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  <front>
    <journal-meta />
    <article-meta>
      <title-group>
        <article-title>Coordinated Evolution of Ontologies of Informed Consent</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <string-name>Jonathan Vajda &amp; J. Neil Otte</string-name>
          <xref ref-type="aff" rid="aff3">3</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Cooper Stansbury</string-name>
          <xref ref-type="aff" rid="aff5">5</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Frank J. Manion, Elizabeth Umberfield, Yongqun He, &amp;</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Jihad Obeid</string-name>
          <xref ref-type="aff" rid="aff1">1</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Mathias Brochhausen</string-name>
          <xref ref-type="aff" rid="aff4">4</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>William D. Duncan</string-name>
          <xref ref-type="aff" rid="aff2">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Cui Tao</string-name>
          <xref ref-type="aff" rid="aff6">6</xref>
        </contrib>
        <aff id="aff0">
          <label>0</label>
          <institution>Marcelline Harris, University of Michigan</institution>
          ,
          <addr-line>Ann Arbor, MI</addr-line>
          ,
          <country country="US">USA</country>
        </aff>
        <aff id="aff1">
          <label>1</label>
          <institution>Medical University of South Carolina</institution>
          ,
          <addr-line>Charleston, SC</addr-line>
          ,
          <country country="US">USA</country>
        </aff>
        <aff id="aff2">
          <label>2</label>
          <institution>Roswell Park Comprehensive Cancer Center</institution>
          ,
          <addr-line>Buffalo, NY</addr-line>
          ,
          <country country="US">USA</country>
        </aff>
        <aff id="aff3">
          <label>3</label>
          <institution>University at Buffalo</institution>
          ,
          <addr-line>Buffalo, NY</addr-line>
          ,
          <country country="US">USA</country>
        </aff>
        <aff id="aff4">
          <label>4</label>
          <institution>University of Arkansas for Medical Sciences</institution>
          ,
          <addr-line>Little Rock, AR</addr-line>
          ,
          <country country="US">USA</country>
        </aff>
        <aff id="aff5">
          <label>5</label>
          <institution>University of Michigan</institution>
          ,
          <addr-line>Dearborn, MI</addr-line>
          ,
          <country country="US">USA</country>
        </aff>
        <aff id="aff6">
          <label>6</label>
          <institution>University of Texas Health Science Center Houston</institution>
          ,
          <addr-line>Houston, TX</addr-line>
          ,
          <country country="US">USA</country>
        </aff>
      </contrib-group>
      <pub-date>
        <year>2018</year>
      </pub-date>
      <fpage>7</fpage>
      <lpage>10</lpage>
      <abstract>
        <p>international governing bodies, while others may be local and locally created, such as directives issued by an institutional review board. II. REPRESENTATION AND USE Tracking not only these materials and data sets, their locations, and the changing nature of directives to which their use is subject, is an enormous task for healthcare professionals, researchers, and institutions. Software systems that aid in tracking such entities are piecemeal, and hampered greatly by a lack of representation of the consent life cycle itself. Furthermore, even for those departments and review boards that have good consent tracking resources available to them, there is not a standard for such resources, and so intraorganizational data requires time intensive recoding.</p>
      </abstract>
      <kwd-group>
        <kwd>informed consent</kwd>
        <kwd>informed consent life cycle</kwd>
        <kwd>ontology collaboration</kwd>
        <kwd>reference ontology</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <sec id="sec-1">
      <title>I. THE INFORMED CONSENT LIFE CYCLE</title>
      <p>Informed consent, whether for health or behavioral research
or clinical treatment, rests on notions of voluntarism,
information disclosure and understanding, and the
decisionmaking capacity of the person providing consent. Whether
consent is for research or treatment, informed consent serves as
a safeguard for trust that permissions given by the research
participant or patient are upheld across the informed consent
(IC) lifecycle. The IC lifecycle involves not only
documentation of the consent when originally obtained, but
actions that require clear communication of permissions from
the initial acquisition of data and specimens through handoffs
to, for example, secondary researchers, allowing them access to
data or biospecimens referenced in the terms of the original
consent.</p>
      <p>What unifies the informed consent lifecycle is a complex
chain of distinct authorizations that flow from a person’s
consent to a researcher or clinician who operates under rules of
specific institutions as well as federal regulations. This flow of
authorizations may further pass through the institution’s
authority derived from its legal authority and the documented
consent provided by the person, which may be exercised
further in authorizing other institutions and individuals to
perform additional actions (such as taking possession of a
biospecimen where it may be subject to further restrictions.
Throughout this lifecycle, various actions involving patient
data or biospecimens derived from the patient are performed,
and come under different sets of policy and legal prescriptions
as they transferred from one researcher in one institution to
another researcher in other institutions or organizations. Some
of these prescriptions may hold across wide jurisdictions, as in
the case of government policy at the level of national and</p>
      <p>Such a representation could make it easier to:
• access data sets and biospecimens for secondary
researchers across institutions;
• organize biospecimens stored within a biorepository
and facilitate sharing among repositories;
• query the content of laws, policies, and directives
concerning particular consent types; and
• facilitate the study of informed consent processes and
patient outcomes across institutions.</p>
      <p>Presently, there are a number of consent life cycle tracking
software tools, but most of these have been developed for the
domain of web platforms that seek to protect user data.1 These
do not address the domain of informed consent within the
domain of clinical care and health and behavioral research, and
are largely proprietary.</p>
      <p>
        While there are many open-source ontologies that represent
informed consent within the domain of clinical care and
research, these ontologies often focus on a single part of the
consent life cycle, and restrict their representations to rules,
codes, and specifications regarding consent, and include no
representation of processes [
        <xref ref-type="bibr" rid="ref2">2</xref>
        ]. For this reason, they have
avoided representing processes of providing consent, processes
of transferring a consent power among institutions, and
processes of a consent power being revoked—all of which are
necessary for tracking consent across the consent lifecycle. In
addition, many of these ontologies are built for particular
applications that occur in a language parochial to a context of
use, and which contain classes and axioms that may be
inappropriate in other institutional contexts. Few of these
ontologies have adopted a realist approach that is characteristic
of reference ontologies [
        <xref ref-type="bibr" rid="ref3">3</xref>
        ].
      </p>
    </sec>
    <sec id="sec-2">
      <title>III. THE INFORMED CONSENT ONTOLOGY</title>
      <p>In Spring 2018, the collaborators for this project came
together to revise and broaden the existing OBO Foundry
ontology, the Informed Consent Ontology (ICO), with the goal
of harmonizing it to work with a number of related ontologies,
including:
• The Document Acts Ontology (D-Acts),
• The Data Use Ontology (DUO), and
• Regulatory Basis for Informed Consent Ontology
(RUBRIC).</p>
      <p>The goal is to develop the Informed Consent Ontology
(ICO) into a reference ontology2 of the consent life cycle,
capable of integrating other ontologies that may represent parts
of the informed consent domain at certain stages, but which
lack a unified framework for tracking consent across the
lifecycle.</p>
      <p>This work also includes an extension of D-Acts, which was
necessary in order to provide a treatment of deontic roles and
deontic power roles. Deontic roles include, for instance, the
permission role that inheres in an organization following a
patient having provided consent to that organization. Deontic
powers are also deontic roles on this account, and are
distinguished by being realized in the creation, modification, or
revocation of an existing role. On this view, a patient’s right to
consent and the patient’s right to later revoke their consent are
deontic power roles, for each either issues a deontic role that
inheres in another, or revokes that permission role.</p>
      <p>
        The Data Use Ontology (DUO) is an ontology representing
consent codes that label datasets. The hierarchy of consent
codes is based upon categories reported in Dyke et al. [
        <xref ref-type="bibr" rid="ref4">4</xref>
        ], and
the ontology extends this representation by relating them to
data restrictions. In revising ICO, part of our goal is also to
extend the representation available in DUO, so that it forms
part of a shared representation that includes a treatment of
deontic roles.
      </p>
      <p>
        The Regulatory Basis for Informed Consent Ontology
(RUBRIC) was originally an ontology of the Common Rule, a
U.S. federal policy regarding biomedical and behavioral
research for human beings [
        <xref ref-type="bibr" rid="ref5">5</xref>
        ]. In this revision, its treatment of
rules is broadened within the framework of Basic Formal
Ontology (BFO) and the Information Artifact Ontology [IAO].
The goal in further elucidating these rule types in RUBRIC is
to render RUBRIC appropriate as a reference ontology for the
international context of informed consent regulation. This is
achieved in three ways. First, there is further elucidation of the
IAO’s treatment of rules, policies, laws, and—more broadly—
directive information content entities as differentiated by their
logical forms (for instance, conditional rules and their parts).
Second, we provide a hierarchy of directives further
distinguished by the content of these rules (i.e. to what class of
actions they apply). Third, we introduce the framework of the
document act, as well as a class ‘stasis of law’, which allows
one to say that following a document act (such as the
legislative signing of a bill), that a document enters into a stasis
of law, whereupon the document has the status of law—a status
that may be lost by further legislation or judicial rules.
      </p>
    </sec>
    <sec id="sec-3">
      <title>IV. SUMMARY OF THE POSTER</title>
      <p>In this poster, we report on the progress we have made in
bringing these ontologies together, our motivations, and the
relation to other ontologies, including Basic Formal Ontology
(BFO) from which all of these ontologies derive their top-level
representation.</p>
      <p>In addition, we also provide clear representations of use
cases at different stages along the consent life cycle, showing
both classes in the ontology, as well as their instances in the
use cases. Furthermore, all files, documents, and slides related
to the project will be publicly available on GitHub repositories,
whose links will be available on the poster.</p>
    </sec>
    <sec id="sec-4">
      <title>ACKNOWLEDGEMENTS Research reported in this abstract was supported in part by NHGRI of the National Institutes of Health under award number 5U01HG009454-02, Tao PI.</title>
    </sec>
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