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Sister citizen : shame, stereotypes, and black women in America
Jezebel's sexual lasciviousness, Mammy's devotion, and Sapphire's outspoken anger -- these are among the most persistent stereotypes that black women encounter in contemporary American life. Hurtful and dishonest, such representations force African American women to navigate a virtual crooked room that shames them and shapes their experiences as citizens. Many respond by assuming a mantle of strength that may convince others, and even themselves, that they do not need help. But as a result, the unique political issues of black women are often ignored and marginalized. The author uses multiple methods of inquiry, including literary analysis, political theory, focus groups, surveys, and experimental research, to understand more deeply black women's political and emotional responses to pervasive negative race and gender images. Not a traditional political science work concerned with office-seeking, voting, or ideology, Sister Citizen instead explores how African American women understand themselves as citizens and what they expect from political organizing. Harris-Perry shows that the shared struggle to preserve an authentic self and secure recognition as a citizen links together black women in America, from the anonymous survivors of Hurricane Katrina to the current First Lady of the United States.
Book
What defines an efficacious COVID-19 vaccine? A review of the challenges assessing the clinical efficacy of vaccines against SARS-CoV-2
The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused more than 1 million deaths in the first 6 months of the pandemic and huge economic and social upheaval internationally. An efficacious vaccine is essential to prevent further morbidity and mortality. Although some countries might deploy COVID-19 vaccines on the strength of safety and immunogenicity data alone, the goal of vaccine development is to gain direct evidence of vaccine efficacy in protecting humans against SARS-CoV-2 infection and COVID-19 so that manufacture of efficacious vaccines can be selectively upscaled. A candidate vaccine against SARS-CoV-2 might act against infection, disease, or transmission, and a vaccine capable of reducing any of these elements could contribute to disease control. However, the most important efficacy endpoint, protection against severe disease and death, is difficult to assess in phase 3 clinical trials. In this Review, we explore the challenges in assessing the efficacy of candidate SARS-CoV-2 vaccines, discuss the caveats needed to interpret reported efficacy endpoints, and provide insight into answering the seemingly simple question, “Does this COVID-19 vaccine work?”
Journal Article
The collected papers of Emmanuel Ghent : heart melts forward
This book brings together an engaging study, using Emmanuel Ghent's collected papers, of theoretical and personal origins of the relational turn in psychoanalysis. Emmanuel Ghent was one of the founders of relational psychoanalysis, and his ideas have been hugely influential. However, he published sparingly and his papers are scattered across a range of sources. In this book, his key writings are reproduced, along with analyses and critiques by major contemporary psychoanalytic figures such as Adam Phillips, Jessica Benjamin, Seth Warren, Adrienne Harris and Barry Magrid. This book provides a thorough examination of the key tenets of Ghent's thinking and illustrates the continued importance of his theoretical and clinical work for the next generation of psychoanalysts.
Book
A randomised controlled test in virtual reality of the effects on paranoid thoughts of virtual humans’ facial animation and expression
Virtual reality (VR) is increasingly used in the study and treatment of paranoia. This is based on the finding that people who mistakenly perceive hostile intent from other people also perceive similar threat from virtual characters. However, there has been no study of the programming characteristics of virtual characters that may influence their interpretation. We set out to investigate how the animation and expressions of virtual humans may affect paranoia. In a two-by-two factor, between-groups, randomized design, 122 individuals with elevated paranoia rated their perceptions of virtual humans, set in an eye-tracking enabled VR lift scenario, that varied in facial animation (static or animated) and expression (neutral or positive). Both facial animation (group difference = 102.328 [51.783, 152.872],
p
< 0.001,
η
p
2
= 0.125) and positive expressions (group difference = 53.016 [0.054, 105.979],
p
= 0.049,
η
p
2
= 0.033) led to less triggering of paranoid thoughts about the virtual humans. Facial animation (group difference = 2.442 [− 4.161, − 0.724],
p
= 0.006,
η
p
2
= 0.063) but not positive expressions (group difference = 0.344 [− 1.429, 2.110],
p
= 0.681,
η
p
2
= 0.001) significantly increased the likelihood of neutral thoughts about the characters. Our study shows that the detailed programming of virtual humans can impact the occurrence of paranoid thoughts in VR. The programming of virtual humans needs careful consideration depending on the purpose of their use.
Journal Article
Acute blood biomarker profiles predict cognitive deficits 6 and 12 months after COVID-19 hospitalization
Post-COVID cognitive deficits, including ‘brain fog’, are clinically complex, with both objective and subjective components. They are common and debilitating, and can affect the ability to work, yet their biological underpinnings remain unknown. In this prospective cohort study of 1,837 adults hospitalized with COVID-19, we identified two distinct biomarker profiles measured during the acute admission, which predict cognitive outcomes 6 and 12 months after COVID-19. A first profile links elevated fibrinogen relative to C-reactive protein with both objective and subjective cognitive deficits. A second profile links elevated D-dimer relative to C-reactive protein with subjective cognitive deficits and occupational impact. This second profile was mediated by fatigue and shortness of breath. Neither profile was significantly mediated by depression or anxiety. Results were robust across secondary analyses. They were replicated, and their specificity to COVID-19 tested, in a large-scale electronic health records dataset. These findings provide insights into the heterogeneous biology of post-COVID cognitive deficits.
Longitudinal proteomic profiling of over 1,800 patients revealed two distinct profiles of blood biomarkers measured on admission to hospital for COVID-19, which predict cognitive deficits 6 and 12 months later.
Journal Article
Review of Toxic Epidermal Necrolysis
Toxic epidermal necrolysis (TEN) is a rare but life threatening mucocutaneous reaction to drugs or their metabolites. It is characterised by widespread keratinocyte apoptosis and sloughing of the skin, erosions of the mucous membranes, painful blistering, and severe systemic disturbance. The pathophysiology of TEN is incompletely understood. Historically, it has been regarded as a drug-induced immune reaction initiated by cytotoxic lymphocytes via a human leukocyte antigen (HLA)-restricted pathway. Several mediators have been identified as contributors to the cell death seen in TEN, including; granulysin, soluble Fas ligand, perforin/granzyme, tumour necrosis factor-α (TNF-α), and TNF-related apoptosis-inducing ligand. Currently, granulysin is accepted as the most important mediator of T cell proliferation. There is uncertainty around the accepted management of TEN. The lack of definitive management guidelines for TEN is explained in part by the rarity of the disease and its high mortality rate, which makes it difficult to conduct randomised control trials on emerging therapies. Developments have been made in pharmacogenomics, with numerous HLA alleles identified; however, these have largely been ethnically specific. These associations have translated into screening recommendations for Han Chinese.
Journal Article
User engagement in clinical trials of digital mental health interventions: a systematic review
Introduction
Digital mental health interventions (DMHIs) overcome traditional barriers enabling wider access to mental health support and allowing individuals to manage their treatment. How individuals engage with DMHIs impacts the intervention effect. This review determined whether the impact of user engagement was assessed in the intervention effect in Randomised Controlled Trials (RCTs) evaluating DMHIs targeting common mental disorders (CMDs).
Methods
This systematic review was registered on Prospero (CRD42021249503). RCTs published between 01/01/2016 and 17/09/2021 were included if evaluated DMHIs were delivered by app or website; targeted patients with a CMD without non-CMD comorbidities (e.g., diabetes); and were self-guided. Databases searched: Medline; PsycInfo; Embase; and CENTRAL. All data was double extracted. A meta-analysis compared intervention effect estimates when accounting for engagement and when engagement was ignored.
Results
We identified 184 articles randomising 43,529 participants. Interventions were delivered predominantly via websites (145, 78.8%) and 140 (76.1%) articles reported engagement data. All primary analyses adopted treatment policy strategies, ignoring engagement levels. Only 19 (10.3%) articles provided additional intervention effect estimates accounting for user engagement: 2 (10.5%) conducted a complier-average-causal effect (CACE) analysis (principal stratum strategy) and 17 (89.5%) used a less-preferred per-protocol (PP) population excluding individuals failing to meet engagement criteria (estimand strategies unclear). Meta-analysis for PP estimates, when accounting for user engagement, changed the standardised effect to -0.18 95% CI (-0.32, -0.04) from − 0.14 95% CI (-0.24, -0.03) and sample sizes reduced by 33% decreasing precision, whereas meta-analysis for CACE estimates were − 0.19 95% CI (-0.42, 0.03) from − 0.16 95% CI (-0.38, 0.06) with no sample size decrease and less impact on precision.
Discussion
Many articles report user engagement metrics but few assessed the impact on the intervention effect missing opportunities to answer important patient centred questions for how well DMHIs work for engaged users. Defining engagement in this area is complex, more research is needed to obtain ways to categorise this into groups. However, the majority that considered engagement in analysis used approaches most likely to induce bias.
Journal Article
Establishing Ebola Virus Disease (EVD) diagnostics using GeneXpert technology at a mobile laboratory in Liberia: Impact on outbreak response, case management and laboratory systems strengthening
The 2014-16 Ebola Virus Disease (EVD) outbreak in West Africa highlighted the necessity for readily available, accurate and rapid diagnostics. The magnitude of the outbreak and the re-emergence of clusters of EVD cases following the declaration of interrupted transmission in Liberia, reinforced the need for sustained diagnostics to support surveillance and emergency preparedness. We describe implementation of the Xpert Ebola Assay, a rapid molecular diagnostic test run on the GeneXpert platform, at a mobile laboratory in Liberia and the subsequent impact on EVD outbreak response, case management and laboratory system strengthening. During the period of operation, site coordination, management and operational capacity was supported through a successful collaboration between Ministry of Health (MoH), World Health Organization (WHO) and international partners. A team of Liberian laboratory technicians were trained to conduct EVD diagnostics and the laboratory had capacity to test 64-100 blood specimens per day. Establishment of the laboratory significantly increased the daily testing capacity for EVD in Liberia, from 180 to 250 specimens at a time when the effectiveness of the surveillance system was threatened by insufficient diagnostic capacity. During the 18 months of operation, the laboratory tested a total of 9,063 blood specimens, including 21 EVD positives from six confirmed cases during two outbreaks. Following clearance of the significant backlog of untested EVD specimens in November 2015, a new cluster of EVD cases was detected at the laboratory. Collaboration between surveillance and laboratory coordination teams during this and a later outbreak in March 2016, facilitated timely and targeted response interventions. Specimens taken from cases during both outbreaks were analysed at the laboratory with results informing clinical management of patients and discharge decisions. The GeneXpert platform is easy to use, has relatively low running costs and can be integrated into other national diagnostic algorithms. The technology has on average a 2-hour sample-to-result time and allows for single specimen testing to overcome potential delays of batching. This model of a mobile laboratory equipped with Xpert Ebola test, staffed by local laboratory technicians, could serve to strengthen outbreak preparedness and response for future outbreaks of EVD in Liberia and the region.
Journal Article
Age and sex distribution of Mycobacterium tuberculosis infection and rifampicin resistance in Myanmar as detected by Xpert MTB/RIF
Background
Detection of tuberculosis disease (TB) and timely identification of
Mycobacterium tuberculosis
(
Mtb
) strains that are resistant to treatment are key to halting tuberculosis transmission, improving treatment outcomes, and reducing mortality.
Methods
We used 332,657 Xpert MTB/RIF assay results, captured as part of the Myanmar Data Utilization Project, to characterize
Mtb
test positivity and rifampicin resistance by both age and sex, and to evaluate risk factors associated with rifampicin resistance.
Results
Overall, 70% of individuals diagnosed with TB were males. Test positivity was higher among males (47%) compared to females (39%). The highest positivity by age occurred among individuals aged 16–20, with test positivity for females (65%) higher than for males (57%). Although a greater absolute number of males were rifampicin resistant, a greater proportion of females (11.4%) were rifampicin resistant as compared to males (9.3%). In the multivariate model, history of previous treatment, age less than 30, testing in the Yangon region, and female sex were significantly positively associated with rifampicin resistance after adjusting for HIV status and year test was performed.
Conclusions
Our results indicate that young adults were more likely to test positive for TB and be identified as rifampicin resistant compared to older adults.
Journal Article
Sister citizen : shame, stereotypes, and Black women in America
Jezebel's sexual lasciviousness, Mammy's devotion, and Sapphire's outspoken anger-these are among the most persistent stereotypes that black women encounter in contemporary American life. Hurtful and dishonest, such representations force African American women to navigate a virtual crooked room that shames them and shapes their experiences as citizens. Many respond by assuming a mantle of strength that may convince others, and even themselves, that they do not need help. But as a result, the unique political issues of black women are often ignored and marginalized.In this groundbreaking book, Melissa V. Harris-Perry uses multiple methods of inquiry, including literary analysis, political theory, focus groups, surveys, and experimental research, to understand more deeply black women's political and emotional responses to pervasive negative race and gender images. Not a traditional political science work concerned with office-seeking, voting, or ideology, Sister Citizen instead explores how African American women understand themselves as citizens and what they expect from political organizing. Harris-Perry shows that the shared struggle to preserve an authentic self and secure recognition as a citizen links together black women in America, from the anonymous survivors of Hurricane Katrina to the current First Lady of the United States.
eBook