Utopian texts function not only as representations of alternatives to the manifold crises of the present, but educate their readers in the ways such alternative futures might become concrete utopian ...presents through radical political activity. Utopian critical theory in the last two decades has suggested that this educational and transformational role of utopian literature is on the wane at a time when the power of late capitalism seems all-encompassing. In response, this essay offers a new periodisation of utopian literature from the 1990s to the present, suggesting that the critical utopias of the 1970s and critical dystopias of the 1990s have, in the last decade, inspired a new tendency in utopian literature: commons utopias. These texts are assiduously of the present moment, refusing to escape from a precarious ongoing present, but engaging prefiguratively with utopian imaginaries to bring them into being today - particularly the radically anti-capitalist idea of the commons. By depicting realistic utopian spaces in opposition to capitalism, commons utopias educate and inspire their readers to transform their own present.
The work of contemporary American poet, critic, and essayist Juliana Spahr is concerned with politically charged questions of connection, collectivity, and community across disparate ontological ...domains and ecological boundaries. This essay argues that Spahr's 2015 poetry collection That Winter the Wolf Came, which has to date garnered less critical attention than her previous work, combines lyric, intertextual reference, asequential narrative, parataxis, and other formal techniques and compositional practices into a commons poetics. This poetics, in turn, allows Spahr to effectively represent a commons which finds space for plural subjects as diverse as the activists of the 2011-2012 Occupy Movement, oil rigs, and Brent geese. Despite Spahr's own fundamental reservations about the political efficacy of poetry, her unique use of lyric, in particular, cultivates radical connections and oppositional tactics for these plural subjects, offering a vision of a utopian commons beyond capitalism.
This thesis explores the representation of utopian spaces as a form of opposition to capitalism in contemporary literature and poetry. The spatial focus of the thesis is the commons - a form of ...spatial, social, and political organisation which, I argue, has been undergoing a decade-long resurgence in literature as well as activist theory and practice. At the same time as commons are witnessing renewed interest, I position the previous decade as defined by interlinked capitalist crises of inequality, political representation, mobility, and climate change, which expose a growing section of the planetary population to precarity. The thesis distinguishes a corpus of texts from the wider field of contemporary political and speculative literature, identifying these texts as commons utopias. Commons utopias are united by a set of valuable features: they build on the forms of earlier utopian literature, particularly the 'critical utopias' of the 1960s-70s; actively oppose contemporary capitalism; depict the crises of the present alongside the utopian spaces which emerge within it; and make use of a commons poetics, a toolkit of literary techniques which captures the politics, subjectivities, and spatialities of oppositional utopian commons. The thesis assembles and examines five commons utopias: the poetry collection That Winter the Wolf Came by Juliana Spahr (2015); and the novels Exit West by Mohsin Hamid (2017), New York 2140 by Kim Stanley Robinson (2017), The Book of Joan by Lidia Yuknavitch (2017), and Walkaway by Cory Doctorow (2017). I also examine the film Snowpiercer, directed by Bong Joon-ho (2013), as a proto-utopian text which illustrates contemporary modalities of precariousness and crisis. I hope that this study succeeds in identifying and critiquing a valuable recent tendency in contemporary literature and poetics; in contributing to ongoing debates in the field of utopian studies; and in furthering the productive relationship between utopianism and oppositional political theory.
Vitamin K antagonists (VKA) is the primary anticoagulant in most settings of Sub-Saharan Africa. Understanding the quality of anticoagulation services in the continent is vital in optimising the ...intended benefits. This study assessed the quality of anticoagulation and associated factors among VKA-treated patients in nine SSA countries. We conducted a retrospective cohort study of randomly selected patients on anticoagulation from 20 clinics in Botswana, the Democratic Republic of Congo, Ethiopia, Gambia, Ghana, Mozambique, Nigeria, Tanzania, and South Africa. Eligible participants were those on VKAs for at least three months and with at least four international normalised ratios (INR) results in 2019–2021. We report the proportion of INR values in the therapeutic range, time-in-therapeutic range (TTR) using the Rosendaal method, and the proportion of patients with TTR ≥ 65% (optimal anticoagulation). The mean age was 51.1(16.1) years, and 64.2% were women. The most common indications for VKA included venous thromboembolism (29.6%), prosthetic valves (26.7%) and atrial fibrillation/flutter (30.1%). We analysed 6743 INR tests from 1011 participants, and of these, 48.5% were sub-therapeutic, 34.1% therapeutic, and 17.4% were supratherapeutic relative to disease-specific reference ranges. TTR was calculated for 660 patients using 4927 INR measurements. The median (interquartile range IQR) TTR was 35.8(15.9,57.2) %. Optimal anticoagulation control was evident in 19.2% of participants, varying from 2.7% in Tanzania to 23.1% in Ethiopia. The proportion of patients with TTR ≥ 65% was 15,4% for prosthetic heart valves, 21.1% for venous thromboembolism and 23.7% for atrial fibrillation or flutter. Countries with universal health coverage had higher odds of optimal anticoagulation control (adjusted odds ratio (aOR) 1.79, 95% confidence interval CI, 1.15– 2.81, p = 0.01). Patients on VKAs for different therapeutic indications in SSA had suboptimal TTR. Universal health coverage increased the odds of achieving TTR by 79%. The evidence calls for more intensive warfarin management strategies in SSA, including providing VKA services without out-of-pocket payments.
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