Seeking informed consent from patients in the acute phase of acute myocardial infarction (AMI) poses an ethical challenge due to the fact that these patients are under stress and require urgent ...medical attention. The very procedure of informed consent, which is supposed to protect eligible patients, may in fact cause harm due to a potential delay in the provision of therapy. Whether or not informed consent can and should be obtained under these particular circumstances is far from evident. Patients participating in various large-scale AMI trials have been enrolled with, as well as without, informed consent in recent years. Little is known, however, about how patients experience the informed consent process in the emergency situation of an AMI.
This paper reports the results from qualitative interviews with 32 patients, who had to decide whether or not to participate in a large multi-centre clinical trial in Denmark. We analyse to what extent patients found the informed consent process acceptable as well as how various factors influenced their experience of the consent process. We argue that it is morally sound to involve those patients in a brief and concise informed consent process and that consent should be sought in such trials. Finally, we discuss how future AMI trials may nonetheless be improved by accommodating some of the concerns of the patients.
An improved high-voltage technique based on the use of a field plate combined with semiresistive layers (SIPOS) on oxide is proposed. The field plate and SIPOS (semi-insulating polycrystalline ...silicon) are shown to have complementary functions. Junction curvature electric field effects are reduced by the presence of the field plate. The silicon surface potential is linearized by a primary SIPOS layer on oxide, thereby reducing the peak electric field at the edge of the field plate. A second high-resistivity SIPOS layer provides an excellent passivation, and also prevents the dielectric breakdown of the underlayer SIPOS film. Moreover, the savings in chip area is about 20% compared to the standard mesa termination. The global yield is 94% for the SIPOS planar transistors and 86% for equivalent devices in mesa technology. The complete fabrication, design, electrical characteristics, and reliability of high-voltage planar transistors are described.< >
Here we present the first reconstruction of changes in surface primary production during the last century from the Puyuhuapi fjord in southern Chile, using a variety of parameters (diatoms, biogenic ...silica, total organic carbon, chlorins, and proteins) as productivity proxies. Two sediment cores from the head and the center of the fjord were analyzed and compared to gain insights on past changes in productivity in these two different depositional environments. Higher sedimentation rates found at the head of the fjord result from the combination of a shallower water column and a restricted circulation by the occurrence of a sill. Additionally, sediment mixing depths estimated from
210Pb data suggest that suboxic conditions may dominate the bottom water and the sediment–water interface in this location.
Productivity of the Puyuhuapi fjord during the last century was characterized by a constant increase from the late 19th century to the early 1980s, then decreased until the late 1990s, and then rose again to present-day values. The influence of rainfall on productivity was most noticeable during periods of low rainfall, which coincided with decreased overall productivity within the Puyuhuapi fjord. Simultaneous variations in productivity and rainfall in the study area suggest that marine productivity could respond to atmospheric–oceanic interactions at a local scale. At a regional scale, marine productivity of the area may be related to other large-scale processes such as the El Niño Southern Oscillation.
In this survey paper, the historical evolution of power MOS transistor structures is presented and mostly used actual devices are described. General considerations on current and voltage capabilities ...are discussed and configuration of popular structures is given. It then presents a synthesis of different modelling approaches proposed in recent years. These include analytical solutions for basic electrical parameters, e.g. threshold voltage, on resistance, saturation and quasi-saturation effects, temperature impact and voltage handling capability. The numerical solutions of basic semiconductor devices are then briefly described along with some typical problems which can be solved this way. The compact circuit modelling method is finally explained with emphasis on dynamic behaviour modelling. Physical numerical models are detailed together with those intended for circuit simulation. A fairly exhaustive bibliography is given for completeness.
Qualitative research in Denmark analysing patients' perceptions about the process used to obtain consent from them to participate in clinical trials while being treated for acute myocardial ...infarction (AMI. (BNI unique abstract) 28 references
OBJECTIVES: To study whether linguistic analysis and changes in information leaflets can improve readability and understanding. DESIGN: Randomised, controlled study. Two information leaflets ...concerned with trials of drugs for conditions/diseases which are commonly known were modified, and the original was tested against the revised version. SETTING: Denmark. PARTICIPANTS: 235 persons in the relevant age groups. MAIN MEASURES: Readability and understanding of contents. RESULTS: Both readability and understanding of contents was improved: readability with regard to both information leaflets and understanding with regard to one of the leaflets. CONCLUSION: The results show that both readability and understanding can be improved by increased attention to the linguistic features of the information.
The aim of this study was to model the cerebral generators following painful electrical stimulation of the sigmoid colon in 10 healthy controls and 10 patients with visceral pain due to the irritable ...bowel syndrome. The evoked brain potentials to 30 painful electrical stimuli from the sigmoid colon were recorded from 31 surface electrodes and subjected to electrical dipole source modelling. Two dipoles in the bilateral insular cortex, one dipole in the anterior cingulate gyrus and two dipoles in the bilateral second somatosensory area were found. The anterior cingulate dipole showed a more posterior position in patients than in control subjects. This finding suggests that the cortical representation of painful stimuli can be modified in presence of chronic visceral pain and that this change involves the anterior cingulate gyrus.
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