Behavioral Treatment of Tourette Syndrome: Past, Present, and Future

Cook and Blacher (2007) provide the most comprehensive review to date of psychosocial treatments for patients with tic disorders and are to be congratulated for their fine effort. The authors' conclusion that habit reversal treatment warrants designation as well established based on the American Psychological Association's Division 12 Task Force criteria should spur increased clinical and research interest in this treatment. However, to fully realize the promise of Cook and Blacher's findings, it is first necessary to understand the broad historical context surrounding the conceptualization and treatment of Tourette syndrome (TS), including fluctuating perceptions within the TS community about the efficacy and utility of psychosocial interventions. In related fashion, this commentary also addresses several barriers, some methodological and others based on historical misconceptions about psychological treatments, that have constrained greater acceptance of such interventions in the past. Finally, we present a model approach for the development and dissemination of evidence-based psychosocial treatments designed to facilitate maximal understanding and acceptance of these interventions by the TS treatment community.     

Mindfulness-Based Interventions in Context: Past, Present, and Future

Baer's review (2003 ; this issue) suggests that mindf ulness-based interventions are clinically efficacious, but that better designed studies are now needed to substantiate the field and place it on a firm foundation for future growth. Her review, coupled with other lines of evidence, suggests that interest in incorporating mindfulness into clinical interventions in medicine and psychology is growing. It is thus important that professionals coming to this field understand some of the unique factors associated with the delivery of mindfulness-based interventions and the potential conceptual and practical pitfalls of not recognizing the features of this broadly unfamiliar landscape. This commentary highlights and contextualizes (1) what exactly mindfulness is, (2) where it came from, (3) how it came to be introduced into medicine and health care, (4) issues of cross-cultural sensitivity and understanding in the study of meditative practices stemming from other cultures and in applications of them in novel settings, ( 5 ) why it is important for people who are teaching mind-fulness to practice themselves, (6) results from 3 recent studies from the Center for Mindfulness in Medicine, Health Care, and Society not reviewed by Baer but which raise a number of key questions about clinical applicability, study design, and mechanism of action, and (7) current opportunities for professional training and development in mindfulness and its clinical applications.     

Yale Conference on Behavioral Medicine: A proposed definition and statement of goals

The Yale Conference on Behavioral Medicine brought a diverse group of behavioral and biomedical scientists together for the purpose of arriving at an interdisciplinary yet consensual definition, statement of goals, and set of recommendations regarding the emerging field of behavioral medicine. It was proposed that behavioral medicine be defined as the field concerned with the development of behavioral science knowledge and techniques relevant to the understanding of physical health and illness and the application of this knowledge and techniques to prevention, diagnosis, treatment, and rehabilitation. Psychosis, neurosis, and substance abuse are included only insofar as they contribute to physical disorders as an end point. The rationale behind this definition and proposals for future developments in the field are discussed.Conference held at Yale University on February 4–6, 1977. Supported by the Department of Psychology, Yale University, the Department of Psychiatry, Yale University School of Medicine, and the National Heart, Lung, and Blood Institute, National Institutes of Health. The opinions expressed at the conference do not necessarily reflect those of Yale University or the National Institutes of Health.     

Artificial kidneys: Past,Present, and Future

The Past—The artificial kidney, the bioengineering substitution of a biological system necessary to maintain life, comprises four subentities: hemodialysis, peritoneal dialysis, hemofiltration, and hemoperfusion. The main emphasis of this discussion will be on hemodialysis, however there are obvious corollaries with peritoneal dialysis, hemofiltration, and hemoperfusion and these will be discussed where relevant. The history and development of the four systems will be discussed. The Present—A better understanding of the limitations of artificial kidneys will be presented by a review of normal kidney function. A discussion of end-stage renal disease (ESRD) physiology and biochemistry including electrolyte metabolism and acid-base balance will be given. The Future—Initially, one might predict a continuing progression of technological sophistication applied to artifical kidney machines: microprocessor controlled functions such as osmolality changes, electrolyte homeostatis, and acid-base balance. However, the two distinct conceptually valid approaches for hemodialysis (and hemofiltration) are [1] daily or even continuous artificial kidney treatments and [2] increasingly sophisticated dialysis techniques used on an intermittent (thrice weekly) basis. These will be discussed in detail including uremic toxins, physiologic feedback controls and biochemistry servocontrols. The future of artificial kidneys is described as following two diverging courses. The first is that of daily or even continuous treatment, which renders redundant all but the simplest of servocontrol mechanisms. The second describes the evolution of logic of complex integrated closed-loop feedback controls for periodic artificial kidney treatments.     

Allergen Immunotherapy: Past,Present, and Future

Allergen-specific immunotherapy (AIT), although in clinical use for more than a century, is still the only causal treatment of allergic diseases. The safety and efficacy of AIT has been demonstrated in a large number of clinical trials. In addition to allergy symptom reduction AIT plays an essential role in preventing new allergies and asthma and shows long-term effects after discontinuation of treatment. Ideally, it is capable of curing allergy. However, AIT is not effective in all allergic individuals and is not equally effective in the treatment of various hypersensitivities to different allergens. For many years, the route of administration and the vaccine compositions have been evolving. Still there is a strong need for research in the field of new AIT modalities to increase its effectiveness and safety. Growing evidence on immunological effects of AIT, especially new T cell subsets involved in antigen/allergen tolerance, provides novel concepts for safer and more effective vaccination. Pharmacoeconomic studies have demonstrated a clear advantage of AIT over pharmacologic therapies.     

Immunotherapy for Infectious Diseases: Past,Present, and Future

Passive immunotherapy for established infections, as opposed to active immunization to prevent disease, remains a tiny niche in the world of antimicrobial therapies. Many of the passive immunotherapies currently available are directed against bacterial toxins, such as botulism, or are intended for agents of bioterrorism such as anthrax, which fortunately has remained rare. The emergence of Ebola virus and multi-drug resistant pathogens, however, may breathe new life into the immunotherapy field as researchers seek non-antibiotic interventions for infectious diseases.     

并行磁共振成像的回顾、现状与发展前景

经过20多年的发展，磁共振成像已经成为临床医学影像学检查最重要的手段之一，但缩短采集时间仍然是磁共振成像研究的重要问题之一。最近10年，成像速度的提高主要依赖于多通道线圈采集技术的出现和并行成像算法的发展。本研究介绍了并行成像的发展历程，并对现有重建算法及其应用进行了阐述、比较与分析。     

Past, Present, and Future of Allergy in Korea

Korean allergology has made great progress in keeping pace with global scientific advances in spite of a short history. Outstanding academic and scientific researches have been performed in a variety of allergy fields in Korea. Epidemiologic studies revealed increasing prevalence of asthma and allergic diseases and considerable morbidity and mortality in Korea. Novel inhalant allergens such as citrus red mite and two-spotted spider mite as causes of asthma and allergic rhinitis have been discovered and reported in Korea. Bidirectional translational researches have been performed and are underway to elucidate the pathogenesis of asthma and allergy, mechanisms of airway inflammation and remodeling, and new therapeutic modalities for asthma and allergic diseases. Experimental asthma models of different phenotypes according to exposed levels of lipopolysaccharide or double-stranded RNA suggested the crucial role of the innate immunity in the development of allergic airway inflammation and a new insight for asthma pathogenesis, in which both Th1 and Th2 inflammation are involved. In the field of genetic researches, numerous genetic associations with asthma and asthma-related phenotypes, such as atopy, IgE production, and airway hyperresponsiveness, have been demonstrated in Korean population. The Easy Asthma Management (EAM) program, a computer-assisted asthma management program, is anticipated to facilitate the achievement of more successful clinical outcomes by filling the gaps between guidelines and actual practices. The Integration of these multi-disciplinary allergy research resources and translation of scientific achievements to the bedside and society will lead to better allergy and asthma control in Korea.     

The Life of a Black Medical Trainee in the United States: Past,Present, Future

An Introduction to the History of Black Medical TraineesIn these unprecedented times, Black medical professionals must deliver excellent medical care and uphold the highest standards of their profession while living through a devastating pandemic. They must do so in a time when the country tries to reconcile with generations of racism and injustice. The current social environment in America is particularly challenging for medical trainees such as medical students and resident physicians who must focus on their educational requirements and careers in settings that are often averse to addressing topics such as racism. This plight is not new for Black medical trainees, as they have been fighting for centuries to obtain an equitable seat at the table of medical education. Throughout the 19th century and early 20th century, Black physicians were repeatedly disenfranchised from the predominantly white medical societies, most notably the American Medical Association (AMA), which was established in 1847. Racially integrated medical organizations such as the National Medical Society of Washington D.C. (NMS), which was founded in 1870, were developed to challenge discriminatory practices of the American Medical Association against Black practitioners. The inception of the National Medical Association (NMA) in 1895 allowed Black doctors to advocate for disadvantaged patient populations and focus efforts on health issues pertinent to the underserved.The Struggles of the Black TraineeHowever, Black and underrepresented minorities continue to face challenges with medical school matriculation and retention. A 2015 AAMC report showed that Black male medical school matriculants failed to increase significantly between 1978 and 2014. From 2006 to 2018, the number of Black medical school matriculants increased from 6.7% to 7.1%.Solutions for Improving Medical Education for the Black TraineeTo improve these matriculation statistics, it is critical that institutions integrate innovative measures such as robust recruitment pipelines to expose underrepresented high school and college students to the medical field, as well as seek diversity actively in administration to dismantle the ingrained ideologies of systemic racism rooted in healthcare and medical education. To combat the institutionalized racism that has plagued medical education throughout its existence, collaboration as a unified front is essential to achieving the equity and social justice in healthcare that patients deserve.     

Behavioral medicine approaches to hypertension: An integrative analysis of theory and research

This article compares behavioral and biological approaches to hypertension, highlights some of the practical, semantic, and theoretical issues involved, and attempts a constructive, behavioral medicine integration of these approaches. The major behavioral approaches to hypertension are described, with a focus on their conceptual limitations as stimulants to research into psychobiological mechanisms. A biobehavioral systems analysis of hypertension is outlined, emphasizing the role of the central nervous system as a common pathway relating environmental and behavioral factors to cardiovascular regulatory dynamics and disease. Schwartz's concept of blood pressure disregulation is discussed, by which behavioral feedback loops may be included in the pathogenesis of homeostatic disorders. A detailed discussion of concepts underlying the clinical pharmacological approach to hypertension is provided; parallels are drawn between the conceptual framework and the theoretical and practical questions facing behavioral researchers concerned with hypertension. Synergistic interactive effects of drug and behavioral treatments are proposed. A biobehavioral overview, which links pressor and depressor stimulus patterns to both pathogenesis and therapy, can serve to integrate the previous biobehavioral systems analysis, the conceptual framework of clinical pharmacology, and the notion of biobehavioral disregulation of blood pressure. Implications for future behavioral medicine research in hypertension are provided.This review was prepared by an Ad Hoc Committee appointed and supported by the National Heart, Lung, and Blood Institute, Department of Health, Education, and Welfare. The views expressed herein are those of the authors and do not necessarily reflect those of either the Institute or the Department of Defense.