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The rapid spread of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) throughout key regions of the United States in early 2020 placed a premium on timely, national surveillance of hospital patient censuses. To meet that need, the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN), the nation’s largest hospital surveillance system, launched a module for collecting hospital coronavirus disease 2019 (COVID-19) data. We present time-series estimates of the critical hospital capacity indicators from April 1 to July 14, 2020.
From March 27 to July 14, 2020, the NHSN collected daily data on hospital bed occupancy, number of hospitalized patients with COVID-19, and the availability and/or use of mechanical ventilators. Time series were constructed using multiple imputation and survey weighting to allow near–real-time daily national and state estimates to be computed.
During the pandemic’s April peak in the United States, among an estimated 431,000 total inpatients, 84,000 (19%) had COVID-19. Although the number of inpatients with COVID-19 decreased from April to July, the proportion of occupied inpatient beds increased steadily. COVID-19 hospitalizations increased from mid-June in the South and Southwest regions after stay-at-home restrictions were eased. The proportion of inpatients with COVID-19 on ventilators decreased from April to July.
The NHSN hospital capacity estimates served as important, near–real-time indicators of the pandemic’s magnitude, spread, and impact, providing quantitative guidance for the public health response. Use of the estimates detected the rise of hospitalizations in specific geographic regions in June after they declined from a peak in April. Patient outcomes appeared to improve from early April to mid-July.
People living in precarious housing or homelessness have higher than expected rates of psychotic disorders, persistent psychotic symptoms, and premature mortality. Psychotic symptoms can be modeled as a complex dynamic system, allowing assessment of roles for risk factors in symptom development, persistence, and contribution to premature mortality.
The severity of delusions, conceptual disorganization, hallucinations, suspiciousness, and unusual thought content was rated monthly over 5 years in a community sample of precariously housed/homeless adults (n = 375) in Vancouver, Canada. Multilevel vector auto-regression analysis was used to construct temporal, contemporaneous, and between-person symptom networks. Network measures were compared between participants with (n = 219) or without (n = 156) history of psychotic disorder using bootstrap and permutation analyses. Relationships between network connectivity and risk factors including homelessness, trauma, and substance dependence were estimated by multiple linear regression. The contribution of network measures to premature mortality was estimated by Cox proportional hazard models.
Delusions and unusual thought content were central symptoms in the multilevel network. Each psychotic symptom was positively reinforcing over time, an effect most pronounced in participants with a history of psychotic disorder. Global connectivity was similar between those with and without such a history. Greater connectivity between symptoms was associated with methamphetamine dependence and past trauma exposure. Auto-regressive connectivity was associated with premature mortality in participants under age 55.
Past and current experiences contribute to the severity and dynamic relationships between psychotic symptoms. Interrupting the self-perpetuating severity of psychotic symptoms in a vulnerable group of people could contribute to reducing premature mortality.
Energy deficit is common during prolonged periods of strenuous physical activity and limited sleep, but the extent to which appetite suppression contributes is unclear. The aim of this randomized crossover study was to determine the effects of energy balance on appetite and physiologic mediators of appetite during a 72-hr period of high physical activity energy expenditure (PAEE, ˜2300kcal/d) and limited sleep designed to simulate military operations (SUSOPS). Ten men consumed an energy-balanced diet while sedentary for 1d (REST) followed by energy balanced (BAL) and energy deficient (DEF) controlled diets during SUSOPS. Appetite ratings, gastric emptying time (GET), and appetite-mediating hormone concentrations were measured. Energy balance was positive during BAL (18±20%) and negative during DEF (-43±9%). Relative to REST, hunger, desire to eat and prospective consumption ratings were all higher during DEF (26±40%, 56±71%, 28±34%, respectively), and lower during BAL (-55±25%, -52±27%, -54±21%, respectively; Pcondition<0.05). Fullness ratings did not differ from REST during DEF, but were 65±61% higher during BAL (Pcondition<0.05). Regression analyses predicted hunger and prospective consumption would be reduced and fullness increased if energy balance were maintained during SUSOPS, and energy deficits of ≥25% would be required to elicit increases in appetite. Between-condition differences in GET and appetite-mediating hormones identified slowed gastric emptying, increased anorexigenic hormone concentrations, and decreased fasting acylated ghrelin concentrations as potential mechanisms of appetite suppression. Findings suggest that physiologic responses that suppress appetite may deter energy balance from being achieved during prolonged periods of strenuous activity and limited sleep.
To identify factors that increase the microbial load in the operating room (OR) and recommend solutions to minimize the effect of these factors.
Observation and sampling study.
Academic health center, public hospitals.
We analyzed 4 videotaped orthopedic surgeries (15 hours in total) for door openings and staff movement. The data were translated into a script denoting a representative frequency and location of movements for each OR team member. These activities were then simulated for 30 minutes per trial in a functional operating room by the researchers re-enacting OR staff-member roles, while collecting bacteria and fungi using settle plates. To test the hypotheses on the influence of activity on microbial load, an experimental design was created in which each factor was tested at higher (and lower) than normal activity settings for a 30-minute period. These trials were conducted in 2 phases.
The frequency of door opening did not independently affect the microbial load in the OR. However, a longer duration and greater width of door opening led to increased microbial load in the OR. Increased staff movement also increased the microbial load. There was a significantly higher microbial load on the floor than at waist level.
Movement of staff and the duration and width of door opening definitely affects the OR microbial load. However, further investigation is needed to determine how the number of staff affects the microbial load and how to reduce the microbial load at the surgical table.
Single-particle reconstruction can be used to perform three-dimensional (3D) imaging of homogeneous populations of nano-sized objects, in particular viruses and proteins. Here, it is demonstrated that it can also be used to obtain 3D reconstructions of heterogeneous populations of inorganic nanoparticles. An automated acquisition scheme in a scanning transmission electron microscope is used to collect images of thousands of nanoparticles. Particle images are subsequently semi-automatically clustered in terms of their properties and separate 3D reconstructions are performed from selected particle image clusters. The result is a 3D dataset that is representative of the full population. The study demonstrates a methodology that allows 3D imaging and analysis of inorganic nanoparticles in a fully automated manner that is truly representative of large particle populations.
Throughout their 250 Myr history, archosaurian reptiles have exhibited a wide array of body sizes, shapes, and locomotor habits, especially in regard to terrestriality. These features make Archosauria a useful clade with which to study the interplay between body size, shape, and locomotor behavior, and how this interplay may have influenced locomotor evolution. Here, digital volumetric models of 80 taxa are used to explore how mass properties and body proportions relate to each other and locomotor posture in archosaurs. One-way, nonparametric, multivariate analysis of variance, based on the results of principal components analysis, shows that bipedal and quadrupedal archosaurs are largely distinguished from each other on the basis of just four anatomical parameters (p < 0.001): mass, center of mass position, and relative forelimb and hindlimb lengths. This facilitates the development of a quantitative predictive framework that can help assess gross locomotor posture in understudied or controversial taxa, such as the crocodile-line Batrachotomus (predicted quadruped) and Postosuchus (predicted biped). Compared with quadrupedal archosaurs, bipedal species tend to have relatively longer hindlimbs and a more caudally positioned whole-body center of mass, and collectively exhibit greater variance in forelimb lengths. These patterns are interpreted to reflect differing biomechanical constraints acting on the archosaurian Bauplan in bipedal versus quadrupedal groups, which may have shaped the evolutionary histories of their respective members.
Clinical intuition suggests that personality disorders hinder the treatment of depression, but research findings are mixed. One reason for this might be the way in which current assessment measures conflate general aspects of personality disorders, such as overall severity, with specific aspects, such as stylistic tendencies. The goal of this study was to clarify the unique contributions of the general and specific aspects of personality disorders to depression outcomes.
Patients admitted to the Menninger Clinic, Houston, between 2012 and 2015 (N = 2352) were followed over a 6–8-week course of multimodal inpatient treatment. Personality disorder symptoms were assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition Axis II Personality Screening Questionnaire at admission, and depression severity was assessed using the Patient Health Questionnaire-9 every fortnight. General and specific personality disorder factors estimated with a confirmatory bifactor model were used to predict latent growth curves of depression scores in a structural equation model.
The general factor predicted higher initial depression scores but not different rates of change. By contrast, the specific borderline factor predicted slower rates of decline in depression scores, while the specific antisocial factor predicted a U shaped pattern of change.
Personality disorder symptoms are best represented by a general factor that reflects overall personality disorder severity, and specific factors that reflect unique personality styles. The general factor predicts overall depression severity while specific factors predict poorer prognosis which may be masked in prior studies that do not separate the two.
The early fifteenth-century Sowdone of Babylon has its roots in a twelfth-century chanson de geste. This chanson blends romance with chivalric violence and nationalistic piety, describing how Charlemagne's knights reclaimed the stolen relics of Christ's crucifixion for the nascent empire of France. Its heroine is the Muslim princess Floripas. Flooded with fiery passion and weeping emotion, she exemplifies the belle sarrasin trope so beloved of French chanson de geste and English romance: the beautiful Muslim woman whose aberrant femininity delimits the boundaries of ideal Christian womanhood, and who is ultimately contained within the structure of Christian marriage. Yet in The Sowdone of Babylon, all certainties are called into question. To anyone familiar with the chanson or the subsequent Anglo-Norman and Middle English versions of the text, the Sowdone of Babylon's most striking quality is what it does not contain. The profuse language of sensuality, which washes through the counterpart texts to infuse both the female protagonist and the religious relics with an almost interchangeable desirability, is nowhere to be found. Desire in the Sowdone is puzzlingly difficult to locate. In this respect, the text stages one of the central questions of this book. Women who do not desire men baffle both medieval and modern categories. How can female desires and emotions defined by resistance to erotic or emotional contact with men be understood, not merely as negative or lacking states, but also as autonomous expressions of sexuality? Related to this enquiry, and often pressed into service in the attempt to pin down these elusive, negatively defined sexualities, is the question of how femininity relates to female sexuality, and how aberrations in gender reflect, predict, coexist with or qualify alternative sexualities. The conversation is not confined to the medieval period, and can be found submerged in some very recent ecofeminist and queer theory. This chapter probes the implications of that seldom-acknowledged relationship between medieval and contemporary, yoking together medieval medical and philosophical theories of female fertility with late medieval anxieties about the pregnant body and the pregnant potential of the relic, to shed light on more recent theories of female, queer and posthuman embodiment. In this chapter, I explore the cultural discourses that inform the Sowdone of Babylon and its tradition, and I argue that the Sowdone's rejection and reconfiguration of those discourses might offer a model for transforming contemporary theorisations of gender and desire.
This book seeks to contextualise the hermeneutic construction of women’s bodies as dangerous and unstable conduits to the expression of deviant desire. I argue that Chaucer's Legend and the Middle English romances explore the possibility of a feminine hermeneutic that considers how differently language might work if we contemplated the possibility of women speaking their desires. In the Legend, this feminine hermeneutic is a nightmarish possibility, in which woman's expressions of desire function as monstrous prostheses, failing to articulate or signify, and simultaneously rendering the bodies they supplement grotesque and deviant. By contrast, the feminine hermeneutic of the romances functions as a technological prosthesis, equipping female characters with new, innovative mechanisms through which they may express and structure their desires. These two representations of feminine hermeneutics are not purely and simply polar opposites, the one negative and pejorative, the other positive and affirming. The Legend, even as it constructs female desires as irrevocably deviant in their articulation, also necessarily constructs a space in which those desires are articulated. It affords them visibility and substance, however circumscribed by censure. The romances, meanwhile, rely upon a surrogacy of embodied desire, constantly using male bodies to ventriloquise female emotions, and thus they insinuate that female emotion is only truly visible, truly palpable, when articulated by and through men. The tensions within these differing attempts to construct a feminine hermeneutic shed light on interpretative practices in a wide sense. In this conclusion, I use the Legend and the romances read both backwards and forwards across hermeneutic traditions. I re-situate the Latin hermeneutics of Jerome and the work of Jean de Meun in relation to an English fourteenth- and fifteenth-century intervention that makes visible the female desires so often left out of consideration. I also seek to reinterpret our own practices as medievalists working on medieval texts, and on medieval women, their embodied desires and emotions.
THE FAILED ENDS OF THE LEGEND's WOMEN
My reading of Chaucer's Legend locates that text within a complex hermeneutic tradition stretching from Jerome's patristic Latin to Jean de Meun’s influential vernacular poetics. There the feminine is coded as a blank space, a tablet to be inscribed or a body to be impregnated. This works to displace or occlude female desires and emotions, to render them rhetorically null. She who has no agency has no desires worth considering.
The ‘Legend of Hipsiphyle and Medea’ continues Chaucer's exploration of the deformations of language that arise from the attempt to articulate female desire. The tale forms part of a sequence of stories about relictae, women abandoned in love, whose paradigmatic example is the Carthaginian queen Dido, subject of Chaucer's third legend. Interpreted as an exemplum of hermeneutic practice, her story posits an intimate relationship between reading and desire, which informs the ‘Legend of Hipsiphyle and Medea’. Defined by her retrograde position in the text, the relicta exerts a pull away from the narrative, geographic and hermeneutic trajectories followed by men. She opens up a space for fluctuating desire, for the back-and-forth of translation, for the seductive pull of texts against teleological history. Many writers, from Virgil onwards, toy with the idea of representing their heroes as deviating briefly from heroic masculinity, or even displaying qualities of what we might call male femininity. Chaucer, however, raises questions about the women’s desires, and the ways in which those desires mobilise or unfix, reflect or reveal, the gendered orientation of their bodies. He presents the antagonist of the ‘Legend of Hipsiphyle and Medea’, the faithless Jason, as a ‘queering device’, whose studied performance of male femininity exposes the latent deviancies of the women he encounters. Drawing together work by Dinshaw, Freeman and Hsy, I argue that the ‘Legend of Hipsiphyle and Medea’ shows how the reciprocality of emotion the women seek is fractured into asynchronous, displaced and unsuccessful attempts to script a new language of desire. As Jason cynically constructs himself as a desirably feminine copy of Aeneas, Hipsiphyle and Medea fail to perceive the duplicitous mobility of his gendered performances. Their desires are thus imbricated with misreadings and failures of citation; their linguistic lack (of Latin) is analogised to the phallic absence that renders female masculinity impotent and inconclusive.
THE RELICTA PARADIGM IN THE LEGEND
The relicta trope in Classical legend is embedded in tales of men flung from shore to shore, propelled by tides, shipwrecked and washed up, driven here and there by storms. Surrounded by and even submerged in the watery element that medieval philosophers and medics associate with the humoral composition of the female body, at the mercy of lunar tides, these men are temporarily unmoored from masculinity. Sea journeys figure the transitional state between immaturity and virile masculinity.
And the Lord God said: It is not good for man to be alone: let us make him a help like unto himself. … The Lord God cast a deep sleep upon Adam: and when he was fast asleep, he took one of his ribs, and filled up flesh for it. And the Lord God built the rib which he took from Adam into a woman: and brought her to Adam. And Adam said: This now is bone of my bones, and flesh of my flesh; she shall be called woman, because she was taken out of man.
(Genesis 2: 21–23)
This passage from Genesis encapsulates the fundamental tensions that attend on medieval representations of female desire. At the moment of his creation, man is complete. His body can only be diminished. But the creation of woman leaves an absence, and she has no fixed definition without reference to that diminished masculinity. Woman is so called, because she was taken out of man. She is constantly defined in the negative and constantly troubled by absences, missing pieces and incomplete beginnings. Her construction follows a prosthetic logic, both in the literal sense that it involves the substitution of one body part (flesh) for another (the rib), and in the epistemic sense Derrida proposes, where the prosthetic is both ‘compensatory and vicarious … an adjunct, a subaltern instance which takes-(the)-place’. A prosthetic both supplements and announces a pre-existing lack, taking the place of what is missing and simultaneously acting as an ever-visible reminder of that lack, by its difference from the substance it replaces. The problem of incompleteness, of prosthetic desire and absent masculine body parts, haunts the imaginary of female desire from Eve onwards.
In a subversive visual twist on the narrative of Genesis, found in a manuscript copied in France in the early fourteenth century, we find the story of the temptation in Eden reflected forwards. In Paris, Bibliothèque nationale de France, MS Fr. 25526, beneath text from Jean de Meun's portion of the Roman de la Rose, there stands a woman clad in a habit and wimple. Beside her, a fruit tree bears a startling crop of pear-like penises that evoke the forbidden apples of the Tree of Knowledge. As the nun reaches for these organs seemingly removed from a male body, her plucking of phallic fruit recalls the moment of Eve's creation from Adam's rib.
Few Middle English authors save Chaucer can claim so widespread a presence in the works of sixteenth-century authors as the anonymous creator of the late fifteenth-century romance Undo Your Door. The text was printed at least twice in the sixteenth century, survives in two different versions and is listed in the Day Book of John Dorne alongside other well-known romances. Spenser retells the tale in the Faerie Queene; Thomas Nashe knows it; Beaumont and Fletcher use its alternative title ‘Squire of Low Degree’ as an insulting epithet in their plays, and Shakespeare borrows its striking image of anagram-solving for Malvolio. Yet scholars have struggled with its chaotically amalgamated representations of romantic desire, taking refuge in the ascription of its popularity to its parodic undermining of an ‘outmoded’ genre steadily going out of fashion. Recent reconsiderations of romance as a genre and periodisation as a practice urge us to reconsider that reading, and to ask again what earlier readers found so compelling, so suggestively evocative, in Undo Your Door. I argue that the romance pointedly locates itself within a Chaucerian tradition of subversive writing, and that it layers together tropes and images associated with female desire, which we have seen operating in various texts and contexts earlier in this book. We see female sexuality represented as a transgressive yet creative force, which disrupts expectations of male–female sexual and erotic relations and assembles its own objects of desire from inanimate materials and from mechanisms disturbingly reminiscent of the objects medieval writers associated with same-sex desire and female autoerotic satisfaction. In this, the romance upends and dissects the paradigm of masculine authority and female passivity in both textual and sexual operations.
CRACKED COPIES: THE REPRODUCTIVE AESTHETICS OF UNDO YOUR DOOR
Undo Your Door has been widely interpreted as the last gasp of the medieval romance tradition, a retrospective parody of the genre that undermines the long-established tropes of chivalric masculinity and reproductive desire. Certainly, the characters are recognisable from earlier romances. There is the low-born hero who proves his worth as a knight; the jealous steward who arranges ham-fisted sabotage; the capricious father, who ultimately capitulates to his son-in-law; and, above all, the desired lady. Yet the plot that draws these familiar elements together is oddly out of joint.
The violent silencing of female desire that lies at the heart of Chaucer’s ‘Legend of Philomela’ also pervades the romance that is the subject of this chapter: the alliterative Morte Arthure. I argue that, like the Legend, this romance presents two almost equally unappealing possibilities: the first, that female desire is simply irrelevant to a poetics founded on rape; the second, that any attempt to articulate or depict female desire must result in sodomitic disruptions to the poetic, narrative and linguistic structures of the text. Written around 1400, the alliterative Morte concentrates upon that most enduringly popular subject of romance: the Matter of Britain and the exploits of King Arthur. Rooted in the chronicles of Geoffrey of Monmouth, Layamon and Wace, the poem is permeated by military and political concerns, European campaigns and set-piece jousts, treachery and usurpation and civil war. Women rarely feature, and scenes of love or desire between men and women are entirely absent. Yet I argue that a brutal rape, early in the text, holds the key to the poem's strangely repetitive structure and odd outbreaks of mingled innuendo and emotion. Drawing on work in trauma theory, I read the Morte as a ‘traumatised narrative’, a narrative whose structure responds to the ‘forgotten wound’ of the rape, which is repeatedly re-performed through scenes of jarring, comedic or parodic episodes of violence and intimacy between men. As with the ‘Legend of Philomela’, this displaced representation of silenced female suffering brings coherence to seemingly dissonant, fragmented, repetitive and structurally disarticulated aspects of the poem. The Morte thus exemplifies the dynamic we will find in other late medieval English romances. It makes space for the expression of female emotions within and through masculine bodies, yet in so doing, it constructs a hermeneutic wherein female emotion is legible only as it takes on the visible contours of sodomitic masculine desire.
EVERYWHERE AND NOWHERE: FORGETTING RAPE IN THE ALLITERATIVE MORTE ARTHURE
The alliterative Morte Arthure is one of several Middle English treatments of the narrative of the death of King Arthur, following the many Latin and French texts that told and retold the famous story.
This chapter confronts the fundamental problem of representing female desire, according to the hermeneutic theories I discuss in the introduction to this book. How can we speak of that which has no definition without reference to an originating masculine desire, unless we speak of it in relation to that masculine desire? At its most brutal, the paradigm we are looking at is Jerome's analogy of rape to textual interpretation, which proposes female desire as an irrelevance to the masculine making of meaning. It is this act of rape, and the silencing that results from it, that lie at the centre of Chaucer's ‘Legend of Philomela’, a text that seeks to explore how female desire might be given space to speak within a context in which it is almost automatically silenced. Raped and mutilated, Philomela weaves her story in tapestry, after her rapist cuts out her tongue. Taking up her narrative from a host of Classical and medieval sources, Chaucer enacts a parallel mutilation. Slashing through the familiar plot, he replicates the damage done to Philomela's body by cutting out the traditional conclusion to her story, leaving only an inarticulate ‘remenaunt’ (line 2383) to which he refuses to give voice. This much-remarked disruption is one of many disjunctive moments within the expected sequence of the narrative, and it serves to conflate two mutilated bodies: the textual corpus of the Philomela myth, and the tongueless, violated woman. As such, the ‘Legend of Philomela’ pointedly recalls Jerome's hermeneutic, and invites readers to reflect upon that traditional conflation of female body with feminised text, to try to understand what is missing, or inarticulate, within the traditional hermeneutic paradigm with which we are presented. Yet as the ‘Legend’ interrogates Jerome's paradigm, it illustrates the remarkable power of that hermeneutic denial of female desire, repeatedly representing attempts to articulate female desire as splintering off into images of deviancy and sexual dissidence. For Philomela, there is no way to articulate a female emotional experience, except by taking on the tools and linguistic strategies gendered masculine, a process that causes her to resemble other women whose appropriation of masculine tools indicates their sexual deviancy. As women seek to voice their emotions, they are forced to take on the habitus, the stance, the rhetorical or somatic devices associated with female deviant desires.