity. Adolescents were intolerant of peers' pain behaviors when the cause was perceived as not severe. These attitudes impacted how adolescents responded to their own pain; males were careful not to express embarrassing pain in front of peers, females felt no restrictions on pain talk or pain expression. Evidence for peer influence on attitudes toward OTC analgesics was apparent in perceptions of over-use and ease of access. Findings are discussed within the context of social information-processing and gender role expectations.
Little research has addressed how young people experience pain within the context of the psychosocial influences that dominate during adolescence. The findings provide some insight into the role of peer influences via verbal and non-verbal communication, in adolescents' pain experience. This exploratory study is a necessary first step in understanding the socialization of adolescents' pain experiences.
PMCID: PMC2254410  PMID: 18190716
24.  Multi-Stage Open Peer Review: Scientific Evaluation Integrating the Strengths of Traditional Peer Review with the Virtues of Transparency and Self-Regulation 
The traditional forms of scientific publishing and peer review do not live up to all demands of efficient communication and quality assurance in today’s highly diverse and rapidly evolving world of science. They need to be advanced and complemented by interactive and transparent forms of review, publication, and discussion that are open to the scientific community and to the public. The advantages of open access, public peer review, and interactive discussion can be efficiently and flexibly combined with the strengths of traditional scientific peer review. Since 2001 the benefits and viability of this approach are clearly demonstrated by the highly successful interactive open access journal Atmospheric Chemistry and Physics (ACP, and a growing number of sister journals launched and operated by the European Geosciences Union (EGU, and the open access publisher Copernicus ( The interactive open access journals are practicing an integrative multi-stage process of publication and peer review combined with interactive public discussion, which effectively resolves the dilemma between rapid scientific exchange and thorough quality assurance. Key features and achievements of this approach are: top quality and impact, efficient self-regulation and low rejection rates, high attractivity and rapid growth, low costs, and financial sustainability. In fact, ACP and the EGU interactive open access sister journals are by most if not all standards more successful than comparable scientific journals with traditional or alternative forms of peer review (editorial statistics, publication statistics, citation statistics, economic costs, and sustainability). The high efficiency and predictive validity of multi-stage open peer review have been confirmed in a series of dedicated studies by evaluation experts from the social sciences, and the same or similar concepts have recently also been adopted in other disciplines, including the life sciences and economics. Multi-stage open peer review can be flexibly adjusted to the needs and peculiarities of different scientific communities. Due to the flexibility and compatibility with traditional structures of scientific publishing and peer review, the multi-stage open peer review concept enables efficient evolution in scientific communication and quality assurance. It has the potential for swift replacement of hidden peer review as the standard of scientific quality assurance, and it provides a basis for open evaluation in science.
PMCID: PMC3389610  PMID: 22783183
open evaluation; public peer review; open access publishing; interactive discussion; open peer commentary; transparency; self-regulation
25.  Health related virtual communities and electronic support groups: systematic review of the effects of online peer to peer interactions 
BMJ : British Medical Journal  2004;328(7449):1166.
Objective To compile and evaluate the evidence on the effects on health and social outcomes of computer based peer to peer communities and electronic self support groups, used by people to discuss health related issues remotely.
Design and data sources Analysis of studies identified from Medline, Embase, CINAHL, PsycINFO, Evidence Based Medicine Reviews, Electronics and Communications Abstracts, Computer and Information Systems Abstracts, ERIC, LISA, ProQuest Digital Dissertations, Web of Science.
Selection of studies We searched for before and after studies, interrupted time series, cohort studies, or studies with control groups; evaluating health or social outcomes of virtual peer to peer communities, either as stand alone interventions or in the context of more complex systems with peer to peer components.
Main outcome measures Peer to peer interventions and co-interventions studied, general characteristics of studies, outcome measures used, and study results.
Results 45 publications describing 38 distinct studies met our inclusion criteria: 20 randomised trials, three meta-analyses of n of 1 trials, three non-randomised controlled trials, one cohort study, and 11 before and after studies. Only six of these evaluated “pure” peer to peer communities, and one had a factorial design with a “peer to peer only” arm, whereas 31 studies evaluated complex interventions, which often included psychoeducational programmes or one to one communication with healthcare professionals, making it impossible to attribute intervention effects to the peer to peer community component. The outcomes measured most often were depression and social support measures; most studies did not show an effect. We found no evidence to support concerns over virtual communities harming people.
Conclusions No robust evidence exists of consumer led peer to peer communities, partly because most peer to peer communities have been evaluated only in conjunction with more complex interventions or involvement with health professionals. Given the abundance of unmoderated peer to peer groups on the internet, research is required to evaluate under which conditions and for whom electronic support groups are effective and how effectiveness in delivering social support electronically can be maximised.
PMCID: PMC411092  PMID: 15142921

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