On Being at Home in Ourselves and the World: Love, Sex, Gender, and Justice

IntroductionHelga Varden’s Sex, Love, & Gender: A Kantian Theory (2020) is a rigorous, beautiful, and transformative book, which does vital work not only in fully developing how Kant’s complex understandings of desire, reflection, and relationality should inform our understanding of his arguments about sex and love but also in positioning these Kantian arguments as absolutely critical resources to contemporary debates about gender identity, sexual orientation, and sexual (in)justice. Rarely is a book so comprehensive, so coherent, and so grounded in a vulnerability we rarely find in philosophy; rarely does it so radically expand the resources we have for dealing with what seems like a familiar problem in such a well-read figure. The literature on Kant and sex is extensive, and yet this book absolutely revolutionizes the kinds of questions we can ask about Kant on sex, love, and gender.Beyond its attendance to essential questions about love, sex, gender, and the phenomenology of human embodiment, Varden’s book makes several key methodological moves. First, she offers a rigorous defense of a “bottom up” approach to Kant, which allows theorists (largely, and not coincidentally, women theorists) to square the sorts of non-ideal experiences with which she is concerned in this book with the systemic features of Kant’s practical philosophy. This is not, as she argues, to decenter freedom in his philosophical project, but to read in a direction that allows these questions to “surface” in our lived, embodied, human experience of freedom. Varden’s Kant, then, is an ideal Kant who is concerned with non-ideal dilemmas, desires, and experiences; he is a reconstructed Kant, whose ample resources for theorizing human experience, morality, teleology, and justice are no longer hampered by his own sexist, homophobic, and cisist preoccupations. There are critical resources here for those drawing on Kant to address a range of non-ideal questions that are beyond the scope of this project. Second, Varden opens with a lineage of both Kantian scholarship by women and feminist Kant scholarship, demonstrating the rich and varied ways that Kant scholarship has been transformed over the past four decades by the influx of women into the field, and revealing Kant scholarship as a site of (perhaps surprising) feminist philosophical innovation. For me, this is both resonant and comforting. I came to Kant because it was, at the time, the only seminar taught by a woman in my graduate department, and as such, was the only seminar in which I was not harassed, belittled, or silenced. Writing about Kant not only allowed me to work with a woman advisor; he provided cover for pursuing questions about love, sex, gender, and race that were not understood as “philosophical” within my graduate department, at least at the time I took them up. Varden’s book articulates my own sense of Kant scholarship as a gateway into feminist philosophy, as a rare space in mainstream philosophical scholarship that passes, if you will, a kind of philosophical Bechdel test. My engagement with Varden’s book is oriented through this gratitude, and through the sense of belonging that is at the center of Varden’s project here: an attendance to the ways that women belong in Kant scholarship, that non-ideal questions of love, sex and gender belong in Kantian philosophy, and that the experiences, desires, and traumas of women and LGBTQIA people belong in philosophical inquiries into what it is to be human. Accordingly, I begin by tracing Varden’s argument through a central theme of the book: that one way to think about problems of love, sex, and gender, from both a phenomenological and a political perspective, is to tend to the importance of being at home with oneself, in the world, and with others. I explore how this framework allows Varden to develop a distinctly and innovatively Kantian account of our sexually loving and gendered selves, and their implications both for questions of virtue and morality, and for questions of justice. I then consider the ways that Varden’s analysis provides us with much needed resources to think about how inhabiting a self-defensive stance in the face of oppression may violate our duties to resist our own oppression. Finally, having traced the arguments at the heart of the book, I turn to two puzzles in Varden’s account of the just state: her understanding of sexual consent, and her defense of the state’s right to restrict abortion.   Helga Varden’s Sex, Love, & Gender: A Kantian Theory (2020) is a rigorous, beautiful, and transformative book, which does vital work not only in fully developing how Kant’s complex understandings of desire, reflection, and relationality should inform our understanding of his arguments about sex and love but also in positioning these Kantian arguments as absolutely critical resources to contemporary debates about gender identity, sexual orientation, and sexual (in)justice. Rarely is a book so comprehensive, so coherent, and so grounded in a vulnerability we rarely find in philosophy; rarely does it so radically expand the resources we have for dealing with what seems like a familiar problem in such a well-read figure. The literature on Kant and sex is extensive, and yet this book absolutely revolutionizes the kinds of questions we can ask about Kant on sex, love, and gender. Beyond its attendance to essential questions about love, sex, gender, and the phenomenology of human embodiment, Varden’s book makes several key methodological moves. First, she offers a rigorous defense of a “bottom up” approach to Kant, which allows theorists (largely, and not coincidentally, women theorists) to square the sorts of non-ideal experiences with which she is concerned in this book with the systemic features of Kant’s practical philosophy. This is not, as she argues, to decenter freedom in his philosophical project, but to read in a direction that allows these questions to “surface” in our lived, embodied, human experience of freedom. Varden’s Kant, then, is an ideal Kant who is concerned with non-ideal dilemmas, desires, and experiences; he is a reconstructed Kant, whose ample resources for theorizing human experience, morality, teleology, and justice are no longer hampered by his own sexist, homophobic, and cisist preoccupations. There are critical resources here for those drawing on Kant to address a range of non-ideal questions that are beyond the scope of this projec

on finding yourself in a state of nature: a kantian account of abortion and voluntary motherhood

In this essay, I draw on Kant’s legal philosophy in order to defend the right to voluntary motherhood by way of abortion at any stage of pregnancy as an essential feature of women’s basic rights. By developing the distinction between innate and acquired right in Kant’s legal philosophy, I argue that the viability standard in US law (as established in Planned Parenthood v. Casey) misunderstands the nature of embodied right. Our body is the site of innate right; it is the means through which we can set and pursue ends in the world. The law, therefore, cannot adjudicate the relationship between the will and the body: it cannot require us to allow our bodies to be used against our will. By comparing unwanted pregnancy to sexual assault, I problematize the notion that consent to pregnancy, like consent to sex, can ever be conclusive. I examine Kant’s own account of unwanted pregnancy, in which he describes mother and child finding themselves “in a state of nature” in order to rethink the status of the fetus in law, and I argue that we should understand the fetus’s right to life as provisional, rather than as enforceable by law

On finding yourself in a state of nature: A Kantian account of abortion and voluntary motherhood

I defend the right to an abortion at any stage of pregnancy by drawing on a Kantian account of consent and innate right. I examine how pregnant women are positioned in moral and legal debates about abortion, and develop a Kanitan account of bodily autonomy in order to pregnant women’s epistemic authority over the experience of pregnancy. Second, I show how Kant's distinction between innate and private right offers an excellent legal framework for embodied rights, including abortion and sexual consent, and I draw on the legal definition of sexual consent in order to show how abortion discourse undermines women's innate right. I then explore Kant’s treatment of the infanticidal mother, and draw out the parallels between this case and contemporary abortion rights in order to develop a distinctly Kantian framework of reproductive rights in non-ideal conditions. Finally, I explore the implications of this non-ideal approach for contemporary abortion discourse, arguing that debates about the legality of abortion should more broadly engage the barbaric conditions of reproductive injustice

Optimising use of electronic health records to describe the presentation of rheumatoid arthritis in primary care: a strategy for developing code lists

Background Research using electronic health records (EHRs) relies heavily on coded clinical data. Due to variation in coding practices, it can be difficult to aggregate the codes for a condition in order to define cases. This paper describes a methodology to develop ‘indicator markers’ found in patients with early rheumatoid arthritis (RA); these are a broader range of codes which may allow a probabilistic case definition to use in cases where no diagnostic code is yet recorded. Methods We examined EHRs of 5,843 patients in the General Practice Research Database, aged ≥30y, with a first coded diagnosis of RA between 2005 and 2008. Lists of indicator markers for RA were developed initially by panels of clinicians drawing up code-lists and then modified based on scrutiny of available data. The prevalence of indicator markers, and their temporal relationship to RA codes, was examined in patients from 3y before to 14d after recorded RA diagnosis. Findings Indicator markers were common throughout EHRs of RA patients, with 83.5% having 2 or more markers. 34% of patients received a disease-specific prescription before RA was coded; 42% had a referral to rheumatology, and 63% had a test for rheumatoid factor. 65% had at least one joint symptom or sign recorded and in 44% this was at least 6-months before recorded RA diagnosis. Conclusion Indicator markers of RA may be valuable for case definition in cases which do not yet have a diagnostic code. The clinical diagnosis of RA is likely to occur some months before it is coded, shown by markers frequently occurring ≥6 months before recorded diagnosis. It is difficult to differentiate delay in diagnosis from delay in recording. Information concealed in free text may be required for the accurate identification of patients and to assess the quality of care in general practice

Azetidines Kill Multidrug-Resistant <i>Mycobacterium tuberculosis</i> without Detectable Resistance by Blocking Mycolate Assembly

Tuberculosis (TB) is the leading cause of global morbidity and mortality resulting from infectious disease, with over 10.6 million new cases and 1.4 million deaths in 2021. This global emergency is exacerbated by the emergence of multidrug-resistant MDR-TB and extensively drug-resistant XDR-TB; therefore, new drugs and new drug targets are urgently required. From a whole cell phenotypic screen, a series of azetidines derivatives termed BGAz, which elicit potent bactericidal activity with MIC99 values &lt;10 μM against drug-sensitive Mycobacterium tuberculosis and MDR-TB, were identified. These compounds demonstrate no detectable drug resistance. The mode of action and target deconvolution studies suggest that these compounds inhibit mycobacterial growth by interfering with cell envelope biogenesis, specifically late-stage mycolic acid biosynthesis. Transcriptomic analysis demonstrates that the BGAz compounds tested display a mode of action distinct from the existing mycobacterial cell wall inhibitors. In addition, the compounds tested exhibit toxicological and PK/PD profiles that pave the way for their development as antitubercular chemotherapies. </p

Fishery Discards: Factors Affecting Their Variability within a Demersal Trawl Fishery

Discards represent one of the most important issues within current commercial fishing. It occurs for a range of reasons and is influenced by an even more complex array of factors. We address this issue by examining the data collected within the Danish discard observer program and describe the factors that influence discarding within the Danish Kattegat demersal fleet over the period 1997 to 2008. Generalised additive models were used to assess how discards of the 3 main target species, Norway lobster, cod and plaice, and their subcomponents (under and over minimum landings size) are influenced by important factors and their potential relevance to management. Our results show that discards are influenced by a range of different factors that are different for each species and portion of discards. We argue that knowledge about the factors influential to discarding and their use in relation to potential mitigation measures are essential for future fisheries management strategies

New loci for body fat percentage reveal link between adiposity and cardiometabolic disease risk

To increase our understanding of the genetic basis of adiposity and its links to cardiometabolic disease risk, we conducted a genome-wide association meta-analysis of body fat percentage (BF%) in up to 100,716 individuals. Twelve loci reached genome-wide significance (P<5 × 10−8), of which eight were previously associated with increased overall adiposity (BMI, BF%) and four (in or near COBLL1/GRB14, IGF2BP1, PLA2G6, CRTC1) were novel associations with BF%. Seven loci showed a larger effect on BF% than on BMI, suggestive of a primary association with adiposity, while five loci showed larger effects on BMI than on BF%, suggesting association with both fat and lean mass. In particular, the loci more strongly associated with BF% showed distinct cross-phenotype association signatures with a range of cardiometabolic traits revealing new insights in the link between adiposity and disease risk

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p&lt;0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (&lt;1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (&lt;1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks