Hegelian Dimensions of The Second Sex: A Feminist Consideration

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Why “intergenerational feminist media studies”?

Feminism and generation are live and ideologically freighted issues that are subject to a substantial amount of media engagement. The figure of the millennial and the baby boomer, for example, regularly circulate in mainstream media, often accompanied by hyperbolic and vitriolic discourses and affects of intergenerational feminist conflict. In addition, theories of feminist generation and waves have been and continue to be extensively critiqued within feminist theory. Given the compelling criticisms directed at these categories, we ask: why bother examining and foregrounding issues of generation, intergeneration, and transgeneration in feminist media studies? Whilst remaining sceptical of linearity and familial metaphors and of repeating reductive, heteronormative, and racist versions of feminist movements, we believe that the concept of generation does have critical purchase for feminist media scholars. Indeed, precisely because of the problematic ways that is it used, and the prevalence of it as a volatile, yet only too palpable, organizing category, generation is both in need of continual critical analysis, and is an important tool to be used—with care and nuance—when examining the multiple routes through which power functions in order to marginalize, reward, and oppress. Exploring both diachronic and synchronic understandings of generation, this article emphasizes the use of conjunctural analysis to excavate the specific historical conditions that impact upon and create generation. This special issue of Feminist Media Studies covers a range of media forms—film, games, digital media, television, print media, as well as practices of media production, intervention, and representation. The articles also explore how figures at particular lifestages—particularly the girl and the aging woman—are constructed relationally, and circulate, within media, with particular attention to sexuality. Throughout the issue there is an emphasis on exploring the ways in which the category of generation is mobilized in order to gloss sexism, racism, ageism, class oppression, and the effects of neoliberalism

Multiscale scenarios for nature futures

Targets for human development are increasingly connected with targets for nature, however, existing scenarios do not explicitly address this relationship. Here, we outline a strategy to generate scenarios centred on our relationship with nature to inform decision-making at multiple scales

A mixed-methods feasibility study of a new digital health support package for people after stroke : The Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) intervention

Background Evidence for digital health programmes to support people living with stroke is growing. We assessed the feasibility of a protocol and procedures for the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) trial. Methods We conducted a mixed-method feasibility study. Participants with acute stroke were recruited from three hospitals (Melbourne, Australia). Eligibility: Adults with stroke discharged from hospital to home within 10 days, modified Rankin Score 0–4 and prior use of Short Message System (SMS)/email. While in hospital, recruited participants contributed to structured person-centred goal setting and completed baseline surveys including self-management skills and health-related quality of life. Participants were randomised 7–14 days after discharge via REDCap® (1:1 allocation). Following randomisation, the intervention group received a 12-week programme of personalised electronic support messages (average 66 messages sent by SMS or email) aligned with their goals. The control group received six electronic administrative messages. Feasibility outcomes included the following: number of patients screened and recruited, study retainment, completion of outcome measures and acceptability of the ReCAPS intervention and trial procedures (e.g. participant satisfaction survey, clinician interviews). Protocol fidelity outcomes included number of goals developed (and quality), electronic messages delivered, stop messages received and engagement with messages. We undertook inductive thematic analysis of interview/open-text survey data and descriptive analysis of closed survey questions. Results Between November 2018 and October 2019, 312 patients were screened; 37/105 (35%) eligible patients provided consent (mean age 61 years; 32% female); 33 were randomised (17 to intervention). Overall, 29 (88%) participants completed the12-week outcome assessments with 12 (41%) completed assessments in the allocated timeframe and 16 also completing the satisfaction survey (intervention=10). Overall, trial participants felt that the study was worthwhile and most would recommend it to others. Six clinicians participated in one of three focus group interviews; while they reported that the trial and the process of goal setting were acceptable, they raised concerns regarding the additional time required to personalise goals. Conclusion The study protocol and procedures were feasible with acceptable retention of participants. Consent and goal personalisation procedures should be centralised for the phase III trial to reduce the burden on hospital clinicians. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12618001468213 (date 31/08/2018); Universal Trial Number: U1111-1206-723

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Engagement and intervention: Feminism\u27s exchange with nineteenth-century master thinkers

This study enacts a feminist engagement with phallogocentric texts and paradigms as I seek to disclose the resources that exist for liberatory projects therein, despite Western phallocracy\u27s “othering” of minority subjects. Specifically, I examine the intersection of contemporary psychoanalytic feminist theory with certain key philosophical texts by formidable nineteenth-century “master thinkers,” Hegel, Marx, and Nietzsche. In Part 1, I explore feminism\u27s insistent return to Hegel, beginning with Simone de Beauvoir\u27s treatment of key Hegelian moments, and then illustrate how the work of Julia Kristeva and Luce Irigaray interrogate the structures and themes of Hegel\u27s Phenomenology as a primary articulation of the phallic logic of masculine economies, including masculinist philosophies, but are unwilling to negate the alterity of woman without first exploring the radical potential of such status. Drawing on Beauvoir\u27s formulation of alterity as endemic to masculinist thought, Kristeva and Irigaray simultaneously refuse the discursive authority of such an ordering principle while invoking Hegelian themes for their own strategies of usurpation. By analyzing the differences in these engagements with Hegel, I demonstrate how confrontations with this exemplar of traditional philosophical thought have the potential to both disrupt complicitous and legitimating apparatuses and generate viable liberatory resources that may be appropriated for feminist ends. In Part II, I emphasize the convergence of bodies with Philosophy, illustrating how psychoanalytic feminists strategically invoke the material and metaphorical body as a means to oppose and interrogate phallogocentric thought. Corporeal paradigms are powerful tools which function to reconceptualize exchange and enact multivalent interventions. By elucidating the way in which bodies are deployed in the work of Irigaray, Kristeva, through their engagement, either covert or overt, with the writings of Marx, Nietzsche, and Hegel, I illuminate the means by which these feminist philosophers provide alternatives to dominant forms of intercourse, or exchange, that emphasize human mediation, recognition, and negotiation. By bringing corporeal substance to the discourses of philosophy in a complex and inventive manner, psychoanalytic feminists at once recover resources from traditional thought and undermine dominant narratives therein. Yet these strategies are provisional ones; ultimately, I argue, feminisms should resist paradigmatic closure