Bye-bye Barack: dislocating afropolitanism, spectral marxism and dialectical disillusionment in two Obama-era novels

In contextually specific and formally distinctive ways, Chimamanda Ngozi Adichie’s Americanah and Imbolo Mbue’s Behold the Dreamers are fictional interrogations of Obama’s presidential pledge to resuscitate the American dream on the wake of the global financial crash. This paper explores how they supplement and challenge familiar tropes associated with African and American, rather than African-American, diaspora writing. Given broader debates within transnational literary studies about flows and exchanges (of people, finance, cultural production, dissemination, consumption et al.) linking the global South and North, I consider how these texts grapple with the complexities and complicities of contemporary neoliberalism through the lens of renascent African Marxisms. While my chosen writers could not be described as Marxist, I engage with more materially oriented scholarship, such as Krishnan’s Writing Spatiality in West Africa and Ngugi’s The Rise of the African Novel, to consider how Americanah and Behold the Dreamers circulate in a global literary marketplace where certain texts, not to mention authors, are seen as symptomatic of an African and/or Afropolitan and/or ‘Africapitalist’ renaissance. By grappling with Marxist-inflected scholarship, this paper interrogates the politics, as well as poetics, of the oft-conspicuous airbrushing of those socio-economic, specifically class concerns at the heart of these entangled debates

A retrospective 'real-world' cohort study of azole therapeutic drug monitoring and evolution of antifungal resistance in cystic fibrosis

Background: Individuals with cystic fibrosis (CF) have an increased susceptibility to fungal infection/allergy, with triazoles often used as first-line therapy. Therapeutic drug monitoring (TDM) is essential due to significant pharmacokinetic variability and the recent emergence of triazole resistance worldwide. Objectives: In this retrospective study we analysed the 'real-world' TDM of azole therapy in a large CF cohort, risk factors for subtherapeutic dosing, and the emergence of azole resistance. Methods: All adults with CF on azole therapy in a large single UK centre were included. Clinical demographics, TDM and microbiology were analysed over a 2 year study period (2015-17) with multivariate logistic regression used to identify risk factors for subtherapeutic dosing. Results: 91 adults were treated with azole medication during the study period. A high prevalence of chronic subtherapeutic azole dosing was seen with voriconazole (60.8%) and itraconazole capsule (59.6%) use, representing significant risk factors for subtherapeutic levels. Rapid emergence of azole resistance was additionally seen over the follow-up period with a 21.4% probability of CF patients developing a resistant fungal isolate after 2 years. No significant relationship was found however between subtherapeutic azole dosing and azole resistance emergence. Conclusions: Our study demonstrates a high prevalence of subtherapeutic azole levels in CF adults with increased risk using itraconazole capsules and voriconazole therapy. We show rapid emergence of azole resistance highlighting the need for effective antifungal stewardship. Further large longitudinal studies are needed to understand the effects of antifungal resistance on outcome in CF and the implications of subtherapeutic dosing on resistance evolution