The Networked Recluse

The image is so well known it is practically iconic: The reclusive poet, feminine and fragile, weaving verse of beguiling complexity from the room in which she kept herself sequestered from the world. The Belle of Amherst, the distinctive American voice, the singer of the soul’s mysteries: Emily Dickinson. Yet that image scarcely captures the fullness and vitality of Dickinson’s life, most notably her many connections—to family, to friends, to correspondents, to the literary tastemakers of her day, even to the unnamed, and perhaps unknowable, “Master” to whom she addressed three of her most breathtaking works of prose. Through an exploration of a relatively small group of items from Dickinson’s vast literary remains, this volume—an accompaniment to an exhibition on Dickinson mounted at The Morgan Library & Museum in New York—demonstrates the complex ways in which these often humble objects came into conversation with other people, places, and events in the poet’s life. Seeing the network of connections and influences that shaped Dickinson’s life presents us with a different understanding of this most enigmatic yet elegiac poet in American letters, and allows us more fully to appreciate both her uniqueness and her humanity. The materials collected here make clear that the story of Dickinson’s manuscripts, her life, and her work is still unfolding. While the image of Dickinson as the reclusive poet dressed only in white remains a popular myth, details of Dickinson’s life continue to emerge. Several items included both in the exhibit and in this volume were not known to exist until the present century. The scrap of biographical intelligence recorded by Sarah Tuthill in a Mount Holyoke catalogue, or the concern about Dickinson’s salvation expressed by Abby Wood in a private letter to Abiah Root, were acquired by Amherst College in the last fifteen years. What additional pieces of evidence remain to be uncovered and identified in the attics and basements of New England? Published to accompany The Morgan Library & Museum’s pathbreaking exhibit I’m Nobody! Who are You? The Life and Poetry of Emily Dickinson—part of a series of exhibits at the Morgan celebrating and exploring the creative lives of significant women authors—The Networked Recluse offers the reader an account of the exhibit itself, together with a series of contributions by curators, scholars of Dickinson, and poets whose own work her words have influenced

Severe hypercalcaemia and hypophosphataemia with an optimised preterm parenteral nutrition formulation in two epochs of differing phosphate supplementation

Objective: To compare in two epochs of differing phosphate provision serum calcium, phosphate, potassium, and sodium concentrations and the frequency of abnormality of these electrolytes and of sepsis in preterm infants who received an optimised higher amino acid-content formulation. Design and setting: Retrospective cohort study at a single tertiary-level neonatal unit. Patients: Preterm infants given parenteral nutrition (PN) in the first postnatal week during two discrete 6-month epochs in 2013–2014. Interventions: In epoch 1 the Ca2+:PO4 molar ratio of the PN formulation was ~1.3–1.5:1 (1.7 mmol Ca2+ and 1.1 mmol PO4 per 100 mL aqueous phase) and in epoch 2 was 1.0:1 via extra phosphate supplementation (1.7 mmol Ca2+ and 1.7 mmol PO4 per 100 mL). Main outcome measures: Peak calcium and nadir phosphate and potassium concentrations, and proportions with severe hypercalcaemia (Ca2+ >3.0 mmol/L), hypophosphataemia (PO4<1.5 mmol/L), and hypokalaemia (K+ <3.5 mmol/L) within the first postnatal week. Results: In epoch 2, peak calcium concentrations were lower than in epoch 1 (geometric means: 2.83 mmol/L vs 3.09 mmol/L, p value<0.0001), fewer babies were severely hypercalcaemic (10/49, 20%, vs 31/51, 61%, p value<0.0001); nadir plasma phosphate concentrations were higher (means: 1.54 mmol/L vs 1.32 mmol/L, p value=0.006), and there were fewer cases of hypophosphataemia (17/49, 35% vs 31/51, 61%, p value=0.009) and hypokalaemia (12/49, 25% vs 23/51, 45%, p value=0.03). Conclusions: Reverting from a PN Ca2+:PO4 molar ratio of 1.3–1.5:1 to a ratio of 1.0:1 was associated with a lower incidence and severity of hypophosphataemia and hypercalcaemia. For preterm infants given higher concentrations of amino acids (≥2.5 g/kg/day) from postnatal day 1, an equimolar Ca2+:PO4 ratio may be preferable during the first postnatal week

Is the early identification and referral of suspected head and neck cancers by community pharmacists feasible?:A qualitative interview study exploring the views of patients in North East England

INTRODUCTION Head and neck cancer (HNC) is the eighth most common cancer in the United Kingdom. Survival rates improve when the cancer is diagnosed at an early stage, highlighting a key need to identify at-risk patients. This study aimed to explore opportunistic HNC identification and referral by community pharmacists (CPs) using a symptom-based risk assessment calculator, from the perspective of patients with a diagnosis of HNC. METHODS Purposive sampling was used to recruit patients from the HNC pathway in three large teaching hospitals in Northern England. Qualitative methodology was used to collect data through an iterative series of semistructured telephone interviews. Framework analysis was utilised to identify key themes. RESULTS Four main themes were constructed through the analytic process: (1) HNC presentation and seeking help; (2) the role of the CP; (3) public perception of HNC and (4) the role of a symptom-based risk calculator. Participants agreed that CPs could play a role in the identification and referral of suspected HNCs, but there were concerns about access as patients frequently only encounter the medicine counter assistant when they visit the pharmacy. HNC symptoms are frequently attributed to common or minor conditions initially and therefore considered not urgent, leading to delays in seeking help. While there is public promotion for some cancers, there is little known about HNC. Early presentation of HNC can be quite variable, therefore raising awareness would help. The use of a symptom-based risk calculator was considered beneficial if it enabled earlier referral and diagnosis. Participants suggested that it would also be useful if the public were made aware of it and could self-assess their symptoms. CONCLUSION In principle, CPs could play a role in the identification and referral of HNC, but there was uncertainty as to how the intervention would work. Future research is needed to develop an intervention that would facilitate earlier identification and referral of HNC while not disrupting CP work and that would promote HNC and the risk calculator more widely. PATIENT OR PUBLIC CONTRIBUTION Patient and public involvement and engagement (PPIE) was integrated throughout the project. Initially, the proposal was discussed during a Cancer Head and Neck Group Experience (CHANGE) PPIE meeting. CHANGE was set up to support HNC research in 2018. The group is composed of seven members (four female, three male) with an age range of 50-71 years, who were diagnosed at Sunderland Royal Hospital. A patient representative from the University of Sunderland PPIE group and a trustee of the Northern HNC Charity were recruited as co-applicants. They attended project management group meetings and reviewed patient-facing documentation

Book Reviews

Reviews of the following books: Mount Hope Cemetery of Bangor, Maine: The Complete History by Trudy Irene Scee; The Reverend Jacob Bailey, Maine Loyalist: For God, King, Country and for Self by James S. Leamon; The Barns of Maine: Our History, Our Stories by Don Perkins; Gateway to Vacationland: The Making of Portland, Maine by John F. Bauman; Maine: The Wilder Half of New England by William David Berry; The Cross of War: Christian Nationalism and U.S. Expansion in the Spanish-American War by Matthew McCullough; Omaha Beach: The Life and Military Service of a Penobscot Indian Elder by Charles Norman Shay

Variable phenotype expression in a family segregating microdeletions of the NRXN1 and MBD5 autism spectrum disorder susceptibility genes

Autism spectrum disorder is a developmental condition of early childhood onset, which impacts socio-communicative functioning and is principally genetic in etiology. Currently, more than 50 genomic loci are deemed to be associated with susceptibility to autism spectrum disorder, showing de novo and inherited unbalanced copy number variants and smaller insertions and deletions (indels), more complex structural variants, as well as single-nucleotide variants deemed of pathological significance. However, the phenotypes associated with many of these genes are variable, and penetrance is largely unelaborated in clinical descriptions. This case report describes a family harboring two copy number variant microdeletions, which affect regions of NRXN1 and MBD5 - each well-established in association with risk of autism spectrum disorder and other neurodevelopmental disorders. Although each copy number variant would likely be categorized as pathologically significant, both genomic alterations are transmitted in this family from an unaffected father to the proband, and shared by an unaffected sibling. This family case illustrates the importance of recognizing that phenotype can vary among exon overlapping variants of the same gene, and the need to evaluate penetrance of such variants in order to properly inform on risks

Needs Assessment of Winooski Food Shelf Clients

Food shelves offer a unique, centralized location to engage with populations with multiple needs. Food shelf clients demonstrate poorer overall health and less access to healthcare and other social services. Winooski has a large refugee and immigrant population, whose needs may differ greatly from clients served by nearby food shelves in Chittenden County. Winooski Food Shelf visits provide opportunities to link clients to other needed health and social services. Previous studies have demonstrated efficacy in resource intervention guided by information gathered from food shelf clients. PROJECT GOAL: Assess the greatest health and social needs for clientele of the Winooski Food Shelf and make recommendations based on data gathered.https://scholarworks.uvm.edu/comphp_gallery/1283/thumbnail.jp

NWSA News and Views

NWSA\u27s New Coordinator The Search Committee is pleased to announce the appointment of Susan Gore as National Coordinator. A founding member of the Association, Susan Gore coordinated the Founding Conference of the South Central Women\u27s Studies Association in 1978 and served on the Coordinating Council in 1979-1980. Previously my most visible contribution to this organization has been handling the Annual Convention T-shirts, she said. I hope to be able to do much more in the role of Coordinator. A self-described persistent optimist, Gore took her place in the National Office on September I, having spent the past year teaching for the University of Maryland\u27s European Division. Prior to that, she taught for four years at Texas Christian University and for one year at Memphis State University. Gore was also Educational Services Coordinator for the Family and Individual Services Association in Ft. Worth, Texas, during 1980