Development of a consensus operational definition of child assent for research

Abstract Background There is currently no consensus from the relevant stakeholders regarding the operational and construct definitions of child assent for research. As such, the requirements for assent are often construed in different ways, institutionally disparate, and often conflated with those of parental consent. Development of a standardized operational definition of assent would thus be important to ensure that investigators, institutional review boards, and policy makers consider the assent process in the same way. To this end, we describe a Delphi study that provided consensus from a panel of expert stakeholders regarding the definitions of child assent for research. Methods Based on current guidelines, a preliminary definition of assent was generated and sent out for review to a Delphi panel including pediatric bioethicists and researchers, Institutional Review Board members, parents, and individuals with regulatory/legal expertise. For each subsequent review, the process of summarizing and revising responses was repeated until consensus was achieved. Panelists were also required to rank order elements of assent that they believed were most important in defining the underlying constructs of the assent process (e.g., capacity for assent, disclosure). In providing these rankings, panelists were asked to frame their responses in the contexts of younger (≤ 11 yrs) and adolescents/older children (12-17 yrs) in non-therapeutic and therapeutic trials. Summary rankings of the most important identified elements were then used to generate written construct definitions which were sent out for iterative reviews by the expert panel. Results Consensus regarding the operational definition was reached by 14/18 (78%) of the panel members. Seventeen (94%) panelists agreed with the definitions of capacity for assent, elements of disclosure for younger children, and the requirements for meaningful assent, respectively. Fifteen (83%) members agreed with the elements of disclosure for adolescents/older children. Conclusions It is hoped that this study will positively inform and effect change in the way investigators, regulators, and IRBs operationalize the assent process, respect children’s developing autonomy, and in concert with parental permission, ensure the protection of children who participate in research.https://deepblue.lib.umich.edu/bitstream/2027.42/136915/1/12910_2017_Article_199.pd

Inhomogeneity of the intrinsic magnetic field in superconducting YBa2Cu3OX compounds as revealed by rare-earth EPR-probe

X-band electron paramagnetic resonance on doped Er3+ and Yb3+ ions in Y0.99(Yb,Er)0.01Ba2Cu3OX compounds with different oxygen contents in the wide temperature range (4-120)K have been made. In the superconducting species, the strong dependencies of the linewidth and resonance line position from the sweep direction of the applied magnetic field are revealed at the temperatures significantly below TC. The possible origins of the observed hysteresis are analyzed. Applicability of the presented EPR approach to extract information about the dynamics of the flux-line lattice and critical state parameters (critical current density, magnetic penetration depth, and characteristic spatial scale of the inhomogeneity) is discussedComment: 17 pages, 5 Figures. Renewed versio

THE EUROPEAN NUCLEAR EDUCATION NETWORK AND ITS ACTIONS IN FAVOUR OF EDUCATION, TRAINING, INFORMATION AND TRANSFER OF EXPERTISE

The European Nuclear Education Network (ENEN) Association is a non-profit organization established by the consortium of the EU 5th Framework Programme (FP) “ENEN” project in 2003. The ENEN Association started as a network of universities and research centers involved in education and training in nuclear engineering in EU countries and is presently involved in the challenging role of coordinating E&T in the nuclear fields in Europe. The main objective of ENEN is, in fact, the preservation and further development of expertise in the nuclear fields by higher education and training. Its members are now universities, research centers and industrial bodies established in European Countries; in addition, MoUs have been signed with several institutions and networks beyond the borders of European Union, thus reaching the number of more than 60 members. The objective of this paper is to provide an up to date view of the actions and plans of the Association in pursuing its missions

On the Whitehead spectrum of the circle

The seminal work of Waldhausen, Farrell and Jones, Igusa, and Weiss and Williams shows that the homotopy groups in low degrees of the space of homeomorphisms of a closed Riemannian manifold of negative sectional curvature can be expressed as a functor of the fundamental group of the manifold. To determine this functor, however, it remains to determine the homotopy groups of the topological Whitehead spectrum of the circle. The cyclotomic trace of B okstedt, Hsiang, and Madsen and a theorem of Dundas, in turn, lead to an expression for these homotopy groups in terms of the equivariant homotopy groups of the homotopy fiber of the map from the topological Hochschild T-spectrum of the sphere spectrum to that of the ring of integers induced by the Hurewicz map. We evaluate the latter homotopy groups, and hence, the homotopy groups of the topological Whitehead spectrum of the circle in low degrees. The result extends earlier work by Anderson and Hsiang and by Igusa and complements recent work by Grunewald, Klein, and Macko.Comment: 52 page

Hardness as a Spectral Peak Estimator for Gamma-Ray Bursts

Simple hardness ratios are found to be a good estimator for the spectral peak energy in Gamma-Ray Bursts (GRBs). Specifically, a high correlation strength is found between the $\nu F_{\nu}$ peak in the spectrum of BATSE GRBs, \epo, and the hardness of GRBs, \hr, as defined by the fluences in channels 3 and 4, divided by the combined fluences in channels 1 and 2 of the BATSE Large Area Detectors. The correlation is independent of the type of the burst, whether Long-duration GRB (LGRB) or Short-duration (SGRB) and remains almost linear over the wide range of the BATSE energy window (20-2000 KeV). Based on Bayes theorem and Markov Chain Monte Carlo techniques, we also present multivariate analyses of the observational data while accounting for data truncation and sample-incompleteness. Prediction intervals for the proposed \hrep ~relation are derived. Results and further simulations are used to compute \epo estimates for nearly the entire BATSE catalog: 2130 GRBs. These results may be useful for investigating the cosmological utility of the spectral peak in GRBs intrinsic luminosity estimates.Comment: MNRAS submitted, Some technical side analyses removed or reduced following the referee's review, 68 pages, 13 figure

Fine sediment reduces vertical migrations of Gammarus pulex (Crustacea: Amphipoda) in response to surface water loss

Surface and subsurface sediments in river ecosystems are recognized as refuges that may promote invertebrate survival during disturbances such as floods and streambed drying. Refuge use is spatiotemporally variable, with environmental factors including substrate composition, in particular the proportion of fine sediment (FS), affecting the ability of organisms to move through interstitial spaces. We conducted a laboratory experiment to examine the effects of FS on the movement of Gammarus pulex Linnaeus (Crustacea: Amphipoda) into subsurface sediments in response to surface water loss. We hypothesized that increasing volumes of FS would impede and ultimately prevent individuals from migrating into the sediments. To test this hypothesis, the proportion of FS (1–2 mm diameter) present within an open gravel matrix (4–16 mm diameter) was varied from 10 to 20% by volume in 2.5% increments. Under control conditions (0% FS), 93% of individuals moved into subsurface sediments as the water level was reduced. The proportion of individuals moving into the subsurface decreased to 74% at 10% FS, and at 20% FS no individuals entered the sediments, supporting our hypothesis. These results demonstrate the importance of reducing FS inputs into river ecosystems and restoring FS-clogged riverbeds, to promote refuge use during increasingly common instream disturbances

A primary care, multi-disciplinary disease management program for opioid-treated patients with chronic non-cancer pain and a high burden of psychiatric comorbidity

BACKGROUND: Chronic non-cancer pain is a common problem that is often accompanied by psychiatric comorbidity and disability. The effectiveness of a multi-disciplinary pain management program was tested in a 3 month before and after trial. METHODS: Providers in an academic general medicine clinic referred patients with chronic non-cancer pain for participation in a program that combined the skills of internists, clinical pharmacists, and a psychiatrist. Patients were either receiving opioids or being considered for opioid therapy. The intervention consisted of structured clinical assessments, monthly follow-up, pain contracts, medication titration, and psychiatric consultation. Pain, mood, and function were assessed at baseline and 3 months using the Brief Pain Inventory (BPI), the Center for Epidemiological Studies-Depression Scale scale (CESD) and the Pain Disability Index (PDI). Patients were monitored for substance misuse. RESULTS: Eighty-five patients were enrolled. Mean age was 51 years, 60% were male, 78% were Caucasian, and 93% were receiving opioids. Baseline average pain was 6.5 on an 11 point scale. The average CESD score was 24.0, and the mean PDI score was 47.0. Sixty-three patients (73%) completed 3 month follow-up. Fifteen withdrew from the program after identification of substance misuse. Among those completing 3 month follow-up, the average pain score improved to 5.5 (p = 0.003). The mean PDI score improved to 39.3 (p < 0.001). Mean CESD score was reduced to 18.0 (p < 0.001), and the proportion of depressed patients fell from 79% to 54% (p = 0.003). Substance misuse was identified in 27 patients (32%). CONCLUSIONS: A primary care disease management program improved pain, depression, and disability scores over three months in a cohort of opioid-treated patients with chronic non-cancer pain. Substance misuse and depression were common, and many patients who had substance misuse identified left the program when they were no longer prescribed opioids. Effective care of patients with chronic pain should include rigorous assessment and treatment of these comorbid disorders and intensive efforts to insure follow up

Fibromyalgia and neuropathic pain - differences and similarities. A comparison of 3057 patients with diabetic painful neuropathy and fibromyalgia

<p>Abstract</p> <p>Background</p> <p>Patients with diabetic neuropathy (DPN) and fibromyalgia differ substantially in pathogenetic factors and the spatial distribution of the perceived pain. We questioned whether, despite these obvious differences, similar abnormal sensory complaints and pain qualities exist in both entities. We hypothesized that similar sensory symptoms might be associated with similar mechanisms of pain generation. The aims were (1) to compare epidemiological features and co-morbidities and (2) to identify similarities and differences of sensory symptoms in both entities.</p> <p>Methods</p> <p>The present multi-center study compares epidemiological data and sensory symptoms of a large cohort of 1434 fibromyalgia patients and 1623 patients with painful diabetic neuropathy. Data acquisition included standard demographic questions and self-report questionnaires (MOS sleep scale, PHQ-9, Pain<it>DETECT</it>). To identify subgroups of patients with characteristic combinations of symptoms (sensory profiles) a cluster analysis was performed using all patients in both cohorts.</p> <p>Results</p> <p>Significant differences in co-morbidities (depression, sleep disturbance) were found between both disorders. Patients of both aetiologies chose very similar descriptors to characterize their sensory perceptions. Burning pain, prickling and touch-evoked allodynia were present in the same frequency. Five subgroups with distinct symptom profiles could be detected. Two of the subgroups were characteristic for fibromyalgia whereas one profile occurred predominantly in DPN patients. Two profiles were found frequently in patients of both entities (20-35%).</p> <p>Conclusions</p> <p>DPN and fibromyalgia patients experience very similar sensory phenomena. The combination of sensory symptoms - the sensory profile - is in most cases distinct and almost unique for each one of the two entities indicating aetiology-specific mechanisms of symptom generation. Beside the unique aetiology-specific sensory profiles an overlap of sensory profiles can be found in 20-35% of patients of both aetiologies.</p