There is growing interest in how helpers working with severely traumatized individuals are affected by their work. A sample of 69 persons working with war and torture survivors across specialized centers throughout Sweden filled out questionnaires evaluating negative (i.e., compassion fatigue—composed of secondary traumatic stress [STS] and burnout—depersonalization, and impairment of functioning) and positive (posttraumatic growth [PTG], compassion satisfaction) reactions related to working with trauma survivors. We also measured attitudes toward human evil and death, demographics, history of trauma, and exposure to trauma narratives in hours per week and years of practice. Compassion satisfaction correlated negatively with most negative posttraumatic reactions. PTG was associated with STS, depersonalization, and impairment in functioning. Negative reactions to trauma work correlated with each other. Regression analyses showed that compassion satisfaction was negatively correlated with fear of death and age, whereas compassion fatigue correlated positively with fear of and resignation towards human evil (EVIL); the latter also predicted burnout and STS. STS also correlated with years in the field. Depersonalization correlated positively with EVIL and negatively with fear of death, whereas impairment of functioning correlated positively with years in the field and EVIL and negatively with fear of death. The more years in the field, the more people reported PTG. A majority of respondents stated that their attitude toward evil had changed because of their work. It is important to consider existential issues, especially human evil, when evaluating the effect of working with trauma.

ObjectivesImmunotherapy by blocking programmed death protein-1 (PD-1) or programmed death protein-ligand1 (PD-L1) with antibodies (PD-1 blockade) has revolutionized treatment options for patients with non-small cell lung cancer (NSCLC). However, the benefit of immunotherapy is limited to a subset of patients. This study aimed to investigate the value of combining immune and genetic variables analyzed within 3–4 weeks after the start of PD-1 blockade therapy to predict long-term clinical response.Materials and methodologyBlood collected from patients with NSCLC were analyzed for changes in the frequency and concentration of immune cells using a clinical flow cytometry assay. Next-generation sequencing (NGS) was performed on DNA extracted from archival tumor biopsies of the same patients. Patients were categorized as clinical responders or non-responders based on the 9 months’ assessment after the start of therapy.ResultsWe report a significant increase in the post-treatment frequency of activated effector memory CD4+ and CD8+ T-cells compared with pre-treatment levels in the blood. Baseline frequencies of B cells but not NK cells, T cells, or regulatory T cells were associated with the clinical response to PD-1 blockade. NGS of tumor tissues identified pathogenic or likely pathogenic mutations in tumor protein P53, Kirsten rat sarcoma virus, Kelch-like ECH-associated protein 1, neurogenic locus notch homolog protein 1, and serine/threonine kinase 11, primarily in the responder group. Finally, multivariate analysis of combined immune and genetic factors but neither alone, could discriminate between responders and non-responders.ConclusionCombined analyses of select immune cell subsets and genetic mutations could predict early clinical responses to immunotherapy in patients with NSCLC and after validation, can guide clinical precision medicine efforts.

In this article Frida Nilsson argues that feminist intersectional studies need to clarify different theoretical understandings of power. Empirical examples from her research in South Africa are used to exemplify the need to integrate cultural and structural understandings of power. Nilsson has interviewed ANC-women politicians about their views on lobola/bridewealth, which is a politically controversial institution widely supported both amongthe politicians interviewed and amongthe African population in general. In pre-colonial societies lobola was constituted by gifts of cattle from the husband's family to the wife's in marriage. The institution was central to the whole organisation of society and regulated, not only the relationship between husband and wife but also that of families and lineages in an intricate web of relations. The institution has undergone fundamental changes with capitalism, missionary activities and apartheid. The "extended family" does not have the same position as before in relation to the wedded couple and money is often used as means of payment. The new forms of lobola is often spöken of as a payment fora woman.The women interviewed describes this objectification of women into goods as the form of lobola which is oppressive but which is also described as a misuse of lobola by men. They make a clear distinction between this form of lobola and "good lobola" which is described as positive tie between families. The clear distinction between good and bad lobola is followed by other discursive distinctions which are interpreted as a discursive strategy to legitimise lobola but which is also coupled with an individualisation and de-politiciation of the institution - the discursive strategy makes "good lobola" seem like a choice every woman is free to make individually irrespective of structures of gender-related power. Women who are negative to lobola in their personal lives and regard it as oppressive to women, also use the mentioned legitimising discourses on lobola in a general discussion of the institution. Nilsson interprets the discursive strategy as a discourse on African identity in the face of colonial discourses on lobola. Furthermore, the same legitimising discourse on lobola may be interpreted as a discursive strategy, which attempts to create a space for action in relation to racist and patriarchal structures.

Abstract-A Hidden Markov Model (HMM) is used to improve the robustness to noise when tracking the atrial fibrillation (AF) frequency in the ECG. Each frequency interval corresponds to a state in the HMM. Following QRST cancellation, a sequence of observed states is obtained from the residual ECG, using the short time Fourier transform. Based on the observed state sequence, the Viterbi algorithm, which uses a state transition matrix, an observation matrix and an initial state vector, is employed to obtain the optimal state sequence. The state transition matrix incorporates knowledge of intrinsic AF characteristics, e.g., frequency variability, while the observation matrix incorporates knowledge of the frequency estimation method and SNRs. An evaluation is performed using simulated AF signals where noise obtained from ECG recordings have been added at different SNR. The results show that the use of HMM considerably reduces the average RMS error associated with the frequency tracking: at 5 dB SNR the RMS error drops from 1.2 Hz to 0.2 Hz.