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This essay focuses on contemporary author Lyudmila Ulitskaya’s novel The Kukotsky Case, which has received little attention from Anglophone scholars. The novel, first published in Russian in 2001 and then in English translation in 2016, centers the ethics of women’s health and medical care in the Soviet Union, from the Stalinist period through the collapse. The complex nexus of questions regarding the (im)per - missible in reproductive health and maternity forms the major narrative arc. Using a conceptual framework from the modern Medical Humanities, which emphasize writing and storytelling as valuable tools that can facilitate healing, I explore how The Kukotsky Case innovates writing the pregnant body in the Russian literary canon. In contrast to her male predecessors (Dostoevsky, Tolstoy, Chekhov), whose descriptions of childbearing and mothering have dominated the Russian literary tradition, Ulitskaya merges her own professional background in genetics with her creative powers as a writer so that experiencers of pregnancy can better access and appreciate their own metamorphosis. [ABSTRACT FROM AUTHOR]

There is increasing recognition of the importance of identifying and perhaps incorporating into psychological services the spiritual and religious beliefs and practices (SRBP) of patients. Research suggests that psychologists are reluctant to address the SRBP of their patients, because they are unsure how to do so without contravention of ethical standards. Moreover, numerous approaches have been published and promoted, and psychologists may feel overwhelmed by the profusion of advice. We organize the suggested approaches into four categories and place them on a continuum, and we discuss the ethical concerns related to each. At one end is spiritually avoidant care, which entails the attempt to avoid conversations with patients about their SRBP. Given the importance of these issues to psychological health and to understanding the patient, this approach is untenable. At the other end of the continuum, spiritually directive psychotherapy is characterized by an explicit attempt to maintain or change the SRBP of patients. Spiritually integrated psychotherapy entails utilizing SRBP to ameliorate patients' emotional distress. We suggest that psychologists should at least engage in spiritually conscious care, which we characterize as the explicit assessment of the general importance of SRBP to the patient, its influence on the presenting problem, and the potential of SRBP as a resource to help recovery. Specific suggestions are presented for how spiritually conscious care might be implemented. Finally, the need for better training in both basic and specific competencies needed to address patients' SRBP is reviewed. Keywords: religion, spirituality, psychotherapy, ethics, competence DOI: 10.1037/a0020953

Emergency department and hospital discharge status are available for less than 2% of events recorded in the National EMS Information System (NEMSIS) Public Release Research dataset. The purpose of this project was to develop a binary ("dead" vs. "alive") end-of-event outcome indicator for the NEMSIS dataset. The data dictionary for the Version 3 NEMSIS dataset was evaluated to identify elements and codes providing information about a patient's end-of-event status—defined as the point at which EMS providers stopped providing care for an encountered patient, whether at the scene of the event or the transport destination. Those element and code combinations were then used to test the criteria using the NEMSIS-2017 dataset. After revising the criteria based on the NEMSIS-2017 results, the final criteria were then applied to the 2018 NEMSIS dataset. To assess representativeness, the characteristics of events with a determinable outcome were compared to those of the entire dataset. To assess accuracy, the end-of-event indicator was compared with the final reported outcome for patients with a known emergency department disposition. Eighteen NEMSIS element and code combinations suggest a patient was likely "dead" at the end of EMS care, and 15 combinations suggest a patient was likely "alive" at the end of EMS care. A binary end-of-event outcome indicator could be determined for 13,045,887 (98.6%) of the 13,229,079 NEMSIS-2018 9-1-1 initiated ground EMS responses in which patient contact was established, and for 132,728 (89.1%) of the 148,963 events with documented cardiac arrest. The characteristics of the events with determinable end-of-event outcomes did not differ from those of the full dataset. Among patients with a known outcome, 99.6% of those with an "alive" end-of-event indicator were in fact alive at the time of emergency department disposition. A binary end-of-event outcome indicator can be determined for 98.6% of 9-1-1 initiated ground EMS scene responses and 89.1% of cardiac arrests included in the NEMSIS dataset. The events with a determinable outcome appear representative of the larger dataset and the end-of-event indicators are generally consistent with reported emergency department outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background Obesity increases the risk for development of cardiomyopathy in the absence of hypertension, diabetes or myocardial ischemia. Not all obese individuals, however, progress to heart failure. Indeed, obesity may provide protection from cardiovascular mortality in some populations. The fatty acid milieu, modulated by diet, may modify obesity-induced myocardial structure and function, lending partial explanation for the array of cardiomyopathic phenotypy in obese individuals. Methods Adult male Sprague-Dawley rats were fed 1 of the following 4 diets for 32 weeks: control (CON); 50% saturated fat (SAT); 40% saturated fat + 10% linoleic acid (SAT+LA); 40% saturated fat + 10% α-linolenic acid (SAT+ALA). Serum leptin, insulin, glucose, free fatty acids and triglycerides were quantitated. In vivo cardiovascular outcomes included blood pressure, heart rate and echocardiographic measurements of structure and function. The rats were sacrificed and myocardium was processed for fatty acid analysis (TLC-GC), and evaluation of potential modifiers of myocardial structure including collagen (Masson's trichrome, hydroxyproline quantitation), lipid (Oil Red O, triglyceride quantitation) and myocyte cross sectional area. Results Rats fed SAT+LA and SAT+ALA diets had greater cranial LV wall thickness compared to rats fed CON and SAT diets, in the absence of hypertension or apparent insulin resistance. Treatment was not associated with changes in myocardial function. Myocardial collagen and triglycerides were similar among treatment groups; however, rats fed the high-fat diets, regardless of composition, demonstrated increased myocyte cross sectional area. Conclusions Under conditions of high-fat feeding, replacement of 10% saturated fat with either LA or ALA is associated with thickening of the cranial LV wall, but without concomitant functional changes. Increased myocyte size appears to be a more likely contributor to early LV thickening in response to high-fat feeding. These findings suggest that myocyte hypertrophy may be an early change leading to gross LV hypertrophy in the hearts of "healthy" obese rats, in the absence of hypertension, diabetes and myocardial ischemia.

The present pilot study sought to describe the development and investigate the educational impact of an innovative 14-session training package focused on increasing skills related to providing culturally conscious mental health care; that is, care that is attentive, sensitive, and responsive to contextual and cultural experiences of patients. Training participants (N = 7) were graduate trainees. The training incorporated experiential, discussion, and didactic components. Additionally, training content centered on constructs broadly applicable to multiple identities and emphasized intersectionality and within-group heterogeneity. This pilot training evidenced high efficacy, acceptability, and feasibility. Limitations of the current training package and recommendations for future directions are discussed. [ABSTRACT FROM AUTHOR]