A lot has been written lately about preprints even though they are not new. Here at Nursing Research, we have had a few queries about publishing papers previously posted on preprint servers. For readers who are unaware, a preprint is a draft of a scientific paper that precedes formal peer review and subsequent publication in a peer-reviewed journal. The preprint, typically found on a web-based preprint server before a paper is published in a journal, is usually available at no cost in a noncopyedited or typeset version. The initial purpose of preprints was to gather input or feedback about the work before final publication. Some disciplines have used a form of preprints well before there were web-based servers to house them; online preprint servers have been in existence since at least the mid-1990s and are widely used in classical sciences such as mathematics and physics. Preprints, however, and preprint servers for clinical research reports remain largely underused by scientists in health-related fields.

Preprint servers are online platforms where authors post their preprint manuscripts. Examples of preprint servers include arXiv (pronounced "archive"), primarily for physics, mathematics, and engineering; ChemRxiv for chemistry; Peer J Preprints for biological, environmental, medical, health sciences, and computer sciences; and psyRxiv (psychological sciences). There are reasons for the limited use of preprints and the absence of preprint servers for clinical sciences, including legitimate concerns about releasing clinical research results before and, perhaps, without adequate peer review. Recently, however, medRxiv was launched to host preprints from the clinical sciences, including nursing.

You may be wondering why you would consider publishing your work as a preprint. In fact, there are a few good arguments for doing so (da Silva, 2018). Because preprint servers were first designed to provide a venue for authors to receive comments and other feedback about their work before submission to a scientific journal, there is, reportedly, engagement from the scientific community about the work that may improve it before formal peer review and publication. Additionally, the time to publication of preprint is significantly shorter (days) than the typical time to publication in traditional research journals (months). Thus, scientific results are more quickly circulated. Preprints are also citable, much like dissertations and proceedings abstracts that have typically undergone less formal peer review. Most preprints eventually become published peer-reviewed papers (Abdill & Blekhman, 2019). Thus, when a preprint is cited, assuming it is on a reputable preprint server, the citation will link to an updated version of the preprint that displays a link to the final, peer-reviewed published version.

Preprint publication is not, however, without its critics or at least not without concerned onlookers (da Silva, 2018; Maslove, 2018). There is particular concern about the publication of non-peer-reviewed health science, especially because the lay public seems intent on obtaining health information from unexamined sources (i.e., Twitter), aided and abetted by unscrupulous authors who advocate their own work in nonscientific venues. The public access to invalid, poorly vetted, or false science could cause harm in ways we cannot really anticipate. Moreover, from a scientific review perspective, authors who post preprints hoping for feedback on their work may receive little or none or may receive feedback from questionable sources or from those who are not really knowledgeable enough to provide scientific review. Thus, authors planning to publish preprints should do so with awareness that a preprint is not a final publication.

For those readers curious enough to have read this far, it is important to know that the National Institutes of Health (NIH) encourages its funded investigators to post interim research products arising from NIH funding in repositories such as preprint servers to speed the dissemination and enhance the rigor of their work (NIH, 2017). There are some specific parameters scientists need to follow to meet NIH requirements about posting research results on preprint servers or similar platforms. These parameters include posting so that the content is findable, accessible, and reusable, including access by permission (e.g., use of Creative Commons licenses) and technology (e.g., application program interfaces). Additionally, the host sites or servers should have clear policies about plagiarism, competing interests, and misconduct; maintain a record of changes or revisions to the posted material; have links to the final peer-reviewed published materials; and have a robust archiving strategy for long-term preservation and access.

Some scientists have suggested a mandate for publicly funded research to use preprint servers for early dissemination of research results (Sever, Eisen, & Inglis, 2019). Calling for a "Plan U" (where U = universal), these scientists suggest that the early availability of research on preprint servers allows other researchers to begin using the results immediately in their own work. They also claim that preprints help authors improve manuscripts by enabling more widespread public and private feedback than occurs during traditional peer review. In fact, they argue that community feedback may improve subsequent peer review by addressing shortcomings in early versions of manuscripts. Plan U assumes that most preprints will eventually be peer-reviewed in traditional journals; this is an important point as a preprint is not a final version of a scientific study. Thus, the findings remain tentative, and the product, the preprint, would not be considered a final manuscript for many purposes, including tenure or promotion review. The preprint remains a draft, albeit perhaps, a good one.

It is the author's responsibility to completely understand the consequences of using a preprint server prior to formal submission of a research report. Authors also need to know whether or not a journal will accept submissions that have been posted as preprints. At Nursing Research, we do accept manuscripts that have been posted on preprint servers. We do not consider these unrefereed manuscripts posted by an author on a preprint server to be a prior publication, provided that the following conditions are met: (a) during submission, authors must acknowledge to have placed a version of the manuscript on a preprint server deposition and provide any associated accession numbers or DOIs (digital object identifier); (b) versions of a manuscript that have been altered as a result of the peer review process may not be deposited; (c) the preprint version itself cannot have been indexed in MEDLINE or PubMed; (d) upon publication, authors are responsible for updating the archived preprint with a DOI and link to the published version of the article.

Careful consideration of when and where to publish the results of your research is always needed. Preprints, like many other forms of publication, require a thoughtful approach. In the end, final publication in a high-quality peer-reviewed journal remains the "gold standard" for scientific products. So yes, we support preprints with caveats and with the expectation that all research results are eventually rigorously peer-reviewed and published in high-quality format.

REFERENCES