Feminist and quantitative? Measuring the extent of domestic violence in Georgetown, Guyana

L'àmplia majoria de la recerca feminista angloamericana en Geografia evita els mètodes quantitatius malgrat saber que tota data és una forma de representació. Com conseqüència d'això, geògrafes i geògrafs feministes s'han estat d'aprofundir en determinades preguntes de recerca i en camins d'investigació epistemològica. En aquest article exploraré els arguments feministes que s'han utilitzat contra l'ús de mètodes quantitatius i les conseqüències d'aquest camí sense sortida per no tenir presents les possibilitats d'adoptar una aproximació crítica a l'anàlisi dels mètodes quantitatius que incorporen les pràctiques feministes. Així mostro un estudi i presento els mètodes utilitzats i els resultats obtinguts a partir d'una enquesta (clúster multivariant) a 360 dones realitzada per una organització de dones de la Guyana, Red Thread, sobre l'extensió i la natura de la violència domèstica, un tema que en sí mateix no és fàcil de quantificar. Concloc de la importància d'obrir la recerca feminista en Geografia cap a les possibilitats que permeten els mètodes quantitatius lluny de les versions masculinistes positivistes i de la importància dels mètodes quantitatius per a la transferència de tècniques en les aliances nord-sud.Una gran parte de la investigación feminista angloamericana en Geografía evita los métodos cuantitativos a pesar de saber que cualquier dato es una forma de representación. A consecuencia de esta situación, geógrafas y geógrafos feministas han evitado profundizar en determinadas preguntas de investigación y en caminos de investigación epistemológica. En este artículo exploraré los argumentos feministas que se han utilizado contra el uso de métodos cuantitativos y las consecuencias de este camino sin salida por no tener presentes las posibilidades de adoptar una aproximación crítica al análisis de los métodos cuantitativos que incorporen las prácticas feministas. Aquí muestro un estudio de caso y presento los métodos utilizados y los resultados obtenidos a partir de una encuesta (clúster multivariante) a 360 mujeres realizada por una organización de mujeres de la Guyana, Red Thread, sobre la extensión y la naturaleza de la violencia doméstica, un tema que en si mismo no es fácil de cuantificar. Concluyo mostrando la importancia de abrir la investigación feminista en Geografía a las posibilidades que permiten los métodos cuantitativos lejanos de las versiones masculinizadas positivistas y de la importancia de los métodos cuantitativos para la transferencia de técnicas en las alianzas norte- sur.The vast majority of Anglo-American feminist research in Geography eschews quantitative methods despite the understanding that all data are forms of representation. As a consequence feminist geographers have refrained from pursuing certain research questions and epistemological paths of investigation. In this article I explore the arguments feminists have raised against using quantitative methods and the consequences of this impasse while raising the possibilities of adopting a critical approach to quantitative methods of analysis that incorporates feminist practices. I then turn to a case study to discuss the methods employed and the results obtained from a (multi-level cluster) survey of 360 women conducted with the Guyanese women’s organisation, Red Thread, on the extent and nature of domestic violence, a topic that does not lend itself easily to quantification. I conclude by assessing the importance of opening up feminist enquiry in Geography to the possibilities unleashed by the uncoupling of quantitative methods from masculinist versions of positivism and of the particular importance of quantitative methods in the transference of skills in north-south alliances

Domestic Violence Is Widespread in Guyana

Domestic violence is a widespread part of everyday life in Guyana. Although the vast majority of abusers are men, women also engage in violence, especially when they have power over vulnerable people such as children and the elderly. The relationships of power that cause domestic violence are complex.York's Knowledge Mobilization Unit provides services and funding for faculty, graduate students, and community organizations seeking to maximize the impact of academic research and expertise on public policy, social programming, and professional practice. It is supported by SSHRC and CIHR grants, and by the Office of the Vice-President Research & Innovation. [email protected] www.researchimpact.c

Dysregulated circulating dendritic cell function in ulcerative colitis is partially restored by probiotic strain Lactobacillus casei Shirota

BACKGROUND: Dendritic cells regulate immune responses to microbial products and play a key role in ulcerative colitis (UC) pathology. We determined the immunomodulatory effects of probiotic strain Lactobacillus casei Shirota (LcS) on human DC from healthy controls and active UC patients. METHODS: Human blood DC from healthy controls (control-DC) and UC patients (UC-DC) were conditioned with heat-killed LcS and used to stimulate allogeneic T cells in a 5-day mixed leucocyte reaction. RESULTS: UC-DC displayed a reduced stimulatory capacity for T cells (P < 0.05) and enhanced expression of skin-homing markers CLA and CCR4 on stimulated T cells (P < 0.05) that were negative for gut-homing marker β7. LcS treatment restored the stimulatory capacity of UC-DC, reflecting that of control-DC. LcS treatment conditioned control-DC to induce CLA on T cells in conjunction with β7, generating a multihoming profile, but had no effects on UC-DC. Finally, LcS treatment enhanced DC ability to induce TGFβ production by T cells in controls but not UC patients. CONCLUSIONS: We demonstrate a systemic, dysregulated DC function in UC that may account for the propensity of UC patients to develop cutaneous manifestations. LcS has multifunctional immunoregulatory activities depending on the inflammatory state; therapeutic effects reported in UC may be due to promotion of homeostasis

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

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

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

Urban Feminist Imaginaries for the ‘21st Century of the City’

In this chapter I address the geographical imaginaries, our taken-for-granted spatial orderings, that are applied to urban places, and argue for a feminist urban imaginary. Dominant among these imaginaries has been the UN Urban Age thesis and vying for its replacement is that of planetary urbanization. The latter, even as it critiques the Urban Age thesis, and, importantly, proposes an alternative imaginary of the urban, like the former, is rooted in a particular masculinist mode of all-encompassing knowledge production. I turn then to the main orientations and commitments of a feminist urban imaginary and highlight three aspects that speak to the twenty-first century urban context: empirical realities and reflexive practices of knowledge production; the urban as a theoretical category; and urban spatial epistemologies and ontological struggles. I argue that feminist urban scholars lean towards understanding the urban as a site of praxis from which to build imaginative counter-geographies

Feminist and quantitative? Measuring the extent of domestic violence in Georgetown, Guyana

L'àmplia majoria de la recerca feminista angloamericana en Geografia evita els mètodes quantitatius malgrat saber que tota data és una forma de representació. Com conseqüència d'això, geògrafes i geògrafs feministes s'han estat d'aprofundir en determinades preguntes de recerca i en camins d'investigació epistemològica. En aquest article exploraré els arguments feministes que s'han utilitzat contra l'ús de mètodes quantitatius i les conseqüències d'aquest camí sense sortida per no tenir presents les possibilitats d'adoptar una aproximació crítica a l'anàlisi dels mètodes quantitatius que incorporen les pràctiques feministes. Així mostro un estudi i presento els mètodes utilitzats i els resultats obtinguts a partir d'una enquesta (clúster multivariant) a 360 dones realitzada per una organització de dones de la Guyana, Red Thread, sobre l'extensió i la natura de la violència domèstica, un tema que en sí mateix no és fàcil de quantificar. Concloc de la importància d'obrir la recerca feminista en Geografia cap a les possibilitats que permeten els mètodes quantitatius lluny de les versions masculinistes positivistes i de la importància dels mètodes quantitatius per a la transferència de tècniques en les aliances nord-sud.The vast majority of Anglo-American feminist research in Geography eschews quantitative methods despite the understanding that all data are forms of representation. As a consequence feminist geographers have refrained from pursuing certain research questions and epistemological paths of investigation. In this article I explore the arguments feminists have raised against using quantitative methods and the consequences of this impasse while raising the possibilities of adopting a critical approach to quantitative methods of analysis that incorporates feminist practices. I then turn to a case study to discuss the methods employed and the results obtained from a (multi-level cluster) survey of 360 women conducted with the Guyanese womens organisation, Red Thread, on the extent and nature of domestic violence, a topic that does not lend itself easily to quantification. I conclude by assessing the importance of opening up feminist enquiry in Geography to the possibilities unleashed by the uncoupling of quantitative methods from masculinist versions of positivism and of the particular importance of quantitative methods in the transference of skills in north-south alliances.Una gran parte de la investigación feminista angloamericana en Geografía evita los métodos cuantitativos a pesar de saber que cualquier dato es una forma de representación. A consecuencia de esta situación, geógrafas y geógrafos feministas han evitado profundizar en determinadas preguntas de investigación y en caminos de investigación epistemológica. En este artículo exploraré los argumentos feministas que se han utilizado contra el uso de métodos cuantitativos y las consecuencias de este camino sin salida por no tener presentes las posibilidades de adoptar una aproximación crítica al análisis de los métodos cuantitativos que incorporen las prácticas feministas. Aquí muestro un estudio de caso y presento los métodos utilizados y los resultados obtenidos a partir de una encuesta (clúster multivariante) a 360 mujeres realizada por una organización de mujeres de la Guyana, Red Thread, sobre la extensión y la naturaleza de la violencia doméstica, un tema que en si mismo no es fácil de cuantificar. Concluyo mostrando la importancia de abrir la investigación feminista en Geografía a las posibilidades que permiten los métodos cuantitativos lejanos de las versiones masculinizadas positivistas y de la importancia de los métodos cuantitativos para la transferencia de técnicas en las alianzas norte- sur