Gendered Violence and International Human Rights: Thinking Non-Discrimination Beyond the Sex Binary

The concept of non-discrimination has been central in the feminist challenge to gendered violence within international human rights law. This article critically explores non-discrimination and the challenge it seeks to pose to gendered violence through the work of Judith Butler. Drawing upon Butler’s critique of heteronormative sex/gender, the article utilises an understanding of gendered violence as effected by the restrictive scripts of sex/gender within heteronormativity to illustrate how the development of non-discrimination within international human rights law renders it ineffective to challenge gendered violence due to its own commitments to binarised and asymmetrical sex/gender. However, the article also seeks to encourage a reworking of non-discrimination beyond the heteronormative sex binary through employing Butler’s concept of cultural translation. Analysis via the lens of cultural translation reveals the fluidity of non-discrimination as a universal concept and offers new possibilities for feminist engagement with universal human rights.

Thinking ‘Dignity’ as a basis towards inclusive development

In an era of increasing political disenfranchisement, deep economic inequalities and associated social humiliations encountered by the rapidly globalising planet, this paper seeks to chart the current thinking about the paths that civil society need to take in order to achieve distinctive peace. Here commitment as part of the universal cosmopolitan order is critical to go beyond the binaries of religious and cultural differences. The role of dignity, of interdependency, respect and understanding has become all the more critical to sustain hope and life in this age of austerity. The paper argues for an empowered citizenship, based on dignity and respect to think socially towards inclusive development.

Improving a regional chemotherapy service by learning from deaths occurring within 30 days of treatment with systemic anti-cancer therapy.

Background: Outwith clinical trials, patient outcomes specifically related to SACT (systemic anti-cancer therapy) are not well reported despite a significant proportion of patients receiving active treatment at the end of life. The NCEPOD reviewing deaths within 30 days of SACT found SACT caused or hastened death in 27% of cases.

Method: Across the Northern Ireland cancer network, 95 patients who died within 30 days of SACT for solid tumours were discussed at the Morbidity and Mortality monthly meeting during 2013. Using a structured template, each case was independently reviewed, with particular focus on whether SACT caused or hastened death.

Results: Lung, GI and breast cancers were the most common sites. Performance status was recorded in 92% at time of final SACT cycle (ECOG PS 0-2 89%).

In 57% the cause of death was progressive disease. Other causes included thromboembolism (13%) and infection (5% neutropenic sepsis, 6% non-neutropenic sepsis). In 26% with death from progressive disease, the patient was first cycle of first line treatment for metastatic disease. In the majority discussion regarding treatment aims and risks was documented. Only one patient was receiving SACT with curative intent, who died from appropriately managed neutropenic sepsis.

A definitive decision regarding SACT's role in death was made in 60%: in 49% SACT was deemed non-contributory and in 11% SACT was deemed the cause of death. In 40% SACT did not play a major role, but a definitive negative association could not be made.

Conclusion: Development of a robust review process of 30-day mortality after SACT established a benchmark for SACT delivery for future comparisons and identified areas for SACT service organisation improvement. Moreover it encourages individual practice reflection and highlights the importance of balancing patients' needs and concerns with realistic outcomes and risks, particularly in heavily pre-treated patients or those of poor performance status.

Global Systemic Risk and International Regulatory Coordination: Squaring Sovereignty and Financial Stability

In recent years much attention has been given to systemic risk and maintaining financial stability. Much of the focus, rightly, has been on market failures and the role of regulation in addressing them. This article looks at the role of domestic policies and government actions as sources of global instability. The global financial system is built upon global markets controlled by national financial and macroeconomic policies. In this context, regulatory asymmetries, diverging policy preferences, and government failures add a further dimension to global systemic risk not present at the national level.
Systemic risk is a result of the interplay between two independent variables: an underlying trigger event, in this analysis a domestic policy measure, and a transmission channel. The solution to systemic risk requires tackling one of these variables. In a domestic setting, the centralization of regulatory power into one single authority makes it easier to balance the delicate equilibrium between enhancing efficiency and reducing instability. However, in a global financial system in which national financial policies serve to maximize economic welfare, regulators will be confronted with difficult policy and legal tradeoffs.
We investigate the role that financial regulation plays in addressing domestic policy failures and in controlling the danger of global financial interdependence. To do so we analyse global financial interconnectedness, and explain its role in transmitting instability; we investigate the political economy dynamics at the origin of regulatory asymmetries and government failures; and we discuss the limits of regulation.

Computational Thinking across a Life Course

Symposium of papers on Computational Thinking

Comorbidity in severe asthma requiring systemic corticosteroid therapy: cross-sectional data from the Optimum Patient Care Research Database and the British Thoracic Difficult Asthma Registry

Objective: To determine the prevalence of systemic corticosteroid-induced morbidity in severe asthma.
Design: Cross-sectional observational study.Setting The primary care Optimum Patient Care Research Database and the British Thoracic Society Difficult Asthma Registry.
Participants: Optimum Patient Care Research Database (7195 subjects in three age- and gender-matched groups)—severe asthma (Global Initiative for Asthma (GINA) treatment step 5 with four or more prescriptions/year of oral corticosteroids, n=808), mild/moderate asthma (GINA treatment step 2/3, n=3975) and non-asthma controls (n=2412). 770 subjects with severe asthma from the British Thoracic Society Difficult Asthma Registry (442 receiving daily oral corticosteroids to maintain disease control).
Main outcome measures: Prevalence rates of morbidities associated with systemic steroid exposure were evaluated and reported separately for each group.
Results: 748/808 (93%) subjects with severe asthma had one or more condition linked to systemic corticosteroid exposure (mild/moderate asthma 3109/3975 (78%), non-asthma controls 1548/2412 (64%); p<0.001 for severe asthma versus non-asthma controls). Compared with mild/moderate asthma, morbidity rates for severe asthma were significantly higher for conditions associated with systemic steroid exposure (type II diabetes 10% vs 7%, OR=1.46 (95% CI 1.11 to 1.91), p<0.01; osteoporosis 16% vs 4%, OR=5.23, (95% CI 3.97 to 6.89), p<0.001; dyspeptic disorders (including gastric/duodenal ulceration) 65% vs 34%, OR=3.99, (95% CI 3.37 to 4.72), p<0.001; cataracts 9% vs 5%, OR=1.89, (95% CI 1.39 to 2.56), p<0.001). In the British Thoracic Society Difficult Asthma Registry similar prevalence rates were found, although, additionally, high rates of osteopenia (35%) and obstructive sleep apnoea (11%) were identified.

Conclusions: Oral corticosteroid-related adverse events are common in severe asthma. New treatments which reduce exposure to oral corticosteroids may reduce the prevalence of these conditions and this should be considered in cost-effectiveness analyses of these new treatments.

Wishful Thinking: Lessons from the internal and external evaluations of an innovatory education project in Northern Ireland

From March 1999 to August 2000, the authors were involved in simultaneous internal and external evaluations of the social civic and political education (SCaPE) project in Northern Ireland. This project was a major initiative established by the Citizenship Foundation, the Northern Ireland Council for the Curriculum, Examination and Assessment (CCEA), and the School of Education at the University of Ulster at Coleraine. It was a 2-year project in 25 secondary schools established to design, develop, pilot and evaluate a new programme of social, civic and political education for Northern Ireland. It also aimed to serve as a model for future Citizenship curriculum developments throughout Northern Ireland and elsewhere. This paper describes the background to the project, the design and conduct of the two evaluations, and the links between them. It outlines the main conclusions of each evaluation and describes the way SCaPE has since evolved into a mainstream curriculum development project. The final part of the paper analyses the key opportunities, tensions and challenges involved in running such evaluations at a critical time in the history of Northern Ireland – a time when innovation is both necessary and controversial. It argues that, especially in such circumstances, evaluation cannot be conducted from a neutral, objective standpoint, and that it is incumbent on evaluators to recognise the emotional, personal and political commitment they make to the projects in which they are engaged.

Fluid strategies and outcomes in patients with acute respiratory distress syndrome, systemic inflammatory response syndrome and sepsis: a protocol for a systematic review and meta-analysis

Background
Fluid administration to critically ill patients remains the subject of considerable controversy. While intravenous fluid given for resuscitation may be life-saving, a positive fluid balance over time is associated with worse outcomes in critical illness. The aim of this systematic review is to summarise the existing evidence regarding the relationship between fluid administration or balance and clinically important patient outcomes in critical illness.

Methods
We will search Medline, EMBASE, the Cochrane Central Register of Controlled Trials from 1980 to the present and key conference proceedings from 2009 to the present. We will include studies of critically ill adults and children with acute respiratory distress syndrome (ARDS), sepsis and systemic inflammatory response syndrome (SIRS). We will include randomised controlled trials comparing two or more fluid regimens of different volumes of fluid and observational studies reporting the relationship between volume of fluid administered or fluid balance and outcomes including mortality, lengths of intensive care unit and hospital stay and organ dysfunction. Two independent reviewers will assess articles for eligibility, data extraction and quality appraisal. We will conduct a narrative and/or meta-analysis as appropriate.

Discussion
While fluid management has been extensively studied and discussed in the critical care literature, no systematic review has attempted to summarise the evidence for post-resuscitation fluid strategies in critical illness. Results of the proposed systematic review will inform practice and the design of future clinical trials.

Systematic review registration
PROSPERO CRD42013005608. (http://​www.​crd.​york.​ac.​uk/​PROSPERO/​)

Marcas portuguesas: uma metodologia para a afirmação e avaliação dos seus impactos

O processo de criação de marcas – branding – decorre da intervenção de um diversificado número de especialistas de áreas científicas distintas como são: a da comunicação, da publicidade, do marketing e das relações públicas. O designer, apesar de ser um dos mais significantes actores no processo de construção da marca é, geralmente, relegado para o plano de fazedor das coisas esteticamente úteis. As razões deste facto podem ser encontradas neste estereótipo que constrange o entendimento sobre a vocação do designer, desvalorizando- se o seu papel de conceptualizador e não respeitando os seus argumentos. A flexibilidade do seu pensar analítico, criativo e sistémico associado à acção direccionada para a mudança leva à consideração de que o Designer é um agente multifacetado e, numa equipa, é um membro agregador de diversas sensibilidades. A síntese que opera através do desenho permite ao designer colocar-se numa posição de dinamização e, porventura, de liderança de carácter identitário. Tendo em conta o exposto o designer necessita de metodologias de apoio ao seu desempenho que lhe permitam realizar o trabalho para o qual está vocacionado. Enquadrado pela lógica sistémica da comunicação institucional, essas metodologias potenciam a observação, análise e avaliação da marca, uma vez que está focalizada na recolha das orientações dos destinatários da marca – cidadãos e consumidores. Conhecer como percepcionam a marca, qual a relação que mantêm com ela e como reagem à forma como a marca comunica é o desafio da metodologia criada. Deste modo, o designer poderá contribuir para a desconstrução dos estereótipos referidos, reforçar a sua posição no mercado de trabalho e afirmar a sua diferença face aos especialistas das áreas complementares com quem intervém. A tese que se apresenta tem por finalidade elaborar uma metodologia para a afirmação e avaliação dos impactos da marca, no sentido de conhecer as orientações de quem melhor sabe lidar com a marca - o público-alvo. E, integrar toda a informação no processo decisão que o designer protagoniza.

A educação para o desenvolvimento sustentável na formação de professores: a Web 2.0 e as interações numa comunidade de prática online

A Educação para o Desenvolvimento Sustentável (EDS) é o cerne de um paradigma emergente na educação do século XXI. A EDS constitui-se um processo de aprendizagem holístico e sistémico e tem como função ensinar a viver de maneira sustentável. Apresenta-se como uma abordagem pedagógica inovadora, que combina aprendizagens ativas e participativas, suportadas por uma multiplicidade de estratégias didático-pedagógicas. Objetiva a promoção da capacidade de pensamento crítico, da resolução de problemas e da tomada de decisão, baseada em valores, por parte dos alunos. Para a implementação da EDS é fundamental que os professores tenham consciência de que lidar com as questões da sustentabilidade, na sala de aula, implica dotarem-se de competências específicas. É, portanto, necessário investir na formação de educadores e formadores; o que compreende o seu desenvolvimento profissional, focado no aperfeiçoamento das suas competências, de modo a potenciar novos processos na aprendizagem coerentes com os princípios da EDS. Neste contexto, no presente estudo, foi criada uma Oficina de Formação para professores do ensino básico, na modalidade b-learning, visando a criação de um espaço de formação que permitisse a integração das TIC/Web 2.0 na prática docente, mais concretamente no apoio à inclusão da EDS no currículo. Partindo do pressuposto que as TIC/Web 2.0 são ferramentas que nos oferecem novas oportunidades, pela sua versatilidade de disseminação do conhecimento, e que permitem reorientar o ensino e a aprendizagem sustentados na teoria sócio-construtivista, promovendo o trabalho colaborativo, criou-se uma Comunidade de Prática online. Recorreu-se, para o efeito, a uma plataforma de alojamento de redes sociais virtuais, o Grouply; visando o estabelecimento de interações entre os professores, a partilha de experiências, recursos e conhecimento, indutores da (re)configuração de práticas ao nível da integração das ferramentas da Web 2.0 no contexto da EDS e, ainda, objetivando promover a atualização, o aperfeiçoamento e a aquisição de novas competências pedagógicas contribuindo para o seu desenvolvimento profissional e social. Metodologicamente o presente estudo assumiu uma natureza qualitativa, segundo um design de investigação-ação, o que implicou um plano de ação realizado numa espiral de três ciclos de investigação-ação: recurso a diferentes técnicas e instrumentos de recolha de dados, particularmente o inquérito por questionário e entrevista, realizados aos professores que frequentaram a oficina de formação; observação com base no diário da Investigadora com os registos de observação das sessões de grupo, reflexões da Investigadora/Formadora e das sessões de acompanhamento individual (Supervisão pedagógica), realizadas ao longo da referida oficina; análise documental dos e-portefolios com registos das reflexões individuais de cada uma das sessões da oficina, as reflexões finais dos professores e o registo dos post´s no fórum de discussão, blogs e Whiteboard da Comunidade de Prática online. Decorrente da análise e discussão dos resultados obtidos, o trabalho realizado sugere que os professores adquiriram/desenvolveram competências em EDS e digitais, tendo-se verificado que a oficina de formação contribui para algumas mudanças nas práticas dos professores.