Informed consent to HIV cure research

Trials with highly unfavourable risk–benefit ratios for participants, like HIV cure trials, raise questions about the quality of the consent of research participants. Why, it may be asked, would a person with HIV who is doing well on antiretroviral therapy be willing to jeopardise his health by enrolling in such a trial? We distinguish three concerns: first, how information is communicated to potential participants; second, participants’ motivations for enrolling in potentially high risk research with no prospect of direct benefit; and third, participants’ understanding of the details of the trials in which they enrol. We argue that the communication concern is relevant to the validity of informed consent and the quality of decision making, that the motivation concern does not identify a genuine problem with either the validity of consent or the quality of decision making and that the understanding concern may not be relevant to the validity of consent but is relevant to the quality of decision making. In doing so, we derive guidance points for researchers recruiting and enrolling participants into their HIV cure trials, as well as the research ethics committees reviewing proposed studies

When is diabetes distress clinically meaningful?: establishing cut points for the Diabetes Distress Scale.

ObjectiveTo identify the pattern of relationships between the 17-item Diabetes Distress Scale (DDS17) and diabetes variables to establish scale cut points for high distress among patients with type 2 diabetes.Research design and methodsRecruited were 506 study 1 and 392 study 2 adults with type 2 diabetes from community medical groups. Multiple regression equations associated the DDS17, a 17-item scale that yields a mean-item score, with HbA(1c), diabetes self-efficacy, diet, and physical activity. Associations also were undertaken for the two-item DDS (DDS2) screener. Analyses included control variables, linear, and quadratic (curvilinear) DDS terms.ResultsSignificant quadratic effects occurred between the DDS17 and each diabetes variable, with increases in distress associated with poorer outcomes: study 1 HbA(1c) (P < 0.02), self-efficacy (P < 0.001), diet (P < 0.001), physical activity (P < 0.04); study 2 HbA(1c) (P < 0.03), self-efficacy (P < 0.004), diet (P < 0.04), physical activity (P = NS). Substantive curvilinear associations with all four variables in both studies began at unexpectedly low levels of DDS17: the slope increased linearly between scores 1 and 2, was more muted between 2 and 3, and reached a maximum between 3 and 4. This suggested three patient subgroups: little or no distress, <2.0; moderate distress, 2.0-2.9; high distress, ≥3.0. Parallel findings occurred for the DDS2.ConclusionsIn two samples of type 2 diabetic patients we found a consistent pattern of curvilinear relationships between the DDS and HbA(1c), diabetes self-efficacy, diet, and physical activity. The shape of these relationships suggests cut points for three patient groups: little or no, moderate, and high distress

Modeling Ionosphere Environments: Creating an ISS Electron Density Tool

The International Space Station (ISS) maintains an altitude typically between 300 km and 400 km in low Earth orbit (LEO) which itself is situated in the Earth's ionosphere. The ionosphere is a region of partially ionized gas (plasma) formed by the photoionization of neutral atoms and molecules in the upper atmosphere of Earth. It is important to understand what electron density the spacecraft is/will be operating in because the ionized gas along the ISS orbit interacts with the electrical power system resulting in charging of the vehicle. One instrument that is already operational onboard the ISS with a goal of monitoring electron density, electron temperature, and ISS floating potential is the Floating Potential Measurement Unit (FPMU). Although this tool is a valuable addition to the ISS, there are limitations concerning the data collection periods. The FPMU uses the Ku band communication frequency to transmit data from orbit. Use of this band for FPMU data runs is often terminated due to necessary observation of higher priority Extravehicular Activities (EVAs) and other operations on ISS. Thus, large gaps are present in FPMU data. The purpose of this study is to solve the issue of missing environmental data by implementing a secondary electron density data source, derived from the COSMIC satellite constellation, to create a model of ISS orbital environments. Extrapolating data specific to ISS orbital altitudes, we model the ionospheric electron density along the ISS orbit track to supply a set of data when the FPMU is unavailable. This computer model also provides an additional new source of electron density data that is used to confirm FPMU is operating correctly and supplements the original environmental data taken by FPMU

Interprofessional Health Team Communication About Hospital Discharge: An Implementation Science Evaluation Study

The Consolidated Framework for Implementation Research guided formative evaluation of the implementation of a redesigned interprofessional team rounding process. The purpose of the redesigned process was to improve health team communication about hospital discharge. Themes emerging from interviews of patients, nurses, and providers revealed the inherent value and positive characteristics of the new process, but also workflow, team hierarchy, and process challenges to successful implementation. The evaluation identified actionable recommendations for modifying the implementation process

Limitations of Telemedicine Vs. Face-to-face Eye Examination in a Patient with New Headaches

Background: During the emergence and rise of COVID-19, precaution directives and limitations on in-person eye examinations re-routed a significant portion of care to telemedicine and virtual modalities. While these technologies allowed for healthcare communications that otherwise could not occur during such trying times, there are major limitations to these sanctioned applications. This report will present a seemingly benign case that could have easily been re-routed from an in-person examination to a telemedicine version due to the patient’s seemingly “routine” vision complaints. Case Report: A 50-year-old male patient contacted the eye clinic with a complaint of a minor, new, unexplained headache that he felt may have been related to a change in his vision. The patient requested a telehealth examination with the eye clinic to avoid exposure to COVID-19. After due consideration, the optometry clinic recommended an in-person eye examination despite the very heavy limitations requiring “emergency only” patients in the hospital. On examination it became evident that the cause of the headaches was a rebound hypertensive crisis and the patient did require emergency medical services to stabilize his condition. Conclusion: This case was ultimately a serious emergency that would have been missed via a remote evaluation. The patient was fortunate to have been given a face-to-face appointment during a time of heavy restrictions and essentially emergency-only appointments. This should serve as a reminder to all eye care practitioners that new headaches are a symptom requiring an in-person evaluation, should a future event require similar clinical limitations. Despite the rarity, even a light headache in an early presbyope, as seen in this case, could be the only overt sign of an emergent condition

The Benefits of Academically Oriented Peer Mentoring for At-Risk Student Populations

This article examines an academically oriented peer-mentoring program at St. John’s University. The program targeted at-risk first-year students who were having difficulty making the transition to college and matched them with trained student mentors within their major discipline. In addition to meeting with one another bi-weekly, all of the students came together for a series of organized events over the course of the academic year. The goals of the program were that mentees would (1) feel an increased sense of belonging at the university, (2) raise their GPAs, and (3) show improved retention to the second year. After examining how successful the program was relative to these goals, the authors recommend some best practices for peer-mentoring programs. These recommendations are based on both features of the program in the study that contributed to its success and areas where the program could have been improved based on the results. &nbsp

Encourage Self Regulated Learning in the Classroom

Self-regulated learning (SLR) is recognized as an important predictor of student academic motivation and achievement. This process requires students to independently plan, monitor, and assess their learning. However, few students naturally do this well. This paper provides a review of the literature including: the definition of SRL; an explanation of the relationship between SRL and motivation in the classroom; specific SRL strategies for student use; approaches for encouraging student SRL; and a discussion of some of the challenges educators might encounter while teaching students to be self-regulated, life-long learners