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Consent for the use of human biological samples for biomedical research: a mixed methods study exploring the UK public's preferences
Celine Lewis1,
Margaret Clotworthy2,
Shona Hilton3,
Caroline Magee4,
Mark J Robertson5,
Lesley J Stubbins6,
Julie Corfield7
1Unit 4D Leroy House, Genetic Alliance UK, London, UK
2Human Focused Testing, Cambridge, UK
3Medical Research Council/CSO Social & Public Health Sciences Unit, Glasgow, UK
4Confederation of Cancer Biobanks, National Cancer Research Institute, London, UK
5AstraZeneca, Science Policy & Relations, Cheshire, UK
6GlaxoSmithKline Medicines Research Centre, Hertfordshire, UK
7Areteva Ltd, Nottingham, UK
Correspondence to Dr Celine Lewis; celine{at}geneticalliance.org.uk
Objective A mixed-methods study exploring the UK general public's views towards consent for the use of biosamples for biomedical research.
Setting Cross-sectional population-based focus groups followed by an online survey.
Participants 12 focus groups (81 participants) selectively sampled to reflect a range of demographic groups; 1110 survey responders recruited through a stratified sampling method with quotas set on sex, age, geographical location, socioeconomic group and ethnicity.
Main outcome measures (1) Views on the importance of consent when donating residual biosamples for medical research; (2) preferences for opt-in or opt-out consent approaches and (3) preferences for different consent models.
Results Participants believed obtaining consent for use of residual biosamples was important as it was 'morally correct' to ask, and enabled people to make an active choice and retain control over their biosamples. Survey responders preferred opt-in consent (55%); the strongest predictor was being from a low socioeconomic group (OR 2.22, 95% CI 1.41 to 3.57, p=0.001) and having a religious affiliation (OR 1.36, 95% CI 1.01 to 1.81, p=0.04). Focus group participants had a slight preference for opt-out consent because by using this approach more biosamples would be available and facilitate research. Concerning preferred models of consent for research use of biosamples, survey responders preferred specific consent with recontact for each study for which their biosamples are eligible. Focus group participants preferred generic consent as it provided 'flexibility for researchers' and reduced the likelihood that biosamples would be wasted. The strongest predictor for preferring specific consent was preferring opt-in consent (OR 4.58, 95% CI 3.30 to 6.35, p=0.015) followed by non-'White' ethnicity (OR 2.94, 95% CI 1.23 to 7.14, p<0.001).
Conclusions There is a preference among the UK public for ongoing choice and control over donated biosamples; however, increased knowledge and opportunity for discussion is associated with acceptance of less restrictive consent models for some people.
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/
http://dx.doi.org/10.1136/bmjopen-2013-003022
Article focus
To explore views of the UK public on the importance of consent being sought for the use of residual biosamples for medical research.
The publics' preferences for opt-in or opt-out approaches to consent.
The publics' preferences for generic, tiered or specific consent.
Obtaining consent for the use of residual biosamples for biomedical research was perceived as important by members of the general public.
Survey participants exhibited a desire to retain active choice and control when donating biosamples and over the uses to which their biosamples might be put, preferring an opt-in system and specific consent; however, these results differ from those reported during focus group discussions, where preference was for less restrictive consent models (an opt-out system and generic consent) that are likely to increase availability of biosamples.
These differences might be accounted for by the fact that focus group participants were given more background information about the use of residual biosamples in research and had time to consider the benefits and disadvantages of the different approaches.
Strengths and limitations of this study
This study contributes further to our understanding of the UK public's views and preferences towards consent for the use of biosamples in medical research. Our study supports the premise that increased knowledge and opportunity for discussion is associated with acceptance of less restrictive consent models.
Owing to the hypothetical nature of the study, the findings may not necessarily correlate with actual behaviour.
Human biological samples (biosamples), including organs, tissues, biofluids such as blood, and their derivatives, are increasingly important resources for biomedical research.1 ,2 For example, they can help us to understand how we diagnose, categorise and treat a whole variety of medical conditions including cancer1 and are particularly important when studying rare diseases or conditions where biosamples are hard to obtain. Biosamples are donated by either healthy volunteers or patients, either through specific research studies or as residual tissues or biofluids surplus to diagnostic requirements, or postmortem. Biosamples can be used fresh or can be first stored in a biobank, a collection of biosamples often linked with the donors' clinical and demographic information, as biosample attributes. Here, the quality of the data linked to the biosample is as important as the quality of the biosamples themselves, providing essential context within which to design analyses and interpret results or carry our further experimental studies. Clinical data may also be enriched with lifestyle and environmental information.3
It is widely accepted that donor consent should be sought and obtained before biosamples can be used in research.4 ,5 Consent in research ethics relates to ensuring respect for the autonomy and dignity of the donors (research participants) and protecting them from abuse5 and in fact, in England, Wales and Northern Ireland, the Human Tissue Act establishes donor consent as the baseline principle for the retention and use of organs and tissue for purposes beyond diagnosis and treatment, although further statutory consent exemptions do exist in certain circumstances, notably use of anonymised tissue from the living for research ethics committee (REC) approved research projects.6 The value of biobanks, in supporting broad, long-term research purposes, means that the model of the consent process needs to be considered in order to ensure that it is valid and appropriate. A number of different consent frameworks which address consent scope and process have been proposed as a result.5 However, there is continued debate as to which is the most appropriate in various situations.4 ,7 ,8
Both the Human Tissue Authority9 and National Research Ethics Service10 recommend generic consent (table 1), a view that has also been endorsed by the UK research funders11 and the Nuffield Council on Bioethics.12 One commonly cited criticism of generic consent is that it is not sufficiently 'informed' as future research uses are not known at the time of donation.13 Empirical research examining public and patient preferences has highlighted that there is no clear consensus on the issue, with specific consent being identified as the most favoured form of consent in some studies,14 ,15 and generic consent in others.16–18
Approaches to consent of biosamples
The 2011 Nuffield Council report on donation of human material for medicine and research also recommends that research funders should work to increase public awareness of the key role of donated tissue in scientific and clinical research.12 Public trust and confidence in the consent process is of paramount importance to maintain and increase public support for donation and use of biosamples for biomedical research in the UK. For this reason, it is important to understand and inform public opinion to ensure that consent models are aligned to public expectations and preferences. While numerous international studies have been conducted which focus on consent preferences, research conducted in the UK has tended to focus on large-scale population biobanks, such as the UK Biobank19 or Generation Scotland,20 which require ongoing contact with donors, or on the views of patients on the donation of residual biosamples.21 The current study was conducted to broaden our understanding of the UK public's views on biosample donation for biomedical research. Moreover, the findings are intended to inform a biobanking policy for Strategic Tissue Repository Alliance Through Unified Methods, a Technology Strategy Boardi and pharmaceutical industry-funded project seeking to address the problem of insufficient numbers of biosamples and associated clinical data of adequate quality to fully support biomedical research in the UK.
The specific aims of this study were to (1) identify participants' views on the importance of consent when donating residual biosamples for medical research; (2) explore preferences for opt-in or opt-out approaches to consent and (3) explore preferences for different consent models (table 1). Public willingness to donate biosamples, views on donation of different biosample types and conditions of their use (by which organisations and for which types of research) are reported in the sister paper related to this study.22
This was a mixed methods study comprising qualitative focus groups and a quantitative on-line survey. Ethical approval for the study was granted by the University of Manchester Research Ethics Committee in April 2012.
Twelve focus groups (including one pilot group) were conducted between May and July 2012 in six different geographic locations across the UK. Participants were recruited face-to-face in the street by a market research company, The Focus Group. Participants were purposively sampled; each group chosen to reflect a particular demographic (age, socioeconomic group (SEG), ethnicity) in order to gather a wide spectrum of views and enable comparisons across groups. Two 'patient' groups were also included, comprising people who had had an operation in the past 2 years requiring an overnight hospital stay, and people who currently have, or have had, either a serious or chronic illness or disability. The latter group comprised people diagnosed with diabetes, cancer, heart disease, asthma and the genetic conditions, like Marfan syndrome. A further group consisted of generally healthy volunteers who had donated a biosample specifically for research purposes.
Before agreeing to take part, potential participants were given a participant information sheet telling them about the study (see online supplementary appendix I). Those who were interested were screened through a questionnaire containing demographic questions to assess their suitability for a particular focus group. These were held in 'neutral' locations such as hotel conference rooms or church halls and facilitated by an experienced facilitator (CL). Before each group discussion, participants were sent a short information leaflet about the use of biosamples in biomedical research to provide some background context for the discussion and to prompt them to think about the key issues (see online supplementary appendix II). This information was written by a core team of authors drawn from across academia and industry, including patient representation. It was reviewed by three members of the patient organisation Genetic Alliance UK as well as the science communication charity Sense about Science to ensure readability and non-bias. Before focus group discussions began, participants were asked to sign a consent form. Each participant received £50 for taking part to cover time and travel costs. Focus groups lasted 90 min and digital audio recordings were taken.
A detailed discussion guide was developed to explore participant views and preferences towards consent scope and process (see online supplementary appendix III). The main focus related to the use of biosamples surplus to diagnostic requirements following surgery or a medical procedure. Questions were informed by other empirical studies of consent in biobanking,16 ,23 developed by the authors and addressed the topics described above. To enhance understanding around the different consent models, participants were given a sheet presenting three different scenarios, each of which elaborated on one of the three consent models chosen for discussion (see online supplementary appendix III, p.4). For each topic, discussions began by asking the group to consider the benefits and disadvantages of each particular approach. Once no new themes were emerging, each participant was asked to complete an accompanying anonymous questionnaire which asked them to select their preferred consent model. The discussion guide, scenario sheet and questionnaire were piloted at the first focus group which resulted in some minor amendments to wording.
Recordings were fully transcribed and transcriptions checked. The software package Nvivo V.9 (QSR International, Pty Ltd) was used to help organise the data for analysis. This comprised grouping responses to questions into broad thematic categories which were then refined through subcodes. Coding of all 12 transcripts was conducted by CL. The first six transcripts to be coded were also independently coded by a second researcher (SR). Codes were then compared to assess consistency of coding and ensure inter-rater reliability. Any discrepancies were discussed until consensus was reached. The remainder of the transcripts were then coded according to the agreed coding framework.
Once data analysis had been conducted on the focus group transcripts, the findings were used to inform development of a quantitative survey which was used to canvas public opinion on the issues of interest across a representative sample of the UK population (see online supplementary appendix IV). The survey was carried out by the market research company Research Now using their online panel community of the UK residents. A stratified sampling method was used: quotas were set on sex, age, geographical location, SEG and ethnicity, in line with data provided by the Office of National Statistics (ONS) to ensure the sample was as representative of the UK population as possible. Within each category, a random sample was selected from the Research Now database containing 451 185 active respondents. We aimed to recruit 1000 responders in total. The sample size required depends on the number of predictors, the expected effect size and the level of power. According to Miles and Shevlin,24 if we are expecting a small effect size, a sample size of 600 is considered adequate to achieve a high level of power of 0.8 (a benchmark suggested by Cohen25) for four predictors. As highlighted in table 2 we can formulate at least four hypothesis, for example, people from a higher SEG are more likely to donate biosamples than those from a lower SEG. With a sample size of 1000, this study would provide highly reliable results. In order to reduce any on-line bias in our sample, 100 face-to-face interviews with non-internet users were conducted. An additional 'boost' sample of 100 people (not included in the main sample analysis) was also conducted with people from three minority ethnic groups ('Black', 'Chinese', 'S Asian') so that we could conduct subgroup analysis between the groups.
Participant characteristics
The survey questions were developed by the authors and piloted with 60 members of Research Now's online panel community who were from low SEG's. Members of the pilot group were then invited to take part in a subsequent telephone interview asking about the survey. Interviews were conducted with 25 pilot survey responders. Questions focused on question clarity, survey length and whether responders felt the survey to be neutral. Some minor amendments to wording were made in light of the responses. The main survey was then conducted in September 2012. Surveys recorded online took, on average, 17 min to complete and each responder received a small payment (around £2) from Research Now.
Survey data were organised and analysed using SPSS statistical software V.20 (SPSS Inc; 2011; Chicago, Illinois, USA). Initial univariate descriptive statistics were obtained for the entire study. Pearson χ² test was used to examine demographic factors associated with willingness to donate and preference for different consent models. Those associations that were found to be significant (p≤0.05) were then entered into a multiple logistic regression to explore the predictivity of these variables. Before running the model, we tested for multicollinearity among the independent variables. No multicollinearity issues were found.
Participant characteristics are detailed in table 2.
One hundred and eighty-two members of the public who were approached were eligible to participate (ie, they fitted the criteria for a particular focus group) and 81 people agreed to participate (45% participation rate; 48 women, 33 men). There were seven participants in each focus group apart from the 18 –25 age group and high SEG group (eight participants in each); serious/chronic illness group and healthy volunteers group (six participants in each) and the pilot group (five participants).
In total, 4607 people were invited to take part in the survey; 2014 did not respond, 860 began completing the survey but did not finish, 102 did not qualify to continue (eg, they were under 18 years old), 521 qualified for the survey but the quota was full and 1110 completed the questionnaire (28% response rate excluding those who did not qualify and where the quota was full). This response rate is comparable with similar studies on this topic.16 Our participant quotas closely, though not exactly, matched our targets based on the UK population data as provided by the ONS. For this reason we carried out both weighted and unweighted analyses. There was no difference in the conclusions we reached by either method. In this paper we present the unweighted results (weighted results can be found at online supplementary appendix V).
Importance of asking for consent
The majority of survey participants believed that obtaining consent for the use of residual biosamples was either extremely important (55%) or important (25%). Only 4% selected 'not at all important'. Focus group participants also saw the consent process as important and cited reasons including: that it was 'polite', 'respectful' and 'morally correct' to ask permission; that it enabled people to feel they had made a contribution and an active choice; that it provided control, in particular for those people that might not want their biosamples to be used, for example, for religious reasons; that taking without asking was akin to theft; and that it was important in order to maintain trust between patients and doctors. It then doesn't allow them to take liberties or advantage of the fact that you're out cold having an operation and someone says 'Oh we need a bit of that'. Male, patient—had operation in past 2 years
A small minority did not feel that consent was important, the main reasons being that they did not want the tissue back, that once it was removed it no longer 'belonged to them', and that the tissue would just go to waste otherwise.
Survey participants were asked what would be their preferred method of consenting to donate leftover biosamples for research use. The majority (65%) wanted to do so face-to-face with a health professional; 15% wanted to complete a form and return it by post. This issue was not specifically addressed with focus group participants due to time constraints.
Preference for 'opt-in' or 'opt-out' consent
Participants were asked whether they preferred an opt-in or opt-out model of consent for donating residual biosamples. The results of the survey showed that opt-in consent was preferred by over half of the participants (55%), 28% preferred opt-out, 14% had no preference and 4% selected 'don't know'. Participants who were significantly more likely to prefer opt-in consent were: from a low SEG (E) (79.8% vs 64.1%, χ²=11.13(1), p=0.001); over 65 years (75.1% vs 64%, χ²=7.68(1), p=0.006); had a religious affiliation (68.8% vs 61.2%, χ²=4.84(1), p=0.028); and had an education level of GCSE or lower (71.1% vs 63.9%, χ²=3.89(1), p=0.048). The strongest significant predictor for preferring opt-in consent was being from a low SEG (E) (OR=2.22, 95% CI 1.41 to 3.57, p=0.001) followed by having a religious affiliation (OR=1.36, 95% CI 1.01 to 1.81, p=0.04; table 3).
Multiple logistic regression of participant preferences for consent models
Focus group participants preferred opt-out consent (n=46; 57%) over opt-in consent (n=29; 36%), with six participants (7%) unsure, after in-depth discussion around the benefits and disadvantages of each approach. The main benefit of opt-out consent cited by participants was that more biosamples would be available and consequently spur research. Other reasons included: that it would be less costly administratively; that it maximised the value of left over biosamples; that patients would not have to consider it every time they were having an operation or blood test; that those that did not want to donate still had the opportunity to opt-out and that it would 'normalise' donating leftover biosamples which would be a positive step. It would be an incentive for society if everyone knew that this is what happens routinely, but you can choose not to be involved. It would be more like 'that's normal'. Male, aged 18–24 group
Those that preferred the opt-in approach cited the following reasons as to why: an active choice whereby participants had to act on a decision to take part was preferable to a passive choice whereby consent was assumed; it enabled people to have more control over their biosamples; it was truly 'informed consent' in the context of donating surplus samples for research (rather than as part of a clinical trial; clinical trials were outside the scope of the study) and hence more ethically acceptable; it enabled people to feel that they were making a positive contribution and would prevent the problem of vulnerable groups not being aware they were automatically 'opted-in'. There are going to be members of the public who are not going to always be able to consider rationally themselves what it actually means. Female, healthy volunteer
While the majority of focus group participants overall preferred opt-out consent, the results were different for the three minority ethnic groups ('Black', 'S. Asian' and 'Chinese'), where opt-in consent was favoured by the majority.
Consent once for life or consent every time
The most prevalent system in current use for donating new biosamples that are surplus to clinical requirements in the UK is the opt-in approach, with potential donors being asked for consent every time a procedure is performed that may result in a biosample becoming available for research. (The law allows for the use of diagnostic archives for research without consent as long as certain criteria are met.) Participants were therefore asked to consider variations on this model and state whether they preferred: (1) consent once for life, covering all subsequent biosamples, until or unless the donor decides to withdraw consent; (2) consent every time samples surplus to diagnostic requirements may become available or (3) consent at certain points in life. Consent every time (43%) was preferred by the majority of survey participants, followed by consent at certain points (27%) and consent once for life, for example, at age 18 (21%). Seven per cent had no preference and 2% did not know. Groups who were significantly more likely to prefer consent every time compared with consent once for life were: under 55 years (70.3% vs 60.9%; χ²=5.88(1), p=0.015); had no knowledge of the research process (72.3% vs 63.4%; χ²=5.77(1), p=0.016) or were either not at all or moderately religious (70.2% vs 51.3%; χ²=5.1(1), p=0.024). When entered into the regression analysis, the strongest significant predictor for preferring consent every time was being not at all or moderately religious (OR=2.04; 95% CI 1.05 to 4.00, p=0.036) followed by being under 55 years (OR=1.60; 95% CI 1.07 to 2.41, p=0.023; table 3).
Unlike survey responders, focus group participants favoured consent once for life (n=35; 43%) followed by consent every time samples surplus to diagnostic requirements may become available (n=27; 33%) and consent at certain points (n=16; 20%) with three choosing do not know (4%). Like opt-out consent, consent once for life was seen to be better as it was 'quicker' and 'easier' administratively and prevented researchers from 'losing out'. Consent provided most control for participants as you would 'know the specific purpose of it', particularly if the sample was considered to be sensitive, for example, eggs; allowed 'no room for error'; and enabled people to change their mind easily. You may feel differently [depending on] what tissue is being donated and for what purpose the research is being carried out. Female, aged 18–24 group
Some participants had concerns about how consent preferences (eg, what types of research they were willing to donate a biosample for), would follow them across the healthcare system if a 'consent once for life' model was adopted. Consent at certain points was seen by some as a good middle ground as patients would still have some control, but would not have to go through the consent process every time they had a medical procedure. Examples of consent at certain points included every '5 or 10 years', or at the beginning of particular episodes of care such as pregnancy or cancer treatment.
Models of consent for research use of biosamples
Survey participants were presented with four consent models (table 1), and asked whether they would consider consenting residual biosamples to each of them, providing the research had been approved by a REC (described as a committee usually made up of doctors, scientist, patients and the general public which ensure any research allowed to be carried out is for the benefit of patients). Eighty per cent would agree to specific consent—once only; 77% would consent to specific consent—for every new study; 71% would agree to tiered consent and 67% of participants would agree to generic consent. When asked which model they preferred, specific consent—for every new study, was the first choice among those who had a preference (30% of participants overall), followed by generic consent and specific consent—once only, jointly second (both 18%) and lastly tiered consent (14%). Sixteen per cent had no preference and 6% did not know.
After collapsing the two specific consent models together (specific consent—for every new study and specific consent—once only), those participants who preferred specific consent were significantly more likely to: have a religious affiliation (63.9% vs 48.9%, χ²=16.88(1); p<0.001); live in the North East or Scotland (60.9% vs 42.7%, χ²=10.23(1), p=0.001); be over 65 years (67.1% vs 57.1%, χ²=5.31(1), p=0.021) and be of a non-'White' ethnicity (68.9% vs 58%, χ²=4.17(1), p=0.041). Using the boost sample we found that 'Black' participants were significantly more likely to prefer specific consent models compared with 'White' participants (75.6% vs 58%, χ²=4.31(1), p=0.038). Those people who preferred opt-in consent were also more likely to prefer specific consent models (71.1% vs 35.3%, χ²=91.72(1), p<0.001). The strongest significant predictor for preferring specific consent was preferring opt-in consent (OR=4.58, 95% CI 3.30 to 6.35, p<0.001) followed by being of non-'White' ethnicity (OR=2.94, 95% CI 1.23 to 7.14, p=0.015; table 3).
We also looked at who was most likely to prefer generic consent, the least restrictive of the proposed consent models. Those who preferred generic consent were significantly more likely to: have no religious affiliation (51.1% vs 36.1%, χ²=15.97(1), p<0.001); have some or good knowledge of the medical research process (26.1% vs 18.3%, χ²=6.79(1), p=0.009); be male (26.8% vs 19.9%, χ²=5.40(1), p=0.02) and be from a higher SEG group (A–D) (24.3% vs 15.1%, χ²=4.66(1), p=0.031). They were also significantly more likely to prefer opt-out consent (64.7% vs 28.9%, χ²=91.72(1), p<0.001). The strongest significant predictor for preferring generic consent was preferring opt-out consent (OR=4.55, 95% CI 3.13 to 6.67, p<0.001) followed by having no religious affiliation (OR=1.56, 95% CI 1.08 to 2.72, p=0.021) and some or good knowledge of the medical research process (OR=1.56, 95% CI 1.06 to 2.28, p=0.024; table 3).
Focus group preferences differed from those of survey responders with generic and tiered consent being equally popular (n=36; 44% and n=35; 43%, respectively). Specific consent—once only, was least popular (n=6; 7%) (this was the only specific consent model given to participants). Four participants (5%) did not know. Generic consent was valued as it provides most 'flexibility for researchers'; reduces the likelihood residual biosamples will go to waste; is more straightforward to put in place; is 'simpler to understand' and enables biosamples to be used for more than 'one specific thing'. It's better not to restrict the possible use of the sample because by restricting it you're increasing the chance that it'll go to waste. You want the highest probability that something good will come from it. Male, patient—affected by a condition
It was also the consent model favoured by all participants who were affected by an illness or disability.
Tiered consent was valued because it provided more control over donated biosamples than generic consent, allowing people to opt-out of certain types of research, and therefore provided 'clarity and peace of mind'. All but one participant in the 'Black' focus group and all participants who had donated biosamples as healthy volunteers preferred tiered consent. While specific consent was seen to provide the most control and enabled participants to have 'some understanding of what it might be used for', concerns raised were that it 'can't be used for anything else', 'could be wasted' and would require a time-consuming explanation from health professionals.
In both the survey and focus groups, the donation of potentially sensitive biosamples produced a preference for specific consent. In the survey, a quarter (25%) preferred specific consent—for every new study, 22% preferred specific consent—once only, 12% preferred generic consent and 9% preferred tiered consent. Nineteen per cent had no preference and 13% did not know. When discussing donation of eggs, one woman commented: People could reproduce a child or whatever and it's about the personal-ness of what's been taken from you. So if it's a bit of blood, yeah take it, I mean you just cut yourself and blood is gone, but if it's something that's quite personal you only have every now and again, that needs to be guarded. Female, 'Black' ethnicity group
We asked survey participants whether they would like to be kept up-to-date with research going on at a particular hospital or biobank to which they had donated a biosample. Eighty-five per cent said they would be interested; the most popular methods to receive updates were via a website (27%), email (27%) or letter (22%).
This study contributes further to our understanding of the UK public's views and preferences towards consent for the use of biosamples in medical research. In summary, we have found that: (1) the consenting process was perceived as important in order to maintain trust between patients and health professionals and respect patient autonomy; (2) survey participants exhibited a desire to retain active choice and control when donating biosamples and over the uses to which their biosamples might be put and (3) these results differ from those reported during focus group discussions, where preference was for less restrictive consent models that are likely to increase availability of biosamples. These differences might be accounted for by the fact that focus group participants were given more background information about the use of residual biosamples in research and had time to consider the benefits and disadvantages of the different approaches. These interventions may have allayed any anxieties participants had about relinquishing control of their biosamples and seem to have encouraged participants to choose approaches that maximised biosample access to researchers, highlighting the importance and potential impact of education on influencing public perception in this area.
The preference for opt-in consent identified in the survey is consistent with the results of other studies in this area.3 ,15 ,16 One reason for this preference may be that it matches the current system for organ donation for transplant in the UK. It was also perceived as being truly informed consent by some participants (although it is worth noting that it is the information provided to potential donors that guarantees consent is informed rather than the consent mechanism). Nevertheless, the sizeable number of survey responders who preferred opt-out consent (27%) coupled with the preference for opt-out among focus group participants (57%) does suggest that there may be broader support than previously believed for this approach. This point is also supported by the finding that fewer than half of survey participants wanted to be consented every time a sample was taken and nearly 30% preferred consent at certain points. Alternate, more streamlined approaches to consenting should therefore be considered and evaluated. Interestingly, our results showed that preference for opt-out consent was associated with being younger (under 65 years), from a higher SEG and a higher education level. These demographic groups may be more trusting of medical institutions to use residual biosamples appropriately, or perhaps feel empowered to be able to opt-out if so desired, for example, online. Similar findings have been reported in relation to organ donation; a study by Gimbel et al26 found an association between cadaveric donation rate and percentage of the population enrolled in third-tier education. Internet access has also been found to correlate with increased organ donation.27
Concerning consent models for research use of biosamples, the majority of people (69%) were willing to donate biosamples via the least restrictive model, generic consent. A study conducted in Sweden found a similar percentage of the general public were happy to agree to generic consent (67%), whereby surrogate decisions were performed by a REC.28 Other national studies have found the acceptability of generic consent among the general public and in particular patients to be higher, between 79% and 95%.4 ,29–32 Nevertheless, our survey findings suggest that willingness to donate increased where greater choice and control over research participation is retained, although the difference between those who were willing to agree to generic compared with specific was only 13%. Similarly, when survey responders were asked about their preferred approach, their preference was also for specific consent for every new study that might be conducted using their biosample. This may indicate a general interest in how samples are being used. This notion is supported by the high number of people who wanted ongoing contact about the research leading from their donation. Moreover, they may have not considered the practicalities of being asked to consent every time their sample is used, and the high level of recontact they might receive from research teams. Nevertheless, it is important to take note of the fact that more tailored forms of consent represent an attractive approach to many people. While specific consent may be practical for individual research projects, this restriction would make biobanking challenging, as biobanks exist to facilitate access to samples for a wide variety of approved research projects without the need for additional consent. It may be that as more sophisticated biosample tracking and management systems are adopted, resources could become available to support more interactive forms of consent, and more biobanks could offer tiered consent, for example. Further public dialogue and information about the use of the samples may also provide the same assurances for people that arise from specific consent, as highlighted by the preference for less restrictive consent models among focus group participants.
Evidence from other empirical studies looking at preferences for consent models is mixed. The UK studies focusing on donations purely for research by 'healthy volunteers' to biobanks (ie, not donating residual biosamples) have identified a preference for specific consent,19 ,33 as did a study conducted in the USA that also focused on healthy volunteers.15 In a pan-European survey, the majority of the UK public also preferred specific consent for every new study, although the percentage that did was slightly lower than the overall European average (65% compared with 67%).34 It was, however, higher than in Denmark and Finland, where the percentage of people who wanted to be recontacted for every new study was lower at 51% and 54%, respectively. These countries were also found to have very few concerns about the collection of personal information by biobanks and had high levels of trust in ethics committees. Other empirical work conducted in the USA, Canada, Sweden and Spain has shown that public preference is for generic consent.3 ,16 ,18 ,35 ,36 These findings highlight the divergence of opinion on this issue, in particular in different contexts and with different information provision, although the difficulty of comparing across studies with different methodologies and backgrounds must also be taken into account. Notably, where participants had some or good knowledge of the research process and where there was in-depth discussion (ie, during focus groups), participants were more likely to prefer generic consent, a finding that has also been identified elsewhere in the literature37 and supports the need for information and education if increasing the acceptability of generic consent is deemed desirable. Focus group participants affected by an illness or disability were also found to prefer generic consent, and is likely to reflect the fact that they have greater interests at stake.38 Preference for specific consent was found to be associated with being over 65 years and from a non-'White' ethnicity, findings which resonate with other studies.3 ,39 ,40 Consent documentation and written information targeted specifically at these particular groups may also help alleviate any specific concerns these groups may have.
This research into current public attitudes regarding biosample donation in the UK provides valuable guidance for biobanking governance. While generic consent is the model largely endorsed by regulators and funders in the UK,9 ,11 the evidence from this study suggests that there is a need to address the potential concerns that some people may have about the minimal information and lack of control provided through this model. Education and opportunity for discussion may be one way to allay concerns, as demonstrated through focus groups. Keeping donors informed of current research taking place at the hospital or research institutions to which they donated also appears to be desirable and is likely to be both motivating and promote public trust and confidence in the research process, a finding reported elsewhere.41 The opportunity for face-to-face discussion with an appropriately trained healthcare professional at the time of donation may also allay any potential concerns, and is indeed the approach usually taken in the UK at present. This approach has been found to yield high acceptance rates among patients of well over 90%.42–44
This was a mixed-methods study to explore public views and preferences towards consent for biosample donation. Integrating quantitative and qualitative approaches is valuable in exploratory research as it can strengthen the inferences made through triangulation and allow for a more nuanced understanding of the topic.45 This study presented participants with a series of hypothetical questions about their preferences and willingness to donate residual biosamples for medical research. By presenting questions as 'real life' scenarios, we hoped to make the questions as realistic as possible. However, as with any hypothetical scenario, the findings may not necessarily correlate with actual behaviour.
The questions for both the focus groups and the survey were piloted to ensure they were clear and understandable and were not biased towards any particular viewpoint. Nevertheless, many of the issues covered were complex, particularly around the meaning of the different consent models which may have contributed to the dropout rate. Focus groups participants were not presented with the option of 'specific consent—for every new study' (they were only given 'specific consent—once only'). This may have been an attractive option for some given that a concern raised was biosamples being wasted. However, given that the key reasons participants' valued generic consent were because it provided most flexibility to researchers and was most straightforward to administer, this seems unlikely. In addition, given time and resource constraints we were unable to explore whether 'stronger' consent models would have been preferable for organisations that donors trusted less. This is an area that would be worth exploring further in future research. Some participants did complete the survey possibly because of strong feelings about the issues raised and this may have skewed the results; however, every effort was made to ensure that the results were as representative of the UK population as possible. The focus groups and survey were conducted in English and so the findings may not be representative of non-English speaking members of the general public. Future research might target these particular groups.
There is a general willingness among the UK population to donate biosamples for medical research. Our research suggests that there is a preference among the UK public for more information on the uses and outcomes of research, and ongoing choice and control over donated biosamples. Our study also supports the premise that increased knowledge and opportunity for discussion is associated with acceptance of less restrictive consent models.
We would like to thank Lisa Bennett, Sarah Dickson, Catherine Elliott, James Ironside and Chris Womack and for their helpful comments on this paper; Sarah Dickson, Jim Elliott and Neil Formstone for their contribution to the design of the study; and Samantha Reeve and Zheng Lei for help with data analysis.
Oosterhuis JW,
Coebergh JW,
van Veen EB
. Tumour banks: well-guarded treasures in the interest of patients. Nature reviews. Cancer 2003;3:73–7.
Elger BS,
Caplan AL
. Consent and anonymization in research involving biobanks: differing terms and norms present serious barriers to an international framework. EMBO Rep 2006;7:661–6.
Murphy J,
Scott JCGC,
Kaufman D,
. Public perspectives on informed consent for biobanking. Am J Public Health 2009;99:2128–34.
Wendler D
. One-time general consent for research on biological samples. BMJ 2006;332:544–7.
Allen J,
McNamara B
. Reconsidering the value of consent in biobank research. Bioethics 2011;25:155–66.
Department of Health. The Human Tissue Act. 2004. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4103686.pdf (accessed 11 Nov 2011).
Hansson MG,
Dillner J,
Bartram CR,
. Should donors be allowed to give broad consent to future biobank research? Lancet Oncol 2006;7:266–9.
Hoeyer K
. Donors perceptions of consent to and feedback from biobank research: time to acknowledge diversity? Public Health Genomics 2010;13:345–52.
Human Tissue Authority. Consent exemptions from the Human Tissue Act 2004. http://www.hta.gov.uk/licensingandinspections/consentexemptions.cfm (accessed 26 Feb 2013).
Integrated Research Application System. Guidance document for researchers. https://www.myresearchproject.org.uk/Help/Help%20Documents/PdfDocuments/researchtissuebank.pdf (accessed 25 Feb 2013).
Medical Research Council (MRC) and National Cancer Research Institute (NCRI). UK Funders' Vision for Human Tissue Resources, 2011.
Nuffield Council on Bioethics. Human bodies: donations for medicine and research. 2011 http://www.nuffieldbioethics.org/sites/default/files/Donation_full_report.pdf (accessed 26 Feb 2013).
Petrini C
. Broad consent, exceptions to consent and the question of using biological samples for research purposes different from the initial collection purpose. Soc Sci Med 2010;70:217–20.
Tupasela A,
Sihvo S,
Snell K,
. Attitudes towards biomedical use of tissue sample collections, consent, and biobanks among Finns. Scand J Public Health 2010;38:46–52.
Bollinger J,
Dvoskin R,
. Preferences for opt-in and opt-out enrollment and consent models in biobank research: a national survey of Veterans Administration patients. Genet Med 2012;14:787–94.
Simon CM,
L'Heureux J,
Murray JC,
. Active choice but not too active: public perspectives on biobank consent models. Genet Med 2011;13:821–31.
Willison DJ,
Swinton M,
Schwartz L,
. Alternatives to project-specific consent for access to personal information for health research: insights from a public dialogue. BMC Med Ethics 2008;9:18.
Kettis-Lindblad Å,
Ring L,
Viberth E,
. Perceptions of potential donors in the Swedish public towards information and consent procedures in relation to use of human tissue samples in biobanks: a population-based study. Scand J Public Health 2007;35:148–56.
Shickle D,
Hapgood R,
Carlisle J,
. Public attitudes to participating in UK Biobank. A public consultation on issues relating to feedback, consent, withdrawal and access: School of Health and Related research (ScHARR). University of Shefield, 2003.
Haddow G,
Cunningham-Burley S,
Murray L
. Can the governance of a population genetic data bank effect recruitment? Evidence from the public consultation of Generation Scotland. Public Underst Sci 2011;20:117–29.
Start RD,
Brown W,
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. Ownership and uses of human tissue: does the Nuffield bioethics report accord with opinion of surgical inpatients? BMJ 1996;313:1366–8.
Lewis C, Clotworthy M, Hilton S, et al. Public views on the donation and use of human biological samples in biomedical research: a mixed methods study. BMJ Open 2013;3:e003056. doi:10.1136/bmjopen-2013-003056.
Ipsos MORI Social Research Institute. Human Tissue Authority General Public Survey. 2010. http://www.hta.gov.uk/_db/_documents/2007-09-10_Ipsos_MORI_general_public_qual_and_quant_report_final_200709101952.pdf (accessed 26 Feb 2013).
Miles JN,
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. Statistical power analysis for the behavioural sciences. 2nd edn. New York: Academic Press, 1988.
Gimbel RW,
Strosberg MA,
Lehrman SE,
. Presumed consent and other predictors of cadaveric organ donation in Europe. Prog Transplant 2003;13:17–23.
Rithalia A,
McDaid C,
Suekarran S,
. Impact of presumed consent for organ donation on donation rates: a systematic review. BMJ 2009;338:a3162.
Hoeyer K,
Olofsson B-O,
Mjörndal T,
. Informed consent and biobanks: a population-based study of attitudes towards tissue donation for genetic research. Scand J Public Health 2004;32:224–9.
McQuillan GM,
Porter KS,
Agelli M,
. Consent for genetic research in a general population: the NHANES experience. Genet Med 2003;5:35–42.
Olofsson BO,
Mjorndal T,
. The ethics of research using biobanks: reason to question the importance attributed to informed consent. Arch Intern Med 2005;165:97–100.
Stegmayr B,
Asplund K
. Genetic research on blood samples stored for years in biobanks. Most people are willing to provide informed consent. Lakartidningen 2003;100:618–20.
Malone T,
Catalano PJ,
O'Dwyer PJ,
. High rate of consent to bank biologic samples for future research: the Eastern Cooperative Oncology Group experience. J Natl Cancer Inst 2002;94:769–71.
Gaskell G,
Gottweis H,
Starkbaum J,
. Publics and biobanks: Pan-European diversity and the challenge of responsible innovation. Eur J Hum Genet 2012;21:14–20.
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Master Z,
Claudio JO,
Rachul C,
. Cancer patient perceptions on the ethical and legal issues related to biobanking. BMC Med Genomics 2013;6:8.
Valle-Mansilla JI,
Ruiz-Canela M,
Sulmasy DP
. Patients' attitudes to informed consent for genomic research with donated samples. Cancer Invest 2010;28:726–34.
Gottweis H
. Biobanks need publicity. Nature 2011;471:159–60.
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. National interests and international collaboration: tensions and ambiguity among Finns towards usages of tissue samples. New Genet Soc 2012;31:424–41.
Nilstun T,
Hermeren G
. Human tissue samples and ethics. Med Health Care Philos 2006;9:81–6.
Ma Y,
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. Attitudes towards biosample donation in andrology patients. Int J Androl 2012;35:170–5.
Bruce A,
. Generation Scotland: consulting publics and specialists at an early stage in a genetic database's development. Crit Public Health 2008;18:139–49.
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Womack C
. Why surgical patients do not donate tissue for commercial research: review of records. BMJ 2003;327:262.
Harrison RF,
. Ownership and uses of human tissue: what are the opinions of surgical in-patients? J Clin Pathol 2008;61:322–6.
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Sugden J,
. Experiences from the front-line routine consenting of surplus surgically removed tissue: without investment by the National Health Service fully informed consent for all is not available. J Clin Pathol 2007;60:351–4.
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. Foundations of mixed methods research: integrating quantitative and qualitative approaches in the social and behavioral sciences. Thousand Oaks, CA: Sage Publications, Inc., 2009.
Files in this Data Supplement:
Data supplement 1 - Online appendix 1
Collaborators Sarah Dickson, Jim Elliott, Neil Formstone, Samantha Reeve.
Contributors JC conceived the study. All authors contributed to the study design. In addition to all the authors, SD, JE and NF also contributed towards the design of the study and development of the focus group and survey questions. CL facilitated the focus groups. Focus group recruitment was conducted by the company The Focus Group; the survey was conducted through the market research company Research Now. CL conducted data analysis and interpretation with the help of SR and ZL. The initial draft of the manuscript was prepared by CL and then circulated repeatedly among the authors for critical revision. All authors approved the final manuscript.
Funding This work was supported by a grant from the Technology Strategy Board through the Stratified Medicines Competition grant number 101021, direct financial contributions by AstraZeneca and resource in kind by AstraZeneca, GlaxoSmithKline and Lab 21.
Competing interests LJS is an employee of GlaxoSmithKline. MJR is an employee of AstraZeneca.
Ethics approval This study was approved by the Ethics Review Board of the University of Manchester, reference 11459.
Data sharing statement Transcripts from the focus groups and full results of the survey are available from CL at celine@geneticalliance.org.uk. Supplementary material is also available at http://www.geneticalliance.org.uk/projects/stratum_docs.htm
↵i Under the Stratified Medicines Programme: Business Models Value Systems.
Public views on the donation and use of human biological samples in biomedical research: a mixed methods study
Celine Lewis Margaret Clotworthy Shona Hilton Caroline Magee Mark J Robertson Lesley J Stubbins Julie Corfield
BMJ Open 2013; 3 - Published Online First: 07 Aug 2013. doi: 10.1136/bmjopen-2013-003056


text:
The student cries without saying "partner" during the virtual class | Viral Video | Trends | Mexico | nnda nnrt | Social Websites
By Social WebsitesDuring the virtual class a video was released expressing her frustration with the non-binary young woman asking her to respect her identity. "I am not your partner, I am your partner"The woman said with tears in her eyes that the video soon went viral.
Apparently, one of the occupants, Max Carvajal, called the young woman, identified as Andrea Escamilla, a "comrade." This angered the woman, who demanded that they treat her with respect. "Sorry, sorry, mate"After apologizing, the young man said he continued his participation.
In the post, Eskimilla finds the pronouns "Elle / he" in parentheses, next to his name in the zoom, thus indicating to those present how he would like to be called. Nevertheless, the clip caused controversy on social media, not only because of the young woman's reaction, but also because of the use of cover language.
Partner pic.twitter.com/cI5cr7pLN9
– Mexican to Mexican (opalNopal_revenge) August 25, 2021
Through his TicTac account, user Luis Hernandez, a student in the class, explained that the discussion started in the middle of a presentation on suicide. But when referring to "gender", the young woman pointed out through the chat that gender is not the same as gender.
Students moved away from the topic and began discussing gender identity and discussion, and then went on to social networks for and against.
What is a viral video?
A Video viral This is a post on social networks and on the internet in general. They are short films that can be professionally made and recorded from your own home and can be shared by thousands or millions of users in a matter of seconds and reproduced in large quantities.
READ Omigron | Corona virus: new variant of Govit-19 confirmed countries | South Africa | The world
The Viral videosOften, they tend to show people's lives in a more honest way, which makes the user who sees the clip feel sorry for them at the time and encourages them to share it with all the friends on the walls of their social networks.
We have Viral videos Called 'Win to Win' according to the website, of the animals that always appear on stage Fever40So, it is not surprising that these posts appear all the time on the internet.
One user records the moment a user enters his backyard and begins to play with his puppy Penny's stuffed dog, who, unable to protect his precious toys, barks helplessly in front of the ferocious animal. (Source: RM Videos)
Previous Uruguay: A teenager was abused by her grandfather, father and uncle from the age of 5 EC Stories | The world
Next The pastor who tried to "follow Jesus" who was resurrected and buried alive on the third day died James Sahara | Viral Video | Trends | nnda nnrt | Social Websites

redpajama_set_name: RedPajamaCommonCrawl


Let's say the digital revolution is over. The enthusiasm that ushered in this revolution has since become counter-balanced, if not submerged, by skepticism and disenchantment. And what we are faced with are ubiquitous surveillance, impoverishment of aesthetic experiences and trivialization of social life, the results of an - at once deep and shallow - immersion in the digital and network media. The way we access, record and archive our presence in the world has also been affected. In this post-digital situation, we all engage in some forms of archiving, whether we want to - or not. When interacting with our devices, we archive and are being archived, held captive by a densely woven net of technologies. How can this condition be approached creatively?
Participants: Jacek Smolicki (curating), Olle Essvik, Malin Pettersson Öberg, Nikita Mazurov, Jenny Soep, Ronda Bautista, Lucy N.


The International Herald Tribune has an outstanding article detailing on how the fact that a country has elections does not mean that a democracy exists. Regular readers of this page recall a previous post regarding the fraud during Mexico's presidential elections of 1988. The IHT reviews the elections in Iran and Russia and how elections are not the main factors that define a democracy.
Today, a majority of the world's countries are indeed electoral democracies. At the same time, most countries still are not free, according to the independent institute Freedom House. How to explain this paradox? Democracy and freedom are not the same. Democracy is the ability to choose one's leaders in elections. Freedom is the ability to exercise one's personal, political and economic rights. . The democratic ideal may be universal, but history reveals that democracy is a luxury. A country can afford democracy only after it fulfills the most basic needs of its citizens, especially their economic security.
Update: D. Duquenal discusses the upcoming local elections in Venezuela in a similar context.
Update: The Arab newspaper Dar Al Hayat challenges arab governments to implement democratic changes after they failed to agree on political reforms at the Arab summitt.
Reform is an integral political operation that guarantees the rights of both women and men. At the economic level, it means fighting corruption and promoting transparency, accountability and equal opportunities. At the social level, it means the reform of education and the rein of democracy.
Arab governments refused the suggested projects without having one of their own. Why didn't we talk about reform in the adequate time? Is not timing an important factor for reform? Delaying the date renders reform impossible; this is maybe why our governments find difficulty to start it. Their positions in the future might be even more difficult because they are still hesitating.
Hesitation is one of the desperation factors to start reform from inside, which opens the door wide for foreign projects. We refuse every foreign project, but foreign countries would not have intervened in our issues if we did something. Democracy is not scaring, for this is how our leaders look at it. Ballots are one of its aspects. Democracy is a complex operation that concerns the entire civil community institutions. It is fighting corruption, protecting human rights, establishing the state of institutions, and freedom of expression.
The Palestinian cause has always been used as a pretext to postpone reforms. But the truth is that nothing harms the Palestinian cause more than the violation of human rights, marginalizing the role of the Arab citizen, and widening the gap between rulers and people. Would Arab human rights be protected, and the citizen free to express himself, the world wouldn't consider Israel an oasis of democracy within Arab totalitarian regimes.


Rivella is the most popular Swiss refreshment drink. Rivella has created an exotic idea for launching its new summer flavor "Rivella Mango": passers-by can try out the new product at a promotions stand and at the same time prove their karaoke skills, singing along to hot summertime rhythms. The performances are recorded with an iPad app. The participants then receive the link to their YouTube video.


Universal Credit is a single monthly payment which merges benefits and tax credit payments. It can only be applied for online. If you don't have access to the internet or you need help making a claim, please call the Income Team on 0207 617 8050.


This is the README for the merriweather package, version 2014-06-19.
letterforms, a mild diagonal stress, sturdy serifs and open forms.
the serif family. There are four weights and italics for each.
main (serifed) text font and MerriweatherSans as the sans font.
This re-defines \familydefault, not \rmdefault.
respectively, for both or single families.
to avoid fontspec may use the type1 option.
MerriweatherSans fonts; the serifed variants are not affected.
allow for localized use of light or black variants.
encodings supported are OT1, T1, LY1 and TS1.
Download the contents of this package in one zip archive (2.8M).


text:
https://www.gameinformer.com/2021/03/29/full-call-of-duty-black-ops-cold-war-and-warzone-season-two-reloaded-update-revealed
Full Call Of Duty: Black Ops Cold War And Warzone Season Two Reloaded Update Revealed
by Liana Ruppert on Mar 29, 2021 at 05:10 PM
Call of Duty: Black Ops Cold War and Warzone Season Two Reloaded is on the horizon and brings with it not only smaller file sizes, but a whole host of new content for players to enjoy. From new multiplayer maps to a brand new sniper, here is what you can expect with Season Two Reloaded in the upcoming update.
Full Call Of Duty: Black Ops Cold War And Warzone Season Two Reloaded Update
The upcoming update brings with it new maps, new modes, new Zombies content, and so much more. Let's break it down by feature to see what's on the horizon for the online shooter.
The new update goes live today, March 29, at 9 p.m. Pacific for Black Ops Cold War. The new season arrives in Warzone on March 30 at 11 p.m. Pacific the next day.
New multiplayer maps
Miami Strike 6v6
Miami Strike will feature a much tighter map layout that will be played in the light of day. Unlike its nighttime counterpart, there are a few new additions with the Paramour Hotel being blocked and the area more controlled. For those that just want to take in the sights, there will be a new waterside path also available within this particular map.
Mansion 2v2, 3v3
Mansion is joining the Gunfight and Face-Off rotation, designed to put players on their toes as they fight across a luscious courtyard that has no idea the kind of chaos that is on the horizon. "The eastern courtyard features palm trees and a gazebo, opposite another with a central statue over a dry fountain," says Activision." Fight in the surrounding arcade among its thick supporting columns or brave it through the middle in a cross-map dash. Look for the center-wrapped room including a small hallway and an exposed balcony for a high risk, high reward power position."
Golova Multi-Team
We're heading back to Russian with the Ural Plains location, but there's much more than what meets the eye. We first saw this location within Outbreak, but now Golova will be available across other modes within MP. From churches to gardens, this map is perfect for those that love to snipe.
New modes and feature
There are quite a few new modes and features to look forward to, including Multi-Team Hardpoint. For a brief overview, here is what you need t know:
Multi-Team Hardpoint
A more chaotic version of Hardpoint
10 squads of four
Multiple Hardpoints at once
More points awarded for teammates within the objective
First squad to reach 1,000 points wins
Prop Hunt
Miami Strike and Satellite maps are now available for Prop Hunt
New props will also be added
Gunsmith Customs
Coming later in the season
Allows players to mix-and-match attachments in Weapon Blueprints of the same weapon type
Weapon Tuning
Weapon tuning will get an overhaul for balancing
Includes the below weapons:
AK-74U
KSP 45
Krig 6
FFAR1
RPG-7
Gunfight Tournaments
Taking Gunfight to a more competitive place with brackets
Zombies is getting some much-needed love with a new Outbreak region found in Sanatorium (night). "As the Dark Aether continues to spread, agents of Requiem must expand their search for outbreak sites across the Ural Mountains into a massive new region: Sanatorium Night."
Players loved the more open-world take on Zombies with recent updates, but this one will have players trying to survive under the cover of nightfall. Because fighting zombies wasn't scary enough, let's add restricted vision into the mix.
A new Outbreak Objective is also on the way with Secure, taking players to control Dark Aether in order to analyze, experiment, and ultimately harness the "transformational properties" of this phenomenon.
Zombies will also see new vehicles, more Intel, and the Dead Ops Arcade Player as well in addition to the Arcade Silverback Slidesways Map and a new Apply Blueprint feature that will allow players to apply any Weapon Blueprint in Outbreak.
New Operators and Weapons
It wouldn't be a new season without new Operators and Weapons. Wolf (NATO) is joining the fray, bringing with him his skills as a hunter from the Louisiana bayous. Wolf will be joined by Rivas (NATO), a powerful fighter that fought back against the Menendez Cartel's influence in Nicaragua.
As far as weapons go, the new ZRG 20mm Sniper is a seasonal addition that promises impressive velocity and range, making it the ultimate tool for those that love to take a more strategic approach to combat.
Warzone and Black Ops Cold War Season Two Reloaded promises a ton of fun and a lot of new additions to enjoy. You can learn even more about what's on the way with the full patch notes right here.
PlayStation 5, Xbox Series X/S, PlayStation 4, Xbox One, PC


An easy-to-install battery pack upgrade for Ham It Up. Powered by 4 common 'AAA' batteries.
An easy-to-install battery pack upgrade for Ham It Up, enabling you to run your upconverter for prolonged periods without connecting to a power source. The ultra-clean nature of battery-sourced DC power greatly improves performance of both the upconverter and noise source circuits of the Ham It Up.


Preheat the oven to 400°. On a baking sheet, brush the peppers with olive oil and roast for 20 minutes, turning once, until lightly browned and softened. Transfer the peppers to a bowl, cover with plastic wrap and let cool for 10 minutes.
Meanwhile, in a medium skillet, heat 2 tablespoons of the olive oil. Add the mushrooms and cook over moderately high heat, stirring, until lightly browned, 4 minutes. Stir in the shallot, garlic and marjoram and cook until fragrant, 2 minutes. Season with salt and pepper and keep warm.
Peel, core and seed the peppers. Transfer the peppers to a blender and puree. With the machine on, add the remaining 3 tablespoons of oil and the hot sauce and puree. Season with salt and pepper.
Bring a large saucepan filled with 3 inches of water to a simmer. Crack each egg into a cup, then slide it into the water. Poach the eggs over low heat until the whites are set and the yolks are runny, 4 minutes. Using a slotted spoon, lift the eggs out of the water and blot them dry.
Spoon the pepper puree onto plates and top with the mushrooms. Set the eggs on the mushrooms, season lightly with salt and pepper and serve.
One serving 294 cal, 15 gm carb, 23 gm fat, 4 gm sat fat, 10 gm protein, 1 gm fiber.
Review Body: so delicious! and the puree keeps really well so double the batch!


text:
Covid-19: Sixteen practical suggestions for easing the lockdown
No one knows with certainty what we should do, but we hope this stimulates public discussion
21 April 2020 By Francois Venter, Kathy Mngadi, Nkuli Mashabane, Di Cooper, Nathan Geffen and Samanta Lalla-Edward Opinion | South Africa
Normally bustling, Long Street in Cape Town is devoid of traffic as a result of the Covid-19 lockdown (7:30am, 21 April 2020). Photo: Gavin Silber
The physical distancing measures announced by President Cyril Ramaphosa on 15 March followed by an extended lockdown may have bought us time to prepare for Covid-19. Good leadership has helped the response, but the current lockdown is not sustainable.
In city centres and middle-class suburbs there is largely adherence, but in many marginalised areas the lockdown is fraying or not being followed. Income has been abruptly stopped, making paying rent or buying food difficult.
Job losses and the prohibition of informal trade are causing increased hardship, making life unbearable.
If there is a further lockdown extension, physical distancing measures will lose legitimacy, allowing the virus to run free with catastrophic consequences for life and the economy.
So, what should we do? The truth is that no-one knows the answer with certainty. But we should all debate this. Our suggestions attempt to balance slowing the spread of the virus with opening the economy and making life more bearable:
Scale up daily tests rapidly. Currently we do about 5,000, which is promising, but not enough. Only by monitoring the epidemic properly can we know which measures work. A spike in infections in a specific area, can attract direct resources: food support, rent and bond relief, suspension/reduction of debit orders, housing, medical support, human rights monitoring and social orientated military support.
The cost of even the most ambitious testing programme, with door-to-door screening, is a pittance compared to that of an extended lockdown.
Allow people to be outside with strict physical distancing. Open parks, streets and public spaces. Let children play ball games and allow people to walk their pets. Encourage walking and running.
Explain to the public why physical distancing is vital. Experience with HIV suggests that most people armed with facts, can work out the details, and act with care towards others. However, they need to understand and trust what they are being told.
Engage with communities, ask for their ideas, equip them to become informed and to communicate reliable information and knowledge and get feedback and questions. Establish inspirational community-based organisations such as the Community Action Networks, and include official government collaborations at this level.
The lockdown necessarily was designed on the fly from the top, but after several weeks of experience, tapping into the creativity of people who bear the brunt of the lockdown would encourage desperately needed social buy-in.
Urge police to take a backseat except for blatant non-adherence, and then without violence. The army should be used to support food distribution and medical programmes, not law enforcement. When lockdown was announced, it was not to punish, but to protect, people. This reason needs to be reinforced and explained within communities by those whom they trust.
Make free or highly subsidised data available to people, now that connectivity is key. Poorer people without access to unlimited fibre or free internet hotspots, need to communicate with anxious families, access information, report food shortages or medical emergencies, or just deal with the boredom and anxiety. More accessible data will allow people to access online learning and free psychological support at this time of uncertainty. Expanding access to what increasingly is a basic right, would be responsible and kind.
Ensure that taxi and bus drivers have protective gear, and insist that all people entering or leaving a vehicle have their hands sanitised, similar to what's happening at many stores. Limiting numbers of bus trips, as Johannesburg has done, may be unwise, leading to remaining vehicles being more crowded. Large corporates should be encouraged to look into transporting workers who cannot afford their own vehicles.
Businesses, both formal and informal, should be allowed to open again, albeit under strict physical distancing measures, including queue management and access to hand sanitiser. Work from home needs to be strongly encouraged, especially in people over a certain age or with chronic illnesses such as diabetes. Masks must be worn in workplaces. No more than a certain number of people should be allowed to work in a specified space. Every meeting should be prefaced with the question: "Can this be virtual?" People with cough or cold symptoms should be sent home to recover, and encouraged to get tested. Government functions where possible should be moved online, with, for example, virtual renewal of driver and car licences, identity documents, voting, and deeds registration.
Relax the list of essential items. People need to be able to buy exercise equipment, toys, crafts and other things to keep themselves and especially their children occupied. People also require clothing – especially as seasons change and as children grow.
Allow people on chronic medication prescriptions to receive three to six months supply at a time.
Encourage restaurants to grow the delivery side of their businesses.
Bars, shebeens, clubs, cinemas, gyms, hairdressers and other potentially high-risk facilities are more challenging to open, but that's all the more reason for consultation with them to find practical suggestions that may allow them to do business, perhaps in a limited way.
The time for government to increase the provision of housing is now. High-rise low cost housing projects, with garden and play amenities, near urban centres run by large, reputable companies are needed to house the millions of South Africans living in informal settlements.
De-densifying informal settlements by moving people en-masse to other remote areas, is reminiscent of apartheid forced removals and bound to fail.
Hotels that are standing vacant with the collapse of the tourism industry, could be contracted by government in the interim to house people.
Despite the long-term public health reasons for discouraging excessive alcohol use pre Covid-19, further prohibition is likely to encourage dangerous illegal markets, with associated criminality. Compromise is possible, for example by limiting how much each person is allowed to buy at the till, and geographically limiting who sells alcohol to prevent hopping from store to store.
End the ban on cigarette sales. Although smoking causes cardiovascular and respiratory diseases and may lead to poorer outcomes with Covid-19, it is unclear whether a ban is effective. Unnecessarily enacting and enforcing rules without clear cause and reason is likely to lead to non-compliance and growth in the already flourishing illegal tobacco market.
Schools are an especially hard problem, as keeping them closed while insisting that parents, especially single parents, return to work, may be impossible. Children appear to be at very low risk of the severe consequences from Covid-19, but they can spread the infection, putting older family members and teachers at high risk. However, parents often rely on schools for childcare and for the associated school feeding schemes. Calls for home-schooling have placed tremendous strain on parents unprepared and untrained for this. Much more discussion is needed to find a way forward. School camps for primary school children where they are boarded for a few weeks at a time, with monitoring of infection rates, should be researched for acceptability and feasibility. Allowing public schools access to private school distance-learning platforms, associated with free wi-fi, should be considered. Universities should be exploring similar options. In the meanwhile read this open letter to Minister Angie Motshekga.
Economic recommendations are beyond our expertise and yet a vital part of the discussion. Increasing cash through the existing child grants and pension programmes appear to us to be a good idea, especially as government food provision programmes miss large numbers of people. There is clear evidence that the social grant system in South Africa mitigates some of the effects of poverty. We recommend reading this open letter to the president by over 70 economists.
Rounding up homeless people should cease. Homeless people, left to stay where they usually do, are probably at no greater risk of a Covid-19 outbreak than if all placed into camps. Homeless people are a minimal infection risk to the rest of the population, and the approach to them needs to be humane.
We need information on immunity urgently, and we need to validate tests that tell us whether people can be issued an ''immunity passport'', so as to allow them to take positions in society that others, at risk of infection or infecting others, can't. It is still unclear whether this immunity exists, or that it holds for everyone, or that we will have a test for it, but if we can, it may allow some people to return to normal life more quickly. We will need to address people's possible fear of testing and its implications for their return to work and their concerns for their and their families' health.
No doubt the above is controversial in parts, but these are not decisions only for political leaders and health experts to make without consultation. A public debate is vital.
Venter has been involved in HIV and broader public health and clinical programme design and implementation. Mngadi works in HIV Vaccine Research in Tembisa. Mashabane has been involved in HIV clinical trials implementation, aiding transformation through the inclusion of unemployed graduates and digital innovations. Lalla-Edward is a public health monitoring and evaluation specialist focussed on research capacity strengthening in HIV, non-communicable diseases and digital health. Geffen is GroundUp editor. Cooper works in Public Health at the University of the Western Cape, and is involved in the socio-economic determinants of health and community health outreach.
Premier Winde calls on President Ramaphosa to intervene in SASSA crisis 15 January 2021
Social grants: the young men who make a living queuing for others 15 January 2021
Covid-19: School opening delayed 15 January 2021
© 2020 GroundUp.
This article is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
TOPICS: Covid-19
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Balsamic White Bean Dip paired with super light and crispy chips might possibly be the best thing to happen to my Friday.
Other than, of course, knowing that the weekend is only a mere 8 hours away and all. And that knowing tomorrow is Saturday, which means it's Market day, which makes me forever happy. And knowing that there is a huge possibility that this weekend will be filled with lots and lots and lots of this sweet garlicky Balsamic White Bean Dip because I just can't seem to get enough of the stuff.
Yup. The weekend plus balsamic white bean dip plus crispy chips equals that emoji with the heart eyes.
Because just like I was years (and weeks and days) late to the Strawberry Banana Smoothie Bowl party I am just as late to the emojis say it all party.
What can I say – they explain my life better than I can.
But in all seriousness, you guys. I'm a snacker. I love snacks. And I really love healthy snacks. In fact, the healthier the better.
I am all for the type of snacks that are good for you and that I don't feel bad about diving my pretty little face into them whenever I feel like it. The kind of snack that doesn't taste like they are healthy but secretly super good for you – and if I can pack an extra serving or two of veggies in there, all the better – those are my favourite types of snacks.
But this. This Balsamic White Bean Dip is my jam. My where have you been all my life jam. It's so rich and creamy with that classic balsamic vinegar flavour sweetened and spiced up with a little agave (or honey!) and mustard and garlic and finished with a little sweet basil up on top.
I quite very much love that the star of the show here are the white beans (white kidney beans… or are they cannellini beans…). Because sometimes the chickpea just gets too much attention.
Bean dips (also known as fancier hummus) are the best and one of my most favourite dips. Healthy, too. Bean dips are loaded with fibre, protein, and good, healthy fats. And you can pretty much dip whatever you'd like – veggies, crackers, chips, grilled sandwiches, pizza crusts (yes!!), the list goes on.
Add beans, tahini, vinegar, mustard, agave, garlic, salt and pepper to a food processor or high-speed blender.
While the food processor is running, slowly stream in water and olive oil.
Continue blending until hummus is smooth and creamy, scraping down the sides of the food processor as needed.
oooooh yes, please! I have had such a love affair with balsamic recently – definitely putting this on the Super Bowl menu!!
Yes!! I love that we both have delicious and healthy dips on the mind (and the blogs)!!


Tons of play time here if you hope to unlock all of the badges. Gets extremely difficult towards the end. Definitely recommended.
I beat the crap outta this game in just a few hours. I love it. It is incredibly addictive so watch out. The only downfall is that there isn't more of it. But hopefully there will be soon? Please? If you are like me and need a game fix I recommend Star Dash!


The lyric above is nestled into one of the verses. It isn't song over and over like the chorus. (Which is truly an awesome piece of music – it can be sung quietly or like an anthem proclaiming the truth.) This little lyric has been working on me lately.
When I accepted Christ, I became one of God's adopted children. I recognize and reciprocate the love that God has for me back then and today. I know God has a purpose for me. I know that his plans for me a for my good…even when I don't know why certain things happen. I love that I have a heavenly Father that loved me enough that Jesus would come and be my Savior to my sin and life's messiness.
So, why is that lyric working me over? I am God's foe. I am human. I am not without sin. The Bible says that I am made in God's image and that He loves me. Yet, I have a human nature that is marred by sin and God cannot love sin. Accepting Christ does not change that. I still battle against sin in my words, thoughts and actions. The enemy has a job to do – to rob, kill and destroy. The Bible says in Revelations 12, "For the accuser of our brothers and sisters has been thrown down to earth–the one who accuses them before our God day and night." The struggle with sin is real but then you also have the devil reminding you of all the times you fail.
The reason the lyric is resonating with me is that even in a relationship with Christ, God is still fighting for those areas of struggle. The power of the cross that brings salvation is the same power that brings freedom through the resurrection of Christ. Where as God loves me, He cannot love my sin. He made a way for me to live without it. In surrendering all the areas of my life to God, He can truly bring freedom. I continue to pursue relationship and freedom.
Maybe that is you today. You are living without a relationship with God or you have one and you are in a battle for a certain area of victory.
The answer is Jesus Christ. No longer a foe…now a Savior and Conqueror.


Oakville, ON. – 360 Athletics Inc. is proud to announce the addition of the Air Relax system to its growing list of sports recovery products. As Recovery is one of the fastest growing segments within the sports industry today, we are pleased to bring this top-tier air compression device to the Canadian market.
The Air Relax system uses the most advanced digitally controlled air pressure system to provide dynamic compression to limbs compromised by poor circulation.
The Air Relax system is a digitally controlled operation cycle, featuring A Mode: Peristaltic, B Mode: Sequential, C Mode: Massage, Auto Mode: Peristaltic + Sequential, Targeted Compression Mode with 4 Pressure Levels. It includes: The digital air release pump and left and right leg sleeves. The leg system is offered in 3 different sizes to ensure a custom fit. To round out the line we carry the Air Relax Shorts, Recovery Arm Sleeves, Foot Inserts and the Air Relax Carry Case.
"The Air Relax compression system is my new favorite tool. After a 6 or 12 hour MTB race, I slide the sleeves on and let the air compression refresh my legs. A very simple to use machine that gets the job done and anyone can afford." – Robert Sandoval – Bike Sport Radio, Endurance Sport Athlete.
360 Athletics has been the most trusted Canadian sporting goods wholesaler for more than 40 years. We pride ourselves on offering our customers the highest quality of products in these core channels: Institutional, Fitness Specialty, Commercial Fitness, Clinical, Retail, and Direct to Consumer.


Inspect the overall condition of the lift truck.
Inspect and check the motors and lift cylinders for leaks.
See if the lift chains are stretched. If they are in a good condition still, it should not be possible to insert a coin between the chain's links.
On a pallet truck (pallet jack), use a second lift truck and elevate the forks' tips off the ground a few inches. Check if the fork trailings and wheels show slack and move. Should they rattle or shake, you can be sure that some expensive repairs are waiting around the corner.
Find out the age of the machine by checking for the serial number, which sometimes includes the manufacturing date. You may find the manufacturing date on some brands printed on the machine's overhead guard. No matter if you buy from a dealer or a private seller, you should always know the forklift's age.
Was the forklift part of a fleet of rental machines?
Was it working in a freezer or in ambient temperatures?
Are the maintenance records available?
Was the machine maintained on a material and time agreement or on a contract?
On an electric forklift: Is the battery used or new?
On an electric forklift: How old or how new is the battery charger?
The above information will influence the resale value of any used lift truck, so you can see why it is vital information to obtain before buying a used unit.


ok ok ok… it's been a BUSY few months for me and i'm finally getting around to featuring sizzling HOT Las Vegas based Maxim Model Lisa Song Sutton!! wooohoo!! it was Lisa's first time in Boston! so wicked psyched and flattered Lisa asked me to work with her.
it was a long day but super fun! special thanks to my friends Suz and Andrea for the laughs and assisting me!
here is a mix of fashion and boudoir… enjoy!


Plugged in Finance: Up 65% in Last 10 Months in my Soft Commodities Investment. Will Likely Rotate into McDonalds as Grain Prices Peak.
Up 65% in Last 10 Months in my Soft Commodities Investment. Will Likely Rotate into McDonalds as Grain Prices Peak.
I bought into the iPath Grains (JJG) ETF on April 5th of last year at $34.18 / share. On Friday, shares traded at $56.20. This is a gain of 64.4% over the 10 months. Of course these gains are only on paper.
I spent part of the afternoon contemplating what I would do with my money as I scaled out of this ETF. I spent some time comparing charts of JJG against a few stocks and happened upon an interesting comparison against McDonalds (MCD). See chart JJG vs. MCD. Looking from 12/8/10 til present and you'll see that the two stocks are moving inversely to each other.
So, unless we have a good stock market correction, my current plan is to ride out JJG for a few more bucks and to start scaling out of JJG between $61 and $71.
I suspect JJG should hit this gate of $61 - $71 within the next couple of months prior to crops being planted. As I scale out, I am planning on moving my funds into McDonalds. I don't think that McDonalds is going to run up like a rocket ship; however, I feel that McDonalds should trounce the S&P 500 after grains and other commodities (e.g. COW) peak and start trending lower. Plus, McDonalds 3.3% yield should provide a level of safety in our current lofty market levels.
Order copy of Official bankruptcy court complete file, Bankruptcy discharge papers, bankruptcy creditors listing, and complete file for $29.99 at lowest cost on web.
McDonald's is a great investment. I've been telling all my clients to buy some stock in it. It's a solid company that just keeps growing and each quarter, there are earnings. Did you know that they only reported quarterly losses only once since they've been public?


Business Zen: Does your business have the X factor?
When it comes to TV viewing, it is almost impossible to find any quality on the free to air channels. I'm an unashamed TV snob and I'll only watch dramas like the Sopranos, The Wire, Breaking Bad and Better Call Saul.
Given my TV snobbery any sojourn into free to air entertainment would be a turn up for the books these days. This is because I almost always find reality TV which dominates the free to air channels to be bordering on asinine. From neighbours fighting over an apricot tree, to Police arresting drunk teens, to the drama of a soufflé not setting, reality TV is in the main cheap and nasty formulaic clap trap.
And watching shows like 'X-Factor' and 'Master Chef' at times can be a marathon because of the almost endless schmaltz which is a bit hard to take. It appears that most of the talent show finalists are either trying to rescue their families from destitution – an increasing factor of life in the economy these days – or it's their "last chance for [my] dream". There's also that interesting 'Americanism' of the involvement of God and Jesus in the progression of contestants through the phases of the show – I'd have thought that assisting people to material wealth and a recording career was low on the list of a deity's priorities.
But through it all, there is a business case behind the tears and running mascara and the search for excellence. The eventual winner of these 'reality game shows' will be someone with something which stands out and sets him or her apart from the rest.
In spite of my growing aversion to the genre, there is a relevant message for today's businesses – "Does your business have an X-Factor?" How does your offering set itself apart from the competition? If you don't know the answer to that question, maybe you should think of something – because your competitors inevitably will.
Like the competitors on the show you might already have that quality, it might be a case of refining it or making time to build on what you already do well. That special quality may reside in a new market or be accentuated by technological advances, as is about to happen.
I guess the one thing I like about the reality show concept is the involvement of experts assisting the contestants to hone their skills – the moulding of that talent into success, which has more than a little to do with the business that I am in.
And this leads to the second message of the week, businesses need to appreciate and foster the talent within their ranks. The days of your staff just turning up for a pay check are long gone, so look ahead to your future and make sure that you build and nurture your team. Because, like the TV based talent shows, the team that can produce the greatest quality performance will win and beat the competition – just as it is for 'master chefs', song & dance and sport, so it can be for you.
Tree fund a hit for Roots Brewing Co.


text:
EU Approves HP Buy of Mercury
CIO	 Oct 20, 2006 8:00 am PDT
The European Commission Friday approved Hewlett-Packard's (HP's) $4.5 billion acquisition of fellow U.S. software company Mercury Interactive, concluding that the proposed deal would not significantly impede competition.
The companies' activities overlap in the area of performance management software, a category of software used to quantify the actual performance of applications once they have gone live with users.
But in a statement, the commission—the European Union's executive and regulatory body—said that adverse effects on competition are unlikely to arise.
The commission had investigated whether the proposed operation could drive competitors out of the market, either because of a bundling of Mercury and HP products, or because other performance management software vendors would be denied access to timely information about HP software.
The commission concluded that the presence of strong competitors in each market would most likely render such strategies unsustainable.
-Paul Meller, IDG News Service (Brussels Bureau)
HP Extends Mercury Offer for 3rd Time
HP Extends Deadline for Mercury Acquisition
HP Spying Scandal


text:
Understanding The Etiology of Psychiatric Illnesses
Kenneth Kendler, M.D. is Professor of Psychiatry and Professor of Human and Molecular Genetics as well as one of the founders of the Virginia Institute for Psychiatric and Behavioral Genetics. In collaboration with Lindon Eaves, Ph.D., Dr. Kendler created VIPBG in 1996 as an effort to bring together expert psychiatrists, statisticians, and molecular geneticists under one roof, where he currently serves as Director.
Throughout his career, Dr. Kendler has published over 850 articles, making him one of the highest cited psychiatry researchers. He has also made many other significant and impressive contributions to the field, such as developing a large population-based study of Virginian twins, chairing the scientific review committee for DSM-5, and mentoring a number of pre-doctoral and post-doctoral trainees, many of whom are now leaders in the field. Because of these substantial contributions, Dr. Kendler has been honored with a number of awards and honors, including the International Society of Psychiatric Genetics Lifetime Achievement Award and most recently, the Rhoda and Bernard Sarnat International Prize in Mental Health, a prestigious award from the Academy of Medicine.
Dr. Kendler's deep commitment to understanding the etiology of psychiatric illnesses began when he was a medical student, where he was initially captured by psychiatry because of early experiences with patients suffering from schizophrenia. He was fascinated by how the brain could dysfunction in such a way to produce these symptoms and how they seemed to aggregate in families. Then, after taking a class in behavioral genetics and reading Douglas Falconer's Introduction to Quantitative Genetics, Dr. Kendler decided he wanted to devote his career to psychiatric genetics.
Dr. Kendler currently has a wide range of research and academic interests. He is interested in both genetic epidemiological studies and molecular genetic studies to understand the genetic and environmental contributions to internalizing and externalizing disorders, substance use disorders, eating disorders, and schizophrenia. In addition to his research interests, his other academic activities involve psychiatric nosology and the philosophy of science.
Outside of work, Dr. Kendler found raising his three children to be one of the most rewarding things he has done, and accordingly enjoys spending time with his family. He also enjoys hiking in remote areas, such as the High Sierra, being outdoors, biking, running, and reading Shakespeare. Finally, he is interested in religious studies and satisfies this interest by reading the Hebrew Bible.
Article by Elizabeth Long.
Cracking the code for resilience
Major mental illnesses unexpectedly share brain gene activity, raising hope for better diagnostics and therapies
Featured Faculty: B. Todd Webb, Ph.D.
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