Strengths and weaknesses of guideline approaches to safeguard voluntary informed consent of patients within a dependent relationship

BACKGROUND: It is thought that a dependent relationship between patients and physicians who enroll their own patients in research compromises voluntary informed consent. Therefore, several ethical guidelines for human subject research provide approaches to mitigate these compromises. Currently, these approaches have not been critically evaluated. In this article, we analyze the approaches of ethical guidelines to manage the influence of a dependent relationship between patients and physicians on voluntary informed consent and discuss the strengths and weaknesses of these approaches. METHODS: We performed a review of international ethical guidance documents on human subject research, listed in the Oxford Textbook of Clinical Research Ethics and found through cross referencing. We also searched Global Ethics Observatory (GEObs) and the World Health Organization (WHO) website. Guidelines from all years were eligible for inclusion. The date last searched was December 2013. DISCUSSION: We identified two basic guideline approaches: 1. a process approach, which focuses on the person who obtains informed consent, that is, an independent individual, such as a research nurse or counselor; and 2. a content approach, emphasizing the voluntary nature of participation. Both approaches are valuable, either because the influence of the physician may diminish or because it empowers patients to make voluntary decisions. However, the approaches also face challenges. First, research nurses are not always independent. Second, physician-investigators will be informed about decisions of their patients. Third, involvement of a counselor is sometimes unfeasible. Fourth, the right to withdraw may be difficult to act upon in a dependent relationship. CONCLUSIONS: Current guideline approaches to protect voluntary informed consent within a dependent relationship are suboptimal. To prevent compromises to voluntary informed consent, consent should not only be obtained by an independent individual, but this person should also emphasize the voluntary nature of participation. At the same time, dependency as such does not imply undue influence. Sometimes the physician may be best qualified to provide information, for example, for a very specialized study. Still, the research nurse should obtain informed consent. In addition, patients should be able to consult a counselor, who attends the informed consent discussions and is concerned with their interests. Finally, both physicians and research nurses should disclose research interests

THE CONTENT OF THE CURRICULUM OF ARABIC LANGUAGE OF THE ARABIC SECONDARY SCHOOLS OF BRUNEI DARUSSALAM: CLASS ELEVEN AS A CASE STUDY

This research aims to identify the content of curriculum of Arabic Language in Brunei Arabic Secondary Schools in which Class Eleven was the case study. The researchers distributed questionnaires to four Arabic teachers who teach Arabic therein. After obtaining the data needed by the research, the researchers analyzed it descriptively and quantitatively in order to achieve the required objectives. The research outcome shows that most of the teaching content of class eleven is in line with the aims and objective of the curriculum, matches the students’ language skills, takes cognizance of individual differences and contains the four Language skills, although some of them do not match their ages.  Article visualizations

Developing an experimental challenge model for gill disease caused by gelatinous zooplankton

Harmful zooplankton, such as jellyfish or cnidarians, play an important role in gill disease development, but there is a lack of scientific and technical understanding of the interactions between gelatinous zooplankton and fish gills that can only be obtained through a lab-based challenge model using lab-reared organisms. Such a model does not exist, so we set out to develop one. We were able to produce a pre-determined quantity of gelatinous zooplankton at a pre-determined point in time, transport them, and challenge salmon with these live gelatinous zooplankton, and present initial results. Currently we are optimizing the model. When developed further, the model is intended to be used as a tool to improve understanding of the role of gelatinous zooplankton in gill disease, identify host responses and assess techniques to mitigate the effects of gelatinous zooplankton on gill health

Developing an experimental challenge model for gill disease caused by gelatinous zooplankton

Harmful zooplankton, such as jellyfish or cnidarians, play an important role in gill disease development, but there is a lack of scientific and technical understanding of the interactions between gelatinous zooplankton and fish gills that can only be obtained through a lab-based challenge model using lab-reared organisms. Such a model does not exist, so we set out to develop one. We were able to produce a pre-determined quantity of gelatinous zooplankton at a pre-determined point in time, transport them, and challenge salmon with these live gelatinous zooplankton, and present initial results. Currently we are optimizing the model. When developed further, the model is intended to be used as a tool to improve understanding of the role of gelatinous zooplankton in gill disease, identify host responses and assess techniques to mitigate the effects of gelatinous zooplankton on gill health

Developing an experimental challenge model for gill disease caused by gelatinous zooplankton

Harmful zooplankton, such as jellyfish or cnidarians, play an important role in gill disease development, but there is a lack of scientific and technical understanding of the interactions between gelatinous zooplankton and fish gills that can only be obtained through a lab-based challenge model using lab-reared organisms. Such a model does not exist, so we set out to develop one. We were able to produce a pre-determined quantity of gelatinous zooplankton at a pre-determined point in time, transport them, and challenge salmon with these live gelatinous zooplankton, and present initial results. Currently we are optimizing the model. When developed further, the model is intended to be used as a tool to improve understanding of the role of gelatinous zooplankton in gill disease, identify host responses and assess techniques to mitigate the effects of gelatinous zooplankton on gill health

Final Technical Report

The following report contributes to our knowledge of how to economically produce wildlife-friendly grass mixtures for future fuel feedstocks in the northern plains. It investigates northern-adapted cultivars; management and harvest regimes that are good for yields, soils and wildlife; comparative analysis of monocultures and simple mixtures of native grasses; economic implications of growing grasses for fuel feedstocks in specific locations in the northern plains; and conversion options for turning the grasses into useful chemicals and fuels. The core results of this study suggest the following: Native grasses, even simple grass mixtures, can be produced profitably in the northern plains as far west as the 100th meridian with yields ranging from 2 to 6 tons per acre. Northern adapted cultivars may yield less in good years, but have much greater long-term sustainable yield potential than higher-yielding southern varieties. Grasses require very little inputs and stop economically responding to N applications above 56kg/hectare. Harvesting after a killing frost may reduce the yield available in that given year but will increase overall yields averaged throughout multiple years. Harvesting after a killing frost or even in early spring reduces the level of ash and undesirable molecules like K which cause adverse reactions in pyrolysis processing. Grasses can be managed for biomass harvest and maintain or improve overall soil-health and carbon sequestration benefits of idled grassland The carbon sequestration activity of the grasses seems to follow the above ground health of the biomass. In other words plots where the above ground biomass is regularly removed can continue to sequester carbon at the rate of 2 tons/acre/year if the stand health is strong and yielding significant amounts of biomass. Managing grasses for feedstock quality in a biomass system requires some of the same management strategies as managing for wildlife benefit. We believe that biomass development can be done in such a way that also maximizes or improves upon conservation and other environmental goals (in some cases even when compared to idled land). Switchgrass and big bluestem work well together in simple mixture plots where big bluestem fills in around the switchgrass which alone grows in bunches and leaves patches of bare soil open and susceptible to erosion. Longer-term studies in the northern plains may also find that every other year harvest schemes produce as much biomass averaged over the years as annual harvests Grasses can be grown for between $23 and$54/ton in the northern plains at production rates between 3 and 5 tons/acre. Land costs, yields, and harvest frequency are the largest determining factors in the farm scale economics. Without any land rent offset or incentive for production, and with annual harvesting, grass production is likely to be around $35/ton in the northern plains (farm gate). Average transportation costs range from$3 to $10/ton delivered to the plant gate. Average distance from the plant is the biggest factor -$3/ton at 10 miles, $10/ton at 50 miles. There is a substantial penalty paid on a per unit of energy produced basis when one converts grasses to bio-oil, but the bio-oil can then compete in higher priced fuel markets whereas grasses alone compete directly with relatively cheap coal. Bio oil or modified bio-oil (without the HA or other chemical fraction) is a suitable fuel for boiler and combustion turbines that would otherwise use residual fuel oil or number 2 diesel. Ensyn has already commercialized the use of HA in smokey flavorants for the food industry but that market is rather small. HA, however, is also found to be a suitable replacement for the much larger US market for ethanolamines and ethalyne oxides that are used as dispersants. Unless crude oil prices rise, the highest and best use of grass based bio-oil is primarily as a direct fuel. As prices rise, HA, phenol and other chemical fractions may become more attractive Although we were able to create available glucose from the AHG fraction in the bio-oil it proved recalcitrant to fermentation by yeast. Although fermentation results were much more positive with wood based bio-oil sugars, ethanol does not appear to be a likely product from grass based bio-oil. A package of policy recommendations has been developed with roughly 75 key stakeholders from throughout the region that would support the transition to greater development of advanced biofuels and products in the region, as well as a strong role for native grass agriculture to support those industries

Translation of evidence-based Assistive Technologies into stroke rehabilitation: Users' perceptions of the barriers and opportunities

Background: Assistive Technologies (ATs), defined as "electrical or mechanical devices designed to help people recover movement", demonstrate clinical benefits in upper limb stroke rehabilitation; however translation into clinical practice is poor. Uptake is dependent on a complex relationship between all stakeholders. Our aim was to understand patients', carers' (P&Cs) and healthcare professionals' (HCPs) experience and views of upper limb rehabilitation and ATs, to identify barriers and opportunities critical to the effective translation of ATs into clinical practice. This work was conducted in the UK, which has a state funded healthcare system, but the findings have relevance to all healthcare systems. Methods. Two structurally comparable questionnaires, one for P&Cs and one for HCPs, were designed, piloted and completed anonymously. Wide distribution of the questionnaires provided data from HCPs with experience of stroke rehabilitation and P&Cs who had experience of stroke. Questionnaires were designed based on themes identified from four focus groups held with HCPs and P&Cs and piloted with a sample of HCPs (N = 24) and P&Cs (N = 8). Eight of whom (four HCPs and four P&Cs) had been involved in the development. Results: 292 HCPs and 123 P&Cs questionnaires were analysed. 120 (41%) of HCP and 79 (64%) of P&C respondents had never used ATs. Most views were common to both groups, citing lack of information and access to ATs as the main reasons for not using them. Both HCPs (N = 53 [34%]) and P&C (N = 21 [47%]) cited Functional Electrical Stimulation (FES) as the most frequently used AT. Research evidence was rated by HCPs as the most important factor in the design of an ideal technology, yet ATs they used or prescribed were not supported by research evidence. P&Cs rated ease of set-up and comfort more highly. Conclusion: Key barriers to translation of ATs into clinical practice are lack of knowledge, education, awareness and access. Perceptions about arm rehabilitation post-stroke are similar between HCPs and P&Cs. Based on our findings, improvements in AT design, pragmatic clinical evaluation, better knowledge and awareness and improvement in provision of services will contribute to better and cost-effective upper limb stroke rehabilitation. © 2014 Hughes et al.; licensee BioMed Central Ltd

Antiepileptic drugs’ tolerability and safety – a systematic review and meta-analysis of adverse effects in dogs

<p>Various anti-epileptic drugs (AEDs) are used for the management of idiopathic epilepsy (IE) in dogs. Their safety profile is an important consideration for regulatory bodies, owners and prescribing clinicians. However, information on their adverse effects still remains limited with most of it derived from non-blinded non-randomized uncontrolled trials and case reports.</p><p><span>This poster won third place, which was presented at the Veterinary Evidence Today conference, Edinburgh November 1-3, 2016. </span></p><br /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" /

Searching for serial refreshing in working memory:Using response times to track the content of the focus of attention over time

One popular idea is that, to support maintenance of a set of elements over brief periods of time, the focus of attention rotates among the different elements thereby serially refreshing the content of Working Memory (WM). In the research reported here, probe letters were presented between to-be-remembered letters. Response times to these probes were used to infer the status of the different items in WM. If the focus of attention cycles from one item to the next, its content should be different at different points in time and this should be reflected in a change in the response time patterns over time. Across a set of four experiments, we demonstrate a striking pattern of invariance in the response time patterns over time, suggesting that either the content of the focus of attention did not change over time or that response times cannot be used to infer the content of the focus of attention. We discuss how this pattern constrains models of WM, attention, and human information processing

Epicrania fugax with backward radiation: clinical characteristics of nine new cases

Epicrania fugax (EF) is a novel syndrome, described as a paroxysmal and brief head pain, starting in posterior cranial regions and rapidly spreading forward ipsilateral eye, nose or forehead. Two patients with comparable clinical features stemming from frontal scalp to ipsilateral posterior regions have been recently described and proposed as backward radiation epicrania fugax (BREF). We report a new series of nine BREF and compare their clinical characteristics with 18 forward radiation EF (FREF). Since first description of BREF in February 2010 we have assessed nine patients (four males, five females) with this clinical picture at an outpatient headache office in a Tertiary Hospital. Comparison is established with 18 FREF patients (6 males, 12 females), attended since the publication of first series of EF in March 2008. We found no differences between BREF and FREF, respectively, in age at onset (43.4 ± 13.1 vs. 42.5 ± 17.7 years), female/male ratio (5/4 vs. 12/6), pain intensity (6.9 ± 2.1 vs. 6.8 ± 2.1 in a 0–10 visual analogical scale), duration (7.1 ± 4.9 vs. 5.7 ± 4.3 s) and frequency of episodes per day (7 ± 8.4 vs. 9.9 ± 15.4). Patients in BREF group presented less frequently interictal pain in stemming point (22.2 vs. 55.5%) and accompanying autonomic signs (33.3 vs. 55.5%), but without statistical significance in both the cases. This series reinforces the proposal of EF as a new headache variant or a new headache syndrome. Clinical picture of brief pain paroxysms starting in the anterior scalp and radiating backwards does not fit known headaches or neuralgias and might correspond to a reverse variant of EF, clinical characteristics of which are comparable to FREF