Suspected Compartment Syndrome, Consumptive Thrombocytopenia, and Anemia Secondary to a Ruptured Arterial Aneurysm or Pseudoaneurysm Following Multiple Stifle Surgeries.

A 12 yr old male neutered beagle was presented on transfer to the intensive care unit with severe anemia, thrombocytopenia, and bruising detected 1 day after undergoing tibial plateau leveling osteotomy surgery. The patient had undergone extra-capsular stifle stabilization surgery 14 wk prior to treat ligament disease in the same knee. Laboratory testing and treatment for anemia, presumptive immune-mediated thrombocytopenia, and possible hemostatic disorder was initiated. A persistent anemia, progressive thrombocytopenia, and the development of a firm swelling and neurologic impairment in the limb raised concerns for compartment syndrome (CS). A musculoskeletal ultrasound revealed a large aneurysm in the caudal thigh surrounded by abnormal muscle tissue. The patient underwent amputation of the limb and recovered without further complication. Pathology findings were consistent with the development of femoral CS secondary to a ruptured peripheral arterial aneurysm or a pseudoaneurysm. A consumptive thrombocytopenia and regenerative anemia were attributed to periodic or progressive thrombosis of the vessel and regional hemorrhage. Postoperative CS can develop in combination with peripheral arterial aneurysm or pseudoaneurysm, and screening for vascular abnormalities as well as CS should be considered in complicated recovery from orthopedic surgery with compatible clinical signs including progressive soft tissue swelling, persistent anemia, and thrombocytopenia.

The Development of Wisdom: A Social Ecological Approach.

Objectives: This study examined the development of wisdom within the context of difficult life events (DLEs), and the importance of individuals and their social environments in this process of growth. Social support has long been studied in adulthood, yet less is known about the ways social transactions can promote wisdom. Method: Semi-structured interviews were conducted with men (n = 14) and women (n = 36), ages 56-91 years (M = 71.71; SD = 8.8) who described a DLE and how they coped with it. The analysis was guided by constructivist grounded theory. Results: DLEs included those from childhood through later life. When personal meaning was disrupted by adversity, the social environment played a key role in facilitating new perspectives that corresponded with aspects of wisdom: self-knowledge, compassion, comfort with uncertainty, and accepting complexity. Discussion: Wisdom is often studied as an individual characteristic, but this study highlighted the relevance of a social ecological perspective to understanding how wisdom development is also facilitated through social transactions.

What Do You Think You Are Measuring? A Mixed-Methods Procedure for Assessing the Content Validity of Test Items and Theory-Based Scaling.

The valid measurement of latent constructs is crucial for psychological research. Here, we present a mixed-methods procedure for improving the precision of construct definitions, determining the content validity of items, evaluating the representativeness of items for the target construct, generating test items, and analyzing items on a theoretical basis. To illustrate the mixed-methods content-scaling-structure (CSS) procedure, we analyze the Adult Self-Transcendence Inventory, a self-report measure of wisdom (ASTI, Levenson et al., 2005). A content-validity analysis of the ASTI items was used as the basis of psychometric analyses using multidimensional item response models (N = 1215). We found that the new procedure produced important suggestions concerning five subdimensions of the ASTI that were not identifiable using exploratory methods. The study shows that the application of the suggested procedure leads to a deeper understanding of latent constructs. It also demonstrates the advantages of theory-based item analysis.

Cross-cultural comparison of self-transcendent wisdom between the United States and Korea.

Whether wisdom is a culturally-specific or universal construct is a matter of some debate (see Curnow 1999; Grossman et al. Psychological Science, 2012). This study compared similarities and differences in the factor structure of a measure of wisdom focused on self-transcendence in U.S. (n = 305, M(age) = 33.99) and Korean samples (n = 838, M(age) = 30.28), with ages ranging from 20 to 73). The Adult Self-Transcendence Inventory (ASTI; Levenson et al. International Journal of Aging and Human Development, 60, 127-143, 2005) has two factors, self-transcendence and alienation, the latter of which was included to differentiate between social withdrawals due to contemplative practices versus that due to depression. Confirmatory factor analyses found a partial scalar factorial invariance model fit the data best, indicating that the factor structure of the ASTI is largely equivalent and that the construct is comparable across the two cultures. Regression analyses showed that age and religiousness were related to self-transcendence and alienation. Education was related to self-transcendence only. The interaction between age and culture was significant on alienation; alienation was higher in mid-life Koreans but not in Americans, which may reflect either age or cohort effects. Thus, self-transcendence may be a more universal measure of wisdom than those based on pragmatics or cognitive functioning.

Aging and social networks in Spain: the importance of pubs and churches.

We examined whether the social convoy model and socioemotional selectivity theory apply in collectivistic cultures by examining the contextual factors which are hypothesized to mediate age-related differences in social support in a collectivist European country. Five hundred Spanish community-dwelling older adults (Mean age = 74.78, SD = 7.76, range = 60-93) were interviewed to examine structural aspects of their social networks. We found that age showed highly complex relationships with network size and frequency of interaction, depending on the network circle and the mediation of cultural factors. Family structure was important for social relations in the inner circle, while pubs and churches were important for peripheral relations. Surprisingly, pub attendance was the most important variable for maintenance of social support of peripheral network members. In general, the results support the applicability of the social convoy and socioemotional selectivity constructs to social support among Spanish older adults.

Do Stress Trajectories Predict Mortality in Older Men? Longitudinal Findings from the VA Normative Aging Study.

We examined long-term patterns of stressful life events (SLE) and their impact on mortality contrasting two theoretical models: allostatic load (linear relationship) and hormesis (inverted U relationship) in 1443 NAS men (aged 41-87 in 1985; M = 60.30, SD = 7.3) with at least two reports of SLEs over 18 years (total observations = 7,634). Using a zero-inflated Poisson growth mixture model, we identified four patterns of SLE trajectories, three showing linear decreases over time with low, medium, and high intercepts, respectively, and one an inverted U, peaking at age 70. Repeating the analysis omitting two health-related SLEs yielded only the first three linear patterns. Compared to the low-stress group, both the moderate and the high-stress groups showed excess mortality, controlling for demographics and health behavior habits, HRs = 1.42 and 1.37, ps <.01 and <.05. The relationship between stress trajectories and mortality was complex and not easily explained by either theoretical model.

Positive emotional change: mediating effects of forgiveness and spirituality.

We evaluated the efficacy of an emotional education program that seeks to reduce the intergenerational transmission of negative interaction patterns by increasing forgiveness and spirituality. We examined both reduction of psychological symptoms and increase in positive psychological outcomes over the course of a year, as well as the mediators of this change. At baseline, the sample consisted of 99 participants and 47 waiting list controls. Comparisons of scores from baseline (Time 1) to one week after the Hoffman Quadrinity Process (Time 2) showed large declines in negative affect (depressive symptoms) and increases in both positive outcomes (mastery, empathy, emotional intelligence, life satisfaction, forgiveness, and spiritual experience) and health and well-being. Over the course of a year, most of these gains were sustained, in comparison with the control group. Further, increases in forgiveness and spirituality mediated the effect of program participation on depressive symptoms.

Coping, affect, and the metabolic syndrome in older men: how does coping get under the skin?

The metabolic syndrome is a complex construct with interrelated factors of obesity, blood pressure, lipids, and glucose. It is a risk factor for a number of chronic diseases in late life. This study tested a model in which the relationship between stress and the metabolic syndrome was mediated by appraisal, coping, and affect. Data were collected from 518 male participants in the Normative Aging Study (X(age) = 68.17 years). The model was partially confirmed. Relationships among stress, appraisal, coping, and affect were valenced along positive and negative pathways. However, affect was not directly related to the metabolic syndrome. The metabolic syndrome was related to positive coping as operationalized by self-regulatory strategies. The results of this study suggest that the influence of coping on physical health may occur through emotional regulation.

Self-transcendence: conceptualization and measurement.

Self-transcendence has been hypothesized to be a critical component of wisdom (Curnow, 1999) and adaptation in later life (Tornstam, 1994). It reflects a decreasing reliance on externals for definition of the self, increasing interiority and spirituality, and a greater sense of connectedness with past and future generations. The Adult Self-Transcendence Inventory was administered to 351 individuals along with the NEO-FFI Personality Scale (McCrae & Costa, 1989). A principal axis factor analysis identified two factors: self-transcendence and alienation. The relationships between self-transcendence and neuroticism, openness to experience, extraversion, and agreeableness were significant, although modest, suggesting that self-transcendence cannot be accounted for in terms of positive personality traits alone. As expected, a multiple regression analysis indicated that self-transcendence was negatively related to neuroticism and positively related to meditation practice. The present study appears to lend support to the construct of self-transcendence.

Drinking to cope among college students: prevalence, problems and coping processes.

OBJECTIVE: To examine four issues regarding college-student drinking to cope: (1) The prevalence of drinking to cope among students in a medium-sized Midwestern state university; (2) the relationships among drinking to cope and alcohol-related outcomes; (3) the use of drinking to cope within the larger context of students' coping processes; and (4) gender differences in drinking to cope. METHOD: Data were drawn from a sample of 275 undergraduates (164 women, 104 men, 7 subjects of unreported gender) in a cross-sectional sample. Of the 275 students assessed, data were analyzed from the 260 who reported ever having consumed alcohol. Drinking to cope was examined both as a style and in response to a specific situation identified by the participant. RESULTS: Drinking to cope is very common among college students and is related to much higher levels of alcohol consumption, episodes of heavy drinking, and levels of both negative and positive alcohol-related consequences. In examining the relative influence of drinking to cope and other variables on alcohol use, regression analyses indicated that positive alcohol expectancies were strongly related to alcohol use and that, even when considering other variables, situational drinking to cope remained a fairly strong predictor of most of the alcohol-use indicators. Analysis of gender differences suggested that men rely on alcohol to cope more than women do. CONCLUSIONS: Drinking to cope is a significant and highly problematic factor in college student alcohol use. Implications for interventions are discussed.

Transcendendo o ego: o modelo liberador do desenvolvimento humano / Egolessness: the human development' free model

Objetiva comparar tres paradigmas do desenvolvimento adulto - o ontogenetico, o sociogenetico e o do autodesenvolvimento - com o modelo liberador. O paradigma ontogenetico propoe a existencia de processos de mudanca que seriam universais e intrinsecos ao desenvolvimento humano. A perspectiva sociogenetica propoe que o curso de vida adulta baseia-se no desempenho de diferentes papeis sociais que ocupamos, normalmente definidos por eventos sociais e historicos. O modelo de autodesenvolvimento alternativo enfatiza a liberacao individual. O modelo liberador assemelha-se ao de autodesenvolvimento, principalmente por enfatizar o papel dos processos conscientes no comportamento orientado a metas de vida pessoal