Neurobio-logy of multiple myeloma and its therapeutical use - results of the pilot study with a control arm.

BACKGROUND: Myeloma cells, occupying a bone marrow niche, are influenced not only by neighbouring stroma cells but also by signals from the axons of sympathetic nervous system. The nervous system is directly involved in the process of myeloma progression. Among other cancers, patients with myeloma suffer the most difficult distress generating intensive adrenergic signals, causing its further progression. There is a question arising from these facts regarding whether psychological interventions, modulating a function of the nervous system, can further improve outcomes of myeloma treatments. We focus on interactions between myeloma cells and the nervous system. PATIENTS AND METHODS: Twelve patients with monoclonal gamapathy of indetermined significance (MGUS) or myeloma have participated in this study; eight in the interventional arm with the intervention of forgiveness therapy and four in the control arm. The patients were in various phases of their treatment, from active observation to immuno-chemotherapy and autologous stem cell transplant. Two major types of parameters were measured during the intervention: parameters of the activity of the disease (MGUS or myeloma) and psycho-neuro-immunological parameters of the patient, such as psychological depression, anxiety, and anger by the validated test PROMIS), as well as activity of the autonomic nervous system by heart rate variability, and immune profile by flow cytometry of peripheral blood. RESULTS: Patients who completed the forgiveness intervention showed improvement of depression, anxiety, and anger measured by PROMIS above population average, significant expansion of physiological plasma cells CD138+38+ (P = 0.04), B memory lymphocytes CD27+ (P = 0.02), and dendritic plasmacytoid cells CD123+ (P = 0.03). Parameters of heart rate variability such as parasympatic nervous system (PNS) index, sympatic nervous system (SNS) index, stress index, standard deviation of NN intervals (SDNN) and root mean square of the successive differences (RMSSD) had improved in a majority of patients. CONCLUSION: An intervention centered on forgiveness therapy was able to improve distress, reduce adrenergic signals in the autonomic nervous system, and restore parameters of the immune profile of patients with plasma cell dyscrasia who suffered from chronic stress caused by repressed anger and unforgiveness. Integrative treatment of myeloma can improve the quality of life of patients and thus affect the efficiency of immuno-chemotherapy. New randomised trials are warranted to test the integrative treatment of myeloma that might be able to improve overall survival.

Athermal operation of multi-section slotted tunable lasers.

Two distinct athermal bias current procedures based on thermal tuning are demonstrated for a low-cost, monotlithic, three section slotted single mode laser, achieving mode-hop free wavelength stability of ± 0.04 nm / 5 GHz over a temperature range of 8-47 °C. This is the first time that athermal performance has been demonstrated for a three-section slotted laser with simple fabrication, and is well within the 50 GHz grid spacing specified for DWDM systems. This performance is similar to experiments on more complex DS-DBR lasers, indicating that strong athermal performance can be achieved using our lower-cost three section devices. An analytical model and thermoreflectance measurements provide further insight into the operation of multi-section lasers and lay the foundation for an accurate predictive tool for optimising such devices for athermal operation.

Reducing thermal crosstalk in ten-channel tunable slotted-laser arrays.

Given the tight constraints on the wavelength stability of sources in optical networks, the thermal crosstalk between operating devices in a ten-channel thermally-tunable slotted laser array for DWDM applications has been investigated. It was found experimentally the current standard thermal solution with the laser array chip mounted on an AlN carrier does not allow for wavelength stability of ± 25 GHz ( ± 2 K) with a temperature rise of 5 K measured in a device with 100 mA (CW) applied to a neighbouring laser (device spacing = 360 µm). A combined experimental/numerical approach revealed solid state submounts comprising diamond or highly ordered pyrolytic graphite are inadequate to reduce crosstalk below an allowable level. Numerical simulations of advanced cooling technologies reveal a microfluidic enabled substrate would reduce thermal crosstalk between operational devices on the chip to acceptable levels. Critically our simulations show this reduced crosstalk is not at the expense of device tunability as the thermal resistance of individual lasers remains similar for the base and microfluidic cases.

The FEV1/FEV6 predicts lung function decline in adult smokers.

The use of FEV1/FEV6 in place of the traditional FEV1/FVC to detect airways obstruction during spirometry testing performed by primary care providers would reduce time and patient effort. We hypothesized that the FEV1/FEV6, would predict the subsequent decline in FEV1 in adult cigarette smokers who enrolled in the multicenter Lung Health Study. Ten clinical centers in the U.S. and Canada recruited 5887 male and female smokers, aged 35-60 years, with borderline to mild airways obstruction by spirometry. Those who successfully stopped smoking during the 5-yr study (usually as the result of the smoking cessation intervention) were excluded from this analysis. In those continuing to smoke, the relative strength of spirometric predictors of the change in FEV1 during 5 years of follow-up (DFEV1) was determined using a linear regression model. The following covariates were significant independent predictors of DFEV1: the baseline degree of airways obstruction, age, gender, cigarettes per day, years of education, and bronchial hyperresponsiveness. The FEV1/FEV6 was nearly as strong an independent predictor as was the FEV1/FVC (a traditional index of airways obstruction). The degree of airways obstruction, as determined by the FEV1/FEV6 from spirometry, is an independent predictor of subsequent decline in lung function; and therefore, may be used to detect smokers at higher risk of developing COPD.

Sexuality and the adolescent with a physical disability: understandings and misunderstandings.

The purpose of this descriptive study was to examine the areas of sexual knowledge, sexual behavior, and beliefs about sexuality among adolescents with congenital physical disabilities. The sample consisted of 15 males and 14 females, ranging in age from 12 to 22 years. The Sexual Knowledge Interview Schedule (SKIS) was administered to all participants during face-to-face interviews. In addition, the participants were asked questions regarding their ability to engage in intimate relationships and their future childbearing potential. Overall, the findings suggested that these adolescents are uninformed or misinformed about general sexual knowledge, have many misconceptions about sexuality and their disability, and depend on health care professionals and parents for sex education. Implications of this research are discussed.

The development of forgiveness in the context of adolescent friendship conflict in Korea.

A developmental pattern of understanding interpersonal forgiveness is proposed and examined with 30 junior high and 30 college students in Seoul, Korea. Three questions are asked: Does the developmental sequence in understanding forgiveness relate to age? Is there a relation between the understanding of forgiveness and the degree of forgiveness offered to one's offending friend? Is there a relation between the way people understand forgiveness and how they go about restoring an actual friendship in conflict? All participants had serious and unfair conflicts with their close friends during the past 5 to 6 months. Results support a developmental sequence in Korea and the observed relation between the sequence and actual friendship restoration strategies. There was at least partial statistical support for the relation between understanding forgiveness and the participants' forgiving behaviour in real life situations. Implications are drawn for the study and implementation of forgiveness in adolescents.

Forgiveness intervention with postabortion men.

An intervention designed to foster forgiveness was implemented with postabortion men. Participants were randomly assigned to either the treatment or the control (wait list) condition, which received treatment after a 12-week waiting period. Following treatment, the participants demonstrated a significant gain in forgiveness and significant reductions in anxiety, anger, and grief as compared with controls. Similar significant findings were evident among control participants after they participated in the treatment. Maintenance of psychological benefits among the 1st set of participants was demonstrated at a 3-month follow-up.

PIP: The effectiveness of an intervention based on a process model of interpersonal forgiveness was investigated in a study of 10 US men who self-identified as hurt by their female partner's abortion decision. Participants were randomly assigned to immediate intervention (n = 5) or to a 12-week waiting period before exposure to the intervention (n = 5). Men in the experimental group showed a significantly greater increase in forgiveness as measured by the Enright Forgiveness Scale both before and after the intervention than controls (p 0.05). In addition, the experimental group's mean change scores on anxiety and grief were significantly reduced compared with controls (p 0.05). After the 12-week delay, when controls were exposed to the same intervention, they also demonstrated significant increases in forgiveness and decreases in anxiety, grief, and anger. Maintenance of psychological benefits among the men who received the intervention first was demonstrated at a 12-week follow-up. These findings provide preliminary evidence for the effectiveness of an intervention aimed at promoting forgiveness and emotional healing among postabortion men.

Forgiveness as an intervention goal with incest survivors.

An intervention, with forgiveness toward their abuser as the goal, was implemented with 12 female incest survivors. The women, from a midwestern city, were 24 to 54 years old, and all were Caucasian. A yoked, randomized experimental and control group design was used. The participants were randomly assigned to an experimental group (receiving the forgiveness intervention immediately) or a waiting-list control group (receiving the intervention when their matched experimental counterpart finished the intervention). Each participant met individually with the intervener once per week. The average length of the intervention for the 12 participants was 14.3 months. A process model of forgiveness was used as the focus of intervention. Dependent variables included forgiveness, self-esteem, hope, psychological depression, and state-trait anxiety scales. After the intervention, the experimental group gained more than the control group in forgiveness and hope and decreased significantly more than the control group in anxiety and depression. When the control group then began the program they showed similar change patterns to the above, as well as in self-esteem improvement.

Time spent caregiving and help received by spouses and adult children of brain-impaired adults.

Caregivers for brain-impaired adults differ in living arrangements, amount of time spent giving care, and assistance received from family and friends and from paid help depending on their kin relationship and employment status. Spousal caregivers devote large amounts of time to caregiving, and husbands spend no less time than wives. Most caregivers receive little assistance from other family members and friends, but husbands receive more than others. Employed spouses receive more paid help than those without jobs, but employment does not affect the amount of paid help received by adult daughters.

The adolescent as forgiver.

A social cognitive developmental model of forgiveness is described and tested in two studies, the second being a replication of the first. In study 1, 59 subjects in grades 4, 7, 10, college and in adulthood were given a forgiveness interview that assessed six stages of forgiveness development, Rest's DIT measure of justice development, and a religiosity scale. As predicted, there were strong age trends for forgiveness and justice. Both forgiveness and justice were related but distinct constructs. The more one practiced one's faith, the higher one was in forgiveness stage. Study 2, with 60 subjects, replicated the above findings. The studies give strong evidence that people's understanding of forgiveness develops with age. Implications for adolescent development are drawn.

The development of the individuation process from a social-cognitive perspective.

A sequence of four developmental levels for the individuation process, from a social-cognitive perspective, was proposed from late childhood to late adolescence. Individuation is defined as the separation of the self from family. The individuation interview, Selman's self-awareness measure and the Lunzer test were administered in 4th, 7th, 10th grades and a post-high school group (N = 78). Results confirmed age increases in individuation as follows: late childhood subjects consolidate on level I, exhibiting the dominance of parental view over individual perspectives; early adolescents on level 2, demonstrating an increased self-awareness and the beginning decline of parental view; mid-adolescents, on level 3, characterized by conflicts between the recognition of the autonomous self and the parental views; and late adolescents (young adults) on level 3 and level 4, showing the ability to integrate the parental view within the self-system without losing individuality. Further, construct validation confirmed the common as well as the discriminant qualities of the individuation sequence to self-awareness and Piagetian logical development. These results support the uniqueness of the individuation construct within the social-cognitive domain.

Exploring three approaches to identity development.

Identifications from the past, current feedback from social relations, and one's own priorities combine to make up one's identity. These insights were incorporated into three separate identity development programs and administered to 57 high school seniors. Pretests and posttests included the Rasmussen Scale of Ego-Identity and a Self-Identity Social-Similarity Grid. Significant differences in change were demonstrated on the grid between the experimental groups and the control. That there were no significant changes in the Rasmussen scores highlights the diverse attempts to operationalize the many aspects of Erikson's theory. Suggestions for administering and evaluating future identity development programs are made.

Do economic conditions influence how theorists view adolescents?

Eighty-nine articles in thePedagogical Seminary and theJournal of Genetic Psychology appearing during two economic depressions and the two world wars were analyzed for their adolescent ideologies. A systematic, ideological bias in the content of these articles was found to be statistically significant. In times of economic depression theories of adolescence emerge that portray teenagers as immature, psychologically unstable, and in need of prolonged participation in the educational system. During wartime, the psychological competence of youth is emphasized and the duration of education is recommended to be more retracted than in depression. The objective, scientific nature of theory building is questioned and discussed.

A clinical model for enhancing adolescent ego identity.

A model of identity formation based on the cognitive developmental stages of social perspective-taking is described. The model assumes that identity can be achieved through cognitive strategies of considering the self in relation to one friend, one's family, the peer group, and society. Two studies were undertaken to test the model. In Study 1, 28 college students participated in a two week program in which the experimental students were asked to take the perspective of each social entity above and then to consider how the self was like and unlike these. The experimentals gained more than the controls on the identity subscale of Rasmussen's EIS. Fifty-nine college students participated in Study 2 which used a more sensitive discrepancy score measure on a revised identity scale. Discrepancy scores in an analysis of covariance indicated that the experimentals were higher than the controls at post-test and at a one month follow-up.

Coordination of perspectives: the importance of stimulus dimensionality.

An evaluation of the importance of the dimensionality of the spatial stimuli in a coordination of perspectives task is presented. It was hypothesized that using three-dimensional comparison stimuli and two-dimensional choice stimuli might result in the tapping of different cognitive skills than when both sets of stimuli are two-dimensional. Children (N = 96) aged between 5 and 12 years as well as college students (n = 24) were tested with either two-dimensional or three-dimensional comparison stimuli and two-dimensional choice stimuli. The lowest error rates for all except the kindergarten groups were found in the two-dimensional condition. It was concluded that the three-dimensional condition may have created a cognitive overload that lessened the likelihood of making correct perspective-taking judgments.

Belief discrepancy reasoning in the elderly.

The development of belief discrepancy reasoning, or how people evaluate disagreeing others, was examined with forty-four college and elderly respondents. Dogmatism and IQ measures were also administered. The results showed that the elderly were significantly lower in belief discrepancy reasoning and higher in dogmatism than the college sample, despite statistically greater IQ for the former sample and controls for education. For belief discrepancy, the elderly sample did not evidence intolerance, but rather relativism and open-mindedness toward disagreeing others. Implications for the construct validation of belief discrepancy and senescent intolerance are discussed.

Adolescent egocentrism-sociocentrism and self-consciousness.

A standardized and objectively scored scale of adolescent egocentrism-sociocentrism (AES) and a self-consciousness scale were given to 44 subjects each in the sixth, eighth, tenth, and twelfth grades and college. The AES assesses three components of egocentrism including the personal fable, the imaginary audience, and general self-focuses, as well as sociocentrism and nonsocial subscales. As predicted, the personal fable and imaginary audience declined with age. The self-focus subscale showed a curvilinear relationship with age, while, again as predicted, sociocentrism increased and nonsocial focuses declined. Adolescent egocentrism, as expected, correlated positively with self-consciousness even with age controlled. Implications for the theories of egocentrism and sociocentrism in the adolescent years are discussed.