Género, espacio y lugar: la experiencia del servicio en el hogar rural de la temprana Edad Moderna

This article examines the organisation and use of domestic space by servants for eating and sleeping, looking particularly at the seventeenth century and at middling sort households, broadly defined. It relates models of architectural and social change to the ways that individuals described their experience and use of domestic space in court records. It concludes that while there was a trend to separate the work and living spaces of servants from the rest of the family, an early modern house was not one where rigid and static social patterns were mapped upon its spaces. A number of social factors struggled to define the social character of a space, a struggle which largely pivoted around the concepts of control and use rather than separation or segregation according to status or gender. Spatial patterns were ephemeral. Nonetheless, it is possible to illustrate how some aspects of the social relations of the household were reflected in and reinforced by the way that domestic space was organised and used. Moreover, the implications of such use and organisation carry important messages about the nature of the household itself.Este artículo examina la organización y el uso del espacio doméstico de los sirvientes durante el siglo XVII y en hogares de clase media. Relaciona los modelos de cambio arquitectónico y social con las formas en que los individuos describieron su experiencia y uso del espacio doméstico en los registros judiciales. Concluye que, si bien existía una tendencia a separar el trabajo y los espacios de vida de los sirvientes del resto de la familia, una casa moderna temprana no era aquella en la que los patrones sociales rígidos y estáticos estaban mapeados. Una serie de factores sociales lucharon por definir el carácter social de un espacio, una lucha que giró en torno a los conceptos de control y uso en lugar de separación o segregación según el estatus o el género. Los patrones espaciales fueron efímeros, no obstante, es posible ilustrar cómo algunos aspectos de las relaciones sociales de la familia se reflejaron y se reforzaron por la forma en que se organizó y utilizó el espacio doméstico.Dossier: El trabajo doméstico y sirviente en la Europa rural (SS. XVI-XIX). Diversidad de modelos regionales y formas de dependencia.Facultad de Humanidades y Ciencias de la Educació

Género, espacio y lugar: la experiencia del servicio en el hogar rural de la temprana Edad Moderna

This article examines the organisation and use of domestic space by servants for eating and sleeping, looking particularly at the seventeenth century and at middling sort households, broadly defined. It relates models of architectural and social change to the ways that individuals described their experience and use of domestic space in court records. It concludes that while there was a trend to separate the work and living spaces of servants from the rest of the family, an early modern house was not one where rigid and static social patterns were mapped upon its spaces. A number of social factors struggled to define the social character of a space, a struggle which largely pivoted around the concepts of control and use rather than separation or segregation according to status or gender. Spatial patterns were ephemeral. Nonetheless, it is possible to illustrate how some aspects of the social relations of the household were reflected in and reinforced by the way that domestic space was organised and used. Moreover, the implications of such use and organisation carry important messages about the nature of the household itself.Este artículo examina la organización y el uso del espacio doméstico de los sirvientes durante el siglo XVII y en hogares de clase media. Relaciona los modelos de cambio arquitectónico y social con las formas en que los individuos describieron su experiencia y uso del espacio doméstico en los registros judiciales. Concluye que, si bien existía una tendencia a separar el trabajo y los espacios de vida de los sirvientes del resto de la familia, una casa moderna temprana no era aquella en la que los patrones sociales rígidos y estáticos estaban mapeados. Una serie de factores sociales lucharon por definir el carácter social de un espacio, una lucha que giró en torno a los conceptos de control y uso en lugar de separación o segregación según el estatus o el género. Los patrones espaciales fueron efímeros, no obstante, es posible ilustrar cómo algunos aspectos de las relaciones sociales de la familia se reflejaron y se reforzaron por la forma en que se organizó y utilizó el espacio doméstico.Dossier: El trabajo doméstico y sirviente en la Europa rural (SS. XVI-XIX). Diversidad de modelos regionales y formas de dependencia.Facultad de Humanidades y Ciencias de la Educació

Use of Coronary Computed Tomographic Angiography to guide management of patients with coronary disease

Background In a prospective, multicenter, randomized controlled trial, 4,146 patients were randomized to receive standard care or standard care plus coronary computed tomography angiography (CCTA). Objectives The purpose of this study was to explore the consequences of CCTA-assisted diagnosis on invasive coronary angiography, preventive treatments, and clinical outcomes. Methods In post hoc analyses, we assessed changes in invasive coronary angiography, preventive treatments, and clinical outcomes using national electronic health records. Results Despite similar overall rates (409 vs. 401; p = 0.451), invasive angiography was less likely to demonstrate normal coronary arteries (20 vs. 56; hazard ratios [HRs]: 0.39 [95% confidence interval (CI): 0.23 to 0.68]; p < 0.001) but more likely to show obstructive coronary artery disease (283 vs. 230; HR: 1.29 [95% CI: 1.08 to 1.55]; p = 0.005) in those allocated to CCTA. More preventive therapies (283 vs. 74; HR: 4.03 [95% CI: 3.12 to 5.20]; p < 0.001) were initiated after CCTA, with each drug commencing at a median of 48 to 52 days after clinic attendance. From the median time for preventive therapy initiation (50 days), fatal and nonfatal myocardial infarction was halved in patients allocated to CCTA compared with those assigned to standard care (17 vs. 34; HR: 0.50 [95% CI: 0.28 to 0.88]; p = 0.020). Cumulative 6-month costs were slightly higher with CCTA: difference $462 (95$303 to $621). Conclusions In patients with suspected angina due to coronary heart disease, CCTA leads to more appropriate use of invasive angiography and alterations in preventive therapies that were associated with a halving of fatal and non-fatal myocardial infarction. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590

Symptoms and quality of life in patients with suspected angina undergoing CT coronary angiography: a randomised controlled trial.

BACKGROUND: In patients with suspected angina pectoris, CT coronary angiography (CTCA) clarifies the diagnosis, directs appropriate investigations and therapies, and reduces clinical events. The effect on patient symptoms is currently unknown. METHODS: In a prospective open-label parallel group multicentre randomised controlled trial, 4146 patients with suspected angina due to coronary heart disease were randomised 1:1 to receive standard care or standard care plus CTCA. Symptoms and quality of life were assessed over 6 months using the Seattle Angina Questionnaire and Short Form 12. RESULTS: Baseline scores indicated mild physical limitation (74±0.4), moderate angina stability (44±0.4), modest angina frequency (68±0.4), excellent treatment satisfaction (92±0.2) and moderate impairment of quality of life (55±0.3). Compared with standard care alone, CTCA was associated with less marked improvements in physical limitation (difference -1.74 (95% CIs, -3.34 to -0.14), p=0.0329), angina frequency (difference -1.55 (-2.85 to -0.25), p=0.0198) and quality of life (difference -3.48 (-4.95 to -2.01), p<0.0001) at 6 months. For patients undergoing CTCA, improvements in symptoms were greatest in those diagnosed with normal coronary arteries or who had their preventative therapy discontinued, and least in those with moderate non-obstructive disease or had a new prescription of preventative therapy (p<0.001 for all). CONCLUSIONS: While improving diagnosis, treatment and outcome, CTCA is associated with a small attenuation of the improvements in symptoms and quality of life due to the detection of moderate non-obstructive coronary artery disease. TRIAL REGISTRATION NUMBER: NCT01149590

Coronary CT Angiography and 5-Year Risk of Myocardial Infarction.

BACKGROUND: Although coronary computed tomographic angiography (CTA) improves diagnostic certainty in the assessment of patients with stable chest pain, its effect on 5-year clinical outcomes is unknown. METHODS: In an open-label, multicenter, parallel-group trial, we randomly assigned 4146 patients with stable chest pain who had been referred to a cardiology clinic for evaluation to standard care plus CTA (2073 patients) or to standard care alone (2073 patients). Investigations, treatments, and clinical outcomes were assessed over 3 to 7 years of follow-up. The primary end point was death from coronary heart disease or nonfatal myocardial infarction at 5 years. RESULTS: The median duration of follow-up was 4.8 years, which yielded 20,254 patient-years of follow-up. The 5-year rate of the primary end point was lower in the CTA group than in the standard-care group (2.3% [48 patients] vs. 3.9% [81 patients]; hazard ratio, 0.59; 95% confidence interval [CI], 0.41 to 0.84; P=0.004). Although the rates of invasive coronary angiography and coronary revascularization were higher in the CTA group than in the standard-care group in the first few months of follow-up, overall rates were similar at 5 years: invasive coronary angiography was performed in 491 patients in the CTA group and in 502 patients in the standard-care group (hazard ratio, 1.00; 95% CI, 0.88 to 1.13), and coronary revascularization was performed in 279 patients in the CTA group and in 267 in the standard-care group (hazard ratio, 1.07; 95% CI, 0.91 to 1.27). However, more preventive therapies were initiated in patients in the CTA group (odds ratio, 1.40; 95% CI, 1.19 to 1.65), as were more antianginal therapies (odds ratio, 1.27; 95% CI, 1.05 to 1.54). There were no significant between-group differences in the rates of cardiovascular or noncardiovascular deaths or deaths from any cause. CONCLUSIONS: In this trial, the use of CTA in addition to standard care in patients with stable chest pain resulted in a significantly lower rate of death from coronary heart disease or nonfatal myocardial infarction at 5 years than standard care alone, without resulting in a significantly higher rate of coronary angiography or coronary revascularization. (Funded by the Scottish Government Chief Scientist Office and others; SCOT-HEART ClinicalTrials.gov number, NCT01149590 .)

3. SPACE, PLACE, AND GENDER: THE SEXUAL AND SPATIAL DIVISION OF LABOR IN THE EARLY MODERN HOUSEHOLD

Much has been written about the history of the work of men and women in the premodern past. It is now generally acknowledged that early modern ideological assumptions about a strict division of work and space between men and productive work outside the house on the one hand, and women and reproduction and consumption inside the house, on the other, bore little relation to reality. Household work strategies, out of necessity, were diverse. Yet what this spatial complexity meant in particular households on a day-to-day basis and its consequences for gender relationships is less clear and has received relatively little historical attention. The aim of this paper is to add to our knowledge through a case study of the way that men and women used and organized space for work in the county of Essex during the "long seventeenth century." Drawing on critiques of the concept of "separate spheres" and the models of economic change to which it relates, together with local/micro historical methods, it places evidence within an appropriate regional context to argue that spatial patterns were enormously varied in early modern England and a number of factors - time, place, occupation, and status, as well as gender - determined them. Understanding of the dynamic, complex, uneven purchase of patriarchy upon the organization, imagination, and experience of space has important implications for approaches to gender relations in early modern England. It raises additional doubts about the utility of the separate spheres analogy, and particularly the use of binary oppositions of male/female and public/private, to describe gender relations and their changes in this period and shows that a deeper understanding demands more research into the local contexts in which the gendered division and meaning of work was negotiated. © Wesleyan University 2013

Gender, Space, and Place: The Experience of Service in the Early Modern English Household c.1580?1720

The boundary between home and work was very blurred in early modern England. Domestic production was an essential element of early modern life and many families had servants and apprentices living and working with them under the same roof. But, to date, little investigation has been conducted into the impact that these practices had on the character of domestic space and how experience varied between different household members. This article attempts to redress the balance by focusing on the ways in which early modern middling householders organized eating and sleeping in the spaces that they shared with their servants. It argues that fixed social patterns were not inscribed upon early modern homes. Rooms were multifunctional; their use and meaning constantly shifted. Moreover, lack of space in most households meant that separation or segregation according to rank or gender was not possible or practical. Nonetheless, the organization of space for these everyday activities played an important role in the expression of the social, age, and gender hierarchies that ordered the early modern domestic world