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Abstract Background Postnatal depression (PND) affects over 12% of mothers, with numbers rising during COVID-19. Singing groups can support mothers with PND; however, online delivery has never been evaluated. SHAPER-PNDO, a single-arm clinical trial, evaluated the feasibility, clinical efficacy, and well-being outcomes of a 6-week online version of Breathe Melodies for Mums (M4M) singing intervention developed for mothers with PND during COVID-19 lockdowns. Methods The primary objective of this study was to assess the feasibility of a group online singing intervention for new mothers with postnatal depression. This was ascertained through recruitment rates, study retention rates, attendance rates to the singing sessions, and study completion rates. The secondary objective of the study was to assess the clinical efficacy and well-being outcomes of the singing intervention. Specifically, we measured change in Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS), and Office for National Statistics Wellbeing Scale (ONS) scores from baseline to end-of-intervention (week 6); follow-up assessments were completed at weeks 3, 16, and 32. Mothers were eligible if they scored ≥10 on the baseline EPDS. Results Eighty-seven percent of the 37 recruited mothers completed the study, attending, on average, 5 of the 6 group singing sessions. With regard to secondary outcomes, at end-of-treatment, mothers experienced significant reductions in depression (EPDS, 16.6 ± 3.7 to 11.2 ± 5.3, 95% CI [0.79,1.65]), anxiety (STAI-S, 48.4 ± 27.1 to 41.7 ± 26.8, 95% CI [4.96, 17.65]) and stress (PSS, 29.0 ± 5.7 to 19.7 ± 5.3, 95% CI [1.33, 7.07]); and, furthermore, significant improvements in life satisfaction (ONS, 50.5 ± 23.0 to 72.8 ± 11.7, 95% CI [− 39.86, − 4.64]) and feelings of worthwhileness (ONS, 51.7 ± 30.4 to 78.6 ± 15.1, 95% CI [− 52.79, − 0.85]). Reduction on the EPDS correlated with a reduction on the BDI and the STAI-S and maternal childhood maltreatment was predictive of a smaller treatment response. Conclusions M4M online was feasible to mothers who partook in the programme. Furthermore, M4M online supports the mental health and well-being of new mothers experiencing PND, especially when barriers to in-person treatment are present. Trial registration ClinicalTrials.gov NCT04857593 . Registered 22 April 2021, retrospectively registered;

Bette Davis played the role of an aging actress in different films throughout her career. In Joseph Mankiewicz’s All about Eve (1950), Davis performs one of her most highly acclaimed parts as Margo Channing, a mature actress who must face the decline of her acting career upon the arrival of a younger and ambitious counterpart. Only two years later, in Stuart Heisler’s The Star (1952), Davis once more played the role of an aging actress, Margaret Elliot, who refuses to accept that her career as an actress has come to an end, thus taking a bleaker approach in comparison with Mankiewicz’s film. Bearing in mind the intertextuality existing between both films, since All about Eve and The Star address the figure of the aging actress and are both considered self-referential films insofar as they are films about the film industry, this article will analyse how these two films address the performance of aging on and off screen, as actresses switch roles between acting younger or older in relation to characters that function as mirrors of aging, and how they eventually come to terms with the dictates of aging and their own aging process as women.

This article aims to offer a comparative analysis between Gaston Leroux’s novel Le fantôme de l’opéra (1910) and Alejandro Amenábar’s film Abre los ojos (1997) in which Amenábar’s film will be interpreted as a postmodern adaptation of Leroux’s original novel. This analysis will also identify those traits pertaining to the Gothic tradition and the nineteenth-century Gothic romance as reflected in Leroux’s modernist approach and reinterpreted in Amenábar’s postmodern film on the basis of the notion of transtextuality.

Ari Arister’s Hereditary (2018) and Natalie Erika James’s Relic (2020) are contemporary films which present significant intertextualities revolving around triads of female characters and draw particular attention to the figure of the older woman. This article aims to provide an analysis of aging femininities in these two films taking into consideration Robert Graves’s mythical archetype of the Triple Goddess, which refers to three distinct mythical figures—the Maiden, the Woman, and the Crone—that join in one single entity. Since the archetype of the Triple Goddess is paradigmatic of different mythical triads, from the Charites to the Gorgons, it will be taken as an allegory in order to interpret images of aging in these two films, as their female characters are portrayed as members of a triad as well as they also represent the same woman at different life stages along her aging process.

Background Postnatal depression (PND) affects 13% of new mothers, with numbers rising during the COVID-19 pandemic. Despite this prevalence, many women have difficulty with or hesitancy towards accessing pharmacological and/or psychological interventions. Group-based mother-baby activities, however, have a good uptake, with singing improving maternal mental health and the mother-infant relationship. The recent lockdowns highlight the importance of adapting activities to an online platform that is wide-reaching and accessible. Aims The SHAPER-PNDO study will primarily analyse the feasibility of a 6-week online singing intervention, Melodies for Mums (M4M), for mothers with PND who are experiencing barriers to treatment. The secondary aim of the SHAPER-PNDO study will be to analyse the clinical efficacy of the 6-week M4M intervention for symptoms of postnatal depression. Methods A total of 120 mothers and their babies will be recruited for this single-arm study. All dyads will attend 6 weekly online singing sessions, facilitated by Breathe Arts Health Research. Assessments will be conducted on Zoom at baseline and week 6, with follow-ups at weeks 16 and 32, and will contain interviews for demographics, mental health, and social circumstances, and biological samples will be taken for stress markers. Qualitative interviews will be undertaken to understand the experiences of women attending the sessions and the facilitators delivering them. Finally, data will be collected on recruitment, study uptake and attendance of the programme, participant retention, and acceptability of the intervention. Discussion The SHAPER-PNDO study will focus on the feasibility, alongside the clinical efficacy, of an online delivery of M4M, available to all mothers with PND. We hope to provide a more accessible, effective treatment option for mothers with PND that can be available both during and outside of the pandemic for mothers who would otherwise struggle to attend in-person sessions, as well as to prepare for a subsequent hybrid RCT. Trial registration ClinicalTrials.gov Identifier: NCT04857593 . Registered retrospectively on 22 April 2021. The first participants were recruited on 27 January 2021, and the trial is ongoing.

Parkinson's disease (PD) is characterized by the progressive dopaminergic neuron degeneration, resulting in striatal dopamine deficiency. Mitochondrial dysfunction and oxidative stress are associated with PD pathogenesis. Physical activity (PA) has been shown to ameliorate neurological impairments and to impede age-related neuronal loss. In addition, skin fibroblasts have been identified as surrogate indicators of pathogenic processes correlating with clinical measures. The PARKEX study aims to compare the effects of two different PA programs, analyzing the impact on mitochondrial function in patients' skin fibroblasts as biomarkers for disease status and metabolic improvement. Early-stage PD patients (n = 24, H&Y stage I to III) will be randomized into three age- and sex-matched groups. Group 1 (n = 8) will undergo basic physical training (BPT) emphasizing strength and resistance. Group 2 (n = 8) will undergo BPT combined with functional exercises (BPTFE), targeting the sensorimotor pathways that are most affected in PD (proprioception-balance-coordination) together with cognitive and motor training (Dual task training). Group 3 (n = 8) will serve as control (sedentary group; Sed). Participants will perform three sessions per week for 12 weeks. Assessment of motor function, quality of life, sleep quality, cognitive aspects and humor will be conducted pre- and post-intervention. Patient skin fibroblasts will be collected before and after the intervention and characterized in terms of metabolic remodeling and mitochondrial bioenergetics. Ethical approval has been given to commence this study. This trial is registered at clinicaltrials.gov (NCT05963425). Trial registration. https://classic.clinicaltrials.gov/ct2/history/NCT05963425.

From the perspective of Neo-Victorian studies, it can be claimed that the character of the Woman in Black in Susan Hill’s eponymous novel, published in 1983, is based on Victorian portrayals of the myth of “the fallen woman.” These Victorian representations often highlight mythemes pertaining to Gothic archetypes, such as the ghost, the vampire, the madwoman and the witch, giving evidence of the association between “the fallen woman” and Kristeva’s notion of the abject, which involves the feeling of subjective horror upon the blurring of what is self and what is other. Hill’s reinterpretation of the myth of “the fallen woman” recaptures Gothic mythemes pervading Victorian representations, but, in contrast with most of these Victorian portrayals, the Woman in Black arises as an actual Gothic archetype insofar as she is a female ghost who is brought back to life to vindicate herself and perpetuate her haunting existence. This article aims at analyzing the intertextuality existing between Hill’s portrayal of the Woman in Black and Victorian representations of “the fallen woman” which resort to Gothic mythemes, with the purpose of identifying Hill’s own contribution to reinterpret and update this Victorian myth.

Entre los estudios sociológicos de Joaquín Costa, destacan sus observaciones sobre la organización familiar en el Alto Aragón. Estas familias estaban asentadas en un sistema de transmisión de propiedad basado en la legislación aragonesa y una serie de normas consuetudinarias que definen el modelo familiar pirenaico. El presente artículo realiza una comparación entre las observaciones de Joaquín Costa y el tipo de familias, matrimonios y métodos de transmisión de la propiedad observables en las fuentes de la Edad Moderna. Este estudio se basa en el análisis de capítulos matrimoniales, testamentos y pleitos derivados de compromisos de matrimonio incumplidos. El resultado observado demuestra que existió una notable fluctuación entre la realidad observada por Costa y los modelos familiares de montaña. El sistema de transmisión de propiedad se adaptó en numerosas ocasiones aprovechando la flexibilidad de la ley aragonesa. Por otra parte, las últimas investigaciones sobre conflictividad familiar da a entender que, pese al innegable poder de las familias, los matrimonios forzados recibían una fuerte contestación

La disciplina de Estética forma parte desde siempre de los planes de estudio de la carrera de Arquitectura. Su inclusión parece tan natural y lógica que ningún legislador ha osado eliminarla. Sin embargo, su carga docente es muy pequeña. Se enseña en una sola asignatura que, además, comparte tiempo con otra materia afín, la Composición, de forma que se ha consolidado como una sola, Estética y Composición. Esta última, en los últimos tiempos se ha independizado e incluso da nombre en muchas escuelas a un departamento, de Composición arquitectónica.

Introduction Stroke survivors, once in the community, face challenges with their long-term rehabilitation care and present higher levels of loneliness, depression and anxiety than the rest of the population. A community-based performance arts programme, Stroke Odysseys (SO), has been devised to tackle the challenges of living with stroke in the UK. In this study, we aim to evaluate the implementation, impact and experiences of SO for stroke survivors.Methods and analysis Scaling-up Health Arts Programmes: Implementation and Effectiveness Research (SHAPER)-SO aims to scale-up SO to 75 participants and 47 stakeholders, while simultaneously evaluating the effectiveness and implementation of the programme. The main research aim is to evaluate the implementation, effectiveness, impact and experiences of a community-based performance arts programme (SO for stroke survivors). This mixed-methods study will evaluate the experience and impact of SO on those participating using mixed methods (interviews, observations and surveys) before and after each stage and carry out non-participant observations during a percentage of the workshops, training and tour. Data will be analysed using quantitative and qualitative approaches. This is a study within the SHAPER programme.Ethics and dissemination Ethical approval has been granted by the King’s College London PNM Research Ethics Panel, REC reference: LRS/DP-20/21–21549. Written informed consent will be sought for participants and stakeholders. The results of the study will be reported and disseminated at international conferences and in peer-reviewed scientific journals.Trial registration number NCT04864470.

Abstract Background The composition and function of the adipose tissue covering the heart are poorly known. In this study, we have investigated the epicardial adipose tissue (EAT) covering the cardiac ventricular muscle and the EAT covering the left anterior descending artery (LAD) on the human heart, to identify their resident stem cell functional activity. Methods EAT covering the cardiac ventricular muscle was isolated from the apex (avoiding areas irrigated by major vessels) of the heart (ventricular myocardium adipose tissue (VMAT)) and from the area covering the epicardial arterial sulcus of the LAD (PVAT) in human hearts excised during heart transplant surgery. Adipose stem cells (ASCs) from both adipose tissue depots were immediately isolated and phenotypically characterized by flow cytometry. The different behavior of these ASCs and their released secretome microvesicles (MVs) were investigated by molecular and cellular analysis. Results ASCs from both VMAT (mASCs) and the PVAT (pASCs) were characterized by the expression of CD105, CD44, CD29, CD90, and CD73. The angiogenic-related genes VEGFA, COL18A1, and TF, as well as the miRNA126-3p and miRNA145-5p, were analyzed in both ASC types. Both ASCs were functionally able to form tube-like structures in three-dimensional basement membrane substrates. Interestingly, pASCs showed a higher level of expression of VEGFA and reduced level of COL18A1 than mASCs. Furthermore, MVs released by mASCs significantly induced human microvascular endothelial cell migration. Conclusion Our study indicates for the first time that the resident ASCs in human epicardial adipose tissue display a depot-specific angiogenic function. Additionally, we have demonstrated that resident stem cells are able to regulate microvascular endothelial cell function by the release of MVs.

Esta investigación aborda las estancias originales de la casa de Goya donde realizó las Pinturas Negras, a partir de las fuentes documentales disponibles, para esclarecer el entorno original donde fueron creadas.

Background: Dissociative (non-epileptic) seizures are potentially treatable by psychotherapeutic interventions; however, the evidence for this is limited. Objectives: To evaluate the clinical effectiveness and cost-effectiveness of dissociative seizure-specific cognitive–behavioural therapy for adults with dissociative seizures. Design: This was a pragmatic, multicentre, parallel-arm, mixed-methods randomised controlled trial. Setting: This took place in 27 UK-based neurology/epilepsy services, 17 liaison psychiatry/neuropsychiatry services and 18 cognitive–behavioural therapy services. Participants: Adults with dissociative seizures in the previous 8 weeks and no epileptic seizures in the previous year and meeting other eligibility criteria were recruited to a screening phase from neurology/epilepsy services between October 2014 and February 2017. After psychiatric assessment around 3 months later, eligible and interested participants were randomised between January 2015 and May 2017. Interventions: Standardised medical care consisted of input from neurologists and psychiatrists who were given guidance regarding diagnosis delivery and management; they provided patients with information booklets. The intervention consisted of 12 dissociative seizure-specific cognitive–behavioural therapy 1-hour sessions (plus one booster session) that were delivered by trained therapists, in addition to standardised medical care. Main outcome measures: The primary outcome was monthly seizure frequency at 12 months post randomisation. The secondary outcomes were aspects of seizure occurrence, quality of life, mood, anxiety, distress, symptoms, psychosocial functioning, clinical global change, satisfaction with treatment, quality-adjusted life-years, costs and cost-effectiveness. Results: In total, 698 patients were screened and 368 were randomised (standardised medical care alone, n = 182; and cognitive–behavioural therapy plus standardised medical care, n = 186). Primary outcome data were obtained for 85% of participants. An intention-to-treat analysis with multivariate imputation by chained equations revealed no significant between-group difference in dissociative seizure frequency at 12 months [standardised medical care: median of seven dissociative seizures (interquartile range 1–35 dissociative seizures); cognitive–behavioural therapy and standardised medical care: median of four dissociative seizures (interquartile range 0–20 dissociative seizures); incidence rate ratio 0.78, 95% confidence interval 0.56 to 1.09; p = 0.144]. Of the 16 secondary outcomes analysed, nine were significantly better in the arm receiving cognitive–behavioural therapy at a p-value

This article aims to analyse the process of aging as a major factor that articulates the politics of gender in Daphne Du Maurier’s novel Rebecca (1938) and Susan Hill’s sequel Mrs de Winter (1993). Even though Du Maurier’s seminal novel has been traditionally interpreted as a novel of romance, by means of focusing on the aging process of different characters, and especially, of the female narrator, this article intends to read Du Maurier’s Rebecca as a novel of awakening. The comparative analysis of Du Maurier’s text with the sequel that Susan Hill published decades later will serve the purpose of defending the interpretation of Du Maurier’s narrative as a novel of awakening, since the action in Susan Hill’s novel takes place twelve years later and gives significant importance to the aging processes of the characters. This article will also analyse the association between male aging and patriarchy, female youth and traditional femininity, old age and masculinity crisis, and female aging and female awakening.