Developing a critical realist positional approach to intersectionality

This article identifies philosophical tensions and limitations within contemporary intersectionality theory which, it will be argued, have hindered its ability to explain how positioning in multiple social categories can affect life chances and influence the reproduction of inequality. We draw upon critical realism to propose an augmented conceptual framework and novel methodological approach that offers the potential to move beyond these debates, so as to better enable intersectionality to provide causal explanatory accounts of the ‘lived experiences’ of social privilege and disadvantage

Women entrepreneurs and their ventures: complicating categories and contextualising gender

Women entrepreneurs and their ventures: complicating categories and contextualising gende

Emancipation through digital entrepreneurship: a critical realist analysis

Digital entrepreneurship is presented in popular discourse as a means to empowerment and greater economic participation for under-resourced and socially marginalised people. However, this emancipatory rhetoric relies on a flat ontology that does not sufficiently consider the enabling conditions needed for successful digital enterprise activity. To empirically illustrate this argument, we examine three paired cases of UK women digital entrepreneurs, operating in similar sectors but occupying contrasting social positionalities. The cases are comparatively analysed through an intersectional feminist lens using a critical realist methodological framework. By examining the relationships between digital entrepreneurship, social positionality, and structural and agential enabling conditions, we interrogate the notion of digital entrepreneurship as an emancipatory phenomenon producing liberated workers

A web of opportunity or the same old story? Women digital entrepreneurs and intersectionality theory

This article critically analyses the manner in which intersectionality and related social positionality shape digital enterprise activities. Despite popular claims of meritocratic opportunity enactment within traditional forms of entrepreneurship, ascribed social characteristics intersect to influence the realisation of entrepreneurial potential. However, it is purported that the emerging field of digital entrepreneurship may act as a ‘great leveller’ due to perceived lower barriers to entry, disembodiment of the entrepreneurial actor and the absence of visible markers of disadvantage online. Using an interpretivist approach, we analyse empirical evidence from UK women digital entrepreneurs which reveals how the privileges and disadvantages arising from intersecting social positions of gender, race and class status are reproduced online. This analysis challenges the notion that the Internet is a neutral platform for entrepreneurship and supports our thesis that offline inequality, in the form of marked bodies, social positionality and associated resource constraints, is produced and reproduced in the online environment

Racial capitalism and entrepreneurship: An intersectional feminist labour market perspective on UK self-employment

This article explains entrepreneurial activity patterns in the United Kingdom (UK) labour market using theories of racial capitalism and intersectional feminism. Using UK Office for National Statistics (ONS) Labour Force Survey (LFS) data 2018-19 and employing probit modelling techniques on employment modes, self-employment types, and work arrangements amongst differing groups, we investigate inequality in self-employment within and between socio-structural groupings of race, class and gender. We find that those belonging to non-dominant gender, race and socioeconomic class groupings experience an intersecting set of entrepreneurial penalties, enhancing understanding of the ways multiple social hierarchies interact in self-employment patterns. This robust quantitative evidence challenges contemporary debates, policy and practice regarding the potential for entrepreneurship to offer viable income generation opportunities by those on the socioeconomic margins

Comparative effectiveness of dual-action versus single-action antidepressants for the treatment of depression in people living with HIV/AIDS

Background Depression is the most common psychiatric comorbidity among people living with HIV/AIDS (PLWHA). Little is known about the comparative effectiveness between different types of antidepressants used to treat depression in this population. We compared the effectiveness of dual-action and single-action antidepressants in PLWHA for achieving remission from depression. Methods We used data from the Centers for AIDS Research Network of Integrated Clinic Systems to identify 1175 new user dual-action or single-action antidepressant treatment episodes occurring from 2005 to 2014 for PLWHA diagnosed with depression. The primary outcome was remission from depression defined as a Patient Health Questionnaire-9 (PHQ-9) score <5. Mean difference in PHQ-9 depressive symptom severity was a secondary outcome. The main approach was an intent-to-treat (ITT) evaluation complemented with a per protocol (PP) sensitivity analysis. Generalized linear models were fitted to estimate treatment effects. Results In ITT analysis, 32% of the episodes ended in remission for both dual-action and single-action antidepressants. The odds ratio (OR) of remission was 1.02 (95%CI=0.63,1.67). In PP analysis, 40% of dual-action episodes ended in remission compared to 32% in single-action episodes. Dual-action episodes had 1.33 times the odds of remission (95%CI=0.55,3.21), however the result was not statistically significant. Non-significant differences were also observed for depressive symptom severity. Limitations Missing data was common but was addressed with inverse probability weights. Conclusions Results suggest that single-action and dual-action antidepressants are equally effective in PLWHA. Remission was uncommon highlighting the need to identify health service delivery strategies that aid HIV providers in achieving full remission of their patients’ depression

Neonatal outcomes following early fetal growth restriction: a subgroup analysis of the EVERREST study

OBJECTIVE: To quantify the risks of mortality, morbidity and postnatal characteristics associated with extreme preterm fetal growth restriction (EP-FGR). DESIGN: The EVERREST (Do e s v ascular endothelial growth factor gene therapy saf e ly imp r ove outcome in seve r e e arly-onset fetal growth re st riction?) prospective multicentre study of women diagnosed with EP-FGR (singleton, estimated fetal weight (EFW) <3rd percentile, <600 g, 20+0-26+6 weeks of gestation). The UK subgroup of EP-FGR infants (<36 weeks) were sex-matched and gestation-matched to appropriate for age (AGA) infants born in University College London Hospital (1:2 design, EFW 25th-75th percentile). SETTING: Four tertiary perinatal units (UK, Germany, Spain, Sweden). MAIN OUTCOMES: Antenatal and postnatal mortality, bronchopulmonary dysplasia (BPD), sepsis, surgically treated necrotising enterocolitis (NEC), treated retinopathy of prematurity (ROP). RESULTS: Of 135 mothers recruited with EP-FGR, 42 had a stillbirth or termination of pregnancy (31%) and 93 had live births (69%). Postnatal genetic abnormalities were identified in 7/93 (8%) live births. Mean gestational age at birth was 31.4 weeks (SD 4.6). 54 UK-born preterm EP-FGR infants (<36 weeks) were matched to AGA controls. EP-FGR was associated with increased BPD (43% vs 26%, OR 3.6, 95% CI 1.4 to 9.4, p=0.01), surgical NEC (6% vs 0%, p=0.036) and ROP treatment (11% vs 0%, p=0.001). Mortality was probably higher among FGR infants (9% vs 2%, OR 5.0, 95% CI 1.0 to 25.8, p=0.054). FGR infants more frequently received invasive ventilation (65% vs 50%, OR 2.6, 95% CI 1.1 to 6.1, p=0.03), took longer to achieve full feeds and had longer neonatal stays (median difference 6.1 days, 95% CI 3.8 to 8.9 and 19 days, 95% CI 9 to 30 days, respectively, p<0.0001). CONCLUSIONS: Mortality following diagnosis of EP-FGR is high. Survivors experience increased neonatal morbidity compared with AGA preterm infants. TRIAL REGISTRATION NUMBER: NCT02097667

EVERREST prospective study: a 6-year prospective study to define the clinical and biological characteristics of pregnancies affected by severe early onset fetal growth restriction

BACKGROUND: Fetal growth restriction (FGR) is a serious obstetric condition for which there is currently no treatment. The EVERREST Prospective Study has been designed to characterise the natural history of pregnancies affected by severe early onset FGR and establish a well phenotyped bio-bank. The findings will provide up-to-date information for clinicians and patients and inform the design and conduct of the EVERREST Clinical Trial: a phase I/IIa trial to assess the safety and efficacy of maternal vascular endothelial growth factor (VEGF) gene therapy in severe early onset FGR. Data and samples from the EVERREST Prospective Study will be used to identify ultrasound and/or biochemical markers of prognosis in pregnancies with an estimated fetal weight (EFW) <3rd centile between 20+0 and 26+6 weeks of gestation. METHODS: This is a 6 year European multicentre prospective cohort study, recruiting women with a singleton pregnancy where the EFW is <3rd centile for gestational age and <600 g at 20+0 to 26+6 weeks of gestation. Detailed data are collected on: maternal history; antenatal, peripartum, and postnatal maternal complications; health economic impact; psychological impact; neonatal condition, progress and complications; and infant growth and neurodevelopment to 2 years of corrected age in surviving infants. Standardised longitudinal ultrasound measurements are performed, including: fetal biometry; uterine artery, umbilical artery, middle cerebral artery, and ductus venosus Doppler velocimetry; and uterine artery and umbilical vein volume blood flow. Samples of maternal blood and urine, amniotic fluid (if amniocentesis performed), placenta, umbilical cord blood, and placental bed (if caesarean delivery performed) are collected for bio-banking. An initial analysis of maternal blood samples at enrolment is planned to identify biochemical markers that are predictors for fetal or neonatal death. DISCUSSION: The findings of the EVERREST Prospective Study will support the development of a novel therapy for severe early onset FGR by describing in detail the natural history of the disease and by identifying women whose pregnancies have the poorest outcomes, in whom a therapy might be most advantageous. The findings will also enable better counselling of couples with affected pregnancies, and provide a valuable resource for future research into the causes of FGR

Annual review article: Is it time to rethink the gender agenda in entrepreneurship research?

This article develops a critique of contemporary approaches to analysing the impact of gender upon entrepreneurial propensity and activity. Since the 1990s, increasing attention has been afforded to the influence of gender upon women’s entrepreneurial behaviour; such analyses have highlighted an embedded masculinity within the entrepreneurial discourse which privileges men as normative entrepreneurial actors. Whilst invaluable in revealing a prevailing masculine bias within entrepreneurship, this critique is bounded by positioning women as a proxy for the gendered subject. This is a potentially limiting analysis that does not fully recognise gender as a human property with myriad articulations enacted throughout entrepreneurial activity. To progress debate, we engage more deeply with the notion of gender as a multiplicity exploring the implications of such for future studies of entrepreneurial activity