Guiding psychologists through inner and outer worlds: reflections from an academic Levinsonian psychobiography of Joe Slovo.

Psychobiography has become valuable within the context of professional psychology training. A recent psychobiography purposively sampled Joe Slovo to uncover, reconstruct and illustrate significant trajectories of his development. Slovo's (1926-1995) lifelong dedication to the struggle against Apartheid has been widely acknowledged, and he held longstanding leadership positions in various South African liberation movements. Levinson's theory of lifespan development served as the study's psychological lens. Alexander's approaches to data identification and extraction were used, followed by a psycho-historical matrix for data categorisation based on the life cycle theory and significant historical periods throughout Slovo's life. To fully embrace the Levinsonian understanding that an individual cannot be separated from their social world, consideration was given to significant historical and sociocultural forces and events during the data analysis. Therefore, this study's findings extend beyond Slovo's individual development to illuminate the complex ways external forces, such as family dynamics, historical events, political movements, community concerns and cultural and language considerations, influence developmental trajectories, life structures and tasks. The authors reflect on the value of sociocultural and contextual sensitivity in psychobiography to help trainee psychologists venture beyond the subject's inner psychological life, including understanding their outer worlds.

Creating a Meaningful Life: Psychobiographical Investigations.

This article serves as the editorial to the Special Issue of Europe's Journal of Psychology that focusses on "Creating a meaningful life: Psychobiographical investigations." The introduction provides a brief overview of the articles that offer original and innovative approaches to the growing research area of psychobiography, meaning and identity from different theoretical, methodological, disciplinary and socio-cultural background.

The Meaning of Life and Death in the Eyes of Frankl: Archetypal and Terror Management Perspectives.

This article aims to uncover the meaning of life and death across the lifespan of the extraordinary person, Viktor E. Frankl (1905-1997). Frankl was purposively sampled due to his international acclaim as an Austrian neurologist and psychiatrist, who later became famous as a holocaust survivor and the founder of logotherapy. Through his approach of "healing through meaning," he became the founder of the meaning-centred school of psychotherapy and published many books on existential and humanistic psychology. The study describes the meaning of life and death through two theoretical approaches: the archetypal analysis based on C.G. Jung's and C.S. Pearson's work and a terror management approach based on the melancholic existentialist work of Ernest Becker. The methodology of psychobiography is used to conduct the psycho-historical analysis of the interplay of archetypes and death annihilation anxiety throughout Frankl's lifespan. The article evaluates how archetypes and death anxiety interacts and how they built meaning in different stages of Frankl's lifespan. The theories are discussed and illustrated in the light of Viktor E. Frankl's life.

Meaning and Wellness: A Comparative Psychobiography on Helen Suzman and Beyers Naudé.

This comparative psychobiographical study provides an in-depth exploration of meaning in the lives of two extraordinary individuals, Helen Suzman and Beyers Naudé. A comparison of the construction of meaning, as an important aspect of wellness within the holistic wellness model, is given for these South African anti-apartheid activists. Suzman (1917-2009) dedicated her career to opposing apartheid policy as a parliamentary politician. Naudé (1915-2004) was a renowned public figure dedicated to social justice in his role as a theologian. The holistic wellness model views the Neo-Adlerian life task of spirituality as crucial to ascribing meaning to life events, acknowledging multiple potential sources of meaning. The differences and similarities pertaining to the domains of meaning-making of these two subjects are explored. The subjects, who differed regarding biographical variables, were found to share a common sense of purpose within the same socio-political milieu. The study findings confirm that commitment to diverse sources of meaning and generativity are central to meaningfulness. This comparative psychobiographical study contributes to the eugraphic exploration of the meaning-making processes of these exemplary individuals.

The Spiritual Wellness of an Intellectual, Novelist, Journalist and Politician: The Meaningful Life of Sol Plaatje.

The study investigates Sol Plaatje's (1876-1932) spiritual wellness across his lifespan. He was purposively sampled due to his impact upon South African society. As an intellectual, novelist, journalist, and politician, Plaatje was also a founder member of the South African Native National Congress, which later became the African National Congress. His life history reflected a significant degree of spiritual wellness, which was uncovered through the systematic analysis of publicly available life-history materials, including primary and secondary sources. The Wheel of Wellness (WoW) model by Sweeney and Witmer was applied to interpret the biographical evidence of spirituality and meaning in his life. Spirituality, as the central life task of the WoW, and regarded as the most influential domain of a healthy individual, incorporates religious beliefs and other individualised aspects of meaning-making. Findings indicate that spirituality characterised Plaatje's childhood years and continued to play a role throughout his adult years. His sense of meaning and purpose was personified in the promotion and preservation of human rights and dignity, which embraced inter-racial respect, compassion, and service to others.

Meaning-Making Narratives Within a Puzzle of Parts: A Psychobiographical Sketch of Sylvia Plath.

This study aimed to unveil Sylvia Plath's (1932-1963) meaning-making narratives, within her life's puzzle of parts, by utilising the Internal Family System (IFS) model of Schwartz. Plath was purposively selected as subject since she has been proclaimed as one of the most renowned and influential voices in 20th century Anglo-American culture and literature. Although she only published one collection of poems, "The Collosus", and one novel, "The Bell Jar", in her lifetime, the plethora of short stories, poems, journal entries and letters which were published after her suicide secured her status as a powerful and creative voice. Methodological strategies utilised to sort and integrate the wealth of publically-available socio-historical data on Plath included the analysis of psychobiographical indicators of salience according to the model of Irving Alexander and the data analysis matrix procedure of Robert Yin. Findings suggest that each stage of Plath's life was characterised by "parts-led" functioning as a result of transferred burdens, imperfect care-taking, existential anxiety and traumatic emotional experiences. This resulted in polarisation of her different parts, which blocked the healing energy of her Self and aggravated feelings of worthlessness, in spite of her creative meaning-making narratives. Since Sylvia used her creative genius to address socio-historical issues and injustices, her life lends itself to meaning-making narratives, especially those that empower and inspire future generations of previously disempowered groups.

Holistic wellness in the life of Angela Merkel: a call to revise the wheel of wellness in the light of new positive psychology movements and socio-cultural changes.

Holistic wellness theories conceptualise wellness as a multidimensional and synergistic construct. The term wellness refers to a way of life oriented towards optimal health and wellbeing in which body, mind, and spirit are integrated by the individual to live life fully within the human and natural community. The proposed Wheel of Wellness Model incorporate five life tasks that are influenced by seven life forces that are, in turn, influenced by global events. In this study, the model is employed to explore the life of Angela Merkel from a psychobiographical and holistic wellness perspective. Merkel was purposively selected as an extraordinary leader who demonstrated exceptional coping abilities and wellness. Findings show that Merkel's wellness is particularly strong in terms of spirituality and self-direction. Suggestions are proposed how to expand the WoW in the context of latest positive psychology developments and with regard to socio-cultural changes within contemporary societies.

[Visual recovery as the target for glaucoma]. / Visuelle Regeneration als Ziel für das Glaukom.

BACKGROUND: Visual recovery is an established but poorly studied phenomenon in glaucoma. OBJECTIVE: To provide insights into functional recovery of retinal ganglion cells (RGCs) with a view to providing information on the development of forms of treatment that improve RGC function after injury. METHOD: A model of recoverable RGC function in the mouse eye, induced by short-term elevation of intraocular pressure (IOP). RESULTS: The RGCs manifest near complete functional recovery after a prolonged period of dysfunction following acute IOP elevation. Increasing age and a high fat diet were subsequently found to impair recovery, whereas exercise substantially improved recovery such that older mice recovered in a similar way to young mice. CONCLUSION: Injured RGCs have the capacity to restore function after periods of functional impairment. Therapies that specifically target injured RGCs and enhance their capacity to recover function may provide a new approach for treating glaucoma.

Kneeling and standing up from a chair as performance-based tests to evaluate knee function in the high-flexion range: a randomized controlled trial comparing a conventional and a high-flexion TKA design.

BACKGROUND: We compared the functional outcome between conventional and high-flexion total knee arthroplasty (TKA) using kneeling and sit-to-stand tests at 1 year post-operative. In addition, the patient's daily functioning, pain and satisfaction were quantified using questionnaires. METHODS: We randomly assigned 56 patients to receive either a conventional or a high-flexion TKA. Primary outcomes were maximum flexion angle and maximum thigh-calf contact measured during kneeling at 1 year post operatively. Secondary outcomes were the angular knee velocity and ground reaction force ratio measured during sit-to-stand performance tests, and questionnaires. RESULTS: At one year post-operative, maximum knee flexion during kneeling was higher for the high-flexion TKA group (median 128.02° (range 108-146)) compared to the conventional TKA group (119.13° (range 72-135)) (p = 0.03). Maximum thigh-calf contact force was higher for the high flexion TKA group (median 17.82 N (range 2.98-114.64)) compared to the conventional TKA group (median 9.37 N (range 0.33-46.58))(p = 0.04). The sit-to-stand tests showed a significantly higher angular knee velocity in the conventional TKA group (12.12 rad/s (95%CI 0.34-23.91); p = 0.04). There were no significant differences between groups in ground reaction force ratios and patient-reported outcome scores. CONCLUSION: Although no differences were found in patient-reported outcome scores, differences in performance-based tests were clearly apparent. Standing up from a chair at 90° of knee flexion appeared to be easier for the conventional group. The kneeling test revealed significantly higher weight-bearing knee flexion for the high-flex group. Hence, if kneeling is an important activity for a patient a high-flex design may be recommendable. TRIAL REGISTRATION: The study was retrospectively registered in ClinicalTrials.gov under identifier NCT00899041 (date of registration: May 11, 2009).

Using the Lower Limit of Normal Instead of the Conventional Cutoff Values to Define Predictors of Pulmonary Function Impairment in Subjects With Chronic Heart Failure.

BACKGROUND: Using the newer lower limit of normal criterion instead of the conventional cutoff values to define pulmonary function abnormalities may result in different predictors of pulmonary function impairment in patients with heart failure. Therefore, we assessed predictors of pulmonary function impairment in subjects with chronic heart failure according to the lower limit of normal in comparison with conventional cutoff values. METHODS: In this prospective cross-sectional study, 164 chronic heart failure subjects (age 68 ± 10 y, 78% men, 88% New York Heart Association class I-II) with left ventricular ejection fraction <40% underwent pulmonary function tests. Predictors of pulmonary function impairment were assessed using the lower limit of normal and conventional cutoff values (ie, 80% predicted value and the fixed ratio of FEV1/FVC <0.7). RESULTS: The lower limit of normal criterion identified an extra independent predictor of diffusion impairment compared with the 80% predicted value; in addition to body mass index, pack-years, and alveolar volume, female sex also turned out to be an independent predictor. A smoking history of ≥10 pack-years was a significant predictor of diffusion impairment and airway obstruction using the lower limit of normal criterion but not using the conventional cutoff values. However, lowering the cutoff points of conventional criteria to match the more stringent lower limit of normal and thus avoid overdiagnosis of diffusion impairment and airway obstruction in the elderly produced similar results as the lower limit of normal. CONCLUSIONS: The lower limit of normal identifies more predictors of diffusion impairment and airway obstruction compared with conventional cutoff values in subjects with chronic heart failure with left ventricular systolic dysfunction. However, lowering the conventional cutoff points yielded similar results as the lower limit of normal. (ClinicalTrials.gov registration NCT01429376.).

Pulmonary function impairment in patients with chronic heart failure: lower limit of normal versus conventional cutoff values.

OBJECTIVE: To determine the prevalence of pulmonary function abnormalities in patients with chronic heart failure (HF) according to recent American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines using the lower limit of normal (LLN) compared to conventional cutoff values. BACKGROUND: Recent ATS/ERS guidelines recommend the use of the LLN instead of the conventional cutoff values to define pulmonary function impairment to avoid misclassification of patients. However, studies addressing the prevalence of pulmonary function abnormalities according to both definitions in patients with chronic HF are lacking. METHODS: In this prospective cross-sectional study, 164 chronic HF outpatients (age 68 ± 10 years, 78% men, 88% New York Heart Association class I-II) with left ventricular ejection fraction < 40% underwent spirometry and measurement of diffusing capacity. Body plethysmography was performed in patients with abnormal spirometry results. RESULTS: Diffusion impairment and airway obstruction were found in 44-58% and 26-37% of the patients, respectively, depending on the definition used (LLN versus conventional cutoff values, p < 0.05). However, restriction was infrequent, irrespective of the definition used (7% versus 5%, respectively, p > 0.05). The LLN identified fewer patients with abnormal lung function, whereas the conventional cutoff values classified more patients with diffusion impairment, airway obstruction, or a mixed category. Twenty-seven percent of patients were misclassified by the conventional cutoff values. CONCLUSION: Pulmonary function abnormalities, especially diffusion impairment and airway obstruction, were highly prevalent in patients with chronic HF. Conventional cutoff values classified more patients with diffusion impairment, airway obstruction, or a mixed category compared to the LLN.

COPD in chronic heart failure: less common than previously thought?

BACKGROUND: Using a fixed ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC) < 0.70 instead of the lower limit of normal (LLN) to define chronic obstructive pulmonary disease (COPD) may lead to overdiagnosis of COPD in elderly patients with heart failure (HF) and consequently unnecessary treatment with possible adverse health effects. OBJECTIVE: The aim of this study was to determine COPD prevalence in patients with chronic HF according to two definitions of airflow obstruction. METHODS: Spirometry was performed in 187 outpatients with stable chronic HF without pulmonary congestion who had a left ventricular ejection fraction <40% (mean age 69 ± 10 years, 78% men). COPD diagnosis was confirmed 3 months after standard treatment with tiotropium in newly diagnosed COPD patients. RESULTS: COPD prevalence varied substantially between 19.8% (LLN-COPD) and 32.1% (GOLD-COPD). Twenty-three of 60 patients (38.3%) with GOLD-COPD were potentially misclassified as having COPD (FEV1/FVC < 0.7 but > LLN). In contrast to patients with LLN-COPD, potentially misclassified patients did not differ significantly from those without COPD regarding respiratory symptoms and risk factors for COPD. CONCLUSIONS: One fifth, rather than one third, of the patients with chronic HF had concomitant COPD using the LLN instead of the fixed ratio. LLN may identify clinically more important COPD than a fixed ratio of 0.7.

Bronchodilator responsiveness in patients with chronic heart failure.

OBJECTIVE: The aim of this study was to evaluate the effect of inhaled bronchodilators on pulmonary function and dyspnea in patients with chronic heart failure (HF). BACKGROUND: Conflicting data exist on whether bronchodilators may improve pulmonary function and dyspnea in patients with chronic HF. METHODS: In this retrospective observational study we analyzed data of 116 chronic HF outpatients with systolic dysfunction who underwent spirometry and Borg dyspnea measurements before and after inhalation of 400 µg salbutamol and 80 µg ipratropium. Patients with chronic obstructive pulmonary disease (COPD) or asthma were excluded. RESULTS: Bronchodilators fully reversed airway obstruction (AO) in 25 of 64 (39.1%) patients with pre-bronchodilator AO. All spirometric measurements, except for forced vital and inspiratory capacities, improved significantly post-bronchodilation. Absolute and percent improvements in forced expiratory volume in 1 s (FEV1) were more pronounced in patients with persistent AO post-bronchodilation compared to those without AO (0.19 ± 0.18 L and 8.4 ± 7.3% versus 0.11 ± 0.12 L and 4.3 ± 4.0%, p < 0.05). Significant bronchodilator responsiveness of FEV1 (>200 mL and >12%) was noted in 12.1% and was more frequent in patients with persistent AO and fully reversible AO than in those without AO (23.1% and 16.0% versus 1.9%, p < 0.05). We measured a small, albeit significant improvement in dyspnea (0.7 ± 1.2 versus 0.9 ± 1.3, p = 0.002). CONCLUSIONS: Inhaled bronchodilators may have an additional role in the management of patients with chronic HF because of their potential to improve pulmonary function, especially in those with AO. The clinical usefulness and possible adverse events of bronchodilators need to be further established.

The patellar tendon bar! Is it a necessary feature?

The purpose of this investigation was to vary the load on the patellar tendon bar and to study the subsequent effect this has on the pattern of the pressure distribution at the stump-socket interface. Ten male subjects from the Southern General Hospital in Glasgow, UK participated in this study. Measuring systems utilising strain gauge and electrohydraulic technologies were designed, developed and constructed to enable pressure measurements to be conducted. One transducer, the patellar tendon (PT) transducer, was attached to the patellar tendon bar of the socket such that the patellar tendon bar was capable of being translated by +/-10 mm towards or away from the tendon. The results of this study showed that the position of the patellar tendon bar had no significant effect on the pressure distribution around the socket indicating that it is an unnecessary feature, which, we propose, may be eliminated during manufacture of a trans-tibial socket.

The agriburb: recalling the suburban side of Ontario, California's agricultural colonization.

This essay spotlights the development of Ontario, California, in the last decades of the nineteenth century. It demonstrates that many agricultural communities in California, particularly so-called agricultural colonies, represent a unique rural suburban type labeled here as "agriburbs." Agriburbs, such as Ontario, were communities consciously planned, developed, and promoted based on the drive for profit in emerging agricultural markets. Advertised as the perfect mix of rural and urban, they promised a superior middle-class lifestyle. On the one hand, agriburbs evoked the myths of agrarian security and virtue, a life on a farm in an environment that was good for both soil and soul. On the other hand, agriburbs were ideally urbane but not urban because of their many amenities that represented cultural symbols of modernity, refinement, and progress. An understanding of California's agriburbs deepens an appreciation for both the growth and development of California at the turn of the twentieth century and the diversity of suburban types across the American landscape.

Delirium scales: A review of current evidence.

OBJECTIVES: Delirium is a common neuropsychiatric condition with many adverse outcomes in elderly populations including death. Despite this, it is often misdiagnosed and mistreated. A number of scales can be used to detect delirium. We review scales that have been used in delirium studies and report their psychometric properties. METHOD: An extensive MEDLINE database search and subsequent examination of reference lists was conducted to identify the various delirium scales that have been designed, primarily for use in the elderly. RESULTS: Twenty-four scales were identified. Delirium instruments differed according to the classification system they were based on, length of time to administer, the rater and whether they were screening scales or measured symptom severity. The psychometric properties of each scale is reported. CONCLUSION: A large number of scales exist, but not all are properly evaluated in terms of psychometric properties, and there is not unanimity about which scale is the best. However, a small number of scales may be considered already to be robust and useable: the CAM, the DRS, the MDAS and the NEECHAM.

Allogeneic hematopoietic stem cell transplantation and norovirus gastroenteritis: a previously unrecognized cause of morbidity.

BACKGROUND: A retrospective study of the clinical, epidemiologic, and virologic features of norovirus gastroenteritis in 12 adult allogeneic hematopoietic stem cell transplant (HSCT) recipients. METHODS: Norovirus infection was diagnosed by reverse-transcriptase polymerase chain reaction. Strains were genotyped by nucleic acid sequence of the most highly conserved region of the norovirus gene encoding the capsid S (shell) domain. RESULTS: Ten of 12 patients presented with vomiting of short duration, but diarrhea was present in all. The median time from onset to norovirus diagnosis was 1 month (range, 0.25-6.0 months). Eleven patients were receiving immunosuppression when norovirus infection was diagnosed: 8 for graft-versus-host disease (GVHD) in an organ other than gut, 1 for previous gut GVHD, and 2 for presumed gut GVHD that proved to be norovirus gastroenteritis. Six patients required enteral or parenteral nutrition for severe weight loss. In 10 patients, diarrhea lasted a median of 3 months (range, 0.5-14 months) and virus was shed at a high level throughout. The remaining 2 patients died after 4 months of diarrhea (one died of unrelated complications, and the other died of malnutrition). The noroviruses found were GII (untyped), GII-3, GII-4, and GII-7 in 1, 1, 9, and 1 patients, respectively. Eleven of the 12 patients had acquired their infection in the community. Phylogenetic analysis of the GII-4 strains demonstrated that all differed. CONCLUSIONS: Noroviruses are a hitherto unsuspected cause of prolonged morbidity and mortality in adults after allogeneic HSCT. The use of reverse-transcriptase polymerase chain reaction to detect high viral load levels in feces distinguishes norovirus gastroenteritis from gut GVHD.

The role of AA sponsors: a pilot study.

AIMS: The aim of this study was to explore the roles of Alcoholics Anonymous (AA) sponsors and to describe the characteristics of a sample of sponsors. METHODS: Twenty-eight AA sponsors, recruited using a purposive sampling method, were administered an unstructured qualitative interview and standardized questionnaires. The measurements included: a content analysis of sponsors' responses; Severity of Alcohol Dependence Questionnaire-Community version (SADQ-C) and Alcoholics Anonymous Affiliation Scale (AAAS). RESULTS: Sample characteristics were as follows: the median length of AA attendance was 9.5 years (range 5-28); the median length of sobriety was 11 years (range 4.5-28); the median number of sponsees per sponsor was 1 but there was a wide range (0-17, interquartile range 3.75); and the sponsors were highly affiliated to AA (median AAAS score 8.75, range 5.5-8.75, maximum possible score 9). Past alcohol dependence scores were surprisingly low: 5 (18%) sponsors had mild, 14 (50%) moderate and 9 (32%) severe dependence according to the SADQ-C (median 26.5, range 11-56). Sponsorship roles were as follows: 16 roles were identified through the initial content analysis. These were distilled into three super-ordinate roles through a thematic analysis: (1) encouraging sponsees to work the programme of AA (doing the 12 steps and engaging in AA activity); (2) support (regular contact, emotional support and practical support); and (3) carrying the message of AA (sharing sponsor's personal experience of recovery with sponsees). CONCLUSIONS: The roles identified broadly corresponded with the AA literature delineating the duties of a sponsor. This non-random sample of sponsors was highly engaged in AA activity but only had a past history of moderate alcohol dependence.