cardiff university school of medicine ethics committee

sharing sensitive information, make sure youre on a federal Patel R, Judge A, Johansen A, Marques EMR, Griffin J, Bradshaw M, Drew S, Whale K, Chesser T, Griffin XL, Javaid MK, Ben-Shlomo Y, Gregson CL. Applications for ethics approval of a research project are considered by the ethics committee of the School where the lead applicant is based. An official website of the United States government. The authors have declared no competing interest. These applications must match the Level 1 Research Ethics criteria as set out here: Criteria for Research Ethics Committees (2014) (PDF 119 kB) Level 2 Research Ethics Applications for Review We are dynamic, innovative and forward looking, and recognised for our excellence in learning, teaching and research. The School of Medicine Research Ethics Committee reviews applications from staff and students from the School of Medicine TCD. 1136855, Career support for international students, Helping young people reach their potential, Educational resources and activities for teachers, schools and colleges, all PhD and Professional Doctorate student projects, members of staff undertaking research not requiring HRA ethical approval, masters students (excluding MSc Advanced Practice). Dr Claire Kelly. Keywords: endstream endobj startxref Research and Development is embedded across the Health Board and we are a leading centre for clinical trials and other studies in Wales. Tel: 0113 34 31642. MKJ has received honoraria, unrestricted research grants, travel and/or subsistence expenses from: Amgen, Consilient Health, Kyowa Kirin Hakin, UCB, Abbvie. By helping to clarify ethical issues and values, facilitating discussion, and providing expertise and educational resources, ethics consultants promote respect for the values, needs, and interests of all participants, especially when there is disagreement or uncertainty about treatment decisions. Review of consent forms in current use revealed great variability in length and content, and sometimes very technical language; therefore, a standard information sheet and generic consent form are proposed. Hip fracture in adults: Quality standard [QS16]. Physicians and other institutional stakeholders should explain their reasoning when they choose not to follow the committees recommendations in an individual case. <>>> Bookshelf %PDF-1.5 Methods and analysis: Sport contact: Staff and students at Cardiff Metropolitan University must conform with the requirements of the Human Tissue Act in all activities involving the storage of human tissue. 2 0 obj . School research ethics committees will assess such applications on a case by case basis. members of staff undertaking research not requiring HRA ethical approval. The COVID-19 pandemic has posed a major challenge to the resilience of services and interviews will explore strategies used to adapt and innovate. University of Leeds Re-use permitted under CC BY. Kate Jefferies in the first instance. Bethesda, MD 20894, Web Policies Projects that are considered low risk may be eligible for proportionate review. of our graduates were in employment and/or further study, due to start a new job or course, or doing other activities, such as travelling. This report from a joint Task Force of the European Heart Rhythm Association and the Regulatory Affairs Committee of the European Society of . Careers. Royal College of Physicians . School of Dentistry For permissions, please email: journals.permissions@oup.com. The Department of Medical Ethics & Health Policy is based in the Perelman School of Medicine at the University of Pennsylvania. 22086/VAC_/Versus Arthritis/United Kingdom. Lessons Learned from the COVID-19 Pandemic: Emphasizing the Emerging Role and Perspectives from Artificial Intelligence, Mobile Health, and Digital Laboratory Medicine. China 2015-013-01 : Chen, Yan The Second Affiliated Hospital of Zhejiang University School of . . UK National Screening Committee (UK NSC) . Ethics committees, or similar institutional mechanisms, offer assistance in addressing ethical issues that arise in patient care and facilitate sound decision making that respects participants values, concerns, and interests. We analyzed cross-sectional data of 292 SCA3 mutation carriers including 57 pre-ataxic individuals, and 108 healthy controls from the European . Information regarding ethical approval for clinical research involving human participants, material and/or data can be accessed via the NHS Health Research Authority. >g&N/3k;QE%R/F>8~-+DJoF1Ao(}DfV$I R' 7~m=$xID$}0k0CZ"0C-6Fp`pFL FpQ}r Ux0!)#! Shaded boxes indicate variables which will be included in analyses. St James University Hospital : 617-525-4535 Fax: 617-525-4533 e-mail: cmorton@bwh . sportethics@cardiffmet.ac.uk Health contact: Unauthorized use of these marks is strictly prohibited. In cases where the lead applicant is not based in a Cardiff Met School, or in PDR, an application will be referred to the most relevant School committee, or direct to UEC. National Library of Medicine Special interests in playing and coaching cricket and squash. This system-wide understanding will inform the development, in partnership with key national stakeholders, of an 'Implementation Toolkit' to inform and improve commissioning and delivery of hip fracture services. When an intervention no longer helps to achieve the patients goals for care or desired quality of life, it is ethically appropriate for physicians to withdraw it. A decision is communicated to the applicant within 5 working days of the date of the meeting or completion of proportionate reviews. 1 "A form of Practical Machinery": The origins of Research Ethics Committees in the UK: 1967-1972. Registered charity no. In addition to facilitating decision making in individual cases (as a committee or through the activities of . Enabling individuals to donate nonvital organs is in keeping with the goals of treating illness and relieving suffering so long as the benefits to both donor and recipient outweigh the risks to both. Informed consent to medical treatment is fundamental in both ethics and law. Preserving opportunity for physicians to act (or to refrain from acting) in accordance with the dictates of conscience is important for preserving the integrity of the medical profession as well as the integrity of the individual physician; Physicians freedom to act according to conscience is not unlimited; They are expected to provide care in emergencies, honor patients informed decisions to refuse life-sustaining treatment, respect basic civil liberties and not discriminate against patients on the basis of arbitrary characteristics. ESC working group on e-cardiology position paper: use of commercially available wearable technology for heart rate and activity tracking in primary and secondary cardiovascular prevention-in collaboration with the European Heart Rhythm Association, European Association of Preventive Cardiology, Association of Cardiovascular Nursing and Allied Professionals, Patient Forum, and the Digital Health Committee. Membership includes a strong nursing component, and a nurse is often part of the three-co-chair leadership. f RNl@ l)2!`v f!DU"DD }`6j1`"J@X&F PfPm| All rights reserved. Our policies are designed to enable researchers to carry out their research effectively, whilst ensuring that it is consistent with the highest standards of integrity and ethics. official website and that any information you provide is encrypted In addition to facilitating decision making in individual cases (as a committee or through the activities of individual members functioning as ethics consultants), many ethics committees assist ethics-related educational programming and policy development within their institutions. Phase 1 The first part of our study explored how frequently C21 FBP was used and if there were patterns in the data indicating user preferences for certain material. The University Ethics Committee (UEC) has ultimate responsibility for the maintenance and monitoring of ethics governance at the institution. 2022 Aug 2;51(8):afac183. Accessibility 479 0 obj <> endobj Griffin XL, Parsons N, Achten J, et al. endobj Multiple hospital organisational factors are associated with adverse patient outcomes post-hip fracture in England and Wales: the REDUCE record-linkage cohort study. Advances in telemedicine for the management of the elderly cardiac patient. Before endstream endobj startxref Skilled in innovation, public speaking, ICT and safeguarding children. The .gov means its official. Jensen MT, Treskes RW, Caiani EG, Casado-Arroyo R, Cowie MR, Dilaveris P, Duncker D, Di Rienzo M, Frederix I, De Groot N, Kolh PH, Kemps H, Mamas M, McGreavy P, Neubeck L, Parati G, Platonov PG, Schmidt-Trucksss A, Schuuring MJ, Simova I, Svennberg E, Verstrael A, Lumens J. Eur Heart J Digit Health. invested in our biggestcampus upgrade for ageneration. , Contact: <> *Include if two or more of the four reviewers categorised variable as include or possible, otherwise exclude; any lack of consensus resolved by a third reviewer (the principal investigator). Copyright Cardiff University. 499 0 obj <>stream The application form and guidance notes can be accessed under the 'Useful Documents' below. An insistence on the highest ethical standards underpins our research, and the welfare of research subjects is paramount. 4 Department of Trauma and Orthopaedics, Southmead Hospital, North Bristol NHS Trust, Bristol, UK. Ethics committees, or similar institutional mechanisms, offer assistance in addressing ethical issues that arise in patient care and facilitate sound decision making that respects participants' values, concerns, and interests. 2022 Nov 8;12(11):e067161. Draw on the resources of appropriate professional organizations, including guidance from national specialty societies, to inform committee recommendations. This site needs JavaScript to work properly. Those patients whose health insurance does not cover assisted reproductive services may also be financially vulnerable. Federal government websites often end in .gov or .mil. A charter for medical schools to prevent and address racial harassment Guidance on how to implement the charter in your medical school Supportive case studies, testimonials from students, and a glossary on what constitutes racial harassment Who has signed up Thank you to the below schools who have committed to the charter. (Intercalated) for Medical Students. 20 School of Medicine, Cardiff University, Cardiff, UK. School of Psychology students and staff should submit their applications electronically via theethics pages of the School website. 2021 Oct;20(3):318-335. doi: 10.1002/wps.20883. access to CSAD students and staffonly), CSESP Framework for ethics approval of research projects, CSM Framework for ethics approval for research project, Contact:Prof Philip James Structure of the multi-level models used in the statistical analyses in the REducing unwarranted variation in the Delivery of high qUality hip fraCture services in England and Wales study. Competing interests: None for RP, SD, XLG, TJ, JG, MB, KW, ECB, YB-S, RG-H, CLG. 10.1007/s00198-020-05404-1 In view of the development of targeted therapies for SCA3, precise knowledge of stage-dependent fluid and MRI biomarker changes is needed. Adopt and adhere to policies and procedures governing the committee and, where appropriate, the activities of individual members as ethics consultants, in keeping with medical staff by-laws. Today the Code is widely recognized as authoritative ethics guidance for physicians through its Principles of Medical Ethics interpreted in Opinions of AMAs Council on Ethical and Judicial Affairs that address the evolving challenges of contemporary practice. Models of care for the delivery of secondary fracture prevention after hip fracture: a health service cost, clinical outcomes and cost-effectiveness study within a region of England. Spinocerebellar ataxia type 3/Machado-Joseph disease (SCA3) is the most common autosomal dominant ataxia. The mixed-methods REducing unwarranted variation in the Delivery of high qUality hip fraCture services in England and Wales (REDUCE) study, aims to determine key organisational factors to target to improve patient care. The R&D office receives funding from . official website and that any information you provide is encrypted School of Psychology (SoPREC) School of Psychology students and staff should submit their applications electronically via the ethics pages of the School . Uphold the principles to which the institution is committed. )kC,^u+.c,{:pG%,2GS^NKfK`Ul"dpU`NsBJ2,i e,nH]421tvE+t+2C{ Clarendon Way Assisted reproduction offers hope to patients who want children but are unable to have a child without medical assistance. School of Healthcare Sciences, Cardiff University, Heath Park Campus, Cardiff, CF14 4XN, Copyright Cardiff University. Physicians should engage patients whose capacity is impaired in decisions involving their own care to the greatest extent possible, including when the patient has previously designated a surrogate to make decisions on his or her behalf. Author(s) (or their employer(s)) 2021. Torous J, Bucci S, Bell IH, Kessing LV, Faurholt-Jepsen M, Whelan P, Carvalho AF, Keshavan M, Linardon J, Firth J. List of schools Competing Interest Statement. Published by BMJ. Registered charity no. Chapter 10 Ethics at Cardiff School of Psychology. School of Medicine Level 1 Trinity Biomedical Sciences Institute Trinity College Dublin 152-160 Pearse Street Dublin 2 Ireland, View the contact page for more contact and location information, School of Medicine > Research > Research Ethics, Trinity College Dublin, The University of Dublin, Faculty of Health Sciences Research Ethics Committee, Online Learning Assistance Resources - Sharepoint Local Access, Fitness to Practice Policy (local access), Postgraduate Course - MSc Sports and Exercise Medicine, Clinical Neurophysiology and Neural Engineering, Neuropharmacology and New Drug Development, Neuropsychology and Cognitive Neuroscience, Practice Education Protocols and Essential Information, Assessing the numbers, needs, risks, and evidence based interventions for children impacted by parental substance misuse within the South East Region, Next Generation Research, the prevalence of children and young people impacted by parental substance misuse across the Tallaght community, Addiction Nursing Models for Best Practice: A review of the addiction nursing role, An analysis of childhood depression, obesity and school performance among urban disadvantaged children, Routine health surveillance data: a retrospective longitudinal analysis of opioid addiction treatment among older adults, Hidden Harms and Hidden Data: Estimating the number of children of parents who misuse substances and exploring risk and protective factors of young people with parents who used heroin, An investigation of how the role of the family influences the health of the school-aged child from a disadvantaged area, The Centre for Health Policy and Management, Mapping the Pathways to Universal Health Care, MSc Biomedical Sciences of Education & Social Policy. @{t={@+`C2bdqE<2`)!>LAQ)T\ The School of Medicine Research Ethics Committee reviews applications from staff and students from the School of Medicine TCD. . This study was approved: quantitative study by London, City and East Research Ethics Committee (20/LO/0101); and qualitative study by Faculty of Health Sciences University of Bristol Research Ethics Committee (Ref: 108284), National Health Service (NHS) Health Research Authority (20/HRA/71) and each NHS Trust provided Research and Development approval. If your project is eligible it will be considered outside of the meeting and submission dates for the full ethics committee. Cardiff University Medicine Publications & Citations Other Cardiff University pages Unauthorized use of these marks is strictly prohibited. doi: 10.1136/bmjopen-2022-067161. Dabla PK, Gruson D, Gouget B, Bernardini S, Homsak E. EJIFCC. Under the direction of the department chair, Ezekiel Emanuel, MD, PhD, the Department stands as one of the premier institutions of research and education in medical ethics and health policy in the world. Cardiff University uses the MMI (Multiple Mini Interviews) format for Medicine interviews. Federal government websites often end in .gov or .mil. The meetings are held on the first Tuesday of every month. Donation of nonvital organs and tissue from living donors can increase the supply of organs available for transplantation, to the benefit of patients with end-stage organ failure. Last year, MMIs for 2022 entry were held online. Hip fracture care pathway flows from prehospital care, through the hospital superspell, through to any occurring hospital activity in the year after hip fracture. . Age Ageing 2016;45:23642. -, Hawley S, Javaid MK, Prieto-Alhambra D, et al. Cynthia C. Morton, Ph.D. Brigham and Women's Hospital Harvard Medical School 77 Avenue Louis Pasteur Boston, MA 02115, USA Tel. Funding Statement. Strong passion in community and volunteering with some experience in charity work and play therapy. %PDF-1.5 % There is an opportunity for students to study abroad, select their own components and intercalate. UEC is administered by Research & Innovation Services and any queries regarding the work of the committee should be directed to Complex organisational factors influence multidisciplinary care for patients with hip fractures: a qualitative study of barriers and facilitators to service delivery. % Ensure that all stakeholders have timely access to the committees services for facilitating decision making in nonemergent situations and as feasible for urgent consultations. 2021 Dec 28;19(1):312. doi: 10.3390/ijerph19010312. The AMA was founded in part to establish the first national code of medical ethics. Ethics Committee for Clinical drug, Equipment and New Medical Technology of The First Affiliated Hospital; Sun-Yat Sen University Room110,F1, Office building, Longzhu Mansion, No.5, Zhu Si : Gang Er Ma Lu . In particular, staff and students should be aware of and adhere to the institution's Code of Practice for obtaining Informed Consent. The Human Tissue Act 2004 established the HTA to regulate activities concerning the removal, storage, use and disposal of human tissue. Flow diagram used to determine organisational data metrics. Associate Professor of Medical Sciences (in Medicine and in Medical Humanities and Ethics) ms4075@cumc.columbia.edu Alexis Walker, PhD Assistant Professor aw3350@cumc.columbia.edu Research Associates Caitlin McMahon, PhD, MPH Project Director cem2173@cumc.columbia.edu Show more Mika Caruncho, MSW, MPH Research Associate mc5176@cumc.columbia.edu Make clear to patients, physicians, and other stakeholders that the institutions defining principles will inform the committees recommendations. Cardiff's five-year Medicine programme centres around case-based learning, which involves more patient contact, small group settings and earlier finals. Our SRECs report to the University's Open Research Integrity and Ethics Committee, which has overarching responsibility for ensuring that research is conducted in accordance with the highest ethical standards. TC is the British Orthopaedic Association (BOA) representative and sits on the board of the Falls and Fragility Fracture Audit Project (which includes the National Hip Fracture Database), he helped set up and perform many of the BOA multidisciplinary peer reviews for hip fractures, he has design and educational contracts with Stryker, Acumed and Swemac. Learn about the historical development of these groups, their current roles in the medical community and how educators can prepare future physicians for ethical challenges they will face in . Faculty of Medicine and Health Research Ethics & Governance Administrator National Library of Medicine Research can only commence for projects when ethical approval has been granted. Orders not to attempt resuscitation (DNAR orders) direct the health care team to withhold resuscitative measures in accord with a patients wishes. x]o82Y oH){1n)tt=NKT*uLyx}|;z6v'gW}~nnvlO~njZOp?%da@AYEL2b9_86fIww[( ;/|*Wf[0la4nU; 0. Application and Lead Reviewer comments are considered by the Committee or the Chair/ nominated person for proportionate review. To be effective in providing the intended support and guidance in any of these capacities, ethics committees should: Ethics committees that serve faith-based or other mission-driven heath care institutions have a dual responsibility to: AMA Principles of Medical Ethics: II, IV, VII. All research ethics applications matching the Level 2 criteria must be submitted to the Faculty Research Ethics Committee. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Published on behalf of the European Society of Cardiology. Please ensure that you are using the most recent version of the form before starting your application, to avoid having it returned to you. 2021 Jun 29;32(2):224-243. eCollection 2021 Jun. eCollection 2021 Mar. Recovery of health-related quality of life in a United Kingdom hip fracture population. Third-party providers of monitoring platforms may act as data processors. Be structured, staffed, and supported appropriately to meet the needs of the institution and its patient population. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Remote Monitoring of CIEDs-For Both Safety, Economy and Convenience? Ethics and dissemination: Ethics Committees in Health Care Institutions, Decisions for Adult Patients Who Lack Capacity, Withholding or Withdrawing Life-Sustaining Treatment, Orders Not to Attempt Resuscitation (DNAR), Sedation to Unconsciousness in End-of-Life Care, Transplantation of Organs from Living Donors. Fox F, Drew S, Gregson CL, Patel R, Chesser T, Johansen A, Javaid MK, Griffin XL, Gooberman-Hill R. BMC Musculoskelet Disord. An official website of the United States government. 0 Room 9.29, Worsley Building Main research topics: Health Science, Oncology and Cancer research, Surgery, Immunology, Psychiatry. In giving or withholding permission for medical treatment for their children, parents/guardians are expected to safeguard their childrens physical health and well-being and to nurture their childrens developing personhood and autonomy; Physicians should evaluate minor patients to determine if they can understand the risks and benefits of proposed treatment; The more mature a minor patient is, the better able to understand what a decision will mean, and the more clearly the child can communicate preferences, the stronger the ethical obligation to seek minor patients assent to treatment. Organisational domains are indicated by green boxes, and these are mapped to the pathway. 0 Specific queries regarding the ethics approval process should therefore be directed to the appropriate School contact in the first instance. (Professor of Clinical Ethics, Warwick Medical School) . | Learn more about Luke Morgan's work experience, education, connections . Manufacturers should always collect and process the minimum amount of identifiable data necessary, and wherever feasible have access only to pseudonymized data. Age Ageing. The University operates a two-tier ethical review model by having a University-wide committee and School Research Ethics Committees (SRECs). <> This includes ensuring that research involving human participants carried out by staff and students conforms to the highest ethical standards as well as safeguarding the general principles laid down in the Cardiff Metropolitan University Ethics Framework. hXo8WZam},iKbGJv'Mf;"ZHs)%Ja3 N8H"DB"$41!aq1#N; J8PS F)X Students should consult their supervisor for meeting dates for the relevant School committees. Unable to load your collection due to an error, Unable to load your delegates due to an error. School committees meet on a regular basis although meetings may be less frequent outside term time. Self-employed cardiologists also are data controllers. - U)ofQNlV$eyG] This report from a joint Task Force of the European Heart Rhythm Association and the Regulatory Affairs Committee of the European Society of Cardiology (ESC) recommends a common legal interpretation of the GDPR. 3 0 obj Provides training for staff and students on research integrity and good practice, misconduct, ethics and governance and is the named point of contact for research integrity matters. Cardiff University - Centre for Trials Research. Accessibility stream . 8600 Rockville Pike HHS Vulnerability Disclosure, Help Prof Edmund Prakash, Contact: At Cardiff University, a devolved or two-tiered system of ethics review has been created in which a top-level university research ethics committee provides policy advice to and oversight of school . Institute of Medical Genetics Cardiff University Heath Park, Cardiff CF14 4XN, UK Tel. Level 7 Wellcome Trust Brenner Building For complex ethical issues in medicine, ethics committees and consultations offer a solutions-oriented approach that is essential to modern health care. endstream endobj 1162 0 obj <>/Metadata 46 0 R/Outlines 80 0 R/PageLayout/OneColumn/Pages 1159 0 R/StructTreeRoot 145 0 R/Type/Catalog>> endobj 1163 0 obj <>/ExtGState<>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 1164 0 obj <>stream hbbd``b`f@QH4XA@E&FF2 || 10.1093/ageing/afv204 FOIA Cybersecurity vulnerabilities have been reported concerning the security of transmission of data between a patient's device and the transceiver, so manufacturers should use secure communication protocols. Int J Environ Res Public Health. It has particular implications for the remote monitoring of cardiac implantable electronic devices (CIEDs). Bone Joint J 2015;97-B:37282. J Geriatr Cardiol. National hip fracture database (NHFD) annual report 2019. HHS Vulnerability Disclosure, Help Would you like email updates of new search results? DREC website, Applications should be submitted viaRachel De Souza Bookshelf 1227 0 obj <>stream . Find out more about the rules and regulations we adhere to when conducting clinical research. 2023 Feb 16;24(1):128. doi: 10.1186/s12891-023-06164-9. The Cardiff Metropolitan University Ethics Committee is a Sub-Committee of The https:// ensures that you are connecting to the Ethical approval is an essential part of conducting research. From 2002-2013 Ruth directed the ESRC Centre for Economic and Social Aspects of Genomics (Cesagen): a Lancaster-Cardiff collaboration. and transmitted securely. Committee membership should represent diverse perspectives, expertise, and experience, including one or more community representatives. Cardiologists who care for patients with CIEDs that are remotely monitored should be aware of these issues. There are four sub-committees of the Faculty of Medicine and Health Research Ethics Committee: Applications should be submitted viaJulie McDermott Tel: 0113 3436210/ 39253 %%EOF Jane Holmes. Bethesda, MD 20894, Web Policies Province 510080 . Email: A.Walsh3@exeter.ac.uk Phone: 01392 726621 Pam Baxter Research Governance Manager (Health and Social Care) %%EOF Email: psyc-ethicssubmissions@leeds.ac.uk, Faculty of Engineering and Physical Sciences, Data protection and freedom of information, Approaching and recruiting research participants, LTHT/UoL Human Tissue Act Standard Operating Procedures, Biological Sciences Faculty Research Ethics Committee, Business, Environment and Social Sciences (AREA) Research Ethics Committee, Medicine and Health Faculty Research Ethics Committee (inc four School RECs), Reviewers Comments Example Standard Responses Common Issues, 2023 University of Leeds, Leeds, LS2 9JT. : (+44) 2920-744062 Fax: (+44) 2920-746551 e-mail: cooperDN@cardiff.ac.uk. Clipboard, Search History, and several other advanced features are temporarily unavailable. The University operates a two-tier ethical review model by having a University-wide committee and School Research Ethics Committees (SRECs). Lisa Nelson, associate professor in Pitt's Graduate School of Public and International Affairs and Philosophy of Science Center fellow, has been selected as co-director of the Collaboratory Against Hate, along with Mark S. Kamlet, professor of economics and public policy at Carnegie Mellon University with appointments in the Institute for Politics and Strategy, Heinz College and the . Jeremy Chalk. EMRM has received funds for an unrelated independent study sponsored by CeramTec UK limited. Please enable it to take advantage of the complete set of features! Adam Hedgecoe Department of Sociology School of Social Sciences and Cultural Studies University of Sussex Falmer Brighton BN1 9QN Telephone: 01273 877633 amh21@sussex.ac.uk Each School has developed a framework for ethics approval of research projects, select the relevant one from the drop down boxes below. Ethics applications being managed in the proportionate review will still receive 2 ethical reviews and evaluation by the chair/ nominated person. Patients' outcomes are partly explained by patient-level risk factors, but it is hypothesised that organisational-level factors account for the persistence of unwarranted variation in outcomes.

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