Genomic research results and incidental findings with health implications for a research participant are of potential interest not only to the participant, but also to the participant's family. Yet investigators lack guidance on return of results to relatives, including after the participant's death. In this paper, a national working group offers consensus analysis and recommendations, including an ethical framework to guide investigators in managing this challenging issue, before and after the participant's death.

Background: The Declaration of Helsinki prohibits the publication of articles that do not meet defined ethical standards for reporting of research ethics board approval and informed consent. Despite this prohibition and a call to highlight the deficiency for the reader, articles with potential ethical shortcomings continue to be published.Objective: To determine what proportion of articles in major medical journals lack statements confirming REB approval and informed consent, and whether accompanying commentary alerts readers to this deficiency.Design: Retrospective, observational study.Setting: Online review (...) of five major medical journals.Population: All clinical research articles published online between 1 January 2005 and 31 December 2006 in the BMJ, Lancet, Annals of Internal Medicine, JAMA and the New England Journal of Medicine.Measurements: Statement of REB approval and informed consent.Results: Of 1780 articles reviewed, 1133 met inclusion criteria , 36 articles lacked a statement of REB approval, 62 lacked disclosure of informed consent and 15 articles lacked both. Articles that did not state REB approval were associated with not stating informed consent . There were no editorial comments to alert readers to the lack of either REB approval or informed consent statements associated with any of the deficient articles.Conclusions: Articles that lack explicit statements of REB approval and informed consent are infrequent but continue to be published in major medical journals without editorial statements to alert the reader to this deficiency. (shrink)

PURPOSE: There is an increasing demand for researchers to provide research results to participants. Our aim was to define an appropriate process for this, based on needs and attitudes of participants. METHODS: A multicenter survey in five sites in the United States and Canada was offered to parents of children with cancer and adolescents with cancer. Respondents indicated their preferred mode of communication of research results with respect to implications; timing, provider, and content of the results; reasons for and against (...) providing results; and barriers to providing results. RESULTS: Four hundred nine parents (including 19 of deceased children) and 86 adolescents responded. Most parents (n = 385; 94.2%) felt that they had a strong right to research results. For positive results, most wanted a letter or e-mail summary (n = 238; 58.2%) or a phone call followed by a letter (n = 100; 24.4%). If the results were negative, phone call (n = 136; 33.3%) or personal visits (n = 150; 36.7%) were preferred. Parents wanted the summary to include long-term sequelae and suggestions for participants (n = 341; 83.4%), effect on future treatments (n = 341; 83.4%), and subsequent research steps (n = 284; 69.5%). Understanding the researcher was a main concern about receiving results (n = 145; 35.5%). Parents felt that results provide information to support quality of life (n = 315; 77%) and raise public awareness of research (n = 282; 68.9%). Adolescents identified similar preferences. CONCLUSION: Parents of children with cancer and adolescents with cancer feel strongly that they have a right to be offered research results and have specific preferences of how and what information should be communicated. (shrink)

PURPOSE: The offer to return research results to participants is increasingly recognized as an ethical obligation, although few researchers routinely return results. We examined the needs and attitudes of parents of children with cancer and of adolescents with cancer to the return of research results. METHODS: Seven experts in research ethics scored content validity on parent and adolescent questionnaires previously developed through focus group and phone interviews. The questionnaires were revised and provided to 30 parents and 10 adolescents in a (...) tertiary care oncology setting. RESULTS: The content validity index for individual questions and the overall questionnaires scored as 0.86 for both questionnaires. All 30 parents and 10 adolescents who agreed to participate returned questionnaires. The majority (>95%) indicated that they had a strong or very strong right to receive results. Letter or e-mail was a satisfactory means to return results described as good or neutral (66% parents, 100% adolescents) but more participants wished face-to-face disclosure of results with negative implications (50% parents, 60% adolescents). Very few wanted results disseminated through a Web site. The majority acknowledged the need for peer-review before disclosure (60% of adolescents and parents) but did not want "to be the last to know." CONCLUSIONS: Our data suggest that pediatric oncology patients and parents of children with cancer strongly feel that they have a right to research results, and that they wish to receive these in a timely manner. (shrink)

OBJECTIVES: To compare 2005 and 1995 ethics guidelines from journal editors to authors regarding requirements for institutional review board (IRB) approval and conflict-of-interest (COI) disclosure. DESIGN: A descriptive study of the ethics guidelines published in 103 English-language biomedical journals listed in the Abridged Index Medicus in 1995 and 2005. Each journal was reviewed by the principal author and one of four independent reviewers. RESULTS: During the period, the proportion of journals requiring IRB approval increased from 42% (95% CI 32.2% to (...) 51.2%, p<0.001) to 76% (95% CI 66.4% to 83.1%, p<0.001). In 2005, an additional 9% referred to the Declaration of Helsinki or the International Committee of Medical Journal Editors' Uniform requirements for ethical guidelines; 15% (95% CI 8.5% to 22.5%, p<0.01) provided ambiguous or no requirements. The proportion of journals requiring COI disclosure increased from 75% (95% CI 66.6% to 83.3%, p<0.05) to 94% (95% CI 89.4% to 98.6%, p<0.05); 41% had comprehensive requirements, while some addressed only funding source (6%), were vague (10%) or both (14%). Criteria for authorship rose from 40% (95% CI 30.5% to 49.5%, p<0.05) to 72% (95% CI 63.3% to 80.7%, p<0.05). Journals with higher impact factors were more likely to require IRB approval (p<0.01). Journals in anaesthesia and radiology all required IRB approval; requirements in other disciplines varied. CONCLUSIONS: Instructions to authors regarding ethical standards have improved. Some remain incomplete, especially regarding the scope of disclosure of COI. The ethical guidelines presented to authors need further clarification and standardisation. (shrink)

What kind of citizenship education, if any, should schools in liberal societies promote? And what ends is such education supposed to serve? Over the last decades a respectable body of literature has emerged to address these and related issues. In this state of the debate analysis we examine a sample of journal articles dealing with these very issues spanning a twenty-year period with the aim to analyse debate patterns and developments in the research field. We first carry out a qualitative (...) analysis where we design a two-dimensional theoretical framework in order to systematise the various liberal debate positions, and make us able to study their justifications, internal tensions and engagements with other positions. In the ensuing quantitative leg of the study we carry out a quantitative bibliometric analysis where we weigh the importance of specific scholars. We finally discuss possible merits and flaws in the research field, as evidenced in and by the analysis. (shrink)

Background: Low rates of participation of adolescents and young adults (AYAs) in clinical oncology trials may contribute to poorer outcomes. Factors that influence the decision of AYAs to participate in health research and whether these factors are different from those that affect the participation of parents of children with cancer. Methods: This is a secondary analysis of data from validated questionnaires provided to adolescents (>12 years old) diagnosed with cancer and parents of children with cancer at 3 sites in Canada (...) (Halifax, Vancouver, and Montreal) and 2 in the United States (Atlanta, GA, and Memphis, TN). Respondents reported their own research participation and cited factors that would influence their own decision to participate in, or to provide parental authorization for their child to participate in health research. Results: Completed questionnaire rates for AYAs and parents were 86 (46.5%) of 185 and 409 (65.2%) of 627, respectively. AYAs (n = 86 [67%]) and parents (n = 409 [85%]) cited that they would participate in research because it would help others. AYAs perceived pressure by their family and friends (16%) and their physician (19%). Having too much to think about at the time of accrual was an impediment to both groups (36% AYAs and 47% parents). The main deterrent for AYAs was that research would take up too much time (45%). Nonwhite parents (7 of 56 [12.5%]) were more apt to decline than white parents (12 of 32 [3.7%]; P < .01). Conclusions: AYAs identified time commitment and having too much to think about as significant impediments to research participation. Addressing these barriers by minimizing time requirements and further supporting decision-making may improve informed consent and impact on enrollment in trials. (shrink)

Secondary findings for adult-onset diseases in pediatric clinical sequencing can benefit parents or other family members. In the absence of data showing harm, it is ethically reasonable for parents to request such information, because in other types of medical decision-making, they are often given discretion unless their decisions clearly harm the child. Some parents might not want this information because it could distract them from focusing on the child's underlying condition that prompted sequencing. Collecting family impact data may improve future (...) policy determinations. (shrink)

BACKGROUND: The offer of return of research results to study participants has many potential benefits. The current study examined the offer of return of research results by analyzing consent forms from 2 acute lymphoblastic leukemia studies of the 235 institutional members of the Children's Oncology Group. METHODS: Institutional review board (IRB)-approved consent forms from 2 standard-risk acute lymphoblastic leukemia studies (Children's Cancer Group [CCG] 1991 and Pediatric Oncology Group [POG] 9407) were analyzed independently by 2 reviewers. RESULTS: The authors received (...) replies from 202 of the 235 institutions that were contacted (85%). One hundred eighty-one institutions had CCG 1991 (n = 96) or POG 9905 (n = 85) protocols that were approved by an IRB. Most institutions provided contact information for the principal investigator (n = 175; 97%) and a member of the institution's research services office (n = 154; 85%). Only 5 (2.8%) institutions provided an indication of a participant's right to receive a summary of research results; most of these institutions provided details on how (n = 5) or when (n = 5) this was to occur. All of these institutions (n = 162; 89.5%) provided a specific statement offering new information that might affect a participant's decision to continue to participate in a study. Only 2 institutional consent forms offered participants the option to receive research results, and only 10 (5.5%) consent forms contained an unambiguous, specific statement offering to provide new information after the study was closed. CONCLUSIONS: Few institutional review board-approved consent forms explicitly indicate the right of research recipients to receive a summary of the results of the research in which they have participated. (shrink)

PURPOSE: The offer to return a summary of results to participants after the conclusion of clinical research has many potential benefits. The authors determined current practice and attitudes and needs of researchers in establishing programs to return results to research participants. METHODS: An Internet survey of all 236 principal investigators (PIs) of the Children's Oncology Group in May 2002 recorded PI and institutional demographics, current practice, and perceived barriers to and needs of PIs for the creation of research results programs. (...) RESULTS: One hundred fifty (63.8%) PIs responded. Few institutions (n = 5) had established, comprehensive programs to offer the return of results. PIs indicated that major impediments to the implementation of such programs are the preparation of lay summaries, time constraints, the task of contacting participants, and potential distress for the participants. PIs identified the following facilitators to the establishment of a program in their own institution: lay summaries, web site, preparation of an oncologist's summary, and financial credits. There was no clear consensus as to when the results should be shared: 30% indicated after the study was closed and 24% indicated at the time of publication of results. A substantial proportion of respondents opposed or strongly opposed the implementation of a universal offering of results to research participants. CONCLUSIONS: Few Children's Oncology Group institutions have programs that offer the return of results to research participants. Significant barriers and facilitators to this process have been identified. (shrink)

Genomic research may uncover results that have direct actionable benefit to the individual. An emerging debate is the degree to which researchers may have responsibility to offer results to the biological relatives of the research participant. In a companion study to one carried out in the United States, we describe the attitudes of Canadian Research Ethics Board chairs to this issue and their opinions as to the role of the REB in developing related policy.

Background: Publication of ethically uncertain research occurs despite well-published guidelines set forth in documents such as the Declaration of Helsinki. Such guidelines exist to aide editorial staff in making decisions regarding ethical acceptability of manuscripts submitted for publication, yet examples of ethically suspect and uncertain publication exist. Our objective was to survey journal editors regarding practices and attitudes surrounding such dilemmas. Methods: The Editor-in-chief of each of the 103 English-language journals from the 2005 Abridged Index Medicus list publishing original research (...) were asked to complete a survey sent to them by email between September-December 2007. Results: A response rate of 33% (n = 34) was obtained from the survey. 18% (n = 6) of respondents had published ethically uncertain or suspect research within the last 10 years. 85% (n = 29) of respondents stated they would always reject ethically uncertain articles submitted for publication on ethical grounds alone. 12% (n = 4) of respondents stated they would approach each submission on a case-by-case basis. 3% (n = 1) stated they would be likely to publish such research, but only with accompanying editorial. Only 38% (n = 13) give reviewers explicit instruction to reject submissions on ethical grounds if found wanting. Conclusions: Editorial compliance with the Declaration of Helsinki in rejecting research that is conducted unethically was difficult to ascertain because of a poor response rate despite multiple attempts using different modalities. Of those who did respond, the majority do reject ethically suspect research but few explicitly advise reviewers to do so. In this study editors did not take advantage of the opportunity to describe their support for the rejection of the publication of unethical research. (shrink)

Returning genomic research results to family members raises complex questions. Genomic research on life-limiting conditions such as cancer, and research involving storage and reanalysis of data and specimens long into the future, makes these questions pressing. This author group, funded by an NIH grant, published consensus recommendations presenting a framework. This follow-up paper offers concrete guidance and tools for implementation. The group collected and analyzed relevant documents and guidance, including tools from the Clinical Sequencing Exploratory Research Consortium. The authors then (...) negotiated a consensus toolkit of processes and documents. That toolkit offers sample consent and notification documents plus decision flow-charts to address return of results to family of living and deceased participants, in adult and pediatric research. Core concerns are eliciting participant preferences on sharing results with family and on choice of a representative to make decisions about sharing after participant death. (shrink)

Si no me falla la memoria, fue el dibujante Álvaro Barrios quien afirmó que el trabajo del artista contemporáneo colombiano se desarrolla según una agenda de trabajo. Si miramos algunos fenómenos del arte último en Colombia, podemos señalar que su agenda está determinada por el intento de comprensión de los procesos de la violencia en el país, a partir de una amplia gama de aproximaciones al concepto de memoria que ha tenido resonancia en las disciplinas humanísticas, las investigaciones académicas, el (...) uso político del concepto por parte de la legislación estatal, y una gran diversidad de eventos artísticos. Desde el ámbito del arte, exposiciones como Destierro y reparación (2008), Tapices de Mampuján (2010), La guerra que no hemos visto (2009) o La piel de la memoria (2011), han discutido sobre la violencia en Colombia desde la aproximación a los procesos de comprensión de la memoria y nuestro pasado reciente. Así, la imbricación de violencia y memoria se manifiesta en la visión del pasado y en los efectos que este puede desplegar sobre el presente, en tanto se ha considerado, incluso, a la memoria como una instancia de reconciliación social. (shrink)

BACKGROUND: Researchers have a moral responsibility to offer to return research results to participants, but the needs and attitudes of parents and adolescents with cancer in paediatric oncology regarding the issue are relatively unknown.OBJECTIVES: To explore the needs of potential research participants or their guardians with respect to the offer of a return of research results. METHODS: A questionnaire was used in a focus group and in telephone interviews with eight adolescents and 12 parents of children with cancer. The participants (...) were asked to respond to the questions and to comment on the inclusiveness of the questionnaire.RESULTS: The majority of participants (18 of 20) wished to receive research results. Two somewhat unexpected findings are described. First, all participants in the present study felt that it was the primary responsibility of the participant to retain contact with the researchers for the purpose of obtaining research results. Second, few participants (n=2) indicated that the Internet would be a satisfactory way of transmitting these results. One-half of the participants wished to have face-to-face communication of results.CONCLUSIONS: These results provide preliminary guidance for the return of research results to participants and validate the use of the questionnaire in a larger study of this issue. (shrink)

En este artículo trabajamos dentro del campo de la música tradicional, vinculándola con la perspectiva de género a través del análisis de los roles establecidos tanto en la tradición como en la actualidad. Para ello establecemos una metodología basada en la realización de entrevistas como medio para suplir la falta de referencias bibliográficas. Nuestros resultados se centran en la continuidad de los roles de género y su distribución a través de relaciones de poder, independientemente de los cambios de contexto acaecidos (...) entre la tradición y la actualidad. Por último reflejaremos el interés actual y las posibilidades didácticas sobre el tema. (shrink)

Guilherme de Ockham: contra a Ideia como exemplar.

La importancia que ha cobrado el ‘giro afectivo’ en los estudios clásicos es indudable, como lo demuestran los múltiples trabajos interdisciplinarios publicados dentro del área en las últimas décadas. Teniendo en cuenta los desafíos y dificultades que siempre implica analizar históricamente la dimensión sentimental, el presente trabajo tiene como intención dar cuenta de los avances que se han producido en los últimos años en el estudio de las emociones en la antigüedad, focalizando sobre todo en la Grecia clásica, a los (...) efectos de ofrecer un amplio panorama teórico que pueda ser de utilidad para quienes opten por adentrarse en este prometedor campo de indagación académica. (shrink)

In this paper we provide a summary of the discussions between Villey and Tierney concerning the rise of a concept of subjective right in late medieval thought, William of Ockham’s place in it, and the differences of this subjective notion with regards to an objective notion of right. Afterwards, we analyze Ockham’s main texts. According to the authors, Ockham’s notion of a natural right of the individual bears a relationship both to a rational concept of morality and to his characteristic (...) emphasis on the free choice of the will. (shrink)

A través de los escritos de Rilke que describen la misión del poeta y de la filosofía de Heidegger que trata de descifrar el sentido del Ser a través del lenguaje, este escrito intenta aproximarse al acontecimiento que tiene lugar en la creación poética. Partiendo de su labor transicional entre el territorio de lo inhóspito y el de lo familiar, se expondrá el modo en que la poesía apela a los orígenes subterráneos, así como la conexión que establece entre el (...) individuo y el mundo a través del amor intransitivo. A continuación, se pasará a analizar el proceso de creación en tanto salto que tiene lugar en un estado de apertura, consumado en la transformación de lo visible en invisible que el poeta lleva a cabo incorporando la realidad y en la figura del ángel de Rilke. Finalmente, se tratará de dar cuenta de la crisis provocada por el imperio de la técnica surgido a partir de la Modernidad, que amenaza con suprimir toda posibilidad de creación artística a través de dominio, fabricación y transparencia. (shrink)

Las relaciones entre los Estados Unidos de América y la actual Federación de Rusia, han sido objeto de minuciosos estudios académicos a lo largo de los años. Estas dos grandes potencias han jugado un importante papel en la configuración del sistema internacional. Con este artículo se pretende realizar un análisis de la política exterior de Rusia, -desde el enfoque realista de las relaciones internacionales- el cual no puede desprenderse de un estudio paralelo que haga referencia al comportamiento de Occidente en (...) general, y en particular de los Estados Unidos de América. (shrink)

El estudio de las emociones en la Antigüedad ha tenido en las últimas décadas una gran eclosión. En su desarrollo, la propuesta aristotélica de los afectos ha recibido una atención especial. En ese marco, se ha observado que la emoción de la ‘indignación’, tal como la define el Estagirita no habría recibido por parte de los griegos el nombre que este le asigna. La objeción se funda, sobre todo, en los testimonios de las oraciones forenses. Nuestra propuesta incorpora el testimonio (...) de la comedia aristofánica a la discusión, ya que la indignación ha sido considerada por muchos la emoción típica de la comedia. (shrink)

This paper is a comparative analysis of the Logica Campsale Anglici, valde utilis et realis contra Ocham , from an anonymous author known as pseudo Richard of Campsall, and Ockham’s Summa logicae , in answer to which the former was written. We summarize both authors’s fundamental positions on five key issues: 1) the synonymy between abstract and concrete terms, 2) the reference of primary and secondary intentions, 3) the nature of the relations of predication between terms in propositions, 4) the (...) status of the “passions of the soul” and 5) the prime signification of spoken words. Our aim is to sketch the polemic between Nominalism and Realism in the second decade of the XIVth century. (shrink)