The Hunchback of Notre Dame (1996 film)
The Hunchback of Notre Dame is a 1996 American animated musical drama film produced by Walt Disney Feature Animation for Walt Disney Pictures. The 34th Disney animated feature film and the seventh animated film produced and released during the period called the Disney Renaissance, the film is based on the 1831 novel of the same name written by Victor Hugo; the plot centers on Quasimodo, the deformed bell-ringer of Notre Dame, his struggle to gain acceptance into society. Directed by Kirk Wise and Gary Trousdale and produced by Don Hahn, the film's voice cast features Tom Hulce, Demi Moore, Tony Jay, Kevin Kline, Paul Kandel, Jason Alexander, Charles Kimbrough, David Ogden Stiers, Mary Wickes in her final film role; as the seventh animated film produced and released during a period known as the Disney Renaissance, the film is considered to be one of Disney's darkest animated films as its narrative explores such mature themes as infanticide, damnation and sin, despite the changes made from the original source material in order to ensure a G rating received by the MPAA.
The musical score was written by Alan Menken, with songs written by Menken and lyricist Stephen Schwartz, who had collaborated on Pocahontas, released the year before. The Hunchback of Notre Dame was released on June 21, 1996 to positive reviews and was a commercial success, grossing over $325 million worldwide and becoming the fifth highest-grossing release of 1996; the film received Academy Award and Golden Globe Award nominations for Menken's musical score. A darker, more gothic stage adaptation of the film, was rewritten and directed by James Lapine and produced by Walt Disney Theatrical in Berlin, Germany, as Der Glöckner von Notre Dame, ran from 1999 to 2002. A direct-to-video sequel, The Hunchback of Notre Dame II, was released in 2002. A live-action adaptation of the film is in development. In 1482 Paris, Clopin, a gypsy puppeteer, narrates the origin of the titular hunchback. A group of gypsies sneak illegally into Paris, but are ambushed by Judge Claude Frollo, Paris' Minister of Justice, his soldiers.
A gypsy woman in the group attempts to flee with her deformed baby, but Frollo chases and kills her outside Notre Dame. He tries to kill the baby as well, but the cathedral's archdeacon intervenes and accuses Frollo of murdering an innocent woman. To atone for his sin, Frollo reluctantly agrees to raise the deformed child in Notre Dame as his son, naming him "Quasimodo". Twenty years Quasimodo develops into a kind yet isolated young man who has lived inside the cathedral his entire life. A trio of living stone gargoyles—Victor and Laverne—serve as Quasimodo's only company, encourage him to attend the annually-held Festival of Fools. Despite Frollo's warnings that he would be shunned for his deformity, Quasimodo attends the festival and is celebrated for his awkward appearance, only to be humiliated by the crowd after two of Frollo's guards start a riot. Frollo refuses to help Quasimodo, but Esmeralda, a kind gypsy, intervenes by freeing the hunchback, uses a magic trick to evade arrest. Frollo sends him back inside the cathedral.
Esmeralda follows Quasimodo inside, only to be followed herself by Captain Phoebus of Frollo's guard. Phoebus refuses to arrest her for alleged witchcraft inside Notre Dame and instead has her confined to the cathedral. Esmeralda finds and befriends Quasimodo, who helps her escape Notre Dame out of gratitude for defending him, she entrusts Quasimodo a pendant containing a map to the gypsies' hideout, the Court of Miracles. Frollo soon develops lustful feelings for Esmeralda and, upon realizing them, begs the Virgin Mary to save him from her "spell" to avoid eternal damnation; when Frollo discovers that she escaped, he instigates a citywide manhunt for her which involves setting fire to countless houses in his way. Phoebus is appalled by Frollo's evil and defies him, Frollo sentences him to death. While fleeing, Phoebus is struck by an arrow and falls into the River Seine, but Esmeralda rescues him and takes him to Notre Dame for refuge; the gargoyles encourage Quasimodo to confess his feelings for Esmeralda, but he is heartbroken to discover she and Phoebus have fallen in love.
Frollo returns to Notre Dame that night and discovers that Quasimodo helped Esmeralda escape. He bluffs to Quasimodo, saying that he knows about the Court of Miracles and that he intends to attack at dawn with 1,000 men. Using the map Esmeralda gave him and Phoebus find the court to warn the gypsies, only for Frollo to follow them and capture all the gypsies present. Frollo prepares to burn Esmeralda at the stake after she rejects his advances, but Quasimodo rescues her and brings her to the cathedral. Phoebus releases the gypsies and rallies the Paris citizens against Frollo and his men, who try to break into the cathedral. Quasimodo and the gargoyles pour molten lead onto the streets to ensure no one enters, but Frollo manages to get inside, he pursues Quasimodo and Esmeralda to the balcony where he and Quasimodo fight and both fall over the edge. Frollo falls to his death in the molten lead. Afterward, Quasimodo comes to accept that Phoebus and Esmeralda are in love, he gives them his blessing.
The two encourage him to leave the cathedral into the outside world, where the citizens hail him as a hero and accept him into society. Tom Hulce as Quasimodo, Notre Dame Cathedral's 20-year-old hunchbacked bell ringer who dreams of seeing life outside the bell tower. Despite the fact that Quasimodo is being informed by his guardian Judge Claude Frollo that he is an ugly monster, Clopin's opening song asks listeners to judge for themselves "who is the monster and, the man" of the two. James Baxter served as t
Benjamin Lay was an Anglo-American Quaker humanitarian and abolitionist. He is best known for his early and strident anti-slavery activities which would culminate in dramatic protests, he was an author and early vegetarian. Born in England, into a farming family, his early trade was as a glove-maker. After becoming a Quaker, he worked as a sailor, in 1718 moved to Barbados. Here he witnessed the poor treatment of African slaves that instilled in him his lifelong abolitionist principles. Lay settled in Philadelphia, was made unpopular among his fellow Quakers by his strident anti-slavery stance, which would culminate in acts of public protest, he published several pamphlets on social causes during his lifetime, one book – All Slave-keepers that keep the Innocent in Bondage, Apostates. Lay was distinguished by his early concern for the moral treatment of animals, was an early vegetarian. Benjamin Lay was born in 1682 to Quaker parents near Colchester, England. After working as a farmhand and shepherd an apprentice glove-maker, Lay ran away to London and became a sailor at age 21.
In 1718, Lay moved to Barbados as a merchant, but soon his abolitionist principles, fueled by his Quaker radicalism, made him hugely unpopular with those fellow residents who broadly profited from slavery and human trafficking. In 1731, Lay emigrated to the British Pennsylvania colony, settling first in Philadelphia, in Abington. In Abington, he was one of the earliest and most zealous opponents of slavery, at a time when Quakers were not yet organized in opposition to slavery. Lay stood over four feet tall, referring to himself as "Little Benjamin", he was a hunchback with a projecting chest, his arms were as long as his legs. He was a strict vegetarian, he did not believe that humans were superior to non-human animals and created his own clothes to boycott the slave-labor industry. He would not wear anything, nor eat anything, made from the loss of animal life or provided by any degree by slave labor. Refusing to participate in what he described in his tracts as a degraded, hypocritical and demonic society, Lay was committed to a lifestyle of complete self-sustenance after his beloved wife died.
Dwelling in the Pennsylvania countryside in a cave with outside entry way attached, Lay kept goats, farmed notably with fruit trees, grew the flax he spun into clothing for himself. He was distinguished less for his eccentricities than for his philanthropy, he published over 200 pamphlets, most of which were impassioned polemics against various social institutions of the time slavery, capital punishment, the prison system, the moneyed Pennsylvania Quaker elite, etc. He first began advocating for the abolition of slavery when, in Barbados, he saw an enslaved man commit suicide rather than be hit again by his owner, his passionate enmity of slavery was fueled by his Quaker beliefs. Lay made several dramatic demonstrations against the practice, he once stood outside a Quaker meeting in winter with no coat and at least one foot bare and in the snow. When passersby expressed concern for his health, he said that slaves were made to work outdoors in winter dressed as he was. On another occasion, he kidnapped the child of slaveholders temporarily, to show them how Africans felt when their relatives were sold overseas.
The most notable act occurred in Burlington, New Jersey, at the 1738 Philadelphia Yearly Meeting of Quakers. Dressed as a soldier, he concluded a diatribe against slavery, quoting the Bible saying that all men should be equal under God, by plunging a sword into a Bible containing a bladder of blood-red pokeberry juice, which spattered over those nearby. Benjamin Lay died in Abington, Pennsylvania, in 1759, his legacy continued to inspire the abolitionist movement for generations. Benjamin Lay was buried in Abington Friends Meeting's burial ground in a grave whose exact location is unknown, but next to the meeting house and adjacent to Abington Friends School in Jenkintown, Pennsylvania. In 2012, during the brief Occupy Jenkintown encampment, protesters symbolically rechristened the Jenkintown Town Square as "Benjamin Lay Plaza". In 2018, the Pennsylvania Historical and Museum Commission erected an historical marker in Abington commemorating Lay. On April 21, 2018, Abington Friends Meeting unveiled a grave marker for Benjamin and Sarah Lay in its graveyard.
Four Quaker meetings had disowned Lay for his inconvenient campaigning. In 2018, Southern East Anglia Area Meeting, part of Britain Yearly Meeting, became the last of the four to "undisown" him; the others were Abington Monthly Meeting and Philadelphia Yearly Meeting in the USA and North London Area Meeting in Britain. Lay's only published book is: Benjamin. All Slave-keepers that keep the Innocent in Apostates. Philadelphia; this book was one of the earliest North American antislavery works. It was printed for Lay by Benjamin Franklin, it has been digitized by the Antislavery Literature Project. List of abolitionist forerunners Claus Bernet. "Benjamin Lay". In Bautz, Traugott. Biographisch-Bibliographisches Kirchenlexikon. 19. Nordhausen: Bautz. Cols. 875–880. ISBN 3-88309-089-1. Rediker, Marcus The Fearless Benjamin Lay: The Quaker Dwarf Who Became the First Revolutionary Abolitionist, ISBN 978-0-8070-3592-4 Benjamin Rush: Biographical Anecdotes of Benjamin Lay. In: The Annual Monitor, or, New Letter-Case and Memorandum Book.
Vol. I. York 181
Computer-aided technologies is the use of computer technology to aid in the design and manufacture of products. Advanced CAx tools merge many different aspects of the product lifecycle management, including design, finite element analysis, production planning, product Computer-aided design Computer-aided architectural design Computer-aided engineering Computer-aided fixture design Computer-aided innovation Computer-aided industrial design Computer-aided manufacturing Computer-aided process planning Computer-aided requirements capture Computer-aided rule definition Computer-aided rule execution Computer-aided software engineering Computer-aided automation Computer-assisted surgery Computer-aided surgical simulation Computational fluid dynamics Component information system Computer-integrated manufacturing Computer Numerical Controlled Electronic design automation Enterprise resource planning Finite element analysis Knowledge-based engineering Manufacturing process management Manufacturing process planning Material requirements planning Manufacturing resource planning Product data management Product lifecycle management Virtual prototyping List of CAx companies LearnCAx Online Education in CAx Technologies
The thorax or chest is a part of the anatomy of humans and various other animals located between the neck and the abdomen. The thorax includes the thoracic wall, it contains organs including the heart and thymus gland, as well as muscles and various other internal structures. Many diseases may affect the chest, one of the most common symptoms is chest pain. In humans and other hominids, the thorax is the chest region of the body between the neck and the abdomen, along with its internal organs and other contents, it is protected and supported by the rib cage and shoulder girdle. The contents of the thorax include lungs. Arteries and veins are contained –. External structures are nipples. In the human body, the region of the thorax between the neck and diaphragm in the front of the body is called the chest; the corresponding area in an animal can be referred to as the chest. The shape of the chest does not correspond to that part of the thoracic skeleton that encloses the heart and lungs. All the breadth of the shoulders is due to the shoulder girdle, contains the axillae and the heads of the humeri.
In the middle line the suprasternal notch is seen above, while about three fingers' breadth below it a transverse ridge can be felt, known as the sternal angle and this marks the junction between the manubrium and body of the sternum. Level with this line the second ribs join the sternum, when these are found the lower ribs can be counted. At the lower part of the sternum, where the seventh or last true ribs join it, the ensiform cartilage begins, above this there is a depression known as the pit of the stomach; the bones of the thorax, called the "thoracic skeleton" is a component of the axial skeleton. It consists of sternum; the ribs of the thorax are numbered in ascending order from 1-12. 11 & 12 are known as floating ribs because they have no anterior attachment point in particular the cartilage attached to the sternum, as 1-7 are, therefore are termed "floating". Whereas ribs 8-10 are termed false ribs as their costal cartilage articulates with the costal cartilage of the rib above; the anatomy of the chest can be described through the use of anatomical landmarks.
The nipple in the male is situated in front of the fourth rib or a little below. A little below it the lower limit of the great pectoral muscle is seen running upward and outward to the axilla; the female nipple is surrounded for half an inch by the areola. The apex of a normal heart is in the fifth left intercostal space, three and a half inches from the mid-line. Different types of diseases or conditions that affect the chest include pleurisy, flail chest and the most common condition, chest pain; these conditions can be caused by birth defects or trauma. Any condition that lowers the ability to either breathe or to cough is considered a chest disease or condition. Injury to the chest results in up to ¼ of all deaths due to trauma in the United States; the major pathophysiologies encountered in blunt chest trauma involve derangements in the flow of air, blood, or both in combination. Sepsis due to leakage of alimentary tract contents, as in esophageal perforations must be considered. Blunt trauma results in chest wall injuries.
The pain associated with these injuries can make breathing difficult, this may compromise ventilation. Direct lung injuries, such as pulmonary contusions, are associated with major chest trauma and may impair ventilation by a similar mechanism. Chest pain can be the result of multiple issues, including respiratory problems, digestive issues, musculoskeletal complications; the pain can trigger cardiac issues as well. Not all pain, felt is associated with the heart, but it should not be taken either. Symptoms can be different depending on the cause of the pain. While cardiac issues cause feelings of sudden pressure in the chest or a crushing pain in the back and arms, pain, felt due to noncardiac issues gives a burning feeling along the digestive tract or pain when deep breaths are attempted. Different people feel pains differently for the same condition. Only a patient knows if the symptoms are mild or serious. Chest pain may be a symptom of myocardial infarctions. If this condition is present in the body, discomfort will be felt in the chest, similar to a heavy weight placed on the body.
Sweating, shortness of breath and irregular heartbeat may be experienced. If a heart attack occurs, the bulk of the damage is caused during the first six hours, so getting the proper treatment as as possible is important; some people those who are elderly or have diabetes, may not have typical chest pain but may have many of
Bone density, or bone mineral density, is the amount of bone mineral in bone tissue. The concept is of mass of mineral per volume of bone, although clinically it is measured by proxy according to optical density per square centimetre of bone surface upon imaging. Bone density measurement is used in clinical medicine as an indirect indicator of osteoporosis and fracture risk, it is measured by a procedure called densitometry performed in the radiology or nuclear medicine departments of hospitals or clinics. The measurement involves low radiation exposure. Measurements are most made over the lumbar spine and over the upper part of the hip; the forearm may be scanned if the lumbar spine are not accessible. There is higher probability of fracture. Fractures of the legs and pelvis due to falls are a significant public health problem in elderly women, leading to much medical cost, inability to live independently and risk of death. Bone density measurements are used to screen people for osteoporosis risk and to identify those who might benefit from measures to improve bone strength.
Bone density tests are not necessary for people without risk factors for weak bones. Unnecessary testing is more to result in superfluous treatment rather than discovery of a true problem; the following are risk factors for low bone density and primary considerations for the need for a bone density test. Females age 65 or older males age 70 or older people over age 50 with any of the following: previous bone fracture from minor trauma rheumatoid arthritis low body weight a parent with a hip fracture Individuals with vertebral abnormalities. Individuals receiving, or planning to receive, long-term glucocorticoid therapy. Individuals with primary hyperparathyroidism. Individuals being monitored to assess the response or efficacy of an approved osteoporosis drug therapy. Individuals with a history of eating disordersOther considerations that are related to risk of low bone density and the need for a test include smoking habits, drinking habits, the long-term use of corticosteroid drugs, a vitamin D deficiency.
For those people who do have bone density tests, two conditions which may be detected are osteoporosis and osteopenia. The usual response to either of these indications is consultation with a physician. Results are reported in 3 terms: Measured areal density in g cm−2 Z-score, the number of standard deviations above or below the mean for the patient's age and ethnicity T-score, the number of standard deviations above or below the mean for a healthy 30-year-old adult of the same sex and ethnicity as the patient While there are many different types of BMD tests, all are non-invasive. Most tests differ according to; these tests include: Dual-energy X-ray absorptiometry Dual X-ray Absorptiometry and Laser Quantitative computed tomography Quantitative ultrasound Single photon absorptiometry Dual photon absorptiometry Digital X-ray radiogrammetry Single energy X-ray absorptiometry DXA is the most used, but quantitative ultrasound has been described as a more cost-effective approach to measure bone density.
The DXA test works by measuring a specific bone or bones the spine and wrist. The density of these bones is compared with an average index based on age and size; the resulting comparison is used to determine risk for fractures and the stage of osteoporosis in an individual. Average bone mineral density = BMC / W BMC = bone mineral content = g/cm W = width at the scanned line Results are scored by two measures, the T-score and the Z-score. Scores indicate. Negative scores indicate lower bone density, positive scores indicate higher; the T-score is the relevant measure. It is the bone mineral density at the site, it is a comparison of a patient's BMD to that of a healthy 30-year-old. The US standard is to use data for a 30-year-old of the same sex and ethnicity, but the WHO recommends using data for a 30-year-old white female for everyone. Values for 30-year-olds are used in post-menopausal women and men over age 50 because they better predict risk of future fracture; the criteria of the World Health Organization are: Normal is a T-score of −1.0 or higher Osteopenia is defined as between −1.0 and −2.5 Osteoporosis is defined as −2.5 or lower, meaning a bone density, two and a half standard deviations below the mean of a 30-year-old man/woman.
The Z-score is the comparison to the age-matched normal and is used in cases of severe osteoporosis. This is the number of standard deviations a patient's BMD differs from the average BMD of their age and ethnicity; this value is used in premenopausal women, men under the age of 50, in children. It is most useful. In this setting, it is helpful to scrutinize for coexisting illnesses or treatments that may contribute to osteoporosis such as glucocorticoid therapy, hyperparathyroidism, or alcoholism. Use of BMD has several limitations. Measurement can be affected by the size of the patient, the thickness of tissue overlying the bone, other factors extraneous to the bones. Bone density is a proxy measurement for bone strength, the resistance to fracture and the significant characteristic. Although the two are related, there are some circumstances in which bone density is a poorer indicator of bone strength. Reference standard
The vertebral column known as the backbone or spine, is part of the axial skeleton. The vertebral column is the defining characteristic of a vertebrate in which the notochord found in all chordates has been replaced by a segmented series of bone: vertebrae separated by intervertebral discs; the vertebral column houses a cavity that encloses and protects the spinal cord. There are about 50,000 species of animals; the human vertebral column is one of the most-studied examples. In a human's vertebral column there are thirty-three vertebrae; the articulating vertebrae are named according to their region of the spine. There are twelve thoracic vertebrae and five lumbar vertebrae; the number of vertebrae in a region overall the number remains the same. The number of those in the cervical region however is only changed. There are ligaments extending the length of the column at the front and the back, in between the vertebrae joining the spinous processes, the transverse processes and the vertebral laminae.
The vertebrae in the human vertebral column are divided into different regions, which correspond to the curves of the spinal column. The articulating vertebrae are named according to their region of the spine. Vertebrae in these regions are alike, with minor variation; these regions are called the cervical spine, thoracic spine, lumbar spine and coccyx. There are twelve thoracic vertebrae and five lumbar vertebrae; the number of vertebrae in a region overall the number remains the same. The number of those in the cervical region however is only changed; the vertebrae of the cervical and lumbar spines are independent bones, quite similar. The vertebrae of the sacrum and coccyx are fused and unable to move independently. Two special vertebrae are the axis, on which the head rests. A typical vertebra consists of two parts: the vertebral arch; the vertebral arch is posterior. Together, these enclose the vertebral foramen; because the spinal cord ends in the lumbar spine, the sacrum and coccyx are fused, they do not contain a central foramen.
The vertebral arch is formed by a pair of pedicles and a pair of laminae, supports seven processes, four articular, two transverse, one spinous, the latter being known as the neural spine. Two transverse processes and one spinous process are posterior to the vertebral body; the spinous process comes out the back, one transverse process comes out the left, one on the right. The spinous processes of the cervical and lumbar regions can be felt through the skin. Above and below each vertebra are joints called facet joints; these restrict the range of movement possible, are joined by a thin portion of the neural arch called the pars interarticularis. In between each pair of vertebrae are two small holes called intervertebral foramina; the spinal nerves leave the spinal cord through these holes. Individual vertebrae are named according to their position. From top to bottom, the vertebrae are: Cervical spine: 7 vertebrae Thoracic spine: 12 vertebrae Lumbar spine: 5 vertebrae Sacrum: 5 vertebrae Coccyx: 4 vertebrae The upper cervical spine has a curve, convex forward, that begins at the axis at the apex of the odontoid process or dens, ends at the middle of the second thoracic vertebra.
This inward curve is known as a lordotic curve. The thoracic curve, concave forward, begins at the middle of the second and ends at the middle of the twelfth thoracic vertebra, its most prominent point behind corresponds to the spinous process of the seventh thoracic vertebra. This curve is known as a kyphotic curve; the lumbar curve is more marked in the female than in the male. It is convex anteriorly, the convexity of the lower three vertebrae being much greater than that of the upper two; this curve is described as a lordotic curve. The sacral curve begins at the sacrovertebral articulation, ends at the point of the coccyx; the thoracic and sacral kyphotic curves are termed primary curves, because they are present in the fetus. The cervical and lumbar curves are compensatory or secondary, are developed after birth; the cervical curve forms when the infant is able to sit upright. The lumbar curve forms from twelve to eighteen months, when the child begins to walk. Anterior surfaceWhen viewed from in front, the width of the bodies of the vertebrae is seen to increase from the second cervical to the first thoracic.
From this point there is a rapid diminution, to the apex of the coccyx. Posterior surfaceFrom behind, the vertebral column presents in the median line the spinous processes. In the cervical region these are short and bifid. In the upper part of the thoracic region they are directed obliquely downward.
Randomized controlled trial
A randomized controlled trial is a type of scientific experiment which aims to reduce bias when testing a new treatment. The people participating in the trial are randomly allocated to either the group receiving the treatment under investigation or to a group receiving standard treatment as the control. Randomization minimises selection bias and the different comparison groups allow the researchers to determine any effects of the treatment when compared with the no treatment group, while other variables are kept constant; the RCT is considered the gold standard for a clinical trial. RCTs are used to test the efficacy or effectiveness of various types of medical intervention and may provide information about adverse effects, such as drug reactions. Random assignment of intervention is done after subjects have been assessed for eligibility and recruited, but before the intervention to be studied begins. Random allocation in real trials is complex. After randomization, the two groups of subjects are followed in the same way and the only differences between them is the care they receive.
For example, in terms of procedures, outpatient visits, follow-up calls, should be those intrinsic to the treatments being compared. The most important advantage of proper randomization is that it minimizes allocation bias, balancing both known and unknown prognostic factors, in the assignment of treatments; the terms "RCT" and randomized trial are sometimes used synonymously, but the methodologically sound practice is to reserve the "RCT" name only for trials that contain control groups, in which groups receiving the experimental treatment are compared with control groups receiving no treatment or a tested treatment. The term "randomized trials" omits mention of controls and can describe studies that compare multiple treatment groups with each other. Although the "RCT" name is sometimes expanded as "randomized clinical trial" or "randomized comparative trial", the methodologically sound practice, to avoid ambiguity in the scientific literature, is to retain "control" in the definition of "RCT" and thus reserve that name only for trials that contain controls.
Not all randomized clinical trials are randomized controlled trials. The term randomized controlled clinical trials is a methodologically sound alternate expansion for "RCT" in RCTs that concern clinical research; the first reported clinical trial was conducted by James Lind in 1747 to identify treatment for scurvy. Randomized experiments appeared in psychology, where they were introduced by Charles Sanders Peirce, in education. Randomized experiments appeared in agriculture, due to Jerzy Neyman and Ronald A. Fisher. Fisher's experimental research and his writings popularized randomized experiments; the first published RCT in medicine appeared in the 1948 paper entitled "Streptomycin treatment of pulmonary tuberculosis", which described a Medical Research Council investigation. One of the authors of that paper was Austin Bradford Hill, credited as having conceived the modern RCT. By the late 20th century, RCTs were recognized as the standard method for "rational therapeutics" in medicine; as of 2004, more than 150,000 RCTs were in the Cochrane Library.
To improve the reporting of RCTs in the medical literature, an international group of scientists and editors published Consolidated Standards of Reporting Trials Statements in 1996, 2001 and 2010, these have become accepted. Randomization is the process of assigning trial subjects to treatment or control groups using an element of chance to determine the assignments in order to reduce the bias. Although the principle of clinical equipoise common to clinical trials has been applied to RCTs, the ethics of RCTs have special considerations. For one, it has been argued. For another, "collective equipoise" can conflict with a lack of personal equipoise. Zelen's design, used for some RCTs, randomizes subjects before they provide informed consent, which may be ethical for RCTs of screening and selected therapies, but is unethical "for most therapeutic trials."Although subjects always provide informed consent for their participation in an RCT, studies since 1982 have documented that RCT subjects may believe that they are certain to receive treatment, best for them personally.
Further research is necessary to determine the prevalence of and ways to address this "therapeutic misconception". The RCT method variations may create cultural effects that have not been well understood. For example, patients with terminal illness may join trials in the hope of being cured when treatments are unlikely to be successful. In 2004, the International Committee of Medical Journal Editors announced that all trials starting enrolment after July 1, 2005 must be registered prior to consideration for publication in one of the 12 member journals of the committee. However, trial registration may still occur not at all. Medical journals have been slow in adapting policies requiring mandatory clinical trial registration as a prerequisite for publication. One way