A systematic randomised case

An attending preparation technique has antecedently been shown to cut down symptoms of anxiousness and depression amongst otherwise healthy persons. The proposed survey will utilize a multiple baseline design to look into whether these benefits are replicated when the attending preparation technique is used with people with acquired encephalon hurt. The survey will besides look into whether participants demonstrate neuropsychological betterments in knowledge after finishing the programme of attending preparation.

Introduction

Wells Attention Training reduced self focussed attending

Brooding thought is thought to be a important factor in the care of mental wellness jobs such as depression ( Watkins & A ; Teasdale, 2001 ) anxiousness ( Segerstrom, et al. , 2000 ) and post traumatic emphasis upset ( Michael et al. , 2007 ) .

Wells ‘ Attention Training Technique ( ATT ) is demonstrated to cut down perseverative contemplation and ego focussed thought in a population of people with mental wellness jobs such as anxiousness ( Wells, 1990 ) , societal phobic disorder ( Wells White & A ; Carter, 1997 ) and perennial major depression ( Papageorgiou & A ; Wells, 2000 ) . The benefits of this attending developing intercession have been maintained at follow up after 6 and 12 months. However, the mechanism of action of this intercession continues to be debated. It is proposed that the intercession interruptions perseverative thought and increases flexible control of attending, to convey about increased control of the attention-cognition system ( Wells, White & A ; Carter, 1997 ) .

The ATT intercession is developed on the footing of Wells ‘ S-REF theoretical account. The S-REF theoretical account predicts that people have trouble disrupting their self-focussed brooding thought procedures and therefore their available attentional capacity is reduced. In people with temper upset, this is suggested as a mechanism for decreased cognitive capacity with which to treat information in the environment that disconfirms negative anticipations. Reduced capacity to treat new information is proposed to keep the temper upset.

Wells ( 1990 ) proposes that developing in accomplishments to increase the executive control of attending will enable participants to switch their thought and thereby interrupt the brooding procedure. The ATT intercession, based upon this S-REF theoretical account, is proposed by Wells and Matthews ( 1994 ) . They describe an auditory attending use that they argue modifies 3 conceptually distinguishable dimensions of attending:

Intensity of ego focal point

Attentional control

Breadth of attending ( to cut down narrowing of focal point )

The preparation Sessionss consist of preparation in selective, rapid shift and divided attending. The exercising must be practiced twice a twenty-four hours as prep and in intervention Sessionss. When used in concurrence with cognitive therapy for emotional upsets, it has been shown to hold good effects. They propose that the effectivity of the intercession is through increased consciousness of mental procedures which enables people to switch their attending off from brooding thought, thereby, cut downing depressive backsliding ( Watkins & A ; Baracaia, 2002 ) .

Williams ( 2006 ) suggests overlapping constructs between facets of the S-REF theoretical account, targeted in ATT, and the Supervisory Attention System of executive operation. A perseverative processing form is arguably a impermanent perseveration in ‘contention scheduling ‘ , which requires intercessions to interrupt the procedure and switch attentional focal point. Therefore, one mechanism of action of ATT is through bettering attentional shift.

Acquired encephalon hurt

The incidence of anxiousness and depression is increased after acquired encephalon hurt ( Jorge & A ; Robinson, 2002 ) . Mental wellness jobs after acquired encephalon hurt, including depression and anxiousness, are among the most important forecasters of psychosocial result ( Draper, Ponsford, & A ; Schonberger, 2007 ) . Concurrently, people with encephalon hurt often experience functional troubles with attending, such as decreased ability to concentrate or increased exposure to distraction. Sohlberg and Mateer ( 2000 ) propose an attending preparation bundle ( Attention Process Training, APT ) for people with acquired encephalon hurt. The bundle has been evaluated and betterments were demonstrated on neuropsychological appraisals of attending including exchanging attending. However, in a recent reappraisal, it was concluded that there is a demand for farther research to clear up the differential effects of different intercessions for attending ( Cicerone et al. , 2005 ) .

To day of the month, ATT has non been consistently evaluated with people with acquired encephalon hurt and temper or attentional jobs. However, it has been applied clinically to choose single instances who report interacting temper and cognitive jobs. Positive results are reported by the single clients, and betterments are demonstrated on baseline steps of attending exchanging velocity or continuance of prolonging attending without a faux pas ( Yeates, 2008 ) . Therefore, the possible neuropsychological and mental wellness benefits of ATT for a encephalon hurt population are suggested in single instance surveies, but have non yet been evaluated consistently.

Given the conceptual para between APT and ATT, analogues may be drawn between them. Both APT and ATT are attending preparation programmes that demonstrate betterments for attentional shift. However, the impact of APT on emotional processing has non been assessed and likewise, the neuropsychological impact of ATT has non been measured. If there were an intercession that could be administered routinely in rehabilitation with incontrovertible benefits both for temper and knowledge, this would be of great significance for planning of rehabilitation attempts.

Integration of knowledge and emotion

In rehabilitation, clients frequently present with coincident attentional damages and temper upset. The convergence between cognitive theoretical accounts of affect and neuropsychological theoretical accounts has non been sufficiently explored so as to enable the clinician to offer clients an grounds based intercession for attending damages where the client has interacting damages of emotion and knowledge. ATT has non been evaluated for its neuropsychological deductions and nor has APT been evaluated for influence on processing of emotion and contemplation.

ATT can be understood from the position of the S-REF theoretical account or from a theoretical account of executive control, such as the SAS. It is possible that the mechanism of action for the good influence on temper is the same mechanism through which it has a good influence on executive control of attending and more loosely upon neuropsychological operation ; participants will go more cognizant of their information processing and will describe greater control over the focal point and shifting of their attending. The differentiation between cognitive intercession and temper intercession may be in the debut to the preparation provided by the clinician.

During rating of APT, the programme ran for 10 hebdomads and neuropsychological betterments were demonstrated after this clip ( Sohlber & A ; Mateer, 2000 ) . The ATT intercession continues with day-to-day pattern until the single rates their attentional ego focal point as equal to or less than 1/7. This has antecedently been achieved during a 2 hebdomad intercession ( Wells, 1990 ) .

This survey will measure the application of Well ‘s attending preparation technique with a population of people with acquired encephalon hurt. If betterments are demonstrated in attentional ego focal point, of para to when the intercession is applied to a non encephalon injured mental wellness population, so this survey will widen geographic expedition to include the neuropsychological impact of Wells attending developing utilizing station hoc analyses. In order that the intercession continues for sufficient period of clip to let neuropsychological alteration, the intercession will run over 10 hebdomads.

Single instance experimental design

The ideal experimental design, in footings of cogency and control, is the randomized control test. However, there are occasions when such a design is non executable. For illustration, when the research population is limited, or where a fresh intercession is being explored. An alternate research design is the individual instance experimental design. Such a design offers the strength of looking in item at the presentation of an single participant, and their idiosyncratic responses to the intercession. In the instance of this research survey, if one were to look into whether Wells ‘ attending preparation technique both reduces ruminative self focal point and enhances attentional public presentation in functional state of affairss when applied to persons with encephalon hurt, the participants would be required to show a shortage of attending, in add-on to a ego reported trouble with brooding thought. The possible figure of participants available for this survey would be limited, and hence this is an juncture when individual instance experimental design would be appropriate.

Further, although the intercession has been evaluated with persons without encephalon hurt, this survey will be using a fresh intercession for people with encephalon hurt. A strength of the individual instance experimental design is that it enables the research workers to mime clinical pattern, and history for single differences in presentation. Therefore, it is hoped that findings will be productive to clinical pattern, and that possible benefits for participants will widen into their twenty-four hours to twenty-four hours lives.

If the individual instance experimental design incorporates multiple baseline measurings, such a design would increase control of pattern effects and non-intervention related factors. The power of a multiple baseline design is further increased when the design is replicated across several participants, and supplying that the length of baseline is randomised for each participant it is possible to execute statistical analysis of alterations measured before and after intercession ( Todman, 2001 ) . The strength of the multiple baseline design is that any bing pattern effects of perennial cognitive appraisals, or alterations due to factors non related to the intercession, will be highlighted and considered in the analysis.

Purposes and hypotheses

Purposes:

The primary purpose of this survey is to measure the effectivity of Wells ‘ Attention Training Technique ( Wells, 1990 ) in cut downing ego focussed attending, when applied to a encephalon hurt population. The secondary purpose of the survey is to measure impact of Wells ‘ Attention Training Technique on consciousness of attending faux pass, neuropsychological correlatives of attending and figure of attending faux pass during daily undertakings.

Hypothesiss:

Following Wells ‘ Attention Training intercession, betterments will be demonstrated in self evaluations of the following 3 countries of attending:

Intensity of ego focal point

Attentional control

Breadth of attending ( to cut down narrowing of focal point )

Given the conceptual para between ATT and APT, neuropsychological betterments will be demonstrated ( in proving and functional steps ) following the attending preparation intercession

Plan of Probe

Participants

Entire figure of participants will be 5 to guarantee the intercession is replicated on a figure of different persons.

Inclusion standards are:

Aged between 18 and 60

greater than 1 twelvemonth station hurt

acquired encephalon hurt

exhibiting functional attending shortages ( in response to testing inquiry )

describing brooding self-focussed thought ( in response to testing inquiry )

neuropsychological shortage in attending ( confirmed by below mean public presentation on ‘Elevator Counting with Distraction ‘ subtest of the Test of Everyday Attention )

Exclusion standards are:

Pre hurt history of neurological status, psychiatric upset or acquisition disablement

Recruitment

Participants will be recruited via the Rehabilitation Assessment procedure at the Oliver Zangwill Centre. Participants who attend the preliminary ( 1 twenty-four hours ) or detailed appraisal ( 8 twenty-four hours ) processes between September and October 2008 will be screened for suitableness for the survey. If the client satisfies the inclusion standards, they will be given the information sheet about the survey and invited to take part.

Screen

A brief screen will be used to place possible participants, as portion of the everyday appraisal.

Make you happen you go more pre-occupied by/ lost in your ain ideas since your encephalon hurt? ( yes/ no )

Do you hold any troubles with attending or concentration since your encephalon hurt? ( yes/ no )

Question to carer or relative: does your client/ relation have jobs with attending or concentration since their encephalon hurt? ( yes/no )

Neuropsychological shortage in attending nowadays, as demonstrated by public presentation below the mean scope on the Elevator numeration with distraction ( TEA )

This specific subtest of the TEA has been selected as it is routinely administered as a portion of the standard appraisal battery and hence the showing appraisals will organize portion of everyday clinical pattern. Further, this step has proven sensitive to jobs with attending exchanging. A choice of old clients at the Centre have reported self-focussed contemplation and low temper, and these people have besides performed below norm on this appraisal.

Measures

Pre-post steps

Neuropsychological appraisals will be used at the terminal of the baseline period, and after the intercession. The selected neuropsychological appraisals ( see Table 1 ) reference the countries of knowledge where an consequence of APT was antecedently demonstrated. The steps are selected order to determine whether the ATT intercession has the same neuropsychological impact as APT

The sustained attending to response undertaking ( SART ) has been selected as an appraisal of watchfulness because this is a step of sustained attending that does non normally demonstrate ceiling effects in a TBI population. The undertaking requires the participant to be actively go toing to the undertaking for the full clip in order to avoid mistakes ( Tom Manly, personal communicating, 2008 ) .

Table 1: Pre-post intercession steps

Measure

Predicted alteration

Rationale

Sustained attending to response undertaking ( SART ; Manly et al. , 2003 )

Improvement

Recommended, as watchfulness could be a medicating factor in the impact of attending preparation intercessions ( Sohlberg & A ; Mateer, 2000 )

This trial will non be repeated at the terminal of the survey.

Paced Auditory Serial Addition Test, 50 points ( PASAT 50 ; Gronwall, 1977 ; Diehr et al. , 2003 )

Improvement

The PASAT demonstrated betterments after APT.

‘Color word intervention trial ‘ subtest from the Delis-Kaplan Executive Function System ( D-KEFS ; Delis, Kaplan & A ; Kramer, 2001 )

Improvement

The Stroop demonstrated betterments after APT ( Sohlberg & A ; Mateer, 2000 ) . The D-KEFs colour word illation trial will be used in topographic point of the stroop because the norms are more recent.

‘TRAILS ‘ subtest from the D-KEFS ( Delis, Kaplan & A ; Kramer, 2001 )

Improvement

Participants would be expected to show betterment on this appraisal of shift, which incorporates attending and executive procedures

The Hospital Anxiety And Depression Scale ( HADS ; Zigmond & A ; Snaith, 1983 )

Decreased entire mark

Brooding thought has a planetary impact on temper and therefore lower degrees of symptoms of anxiousness and depression would be predicted.

DiVa questionnaire from the Test of Divided Attention

( DiVA ; Wilson et al. , 2005

Decreased entire mark indicates betterment in double tasking ability

ATT is argued to increase comprehensiveness of attentional focal point, which is likely to be seen demonstrated through improved ability to double undertaking.

Repeated steps

A figure of self evaluations will be repeated throughout the survey. These are outlined in Table 2 with a description of the process for how the information will be gathered.

Table 2: Summary of steps that will be repeated throughout the survey with each participant.

Measure

Description

Rationale and predicted alteration point

Frequency

Functional faux pass

Number of self-rated faux pass recorded during personally relevant functional undertaking that happens at least x1 per hebdomad

If it is possible to besides determine an perceiver evaluation on specified mistakes on a specified undertaking this will besides be collected and analysed individually.

Time to first faux pas on functional undertaking

This mark will alter after hebdomad 9 of intercession stage

3 tens per hebdomad ( lower limit )

‘Functional Slips ‘ process

Clients will be asked to place a twenty-four hours to twenty-four hours undertaking in which they experience troubles with attending ( e.g. ability to concentrate on reading, follow the secret plan of a Television programme or listening to a conversation ) . They will number figure of times their attending ‘slips ‘ ( goes off subject ) during a set sum of clip on the undertaking ( e.g. 30 proceedingss ) on 3 different pre-planned occasions during the hebdomad. In session, the clip elapsed between task start point and first attentional faux pas will be recorded.

Beliefs about control of attending

Self evaluation from 0-10/10 of:

“ I am able to command where my attending focal points ” ( taken from the Generalised Anxiety Disorder Scale Wells, 2002 )

Self focal point strength evaluation before and after preparation ( utilizing ocular parallel graduated table O ; wholly self focused and 10 ; every bit cognizant of ego and environment ) .

Rating of ability to concentrate on more than one stimulation at the same clip ( taken from the Test of Divided Attention ( DiVA ; Wilson et al. , 2005 )

These tonss are predicted to alter between hebdomads 1 and 4

& A ; 3:

3x per hebdomad

Every twenty-four hours ( after practising ATT )

‘Beliefs ‘ process

At the beginning of each session, participants will be asked to rate their ability to command their attending, and their ability to concentrate on more than one stimulation at a clip. They will be asked to rate this on 2 other pre-planned occasions during the hebdomad. At the beginning and terminal of each session, the participant will besides be asked to rate the strength with which they are focussed on themselves. They will be asked to make this after each pattern session during the hebdomad.

Awareness of attending

Visual parallel graduated table of 10 points will utilize the undermentioned ground tackle points

0 ; “ I am cognizant of when I lose my concentration, or attending on undertaking ” , 10 ; And “ I am non cognizant of when I lose my concentration, or attending on undertaking ”

This mark is likely to alter during baseline.

Score predicted to

alteration between baseline and hebdomad 4

3 tens per hebdomad

‘Awareness ‘ process

The participants will be asked to rate their consciousness of when they lose their attending on a graduated table of 0-10. They will be asked to rate this on 2 other pre-planned occasions during the hebdomad

Subjective effects of attending jobs

Happening of personally important effects of attending jobs as rated on personal evaluation graduated tables ( 0-10 ) defined pre intercession with the participant.

Predicted to alter during state of affairss developing ( hebdomads 7-8 )

3 tens per hebdomad

‘Subjective experiences ‘ process

Participants will be interviewed prior to the beginning of the intercession. This interview will clear up the personal experience of attending troubles, and place 3 countries in which the person would wish to see alteration. These points will be transposed into evaluation graduated tables that the participant will utilize to rate the happening of these jobs on 2 pre planned occasions during the hebdomad.

Design and Procedures

Design Rationale

This survey will integrate an AB ( 2 stage ; baseline and ATT intercession ) multiple baseline design across five topics. The scope of baseline steps will be taken throughout phases A and B, and are hypothesised to alter at different points during the ATT intercession, as described below. It is non possible to return to baseline after the ATT intercession and hence the multiple baseline design was preferred over an ABA design. The A stage ( baseline ) will integrate a lower limit of 6 observation points ( collected at 3 observation points per hebdomad per participant ) . Owing to the control inbuilt within the multiple baseline design, it will non be necessary to integrate an extra control variable.

Design Summary

5 participants will be recruited to the survey. Baseline appraisals will be measured ( SART, TEA, HADS, DiVA, color-word intervention trial, Trails trial ) .

Data will be collected on a lower limit of 6 occasions and a upper limit of 15 occasions ( 3 times per hebdomad ) sing each participant ‘s ego evaluation of their beliefs about attending, consciousness of attending, subjective study of jobs caused by attending ‘slips ‘ .

Additionally, informations will be collected on a lower limit of 6 occasions and a upper limit of 15 occasions ( 3 times per hebdomad ) about figure of ascertained attending faux pass as noted by the participant.

Length of baseline will be selected utilizing restricted randomization trial ( minimal 6 and maximal 15 )

Intervention stage will be conducted in the same manner for each participant, as described below.

At the terminal of intercession stage, the original appraisals will be re-administered, utilizing analogue signifiers where available ( SART, TEA, HADS, DiVA, color-word intervention trial, Trails trial ) .

All repeated variables will be measured at three points during each hebdomad. Length of baseline for each participant separately will be determined by restricted randomization trial ( Todman, 2001 ) . In maintaining with the demands of the randomization trial, all participants will hold the same figure of observation/ informations points ( maximal 42 ) .

The bounds of the informations will hence be: participants ( 5 ) , entire observation points ( 42 ) , minimal observation points in baseline stage ( 6 ) and minimal observation points during full intervention stage ( 30 ) . Participants will be indiscriminately assigned an intercession stage get down point between observation point 7 and observation point 16 utilizing Microsoft Excel random figure coevals expression.

Intervention Phase processs

During intercession, observations and recordings will go on as in the baseline stage.

Intervention stage of attending preparation will take topographic point over a period of 10 hebdomads, an tantamount clip period to that used in the rating of APT. See Table 3 for inside informations of the protocol for each hebdomad of the attending preparation intercession. In maintaining with the hypotheses outlined above, the way of alterations predicted on steps is illustrated in Table 4.

Table 3: Intervention Planing

Week of intercession ( B ) stage

Session content

Between session activity

1 & A ; 2

Goals, monitoring and instruction

Question: How helpful do you believe this will be? ( 0-100 )

Education about neuropsychological facets of attending control.

Introduction attending beam and principle for intercession ( commence ATT )

Measure clip to first attending faux pas on participant ‘s selected undertaking ( television programme, reading or wireless programme )

Practice ATT 2x per twenty-four hours for 10-15 proceedingss

3 & A ; 4

Continue ATT

( external sounds )

Audio recording of sounds used to pattern exchanging utilizing 2, 3 and 4 sounds plus external sounds, following book from Adrian Wells

Practice ATT 2x per twenty-four hours for 10-15 proceedingss

5 & A ; 6

ATT ( with internal distractions )

Switch overing between sounds on the sound recording and internal/ bodily events such as 1 the feeling of ego on chair, 2 the feeling of toes in places, 3 the feeling of external respiration, 4 the ideas go throughing through my head

Practice beam for internal events, ideas etc

7 & A ; 8

Situational preparation ( self focal point )

Using exchanging scheme from hebdomads 3-6 to personally meaningful state of affairss i.e. detecting when one is self focussed or at hazard of going unhelpfully self focussed and utilizing the exchanging schemes to alter focal point to external events including ocular and audile external focal point.

Practice SAR

9 & A ; 10

Situational preparation ( twenty-four hours to twenty-four hours faux pass )

Using exchanging scheme from hebdomads 3-6 to functional state of affairss ( e.g. watching television, reading a book, cooking a repast ) and mensurating length of clip to first faux pas taking to lengthen clip to first faux pas.

Practice functional undertaking

11

Repeat pre station steps

The design of this probe meets the standards for high quality individual instance experimental designs set out by Tate et al. , ( 2008 ) as detailed in the appendix.

Table 4: Predicted alterations on steps throughout the intercession stage

Measure

Functional faux pass

*

Subjective effects of faux pass

*

Beliefs about attending control

*

*

Awareness of attending

*

*

*

Phase

Baseline

Goals, supervising & A ; instruction

ATT ( external sounds )

ATT

( internal distractions )

Situational preparation: ego focal point

Situational preparation: twenty-four hours to twenty-four hours faux pass

Week

Length to be confirmed

1-2

3-4

5-6

7-8

9-10

Symbol for predicted alteration = *

Settings and Equipment

To carry on this survey, the research worker requires entree to the undermentioned equipment:

Appraisal tools: SART, PASAT, D-KEFs ( colour word intervention trial and Trails subtest ) , DiVA questionnaire, GADS questionnaire, HADS questionnaire.

In order to mensurate clip to first faux pas, and to develop evaluation graduated tables with the participants, the research worker requires a stop watch, pens, pencils and paper.

Data will be entered into an SPSS ( version 12 ) spreadsheet

Data Analysis and Power Calculations

Pre-Post Measures

To set up whether a dependable alteration is demonstrated ( from neuropsychological appraisal ) for each single pre and station intercession, the consequences will be entered into a arrested development equation as described by Crawford & A ; Garthwaite ( 2006 ) . It will non be possible to carry on group comparings owing to the little figure of participants in the survey.

Repeated Measures

Interpretation of impact of intercession on repeated steps will foremost be analysed by ocular review. Secondary analysis, to determine whether there are statistically important differences between stage A and stage B information, will be conducted utilizing a randomization trial ( Todman, 2001 ) for each variable ‘s information set. The survey hypothesises that alteration will happen at different clip points harmonizing to the intercession phase ( for illustration, beliefs about control of attending are predicted to alter during hebdomads 1-4, whereas functional attending faux pass are predicted to alter after hebdomad 9 ) . The predicted alteration points are defined in Table 2. Therefore, the identified intercession onset point will be different for each step, consistent with the earliest point at which alteration would be predicted on that step.

In add-on, an exact chance trial ( Todman, 2001 ) will be conducted for each repeated variable ( see Table 2 ) to determine the likeliness of any found differences in the recorded information earlier named intercession start point.

Power Calculation

Using this design, there will be 7 possible intercession points hence with 5 participants, there will be 75 = 16807 possible agreements of the informations, therefore the lowest possible P value will be 1/16807 = 0.0000595. If merely 4 participants are used in the survey so there will be 74 = 2401 possible agreements and therefore the lowest possible P value would be 1/ 2401 = 0.000416 and if merely 3 participants were used in the survey, there will be 73 = 343 possible agreements of the information, and hence the lowest P value would be p= 0.00291

Practical Application

Timescale

Invite participants ( direct letters ) at terminal November 2008

Submit literature reappraisal 19 December

Begin informations aggregation 6 January 2009 ( baseline plus intervention clip will be a maximal 14 hebdomads )

Submit debut 27 March 2009

Submit Method subdivision 30 April 2009

Submit consequences 30 May 2009

Final entry August 31 2009

Ethical issues and blessing procedure

All of the participants will be having a potentially good intercession. However, engagement in the research undertaking will necessitate a significant clip committedness to the probe ( one time a hebdomad for about 12 hebdomads ) . This will be outlined to participants in the information sheet and will be discussed to the full with the participant before they commit to the survey and subscribe the consent signifier. Participants will besides be supported to be after and organize themselves in doing the hebdomadal assignments, as the research workers have an grasp of the impact of attending on memory, and on be aftering ability. Therefore, research workers will compose down the assignment times down for the participant and enterprise to keep assignments at the same clip each hebdomad ( where possible for the participant and research worker ) .

Occasionally appraisal of cognitive operation can arouse emotion in the individual being assessed. The consequences of the appraisals will be explained to the participant and a comparative or carer ( should the participant petition this ) . The survey is non designed to bring on brooding thought in participants. Participants will merely be advised how the technique can be applied to contemplation and will non be asked to pattern this in Sessionss. However, if appropriate, participants will be offered an chance to discourse their emotional reactions in a non-research context. Participants who express hurt, and who consent, can be referred to or advised about appropriate services, or advised to discourse farther with their GP.

Finally, the unafraid direction of informations will be ensured by the undermentioned stairss:

( a ) Participant information will be stored in a locked filing cabinet

( B ) Computer-based information will be saved utilizing an encrypted format

( degree Celsius ) Data will be to the full anonymised prior to any communications outside of the research squad, should it be requested for audit or for the intents of describing the survey.

Cambridge REC meets as below. Proposed entry for run intoing on 26 September ( cut off day of the month 8 September ) .

Name of Committees

Classs

Meeting Date

Cut-off Date

Cambridgeshire 1 Research Ethics Committee

“ 3 ” D & A ; HTB

21 October 2008

06 October 2008

Cambridgeshire 2 Research Ethics Committee

“ 2 ” D, C & A ; HTB

24 October 2008

06 October 2008

Cambridgeshire 3 Research Ethics Committee

“ A ” ALC

02 October 2008

17 September 2008

Cambridgeshire 4 Research Ethics Committee

“ 3 ”

23 October 2008

07 October2008

Appropriate moralss commission will be one of the 4 Cambridgeshire RECs ( as above ) . The most appropriate meeting is Ethics Committee 3. Following the flow chart counsel from hypertext transfer protocol: //www.nres.npsa.nhs.uk/ this survey can be submitted straight to the REC.

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