Research in Emergency and Critical Care Settings: Debates,Obstacles and Solutions

Research is an integral part of evidence-based practice in the emergency department and critical care unit that improves patient management. It is important to understand the need and major obstacles for conducting research in emergency settings. Herein, we review the literature for the obligations, ethics and major implications of emergency research and the associated limiting factors influencing research activities in critical care and emergency settings. We reviewed research engines such as PubMed, MEDLINE, and EMBASE for the last two decades using the key words “emergency department”, “critical care”, “research”, “consent”, and “ethics” as the search terms. Research within emergency settings is slow or non-existent due to time and financial constraints as well as the lack of a research tradition. There are several barriers to conducting research studies in emergency situations such as who, what, when, and how to obtain patient consent. The emergency environment is highly pressurized, emotional, and overburdened. The time taken for research is a particular risk that could delay the desired immediate interventions. Ethical issues abound, particularly relating to informed consent. Research in emergency settings is still in its infancy. Thus, there is a strong need for extensive research in the emergency setting through community awareness, resource management, ethics, collaborations, capacity building, and the development of a research interest for the improvement of patient care and outcomes. We need to establish a well-structured plan to assess and track the decision-making capacity, consider a multistep enrolment and consent strategy, and develop an integrated approach for recruitment into studies.     

Race,gender, and the response to stress: Autoworkers' vulnerability to long-term unemployment

A three-wave panel study of auto plant closings focused on the mental health effects of unemployment on blue-collar workers. This paper explores how the impact of long-term unemployment varies across race and gender. We also examine whether other demographic factors can themselves modify the impactsof race and gender. Dependent variables include two measures of distress and two drinking measures. Results showed that the effect of long-term unemployment on distress and drinking was more severe among less educated workers, and responses of blacks were especially sensitive to level of education. In addition, men showed a greater association of long-term unemployment with depression (and to some extent anxiety) than did women. Marriage affected the responses of men but not of women, and of whites but not of blacks. Explanatory variables—the worker's experiences of financial hardship, other negative life events, and lack of a confidant—largely accounted for male-female differences. We conclude by discussing theoretical implications of these effects and address the limitations of the traditional term “vulnerability” in describing them. A prior version of this paper was presented at the North Central Sociological Association meeting in Dearborn, Michigan, April 25, 1991. Funds for the research were provided by the Michigan Health Care Research and Education Foundation and by the International Union-UAW. We are especially grateful to the men and women of the UAW, whose experiences and views form this investigation. We thank Kiseon Chung, Scott McKearney, David Rauma, and the anonymous reviewers for their comments on earlier drafts.     

Failure of further learning: Activities,structure, and meaning

Previous research has shown that little benefit is achieved through spaced study and recall of text passages after the first recall attempt, an effect that we term the failure‐of‐further‐learning. We hypothesized that the effect occurs because a situation model of the text's gist is formed when the text is first comprehended and is consolidated when recalled; it dominates later recall after verbatim memories of more recent study episodes have been lost. Experiments 1 and 2 attempted to circumvent the effect by varying the activities of participants and requiring interactive exploration. In both experiments, recall after four, weekly sessions showed little benefit beyond performance on the first recall. Experiment 3 interfered with the formation of an immediate situation model by introducing passages that were hard to comprehend without a title. Performance improved substantially across four sessions when titles were not supplied, but the standard effect was replicated when titles were given. Experiment 4 made verbatim memories available by incorporating all re‐presentations and tests into one session; as predicted, recall improved over successive tests.     

Effect of Identifiability,Rating Audience,and Conscientiousness on Rating Level

This paper investigated three factors, two related to accountability and one an individual difference factor, which may influence rating level: (1) identifiability, (2) to whom one feels accountable (audience), and (3) conscientiousness. In study 1, results from students who rated their instructors indicated that not only did raters relatively high in conscientiousness report feeling more accountability but also that identifiability and conscientiousness interacted in predicting rating level. Raters relatively low in conscientiousness provided higher ratings when identified but raters relatively high in conscientious did not provide higher ratings. Rating audience did not influence rating level. Study 2 replicated the findings from study 1: Low conscientious raters assigned higher ratings when identified than when anonymous but high conscientious raters did not assign higher ratings when identified. Implications are discussed.     

Mediating Factors in Literacy Instruction: How Novice Elementary Teachers Navigate New Teaching Contexts

This longitudinal study, framed by activity theory, examines what seven novice teachers’ talk and actions reveal about their literacy teaching practices then delves into mediating influences of the teaching context. Utilizing collective, multi-case methods, data sources included interviews, observations, and artifacts. Findings indicate novices navigated school contexts by following existing practices, adjusting to conditions, and pushing back. Mediating influences, internal and external, were factored how novices applied knowledge from teacher preparation programs. Authors employed the metaphor of paddling a constantly changing river to convey novices’ actions for meeting students’ literacy learning. Recommendations for teacher educators and policymakers are suggested.     

LAW AND ETHICS IN ISLAMIC BIOETHICS: NONMALEFICENCE IN ISLAMIC PATERNITY REGULATIONS

In Islamic law paternity is treated as a consequence of a licit sexual relationship. Since DNA testing makes a clear distinction between legal and biological paternity possible, it challenges the continued correlation between paternity and marriage. This article explores the foundations of paternity regulations in the Islamic ethico‐legal tradition, with a particular focus on what is termed here “the licit sex principle,” and investigates the extent to which a harm‐based argument can be made either by appeal to or against Islamic paternity regulations. It argues that in Islamic bioethics the definition of harm and its boundaries is a function of both: (1) identification of legal and religious rights and the extent to which these rights are violated; and (2) balancing and reconciling perceived harm against both specific principles in relation to a given issue and also the overarching objectives of Islamic law. The article is divided into three main sections addressing the Islamic legal, ethical, and bioethical dimensions of paternity.