Understanding the malleable determinants of cellular aging is critical to understanding human longevity. Telomeres may provide a pathway for exploring this question. Telomeres are the protective caps at the ends of chromosomes. The length of telomeres offers insight into mitotic cell and possibly organismal longevity. Telomere length has now been linked to chronic stress exposure and depression. This raises the question of mechanism: How might cellular aging be modulated by psychological functioning? We consider two psychological processes or states that are in opposition to one another-threat cognition and mindfulness-and their effects on cellular aging. Psychological stress cognitions, particularly appraisals of threat and ruminative thoughts, can lead to prolonged states of reactivity. In contrast, mindfulness meditation techniques appear to shift cognitive appraisals from threat to challenge, decrease ruminative thought, and reduce stress arousal. Mindfulness may also directly increase positive arousal states. We review data linking telomere length to cognitive stress and stress arousal and present new data linking cognitive appraisal to telomere length. Given the pattern of associations revealed so far, we propose that some forms of meditation may have salutary effects on telomere length by reducing cognitive stress and stress arousal and increasing positive states of mind and hormonal factors that may promote telomere maintenance. Aspects of this model are currently being tested in ongoing trials of mindfulness meditation.

Racism and racial/ethnic socialization are proposed as interactive risk and resilience factors that promote the development of multiple dimensions of racial identity among African American youth are the focus of this study. One-hundred and eight African American students responded to questions about their racial identity and socialization. Controlling for demographic characteristics of ecological support (from family, friends, and neighbors), neighborhood racial composition, and gender, findings revealed that racism exposure significantly explained the variance of several racial identity components and ideologies but that racial/ethnic socialization mediated that influence. We discuss the implications for future study of racism experience on the racial identity development of African American youth.(PsycINFO Database Record (c) 2009 APA, all rights reserved).

The intensity of emotions associated with memory of pleasant events generally fades more slowly across time than the intensity of emotions associated with memory of unpleasant events, a phenomenon known as the fading affect bias (FAB). Four studies examined variables that might account for, or moderate, the bias. These included the activation level of the emotions, individual differences in dispositional mood, and participant expectations of emotion change across time. Results suggest that (a) although emotion activation level was related to overall fading of affect, it was unrelated to the FAB;(b) dispositional mood moderated the FAB, but could not fully account for it; and (c) although participants' predictions of event-related emotion change across time were somewhat veridical, the FAB emerged even when these predictions were accounted for statistically. Methodological and theoretical implications for research on the affect associated with autobiographical events are discussed.

This study examined cognitive distortions and coping styles as potential mediators for the effects of mindfulness meditation on anxiety, negative affect, positive affect, and hope in college students. Our pre- and postintervention design had four conditions: control, brief meditation focused on attention, brief meditation focused on loving kindness, and longer meditation combining both attentional and loving kindness aspects of mindfulness. Each group met weekly over the course of a semester. Longer combined meditation significantly reduced anxiety and negative affect and increased hope. Changes in cognitive distortions mediated intervention effects for anxiety, negative affect, and hope. Further research is needed to determine differential effects of types of meditation.(c) 2009 Wiley Periodicals, Inc. J Clin Psychol 65: 1-13, 2009.

The use of stimulants has important implications for HIV prevention and care. However, few investigations have examined psychological correlates of substance use and adherence to anti-retroviral therapy (ART) among HIV-positive stimulant users. This cross-sectional investigation examined affective correlates of stimulant use and ART adherence among HIV-positive methamphetamine users. In total, 122 HIV-positive men who have sex with men or transgendered individuals on ART who reported using methamphetamine in the past 30 days were recruited from the community. HIV-specific traumatic stress was consistently and independently associated with more frequent cocaine/crack use (but not with methamphetamine use). Positive affect was independently associated with a decreased likelihood of reporting any injection drug use and an increased likelihood of reporting perfect ART adherence. HIV-specific traumatic stress may be an important determinant of increased cocaine/crack use in this population. Positive affect may increase the likelihood that individuals will refrain from injection drug use and achieve high levels of ART adherence.

This study focuses on a set of dreams related to the September 11, 2001 terrorist attacks and their aftermath, using content analysis and cognitive psychology to explore the interweaving of external public catastrophe and internal psychological processes. The study tests several recent claims in contemporary dream research, including the central image theory of Hartmann [Hartmann, E.,& Basile, R.(2003). Dream imagery becomes more intense after 9/11/01. Dreaming, 13(2), 61-66; Hartmann, E.,& Brezler, T.(2008). A systematic change in dreams after 9/11/01. Sleep, 31(2), 213-218], the media exposure factor postulated by Propper [Propper, R. E., Stickgold, R., Keeley, R.,& Christman, S. D.(2007). Is television traumatic? Dreams, stress, and media exposure in the aftermath of September 11, 2001. Psychological Science, 18(4), 334-340], the continuity hypothesis of Domhoff [Domhoff, W. G.(1996). Finding meaning in dreams: A quantitative approach. New York: Plenum], the cognitive and metacognitive approach of Kahan [Kahan, T. L.(2001). Consciousness in dreaming: A metacognitive approach. In K. Bulkeley (Ed.), Dreams: A reader on the religious, cultural, and psychological dimensions of dreaming (pp. 333-360). New York: Palgrave], and the threat simulation theory of Revonsuo [Revonsuo, A.(2000). The reinterpretation of dreams: An evolutionary hypothesis of the function of dreaming. Behavioral and Brain Sciences, 23(6), 877-901]. Our findings suggest the terrorist attacks had a tangible impact on the content of many people's dreams, but did not fundamentally alter the cognitive processing features of their dreaming. The 9/11 attacks affected what they dreamed about, but not the way they dreamed.

Aim. This paper is a report of a study to adapt the Life Attitude Profile-Revised Scale for Turkish patients with cancer and to evaluate its psychometric properties. Background. Cancer is a life-threatening illness that can challenge the experience of meaning in life. Meaning in life is a multidimensional concept involving meaning and purpose in life, as well as the motivation to find meaning and purpose in life. As meaning in life may be influenced by culture, a culture-sensitive tool is needed for its measurement. Methods. A convenience sample of 199 patients with cancer at a Turkish university hospital completed a structured questionnaire including demographic characteristics and the Life Attitude Profile-Revised Scale for Patients with Cancer in 2006. Item analysis, principal components analysis, internal consistency reliability and Cronbach's alpha were used to measure the psychometric properties of the items of the scale. Findings. In the assessment of construct validity, identified four factors with eigenvalues greater than 1 explained 46.91% of the total variance. Internal reliability coefficients of these four factor-based scales were 0.73 and 0.82 respectively. Conclusions. The present study provides evidence of the Life Attitude Profile-Revised Scale's validity, reliability and acceptability. This scale should be further evaluated with a larger sample, in different regions in Turkey and diverse populations of world. The scale has potential applications for use both in research and as a screening tool in clinical settings.

Understanding the malleable determinants of cellular aging is critical to understanding human longevity. Telomeres may provide a pathway for exploring this question. Telomeres are the protective caps at the ends of chromosomes. The length of telomeres offers insight into mitotic cell and possibly organismal longevity. Telomere length has now been linked to chronic stress exposure and depression. This raises the question of mechanism: How might cellular aging be modulated by psychological functioning? We consider two psychological processes or states that are in opposition to one another-threat cognition and mindfulness-and their effects on cellular aging. Psychological stress cognitions, particularly appraisals of threat and ruminative thoughts, can lead to prolonged states of reactivity. In contrast, mindfulness meditation techniques appear to shift cognitive appraisals from threat to challenge, decrease ruminative thought, and reduce stress arousal. Mindfulness may also directly increase positive arousal states. We review data linking telomere length to cognitive stress and stress arousal and present new data linking cognitive appraisal to telomere length. Given the pattern of associations revealed so far, we propose that some forms of meditation may have salutary effects on telomere length by reducing cognitive stress and stress arousal and increasing positive states of mind and hormonal factors that may promote telomere maintenance. Aspects of this model are currently being tested in ongoing trials of mindfulness meditation.

OBJECTIVE: Mediators of childhood sexual abuse (CSA) and HIV risk behavior were examined for men-who-have-sex-with-men (MSM). METHOD: Data from a dual frame survey of urban MSM (N=1078) provided prevalence estimates of CSA, and a test of two latent variable models (defined by partner type) of CSA-risk behavior mediators. RESULTS: A 20% prevalence of CSA was reported. For MSM in secondary sexual relationships, our modeling work identified two over-arching but inter-related pathways (e.g., both pathways include effects on interpersonal skills) linking CSA and high-risk behavior:(1) CSA-Motivation-Scripts-Skills-Risk Behavior; and (2) CSA-Motivation-Coping-Risk Appraisal-Skills-Risk Behavior. For men in primary relationships, there was one over-arching pathway including CSA-Motivation-Coping-Risk Appraisal-Risk Behavior processes. Exploratory analyses indicated that men with a history of CSA in only primary relationships versus only secondary relationships had, for example, fewer motivational problems, and better coping and interpersonal skills. CONCLUSIONS: CSA contributes to the ongoing HIV epidemic among MSM by distorting or undermining critical motivational, coping, and interpersonal factors that, in turn, influence adult sexual risk behavior. Further, the type of adult relationships men engage in serve as markers for adult CSA-related problems. The findings are discussed in the context of current theory and HIV prevention strategies. PRACTICE IMPLICATIONS: Direct extrapolation from our findings to practice is limited. However, there are general implications that may be drawn. First, the complex challenges faced by men with severe CSA experiences may limit the effectiveness of typical short-term HIV risk reduction programs; more intensive treatment maybe needed. Secondly, Clinical Psychologists and Psychiatrists with MSM patients with CSA histories should, if not already, routinely consider issues of sexual health; patterns and types of sexual partners may be useful markers for identifying more problematic cases. Lastly, public service messages directed at destigmatizing CSA for MSM may increase use of health and mental health services.

Objectives: To determine whether new-onset clinical depression emerges over time, and whether positive and negative mood levels change among patients with terminal cancer.Methods: In this two-site study, 58 cancer patients seen at least twice were interviewed monthly until death or study termination. Major measures included the Patient Health Questionnaire-9, Holland System of Beliefs Inventory, and Positive and Negative Affect Schedule.Results: At study entry, 7% of patients had major depressive disorder; another 9% had depressive symptoms but no Axis I diagnosis. Twenty-two percent were taking antidepressants. During visits ranging from 2 to 21 per patient, 76% of patients never had a depression diagnosis, 3% were always depressed, and 14% became depressed for the first time, almost exclusively at their final visit before death. Scores on positive mood were equivalent to or higher than scores on negative mood and did not change over time. Cancer site, hospice, spiritual beliefs, income, and caregiver mood were unrelated to depression. Spiritual beliefs were, however, associated with positive mood, hope, and better quality of life.Conclusions: In this exploratory study, terminally ill patients approaching death experienced positive as well as negative mood although a significant minority met criteria for major depression at the last visit before death. The findings suggest that major depression is not an inevitable part of the dying process in patients with terminal cancer. Further, the appropriateness of classifying sadness, loss of interest and thoughts that one would be better off dead in the last days of life as psychopathology should be reconsidered. Copyright (c) 2008 John Wiley & Sons, Ltd.

The extent to which religiosity is related to well-being may differ as a function of race/ethnicity, education or income. We asked 155 caregivers to complete measures of religiosity, prayer, physical symptoms and quality of life. Lower education and, to a lesser extent, lower income were correlated with religiosity and prayer. There were few direct relationships of religiosity and prayer with quality of life and health symptoms. However, the relationships became significant when education and, to a lesser degree, income were taken into account. Prayer was associated with fewer health symptoms and better quality of life among less educated caregivers.

We propose an integrative risk factor framework to enhance understanding of individual differences in adjustment to bereavement and to encourage more systematic analysis of factors contributing to bereavement outcome (e.g., examination of interactions between variables and establishing pathways in the adaptation process). The examination of individual differences in adaptation to bereavement is essential for practical (e.g. targeting high risk individuals for intervention) and theoretical (e.g. testing the validity of theoretical claims about sources of differences) purposes. And yet, existing theoretical approaches have not led to systematic empirical examination and empirical studies in the current literature are fraught with shortcomings. Derived from Cognitive Stress Theory [Lazarus, R. S.& Folkman, S.(1984). Stress, appraisal, and coping. New York: Springer] and the stressor-specific Dual Process Model of Coping with Bereavement [Stroebe, M. S.,& Schut, H. A. W.(1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23, 197-224], the framework incorporates an analysis of stressors, intra/interpersonal risk/protective factors, and appraisal and coping processes that are postulated to impact on outcome. Advantages of using the approach are outlined. Challenges in undertaking such research are addressed.

OBJECTIVES: Investigate the psychometric characteristics of the coping self-efficacy (CSE) scale, a 26-item measure of one's confidence in performing coping behaviors when faced with life challenges. DESIGN: Data came from two randomized clinical trials (N1=149, N2=199) evaluating a theory-based Coping Effectiveness Training (CET) intervention in reducing psychological distress and increasing positive mood in persons coping with chronic illness. METHODS: The 348 participants were HIV-seropositive men with depressed mood who have sex with men. Participants were randomly assigned to intervention and comparison conditions and assessed pre- and post-intervention. Outcome variables included the CSE scale, ways of coping, and measures of social support and psychological distress and well-being. RESULTS: Exploratory (EFA) and confirmatory factor analyses (CFA) revealed a 13-item reduced form of the CSE scale with three factors: Use problem-focused coping (6 items, alpha=.91), stop unpleasant emotions and thoughts (4 items, alpha=.91), and get support from friends and family (3 items, alpha=.80). Internal consistency and test-retest reliability are strong for all three factors. Concurrent validity analyses showed these factors assess self-efficacy for different types of coping. Predictive validity analyses showed that residualized change scores in using problem- and emotion-focused coping skills were predictive of reduced psychological distress and increased psychological well-being over time. CONCLUSIONS: The CSE scale provides a measure of a person's perceived ability to cope effectively with life challenges, as well as a way to assess changes in CSE over time in intervention research.

BACKGROUND: Providing home care for a child with a chronic illness can be stressful for the family. The purpose of this paper is to examine patterns of caregiving and the associated psychological impact on maternal caregivers of children with sickle cell disease (SCD). PROCEDURE: Fourteen maternal caregivers of children with SCD were interviewed as part of a larger study of maternal caregivers of children with chronic illness. Forty-four caregivers of children with HIV and 36 caregivers of healthy children were included as comparison groups. Interviews included questions regarding amount of time spent providing care for the child (technical care, non-technical care, health care management), hospitalization, emergency room visits, illness stigma, and mental health of the caregiver. RESULTS: Children with SCD had significantly lower functional status and significantly more hospitalizations in the previous 3 months than children with HIV. Caregivers of children with SCD were more likely to work full-time and had higher incomes than caregivers of children with HIV. The three caregiving groups did not differ significantly on amount of total care, although caregivers of children with SCD and caregivers of children with HIV both reported significantly more time spent in technical care than caregivers of healthy children. Despite lower functional status of the children in the SCD group, when group comparisons on caregiving time variables were adjusted for child's functional status, the differences between groups increased. This appeared to be due to the fact that caregivers in the HIV group spent more time in all caregiving categories except skin, crisis, and other care. In terms of caregiver mental health, caregivers of children with HIV and SCD had significantly higher depressive mood scores than caregivers of healthy children but the groups did not differ on caregiving burden. CONCLUSIONS: The perceived care burden of caregivers of children with SCD may be related to the unpredictable nature of the crisis care they provide. Additional attention is warranted to developing adequate resources for caregivers of children with SCD to mitigate the stress of unexpected crises. Pediatr Blood Cancer (c) 2006 Wiley-Liss, Inc.

OBJECTIVES: We compared types, amounts, and costs of home care for children with HIV and chronic illnesses, controlling for the basic care needs of healthy children to determine the economic burden of caring for and home care of chronically ill children. METHODS: Caregivers of 97 HIV-positive children, 101 children with a chronic illness, and 102 healthy children were surveyed regarding amounts of paid and unpaid care provided. Caregiving value was determined according to national hourly earnings and a market replacement method. RESULTS: Chronically ill children required significantly more care time than HIV-positive children (7.8 vs 3.9 hours per day). Paid care accounted for 8% to 16% of care time. Annual costs were $9300 per HIV-positive child and $25,900 per chronically ill child. Estimated national annual costs are $86.5 million for HIV-positive children and $155 to $279 billion for chronically ill children. CONCLUSIONS: Informal caregiving represents a substantial economic value to society. The total care burden among chronically ill children is higher than that among children with HIV.

This study approached pediatric adherence practices from the perspective of mothers of children with HIV in the USA. The study aimed to articulate what is involved in the daily life experience of giving or supervising a child's HIV medication (i.e., adherence practices) in order to clarify, in more dynamic terms than is often found in adherence research, what promotes or impedes adherence. A team-based qualitative analytic approach was used to analyze the narrative responses of 71 maternal caregivers of children with HIV to interview questions regarding the activities and stresses of caring for a child with HIV. Four themes of dealing with medication on a daily basis that impacted mothers' adherence practices emerged from the analysis:(1) Mothers' attitudes and feelings related to adherence practices.(2) The impact of the medications on adherence practices.(3) Interactions of mothers and children related to adherence practices.(4) Developmental issues and responsibility for medication adherence. These themes, taken together, demonstrate the contextual and longitudinal factors that impact adherence and illustrate the complexity of influences on adherence practices. We found that adherence practices were impacted in a positive way by mothers' commitment to adherence, and in a negative way by feelings of stigma and guilt, by the effects of bereavement on children and by children adopting their mothers' attitudes about medications. The interactive process of giving medication was shaped by children's behavior, mothers' developmental expectations for children, and, for mothers with HIV, their adherence for themselves. We found that pediatric adherence often came at a cost to the caregiving mother's well-being.

In this paper, we consider that our experience of time (to come) depends on the emotions we feel when we imagine future pleasant or unpleasant events. A positive emotion such as relief or joy associated with a pleasant event that will happen in the future induces impatience. Impatience, in our context, implies that the experience of time up to the forthcoming event expands. A negative emotion such as grief or frustration associated with an unpleasant event that will happen in the future triggers anxiety. This will give the experience of time contraction. Time, therefore, is not exogeneously given to the individual and emotions, which link together events or situations, are a constitutive ingredient of the experience of time. Our theory can explain experimental evidence that people tend to prefer to perform painful actions earlier than pleasurable ones, contrary to the predictions yielded by the standard exponential discounting framework.

This study explored the reported processes, conditions, and consequences of lesbian and heterosexual female smoking and relapse to understand the reasons for elevated lesbian smoking rates. Using grounded theory techniques, we conducted semistructured, face-to-face interviews with an ethnically diverse sample of 35 lesbian and 35 heterosexual female participants in Northern California. We found minority stress/sexual stigma to be an additional, unique cause of negative emotions and stress reported by 75% of lesbian participants, leading to smoking and relapse. Implications for smoking cessation programs tailored to lesbians are discussed.

From the foregoing description of the histological changes in the leptomeninx it is quite evident that we are dealing with a chronic, stationary, healing form of tuberculous inflammation. This statement is substantiated, in the first place, by the clinical history. The only reasonable interpretation of the symptoms would establish the duration of the process as four months. The imaginable contingency that there existed first a meningeal syphilitic lesion that was dispersed by the iodide of potassium only to be followed by a tuberculous infection is so remote and unlikely that it need not be discussed. At all events the tuberculous leptomeningitis, which presented a typical distribution, began insidiously, existed at times in a latent condition, and pursued a very anomalous course, marked by a relative mildness of all the symptoms, and thus it came about that when an apparent or real improvement followed the administration of iodide of potassium able observers were induced to make an erroneous diagnosis. Death occurred as a result of an intercurrent infection. The long duration of the process is also shown, anatomically, by the thick layer of firm, translucent and gelatinous material that matted together the structures at the base, and also by the evident adhesions between the pia and the brain. The histological examination furnishes proof positive of the correctness of the conclusion in regard to the peculiar character of this process because it shows:(1) That the tuberculous proliferation is uniform in development and has reached nearly the same stage of evolution throughout the entire extent of the leptomeninx involved; it is not a process that has advanced by exacerbations and irregular extensions; the lesions are, generally speaking, of nearly the same age everywhere and must have begun at about the same time.(2) That only a very limited degree of caseous degeneration is present, pointing to an early arrest of the activity of the tubercle bacillus or to a very decided diminution or attenuation of its virulence.(3) That the subendothelial intimal proliferations of epithelioid cells, so generally found in acute tuberculous leptomeningitis,* have in this case become more or less completely changed into distinct fibrous tissue in which but very slight, if any, direct evidence of its tuberculous origin can be found. It is only by recognizing that the chronic endarteritis is most marked in correspondence with the most advanced adventitial tuberculous changes, and by finding an imperfect, much altered giant cell in one district of intimal thickening, that we were able to establish the direct kinship of the endovascular changes with those of the pia in general.(4) That acute inflammatory changes, in the form of emigration of polymorphonuclear leucocytes and of fibrinous exudation, are entirely absent in all parts of the district involved. The presence of a turbid serous fluid is of course not at all inconsistent with the view that the anatomical changes are of long duration.(5) That the granulation tissue present is, in general, undergoing fibrillation and contains a rich supply of enabryonal capillary vessels as well as of larger blood-vessels of evidently new formation. The absence of any considerable extent of polymorphonuclear leucocytic infiltration in this tissue has already been referred to. The cells in the granulation tissue correspond to the cells of embryonal or formative connective tissue. Vacuolation is rarely present.(6) That the unusually large number of giant cells present are remarkably free from evidences of necrosis and degeneration of the character ordinarily observed in tuberculous proliferations, that they do not contain in demonstrable form tubercle bacilli, and that the majority of the giant cells seem to be separating into individual cells and smaller masses often with, but sometimes also without, evidences of nuclear disintegration. The possibility that these phenomena may signify fusion instead of the sundering of cells will be discussed below. For these reasons there can be no doubt that the general claim that we are dealing with an instance of chronic, healing tuberculous meningitis must be regarded as established beyond dispute. The growth of tubercle bacilli in the glycerine-agar tubes, inoculated with the fluid from the pial meshes, and the demonstration of tubercle bacilli, though in very small numbers, between the cells of the embryonal tissue, furnish the positive evidence that we are actually dealing with a tuberculous process due to living and not to dead bacilli. The degree of virulence of the cultures of tubercle bacilli was, unfortunately perhaps, not studied. The presence of living tubercle bacilli in a tissue free from active and acute changes characteristic of tuberculosis demonstrates that, whatever the actual degree of virulence of the bacilli may have been, the tissue in which they were found was at this time relatively immune from their action. The manner in which this immunity was produced, and in which the process of healing was initiated, need not be discussed at this time any further than to again direct attention to the fact that the bacilli lost their virulency as regards the cells in this leptomeninx before these cells underwent any marked degree of degeneration. The cells of the tuberculous proliferations survived the further action of the bacilli whose original effect it was to initiate cell accumulation or proliferation; the cells also retained sufficient vitality to develop, in some instances at any rate, into formative cells according as their origin would dictate, e. g. into fibroblasts. That fibroblasts are formed only by embryonal connective tissue cells, and not by wandering cells, such as the large mononuclear leucocytes, we are well aware, is possibly still a disputable assumption, and we do not consider it pertinent to discuss the question any further in connection with this study, but would only emphasize the point that some of the cells of tuberculous proliferations may, under favorable circumstances, become formative cells, and, furthermore, that the amount of formative tissue produced may be far in excess of what is actually needed for purposes of repair only. Surely the appearances here noted indicate that the bacillus of tuberculosis has the power to stimulate fixed cells to multiply, unless one assumes that all, or almost all, the formative cells here seen are derived from wandering cells attracted by the presence of the bacillus and its products. As to the ultimate fate of the formative and other cells in this healing tuberculous tissue no final statements can be made. It must be remembered that it is only one stage in the process of healing that is dealt with. The well marked evidences of fibrillation, the quite extensive formation of new vessels, the absence of evidences of degenerative changes in the uninuclear cells, all point to the production of new fibrous tissue as sure to occur, but it seems quite probable that occasional epithelioid cells may undergo or have undergone dropsical or other forms of degeneration, although it is certainly apparent that so far as the small cells are concerned the involution of the tuberculous tissue is not occurring through disintegration. Perhaps the most interesting feature in this case is the opportunity it affords to study the changes in the giant cells of healing, non-degenerated tuberculous tissue. In the first place, the large number of giant cells is quite remarkable. The general characters of the tissue in which they are found recall the fact that giant cells are regarded as quite constant elements in chronic mild tuberculosis; often the giant cells are the only cells that contain bacilli (Koch). In this instance the giant cells do not contain bacilli that are demonstrable by the usual methods; neither do they contain bodies that can be definitely interpreted as degenerate forms of bacilli such as those found by Metchnikoff, Stchastny, Weicker, and others, in the giant cells of Spermophilus guttatus, in avian and in human tuberculosis. Metchnikoff states, however, that he knows of the occurrence of such degenerate forms only in the Spermophilus guttatus under the circumstances mentioned, and in the rabbit and guinea-pig in mammalian tuberculosis, but not in man; consequently, the manner in which the giant cells rid themselves of the bacilli undoubtedly present in their interior at some time during their existence, must as yet remain without any explanation. In the description of the histological changes the various appearances presented by the giant cells are described somewhat minutely. The essential observations made concern, in my opinion, the further fate of giant cells which are still found to persist in healing nondegenerated tuberculous tissue. It was, I believe, quite conclusively shown that the consecutive changes appear to consist in the breaking up of the nuclei, the removal of the detritus by phagocytes, and the formation of a few apparently viable uninuclear cells in the case of more degenerated, exhausted giant cells, while other, and, as it would seem, better preserved or younger giant cells, separate into a number of individual, uninuclear cells with but little or no nuclear disintegration. Objection might be raised to this interpretation of the appearances in the giant cells. While no one could very well dispute the view that part of the giant cells are undergoing retrogressive and absorptive changes with the production of some viable cells, a question might well be raised concerning the nature of the process taking place in those giant cells that have been spoken of as splitting up or dividing into uninuclear cells and smaller multinucleated masses without much evidence of nuclear disintegration. It might be claimed that the process is one of fusion of many cells to form giant cells, and not one of division of fully formed giant cells into small cells. But a broad view of the processes described speaks against fusion. In the first place we are not dealing with a stage of tuberculous proliferation (Baumgarten), or cell accumulation (Metchnikoff), in which one would look for the production of giant cells, no matter which view concerning the histogenesis of tubercle be assumed as the correct one, because it has been demonstrated that, from whichever point of view the lesions are examined, the same positive conclusion that they are in the process of healing is reached; there is, therefore, no occasion for the formation of new giant cells in such wide-spread degree throughout the district involved. It might he claimed that the cells became arrested and, as it were, fixed in the act of fusion which was taking place in the early stage of the meningitis, but it would be difficult to understand the nature of the stimulus that could hold the cells together in such a peculiar manner for such a long time. It must be remembered that bacilli or bacillary detritus could not be found among the incomplete or in the complete giant cells. In the second place the difference between the cells that are undergoing disintegration and those regarded as dividing is essentially, to a certain extent at any rate, one of degree, because in the first instance there is not much, if any, doubt but that viable smaller cells are also formed, and in the second instance some, though often very slight, evidence of nuclear fragmentation is nearly always present; it would also be correct to infer that in advanced subdivision of a giant cell much, and perhaps all, of the nuclear detritus produced might have been removed up to the last trace; finally, the two extremes of these changes in the giant cells are connected by transition stages passing by gradation from the one to the other. Hence it is justifiable to conclude, for the time being, that in healing non-degenerated tuberculous tissue, the multinucleated giant cells may in part disintegrate and undergo absorption, in part form viable small cells; that both these changes may, and usually do, affect the same cell, but that in one class of cells-presumably the older or the more exhausted-the retrogressive process is predominant, while in a second class of cells-presumably the young and vigorous-the progressive changes are the more marked. In this connection it may be pointed out that while there cannot very well be any question but that we are dealing only with dividing and not coalescing cells, yet if this conclusion should be disputed and found incorrect, then the only remaining alternative would be to infer that this tissue furnished a unique and striking example of the formation of plasmodial masses by fusion in human tuberculosis, a conclusion to which many pathologists would refuse to subscribe, if for no other reason than because it is not in accordance with the almost universally accepted teachings of Baumgarten and Weigert in regard to the mode of formation of the giant cells in tuberculosis. Believing as I do that the giant cells under consideration are in the act of division and not at all of fusion, there remain to be discussed some of the histological and other features presented by the dividing cells. Many of the giant cells, perhaps the majority, contain larger and smaller vacuoles in the protoplasm. The exact significance of this vacuolation is not always clear. When the vacuolation accompanies an evident solution of the nucleus (karyolysis), there cannot be any doubt but that we are in the presence of a distinctly retrogressive process. Vacuoles are also most numerous in the giant cells that present other evidences of degeneration, such as coarseness of the granules in the protoplasm and extensive nuclear disintegration, but they occur as well around nuclei that stain deeply, around cells that seem to be separating from the giant cell, and even about nuclei that present mitoses. The formation of vacuoles seems to be responsible, to a certain extent at any rate, for the diminution in the volume of disintegrating and dividing giant cells, as shown by the clear spaces that form about them; these spaces are too large and occur too uniformly to be attributed solely to artificial shrinking produced by the hardening in alcohol. Further undoubted evidence of retrogression in certain giant cells is the occurrence of nuclear disintegration, or karyorhexis, which sets free larger and smaller chromatin masses that are recognized in the giant cell as well as in the interior of the phagocytes usually found around such cells. Almost all the polymorphonuclear leucocytes found in this tissue are met with around giant cells with broken-up nuclei. In many nuclei of disintegrating giant cells can be noted appearances that correspond well to certain stages in the complicated karyorhexis observed in anaemic necrosis by Schmaus and Albrecht; some of the nuclei with budding processes correspond particularly well with those in certain of their drawings; the interior of giant cells of tuberculous tissue may, it would seem, present conditions favorable to the development of this series of postnecrotic nuclear change. Vacuolation, karyolysis and karyorhexis are the essential steps that lead to destruction of the whole or parts of some of the giant cells; associated with these processes there is usually observed a splitting up of the body of the giant cell into irregular fragments with as well as without nuclei; and, as described, more or less phagocytosis of the resulting remnants of various kinds is seen. But evident degenerative and necrotic processes in a giant cell may be associated with progressive changes. While some nuclei undergo vacuolation or break up, others seem to become richer in chromatin and to stain more deeply at the same time that they seem to acquire cell bodies quite distinct from the protoplasm of the giant cells: this hyperchromatosis does not, therefore, seem to be a stage in karyorhexis. A very few but undoubted karyokinetic figures were found, together with evidences of division of the cell body formed in the giant cell protoplasm. Precisely similar changes are described by Klebs in healing pulmonary tuberculosis of the guinea-pig; the nuclei of the giant cells became rich in chromatin and karyokinetic figures occurred. Krückmann among others has found occasional mitoses in giant cells around foreign bodies, as well as elsewhere, but it would seem that such mitoses have always been interpreted as indicating the probable mode of formation of the giant cells rather than of their involution. The question of mitosis in existing multinucleated cells has recently been studied by Krompecher, who concludes that the individual nuclei of such cells may undoubtedly divide by mitosis, either simultaneously or at separate times. Division by amitosis can also occur, but mitosis is the only progressive form of division, amitosis being a retrogressive, disintegrating process that must be looked upon as an evidence of degeneration of the nucleus. Ziegler states that in division of giant cells whose nuclei have multiplied by mitosis it may happen that the separating cell remains enclosed in the protoplasm of the mother cell. A singular phase in the involution of the giant cells in this pia is to be found in the existence of progressive changes side by side with nuclear necrosis and with degeneration; this finding indicates that giant cells may contain many independent elements which, though apparently fused into one large cell, may preserve their individuality so that while some nuclei die, others proliferate and perhaps feed on the remnants of their dead brethren and form new, viable small cells. The nuclei in giant cells may be looked upon as representing independent centres, capable at times of existing even though the cell protoplasm is disintegrated. Many of the giant cells separate into individual cells, unaccompanied or unassociated with much evidence of necrosis. These cells may be regarded as the more vigorous forms. Here also are observed occasional mitoses-but on the whole extremely few-and very constantly an evident increase in the amount of chromatin in the nuclei of the new cells as compared with the amount ordinarily found in the nuclei of giant cells. These deductions concerning the persistence of the vitality of some of the nuclei, even in the presence of molecular and morphological changes in the cytoplasm and in other nuclei of the giant cell that lead to disintegration, are not entirely without the support of previous observations on cells, which, although made under different conditions, are nevertheless, it would seem, applicable to cells in general. Thus the brilliant investigations of Loeb upon the effects of various unfavorable surroundings, such as absence of oxygen or reduction of the amount of water, upon the cleavage of eggs of many kinds, show that the conditions which arrest development are qualitatively alike for nucleus and protoplasm, but quantitatively less for the protoplasm; when the irritability of the protoplasm is suspended the nucleus may segment without segmentation of the protoplasm, but upon re-establishment of favorable conditions the protoplasm may divide into about as many spheres as there are nuclei preformed-the nucleus persists, preserves the irritability of the cell and stimulates the protoplasm to segmentation. From the appearances of the giant cells here described it would seem, then, that some nuclei are able to maintain their vitality longer than others in the same cell, and under certain conditions to stimulate parts of the protoplasm to segment; in other cells all the nuclei have, as a rule, preserved their irritability. The groups of cells formed by the dividing of the giant cells can be traced by studying the process at the different stages in the different parts of the tissue. They assume an oval or spindle-shaped form, becoming more and more like the formative and endothelioid cells of young connective tissue, but their ultimate fate cannot be determined because it concerns essentially only one limited period in the involution of the tissue. It may be said with reasonable certainty, however, that the new cells do not form blood-vessels, but as regards their forming lymph-vessels nothing definite can be concluded. It would not be safe to draw any definite conclusions, from the appearances described, with regard to the origin and the mode of formation of the giant cells. The resulting small cells in general resemble very much endothelial and formative cells, but some of them are, at certain stages at any rate, not unlike large mononuclear leucocytes; their final fully developed or mature condition being unknown, no positive inference can be drawn as to their pre-giant-cell origin. The evidence points to the fact that the most probable origin of the giant cells, as indicated by their form and the apparent future career of their descendants, would be the fixed mesoblastic cells of the pia. In regard to the mode of formation of the giant cells it is quite clear that it must involve some process which is not incompatible with the viability of the small cells which may spring from the giant cells. Whether this would speak more in favor of formation by fusion than by karyokinesis of a single cell without division of the cell body cannot be well determined, and as long as authors are not agreed upon the question of the production of living, procreative cells by amitosis (direct segmentation, direct and indirect fragmentation) it would not be profitable to discuss the compatibility or incompatibility of the views of those investigators who trace the origin of giant cells to amitotic division, with the progressive changes that giant cells have been shown to be capable of. The fact that giant cells in tuberculous tissue, under certain conditions, undergo progressive changes and separate into small, living cells proves that they are not, as claimed by Baumgarten, Weigert and others, necrobiotic elements that are doomed to destruction from their very inception. On the other hand it lends more strength, if that were necessary, to the teleological view urged by Metchnikoff that they are living, defensive cells (whatever their origin may be), formed for the distinct purpose, like plasmodial masses in general, of isolating and removing foreign, harmful bodies, in this case the tubercle bacillus, and, having accomplished their object without being destroyed or exhausted, or the cause of their formation being removed or neutralized in some way, they, or their nuclei, may retain enough irritability to form a larger or smaller number of living, small, uninuclear cells.

How do stressful events and negative emotions influence the immune system, and how big are the effects? This broad question has been intensely interesting to psychoneuroimmunology researchers over the last three decades. Many promising lines of work underscore the reasons why this question is still so important and pivotal to understanding and other advances. New multidisciplinary permutations provide fresh vistas and emphasize the importance of training psychologists more broadly so that they will be central and essential players in the advancement of biomedical science.

BACKGROUND: Some studies find that parents of children with Down's syndrome may experience symptoms of depression, while other studies find that parents adapt well. This study aimed to clarify this variability in adaptive strength by investigating a stress-coping model to explain depressive symptoms and positive affect. METHOD: Questionnaires were completed by 553 parents of children (aged 0-18) with Down's syndrome, containing measures of goal disturbance, cognitive coping, social support, partner bonding, and coping self-efficacy. RESULTS: Different models for positive affect and depressive symptoms were found. The coping strategies of self-blame and rumination were positively related to depressive symptoms, and positive reappraisal was positively related to positive affect. Partner bonding characteristics played relevant roles in both models, as did coping self-efficacy and goal disturbance. Social support seemed mainly relevant in explaining positive affect. CONCLUSIONS: Different psychological factors were related to depressive symptoms and positive affect in parents of children with Down's syndrome. Implications are discussed.

The aims of this study were to (a) explore the emotions generated during or as a consequence of stress appraisals, after coping, and after the event outcome,(b) explore whether multiple emotions were generated from the initial stress appraisal through to event outcome, and (c) to explore whether outcomes that were perceived as favorable resulted in positive emotions and outcomes that were perceived as unfavorable or neither favorable nor unfavorable resulted in negatively toned emotions. Participants were 10 male English international adolescent golfers (mean+/-SD; age 16.7+/-1.6 years), who were interviewed regarding their experiences of stress appraisals, emotions, and coping during competitive golf. Results revealed that emotions were generated within or as a consequence of stress appraisals, after coping, and after the event outcome. Additionally, multiple emotions were generated from the stressful appraisal to the event outcome. Positively toned emotions were cited more frequently than negatively toned emotions after favorable events, whereas negatively toned emotions were reported more frequently than positively toned emotions after unfavorable events. Coping appears important in generating positively toned emotions.

Happiness-a composite of life satisfaction, coping resources, and positive emotions-predicts desirable life outcomes in many domains. The broaden-and-build theory suggests that this is because positive emotions help people build lasting resources. To test this hypothesis, the authors measured emotions daily for 1 month in a sample of students (N = 86) and assessed life satisfaction and trait resilience at the beginning and end of the month. Positive emotions predicted increases in both resilience and life satisfaction. Negative emotions had weak or null effects and did not interfere with the benefits of positive emotions. Positive emotions also mediated the relation between baseline and final resilience, but life satisfaction did not. This suggests that it is in-the-moment positive emotions, and not more general positive evaluations of one's life, that form the link between happiness and desirable life outcomes. Change in resilience mediated the relation between positive emotions and increased life satisfaction, suggesting that happy people become more satisfied not simply because they feel better but because they develop resources for living well.(PsycINFO Database Record (c) 2009 APA, all rights reserved).

INTRODUCTION: In extreme life events basic assumptions are frequently reassessed and changed. Therefore, trauma requires re-education. Effective coping strategies enable individual to tolerate, minimize, accept or ignore what one cannot manage and to moderate the consequences of stressful, traumatic events. MATERIALS AND METHODS: The aim of this study was to evaluate coping strategies in refugees with post-traumatic stress disorder prior and after group cognitive-behavioural therapy. The sample included 70 refugees who experienced multiple stressors such as organized violence, ethnic conflicts, bombing, expelling from their homes and life in exile. Impact Event Scales-Revised, Ways of Coping-Revised, Scale of Cognitive Self-regulation and Scale of Coping Strategies were administered before and after six months of group cognitive-behavioural therapy. RESULTS: Post-traumatic stress disorder in refugees after therapy significantly decreased. Cognitive self-regulation was improved by moving locus of control from external to internal resources. Coping was qualitatively different, with a wider repertoire of adaptive strategies. DISCUSSION: Cognitive group work facilitates processes of grieving, working-through of traumatic material, increasing emotional awareness and developing creativity in coping. CONCLUSION: Our findings highlight the positive impact of cognitive-behavioural treatment on post-traumatic stress disorder and post-traumatic adjustment.

Search for meaning in the aftermath of a traumatic event has been recognized as an important task in the recovery process of victims. Several terms have been used to describe the process and outcome related to search for meaning, such as perceived positive and negative changes, perceived benefits and post-traumatic growth. This article has three objectives. First, it aims to present three conceptual models of search for meaning and related concepts. Second, it reviews empirical data on search for meaning amongst different types of traumatic events. Third, it exposes shortcomings and paths for future studies.

A growing body of evidence indicates that health care professionals are in need of support. Beside heavy clinical patient volume or administrative duties, stress related to the significance of contextual factors is an important source of clinician's distress. Identification of and working through such stress can be a durable source of support. This article discusses key elements of these stressors, namely, the role of emotions of the clinician, awareness of limits, confusion about empathy, the influence of development and life trajectory on professional identity and the conflicting roles of the health care provider being in need of support.