A Psychoneuroimmunological Reading of Jane Austen's Persuasion in the Context of Bodily Aging.

Jane Austen normally avoids discussing appearance throughout her works. Persuasion constitutes the exception to the rule, as the story focuses on the premature aging experienced by her protagonist, Anne Elliot, seemingly due to disappointed love. Much has been written about Anne's "loss of bloom," but never from the perspective of psychoneuroimmunology, the field that researches the interrelation between psychological processes and the nervous and immune systems. In this paper, we adopt a perspective of psychoneuroimmunology to argue that Austen established a connection between psychological distress, specifically lovesickness, and the development of early senescence signs, and vice versa, since the recovery of love is associated with happiness and physical glow. From a gender perspective, we discuss how Austen brightly reflected these interrelationships through the story of Anne, when the latest psychoneuroimmunological research has actually shown that women age earlier than men as a consequence of psychological turmoil.

(Un)triggering Anorexia: A Cognitive Literary Analysis of Lia "the Liar" in Wintergirls (2009).

The importance of authorial intention has been debated extensively in literary studies. In cognitive literary studies, however, the effects books provoke in readers are of greater relevance. With an unreliable intradiegetic narrator, ambivalent about her denial of hunger, Wintergirls (2009), a US YA anorexia novel, embodies the spiraling network of lies that feeds this condition. This essay takes Wintergirls as a starting point to discuss the therapeutic or harmful effects of literature, over and above the intentions of the writer. Adopting a cognitive literary perspective, this essay proposes the concept of an "unreliable reader," and uses that concept to demonstrate that the novel has a self-triggering potential to reinforce anorexia. This is an unusual approach, inasmuch as it runs counter to previous positive literary criticism of Wintergirls, but it is a perspective in urgent need of reconsideration for the sake of disordered readers.

Pulmonary hypertension in adults with congenital heart disease. Clinical phenotypes and outcomes in the advanced pulmonary vasodilator era.

BACKGROUND: Mortality of pulmonary hypertension associated with congenital heart disease (PAH-CHD) in adults remains high. OBJECTIVES: To identify predictors of death and to assess the impact of treatment on outcome. METHODS: Retrospective, multicenter cohort study of 103 adults with PAH-CHD followed-up for 8.6 ± 4.6 years. Patients were grouped according to underlying shunt type into pre-tricuspid, post-tricuspid and complex. Survival rates were analyzed and predictors of death were investigated with Cox regression models. RESULTS: In the post-tricuspid and complex groups (38 and 37 patients, respectively), the most common clinical PAH-CHD subgroup was Eisenmenger syndrome (76.3% and 59.5%, respectively) whereas, in the pre-tricuspid group (28 patients), 46.5% of patients had small or corrected defects. Overall, 88 patients received vasodilators; 39% required combination-therapy. Overall survival at 10 years was 65%. Mortality was highest in the pre-tricuspid group, FC-III-IV and amongst patients receiving monotherapy (p < 0.050). On multivariate analysis, predictors of poor outcome were pericardial effusion (HR: 4,520 [1,470-13,890]; p = 0,008), oxygen saturation(HR: 0.940 [0,900 - 0,990]; p = 0,018) and genetic syndromes(HR: 3,280 [1,098-9,780]; p = 0,033). CONCLUSIONS: Patients in advanced stages at initiation of treatment were at high risk of death and strong consideration should be given for more aggressive therapy.

Assessment of Age Effects on Ovarian Hemodynamics Using Doppler Ultrasound and Progesterone Concentrations in Cycling Spanish Purebred Mares.

In equine reproduction, accurate and timely detection of the moment of ovulation is of great importance. Power Doppler ultrasound technology is a non-invasive method that enables to assess the morpho-echogenic features and blood flow changes during the estral cycle in mares. The objective of the present study was to evaluate the influence of age on ultrasonographic parameters (follicular diameter, follicular blood flow-FBF, corpus luteum (CL) area and corpus luteum blood flow-CLBF) and blood plasma progesterone concentrations in cycling Spanish Purebred mares (15 less than 8 years old and 15 equal o higher than 8 years old). The ultrasound images obtained were analyzed with the Image Colour Summarizer software, which allows the quantification of the pixels of each image. Young mares had significantly higher FBF, CLBF and plasma progesterone levels. Moreover, linear regression analysis showed that blood progesterone levels could be predicted in both groups from CLBF with moderate precision and accuracy. In conclusion, Power Doppler was useful to assess ovarian hemodynamics. Our results support that age is a factor that significantly influences FBF and CLBF as well as blood progesterone concentration in mares. More studies would be needed to develop high precision and accuracy predictive models of blood progesterone concentration from CLBF measured by Power Doppler.

Quality of Life: Changes in Self-Perception in People with down Syndrome as a Result of Being Part of a Football/Soccer Team. Self-Reports and External Reports.

The hypothesis posed was whether being part of a football/soccer team influenced the quality of life (QL) of the people who participated in it since their perception of themselves is enhanced by factors, such as self-determination, social inclusion, emotional well-being, physical well-being, material well-being, rights, personal development, and internal relationships. The objective was to evaluate the QL of people with Down Syndrome (DS) using their self-perception (n = 39) and the perception of the informants (family members, teachers) (n = 39). The KidsLife-Down Scale, with a few modifications, was used. In general, differences of opinion between the subgroups of participants with DS and informants showed that results were higher in terms of perception for participants in the DS subgroup. Scores for all variables were higher for those participants with DS who said they did engage in practicing competitive football/soccer. Although the perception of informants provides a great deal of information regarding the QL of participants with DS, participants with DS should also be involved in the evaluation process and their self-perceptions taken into account. It is not participating in a football team that causes the conclusions of the study, but training (which includes the friendly matches that are played), the cause correlated with the improvements detected in the athlete's DS.

Is Virtual Reality Effective for Balance Recovery in Patients with Spinal Cord Injury? A Systematic Review and Meta-Analysis.

Virtual reality (VR) is an emerging tool used in the neurological rehabilitation of patients with spinal cord injury (SCI), focused on recovering balance, mobility, and motor function, among other functional outcomes. The main objective of this study was to analyze the effectiveness of VR systems to recover balance in patients with SCI. The literature search was performed between October and December 2019 in the following databases: Embase, Web of Science, CINAHL, Scopus, Medline, Physiotherapy Evidence Database (PEDro), PubMed, and the Cochrane Central Register of Controlled Trials. The methodological quality of each study was assessed using the Spinal Cord Injury Rehabilitation Evidence (SCIRE) system and the PEDro scale, while the risk of bias was analyzed by the Cochrane Collaboration's tool. A total of 12 studies, involving 188 participants, were included in the systematic review, of which two were included in the meta-analysis. Statistical analysis showed favorable results for balance measured by the modified Functional Reach Test (standardized mean difference (SMD) = 3.42; 95% confidence interval: 2.54 to 4.29) and by the t-shirt test (SMD= -2.29; 95% confidence interval: -3.00 to -1.59). The results showed that VR interventions provided potential benefits, in addition to conventional physical therapy, to recover balance in patients with SCI.

Effectiveness of Virtual Reality on Functional Performance after Spinal Cord Injury: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

A spinal cord injury (SCI) usually results in a significant limitation in the functional outcomes, implying a challenge to the performance of activities of daily living. The main aim of this study is to analyze the effectiveness of virtual reality to improve functional performance in patients with SCI. The search was performed between October and December 2019 in Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database (PEDro), PubMed, Scopus, Web of Science, and Embase. The methodological quality of the studies was evaluated through the PEDro scale, and the risk of bias was evaluated with the Cochrane collaboration's tool. Seven articles were included in this systematic review, and five of them in the meta-analysis. Statistical analysis showed favorable results for functional performance in control group performing conventional therapy, measured by the functional independence measure (standardized mean difference (SMD)= -0.70; 95% confidence interval: -1.25 to -0.15). Results were inconclusive for other outcomes. Most studies have not shown beneficial effects on functional performance compared with conventional physical therapy. The results obtained showed that virtual reality may not be more effective than conventional physical therapy in improving functional performance in patients with SCI.

Short-term effects of ultrafine particles on daily mortality by primary vehicle exhaust versus secondary origin in three Spanish cities.

BACKGROUND: Evidence on the short-term effects of ultrafine particles (with diameter<100nm, UFP) on health is still inconsistent. New particles in ambient urban air are the result of direct emissions and also the formation of secondary UFP from gaseous precursors. We segregated UFP into these two components and investigated their impact on daily mortality in three Spanish cities affected by different sources of air pollution. METHODS: We separated the UFP using a method based on the high correlation between black carbon (BC) and particle number concentration (N). The first component accounts for aerosol constituents emitted by vehicle exhaust (N1) and the second for the photochemical new particle formation enhancements (N2). We applied city-specific Poisson regression models, adjusting for long-term trends, temperature and population dynamics. RESULTS: Mean BC levels were higher in Barcelona and Tenerife (1.8 and 1.2µg·m-3, respectively) than in Huelva (0.8µg·m-3). While mean UFP concentrations were similar in the three cities, from which N1 was 40% in Barcelona, 46% in Santa Cruz de Tenerife, and 27% in Huelva. We observed an association with N1 and daily mortality in Barcelona, by increasing approximately 1.5% between lags 0 and 2, per an interquartile increase (IQR) of 3277cm-3, but not with N2. A similar pattern was found in Santa Cruz de Tenerife, although none of the associations were significant. Conversely, in the industrial city of Huelva mortality was associated with N2 at lag 0, by increasing 3.9% per an IQR of 12,032·cm-3. CONCLUSION: The pattern and origin of UFP determines their short-term effect on human health. BC is possibly the better parameter to evaluate the health effects of particulate vehicle exhaust emissions, although in areas influenced by domestic solid fuel combustion this should also be taken into account.

Urban NH3 levels and sources in six major Spanish cities.

A detailed spatial and temporal assessment of urban NH3 levels and potential emission sources was made with passive samplers in six major Spanish cities (Barcelona, Madrid, A Coruña, Huelva, Santa Cruz de Tenerife and Valencia). Measurements were conducted during two different periods (winter-autumn and spring-summer) in each city. Barcelona showed the clearest spatial pattern, with the highest concentrations in the old city centre, an area characterised by a high population density and a dense urban architecture. The variability in NH3 concentrations did not follow a common seasonal pattern across the different cities. The relationship of urban NH3 with SO2 and NOX allowed concluding on the causes responsible for the variations in NH3 levels between measurement periods observed in Barcelona, Huelva and Madrid. However, the factors governing the variations in A Coruña, Valencia and Santa Cruz de Tenerife are still not fully understood. This study identified a broad variability in NH3 concentrations at the city-scale, and it confirms that NH3 sources in Spanish urban environments are vehicular traffic, biological sources (e.g. garbage containers), wastewater treatment plants, solid waste treatment plants and industry. The importance of NH3 monitoring in urban environments relies on its role as a precursor of secondary inorganic species and therefore PMX. Further research should be addressed in order to establish criteria to develop and implement mitigation strategies for cities, and to include urban NH3 sources in the emission inventories.