How to Do Things With Words

Preface (1999) Preface (1990) 1. Subjects of Sex/Gender/Desire I. 'Women' as the Subject of Feminism II. The Compulsory Order of Sex/Gender/Desire III. Gender: The Circular Ruins of Contemporary Debate IV. Theorizing the Binary, the Unitary and Beyond V. Identity, Sex and the Metaphysics of Substance VI. Language, Power and the Strategies of Displacement 2. Prohibition, Psychoanalysis, and the Production of the Heterosexual Matrix I. Structuralism's Critical Exchange II. Lacan, Riviere, and the Strategies of Masquerade III. Freud and the Melancholia of Gender IV. Gender Complexity and the Limits of Identification V. Reformulating Prohibition as Power 3. Subversive Bodily Acts I. The Body Politics of Julia Kristeva II. Foucault, Herculine, and the Politics of Sexual Discontinuity III. Monique Wittig - Bodily Disintegration and Fictive Sex IV. Bodily Inscriptions, Performative Subversions Conclusion - From Parody to Politics

Postmodern Subjects, Postmodern BodiesThinking Fragments: Psychoanalysis, Feminism, and Postmodernism in the Contemporary WestYearning: Race, Gender, and Cultural PoliticsGender Trouble: Feminism and the Subversion of Identity

Background Coronavirus disease 2019 (COVID-19) has rapidly instigated a global pandemic. Vaccine development is proceeding at an unprecedented pace. Once available, it will be important to maximize vaccine uptake and coverage. Objective To assess intent to be vaccinated against COVID-19 among a representative sample of adults in the United States and identify predictors of and reasons for vaccine hesitancy. Design Cross-sectional survey, fielded from 16 through 20 April 2020. Setting Representative sample of adults residing in the United States. Participants Approximately 1000 adults drawn from the AmeriSpeak probability-based research panel, covering approximately 97% of the U.S. household population. Measurements Intent to be vaccinated against COVID-19 was measured with the question, "When a vaccine for the coronavirus becomes available, will you get vaccinated?" Response options were "yes," "no," and "not sure." Participants who responded "no" or "not sure" were asked to provide a reason. Results A total of 991 AmeriSpeak panel members responded. Overall, 57.6% of participants (n = 571) intended to be vaccinated, 31.6% (n = 313) were not sure, and 10.8% (n = 107) did not intend to be vaccinated. Factors independently associated with vaccine hesitancy (a response of "no" or "not sure") included younger age, Black race, lower educational attainment, and not having received the influenza vaccine in the prior year. Reasons for vaccine hesitancy included vaccine-specific concerns, a need for more information, antivaccine attitudes or beliefs, and a lack of trust. Limitations Participants' intent to be vaccinated was explored before a vaccine was available and when the pandemic was affecting a narrower swath of the United States. Questions about specific information or factors that might increase vaccination acceptance were not included. The survey response rate was 16.1%. Conclusion This national survey, conducted during the coronavirus pandemic, revealed that approximately 3 in 10 adults were not sure they would accept vaccination and 1 in 10 did not intend to be vaccinated against COVID-19. Targeted and multipronged efforts will be needed to increase acceptance of a COVID-19 vaccine when one becomes available. Primary funding source Agency for Healthcare Research and Quality.

Attitudes Toward a Potential SARS-CoV-2 Vaccine: A Survey of U.S. Adults.

Background
Addressing COVID-19 is a pressing health and social concern. To date, many epidemic projections and policies addressing COVID-19 have been designed without seroprevalence data to inform epidemic parameters. We measured the seroprevalence of antibodies to SARS-CoV-2 in Santa Clara County.

Methods
On 4/3-4/4, 2020, we tested county residents for antibodies to SARS-CoV-2 using a lateral flow immunoassay. Participants were recruited using Facebook ads targeting a representative sample of the county by demographic and geographic characteristics. We report the prevalence of antibodies to SARS-CoV-2 in a sample of 3,330 people, adjusting for zip code, sex, and race/ethnicity. We also adjust for test performance characteristics using 3 different estimates: (i) the test manufacturer9s data, (ii) a sample of 37 positive and 30 negative controls tested at Stanford, and (iii) a combination of both. 

Results
The unadjusted prevalence of antibodies to SARS-CoV-2 in Santa Clara County was 1.5% (exact binomial 95CI 1.11-1.97%), and the population-weighted prevalence was 2.81% (95CI 2.24-3.37%). Under the three scenarios for test performance characteristics, the population prevalence of COVID-19 in Santa Clara ranged from 2.49% (95CI 1.80-3.17%) to 4.16% (2.58-5.70%). These prevalence estimates represent a range between 48,000 and 81,000 people infected in Santa Clara County by early April, 50-85-fold more than the number of confirmed cases.

Conclusions
The population prevalence of SARS-CoV-2 antibodies in Santa Clara County implies that the infection is much more widespread than indicated by the number of confirmed cases. Population prevalence estimates can now be used to calibrate epidemic and mortality projections.

/pdf/covid-19-antibody-seroprevalence-in-santa-clara-county-4guiemtgxt.pdf

COVID-19 Antibody Seroprevalence in Santa Clara County, California

Summary Background Seizures and their consequences contribute to the burden of epilepsy because they can cause health loss (premature mortality and residual disability). Data on the burden of epilepsy are needed for health-care planning and resource allocation. The aim of this study was to quantify health loss due to epilepsy by age, sex, year, and location using data from the Global Burden of Diseases, Injuries, and Risk Factors Study. Methods We assessed the burden of epilepsy in 195 countries and territories from 1990 to 2016. Burden was measured as deaths, prevalence, and disability-adjusted life-years (DALYs; a summary measure of health loss defined by the sum of years of life lost [YLLs] for premature mortality and years lived with disability), by age, sex, year, location, and Socio-demographic Index (SDI; a compound measure of income per capita, education, and fertility). Vital registrations and verbal autopsies provided information about deaths, and data on the prevalence and severity of epilepsy largely came from population representative surveys. All estimates were calculated with 95% uncertainty intervals (UIs). Findings In 2016, there were 45·9 million (95% UI 39·9–54·6) patients with all-active epilepsy (both idiopathic and secondary epilepsy globally; age-standardised prevalence 621·5 per 100 000 population; 540·1–737·0). Of these patients, 24·0 million (20·4–27·7) had active idiopathic epilepsy (prevalence 326·7 per 100 000 population; 278·4–378·1). Prevalence of active epilepsy increased with age, with peaks at 5–9 years (374·8 [280·1–490·0]) and at older than 80 years of age (545·1 [444·2–652·0]). Age-standardised prevalence of active idiopathic epilepsy was 329·3 per 100 000 population (280·3–381·2) in men and 318·9 per 100 000 population (271·1–369·4) in women, and was similar among SDI quintiles. Global age-standardised mortality rates of idiopathic epilepsy were 1·74 per 100 000 population (1·64–1·87; 1·40 per 100 000 population [1·23–1·54] for women and 2·09 per 100 000 population [1·96–2·25] for men). Age-standardised DALYs were 182·6 per 100 000 population (149·0–223·5; 163·6 per 100 000 population [130·6–204·3] for women and 201·2 per 100 000 population [166·9–241·4] for men). The higher DALY rates in men were due to higher YLL rates compared with women. Between 1990 and 2016, there was a non-significant 6·0% (−4·0 to 16·7) change in the age-standardised prevalence of idiopathic epilepsy, but a significant decrease in age-standardised mortality rates (24·5% [10·8 to 31·8]) and age-standardised DALY rates (19·4% [9·0 to 27·6]). A third of the difference in age-standardised DALY rates between low and high SDI quintile countries was due to the greater severity of epilepsy in low-income settings, and two-thirds were due to a higher YLL rate in low SDI countries. Interpretation Despite the decrease in the disease burden from 1990 to 2016, epilepsy is still an important cause of disability and mortality. Standardised collection of data on epilepsy in population representative surveys will strengthen the estimates, particularly in countries for which we currently have no or sparse data and if additional data is collected on severity, causes, and treatment. Sizeable gains in reducing the burden of epilepsy might be expected from improved access to existing treatments in low-income countries and from the development of new effective drugs worldwide. Funding Bill & Melinda Gates Foundation.

https://minerva-access.unimelb.edu.au/bitstream/handle/11343/247230/PMC6416168.pdf

Global, regional, and national burden of epilepsy, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016

The global burden of disease study—which has been affiliated with the World Bank and the World Health Organisation (WHO) and is now housed in the Institute for Health Metrics and Evaluation (IHME)—has become a very important tool to global health governance since it was first published in the 1993 World Development Report. In this article, based on literature review of primary and secondary sources as well as field notes from public events, we present first a summary of the origins and evolution of the GBD over the past 25 years. We then analyse two illustrative examples of estimates and the ways in which they gloss over the assumptions and knowledge gaps in their production, highlighting the importance of historical context by country and by disease in the quality of health data. Finally, we delve into the question of the end users of these estimates and the tensions that lie at the heart of producing estimates of local, national, and global burdens of disease. These tensions bring to light the different institutional ethics and motivations of IHME, WHO, and the World Bank, and they draw our attention to the importance of estimate methodologies in representing problems and their solutions in global health. With the rise in the investment in and the power of global health estimates, the question of representing global health problems becomes ever more entangled in decisions made about how to adjust reported numbers and to evolving statistical science. Ultimately, more work needs to be done to create evidence that is relevant and meaningful on country and district levels, which means shifting resources and support for quantitative—and qualitative—data production, analysis, and synthesis to countries that are the targeted beneficiaries of such global health estimates.

/pdf/metric-partnerships-global-burden-of-disease-estimates-i4ckmlky25.pdf

Metric partnerships: global burden of disease estimates within the World Bank, the World Health Organisation and the Institute for Health Metrics and Evaluation.

In the second article of the series, Marlee Tichenor and Devi Sridhar discuss how the World Bank is promoting better access to healthcare

https://www.bmj.com/content/bmj/358/bmj.j3347.full.pdf

Universal health coverage, health systems strengthening, and the World Bank

Global health security and universal health coverage have been frequently considered as “two sides of the same coin”. Yet, greater analysis is required as to whether and where these two ideals converge, and what important differences exist. A consequence of ignoring their individual characteristics is to distort global and local health priorities in an effort to streamline policymaking and funding activities. This paper examines the areas of convergence and divergence between global health security and universal health coverage, both conceptually and empirically. We consider analytical concepts of risk and human rights as fundamental to both goals, but also identify differences in priorities between the two ideals. We support the argument that the process of health system strengthening provides the most promising mechanism of benefiting both goals.

https://gh.bmj.com/content/bmjgh/4/1/e001145.full.pdf

Global Health Security and Universal Health Coverage: from a Marriage of Convenience to a Strategic, Effective Partnership

In this article, I investigate the ramifications of health data production in the health fight against malaria in and around Dakar, Senegal. Malaria health development funding at the community level is contingent on performativity; the Global Fund's "performance-based funding," for example, requires that local actors produce certain forms of evidence and that intermediaries synthesize this evidence into citable data. Analyzing the practices of diagnosis and approximation in health clinics and in global malaria documents, I argue that data production in Senegal is conditioned by and reifies preconceived notions of malaria as a problem addressable by the enumeration of technological fixes.

Marlee Tichenor

Papers

Metric partnerships: global burden of disease estimates within the World Bank, the World Health Organisation and the Institute for Health Metrics and Evaluation.

Universal health coverage, health systems strengthening, and the World Bank

Global Health Security and Universal Health Coverage: from a Marriage of Convenience to a Strategic, Effective Partnership

Data Performativity, Performing Health Work: Malaria and Labor in Senegal.

The Power of Data: Global Health Citizenship and the Senegalese Data Retention Strike