Accumulating research: a systematic account of how cumulative meta-analyses would have provided knowledge, improved health, reduced harm and saved resources

BACKGROUND: "Cumulative meta-analysis" describes a statistical procedure to calculate, retrospectively, summary estimates from the results of similar trials every time the results of a further trial in the series had become available. In the early 1990 s, comparisons of cumulative meta-analyses of treatments for myocardial infarction with advice promulgated through medical textbooks showed that research had continued long after robust estimates of treatment effects had accumulated, and that medical textbooks had overlooked strong, existing evidence from trials. Cumulative meta-analyses have subsequently been used to assess what could have been known had new studies been informed by systematic reviews of relevant existing evidence and how waste might have been reduced.

METHODS AND FINDINGS: We used a systematic approach to identify and summarise the findings of cumulative meta-analyses of studies of the effects of clinical interventions, published from 1992 to 2012. Searches were done of PubMed, MEDLINE, EMBASE, the Cochrane Methodology Register and Science Citation Index. A total of 50 eligible reports were identified, including more than 1,500 cumulative meta-analyses. A variety of themes are illustrated with specific examples. The studies showed that initially positive results became null or negative in meta-analyses as more trials were done; that early null or negative results were over-turned; that stable results (beneficial, harmful and neutral) would have been seen had a meta-analysis been done before the new trial; and that additional trials had been much too small to resolve the remaining uncertainties.

CONCLUSIONS: This large, unique collection of cumulative meta-analyses highlights how a review of the existing evidence might have helped researchers, practitioners, patients and funders make more informed decisions and choices about new trials over decades of research. This would have led to earlier uptake of effective interventions in practice, less exposure of trial participants to less effective treatments, and reduced waste resulting from unjustified research.

Changing the narrative – Life span perspectives on multiple adversity

Although the impact of multiple adverse events in childhood is well known, it is equally accepted that the variation in individual trajectories and outcomes is significant. Resilience focuses on positive adaption in the face of adversity, offering a counterbalance to deficit-based research and risk averse, procedurally driven practice. Positive relationships and secure attachments are widely considered to be the cornerstone of resilience, yet, within social work practice, there is a tendency to consider attachment only in relation to children and adults. Three biographical narratives are used to explore resilience and attachment through a narrative identity framework, exploring parents' experiences of multiple adversities over their lifespan, their close relationships, and their experiences of child welfare interventions. It argues for the importance of narrative in social work assessment, particularly in relation to families with complex needs, illustrating how this enables a richer, more nuanced understanding of mothers and fathers as individuals in their own right, and provides insight into how alternative narratives might be better supported and developed.

Movement of Capital and Trade in Services:Distinguishing Myth from Reality Regarding the GATS and the Liberalization of the Capital Account

This article will analyze the interplay between capital movements and trade
in services as structured in World Trade Organization (WTO) law, and it will
assess the implications of the capital account liberalization for the freedom of
WTO Members to pursue their economic policies. Although the movement
of capital is largely confined to the domain of international financial or monetary
policy, it is regulated by WTO law due to its role in the process of
financial services liberalization, which generally requires liberalized capital
flows. From a legal perspective, the interplay between capital movements
and trade in services requires striking a delicate balance between the right
of market access and the parallel right of economic stability. Indeed, a liberalized
regime for capital movements could pose serious stability problems
during times of crisis. For this reason, it is necessary that Members are able
to derogate from their obligations and adopt emergency measures.
Regulating the movement of capital in the General Agreement on Trade in
Services (GATS) requires stretching the regulatory oversight of WTO law
over different aspects of international economic policy. Indeed, capital movements are a fundamental component of the balance of payments and have a
major role in shaping monetary, fiscal, and financial policies. This article will
analyze how the discipline provided by the GATS on capital movements will
affect not only trade in services, but also the Members’ policy space on
monetary and fiscal policy. The article will conclude that while the GATS offers enough policy space for the maintenance of financial stability, it does
not fully take into consideration the need of Members to control capital
movements in order to conduct monetary policies.

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: An evidence synthesis

DESIGN We will address our research objectives by searching the published and unpublished literature and conducting an evidence synthesis of i) studies of the effectiveness of psychosocial interventions provided for children and adolescents who have suffered maltreatment, ii) economic evaluations of these interventions and iii) studies of their acceptability to children, adolescents and their carers. SEARCH STRATEGY: Evidence will be identified via electronic databases for health and allied health literature, social sciences and social welfare, education and other evidence based depositories, and economic databases. We will identify material generated by user-led,voluntary sector enquiry by searching the internet and browsing the websites of relevant UK government departments and charities. Additionally, studies will be identified via the bibliographies of retrieved articles/reviews; targeted author searches; forward citation searching. We will also use our extensive professional networks, and our planned consultations with key stakeholders and our study steering committee. Databases will be searched from inception to time of search. REVIEW STRATEGY Inclusion criteria: 1) Infants, children or adolescents who have experienced maltreatment between the ages of 0 17 years. 2) All psychosocial interventions available for maltreated children and adolescents, by any provider and in any setting, aiming to address the sequelae of any form of maltreatment, including fabricated illness. 3) For synthesis of evidence of effectiveness: all controlled studies in which psychosocial interventions are compared with no-treatment, treatment as usual, waitlist or other-treated controls. For a synthesis of evidence of acceptability we will include any design that asks participants for their views or provides data on non-participation. For decision-analytic modelling we may include uncontrolled studies. Primary and secondary outcomes will be confirmed in consultation with stakeholders. Provisional primary outcomes are psychological distress/mental health (particularly PTSD, depression and anxiety, self-harm); ii) behaviour; iii) social functioning; iv) cognitive / academic attainment, v) quality of life, and vi) costs. After studies that meet the inclusion criteria have been identified (independently by two reviewers), data will be extracted and risk of bias (RoB) assessed (independently by two reviewers) using the Cochrane Collaboration RoB Tool (effectiveness), quality hierarchies of data sources for economic analyses (cost-effectiveness) and the CASP tool for qualitative research (acceptability). Where interventions are similar and appropriate data are available (or can be obtained) evidence synthesis will be performed to pool the results. Where possible, we will explore the extent to which age, maltreatment history (including whether intra- or extra-familial), time since maltreatment, care setting (family / out-of-home care including foster care/residential), care history, and characteristics of intervention (type, setting, provider, duration) moderate the effects of psychosocial interventions. A synthesis of acceptability data will be undertaken, using a narrative approach to synthesis. A decision-analytic model will be constructed to compare the expected cost-effectiveness of the different types of intervention identified in the systematic review. We will also conduct a Value of information analysis if the data permit. EXPECTED OUTPUTS: A synthesis of the effectiveness and cost effectiveness of psychosocial interventions for maltreated children (taking into account age, maltreatment profile and setting) and their acceptability to key stakeholders.

A.·. 418: um método de sistematização da concepção musical interpretativa

Este trabalho consiste numa proposta metodológica, denominada A∴418, que visa abordar a actividade especulativa dos performers no que diz respeito às suas concepções interpretativas dos discursos musicais. Foram identificados dois factores inerentes a esta actividade – as concepções expressiva e técnica – como estando na base da configuração final deste processo. O A∴418 resulta de um processo de aplicação de técnicas de análise musical vocacionadas para o estudo da interpretação musical, são elas a Análise da Intenção Musical Interpretativa (direccionada para a concepção expressiva da narrativa sonora) e a Análise Técnica da Intenção Musical Interpretativa (direccionada para a concepção técnico-instrumental do discurso musical). A sistematização deste processo metodológico conduz à produção de uma partitura final, revista pelo músico-instrumentista, na qual acrescem ao discurso original do compositor indicações que reflectem a concepção técnicoexpressiva produzida pelo performer que interpreta a obra musical. Esta metodologia foi demonstrada através da sua aplicação à concepção musical interpretativa do Concerto para Violoncelo em La menor, RV 418, de Antonio Vivaldi, tendo em conta as demandas específicas deste instrumento musical e a leitura idiossincrática que o autor fez desta obra musical em concreto.

A educação intercultural na formação contínua de professores de línguas

Situado entre o discurso investigativo e o profissional da Didática de Línguas, o presente estudo assenta: num entendimento da educação em línguas como um processo valorizador da diversidade linguística e cultural, tendo como fim último a promoção da intercompreensão e do diálogo intercultural, dentro dos pressupostos de uma didática das línguas e do plurilinguismo; na conceção do professor de línguas como um dos principais atores na educação de cidadãos / comunicadores interculturais, vendo-se, portanto, a braços com novas exigências, para as quais, muitas vezes, não se sente preparado; e nos pressupostos de que a identidade profissional condiciona fortemente a forma como o professor desempenha a sua ação didática, sendo este processo de se tornar professor contínuo e dependente, quer do sujeito-professor e dos seus percursos profissionais e formativos, quer do contexto (profissional, local, nacional, global) em que este se insere. Pretende-se, com este estudo, contribuir para que a educação intercultural seja uma realidade nas nossas escolas, potenciando a sua migração contextualizada dos documentos orientadores das políticas linguísticas e educativas nacionais e transnacionais e dos discursos da investigação em Didática de Línguas. Para o efeito, desenvolvemos um programa de investigação/formação denominado O Professor Intercultural, durante o ano letivo 2006/2007, com professores de línguas (materna e estrangeiras) de três escolas básicas e secundárias do distrito de Aveiro. Este programa integrava um curso (25 horas) e uma oficina (50 horas), ambas as ações de formação acreditadas pelo Conselho Científico-Pedagógico da Formação Contínua. Do ponto de vista formativo, com este programa pretendíamos levar as professoras em formação a desenvolver competências pessoais e profissionais que lhes permitissem gerir a diversidade nos seus contextos profissionais, tendo em vista o desenvolvimento nos seus alunos de uma competência de comunicação intercultural (CCI). Do ponto de vista investigativo, não só pretendíamos compreender as representações dos sujeitos relativamente à educação intercultural em geral e à CCI em particular; como também identificar princípios e estratégias de formação potenciadores do desenvolvimento de competências profissionais docentes para trabalhar a CCI, a partir das perspetivas dos próprios sujeitos. Trata-se, portanto, de um estudo de caso de cariz qualitativo e interpretativo / fenomenológico, com potencialidades heurísticas, que pretende evidenciar os sujeitos, as suas representações, as interações consigo e com os outros e a forma como conceptualizam a identidade profissional docente e as suas dinâmicas de desenvolvimento. Como instrumentos de recolha de dados, privilegiámos os Portefólios Profissionais que foram sendo construídos ao longo do percurso de formação; a sessão “Entre Línguas e Culturas” da plataforma Galanet (www.galanet.eu), recurso de formação no âmbito da oficina (entre fevereiro e maio de 2007); o “Diário do Investigador”; e as “entrevistas narrativas e de confrontação” efetuadas sensivelmente um ano após o final do programa de investigação/formação. Os resultados da análise de conteúdo revelam que os sujeitos consideram a CCI uma competência multidimensional e complexa, reconhecendo três componentes: afetiva (domínio do saber ser e saber viver com o outro), cognitiva (domínio do saber) e praxeológica (domínio do saber-fazer). A componente afetiva constitui, de acordo com os resultados, o motor de arranque do desenvolvimento desta competência, que, posteriormente, é alargada em dinâmicas de informação-(inter)ação-reflexão. Por outro lado, dada a grande pertinência que atribuem à abordagem intercultural e à urgência com que veem a sua integração escolar, os sujeitos consideram a CCI uma das competências inerentes à competência profissional docente, elemento integrador da identidade profissional, numa forte ligação com a missão ética e política que cada vez mais é associada ao docente (de línguas). Para além disso, percecionam o seu desenvolvimento profissional docente como um processo que os acompanha ao longo da vida, fruto das idiossincrasias e predisposições do próprio indivíduo, mas também das dinâmicas da sua formação, das caraterísticas dos contextos em que se movimenta e da colaboração com o Outro, no seu espaço profissional ou fora dele. Importa salientar que este desenvolvimento profissional é potenciado, segundo os nossos resultados, por propostas de formação assentes numa abordagem acional e reflexiva, articulando dinâmicas investigação-ação-reflexão como as propostas no nosso programa de formação, nomeadamente no âmbito da oficina. Neste quadro, concluímos o presente estudo, indicando alguns caminhos possíveis para a formação de professores de línguas para a educação intercultural.

Narrative change in psychotherapy

This thesis focuses on the processes of narrative change in psychotherapy. Previous reviews of the processes of narrative change in psychotherapy concluded that a general theory that details narrative concepts appropriate to understand psychotherapy processes, explains the dynamic processes between narratives, and how they relate to positive outcomes is needed. This thesis addresses this issue by suggesting a multi-layered model that accounts for transformations in different layers of narrative organization. Accordingly, a model was specified that considers three layers of narrative organization: a micro-layer of narrative innovations that disrupt the clients’ usual way of construct meaning from life situations (innovative moments), a meso-layer of narrative scripts that integrate these narrative innovations in narrative scripts that consolidate its transformative potential (protonarratives), and, finally, a macro-layer of clients’ life story (self-narrative). Globally, the empirical studies provided support for the conceptual plausibility of this model and to the specific hypothesis that were formulated on its basis. Our observations complement previous research that had underlined the integrative processes either by emphasizing thematic coherence or integration, by emphasizing the role of dynamicity and differentiation of narrative contents and processes. Additionally, they also contribute to expand previous accounts of narrative innovation through insights on the processes that characterize narrative innovation development across psychotherapy. These studies also emphasize the role of quantitative procedures in the study of narrative processes of change as they allow us to accommodate the complexity and dynamic properties of narrative processes.

Narrative Personae and Visual Signs: Reading Leonard’s intimate photo-memoir. a/b: Auto/Biography Studies.

: In this paper, I look at Joanne Leonard’s Being in Pictures and engage in a critical dialogue with an assemblage of visual and textual narratives that comprise her intimate photo memoir. In doing this I draw on Hannah Arendt’s take on narratives as tangible traces of uniqueness and plurality, political traits par excellence in the cultural histories of the human condition. Being aware of my role as a reader/viewer/interpreter of a woman artist’s auto/biographical narratives, I move beyond dilemmas of representation or questions of unveiling “the real Leonard”. The artist is instead configured as a narrative persona, whose narratives respond to three interrelated themes of inquiry, namely the visualization of spatial technologies, vulnerability and the gendering of memory. Key words: gendered memories, narrative persona, spatial technologies, photo memoir, vulnerability

Développement d’un cosmopolitisme: L’expérience des étudiants participant à un programme de mobilité de l’Université Laval

Cette thèse s’intéresse à la manière dont des étudiants de l’Université Laval, à Québec, engagés dans différents programmes de mobilité pendant leur formation, donnent un sens à leur expérience et, ainsi, permettent pour une majorité d’entre eux l’émergence d’un cosmopolitisme. J’explore ces expériences de mobilité en plaçant l’étudiant au centre de ma réflexion. Ceci m’amène à analyser le sens profond de leur récit, dans le contexte de l’éducation supérieure et des enjeux de l’éducation au XXIe siècle. Mon analyse débouche sur trois parcours types d’étudiants, qui peuvent servir de guide pour faire émerger une pratique cosmopolite. À la suite d’une enquête ethnologique, j’ai analysé les données découlant de plus de 80 entrevues menées auprès de 53 étudiants inscrits dans une quarantaine de programmes d’études des trois cycles universitaires et ayant participé à l’un des dix programmes de mobilité offerts par le Bureau international. Un groupe de discussion a permis de compléter ces données et de valider un premier examen des diverses politiques en internationalisation de la formation (UNESCO, BCEI, MELS, UL) qui m’ont aidée à comprendre et à problématiser les données de la mobilité étudiante. Mon analyse s’appuie sur deux champs théoriques : d’une part, elle interpelle la théorie de la structuration d’Anthony Giddens (1987) et s’intéresse aux motivations, aux positionnements et à la capacité réflexive qui débouchent sur les interprétations qui structurent les pratiques liées à ces séjours. D’autre part, elle s’ancre dans une conceptualisation du cosmopolitisme proposée par Ulf Hannerz (2010). J’ai ainsi adopté une approche contemporaine du phénomène dans le cadre des études supérieures et construit les trois parcours types basés sur une approche anthropologique de la réflexivité de l’acteur en situation, en tenant compte de la complexité des expériences et des cheminements vécus lors d’une pratique de mobilité. Cette étude s’inscrit dans une anthropologie du chez-soi, et explore ainsi de nouveaux sentiers de recherche à considérer pour mieux saisir la construction du cosmopolitisme contemporain.