Winning spaces : participatory methodologies in rural processes in Mexico

This study examines the development and impact of participatory methodologies (PMs) in Mexico, and forms part of the wider research programme Pathways to Participation. The material for this paper was gathered from interviews and workshops with practitioners of PMs across Mexico, and includes three case studies drawn from contrasting initiatives promoted by organisations as disparate as research institutes, state and federal government, and the World Bank. Mexico has a strong and distinctive participatory tradition stretching back to the 1960s, when currents of thought such as liberation theology and Freireian concientización, predating the arrival of Participatory Rural Appraisal (PRA) in the region, were influential in the development of endogenous PMs. The Mexican version of PRA and other PMs are thus different to those which have been introduced from Anglo Saxon cultures: in Mexican versions, there is greater emphasis on increasing the capacity for critical analysis and personal and social consciousness. These differences are found to contribute to the flexibility and adaptability of PMs and their potential to generate social action and transformation. Generally, PMs and particularly PRA are found to have theoretical and methodological weaknesses in the Mexican context, in relation to knowledge and respect for rural reality and practices, and recognition of opportunities for its transformation. The study suggests a need to adapt these methods to the political context of conflict and socio-cultural diversity, and to address the challenge of developing an ethical code for implementing participatory processes, and of how to scale up and deepen the achievements of each intervention in the countryside. PRA has been adopted and modified by many practitioners to suit the local context, but the challenge of this modified PRA continues to be finding a balance between respect for the practice, knowledge and institutions of a community, and the use of educational methods that question and challenge injustices in the established order

Human rights from the Great Depression to the Great Recession: the United States, economic liberalism and the shaping of economic and social rights in international law

This thesis takes a ‘law in context’ and ‘history of ideas’ approach to examining the emergence, elaboration and evolution of ‘economic and social rights’ as human rights, including how and why they came to be included in the international human rights regime. The central thesis is that economic and social rights have been fundamentally shaped by the economic context and economic theories of the times in which they emerged and were elaborated. I have argued these rights emerged, and were elaborated, in times of economic crises, as part of a (liberal) challenge to liberal legal and economic orthodoxies. This thesis suggests that one important strand of the history of human rights lies in struggles within ‘western’ liberalism over rights, freedom and the role of the state in the economy. Challenging other histories of human rights, the first part of this thesis shows how the phrase ‘human rights’ emerged as part of a challenge to ‘property rights’ and laissez-faire constitutionalism in the United States during the Great Depression, shaped by the theories of the legal realists, institutional economists and later by economic Keynesianism. The second part, drawing on newly discovered archival material, charts an untold story of how these US conceptions profoundly influenced the nature and scope of ‘economic and social rights’ during the drafting of the 1948 Universal Declaration of Human Rights (UDHR) and the 1966 International Covenant on Economic, Social and Cultural Rights (ICESCR). The third part shows how economic and social rights were later elaborated by the UN Committee on ESCR, again in the context of economic crisis and again as a challenge to economic (neo)liberalism, this time shaped by heterodox economist, Amartya Sen. However, some of the key theoretical insights that shaped these rights during the Great Depression have been lost, in ways that circumscribe their power to challenge economic (neo)liberalism and the ‘constitutionalisation’ of austerity in our own Great Recession

Basic science232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function

Background: Cardiovascular disease is a major comorbidity of rheumatoid arthritis (RA) and a leading cause of death. Chronic systemic inflammation involving tumour necrosis factor alpha (TNF) could contribute to endothelial activation and atherogenesis. A number of anti-TNF therapies are in current use for the treatment of RA, including certolizumab pegol (CZP), (Cimzia ®; UCB, Belgium). Anti-TNF therapy has been associated with reduced clinical cardiovascular disease risk and ameliorated vascular function in RA patients. However, the specific effects of TNF inhibitors on endothelial cell function are largely unknown. Our aim was to investigate the mechanisms underpinning CZP effects on TNF-activated human endothelial cells. Methods: Human aortic endothelial cells (HAoECs) were cultured in vitro and exposed to a) TNF alone, b) TNF plus CZP, or c) neither agent. Microarray analysis was used to examine the transcriptional profile of cells treated for 6 hrs and quantitative polymerase chain reaction (qPCR) analysed gene expression at 1, 3, 6 and 24 hrs. NF-κB localization and IκB degradation were investigated using immunocytochemistry, high content analysis and western blotting. Flow cytometry was conducted to detect microparticle release from HAoECs. Results: Transcriptional profiling revealed that while TNF alone had strong effects on endothelial gene expression, TNF and CZP in combination produced a global gene expression pattern similar to untreated control. The two most highly up-regulated genes in response to TNF treatment were adhesion molecules E-selectin and VCAM-1 (q 0.2 compared to control; p > 0.05 compared to TNF alone). The NF-κB pathway was confirmed as a downstream target of TNF-induced HAoEC activation, via nuclear translocation of NF-κB and degradation of IκB, effects which were abolished by treatment with CZP. In addition, flow cytometry detected an increased production of endothelial microparticles in TNF-activated HAoECs, which was prevented by treatment with CZP. Conclusions: We have found at a cellular level that a clinically available TNF inhibitor, CZP reduces the expression of adhesion molecule expression, and prevents TNF-induced activation of the NF-κB pathway. Furthermore, CZP prevents the production of microparticles by activated endothelial cells. This could be central to the prevention of inflammatory environments underlying these conditions and measurement of microparticles has potential as a novel prognostic marker for future cardiovascular events in this patient group. Disclosure statement: Y.A. received a research grant from UCB. I.B. received a research grant from UCB. S.H. received a research grant from UCB. All other authors have declared no conflicts of interes

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

Exploring understandings of institutions and uncertainty: new directions in natural resource management

The paper outlines three different forms of uncertainty: ecological, livelihood and knowledge uncertainty. By reviewing a large literature, the paper demonstrates how conventional understandings of institutions neglect the everyday contexts within which institutions are located and the overlapping domains between different institutional arrangements. By drawing on a wide range of theoretical approaches to understanding institutions and by exploring case studies around water, pastoralism and biotechnology, the paper argues that a sophisticated understanding of the relationship between institutions and uncertainty calls for a radical re-thinking of conventional ways of viewing resources, legal systems and, property regimes. This calls for new forms of governance, inclusionary decision-making arenas, the addressing of questions of power and the overhauling of sharp dichotomies between local and the global as well as formal and informal processes

Winning spaces Participatory methodologies in rural processes in Mexico

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