"Yo sé quién soy": Don Quixote, Don Diego de Miranda and the Paradox of Self-Knowledge

En el Quijote, el problema que encierra la máxima socrática ¿Conócete a ti mismo¿ se dramatiza de modo explícito en los capítulos dedicados al encuentro entre don Quijote y don Diego de Miranda, ¿El Caballero del Verde Gabán¿ (II, 16-18). El presente ensayo investiga el problema del autoconocimiento que se manifiesta en estos capítulos a la luz de la tradición retórica de la paradoja en occidente. Para ello, comienza el estudio con una breve descripción de las tres principales acepciones del término ¿paradoja¿ y de tres fuentes importantes de la literatura paradójica. Conocedor e innovador de esta tradición, Cervantes emplea el encuentro entre dos hidalgos, contrarios y complementarios a la vez, para presentar el problema del autoconocimiento como un quehacer en sí paradójico, radicado en un diálogo siempre inacabado entre el ¿yo¿ y el ¿otro.¿ Además, se observa que Cervantes estructura la narración de este episodio de modo que el reto implícito que presenta don Quijote, en cuanto casi-espejo, para que don Diego examine su concepto de sí mismo, funcione como un reflejo del reto análogo que el texto presenta a su lector. Así, Cervantes realza la idea de su texto como espejo móvil, discursivo, en el que el lector se va observando y, quizá, examinando a sí mismo, en su esfuerzo por conciliar las contradicciones aparentes, o los complementarios contrarios, de lo narrado

Precious Exchanges: The Poetics of Desire, Power, and Reciprocity in Cervantes's La gitanilla

A la luz de teorías sociales tanto antiguas como contemporáneas ¿la Etica Nicómaco de Aristóteles, la llamada ¿teoría del intercambio¿ (¿exchange theory¿) que proviene de la sociología norteamericana, y la ¿economía general¿ que examina el ¿ateo religioso¿ Georges Bataille en su Parte Maldita¿ el presente estudio indaga sobre el ¿sistema de intercambio¿ (Sieber) que estructura la acción social en La gitanilla. Tras una breve introducción teórica, el análisis se concentra en Preciosa como agente de cambio ético y estético, capaz de elevar los actos sociales basados en ¿la utilidad¿ y ¿el placer¿ a su propia poética narrativa y social, que radica en el principio de la amistad caritativa y la entrega mutua, semejante a lo que Bataille llama ¿dépense,¿ o el desperdicio. El resultado es una ganancia máxima en los ámbitos personales y colectivos del poder y el deseo. Se concluye que, a través de Preciosa, protagonista emblemática y única a la vez, el cuento representa su propio acto poético y la poesía en general como una valiosa transacción comunitaria, efectuada en moneda verbal, que pertenece a la economía artística del ocio. Dicha economía funciona como mediadora entre lo que Cervantes identifica en su Prólogo como la economía utilitaria del ¿negocio¿ y la economía divina de ¿los templos.

Clinical Differences and Outcomes between Methamphetamine-associated and Idiopathic Pulmonary Arterial Hypertension in the Pulmonary Hypertension Association Registry.

Rationale: Single-center studies demonstrated that methamphetamine use is associated with pulmonary arterial hypertension (Meth-APAH). We used the Pulmonary Hypertension Association Registry to evaluate the national distribution of Meth-APAH and to compare its impact on patient-reported and clinical outcomes relative to idiopathic PAH.Objectives: To determine if patients with Meth-APAH differ from those with idiopathic PAH in demographics, regional distribution in the United States, hemodynamics, health-related quality of life, PAH-specific treatment, and health care use.Methods: The Pulmonary Hypertension Association Registry is a U.S.-based prospective cohort of patients new to care at a Pulmonary Hypertension Care Center. The registry collects baseline demographics, clinical parameters, and repeated measures of health-related quality of life, World Health Organization functional class, 6-minute walk distance, therapy, and health care use. Repeated measures of functional class, health-related quality of life, type of therapy, emergency department visits, and hospitalizations were compared using generalized estimating equations.Results: Of 541 participants included, 118 had Meth-APAH; 83% of Meth-APAH arose in the western United States. The Meth-APAH group was younger and had a poorer socioeconomic status and lower cardiac index than the idiopathic PAH group, despite no difference in mean pulmonary artery pressure or pulmonary vascular resistance. The Meth-APAH group had a more advanced functional class in longitudinal models (0.22 points greater; 95% confidence interval [CI], 0.07 to 0.37) and worse PAH-specific (emPHasis-10) health-related quality of life (-5.4; 95% CI, -8.1 to -2.8). There was no difference in dual combination therapy; however, participants with Meth-APAH were less likely to be initiated on triple therapy (odds ratio [OR], 0.43; 95% CI, 0.24 to 0.77) or parenteral therapy (OR, 0.10; 95% CI, 0.04 to 0.24). Participants with Meth-APAH were more likely to seek care in the emergency department (incidence rate ratio, 2.30; 95% CI, 1.71 to 3.11) and more likely to be hospitalized (incidence rate ratio, 1.42; 95% CI, 1.10 to 1.83).Conclusions: Meth-APAH represents a unique clinical phenotype of PAH, most common in the western United States. It accounts for a notable proportion of PAH in expert centers. Assessment for methamphetamine use is necessary in patients with PAH

Obesity in Pulmonary Arterial Hypertension (PAH): The Pulmonary Hypertension Association Registry (PHAR).

RationaleObesity is associated with pulmonary arterial hypertension (PAH), but its impact on outcomes such as health-related quality of life (HRQoL), hospitalizations and survival is not well understood.ObjectivesTo assess the effect of obesity on health-related quality of life (HRQoL), hospitalizations and survival in patients with PAH.MethodsWe performed a cohort study of adults with PAH from the Pulmonary Hypertension Association Registry, a prospective multicenter registry. Multivariate linear mixed effects regression was used to examine the relationship between weight categories and HRQoL using the Short Form-12 (SF-12) and emPHasis-10 (e10). We used multivariable negative binomial regression to estimate hospitalization incidence rate ratios (IRRs) and Cox regression to estimate hazard ratios (HRs) for transplant-free survival by weight status.Results767 subjects were included: mean age of 57 years, 74% female, 33% overweight and 40% obese, with median follow-up duration of 527 days. Overweight and obese patients had higher baseline e10 scores (worse HRQoL), which persisted over time (p<0.001). The overweight and obese have a trend towards increased incidence of hospitalizations compared to normal weight (IRR 1.34, 95% confidence interval (95%CI) 0.94-1.92 and 1.33, 95%CI 0.93-1.89, respectively). Overweight and obese patients had lower risk of transplant or death as compared to normal weight patients (HR 0.45, 95%CI 0.25-0.80 and 0.39, 95%CI 0.22-0.70, respectively).ConclusionsIn a large multicenter, prospective cohort of PAH, overweight and obese patients had worse disease-specific HRQoL despite better transplant-free survival compared to normal weight patients. Future interventions should address the specific needs of these patients

"A Riotous Spray of Words": Rethinking the Medieval Theory of Satire

This article offers a reconsideration of the theory of satire found in medieval exegesis. While acknowledging the importance of recent scholarship on the subject, such as the studies by Paul Miller and Udo Kindermann, it also seeks to develop the findings of this criticism further. Particular attention is paid to commentaries that offer more unusual remarks on classical satire. It is argued that these observations constitute a second tendency in the medieval response to satire, which identifies more scurrilous and disruptive potential in the genre