Fall 2013
IPHY 3435: PHYSIOLOGY LABORATORY – STUDENT EXPERIMENTS
AGREEMENT OF RELEASE AND WAIVER OF LIABILITY
(Read carefully before signing.)
You are being asked to participate as a subject in a student-designed experiment. The procedures
associated with the experiment have been reviewed and approved by the Lab Coordinator. A general
description of the experiment and explanation of what the subject will encounter while participating are
provided below:
The aim of this study is to determine if differential tempos of instrumental music (i.e. slow, medium,
fast, and no sound) will affect systolic blood pressure and heart rate. In these tests the subject will
submit to BP and HR tests immediately before and after a 3 minute listening period (total 20 tests).
Systolic blood pressure will be assessed with a blood pressure cuff (Sphygmomanometer) and
stethoscope or with a Lab Chart blood pressure transducer. Heart rate will be assessed with a finger
pulse transducer. Music will be “administered” with a student owned MP3 player and headphones that
will be sterilized in between subjects.
I, ___________________________________________, hereby acknowledge and agree to the following:
I am voluntarily participating as a subject in a student-designed experiment in the Physiology Lab course,
Offered by the Department of Integrative Physiology at the University of Colorado, Boulder. I recognize
that participating as a subject may require some physical exertion, which may be strenuous and may
cause physical injury, and I am fully aware of the risks and hazards involved. I recognize that
participating as a subject may involve some situations that are psychologically stressful, and I am fully
aware of the risks and hazards involved. In consideration of being permitted to participate as a subject
in the Physiology Lab activities, I knowingly, voluntarily and expressly waive any claim I may have against
the employees of the University of Colorado, and the Department of Integrative Physiology, and by the
execution of this release, hereby assume all such risks, injuries or damages, known and unknown, which
I might incur as a result of participating in the student-designed experiments.
I understand that is my responsibility to consult with a physician prior to and regarding my participation
in the Physiology Lab exercises. I represent and warrant that I am psychologically and physically fit and I
have no medical condition, which would prohibit or discourage me from participating fully and safely as
a subject in the laboratory exercises; including, but not limited to the risks and discomforts checked in
the list below.
Physical risks and discomforts (<<Place an “x” in the box(es) for procedures included in your
experiment>>)
Bar stimulating electrode for muscle activation: You will be using a bar-stimulating electrode to
elicit muscle contractions. The bar-stimulating electrode is placed on the skin of the forearm and
you will use electrode gel to aide in the conductance of the stimulus. If there is not enough gel
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used, or the skin is extremely sensitive, it is possible to burn the skin during stimulation.
Electrical stimulation may deliver a shock strong enough to produce pain and discomfort. The
involuntary contraction of your muscles, in response to the stimulus, may create a tingly or
prickling sensation.
Blood pressure measurements: Blood pressure measurements will be taken with either a
LabChart blood pressure transducer that shows a digital output recording of a subject’s blood
pressure, or using a manual method with a sphygmanometer and stethoscope. You will feel a
squeeze on your arm while the blood pressure cuff is inflated, but this will not last for more than
30 seconds.
Electrocardiography (ECG): An electrocardiogram is a safe procedure. There may be minor
discomfort, similar to removing a bandage, when the electrodes taped to your body to measure
your heart's electrical signals are removed. Rarely, a reaction to the electrodes may cause
redness or swelling of the skin.
Electroencephalography (EEG): Electroencephalography is a method by which electrical activity
of the brain can be noninvasively recorded through the use of recording electrodes. The
electrodes will be placed on various locations around the scalp and there will be electrode paste
between the electrode and the scalp. An elastic band will be placed around the head to keep the
electrodes in the proper position. Rarely, a reaction to the electrodes or electrode paste may
cause redness or swelling of the skin.
Cycle ergometer aerobic exercise: There are inherent risks associated with aerobic physical
activity. Aerobic exercise may result in a fast or slow irregular heart rhythm, abnormal blood
pressure changes, light-headedness, dizziness, fainting, chest pain, and other discomforts. Any
type of physical activity may in rare instances lead to heart attack, stroke, or death, but this is
unusual, especially if participants are free of known coronary heart disease (CHD), free of any
signs or symptoms of CHD, and with few major risk factors of CHD. Please avoid participation in
exercise experiments if you have any heart conditions.
Facial submersion in cold water: You will submerge your face in cold water during this lab. Coldwater submersion without a scuba mask or snorkel can produce some discomfort and anxiety as
a result of the contact between your face and the cold water and from holding your breath
during the submersion.
Finger stick capillary blood collection: The risks of blood draws through finger pricks are
minimal. A small percentage of individuals experience lightheadedness and fainting when
exposed to blood. Some momentary pain will be felt while the finger is being pricked. If you
have experienced fainting at the sight of blood in the past, please inform the instructor. Please
be cognizant of the exposure risks that blood sampling poses to the rest of the class and use the
proper personal protective equipment (gloves, glasses, lab coats) during the lab.
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Muscle force measurement procedures: You will squeeze a hand dynamometer or place your
finger against a pulse pressure transducer so that we can measure your muscle force. These
procedures should not produce any pain or discomfort, but your muscles may become fatigued
after repeated measurements.
Oral caffeine intake: You will consume a caffeinated beverage that contains ________ grams of
caffeine. Some participants may experience nausea or vomiting after drinking the caffeinated
beverage. Drinking a caffeinated beverage can cause an acute increase in your heart rate and
blood pressure. If you have a cardiac problem, you should not participate in this experiment.
Oral glucose intake: You will consume a flavored glucose drink that contains 75 grams of
glucose. Some participants may experience nausea or vomiting after drinking the glucose.
Drinking highly concentrated glucose will cause an acute increase in your blood glucose levels. If
you are a known diabetic or pre-diabetic, you should not participate in this experiment. It is
possible that your blood glucose levels will remain elevated for an extended period of time
following this task.
Urinary glucose assessment: This test involves only normal urination and there is no discomfort.
There is no risk associated with this test; however, we do ask that you wash your hands after
you have completed the test so that you do not risk exposing your classmates to biological
pathogens. You will need to use the restrooms in the Ramaley building for this test, but you will
do it on your own, without the help of any of your lab partners.
Ventilation of altered gas mixtures: For the mystery gas experiment, you will breath various gas
mixtures during this experiment (room air, 10% O2, 15% O2, and 6% CO2) for a period of no
greater than 5 minutes. While these gas mixtures are safe to breath for 5 minutes, you could
experience shortness of breath, an increased heart rate, faintness, nausea, trembling, dizziness,
and other unusual body sensations. If you are pregnant, or have heart disease, lung disease, or a
seizure disorder, you should not participate in the mystery gas experiment. For the breathholding experiment, you will perform an intervention that causes you to be either hypercapnic
or hypocapnic, then you will try to hold your breath for as long as possible. Breath holding is
voluntary and you can stop holding your breath whenever you would like, so there is no risk
involved in the procedure.
Other: Students volunteers will submit to 5 minute music listening periods. Discomfort may be
incurred as a result of music volume and headphone chaffing. Care will be taken to minimize
said discomfort and volunteers may elect to discontinue administration of music at any time.
Psychological risks and discomforts
Psychological stressors: You may experience some psychological discomfort when asked to
participate in an experiment that involves a psychological stressor. Psychological stressors can
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produce feelings of anxiety, embarrassment, frustration, anger, sadness, nervousness, or other
feelings. You will be given the opportunity to discontinue the test if you appear to be
experiencing an adverse reaction.
Ventilation of altered gases: Some individuals may experience some anxiety due to the
sensations brought on by breathing the mystery gases; however, these sensations last only as
long as you are breathing the gas and you can discontinue at any time if you are uncomfortable.
Other: Students may experience some anxiety or some milieu of emotional discomfort during
the music listening period (depending on the tempo and subject’s preference for the music).
However, these feelings will only persist through the duration of the music administration and
the subject can elect to discontinue the treatment at any time.
I am aware that no medical practitioners are present during these laboratory exercises and that I
participate at my own risk.
I understand that I am not obligated to serve as a test subject in any laboratory exercises of this course,
and that if I do choose to participate, I can drop out at any time.
I understand that my decision not to participate as a test subject in these laboratory exercises will have
no influence on my grade in this course.
I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree
to the terms and conditions stated above.
SIGNATURE: _______________________________________________________________________
PRINTED NAME: ____________________________________________________________________
DATE: ____________________________________________________________________________
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<<Complete the following with your group’s information.>>
GROUP MEMBER NAMES: Isabella Asamoah, Logan Bannon, Parsa Ghasem Anna Vavra,
SECTION DAY/TIME: Monday AM
TA/INSTRUCTOR: Jim Peterman
<<When you are finished customizing this consent form, delete all of the instructions that are
highlighted in yellow and save the document as “Consent_Name1_Name2_Name3_Name4.” Email the
document to your TA/Instructor by the end of your lab section during the week of 12/2/13. Make sure
to print off enough consent forms for the number of subjects that you will include in your experiment.>>
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