Extramarital Involvement: A Core Relationship Issue in Need of a Coherent Model, Comprehensive Research, and Empirically Based Intervention

Clinical interventions for extramarital involvement (EMI) have outpaced empirical knowledge about both risk factors for infidelity and effective treatments. Allen et al. (this issue) provide a systematic review of current knowledge organized around stages of the development of EMI and factors concerning the involved partner, the spouse, the couple's relationship, and the interpersonal context. Their review identifies significant gaps in knowledge for which research is needed. Because EMI has multiple determinants, conceptual models and research on it must be multivariate. This comment focuses on priorities for increasing knowledge about EMI, including (a) clarification of variation in definitions and personal standards for EMI through consideration of participants' subjective experiences as well as the views of outsiders (researchers, clinicians); (b) improved qualitative research using interview methods designed to minimize biased questioning by investigators and biased reporting by subjects, to tap individuals' internal experiences with the developmental process of EMI; (c) nonblaming research on characteristics of the noninvolved spouse and the couple's interaction that predict EMI; and (d) adaptation of generic preventive and relationship enrichment interventions for couples involving communication skill-building and psychoeducation, to include information about ways to "inoculate" relationships against commonly unexpected risks of EMI.     

The Prevention of Extramarital Involvement: Steps Toward "Affair Proofing" Marriage

In this paper I provide comments on the Allen et al. paper (this issue). I note that it provides the first critical, comprehensive, and integrative review of extramarital involvement (EMI) to appear in the literature, and I summarize some of its major contributions to the field. I then focus on how the review stimulated my thinking about current and future best practices in marriage education for the prevention of EMI. I conclude by suggesting several directions for future research and practice. Key words: affair prevention, infidelity, couples.     

Commentary on Intrapersonal, Interpersonal, and Contextual Factors in Extramarital Involvement

Extramarital Involvements (EMIs) attract significant societal attention, as exemplified by the revelation of former President Clinton's EMI. Depression, anxiety, and divorce are important sequelae of EMIs, though it will be important to learn which couples successfully cope with EMIs. Allen et al. (this issue) provide an excellent overview of the prevalence of EMIs and the problems in trying to ascertain accurate estimates thereof. The impact of a very close relationship even without explicit sexual contact was noted, and Allen et al. present a useful framework for organizing theoretical positions and data on EMIs. It is an excellent review for a clinician or researcher addressing EMIs.     

Ultrastructural features of endometrial-myometrial interface and its alteration in adenomyosis

The endometrial-myometrial interface (EMI) is a specific functional region of uterus. However, our knowledge on EMI ultrastructure both in normal uterus and adenomyosis is far from enough to understand its pathology. In this study, used the samples of EMI and outer myometrium (OM) from the adenomyosis hysterectomy specimens and the subjects from the control uteri, we prospectively compared the ultrastructure of myocytes from EMI and OM, the ultrastructural changes of EMI between the proliferative and secretory phases, and the ultrastructural difference of EMI between adenomyosis and the control group. In both adenomyosis and control group, there were differences in ultrastructure between myocytes from EMI and OM. Specifically, the myocytes from EMI were rich in organelles. In contrast, the myocytes from OM had abundant contractile structural components. In the proliferative phase, the myocytes from EMI in adenomyosis had significantly smaller cell and nucleus diameter than those from the control group, but in the secretory phase, the difference was not significant. In the control group, the various ultrastructural features of myocytes from EMI including the mean diameter of cell and nuclei and the myofilaments/cytoplasm ratio exhibited cyclical changes, but in adenomyosis, the normal cyclical changes were absent. In conclusions, there are significant ultrastructural differences between the myocytes from EMI and OM. The myocytes in women with adenomyosis were significantly different to the control subjects, primarily because the normal cyclical changes were absent.     

Protection effects of a silver fiber textile against electromagnetic interference in patients with pacemakers

 The use of the wireless cellular phone has increased dramatically, and this use could influence pacemaker function with electromagnetic interference (EMI). A textile lined with silver fiber has been developed for protection against electromagnetic waves. The purpose of this study was to evaluate the EMI protection effects in cardiac pacemaker patients wearing this textile. Participants in this study had pacemakers that were capable of obtaining endocardial electrograms, markers/annotations, and surface electrocardiograms via a programmer. A cellular phone was placed over the pulse generator. The presence of EMI was confirmed when a change in a parameter was observed. When EMI was confirmed, the subject wore a silver fiber shirt (rated at −30 dB), and EMI was evaluated. If the EMI persisted, the subject wore a heavier silver fiber shirt (rated at −50 dB), and again EMI was assessed. The same procedure was performed by using a ham radio device. Thirty-one subjects were tested. There was no EMI observed with the use of a cellular phone. However, interference by a ham device was confirmed in eight subjects (25.8%). Among six subjects, no further interference was observed after the patient wore a −30 dB shirt. For one subject, EMI was eliminated when a −50 dB shirt was used. However, one subject demonstrated persistent EMI when wearing a double layer of −30 dB and −50 dB shirts. Beneficial protection from EMI with the use of clothing lined with silver fiber has been demonstrated in this study. However, electromagnetic waves are diverse in both source and strength. Future studies are needed to confirm the benefits of wearing silver fiber clothing for the reduction of pacemaker–EMI interaction. Received: January 15, 2002 / Accepted: June 18, 2002 Correspondence to:T. Yajima     

Restless legs syndrome, periodic limb movements in sleep, and depression

STUDY OBJECTIVES: To review the literature on restless legs syndrome (RLS), periodic limb movements in sleep, and depression. DESIGN: Literature review. SETTING, PARTICIPANTS, AND INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: We conducted a comprehensive review of the literature searching for publications that included data on depression or antidepressants and RLS or periodic limb movements in sleep. Sixty-two relevant literature references were found and reviewed. Four population-based studies and 9 clinical studies reported significantly higher rates of depression symptoms in individuals with RLS than in controls. Conversely, the prevalence of RLS in patients presenting with depression was reported as elevated in 2 studies. Conflicting data were found regarding the effect of antidepressants on the sensory symptoms of RLS. In contrast, several studies have found that selective serotonin reuptake inhibitor antidepressant use is associated with increased periodic limb movements in sleep. CONCLUSIONS: Depression symptoms are common in adults with RLS. However, the relationship appears complex, with overlap between RLS- and depression-related symptoms confounding the issue. Given what is known at this time, we propose a specific treatment approach to patients with RLS and depression symptoms.     

Effects of differential preweaning social isolation on emotional reactivity and stress tolerance in the rat

The effects of differential preweaning social isolation of rats during Days 17–22 on the development of muricide, open field behavior, and starvation stress tolerance were examined. Four weaning isolation groups were used in order to separate the effects of maternal and littermate isolation during this period. EMLI was deprived of maternal and littermate contact; EMI , maternal contact; and ELI , littermate contact. NWI rats were isolated on the day following normal laboratory weaning. The results indicated a marked decrease in muricide in response to maternal isolation ( EMLI and EMI ) and a slight decrease in response to littermate isolation. In the open field the maternally isolated rats were more active than the other groups and exhibited less defecation. There were, however, notable differences between EMLI and EMI. EMLI was more active than EMI in the open field and exhibited an increase in activity over the 4 testing periods while EMI , ELI , and NWI decreased activity. EMLI was clearly hyperactive during muricide testing while EMI was the least active. EMI rats weighed less than those in the other groups on Days 35, 50, and 100 but survived terminal food deprivation the longest. Significant differences in nonstressed adrenal gland weight were observed among groups but did not appear to correlate with any of the other measures. Terminal starvation eliminated these differences. Starvation also induced muricide in nonkillers in each of the groups. NWI rats appeared to be most easily converted and exhibited more consistent muricide than the other groups. These results are discussed in terms of a theory of altered forebrain regulation of emotional reactivity in response to preweaning stress and isolation.     

G-protein-coupled receptor expression, function, and signaling in macrophages

G-protein-coupled receptors (GPCRs) are widely targeted in drug discovery. As macrophages are key cellular mediators of acute and chronic inflammation, we review here the role of GPCRs in regulating macrophage function, with a focus on contribution to disease pathology and potential therapeutic applications. Within this analysis, we highlight novel GPCRs with a macrophage-restricted expression profile, which provide avenues for further exploration. We also review an emerging literature, which documents novel roles for GPCR signaling components in GPCR-independent signaling in macrophages. In particular, we examine the crosstalk between GPCR and TLR signaling pathways and highlight GPCR signaling molecules which are likely to have uncharacterized functions in this cell lineage.     

Electromagnetic interference in intraoperative monitoring of motor evoked potentials and a wireless solution

Intraoperative neurophysiological monitoring (IONM) is utilized to minimize neurological morbidity during spine surgery. Transcranial motor evoked potentials (TcMEPs) are principal IONM signals in which the motor cortex of the subject is stimulated with electrical pulses and the evoked potentials are recorded from the muscles of interest. Currently available monitoring systems require the connection of 40–60 lengthy lead wires to the patient. These wires contribute to a crowded and cluttered surgical environment, and limit the maneuverability of the surgical team. In this work, it was demonstrated that the cumbersome wired system is vulnerable to electromagnetic interference (EMI) produced by operating room (OR) equipment. It was hypothesized that eliminating the lengthy recording wires can remove the EMI induced in the IONM signals. Hence, a wireless system to acquire TcMEPs was developed and validated through bench-top and animal experiments. Side-by-side TcMEPs acquisition from the wired and wireless systems in animal experiments under controlled conditions (absence of EMI from OR equipment) showed comparable magnitudes and waveforms, thus demonstrating the fidelity in the signal acquisition of the wireless solution. The robustness of the wireless system to minimize EMI was compared with a wired-system under identical conditions. Unlike the wired-system, the wireless system was not influenced by the electromagnetic waves from the C-Arm X-ray machine and temperature management system in the OR.     

Electromagnetic compatibility aspects of active robotic systems for surgery: the robotic prostatectomy experience

The paper discusses the susceptibility to electromagnetic interference (EMI) of active robots for surgery, which are safety-critical systems. The high EMI environment of an operating room in the presence of an electrosurgical generator is considered. Experience of a surgeon assistant robot for prostatectomies in improving the immunity to EMI is described. It has been found that effective isolation of the robotic system hardware from grounded metal objects provides significant improvements to safety by its immunity to EMI, in minimising the flow of high-frequency current to ground through the system hardware.     

Scientific Expert Testimony in CSA Cases: Legal, Ethical, and Scientific Considerations

We strongly agree with Sbraga and O'Donohue (2003 , this issue) that the science and ethics of clinical psychology, as well as the legal standards of Daubert v. Merrell Dow Pharmaceuticals, Inc . (1993), prohibit testifying that a child has been sexually abused based on the child's postabuse psychological functioning. Moreover, based on a review of the literature, we argue that it is highly unlikely that a symptom marker of childhood sexual abuse (CSA) will ever emerge that could be used in court to prove a history of childhood abuse. In light of the current status of literature on CSA, we offer some practical suggestions and guidelines for practitioners who accept the role of expert witness in this area.     

Signals and molecular pathways involved in apoptosis, with special emphasis on human endometrium

Apoptosis is a selective process for deletion of cells in variousbiological systems. This event, similar to proliferation, istightly regulated, with both processes playing essential rolesin the homeostasis of renewable tissues. In human endometrium,proliferation and apoptosis occur at opposing poles of the menstrualcycle. The proliferative phase is marked by rapid growth ofthe endometrial epithelial lining, whereas progressive increasein apoptosis in this tissue is the hallmark of the secretoryand menstrual phases. The purpose of this review is to highlightsome of the signals and molecular events which are associatedwith and that may participate in apoptosis. This is followedby a review of the current literature regarding apoptosis inhuman endometrium.     

Vasospasm, vascular injury, and atherogenesis: a perspective

It is generally believed that injury of the vessel wall is an important condition for the development of atherosclerosis. The nature of this injury and its relationship to lesion origin, however, are not clearly understood. Based on early work by the author and a selective review of the literature, evidence is presented to show how a common cardiovascular event, vasospasm, may be one of the factors responsible for this tissue damage, because it produces a substantial arteriopathy in the very vessel in which it occurs.     

The relevance of attachment theory to the philosophy,organization, and practice of adult mental health care

This review is an inquiry into the relevance of attachment theory to the current philosophy, organization, and practice of adult mental health care, via an examination of the literature relating to attachment theory and, in particular, the literature relating to research into adult attachment. The review does not seek to critique attachment theory itself, but considers carefully the relevance of the theory to adulthood and to the field of adult mental health. In so doing, research into individual difficulties is examined, as is the provision and delivery of therapeutic services. In addition, the literature regarding the importance of mental health staff's own attachments and the influence of attachment theory on mental health service philosophy and organization are evaluated. Finally, potential areas for future research and development in this field are suggested.     

The human meniscus: A review of anatomy,function, injury,and advances in treatment

Meniscal injuries are recognized as a cause of significant musculoskeletal morbidity. The menisci are vital for the normal function and long‐term health of the knee joint. The purpose of this review is to provide current knowledge regarding the anatomy and biomechanical functions of the menisci, incidence, injury patterns and the advancements in treatment options of meniscal injury. A literature search was performed by a review of PubMed, Google Scholar, MEDLINE, and OVID for all relevant articles published between 1897 and 2014. This study highlights the anatomical and biomechanical characteristics of the menisci, which may be relevant to injury patterns and treatment options. An understanding of the normal anatomy and biomechanical functions of the knee menisci is a necessary prerequisite to understanding pathologies associated with the knee. Clin. Anat. 28:269–287, 2015. © 2014 Wiley Periodicals, Inc.     

Models of anger: contributions from psychophysiology, neuropsychology and the cognitive behavioral perspective

The current review examined the research and current models of anger from three distinct literatures: psychophysiology, neuropsychology and the cognitive-behavioral perspective. Two primary conceptual difficulties are addressed in this review. First, the debate over how and when to differentiate between anger and hostility is discussed. Second, the issue regarding cognitive or emotional dominance or primacy in the experience of anger is considered. Once the conceptual ambiguity is addressed, data from the cognitive-behavioral, psychophysiological and neuropsychological literatures are reviewed with a focus on issues of laterality. Particular attention is given to research of appraisal theory from the cognitive literature, cortical arousal and related cerebral models from the psychophysiological literature, and functional cerebral systems from the neuropsychological literature. Despite significant differences appearing both within and between the bodies of literature, when viewed without the traditional ambiguity surrounding this topic, there appears to be a great deal of overlap which may be conducive to the construction of a unified theoretical model. Such a model is proposed in the final section of this paper.     

Enigmatic human tails: A review of their history,embryology, classification,and clinical manifestations

The presence of a human tail is a rare and intriguing phenomenon. While cases have been reported in the literature, confusion remains with respect to the proper classification, definition, and treatment methods. We review the literature concerning this anatomical derailment. We also consider the importance of excluding underlying congenital anomalies in these patients to prevent neurological deficits and other abnormal manifestations. Clin. Anat. 29:430–438, 2016. © 2016 Wiley Periodicals, Inc.