Attitudes to drug trials among relatives of unconscious intensive care patients

BACKGROUND: In many countries relatives are asked to consent on behalf of ICU patients prior to inclusion in clinical trials. However, the attitudes to drug trials among relatives of unconscious ICU patients are largely unknown. METHODS: We performed a prospective questionnaire survey at two university hospital ICUs of the next-of-kin to 50 unconscious adult patients. They were asked to complete a questionnaire within 48 hours of the patients' acute ICU admission. RESULTS: Forty-two relatives returned the questionnaire of which 41 were completed by direct family members and in one case by a friend to the patient. The majority of relatives (36/42) were positive/positive with some scepticism towards performing drug trials in unconscious ICU patients and 30/42 would most likely accept trial-participation by their relative. The majority (30/42) agreed that they should decide if their relative was to participate in a drug trial and 24 of these found that the treating clinician/ICU consultant should also consent. The majority (27/42) found that deferred consent would be acceptable if there was a limited time frame for initiation of treatment, however 8 respondents found this unacceptable when the intervention was a new drug. The majority of relatives stipulated that adherence to legislation, treatment benefit for the study patient and for future patients, no patient-risk or -discomfort and development of new drugs were important factors if their relative was to participate in an ICU drug trial. When questioned about doctors' motives for performing drug trials the wish for drug development and better patient care were highly rated among relatives. CONCLUSIONS: In general, relatives to unconscious ICU patients expressed positive attitudes to drug trials in the ICU and the inclusion of their relative in drug trials. Consent by next-of-kin and deferred consent was acceptable to the majority of relatives

Labour market signalling and unemployment duration: an empirical analysis using employer-employee data

This paper tests the signalling hypothesis using detailed flow-based employer-employee data from Denmark. The primary focus is to explore how the conditions in the pre-displacement firm affect the duration of unemployment. The empirical analysis is conducted within a competing risk framework, with destinations into reemployment and inactivity, which yields more plausible estimates of the signalling effect. It is established that the positive ability signal of being displaced due to a plant closure is significant but also that the signal of displacement from severe downsizing is important. Issues that have previously been ignored in the empirical analysis of the signalling hypothesis such as local labour market conditions, the sector of employment and the duration of the previous employment match are established to be important determinants for the time spent in unemployment. The heterogeneity of the signalling effect across various employee subgroups in the economy is also explored. These findings emphasize that individuals' reemployment prospects are heavily influenced by the labour market history and in particular by the conditions in the firms in which they were previously employed

Point-by-point inscription of apodized fiber Bragg gratings

We demonstrate apodized fiber Bragg gratings inscribed with a point-by-point technique. We tailor the grating phase and coupling amplitude through precise control over the longitudinal and transverse position of each laser-inscribed modification. This method of apodization is facilitated by the highly-localized, high-contrast modifications generated by focussed IR femtosecond laser inscription. Our technique provides a simple method for the design and implementation of point-by-point fiber Bragg gratings with complex apodization profiles.Comment: 6 pages, 4 figures, article in revie

The role of civil society in securing self-assessed quality of life in rural areas

This chapter asks how do inhabitants in Danish rural areas assess whether, how and why participation in civil society influences their quality of life. Theoretically, we argue that the importance for civil society’s role in influencing life satisfaction depends on whether the citizens are engaged in social networks which are profound and long lasting. Twenty-eight semi-structured interviews with individuals who were in different ways and to a different extent engaged in civil society in three different rural settings in Denmark form the empirical base of the analysis. In the analysis we show that long-lasting and deep participation in civil society results in higher levels of quality of life. Specifically, we point to three different mechanisms which we illustrate in three themes: Theme 1: Making activities possible for other local citizens, Theme 2: Contributing to civil society is rewarding for the individual, and Theme 3: It is rewarding to be a part of the struggle for overcoming the challenges of living in rural areas. Further, we argue that an age difference exists, as the younger persons, to a greater extent than older persons, participate in civil society to get a rich social life with friends. The older persons to a greater extent highlight the altruistic motives for contributing to civil society. Finally, we argue that with regard to increasing quality of life, ‘collective volunteering’ seems to be of higher importance than ‘reflexive volunteering’ for the interviews in this study.</p

Where do we meet? Exploring how facilities and meeting places in rural areas contribute to quality of life

As a result of structural and demographic changes in rural areas, fewer facilities and meeting places exist in Denmark. In this article, we assess which role facilities and meeting places in rural areas might have for the self-assessed Quality of Life (QoL) of the individuals living in the rural areas. Based on 27 semi-structured qualitative interviews with persons from three different rural areas in Denmark, we show how facilities and meeting places in rural areas play a role in relation to self-assessed QoL via two different types of mechanism: 1) through providing a framework for activities and 2) through the symbolic role facilities and meeting places might have to indicate that one is part of a thriving village. We argue that it is important to acknowledge both mechanisms when assessing the role of facilities and meeting places for QoL in rural areas. The findings in this study focus on the users of the local facilities. Further qualitative research could explore which role the presence of facilities and meeting places might play for the inhabitants who do not use the local facilities and meeting places to the same extent as the interview persons in this study.</p

Exploring the impact of stressful life events on quality of life:meaning making and narrative reconstruction

Purpose: Stressful life events have the capacity to disrupt an individual’s worldview and life goals, leading to existential questions and identity loss. The subjective perception of identity is intricately linked with quality of life (QoL), and how individuals derive meaning from these stressful life events significantly influences their well-being. This article explored the impact of stressful life events on individuals’ QoL, and examined the potential for enhancing QoL through meaning making and narrative reconstruction. Methods: Qualitative interviews were conducted with 11 individuals reporting diminished QoL and analysed using thematic analysis. Results: The study reveals that stressful life events confront interviewees with the vulnerability of their values in life and the limits of their control, leading them to question their own beliefs and purpose in life. Consequently, these events prompt individuals to reconstruction their narratives to adapt to new life circumstances. Conclusions: The study suggests that “securing the base,” including strong social relations and security in economic and housing conditions, is a prerequisite for enhancing QoL. The insights on “the base” have profound implications for QoL. Recognizing their fundamental importance, policymakers, healthcare professionals, and social service providers can support mechanisms to enhance these foundations, improving overall well-being for individuals and communities.</p

Consecutive Daily Measurements of Luminal Concentrations of Lactate in the Rectum in Septic Shock Patients

In a recent study we found no difference in the concentrations of luminal lactate in the rectum between nonsurvivors and survivors in early septic shock (<24 h). This study was initiated to investigate if there are any changes in the concentrations of luminal lactate in the rectum during the first 3 days of septic shock and possible differences between nonsurvivors and survivors. Methods. We studied 22 patients with septic shock in this observational study. Six to 24 h after the onset of septic shock the concentration of lactate in the rectal lumen was estimated by 4 h equilibrium dialysis (day 1). The rectal dialysis was repeated on day 2 and day 3. Results. The concentration of lactate in the rectal lumen did not change over the 3 days in neither nonsurvivors nor survivors. Rectal luminal and arterial lactate concentrations were not different. Conclusion. There was no change in the concentration of lactate in the rectal lumen over time in patients with septic shock. Also, there was no difference between nonsurvivors and survivors