Assessing the Ethics of Medical Research in Emergency Settings: How Do International Regulations Work in Practice?

Different ethical principles conflict in research conducted in emergency research. Clinical care and its development should be based on research. Patients in critical clinical condition are in the greatest need of better medicines. The critical condition of the patient and the absence of a patient representative at the critical time period make it difficult and sometimes impossible to request an informed consent before the beginning of the trial. In an emergency, care decisions must be made in a short period of time, and the more time is wasted, the more the risk of death or severe tissue damage and incapacity increases. Consent requests take time, and so the time period before treatment might put the patient’s life in jeopardy. Not requesting consent before a trial is also contradictory. A person should not be forced to participate in a trial against his or her will. Due to the dark history of medical research previously, international declarations and conventions have set up ethical principles for medical research. They emphasize the autonomy of the research participant—or his or her legal representative—to give a free and informed consent prior to the initiation of research. In the case of a critical emergency, the unconscious state of the patient, the emotional stress of family members or the lack of time to start life-sustaining measures may often restrict the possibilities of communicating with the patient or his/her representative. Therefore, written informed consent is difficult to achieve, and its voluntariness in emergency situations is, at best, open to question. The mortality of patients is high without clinical interventions in emergency research. Random selection of patients is difficult and requires extra work from personnel in the emergency rooms. Recruitment, information and asking for consent may also take time, postpone the initiation of treatment and increase the risk of death and irreversible tissue and organ damage, and therefore be risky for the patient. It is therefore essential that the health care professionals recruiting suitable research participants are well motivated and well trained. Medical research in an emergency setting should always be regarded as an exceptional situation requiring special provisions. Only such research should be done as cannot be done in other conditions. An independent body must approve the research protocol and the ways in which the consent of the participant or proxy are to be sought. In addition, the trial must be expected to result in direct and significant benefit for the research participants. If research without prior consent is not approved, the development of emergency care is threatened. On the other hand, if prior consent is not required, a person could be recruited into a clinical trial against his or her will. Doing good and avoiding harm, and respecting the autonomy of the patient are in conflict in the context of emergency medical research. To develop better medicines for patients experiencing acute medical emergencies, research into such conditions should be allowed. Research participants should have the possibility to participate or refuse to participate in research that may benefit them and other patients. The risk of irreversible damage occurring as the consequence of time delays for seeking consent is unacceptable. A prior wish about participation in clinical trials should be respected, if known. The conditions under which medical research in emergencies can be considered acceptable can be determined and agreed upon nationally and internationally. An earlier version of this paper was presented at The 7th International Conference on Bioethics on “The Ethics of Research in Emergency Medicine”, held on June 2, 2006, Warsaw, Poland.     

Nation building and the politics of Islamic internationalism in Guinea: toward an understanding of Muslims’ experience of globalization in Africa

This article discusses the historical role of Islam in the political evolution of Guinea in the broader context of Muslims’ experience of nation/state building and globalization in Africa. This role is examined on the premise that Islam is one of the major globalizing forces (more in the body of the paper on this idea of Islam as a globalizing force) responsible for the formation of what experts have conceptualized as Africa’s “triple heritage” or the juncture of African traditional values, Islamic influence, and the legacy of Western colonialism. The article examines Islam’s role in the creation of cultural identities, territorial polities, and complex regional and trans-continental networks of trade and scholarship in pre-colonial West Africa; the formation of fronts of resistance to European colonial conquest and occupation; and the mobilization of new nationalist forces which sparked the national liberation struggle of the 1940s and 1950s in the region. The discussion of key concepts such as nationalism, nation/state building, internationalism, and globalization exposes the limited applicability of existing theories to the African experience by highlighting the complexity of post-colonial cultural reconstruction and nation building on the continent. From this perspective, the article focuses upon the political and ideological contradictions having marked the relations of the regime of the Parti Démocratique de Guinée (PDG) under President Ahmed Sékou Touré and conservative Guinean Muslim circles in the early years of independence, due in part to Touré’s Marxist and socialist leanings of the time. Also comprehensively discussed is this regime’s subsequent ideological incorporation and diplomatic use of Islam in an effort to curb anti-PDG opposition at home and abroad and to free itself from isolation by the West. Hence, President Touré’s successful policy of “offensive diplomatique” geared primarily toward Arab and Muslim nations and organizations but also, though somewhat indirectly, toward Western powers, serves as an example of the dynamics of Islamic internationalism in Cold War global affairs. Past experiences of party-centered and state-controlled regimentation of religious organizations under Touré’s state-party regime is compared to the current trend of self-decentralization and self-internationalization of Islamic forces in light of the challenges of religious radicalism and post-Cold War politics in Africa.

Children's rights and school psychology: Children's right to participation

The Convention on the Rights of the Child detailed an international imperative to fulfilling, protecting, and respecting the rights of every child. In particular, the Convention set out a clear mandate for guaranteeing opportunities for children to be heard on all matters of concern to them. The attainment of these goals involves respecting and valuing children as active participants in the educational process. If fully implemented, the right of children to express views and have them taken seriously, throughout the school environment, would represent one of the most profound transformations in moving towards a culture of respect for children's rights, for their dignity and citizenship, and for their capacities to contribute significantly towards their own well-being. These values and principles are consistent with those of the school psychology profession, thus, school psychologists are encouraged to be at the Center of the process advocating and actualizing the Convention in schools throughout the world.     

Uncovering Substantive Patterns in Student Responses in International Large-Scale Assessments—Comparing a Latent Class to a Manifest DIF Approach

In this study, we contrast results from two differential item functioning (DIF) approaches (manifest and latent class) by the number of items and sources of items identified as DIF using data from an international reading assessment. The latter approach yielded three latent classes, presenting evidence of heterogeneity in examinee response patterns. It also yielded more DIF items with larger effect sizes and more consistent item response patterns by substantive aspects (e.g., reading comprehension processes and cognitive complexity of items). Based on our findings, we suggest empirically evaluating the homogeneity assumption in international assessments because international populations cannot be assumed to have homogeneous item response patterns. Otherwise, differences in response patterns within these populations may be under-detected when conducting manifest DIF analyses. Detecting differences in item responses across international examinee populations has implications on the generalizability and meaningfulness of DIF findings as they apply to heterogeneous examinee subgroups.     

A longitudinal investigation of children internationally adopted at school age

Most existing research on children adopted internationally has focused on those adopted as infants and toddlers. The current study longitudinally tracked several outcomes, including cognitive, behavioral, emotional, attachment, and family functioning, in 25 children who had been internationally adopted at school age (M = 7.7 years old at adoption, SD = 3.4, range = 4–15 years). We examined the incidence of clinically significant impairments, significant change in outcomes over the three study points, and variables that predicted outcomes over time. Clinically significant impairments in sustained attention, full-scale intelligence, reading, language, executive functioning, externalizing problems, and parenting stress were common, with language and executive functioning impairments present at higher levels in the current study compared with past research focusing on children adopted as infants and toddlers. Over the three study points, significant improvements across most cognitive areas and attachment functioning were observed, though significant worsening in executive functioning and internalizing problems was present. Adoptive family-specific variables, such as greater maternal education, smaller family size, a parenting approach that encouraged age-expected behaviors, home schooling, and being the sole adopted child in the family were associated with greater improvement across several cognitive outcomes. In contrast, decreased parenting stress was predicted by having multiple adopted children and smaller family sizes were associated with greater difficulties with executive functioning. Child-specific variables were also linked to outcomes, with girls displaying worse attachment and poorer cognitive performance and with less time in orphanage care resulting in greater adoption success. Implications for future research and clinical applications are discussed.     

The transnational experience of sport psychology practitioners from training to practice

ObjectiveDespite a growing body of literature examining the migratory experiences of athletes, limited attention has been paid to the migratory experience of sport psychology practitioners (SPPs). This study explores SPPs’ experiences of transnational migration; specifically, for those who expatriated to receive their training and repatriated to begin their professional careers.DesignAdhering to consensual qualitative research methodology, we conducted a qualitative study using semi-structured interviews.MethodsFollowing criterion-based sampling, we interviewed six female and four male SPPs who worked in academic (n = 3), applied (n = 3), and governmental (n = 4) environments. We used an analytical procedure encompassing concurrent deductive and inductive processes.ResultsParticipants described their motivations for expatriation and repatriation. They shared the challenges and benefits they faced throughout their transnational experience, recognizing the value that this experience brought to their lives. In most cases, SPPs shared how their training abroad became a professional advantage, once repatriated. They also described how the process of repatriation was more challenging than expected due to personal and professional difficulties.ConclusionsParticipants highlighted the positive influence that their transnational experience had in their personal and professional lives. Their transnational experience helped them grow personally and professionally, and provided them with professional advantages. However, our participants’ stories also highlighted systematic barriers that professional organizations could address to facilitate the transnational experience of practitioners, which would subsequently enhance the cultural growth of the field. Recommendations for professionals engaging in similar transnational experiences are discussed.     

Psychological implications of the COVID-19 pandemic around the world: Introduction to the special issue

Although psychological researchers have long studied the implications of major crises, the outbreak and spread of the COVID-19 pandemic have confronted the global community of psychologists and psychological researchers with new challenges. This special issue contributes to the growing empirical literature on the immediate psychological implications of the COVID-19 pandemic. We present and discuss diverse work from authors that followed our call for papers in May 2020, shortly after the World Health Organisation declared COVID-19 a global pandemic. The studies focus on the early phases of the pandemic by addressing (a) implications of the pandemic for psychological well-being and mental health, (b) psychological effects of lockdown scenarios as well as (c) individual compliance with COVID-19 prevention and intervention measures. We conclude by highlighting the need for new research efforts, with a special focus on low- and middle-income regions, international research collaborations and cross-cultural research designs.     

“Love is calling”: Academic friendship and international research collaboration amid a global pandemic

In this intervention we desire to document and celebrate our own international research collaboration as an intimate long-distance relationship that sustains us amid a global pandemic of the coronavirus that causes COVID-19. We share “love letter” poems that we wrote to each other, in response to a poem by Yayoi Kusama titled “Residing in a Castle of Shed Tears,” incorporated into her mirror room installation “Love is Calling.” In our discussion we reflect upon the emotional connections that sustain academic researchers, particularly those relationships that extend beyond national boundaries and conventional heteronormative expectations.     

A Model of Intention to Participate in Parenting Interventions: The Role of Parent Cognitions and Behaviors

A wide range of factors, from perceived child behavior problems to sociocultural factors, have been identified as impacting the engagement of parents in parenting interventions. However, parents’ cognitions and behaviors have not been evaluated sufficiently to understand their role in initial parental engagement. The current study aimed to examine why some parents are more likely to want to participate in parenting programs and how their cognitions and behaviors are related to their intention to participate in future parenting interventions. We tested the hypothesised model of parental factors on intention to participate using structural equation modelling (SEM) in AMOS. This study (N = 6,733) analyzed existing data from the International Parenting Survey (IPS), a web-based tool developed to collect information about parents’ views on family and parenting at a population level in several countries. Results showed that parents’ coercive parenting, parental consistency, positive encouragement, relationship with their child, parental self-efficacy, psychological distress, and help-seeking behaviors were significantly related to their intention to participate in future parenting interventions. The structural model of parents’ cognitions and behaviors explained 16% of the variance in intention to participate. Although the current model explained a small but significant percentage of the variance, it expands existing understanding regarding parental cognitions and behaviors and their relationship to intention. Implications for further research and engagement practice are discussed.     

Adopted children's language difficulties and their relation to symptoms of reactive attachment disorder: FinAdo study

This study investigated the potential association between symptoms of reactive attachment disorder and language difficulties among internationally adopted children in Finland (the FinAdo study). The language difficulties were assessed using a standardised Five to Fifteen (FTF) parental questionnaire and the symptoms of reactive attachment disorder using a FinAdo questionnaire. The study sample consisted of 689 6–15 year old children (49.2% boys, response rate 48%). Twenty-nine percent of the children were reported to have language difficulties and 8% severe language difficulties (10% and 2%, respectively, in the general population). A child's symptoms of reactive attachment disorder were associated with language difficulties and severe language difficulties, OR 2.15, 95% CI [1.39, 3.31] and OR 4.33, 95% CI [1.57, 11.98], respectively, the associations being robust to adjustments for background factors.