Parental perspectives long term after neonatal clinical trial participation: a survey

Background: Although recruiting newborns is ethically challenging, clinical trials remain essential to improve neonatal care. There is a lack of empirical data on the parental perspectives following participation of their neonate in a clinical trial, especially at long term. The objective of this study is to assess experiences and emotions of parents, long term after trial participation in an interventional drug trial. Methods: Parents of former participants of five neonatal interventional drug trials were surveyed at long term (3– 13 years ago) after participation. The survey assessed parental contentment with trial participation, perceived influence of the trial on care and health, emotional consequences of participation, and awareness of typical clinical trial characteristics on 6-point Likert scales. Results: Complete responses were received from 123 parents (52% of involved families). Twenty percent of parents did not remember participation. Those who remembered participation reported high contentment with overall trial participation (median 5.00), but not with follow-up (median 3.00). Most parents did not perceive any influence of the trial on care (median 2.00) and health (median 2.43). Almost all parents reported satis

Common vs. independent limb control in sequential vertical aiming: The cost of potential errors during extensions and reversals

The following study explored movement kinematics in two-component aiming contexts that were intended to modulate the potential cost of overshoot or undershoot errors in up and down directions by having participants perform a second extension movement (Experiment 1) or a reversal movement (Experiment 2). For both experiments, the initial movement toward a downward target took longer, and had lower peak acceleration and peak velocity than upward movements. These movement characteristics may reflect a feedback-based control strategy designed to prevent energy-consuming limb modifications against gravitational forces. The between-component correlations of displacement at kinematic landmarks (i.e., trial-by-trial correlation between the first and second components) increased as both components unfolded. However, the between-component correlations of extensions were primarily negative, while reversals were positive. Thus, movement extensions appear to be influenced by the use of continuous on-line sensory feedback to update limb position at the second component based on the position attained in the first component. In contrast, reversals seem to be driven by pre-planned feedforward procedures where the position of the first component is directly replicated in the second component. Finally, the between-component correlations for the magnitude of kinematic landmarks showed that aiming up generated stronger positive correlations during extensions, and weaker positive correlations toward the end of the first component during reversals. These latter results suggest the cost of potential errors associated with the upcoming second component directly influence the inter-dependence between components. Therefore, the cost of potential errors is not only pertinent to one-component discrete contexts, but also two-component sequence aims. Together, these findings point to an optimized movement strategy designed to minimize the cost of errors, which is specific to the two-component context

Fashioning Entitlements: A Comparative Law and Economic Analysis of the Judicial Role in Environmental Centralization in the U.S. and Europe

This paper identifies and evaluates, from an economic point of view, the role of the judiciary the steady shift of environmental regulatory authority to higher, more centralized levels of government in both the U.S. and Europe. We supply both a positive analysis of how the decisions made by judges have affected the incentives of both private and public actors to pollute the natural environment, and normative answers to the question of whether judges have acted so as to create incentives that move levels of pollution in an efficient direction, toward their optimal, cost-minimizing (or net-benefit-maximizing) levels. Highlights of the analysis include the following points: 1) Industrial-era local (state or national) legislation awarding entitlements to pollute was almost certainly inefficient due to a fundamental economic obstacle faced by those who suffer harm from the over-pollution of publicly owned natural resources: the inability to monetize and credibly commit to repay the future economic value of reducing pollution. 2) When industrial era pollution spilled across state lines in the US, the federal courts, in particular the Supreme Court, fashioned a federal common law of interstate nuisance that set up essentially the same sort of blurry, uncertain entitlements to pollute or be free of pollution that had been created by the state courts in resolving local pollution disputes. We argue that for the typical pollution problem, a legal regime of blurry interstate entitlements - with neither jurisdiction having a clear right either to pollute or be free of pollution from the other - is likely to generate efficient incentives for interjursidictional bargaining, even despite the public choice problems besetting majority-rule government. Interestingly, a very similar system of de facto entitlements arose and often stimulated interjursidictional bargaining in Europe as well as in the U.S. 3) The US federal courts have generally interpreted the federal environmental statutes in ways that give clear primacy to federal regulators. Through such judicial interpretation, state and local regulators face a continuing risk of having their decisions overridden by federal regulators. This reduces the incentives for regulatory innovation at the state and local level. Judicial authorization of federal overrides has thus weakened the economic rationale for cooperative federalism suggested by economic models of principal-agent relationships. As a result of the principle of attribution, there is less risk in Europe that (like in the US) courts would enlarge the federal purview and thereby limit the powers of the Member States. Despite this principle, the power of the European bureaucracy (that is, the European Commission) has steadily increased and led to a steady shift of environmental regulatory competencies to the European level. This shift is only sometimes normatively desirable, and yet there is little that the ECJ can or will do to slow it