Boston inside out: a brothel, a boardinghouse, and the construction of the 19th-century North End's urban landscape through embodied practice

This dissertation examines how the urban landscape of mid-19th-century Boston's North End was constructed and understood—physically, socially, and culturally—by the city's different social groups. Over the course of the 19th century, Boston's North End gained a reputation as a "slum" characterized by its deteriorating buildings, overcrowded housing, and immoral immigrant population—a stereotype that did not reflect the reality of the neighborhood's working-class residents. The dissertation identifies specific experiences, practices, and perceptions that created different understandings of the same physical space. This study makes a significant contribution to the understanding of urban landscapes by incorporating tangible artifacts excavated from domestic contexts in analyzing intangible social processes by employing a practice theory-based framework that interweaves archaeological and historical data to address social structures on multiple spatial scales: Boston as a macro-scale landscape; the medium-scale North End neighborhood; and micro-scale individual actions. The archaeological data analyzed for viii the study originated from two ca. 1850–1880 privy deposits associated with working-class North End households: a brothel/tenement at 27–29 Endicott Street and a boardinghouse at 19–21 North Square. To interpret these data within their historical and cultural context, city directory and census records are cross-referenced with Boston Valuation List tax records to compile a database of residential and commercial activity between 1850 and 1880 on the blocks surrounding these sites. The research shows how the conceptualization of the North End as a "slum" was constructed by middle-class and elite observers to assign personal responsibility to the poor for the structural poverty endemic to a capitalist economy and also to facilitate the development of their own class identities. Archaeological analysis reveals that North End residents constructed their neighborhood landscape by enacting household practices in public spaces, creating a sense of familiarity and control. They re-appropriated objects usually associated with middle-class culture by using them in unintended ways, creating new symbols and values that helped form a distinct working-class culture. By dressing and behaving in public in ways that subverted dominant social norms, working-class Bostonians used their bodies to create an urban landscape in which they and their culture could thrive

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years