Reasons for accepting or declining to participate in randomized clinical trials for cancer therapy

This paper reports on the reasons why patients agreed to or declined entry into randomized trials of cancer following discussions conducted by clinicians in both District General and University Hospitals. Two hundred and four patients completed a 16-item questionnaire following the consultation, of these 112 (55%) were women with breast cancer. Overall results showed that 147 (72.1%) patients accepted entry to a randomized clinical trial (RCT). The main reasons nominated for participating in a trial were that ‘others will benefit’ (23.1%) and ‘trust in the doctor’ (21.1%). One of the main reasons for declining trial entry was that patients were ‘worried about randomization’ (19.6%). There was a significantly higher acceptance rate for trials providing active treatment in every arm 98 (80.6%) compared with those trials with a no treatment arm 46 (60.5%), χ2test P = 0.003. The study outlines a number of factors that appear to influence a patient’s decision to accept or decline entry into an RCT of cancer therapy. An important factor is whether or not the trial offers active treatment in all arms of the study. Communication that promotes trust and confidence in the doctor is also a powerful motivating influence. © 2000 Cancer Research Campaig

Methodologies used to estimate tobacco-attributable mortality: a review

<p>Abstract</p> <p>Background</p> <p>One of the most important measures for ascertaining the impact of tobacco on a population is the estimation of the mortality attributable to its use. To measure this, a number of indirect methods of quantification are available, yet there is no consensus as to which furnishes the best information. This study sought to provide a critical overview of the different methods of attribution of mortality due to tobacco consumption.</p> <p>Method</p> <p>A search was made in the Medline database until March 2005 in order to obtain papers that addressed the methodology employed for attributing mortality to tobacco use.</p> <p>Results</p> <p>Of the total of 7 methods obtained, the most widely used were the prevalence methods, followed by the approach proposed by Peto et al, with the remainder being used in a minority of studies.</p> <p>Conclusion</p> <p>Different methodologies are used to estimate tobacco attributable mortality, but their methodological foundations are quite similar in all. Mainly, they are based on the calculation of proportional attributable fractions. All methods show limitations of one type or another, sometimes common to all methods and sometimes specific.</p

Repeated Assessments of Informed Consent Comprehension among HIV-Infected Participants of a Three-Year Clinical Trial in Botswana

Informed consent (IC) has been an international standard for decades for the ethical conduct of clinical trials. Yet frequently study participants have incomplete understanding of key issues, a problem exacerbated by language barriers or lack of familiarity with research concepts. Few investigators measure participant comprehension of IC, while even fewer conduct interim assessments once a trial is underway.We assessed comprehension of IC using a 20-question true/false quiz administered in 6-month intervals in the context of a placebo-controlled, randomized trial for the prevention of tuberculosis among HIV-infected adults in Botswana (2004-2009). Quizzes were offered in both Setswana and English. To enroll in the TB trial, participants were required to have ≥ 16/20 correct responses. We examined concepts understood and the degree to which understanding changed over three-years. We analyzed 5,555 quizzes from 1,835 participants. The participants' highest education levels were: 28% primary, 59% secondary, 9% tertiary and 7% no formal education. Eighty percent of participants passed the enrollment quiz (Quiz1) on their first attempt and the remainder passed on their second attempt. Those having higher than primary education and those who took the quiz in English were more likely to receive a passing score on their first attempt (adjusted odds ratios and 95% confidence intervals, 3.1 (2.4-4.0) and 1.5 (1.2, 1.9), respectively). The trial's purpose or procedures were understood by 90-100% of participants, while 44-77% understood randomization, placebos, or risks. Participants who failed Quiz1 on their initial attempt were more likely to fail quizzes later in the trial. Pass rates improved with quiz re-administration in subsequent years.Administration of a comprehension quiz at enrollment and during follow-up was feasible in a large, international collaboration and efficiently determined IC comprehension by trial participants. Strategies to improve understanding of concepts like placebos and randomization are needed. Comprehension assessments throughout a study may reinforce key concepts

Proxy evidence for state-dependence of climate sensitivity in the Eocene greenhouse

Despite recent advances, the link between the evolution of atmospheric CO2 and climate during the Eocene greenhouse remains uncertain. In particular, modelling studies suggest that in order to achieve the global warmth that characterised the early Eocene, warmer climates must be more sensitive to CO2 forcing than colder climates. Here, we test this assertion in the geological record by combining a new high-resolution boron isotope-based CO2 record with novel estimates of Global Mean Temperature. We find that Equilibrium Climate Sensitivity (ECS) was indeed higher during the warmest intervals of the Eocene, agreeing well with recent model simulations, and declined through the Eocene as global climate cooled. These observations indicate that the canonical IPCC range of ECS (1.5 to 4.5 °C per doubling) is unlikely to be appropriate for high-CO2 warm climates of the past, and the state dependency of ECS may play an increasingly important role in determining the state of future climate as the Earth continues to warm

Broadly tunable infrared femtosecond optical parametric oscillator based on periodically-poled RbTiOAsO4

We present results from what we believe is the first reported example of an optical parametric oscillator based on periodically poled RbTiOAsO4. The oscillator is pumped by a femtosecond self-mode-locked Ti:sapphire laser and, with a single-grating a-mm-long crystal and one mirror set, a combination of pump and cavity-length tuning provided wavelength coverage from 1060 to 1225 nm (signal) and 2.67 to 4.5 mu m (idler). Average output powers were as much as 120 mW in the signal and 105 mW in the idler and interferometric autocorrelations recorded at signal and idler wavelengths of 1.1 and 3.26 mu m, respectively, imply pulse durations of 125 and 115 fs, respectively. (C) 1997 Optical Society of America.</p

Femtosecond optical parametric oscillators based on periodically poled lithium niobate

We describe two configurations of collinearly pumped femtosecond optical parametric oscillator based on periodically poled lithium niobate and tunable in the infrared from 975 nm to 4.98 mu m. Maximum output powers of 240 mW for the signal and 106 mW for the idler were recorded with 25 mW of average power measured at 4.88 mu m. An overall conversion efficiency of 35% and slope efficiencies for the signal of 46% at a wavelength of 1.04 mu m and 70% at 1.11 mu m were measured. Interferometric autocorrelations of the signal and idler pulses at various wavelengths within the tuning range have been obtained and imply nearly transform-limited pulse durations of about 140 fs for the signal and about 190 fs for the idler.</p

Femtosecond optical parametric oscillators based on periodically poled lithium niobate

We describe two configurations of collinearly pumped femtosecond optical parametric oscillator based on periodically poled lithium niobate and tunable in the infrared from 975 nm to 4.98 mu m. Maximum output powers of 240 mW for the signal and 106 mW for the idler were recorded with 25 mW of average power measured at 4.88 mu m. An overall conversion efficiency of 35% and slope efficiencies for the signal of 46% at a wavelength of 1.04 mu m and 70% at 1.11 mu m were measured. Interferometric autocorrelations of the signal and idler pulses at various wavelengths within the tuning range have been obtained and imply nearly transform-limited pulse durations of about 140 fs for the signal and about 190 fs for the idler.</p