Consensus and Diversity in the World Trade Organization: A Queer Perspective

When the World Trade Organization (WTO) was established in 1995, it was seen as representative of a new era in international law, which claimed to be more functional and cooperative than the Cold War years. Fast forward to 2022, most commentators proclaim that the WTO is in “crisis.” For over two decades, its membership has struggled to reach decisions and, in 2019, the WTO was “dejudicialized” by the United States blocking consensus on appointments to the Appellate Body. In seeking to understand what went wrong, some commentators have focused on the operation of the WTO's consensus procedure and, in particular, the way it can afford states a veto power. In this essay, I take a different approach by considering how the discursive effects of consensus decision making have played into some of the problems facing the WTO today. Inspired by Gibson-Graham's work on “queering the economy,” I do so by unmooring queer theory from its base of gender and sexuality and applying queer insights to a discourse analysis of statements made in relation to the Uruguay Round of multilateral trade negotiations, which lasted from 1986 until 1993 and culminated in the agreement to establish the WTO. I show how the use of consensus decision making served to cultivate an intolerance of economic difference by giving rise to discourses of worldwide sameness and agreement. Finally, I consider what a queerer approach to trade-related decision making might look like.

Sustainable Neonatal CLABSI Surveillance: Consensus Toward New Criteria in the Netherlands

Group Name: Working Group on Neonatal Infectious Diseases of the Section of Neonatology of the Dutch Paediatric SocietyBackground: Central-line–associated bloodstream infections (CLABSIs) are a main focus of infection prevention and control initiatives in neonatal care. Standardized surveillance of neonatal CLABSI enables intra- and interfacility comparisons, which can contribute to quality improvement. To date, there is no national registration system for CLABSI in neonatal care in the Netherlands. Across neonatal intensive care units (NICUs), several different sets of CLABSI criteria and surveillance methods are used for local monitoring of CLABSI incidence rates. To achieve standardized CLABSI surveillance, we conducted a consensus procedure with regard to nationwide neonatal CLABSI surveillance criteria. Method: A modified Delphi consensus procedure for the development of nationwide neonatal CLABSI surveillance criteria was performed between January 2016 and January 2017 in the Netherlands. An expert panel was formed by members of the Working Group on Neonatal Infectious Diseases of the Section of Neonatology of the Dutch Paediatric Society. The consensus procedure consisted of 3 expert panel rounds. Figure 1 shows a detailed description of the consensus procedure. Result: The expert panel achieved consensus on Dutch neonatal CLABSI surveillance criteria, which are summarized in Figure 2. Neonatal CLABSI is defined as a bloodstream infection occurring >72 hours after birth, associated with an indwelling central venous or arterial line and laboratory confirmed by 1 or more blood cultures. In addition, the blood culture finding should not be related to an infection at another site and one of the following criteria can be applied: (1) a bacterial or fungal pathogen is identified from 1 or more blood cultures; (2) the patient has clinical symptoms of sepsis and (2A) a common commensal is identified in 2 separate blood cultures or (2B) a common commensal is identified by 1 blood culture and C-reactive protein (CRP) level is >10 mg/L in the first 36 hours following blood culture collection. Conclusion: The newly developed Dutch neonatal CLABSI surveillance criteria are concise, are specific to the neonatal population, and comply with a single blood-culture policy in actual neonatal clinical practice. International agreement upon neonatal CLABSI surveillance criteria is needed to identify best practices for infection prevention and control.Funding: NoDisclosures: None

How to Amend UNCLOS and Why It Has Never Been Done

The United Nations Convention on the Law of the Sea (UNCLOS) contains detailed provisions concerning its amendment, but these have never been used and this article explores why this is so. States have instead maintained the Convention as a “living instrument” by adopting updated rules in other organisations, especially the International Maritime Organisation and the International Labour Organisation. States have also used the consensus procedure at Meetings of the States Parties to modify procedural provisions in UNCLOS, and have adopted two Implementation Agreements relating to UNCLOS. In addition, port State jurisdiction has developed considerably since the adoption of UNCLOS, and of course other international organisations have been active in related fields.

Selecting a Contextualized Set of Urban Quality of Life Indicators: Results of a Delphi Consensus Procedure

Although indicators are commonly used to measure/assess urban quality of life (QOL), there is no consensus in the literature on the core indicators of urban QOL. This paper aims to identify a set of key indicators that will be used to assess/measure urban QOL in the Saudi Arabia (SA) context. For this purpose, a three-round online Delphi procedure is used. A group of 92 local experts were asked to rate the importance of a set of pre-defined indicators in assessing/measuring urban QOL. The results reveal that the panel of experts reached consensus and agreed on the high importance of 53 indicators for assessing/measuring urban QOL. These indicators provide appropriate coverage of the three core dimensions of urban QOL: environmental, social and economic. However, the results also show that the social indicators are perceived as more essential than economic and environmental indicators. This finding has practical implications for designing and developing QOL assessment tools to better capture and measure urban QOL in the SA context. Furthermore, research findings also identified some methodological limitations associated with using the Delphi approach, which need to be addressed to ensure the development of comprehensive QOL assessment tools.

Consensus decision-making and democratic discourse in the General Agreement on Tariffs and Trade 1947 and World Trade Organisation

This paper provides a genealogy of consensus decision-making and democratic discourse in the multilateral trade regime. It argues that the contemporary link between the World Trade Organisation’s consensus procedure and ideas of ‘international democracy’ has its roots in a struggle that took place over the international economic order in the 1960s and 1970s.

Sustainable neonatal CLABSI surveillance: consensus towards new criteria in the Netherlands

Background Central line-associated bloodstream infections (CLABSI) are a main focus of infection prevention and control initiatives in neonatal care. Standardised surveillance of neonatal CLABSI enables intra- and interfacility comparisons which can contribute to quality improvement. To date, there is no national registration system for CLABSI in neonatal care in the Netherlands and several criteria are used for local monitoring of CLABSI incidence rates. To achieve standardised CLABSI surveillance we conducted a consensus procedure with regard to nationwide neonatal CLABSI surveillance criteria (SC). Methods A modified Delphi consensus procedure for the development of nationwide neonatal CLABSI SC was performed between January 2016 and January 2017 in the Netherlands. An expert panel was formed by members of the Working Group on Neonatal Infectious Diseases of the Section of Neonatology of the Dutch Paediatric Society. The consensus procedure consisted of three expert panel rounds. Results The expert panel achieved consensus on Dutch neonatal CLABSI SC. Neonatal CLABSI is defined as a bloodstream infection occurring more than 72 h after birth, associated with an indwelling central venous or arterial line and laboratory confirmed by one or more blood cultures. In addition, the blood culture finding should not be related to an infection at another site and one of the following criteria can be applied: 1. a bacterial or fungal pathogen is identified from one or more blood cultures; 2. the patient has clinical symptoms of sepsis and 2A) a common commensal is identified in two separate blood cultures or 2B) a common commensal is identified by one blood culture and C-reactive protein level is above 10 mg/L in the first 36 h following blood culture collection. Conclusions The newly developed Dutch neonatal CLABSI SC are concise, specified to the neonatal population and comply with a single blood culture policy in actual neonatal clinical practice. International agreement upon neonatal CLABSI SC is needed to identify best practices for infection prevention and control.

Towards development of guidelines for virtual administration of paediatric standardized language and literacy assessments: Considerations for clinicians and researchers

Objectives: Previous virtual care literature within the field of speech-language pathology has primarily focused on validating the virtual use of intervention programmes. There are fewer articles addressing the validity of conducting virtual assessments, particularly standardized assessment of oral language and literacy abilities in children. In addition, there is a lack of practical, useful recommendations available to support clinicians and researchers on how to conduct these assessment measures virtually. Given the recent rapid rise in virtual care and research as a result of the Coronavirus-19 pandemic, clinicians and researchers require guidance on best practices for virtual administration of these tools imminently. This article seeks to fill this gap in the literature by providing such recommendations. Methods: We (a) completed a narrative review of the extant literature, and (b) conducted semi-structured interviews with a group of 12 clinicians, students and researchers who had administered standardized language and literacy assessments with a variety of monolingual and multilingual school-aged children, with and without speech and language difficulties, in clinical and research settings. Six themes: candidacy for virtual assessment, communication and collaboration with caregivers, technology and equipment, virtual administration, ethics, consent and confidentiality, and considerations for bilingual populations were identified as a result of these two processes and were used to develop a set of recommendations to guide the use of standardized assessments in a virtual setting. In line with the Guidelines International Network, these recommendations were rated by group members, and reviewed by external stakeholders. A quasi-Delphi consensus procedure was used to reach agreement on ratings for recommendations. Results: We have developed and outlined several recommendations for clinicians and researchers to guide their use of standardized language and literacy assessments in virtual care, across six key themes. Conclusions: This article is one of the first to share practical recommendations for virtual assessment in the domain of oral language and literacy assessment for clinicians and researchers. We hope the current recommendations will facilitate future clinical research in this area, and as the body of research in this field grows, this article will act as a basis for the development of formal Clinical Practice Guidelines.

Process Risks in Perioperative Medication Delivery

One anesthesia provider is often responsible for prescribing, formulating, dispensing, administering, and documenting medications in the operating room. Unlike other hospital units, there are few safety interventions. Systems engineering approaches can provide important insights into improving patient safety during medication delivery processes (Kaplan et al., 2013; Reid et al., 2005). This study observed anesthesia medication delivery during 20 anesthetic cases in the OR and interviewed 10 anesthesia providers in a large midatlantic academic hospital using a Systems Engineering Initiative for Patient Safety (SEIPS) framework to identify process risk in perioperative medication delivery (Holden et al., 2013). Anesthesia attendings, fellows, residents, and certified resident nurse anesthetists (CRNAs) were sampled based on who was in the OR during observations and who volunteered for interviews. Interviews were transcribed and coded through a consensus procedure. The medication delivery process was described using a SEIPS-based process map. Tasks were separated based on the anesthesia phase, though the tasks and phases are not linear; e.g: a provider may prepare for the next case during the maintenance phase.

How to communicate with families living in complete isolation

ImportanceDuring the SARS-CoV-2 pandemic, a complete physical isolation has been worldwide introduced. The impossibility of visiting their loved ones during the hospital stay causes additional distress for families: in addition to the worries about clinical recovery, they may feel exclusion and powerlessness, anxiety, depression, mistrust in the care team and post-traumatic stress disorder. The impossibility of conducting the daily meetings with families poses a challenge for healthcare professionals.ObjectiveThis paper aims to delineate and share consensus statements in order to enable healthcare team to provide by telephone or video calls an optimal level of communication with patient’s relatives under circumstances of complete isolation.Evidence reviewPubMed, Cochrane Database of Systematic Reviews, Database of Abstracts and Reviews of Effectiveness and the AHCPR Clinical Guidelines and Evidence Reports were explored from 1999 to 2019. Exclusion criteria were: poor or absent relevance regarding the aim of the consensus statements, studies prior to 1999, non-English language. Since the present pandemic context is completely new, unexpected and unexplored, there are not randomised controlled trials regarding clinical communication in a setting of complete isolation. Thus, a multiprofessional taskforce of physicians, nurses, psychologists and legal experts, together with some family members and former intensive care unit patients was established by four Italian national scientific societies. Using an e-Delphi methodology, general and specific questions were posed, relevant topics were argumented, until arriving to delineate position statements and practical checklist, which were set and evaluated through an evidence-based consensus procedure.FindingsTen statements and two practical checklists for phone or video calls were drafted and evaluated; they are related to who, when, why and how family members must be given clinical information under circumstances of complete isolation.Conclusions and relevanceThe statements and the checklists offer a structured methodology in order to ensure a good-quality communication between healthcare team and family members even in isolation, confirming that time dedicated to communication has to be intended as a time of care.