“WHAT DOES A WOMAN WANT?” EMBRACING THE GODDESS IN MEDIEVAL ROMANCE

This paper examines an archetype, or mytheme, that lies at the heart of a medieval tale, Chaucer’s Wife of Bath’s Tale from The Canterbury Tales. Writers of the fourteenth century used classical mythology as a way of aligning themselves with a revered past and Celtic myth asa way of incorporating the pre-Christian heritage of magic. The mythic narrative employed often changed form to serve the author’s purpose. The Celtic archetype in the Wife’s Tale, an image of transformation, was transformed by Chaucer so that it contributed to the ongoing argumentsthroughout the Tales about marriage and the nature of women. One of the most compelling images in European mythology is the hero’s embrace of the goddess. This great moment is often represented as a mystical marriage, the hieros gamos, which was described by Carl Gustav Jungas the union of self and soul. This ancient story appears in many versions in medieval European literature, including Chaucer’s Wife of Bath’s Tale from the Canterbury Tales. It is tempting to read Chaucer’s Wife’s tale as a woman’s story: it is told by a female character and arguably bearssome relation to the psychology of that character; it is based on an offense done to a young woman; it features the magical hag as a central character; it demonstrates the significant political power of the queen’s court. However, the Wife’s tale derives from the ancient Celtic myth withits archetypal patterns for masculine development. This paper will explore the implications of the myths of the old hag, sometimes called the Loathly Lady, for Chaucer’s Wife’s tale as well as other medieval romances, and it will offer a reading that respects the masculine dynamic implicit in the mythic foundation.“O QUE A MULHER DESEJA?” – ABRAÇANDO A DEUSA NO ROMANCE MEDIEVALEste ensaio examina um arquétipo que é central a um conto medieval, “O Conto da Mulher de Bath”, de Os Contos de Cantuária, de Chaucer. Os escritores do século XIV usavam a mitologia clássica como um modo de se associar ao mito celta e a um passado reverenciado, de forma a incorporar uma herança pré-cristã. A narrativa mítica empregada freqüentemente trocava de forma para servir aos propósitos do autor. O arquétipo celta em “O Conto da Mulher de Bath”, uma imagem de transformação, foi mudada por Chaucer de forma a contribuir para os argumentos apresentados ao longo dos Contos sobre o casamento e a natureza das mulheres. Uma das mais interessantes imagens da mitologia européia é a do abraço do herói à deusa. Este grande momento é freqüentemente representado como um casamento místico, o hieros gamos, que foi descrito por Carl Gustav Jung como a união do eu e da alma. Esta história aparece em muitas versõesda literatura européia medieval, inclusive em “O Conto da Mulher de Bath”, em Os Contos de Cantuária de Chaucer. É tentador ler esse conto como uma história de uma mulher: é contado por uma personagemfeminina e tem relação com sua psicologia; é baseado numa ofensa cometida contra uma jovem mulher, tem como seu personagem central a velha e feia mágica e demonstra o significativo poder político da corte darainha. Contudo, “O Conto da Mulher de Bath” deriva de antigo mito celta, com seus padrões para o desenvolvimento masculino. Este estudo explora as implicações do mito da velha feia, algumas vezes chamada de Dama Repugnante, no conto de Chaucer e em outros romances medievais, e oferece uma leitura da dinâmica masculina implícita nesse mito fundacional

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

Older adults’ home- and community-based care service use and residential transitions: a longitudinal study

<p>Abstract</p> <p>Background</p> <p>As Home-and Community-Based Services (HCBS), such as skilled nursing services or personal care services, have become increasingly available, it has become clear that older adults transit through different residential statuses over time. Older adults may transit through different residential statuses as the various services meet their needs. The purpose of this exploratory study was to better understand the interplay between community-dwelling older adults’ use of home- and community-based services and their residential transitions.</p> <p>Methods</p> <p>The study compared HCBS service-use patterns and residential transitions of 3,085 older adults from the Second Longitudinal Study of Aging. Based on older adults’ residential status at the three follow-up interviews, four residential transitions were tracked: (1) Community-Community-Community (CCC: Resided in community during the entire study period); (2) Community-Institution-Community (CIC: Resided in community at T1, had lived in an institution at some time between T1 and T2, then had returned to community by T3); (3) Community-Community-Institution (CCI: Resided in community between at T1, and betweenT1 and T2, including at T2, but had used institutional services between T2 and T3); (4) Community-Institution-Institution (CII: Resided in community at T1 but in an institution at some time between T1 and T2, and at some time between T2 and T3.).</p> <p>Results</p> <p>Older adults’ use of nondiscretionary and discretionary services differed significantly among the four groups, and the patterns of HCBS use among these groups were also different. Older adults’ use of nondiscretionary services, such as skilled nursing care, may help them to return to communities from institutions. Personal care services (PCS) and senior center services may be the key to either support elders to stay in communities longer or help elders to return to their communities from institutions. Different combinations of PCS with other services, such as senior center services or meal services, were associated with different directions in residential transition, such as CIC and CII respectively.</p> <p>Conclusions</p> <p>Older adults’ differing HCBS use patterns may be the key to explaining older adults’ transitions. Attention to older adults’ HCBS use patterns is recommended for future practice. However, this was an exploratory study and the analyses cannot establish causal relationships.</p