Evaluating interventions for informed consent for surgery (ICONS) :Protocol for the development of a core outcome set

Abstract Background The concept of informed consent is fundamental to medical practice. Shortcomings in the process can lead to patient complaints, litigation, unmet expectations and poor outcomes. Consent research has focused on developing tools to improve patient recall and understanding. However, the definitions, methods of measurement and timing of measurement vary widely across the studies that have been done. Although a Cochrane review has reported that many of these interventions appear to work, the high level of heterogeneity in outcome reporting prevents the identification of those interventions that work best and why they do so. It is also not clear which outcomes are most important to each party involved in the consent process and why. Methods/design This project will develop a core outcome set for assessing the effects of interventions aimed at improving informed consent for surgery and other invasive procedures for adult patients with the capacity to consent for themselves. We will conduct a systematic review of the qualitative and quantitative literature to identify outcomes used to date in consent research and map these into domains. A series of semi-structured key stakeholder interviews will also be used to identify relevant outcomes. These processes will produce a list of potential outcomes for assessing the effects of interventions to improve consent, which will be refined through an international Delphi survey and consensus webinars involving key stakeholders to produce the core outcome set. Discussion The ICONS study aims to develop a core outcome set for use in trials and reviews of interventions designed to improve the informed consent process for surgery and other invasive procedures. Our aim is that this core outcome set will reduce the level of selection and reporting bias in consent research and help clinicians to compare tools to improve consent

“Oh! How modern! And... are you ok with that?": Consensually non-monogamous people’s experiences when accessing sexual health care.

The current research explored consensually non-monogamous peoples’ experiences accessing sexual healthcare. Using a mixed method approach, a sample of 67 consensually non-monogamous individuals (48% Polyamorous; 42% Relationship Anarchy/Solo polyamory; 6% Swingers; 4% Uncategorized) reported having significantly lower rates of trust in healthcare professionals compared to standardized scores. Sixty-three percent of participants reported disclosing their relationship status to a clinician when accessing sexual health services, whereas 37% sometimes or never disclosed. Qualitative responses identified that some participants reported a willingness to be open about their relationships, but many chose to “pass” as monogamous to both simplify and streamline their interactions as well as to avoid potential stigma. Participants reported a wide range of experiences with clinicians from those who were accepting and professional, to some who displayed prejudice and withheld treatment. This research outlines some of the experiences and challenges presented to consensual non-monogamists when accessing sexual healthcare as well as providing suggestions for clinicians to help remove some of the barriers to appropriate patient care

Structural Performance Monitoring Using a Dynamic Data-Driven BIM Environment

Structural health monitoring data has not been fully leveraged to support asset management due to a lack of effective integration with other datasets. A Building Information Modelling (BIM) approach is presented to leverage structural monitoring data in a dynamic manner. The approach allows for the automatic generation of parametric BIM models of structural monitoring systems that include time-series sensor data; and it enables data-driven and dynamic visualisation in an interactive 3D environment. The approach supports dynamic visualisation of key structural performance parameters, allows for the seamless updating and long-term management of data, and facilitates data exchange by generating Industry Foundation Classes (IFC) compliant models. A newly-constructed bridge near Stafford, UK, with an integrated fibre-optic sensor based monitoring system was used to test the capabilities of the developed approach. The case study demonstrated how the developed approach facilitates more intuitive data interpretation, provides a user-friendly interface to communicate with various stakeholders, allows for the identification of malfunctioning sensors thus contributing to the assessment of monitoring system durability, and forms the basis for a powerful data-driven asset management tool. In addition, this project highlights the potential benefits of investing in the development of data-driven and dynamic BIM environments

Searching for the Kaluza-Klein Graviton in Bulk RS Models

The best-studied version of the RS1 model has all the Standard Model particles confined to the TeV brane. However, recent variants have the Standard Model fermions and gauge bosons located in the bulk five-dimensional spacetime. We study the potential reach of the LHC in searching for the lightest KK partner of the graviton in the most promising such models in which the right-handed top is localized very near the TeV brane and the light fermions are localized near the Planck brane. We consider both detection and the establishment of the spin-2 nature of the resonance should it be found.Comment: 17 pages, 6 figures - JHEP published version, figures added, branching ratio correcte

Canadian Hydrogen Intensity Mapping Experiment (CHIME) Pathfinder

A pathfinder version of CHIME (the Canadian Hydrogen Intensity Mapping Experiment) is currently being commissioned at the Dominion Radio Astrophysical Observatory (DRAO) in Penticton, BC. The instrument is a hybrid cylindrical interferometer designed to measure the large scale neutral hydrogen power spectrum across the redshift range 0.8 to 2.5. The power spectrum will be used to measure the baryon acoustic oscillation (BAO) scale across this poorly probed redshift range where dark energy becomes a significant contributor to the evolution of the Universe. The instrument revives the cylinder design in radio astronomy with a wide field survey as a primary goal. Modern low-noise amplifiers and digital processing remove the necessity for the analog beamforming that characterized previous designs. The Pathfinder consists of two cylinders 37\,m long by 20\,m wide oriented north-south for a total collecting area of 1,500 square meters. The cylinders are stationary with no moving parts, and form a transit instrument with an instantaneous field of view of $\sim$100\,degrees by 1-2\,degrees. Each CHIME Pathfinder cylinder has a feedline with 64 dual polarization feeds placed every $\sim$30\,cm which Nyquist sample the north-south sky over much of the frequency band. The signals from each dual-polarization feed are independently amplified, filtered to 400-800\,MHz, and directly sampled at 800\,MSps using 8 bits. The correlator is an FX design, where the Fourier transform channelization is performed in FPGAs, which are interfaced to a set of GPUs that compute the correlation matrix. The CHIME Pathfinder is a 1/10th scale prototype version of CHIME and is designed to detect the BAO feature and constrain the distance-redshift relation.Comment: 20 pages, 12 figures. submitted to Proc. SPIE, Astronomical Telescopes + Instrumentation (2014

Spectacles of intimacy? Mapping the moral landscape of teenage social media

This paper explores young people's expressed concerns about privacy in the context of a highly mediated cultural environment, mapping social media practices against axes of visibility and participation. Drawing on interdisciplinary conceptual resources from both the humanities and social sciences, we use ‘spectacles of intimacy’ to conceptualise breaches of privacy, mapping an emergent moral landscape for young people that moves beyond concerns with e-safety to engage with the production and circulation of audiences and value. The paper draws on data from a methodological innovation project using multi-media and mixed methods to capture lived temporalities for children and young people. We present a model that captures a moral landscape shaped by emotional concerns about social media, the affordances of those media and affective discourses emerging from young people's use of the media

Is hybridization a source of adaptive venom variation in rattlesnakes? A test, using a crotalus scutulatus × viridis hybrid zone in Southwestern New Mexico

Venomous snakes often display extensive variation in venom composition both between and within species. However, the mechanisms underlying the distribution of different toxins and venom types among populations and taxa remain insufficiently known. Rattlesnakes (Crotalus, Sistrurus) display extreme inter- and intraspecific variation in venom composition, centered particularly on the presence or absence of presynaptically neurotoxic phospholipases A2 such as Mojave toxin (MTX). Interspecific hybridization has been invoked as a mechanism to explain the distribution of these toxins across rattlesnakes, with the implicit assumption that they are adaptively advantageous. Here, we test the potential of adaptive hybridization as a mechanism for venom evolution by assessing the distribution of genes encoding the acidic and basic subunits of Mojave toxin across a hybrid zone between MTX-positive Crotalus scutulatus and MTX-negative C. viridis in southwestern New Mexico, USA. Analyses of morphology, mitochondrial and single copy-nuclear genes document extensive admixture within a narrow hybrid zone. The genes encoding the two MTX subunits are strictly linked, and found in most hybrids and backcrossed individuals, but not in C. viridis away from the hybrid zone. Presence of the genes is invariably associated with presence of the corresponding toxin in the venom. We conclude that introgression of highly lethal neurotoxins through hybridization is not necessarily favored by natural selection in rattlesnakes, and that even extensive hybridization may not lead to introgression of these genes into another species