Improving the quality of consent to randomised controlled trials by using continuous consent and clinician training in the consent process

Objectives: To assess whether continuous consent, a process whereby information is given to research participants at different stages in a trial, plus clinician training in that process was effective when used by clinicians gaining consent to the TOBY trial. The TOBY trial is a randomised controlled trial investigating the use of whole body cooling for neonates with evidence of perinatal asphyxia. Obtaining valid informed consent for TOBY is difficult; as such, it is a good test of the effectiveness of continuous consent. Methods: Semi-structured interviews were conducted with 30 sets of parents who gave consent to TOBY and with 10 clinicians who sought it using the continuous consent process. Analysis focused on the validity of parental consent based upon the consent components of competence, information, understanding and voluntariness. Results: 19/27 (70%) couples had no significant problems with consent validity at the point of signature. Problems lay mainly with the parents’ competence and understanding. Mothers particularly had competence problems in the early stages of consent. The understanding problems were primarily to do with side effects. Problems in both areas (competence and understanding) reduced markedly, particularly for mothers, in the post signature phase when further discussion took place. Randomisation was generally understood but unpopular. Clinicians did not always give information in stages during the short period of time available before parents gave consent. However, most clinicians were able to give follow up information. Discussion: The consent validity compares favourably with similar trials examined in a comparable study (the Euricon study). Conclusion: Researchers should consider adopting elements of the continuous consent process and clinician training in RCTs, particularly where they have concerns about the quality of consent they are likely to obtain using a conventional process.</p

Should desperate volunteers be included in randomised controlled trials?

Randomised controlled trials (RCTs) sometimes recruit participants who are desperate to receive the experimental treatment. Some claim this practice is unethical for at least three reasons. The first is that the notion of equipoise, which is often used as a justification for running a RCT, is subjective and value-based. Desperate volunteers are clearly not in equipoise and it is their values that should take precedence. The second is that clinicians who enter patients onto trials are disavowing their therapeutic obligation to deliver the best treatment to patients; they are following trial protocols rather than delivering individualised care. Research is not treatment; its ethical justification is different. Consent is crucial. This leads to the third reason: desperate volunteers do not give a proper consent; they are, in effect, coerced. We begin our reply by advocating a notion of equipoise based on, first, expert knowledge and, second, widely shared values. Where such collective, expert equipoise exists there is a prima facie case for a RCT. Next we argue that trial entry does not involve clinicians’ disavowing their therapeutic obligation; individualised care based on whims and fancies is not in patients’ best interest. Finally, we argue that where equipoise exists it is acceptable to limit access to experimental agents. In the cases desperate volunteers are not coerced because their desperation does not translate into a right to receive what they desire. </p

Medical operations and life sciences activities on space station

Space station health maintenance facilities, habitability, personnel, and research in the medical sciences and in biology are discussed. It is assumed that the space station structure will consist of several modules, each being consistent with Orbiter payload bay limits in size, weight, and center of gravity

Limit Theorems For Quantum Walks Associated with Hadamard Matrices

We study a one-parameter family of discrete-time quantum walk models on the line and in the xy-plane associated with the Hadamard walk. Weak convergence in the long-time limit of all moments of the walker's pseudo-velocity on the line and in the xy-plane is proved. Symmetrization on the line and in the xy-plane is theoretically investigated, leading to the resolution of the Konno-Namiki-Soshi conjecture in the special case of symmetrization of the unbiased Hadamard walk on the line . A necessary condition for the existence of a phenomenon known as localization is given

Space Station medical sciences concepts

Current life sciences concepts relating to Space Station are presented including the following: research, extravehicular activity, biobehavioral considerations, medical care, maintenance of dental health, maintaining health through physical conditioning and countermeasures, protection from radiation, atmospheric contamination control, atmospheric composition, noise pollution, food supply and service, clothing and furnishings, and educational program possibilities. Information on the current status of Soviet Space Stations is contained

Collapsible reflector Patent

Self erecting parabolic reflector design for use in spac

The impact of uncertainty in satellite data on the assessment of flood inundation models

The performance of flood inundation models is often assessed using satellite observed data; however these data have inherent uncertainty. In this study we assess the impact of this uncertainty when calibrating a flood inundation model (LISFLOOD-FP) for a flood event in December 2006 on the River Dee, North Wales, UK. The flood extent is delineated from an ERS-2 SAR image of the event using an active contour model (snake), and water levels at the flood margin calculated through intersection of the shoreline vector with LiDAR topographic data. Gauged water levels are used to create a reference water surface slope for comparison with the satellite-derived water levels. Residuals between the satellite observed data points and those from the reference line are spatially clustered into groups of similar values. We show that model calibration achieved using pattern matching of observed and predicted flood extent is negatively influenced by this spatial dependency in the data. By contrast, model calibration using water elevations produces realistic calibrated optimum friction parameters even when spatial dependency is present. To test the impact of removing spatial dependency a new method of evaluating flood inundation model performance is developed by using multiple random subsamples of the water surface elevation data points. By testing for spatial dependency using Moran’s I, multiple subsamples of water elevations that have no significant spatial dependency are selected. The model is then calibrated against these data and the results averaged. This gives a near identical result to calibration using spatially dependent data, but has the advantage of being a statistically robust assessment of model performance in which we can have more confidence. Moreover, by using the variations found in the subsamples of the observed data it is possible to assess the effects of observational uncertainty on the assessment of flooding risk