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For decades, violent conflict has caused forced displacement throughout Myanmar. Chin people, largely from the northwestern Chin state in Myanmar, have been subjected to this violence resulting in displacement and resettlement with refugee status for thousands of Chin people. Scholars have often endeavored to understand the psychological outcomes of displacement and resettlement, with empirical work often dedicated to the onset of posttraumatic stress, depression, anxiety, and other Western-defined constructs of mental illness being correlated with traumatic experiences. These endeavors fail to center cultural explanations of mental illness among specific cultural groups like the Chin. Therefore, we used a community-collaborative, grounded theory approach to interview Chin people ( N = 20) resettled in the midwestern United States. Grounded theory analyses led to identification of two categories reflecting participants’ explanatory models of mental illness: (a) The Brain is Not working and (b) Causal Beliefs of The Brain not Working. The first category has one subcategory (Symptoms of the Brain not Working) and the second category is separated into three subcategories: (a) Going Crazy, Being Born Like that, and Thinking too Much as Causes, (b) Religion as an Explanation, and (c) “Control Your Heart”: Personal Responsibility and the Onset of Illness. These are discussed in light of the need to better understand cultural models of illness for Chin people with refugee status in contexts of resettlement. Specific attention is afforded to potential importance of this idiom of distress.

Background Despite their impressive efficacy in phase 3 trials, biologic agents for psoriasis (PsO) may lose efficacy over time. The factors associated with loss of efficacy have yet to be fully elucidated. Objective We aimed to identify factors associated with PsO patients using multiple biologics in comparison to patients who used 1 biologic. We also reviewed the literature comparing the survival of different biologic agents for PsO. Methods We examined clinical data from 222 psoriasis patients at the University of California San Francisco, of whom 51 reported use of 3 or more biologics and of whom 171 reported use of only a single biologic agent at the time of enrollment into a research database from 2006-2020. This study was IRB-approved at UCSF (#10-02830) and all subjects provided written informed consent. We performed univariate and multivariate regression analysis to identify significant demographic features, clinical features, and co-morbidities associated with multi-biologic use. We performed a literature review of studies comparing psoriasis biologic survival at 1, 2, and 5 years and factors associated with single biologic failure. Results In univariate analysis, duration of PsO, initial presentation of PsO on the gluteal cleft, erythrodermic psoriasis, and acne were associated with using 3 or more biologics. In multivariate analysis, duration of PsO, erythrodermic psoriasis, and acne remained significant. Our review of biologic survival revealed differences according to biologic class. Conclusion We identified novel factors associated with multi-biologic use in PsO. Further studies in this area are needed to achieve a precision medicine approach.

Background The potential for prehabilitation programs to impact clinical outcomes is uncertain in abdominal cancer patients due to the short window of time to intervene and the weakened state of the patients. To improve the effectiveness of prehabilitation intervention, a multimodal sports science approach was implemented. Methods Prior to cancer-related surgery, 21 patients participated in a 4-week exercise and nutrition prehabilitation program comprised of blood flow restriction exercise (BFR) and a sports nutrition supplement. Retrospective data of 71 abdominal cancer patients who underwent usual preoperative care was used as a comparator control group (CON). At 90 days post-surgery, clinical outcomes were quantified. Results Prehabilitation was associated with a shorter length of hospital stay ( P = .02) with 5.5 fewer days (4.7 ± 2.1 vs 10.2 ± 1.2 days in CON) and decreased incidence of any complications ( P = .03). Prehabilitation was not related to incidence of serious complications ( P = .17) or readmission rate ( P = .59). The prehabilitation group recorded 58% more steps on day 5 after surgery ( P = .043). Discussion A 4-week home-based prehabilitation program composed of BFR training and sports nutrition supplementation was effective in reducing postoperative complications and length of hospital stay in older patients with abdominal cancer. ClinicalTrials.gov Identifier: NCT04073381.

This article focuses on LDS missionary theology; changing missionary practices, training, and demographics of the missionary force in historical perspective; the relationship between the size of the missionary force and church growth; and the LDS Church’s geographic expansion as an international church.

Background and Purpose Mutations in KCNQ3 have classically been associated with benign familial neonatal and infantile seizures and more recently identified in patients with neurodevelopmental disorders and abnormal electroencephalogram (EEG) findings. We present 4 affected patients from a family with a pathogenic mutation in KCNQ3 with a unique constellation of clinical findings. Methods A family of 3 affected siblings and mother sharing a KCNQ3 pathogenic variant are described, including clinical history, genetic results, and EEG and magnetic resonance imaging (MRI) findings. Results This family shows a variety of clinical manifestations, including neonatal seizures, developmental delays, autism spectrum disorder, and anxiety. One child developed absence epilepsy, 2 children have infrequent convulsive seizures that have persisted into childhood, and their parent developed adult-onset epilepsy. An underlying c.1091G>A (R364H) variant in KCNQ3 was found in all affected individuals. Conclusions The phenotypic variability of KCNQ3 channelopathies continues to expand as more individuals and families are described, and the variant identified in this family adds to the understanding of the manifestations of KCNQ3-related disorders.

What information is used for familiar face recognition? While previous research suggests a particular importance of the eye region, information from the rest of the face also needs to be integrated. What type of information is used in conjunction with the eyes is largely unclear. In three experiments, participants were asked to recognise so-called face chimeras, in which the eye region was not manipulated, while the rest of the face was either presented in negative contrast (contrast chimeras) or low-pass filtered (blur chimeras). We show (1) that both chimeras are recognised substantially better than fully blurred faces, (2) that the recognition advantage for blur chimeras is specific to the eye region but cannot be explained by cues available in this part of the face alone, and (3) that a combination of negative contrast and blurring outside of the eye region eliminates the chimera advantage. We conclude that full-frequency but distorted surface reflectance cues (in contrast chimeras) or coarse shape information (in blur chimeras) can be used in combination with the eye region for effective face recognition. Our findings further suggest that the face recognition system can flexibly use both types of information, depending on availability.

Researchers have suggested that people with refugee status have heightened rates of western-defined psychiatric symptoms. Following this evidence, treatments have been adapted with the intent to foster culturally competent service provision for members of refugee communities. Absent in this research is attention to how clinicians address diverse beliefs about illness constructed within the cultures of refugee individuals. As such, even adapted treatments may not readily integrate beliefs about illness espoused in these communities into counseling. The purpose of this descriptive phenomenological study was to explore the meaning mental health care providers ascribe to integrating refugee individuals’ cultural beliefs about illness and treatment into counseling. Interviews ( N = 8) were analyzed accordant with descriptive phenomenology. Four themes were identified: (a) Presenting Concerns, Stigma, and Expectations, (b) Centering Diverse Explanations of Distress, (c) Shifting the Work to Connect, and (d) Language as Barrier and Opportunity. The themes represent the meaning that participants ascribed to focusing on what their clients from refugee communities bring to treatment and the value of centering their explanations of distress. Further, they expressed the clinical value of changing how they work and the difficulty as well as benefit of language in treatment. The value of integrating diverse illness beliefs into counseling from a multiculturally oriented perspective is discussed.

Researchers have demonstrated links between general hope and symptoms of distress. Findings like these are important given the conceptual role of hope in psychotherapy theories like Frank and Frank’s contextual model. Existing literature, however, has involved researchers employing general hope measures despite hope being variable across domains rather than a general trait. The purpose of this study was to explore the relationships between hope for counseling and clients’ outcomes as well as the working alliance. Self-report data were collected from 103 clients in a doctoral training clinic. Evidence (from multilevel modeling) demonstrated that increases in working alliance predict increases in hope for counseling over the course of treatment and that increases in hope for counseling significantly predict decreases in distress over the course of counseling when working alliance and session number are controlled. We discuss implications for clinical practice and positively-oriented work in counseling psychology.

Background Lipedema is a loose connective tissue disease predominantly in women identified by increased nodular and fibrotic adipose tissue on the buttocks, hips and limbs that develops at times of hormone, weight and shape change including puberty, pregnancy, and menopause. Lipedema tissue may be very painful and can severely impair mobility. Non-lipedema obesity, lymphedema, venous disease, and hypermobile joints are comorbidities. Lipedema tissue is difficult to reduce by diet, exercise, or bariatric surgery. Methods This paper is a consensus guideline on lipedema written by a US committee following the Delphi Method. Consensus statements are rated for strength using the GRADE system. Results Eighty-five consensus statements outline lipedema pathophysiology, and medical, surgical, vascular, and other therapeutic recommendations. Future research topics are suggested. Conclusion These guidelines improve the understanding of the loose connective tissue disease, lipedema, to advance our understanding towards early diagnosis, treatments, and ultimately a cure for affected individuals.

We examined two structural equation models of international students’ suicidal ideation using data from 595 international students in two public universities in the United States. The models represented competing hypotheses about the relationships among discrimination, cross-cultural loss, academic distress, thwarted belongingness, perceived burdensomeness, and suicidal ideation. The findings indicated there were direct, positive links between discrimination, cross-cultural loss, and academic distress to perceived burdensomeness; a direct, positive link between perceived burdensomeness and suicidal ideation; and indirect, positive links between discrimination, cross-cultural loss, and academic distress to suicidal ideation via perceived burdensomeness. The only predictors that related to thwarted belongingness were cross-cultural loss and academic distress, and there were no indirect links to suicidal ideation via thwarted belongingness. In fact, with all other variables in the model, thwarted belongingness was unrelated to suicidal ideation. Finally, academic distress was directly related to suicidal ideation. We discuss implications of the findings.

To understand mental illness in cultural contexts, research should focus on locally informed concepts of illness and the lived experiences of such conditions. Understanding mental illness, its prevalence, and its influence on people’s lives in Namibia represents one such context where attention to the lived experience of mental illness remains understudied. The purpose of the current study was to build upon ethnographic findings about mental illness as madness ( eemwengu) among the Namibian Aawambo. To that end, a multiple case study design was used to explore the lived experience of being omunanamwengu (the mad one). Data were collected from four cases that were bound by the experience of mental illness. Within each case, the individual experiencing illness ( omunanamwengu), family members, and both omunanamwengu and family members were interviewed formally (via a semi-structured interview protocol) or informally due to participants’ preferences for not being recorded. Using Stake’s suggested approach to multiple-case study cross-case analysis, each individual case is described and cross-case themes (Development and Symptoms of Mental Illness; Marginalization and Omunanamwengu; Family Roles in the Lives of the Distressed and Eemwengu; Belief in Treatment) were identified. Findings are discussed in light of the role of beliefs in treatment as well as family involvement, the potential influence of discrimination on mental illness, and implications for practice and cross-cultural psychology.

Background Malignancies affecting the gastrointestinal tract are among the principal threats to global public health. In Ghana, these cancers are responsible for a significant number of hospitalizations and mortalities at major health facilities across the country. The increasing incidence of these malignancies necessitates an investigation of the association between lifestyle (modifiable risk factors) and these disorders. Main Objective To determine the association between lifestyle and gastrointestinal cancers of patients attending the Korle Bu Teaching Hospital (KBTH). Study Design This was a cross-sectional prospective study where demographic data were obtained from consenting patients diagnosed with gastrointestinal cancer at the oncology and surgical clinics of the KBTH. Diagnostic investigations, gastrointestinal cancer phenotype, year of diagnosis and treatment(s) received were also obtained from the participants. Information on smoking status, alcohol consumption, sources of dietary proteins, daily intake of water, and frequency of fruit intake were also obtained from the participants. Odds ratio and P-values were determined to ascertain whether there might be a significant association between gastrointestinal cancers and specified lifestyle. Results Colorectal cancers were the most prevalent form of gastrointestinal cancers among the participants. Alcohol consumption or smoking habits were not significantly associated with onset of gastrointestinal cancers among the study participants. There was a significant association but weak correlation between red meat consumption and the colorectal cancer. Conclusion This study shows consumption of red meat to be a modifiable risk factor that is associated with lower gastrointestinal cancers in the study participants. Further longitudinal studies using large number of participants is needed for confirming the observations from this current study.

To assess the knowledge, attitude, practice, and determinants of intimate partner violence (IPV) among nursing female student in a tertiary hospital in Abakaliki. A cross-sectional descriptive study was done in a tertiary hospital in Abakaliki between 1st March 2018 and 31st August 2018 among 450 nursing female student. They were interviewed using a Composite Abuse Scale (CAS) version 2013. Analysis was done using IBM SPSS Statistic version 20. The prevalence of any type of IPV among respondents was 47.8%. The majority (70.9%) were aware of IPV and the commonest mode of information was mass media (60.0%). Majority of the respondent would resort to prayer following IPV and only 15.5% would report to police. The most common form of abuse reported was emotional &or harassment abuse (26.6%). Student’s age (OR = 0.42; 95% CI [0.41, 0.92]), social class (OR = 0.60; 95% CI [0.40, 0.90]), level of study (OR = 0.45; 95% CI [0.29, 0.68]), and partner’s level of education (OR = 0.60; 95% CI [0.42, 0.88]) were determinant of respondent experiencing IPV. Less than 50% of the respondent were aware of legislation against IPV. The study shows a high level of IPV among the studied group. Screening for IPV is advocated among the students’ population especially among the young adolescent. Efforts should also be made by the government to increase awareness about Nigerian law against IPV.

Background Stapled vs handsewn methods of bowel anastomosis have been extensively studied, however, no study has compared the handsewn vs stapled technique of closing the common enterotomy. Anecdotal concerns of higher leak rates due to crossing staple lines has led some to prefer a handsewn technique for closing the common enterotomy. Methods Patients undergoing stapled side-to-side enteroenteric and enterocolonic anastomoses in both emergent and elective settings at 1 tertiary center from 2016 to 2020 were studied. 758 patients were included. They were divided into 2 cohorts: Stapled-Stapled (SS) and Stapled-Handsewn (SH) depending on the fashion in which their stapled common enterotomy was closed. Association of anastomotic leak rate overall, in the emergent vs elective setting, and within enteroenteric and enterocolonic anastomotic subgroups was evaluated with both univariate and multivariate analysis. Association with the closure technique, mortality and average operative time was also compared. Results Multivariate analysis overall leak rates (SS 5.9% vs SH 3.7%, P = .23) and enteroenteric leak rates (SS 2.9 vs SH 4.1, P = .52) were similar between cohorts. Operative times were significantly shorter in the SS cohort (SS 121.8 min vs SH 138.1 min, P = .049), with a difference of 16.3 min on average. No difference in mortality was seen. Discussion The SH and SS result in similar anastomotic leak rates overall, and the SS technique is significantly faster than the SH technique. We therefore consider the SS technique to be an acceptable, and in the emergent setting, potentially preferred method of anastomotic technique.

Fibrosing mediastinitis (FM) is a rare disorder of inflammation and fibrosis involving the mediastinum. The formation of fibroinflammatory mass in the mediastinum can lead to obstruction of mediastinal structures and cause severe debilitating and life-threatening symptoms. Superior vena cava syndrome (SVCS) is a dreaded complication of FM with no medical therapy proven to be efficacious. Spiral vein grafting has long been utilized as first-line therapy for SVC syndrome due to FM. Endovascular repair with stents and angioplasty for malignant causes of SVC syndrome is well established. However, there are limited data on their utility in SVC syndrome due to FM. We present two cases of SVC syndrome due to FM treated with endovascular stenting and a detailed review of current literature on its utility in SVCS due to benign causes.

Hope is a critical component of therapeutic change. However, hope does not singularly emanate from clients. Therapists’ hope for their clients represents a specific therapeutic factor that may impact clinical outcomes. Currently no measure exists to assess the uniqueness of therapist’s hope in therapy with specific clients. Our purpose in this study was to develop and initially validate the Therapist Hope for Clients Scale (THCS). Participants ( N = 380) completed the THCS, plus four additional measures to assess therapists’ use of clients’ strengths, self-efficacy in helping skills, working alliance with individual clients, and a general measure of hope. We subjected the THCS to parallel analysis, factor analyses, reliability testing, and validity testing. These steps led to the development of a 10-item measure. THCS scores were positively related to therapists’ use of clients’ strengths, helping skills, self-efficacy, and working alliance. Implications of the THCS are discussed.

This article examines how class, consumerism, and employment influence beliefs of an idealized digital world in marginalized communities. I recount 24 months of ethnographic and institutional observation in a non-governmental organization that promoted the concept of “ utopia digital” (digital utopia in Portuguese) in Rio de Janeiro’s favelas (shantytowns). This corporate-funded non-governmental organization employed members of Brazil’s traditional middle class and promoted the liberating potentials of digital inclusion to members of a “New Middle Class” made up of 35 million “previously poor” Brazilians. Interviews with middle-class employees reveal how ideas of digital utopia act as a code for corporate efforts to encourage consumerism among the New Middle Class and bolster employment opportunities for members of Brazil’s traditional middle class. Reflecting on informal conversations, I also highlight a middle-class “crime talk” that frames the favela as an inherently violent place and, in contrast to their inclusionary work related to digital utopia, encourages non-governmental organization workers to physically avoid favela space. I use Zygmunt Bauman’s discussion of an “active” or “hunter” utopia as an ethnographic lens to discuss the practical and everyday experiences of technological inclusion in classed settings. By describing digital utopias as actively shaped by everyday understandings of urban exclusion and privilege, this article provides an ethnographic framework for decoding the socially reproductive nature of class-inflected consumer interventions in marginalized communities.

Background:Infants with cyanotic congenital heart disease demonstrate wide fluctuations in hemoglobin (Hb), oxygen saturation, and cardiac output following palliation. Methemoglobin (Met-Hb), the product of Hb oxidation, may represent a compensatory mechanism during hypoxia and may be utilized as a biomarker.Methods:Arterial and venous Met-Hb levels were obtained from infants requiring palliation. The primary outcome was to describe the relationship between Met-Hb and other indices of tissue oxygenation (venous saturation, estimated arteriovenous oxygen difference [Est AV-Diff], and lactate). Secondary outcomes were to determine the impact of elevated Met-Hb levels ≥1.0% and the effect of red blood cell (RBC) transfusion on Met-Hb levels.Results:Fifty infants and 465 Met-Hb values were studied. Venous Met-Hb levels were significantly higher than arterial levels (venous: 0.84% ± 0.36% vs arterial: 0.45% ± 0.18%; P < .001). Venous Met-Hb demonstrated a significant inverse relationship with venous oxygen saturation ( R = −0.6; P < .001) and Hb ( R = −0.3, P < .001) and a direct relationship with the Est AV-Diff ( R = 0.3, P < .001). A total of 129 (29.6%) venous Met-Hb values were elevated (≥1.0%) and were associated with significantly lower Hb and venous saturation levels and higher Est AV-Diff and lactate levels. Methemoglobin levels decreased significantly following 65 RBC transfusions (0.94 ± 0.40 vs 0.77 ± 0.34; P < .001). Linear mixed models demonstrated that higher venous Met-Hb levels were associated with lower measures of tissue oxygenation and not related to any preoperative clinical differences.Conclusion:Methemoglobin may be a clinically useful marker of tissue oxygenation in infants following surgical palliation.

The July 2018 issue of the NASN School Nurse, featured the first in a series of articles exploring the history, examining the present, and visioning the future of our organization in celebration of NASN’s 50th anniversary. While Parts 1 through 4 of this series focuses on the past and present, Part 5 is the first of two articles presenting the force of the future. In developing the content for Part 5, the authors posed a question to past and current NASN Officers, State Directors, and other school nursing colleagues. Areas of identified importance are grouped into the following major headings: research, education, collaboration, advocacy, image, technology, and leadership.