CONSENT FORM

            You are invited to participate in a research study conducted by the laboratory of Professor Terry Takahashi, of the Institute of Neuroscience, University of Oregon.   My research team and I hope to develop better ways of evaluating human hearing.  You were selected as a possible participant in this study because you responded to our advertisement.

            During the experiment, you will be comfortably seated in a quiet lab room or a special sound-deadening chamber, facing a computer screen and wearing a pair of earphones.   These earphones are used exclusively by you.  During a trial, you will be asked to listen for a sound presented to both of your ears, and your task is to indicate, when prompted, whether or not you heard a sound.   The entire session lasts about 45-60 min.

            To begin, we will ask you to follow a small red dot as it moves to all four corners of the computer screen: this helps the computer relate your eye movement to locations on the computer monitor.  During the actual trials, you will be required to look directly at a mark on the computer screen without blinking for 4-5 sec.  The direction in which your eyes aimed and the diameter of your pupil will be monitored by video camera, but we will not record an image of your eyes or face.  Between trials, you may blink and move your eyes and head.  If needed, you can ask for a break at any time.

            Depending on our findings, we might ask if you could return for further experimental sessions.  However, you are under no obligation to return; participating in one session is not a commitment to participate in future sessions. Follow-up sessions will closely resemble the first session.  The only difference is that the sounds may be really quiet, and may sound different. We use tones – which sound like beeps – as well as broadband noises – which sound like a hiss.  Other than the characteristics of the sound, all sessions will be identical.

Subjects will receive $7 for the first hour or part thereof, and additional $7 for every additional hour or part thereof.  Subjects are free to terminate the experiment at any time (for example, due to discomfort), and will receive the full compensation of $7 if they are still within the first hour, and additional $7 hour if the time has already run over an hour. This rate of compensation holds over all sessions the subject participates in.  The risks of participating in our experiments are minimal.  At no time will the loudness of the sounds be louder than an ordinary, quiet conversation.  You might develop a slight headache or eye fatigue from prolonged concentration, as you might during an exam.  These symptoms are likely to be very short-lived.  You may, however, stop the sessions at any time, without penalty.

            Your participation will help us gain baseline data on ways that we may be able to evaluate hearing with greater speed and accuracy.   However, I cannot guarantee that you, personally, will receive any benefits from this research, aside from monetary payment.

            To protect your privacy, you will be assigned a subject number at your first session.  Files containing your data are labeled with your subject number, not with your name or other designation, such as a UO ID number, that can be associated with you.  The key that associates your name with your subject number is kept in an encrypted, password protected spreadsheet.  Computer data files are password-protected and hardcopies of your private information are stored under lock and key in the laboratory.  Your data will be disclosed only with your permission.

            The data gathered in this study will likely be published in reports to scientific journals, presented at scientific meetings, or both.  In such announcements, data that we obtained from you are referred to by a designation that cannot be traced to you.

            Your participation is voluntary. Your decision whether or not to participate will not affect your relationship with the University.  You are free to withdraw your consent and discontinue participation at any time without penalty.

            If you have any questions, please feel free to contact Terry Takahashi, Professor of Biology: terry@uoregon.edu; (541) 346-4544.  If you have questions regarding your rights as a research subject, contact the Office for Protection of Human Subjects, University of Oregon, Eugene, OR 97403, (541) 346-2510.  You will be given a copy of this form to keep.

            Your signature indicates that you have read and understand the information provided above, that you willingly agree to participate, that you may withdraw your consent at any time and discontinue participation without penalty, that you have received a copy of this form, and that you are not waiving any legal claims, rights or remedies.

Print Name________________________________________________________

Signature ________________________________________________________

Date _________________________

PDF version of this document to print and fill out.

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Prof. Terry Takahashi. email Terry.
Dr. Avinash Singh. email Avinash
University of Oregon