The Bioscience-Industrial Complex, Radical Materialist Aesthetics, and Interspecies Political Ecologies: The Unforeseen Posthuman Future in Mary Shelley\u27s Frankenstein and Margaret Atwood\u27s MaddAddam Trilogy

This project traces how Mary Shelley’s Frankenstein and Margaret Atwood’s MaddAddam Trilogy, science fiction novels from the Romantic and contemporary literary periods respectively, contest the problematic relationships between subjecthood, science, ecological health, and patriarchal, capitalist societies by crafting radical materialist alternatives to such a system and its dualistic and destructive interpersonal/interspecies relations. Through the theoretical framework of ecofeminism that recognizes the conceptual linkages between women and nature in Western systems of thought, as well as psychoanalytical feminist critiques of the masculinization of scientific epistemology, this project examines the developmental and ontological overlaps between literary “masculine” and “scientific” subjects socialized under Western patriarchal capitalism and their exploitatively destructive responses to things associated with the “feminine” (i.e. the sensual body, nonhuman animals, people of color, ecological systems, spirituality). The second half of this thesis investigates how the environmental group of Atwood’s trilogy practices a kind of radical materialist philosophy that resembles Deleuze and Guattari’s notion of “becoming-animal” and Jane Bennett’s apprehension of the enchanted materialism of the world of things to elucidate the inadequacy of dualist, patriarchal culture’s models for lived experience. The God’s Gardeners’ belief system advocates practicing a curious “attentiveness,” or sensual receptiveness, to nature in which an energetic, agential wilderness of nonhuman intentionality might be perceived and thereby enable a more interconnected across-species co-existence. The intercommunications between the transgenic animals, humanoid Crakers, and bizarre cult-like humans are a source of hope in that they suggest that our human-nature relation must henceforth be more carefully considerate of more-than-human interests than it has been, more biocentric in its scope as opposed to narrowly homocentric. This newfound sense of continuity helps one begin to think of nature as composed of living, breathing others with unique interests, which then propels one to engage in dialogic ethical responses to and interactions with nonhumans over the more unfortunate and historically popular dialectic between so-called free humans and mechanistic nonhuman natures. The combination of Atwood’s vision of interspecies alliances, Deleuze and Guattari’s politics of becoming, and Bennett’s enchanted stance toward nature provide a viable model of resistance to the continued destruction of the planet

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

The US Program in Ground-Based Gravitational Wave Science: Contribution from the LIGO Laboratory

Recent gravitational-wave observations from the LIGO and Virgo observatories have brought a sense of great excitement to scientists and citizens the world over. Since September 2015,10 binary black hole coalescences and one binary neutron star coalescence have been observed. They have provided remarkable, revolutionary insight into the "gravitational Universe" and have greatly extended the field of multi-messenger astronomy. At present, Advanced LIGO can see binary black hole coalescences out to redshift 0.6 and binary neutron star coalescences to redshift 0.05. This probes only a very small fraction of the volume of the observable Universe. However, current technologies can be extended to construct "3rd Generation" (3G) gravitational-wave observatories that would extend our reach to the very edge of the observable Universe. The event rates over such a large volume would be in the hundreds of thousands per year (i.e. tens per hour). Such 3G detectors would have a 10-fold improvement in strain sensitivity over the current generation of instruments, yielding signal-to-noise ratios of 1000 for events like those already seen. Several concepts are being studied for which engineering studies and reliable cost estimates will be developed in the next 5 years

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

Dreams of a Therapeutic Planet: (Dis)entangling Narratives of Post-Human Care in Anglo-American Speculative Literature

“Dreams of a Therapeutic Planet” draws on psychoanalytic theory, intersectional gender and sexuality studies, radical Black theorizing, and ecocriticism to investigate how readers are made aware of and feel trans-species, matrixial trans-subjectivity through speculative literature and what creative and ethical practices of care ensue from these aesthetic experiences. I argue that select Romantic-era and contemporary Anglo-American eco-speculative writers analogously construct defamiliarizing, post-Human narratives and models of quotidian practices of care to foreground the planetary-scale significance of the erotic ecologies of diverse human psychosocial lifecycles. I show how the texts in this study move toward the theoretical, aesthetic, and narrative convergence of ecology and psychosexuality as a viable other-worldly site of psychoanalytic care. That is, “Dreams of a Therapeutic Planet” explores how Anglo-American speculative writers focus on scenes of post-Human caregiving between non/human characters to argue that these wildly caring, creaturely m/other figures (dis)entangle the un/conscious thinking and feeling of both adult characters and undeveloped/immature presubjects (i.e., literal and figurative children & newborns) as well as the actual readers who identify with such protagonists. My project proposes that particular articulations of Anglo-American eco-literary speculation explore and enact the revitalization of the wild and matrixial qualities of mind that have been long repressed, denied, and/or foreclosed by the anti-Black, biophobic, and phallocentric logics, narratives, and aesthetics of “monohumanist Man2,” to invoke Sylvia Wynter’s formulation. As cultural responses to the Romantic Anthropocene, to use a conceptualization inspired by Kate Rigby’s work, I argue that my archive of texts together construct an aesthetic of wonder-full wildness for their post-Human, transformational quest narratives that trace the development of presubjects into matrixial trans-subjects. Matrixial trans-subjects are non/human entities capable of approaching the unknown in the self and other in a mode of “positive” epistemophilic wonder. Thinking with Alexis Pauline Gumbs and bell hooks, respectively, gives me insight into how these matrixial figures also engage with m/other natures via the related ethical praxis of “revolutionary mothering” within “homeplaces” of interdependency that I identify in these texts as scenes of “developmental entanglements of care.” I therefore show how these authors speculate about the developmental mechanisms and aesthetic forms behind the cultivation of this post-Human subjectivity that “is always-already full of other beings and ways of being,” to call on L.O. Aranye Fradenburg Joy’s words. Overall, I show how these Romantic eco-speculative writers imagine the post-Human mind as potentially creatively equipped with and enriched by the intersubjective, interspecies, and trans-species psychological capacities for care/curiosity/concern, dialogic communication, and mutual transformation—psychic modes of approaching the self and other that exist in both conscious/cognitive and unconscious dimensions. My argument shows how this matrixial aesthetic of developmental entanglements of care manifests in representations of intersubjective sites, processes, and practices that might be said to effect the green and blue “dreams of a therapeutic planet.

Immunization Status and the Management of Febrile Children in the Pediatric Emergency Department: What Are We Doing?

Objectives: Widespread Haemophilus influenzae and Streptococcus pneumoniae immunization has decreased occult bacteremia and bacterial meningitis rates. Practice has evolved in pediatric emergency departments (PEDs) to favor fewer diagnostic tests for and empiric treatment of invasive bacterial infection. We lack evidence-based guidance on evaluation and treatment of unimmunized (UnI) or underimmunized (UnderI) febrile children. This study aims to determine how parental report of immunization status in febrile PED patients impacts rates of diagnostic testing, interventions, and hospital admissions. Methods: This is a retrospective cohort study with chart review of encounters of children aged 3 to 36 months presenting to an academic, tertiary care PED in 2019 using International Classification of Diseases-10 code for fever (R50.9). Inclusion criteria were documented fever of 38°C and higher and well appearance. Encounters were excluded if there was a history of chronic illness or documentation of ill appearance or hemodynamic instability. Encounters were grouped by provider-documented immunization status. Fischer exact test and logistic regression compared rates of diagnostic testing (serum, urine or cerebrospinal fluid laboratory studies, and chest radiographs), interventions (intravenous fluid bolus, intravenous antibiotic or steroid administration, respiratory support, or breathing treatment), and hospital admissions between UnderI, UnI, and fully immunized (FI) groups. Results: Of the 1813 encounters reviewed, 1093 (60%) included provider-documented immunization status and 788 (43%) met final inclusion criteria: 23 (2.1%) UnI, 44 (5.8%) UnderI, and 721 (92.1%) FI. The UnderI and UnI children experienced significantly higher rates of laboratory evaluation including complete blood count and blood culture, medical intervention, and antibiotic prescriptions while in the PED. No significant differences were observed for rates of chest radiographs, hospital admissions, or 72-hour PED return visits. Conclusions: Higher rates of laboratory testing and interventions were observed in UnderI and UnI versus FI febrile patients at a PED, likely demonstrating increased clinical suspicion for invasive bacterial infection in this group despite lacking national guidelines. Given continued vaccine hesitancy, further studies are needed for guiding management of febrile UnI and UnderI children presenting for emergency care

High pathogenicity avian influenza (H5N1) in northern gannets: global spread, clinical signs, and demographic consequences

During 2021 and 2022 High Pathogenicity Avian Influenza (HPAI) killed thousands of wild birds across Europe and North America, suggesting a change in infection dynamics and a shift to new hosts, including seabirds. Northern Gannets (Morus bassanus) appeared especially severely impacted, but a detailed account of the data available is required to help understand how the virus spread across the metapopulation, and the ensuing demographic consequences. Accordingly, we analyse information on confirmed and suspected HPAIV outbreaks across most North Atlantic Gannet colonies and for the largest colony (Bass Rock, UK), provide impacts on population size, breeding success, and preliminary results on apparent adult survival and serology. Unusually high numbers of dead Gannets were first noted at colonies in Iceland during April 2022. Outbreaks in May occurred in many Scottish colonies, followed by colonies in Canada, Germany and Norway. By the end of June, outbreaks had occurred in colonies in Canada and the English Channel. Outbreaks in 12 UK and Ireland colonies appeared to follow a clockwise pattern with the last infected colonies recorded in late August/September. Unusually high mortality was recorded at 40 colonies (75% of global total colonies). Dead birds testing positive for HPAIV H5N1 were associated with 58% of these colonies. At Bass Rock, the number of occupied nest sites decreased by at least 71%, breeding success declined by ~66% compared to the long-term UK mean and the resighting of marked individuals suggested that apparent adult survival between 2021 and 2022 could have been substantially lower than the preceding 10-year average. Serological investigation detected antibodies specific to H5 in apparently healthy birds indicating that some Gannets recover from HPAIV infection. Further, most of these recovered birds had black irises, suggestive of a phenotypic indicator of previous infection. Untangling the impacts of HPAIV infection from other challenges faced by seabirds is key to establishing effective conservation strategies for threatened seabird populations as the likelihood of further epizootics increases, due to increasing habitat loss and the industrialization of poultry production

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

International audienc